Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia.
J Int Neuropsychol Soc. 2022 Apr;28(4):382-390. doi: 10.1017/S1355617721000588. Epub 2021 May 17.
Post-traumatic amnesia (PTA) is a transient period of recovery following traumatic brain injury (TBI) characterised by disorientation, amnesia, and cognitive disturbance. Agitation is common during PTA and presents as a barrier to patient outcome. A relationship between cognitive impairment and agitation has been observed. This prospective study aimed to examine the different aspects of cognition associated with agitation.
The sample comprised 82 participants (75.61% male) admitted to an inpatient rehabilitation hospital in PTA. All patients had sustained moderate to extremely severe brain injury as assessed using the Westmead Post-Traumatic Amnesia Scale (WPTAS) (mean duration = 42.30 days, SD = 35.10). Participants were assessed daily using the Agitated Behaviour Scale and WPTAS as part of routine clinical practice during PTA. The Confusion Assessment Protocol was administered two to three times per week until passed criterion was achieved (mean number assessments = 3.13, SD = 3.76). Multilevel mixed modelling was used to investigate the association between aspects of cognition and agitation using performance on items of mental control, orientation, memory free recall, memory recognition, vigilance, and auditory comprehension.
Findings showed that improvement in orientation was significantly associated with lower agitation levels. A nonsignificant trend was observed between improved recognition memory and lower agitation.
Current findings suggest that the presence of disorientation in PTA may interfere with a patient's ability to understand and engage with the environment, which in turn results in agitated behaviours. Interventions aimed at maximizing orientation may serve to minimize agitation during PTA.
创伤性脑损伤（TBI）后，逆行性遗忘（PTA）是一段短暂的恢复期，表现为定向障碍、遗忘和认知障碍。在 PTA 期间，患者通常会出现激越，这对患者的预后构成了障碍。认知障碍与激越之间存在关联。本前瞻性研究旨在检查与激越相关的认知的不同方面。
该样本包括 82 名（75.61%为男性）在 PTA 期间入住住院康复医院的患者。所有患者的脑损伤程度从中度到极度严重，均使用 Westmead 创伤后遗忘量表（WPTAS）进行评估（平均持续时间=42.30 天，SD=35.10）。作为 PTA 期间常规临床实践的一部分，每天使用激越行为量表和 WPTAS 对患者进行评估。每周对意识混乱评估协议进行两次到三次评估，直到达到通过标准（平均评估次数=3.13，SD=3.76）。使用多级混合模型来研究认知的各个方面与使用精神控制、定向、自由回忆记忆、记忆识别、警觉性和听觉理解等项目的表现之间的关联。
研究结果表明，定向能力的提高与激越水平的降低显著相关。识别记忆的改善与激越的降低之间存在不显著的趋势。
目前的研究结果表明，在 PTA 中存在定向障碍可能会干扰患者理解和参与环境的能力，从而导致激越行为。旨在最大限度地提高定向能力的干预措施可能有助于减少 PTA 期间的激越。
