Neuropsychological Assessment of mTBI in Adults
Yates, Philip J
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Mild traumatic brain injury (mTBI), comprising 70–80% of all TBIs, is the commonest form of TBI, representing those injuries deemed to be at the lower end of the severity spectrum. In the general population, mTBI may occur as a result of a fall, work-related injury, sport or recreational activity, assault, motor vehicle accident, or any other activity that results in an impact to the head, but in military service, members’ blast-related and combat injuries are a further source of such injuries. There are various classification criteria for determining severity of TBI. mTBI is indicated by a Glasgow Coma Scale (GCS) score of 13–15 at the time of assessment, a duration of loss of consciousness (LOC) of less than 30 minutes, and/or a duration of post-traumatic amnesia (PTA) of less than 24 hours. In terms of the clinical pathology, mTBI is characterized by a diverse range of clinical features, demonstrating tremendous heterogeneity of the underlying pathology. Individuals suffering from mTBI may report a range of enduring1+ symptoms for weeks, months, and even years post-injury. In over 90% of mTBI cases, computed tomography (CT) and structural magnetic resonance imaging (MRI) investigation are unremarkable; however, with the more sophisticated brain function-related techniques abnormalities may be detected. While many mTBIs tend to result in a recovery period of days or weeks, this is not the case for all mTBIs. In some instances, the use of the classification “mild” is a misnomer, particularly for the group of patients that experience a prolonged recovery and meet criteria for persistent concussional symptoms/post-concussion syndrome (PCS). This review will focus on the post-injury cognitive sequelae and neuropsychological assessment in the management of mTBI, in the context of pre-injury characteristics and other post-injury sequelae.