Article

OBJECTIVE: To assess prospectively the degree of postrecovery long-term cognitive
decline after moderate to severe traumatic brain injury (TBI). DESIGN:
Observational cohort. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS:
Adults (N=33) with moderate and severe TBI from a well characterized sample with
low attrition. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Recovery of
functioning was ascertained through repeat neuropsychological assessments over
the first 5 years postinjury. Cognitive decline from a baseline of 12 months
postinjury to a follow-up evaluation conducted on average +/- SD 2.1+/-0.99 years
later. Change was calculated using the reliable change index (RCI) for 12
neuropsychological tests commonly used in the assessment of TBI. RESULTS: At the
group level, negligible changes in cognitive function were observed over time.
However, application of the RCI using 90% confidence intervals showed
statistically significant cognitive decline on at least 2 neuropsychological
measures in 27.3% of study participants. Decline was most commonly observed on a
test of verbal fluency and the delayed recall portion of a test of verbal list
learning (Rey Auditory Verbal Learning Test), although substantial variability
existed across patients. Decline was significantly correlated with hours of
therapy received at 5 months postinjury (P<.02). CONCLUSIONS: Consistent with a
small number of previous studies, cognitive deterioration may follow an initial
period of recovery. Overall, the pattern of decline across tests varied across
individuals. Possible mechanisms of decline are discussed. Further research is
needed to understand the stability of this finding and its functional
implications.

Langue : ANGLAIS