Cognitive Function Outcomes of Post-operative Mild to Moderate Traumatic Brain Injury using Combination of Mini-mental State Examination, Digit Span, and Constructional Praxis

Achmad Adam; Christian Ariono; Muhammad Z. Arifin; Ahmad Faried

doi:10.3889/oamjms.2020.5464

Authors

Achmad Adam Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
Christian Ariono Department of Neurosurgery, Mandaya Royal Hospital Puri, Tangerang, Banten, Indonesia
Muhammad Z. Arifin Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
Ahmad Faried Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5464

Keywords:

Post-traumatic cognitive function, Neuropsychological assessments, Traumatic brain injury

Abstract

BACKGROUND: Progress has been made in developing systems of care that strives to minimize traumatic brain injury (TBI)-related morbidity and mortality. As the TBI survivors, one’s might be experienced cognitive function disorders that affect their quality of life.

AIM: We sought to investigate the changes of cognitive function in patients with mild or moderate TBI.

METHODS: This was a prospective study on 80 patients with mild and moderate TBI who had undergone surgery; 79 patients included in the study and one patient excluded due to incompletion of cognitive tasks. We assessed the cognitive function using a combination of mini-mental state examination (MMSE), digit span (DS), and constructional praxis (CP) tests. The correlations between clinical variables and neuropsychological tests were analyzed.

RESULTS: In this study, majority of the patients were male (77.2%) with the mean of age 28.4 years, ranging from 15 to 74 years, predominantly was a young adult (15–20 years, 32.9%). In this series, majority of the patients had moderate TBI (69.6%). Most of the patients (55.7%) had 12 or more education years. MMSE examination revealed that 6.3% and 2.5% of patients had mild- and moderate-cognitive disturbances, respectively, significantly correlated with age (p = 0.049) and educational level (p = 0.008). From DS tests, 13.9% patients had attention disorders and significantly correlated with age (p = 0.015), educational level (p = 0.000), and the severity of TBI (p = 0.018). From CP tests, 24.1% and 5.1% had mild- and moderate-disturbances, respectively, significantly correlated with the severity of TBI (p = 0.025) and the type of intracranial lesion (p = 0.009).

CONCLUSIONS: We found (using a combination of MMP, DS, and CP test) cognitive impairment more frequently in patients with moderate TBI, older age, and low education level, hence, emphasized the importance of holistic neuropsychological assessments and neurological rehabilitation for adequate management of patients with TBI.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Field JH. Epidemiology of head injury in England and Wales. London: Department of Health and Social Security, Her Majesty’s Stationery Office; 1976.

Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Br J Neurosurg. 2002;16(3):220-42. https://doi.org/10.1080/02688690220148824 PMid:12201393

Fearnside RR, Simpson DA. Epidemiology. In: Reilly P, Bullock R, editors. Head Injury: Patophysiology and Management. London: Hodder Arnold; 2007. p. 4-9.

Bullock MR, Hovda DA. Introduction to traumatic brain injury. In: Winn H, Beger MS, Dacey RG, editors. Youman’s Neurological Surgery. Philadelphia, PA: Elsevier Saunders; 2011. p. 3267-9. https://doi.org/10.1016/b978-1-4160-5316-3.00325-7

Faried A, Halim D, Widjaya IA, Badri RF, Sulaiman SF, Arifin MZ. Correlation between the skull base fracture and the incidence of intracranial hemorrhage in patients with traumatic brain injury. Chin J Traumatol. 2019;22(5):286-9. https://doi.org/10.1016/j.cjtee.2019.05.006 PMid:31521457

McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild traumatic brain injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One. 2017;12(4):e0174847. https://doi.org/10.1371/journal.pone.0174847 PMid:28399158

Andrewes D. Neurophysiology, From Theory to Practice. United States: Physiology Press Taylor and Francis Group; 2001.

Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98. https://doi.org/10.1002/(sici)1099-1166(199805)13:5<285::aid-gps753>3.0.co;2-v PMid:1202204

Figueiredo VL, Nascimento E. Performances in the forward and backward digit span in the WISC-III and WAIS-III. Psicologia (Portuguese). 2007;23(3):313-8.

Carlesimo GA, Caltagirone C, Gainotti G. The Mental Deterioration Battery: Normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The group for the standardization of the mental deterioration battery. Eur Neurol. 1996;36(6):378-84. https://doi.org/10.1159/000117297 PMid:8954307

Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. New York: Oxford University Press; 2004. p. 15-37.

Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1-16. https://doi.org/10.15585/mmwr.ss6609a1 PMid:28301451

Arciniegas DB, Held K, Wagner P. Cognitive impairment following traumatic brain injury. Curr Treat Options Neurol. 2002;4(1):43-57. https://doi.org/10.1007/s11940-002-0004-6 PMid:11734103

Goldstein FC, Levin HS. Cognitive outcome after mild and moderate traumatic brain injury in older adults. J Clin Exp Neuropsychol. 2001;23(6):739-53. https://doi.org/10.1076/jcen.23.6.739.1028 PMid:11910541

Kinsella GJ, Olver J, Ong B, Gruen R, Hammersley E. Mild traumatic brain injury in older adults: Early cognitive outcome. J Int Neuropsychol Soc. 2014;20(6):663-71. https://doi.org/10.1017/s1355617714000447 PMid:24834461

Sumowski JF, Chiaravalloti N, Krch D, Paxton J, Deluca J. Education attenuates the negative impact of traumatic brain injury on cognitive status. Arch Phys Med Rehabil. 2013;94(12):2562- 4. https://doi.org/10.1016/j.apmr.2013.07.023 PMid:23932968

Leary JB, Kim GY, Bradley CL, Hussain UZ, Sacco M, Bernad M, et al. The association of cognitive reserve in chronic-phase functional and neuropsychological outcomes following traumatic brain injury. J Head Trauma Rehabil. 2018;33(1):E28-35. https://doi.org/10.1097/htr.0000000000000329 PMid:28731870

Cardoso MG, Faleiro RM, de Paula JJ, Kummer A, Caramelli P, Teixeira AL, et al. Cognitive impairment following acute mild traumatic brain injury. Front Neurol. 2019;10:198. https://doi.org/10.3389/fneur.2019.00198 PMid:30906278

Miotto EC, Cinalli FZ, Serrao VT, Benute GG, Lucia MC, Scaff M. Cognitive deficits in patients with mild to moderate traumatic brain injury. Arq Neuropsiquiatr. 2010;68(6):862-8. https://doi.org/10.1590/s0004-282x2010000600006

PMid:21243242