Cognitive impairment in the acute phase of traumatic brain injury

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Introduction. TBI is the most common type of TBI. Mild trauma includes concussion, mild brain injury and accounts for up to 83% of all TBI cases [1]. TBI of moderate severity is in second place after mild. According to the American Congress on Rehabilitation Medicine, HCMT can lead to short-term loss of consciousness from a few seconds to several minutes, after recovery of consciousness there may be antegrade amnesia for up to one hour, followed by impaired cognitive functions (CF), as well as complaints of headache, dizziness and general weakness [2]. TBI of moderate severity, in addition to HF and the above symptoms, is manifested by repeated vomiting, nausea, severe headache, and there are also: focal neurological symptoms, determined by the localization of brain injury; horizontal nystagmus; the degree of wakefulness decreases to the level of moderate or severe deafness; psychomotor agitation and sometimes seizures can be observed on the first day. In most cases, patients with mild to moderate severity fully recover within 3 months, and a significant number of people may continue to experience persistent heart failure.

TBI is registered annually in 4 people per 1000 of the population, most often this injury occurs in people of working age from 20 to 39 years, in particular in men [1].

Cognitive functions (CF) are the ability to understand, cognize, study, recognize and perceive, as well as process external information. TBI can cause impairments in many cognitive areas, including attention, memory, executive functions, information processing speed, as well as learning and problem solving. Getting even one mild TBI disrupts the brain functions that are based on CF. In the acute phase of TBI, cognitive impairments will be stable and easy to notice.

The purpose of the work. To evaluate the relationship between mild and moderate traumatic brain injury in the acute phase and impaired cognitive functions.

Materials and methods of research. The literature was searched in databases such as PubMed, Scopus, and Embase. This literature review analyzed studies on cognitive impairment in the acute phase of traumatic brain injury in the period from 2020 to 2024. The following scales are used to assess cognitive impairment: the Montreal Cognitive Function Assessment Scale, the MMSE test, and the HADS scale; as well as neuroimaging to determine structural changes in brain matter.

The results of the study. The timing of the appearance of CN in the acute phase of TBI depends on the severity of the injury, as well as on individual characteristics. Studies have shown that in most cases, CNS passes within 3 months [1]. However, some patients develop post-concussion syndrome, in which CF impairment persists for several years. If TBI was complicated, the course of CI worsened significantly, and patients developed depression and anxiety [2].

Thus, there are correlations between the severity of TBI and the likelihood of KN. In addition, the duration of CN is influenced by age, education, place of work, social status, and a history of early acquired TBI. When all of the above reasons are combined, it is important to monitor cognitive impairments in people who have suffered even mild traumatic brain injury.

Studies have shown that TBI of mild and moderate severity is more favorable in children than in adults [1]. Consequently, CNS disappear in a shorter period of time with minor residual effects such as hyperactivity and visual memory deficits.

Sources report that 26% of patients with TBI show a decrease in global cognitive functions according to the results of the MMSE test.

In the acute phase of TBI, executive dysfunction may appear, which is characterized by attention deficit, decreased memory and cognitive flexibility. Key memory functions include the ability to store and process information that is impaired in cognitive disorders, which greatly affects the quality of life[3]. Even with a mild traumatic brain injury, the patient may experience amnesia lasting up to 24 hours. Impaired information processing speed and attention are more often noted in the acute phase of moderate traumatic brain injury. Memory and attention disorders can be noticed immediately after injury.

Even if objective cognitive impairments have not been detected by neuropsychological tests, patients may still complain of impaired memory, attention, and decreased information processing speed in everyday life after receiving a TBI [5]. This is called a subjective decrease in CF. The study also showed that depression can increase the duration of heart failure.

The prognosis of KN after TBI directly depends on the severity of the injury, as well as on the frequency. Studies have shown that CF disorders improve or disappear altogether within a year of injury. If the patient has more than one TBI in the anamnesis, then it is more likely that TBI will accompany the person throughout his life. The prognosis of cognitive impairment is also influenced by age, education, and social status[4].

Biomarkers of CN are: tau protein, beta-amyloid, S100B – potential biomarkers in blood and cerebrospinal fluid [2].

Conclusion. Thus, cognitive impairment in the acute phase of traumatic brain injury is a common and serious consequence, the nature and severity of which depends on the severity of the injury. Cognitive impairments can range from mild attention and memory disorders to severe cognitive impairments. Cognitive impairments can be temporary or permanent, depending on the severity of the injury. Early rehabilitation plays an important role in minimizing the long-term cognitive effects of traumatic brain injury.

About the authors

Ekaterina Vladimirovna Solopova

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: Ekaterinaa.16@mail.ru
ORCID iD: 0009-0005-9686-4894

4th year student of the Faculty of Pediatrics

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Elizaveta Sergeevna Avdeeva

Voronezh State Medical University named after N. N. Burdenko

Email: eavdeeva03@bk.ru
ORCID iD: 0009-0003-0175-9350
SPIN-code: 3238-6087

4th year student of the Faculty of Pediatrics

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Olga Vladimirovna Ulyanova

Voronezh State Medical University named after N. N. Burdenko

Email: alatau08@mail.ru
ORCID iD: 0000-0003-2754-2670
SPIN-code: 9099-1878

Candidate of Medical Sciences, Associate Professor of the Department of Neurology

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

References

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