Article

Predictors of postconcussive symptoms 3 months after mild traumatic brain injury.

Monash University, Melbourne, Australia.
Neuropsychology (Impact Factor: 3.58). 04/2012; 26(3):304-13. DOI:10.1037/a0027888
Source: PubMed

ABSTRACT There is continuing controversy regarding predictors of poor outcome following mild traumatic brain injury (mTBI). This study aimed to prospectively examine the influence of preinjury factors, injury-related factors, and postinjury factors on outcome following mTBI.
Participants were 123 patients with mTBI and 100 trauma patient controls recruited and assessed in the emergency department and followed up 1 week and 3 months postinjury. Outcome was measured in terms of reported postconcussional symptoms. Measures included the ImPACT Post-Concussional Symptom Scale and cognitive concussion battery, including Attention, Verbal and Visual memory, Processing Speed and Reaction Time modules, pre- and postinjury SF-36 and MINI Psychiatric status ratings, VAS Pain Inventory, Hospital Anxiety and Depression Scale, PTSD Checklist-Specific, and Revised Social Readjustment Scale.
Presence of mTBI predicted postconcussional symptoms 1 week postinjury, along with being female and premorbid psychiatric history, with elevated HADS anxiety a concurrent indicator. However, at 3 months, preinjury physical or psychiatric problems but not mTBI most strongly predicted continuing symptoms, with concurrent indicators including HADS anxiety, PTSD symptoms, other life stressors and pain. HADS anxiety and age predicted 3-month PCS in the mTBI group, whereas PTSD symptoms and other life stressors were most significant for the controls. Cognitive measures were not predictive of PCS at 1 week or 3 months.
Given the evident influence of both premorbid and concurrent psychiatric problems, especially anxiety, on postinjury symptoms, managing the anxiety response in vulnerable individuals with mTBI may be important to minimize ongoing sequelae.

0 0
 · 
0 Bookmarks
 · 
78 Views
  • [show abstract] [hide abstract]
    ABSTRACT: The purpose of this study was to examine the biopsychosocial outcome from uncomplicated mild traumatic brain injury (MTBI) within the first three weeks post injury. Participants were 48 prospectively enrolled patients from the Emergency Department of Tampere University Hospital, Finland who sustained an uncomplicated MTBI. At three weeks post injury, diffusion tensor imaging (DTI) of the whole brain was undertaken using a Siemens 3T scanner. Measures of fractional anisotropy (FA) were calculated for 16 regions of interest (ROIs) and measures of apparent diffusion coefficient (ADC) were calculated for 10 ROIs. Twenty-four healthy control participants also completed DTI of the whole brain for comparison. All participants were administered a brief battery of self-report (e.g., post-concussion symptoms, depression, and fatigue) and neurocognitive measures (e.g., verbal learning and memory). There were no significant differences between the uncomplicated MTBI and healthy control group on any measures of learning and memory. Compared to the control group, the uncomplicated MTBI group reported a greater number of post-concussion symptoms and fatigue, but not depression. When considering all DTI ROIs simultaneously, the MTBI group had a significantly larger number of low DTI measures (FA values) compared to the healthy controls. MTBI patients with multifocal white matter changes did not show evidence of worse symptoms, cognitive impairment, or slower return to work compared to MTBI patients with broadly normal white matter.
    Journal of neurotrauma 08/2013; · 4.25 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Several factors have been linked to severity of postconcussive-type (neurobehavioral) symptoms. In this study, predictors of neurobehavioral symptoms were examined using multivariate methods to determine the relative importance of each. Data regarding demographics, symptoms, current alcohol use, history of traumatic brain injury (TBI), orthopedic injuries, and psychiatric/developmental diagnoses were collected via questionnaire from 3027 university students. The most prominent predictors of symptoms were gender, history of depression or anxiety, history of attention-deficit/hyperactivity disorder or learning disability diagnosis, and frequency of alcohol use. Prior mild TBI was significantly related to overall symptoms, but this effect was small in comparison to other predictors. These results provide further evidence that neurobehavioral symptoms are multi-determined phenomena, and highlight the importance of psychiatric comorbidity, demographic factors, and health behaviors to neurobehavioral symptom presentation after mild TBI. (JINS, 2013, 19, 1-9).
    Journal of the International Neuropsychological Society 07/2013; · 2.70 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: This study examined the neuropsychological performance of 125 outpatient Operation Enduring Freedom/Operation Iraqi Freedom combat veterans with posttraumatic stress disorder (PTSD) and nonacute mild traumatic brain injury (TBI) (n = 66) and PTSD (n = 59) across multiple cognitive domains to determine whether mild TBI results in greater impairment among those with PTSD. Profile analyses revealed that veterans with PTSD and mild TBI did not differ significantly from those with just PTSD across domains, suggesting that comorbid mild TBI does not result in an additive effect. A norms-based comparison also revealed that neither group demonstrated impaired performance on any of the objective neuropsychological measures examined. However, both groups endorsed moderately elevated symptoms of depression and anxiety, indicating that comorbid psychopathology may contribute to subjective cognitive complaints.
    Journal of Clinical and Experimental Neuropsychology 05/2013; · 1.86 Impact Factor