Psychological complaints and neuropsychological functions in patients with chronic complicated mild traumatic brain injury

Abstract

Background and aims: Traumatic brain injury (TBI) is one of the leading cause of disability and is recognized as a main health problem Besides brain damage has resulted in a condition that may be progressive which emphasized that TBI should be managed as chronic disease In Taiwan the primary cause of TBI was motorcycle-related injury and the vast majority of TBI is classified as mild TBI (mTBI) It is known that even after mTBI persistence of psychological complaints incomplete neuropsychological recovery and psychosocial maladjustments are highly prevalent It is common in clinical practice to see patients with mTBI who complain about residual problems after brain injury which may offer meaningful clinical information and are related to the nature of the disability treatment needs and functional outcomes Nevertheless the definition of mTBI is heterogeneous with a wide range of possible clinical outcomes and the consequences of mTBI are often invisible Thus exploring the prognosis for subgroups of different severity degrees of mTBI was important The dissertation comprises three original studies from this context First of all we investigated patients with complicated mTBI and different return to work (RTW) statuses in order to identify the risk factors of memory or emotional complaints In the second study we investigated the association between neurological factors and memory complaints in patients with chronic complicated mTBI and Glasgow Coma Scale (GCS) scores of 14 to 15 In the third study we investigated the correlations between psychological complaints and brain lesions with neuropsychological functions in patients with chronic complicated mTBI and GCS score of 14 to 15 Methods: Study 1: retrospective analysis of medical records was conducted by physicians in a teaching hospital in Southern Taiwan and complicated mTBI had been identified by means of computed tomography Psychological complaints including problems with memory and emotions were collected by structured telephone interviews 10–15 minutes long and were held with subjects who agreed to participate in our study We used demographic data and neurological factors to predict memory or emotional complaints without muscle power or response speed (MEMR) complaints Study 2: medical records were retrospectively analyzed by physicians and clinical neuropsychologists in several teaching hospitals in southern Taiwan Subjective memory complaints were determined in structured telephone interviews with patients in the chronic stage of complicated mTBI Study 3: computerized tomography (CT) scans and medical records were retrospectively analyzed by physicians and neuropsychologists in southern Taiwan We evaluated all patients’ psychological complaints and EF including executive attention working memory verbal fluency planning and flexibility measured by Comprehensive Nonverbal Attention test (CNAT) Comprehensive Nonverbal Memory Test (CNMT) Serial Verbal Memory Task (SVMT) Instrumental Verbal Working Memory of Daily Life (IVWM) Wisconsin Card Sorting Test (WCST) Tower of Landon (Toll) and Stroop test Results: Study 1 showed that only the presence or absence of cerebral contusions predicted memory or emotional complaints without MEMR complaints in different employed status and the odds ratio was 4 82–13 50 times higher for those with cerebral contusions than for those without ? Study 2 showed that 133 patients (39 94%) complained about memory complaints (MCs) and 46 patients (13 81%) complained about memory complaints only (MCOs) No demographic factors were associated with MCOs However brain contusions and mixed types of hemorrhage (brain contusions and subarachnoid hemorrhage [SAH]) showed significant associations with MCOs Study 3 showed that 15 patients (21 1%) with brain contusions had much less CL on CMNT (F = 8 544 P < 01 η2 = 0 125) and total number of C errors on the ToL (F = 5 268 P < 05 η2 = 0 076) than those without brain contusions Thirty-one patients (43 7%) with frontal lesions on CT had significantly lower total ToL scores more ToL commission errors more impulsive CNAT errors lower IVWM auditory scores and less verbal fluency Confounding factors were excluded after demographic factors had been controlled for Discussions and Conclusions: The findings of these studies demonstrated that patients with complicated mTBI might have long-term sequelae Brain contusions or mixed types of hemorrhage might be markers for detecting high-risk patients with subjective complaints In addition complicated mTBI with frontal lobe lesions might be also an indicator for predicting poorer EF even in the chronic stage In summary complaints might imply meaningful information rather than represent noise and brain pathology of mTBI needs more attention in clinical settings when considering prognosis and neuropsychological rehabilitation

Date of Award	2018 Jan 22
Original language	English
Supervisor	Nai-Wen Guo (Supervisor)