Till Christine, Colella Brenda, Verwegen Joel, Green Robin E
Toronto Rehabilitation Institute, University Centre, Toronto, ON, Canada.
Arch Phys Med Rehabil. 2008 Dec;89(12 Suppl):S25-34. doi: 10.1016/j.apmr.2008.07.004.
To assess prospectively the degree of postrecovery long-term cognitive decline after moderate to severe traumatic brain injury (TBI).
Observational cohort.
Inpatient rehabilitation hospital.
Adults (N=33) with moderate and severe TBI from a well characterized sample with low attrition.
Not applicable.
Recovery of functioning was ascertained through repeat neuropsychological assessments over the first 5 years postinjury. Cognitive decline from a baseline of 12 months postinjury to a follow-up evaluation conducted on average +/- SD 2.1+/-0.99 years later. Change was calculated using the reliable change index (RCI) for 12 neuropsychological tests commonly used in the assessment of TBI.
At the group level, negligible changes in cognitive function were observed over time. However, application of the RCI using 90% confidence intervals showed statistically significant cognitive decline on at least 2 neuropsychological measures in 27.3% of study participants. Decline was most commonly observed on a test of verbal fluency and the delayed recall portion of a test of verbal list learning (Rey Auditory Verbal Learning Test), although substantial variability existed across patients. Decline was significantly correlated with hours of therapy received at 5 months postinjury (P<.02).
Consistent with a small number of previous studies, cognitive deterioration may follow an initial period of recovery. Overall, the pattern of decline across tests varied across individuals. Possible mechanisms of decline are discussed. Further research is needed to understand the stability of this finding and its functional implications.
前瞻性评估中重度创伤性脑损伤（TBI）后恢复后期长期认知功能衰退的程度。
观察性队列研究。
住院康复医院。
来自特征明确、损耗率低的样本中的33例中重度TBI成人患者。
不适用。
通过伤后前5年的重复神经心理学评估确定功能恢复情况。认知功能衰退指从伤后12个月的基线水平到平均在伤后2.1±0.99年（标准差）进行的随访评估期间的变化。使用评估TBI常用的12项神经心理学测试的可靠变化指数（RCI）计算变化情况。
在组水平上，随时间观察到认知功能变化可忽略不计。然而，使用90%置信区间的RCI显示，27.3%的研究参与者至少在2项神经心理学测量指标上出现了具有统计学意义的认知衰退。衰退最常出现在言语流畅性测试以及言语列表学习测试（雷伊听觉词语学习测试）的延迟回忆部分，不过患者之间存在很大差异。衰退与伤后5个月接受的治疗时长显著相关（P<0.02）。
与少数先前研究一致，认知功能恶化可能发生在初始恢复阶段之后。总体而言，不同测试中衰退模式因人而异。讨论了可能的衰退机制。需要进一步研究以了解这一发现的稳定性及其功能意义。
