Major/Mild Neurocog D/O Due to TBI

Question 1

criterion A for M/M NCD due to TBI

Answer 1

criteria are met for M/M NCD

Question 2

criterion B for M/M NCD due to TBI

Answer 2

there is evidence of a traumatic brain injury

Question 3

define traumatic brain injury

Answer 3

“brain trauma”–>an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following:

loss of consciousness

posttraumatic amnesia

disorientation and confusion

neurological signs (i.e neuroimaging demonstrates injury; a new onset of seizures; a marked worsening of preexisting seizure disorders; visual field cuts; anosmia; hemiparesis)

Question 4

criterion C for M/M NCD due to TBI

Answer 4

the NCD presents immediately after the occurrence of the TBI or immediately after recovery of consciousness and persists past the acute post injury period

Question 5

what specifiers are there for M/M NCD due to TBI

Answer 5

severity specifier

rate the severity of the NCD, NOT the underlying TBI

Question 6

what is the cognitive presentation of M/M NCD due to TBI

Answer 6

variable

commonly see difficulties in the domains of:

• -complex attention
• -executive ability
• -learning
• -memory
• -slowing speed of info processing
• -disturbances in social cognition

*in more severe TBI, there may be additional neurocognitive deficits like aphasia, neglect, or constructional dyspraxia

Question 7

what are some other categories of symptoms that may be associated with M/M NCD due to TBI

Answer 7

disturbances in emotional function

personality changes

physical disturbances

neurological symptoms and signs

orthopedic injuries

Question 8

what deficits in emotional function may be present in those with M/M NCD due to TBI

Answer 8

irritability

easy frustration

tension

anxiety

affective lability

Question 9

what personality changes may accompany M/M NCD due to TBI

Answer 9

disinhibition

apathy

suspiciousness

aggression

Question 10

what physical disturbances may accompany M/M NCD due to TBI

Answer 10

headache

fatigue

sleep disorders

vertigo, dizziness

tinnitus or hyperacuity

photosensitivity

anosmia

reduced tolerance to psychotropic medications

Question 11

what % of the population lives with a TBI associated disability

Answer 11

2%

Question 12

what % of TBIs are in males

Answer 12

59% (in the USA)

Question 13

what are the most common etiologies of TBI in the USA

Answer 13

falls

vehicular accidents

being struck on the head

*collisions and blows to the head that occur in the course of contact sports are increasingly recognized as sources of mild TBI with a concern that repeated mild TBI may have a cumulatively persisting sequelae

Question 14

what are the severity levels of TBI and when are they rated

Answer 14

rated AT TIME OF INJURY

mild–> moderate–> severe

Question 15

what are the three injury characteristics taken into consideration when judging the severity of a TBI

Answer 15

loss of consciousness (length of time)

posttraumatic amnesia (length of time)

disorientation and confusion at initial assessment (GCS)

Question 16

list the characteristics of a mild TBI

Answer 16

loss of consciousness less than 30 min

posttraumatic amnesia less than 24 hours

GCS 13-15 at initial assessment (not below 13 at 30 min)

Question 17

list the characteristics of moderate TBI

Answer 17

loss of consciousness 30 min-24 hours

posttraumatic amnesia 24 hours - 7 days

GCS 9-12 at initial assessment

Question 18

list the characteristics of severe TBI

Answer 18

loss of consciousness over 24 hours

posttraumatic amnesia more than 7 days

GCS 3-8 at initial assessment

Question 19

does the severity rating of the TBI correspond to the severity of the resulting NCD?

Answer 19

no not necessarily

Question 20

what are factors that affect course of recovery from TBI

Answer 20

course of recovery is variable

depends on:

• -specifics of injury
• -age
• -prior history of brain damage
• -hx of substance use

Question 21

when are neurobehavioural symptoms most severe after TBI

Answer 21

in immediate aftermath

Question 22

what is the usual recovery course in the case of mild or moderate TBI

Answer 22

typical course is that of complete or substantial improvement in associated neurocognitive, neurological and psychiatric symptoms and signs

Question 23

how quickly do neurocognitive symptoms associated with mild TBI tend to resolve

Answer 23

within days to weeks after the injury

complete resolution typical by 3 months

*other symptoms that co occur with the neuro symptoms, like photosensitivity, headache, irritability, fatigue, sleep disturbance) tend to also resolve in the WEEKS following mild TBI

Question 24

what may happen in the case of repeated mild TBI

Answer 24

may have persisting neurocognitive disturbance

Question 25

list some of the symptoms that can persist in the cases of moderate and severe TBI

Answer 25

seizures (particularly in the first year)

photosensitivity

hyperacusis

irritability

aggression

depression

sleep disturbance

fatigue

apathy

inability to resume occupational and social functioning at pre-morbid level

deterioration in interpersonal relationships

Question 26

moderate and severe TBI increases risk for which disorders

Answer 26

depression

aggression

possible NCDs like alzheimers

Question 27

how might persisting-TBI related impairment present in a child

Answer 27

delays in reaching milestones

worse academic performance

impaired social development

Question 28

how might persisting-TBI related impairments present in a teen or adult

Answer 28

various neurocognitive deficits

irritability

hypersensitivity to light and sound

easy fatigability

mood changes (including depression, anxiety, hostility or apathy)

Question 29

which populations are at highest risk for TBI

Answer 29

kids younger than age 4

older adolescents

adults older than 65 years

Question 30

what is the most common cause of TBI

Answer 30

falls (then MVAs)

sports concussions are frequent cause of TBI in older kids, teens and young adults

Question 31

what are some risk factors for neurocognitive disorder after TBI

Answer 31

repeated concussions –> can lead to clinical NCD and neuropathological evidence of traumatic encephalopathy

co-occuring intoxication with substance may increase severity of TBI from MVA but not sure if it affect cognitive outcome

Question 32

list factors associated with worse outcome from moderate to severe TBI

Answer 32

older age (above 40)

initial clinical parameters (low GCS, worse motor function, pupillary nonreactivity, CT evidence of brain injury)

Question 33

what might you see on CT scan in the setting of TBI

Answer 33

petechial hemorrhages

SAH

contusion

Question 34

what might people notice functionally in the case of MILD NCD due to TBI

Answer 34

reduced cognitive efficiency

difficulty concentrating

lessened ability to perform usual activities

Question 35

what might people notice functionally in the case of MAJOR NCD due to TBI

Answer 35

may have difficulty with independent living and self care

may have prominent neuromotor features like:

• -severe incoordination
• -ataxia
• -motor slowing

Question 36

what psychiatric disorder can often co occur with TBI, and also have overlapping symptoms

Answer 36

PTSD (especially in military populations)