Cohort Differences in Neurobehavioral Symptoms in Chronic Mild to Severe Traumatic Brain Injury.

Shannon B. Juengst,Lauren Terhorst,Andrew Nabasny

doi:10.3389/fneur.2019.01342

Abstract

Our understanding of neurobehavioral symptoms after traumatic brain injury (TBI) largely relies on data gathered in studies conducted at academic medical centers or large clinical centers with research infrastructure. Though this often provides a well-characterized clinical sample, it may also introduce bias based on geographic locations served by these institutions and personal factors associated with patient access to these institutions. We collected neurobehavioral symptoms via the self-reported Behavioral Assessment Screening Tool (BAST) in a National TBI Cohort (n = 263) and a Medical Center TBI Cohort (n = 218) of English-speaking community-dwelling adults with chronic TBI. The primary focus of the present study was to compare demographics and neurobehavioral symptom reporting across the two cohorts and to discuss the implications of any such differences on interpretation of symptom scores. Across all BAST subscales (Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse), participants in the National TBI Cohort reported significantly more frequent symptoms than those in the Medical Center TBI Cohort (p's < 0.001). Participants in the National TBI Cohort were more likely to be non-White and Hispanic compared to the Medical Center TBI Cohort, and those with mild TBI in the National TBI Cohort were more likely to have less than a high school education than those with mild TBI in the Medical Center TBI Cohort. Individuals with TBI recruited through academic and clinical institutions may not be representative of individuals with TBI living across the United States.

Highlights

Neurobehavioral symptoms, including aggression, disinhibition, lack of motivation, and difficulty planning/executing actions [1, 2], are common after traumatic brain injury (TBI) and adversely affect participation and quality of life even many years after injury [3,4,5,6,7,8,9]
In the National TBI Cohort, men reported significantly higher Substance abuse than women did (p = 0.001), and women reported significantly higher negative affect than men did (p < 0.001), which was not observed in the Medical Center TBI Cohort
In the Medical Center TBI Cohort, men reported more Impulsivity than women did (p = 0.010), which was not observed in the National TBI Cohort

Summary

Introduction

Neurobehavioral symptoms, including aggression, disinhibition, lack of motivation, and difficulty planning/executing actions [1, 2], are common after traumatic brain injury (TBI) and adversely affect participation and quality of life even many years after injury [3,4,5,6,7,8,9]. Racial and ethnic minority groups report more psychiatric symptoms and cognitive deficits after TBI than non-Hispanic white individuals [10, 14,15,16]. The authors suggest multiple potential mediating factors between race/ethnicity and poor outcomes, including socioeconomic status, quality (not just quantity) of education, access to care, quality of care, and transportation barriers [14]. These factors are all associated with where an individual lives. For individuals with TBI, those living in more rural areas, as compared to those living in more urban areas, have more pre- and post-injury comorbities and report more unmet service needs [28]. Unmet needs may be the result of fewer rehabilitation professionals, services, and facilities available in rural areas [29]

Methods

Results

Conclusion