Early Diagnosis of Cognitive Impairment in Mild TBI

Abstract

Background: Traumatic brain injury (TBI) is the first cause of death and disability in the young and active population. In the context of TBI, Mild Traumatic brain Injury (m-TBI) is frequent and it is often associated with transient cognitive disorders. Aim: The aim of this study was to promote the early diagnosis of cognitive and behavioral disorders in patients with m-TBI and to prevent under-diagnosed and long-term symptoms, reducing the risk of a decline in patient’s quality life. Design: A Longitudinal observational study was conducted on subjects who received diagnosis of mTBI in emergency department along a period of time between October 2018 and June 2021. Setting: Patients were primarily evaluated in Emergency Department of the Buccheri La Ferla Hospital in Palermo. Rehabilitation and follow-ups were conducted in Rehabilitation Medicine Complex Operative Unit of the same medical center. Population: 520 patients were registered with a diagnosis of Head Trauma in Emergency Rooms during the observational period. 65 patients (12, 5%) had a diagnosis of non-commotional head injury and therefore the possibility of being part of the study. 49 patients were included, 9 patients were excluded, 4 patients refused to be part of the study. The average age was 46, 7 years. Methods: a first neuro-psychological evaluation of the patient with m-TBI was conducted within 48 hours of the event. Anamnestic data were collected and standardized neuro-psychological screening tests were administered. Patients were followed up by a team of doctors and neuro-psychologists for a period of 12 months in order to monitor cognitive and behavioral condition. Patients with a cognitive deficit underwent to neuro-psychological rehabilitation. Results: 41% of the patients showed cognitive deficits, especially in executive functions. Patients who underwent to neuro-psychological rehabilitation obtained a normal profile at subsequent follow-up evaluations. Conclusion: m-TBI can cause different clinical manifestations. Therefore, a multidisciplinary intervention is important in order to recognize the patients most at risk of developing long-term cognitive symptoms that can compromise social and occupational functioning. Clinical Rehabilitative Impact: Post-trauma neuropsychological evaluation allows for early recognition of cognitive disorders. Neuro-psychological rehabilitation improves the quality of life of patients and reduces healthcare cost.