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Advanced Neurology Cognition in children with mild TBI

All participants were individually evaluated over Primary Scale of Intelligence (WPPSI-III). The WISC-IV
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2 – 3 sessions, each lasting approximately 30 – 45 min, (or WPPSI-III) was administered during T1 and T2
on different days at intervals of <1 week. The timing of evaluations. The FSIQ scores from WISC-IV and WPPSI-
neuroradiological examinations (magnetic resonance III were combined for the analyses.
imaging [MRI]) was not standardized. However, they were
usually performed on the basis of the clinical status and 2.3.3. Emotional and behavioral assessment
close to the T0 or T1 neuropsychological evaluations. The emotional and behavioral aspects of the patients were
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The study was approved by the local Institutional assessed using the Child Behavior Checklist (CBCL). The
Review Board (approval no.: CEUR-2020-OS-265), and CBCL is a standardized tool that provides a parental report
written informed consent was obtained from the parents of emotional, social, and behavioral problems in children
aged 6 – 18 years. The questionnaire comprises 113 items.
of all enrolled children.
Each item is scored using a three-point Likert scale (0 =
2.3. Assessment “not true,” 1 = “somewhat or sometimes true,” and 2 =
“very true or often true”). The total score is derived from
2.3.1. Neuropsychological assessment several subscales, including internalizing aspects (e.g.,
Patients underwent neuropsychological evaluation using anxiety/depression, withdrawal, and somatic complaints)
the Italian version of the Developmental Neuropsychology and externalizing aspects (e.g., attention problems, rule-
Assessment II Edition (NEPSY-II). 25,26 NEPSY-II is an age- breaking, and aggressive behavior) together with social
based flexible instrument; some items can be administered problems and thoughts problems scales. For the subscales
to all age groups, whereas others are age specific. We chose of “internalizing,” “externalizing,” and “total” issues, a
to include only tasks administered to all children in the t-score of ≤59 indicates nonclinical symptoms, a t-score of
final analysis. As the NEPSY item “language function” was 60 – 64 indicates a risk of behavioral issues, and a t-score of
assessed via other tests according to the age of patients, it ≥65 indicates clinical symptoms.
was excluded from the analysis. The CBCL was administered during T0 (related to
The following domains were explored: pre-morbid functioning) and T1 evaluations. Analysis of
• Attention and executive functioning: visual attention, CBCL data was limited to patients aged 6 – 16 years.
graphic fluency, auditory attention and response set, 2.3.4. MRI and CT data acquisition
inhibition, clocks, and animal sorting
• Memory and learning: memory for faces, word Standard head CT was obtained for all children. MRI
list interference, memory for designs, list memory, was performed for specific clinical reasons using a 1.5 T
memory for names, narrative memory, and sentence scanner (Magnetom Area, Siemens, Erlangen, Germany).
repetition The MRI protocol included conventional MRI and 3D
• Sensorimotor functions: fingertip tapping, imitating reconstruction of T1-weighted images. The following
hand positions, and manual motor sequence parameters were selected for each sequence: T1-weighted
• Social perception: theory of mind and affect (repetition time/time to echo [TR/TE] = 500/17 ms, 19
recognition slices, thickness = 4 mm, field of view [FOV] = 180 mm,
• Visuospatial processing: design copying, block matrix size = 256), T2-weighted (TR/TE = 4000/86 ms,
construction, picture and geometric puzzles, route 20 slices, thickness = 4 mm, FOV = 200 mm, matrix size
= 320), fluid-attenuated inversion recovery (TR/TE =
finding, and arrows.
8500/81 ms, 20 slices, thickness = 4 mm, FOV = 200 mm,
The results of the NEPSY-II evaluation were expressed matrix size = 320), and volumetric T1-weighted (TR/TE
as age-adjusted scaled scores and compared with the = 2200/3.02 ms, 240 slices, thickness = 1 mm, FOV = 250,
normative reference values (mean = 10; standard deviation matrix size = 256).
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[SD] = 3). NEPSY-II was administered during T1 (attention
and executive functioning as well as memory and learning 2.4. Statistical analysis
domains) and T2 (complete assessment) evaluations. Descriptive analysis was performed to characterize the
study population. Continuous variables were expressed as
2.3.2. Cognitive assessment
mean and SD or median with interquartile range (IQR),
The full-scale intelligence quotient (FSIQ) was assessed in as appropriate. Categorical variables were expressed as
patients aged 6 – 16 years using the Wechsler Intelligence percentages or frequencies. All variables were analyzed
Scale for Children IV Edition (WISC-IV) and in for normality distribution (D’Agostino–Pearson omnibus
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patients aged <6 years using the Wechsler Preschool and normality test). Differences between evaluations

Volume 3 Issue 4 (2024) 3 doi: 10.36922/an.3886