Longer term neurocognitive outcomes after acquired brain injury

  • Rebecca Rooney

Student thesis: Doctoral ThesisDoctorate in Clinical Psychology

Abstract

Most of the research on treatment approaches for acute ischemic stroke have focused on the effect of thrombolysis (IVT) and thrombectomy (EVT) on survival and functional outcomes. Little is known about the cognitive outcomes after IVT and EVT following acute ischemic stroke. The objective of this systematic review was to determine the differential cognitive and functional outcomes following thrombolysis or thrombectomy after mild to severe ischemic stroke in adults. Data was sourced using seven online databases. The SITS Registry was also searched as well as the grey literature in the form of Open Grey and Google Scholar. Initially, 1,040 articles were identified from 2000-2020. After screening full text papers, a total of 7 articles were eligible for data synthesis. Cognitive impairment on the Montreal Cognitive Assessment (MoCA) at 90 days post stroke was evident in patients who received either IVT or EVT. On tasks of executive function in particular the Trail Making Test, impaired performance was observed for EVT at 90 days and 365 days post stroke and IVT at 180 days post-stroke. A higher percentage of patients treated with EVT achieved functional independence on activities of daily living on the Barthel Index (BI) at 90 days and 2190 days post stroke, compared to those treated with IVT.  The current empirical study examined predictors of post-acute memory impairment and the relative contributions of alcohol (intoxication at time of injury and history of problematic alcohol use) on memory during the post- acute recovery stage after Traumatic Brain Injury (TBI). Case files from 303 individuals admitted to inpatient neuro-rehabilitation after single incident TBI were reviewed. Approximately 40% had a documented history of problematic alcohol use and around one third were intoxicated at time of injury. Using hierarchical regression analyses, older age and history of problematic alcohol use significantly predicted poorer performance on measures of immediate memory and global memory. Having a high skilled occupation significantly predicted better performance on the immediate and delayed memory index on the RBANS. Both history of problematic alcohol use and intoxication at time injury provided a significant and unique contribution to the prediction of global memory performance on the RBMT in the post-acute recovery stage after TBI (F (9,167) = 6.24, p <.001), albeit accounting for a small variance. Being intoxicated at time of injury resulted in more intact global memory in this mild to severe TBI sample. Clinical implications and limitations are discussed.
Date of AwardDec 2021
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SupervisorDonncha Hanna (Supervisor) & David Curran (Supervisor)

Keywords

  • Ischemic stroke
  • intravenous thrombolysis
  • endovascular thrombectomy
  • cognition
  • traumatic brain injury
  • alcohol
  • post-acute memory

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