Relationships between neuropsychological impairments and functional outcome eight years after severe traumatic brain injury: Results from the PariS-TBI study

ABSTRACT

Background/objectives

The objective was to assess the relationships between neuropsychological impairments, functional outcome and life satisfaction in a longitudinal study of patients after a severe traumatic brain injury (TBI) (PariS-TBI study).

Patients

Out of 243 survivors, 86 were evaluated 8 years post-injury. They did not significantly differ from patients lost-to-follow up except for the latter being more frequently students or unemployed before the injury.

Methods

Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), a functional independence questionnaire, employment, mood, fatigue and satisfaction with life. Neuropsychological outcome was assessed by two ways: performance-based outcome measures, using neuropsychological tests and patient and relative-based measures.

Results

Neuropsychological measures were not significantly related to initial injury severity nor to gender, but were significantly related to age and education. After statistical correction for multiple comparisons, cognitive testing and cognitive questionnaires were significantly correlated with most outcome measures. By contrast, satisfaction with life was only related with patient-rated questionnaires. A regression analysis showed that the Trail-Making-Test-A was the best predictor of functional outcome, in addition to education duration.

Conclusions

Cognitive measures, particularly slowed information processing speed, were significant indicators of functional outcome at a long-term post-injury, beyond and above demographics or injury severity measures.

KEYWORDS:

• Traumatic brain injury
• disability
• outcome
• cognition
• neuropsychology

Acknowledgments

The authors thank all members of the CRFTC Steering Committee (Centre Ressource Francilien du Traumatisme Crânien) for their valuable help.

The first part of this study and the eight-year evaluation was funded by a grant from the French Ministry of Health (Programme hospitalier de recherche clinique 2004 and 2012, AOM04084) and sponsored by AP–HP (Département de la recherche clinique et du développement). The second part of this study was funded by a grant from the Institut de recherche en santé publique (IRESP).

Disclosure statement

The authors have no conflict of interest to disclose.

Clinical trial registration number

NCT01437683

Author contributions

CVA, AR, EB, PPD, JC, CJ and PAz contributed to the study design and monitoring.

CVA, GN and MS contributed to data collection, data clearing and statistical analyses.

IG, LM and PAe contributed to data management, statistical supervision, and administrative and financial matters.

CVA, PAz, AR and CJ contributed to writing the manuscript.

Additional information

Funding

This work was supported by the French ministry of health [PHRC-AOM04084]; Institut de recherche en santé publique [Appel à projet handicap].