Cognitive and Behavioral Outcomes from Traumatic Brain Injury

Griffen, Julie A.; Hanks, Robin A.

doi:10.1007/978-1-4939-0784-7_2

Cited by 17 publications

(18 citation statements)

References 150 publications

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“…Two main findings—that TBI was associated with subsequent adverse adulthood outcomes, and the dose-response relationship with injury severity—are consistent with previous research [17–20,44], although these studies have mostly focused on small and selected samples that rely extensively on self-reported data either from (severely) injured patients or their caregivers; an approach subject to substantial bias [45]. Similar results have been reported in studies examining global disability indices [10], such as the extended Glasgow Outcome Scale (GOSE) [21].…”

Section: Discussionsupporting

confidence: 85%

Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

et al. 2016

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BackgroundTraumatic brain injury (TBI) is the leading cause of disability and mortality in children and young adults worldwide. It remains unclear, however, how TBI in childhood and adolescence is associated with adult mortality, psychiatric morbidity, and social outcomes.Methods and FindingsIn a Swedish birth cohort between 1973 and 1985 of 1,143,470 individuals, we identified all those who had sustained at least one TBI (n = 104,290 or 9.1%) up to age 25 y and their unaffected siblings (n = 68,268) using patient registers. We subsequently assessed these individuals for the following outcomes using multiple national registries: disability pension, specialist diagnoses of psychiatric disorders and psychiatric inpatient hospitalisation, premature mortality (before age 41 y), low educational attainment (not having achieved secondary school qualifications), and receiving means-tested welfare benefits. We used logistic and Cox regression models to quantify the association between TBI and specified adverse outcomes on the individual level. We further estimated population attributable fractions (PAF) for each outcome measure. We also compared differentially exposed siblings to account for unobserved genetic and environmental confounding. In addition to relative risk estimates, we examined absolute risks by calculating prevalence and Kaplan-Meier estimates. In complementary analyses, we tested whether the findings were moderated by injury severity, recurrence, and age at first injury (ages 0–4, 5–9, 6–10, 15–19, and 20–24 y).TBI exposure was associated with elevated risks of impaired adult functioning across all outcome measures. After a median follow-up period of 8 y from age 26 y, we found that TBI contributed to absolute risks of over 10% for specialist diagnoses of psychiatric disorders and low educational attainment, approximately 5% for disability pension, and 2% for premature mortality. The highest relative risks, adjusted for sex, birth year, and birth order, were found for psychiatric inpatient hospitalisation (adjusted relative risk [aRR] = 2.0; 95% CI: 1.9–2.0; 6,632 versus 37,095 events), disability pension (aRR = 1.8; 95% CI: 1.7–1.8; 4,691 versus 29,778 events), and premature mortality (aRR = 1.7; 95% CI: 1.6–1.9; 799 versus 4,695 events). These risks were only marginally attenuated when the comparisons were made with their unaffected siblings, which implies that the effects of TBI were consistent with a causal inference. A dose-response relationship was observed with injury severity. Injury recurrence was also associated with higher risks—in particular, for disability pension we found that recurrent TBI was associated with a 3-fold risk increase (aRR = 2.6; 95% CI: 2.4–2.8) compared to a single-episode TBI. Higher risks for all outcomes were observed for those who had sustained their first injury at an older age (ages 20–24 y) with more than 25% increase in relative risk across all outcomes compared to the youngest age group (ages 0–4 y). On the population level, TBI explained between 2%–6% of the varianc...

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Section: Discussionsupporting

confidence: 85%

Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

et al. 2016

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“…It is possible that an association exists; however, no significant relationship was found after the fixel data were corrected for age; it is therefore possible that any effect was confounded by age. Although the physical, psychological, behavioural, and cognitive impairments experienced by people who suffer a TBI (Cristofori & Levin, ; Griffen & Hanks, ) may be the result of decreased FD in addition to alterations to the broader WM structure (i.e., fewer axons contained within WM tracts that have a reduced cross‐sectional area), further research is needed to determine this.…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic brain injury (TBI) is a major cause of death and disability, affecting an estimated 69 million people each year (Dewan et al, ). Cognitive, physical, psychological, and behavioural problems are all common following TBIs and can vary in both severity and duration (Bigler & Stern, ; Cristofori & Levin, ; Griffen & Hanks, ). Diffuse axonal injury (DAI), which alters white matter (WM) micro‐structure and affects the ability of axons to relay information, is thought to be a primary contributor to these problems (Hill, Coleman, & Menon, ; Huisman et al, ; Hulkower, Poliak, Rosenbaum, Zimmerman, & Lipton, ).…”

Section: Introductionmentioning

confidence: 99%

A fixel‐based analysis of micro‐ and macro‐structural changes to white matter following adult traumatic brain injury

Wallace

Mathias

Ward

et al. 2020

Human Brain Mapping

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Diffusion tensor imaging is often used to assess white matter (WM) changes following traumatic brain injury (TBI), but is limited in voxels that contain multiple fibre tracts.Fixel-based analysis (FBA) addresses this limitation by using a novel method of analysing high angular resolution diffusion-weighted imaging (HARDI) data. FBA examines three aspects of each fibre tract within a voxel: tissue micro-structure (fibre density [FD]), tissue macro-structure (fibre-bundle cross section [FC]) and a combined measure of both (FD and fibre-bundle cross section [FDC]). This study used FBA to identify the location and extent of micro-and macro-structural changes in WM following TBI. A large TBI sample (N mild = 133, N moderate-severe = 29) and control group (healthy and orthopaedic; N = 107) underwent magnetic resonance imaging with HARDI and completed reaction time tasks approximately 7 months after their injury (range:98-338 days). The TBI group showed micro-structural differences (lower FD) in the corpus callosum and forceps minor, compared to controls. Subgroup analyses revealed that the mild TBI group did not differ from controls on any fixel metric, but the moderate to severe TBI group had significantly lower FD, FC and FDC in multiple WM tracts, including the corpus callosum, cerebral peduncle, internal and external capsule. The moderate to severe TBI group also had significantly slower reaction times than controls, but the mild TBI group did not. Reaction time was not related to fixel findings.Thus, the WM damage caused by moderate to severe TBI manifested as fewer axons and a reduction in the cross-sectional area of key WM tracts. K E Y W O R D Sadults, diffusion-weighted imaging, fixel-based analysis, neuroimaging, traumatic brain injury

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“…Presently, TBI is considered to be the leading cause of death and disability (Roebuck‐Spencer & Cernich, ), affecting both physical and psychological health, as well as psychosocial relations. Among those with moderate to severe TBI, common symptoms are irritability, temper, dizziness, sensitivity to noise, blurred vision, lack of initiative, fatigue, and impairments in attention, processing speed, learning, and memory (Griffen & Hanks, ). Outcome from TBI varies considerably, but regaining of functions is most pronounced during the first 5–6 months.…”

Section: Step 2: Considerations On Disabilitymentioning

confidence: 96%

Care and consequences of traumatic brain injury in Neolithic Sweden: A case study of ante mortem skull trauma and brain injury addressed through the bioarchaeology of care

Tornberg

Jacobsson

2018

Intl J of Osteoarchaeology

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A number of papers have provided insight into frequencies of violence‐related trauma, especially skull trauma, in Northern European skeletal assemblages dating to the Neolithic and Bronze Age. Although the cases are often well described, they lack further discussion about the consequences of skull trauma for the injured individual and the implications for the surrounding society, especially considering severe skull trauma leading to traumatic brain injuries. In this paper, we address questions of trauma and care for one individual associated with the Swedish–Norwegian Battle Axe Culture who suffered from 2 severe ante mortem skull traumas probably leading to brain injuries. These questions are addressed using the Web‐based application and analytic tool Index of Care. We found that daily care, both short term with basic needs such as nutrition and grooming and long term with cognitive impairments, was available in the Neolithic society. Considering the frequent number of ante mortem skull trauma in the Neolithic and Bronze Age skeletal assemblages, traumatic brain injury was probably a common phenomenon. We argue that the care provided was a necessity for survival and maintenance of a socially sustainable society.

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Cognitive and Behavioral Outcomes from Traumatic Brain Injury

Cited by 17 publications

References 150 publications

Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

A fixel‐based analysis of micro‐ and macro‐structural changes to white matter following adult traumatic brain injury

Care and consequences of traumatic brain injury in Neolithic Sweden: A case study of ante mortem skull trauma and brain injury addressed through the bioarchaeology of care

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