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Neuropsychological Recovery Trajectories in Moderate to Severe Traumatic Brain Injury: Influence of Patient Characteristics and Diffuse Axonal Injury

Published online by Cambridge University Press:  16 October 2017

Amanda R. Rabinowitz ,
Tessa Hart ,
John Whyte  and
Junghoon Kim
Amanda R. Rabinowitz*
Affiliation:
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania CUNY School of Medicine, The City College of New York, New York, New York
Tessa Hart
Affiliation:
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
John Whyte
Affiliation:
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
Junghoon Kim
Affiliation:
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
*
Correspondence and reprint requests to: Amanda Rabinowitz, Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027. E-mail: rabinowa@einstein.edu
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Abstract

Objectives: The goal of the present study was to elucidate the influence of demographic and neuropathological moderators on the longitudinal trajectory neuropsychological functions during the first year after moderate to severe traumatic brain injury (TBI). In addition to examining demographic moderators such as age and education, we included a measure of whole-brain diffuse axonal injury (DAI), and examined measures of processing speed (PS), executive function (EF), and verbal learning (VL) separately. Methods: Forty-six adults with moderate to severe TBI were examined at 3, 6, and 12 months post-injury. Participants underwent neuropsychological evaluation and neuroimaging including diffusion tensor imaging. Using linear mixed effects modeling, we examined longitudinal trajectories and moderating factors of cognitive outcomes separately for three domains: PS, VL, and EF. Results: VL and EF showed linear improvements, whereas PS exhibited a curvilinear trend characterized by initial improvements that plateaued or declined, depending on age. Age moderated the recovery trajectories of EF and PS. Education and DAI did not influence trajectory but were related to initial level of functioning for PS and EF in the case of DAI, and all three cognitive domains in the case of education. Conclusions: We found disparate recovery trajectories across cognitive domains. Younger age was associated with more favorable recovery of EF and PS. These findings have both clinical and theoretical implications. Future research with a larger sample followed over a longer time period is needed to further elucidate the factors that may influence cognitive change over the acute to chronic period after TBI. (JINS, 2018, 24, 237–246)

Keywords

Brain injuryNeuropsychological testsCognitionExecutive functionVerbal learningDiffusion tensor imaging
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 24 , Issue 3 , March 2018 , pp. 237 - 246
Copyright
Copyright © The International Neuropsychological Society 2017 

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