VU University Amsterdam, FPP Department of Clinical Neuropsychology, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands.
J Neurol Neurosurg Psychiatry. 2012 Nov;83(11):1048-55. doi: 10.1136/jnnp-2012-302635. Epub 2012 Jul 11.
Worldwide, millions of patients with traumatic brain injury (TBI) suffer from persistent and disabling intelligence impairment. Post-traumatic amnesia (PTA) duration is a promising predictor of intelligence following TBI.
To determine (1) the impact of TBI on intelligence throughout the lifespan and (2) the predictive value of PTA duration for intelligence impairment, using meta-analytic methods.
Electronic databases were searched for peer reviewed articles, published until February 2012. Studies reporting intelligence following TBI and injury severity by PTA duration were included. Meta-analytic methods generated effect sizes for full scale IQ (FSIQ), performance IQ (PIQ) and verbal IQ (VIQ), following mild TBI (PTA duration 1-24 h) and severe TBI (PTA duration >7 days), during the subacute phase of recovery (≤6 months post-injury) and the chronic phase (>6 months post-injury). Meta-regression elucidated the predictive value of PTA duration for intelligence impairment.
Patients with severe TBI exhibited large depressions in FSIQ in the subacute phase of recovery (d = -1.07, 95% CI to 1.52 to -0.62; p<0.001), persisting into the chronic phase (d = -0.78, 95% CI -1.06 to -0.51; p<0.001). PIQ was more severely affected than VIQ in the subacute phase (Q1 =3.85; p<0.05) but not in the chronic phase (Q1 =0.03, p=0.87). Most importantly, longer PTA duration strongly predicted greater depressions of FSIQ and PIQ in the subacute phase (-0.76 ≤ βs ≤ -0.73, Ps<0.01) and FSIQ, PIQ and VIQ in the chronic phase (-0.80 ≤ βs ≤ -0.61, Ps<0.05).
PTA duration is a valuable predictor of intelligence impairment following TBI. Results support the routine assessment of PTA duration in clinical settings.
全世界有数百万创伤性脑损伤（TBI）患者患有持续性和致残性智力障碍。创伤后遗忘（PTA）持续时间是 TBI 后智力的一个有希望的预测指标。
使用荟萃分析方法确定（1）TBI 对整个生命周期智力的影响，以及（2）PTA 持续时间对智力障碍的预测价值。
搜索了同行评审的文章电子数据库，这些文章发表到 2012 年 2 月。纳入了报告 TBI 后和 PTA 持续时间（1-24 小时）的轻度 TBI 和（>7 天）的重度 TBI后智力，并在恢复的亚急性期（受伤后≤6 个月）和慢性期（受伤后>6 个月）进行了研究。荟萃分析方法生成了轻度 TBI（PTA 持续时间 1-24 小时）和重度 TBI（PTA 持续时间>7 天）后的全量表智商（FSIQ）、表现智商（PIQ）和言语智商（VIQ）的效应大小。通过元回归阐明了 PTA 持续时间对智力障碍的预测价值。
严重 TBI 患者在亚急性期的 FSIQ 中出现较大的抑郁（d=-1.07，95%CI 为 1.52 至-0.62；p<0.001），并持续到慢性期（d=-0.78，95%CI-1.06 至-0.51；p<0.001）。PIQ 在亚急性期比 VIQ 受影响更严重（Q1=3.85；p<0.05），但在慢性期没有（Q1=0.03，p=0.87）。最重要的是，较长的 PTA 持续时间强烈预测了亚急性期 FSIQ 和 PIQ 的更严重抑郁（-0.76≤βs≤-0.73，Ps<0.01）以及慢性期的 FSIQ、PIQ 和 VIQ 的更严重抑郁（-0.80≤βs≤-0.61，Ps<0.05）。
PTA 持续时间是 TBI 后智力障碍的一个有价值的预测指标。结果支持在临床环境中常规评估 PTA 持续时间。
