Monitoring emergence from coma following severe brain injury in an octogenarian using behavioural indicators, electrophysiological measures and metabolic studies: A demonstration of the potential for good recovery in older adults

This case study describes a multi-disciplinary investigation of the emergence from coma of an 80-year old female (KE) following severe traumatic brain injury. The relationship between cognitive/behavioural ability and the integrity of cerebral function was assessed using neuropsychological measures, positron emission tomography, electroencephalography, somatosensory evoked potentials and trans-cranial magnetic stimulation. These investigations were performed as KE was beginning to emerge from coma (4 weeks) and, again, ∼1 year following brain injury, when she was judged to have achieved her maximum level of recovery. Neuropsychological measures revealed improvement during the first year post-injury in KE's speed of information processing, memory and executive abilities. Electrophysiological and metabolic studies indicated a restoration of functional integrity that was consistent with the gradual recovery in higher brain function documented using behavioural procedures. This case study demonstrates the rehabilitation potential of pre-morbidly healthy older adults following severe traumatic brain injury.

[1]  A N Clark,et al.  Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults , 2001, Journal of the International Neuropsychological Society.

[2]  G. Teasdale,et al.  Emotional and cognitive consequences of head injury in relation to the Glasgow outcome scale , 2000, Journal of neurology, neurosurgery, and psychiatry.

[3]  A. Kaye,et al.  A study of the functional outcome and mortality in elderly patients with head injuries , 2000, Journal of Clinical Neuroscience.

[4]  M J Campbell,et al.  The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury , 2000, Clinical rehabilitation.

[5]  S. Majerus,et al.  Wessex Head Injury Matrix and Glasgow/Glasgow-Liege Coma Scale: A Validation and Comparison Study , 2000 .

[6]  S. Dikmen,et al.  Aging effect on psychosocial outcome in traumatic brain injury. , 1998, Archives of physical medicine and rehabilitation.

[7]  G. Teasdale,et al.  Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. , 1998, Journal of neurotrauma.

[8]  B Jennett,et al.  Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. , 1998, Journal of neurotrauma.

[9]  M E Phelps,et al.  Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study. , 1997, Journal of neurosurgery.

[10]  M. Rosenthal,et al.  Impact of Age on Functional Outcome Following Traumatic Brain Injury , 1996 .

[11]  D. McArthur,et al.  Epidemiologic aspects of brain injury. , 1996, Neurologic clinics.

[12]  C. Boake,et al.  Functional outcome from traumatic brain injury: unidimensional or multidimensional? , 1996, American journal of physical medicine & rehabilitation.

[13]  J. Greene.  Contributions to Neuropsychological Assessment , 1995 .

[14]  H. Levin,et al.  Neurobehavioral outcome of traumatic brain injury in older adults: Initial findings , 1995 .

[15]  P. Satz.  Brain reserve capacity on symptom onset after brain injury: A formulation and review of evidence for threshold theory. , 1993 .

[16]  M. Abdalla,et al.  The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? , 1993, BMJ.

[17]  C. McHorney,et al.  The MOS 36‐Item Short‐Form Health Survey (SF‐36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs , 1993, Medical care.

[18]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[19]  Anthony Marmarou,et al.  Age and outcome following traumatic coma : why do older patients fare worse ? , 1991 .

[20]  C. Patlak,et al.  Graphical Evaluation of Blood-to-Brain Transfer Constants from Multiple-Time Uptake Data. Generalizations , 1985, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[21]  C S Patlak,et al.  Graphical Evaluation of Blood-to-Brain Transfer Constants from Multiple-Time Uptake Data , 1983, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[22]  L. Radloff.  The CES-D Scale , 1977 .

[23]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[24]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[25]  W. Sturm,et al.  Neuropsychological assessment , 2007, Journal of Neurology.

[26]  M. Rapoport,et al.  Outcome following traumatic brain injury in the elderly: a critical review. , 2000, Brain injury.

[27]  N. Raz.  Aging of the brain and its impact on cognitive performance: Integration of structural and functional findings. , 2000 .

[28]  Alan D. Baddeley,et al.  The Rivermead Behavioural Memory Test - Extended Version , 1999 .

[29]  M. Childers,et al.  The effects of normal ageing on neuropsychological functioning following traumatic brain injury. , 1998, Brain injury.

[30]  R. Reitan.  Trail Making Test: Manual for Administration and Scoring , 1992 .

[31]  A. Krieger,et al.  The pathophysiology of head trauma. , 1983, The Journal of the Medical Society of New Jersey.

[32]  Denise C. Park,et al.  Handbook of the Psychology of Aging , 1979 .