![]() ![]() The American Congress of Rehabilitation Medicine (ARCM) definition of mild (or greater) TBI ( 10) ( Table 1) and the clinical case definition used by the Centers for Disease Control and Prevention ( 11) ( Table 2) are useful guides to the evaluation for TBI. Of utmost importance is determining whether one’s patient experienced a TBI and whether that patient’s cognitive difficulties are attributable to TBI. The content and organization of this type of clinical evaluation are described in detail elsewhere ( 7- 9) readers may find these references useful guides to the development of a comprehensive assessment of a patient with neuropsychiatric problems after TBI. Thereafter, pharmacologic and rehabilitative interventions that may facilitate cognitive and functional recovery at each stage of posttraumatic encephalopathy are discussed.Ĭomprehensive evaluation is a prerequisite to the treatment of any posttraumatic neuropsychiatric problem, including cognitive impairment. The overarching course of recovery after TBI, framed as a progression through the stages of posttraumatic encephalopathy, is reviewed next. An approach to understanding posttraumatic cognitive impairments in relation to injury severity as well as time post-injury is presented. We discuss first, in brief and in general terms, the importance of pre-treatment evaluation as well as consideration of non-cognitive contributors to cognitive problems and functional limitations. Toward that end, this article reviews the evaluation and treatment of posttraumatic cognitive impairments. As such, familiarity with the evaluation, differential diagnosis, and management of posttraumatic cognitive complaints is needed to serve well these patients. ![]() Cognitive complaints are often prominent features of the clinical presentation of patients referred for psychiatric care after TBI ( 7). Psychiatrists are increasingly called upon to care for individuals with cognitive, emotional, and behavioral disturbances after TBI, especially in settings serving military service personnel and Veterans. Cognitive impairments contribute to disability among persons with TBI ( 3- 5) and are potentially substantial sources of suffering for persons with TBI and their families ( 6). In both the early and late post-injury periods, impairments of arousal, speed of information processing, attention, working memory, episodic memory, language and social communication, and executive functioning are common ( 1, 2). Finally, pharmacologic and rehabilitative interventions that may facilitate cognitive and functional recovery at each stage of posttraumatic encephalopathy are presented.Ĭognitive impairments are common consequences of traumatic brain injury (TBI). The course of recovery after TBI, framed as a progression through posttraumatic encephalopathy, is reviewed next and used to anchor the evaluation and treatment of posttraumatic cognitive impairments in relation to injury severity as well as time post-injury. The importance of pre-treatment evaluation as well as consideration of non-cognitive contributors to cognitive problems and functional limitations is emphasized first. In this article, the differential diagnosis, evaluation, and management of posttraumatic cognitive complaints is reviewed. In both the early and late post-injury periods, cognitive impairments contribute to disability among persons with TBI and are potentially substantial sources of suffering for persons with TBI and their families. ![]()
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