Neurobehavioral sequelae and brain compromise in mild head injury

Abstract

The purpose of this study was to determine the role that cognitive and emotional factors play in mild head-injured patients and how these factors effect overall brain functioning, with specific focus on the relationship between neurobehavioral symptoms (such as anergia and sleep difficulties), with severity of cognitive deficits. Ability to report and unawareness factors were addressed.;Subjects consisted of 119 mild head-injured patients all involved in motor vehicle accidents with alteration of mental functioning post-insult. Cognitive functioning was evaluated by performance on six individual neuropsychological measures utilizing both process and nomethetic (statistical) data and on a general cognitive deficit score. Emotional functioning was evaluated by subjects' performance on the Beck Depression Inventory (BDI) and the Personality Assessment Inventory (PAI).;Support was obtained for differences in severity of cognitive deficits which were related to patterns of depressive symptomatology. Greater specificity of neurobehavioral patterns (as measured by specific BDI items), were related to depressive symptomatology and cognitive functioning. Those patients with higher cognitive deficits on the process memory functioning task reported having more stress and somatic complaints. Statistically significant relationships were found between immediate logical memory and psychological adjustment issues and between digit span and the BDI total score. Those patients with more severe deficits displayed greater emotional difficulties and had higher scores on the BDI total score. Contrary to the hypothesized direction of means, those patients with fewer general cognitive deficits displayed more anxiety-related disorder traits on the PAL. A statistically small relationship was found between auditory memory processing difficulty and sleep disturbance. Supplemental analyses found support for differences among the two severity groups for endorsement rates of specific somatic items on the BDI and their cognitive performance. Mixed results were found regarding patients' ability to report somatic complaints, with those less cognitively impaired reporting more sleep difficulties.;Implications of this study for investigation into the nature of the relationship between cognitive and emotional factors in mild head-injured patients, its' effect on brain functioning, unawareness issues and ability to report, as well as the neurobehavioral symptomatology of this patient population are discussed, along with the critical need for future research.