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Advanced Neurology Cognition in children with mild TBI

Table 7. Univariate analysis to determine possible risk Our results demonstrated that children with a
factors for any type of cognitive deficits in children with history of mTBI may exhibit lower scores in specific
traumatic brain injury at follow‑up neuropsychological functions and in the long-term
follow-up (24 months after the event). These may impact
Variable Risk of any cognitive deficit their routine life, including school performance (when
OR 95% CI P* memory and visuospatial abilities are impaired) and social
Sex (male) 0.525 0.009 – 23.78 0.727 relationships (when affect recognition is impaired). Thus,
Age (≤6 years) 0.149 0.003 – 4.02 0.273 these children should be systematically screened and
Cause (High energy TBI) 0.721 0.012 – 46.2 0.864 evaluated for a longer period.
GCS (≤14) 9.33 0.669 – 127 0.119 4.2. Neuropsychological functioning in the
Baseline head CT (Any injury) - - - monocentric study
MRI (Any injury) 1.4 0.059 – 47.5 0.83 Children enrolled in our study exhibited significantly lower
Notes: Statistical analysis was performed using Fisher’s exact test. scores in most memory tasks compared with the normal
*P<0.05.
Abbreviations: CI: Confidence interval; CT: Computed tomography; values. Memory functioning may be highly variable
GCS: Glasgow coma scale; MRI: Magnetic resonance imaging; in children with a history of severe TBI. 50,51 Recently,
OR: Odds ratio. similar findings were reported in children with mTBI. 33,40
However, memory deficits may also emerge with time or
especially in the first few weeks after the injury, and these be misdiagnosed in the immediate post-injury phase, as
subtle deficits may persist even after several months. 45-49 some memory functions mature later during childhood. 52
According to previous systematic reviews 44,45 and Our study population also exhibited lower scores in
studies, 31,33,38,42,43 evidence on psychological, behavioral, visuospatial abilities compared with the normal reference
and psychiatric problems following an mTBI remains values. In particular, children performed worse in design
controversial. This may be attributable to the fact that copying (aimed at evaluating visual–constructional and
many results are often based only on symptom ratings (not visual–perceptual skills). This finding is consistent with that
the actual diagnosis) and are based on research protocols of a recent study on the effects of concussion in adolescent
characterized by multiple methodological limitations, such hockey players. In another study, young athletes with
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as the use of healthy controls. 33,45 When control groups a concussion performed worse than controls in a spatial
include patients with non-head injuries (e.g., orthopedic configuration task, which was specifically designed to
fractures), statistical significance may disappear over time measure their ability to form a mental representation of the
compared with that in analyses based on a healthy control spatial surrounding. These abilities require an extended
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group alone. 31,34,50 neural network that encompasses cortical and subcortical
Although the likelihood of psychological or psychiatric structures, especially bilateral parietal cortex activation. 55
issues increases in the period immediately after an According to our study results, children with a history
mTBI, 44,45 there is no evidence regarding their long-term of mTBI may also present with subsequent difficulties in
consequences. 31,33,35 However, the time to follow-up across facial affect recognition. However, the ability to put oneself
the studies was not standardized. Children with mTBI in the other’s shoes (theory of mind), as measured by the
across different studies were assessed over a wide and NEPSY-II, was not compromised. Some previous studies
heterogenous period, usually limited to 1 year after the have suggested persistent alterations in the recognition of
injury 30,31,34,36,40 or after only 3 months. 33,35,37,41 Although non- facial emotional expressions 56-59 in children who sustained
injury factors are more consistently related to persistent mTBI. This finding may account for the reduction in social
PCS, the injury characteristics may predict the PCS in the competence in patients with TBI because the ability to
first few months after an mTBI. However, the evidence perceive emotions displayed by others through non-verbal
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on both children-related 34,35,37,39 and family-related 31,32,39,42 cues is crucial in shaping optimal reactions and behaviors
factors remains unclear. Therefore, if neuropsychological toward others. Communication issues are also significantly
morbidity impacts children with mTBI, psychological and negatively associated with the ability to recognize
support should be a part of the follow-up in these facial emotions. Although data on the neurobiological
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patients and those with more severe traumas. Preliminary mechanisms of impairment of facial affect recognition are
studies have demonstrated that a child’s emotional and limited, functional neuroradiological studies in adults have
cognitive functions improve after prolonged exposure to revealed a correlation of impaired facial recognition ability
psychological intervention support and with the promotion with reduced activation in the right fusiform gyrus and
of high levels of caregiver satisfaction. 36,41 medial prefrontal regions. 61

Volume 3 Issue 4 (2024) 17 doi: 10.36922/an.3886