Functional outcome 10 years after traumatic brain injury: Its relationship with demographic, injury severity, and cognitive and emotional status

Abstract

Previous investigations of long-term outcome following traumatic brain injury (TBI) have yielded mixed results regarding the predictive power of injury severity and demographic factors. Furthermore, there has been limited investigation of the association between long-term outcome and current cognitive functioning and psychiatric state. The aim of this study was to investigate the association of injury severity, demographic factors, and concurrent cognitive and psychiatric functioning with functional outcome 10 years following mild to severe TBI. Outcome was rated using the Extended Glasgow Outcome Scale (GOSE) for 60 participants, who also completed neuropsychological measures of attention, speed of processing, memory and executive function and the Hospital Anxiety and Depression Scale (HADS). Outcome on the GOSE ranged from upper good recovery (32%) to lower severe disability (2%). Participants showing poorer outcome on the GOSE had significantly longer posttraumatic amnesia duration; less education; performed more poorly on cognitive measures of information processing speed, attention, memory, and executive function; and showed higher levels of anxiety on the HADS. (JINS, 2008, 14, 233-242.)

The Glasgow Outcome Scale — 40 years of application and refinement

“…Results of these longitudinal studies indicate that some outcomes remain unchanged, but others are dynamic and can improve or deteriorate even ten years or more after injury 4,35,45,74,75 .…”

“…The GOSs have been described as indices of quality of life, although are perhaps more precisely assessments of life function, which is just one component of QoL. Emotional distress continues to be associated with poor functional outcome many years after injury 74 , and GOS measures correlate closely with emotional distress and QoL as measured with generic QoL assessments, such as the SF-36, and with the Quality of Life After Brain Injury (QOLIBRI) measure, which is specific for patients with head injury. 35,56 The strength of the association between these measures indicates excellent validity of the clinician rating scales in relation to patient-reported outcomes.…”

“…In many studies, the scale has been dichotomized, leading to reduced sensitivity. The point of dichotomization has varied: in some studies of medical interventions, a GOSE ranking of 5-8 has indicated a good outcome [76][77][78]80 , whereas in some studies of rehabilitation , rankings of 7-8 were good outcomes 74,75 . Not all of these dichotomizations are necessarily sensible:…”

Apolipoprotein E epsilon 4 (APOE‐ε4) genotype is associated with decreased 6‐month verbal memory performance after mild traumatic brain injury

“…mTBIs constitute 70%–90% of all traumatic brain injuries (TBI) (Cassidy et al., 2004); it is estimated that 20%–25% of patients experience persistent symptoms and/or cognitive and neuropsychiatric deficits at 6–12 months postinjury (Arciniegas, Anderson, Topkoff, & McAllister, 2005). A major health system challenge is that individuals with similar injuries will often manifest different symptoms, follow divergent clinical trajectories, and have varied functional outcomes (Ponsford, Draper, & Schönberger, 2008). …”

Predictores de Calidad de Vida en pacientes con Daño Cerebral Adquirido: Déficit, Actividad y Participación

“…Los resultados de este trabajo también muestran la presencia de limitaciones a nivel funcional en estos pacientes con lesión cerebral, tal y como evidencian otros estudios (Novack & Alderson, 2000;Ponsford, Draper, & Schönberger, 2008). En las medidas de independencia funcional-participación, donde mayor grado de participación presentan los pacientes de esta muestra sería en los ámbitos sociales, mientras que es mucho menor en los ámbitos laborales y de ocupación-productividad.…”