Cognitive Sequelae, Autonomy, Social Participation and Quality of Life Over 10 Years after Traumatic Brain Injury

Special Article: Disability and Rehabilitation

Gerontol Geriatr Res. 2023; 9(3): 1094.

Cognitive Sequelae, Autonomy, Social Participation and Quality of Life Over 10 Years after Traumatic Brain Injury

Holin S1*; Allart E2,3; Kozlowski O3-5; Delecroix H5; Moroni C1

1Univ. Lille, ULR 4072 – PSITEC - Psychology: Interactions, Time, Emotions, Cognition, France

2Univ. Lille, Inserm UMR-S-1172 – Lille Neuroscience and Cognition, Univ. Lille, France

3Neurorehabilitation unit, Lille University Hospital, France

4Reseau de la cérébrolésion TC-AVC Hauts-de-France, France

5Auprès-TC, Fondation Partage et Vie, France

*Corresponding author: Samantha Holin Univ. Lille, ULR 4072 – PSITEC - Psychology: Interactions, Time, Emotions, Cognition, 59000 Lille, France. Email holin.sam@gmail.com

Received: June 28, 2023 Accepted: August 10, 2023 Published: August 17, 2023

Abstract

Objective: This study aimed to describe the cognitive status, autonomy, quality of life, and social participation of individuals who had experienced a Traumatic Brain Injury (TBI) at least 10 years prior.

Method: Data were collected from 29 individuals with moderate to severe TBI, with a mean age of 49 at the assessment time. Interviews were conducted approximately 22 years after the onset of the brain injury (mean age at onset was 27 years). Participants were divided into two groups based on the time elapsed since the TBI. Participants were asked about changes in their difficulties with age.

Results: The study revealed that half of the participants perceived a decline in their cognitive abilities. Autonomy in activities of daily living deteriorated more than basic autonomy. Quality of life appeared to improve with age. Furthermore, there was a correlation between social participation and overall cognitive ability. No differences were found between the participant groups, suggesting that the time elapsed since the TBI did not seem to influence their progression.

Conclusion: These findings underscore the evolution of the abilities of individuals with TBI several years after the initial incident, emphasizing the importance of long-term follow-up to tailor support throughout the individual’s lifespan. The study also demonstrates substantial variability in developmental profiles. Additionally, social participation emerges as a pivotal factor to consider, potentially mitigating cognitive decline as individual’s age.

Keywords: Traumatic brain injury; Aging; Cognitive abilities; Autonomy; Quality of life; Social participation.

Abbreviations: DANEL: Dépistage Autonomie du Nord Et du Littoral; MoCA: Montreal Cognitive Assessment; PART-O: Participation Assessment With Recombined Tools–Objective; QOLBI: Quality of Life after Brain Injury; QOLIBRI: Quality Of Life after traumatic Brain Injury; TBI: Traumatic Brain Injury

Introduction

Traumatic Brain Injury (TBI) is part of the most common medical conditions and is the leading cause of acquired disability in individuals aged 15 to 30 [1] as it is responsible for cognitive and behavioral disorders. Cognitively, there is an impairment of mnemonic, executive, and attentional functions, as well as a slowdown in cognitive processing speed. Behaviorally, individuals who have experienced a TBI exhibit fatigue, irritability, frustration intolerance, and even apathy [2,3]. The intensity of these cognitive-behavioral sequelae decreases during the first years following the TBI (mainly due to mechanisms of brain plasticity and recovery), after which they stabilize [4,5]. For 22.2% of patients, this improvement in performance can continue for up to five years after the TBI [6-10]. However, in the medium term (five years after the TBI), these cognitive-behavioral difficulties impact the independence of individuals with moderate to severe TBI, especially for complex activities (cooking, shopping, managing finances, administrative tasks, etc.) as well as basic activities (personal hygiene, dressing, etc.) of daily life [11]. These cognitive-behavioral challenges lead to a decrease in independence and difficulties in social and occupational reintegration. In this regard, they result in an invisible disability that becomes apparent only in specific situations, such as during professional activities. Therefore, individuals who have experienced a TBI will age while dealing with a disability.

In the aging process of individuals who have not experienced a TBI, cognitive decline is observed, characterized by changes in memory, attention, visuospatial abilities, language, and executive functions [12,13]. According to the "Daily Life and Health" survey of people over 60 years old, 26% of them reported at least one functional limitation (physical, sensory, or cognitive), 12% had difficulty bathing (basic autonomy decline), and 28% required human assistance for daily activities [14]. A decrease in quality of life has also been demonstrated, which is associated with an increased risk of depression as people age [15]. The existing similarities between the evolution of cognitive-behavioral sequelae after a TBI and the cognitive-behavioral changes described during aging suggest that the aging process for TBI survivors should have specific characteristics. Few studies have focused on the very long-term evolution of cognitive-behavioral sequelae in individuals with moderate to severe TBI. However, some research has investigated this evolution five years after the TBI [6-10]. These studies have shown heterogeneity in long-term cognitive performance after TBI (16 to 30 years), with some individuals improving, others plateauing, and still others experiencing cognitive decline [16,17]. According to the literature review conducted by Wood in 2017, a moderate to severe head injury depletes an individual's cognitive resources, thereby accelerating cognitive decline and potentially leading to premature cognitive aging and an increased risk of dementia. This risk is identified in the literature [18,19]. Moreover, factors such as gender [20], duration of the initial loss of consciousness [21], TBI severity (severe or moderate [22], and advanced chronological age at the time of the TBI [22,23] significantly increase this risk.

Recently, Hicks et al. (2021) [24] through a longitudinal study, demonstrated that 10 years after their TBI, individuals with TBI exhibited poorer cognitive performance compared to a group of healthy volunteers matched in terms of age, gender, and education level. This result confirms the cognitive sequelae following TBI. However, a comparison of cognitive performance for TBI individuals over a 13-year interval did not show a cognitive decline in these individuals. Therefore, individuals with TBI have cognitive performance impacted by the TBI compared to non-brain-injured participants, but with advancing age, their cognitive performance does not decline faster than that of non-brain-injured participants. The study by Hicks et al.[24] suggests that cognitive aging in individuals who have experienced a TBI is not characterized by accelerated cognitive decline.

Currently, there are still few studies in the literature that definitively establish whether accelerated cognitive decline occurs after a TBI. Additionally, Wood (2017) emphasizes the need for studies on the aging process in individuals who have experienced a TBI. The limited existing studies primarily focus on cognitive functioning. In the context of this study, we aim to investigate the evolution of cognitive performance in individuals with moderate and severe TBI as they age and to relate this evolution to their independence, quality of life, and social participation. Social participation is a factor described in studies on physiological aging as associated with successful aging [25]. Thus, individuals who maintain strong social engagement are less likely to experience cognitive decline as they age. We intend to describe the existing connections between cognitive performance, quality of life, and independence in aging individuals with TBI. Is the evolution of these three dimensions the same, and what role does social participation play in this evolution? Does the time elapsed since the TBI influence long-term outcomes?

Materials and Methods

Participants

We selected individuals from the archives of the TC-AVC network in Hauts-de-France (France) who were victims of a TBI meeting the selection criteria: (1) having suffered a moderate to severe TBI (initial Glasgow Coma Scale score =12), (2) being between 18 and 55 years old at the time of the TBI, (3) being at least 10 years post-TBI, (4) having a strong command of the French language, and (5) not having any other neurological history. The inclusion diagram is depicted in Figure 1. Twenty-nine participants took part (22 males and 7 females), with an average age of 49 years (SD=12.4; Min=30 – Max=73), and they experienced a TBI at an average age of 27 years (SD=9.06; Min=18 – Max=51). On average, they were at a distance of 22 years (SD=9.32; Min=10 – Max=47) from their TBI (Figure 1).