Browsing by Author "Schaffert, Jeff"

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    Identification of Factors in Moderate-Severe TBI Related to a Functional Decline in Cognition Decades After Injury
    (Elsevier, 2023) LoBue, Christian; Schaffert, Jeff; Dams-O’Connor, Kristen; Taiwo, Zinat; Sander, Angelle; Venkatesan, Umesh M.; O’Neil-Pirozzi, Therese M.; Hammond, Flora M.; Wilmoth, Kristin; Ding, Kan; Bell, Kathleen; Cullum, C. Munro; Physical Medicine and Rehabilitation, School of Medicine
    Objective: To investigate whether a functional decline in cognitive activities decades after moderate-to-severe traumatic brain injury (m-sTBI) might relate to injury features and/or lifetime health factors, some of which may emerge as consequences of the injury. Design: Secondary analysis of the TBI Model Systems National Database, a prospective, multi-center, longitudinal study of patients with m-sTBI. Setting: TBI Model Systems Centers. Participants: Included were 732 participants rated on the cognitive subscale of the Functional Independence Measure (FIM Cognitive), a metric for everyday cognitive skills, across 3 time points out to 20 years (visits at 2-, 10-, and 20-year follow-ups; N=732). Interventions: Not applicable. Main outcome measure(s): FIM Cognitive Scale. Injury characteristics such as timing and features pertaining to severity and health-related factors (eg, alcohol use, socioeconomic status) were examined to discriminate stable from declining participants on the FIM Cognitive Scale using logistic regression. Results: At 20 years post-injury, there was a low base rate of FIM Cognitive decline (11%, n=78), with most being stable or having meaningful improvement (89%, n=654). Older age at injury, longer duration of post-traumatic amnesia, and presence of repetitive seizures were significant predictors of FIM Cognitive decline in the final model (area under the curve=0.75), while multiple health-related factors that can represent independent co-morbidities or possible consequences of injury were not. Conclusion(s): The strongest contributors to reported functional decline in cognitive activities later-in-life were related to acute characteristics of m-sTBI and experiencing post-traumatic seizures. Future studies are needed integrating functional with performance-based cognitive assessments to affirm conclusions and identify the timeline and trajectory of cognitive decline.