Cognitive Impairment Following Traumatic Brain Injury.
Cognitive Impairment Following Traumatic Brain Injury.
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DOI：
10.1007/s11940-002-0004-6
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发表时间：
2002-01-01
影响因子：
2
通讯作者：
Wagner, Peter
中科院分区：
文献类型：
--
作者：
Arciniegas, David B.;Held, Kerri;Wagner, Peter
创伤性脑损伤（TBI）引起的认知障碍是受影响个人、其家庭成员和社会发病率的重要来源。注意、记忆和执行功能障碍是创伤性脑损伤最常见的神经认知后果，无论严重程度如何。注意力和记忆的障碍尤其有问题，因为这些相对基本的认知功能的破坏可能导致或加剧执行功能、沟通和其他相对更复杂的认知功能的额外障碍。由于TBI后其他身体、神经和精神综合征的发生率很高，因此对患者进行彻底的神经精神评估是任何认知障碍治疗处方的先决条件。精神兴奋剂和其他多巴胺能活性药物（如哌醋甲酯、右苯丙胺、金刚烷胺、左旋多巴/卡比多巴、溴隐碱）可适度改善唤醒和信息处理速度，减少注意力分散，并改善执行功能的某些方面。建议谨慎给药（低剂量和慢剂量），经常对效果和副作用进行标准化评估，并监测药物-药物相互作用。认知康复对脑外伤后记忆障碍的治疗是有用的。认知康复也可用于治疗创伤性脑损伤后的注意力、人际沟通技巧和执行功能受损。这种形式的治疗对轻度至中度认知障碍的患者最有用，对那些功能相对独立、有动力参与和演练这些策略的患者尤其有用。心理治疗（如支持性、个人、认知行为、团体和家庭）是治疗的重要组成部分。对于有药物治疗和康复难治性认知障碍的患者，可能需要心理治疗来帮助患者和家庭适应永久性残疾。
Cognitive impairments due to traumatic brain injury (TBI) are substantial sources of morbidity for affected individuals, their family members, and society. Disturbances of attention, memory, and executive functioning are the most common neurocognitive consequences of TBI at all levels of severity. Disturbances of attention and memory are particularly problematic, as disruption of these relatively basic cognitive functions may cause or exacerbate additional disturbances in executive function, communication, and other relatively more complex cognitive functions. Because of the high rate of other physical, neurologic, and psychiatric syndromes following TBI, a thorough neuropsychiatric assessment of the patient is a prerequisite to the prescription of any treatment for impaired cognition. Psychostimulants and other dopaminergically active agents (eg, methylphenidate, dextroamphetamine, amantadine, levodopa/carbidopa, bromocriptine) may modestly improve arousal and speed of information processing, reduce distractibility, and improve some aspects of executive function. Cautious dosing (start-low and go-slow), frequent standardized assessment of effects and side effects, and monitoring for drug-drug interactions are recommended. Cognitive rehabilitation is useful for the treatment of memory impairments following TBI. Cognitive rehabilitation may also be useful for the treatment of impaired attention, interpersonal communication skills, and executive function following TBI. This form of treatment is most useful for patients with mild to moderate cognitive impairments, and may be particularly useful for those who are still relatively functionally independent and motivated to engage in and rehearse these strategies. Psychotherapy (eg, supportive, individual, cognitive-behavioral, group, and family) is an important component of treatment. For patients with medication- and rehabilitation-refractory cognitive impairments, psychotherapy may be needed to assist both patients and families with adjustment to permanent disability.