Understanding the interplay between mild traumatic brain injury and cognitive fatigue: models and treatments

Abstract

Nearly 2 million traumatic brain injuries occur annually, most of which are mild (mTBI). One debilitating sequela of mTBI is cognitive fatigue: fatigue following cognitive work. Cognitive fatigue has proven difficult to quantify and study, but this is changing, allowing models to be proposed and tested. Here, we review evidence for four models of cognitive fatigue, and relate them to specific treatments following mTBI. The evidence supports two models: cognitive fatigue results from the increased work/effort required for the brain to process information after trauma-induced damage; and cognitive fatigue results from sleep disturbances. While there are no evidence-based treatments for fatigue after mTBI, some pharmacological and nonpharmacological treatments show promise for treating this debilitating problem. Future work may target the role of genetics, neuroinflammation and the microbiome and their role in complex cognitive responses such as fatigue.

The role of mood, post-traumatic stress, post-concussive symptoms and coping on outcome after MTBI in elderly patients

“…We have also shown that higher numbers of post-concussive symptoms are significantly associated with a decreased likelihood of complete recovery. In accordance with previous studies, the most frequently reported complaints in our cohort were dizziness, fatigue, and headache (van der Naalt et al, 1999;Wylie & Flashman, 2017). Collectively, these findings further underline the importance of early post-concussive symptoms and depression as determining factors for outcome, and suggest that elderly patients might benefit from early rehabilitation.…”

Cognitive fatigue in relation to depressive symptoms after treatment for childhood cancer

“…One of the main reasons for differentiating between cognitive and physical fatigue is the theory of diverse origins of the conditions [21][22][23]. Cognitive fatigue is suggested to be associated with neuroinflammation [24], and believed to be the result of down-regulation of glutamate transmission and dysfunction of the astroglial cells in removing glutamate from the extracellular space.…”

Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients

“…symptoms of posttraumatic stress disorder after mild traumatic brain injury). 15 Between 5 and 25% of treated major traumata result in preventable deaths, and errors in treatment are most frequently encountered in the prehospital stage. [16][17][18][19][20] Nearly 40% of the patients with a major trauma die before they reach the hospital.…”