| dc.description.abstract | Cognitive, behavioral, and neuropsychiatric changes are commonly observed in patients
with moderate and severe traumatic brain injury (TBI). Growing evidence supports that
patients with mild TBI also have these changes. The aim of this work was to investigate
cognitive alterations in patients with mild TBI in the acute stage and to investigate
cognitive and behavioral alterations and associated biomarkers up to one month after TBI.
The result is divided into three studies: 1) article on cognitive assessment in mild TBI up
to 24 hours after trauma; 2) systematic review of impulsivity in TBI; and 3) article on the
assessment of impulsivity, cognitive and behavioral changes, and blood markers in mild
TBI patients within one month after TBI. The common methodology of studies 1 and 3
included patients with mild TBI treated at the neurology emergency room at Hospital
João XXIII up to 24 hours after mild TBI. Patients were assessed using cognitive tests
and self-report scales. In study 3, inflammatory, neuronal, and vascular markers were also
measured in the serum of patients and controls in an exploratory manner. In study 1,
patients with mild TBI (n=53) had worse performance in general cognition, episodic
memory, learning and executive functioning compared to controls (n=28). In study 2,
there was great heterogeneity in the included studies (n=39), with patients of different
severities, different methods of diagnosis of TBI, and time of assessment ranging from 1
month to 63 years after TBI. It was possible to find evidence of cognitive, behavioral and
self-report changes indicative of increased impulsivity in patients compared to controls.
In study 3, patients with mild TBI (n=21) were more impulsive and anxious than controls
(n=19) within 30 days after TBI on self-report measures. Mild TBI patients presented
higher blood levels of copeptin, GRO, LIGHT/TNFSF14, MMP9 and Lipocalin2/NGAL, and lower levels of MIF, EGF, enolase/NSE and ECA compared to controls.
There was an association between impulsivity scores with the markers copeptin, MMP9,
Lipocalin-2, LIGHT, APP, NCAM, and with TBI. There was no difference in cognitive
measures. The findings point out changes in cognitive functioning in patients with mild
TBI in the acute stage (Study 1), and to changes indicative of impulsivity in patients with
TBI (studies 2 and 3). In addition, findings regarding the blood markers may indicate
changes in central nervous system, related to neuroinflammation, neuronal and vascular
damage in mild TBI and its association to impulsivity (study 3). The identification of
cognitive-behavioral and neuropsychiatric alterations may contribute to the development
of better care and follow-up to patients suffering from mild TBI. Additionally, the better
comprehension of mild TBI pathophysiology may open new avenues for the development
of novel therapy strategies focus in prevent or minimize mild TBI cognitive and
behavioral outcomes. | |
