Neuropsychological Characteristics of the Confusional State Following Traumatic Brain Injury

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)

The Traumatic Brain Injury Model Systems National Database: A Review of Published Research

“…Altogether, 23 studies gathered information from additional sources. Additional information from other databases included relevant information from surveys, [17][18][19][20][21][22][23][24] hospital records, [25][26][27][28][29] death indices, [30][31][32][33] quality of life indices, 32,34,35 measures of neurocognition, 36,37 and national geographic information systems. 38 Moreover, external validation cohorts were collected.…”

“…Twelve of these 51 studies focused further on a specific cohort within the data set. Examples of these specific cohorts include mortality, 40 participants of a specified age range, 23,36,[41][42][43][44] and patients who underwent cranial procedures, 45 developed post-injury conditions such as post-traumatic brain injury fatigue (PTBIF), 34 post-traumatic confusional state (PTCS), 37 or disorders of consciousness (DOC). 28 It is important to note that each study's objective(s) determined how the TBIMS data were used, and whether other data sources were required to conduct their analysis.…”

“…Sixty studies (81%) had a longitudinal design, whereas 14 did not use longitudinal data. Three studies 27,33,37 had a follow-up period of less than 1 year. One study used up to 25 years of follow-up data.…”

“…Of these, 13 studies used the external information as a primary outcome measure in conducting their research. Information was collected from surveys for cognitive assessments, 36,37 Internet usage, 24 resilience, 33,35 sleep quality, 34 and sexual satisfaction. 32 Other trauma registries, [18][19][20][21]23,30,38,39,57 hospital records, [25][26][27][28][29] death indices, 22,30,31 and inmate databases 22 were used to collect additional information.…”

“…14,18,20,23,27,28,[32][33][34]38,40,50,53,55,[57][58][59][60][61][62]64,[66][67][68][69][70][71] In addition, certain variable groups such as ''race'' were under-or over-representative of the U.S. population overall, therefore serving as a limitation to generalizability in results due to the unequal representation of groups within variables. 60 In many studies, cohorts were dichotomized into sub-cohorts based on specific thresholds 21,23,[28][29][30][31]34,37,41,45,55,60,61,68,69,72,73 ; therefore caution is required when applying these findings to a more general population.…”