Risk factors of cognitive impairment in patients with blast-related mild traumatic brain injury

Abstract

In modern local military conflicts, the prevalence of mine blast injury (MBI) is very high. In Ukraine, the frequency of MBI has significantly increased in recent years as a result of military conflict in the east of the country. Thus, it is necessary to develop a standardized approach to diagnosing mild traumatic brain injury (mTBI) effects in order to objectify the functional state of the brain and cognitive impairment (CI), to correct treatment and control in the dynamics. Predictors of CI in these patients (pts) are studied insufficiently either.Aim. To investigate the risk factors of CI in pts with mTBI as a result of using mine explosive weapon.Materials and methods. One hundred and fifty men aged 18 to 45 years with mTBI were examined in SI Romodanov Neurosurgery Institute of NAMS of Ukraine. The diagnosis was established in Ukrainian Military Medical Academy according to the criteria of mild traumatic brain injury determined in clinical guidelines VA/DoD Clinical Practice Guideline for Management of Concussion/mTBI (2009). The study used a single survey scheme for the pts: complaints, anamnesis morbi, neurological status, neuropsychological testing by using MoCA and HADS scales, quantitative electroencephalography (EEG), cognitive evoked potentials Р300 (CEP P300), and further phased statistical processing of the data obtained.Results. The analysis results demonstrated the following predictors of CI as: the patients’ complaints of fatigue and headache (p=0.003), neurological signs in the form of elements of pyramidal insufficiency, increase of tendon reflexes (p=0.02), high anxiety level on the HADS scale (p=0.001), changes in KEEG indicators (p<0.05), decrease in peak amplitude P3 (p=0.003), increase in latency of CEP P300 (p=0.003).Conclusions. The study proposed and grounded the necessity of using clinical and neurophysiological complexes to verify CI in the interim and long-term period. The study investigated the predictors of CI in pts with MBI, which is important for identification of pts with a high risk of progressive neurodegeneration as a consequence of MBI as well as for the individualization of rehabilitation approaches and treatment tactics for the pts.