Long-term neuropsychological outcome after traumatic brain injury

Objective: To describe neuropsychological outcome 5 years after injury in p ersons with traumatic brain injury (TBI) who received inpatient medical reh abilitation. To determine the magnitude and pattern neuropsychological reco very from 1 year to 5 years after injury Design: Longitudinal cohort study with inclusion based on the availability If neuropsychological data at I ye ar and 5 years after injury. Setting: National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems of Care. Parti cipants: One hundred eighty-two persons with complicated mild to severe tra umatic brain injury. Primary Outcome Measures: Digits Forward and Backward, Logical Memory I and II, Token Test, Controlled Oral Word Association Test , Symbol Digit Modalities Test, Trail Making Test, Rey Auditory Verbal Lear ning Test, Visual Form Discrimination, Block Design, Wisconsin Card Sorting Test, and Grooved Pegboard. Results: Significant variability in outcome wa s found 5 years after TBI, ranging from no measurable impairment to severe impairment on neuropsychological tests. improvement from I year after injur y to 5 years was also variable. Using the Reliable Change Index, 22.2% impr oved, 15.2% declined, and 62.6% were unchanged on test measures. Conclusion s: Neuropsychological recovery after TBI is not uniform across individuals and neuropsychological domains. For a subset of persons with moderate to se vere TBI, neuropsychological recovery may continue several years after inju ry with substantial recovery. For other persons, measurable impairment rema ins 5 years after injury. Improvement was most apparent on measures of cogn itive speed, visuoconstruction, and verbal memory.