Association of Anxiety and Depressive Symptoms with Memory Function following Traumatic Brain Injury

Nurse-led care versus neurologist-led care for long-term outcomes of patients who underwent craniotomy in traumatic brain injuries: an efficacy analysis

Background

After craniotomy, patients require rehabilitation efforts for the recovery process, and neurologists are mostly engaged for that (in the management of post-craniotomy complications). However, neurologists are not always available for care after neurosurgery during follow-up (situation of our institute). The objectives of the study were to compare the effects of two different types of care (nurse-led and neurologist-led) on various long-term outcomes in patients who have undergone craniotomy due to traumatic brain injuries.

Methods

Electronic medical records of patients (aged ≥18 years) who underwent craniotomy for traumatic brain injuries and their caregivers were extracted and retrospectively reviewed. Patients received nurse-led care (NL cohort, n = 109) or neurologist-led care (GL cohort, n = 121) for 6 months after craniotomy.

Results

Before the nurse-or neurologist-led care (BC), all patients had activities of daily living (ADL) ≤ 11, ≤ 50 quality of life (QoL), and 69% of patients had definitive anxiety, 87% of patients had definitive depression, and all caregivers had Zarit Burden interview scores ≥50. Nurse-led post-surgical care was associated with improved ADL and QoL, relieved anxiety and depression of patients, relieved the burden on caregivers, and the higher overall satisfaction of patients and their caregivers after 6-months of care (AC) as compared to their BC condition (p < 0.05) and also compared to those of patients in the GL cohort under AC condition (p < 0.01). Patients in the GL cohort reported pressure sores (p = 0.0211) and dizziness [15 (12%) vs. 5 (5%)] after craniotomy during follow-up than those in the NL cohort.

Conclusion

ADL, QoL, and psychological conditions of patients who undergo craniotomy for traumatic brain injuries must be improved and the burdens of their caregivers must be relived. Not only is the care provided by nursing staff equivalent to that offered by neurologists, but in some aspects, it is superior for patients who have undergone craniotomy for traumatic brain injuries and their caregivers during follow-up.

Memory rehabilitation: restorative, specific knowledge acquisition, compensatory, and holistic approaches

Memory impairment following an acquired brain injury can negatively impact daily living and quality of life—but can be reduced by memory rehabilitation. Here, we review the literature on four approaches for memory rehabilitation and their associated strategies: (1) the restorative approach, aimed at a return to pre-morbid functioning, (2) the knowledge acquisition approach, involving training on specific information relevant to daily life, (3) the compensatory approach, targeted at improving daily functioning, and (4) the holistic approach, in which social, emotional, and behavioral deficits are addressed alongside cognitive consequences of acquired brain injury. Each memory rehabilitation approach includes specific strategies such as drill and practice (restorative), spaced retrieval (knowledge acquisition), memory aids (compensatory), or a combination of psychotherapy and cognitive strategies (holistic). Past research has demonstrated mixed support for the use of restorative strategies to improve memory function, whereas knowledge acquisition strategies show promising results on trained tasks but little generalization to untrained tasks and activities of daily living. Compensatory strategies remain widely used but require intensive training to be effectively employed. Finally, the holistic approach is becoming more widespread due to improvements in psychosocial wellbeing, yet there are considerable resource and cost requirements. Several factors can influence rehabilitation outcomes including metacognition and emotional disturbances. Considerations for future research to improve the applicability of strategies for memory rehabilitation include assessing memory impairment severity, examining memory needs in daily life, and exploring the long-term effects of memory rehabilitation.

Ghani ARIG, Wan Mohamad WNA, Mohamed Mustafar MF, Hanafi MH, Reza MF, Umar H, Mohd Zulkifly MF, Ang SY, Zakaria Z, Musa KI, Othman A, Embong Z, Sapiai NA, Kandasamy R, Ibrahim H, Abdullah MZ, Amaruchkul K, Valdes-Sosa P, Luisa-Bringas M, Biswal B, Songsiri J, Yaacob HS, Sumari P, Jamir Singh PS, Azman A, Abdullah JM. Alteration in the Functional Organization of the Default Mode Network Following Closed Non-severe Traumatic Brain Injury

The debilitating effect of traumatic brain injury (TBI) extends years after the initial injury and hampers the recovery process and quality of life. In this study, we explore the functional reorganization of the default mode network (DMN) of those affected with non-severe TBI. Traumatic brain injury (TBI) is a wide-spectrum disease that has heterogeneous effects on its victims and impacts everyday functioning. The functional disruption of the default mode network (DMN) after TBI has been established, but its link to causal effective connectivity remains to be explored. This study investigated the differences in the DMN between healthy participants and mild and moderate TBI, in terms of functional and effective connectivity using resting-state functional magnetic resonance imaging (fMRI). Nineteen non-severe TBI (mean age 30.84 ± 14.56) and twenty-two healthy (HC; mean age 27.23 ± 6.32) participants were recruited for this study. Resting-state fMRI data were obtained at the subacute phase (mean days 40.63 ± 10.14) and analyzed for functional activation and connectivity, independent component analysis, and effective connectivity within and between the DMN. Neuropsychological tests were also performed to assess the cognitive and memory domains. Compared to the HC, the TBI group exhibited lower activation in the thalamus, as well as significant functional hypoconnectivity between DMN and LN. Within the DMN nodes, decreased activations were detected in the left inferior parietal lobule, precuneus, and right superior frontal gyrus. Altered effective connectivities were also observed in the TBI group and were linked to the diminished activation in the left parietal region and precuneus. With regard to intra-DMN connectivity within the TBI group, positive correlations were found in verbal and visual memory with the language network, while a negative correlation was found in the cognitive domain with the visual network. Our results suggested that aberrant activities and functional connectivities within the DMN and with other RSNs were accompanied by the altered effective connectivities in the TBI group. These alterations were associated with impaired cognitive and memory domains in the TBI group, in particular within the language domain. These findings may provide insight for future TBI observational and interventional research.