Cognitive impairment was present in 41-61.9% of patients 3 months after mild or moderate traumatic brain injury (TBI). The study assessed 63 patients admitted to the hospital with mild or moderate TBI as determined by the Glasgow Coma Scale and CT scans. Cognitive impairment was measured using the Montreal Cognitive Assessment and was related to older age, lower education levels, and presence of brain lesions on CT scans. Brain regions involving attention, abstraction, and executive function were most commonly impaired.

1. COGNITIVE IMPAIRMENT AFTER
MILD AND MODERATE TRAUMATIC
BRAIN INJURY
Trần CôngThắng MD
LêThịYến Phụng MD

2. Introduction
 TBI refers to any external mechanical force
acting on the brain which may cause temporary
or permanent dysfunction
 TBI can be Open / Closed ;
 Focal / Diffuse

3. Introduction
 Traffic accidents in
1 month (2015):
 1759 accidents
 700 deaths
 Labour accidents
in 2015:
 7600 accidents
 660 deaths
 1700 injuries

4. Traumatic Brain Injury
 Death due to traffic accidents: 18/100.000 ,
labour accidents: 2,6/100.000 (1)
 PostTBI: (2)
 37% GCS ≤ 8  Death 25%
 63% GCS >8  Death 12,5%
(1) Health StatisticYearbook 2013-VN MOH (2) An Giang hospital 2012

5. Impacts of TBI
Mean Age
40

6. Mechanisms of TBI
 Mechanical forces applied to the skull and
transmitted to the brain.
 This may lead to focal and/or diffuse brain
damage.
 Focal lesions direct blow to the head
brain laceration
contusion
intracerebral hemorrhage
subarachnoid or SDH
ischemic infarct

7.  In addition to brain damage occurring at the
time of the impact, secondary damage from
several processes may occur during the
recovery period.
 Hypoxia
 Anemia
 Metabolic abnormalities
 Hydrocephalus
 Intracranial hypertension

8. Neurobiological changes
 Abnormality in glutamate pathway.
 Abnormality in cholinergic neuronal activity.
 Abnormality in ascending biogenic amine
pathway.

9. Lobe functions

11. Cognitive impairment post TBI
 Skandsen et al 2010, Cognitive Impairment 3
months postTBI: (1)
 Maen age: 30
 Mean GCS : 9 [7-13]
 Cognitive Impairment in moderateTBI: 43%
 Cognitive Impairment in severeTBI : 65%
 After 1 year: 43% normal Pts group have Cognitive
Impairment
 Tunvirachaisakul et al,2011: (2)
 2 weeks post mildTBI: 21,7% executive disorder
(1) SkandsenT, FinnangerTG, et al. (2010). Archives of Physical Medicine and Rehabilitation, 91 (12), pp. 1904-13
(2)Tunvirachaisakul C,Thavichachart N, Worakul P (2011). Asian Biomedicine 5 (3), pp. 407-11.

12. Objective
Determine the frequency, characteristics,
and factors related to cognitive
impairment 3 months after mild and
moderateTBI

13. Methods
 A cross-sectional descriptive study
 Participants: mild/moderateTBI pts admited to
ChoRay hospital in Feb 2016 (DSM5)
 Pts characteristics
 Injury-RelatedVariables:CTscan
 MoCA test 3 months afterTBI: Cognitive
Impairment/ Normal Cognitive functions
 Statistical Analysis:
 Comparisons betweenTBI pts with/without TBI Cognitive
Impairment were performed using the χ2 test, exact Fisher
test, t-Student test.
 P value of 0.05 or less was regarded as significant

14. DSM-5

16. Marshall CT Grading of Brain
Trauma

17. Cut-off: 26

18. RESULTS
 95TBI pts (Feb 2016)
 Missing: 32 pts (normal activities)
 No death
 63TBI pts (after 3 months)
 MoCA < 26: 39 pts
 MoCA ≥ 26: 24 pts
COGNITIVE IMPAIRMENT 3 months after
mild/moderateTBI:
41% - 61,9%

19. Cognitive impairment post TBI
 Skandsen et al 2010, Cognitive Impairment 3
months postTBI: (1)
 Maen age: 30
 Mean GCS : 9 [7-13]
 Cognitive Impairment in moderateTBI: 43%
 Cognitive Impairment in severeTBI : 65%
 After 1 year: 43% normal Pts group have Cognitive
Impairment
(1) SkandsenT, FinnangerTG, et al. (2010). Archives of Physical Medicine and Rehabilitation, 91 (12), pp. 1904-13

20. Results (63pts)
 Mean age: 37±13 [19-68]
 BV AG (40), Tunvirachaisakul (29,5), Skandsen
(30,6)
(1) SkandsenT, FinnangerTG, et al. (2010). Archives of Physical Medicine and Rehabilitation, 91 (12), pp. 1904-13
(2)Tunvirachaisakul C,Thavichachart N, Worakul P (2011). Asian Biomedicine 5 (3), pp. 407-11.

21. Results (63pts)
 Accident situations:
 Traffic accident: 56 cases (88.9%)
 Education (school year)
 30.2%: 1-6 yrs
 47.6%: 7-12 yrs
 22,2% > 12 yrs

22. Level of Brain Injury
 Clinical assessment:
 Mild: 42 cases (66.7%)
 Moderate: 21 cases (33.3%)

23. Marshall CT Classification
Diffuse Injury
Grade
CT appearance Case (%)
I Normal CT scan 25 (39.7%)
II Cisterns present. Shift <
5mm
38(60.3%)
III Cisterns
compressed/absent.
Shift < 5mm.
0%
IV Shift > 5mm 0%

24. Brain lesions on CTscan

25. Relation to age & education

26. Cognitive areas Impairment

27. Brain lesions and Cognitive Impairment

30. Conclusions
 COGNITIVE IMPAIRMENT 3 months after
mild/moderateTBI: 41% - 61,9%
 Old age and low education related to Cog
Impair postTBI.
 TBI affect several cognitive functions
 Pts with brain lesion have low attention
and abstraction

31. THANK YOU
FOR YOUR ATTENTION