Long-term neuropsychological outcome after traumatic brain injury.
OBJECTIVE
To describe neuropsychological outcome 5 years after injury in persons with traumatic brain injury (TBI) who received inpatient medical rehabilitation. To determine the magnitude and pattern neuropsychological recovery from 1 year to 5 years after injury.


METHODS
Longitudinal cohort study with inclusion based on the availability of neuropsychological data at 1 year and 5 years after injury.


METHODS
National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems of Care.


METHODS
One hundred eighty-two persons with complicated mild to severe traumatic brain injury.


METHODS
Digits Forward and Backward, Logical Memory I and II, Token Test, Controlled Oral Word Association Test, Symbol Digit Modalities Test, Trail Making Test, Rey Auditory Verbal Learning Test, Visual Form Discrimination, Block Design, Wisconsin Card Sorting Test, and Grooved Pegboard.


RESULTS
Significant variability in outcome was found 5 years after TBI, ranging from no measurable impairment to severe impairment on neuropsychological tests. Improvement from 1 year after injury to 5 years was also variable. Using the Reliable Change Index, 22.2% improved, 15.2% declined, and 62.6% were unchanged on test measures.


CONCLUSIONS
Neuropsychological recovery after TBI is not uniform across individuals and neuropsychological domains. For a subset of persons with moderate to severe TBI, neuropsychological recovery may continue several years after injury with substantial recovery. For other persons, measurable impairment remains 5 years after injury. Improvement was most apparent on measures of cognitive speed, visuoconstruction, and verbal memory.
Millis
S R
SR
Kessler Medical Rehabilitation Research and Education Corporation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, West Orange, New Jersey 07052, USA. smillis@KMRREC.org
Rosenthal
M
M
Novack
T A
TA
Sherer
M
M
Nick
T G
TG
Kreutzer
J S
JS
High
W M
WM
Ricker
J H
JH
D000328:Adult; D001930:Brain Injuries / Q000503:physiopathology* / Q000523:psychology* / Q000534:rehabilitation; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007206:Individuality; D007297:Inpatients; D008137:Longitudinal Studies; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011597:Psychomotor Performance; D020127:Recovery of Function; D013997:Time Factors