13.5% of mTBI patients had poor cognitive outcomes; predicting risk, referral to cognitive rehabilitation

Apr 16

By Conor Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.

According to a study published in Neurology, 13.5% of mTBI patients had “poor cognitive outcomes” (vs. 4.5 % in a control group) one year after a mild traumatic brain injury (concussion). Using data from the TRACK-TBI study, the researchers created a clinical prediction model to identify acute mTBI patients who might be at risk for poor cognitive outcomes. Study authors Andrea Lauren Christman Schneider et al. recommend additional research to “find out the role of cognitive rehabilitation” for at-risk patients, according to a HealthDay article.

This study looked at 656 adults (17+) “presenting to Level 1 trauma centers within 24 hours of mTBI” and 156 healthy controls. Of the 13.5% of mTBI patients with poor cognitive outcomes, “10.1% had cognitive impairment only, 1.6% had cognitive decline only, and 1.8% had both.”

Variables such as the patient’s level of education, health insurance or lack thereof, depression prior to mTBI, hyperglycemia, and Rotterdam CT Score>3 contributed to their elevated risk level for a poor cognitive outcome a 1-year post mTBI. In the multivariable prediction model, each variable was “associated with >2-fold increased odds of poor 1-year cognitive outcome.”

The results of several cognitive tests suggested that “the domains of memory and processing speed are most affected at 1-year post-mild TBI,” according to study co-author Raquel C. Gardner in a MedPage article.

Concernedly, the study found that “poor 1-year cognitive outcomes were associated with worse 1-year functional outcomes, more neurobehavioral symptoms, greater psychological distress, and lower satisfaction with life.”

In the univariable analysis, non-white race and income level were statistically significantly associated with poorer cognitive outcomes. However, these variables did not improve the accuracy of the final multivariable prediction model.

For further information, see our page on Cognitive Rehabilitation.