1Moss Rehabilitation Research Institute,Elkins Park,Pennsylvania.
J Int Neuropsychol Soc. 2018 Mar;24(3):237-246. doi: 10.1017/S1355617717000996. Epub 2017 Oct 16.
The goal of the present study was to elucidate the influence of demographic and neuropathological moderators on the longitudinal trajectory neuropsychological functions during the first year after moderate to severe traumatic brain injury (TBI). In addition to examining demographic moderators such as age and education, we included a measure of whole-brain diffuse axonal injury (DAI), and examined measures of processing speed (PS), executive function (EF), and verbal learning (VL) separately.
Forty-six adults with moderate to severe TBI were examined at 3, 6, and 12 months post-injury. Participants underwent neuropsychological evaluation and neuroimaging including diffusion tensor imaging. Using linear mixed effects modeling, we examined longitudinal trajectories and moderating factors of cognitive outcomes separately for three domains: PS, VL, and EF.
VL and EF showed linear improvements, whereas PS exhibited a curvilinear trend characterized by initial improvements that plateaued or declined, depending on age. Age moderated the recovery trajectories of EF and PS. Education and DAI did not influence trajectory but were related to initial level of functioning for PS and EF in the case of DAI, and all three cognitive domains in the case of education.
We found disparate recovery trajectories across cognitive domains. Younger age was associated with more favorable recovery of EF and PS. These findings have both clinical and theoretical implications. Future research with a larger sample followed over a longer time period is needed to further elucidate the factors that may influence cognitive change over the acute to chronic period after TBI. (JINS, 2018, 24, 237-246).
本研究旨在阐明人口统计学和神经病理学调节因素对中重度创伤性脑损伤（TBI）后第一年神经心理学功能的纵向轨迹的影响。除了检查年龄和教育等人口统计学调节因素外，我们还包括了全脑弥散性轴索损伤（DAI）的测量，并分别检查了处理速度（PS）、执行功能（EF）和言语学习（VL）的测量。
46 名中重度 TBI 成人在受伤后 3、6 和 12 个月接受检查。参与者接受神经心理学评估和神经影像学检查，包括弥散张量成像。使用线性混合效应模型，我们分别检查了三个领域（PS、VL 和 EF）的认知结果的纵向轨迹和调节因素。
VL 和 EF 表现出线性改善，而 PS 表现出初始改善后趋于平稳或下降的曲线趋势，这取决于年龄。年龄调节了 EF 和 PS 的恢复轨迹。教育和 DAI 不影响轨迹，但与 PS 和 EF 的初始功能水平有关，在 DAI 的情况下与所有三个认知领域有关，在教育的情况下也是如此。
我们发现认知领域存在不同的恢复轨迹。年龄较小与 EF 和 PS 的恢复更有利有关。这些发现具有临床和理论意义。需要更大的样本和更长的随访时间进行未来的研究，以进一步阐明 TBI 后急性期到慢性期可能影响认知变化的因素。（JINS，2018，24，237-246）。
