title: Improvement of verbal fluency in patients with diffuse brain injury over time.
abstract: BACKGROUND
  Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic brain injury (TBI), is considered one of the most prevalent forms of primary neuronal injury in patients with severe TBI. Cognitive deficits induced by DAI can persist over time, especially following moderate or severe injuries. The aim of the present study was to compare verbal fluency (VF) performance at 6 and 12 months after the trauma in a same group of patients with DAI.
  
  
  METHODS
  Eighteen patients with moderate to severe DAI and 17 healthy volunteers were enrolled. All DAI participants had sustained a TBI at least 6 months prior to the start of the study, were between 18 and 50 years of age, and had at least 4 years of education. The VF test was administered within an extensive neuropsychological test battery. We evaluated the same patients at 6 months (DAI1 group) and 12 months (DAI2 group) and compared the results of neuropsychological tests with a control group of healthy volunteers who were matched to patients for sex, age, and educational level.
  
  
  RESULTS
  In comparison to controls, the DAI1 group produced significantly fewer words. The DAI2 group produced significantly more semantic words than DAI1 (P<0.05) and demonstrated a trend towards the production of more clusters for letter A (P=0.09) and total words generated in a phonemic test (P=0.09). No significant differences were observed between DAI2 and the control group in the total number of words generated in phonetic FAS or semantic fluency scores.
  
  
  CONCLUSIONS
  The present findings may be useful in the construction of a management plan for long-term TBI rehabilitation that considers the trauma of each patient. Further, our results suggest the VF test is a suitable instrument for the assessment of cognitive difficulties following TBI.
authors.affiliation: Division of Psychology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Zaninotto
authors.affiliation: Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Vinícius Monteiro
authors.initials: VM
authors.lastname: de Paula Guirado
authors.affiliation: Division of Psychology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Baldivia
authors.affiliation: Division of Psychology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Monica Domiano
authors.initials: MD
authors.lastname: Núñes
authors.affiliation: Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Robson Luis Oliveira
authors.initials: RL
authors.lastname: Amorim
authors.affiliation: Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Division of Psychology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Mara Cristina Souza
authors.initials: MC
authors.lastname: de Lucia
authors.affiliation: Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Almir Ferreira
authors.initials: AF
authors.lastname: de Andrade
authors.affiliation: Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Wellingson Silva
authors.initials: WS
authors.lastname: Paiva
keywords: diffuse axonal injury; executive function; neuropsychological tests; prognosis; traumatic brain injury