DOI: https://doi.org/10.22141/2224-0586.6.85.2017.111612

Cognitive impairment in the acute period of combat trauma in comparison with the combined trauma of peacetime

A.A. Krishtafor, L.V. Usenko, I.A. Yovenko, D.A. Krishtafor, V.G. Chernenko, O.A. Shajda

Abstract


Background. Injuries are one of the causes of the development of critical states and cognitive disorders as their consequences. Cognitive impairment that occur in critical patients can not only significantly slow the recovery process and worsen the quality of life after discharge from the hospital, but also directly related to higher lethality. One of the important factors that oppress cognitive functions in traumatized patients may be posttraumatic stress disorder. The purpose of the study was to determine the differences in severity and nature of cognitive impairment caused by combat trauma from trauma caused in a peaceful environment and the impact on cognitive functions of the posttraumatic stress disorder syndrome in the acute period. Materials and methods. 42 victims (26 with a “peaceful” trauma and 16 with a combat trauma) were examined. The level of cognitive functions before the injury was assessed by the Cognitive Failures Questionnaire for 2–3 days after injury; the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scales were used on the day 2 in the intensive care unit, when transferring from the department and before discharge. The severity of the injury was assessed on the Injury Severity Score. The severity of the response to traumatic stress was evaluated according to the Impact of Event Scale — Revised scale. The data were processed using parametric and non-parametric statistics. Results. In both groups, the baseline level of cognitive function was within the age range. Both groups were comparable by age and severity of the injuries. There was a significant decrease in cognitive functions in both groups in relation to the baseline (by 15–20 %). During the treatment, the cognitive functions of the victims were gradually restored, but by the end of treatment, they did not reach the baseline level. The psychological response to trauma and stress at the time of being in the intensive care unit was low in both groups, but in the group with the combat trauma, it was significantly higher due to a higher physiological excitability. Despite the low severity of the response to stress, a moderate negative correlation between the cognitive scales and the stress response scale was found in both groups (r = –0.47 with the MoCA and r = –0.33 with the MMSE). With the recovery, the severity of this relationship decreased to –0.44 and –0.27, respectively. Conclusions. When using the MoCA, there was a more pronounced decrease in cognitive functions than when using the MMSE. An assessment of which of the scales is more objective requires a separate study.

Keywords


cognitive impairment; polytrauma; combat trauma; posttraumatic stress disorder

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