The prevalence of cognitive dysfunction following traumatic brain injury in patients at Kenyatta National Hospital

Abstract

Modern cognitive psychology has led us to understand and appreciate that all mental processes comprise of perceiving, thinking, recall, learning and language skills. These cognitive skills become impaired following a brain injury. Traumatic brain injury often impairs various parts of the brain and consequently alters the functioning of the brain. With the increase in modern technology and brain science many of the individuals who would have previously succumbed to their injuries often survive their head trauma only to be left with severe cognitive impairments. Road traffic accidents are the major cause of head injury with a rate of over half the overall incidence, while the rest are caused by sports and recreation falls, violence, and constructional accidents form the other bulk. The risk factors for sustaining a brain injury are being male, low socioeconomic status, unemployment low education levels and the use of alcohol. This research study is significant in that it will seek to determine the prevalence of cognitive dysfunction and thus come up with recommendations on how to handle this major health problem. Objective: The purpose of the study was to find out the prevalence of cognitive dysfunction following traumatic brain injury in patients at the Kenyatta National Hospital. Study Site: The study took place at Kenyatta National Hospital in the neurology, surgical clinics and the wards. Study Design: This was a cross sectional descriptive study that was conducted at the Kenyatta National Hospital. Data was collected using a structured demographic questionnaire, the Mini Mental Status Examination, the Trail Making Test and the Repeatable Battery for the Assessment of Neuropsychological Status. The researcher interviewed 75 study participants in this study. Results: A total of 75 brain injury patients were recruited for the study. The actual study participants were 74. One study participants was excluded because their cognitive impairment was very severe as measured on the MMSE. The study comprised of 58(78.4%) male study participants and 16 (22.6%) female study participants. The mean age of the study participants was 33.94 years. On the MMSE a majority of the respondent (67.7, 50) had no cognitive impairment, 31.1% (23) had moderate cognitive impairment while 1.4% (1) had severe cognitive impairment. On the Trail Making Test(TMT) part A, 4.1% (3) had no cognitive impairment. A majority of the study participants 44 (59.5%) had mild cognitive impairment 36.5% (27) had moderate to severe levels of cognitive impairment. On the TMT part B 8.1% (6) had no cognitive impairment. A majority of the study participants 31 (41.9%) had mild cognitive impairment, 22 (29.7%) had moderate impairment while 15 (20.3%) had severe impairment. In the RBANS, 39 (51.4%) had severe cognitive impairment, 26.8% (19) of the study participants had moderate cognitive impairment. 13.4% (10) had mild cognitive impairment while the remaining 8.4% (6) scored in the average range of the standardized scores on the RBANS. In this study there was significant cognitive impairment following TBI that was seen in the study participants. Cognitive impairment was significantly associated with age with a p= (0.037), gender with a p value of p=0.012, occupation p= 0.000, educational level 0.000, monthly income p= 0.016, and the cause of injury p= 0.006. Conclusion: In conclusion there was significant cognitive impairment in the various areas of cognition to do with memory, attention, visual spatial abilities, constructional skills, language skills and executive skills in this study. Head injuries including those that are mild have a cumulative effect on the functioning of the brain. Their outcomes are far reaching beyond the physical scars or physical disability that is seen. Recommendation: There is need for clinical screening and neurocognitive rehabilitation for those who are found to be impaired in order to improve the quality of life for these patients. There is need to screen for cognitive impairment in primary health care and to refer patients for prompt psychological care to deal with the psychological issues and cognitive impairment following head injury.