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Neuropsychological Characteristics of the Confusional State Following Traumatic Brain Injury

Published online by Cambridge University Press:  25 January 2019

Rachel E. Keelan ,
Elaine J. Mahoney ,
Mark Sherer ,
Tessa Hart ,
Joseph Giacino ,
Yelena G. Bodien ,
Risa Nakase-Richardson ,
Kristen Dams-O’Connor ,
Thomas A. Novack  and
Rodney D. Vanderploeg
Rachel E. Keelan
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan
Elaine J. Mahoney
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida
Mark Sherer
Affiliation:
TIRR Memorial Hermann, Houston, Texas
Tessa Hart
Affiliation:
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
Joseph Giacino
Affiliation:
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts
Yelena G. Bodien
Affiliation:
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
Risa Nakase-Richardson*
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida Defense and Veterans Brain Injury Center (DVBIC), Tampa, Florida Morsani College of Medicine, Division of Sleep and Pulmonary Medicine, University of South Florida, Tampa, Florida VA HSRD Center of Innovation on Disability and Rehabilitation Research, Tampa, Florida
Kristen Dams-O’Connor
Affiliation:
Department of Rehabilitation Medicine, The Mount Sinai Hospital, New York, New York Department of Neurology Icahn School of Medicine at Mount Sinai, New York, New York
Thomas A. Novack
Affiliation:
Department of Physical Medicine & Rehabilitation, The University of Alabama at Birmingham, Birmingham, Alabama
Rodney D. Vanderploeg
Affiliation:
Mental Health & Behavioral Sciences, James A. Haley Veterans’ Hospital, Tampa, Florida Defense and Veterans Brain Injury Center (DVBIC), Tampa, Florida Department of Psychiatry and Behavioral Neurosciences, and Department of Psychology, University of South Florida, Tampa, Florida
*
Correspondence and reprint requests to: Risa Nakase-Richardson, Polytrauma TBI Rehabilitation/Mail Code 117, 13000 Bruce B. Downs Blvd., Tampa, FL. E-mail: risa.richardson@va.gov
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Abstract

Objectives: Individuals with moderate–severe traumatic brain injury (TBI) experience a transitory state of impaired consciousness and confusion often called posttraumatic confusional state (PTCS). This study examined the neuropsychological profile of PTCS. Methods: Neuropsychometric profiles of 349 individuals in the TBI Model Systems National Database were examined 4 weeks post-TBI (±2 weeks). The PTCS group was subdivided into Low (n=46) and High Performing PTCS (n=45) via median split on an orientation/amnesia measure, and compared to participants who had emerged from PTCS (n=258). Neuropsychological patterns were examined using multivariate analyses of variance and mixed model analyses of covariance. Results: All groups were globally impaired, but severity differed across groups (F(40,506)=3.44; p<.001; ŋp2 =.206). Rate of forgetting (memory consolidation) was impaired in all groups, but failed to differentiate them (F(4,684)=0.46; p=.762). In contrast, executive memory control was significantly more impaired in PTCS groups than the emerged group: Intrusion errors: F(2,343)=8.78; p<.001; ŋp2=.049; False positive recognition errors: F(2,343)=3.70; p<.05; ŋp2=.021. However, non-memory executive control and other executive memory processes did not differentiate those in versus emerged from PTCS. Conclusions: Executive memory control deficits in the context of globally impaired cognition characterize PTCS. This pattern differentiates individuals in and emerged from PTCS during the acute recovery period following TBI. (JINS, 2019, 25, 302–313)

Keywords

Posttraumatic amnesiaHead injuryDeliriumCognitionMemoryExecutive functioning
Type
Special Section: Traumatic Brain Injury
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 3 , March 2019 , pp. 302 - 313
Copyright
Copyright © The International Neuropsychological Society 2019 

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