From the Research
Introduction to Amnesia and Multiple Concussions
The evaluation of a patient with amnesia and multiple concussions requires a comprehensive approach, considering the complex interplay of cognitive, emotional, and physical symptoms. According to 1, a thorough history and physical examination are essential in assessing patients with concussion, focusing on elements of autonomic function, oculomotor and vestibular function, and the cervical spine.
Clinical Assessment and Diagnosis
The differential diagnosis of persistent post-concussive symptoms (PPCS) is based on the mechanism of injury, medical history, and concussion-pertinent neurological and cervical physical examinations 1. Post-traumatic amnesia (PTA) is a critical aspect of traumatic brain injury (TBI), involving extensive memory disturbance, confusional state, and behavioral disturbance 2. The Westmead PTA scale (WPTAS) is commonly used in directing neurosurgical practice, although its limitations have been identified.
Cognitive Screening and Assessment
Cognitive screening tests, such as the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), play a crucial role in detecting mild cognitive impairment (MCI) and monitoring cognitive changes 3, 4. The MoCA test has been shown to be more sensitive than MMSE in detecting MCI among people aged over 60 3. However, both MMSE and MoCA are comparable as cognitive assessment tools to monitor cognitive changes in patients with Alzheimer's disease 4.
Next Evaluation Steps
The next evaluation for a patient with amnesia and multiple concussions should include:
- A thorough medical history and physical examination, focusing on concussion-pertinent neurological and cervical physical examinations 1
- Assessment of PTA using a validated scale, such as the WPTAS 2
- Cognitive screening using MMSE or MoCA to detect MCI and monitor cognitive changes 3, 4
- Consideration of adjunct tests, such as neuropsychological assessments, to identify specific symptom generators and inform rehabilitation strategies 1, 5
Treatment and Rehabilitation
Treatment and rehabilitation strategies should be tailored to the individual patient's needs, addressing cognitive, emotional, and physical symptoms. This may include:
- Cognitive rehabilitation to improve attention, memory, and executive function
- Vestibular rehabilitation to address balance and dizziness issues
- Physical therapy to improve mobility and reduce pain
- Psychological support to address anxiety, depression, and other emotional symptoms
Caveats and Considerations
It is essential to consider the following caveats and considerations when evaluating and managing patients with amnesia and multiple concussions:
- The pathophysiology of persistent post-concussive symptoms remains a subject of debate, and both injury-related and non-injury-related factors may contribute to long-lasting symptoms 5
- Mental fatigue can exacerbate cognitive deficits and should be addressed in rehabilitation strategies 5
- Personality and behavioral changes, such as impulsivity and apathy, may occur after TBI and require comprehensive management 5