Department of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
J Neurotrauma. 2021 Sep 15;38(18):2590-2599. doi: 10.1089/neu.2020.7513. Epub 2021 Jun 18.
This study is the first to examine cognitive outcomes after pediatric mild TBI using the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB), a computerized cognitive test battery. The NIHTB-CB includes two complex measures of attention and executive function that allow differentiation of accuracy and response speed. We compared performance on the NIHTB-CB among children 8-16 years of age with mild TBI ( = 143) versus children with orthopedic injuries (OIs; = 74) recruited in emergency departments and followed for 6 months post-injury. Mixed-model analyses showed that the mild TBI group showed significantly lower Fluid Cognition composite scores than the OI group at 10 days (group intercept, = 0.018); the magnitude of group differences declined modestly over time (group × time interaction, = 0.055). Effect sizes were = 0.34 at 10 days post-injury, = 0.27 at 3 months, and = 0.10 at 6 months. No significant effects of group or time were found for the Crystallized Cognition composite. Analyses of Fluid Cognition subtests indicated that children with mild TBI displayed deficits for as long as 3 months on measures of attention and executive function (e.g., cognitive flexibility, inhibitory control), but not on measures of explicit memory, working memory, or processing speed. The poorer performance of the mild TBI group on measures of attention and executive function was attributable largely to slowed reaction time, not decreased accuracy. The findings suggest that children with mild TBI demonstrate persistent deficits in fluid cognition that are most apparent on tasks that combine demands for both speed and executive function.
这项研究首次使用国家卫生研究院工具包认知电池（NIHTB-CB）检查儿科轻度创伤性脑损伤后的认知结果，NIHTB-CB 是一种计算机化认知测试电池。NIHTB-CB 包括两个复杂的注意力和执行功能测量方法，可以区分准确性和反应速度。我们比较了 8-16 岁患有轻度 TBI（ = 143）和患有骨科损伤（OIs； = 74）的儿童在急诊部门招募并在受伤后 6 个月内的 NIHTB-CB 表现。混合模型分析表明，轻度 TBI 组在 10 天时的流体认知综合评分明显低于 OI 组（组截距， = 0.018）；组间差异随时间略有下降（组 × 时间交互作用， = 0.055）。受伤后 10 天的效应大小为 = 0.34，3 个月时为 = 0.27，6 个月时为 = 0.10。晶体认知综合评分无明显组间或时间效应。流体认知子测试的分析表明，患有轻度 TBI 的儿童在注意力和执行功能（例如认知灵活性、抑制控制）的测量上至少在 3 个月内存在缺陷，但在明确记忆、工作记忆或处理速度的测量上没有缺陷。轻度 TBI 组在注意力和执行功能测量上的较差表现主要归因于反应时间较慢，而不是准确性降低。研究结果表明，患有轻度 TBI 的儿童表现出明显的流体认知缺陷，在需要速度和执行功能的任务上最为明显。
