1 Rijndam Rehabilitation , Rotterdam, The Netherlands .
2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands .
J Neurotrauma. 2018 Jul 1;35(13):1543-1551. doi: 10.1089/neu.2017.5404. Epub 2018 Apr 6.
The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18-67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.
这项研究的目的是评估中重度创伤性脑损伤（TBI） 10 年后的认知功能，并探讨认知功能、抑郁和健康相关生活质量（HRQoL）之间的关系。在这项前瞻性队列研究中，对 18-67 岁（n=113）的中重度 TBI 患者进行了 3、6、12、18、24、36 和 120 个月的测量。主要结局指标为抑郁（流行病学研究中心抑郁量表[CES-D]）、主观认知功能（认知失败问卷[CFQ]）、客观认知功能和 HRQoL（医疗结局研究 36 项简短健康调查[SF-36]）。最初的 113 名患者中有 50 名完成了 10 年随访。20%的患者出现抑郁症状（CES-D≥16）。与非抑郁患者相比，这些患者在出院时的精神症状更多（p=0.048），更常被转至康复或疗养院（p=0.015）。此外，他们在 SF-36 的八个子领域中的六个子领域的得分也明显较低。非抑郁患者在 SF-36 的所有子领域中的得分与荷兰普通人群相当。出院时的认知问题与 10 年后 TBI 的认知结果较差有关，但与抑郁或 HRQoL 无关。中重度 TBI 10 年后，抑郁评分与两项客观认知功能评分之间仅存在微弱关联（p<0.05）。然而，抑郁评分、HRQoL 和主观认知功能之间存在中度关联（p<0.01）。因此，中重度 TBI 后抑郁症状的早期发现和治疗可能对长期优化 HRQoL 至关重要。我们没有发现中重度 TBI 后长期抑郁与客观认知功能之间存在强烈关联的证据。疾病意识和选择性脱落可能在中重度 TBI 的长期随访研究中发挥作用。该领域需要更多的长期研究。
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