Sains Malaysiana 42(3)(2013): 403–408

Neuropsychological Profile at Three Months Post Injury in Patients with Traumatic Brain Injury

(Profil Neuropsikologi Tiga Bulan Selepas Kecederaan pada Pesakit dengan Kecederaan Trauma Otak)

Ramli Ali

Department of Psychiatry, Hospital Selayang, Lebuhraya Selayang-Kepong

68100 Batu Caves, Selangor Darul Ehsan, Malaysia

Suzaily Wahab* & Abdul Hamid Abdul Rahman

Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia

Diserahkan: 12 Mei 2012/Diterima: 4 Julai 2012

ABSTRACT

This study looked into the rate and pattern of neuropsychological impairment in patients with traumatic brain injury patients at three months post injury. Forty patients attending the neurosurgery outpatient clinic were included in the study. Benton visual retention test (BVRT), rey auditory verbal learning test (RAVLT), digit span test, trail making test (TMT) and mini mental state examination (MMSE) were used for assessment. Forty five percent (n=18) sustained moderate to severe head injury. Twenty five percent (n=10) have abnormal MMSE result. Forty two and a half percent (n=17) have abnormal BVRT result. Seventy five percent (n=30) have abnormal RAVLT result while 35% (n=14) have abnormal digit span test result. Seventy seven and a half percent (n=31) have at least one neurological deficit. There was significant association between severity of head injury (GCS score) and neuropsychological deficit. This study highlights the point that in post head injury patients, there are high occurrences of cognitive dysfunction. MMSE and GCS play a significant and important role in assessing cognitive dysfunction. Severity of head injury as determined by GCS scores also influence the outcome in patients with head injury.

Keywords: Cognitive dysfunction; head injury; neuropsychological impairment

ABSTRAK

Kajian ini melihat kadar dan bentuk kelainan neuropsikologi dalam kalangan mereka yang mengalami kecederaan kepala tiga bulan selepas kemalangan. Empat puluh pesakit yang datang ke klinik pesakit luar neurosurgeri diambil untuk kajian ini. Ujian pengekalan penglihatan Benton (BVRT), ujian pembelajaran pendengaran verbal rey (RAVLT), ujian digit span, ujian membuat jejak (TMT) dan pemeriksaan keadaan mental mini (MMSE) digunakan untuk pengukuran. Empat puluh lima peratus (n=18) mengalami kecederaan kepala yang sederhana kepada teruk. Dua puluh lima peratus (n=10) menunjukkan keputusan MMSE yang tidak normal. Empat puluh dua setengah peratus (n=17) menunjukkan keputusan BVRT tidak normal. Tujuh puluh lima peratus (n=30) menunjukkan keputusan RAVLT tidak normal, sementara 35% (n=14) menunjukkan ujian digit span tidak normal. Tujuh puluh tujuh setengah peratus (n=31) mengalami sekurang-kurangnya satu kelainan neuropsikologi. Terdapat hubungan yang signifikan antara keterukan kecederaan kepala (skor GCS) dengan kelainan neuropsikologi. Kajian ini menunjukkan bahawa selepas berlakunya kecederaan kepala terdapat disfungsi kognitif pada kadar yang tinggi. MMSE dan GCS memainkan peranan yang signifikan dan penting dalam mengukur disfungsi kognitif. Keterukan kecederaan kepala yang diukur oleh skor GCS juga mempengaruhi kesan akhir pada pesakit yang mengalami kecederaan kepala.

Kata kunci: Kecederaan kepala; kecelaan kognitif; kelainan neuropsikiologi

RUJUKAN

Arnett, J.A. & Seth, S.L.1995. Effect of physical layout in performance of the trail making test. Psychological Assessment 7(2): 220-221.

Ashendorf, L., Jefferson, A.L., O’Connor, M.K., Chaisson, C., Green, R.C. & Stearn, R.A. 2008. Trail making test errors in normal aging, mild cognitive impairment, and dementia. Archives of Clinical Neuropsychology 23: 129-137.

Beatty, W.W. & Goodkin, D.E. 1990. Screening for cognitive impairment in multiple sclerosis: An evaluation of the mini mental state examination. Archive of Neurology 47: 297-301.

Benton, A.L. 1955. The Revised Visual Retention Test: Clinical and Experimental Applications. New York: Psychological Corporation.

Benton, A.L. 1974. The Revised Visual Retention Test: Clinical and Experimental Application. 4th ed. New York: The Psychological Corporation.

Brigler, E.D. 1989. Rey auditory verbal learning and Rey-osterrieth complex figure design performance in Alzheimer’s disease and close head injury. Journal of Clinical Psychiatry 45: 277-280.

Bruns, J. & Hauser, W.A. 2003. The epidemiology of traumatic brain injury: Areview. Epilepsia 44(suppl 10): 2-10.

Carroll, L.J., Cassidy, J.D., Peloso, P.M., Borg, J., Holst, H.V., Holm, L., Paniak, C. & Pépin, M. 2004. Prognosis for mild traumatic brain injury: Results of the WHO collaborating centre task force on mild traumatic brain injury. J. Rehabil. Med. 36(43): 84-105.

Clifton, G.L., Kreutzer, J.S., Choi, S.C., Devany, C.W., Eisenberg, H.M., Foulkes, M.A., Jane, J.A., Marmarou, A. & Marshall, L.F.1993. Relationship between Glasgow coma scale and neuropsychological measures after brain injury. Neurosurgery 33(1): 34-39.

Deb, S., Lyons, I. & Koutzoukis, C. 1999. Neurobehavioural symptoms one year after a head injury. British Journal of Psychiatry 174: 360-365.

Dikmen, S.S., Machamer, J.E., Winn, H.R. & Temkin, N.R.1995. Neuropsychological outcome at 1-year post head injury. Neuropsychology 9(1): 80-90.

Dikmen, S.S., Machamer, J.E. & Temkin, N.R. 2001. Mild head injury: Facts and artifacts. J. Clin. Exper. Neuropsychol. 23: 729-738.

Fenton, G., McClelland, R., Montgomery, A., MacFlynn, G. & Rutherford, W. 1993. The postconcussional syndrome: Social antecedents and psychological sequelae. Br. J. Psychiatry 162(4): 493-497.

Folstein, M., Folstein, S. & McHugh, P. 1975. Mini Mental State: Apractical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12: 189-198.

Frankowski, R.F., Annegers, J.F. & Whitman, S. 1985. Epidemiological and descriptive studies. Part 1. The descriptive epidemiology of head trauma in the United States. In: Central Nervous System Trauma Status Report-1985, edited by Becker, D.P. & Povlishock, J.T. Bethesda: NIH, NINCDS. pp. 33-43.

Galasko, D., Klauber, M.R., Hofstetter, C.R., Salmon, D.P., Lasker, B. & Thal, L.J. 1990. The mini mental state examination in the early diagnosis of Alzheimer’s disease. Archive of Neurology 47(1): 49-52.

Levin, H.S., Benton, A.L. & Grossman, R.G. 1982. Neurobehavioural Consequences of Close Head Injury. New York: Oxford University Press.

Levin, H.S., Gary, H.E. Jr., Eisenberg, H.M., Ruff, R.M., Barth, J.T., Kreutzer, J., High, W.M. Jr., Portman, S., Foulkes, M.A., Jane, J.A., Marmarou, A. & Marshall, L.F. 1990. Neurobehavioural outcome 1 year after head injury: Experience of the traumatic coma data bank. J. Neurosurgery 73(5): 699-709.

Lishman, W.A. 1968. Brain damage in relation to psychiatric disability after head injury. British Journal of Psyhiatry 114: 373-416.

Lishman, W.A. 1988. Physiogenesis in the ‘post- concussional syndrome’. British Journal of Psychiatry 153: 460-469.

Mandleberg, I.E. & Brooks, D.N. 1975. Cognitive recovery after severe head injury. 1. Serial testing on the WAIS. Journal Neurology, Neurosurgery and Psychiatry 38(11): 1121-1126.

McKinlay, W.W., Brooks, D.N., Bond, M.R., Martinage, D.P. & Marshall, M.M. 1981. The short-term outcome of severe blunt head injury as reported by relatives of the injured person. J. Neurol. Neurosurg. Psychiatry 44(6): 527-533.

O’Donnell, J.P., Rasdtke, R.C., Leicht, D.J. & Caesar, R. 1998. Encoding and retrieval processes in learning disabled, head-injured, and non-disable young adults. The Journal of General Psychology 115: 355-368.

Peck, E.A. & Mitchell, S.A. 1990. Normative data for 538 head injury patients across seven time periods after injury. In: Practitioner’s Guide to Clinical Neuropsychology, edited by Anderson, R.M. p. 235.

Periáñez, J.A., Ríos-Lago, M., Rodríguez-Sánchez, J.M., Adrover-Roig, D., Sánchez-Cubillo, I., Crespo-Facorro, B., Quemada, J.I. & Barceló, F. 2007. Trail making test in traumatic brain injury, schizophrenia, and normal ageing: Sample comparisons and normative data. Arch. Clin. Neuropsychol. 22(4): 433-447.

Reekum, R., Cohen, T. & Wong, J. 2000. Can traumatic brain injury cause psychiatric disorders? J. Neuropsychiatry Clin. Neurosci. 12: 316-327.

Rey, A. 1964. L’Examen Clinique en Psychologie. [Clinical tests in psychology]. Paris: Press Universitaire de France.

Rosenberg, S.J., Ryan, J.J. & Prifitera, A. 1984. Rey auditory verbal learning test performance of patients with and without memory impairment. Journal of Clinical Psychology 40: 785-787.

Sivan, A.B. 1991. Benton Visual Retention Test Manual. 5th ed. San Antonio, TX: Harcourt Brace & Company.

Spreen, O. & Strauss, E. 1998. A Compendium of Neuropsychological Tests: Administration, Norms and Commentary. New York: Oxford University Press.

Stuss, D.T., Bisschop, S.M., Alexander, M.P., Levine, B., Katz, D. & Izukawa, D. 2001. The trail making test: Astudy in focal lesion patients. Psychological Assessment 13: 230-239.

Thatcher, R.W., North, D.M., Curtin, R.T., Walker, R.A., Biver, C.J., Gomez, J.F. & Salazar, A.M. 2001. An EEG severity index of traumatic brain injury. J. Neuropsychiatry Clin. Neurosci. 13(1): 77-87.

Thompson, S.B.N. 2006. Dementia and Memory: A Handbook for Students and Professionals. Aldershot: Ashgate.

Thompson, S.B.N., Ennis, E., Coffin, T. & Farman, S. 2007. Design and evaluation of a computerised version of the Benton visual retention test. Computers in Human Behavior 23: 2383-2393.

Vanderploeg, R., Curtiss, G. & Belanger, H. 2005. Long-term neuropsychological outcomes following mild traumatic brain injury. J. Int. Neuropsychol. Soc. 11: 228-236.

*Pengarang untuk surat-menyurat: suzailywhb@yahoo.com