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

Abstract

Introduction: Behavioral disturbances are found in 50-60% of traumatic brain injury (TBI) survivors with an enormous impact on daily functioning and level of recovery. However, whether typical profiles can be distinguished and how these relate to provided care is unclear. The purpose of this study is to specify the characteristics of behavioral disturbances in patients with various severity of TBI and the impact on functional outcome. Furthermore, the pathways of care after hospital discharge for patients and their care givers are analyzed. Methods: We performed a retrospective cohort study comprising 226 patients with mild TBI (mTBI; n = 107) and moderate-to-severe TBI (mod/sevTBI; n = 119) treated at the outpatient clinic and/or rehabilitation center of our university hospital between 2010 and 2015. Inclusion criteria were: behavioral disturbances as determined with the Differential Outcome Scale and age ≥16 years. Functional outcome was determined by the Glasgow Outcome Scale Extended and return to work (RTW) at six months to one year post-injury. Behavioral impairments and pathway of care were derived from medical files and scored according to predefined criteria. Results: Overall 24% of patients showed serious behavioral disturbances; three times higher in mod/sevTBI (35%) compared to mTBI (13%). mTBI patients mostly showed irritation (82%) and anger (49%), while mod/sevTBI patients mostly showed irritation (65%) and disinhibition (55%). Most (92%) patients returned home, half of the patients did not RTW. Deficits in judgment and decision-making increased risk of no RTW 10-fold. One in ten patients was (temporarily) admitted to a nursing home or psychiatric institution. 13% Of caregivers received support for dealing with impairments of patients and 13% of the mTBI and 17% of the mod/sevTBI patients experienced relational problems. Conclusions: The spectrum of behavioral disturbances differs between TBI severity categories and serious behavioral disturbances are present in a quarter of patients. Only half of the patients resumed work regardless of severity of injury suggesting that

Behaviors of Concern after Acquired Brain Injury: The Role of Negative Emotion Recognition and Anger Misattribution

“…This study shows BoC in a considerable percentage of SAH and TBI patients, which is in accordance with previous research (Al-Khindi et al, 2010;Hicks et al, 2017;Timmer et al, 2020). Problems in impulsivity and aggression were experienced by 13.2% of participants, while 54.4% of participants experienced problems in social monitoring and empathy.…”

“…Patients with TBI and SAH have a higher risk of both PTSD and depression, which is related to increased aggression (Hedlund, Zetterling, Ronne-Engström, Carlsson, & Ekselius, 2011;Perroud, Baud, Mouthon, Courtet, & Malafosse, 2011;Stein et al, 2019;Taft, Creech, & Murphy, 2017). That aggression is not solely related to the severity and location of brain damage is supported by a recent study of Timmer et al (2020), who showed that anger (49%), verbal aggression (11%), and physically violent behavior (1.9%) occur in mild TBI patients who have very limited to no brain damage. In comparison, moderate-to-severe TBI patients experienced similar amounts of anger (40%), verbal aggression (10%), and physically violent behavior (.8%).…”

“…BoC was demonstrated in 70.5% of moderate-severe TBI patients, with verbal aggression and socially inappropriate behavior being most common (Hicks et al, 2017). In a recent study on long-term BoC, mild behavioral disturbances were found in 76% of TBI patients, while 24% of patients displayed serious behavioral disturbances (Timmer, Jacobs, Schonherr, Spikman, & van der Naalt, 2020). In a study by Buchanan, Elias, and Goplen (2000), the majority of SAH patients indicated significant negative behavioral changes.…”

Effects of transcranial direct current stimulation (tDCS) and concurrent cognitive training on episodic memory in patients with traumatic brain injury: a double-blind, randomised, placebo-controlled study

“…As for sex differences, a recent study aimed at characterising the demographic, social and economic profile of patients with TBI in Brazil showed that men were hospitalised almost 3.5 times more frequently for TBI than women and that the incidence of TBI in the male population was 102/100 000/year. 69–71 …”

Self-Reported Complaints as Prognostic Markers for Outcome After Mild Traumatic Brain Injury in Elderly: A Machine Learning Approach

“…With regard to the emotional domain, we found a post-injury irritability score as a predictor of IR after sustaining an mTBI at an older age. Previous studies on adults with mTBI identified irritability among post-traumatic complaints that can persist for longer than 1 year ( 46 , 47 ) and are associated with its severity ( 48 ). Interestingly, Yang et al ( 49 ) studied adults with mild- and moderate-to-severe TBI and found that annoyance (i.e., an aspect of irritability) was self-reported by patients with mTBI but remained unnoticed by their caregivers.…”