Dual Diagnosis

Kushner, David S.; Alvarez, Gemayaret

doi:10.1016/j.pmr.2014.04.005

Cited by 33 publications

(6 citation statements)

References 45 publications

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“…This rate is lower than reported elsewhere (15% to 60%, depending on the criteria used). 10 In the less than 1% of TBI patients who entered inpatient rehabilitation within 1 year of injury, those with dual diagnosis gained less during inpatient rehabilitation than matched TBI-only patients. This finding held regardless of dependence and functional levels at inpatient rehabilitation admission.…”

Section: Discussionmentioning

confidence: 99%

“…In practice, TBI and SCI often occur in conjunction, with estimates of dual diagnoses ranging from 15% to 60%, depending on the criteria used. 10 A recent population-based lifespan study found that comorbid neck injury with concussion (mild TBI [mTBI]) is common, with a significantly higher rate in female patient across most ages and all injury contexts, including motor vehicle collisions and sports. 11 This points to pointing to potential sex-based differences in TBI-SCI overlap clinical phenotype as manifested in cognitive function recovery course and outcomes, even in patients with mTBI.…”

mentioning

confidence: 99%

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The Impact of a Comorbid Spinal Cord Injury on Cognitive Outcomes of Male and Female Patients with Traumatic Brain Injury

Mollayeva

Sutton

Escobar

et al. 2020

PM&R

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Introduction Evidence of the effect of comorbid spinal cord injury (SCI) on cognitive outcomes in persons undergoing rehabilitation following newly diagnosed traumatic brain injury (TBI) is limited. We conducted a population‐based study to investigate this effect. Objective To compare cognitive outcomes in patients with TBI with and without a comorbid SCI. Setting/Participants Adult patients diagnosed with TBI were identified and followed for 1 year through provincial health administrative data; those who entered inpatient rehabilitation were studied. Design A retrospective matched cohort study using the National Rehabilitation Reporting System data of all acute care and freestanding rehabilitation hospitals in Ontario, Canada. Main Measures The exposure was a comorbid SCI in patients with diagnosed TBI. Exposed patients were matched to unexposed (TBI‐only) on sex, age, injury severity, and income, in a ratio of one to two. Gain differences in the cognitive subscale of the Functional Independence Measure were compared between exposed and unexposed patients using multivariable mixed linear model, controlling for comorbidity propensity score, gains in motor function, and rehabilitation care indicators. Results Over the first year post injury, 12 750 (0.84%) of all TBI patients entered inpatient rehabilitation, of whom 1359 (10.66%) had a comorbid SCI. A total of 1195 exposed patients (65.4% male, mean age 50.9 ± 20.6 for male and 61.8 ± 21.8 for female patients) were matched to 2390 unexposed patients. Controlling for confounding, exposed patients had lower cognitive gain (beta −0.43; 95% CI −0.72, −0.15), for both male (beta −0.39; 95% CI −0.75, −0.03) and female (beta −0.51; 95% CI −0.97, −0.05) patients. The adverse effects of comorbid SCI were driven largely by lower gains in problem solving and comprehension. Conclusions Adult patients with TBI and comorbid SCI showed a lower cognitive domain response to inpatient rehabilitation than patients with TBI alone. Identifying patients at risk for worse cognitive outcomes may facilitate the development of targeted strategies that improve cognitive outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Impact of a Comorbid Spinal Cord Injury on Cognitive Outcomes of Male and Female Patients with Traumatic Brain Injury

Mollayeva

Sutton

Escobar

et al. 2020

PM&R

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“…Cognitive deficits after SCI are not the topic of many scientific investigations and may be clinically misinterpreted as nonadherence to treatment, inability to learn, poor coping, and/or poor motivation (Bradbury et al, 2008; Inoue et al, 2013; Kushner & Alvarez, 2014). This relative neglect and misunderstanding is unfortunate because cognitive limitations may affect some individuals’ rehabilitation, community reintegration, and/or quality of life (Bradbury et al, 2008; Davidoff et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

“…Reported rates of concurrent SCI and TBI vary widely in the literature, from 16% to 74% (Davidoff et al, 1988; Ghobrial et al, 2014; Kushner & Alvarez, 2014; Macciocchi et al, 2008). One limitation of this study is that we do not know the rate of known concurrent TBI in this sample, a challenge shared by other studies of cognition in community-dwelling individuals with SCI (Dowler et al, 1997; Dowler et al, 1995).…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the fact that cognition affects self-care and community reintegration (Bradbury et al, 2008; Davidoff, Roth, & Richards, 1992), relatively little has been published on the cognitive correlates of SCI. Clinically, cognitive limitations may be misinterpreted as nonadherence to treatment, inability to learn, poor coping, and/or poor motivation (Bradbury et al, 2008; Inoue et al, 2013; Kushner & Alvarez, 2014). …”

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confidence: 99%

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Cognition among community-dwelling individuals with spinal cord injury.

Cohen¹,

Tulsky²,

Holdnack³

et al. 2017

Rehabilitation Psychology

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Purpose/Objective To compare the cognitive profiles of a well-characterized sample of adults with and without spinal cord injury (SCI) using the NIH Toolbox – Cognition Battery (NIHTB-CB). Research Method/Design 156 community-dwelling individuals with SCI were recruited from three academic medical centers. 156 individuals without SCI were selected from the NIHTB-CB normative database. The main outcome measures were the demographically-adjusted NIHTB-CB subtest and composite scores. Results Individuals with and without SCI performed equivalently on the NIHTB-CB crystallized composite score, suggesting comparable premorbid functioning. Individuals with SCI produced lower scores on the NIHTB-CB fluid composite score by an average of 4.5 T-score points (Cohen’s d = 0.50; a medium effect size). As a group, individuals with SCI had the most difficulty on tests of processing speed and executive functions, and some difficulty on a test of episodic memory, although effect sizes were small. These differences remained even after accounting for fine motor speed and dexterity. Individuals with tetraplegia produced lower scores than individuals with paraplegia on tests of processing speed and executive functioning. Conclusions/Implications Community-dwelling individuals with SCI are at elevated risk of mild cognitive difficulties, particularly on tasks that rely on processing speed and executive functions. The NIHTB-CB is relatively brief, samples important cognitive domains, has good normative data, and is appropriate for some individuals with SCI (those who have functional use of one hand). The battery has standardized accommodations for individuals with minor motor limitations, but timed tests are inaccessible for individuals who are unable to perform a rapid button press.

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Concurrent Traumatic Brain Injury with Spinal Cord Injury

2019

Management and Rehabilitation of Spinal Cord Injuries

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Dual Diagnosis

Cited by 33 publications

References 45 publications

The Impact of a Comorbid Spinal Cord Injury on Cognitive Outcomes of Male and Female Patients with Traumatic Brain Injury

The Impact of a Comorbid Spinal Cord Injury on Cognitive Outcomes of Male and Female Patients with Traumatic Brain Injury

Cognition among community-dwelling individuals with spinal cord injury.

Concurrent Traumatic Brain Injury with Spinal Cord Injury

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