52 - Relationship of persistent self-reported concussive and post-traumatic stress disorder symptoms with cognitive performance following a mild Traumatic Brain Injury
Research assistant University of Maryland Baltimore school of medicine baltimore, Maryland
Abstract Text: Introduction Traumatic brain Injury (TBI) is an important public health problem with more than 50 million cases worldwide1. The majority (80-85%) of TBI are mild2 . In the acute phase, patients may experience some cognitive issues as well as suffer from various post-concussion (PC) and post-traumatic stress disorder (PTSD) symptoms 3. An overlap has been noted between PC and PTSD symptoms due to similarities between PC symptoms and symptoms associated with the hyper arousal subdomain of PTSD 3. While most symptoms and cognitive complaints reported by mTBI patients are resolved within 3 months of the injury, a small subset of mTBI patients experience persistent cognitive deficit 6 months after injury. It is possible that these cognitive complaints might arise from deficits caused by the brain injury resulting in persistent PC and PTSD4 symptoms. The objective of this study is to add to our understanding of the relationship between self-reported PC and PTSD symptoms and look at the association between these symptoms and cognitive function. Methods Participants: 17 mTBI (31.5±11.8 years) and 19 orthopedic controls (36.3±13.4 years) were recruited from the R. Adam Cowley Shock Trauma Center at the University of Maryland Medical Center as part of the Magnetic Resonance Imaging of Neurotrauma II (MagNetsII) study with no history of neurologic disease or penetrating head injury. The 17 mTBI are a subset of patients from MagNetsII study who had two visits. Measures The PTSD checklist for DSM-5 (PCL-5) and the modified rivermead post-concussion symptoms (RPQ) questionnaires and The NIH Toolbox (NIHTB)5 were administered to both groups at the acute stage and to the mTBI at the chronic stage (6 months). To examine cognitive functioning in the most standardized framework, fully adjusted scores were used for the NIHTB tasks except for the Auditory Verbal Learning (Rey) and Oral Symbol digit tests where raw scores were used. Data analysis Data analysis was performed using SPSS. T test was used to assess the difference in performance of the orthopedic controls and mild TBI patients. Spearman correlations and linear regressions were used to examine the relationship between the NIHTB and the neuropsychological measures to assess convergent and discriminant validity. Statistical significance was judged based on p-value < 0.05. Results The majority of symptoms endorsed by the mTBI subjects (score of 2 or higher on the RPQ at the acute stage) are headaches (56%), slow thinking, memory problems and trouble concentrating (44%), depression and anxiety (39%). In contrast, the major symptoms reported by the control group were sleep problems (43%), anxiety (38%), depression and poor coordination (33%). Overall, the mTBI group had the same level of performance as the control group (no statistical difference) on cognitive tests of the NIHTB. Most subjects in the two groups scored below the average (T score < 50 ) in both groups with the lowest performance on the flanker inhibitory Control and attention task. Six months following TBI, 53% of mTBI patients reported trouble concentrating, 42% memory problems, slow thinking, irritability, sleep problems, anxiety, and 37% of subjects reported depression. The least reported symptom at both the acute and chronic stages were hyperactivity. A positive correlation between the total RPQ scores with the PCL-5 total scores was observed. In addition, a negative correlation between RPQ and PCL-5 and the language and episodic memory composite scores was observed. Higher RPQ and PCL-5 scores were associated with poorer performance on the oral symbol digit and Rey tests Discussion Our preliminary results in this study are in general agreement with those of Machamer et al. who showed persistence of PC and PTSD symptoms at 6 months following injury. There was no significant difference between cognitive performance on the NIHTB between orthopedic controls and mTBI patients at the acute stage. In addition, a negative correlation can be observed between the PC and PTSD measures and neurocognitive performance at the chronic stage. The results of this preliminary study should be treated with caution given its small sample size. Active recruitment of patients is currently ongoing, and it remains to be seen if the results presented here hold with a larger sample size.
Keywords: cognitive assessment; neuropsychological assessment; head injury; concussion; post traumatic stress disorder