Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

Abstract

Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, selfawareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. Methods: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. Results: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. Conclusions: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.

The trajectories of overall disability in the first 5 years after moderate and severe traumatic brain injury

“…Of particular note is that women and men had no differences in long-term outcomes after TBI across the three time points. The anecdotal observations from clinical practice that women tend to experience better outcomes than men after TBI, as well as findings from the US examining functioning during discharge from acute TBI (36) were not confirmed in this study. Our results are also not in line with number of studies that showed gender influence on TBI outcomes such as a metaanalysis of outcome studies from mild-to-severe TBI that found poorer outcomes in women for 85% of the measured variables, including disability and subjective symptoms (37).…”

Sex Differences in Abnormal Intrinsic Functional Connectivity After Acute Mild Traumatic Brain Injury

“…Controlled animal experiments have shown better cognitive outcomes among females after mild TBI (Bramlett and Dietrich, 2001 ; O’Connor et al, 2003 ; Bazarian et al, 2010 ). Evidence from a human study also finds that women have superior executive functioning when compared with men after acute TBI (Niemeier et al, 2014 ). Other studies show that women outperform men in the tasks of verbal memory and learning measures following TBI (Farace and Alves, 2000 ; Covassin et al, 2012 ).…”

Awareness of cognitive decline trajectories in asymptomatic individuals at risk for AD

“…Research ndings have been strikingly consistent in showing that men and women have different health-related behaviours (e.g. [39]). For instance, men, as a group, are more likely to avoid seeking help for physical and mental health problems, due to a gender-role con ict (see [40] for a review).…”