Life after Adolescent and Adult Moderate and Severe Traumatic Brain Injury: Self-Reported Executive, Emotional, and Behavioural Function 2–5 Years after Injury

Abstract

Survivors of moderate-severe Traumatic Brain Injury (TBI) are at risk for long-term cognitive, emotional, and behavioural problems. This prospective cohort study investigated self-reported executive, emotional, and behavioural problems in the late chronic phase of moderate and severe TBI, if demographic characteristics (i.e., age, years of education), injury characteristics (Glasgow Coma Scale score, MRI findings such as traumatic axonal injury (TAI), or duration of posttraumatic amnesia), symptoms of depression, or neuropsychological variables in the first year after injury predicted long-term self-reported function. Self-reported executive, emotional, and behavioural functioning were assessed among individuals with moderate and severe TBI (N = 67, age range 15–65 years at time of injury) 2–5 years after TBI, compared to a healthy matched control group (N = 72). Results revealed significantly more attentional, emotional regulation, and psychological difficulties in the TBI group than controls. Demographic and early clinical variables were associated with poorer cognitive and emotional outcome. Fewer years of education and depressive symptoms predicted greater executive dysfunction. Younger age at injury predicted more aggressive and rule-breaking behaviour. TAI and depressive symptoms predicted Internalizing problems and greater executive dysfunction. In conclusion, age, education, TAI, and depression appear to elevate risk for poor long-term outcome, emphasising the need for long-term follow-up of patients presenting with risk factors.

The Spectrum of Long-Term Behavioral Disturbances and Provided Care After Traumatic Brain Injury

“…Behavioral disturbances interfere with daily life and social interaction and vary from apathy, disinhibition, and agitation, to aggression and violent behavior, that frequently exist simultaneously (7,8). These behavioral disturbances are in general difficult to manage due to impaired self-awareness and may still be present several years after trauma (9)(10)(11). In severe TBI behavioral disturbances have been found in 50-60% of survivors with an enormous impact on participation, in particular vocational and family functioning (12)(13)(14)(15)(16) but limited information is available on the presence and effect of behavioral disturbances in mTBI patients.…”

Incidence of progressive hemorrhagic injury in patients presenting with traumatic brain injury at a large tertiary care hospital in Karachi, Pakistan. A Case Series.

“…Among adolescents and young adults, traumatic brain injury has been recognized as a cause of disability and mortality. 8,14,15,16 The worldwide incidence is 106 per 100,000 and is expected to increase. 16 The cause of traumatic brain injury changes according to the age range of the patient population.…”

Quality of life after traumatic brain injury: a cross-sectional analysis uncovers age- and sex-related differences over the adult life span

“…Hence, the assessment of HRQoL yields additional and therapeutically relevant data as compared with traditional outcome scores. Fourth, why midlife and older females experience less good HRQoL than aged-matched males in the long run after TBI needs further investigation with age-, sex-, and gender-related analyses including clinical parameters, environmental factors, as well as fluid and neuroimaging biomarkers that might help to strengthen the link between psychiatric disorders and the risk of posttraumatic cognitive burden or even dementia [52][53][54].…”

“…cross-sectional study, we present age-and sex-related demographics and HRQoL up to 10 years after TBI using the Quality of Life after Brain Injury (QOLIBRI) instrument. The QOLIBRI total score ranges from zero to 100 indicating good (≥ 60), moderate (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59) or unfavorable (< 40) HRQoL. Two-thirds of the entire chronic TBI cohort (102 males; 33 females) aged 18-85 years reported good HRQoL up to 10 years after TBI.…”