Cariello Anna N, Perrin Paul B, Agudelo Yaneth Rodriguez, Olivera Plaza Silvia Leonor, Quijano-Martínez Maria Cristina, Trujillo Michael A, Arango-Lasprilla Juan Carlos
Virginia Commonwealth University, Richmond, USA.
Department of Neuropsychology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
NeuroRehabilitation. 2020;46(2):205-212. doi: 10.3233/NRE-192972.
Latin America has exceptionally high rates of traumatic brain injury (TBI), but very little research has been conducted on longitudinal TBI outcomes in this global region.
This study examined whether cognitive dysfunction and social disadaptation in individuals with TBI in Latin America at hospital discharge predict longitudinal trajectories of depression at baseline, 2 months, and 4 months.
A sample of 109 people with a new TBI was recruited from three hospitals: Mexico City, Mexico, Cali, Colombia and Neiva, Colombia. Participants completed measures of cognitive dysfunction and social disadaptation before hospital discharge and measures of depression at baseline, 2 months, and 4 months.
Results suggested that depression scores were found to decrease over time in a quadratic (or U-shaped) fashion, and more significant cognitive dysfunction at hospital discharge was associated with higher longitudinal depression trajectories. Social disadaptation did not exert a unique effect on depression trajectories after controlling for cognitive dysfunction. Depression trajectories changed differentially over time as a function of baseline cognitive dysfunction, such that for those with high cognitive impairment, depression scores started high and then dropped to a moderated range and plateaued, but for individuals with low cognitive dysfunction, depression scores started lower and decreased linearly but moderately.
The results suggest a strong need for neuropsychological assessments and evidence-based cognitive rehabilitation strategies to be implemented immediately after TBI in Latin America, which could exert salubrious effects on depression trajectories over time.
拉丁美洲创伤性脑损伤（TBI）的发生率极高，但在这个全球区域针对创伤性脑损伤的纵向结果开展的研究却非常少。
本研究考察了拉丁美洲创伤性脑损伤患者出院时的认知功能障碍和社会适应不良是否能预测其在基线、2个月和4个月时抑郁症状的纵向变化轨迹。
从三家医院招募了109名新发创伤性脑损伤患者，分别来自墨西哥城、墨西哥，卡利、哥伦比亚和内瓦、哥伦比亚。参与者在出院前完成了认知功能障碍和社会适应不良的测量，并在基线、2个月和4个月时完成了抑郁测量。
结果表明，抑郁评分随时间呈二次函数（或U形）下降，出院时更严重的认知功能障碍与更高的纵向抑郁轨迹相关。在控制了认知功能障碍后，社会适应不良对抑郁轨迹没有独特影响。抑郁轨迹随时间变化因基线认知功能障碍而异，对于认知损害严重的患者，抑郁评分开始较高，然后降至中等范围并趋于平稳，但对于认知功能障碍较轻的个体，抑郁评分开始较低，并呈线性但适度下降。
结果表明，拉丁美洲迫切需要在创伤性脑损伤后立即实施神经心理学评估和循证认知康复策略，这可能会对抑郁轨迹产生长期有益影响。
