Traumatic brain injury
Traumatic brain injury (TBI) is the most common cause of death and disability in more young and old persons in many countries including the USA and Canada,1 with resulting from TBI in chronic neurological, cognitive, and behavioral impairments.2 Then it can be one of the most challenging and rewarding aspects of clinical neurocritical care.3 Traumatic brain injury patients are at high risk for impairments in pragmatic language and social communication more broadly.4 Meanwhile post-traumatic brain-injured person after coming out of a coma, they reference to behavioural with the specific report and cognitive impairments.5
Cognitive impairment is a common consequence of traumatic brain injury and a substantial source of disability, across all levels of TBI severity indicated attention, processing speed, episodic memory, and executive function are most commonly affected.6 Cognitive impairment is common outcomes in each level and cause of TBI patients. In particular, during the follow up after the trauma, all patients underwent neurological examination including mini mental state examination (MMSE) and Glasgow outcome scale (GOS).7 Study shows moderate to severe TBI patients reported cognitive deficits include memory, language, executive functions, attention and information processing speed deficiencies.8 TBI patients are at risk of subjective memory impairment which was significantly greater among TBI with loss of consciousness, post-TBI cognitive impairment primarily affects executive function and processing speed.9
However, there was a statistically significant increase in the composite cognitive score and decrease in functional connectivity in the right inferior frontal gyrus, with changes in the brain-behavior in the Traumatic brain injury patients,.10 White matter disruption after brain injury shows cognitive impairment, then, white matter damaged was related with particular patterns of cognitive impairment.11 The meantime, cognitive function was combined with outcomes, screening of cognitive function could be of importance in a clinical setting.12
Furthermore, severity levels of traumatic brain injury determine cognitive impairment. Various levels of traumatic brain injury contain; severe- moderate-mild could have various outcomes in cognitive impairment. Similar research declared moderate-to-severe traumatic brain injury can cause varying degrees of cognitive control deficits positive relationship to injury severity correlated with self-reported cognitive control problems in everyday-life situations.13 Traumatic brain injury is a risk factor for cognitive decline in mild cognitive impairment older adults patients.14 Patients with mild traumatic brain injury had worse neurocognitive function, higher overall symptom severity and higher total number of symptoms, there is a cognitive deficit and symptom burden in patients with TBI.15
In other words, traumatic brain injury is usually caused by a strike or other traumatic injury to the head or body.16 The most common causes of TBI are falls and vehicle accidents, followed by acts of violence and other reasons, such as for example fights injuries. Also, different causes of TBI suffer from various cognitive impairment. In particular, car accident, head trauma, and fall reported different cognitive impairment.
Education plays important role in cognitive impairment following TBI. Literature indicated that education appeared to affect verbal and nonverbal task performance in mild cognitive impairment patients. While higher educated patients are more acquainted with the tasks, slower deterioration in consecutive follow-up considerations could be explained by the cognitive reserve theory.17
In fact, the importance of comprehensive neuropsychological assessments in each case of TBI in order to identify impaired and preserved functions as long as sufficient managing including rehabilitation programs for each case.18 Therefore, the aims of this study were to consider and predict the cognitive impairments through different levels, causes of TBI, and education status in traumatic brain injury patients to consider this three-factor to set more essential rehabilitation program in future.
