Cognitive Impairment in Diffuse Axonal Injury Patients with Favorable Outcome

Overview

Journal Front Neurosci

Date 2023 Feb 10

PMID 36761409

Authors

Weiliang Chen

Chunyu Yao

Shengwen Li

Hongguang Huang

Zujian Zhu

Rui Chen

Wen Su

Xiao Huang

Lisheng Xu

Kaijie Sun

Jiannan Song

Rongcai Jiang

Guanjun Wang

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Traumatic brain injury (TBI), especially the severe TBI are often followed by persistent cognitive sequalae, including decision-making difficulties, reduced neural processing speed and memory deficits. Diffuse axonal injury (DAI) is classified as one of the severe types of TBI. Part of DAI patients are marginalized from social life due to cognitive impairment, even if they are rated as favorable outcome. The purpose of this study was to elucidate the specific type and severity of cognitive impairment in DAI patients with favorable outcome.

Methods: The neurocognition of 46 DAI patients with favorable outcome was evaluated by the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC), and the differences in the domains of cognitive impairment caused by different grades of DAI were analyzed after data conversion of scores of nine cognitive domains of MoCA-BC by Pearson correlation analysis.

Results: Among the 46 DAI patients with favorable outcome, eight had normal cognitive function (MoCA-BC ≥ 26), and 38 had cognitive impairment (MoCA-BC < 26). The MoCA-BC scores were positively correlated with pupillary light reflex ( = 0.361, = 0.014), admission Glasgow Coma Scale (GCS) ( = 0.402, = 0.006), and years of education ( = 0.581, < 0.001). Return of consciousness ( = -0.753, < 0.001), Marshall CT ( = -0.328, = 0.026), age ( = -0.654, < 0.001), and DAI grade ( = -0.403, = 0.006) were found to be negatively correlated with the MoCA-BC scores. In patients with DAI grade 1, the actually deducted scores (Ads) of memory ( = 0.838, < 0.001), abstraction ( = 0.843, < 0.001), and calculation ( = 0.782, < 0.001) were most related to the Ads of MoCA-BC. The Ads of nine cognitive domains and MoCA-BC were all proved to be correlated, among patients with DAI grade 2. However, In the DAI grade 3 patients, the highest correlation with the Ads of MoCA-BC were the Ads of memory ( = 0.904, < 0.001), calculation ( = 0.799, = 0.006), orientation ( = 0.801, = 0.005), and executive function ( = 0.869, = 0.001).

Conclusion: DAI patients with favorable outcome may still be plagued by cognitive impairment, and different grades of DAI cause different domains of cognitive impairment.

Citing Articles

Dynamic changes in neuron-specific enolase level to glasgow coma scale score ratio predict long-term neurological function of diffuse axonal injury patients.

Chen W, Wu J, Li S, Yao C, Chen R, Su W BMC Neurol. 2025; 25(1):89.

PMID: 40050785 PMC: 11884207. DOI: 10.1186/s12883-025-04116-5.

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