Avaliação neuropsicológica do traumatismo crânioencefálico leve: perspectivas das fases agudas e de seguimento longitudinal

Abstract

Introduction: Traumatic Brain Injury (TBI) is an anatomical lesion and/or functional impairment of the scalp, skull, meninges or brain due to external mechanical force directed at the skull. TBI is a major public health problem with significant socioeconomic impact. In addition, to affect the individual physically and emotionally, cognitive changes resulting from TBI can be measures by neuropsychological tests. Objetives: 1) To describe the cognitive profile of patients with mild TBI in the acute phase (24h) and 2) To investigate the predictive value of neuropsychological tests in detecting cognitive deficits 30 days after the event. Methods: A neuropsychological test battery containing tests of global cognitive efficiency, memory, fluency and executive functions, as well as self-report questionnaires about daily cognitive failures, applied to patients admitted to the emergency care unit of the neurology department of João XXIII Hospital. Results: The vast majority of mild TBI occurred in young adults (52.2% women, mean age = 32.7 years ± 8.2 and 47.8% men, mean age = 37.7 years ± 8.27). The main causes were falls (39.1%), traffic accidents (26%), assaults (13%), and hit (4.3%). In the acute evaluation, the greatest impairment was observed in the Span Digit (86.9% of individuals below the norm), Mini Mental State Examination - MMSE (34.8%) and in the Frontal Assessment Battery - FAB (30.4%). After 30 days there were considerable changes in the performance of patients with mild TBI. The tests showed statistically significant associations indicating predictors for performance in the subacute phase of TBI. The relative risk for this population is higher for patients who had worse performance in the MMSE, FAB, Digit Span (direct and reverse order). Conclusion: Individuals affected by mild TBI showed significant cognitive impairment that may change over time. Therefore, the premise that the alterations reported in mild cases of trauma cannot be neglected and studies by longitudinal follow-up are strongly recommended. Keywords: Traumatic Brain Injury; Neuropsychological Assessment; Cognitive Deficits;