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Cognitive Performance in Multiple Trauma Patients 3 Years After Injury

From the Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo (A.F.); Department of Physical Medicine and Rehabilitation, University Hospital of Tromsø, Tromsø, (A.W.A.); Sunnaas Rehabilitation Hospital, University of Oslo, Nesoddtangen (E.H., J.K.S.); Centre for Physiotherapy Research and Development, Oslo (K.S.R.); and Department of Surgery, Ullevål Hospital, University of Oslo, Oslo (J.P.-L.), Norway.

Address reprint requests to: A. Finset, PhD, Department of Behavioural Sciences in Medicine, University of Oslo, POB 1111 Blindern, N-0317 Oslo, Norway. Email: arnstein.finset{at}basalmed.uio.no

OBJECTIVES: Patients with sequelae from multiple trauma commonly display cognitive disturbances, specifically in the areas of attention and memory. This study was designed to assess cognitive functioning 3 years after severe multiple trauma and to investigate how cognitive performance is related to head injury severity and psychological distress respectively.

METHODS: Sixty-eight multiple trauma patients were tested with a screening battery consisting of six neuropsychological tasks 3 years after injury. A measure of psychological distress (20-item General Health Questionnaire, or GHQ-20) was also administered.

RESULTS: Patients who neither showed signs of reduced consciousness on admission to the hospital nor reported significant psychological distress at follow-up tended to have normal test performance. In five of the six tasks, cognitive impairment was related to the severity of the traumatic brain injury as measured by the Glasgow Coma Scale (GCS). In both attention span tasks, patients designated as cases by the GHQ had significantly lower scores than noncase patients. These bivariate relationships were upheld in multiple regression analyses, in which age, sex, and GCS and GHQ scores were entered as independent variables. When patients with severe head injuries were excluded from the analyses, GCS scores still contributed to the variance in tests of verbal attention span and delayed recall, but performance on attentional tasks was more strongly related to psychological distress than to GCS scores.

CONCLUSIONS: Cognitive deficits in multiple trauma patients were related both to the severity of the traumatic brain injury and to the degree of psychological distress. The strength of the association between brain injury as indicated by GCS scores and cognitive performance differed between different tasks. Neuropsychological testing may assist in differentiating primary organic from secondary psychogenic impairments.

Key Words: multiple trauma • neuropsychological tests • cognitive impairment • psychological distress • brain injuries

Abbreviations: AIS = Abbreviated Injury Scale; ANOVA = analysis ofvariance; GCS = Glasgow Coma Scale; GHQ = General HealthQuestionnaire; GHQ-20 = 20-item General Health Questionnaire; MT = multiple trauma; PASAT = Paced Auditory Serial AdditionTask; TBI = traumatic brain injury.