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More than amnesia: prospective cohort study of an integrated novel assessment of the cognitive and behavioural features of PTA

Published online by Cambridge University Press:  18 February 2021

Maria J. Hennessy Open the ORCID record for Maria J. Hennessy [Opens in a new window] ,
Lorryn Delle Baite Open the ORCID record for Lorryn Delle Baite [Opens in a new window]  and
Laurence A. G. Marshman
Maria J. Hennessy*
Affiliation:
Psychology, James Cook University Singapore, Singapore Psychology, James Cook University, Townsville, Queensland, Australia
Lorryn Delle Baite
Affiliation:
Psychology, James Cook University, Townsville, Queensland, Australia
Laurence A. G. Marshman
Affiliation:
School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Neurosurgery, The Townsville Hospital, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
*
*Corresponding author. Email: [email protected]
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Abstract

Background and Objective:

Post-traumatic amnesia (PTA) is an early significant stage of recovery from traumatic brain injury (TBI). Current prospective PTA scales do not assess the full range of PTA symptomatology. This study conducted a novel integrated assessment of cognition and behaviour during PTA.

Method:

Twenty-four moderate-to-severe TBI participants in PTA and 23 TBI controls emerged from PTA were matched for age, gender, and years of education. All completed PTA measures (Galveston Orientation and Amnesia Test: GOAT, Westmead Post-traumatic Amnesia Scale: WPTAS), a cognitive battery; and behaviour ratings scored by 2 independent raters (informant and staff).

Results:

Significantly poorer performance was found during PTA for attention, processing speed, delayed verbal free recall and recognition, and visual learning. A large effect size was found for category fluency only. Behaviour ratings were significantly higher during PTA. Five behaviours were rated as high frequency (>50%) by both raters: Inattention, Impulsivity, Sleep Disturbance, Daytime Arousal, and Self-Monitoring. Prospective PTA measures produced significantly different duration estimates from 2 days (GOAT vs. WPTAS 1st day) to 9 days (WPTAS 1st day vs. 3-day). The WPTAS correlated most highly with processing speed and language tasks; whilst the GOAT correlated most highly with language and executive control of verbal memory.

Conclusion:

New prospective measures are needed that integrate core cognitive and behavioural features are brief, easy to administer, and capable of measuring emergence. The term PTA is a misnomer that requires revision to better accommodate the clinical syndrome.

Keywords

Post-traumatic amnesiatraumatic brain injuryassessment
Type
Articles
Information
Brain Impairment , Volume 22 , Issue 3 , December 2021 , pp. 294 - 311
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment

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References

Andriessen, T. M. J. C., De Jong, B., Jacobs, B., Van Der Werf, S. P., & Vos, P. E. (2009). Sensitivity and specificity of the 3-item memory test in the assessment of post traumatic amnesia. Brain Injury, 23(4), 345–352. doi: 10.1080/02699050902791414 CrossRefGoogle ScholarPubMed
Baddeley, A. D. (1997). Human memory: Theory and practice (Revised Edition). Psychology Press.Google Scholar
Bogner, J. A., & Corrigan, J. D. (2000). Rating scale analysis of the Agitated Behaviour Scale. Journal of Head Trauma Rehabilitation, 15(1), 656–669.CrossRefGoogle Scholar
Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J. & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, Supplement 43, 113–125. doi: 10.1080/16501960410023877 CrossRefGoogle Scholar
Cohen, J. (1977). Statistical power analysis for the behavioural sciences. New York: Academic Press.Google Scholar
Colarusso, R.P., & Hammill, D.D. (2003). Motor-free visual perception test (3rd ed.). Novato, CA: Academic Therapy Publications.Google Scholar
Corrigan, J. D. (1989). Development of a scale for assessment of agitation following traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 11(2), 261–277. doi: 10.1080/01688638908400888 CrossRefGoogle ScholarPubMed
De Simoni, S., Grover, P. J., Jenkins, P. O., Honeyfield, L., Quest, R. A., Ross, E., … Sharp, D. J. (2016). Disconnection between the default mode network and medial temporal lobes in post-traumatic amnesia. Brain, 139, 3137–3150. doi: 10.1093/brain/aww241 CrossRefGoogle Scholar
Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (2000). California verbal learning test (2nd ed.). San Antonio, TX: Psychological Corporation.Google Scholar
Ewert, J., Levin, H. S., Watson, M. G., & Kalisky, Z. (1989). Procedural memory during posttraumatic amnesia in survivors of severe closed head injury. Archives of Neurology, 46(8), 911–916. doi: 10.1001/archneur.1989.00520440105027 CrossRefGoogle ScholarPubMed
Fodor, I. E. (1972). Impairment of memory functions after acute head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 35, 818–824. doi: 10.1136/jnnp.35.6.818 CrossRefGoogle ScholarPubMed
Gasquoine, P. G. (1991). Learning in post-traumatic amnesia following extremely severe closed head injury. Brain Injury, 5(2), 169–175. doi: 10.3109/02699059109008087 CrossRefGoogle ScholarPubMed
GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators (2019). Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurology, 18, 56–87. doi: 10.1016/S1474-4422(18)30415-0 CrossRefGoogle Scholar
Glisky, E. L., & Delaney, S. M. (1996). Implicit memory and new semantic learning in posttraumatic amnesia. Journal of Head Trauma Rehabilitation, 11(2), 31–42. doi: 10.1097/00001199-199604000-00004 CrossRefGoogle Scholar
Hart, R. P., Levenson, J. L, Sessler, C. N, Best, A. M, Schwartz, S. M, & Rutherford, L. E. (1996). Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics, 37, 533–546. doi: 10.1016/S0033-3182(96)71517-7 CrossRefGoogle ScholarPubMed
Hennessy, M. J., Marshman, L. A. G., delle Baite, L., & McLellan, J. (2020). Optimizing and simplifying post-traumatic amnesia testing after moderate-to-severe traumatic brain injury despite common confounders in clinical practice. Journal of Clinical Neuroscience, 81, 37–42. doi: 10.1016/j.jocn.2020.09.030 CrossRefGoogle Scholar
Kalmar, K., Novack, T. A., Nakase-Richardson, R., Sherer, M., Frol, A. B., Gordon, W. A., Ricker, J. H. (2008). Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89, 942–949. doi: 10.1016/j.apmr.2008.01.008 CrossRefGoogle ScholarPubMed
Keelan, R. E., Mahoney, E. J., Sherer, M., Hart, T., Giacino, J., Bodien, Y. G., … Vanderploeg, R. D. (2019). Neuropsychological characteristics of the confusional state following traumatic brain injury. Journal of the International Neuropsychological Society, 25, 302–313. doi: 10.1017/S1355617718001157 CrossRefGoogle Scholar
Leach, K., Kinsella, G., Jackson, M., & Matyas, T. (2006). Recovery of components of memory in post-traumatic amnesia. Brain Injury, 20(12), 1241–1249. doi: 10.1080/02699050601049874 CrossRefGoogle ScholarPubMed
Levin, H. S., High, W. M., & Eisenberg, H. M. (1988). Learning and forgetting during posttraumatic amnesia in head injured patients. Journal of Neurology, Neurosurgery, & Psychiatry, 51, 14–20. doi: 10.1136/jnnp.51.1.14 CrossRefGoogle ScholarPubMed
Levin, H. S., O’Donnell, V. M., & Grossman, R. G. (1979). The Galveston Orientation and Amnesia Test: A practical scale to assess cognition after head injury. The Journal of Nervous and Mental Disease, 167(11), 675–684. doi: 10.1097/00005053-197911000-00004 CrossRefGoogle ScholarPubMed
Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York: Oxford University Press.Google Scholar
Marshman, L. A. G, Jakabek, D., Hennessy, M., Quirk, F., & Guazzo, E. P. (2013). Post-traumatic amnesia. Journal of Clinical Neuroscience, 20(11), 1475–1481. doi: 10.1016/j.jocn.2012.11.022 CrossRefGoogle ScholarPubMed
McKay, A., Love, J., Trevena-Peters, J., Gracey, J. & Ponsford, J. (2018). The relationship between agitation and impairments of orientation and memory during the PTA period after traumatic brain injury. Neuropsychological Rehabilitation. doi: 10.1080/09602011.2018.1479276 Google ScholarPubMed
McLellan, J., Marshman, L. A. G. & Hennessy, M. (2017). Anterograde amnesia and disorientation are associated with in-patients without traumatic brain injury taking opioids. Retrograde amnesia (RA) is absent. RA assessment should be integral to post-traumatic amnesia testing. Journal of Clinical Neuroscience, 44, 184–187. doi: 10.1016/j.jocn.2017.06.027 CrossRefGoogle Scholar
Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., … Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatric Association, 53(4), 695–699. doi: 10.1111/j.1532-5415.2005.53221.x CrossRefGoogle ScholarPubMed
Nott, M. T., Chapparo, C., Heard, R., & Baguley, I. J. (2010). Patterns of agitated behaviour during acute brain injury rehabilitation. Brain Injury, 24(10), 1214–1221. doi: 10.3109/02699052.2010.506858 CrossRefGoogle ScholarPubMed
Paradis, M., & Libben, G. (1987). The assessment of bilingual aphasia. Hillsdale, NJ: Erlbaum. doi: 10.3109/02699052.2010.506858 Google Scholar
Rimel, R. W., Giordani, B., Barth, J. T., & Lane, J. A. (1982). Moderate head injury: Completing the clinical spectrum of brain trauma. Neurosurgery, 11(3), 344–351. doi: 10.1227/00006123-198209000-00002 CrossRefGoogle ScholarPubMed
Roberts, C. M., Spitz, G. & Ponsford, J. L. (2015). Retrospective analysis of the recovery of orientation and memory during posttraumatic amnesia. Neuropsychology, 29(4), 522–529. doi: 10.1037/neu0000178 CrossRefGoogle ScholarPubMed
Roberts, C. M., Spitz, G., Mundy, M. & Ponsford, J. L. (2018). Retrograde personal semantic memory during posttraumatic amnesia and following emergence. Journal of the International Neuropsychological Society, 24, 1064–1072. doi: 10.1017/S1355617718000565 CrossRefGoogle Scholar
Russell, W. R. (1932). Cerebral involvement in head injury: A study based on the examination of two hundred cases. Brain, 55, 549–603. doi: 10.1093/brain/55.4.549 CrossRefGoogle Scholar
Russell, W. R, & Smith, A. (1961). Post-traumatic amnesia in closed head injury. Archives of Neurology, 5(1), 4–7. doi: 10.1001/archneur.1961.00450130006002 CrossRefGoogle ScholarPubMed
Sherer, M., Nakase-Thompson, R., Yablon, S. A., & Gontkovsky, S. T. (2005). Multidimensional assessment of acute confusion after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 86(5), 896–904. doi: 10.1016/j.apmr.2004.09.029 CrossRefGoogle ScholarPubMed
Shores, E. A. (1995). Further concurrent validity data on the Westmead PTA Scale. Applied Neuropsychology, 2, 167–169. doi: 10.1080/09084282.1995.9645356 CrossRefGoogle Scholar
Shores, E. A., Marosszeky, J. E., Sandanam, J., & Batchelor, J. (1986). Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. The Medical Journal of Australia, 144, 569–572. doi: 10.5694/j.1326-5377.1986.tb112311.x CrossRefGoogle ScholarPubMed
Smith, A. (1991). Symbol digit modalities test. Los Angeles, CA: Western Psychological Services.Google Scholar
Steel, J., Ferguson, A., Spencer, E. & Togher, L. (2017). Social communication assessment during post-traumatic amnesia and the post-acute period after traumatic brain injury. Brain Injury, 31(10), 1320–1330. doi: 10.1080/02699052.2017.1332385 CrossRefGoogle ScholarPubMed
Stiell, I. G., Wells, G. A, Vandemheen, K., Clement, C., Lesiuk, H., Laupacis, A., Worthington, J. (2001). The Canadian CT head rule for patients with minor head injury. The Lancet, 357, 1391–1396. doi: 10.1016/s0140-6736(00)04561-x CrossRefGoogle ScholarPubMed
Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.). New York: Oxford University Press.Google Scholar
Stuss, D. T., Binns, M. A., Carruth, F., Levine, B., Brandys, C. E., Moulton, R. J., … Schwartz, M. L. (1999). The acute period of recovery from traumatic brain injury: posttraumatic amnesia or posttraumatic confusional state? Journal of Neurosurgery, 90(4), 635–643. doi: 10.3171/jns.1999.90.4.0635 CrossRefGoogle ScholarPubMed
Symonds, C. P. (1937). Mental disorder following head injury. Proceedings of the Royal Society of Medicine, 30(9), 1081–1094. doi: 10.1177/003591573703000926 CrossRefGoogle ScholarPubMed
Symonds, C. (1940). Concussion and contusion of the brain and their sequelae. In Brock, S. (Ed.), Injuries of the Brain and Spinal Cord (pp. 100–161). The Williams & Wilkins Company.Google Scholar
Symonds, C. P., & Russell, W. R. (1943). Accidental head injuries: Prognosis in service patients. The Lancet, 241(6227), 7–10. doi: 10.1016/S0140-6736(00)70687-8 CrossRefGoogle Scholar
Tate, R. L., Baguley, I. J., Marosszeky, J. E., Gurka, J. A., Hodgkinson, A. E., King, C., … Hanna, J. (2006). A multicenter, randomized trial examining the effect of test procedures measuring emergence from post-traumatic amnesia. Journal of Neurology, Neurosurgery, & Psychiatry, 77, 841–849. doi: 10.1136/jnnp.2005.074989 CrossRefGoogle ScholarPubMed
Tate, R. L., & Pfaff, A. (2000). Problems and pitfalls in the assessment of posttraumatic amnesia. Brain Impairment, 1(2), 116–129. doi: 10.1375/brim.1.2.116 CrossRefGoogle Scholar
Tittle, A., & Burgess, G. H. (2011). Relative contribution of attention and memory toward disorientation or post-traumatic amnesia in an acute brain injury sample. Brain Injury, 25(10), 933–942. doi: 10.3109/02699052.2011.597042 CrossRefGoogle ScholarPubMed
Walker, W. C., Strombert, K. A., Marwitz, J. H., Sima, A.P., Agyemang, A. A., Graham, K. M., … Merchant, R. (2018). Predicting long-term global outcome after traumatic brain injury: Development of a practical prognostic tool using the traumatic brain injury model systems national database. Journal of Neurotrauma, 35, 1587–1595. doi: 10.1089/neu.2017.5359 CrossRefGoogle Scholar
Walsh, K.W. (1985). Understanding brain damage: A primer of neuropsychological evaluation. Melbourne, Australia: Churchill Livingstone.Google Scholar
Walterfang, M., Velakoulis, D., Gibbs, A., & Lloyd, J. (2003). The NUCOG: Construction and piloting of a cognitive screening instrument in a neuropsychiatric unit. Australasian Psychiatry, 11(3), 325–329. doi: 10.1046/j.1440-1665.2003.t01-1-00558.x CrossRefGoogle Scholar
Weir, N., Doig, E. J., Fleming, J. M., Wiemers, A., & Zemljic, C. (2006). Objective and behavioural assessment of the emergence from post-traumatic amnesia (PTA). Brain Injury, 20(9), 927–935. doi: 10.1080/02699050600832684 CrossRefGoogle Scholar
Wilson, B. A., Baddeley, A., Shiel, A., & Patton, G. (1992). How does post-traumatic amnesia differ from the amnesic syndrome and from chronic memory impairment? Neuropsychological Rehabilitation, 2, 231–243. doi: 10.1080/09602019208401410 CrossRefGoogle Scholar
Wilson, B. A., Evans, J. J., Emslie, H., Balleny, H., Watson, P. C., & Baddeley, A. (1999). Measuring recovery from post-traumatic amnesia. Brain Injury, 13(7), 505–520. doi: 10.1080/026990599121412 CrossRefGoogle ScholarPubMed
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