title: INCOG recommendations for management of cognition following traumatic brain injury, part I: posttraumatic amnesia/delirium.
abstract: BACKGROUND
  After traumatic brain injury (TBI) and emergence from coma, the majority of people experience posttraumatic amnesia (PTA), characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention, and sometimes agitation and delusions. An international team of researchers and clinicians developed recommendations for assessment and management of PTA.
  
  
  METHODS
  The experts met to select recommendations, then reviewed literature to ensure they were current. The team then prioritized recommendations for implementation and developed audit criteria to evaluate the adherence to the best practice recommendations.
  
  
  RESULTS
  Evidence in support of assessment and management strategies during PTA is weak. It is recommended that duration of PTA be assessed prospectively using a validated tool. Consideration should also be given to use of a delirium assessment tool. No cognitive or pharmacological treatments are known to reduce PTA duration. Recommendations for environmental manipulations to reduce agitation during PTA are made. Minimizing use of neuroleptic medication is supported by animal research and 1 retrospective study.
  
  
  CONCLUSIONS
  The duration of PTA is an important predictor of late outcome after TBI and should be monitored prospectively with a standardized tool. Neuroleptic medication should be avoided. There is a significant need for controlled studies evaluating the impact of therapy during PTA.
authors.affiliation: NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Australia (Drs Ponsford and Tate); School of Psychological Sciences, Monash University and Epworth Hospital, Melbourne, Australia (Dr Ponsford); National Trauma Research Institute, Monash University and the Alfred Hospital (Dr Ponsford); Lawson Health Research Institute, St Joseph's Parkwood Hospital, London, Ontario, Canada (Mss Janzen and McIntyre); Neuro Rehabilitation Program, Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada (Dr Bayley); Neuropsychology, Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, Canada (Dr Velikonja); Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Velikonja); Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School - Northern, University of Sydney, Australia (Dr Tate); and Royal Rehabilitation Centre Sydney, Australia (Dr Velikonja).
authors.forename: Jennie
authors.initials: J
authors.lastname: Ponsford
authors.forename: Shannon
authors.initials: S
authors.lastname: Janzen
authors.forename: Amanda
authors.initials: A
authors.lastname: McIntyre
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.forename: Diana
authors.initials: D
authors.lastname: Velikonja
authors.forename: Robyn
authors.initials: R
authors.lastname: Tate
mesh_terms: D000647:Amnesia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D001930:Brain Injuries / Q000523:psychology* / Q000628:therapy*; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans