Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury
Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury
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DOI：
10.1136/jnnp-2020-324492
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发表时间：
2021-04-01
影响因子：
11
通讯作者：
Menon, David
中科院分区：
文献类型：
--
作者：
Wilson, Lindsay;Horton, Lindsay;Menon, David
目的认知障碍是创伤性脑损伤 (TBI) 后残疾的一个关键原因，但与日常生活整体功能的关系往往不大。目的是检查不同功能水平的认知并确定与残疾相关的领域。方法在受伤后 6 个月，对 1554 名轻度至重度 TBI 患者进行了格拉斯哥结果量表扩展 (GOSE)、简表 12v2 和一系列认知测试的评估。使用针对年龄、性别和教育程度调整的协方差分析来比较各个 GOSE 类别的结果。结果总体效应大小为小到中等，对于涉及处理速度 (eta(2)(p) 0.057-0.067）和学习和记忆（eta(2)(p) 0.048-0.052）的测试影响最大。认知能力缺陷在依赖他人（GOSE 3 或 4）或无法参与一项或多项主要生活活动（GOSE 5）的患者中尤其明显。在较高的功能水平（GOSE 6-8）下，不同类别的认知表现惊人地相似。即使在报告完全康复且没有明显症状的患者中，表现也会下降。认知（eta(2)(p) 0.111）、心理健康（eta(2)(p) 0.131）和身体健康（eta(2)(p) 0.252）的汇总测量存在中到大的效应大小。结论这项大规模研究为不同残疾程度的认知表现提供了新的见解，并强调了日常生活中功能处理速度的重要性。在较高的结果水平上，认知对整体功能的影响明显减弱，心理健康方面的差异也很明显。
ObjectiveCognitive impairment is a key cause of disability after traumatic brain injury (TBI) but relationships with overall functioning in daily life are often modest. The aim is to examine cognition at different levels of function and identify domains associated with disability.Methods1554 patients with mild-to-severe TBI were assessed at 6 months post injury on the Glasgow Outcome Scale-Extended (GOSE), the Short Form-12v2 and a battery of cognitive tests. Outcomes across GOSE categories were compared using analysis of covariance adjusting for age, sex and education.ResultsOverall effect sizes were small to medium, and greatest for tests involving processing speed (eta(2)(p) 0.057-0.067) and learning and memory (eta(2)(p) 0.048-0.052). Deficits in cognitive performance were particularly evident in patients who were dependent (GOSE 3 or 4) or who were unable to participate in one or more major life activities (GOSE 5). At higher levels of function (GOSE 6-8), cognitive performance was surprisingly similar across categories. There were decreases in performance even in patients reporting complete recovery without significant symptoms. Medium to large effect sizes were present for summary measures of cognition (eta(2)(p) 0.111), mental health (eta(2)(p) 0.131) and physical health (eta(2)(p) 0.252).ConclusionsThis large-scale study provides novel insights into cognitive performance at different levels of disability and highlights the importance of processing speed in function in daily life. At upper levels of outcome, any influence of cognition on overall function is markedly attenuated and differences in mental health are salient.