The Course of Post-Traumatic Amnesia: Three Little Words

Abstract

ABSTRACT:Objective: To provide a simple means of "real time" recognition of emergence from post-traumatic amnesia (PTA). Methods: Ninety-one patients with traumatic brain injury (PBI); 53 minor , 19 moderate (GCS 9-12), 18 severe . Twenty-seven control subjects treated at two regional trauma units for their acute phase and followed in a hospital-based research institute were studied prospectively. Subjects were examined repeatedly following injury with the Galveston Orientation and Amnesia Test (GOAT) and tests of their ability to learn and retain new information. Word triplets balanced for concreteness and frequency were presented. Immediate and 24-hour recall were tested. If 24-hour recall was imperfect, recognition was tested by presenting the 3 target words and 6 distracters. The target words were then re-presented and recall was tested the next day. The time intervals to first perfect recognition and first free perfect recall were compared with the patients' first GOAT score of 75 or greater on 2 successive days. Simple line drawings of common objects were also presented to the subjects using an identical paradigm. The outcome measures were GOAT, 3-word recognition and recall, 3 picture recognition and recall. Results: For all categories of head injury severity, the median interval to perfect free recall of words followed the achievement GOAT criterion by a significant interval. The mean GOAT scores for perfect 3-word recall and recognition corresponding to minor, moderate and severe injuries were 97, 90 and 88, and 97, 76 and 68 respectively. The recognition and recall of pictures preceded the recognition and recall of words by approximately 1 day. Conclusions: The orientation measures of the GOAT that contain material that the patient knew prior to injury obscure the determination of recovery of continuous memory and should be tested separately. Three-word recall which is simpler to administer than the GOAT is a more reliable measure of emergence from PTA. For patients who are dysphasic or who do not share a common language with the examiner, 3-picture recognition and recall may substitute for word recognition and recall. Conclusions: Les mesures d'orientation du TOAG qui contiennent du materiel connu du patient avant le traumatisme masquent revaluation de la recuperation de la memoire continue et devraient etre evaluees separement. L'evocation de 3 mots, qui est plus simple a administrer que le TOAG, est une mesure plus fiable pour indiquer que le patient sort de I'APT. Pour les patients qui sont dysphasiques ou dont la langue n'est pas celle de I'examinateur, la reconnaissance et revocation de trois images peuvent etre substituees a la reconnaissance et a revocation de mots.

Comparison of the O-Log and GOAT as measures of posttraumatic amnesia

“…However, the validity and reliability of the GOAT -and hence its status as the 'gold-standard' assessment of PTA -is a subject of considerable debate [6,21,[24][25][26].…”

Predictors of Recovery From Posttraumatic Amnesia

“…Although PTA has been the favored term for the post-TBI confusional period, debate on the nature of the cognitive deficits has been ongoing for nearly as long as the term's existence; the debate particularly centers on whether the deficits observed are primarily the result of delirium/ confusion versus episodic memory deficits versus attention impairment. 4,35,36 A recent study used the term acute traumatic encephalopathy to stratify the cognitive deficits into categories of coma, posttraumatic delirium, PTA, and posttraumatic dysexecutive syndrome, which are conceptualized as occurring in temporal sequence after recovery of function in an ascending pattern from the brainstem toward the cortex. 37 This follows the hypothesis of biochemical and localizationist theories of emergence from disorder of consciousness, which involves recovery of function at the brainstem level first, followed by the diencephalon and then the telencephalon.…”

“…We repeated the independent-samples t test to compare discharge FIM scores for patients with and without parietal lobe lesions but with those patients excluded. There was now a trend but not a significant difference in discharge FIM scores for patients with no lesion in the parietal lobe (mean=68.0 [SD=16.62]) versus those with lesions present in the parietal lobe (mean=56 [SD=19.64], t (36) =1.79, p=0.083). These results suggest that visuospatial neglect may be driving the effect, although presence of a trend toward significance even with those patients excluded may suggest that other mechanisms may also be at play.…”

Amnésia pós-traumática: fatores relacionados e qualidade de vida pós-trauma

“…Pontuação até 8 tem sido indicador importante de TCE grave; entre 9 e 12, trauma moderado e maior ou igual a 13, trauma leve (19,39,76,77,(79)(80)(81)(82)(83) .…”

“…Críticas relacionadas à acurácia da medida retrospectiva apontaram a subjetividade do método e consideraram que a duração e o término da APT poderiam, dessa forma, apenas ser estimados após o paciente ter se recuperado da confusão mental (11,18,34,39,40) .…”