Chen Weiliang, Yao Chunyu, Li Shengwen, Huang Hongguang, Zhu Zujian, Chen Rui, Su Wen, Huang Xiao, Xu Lisheng, Sun Kaijie, Song Jiannan, Jiang Rongcai, Wang Guanjun
Department of Neurosurgery, Haining People's Hospital, Jiaxing, Zhejiang, China.
The Second Department of Orthopaedics, Haining People's Hospital, Haining, Zhejiang, China.
Front Neurosci. 2023 Jan 25;17:1077858. doi: 10.3389/fnins.2023.1077858. eCollection 2023.
Traumatic brain injury (TBI), especially the severe TBI are often followed by persistent cognitive sequalae, including decision-making difficulties, reduced neural processing speed and memory deficits. Diffuse axonal injury (DAI) is classified as one of the severe types of TBI. Part of DAI patients are marginalized from social life due to cognitive impairment, even if they are rated as favorable outcome. The purpose of this study was to elucidate the specific type and severity of cognitive impairment in DAI patients with favorable outcome.
The neurocognition of 46 DAI patients with favorable outcome was evaluated by the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC), and the differences in the domains of cognitive impairment caused by different grades of DAI were analyzed after data conversion of scores of nine cognitive domains of MoCA-BC by Pearson correlation analysis.
Among the 46 DAI patients with favorable outcome, eight had normal cognitive function (MoCA-BC ≥ 26), and 38 had cognitive impairment (MoCA-BC < 26). The MoCA-BC scores were positively correlated with pupillary light reflex ( = 0.361, = 0.014), admission Glasgow Coma Scale (GCS) ( = 0.402, = 0.006), and years of education ( = 0.581, < 0.001). Return of consciousness ( = -0.753, < 0.001), Marshall CT ( = -0.328, = 0.026), age ( = -0.654, < 0.001), and DAI grade ( = -0.403, = 0.006) were found to be negatively correlated with the MoCA-BC scores. In patients with DAI grade 1, the actually deducted scores (Ads) of memory ( = 0.838, < 0.001), abstraction ( = 0.843, < 0.001), and calculation ( = 0.782, < 0.001) were most related to the Ads of MoCA-BC. The Ads of nine cognitive domains and MoCA-BC were all proved to be correlated, among patients with DAI grade 2. However, In the DAI grade 3 patients, the highest correlation with the Ads of MoCA-BC were the Ads of memory ( = 0.904, < 0.001), calculation ( = 0.799, = 0.006), orientation ( = 0.801, = 0.005), and executive function ( = 0.869, = 0.001).
DAI patients with favorable outcome may still be plagued by cognitive impairment, and different grades of DAI cause different domains of cognitive impairment.
创伤性脑损伤（TBI），尤其是重度TBI，常伴有持续性认知后遗症，包括决策困难、神经处理速度降低和记忆缺陷。弥漫性轴索损伤（DAI）被归类为重度TBI类型之一。部分DAI患者即使被评定为预后良好，也因认知障碍而被社会生活边缘化。本研究的目的是阐明预后良好的DAI患者认知障碍的具体类型和严重程度。
采用中文版蒙特利尔认知评估基础量表（MoCA-BC）对46例预后良好的DAI患者进行神经认知评估，并通过Pearson相关分析对MoCA-BC九个认知领域的得分进行数据转换后，分析不同等级DAI所致认知障碍领域的差异。
在46例预后良好的DAI患者中，8例认知功能正常（MoCA-BC≥26），38例有认知障碍（MoCA-BC＜26）。MoCA-BC得分与瞳孔对光反射（r = 0.361，P = 0.014）、入院时格拉斯哥昏迷量表（GCS）评分（r = 0.402，P = 0.006）和受教育年限（r = 0.581，P＜0.001）呈正相关。意识恢复情况（r = -0.753，P＜0.001）、Marshall CT分级（r = -0.328，P = 0.026）、年龄（r = -0.654，P＜0.001）和DAI分级（r = -0.403，P = 0.006）与MoCA-BC得分呈负相关。在1级DAI患者中，记忆（r = 0.838，P＜0.001）、抽象思维（r = 0.843，P＜0.001）和计算（r = 0.782，P＜0.001）的实际扣分与MoCA-BC的实际扣分最相关。在2级DAI患者中，九个认知领域的实际扣分与MoCA-BC均被证明相关。然而，在3级DAI患者中，与MoCA-BC实际扣分相关性最高的是记忆（r = 0.904，P＜0.001）、计算（r = 0.799，P = 0.006）、定向力（r = 0.801，P = 0.005）和执行功能（r = 0.869，P = 0.001）的实际扣分。
预后良好的DAI患者仍可能受到认知障碍的困扰，不同等级的DAI导致不同领域的认知障碍。
