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Neuropsychological Characteristics of the Confusional State Following Traumatic Brain Injury

Published online by Cambridge University Press:  25 January 2019

Rachel E. Keelan ,
Elaine J. Mahoney ,
Mark Sherer ,
Tessa Hart ,
Joseph Giacino ,
Yelena G. Bodien ,
Risa Nakase-Richardson ,
Kristen Dams-O’Connor ,
Thomas A. Novack  and
Rodney D. Vanderploeg
Rachel E. Keelan
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan
Elaine J. Mahoney
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida
Mark Sherer
Affiliation:
TIRR Memorial Hermann, Houston, Texas
Tessa Hart
Affiliation:
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
Joseph Giacino
Affiliation:
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts
Yelena G. Bodien
Affiliation:
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
Risa Nakase-Richardson*
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida Defense and Veterans Brain Injury Center (DVBIC), Tampa, Florida Morsani College of Medicine, Division of Sleep and Pulmonary Medicine, University of South Florida, Tampa, Florida VA HSRD Center of Innovation on Disability and Rehabilitation Research, Tampa, Florida
Kristen Dams-O’Connor
Affiliation:
Department of Rehabilitation Medicine, The Mount Sinai Hospital, New York, New York Department of Neurology Icahn School of Medicine at Mount Sinai, New York, New York
Thomas A. Novack
Affiliation:
Department of Physical Medicine & Rehabilitation, The University of Alabama at Birmingham, Birmingham, Alabama
Rodney D. Vanderploeg
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida Defense and Veterans Brain Injury Center (DVBIC), Tampa, Florida Department of Psychiatry and Behavioral Neurosciences, and Department of Psychology, University of South Florida, Tampa, Florida
*
Correspondence and reprint requests to: Risa Nakase-Richardson, Polytrauma TBI Rehabilitation/Mail Code 117, 13000 Bruce B. Downs Blvd., Tampa, FL. E-mail: [email protected]
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Abstract

Objectives: Individuals with moderate–severe traumatic brain injury (TBI) experience a transitory state of impaired consciousness and confusion often called posttraumatic confusional state (PTCS). This study examined the neuropsychological profile of PTCS. Methods: Neuropsychometric profiles of 349 individuals in the TBI Model Systems National Database were examined 4 weeks post-TBI (±2 weeks). The PTCS group was subdivided into Low (n=46) and High Performing PTCS (n=45) via median split on an orientation/amnesia measure, and compared to participants who had emerged from PTCS (n=258). Neuropsychological patterns were examined using multivariate analyses of variance and mixed model analyses of covariance. Results: All groups were globally impaired, but severity differed across groups (F(40,506)=3.44; p<.001; ŋp2 =.206). Rate of forgetting (memory consolidation) was impaired in all groups, but failed to differentiate them (F(4,684)=0.46; p=.762). In contrast, executive memory control was significantly more impaired in PTCS groups than the emerged group: Intrusion errors: F(2,343)=8.78; p<.001; ŋp2=.049; False positive recognition errors: F(2,343)=3.70; p<.05; ŋp2=.021. However, non-memory executive control and other executive memory processes did not differentiate those in versus emerged from PTCS. Conclusions: Executive memory control deficits in the context of globally impaired cognition characterize PTCS. This pattern differentiates individuals in and emerged from PTCS during the acute recovery period following TBI. (JINS, 2019, 25, 302–313)

Keywords

Posttraumatic amnesiaHead injuryDeliriumCognitionMemoryExecutive functioning
Type
Special Section: Traumatic Brain Injury
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 3 , March 2019 , pp. 302 - 313
Copyright
Copyright © The International Neuropsychological Society 2019 

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References

REFERENCES

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Baddeley, A. (2012). Working memory: Theories, models, and controversies. Annual Review of Psychology. 63, 1–29.Google Scholar
Corrigan, J.D., Cuthbert, J.P., Whiteneck, G.G., Dijkers, M.P., Coronado, V., Heinemann, A.W., . . . Graham, J.E. (2012). Representativeness of the traumatic brain injury model systems national database. The Journal of Head Trauma Rehabilitation, 27(6), 391.Google Scholar
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (2000). California Verbal Learning Test. (2nd ed.). Adult version manual. San Antonio, TX: Psychological Corp.Google Scholar
Dijkers, M.P., Harrison-Felix, C., & Marwitz, J.H. (2010). The traumatic brain injury model systems: history and contributions to clinical service and research. The Journal of head trauma rehabilitation, 25(2), 81–91.Google Scholar
Duchnick, J.J., Vanderploeg, R.D., & Curtiss, G. (2002). Identifying retrieval problems using the California Verbal Learning Test. Journal of Clinical and Experimental Neuropsychology, 24, 840–851.Google Scholar
Fontaine, A., Azouvi, P., Remy, P., Bussel, B., & Samson, Y. (1999). Functional anatomy of neuropsychological deficits after severe traumatic brain injury. Neurology, 53(9), 1963–1963.Google Scholar
Gordon, W., Mann, N., & Willer, B. (1993). Demographic and social characteristics of the traumatic brain injury model system database. Journal of Head Trauma Rehabilitation, 8(2), 26–33.Google Scholar
Giacino, J.T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D.I., . . . Zasler, N.D. (2002). The minimally conscious state: Definition and diagnostic criteria. Neurology, 58, 349–353.Google Scholar
Gladsjo, J.A., Schuman, C.C., Evans, J.D., Peavy, G.M., Miller, S.W., & Heaton, R.K. (1999). Norms for letter and category fluency: Demographic corrections for age, education, and ethnicity. Assessment, 6, 147–178.Google Scholar
Green, R., Melo, B., Christensen, B., Ngo, L.A., Monette, G., & Bradbury, C. (2008). Measuring premorbid IQ in traumatic brain injury: An examination of the validity of the Wechsler Test of Adult Reading (WTAR). Journal of Clinical and Experimental Neuropsychology, 30(2), 163–172. doi:10.1080/13803390701300524Google Scholar
Hanks, R.A., Millis, S.R., Ricker, J.H., Giacino, J.T., Nakese-Richardson, R., Frol, A.B., . . . Gordon, W.A. (2008). The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(5), 950–957.Google Scholar
Heaton, R.K., Miller, S.W., Taylor, M.J., & Grant, I. (2004). Revised comprehensive norms for an expanded Halstead-Reitan Battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults. Lutz, FL: Psychological Assessment Resources.Google Scholar
Iverson, G.L., & Lange, R.T. (2011). Moderate and severe traumatic brain injury. In The Little Black Book of Neuropsychology (pp. 663–696). Boston, MA: Springer.Google Scholar
Jennett, B., & Plum, F. (1972). Persistent vegetative state after brain damage: A syndrome in search of a name. The Lancet, 299(7753), 734–737.Google Scholar
Kalmar, K., Novack, T.A., Nakase-Richardson, R., Sherer, M., Frol, A.B., Gordon, W.A., . . . Ricker, J.H. (2008). Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(5), 942–949.Google Scholar
Katz, D.I., & Alexander, M.P. (1994). Traumatic brain injury: Predicting course of recovery and outcome for patients admitted to rehabilitation. Archives of Neurology, 51(7), 661–670.Google Scholar
Kashluba, S., Hanks, R.A., Casey, J.E., & Millis, S.R. (2008). Neuropsychologic and functional outcome after complicated mild traumatic brain injury. Archives of physical medicine and rehabilitation, 89(5), 904–911.Google Scholar
Kongs, S.K., Thompson, L.L., Iverson, G.L., & Heaton, R.K. (2000). Wisconsin Card Sorting Test-64 Card Version Professional Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Levin, H.S., O’Donnell, V.M., & Grossman, R.G. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. Journal of Nervous and Mental Disorders, 167, 675–684.Google Scholar
Levin, H.S., Williams, D.H., Eisenberg, H.M., High, W.M., & Guinto, F.C. (1992). Serial MRI and neurobehavioural findings after mild to moderate closed head injury. Journal of Neurology, Neurosurgery, & Psychiatry, 55(4), 255–262.Google Scholar
Lezak, M.D. ( 1995). Neuropsychological Assessment. (3rd ed.). New York: Oxford University Press.Google Scholar
Loring, D.W., & Meador, K.J. (Eds.). (1999). INS Dictionary of Neuropsychology. New York: Oxford University Press.Google Scholar
Mahoney, C.J., Simpson, I. J. A., Nicholas, J.M., Fletcher, P.D., Downey, L.E., Golden, H.L., . . . Fox, N.C. (2015). Longitudinal diffusion tensor imaging in frontotemporal dementia. Annals of Neurology, 77(1), 33–46. http://doi.org/10.1002/ana.24296 Google Scholar
Mathias, J.L., & Wheaton, P. (2007). Changes in attention and information-processing speed following severe traumatic brain injury: A meta-analytic review. Neuropsychology, 21(2), 212–223.Google Scholar
Marosszeky, N. E. V., Ryan, L., Shores, E.A., Batchelor, J., & Marosszeky, J.E. (1997). The PTA Protocol: Guidelines for using the Westmead Post-Traumatic Amnesia (PTA) Scale. Sydney: Wild & Wooley.Google Scholar
Meagher, D.J., Moran, M., Raju, B., Gibbons, D., Donnelly, S., Saunders, J., & Trzepacz, P.T. (2007). Phenomenology of delirium: Assessment of 100 adult cases using standardised measures. The British Journal of Psychiatry, 190(2), 135–141.Google Scholar
Mesulam, M.M. (1981). A cortical network for directed attention and unilateral neglect. Annals of Neurology, 10, 309–325. doi:10.1002/ana.410100402Google Scholar
Mesulam, M.M. (1990). Large-scale neurocognitive networks and distributed processing for attention, language, and memory. Annals of Neurology, 28, 597–613.Google Scholar
Mirsky, A.F., Anthony, B.J., Duncan, C.C., Ahearn, M.B., & Kellam, S.G. (1991). Analysis of the elements of attention: A neuropsychological approach. Neuropsychology Review, 2, 109–145.Google Scholar
Nakase-Richardson, R., Yablon, S.A., & Sherer, M. (2007). Prospective comparison of acute confusion severity with duration of post-traumatic amnesia in predicting employment outcome after traumatic brain injury. Journal of Neurology, Neurosurgery, & Psychiatry, 78(8), 872–876.Google Scholar
Novack, T. (2000). Introduction to the Orientation Log. The Center for Outcome Measurement in Brain Injury. Retrieved from http://www.tbims.org/combi/olog Google Scholar
Novack, T.A., Dowler, R.N., Bush, B.A., Glen, T., & Schneider, J.J. (2000). Validity of the Orientation Log, relative to the Galveston Orientation and Amnesia Test. Journal of Head Trauma Rehabilitation, 15, 957–961.Google Scholar
Nowrangi, M.A., Okonkwo, O., Lyketsos, C., Oishi, K., Mori, S., Albert, M., & Mielke, M.M. (2015). Atlas-based diffusion tensor imaging correlates of executive function. Journal of Alzheimer’s Disease, 44(2), 585–598.Google Scholar
Posner, M.I., Peterson, S.E., Fox, P.T., & Raichle, M.E. (1988). Localization of cognitive operations in the human brain. Science, 240, 1627–1630.Google Scholar
Rabinowitz, A.R., & Levin, H.S. (2014). Cognitive sequelae of traumatic brain injury. The Psychiatric Clinics of North America, 37(1), 1–11.Google Scholar
Reitan, R.M. & Wolfson, D. (1993). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. (2nd ed.). Tucson, AZ: Neuropsychological Press.Google Scholar
Roberts, R.M., Mathias, J.L., & Rose, S.E. (2016). Relationship between Diffusion Tensor Imaging (DTI) findings and cognition following pediatric TBI: A meta-analytic review. Developmental Neuropsychology, 41(3), 176–200.Google Scholar
Russell, W.R. (1932). Cerebral involvement in head injury. Brain, 55, 549–603.Google Scholar
Russell, W.R., & Smith, A. (1961). Post-traumatic amnesia in closed head injury. Archives of Neurology, 5(1), 4–17.Google Scholar
Sherer, M., Nakase-Thompson, R., Yablon, S.A., & Gontkovsky, S.T. (2005). Multidimensional assessment of acute confusion after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 86(5), 896–904.Google Scholar
Sherer, M., Yablon, S.A., & Nakase-Thompson, R. (2009). Patterns of recovery of posttraumatic confusional state in neurorehabilitation admissions after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 90(10), 1749–1754.Google Scholar
Smith, A. (1973). Symbol Digit Modalities Test Manual. Los Angeles: Western Psychological Services.Google Scholar
Stuss, D.T., Binns, M.A., Carruth, F.G., Levine, B., Brandys, C.E., Moulton, R.J., . . . Schwartz, M.L. (1999). The acute period of recovery from traumatic brain injury: Posttraumatic amnesia or posttraumatic confusional state?. Journal of Neurosurgery, 90(4), 635–643.Google Scholar
Stuss, D.T., (2011). Functions of the frontal lobes: Relation to executive functions. Journal of the International Neuropsychological Society, 17, 759–765.Google Scholar
Symonds, C.P., & Russell, W.R. (1943). Accidental head injuries: Prognosis in service patients. The Lancet, 241(6227), 7–10.Google Scholar
Vanderploeg, R. D, Crowell, T.A., & Curtiss, G. (2001). Verbal learning and memory deficits in traumatic brain injury: Encoding, consolidation, and retrieval. Journal of Clinical and Experimental Neuropsychology, 23 (2), 185–195.Google Scholar
Vanderploeg, R.D., Donnell, A.J., Belanger, H.G., & Curtiss, G. (2014). Consolidation deficits in TBI: The core and residual verbal memory defect. Journal of Clinical and Experimental Neuropsychology, 36(1), 58–73. doi:10.1080/13803395.2013.864600Google Scholar
Wechsler, D. (2001). Wechsler Test of Adult Reading Manual. San Antonio, TX: Psychological Corporation.Google Scholar
World Health Organization. (1992). International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva: WHO.Google Scholar
Wilson, B.A., Evans, J.J., Emslie, H., Balleny, H., Watson, P.C., & Baddeley, A.D. (1999). Measuring recovery from post traumatic amnesia. Brain Injury, 13(7), 505–520.Google Scholar
Wixted, J.T. (2004). The psychology and neuroscience of forgetting. Annual Review of Psychology, 55, 235–269. doi:10.1146/annurev.psych.55.090902.141555Google Scholar
Wright, M.J., Schmitter-Edgecombe, M., & Ellen Woo, E. (2010). Verbal memory impairment in severe closed head injury: The role of encoding and consolidation. Journal of Clinical and Experimental Neuropsychology, 32, 728–736.Google Scholar