Traumatic brain injury (TBI) is the most common cause of death and disability in more young and old persons in many countries including the USA and Canada,1 with resulting from TBI in chronic neurological, cognitive, and behavioral impairments.2 Then it can be one of the most challenging and rewarding aspects of clinical neurocritical care.3 Traumatic brain injury patients are at high risk for impairments in pragmatic language and social communication more broadly.4 Meanwhile post-traumatic brain-injured person after coming out of a coma, they reference to behavioural with the specific report and cognitive impairments.5
Cognitive impairment is a common consequence of traumatic brain injury and a substantial source of disability, across all levels of TBI severity indicated attention, processing speed, episodic memory, and executive function are most commonly affected.6 Cognitive impairment is common outcomes in each level and cause of TBI patients. In particular, during the follow up after the trauma, all patients underwent neurological examination including mini mental state examination (MMSE) and Glasgow outcome scale (GOS).7 Study shows moderate to severe TBI patients reported cognitive deficits include memory, language, executive functions, attention and information processing speed deficiencies.8 TBI patients are at risk of subjective memory impairment which was significantly greater among TBI with loss of consciousness, post-TBI cognitive impairment primarily affects executive function and processing speed.9
However, there was a statistically significant increase in the composite cognitive score and decrease in functional connectivity in the right inferior frontal gyrus, with changes in the brain-behavior in the Traumatic brain injury patients,.10 White matter disruption after brain injury shows cognitive impairment, then, white matter damaged was related with particular patterns of cognitive impairment.11 The meantime, cognitive function was combined with outcomes, screening of cognitive function could be of importance in a clinical setting.12
Furthermore, severity levels of traumatic brain injury determine cognitive impairment. Various levels of traumatic brain injury contain; severe- moderate-mild could have various outcomes in cognitive impairment. Similar research declared moderate-to-severe traumatic brain injury can cause varying degrees of cognitive control deficits positive relationship to injury severity correlated with self-reported cognitive control problems in everyday-life situations.13 Traumatic brain injury is a risk factor for cognitive decline in mild cognitive impairment older adults patients.14 Patients with mild traumatic brain injury had worse neurocognitive function, higher overall symptom severity and higher total number of symptoms, there is a cognitive deficit and symptom burden in patients with TBI.15
In other words, traumatic brain injury is usually caused by a strike or other traumatic injury to the head or body.16 The most common causes of TBI are falls and vehicle accidents, followed by acts of violence and other reasons, such as for example fights injuries. Also, different causes of TBI suffer from various cognitive impairment. In particular, car accident, head trauma, and fall reported different cognitive impairment.
Education plays important role in cognitive impairment following TBI. Literature indicated that education appeared to affect verbal and nonverbal task performance in mild cognitive impairment patients. While higher educated patients are more acquainted with the tasks, slower deterioration in consecutive follow-up considerations could be explained by the cognitive reserve theory.17
In fact, the importance of comprehensive neuropsychological assessments in each case of TBI in order to identify impaired and preserved functions as long as sufficient managing including rehabilitation programs for each case.18 Therefore, the aims of this study were to consider and predict the cognitive impairments through different levels, causes of TBI, and education status in traumatic brain injury patients to consider this three-factor to set more essential rehabilitation program in future.
METHODS
Participants and Procedures for data collection
This study examined a subset of patients from a pilot study with selecting sample availability random method. The investigation covered a 6-month period from March 2017 to October 2017. Study was conducted at a level one trauma centre in the Zahedan city. The patients had medical cares. Subjects were evaluated qualify if they were 18 years of age or older and had resistant five kinds of brain traumatic injuries within 24 hours of presence to the emergency department. Children and patients with previous orthopaedic conditions were excluded.
Data regarding the levels of severe Brain Injury, Moderate, and Mild Traumatic Brain Injury and causes of the injury, including a car accident, car accident multiple trauma, head trauma, head trauma multiple trauma, and fall were also collected with 2 months after patients’ discharge. Generally, study was done in 6 months.
The Demographic Questionnaire
Patients were enrolled prospectively after providing written informed consent and ask Mini-Mental State Examination (MMSE) questions. This is a well-validated for cognitive impairment in Iranian adults. Cognitive tests will provide valuable information for understanding the mechanism of cognitive impairment after traumatic brain injury and manage TBI patients.19 Investigation indicated that MMSE function as similar predictors of the Disability Rating Scale in TBI patients.20 Demonstrated the validity of the Persian MMSE in recognizing normal versus abnormal cognition cut-off score for our subjects with a sensitivity and specificity of 98% and 100%, respectively, the test usually takes about ten minutes to complete The MMSE evaluates a range of cognitive domains, containing orientation, memory, language, attention and calculation, and ability to follow simple verbal and written commands.21 The MMSE is usually used as a short-form test in clinics and research instrument for assessing the cognitive impairment and dementia, MMSE function as similar predictors of the Disability Rating Scale at discharge.22 Scores of 25-30 out of 30 are measured normal; the National Institute for Health and Care Excellence (NICE) classifies 21-24 as mild, 10-20 as moderate and