Age aspect of neurophysiological diagnostics of post-concussion syndrome in patients with mild blast traumatic brain injury

Introduction. It is generally accepted that age influences neuropsychological and neurophysiological findings due to a decrease in memory and attention in older age groups as a result of diseases and damage to the central nervous system of various origins. This should be taken into account when dealing with patients who underwent mild blast traumatic brain injury (mbTBI), and focus on standard characteristics considering the age factor. Purpose: to investigate the influence of the age factor on the characteristics of cognitive evoked potentials in patients with post-concussion syndrome (PCS) in the long-term period of mbTBI. Materials and methods. The study involved 41 patients with PCS aged 18-45 years (study group) and 30 healthy subjects (control group). The patients were in the late period of trauma (from 6 months to 3 years). The age distribution of patients in the study group was the following: 6 patients under 30 years old, 18 patients aged 31-40 years, 17 patients over 40 years old. Neuropsychological testing was performed according to the Montreal Cognitive Assessment Scale. Quantitative electroencephalography was performed according to standard parameters (sensitivity ‒ 70 μV/cm, time constant ‒ 0.1 s, filter ‒ 40 Hz). The results. Neurophysiological testing using the CEP P300 method allows us to verify the dysfunction of brain activity in the form of attention and memory disorders in patients with PCS as a result of mbTBI in the chronic period of damage. Exceeding the upper limit of the age norm of P2 and P3 latency components of CEP P300 is statistically significantly associated with the presence of cognitive impairment in patients with PCS. Conclusions. The CEP P300 method can be recommended for the use in the complex diagnostics of cognitive disorders in patients with PCS in the subacute and chronic periods of the injury. In the clinical interpretation of latency characteristics of CEP P300 components, it is reasonable to focus on standard parameters, including age factor

Cognitive evoked potentials in the diagnosis of post-concussion syndrome due to blast mild traumatic brain injury

Hostilities in the East of Ukraine are characterized by the use of new weapons, including rocket artillery, rocket-propelled grenades and landmines. This has led to an increase in the number of victims with blast mild traumatic brain injury (BMTBI) and the need to provide them with effective assistance and rehabilitation. An important task is to improve the BMTBI diagnosis by specifying the objective criteria for structural and functional disorders of the central nervous system. This will improve the prognosis of the course of BMTBI in the injured and the treatment program, including personalized, to prevent the development of persistent neurological deficit. Objective: to investigate the possibilities of the cognitive evoked potentials (CEP) method for the objective diagnosis of cognitive disorders in post-concussion syndrome (PCS) BMTBI. Materials and methods. The study involved 115 men with PCS (main group) and 30 healthy individuals (control group). The cognitive functions of the study participants were studied using the questionnaire "Cicerone". The neurophysiological method for assessing the functional state of the brain involved the registration of CEP, event-related (P300 CEP). Results. The selection of a subgroup of patients with PCS, characterized by a predominance of cognitive impairments, allowed us to trace the relationship between the results of neurophysiological studies with the cognitive indicators of patients with BMTBI. P300 latency indices are inversely proportional to cognitive assessment the questionnaire "Cicerone" and statistically significantly depend on the severity of cognitive impairment. Conclusions. The CEP P300 method can be an effective means of objectifying the degree of cognitive impairment in patients with PCS due to BMTBI

Neurological and neuropsychological characteristics of postconcussion syndrome following blast mild traumatic brain injury

A common complication of blast mild traumatic brain injury (mTBI) is postconcussion syndrome (PCS), the diagnostic criteria of which are based on the patient's subjective complaints. Creation of reliable tools for clinical signs of blast mild TBI objectification is of great priority. Objective: using a comprehensive neurological and neuropsychological examination to determine the characteristics of clinical signs of blast mild TBI in the long-term period to assess the correlation with the data of neurophysiological and radiological studies. Materials and methods. The study involved 115 male participants of hostilities in the East of Ukraine (main group) with a diagnosis of " PCS after previous blast mTBI " and 30 healthy individuals (control group).  Patients were in the long-term period of injury (from 6 months to 3 years). After collecting complaints and medical history data, the neurological status and the state of cognitive functions were examined. The latter were studied using the questionnaire "Cicerone". Neuropsychological testing according to the Montreal Cognitive Assessment score (MoCA) was carried out. The Hospital Anxiety and Depression Scale (HADS) was also used, and to objectify asthenic disorders - the Asthenic State Scale (ASS). Results. Assessment of the severity of cognitive impairment using the questionnaire "Cicerone" allowed identifying three clinical variants of PCS: 1) with cognitive impairment in combination with affective disorders (44,3 ± 9,1) % of patients), 2) with a predominance of affective disorders (23,5 ± 7,7) % of patients), 3) moderate and mild disorders of the cognitive and affective spectrum in combination with moderate autonomic disorders ((32,2 ± 8,5) % of patients). In 43,5% of cases, according to the MoCA scale, a decrease in cognitive impairment was found for memorization (memory), attention, delayed recall, total score. According to the HADS scale, the distribution of patients was as follows: clinically significant anxiety was noted in (9,6%) patients, depression - in (11,3%) patients, combination of clinically significant anxiety with depression - in (5,2%) patients, subclinical symptoms of anxiety of various severity - in (55,7%) patients. The phenomena of asthenia due to fatigue with mood swings, loss of the ability to concentrate for a long time on mental and physical tasks occurred in all patients with PCS. Factors with a probably higher risk of cognitive impairment were identified: 1) complaints of extreme fatigue and headache, 2) neurological signs in the form of pyramidal insufficiency, brisk tendon reflexes, 3) anxiety level according to the HADS scale. They can be considered as predictors of detection of cognitive deficit in patients with PCS as a result of blast mild TBI. Conclusions. Comprehensive neurological and neuropsychological examination is an effective tool for diagnosing cognitive changes in PCS as a result of blast mild TBI

Evaluation of Doppler and electroencephalographic changes in patients with postconcussion syndrome due to mild blast traumatic brain injury

Mild blast traumatic brain injury (mbTBI) often remains undiagnosed and untreated due to lack of treatment of patient, imperfect screening tools, unclear diagnostic criteria, and lack of means to objectify or visualize the injury. Objective: to investigate Doppler and electroencephalographic changes in patients with postconcussion syndrome (PCS) due to mbTBI and the possibility of their use to objectify the injury. Materials and methods. The study involved 115 male participants of hostilities in the East Ukraine (main group) with a diagnosis of "PCS after previous mbTBI" and 30 healthy individuals (control group). Patients were in the long-term period of injury (from 6 months to 3 years). After collecting complaints and history data, the neurological status and the state of cognitive functions were examined. Neuropsychological testing according to the Montreal cognitive assessment score was carried out. Ultrasound duplex scanning with color Doppler mapping of neck and head vessels and transcranial duplex scanning were performed. Quantitative electroencephalography was performed according to standard parameters (sensitivity - 70 μV / cm, time constant - 0.1 s, filter - 40 Hz). Results. In patients with PCS after mbTBI, transcranial duplex scanning can detect changes in vascular resistance in the intracranial vessels of both the carotid and vertebrobasilar basins (mostly reduced resistance values), as well as signs of venous discirculation in the basal veins of the brain, quantitative electroencephalography – changes in the frequency and topic of the α-rhythm, a decrease in its amplitude, frequency-spatial inversion, the presence of signs of dysfunction of nonspecific brain structures, according to spectral analysis – a decrease in α-power, an increase in β-power, activity in θ- and δ-bands. Conclusions. Detected Doppler and electroencephalographic changes may persist in the long-term period of mbTBI. They should be taken into account in the differential diagnosis of post-traumatic stress disorder