Cognitive impairment in diffuse axonal injury patients with favorable outcome
Wei‐Liang Chen, Chunyu Yao, Shengwen Li, Hongguang Huang, Zujian Zhu, Rui Chen, Wen Su, Xiao Huang, Lisheng Xu, Kaijie Sun, Jiannan Song, Rongcai Jiang, Guanjun Wang
Abstract
Background and purpose Traumatic brain injury (TBI), especially the severe TBI are often followed by persistent cognitive sequalae, including decision-making difficulties, reduced neural processing speed and memory deficits. Diffuse axonal injury (DAI) is classified as one of the severe types of TBI. Part of DAI patients are marginalized from social life due to cognitive impairment, even if they are rated as favorable outcome. The purpose of this study was to elucidate the specific type and severity of cognitive impairment in DAI patients with favorable outcome. Methods The neurocognition of 46 DAI patients with favorable outcome was evaluated by the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC), and the differences in the domains of cognitive impairment caused by different grades of DAI were analyzed after data conversion of scores of nine cognitive domains of MoCA-BC by Pearson correlation analysis. Results Among the 46 DAI patients with favorable outcome, eight had normal cognitive function (MoCA-BC ≥ 26), and 38 had cognitive impairment (MoCA-BC < 26). The MoCA-BC scores were positively correlated with pupillary light reflex ( r = 0.361, p = 0.014), admission Glasgow Coma Scale (GCS) ( r = 0.402, p = 0.006), and years of education ( r = 0.581, p < 0.001). Return of consciousness ( r = −0.753, p < 0.001), Marshall CT ( r = −0.328, p = 0.026), age ( r = −0.654, p < 0.001), and DAI grade ( r = −0.403, p = 0.006) were found to be negatively correlated with the MoCA-BC scores. In patients with DAI grade 1, the actually deducted scores (Ads) of memory ( r = 0.838, p < 0.001), abstraction ( r = 0.843, p < 0.001), and calculation ( r = 0.782, p < 0.001) were most related to the Ads of MoCA-BC. The Ads of nine cognitive domains and MoCA-BC were all proved to be correlated, among patients with DAI grade 2. However, In the DAI grade 3 patients, the highest correlation with the Ads of MoCA-BC were the Ads of memory ( r = 0.904, p < 0.001), calculation ( r = 0.799, p = 0.006), orientation ( r = 0.801, p = 0.005), and executive function ( r = 0.869, p = 0.001). Conclusion DAI patients with favorable outcome may still be plagued by cognitive impairment, and different grades of DAI cause different domains of cognitive impairment.