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. 2023 Dec 1;6(12):e2349118.
doi: 10.1001/jamanetworkopen.2023.49118.

Profiles of Cognitive Functioning at 6 Months After Traumatic Brain Injury Among Patients in Level I Trauma Centers: A TRACK-TBI Study

Andrew M Bryant  1   2 , Nathan B Rose  1 , Nancy R Temkin  3   4 , Jason K Barber  3   4 , Geoffrey T Manley  5 , Michael A McCrea  1 , Lindsay D Nelson  1 ; TRACK-TBI Investigators; Neeraj Badjatia  6 , Shankar Gopinath  7 , C Dirk Keene  8 , Christopher Madden  9 , Laura B Ngwenya  10 , Ava Puccio  11 , Claudia Robertson  12 , David Schnyer  13 , Sabrina R Taylor  5 , John K Yue  5
Affiliations

Profiles of Cognitive Functioning at 6 Months After Traumatic Brain Injury Among Patients in Level I Trauma Centers: A TRACK-TBI Study

Andrew M Bryant et al. JAMA Netw Open. .

Abstract

Importance: Cognitive dysfunction is common after traumatic brain injury (TBI), with a well-established dose-response relationship between TBI severity and likelihood or magnitude of persistent cognitive impairment. However, patterns of cognitive dysfunction in the long-term (eg, 6-month) recovery period are less well known.

Objective: To characterize the prevalence of cognitive dysfunction within and across cognitive domains (processing speed, memory, and executive functioning) 6 months after injury in patients with TBI seen at level I trauma centers.

Design, setting, and participants: This prospective longitudinal cohort study used data from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) and included patients aged 17 years or older presenting at 18 US level I trauma center emergency departments or inpatient units within 24 hours of head injury, control individuals with orthopedic injury recruited from the same centers, and uninjured friend and family controls. Participants were enrolled between March 2, 2014, and July 27, 2018. Data were analyzed from March 5, 2020, through October 3, 2023.

Exposures: Traumatic brain injury (Glasgow Coma Scale score of 3-15) or orthopedic injury.

Main outcomes and measures: Performance on standard neuropsychological tests, including premorbid cognitive ability (National Institutes of Health Toolbox Picture Vocabulary Test), verbal memory (Rey Auditory Verbal Learning Test), processing speed (Wechsler Adult Intelligence Scale [4th edition] Processing Speed Index), and executive functioning (Trail Making Test).

Results: The sample included 1057 persons with TBI (mean [SD] age, 39.3 [16.4] years; 705 [67%] male) and 327 controls without TBI (mean [SD] age, 38.4 [15.1] years; 222 [68%] male). Most persons with TBI demonstrated performance within 1.5 SDs or better of the control group (49.3% [95% CI, 39.5%-59.2%] to 67.5% [95% CI, 63.7%-71.2%] showed no evidence of impairment). Similarly, 64.4% (95% CI, 54.5%-73.4%) to 78.8% (95% CI, 75.4%-81.9%) of participants demonstrated no evidence of cognitive decline (defined as performance within 1.5 SDs of estimated premorbid ability). For individuals with evidence of either cognitive impairment or decline, diverse profiles of impairment across memory, speed, and executive functioning domains were observed (ie, the prevalence was >0 in each of the 7 combinations of impairment across these 3 cognitive domains for most TBI subgroups).

Conclusions and relevance: In this cohort study of patients seen at level I trauma centers 6 months after TBI, many patients with TBI demonstrated no cognitive impairment. Impairment was more prevalent in persons with more severe TBI and manifested in variable ways across individuals. The findings may guide future research and treatment recommendations.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bryant reported receiving grants from the National Institute for Neurological Disorders and Stroke (NINDS), One Mind, NeuroTrauma Sciences LLC, and the US Department of Defense TBI Endpoints Development Initiative during the conduct of the study. Dr Temkin reported receiving grants from the US Federal Government during the conduct of the study. Dr Manley reported receiving a contract from the US Department of Defense (DOD)/Medical Technology Enterprise Consortium (MTEC) Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Network and receiving grants from the DOD TBI Endpoints Development Initiative, National Institutes of Health (NIH) NINDS TRACK-TBI, and DOD TRACK-TBI Precision Medicine during the conduct of the study, as well as receiving grants from the National Football League (NFL) Scientific Advisory Board’s TRACK-TBI Longitudinal; funding from NeuroTruama Sciences, LLC, for TRACK-TBI data curation; and stipends and support funding for TRACK-TBI patients from One Mind to clinical sites, all outside the submitted work. Dr McCrea reported receiving grants or research funding from the NIH to Medical College Wisconsin (MCW) during the conduct of the study; receiving grants or research funding to MCW from the NIH, DOD, Centers for Disease Control and Prevention (CDC), US Department of Veterans Affairs, National Collegiate Athletic Association, NFL, and Abbott Labs outside the submitted work; and consulting for NeuroTrauma Sciences, LLC, outside the submitted work. Dr Nelson reported receiving grants from the NINDS and DOD during the conduct of the study; receiving grants from the NINDS, CDC, DOD, Medical College of Wisconsin Advancing a Healthier Wisconsin Endowment, and MTEC for unrelated research outside the submitted work; and receiving stipends from the DOD for grant reviewing and from the American College of Emergency Medicine Physicians for consulting (paid for by a grant from Abbott). Dr Madden reported receiving grant funding from NIH TRACK-TBI during the conduct of the study. Dr Ngwenya reported receiving grants from Biogen and Abbott outside the submitted work. Dr Robertson reported receiving grants from the NIH and DOD during the conduct of the study. Dr Schnyer reported receiving grants from the NIH during the conduct of the study and from the NIH and DOD outside the submitted work. Dr Yue reported receiving grants from the Neurosurgery Research & Education Foundation and a Research Fellowship Award from the Bagan Family Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence of Cognitive Impairment and Cognitive Decline
A, Performance more than 1.5 SDs below the normatively adjusted mean. B, Performance more than 1.5 SDs below estimated premorbid cognitive ability, based on the National Institutes of Health (NIH) Toolbox Picture Vocabulary Test. Whiskers represent 95% CIs. CT indicates computed tomography; RAVLT, Rey Auditory Verbal Learning Test; WAIS-IV PSI, Wechsler Adult Intelligence Scale (4th edition) Processing Speed Index; TMT-A, Trail Making Test, part A; TMT-B, Trail Making Test, part B; TMT-B/A, ratio of Trail Making Test B to A.
Figure 2.
Figure 2.. Prevalence of Different Profiles of Cognitive Impairment
A, Performance more than 1.5 SDs below the normatively adjusted mean. B, Performance more than 1.5 SDs below estimated premorbid cognitive ability, based on a picture vocabulary test. Percentages may not total to 100 due to rounding. Whiskers represent 95% CIs.
See this image and copyright information in PMC

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