Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
University of Toronto, Toronto, ON, Canada.
Neurorehabil Neural Repair. 2023 Dec;37(11-12):799-809. doi: 10.1177/15459683231212861. Epub 2023 Nov 22.
Moderate-severe traumatic brain injury (TBI) has been associated with progressive cognitive decline in the chronic injury stages in a small number of studies.
This study aimed to (i) replicate our previous findings of decline from 1 to 3+ years post-injury in a larger, non-overlapping sample and (ii) extend these findings by examining the proportion of decliners in 2 earlier time windows, and by investigating novel predictors of decline.
N = 48 patients with moderate-severe TBI underwent neuropsychological assessment at 2, 5, 12 months, and 30+ months post-injury. We employed the Reliable Change Index (RCI) to evaluate decline, stability and improvement across time and logistic regression to identify predictors of decline (demographic/cognitive reserve; injury-related).
The proportions of patients showing decline were: 12.5% (2-5 months post-injury), 17% (5-12 months post-injury), and 27% (12-30+ months post-injury). Measures of verbal retrieval were most sensitive to decline. Of the predictors, only left progressive hippocampal volume loss from 5 to 12 months post-injury significantly predicted cognitive decline from 12 to 30+ months post-injury.
Identical to our previous study, 27% of patients declined from 12 to 30+ months post-injury. Additionally, we found that the further from injury, the greater the proportion of patients declining. Importantly, earlier progressive hippocampal volume loss predicted later cognitive decline. Taken together, the findings highlight the need for ongoing research and treatment that target these deleterious mechanisms affecting patients in the chronic stages of moderate-severe TBI.
在少数研究中，中度至重度创伤性脑损伤（TBI）与慢性损伤阶段的进行性认知下降有关。
本研究旨在（i）在更大、非重叠的样本中复制我们之前发现的从受伤后 1 年到 3 年以上的下降，（ii）通过检查 2 个较早时间窗口的下降患者比例，并通过研究新的下降预测因素来扩展这些发现。
N = 48 名中度至重度 TBI 患者在受伤后 2、5、12 个月和 30 个月以上进行神经心理评估。我们采用可靠变化指数（RCI）来评估随时间的下降、稳定和改善，并采用逻辑回归来识别下降的预测因素（人口统计学/认知储备；与损伤相关）。
表现出下降的患者比例为：12.5%（2-5 个月后），17%（5-12 个月后），27%（12-30 个月后）。言语检索测量对下降最敏感。在预测因素中，只有从受伤后 5 个月到 12 个月左海马渐进性体积损失，从受伤后 12 个月到 30 个月以上显著预测认知下降。
与我们之前的研究相同，27%的患者从受伤后 12 个月到 30 个月以上出现下降。此外，我们发现，离受伤越远，下降的患者比例越大。重要的是，更早的海马渐进性体积损失预测了以后的认知下降。总之，这些发现强调了需要进行持续的研究和治疗，以针对中度至重度 TBI 慢性阶段的这些有害机制影响患者。
