Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX.
Arch Phys Med Rehabil. 2023 Nov;104(11):1865-1871. doi: 10.1016/j.apmr.2023.04.017. Epub 2023 May 7.
To investigate whether a functional decline in cognitive activities decades after moderate-to-severe traumatic brain injury (m-sTBI) might relate to injury features and/or lifetime health factors, some of which may emerge as consequences of the injury.
Secondary analysis of the TBI Model Systems National Database, a prospective, multi-center, longitudinal study of patients with m-sTBI.
TBI Model Systems Centers.
Included were 732 participants rated on the cognitive subscale of the Functional Independence Measure (FIM Cognitive), a metric for everyday cognitive skills, across 3 time points out to 20 years (visits at 2-, 10-, and 20-year follow-ups; N=732).
Not applicable.
MAIN OUTCOME MEASURE(S): FIM Cognitive Scale. Injury characteristics such as timing and features pertaining to severity and health-related factors (eg, alcohol use, socioeconomic status) were examined to discriminate stable from declining participants on the FIM Cognitive Scale using logistic regression.
At 20 years post-injury, there was a low base rate of FIM Cognitive decline (11%, n=78), with most being stable or having meaningful improvement (89%, n=654). Older age at injury, longer duration of post-traumatic amnesia, and presence of repetitive seizures were significant predictors of FIM Cognitive decline in the final model (area under the curve=0.75), while multiple health-related factors that can represent independent co-morbidities or possible consequences of injury were not.
CONCLUSION(S): The strongest contributors to reported functional decline in cognitive activities later-in-life were related to acute characteristics of m-sTBI and experiencing post-traumatic seizures. Future studies are needed integrating functional with performance-based cognitive assessments to affirm conclusions and identify the timeline and trajectory of cognitive decline.
探究中重度创伤性脑损伤（m-sTBI）数十年后认知活动功能下降是否与损伤特征和/或终生健康因素有关，其中一些因素可能是损伤的后果。
对 TBI 模型系统国家数据库的二次分析，这是一项对 m-sTBI 患者进行的前瞻性、多中心、纵向研究。
TBI 模型系统中心。
纳入了 732 名参与者，他们在功能独立性测量（FIM 认知）的认知子量表上进行了评分，这是一种衡量日常认知技能的指标，在 3 个时间点上进行了 20 年的随访（在 2 年、10 年和 20 年的随访中进行了 732 次访问）。
不适用。
FIM 认知量表。使用逻辑回归检查损伤特征，如发病时间、严重程度相关特征和健康相关因素（如饮酒、社会经济地位），以区分 FIM 认知量表上稳定和下降的参与者。
在损伤后 20 年，FIM 认知下降的发生率较低（11%，n=78），大多数参与者稳定或有显著改善（89%，n=654）。在最终模型中，年龄较大、创伤后遗忘时间较长和反复癫痫发作是 FIM 认知下降的显著预测因素（曲线下面积=0.75），而多个健康相关因素，这些因素可能代表独立的合并症或损伤的可能后果，不是。
报告的中重度创伤性脑损伤后认知活动功能下降的最强因素与 m-sTBI 的急性特征和创伤后癫痫发作有关。需要进行进一步的研究，将功能评估与基于表现的认知评估相结合，以证实结论并确定认知下降的时间和轨迹。
