@article{ref1,
title="Identification of factors in moderate-severe TBI related to a functional decline in cognition decades after injury",
journal="Archives of physical medicine and rehabilitation",
year="2023",
author="LoBue, Christian and Schaffert, Jeff and Dams-O'connor, Kristen and Taiwo, Zinat and Sander, Angelle and Venkatesan, Umesh M. and O'Neil-Pirozzi, Therese M. and Hammond, Flora M. and Wilmoth, Kristin and Ding, Kan and Bell, Kathleen and Cullum, C. Munro",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: To investigate whether a functional decline in cognitive activities decades after moderate-to-severe traumatic brain injury (m-sTBI) might relate to injury features and/or lifetime health factors, some of which may emerge as consequences of the injury. <br><br>DESIGN: Secondary analysis of the TBI Model Systems National Database, a prospective, multi-center, longitudinal study of patients with m-sTBI. SETTING: TBI Model Systems Centers PARTICIPANTS: Included were 732 participants rated on the cognitive subscale of the Functional Independence Measure (FIM Cognitive), a metric for everyday cognitive skills, across three time points out to 20 years (visits at 2-, 10-, and 20-year follow ups). INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE(S): FIM Cognitive Scale. Injury characteristics such as timing and features pertaining to severity and health-related factors (e.g., alcohol use, socioeconomic status) were examined to discriminate stable from declining participants on the FIM Cognitive Scale using logistic regression. <br><br>RESULTS: At 20 years post-injury, there was a low base rate of FIM Cognitive decline (11%, n=78), with the majority being stable or having meaningful improvement (89%, n=654). Older age at injury, longer duration of post-traumatic amnesia, and presence of repetitive seizures were significant predictors of FIM Cognitive decline in the final model (AUC=0.75), while multiple health-related factors that can represent independent co-morbidities or possible consequences of injury were not. <br><br>CONCLUSION(S): The strongest contributors to reported functional decline in cognitive activities later-in-life were related to acute characteristics of m-sTBI and experiencing post-traumatic seizures. Future studies are needed integrating functional with performance-based cognitive assessments to affirm conclusions and identify the timeline and trajectory of cognitive decline.<p /> <p>Language: en</p>",
language="en",
issn="0003-9993",
doi="10.1016/j.apmr.2023.04.017",
url="http://dx.doi.org/10.1016/j.apmr.2023.04.017"
}