Los Angeles Brain

Discussion of post-traumatic cognitive symptoms

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Not surprisingly, cognitive impairment is a common symptom after traumatic brain injury. The most commonly reported affected areas include areas of concentration, focus, executive functioning, memory, and processing speed, all centralized to frontal lobe circuits. Accordingly,  a majority of people suffering from a TBI complain of feeling “foggy” or “slow,” and in mild TBI a subtle decline in performance on cognitive testing can be seen after head injury. In a study observing the effects of prolonged cognitive outcome after a concussion in women, results showed a significant impairment of performance on a neuropsychological test of “processing speed associated with executive functions” often utilized in female soccer players (Ellemberg et al., 2007). Nonetheless, similar to other post-traumatic symptoms, full cognitive recovery occurs within 2-4 months of an injury. 

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The treatment for TBI-related cognitive dysfunction is largely based upon accommodation of cognitive deficits and slowly returning to normal functioning. As individuals often struggle with focus and concentration,  returning to cognitively demanding activities such as work and school can be frustrating and delay eventual recovery.  Cognitive behavioral therapy is a structured approach to increasing understanding of deficits, offering accommodations to help with mental slowness, and teaching methods to improve cognitive functioning (Chung et al.,2013). Additionally, approaches such as mindfulness, use of memory aids, and relaxation activities have shown effectiveness in executive function rehabilitation (Pasini et al., 2014).

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Additional to cognitive therapies, prescription medications have demonstrated improvement in impaired attention.  Stimulants work on the transmission of neurotransmitters between neurons, and improvements in attention and cognitive testing have been shown with the treatment of stimulants. A study using methylphenidate, a widely prescribed psychostimulant, showed improvement in accuracy and reaction time in traumatic brain injury patients in sustained attention tasks (Kim et al., 2011).

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Treatment for post-traumatic cognitive disorder
 

• Referral for cognitive behavioral therapy

• Referral to Speech Therapy​​

• Start medications:

  • Modafinil

  • Other stimulants

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Mindfulness exercises 

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Scientific studies have revealed that a variety of mindfulness exercises, including meditation, hypnosis, and yoga, can improve cognitive functioning. In a study tracking the improvement of cognition with mindfulness-based exercises, researchers observed improvements in general cognition in addition to improved memory, attention, executive function, and processing speed (Sevinc, 2021). 

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At Los Angeles Brain Science Project, we have curated this document including mindfulness resources we find most effective in improving cognitive symptoms in traumatic brain injury patients. 

 

 

References

Chung CS, Pollock A, Campbell T, Durward BR, Hagen S. Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage. Cochrane Database Syst Rev. 2013 Apr 30;2013(4):CD008391. doi: 10.1002/14651858.CD008391.pub2. PMID: 23633354; PMCID: PMC6464714.

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Ellemberg, Dave PhD*†; Leclerc, Suzanne MD, PhD*; Couture, Sandra BA*; Daigle, Chantal MA*. Prolonged Neuropsychological Impairments Following a First Concussion in Female University Soccer Athletes. Clinical Journal of Sport Medicine: September 2007 - Volume 17 - Issue 5 - p 369-374 doi: 10.1097/JSM.0b013e31814c3e3e

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Krasny-Pacini A, Chevignard M, Evans J. Goal Management Training for rehabilitation of executive functions: a systematic review of effectiveness in patients with acquired brain injury. Disabil Rehabil. 2014;36(2):105-16. doi: 10.3109/09638288.2013.777807. Epub 2013 Apr 18. PMID: 23597002.

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Sevinc, Gunes et al. “Mindfulness Training Improves Cognition and Strengthens Intrinsic Connectivity Between the Hippocampus and Posteromedial Cortex in Healthy Older Adults.” Frontiers in aging neuroscience vol. 13 702796. 27 Aug. 2021, doi:10.3389/fnagi.2021.702796

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