Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
Department of Physical Medicine and Rehabilitation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
J Int Neuropsychol Soc. 2020 Aug;26(7):654-667. doi: 10.1017/S1355617720000193. Epub 2020 Feb 26.
This study aimed to explore the 10-year trajectories of neurocognitive domains after moderate-severe traumatic brain injury (TBI), to identify factors related to long-term neurocognitive functioning, and to investigate whether performance remained stable or changed over time.
Seventy-nine patients with moderate-severe TBI between the ages of 16 and 55 years were assessed at 3 months, 1, 5, and 10 years postinjury using neuropsychological tests and functional outcomes. Three hierarchical linear models were used to investigate the relationships of domain-specific neurocognitive trajectories (Memory, Executive function, and Reasoning) with injury severity, demographics, functional outcome at 3 months (Glasgow Outcome Scale-Extended) and emotional distress at 1 year (Symptom Checklist 90-Revised).
Education, injury severity measures, functional outcome, and emotional distress were significantly associated with both Memory and Executive function. Education and emotional distress were related to Reasoning. The interaction effects between time and these predictors in predicting neurocognitive trajectories were nonsignificant. Among patients with data at 1 and 10 year follow-ups (n = 47), 94-96% exhibited stable scores on Executive function and Reasoning tasks, and 83% demonstrated stable scores on Memory tasks. Significant memory decline was presented in 11% of patients.
The findings highlight the differential contribution of variables in their relationships with long-term neurocognitive functioning after moderate-severe TBI. Injury severity was important for Memory outcomes, whereas emotional distress influenced all neurocognitive domains. Reasoning (intellectual) abilities were relatively robust after TBI. While the majority of patients appeared to be cognitively stable beyond the first year, a small subset demonstrated a significant memory decline over time.
本研究旨在探讨中重度创伤性脑损伤（TBI）后神经认知领域的 10 年轨迹，确定与长期神经认知功能相关的因素，并研究其表现是否随时间保持稳定或变化。
对 79 名年龄在 16 至 55 岁之间的中重度 TBI 患者，在伤后 3 个月、1 个月、5 个月和 10 个月时，使用神经心理学测试和功能结果进行评估。采用三个层次线性模型，调查特定领域神经认知轨迹（记忆、执行功能和推理）与损伤严重程度、人口统计学、3 个月时的功能结果（格拉斯哥结局量表-扩展版）和 1 年时的情绪困扰（症状清单 90-修订版）之间的关系。
教育、损伤严重程度测量、功能结果和情绪困扰与记忆和执行功能均显著相关。教育和情绪困扰与推理相关。在预测神经认知轨迹时，时间与这些预测因子之间的交互作用不显著。在有 1 年和 10 年随访数据的患者中（n=47），94%-96%的患者在执行功能和推理任务上表现出稳定的分数，83%的患者在记忆任务上表现出稳定的分数。11%的患者表现出明显的记忆下降。
这些发现强调了变量在与中重度 TBI 后长期神经认知功能的关系中的不同贡献。损伤严重程度对记忆结果很重要，而情绪困扰则影响所有神经认知领域。推理（智力）能力在 TBI 后相对较强。虽然大多数患者在第一年以后似乎认知稳定，但一小部分患者随着时间的推移表现出明显的记忆下降。
