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Executive Functions Deficits After Severe Traumatic Brain Injury: The GREFEX Study

Philippe Azouvi¹, Claire Vallat-Azouvi, Pierre-Alain Joseph

¹AP-HP, hôpital Raymond Poincaré, service de Médecine Physique et de Réadaptation, Garches (Dr Azouvi); EA 4047 HANDIReSP, Université de Versailles Saint Quentin (Drs Azouvi and Vallat-Azouvi); Antenne UEROS et SAMSAH92- UGECAMIDF, Hôpital Raymond Poincaré, Garches (Dr Vallat-Azouvi); EA 4136 Université de Bordeaux (Dr Joseph); Neuropsychology Unit, University of Liège, Liège, Belgium (Dr Meulemans); CRF Calve, Fondation Hopale, Berck, France (Ms Bertola); LPPL, EA 4638, and Unité de Neuropsychologie, CHU and Université d'Angers, Angers, France (Dr Le Gall); Clinique romande de réadaptation, Sion, Switzerland (Dr Bellmann); Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens, Amiens, France (Drs Roussel and Godefroy); Saint Luc University Hospital Bruxelles, Brussels, Belgium (Ms Coyette); Institut régional de médecine physique et de réadaptation, Nancy, France (Ms Krier); University Hospital, Nimes, France (Ms Franconie); Lausanne University Hospital, Lausanne, Switzerland (Dr Bindschadler); and Department of Biostatistics, University Hospital of Amiens, Amiens, France (Mr Diouf).

The Journal of Head Trauma Rehabilitation

|September 23, 2015

Abstract

Objective:

To assess the sensitivity of traditional neuropsychological tests and of a behavioral inventory of executive disorders in a large sample of patients with chronic severe traumatic brain injury.

Methods:

A total of 112 patients were compared with 780 healthy controls from a larger database. The GREFEX battery included 7 widely used tests and the Behavioral Dysexecutive Syndrome Inventory (proxy rating). A previously described statistical methodology was used, controlling for age, education, and gender. Summary scores were computed and performance was dichotomized on the basis of 5th percentile cutoffs from controls' z scores.

Results:

The frequency of cognitive impairment was high (55.4%) but lower than that of behavioral changes (81.5%). Double dissociations were observed between cognitive and behavioral assessments. Behavioral changes exhibited larger effect-sizes as compared with cognitive impairments. Logistic regression analysis showed that 3 cognitive tests (verbal fluency, Stroop reading, and Trail Making Test-B) and 3 behavior z scores (hypoactivity, anticipation, and hyperactivity) best discriminated patients from controls.

Conclusion:

Behavioral changes were more frequent and severe than cognitive deficits, at least as assessed with traditional testing. The present results also suggest that a shortened battery may provide a rapid screening method with reasonable sensitivity to detect deficits of executive functions in patients with severe traumatic brain injury.

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