Examining the Subacute Effects of Mild Traumatic Brain Injury Using a Traditional and Computerized Neuropsychological Test Battery

Abstract

This study investigates subacute cognitive effects of mild traumatic brain injury (MTBI) in the Trondheim Mild TBI Study, as measured, in part, by the neuropsychological test battery of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) program, including computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and traditional paper-and-pencil tests. We investigated whether cognitive function was associated with injury severity: intracranial traumatic lesions on neuroimaging, witnessed loss of consciousness (LOC), or post-traumatic amnesia (PTA) >1 h. Further, we explored which of the tests in the CENTER-TBI battery might be associated with the largest subacute effects of MTBI (i.e., at 2 weeks postinjury). We recruited 177 patients with MTBI (16-59 years of age) from a regional trauma center and an outpatient clinic,79 trauma control participants, and 81 community control participants. The MTBI group differed from community controls only on one traditional test of processing speed (coding; p = 0.009, Cliff's delta [D] = 0.20). Patients with intracranial abnormalities performed worse than those without on a traditional test (phonemic verbal fluency; p = 0.043, D = 0.27), and patients with LOC performed differently on the Attention Switching Task from the CANTAB (p = 0.020, D =-0.20). Patients with PTA >1 h performed worse than those with <1 h on 10 measures, from traditional tests and the CANTAB (D = 0.33-0.20), likely attributable, at least in part, to pre-existing differences in intellectual functioning between groups. In general, those with MTBI had good neuropsychological outcome 2 weeks after injury and no particular CENTER-TBI computerized or traditional tests seemed to be more sensitive to subtle cognitive deficits.

Investigating the diagnostic accuracy of a paper-and-pencil and a computerized cognitive test battery for pediatric mild traumatic brain injury.

“…In contrast, the HVLT-R, TMT, and WAIS-IV/WISC-V subtests have been identified as highly recommended (i.e., have been used and validated in previous research on concussions). Present results, along with findings from a recent study with a similar methodology (Karlsen et al, 2021), do not support this hierarchy based solely on diagnostic utility. Specifically, mTBI patients aged 16-59 years old scored differently than controls on a single measure (WAIS-IV Coding) within the Cambridge Neuropsychological Test Automated Battery (CANTAB), as well as on a paper-and-pencil battery, including Rey Auditory Verbal Learning Test [RAVLT], TMT-A and -B, WAIS-IV Symbol Search and Coding, Wechsler Abbreviated Scale of Intelligence (WASI) Vocabulary, and Matrix Reasoning, at 2-week postinjury.…”

“…The proportion of mTBI patients and controls scoring below 1.5 SD were similar on all measures, with most performances being in the normal ranges. Akin to the present study, paper-and-pencil and computerized tests performed similarly in terms of sensitivity to the subtle cognitive effects of mTBI (Karlsen et al, 2021).…”

Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches

“…Issues flagged by such self-assessment tools can then be further investigated through formal neurocognitive testing or validated computerized test batteries. 92 Cognitive rehabilitation should be considered as a treatment option when clinically significant objective cognitive deficits have been found following valid testing. 18 Three examples of evidence-based interventions that have been manualized for cognitive rehabilitation include Attention Process Training, 93 Goal Management Training, 94 and CogSMART compensatory cognitive training.…”

“…104 It has been extensively reviewed 102,105 and draws upon theories concerning goal processing and sustained attention 106 which posit that executive deficits emerge from disruption of the sustained attention system which is responsible for maintaining higher order goals in mind while inhibiting automatic process-resulting in distracted behavior. 92 The aim of Goal Management Training is to train individuals to periodically stop ongoing behaviors to reevaluate and define goal hierarchies and monitor performance. This is achieved through a combination of psychoeducation, interactive tasks that help patients identify their own personal goals, in-class discussion of real-life examples of goal attaining failures, and homework assignments aimed at promoting greater self-awareness spread over approximately 20 hours of training (generally over the course of several weeks).…”

Poor sleep quality is associated with greater negative consequences for cognitive control function and psychological health after mild traumatic brain injury than after orthopedic injury.

“…Neuropsychological results for the full test battery used in the Trondheim mTBI follow-up study have been published elsewhere (Karlsen et al, 2020;Stenberg, Håberg, et al, 2020). Here, we included a selection of computerized tests that measure response speed with milliseconds precision and accuracy from the Cambridge Neuropsychological Test Automated Battery (CANTAB; CANTA-Beclipse version 5.0.0).…”