Serial Mini-Mental Status Examination to Evaluate Cognitive Outcome in Patients with Traumatic Brain Injury

Prediction of early prognosis after traumatic brain injury by multifactor model

AIMS

To design a model to predict the early prognosis of patients with traumatic brain injury (TBI) based on parameters that can be quickly obtained in emergency conditions from medical history, physical examination, and supplementary examinations.

METHODS

The medical records of TBI patients who were hospitalized in two medical institutions between June 2015 and June 2021 were collected and analyzed. Patients were divided into the training set, validation set, and testing set. The possible predictive indicators were screened after analyzing the data of patients in the training set. Then prediction models were found based on the possible predictive indicators in the training set. Data of patients in the validation set and the testing set was provided to validate the predictive values of the models.

RESULTS

Age, Glasgow coma scale score, Apolipoprotein E genotype, damage area, serum C-reactive protein, and interleukin-8 (IL-8) levels, and Marshall computed tomography score were found associated with early prognosis of TBI patients. The accuracy of the early prognosis prediction model (EPPM) was 80%, and the sensitivity and specificity of the EPPM were 78.8% and 80.8% in the training set. The accuracy of the EPPM was 79%, and the sensitivity and specificity of the EPPM were 66.7% and 86.2% in the validation set. The accuracy of the early EPPM was 69.1%, and the sensitivity and specificity of the EPPM were 67.9% and 77.8% in the testing set.

CONCLUSION

Prediction models integrating general information, clinical manifestations, and auxiliary examination results may provide a reliable and rapid method to evaluate and predict the early prognosis of TBI patients.

Cognitive Impairment in Moderate Degree Diffuse Axonal Head Injuries: Analysis of 84 Cases Using MMSE

Background Cognitive impairment is commonly seen in traumatic brain injury survivors. Posttraumatic cognitive sequelae may be more devastating than focal motor and focal sensory deficits, and are usually left unattended.

Aim and Objective Aim of this study was to assess cognitive impairment in patients who had sustained moderate degree diffuse axonal injuries and having good outcome (Glasgow Outcome Score of 5).

Methods and Materials Prospective observational study was done from 2011 to 2015 on the patients who had sustained moderated degree diffuse brain injuries. Eighty-four cases fulfilling the inclusion criteria were studied. Patients were assessed with Mini-Mental Status Examination at discharge, end of 1 month, and at 3 months.

Result Seventy-six were males and 8 were females. Age ranged from 16 to 49 years. Note that 4.76% (4) patients had hypotension at presentation, 32.14% (27) patients had associated injuries, and 19.04% (16) patients had hyponatremia at presentation. Diabetes mellitus was seen in 34.52% (29) patients, while hypertension was seen in 14.28% (12). At 3 months’ follow-up, 19.06% (16) patients had cognitive impairment. The present study revealed that hypotension and presence of associated injuries at presentation raises the odds of having cognitive impairment by 8 and 5 times, respectively.

Conclusion Routine assessment of cognitive impairment in head injury survivors is essential as it may help in identifying cognitive deficits. Early intervention of neurorehabilitation to such patients results in better neurocognitive outcome. Hypotension and associated injuries are associated with poor cognitive outcome.

Cross-cultural adaptation and psychometric properties of the MMSE and MoCA questionnaires in Tanzanian Swahili for a traumatic brain injury population

BACKGROUND

Traumatic Brain Injury (TBI) is the most common cause of injury-related death and disability globally, and a common sequelae is cognitive impairment. Addressing post-TBI cognitive deficits is crucial because they affect rehabilitation outcomes, but doing this requires valid and reliable cognitive assessment measures. However, no such instrument has been validated in Tanzania's TBI population. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used instruments to measure cognitive impairment, and there have been a few studies reporting their use in post-TBI cognitive assessment. Our aim was to report the psychometric properties of the Swahili version of both scales amongst the TBI population in Tanzania.

METHODS

A cross-cultural adaptation committee participated in the translation and content validation process for both questionnaires. Our patient sample consisted of 192 adults with TBI who were admitted to Kilimanjaro Christian Medical Center (KCMC) in Tanzania. Confirmatory factor analysis, reliability and external validity were evaluated.

RESULTS

MoCA showed adequate factor loadings (values > 0.50 for all items except items 7 & 10) and adequate reliability (values > 0.70). Factor loadings for most of the MMSE items were below 0.5 and internal consistency was medium (< 0.7). Polychoric correlation between MMSE and MoCA was strong, positive and statistically significant (r = 0.68, p = 0.001); correlation with the cognitive subscale of FIM indicated moderately positive relationships - MMSE (r = 0.35, p = 0.001) and MoCA (r = 0.43, p = 0.001).

CONCLUSIONS

With the exception of the language and memory items, MoCA is a valid and reliable instrument for cognitive impairment screening in Tanzania's adult TBI population. On the other hand, MMSE does not appear to be an appropriate tool in this patient group, but its positive correlations with MoCA and cFIM indicate similar theoretical concepts. Both instruments require further validation studies to prove their predictive ability for screening cognitive impairment before they are considered suitable for clinical use.

Behavioral and neurophysiological abnormalities during cued continuous performance tasks in patients with mild traumatic brain injury

OBJECTIVE

This study's aim was to investigate the features and neural mechanisms of sustained attention in patients with mild traumatic brain injury (mTBI) by comparing and analyzing neuropsychological, behavioral, event-related potentials, and event-related desynchronization and synchronization between mTBI patients and healthy controls.

METHODS

Twenty mTBI patients with mTBI and 20 healthy controls underwent the Mini-Mental State Examination (MMSE) and a cued continuous performance task (AX-CPT). Neuropsychological, behavioral, and electroencephalogram (EEG) data were collected and analyzed.

RESULTS

There were significant differences between the mTBI group and the control group in their MMSE total scores, attention, and calculation, but there were no significant differences in orientation, memory, recall, and verbal scores. There were significant differences between the mTBI group and the control group in hitting the number, reaction time, and the number of errors of omission, but there were no significant differences in the number of false errors. The amplitude of Go-N2 and Nogo-N2 was significantly smaller for the mTBI group than that for the control group. The amplitude of Go-P3 was significantly smaller for the mTBI group than that for the control group, but not for the amplitude of Nogo-P3. The Go-αERS were significantly less for the mTBI group than for the control group during the 0-200 ms after the stimulus onset. The Go-αERD and Nogo-αERD were significantly less for the mTBI group than for the control group during the 600-1,000 ms after the stimulus onset. The Go-βERS were significantly less for the mTBI group than for the control group during the 200-400 ms after the stimulus onset. There were no significant differences in the Nogo-αERS and Nogo-βERD/ERS between the mTBI group and the control group.

CONCLUSION

Patients with mTBI exhibited impairments in sustained attention and conflict monitoring, while response inhibition may have been spared.