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Citation
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LoBue C, Schaffert J, Dams-O'connor K, Taiwo Z, Sander A, Venkatesan UM, O'Neil-Pirozzi TM, Hammond FM, Wilmoth K, Ding K, Bell K, Cullum CM. Arch. Phys. Med. Rehabil. 2023; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: To investigate whether a functional decline in cognitive activities decades after moderate-to-severe traumatic brain injury (m-sTBI) might relate to injury features and/or lifetime health factors, some of which may emerge as consequences of the injury.
DESIGN: Secondary analysis of the TBI Model Systems National Database, a prospective, multi-center, longitudinal study of patients with m-sTBI. SETTING: TBI Model Systems Centers PARTICIPANTS: Included were 732 participants rated on the cognitive subscale of the Functional Independence Measure (FIM Cognitive), a metric for everyday cognitive skills, across three time points out to 20 years (visits at 2-, 10-, and 20-year follow ups). INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE(S): FIM Cognitive Scale. Injury characteristics such as timing and features pertaining to severity and health-related factors (e.g., alcohol use, socioeconomic status) were examined to discriminate stable from declining participants on the FIM Cognitive Scale using logistic regression.
RESULTS: At 20 years post-injury, there was a low base rate of FIM Cognitive decline (11%, n=78), with the majority being stable or having meaningful improvement (89%, n=654). Older age at injury, longer duration of post-traumatic amnesia, and presence of repetitive seizures were significant predictors of FIM Cognitive decline in the final model (AUC=0.75), while multiple health-related factors that can represent independent co-morbidities or possible consequences of injury were not.
CONCLUSION(S): The strongest contributors to reported functional decline in cognitive activities later-in-life were related to acute characteristics of m-sTBI and experiencing post-traumatic seizures. Future studies are needed integrating functional with performance-based cognitive assessments to affirm conclusions and identify the timeline and trajectory of cognitive decline.
Language: en |