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Doktorsavhandling vid Karolinska Institutet |
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Lundin, AndersMild traumatic brain injury : clinical course and prognostic factors for postconcussional disorderFredagen den 19 januari 2007, kl. 09.00. Aulan, Danderyds sjukhus. |
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| ISBN: 91-7357-078-8 | Diss: 07:9 |
Abstract:
Background
Mild traumatic brain injury (MTBI) is frequent and sometimes leads to persistent disability. It remains
a matter of controversy as to what impact the different main determinants - brain injury factors and
psychosocial factors - exert on the development of postconcussional disorder (PCD).
Aims, subjects and methods
The overall aim was to find predictors for PCD after MTBI. One hundred and twenty-two persons with
MTBI were assessed with CT and MRI brain scans, S 100B, S 100A1B, and clinical variables. The first
week after the trauma an extended assessment was performed, including previous history of psychiatric
disorder, psychological function the year before the trauma, personality, coping ability, and concurrent
psychosocial streamers. Three months post injury outcome was assessed by use of self assessment
questionnaires for MTBI symptoms and disability. Cognitive impairment was assessed with a
computerized Automated Psychology Test (APT) and neuropsychological testing. Thirtyfive healthy
control persons were assessed for comparison.
Results
Is increased S 100 associated with cognitive impairment?
S 100B and S 100A1B were increased in 42
% and 64 % of the patients. Cognitive impairment was found in 8 % when assessed with APT and in 30
% when assessed with neuropsychological tests. No significant correlation was found between S 100B or
S 100A1B and cognitive impairment, nor between subjectively reported cognitive dysfunction and test
performance, regardless of the method used.
What is the clinical course after MTBI?
At least one persisting symptom was reported by 49 % of the patients at three months - most
commonly poor memory, sleeping problems and fatigue. High symptom load at day one correlated
with high symptom load and disability at three months, when 25 % also reported disability in at least
one domain of everyday life.
How should PCD be defined?
The ICD-10 definition of PCD was considered too liberal as no disability was required. Sixteen % of
control subjects were considered "cognitive impairment cases" as compared to 28 % in the MTBI
group. The results from neuropsychological testing had insufficient specificity to qualify, as proposed
in the DSM-IV, as a defining property of PCD. A definition of PCD based on a minimum of three
symptoms and two domains of disability at three months post injury was proposed, which yielded 17 %
PCD cases in the whole sample.
Which risk factors predict the development of PCD?
Preinjury psychological vulnerability (previous psychiatric disorder, trait anxiety, embitterment),
lower preinjury psychological function (GAF) and concurrent psychosocial stressors were significant
predictors of PCD. Posttraumatic stress (hyperarousal) one week after the MTBI had the highest
impact on the outcome. Female gender and concurrent medical condition were also correlated to PCD,
but no correlation was found between PCD and injury related factor.
Summary
Signs of brain injury or brain dysfunction are present in the early phase after MTBI but show poor
correlation to PCD as defined by at least three symptoms in combination with disability at three
months post injury. The results from neuropsychological testing had insufficient specificity to qualify
as a defining property of PCD. Prognosis after MTBI is good in most cases, but a minority of patients
develop PCD, which emerges as a result of the interaction between premorbid psychological
vulnerability, brain dysfunction in the early phase, posttraumatic hyperarousal and concurrent
psychosocial stressors.
Keywords: Mild traumatic brain injury, S 100, cognitive impairment, symptoms, disability, postconcussional disorder, prognostic factors
Keywords: Mild traumatic brain injury, S 100, cognitive impairment, symptoms, disability, postconcussional disorder, prognostic factors
List of papers
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S100 and cognitive impairment after mild traumatic brain injury. de Boussard CN, Lundin A, Karlstedt D, Edman G, Bartfai A, Borg J. J Rehabil Med, 2005; 37(1): 53-7 |
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Symptoms and disability until 3 months after mild TBI. Lundin A, de Boussard C, Edman G, Borg J. Brain Inj, 1970; 20(8): 799-806 |
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A comparison of three criteria sets for postconcussional disorder
after mild traumatic brain injury. Lundin A, de Boussard C, Karlstedt D, Bartfai A, Edman G, Borg J. Submitted |
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Prognostic factors for postconcussional disorder after mild
traumatic brain injury. Lundin A, de Boussard C, Edman G, Borg J. Submitted |
