Symptoms and disability until 3 months after mild TBI

Department of Psychiatry, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Brain Injury (Impact Factor: 1.81). 07/2006; 20(8):799-806. DOI: 10.1080/02699050600744327
Source: PubMed


Examine frequency, character and course of symptoms until 3 months after MTBI and the relation between symptoms and disability.
Prospective cohort study of 122 consecutive patients with MTBI. Symptom assessment after 1, 7 and 14 days and 3 months post-injury by use of Rivermead Post-concussional Questionnaire. Disability assessment by use of Rivermead Head Injury Follow-up Questionnaire.
Patients reporting one or more symptoms declined from 86% on day 1 to 49% 3 months post-injury, when 25% also reported change in one or more domains of everyday activities. Poor memory, sleep disturbance and fatigue were most commonly reported. Symptom and disability scores were correlated (tau = 0.60; p < 0.001). Early symptom load correlated with late symptom load (tau = 0.38; p < 0.01).
Symptoms gradually decline post-injury. Symptoms correlate with disability at 3 months. Patients with early high symptom load are at risk for developing persisting complaints.

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    • "The effects of TBI are wide ranging and disabling, with symptoms persisting for many years after injury, even following a mild TBI [4] [5]. The most common symptoms following a mild TBI include memory difficulties , fatigue, and poor sleep [6]. In the general population, rates of sleep problems can vary considerably based on how sleep is measured. "
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    ABSTRACT: Sleep quality affects all aspects of daily functioning, and it is vital for facilitating recovery from illness and injury. Sleep commonly becomes disrupted following moderate to severe brain injury, yet little is known about the prevalence of sleep disruption over time and how it impacts on recovery following mild injury. This was a longitudinal study of 346 adults who experienced a mild brain injury (aged ≥16 years) identified within a population-based incidence sample in New Zealand. The prevalence of sleep difficulties was assessed at baseline (within two weeks), one, six and 12 months, alongside other key outcomes. One year post injury, 41.4% of people were identified as having clinically significant sleep difficulties, with 21.0% at a level indicative of insomnia. Poor sleep quality at baseline was significantly predictive of poorer post-concussion symptoms, mood, community integration, and cognitive ability one year post injury. The prevalence of insomnia following mild traumatic brain injury (TBI) was more than three times the rate found in the general population. Of those completing a sleep assessment at six and 12 months, 44.9% of the sample showed improvements in sleep quality, 16.2% remained stable, and 38.9% worsened. Screening for sleep difficulties should occur routinely following a mild brain injury to identify adults potentially at risk of poor recovery. Interventions to improve sleep are needed to facilitate recovery from injury, and to prevent persistent sleep difficulties emerging. Copyright © 2015 Elsevier B.V. All rights reserved.
    Sleep Medicine 05/2015; 16(8). DOI:10.1016/j.sleep.2015.04.013 · 3.15 Impact Factor
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    • "Instead they may be seen in private clinics, by primary care physicians, or may not seek or receive any medical attention (NCIPC 2003; Langlois et al. 2006). In the majority of individuals, the somatic, affective, and cognitive symptoms seen after mTBI (Ryan and Warden 2003) resolve within 3 months of injury (Korinthenberg et al. 2004; Lundin et al. 2006; Lannsjo et al. 2009; Sigurdardottir et al. 2009; Yang et al. 2009), but 5–10% of individuals go on to have persistent postconcussion syndrome [PCS (WHO 1992; Iverson 2005; Bigler 2008)] which can last a year or more postinjury (Killam et al. 2005; Sterr et al. 2006; Stulemeijer et al. 2007; Hessen et al. 2008; Dikmen et al. 2010). This is a potentially long-lasting problem as a large proportion of those reporting to hospital with mTBI are in younger age groups [e.g., around 30% are between 15 and 34 years old (Bazarian et al. 2005)]. "
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    ABSTRACT: Persistent postconcussion syndrome (PCS) occurs in around 5-10% of individuals after mild traumatic brain injury (mTBI), but research into the underlying biology of these ongoing symptoms is limited and inconsistent. One reason for this could be the heterogeneity inherent to mTBI, with individualized injury mechanisms and psychological factors. A multimodal imaging study may be able to characterize the injury better. To look at the relationship between functional (fMRI), structural (diffusion tensor imaging), and metabolic (magnetic resonance spectroscopy) data in the same participants in the long term (>1 year) after injury. It was hypothesized that only those mTBI participants with persistent PCS would show functional changes, and that these changes would be related to reduced structural integrity and altered metabolite concentrations. Functional changes associated with persistent PCS after mTBI (>1 year postinjury) were investigated in participants with and without PCS (both n = 8) and non-head injured participants (n = 9) during performance of working memory and attention/processing speed tasks. Correlation analyses were performed to look at the relationship between the functional data and structural and metabolic alterations in the same participants. There were no behavioral differences between the groups, but participants with greater PCS symptoms exhibited greater activation in attention-related areas (anterior cingulate), along with reduced activation in temporal, default mode network, and working memory areas (left prefrontal) as cognitive load was increased from the easiest to the most difficult task. Functional changes in these areas correlated with reduced structural integrity in corpus callosum and anterior white matter, and reduced creatine concentration in right dorsolateral prefrontal cortex. These data suggest that the top-down attentional regulation and deactivation of task-irrelevant areas may be compensating for the reduction in working memory capacity and variation in white matter transmission caused by the structural and metabolic changes after injury. This may in turn be contributing to secondary PCS symptoms such as fatigue and headache. Further research is required using multimodal data to investigate the mechanisms of injury after mTBI, but also to aid individualized diagnosis and prognosis.
    Brain and Behavior 02/2015; 5(1):45-61. DOI:10.1002/brb3.292 · 2.24 Impact Factor
    • "Common symptoms related to MTBI are broadly classified as physical (such as headache, nausea, dizziness, blurring of vision), behavioural/emotional (for example irritability, anxiety) and cognitive (examples are being dazed, difficulty with memory and in concentration). Whilst most people experiencing MTBI recover fully within days to months, a small percentage (1–20%) of individual's continue to experience symptoms 3 months after injury [15] [16]. Some researchers have reported that MTBI does not predict post-concussion syndrome [17]; however it is also suggested that trajectory of health outcomes may vary with mechanism of injury, particularly in context of motor vehicle crash injury [4]. "

    Injury 09/2014; 304(10). DOI:10.1016/j.injury.2014.08.044 · 2.14 Impact Factor
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