J Korean Neurosurg Soc.  2014 Jan;55(1):18-25. 10.3340/jkns.2014.55.1.18.

Prognostic Factors of Neurocognitive and Functional Outcomes in Junior and Senior Elderly Patients with Traumatic Brain Injury Undergoing Disability Evaluation or Appointed Disability Evaluation

• Jung YJ
• Kim OL
• Kim MS
• Cheon EJ
• Bai DS

• KMID: 2191035
• DOI: http://doi.org/10.3340/jkns.2014.55.1.18

Abstract

OBJECTIVE
This study explored the relationships among demographic (DVs) and clinical variables (CVs), neurocognitive (NOs) and functional outcome (FO) that could be used as prognostic factors for old aged patients with traumatic brain injury (TBI) undergoing or appointed disability evaluation (DE) after treatment.
METHODS
A total of 162 subjects with TBI above the age of 55 years undergoing DE or appointed to do so after treatments were selected. The patients were divided into two subgroups according to age : a junior elderly group 55 to 64 years old and a senior elderly group over the age of 65. NOs and FO were evaluated using the Seoul Neuropsychological Screening Battery and Clinical Dementia Rating scale.
RESULTS
Gender, age, and education level were shown to significantly impact the recovery of NOs after TBI. Other DVs and CVs such as area of residency, occupation, type of injury, or loss of consciousness were not found to significantly affect the recovery of NOs after TBI. Analysis of the relationships among DVs, CVs and NOs demonstrated that gender, age, and education level contributed to the variance of NOs. In FO, loss of consciousness (LOC) was included to prognostic factor.
CONCLUSION
Gender, age and education level significantly influence the NOs of elderly patients with TBI. LOC may also serve as a meaningful prognostic factor in FO. Unlike younger adult patients with TBI, old aged patients with TBI did not show global faking-bad or malingering attitudes to DE for compensation, but assume that they could faking their performance in a test set available visual feedback.

Keyword

Advanced age; Traumatic brain injury; Prognosis; Gender; Education

MeSH Terms

Adult
Aged*
Brain Injuries*
Compensation and Redress
Dementia
Disability Evaluation*
Education
Feedback, Sensory
Humans
Internship and Residency
Malingering
Mass Screening
Occupations
Prognosis
Seoul
Unconsciousness

Figure

• 

  Fig. 1 Distribution of MMSE low and standard scores according to years of education. JES : junior elderly subjects, SES : senior elderly subjects, MMSE : Mini Mental State Examination.

Reference

1. Albert M, Duffy FH, Naeser M. Nonlinear changes in cognition with age and their neuropsychologic correlates. Can J Psychol. 1987; 41:141–157. PMID: 3502893.

2. Carroll LJ, Cassidy JD, Peloso PM, Borg J, von Holst H, Holm L, et al. Prognosis for mild traumatic brain injury : results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004; (43 Suppl):84–105. PMID: 15083873.

3. Chesnust RM, Ghajar J, Maas AIR, Marion DW, Servadei R, Teasdale GM, et al. Early indicators of prognosis in severe traumatic brain injury. Brain Trauma Foundation, American Association of Neurological Surgeons. Management and Prognosis of Severe Traumatic Brain Injury. New York: Brain Trauma Foundaion;2000. p. 1–116.

4. Choi SH, Na DL, Lee BH, Hahm DS, Jeong JH, Yoon SJ, et al. Estimating the validity of the Korean version of expanded clinical dementia rating (CDR) scale. J Korean Neurol Assoc. 2001; 19:585–591.

5. Choi SW, Koh HS, Yeom JY, Kim SH, Song SH, Kim Y. Clinical analysis of the risk factors and prognostic factors of delayed deterioration following mild head injury. J Korean Neurosurg Soc. 1999; 28:1316–1323.

6. Depreitere B, Meyfroidt G, Roosen G, Ceuppens J, Grandas FG. Traumatic brain injury in the elderly : a significant phenomenon. Acta Neurochir Suppl. 2012; 114:289–294. PMID: 22327710.

7. Farace E, Alves WM. Do women fare worse? A metaanalysis of gender differences in outcome after traumatic brain injury. Neurosurg Focus. 2000; 8:e6. PMID: 16924776.

8. Fillenbaum GG, Peterson B, Morris JC. Estimating the validity of the clinical Dementia Rating Scale : the CERAD experience. Consortium to Establish a Registry for Alzheimer's Disease. Aging (Milano). 1996; 8:379–385. PMID: 9061124.

9. Hyde JS, Linn MC. Gender differences in verbal ability : a meta-analysis. Psychol Bull. 1988; 104:53–69.

10. Jeon IC, Kim OL, Kim MS, Kim SH, Chang CH, Bai DS. The effect of premorbid demographic factors on the recovery of neurocognitive function in traumatic brain injury patients. J Korean Neurosurg Soc. 2008; 44:295–302. PMID: 19119465.

11. Jeung YH. The Life Expectancy and Health-Adjusted Life Expectancy of Koreans. Health Welf Policy Forum. 2012; 193:5–18.

12. Kang YU, Na DL. Seoul neuropsychological screening battery. Incheon: Human Brain Research & Consulting Co;2003.

13. Kim E. Elderly. In : Silver JM, McAllister TW, Yudofsky SC, editors. Textbook of Traumatic Brain Injury. Arlington: American Psychiatric Publishing, Inc.;2005. p. 495–508.

14. Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological Assessment. ed 5. New York: Oxford University Press;2012. p. 354–361.

15. Morris JC. The Clinical Dementia Rating (CDR) : current version and scoring rules. Neurology. 1993; 43:2412–2414. PMID: 8232972.

16. MRC CRASH Trial Collaborators. Perel P, Arango M, Clayton T, Edwards P, Komolafe E, et al. Predicting outcome after traumatic brain injury : practical prognostic models based on large cohort of international patients. BMJ. 2008; 336:425–429. PMID: 18270239.

17. Murray GD, Teasdale GM, Braakman R, Cohadon F, Dearden M, Iannotti F, et al. The European Brain Injury Consortium survey of head injuries. Acta Neurochir (Wien). 1999; 141:223–236. PMID: 10214478.

18. O'Neill S, Brady RR, Kerssens JJ, Parks RW. Mortality associated with traumatic injuries in the elderly : a population based study. Arch Gerontol Geriatr. 2012; 54:e426–e430. PMID: 22322093.

19. Park YS, Kim HJ, Whang K, Pyen JS, Hu C, Hong SK. Clinical characteristics and prognosis of mild head injury in the elderly. J Korean Neurosurg Soc. 2002; 31:564–568.

20. Shin TH, Gong CB, Kim MS, Kim JS, Bai DS, Kim OL. Development of a cognitive level explanation model in brain injury : comparisons between disability and non-disability evaluation groups. J Korean Neurosurg Soc. 2010; 48:506–517. PMID: 21430977.

21. Statistics Korea. Press materials : Statistics of old ages at 2011. Seoul: Statistics Korea;2012.

22. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2:81–84. PMID: 4136544.

23. van Velzen JM, van Bennekom CA, Edelaar MJ, Sluiter JK, Frings-Dresen MH. Prognostic factors of return to work after acquired brain injury : a systematic review. Brain Inj. 2009; 23:385–395. PMID: 19408163.

24. Wilson RS, Hebert LE, Scherr PA, Barnes LL, Mendes de Leon CF, Evans DA. Educational attainment and cognitive decline in old age. Neurology. 2009; 72:460–465. PMID: 19188578.