Mohammed Maleki

The mini-mental state examination and the montreal cognitive assessment after traumatic brain injury: An early predictive study

Abstract Primary objective: To compare results on the Montreal Cognitive Assessment (MoCA) to those on the Mini-Mental State Examination (MMSE) in patients with traumatic brain injury (TBI) and to predict the outcome at discharge from the acute care setting. Research design: A retrospective study. Methods and procedures: The MoCA and the MMSE were administered to 214 patients with TBI during their acute care hospitalization in a Level I trauma centre. Outcome was measured with the Disability Rating Scale (DRS). Main outcomes and results: A linear regression determined that the MoCA, the MMSE, TBI severity, education level and presence of diffuse injuries predicted 57% of the total variability of the DRS scores. The model without the MMSE had a R2 of 53.7% and the model without the MoCA had a R2 of 55.0%. The models without the MMSE or the MoCA had a R2 of 24.9%. Conclusions: These results indicated that the MoCA and the MMSE function as similar predictors of the DRS at discharge.

Acute evaluation of conversational discourse skills in traumatic brain injury

Abstract This study looked at performance on the conversational discourse checklist of the Protocole Montréal d’évaluation de la communication (D-MEC) in 195 adults with TBI of all severity hospitalized in a Level 1 Trauma Centre. To explore validity, results were compared to findings on tests of memory, mental flexibility, confrontation naming, semantic and letter category naming, verbal reasoning, and to scores on the Montreal Cognitive Assessment. The relationship to outcome as measured with the Disability Rating Scale (DRS), the Extended Glasgow Outcome Scale (GOS-E), length of stay, and discharge destinations was also determined. Patients with severe TBI performed significantly worse than mild and moderate groups (χ2KW2df = 24.435, p = .0001). The total D-MEC score correlated significantly with all cognitive and language measures (p < .05). It also had a significant moderate correlation with the DRS total score (r = −.6090, p < .0001) and the GOS-E score (r = .539, p < .0001), indicating that better performance on conversational discourse was associated with a lower disability rating and better global outcome. Finally, the total D-MEC score was significantly different between the discharge destination groups (F(3,90) = 20.19, p < .0001). Thus, early identification of conversational discourse impairment in acute care post-TBI was possible with the D-MEC and could allow for early intervention in speech-language pathology.

Early conversational discourse abilities following traumatic brain injury: An acute predictive study

Abstract Primary objective: To date, little information is available regarding communication and conversational discourse proficiency post-traumatic brain injury (TBI) in the acute care phase. The main goal of this study was to examine how conversational discourse impairment following TBI predicts early outcome. Factors which influence conversational discourse performance were also explored. Methods: The conversational discourse checklist of the Protocole Montréal d’évaluation de la communication (D-MEC) was administered in an acute tertiary care trauma centre to 195 adults within 3 weeks post-TBI. Outcome was measured with the Disability Rating Scale (DRS), the extended Glasgow Outcome Scale (GOS-E) and included discharge destinations from acute care. Main outcomes and results: Linear regression results showed that the D-MEC total score, age and initial GCS score accounted for 50% of the variation of the DRS scores. The DRS score was lower, signifying better outcome, when the total D-MEC score was higher, the subject was younger and when the initial GCS score was higher. Moreover, D-MEC performance significantly predicted the moderate and severe disability categories of the GOS-E and the probability of requiring rehabilitation (p < 0.05). Conclusion: These results provide additional information to guide healthcare professionals in predicting overall outcome acutely post-TBI.

The Montreal Cognitive Assessment in Persons with Traumatic Brain Injury

The objective of this study was to examine the performance of patients with traumatic brain injury (TBI) on the Montreal Cognitive Assessment (MoCA). The MoCA was administered to 214 patients with TBI during their acute care hospitalization in a Level 1 trauma center. The results showed that patients with severe TBI had lower scores on the MoCA compared with patients with mild and moderate TBI, F(2, 211) = 10.35, p = .0001. This difference was found for visuospatial/executive, attention, and orientation subtests (p < .05). Linear regression demonstrated that age, education, TBI severity, and the presence of neurological antecedents were the best predictors of cognitive impairments explaining 42% of the total variability of the MoCA. This information can enable clinicians to predict early cognitive impairments and plan cognitive rehabilitation earlier in the recovery process.

Olfactory and executive dysfunctions following orbito-basal lesions in traumatic brain injury

Abstract Objective: To study the acute relationship between olfactory function and traumatic brain injury (TBI), cognitive functions and outcome. Methods: Sixty-two patients with TBI were evaluated within the first 2 weeks following TBI. The Sniffin’Sticks identification test was used to assess olfaction. A neuropsychological evaluation was carried out to assess attention, verbal fluency, naming, memory, problem-solving and mental flexibility. The extended Glasgow Outcome Scale (GOSE) and the Disability Rating Scale (DRS) were rated at discharge from acute care. Results: Traumatic lesions located in the basal frontal area resulted in odour identification scores that were significantly lower than when lesions were elsewhere (p < 0.001). A significant positive correlation was shown between odour identification scores and mental flexibility scores (p = 0.004) and patients with hyposmia had worse performances on executive tests measuring problem-solving, verbal fluency and mental flexibility (p < 0.01). Moreover, the odour identification score and the DRS total score were related (p = 0.019). Conclusions: These findings add information regarding acute olfactory status following TBI and provide evidence on the importance of assessing olfaction very early post-TBI in order to plan intervention and determine what accident prevention advice will be required for home or work re-integration.

Neuroanatomical correlates of the clock drawing test in patients with traumatic brain injury.

Objective: The clock drawing test (CDT) is a quick and easy to administer test that has traditionally shown parietal lobe dysfunction. The aim of this study was to correlate performance on the CDT with the presence of acute traumatic cerebral injuries sustained after traumatic brain injury (TBI). Methods: A retrospective study was conducted on 170 patients with TBI of all severity admitted to an acute care setting. These patients sustained different types of injuries (epidural haematoma, subdural haematoma, subarachnoid haemorrhage, intraparenchymal haematoma and brain oedema) in different sites (frontal, temporal, parietal, occipital lobes, bilateral and right or left hemisphere). Results: The CDT total score was significantly lower for subjects presenting subarachnoid haemorrhage (4.80 ± 3.34 vs 7.04 ± 3.14, t168df = 4.477, p < 0.001) and for those presenting brain oedema (4.50 ± 3.06 vs 6.69 ± 3.38, t168df = 4.214, p < 0.001), parietal injury (5.15 ± 3.17 vs 6.42 ± 3.52, t168df = 2.416, p = 0.017) or bilateral injuries (5.28 ± 3.31 vs 6.62 ± 3.44, t168df = 2.569, p = 0.011) compared to those who did not. Conclusion: This study provides empirical evidence of the relationship between TBIs and results on the CDT, supporting previous studies done with other populations.

Traumatic brain injury in the elderly: A level 1 trauma centre study

Abstract Objective: To explore the characteristics and outcome of patients with TBI over 65 years old admitted to an acute care Level 1 Trauma centre in Montreal, Canada. Methods: Data were retrospectively collected on patients (n = 1812) who were admitted post-TBI to the McGill University Health Centre-Montreal General Hospital from 2000–2011. The cohort was composed of four groups over 65 years old (65–75; 76–85; 86–95; and 96 and more). Outcome measures used were the extended Glasgow Outcome Scale (GOSE) as well as discharge destination. Results: As the patients got older, the odds of having a poor outcome increased (OR = 2.344 for those 75–85 years old, 4.313 for those 86–95 years of age and 3.465 for those aged 96 years of age or older). Also, the proportion of patients going home or going home with out-patient rehabilitation decreased as age increased (p = 0.001 and p < 0.001, respectively). In contrast, the proportion of patients being discharged to long-term care facilities increased significantly as age increased (p < 0.001). Conclusion: This descriptive study provides a better understanding of characteristics and outcome of different age groups of patients with TBI all over 65 years old in Montreal, Canada.

Characteristics of patients with acute traumatic brain injury discharged against medical advice in a level 1 urban trauma centre.

Abstract Primary objective: To predict which characteristics are associated with patients at risk of discharge against medical advice (AMA). Research design: Data were retrospectively collected on individuals (n = 5642) admitted to the Traumatic Brain Injury Program of the MUHC-MGH. Methods and procedures: Outcome measures used were length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE) as well as the Functional Independence Measure (FIM®). Main outcomes: The overall rate of patients leaving AMA was 1.9% (n = 108). Age was negatively associated with AMA discharge (95% CI OR = [0.966;0.991]). Patients with a history of substance abuse were ∼2-times more likely to leave AMA than those not using substances before injury (95% CI OR = [1.172;3.314]) and the homeless were ∼3-times more likely to leave AMA compared to those who were not homeless (95% CI OR = [1.260;7.138]). Length of stay (LOS) was shorter for patients leaving AMA (p < 0.001) and they showed better outcome (GOSE: p < 0.001; FIM®: p = 0.032). Conclusions: Knowing the profile of patients with TBI leaving AMA hospitalized in an urban Level 1 Trauma centre will help in the development of effective strategies based on patient needs, values and pre-injury psychosocial situation to encourage them to complete their treatment course in hospital.

Antithrombotic agents intake prior to injury does not affect outcome after a traumatic brain injury in hospitalized elderly patients

BACKGROUND The purpose of this study is to investigate the effect of risk factors including International Normalized Ratio (INR) as well as the Partial Thromboplastin Time (PTT) scores on several outcomes, including hospital length of stay (LOS) and The Extended Glasgow Outcome Scale (GOSE) following TBI in the elderly population. METHODS Data were retrospectively collected on patients (n=982) aged 65 and above who were admitted post TBI to the McGill University Health Centre-Montreal General Hospital from 2000 to 2011. Age, Injury Severity Score (ISS), Glasgow Coma Scale score (GCS), type of trauma (isolated TBI vs polytrauma including TBI), initial CT scan results according to the Marshall Classification and the INR and PTT scores and prescriptions of antiplatelet or anticoagulant agents (AP/AC) were collected. RESULTS Results also indicated that age, ISS and GSC score have an effect on the GOSE score. We also found that taking AC/AP has an effect on GOSE outcome, but that this effects depends on PTT, with lower odds of a worse outcome for those taking AC/AP agents as the PTT value goes up. However, this effect only becomes significant as the PTT value reaches 60 and above. CONCLUSION Age and injury severity rather than antithrombotic agent intake are associated with adverse acute outcome such as GOSE in hospitalized elderly TBI patients.

The Relationship between Acute Functional Status and Long-Term Ambulation after Severe Traumatic Brain Injury

Objective. To correlate long-term physical impairments of patients with severe traumatic brain injury (sTBI) based on their functional status in an acute care setting. Methods. 46 patients with sTBI participated in this prospective study. The Extended Glasgow Outcome Scale (GOSE) and the FIM instrument were rated at discharge from the acute care setting and at followup. The Functional Ambulation Classification (FAC), the Five-Meter Gait Speed, a quantified measure of negotiating stairs (Stair Climbing Speed and Rails used), and the functional reach test were rated at followup. Results. The subject with a score of 6 on the GOSE at discharge remained nonfunctional ambulator at followup. None of the subjects with a GOSE score of 5 became independent ambulators. Fifty percent of the subjects with a GOSE score of 4 were dependent ambulators. 100% of the subjects with a GOSE score of 2 or 3 at discharge were independent ambulators. A higher FIM score at discharge was associated with a greater chance of ambulating independently at 2 to 5 years after TBI (𝜒KW22𝑑𝑓). Conclusions. These data will allow physical health professionals in acute rehabilitation settings to provide more precise long-term physical outcome information to patients and families.