Association between long-term cognitive decline in Vietnam veterans with TBI and caregiver attachment style.
OBJECTIVE
To examine whether a caregiver's attachment style is associated with patient cognitive trajectory after traumatic brain injury (TBI).


METHODS
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.


METHODS
Forty Vietnam War veterans with TBI and their caregivers.


METHODS
Cognitive performance, measured by the Armed Forces Qualification Test percentile score, completed at 2 time points: preinjury and 40 years postinjury.


METHODS
On the basis of caregivers' attachment style (secure, fearful, preoccupied, dismissing), participants with TBI were grouped into a high or low group. To examine the association between cognitive trajectory of participants with TBI and caregivers' attachment style, we ran four 2 × 2 analysis of covariance on cognitive performances.


RESULTS
After controlling for other factors, cognitive decline was more pronounced in participants with TBI with a high fearful caregiver than among those with a low fearful caregiver. Other attachment styles were not associated with decline.


CONCLUSIONS
Caregiver fearful attachment style is associated with a significant decline in cognitive status after TBI. We interpret this result in the context of the neural plasticity and cognitive reserve literatures. Finally, we discuss its impact on patient demand for healthcare services and potential interventions.
Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (Mss Brioschi Guevara, Polejaeva, and Knutson and Dr Wassermann); Faculty of Biology and Medicine, University of Lausanne, Lausanne, VD, Switzerland (Ms Brioschi Guevara and Prof. Démonet); Department of Clinical Neuroscience, Memory Center, CHUV, University Hospital Lausanne, Lausanne, Switzerland (Prof. Démonet); Molecular Neuroscience Department and Department of Psychology, George Mason University, Fairfax, Virginia (Dr Krueger); and Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois (Prof. Grafman).
Andrea
A
Brioschi Guevara
Jean-François
JF
Démonet
Elena
E
Polejaeva
Kristine M
KM
Knutson
Eric M
EM
Wassermann
Frank
F
Krueger
Jordan
J
Grafman
D000368:Aged; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation; D017028:Caregivers / Q000523:psychology*; D060825:Cognitive Dysfunction / Q000209:etiology* / Q000523:psychology*; D058245:Cognitive Reserve; D005239:Fear; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D014728:Veterans; D047829:Vietnam Conflict