Evaluation and Management of Posttraumatic Cognitive Impairments

Abstract

Psychiatrists are increasingly called upon to care for individuals with cognitive, emotional, and behavioral disturbances after TBI, especially in settings serving military service personnel and Veterans. In both the early and late post-injury periods, cognitive impairments contribute to disability among persons with TBI and are potentially substantial sources of suffering for persons with TBI and their families. In this article, the differential diagnosis, evaluation, and management of posttraumatic cognitive complaints is reviewed. The importance of pre-treatment evaluation as well as consideration of non-cognitive contributors to cognitive problems and functional limitations is emphasized first. The course of recovery after TBI, framed as a progression through posttraumatic encephalopathy, is reviewed next and used to anchor the evaluation and treatment of posttraumatic cognitive impairments in relation to injury severity as well as time post-injury. Finally, pharmacologic and rehabilitative interventions that may facilitate cognitive and functional recovery at each stage of posttraumatic encephalopathy are presented.

ICF profiling of patients with traumatic brain injury: an international professional survey

“…The experts regularly reported that impairments involving impulsivity, irritability, and lack of frustration tolerance were present in the daily life of patients after TBI. These answers correlate with the evidence of previous studies [28] in which disability levels among persons with TBI was shown to be highly related to cognitive impairment and that these types of impairment were a substantial source of familial stress [29]. The lack of participation in normal routine activities is therefore an important aspect of functioning or lack thereof after TBI.…”

Assessment of executive functioning in children and young adults treated for frontal lobe tumours using ecologically valid tests

“…Reported predictors of impaired executive functioning following early frontal lobe lesions include younger age at injury (Anderson, Brown, Newitt, & Hoile, 2011;Anderson, Catroppa, Morse, Haritou, & Rosenfeld, 2000), injury severity (Anderson et al, 2000, associated epilepsy (Arciniegas, Frey, Newman, & Wortzel, 2010), as well as lower socioeconomic status (SES) (Anderson, 2009). The association between IQ and EFs in children has rarely been investigated.…”

Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot

“…Given the study participants' mTBI diagnoses and their reported needs and cognitive deficits, it is possible that their cognitive deficits are limiting their development and use of strategies (Figure 1) [3,5,[17][18][19]. It is possible that the lack of spontaneous suggestions from the participants might be a result of the mental status at the time they were interviewed.…”

“…These cognitive difficulties are likely to hamper successful reintegration of Veterans with TBI. To make matters worse, the VA faces challenges in screening and evaluating servicemembers for mTBI because the symptoms of mTBI often mirror those of other disorders such as posttraumatic stress disorder (PTSD), depression, anxiety disorder, and adjustment disorder, all of which can also exist within the context of TBI [5,7,15,[18][19][20][21]. Even Veterans with mTBI can experience cognitive difficulties compounded by other disorders that can hamper successful reintegration into society after combat [22][23][24][25][26].…”