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Cognitive Performance is Associated With 1-Year Participation and Life Satisfaction Outcomes: A Traumatic Brain
Natalie Gilmore1, Thomas F Bergquist, Jennifer Bogner
1Author Affiliations: Department of Neurology (Drs Gilmore, Healy, Edlow and Bodien), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Neurotechnology and Neurorecovery (Drs Gilmore, Edlow, and Bodien), Biostatistics Center (Dr Healy), Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic College of Medicine and Science (Dr Bergquist), Departments of Physical Medicine and Rehabilitation and Psychiatry and Psychology (Dr Bergquist), Mayo Clinic, Rochester, Minnesota; Department of Physical Medicine and Rehabilitation (Drs Bogner and Corrigan), College of Medicine, The Ohio State University, Columbus, Ohio; Department of Rehabilitation and Human Performance (Drs Dams-O'Connor and Kumar), Department of Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Ophthalmology and Visual Sciences & Physical Medicine and Rehabilitation (Dr Dreer), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Brain Injury Research Center (Dr Juengst), TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation (Dr Juengst), UT Health Sciences Center at Houston, Houston, Texas; Department of Physical Medicine and Rehabilitation (Drs O'Neil-Pirozzi, Giacino, and Bodien), Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Communication Sciences and Disorders (Dr O'Neil-Pirozzi), Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts; Departments of Physical Medicine & Rehabilitation and Neuroscience (Dr Wagner), Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and Athinoula A. Martinos Center for Biomedical Imaging (Dr Edlow), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Objective:
To determine, in persons with traumatic brain injury (TBI), the association between cognitive change after inpatient rehabilitation discharge and 1-year participation and life satisfaction outcomes.
Design:
Secondary analysis of prospectively collected TBI Model Systems (TBIMS) data.
Setting:
Inpatient rehabilitation and community.
Participants:
499 individuals with TBI requiring inpatient rehabilitation who completed the Brief Test of Adult Cognition by Telephone (BTACT) at inpatient rehabilitation discharge (ie, baseline) and 1-year postinjury.
Main Outcome Measures:
Participation Assessment with Recombined Tools-Objective (PART-O) and Satisfaction with Life Scale (SWLS).
Results:
Of 2,840 TBIMS participants with baseline BTACT, 499 met inclusion criteria (mean [standard deviation] age = 45 [19] years; 72% male). Change in BTACT executive function (EF) was not associated with 1-year participation (PART-O; β = 0.087, 95% CI [-0.004, 0.178], P = .061) when it was the sole model predictor. Change in BTACT episodic memory (EM) was associated with 1-year participation (β = 0.096, [0.007, 0.184], P = .035), but not after adjusting for demographic, clinical, and functional status covariates (β = 0.067, 95% CI [-0.010, 0.145], P = .089). Change in BTACT EF was not associated with life satisfaction total scores (SWLS) when it was the sole model predictor (β = 0.091, 95% CI [-0.001, 0.182], P = .0503). Change in BTACT EM was associated with 1-year life satisfaction before (β = 0.114, 95% CI [0.025, 0.202], P = .012) and after adjusting for covariates (β = 0.103, [0.014, 0.191], P = .023). In secondary analyses, change in BTACT EF was associated with PART-O Social Relations and Out and About subdomains before (Social Relations: β = 0.127, 95% CI [0.036, 0.217], P = .006; Out and About: β = 0.141, 95% CI [0.051, 0.232], P = .002) and after (Social Relations: β = 0.168, 95% CI [0.072, 0.265], P < .002; Out and About: β = 0.156, 95% CI [0.061, 0.252], P < .002) adjusting for functional status and further adjusting for covariates (Social Relations: β = 0.127, 95% CI [0.040, 0.214], P = .004; Out and About: β = 0.136, 95% CI [0.043, 0.229], P = .004). However, only the models adjusting for functional status remained significant after multiple comparison correction (ie, Bonferroni-adjusted alpha level = 0.002).
Conclusion:
EF gains during the first year after TBI were related to 1-year social and community participation. Gains in EM were associated with 1-year life satisfaction. These results highlight the potential benefit of cognitive rehabilitation after inpatient rehabilitation discharge and the need for interventions targeting specific cognitive functions that may contribute to participation and life satisfaction after TBI.
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