Study Of Cognitive Function Between Aphasia And Non-aphasia Patients With Severe Traumatic Brain Injury

BACKGROUNDTraumatic brain injury (TBI) is a common wound and it has a inferior rate than limbs wound in our country. Especially, the severe traumatic brain injury usually has many places involved and severe injured. The patients after severe traumatic brain injury common have movement, consciousness, sense impediment, cognitive and language impediment. Compare to the movement impediment, cognitive and language impediment may have more influence to the patient's further living.Aphasia is a language function impediment that cause by brain injury. The patients have handicap in cognition and application with communion-symbolic when they have no consciousness problems. In an other word, the patients have expression and understanding problems. The aphasia patients can listening speech voice and seeing the word, but they can not understanding the meaning of what they listened or seen; they have no paralysis, ataxia or independent movement with throat muscle but they can not talking or expressing theirs meaning. The assessment of language impediment can be used by scales, there are some scales for domestic and international clinical research such as Boston Diagnostic Aphasia Examination (BDAE), Western Aphasia Battery (WAB), Aphasia Battery of Chinese (ABC) and China Rehabilitation Research Center Aphasia Examination (CRRCAE).The cognition is a kind of activity that people understand the outside and it is the process of acquisition, organization and application for knowledge too. It can show the intelligence process of function and behavior. Cognitive function is constitute with 1. thinking : include concept formation, creativeness, judgment, decision making, esthetic and problem solving. 2. memory : include instanteous memory, short-term memory, long-term memory. 3. Attention. 4. Imagination. 5. Intuition. 6. fantasy. The patients who have brain injurey may have the impediment in sense, speech, memory and thinking to influence cognition because of damaged nervous central system. The measure of cognitive impediment can be used by scale too. Currently, there are some scales for research such as Loewenstein Occupational Therapy Cognitive Assessment(LOTCA), Mini-Mental State Examination(MMSE), Neurobehavioral Cognitive State Examination(NCSE) and Functional Independence Measure ( FIM).Domestic and international research indicated that the patients with aphasia following brain injury have more cognitive impediment than the non-aphasia patients and the language impediment has correlation with cognitive function. Given the aphasia patients especially language and cognitive training at the same time may promote the resume of aphasia. But the research about aphasia with severe traumatic brain injury is not so much. So this object is to explore the cognitive function between aphasia and non-aphasia patients after severe traumatic brain injury and the correlation of language impediment with cognitive function in aphasia patients. In order to offer evidence for clinical training.This object used CRRCAE scale and LOTCA scale.Used the aphasia examination scale is China Rehabilitation Research Center Aphasia Examination (CRRCAE), this scale is from the Japanese standard aphasia examination in the design theory and framework, and in accordance with the terms of Chinese words and phrases compiled from customs and rules, applicable to the chineses language environment and can be applied to the diagnosis and treatment, its good reliability and validity is verified.The LOTCA scale was made for soldiers who had traumatic brain injury in the Middle East-battle in 1973 and published by Hebrew University Lowenstein Hospital Rehabilitation Center in 1989. Compare with the other assessment methods, its' biggest characteristic is to lead several occupational tasks into the cognition assess and have the advantages of effective affirmation, simple operating and clear entries. The LOTCA researchers had the second version from the foundation of the first one. The second version LOTCA include Orientation, Visual perception, Spatial perception, Motor praxis, Visuomotor organization and Thinking operations. The test sub-items also increased from 20 items of the first version to 26 items of the second version. The China Rehabilitation Research Center introduced and translated the first version in 1999, and the second version began to using in domestic from 2004. LOTCA is an excellence cognitive assessment, its excellent reliability and validity had been confirmed by Nan Fang Hospital, Zhong Shan Hospital and many other units. Our section explored the Chinese computer software test and tested it, the result revealed that its has an excellent reliability and validity and may have advantages than the manual one.ObjectiveThe object is through explore the results of LOTCA scale to find whether there is cognition differences in aphasia group and non-aphasia group. And further more to explore the items of CRRCAE scale and LOTCA scale to checkout if there is a correlation with language impediment and cognitive function in aphasia group, in order to apply the clinical basis for further patients.Object and Methods1. Object: Patients after severe traumatic brain injury were selected from Na Fang Hospital from February 2008 to December 2008, his condition is stable and be able to cooperate aphasia and cognitive assessment. In to standard:①post-traumatic coma time more than 6 hours or Glasgow Coma Score (GCS) less than 8 cents,②patient with brain injury has been considered by CT or MRI,③patient is in stable condition and conscious,④not has young diseases due to study difficulties led to language function defective,⑤not given the perception of language and cognitive training,⑥given standard clinical treatment. Exclusion standard:①patient has the history of traumatic brain injury, cerebral vascular accident or other intracephalic space-occupying history, history of encephalitis,②patient before brain injury has psychosis history, drug and alcohol addiction history,③age younger than 18 years or older than 65 years when he injured,④spirit restless or otherwise unable to cooperate examination,⑤not has other severe injured. Patient who meet the criteria (all signed consent form) according clinical features and the results of aphasia screening scale of Nan Fang hospital to divided into aphasia group and non-aphasia group. There are 29 patients in aphasia group and 14 patients in non-aphasia group.2. Design: the cross-sectional study and related analysis.3. Methods: 43 cases of standard with severe traumatic brain injury were given CRRCAE and LOTCA test in reception time or no more than one week.①CRRCAE scale: this scale include 9 items and 30 sub-items, I .Auditory verbal comprehension, include 4 sub-items, II .Repeition, include 3 sub-items, III.Oral-expression, include 5 sub-items, IV.Reading aloud, include 3 sub-items, V.Reading comprehension, include 4 sub-items, VI.Transcription, include 3 sub-items, VII. Description, include 5 sub-items, VIII. Dictation, include 3 sub-items, IX. Calculation. In addition to calculation (full score is 20 cents and the lowest is 0 cent) and fruit naming (full score is 10 cents and the lowest is 0 cent), the other sub-items full score is 6 cents and the lowest is 1 cent.②The second Chinese version LOTCA software is made up of 6 items and 26 sub-items, I .Orientation, include 2 sub-items, II .Visual perception, include 4 sub-items, III. Spatial perception, include 3 sub-items, IV. Motor praxis, include 3 sub-items, V.Visuomotor organization, include 7 sub-items, VI. Thinking operations, include 7 sub-items. In addition to Orientation (full score is 8 cents and the lowest is 1 cent) and organization category (full score is 5 cents and the lowest is 1 cent), the rest sub-items full score is 6 cents and the lowest is 1 cent.STATISTICAL TREATMENTThe data was analysed by SPSS 13.0.①Balance test: Two groups' data with age used independent-samples t-test, education level and post-traumatic coma time used nonparametric-test 2 independent samples test;②Compare with cents of LOTCA scale: used nonparametric-test 2 independent samples test;③Correlation analysis with items of CRRCAE scale and LOTCA scale in aphasia group: used canonical correlation analysis. Statistical significance was set at P<0.05. (Aphasia patients with right hemiparesis were written by left-hand and who two hands could not writing the cents of CRRCAE in transcription, description and dictation were recorded as missing values and excluded in the analysis, so did the LOTCA scale.)RESULTS1. Compare with baseline: The median of education years and post-traumatic coma time(hours) in aphasia group and non-aphasia group are 9.00 and 10.05, 48.00 and 84.00 , the mean of age (years) are 32.41±12.17 and 31.36±10.06. There is no significant differences in both group with age, education years and post-traumatic coma time. (P>0.05,α=0.05)2. Compare with cognitive function:①There is a significant differences in Orientation, Visual perception, Spatial perception, Motor praxis, Visuomotor organization and Thinking operations with two groups. (P<0.01)②There is a significant differences in sub-items of OP,OT,OI,SI,OF,OC,SP1,SP2,SP3,P1,P2,P3,GF,TM,PC,CB,PB,RP,DC,CA,(P<0.05 or P<0.01) But there is no significant differences in sub-items of S P 1,P1,TM,PC,DC. ( P>0.05)3. Correlation analysis with items of CRRCAE scale and LOTCA scale in aphasia group: There is a significant positive correlation with language impediment and cognitive function. Auditory verbal comprehension impediment has the main correlation with Orientation and Visual perception function. Repetition impediment has the main correlation with Orientation and Visual perception function, but the correlation is not so strong as other items. Oral expression impediment has the main correlation with Motor praxis function. Reading aloud impediment has the main correlation with Orientation and Motor praxis function. Reading comprehension impediment has the main correlation with Orientation, Motor praxis and Visuomotor organization function. Transcription impediment has the main correlation with Orientation, Visuomotor organization function. Description impediment has the main correlation with Orientation function. Dictation impediment has the main correlation with Orientation function. Calculation impediment has the main correlation with Orientation, Motor praxis and Visuomotor organization function. Auditory verbal comprehension has highest correlation with the items of LOTCA scale than other items in CRRCAE scale. Orientation has the highest correlation of CRRCAE scale than other items in LOTCA scale.CONCLUSION:1. Aphasia patients after severe traumatic brain injury have more cognitive impediment than the patients who haven't. There is a significant statistical differences of cognitive items in aphasia patients and non-aphasia patients after severe traumatic brain injury and so does the most sub-items .2. Cognitive function has nearly relation with language impediment in aphasia patients after severe traumatic brain injury. Through canonical correlation analysis we can deduced that: the items of LOTCA have the strong positive correlation with Auditory verbal comprehension, Oral-expression, Reading aloud, Reading comprehension, Transcription, Description, Dictation and Calculation, but have less positive correlation with Repetition; patients who have language impediment are easy to have Orientation impediment; Auditory verbal comprehension compare to the other items in CRRCAE scale has bigger influence to cognitive function.3. Over all, if the aphasia patients after severe traumatic brain injury should be given cognitive assessment and especially cognitive training to compare with language training should be more exploring in the further.