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Severity of Ongoing Post-Concussive Symptoms as a Predictor of Cognitive Performance Following a Pediatric Mild
Veronik Sicard1, Danielle C Hergert1, Sharvani Pabbathi Reddy1
1The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, USA.
Insights
Pediatric mild traumatic brain injury (pmTBI) patients showed lower visual learning accuracy in the sub-acute phase, but cognitive recovery was observed by 4 months. Ongoing symptoms predicted performance, not premorbid factors.
Area of Science:
- Neuroscience
- Pediatric neurology
- Cognitive psychology
Background:
- Pediatric mild traumatic brain injury (pmTBI) can impact cognitive function.
- Understanding predictors of cognitive performance is crucial for recovery.
- Sub-acute (SA) and early chronic (EC) phases require distinct investigation.
Purpose of the Study:
- To identify predictors of cognitive performance in pediatric mild TBI (pmTBI) patients.
- To compare cognitive performance between pmTBI patients and healthy controls (HC) in SA and EC phases.
- To investigate the role of post-concussive symptoms (PCS) and clinical risk scores.
Main Methods:
- 203 pmTBI patients and 159 HC (ages 8-18) completed computerized cognitive testing (Cogstate) and symptom inventories.
- Assessments were conducted in the SA phase (1-11 days) and a subset in the EC phase (~4 months).
- Regression analyses examined predictors of cognitive performance, including PCS and 5P clinical risk scores.
Main Results:
- In the SA phase, pmTBI patients showed lower accuracy on the One-Card Learning visual task compared to HC.
- Higher ongoing PCS and 5P clinical risk scores predicted lower One-Card Learning accuracy in the SA phase.
- Premorbid variables did not predict cognitive performance in the SA phase.
Conclusions:
- Cognitive recovery is suggested by the absence of group differences in the EC phase (4 months post-injury).
- Ongoing PCS and 5P scores were better predictors of SA cognitive performance than premorbid factors.
- Current models explain limited variance, indicating a need for further research into cognitive outcome predictors.
Objective:
This study aimed to examine the predictors of cognitive performance in patients with pediatric mild traumatic brain injury (pmTBI) and to determine whether group differences in cognitive performance on a computerized test battery could be observed between pmTBI patients and healthy controls (HC) in the sub-acute (SA) and the early chronic (EC) phases of injury.
Method:
203 pmTBI patients recruited from emergency settings and 159 age- and sex-matched HC aged 8-18 rated their ongoing post-concussive symptoms (PCS) on the Post-Concussion Symptom Inventory and completed the Cogstate brief battery in the SA (1-11 days) phase of injury. A subset (156 pmTBI patients; 144 HC) completed testing in the EC (~4 months) phase.
Results:
Within the SA phase, a group difference was only observed for the visual learning task (One-Card Learning), with pmTBI patients being less accurate relative to HC. Follow-up analyses indicated higher ongoing PCS and higher 5P clinical risk scores were significant predictors of lower One-Card Learning accuracy within SA phase, while premorbid variables (estimates of intellectual functioning, parental education, and presence of learning disabilities or attention-deficit/hyperactivity disorder) were not.
Conclusions:
The absence of group differences at EC phase is supportive of cognitive recovery by 4 months post-injury. While the severity of ongoing PCS and the 5P score were better overall predictors of cognitive performance on the Cogstate at SA relative to premorbid variables, the full regression model explained only 4.1% of the variance, highlighting the need for future work on predictors of cognitive outcomes.
