What are the outcomes for patients with Acquired Brain Injury (ABI) whose functional cognition has not been assessed?

Outcomes of Patients with Acquired Brain Injury Without Functional Cognitive Assessment

Patients with acquired brain injury (ABI) who have not undergone functional cognitive assessment experience significantly poorer outcomes, including higher mortality, increased morbidity, and reduced quality of life. 1

Negative Consequences of Missed Cognitive Assessment

Clinical Outcomes

• Increased mortality and morbidity due to unrecognized cognitive deficits 1
• Delayed recognition of neurological deterioration 1
• Missed opportunities for early intervention in cognitive deficits 1
• Increased risk of secondary complications due to unrecognized cognitive impairments 1
• Inappropriate rehabilitation planning leading to delayed recovery 1

Functional Outcomes

• Reduced quality of life 1
• Decreased ability to reintegrate into everyday settings 2
• Difficulties in organizing and executing everyday tasks despite potentially normal performance on standard cognitive tests 2
• Impaired ability to return to work and previous social roles 3
• Reduced independence in activities of daily living 4

Assessment Recommendations

The Canadian Stroke Best Practice Guidelines strongly recommend that:

1. Individuals with ABI who have clinically evident or reported cognitive, perceptual, or functional changes should be screened for cognitive impairment 4
2. Validated screening tools should be used when assessing cognition and function 4
3. When screening results are insufficient or inconsistent with functional skills, referral for formal cognitive, language, and/or functional assessments should be considered 4
4. Assessment should include the impact of cognitive deficits on function and safety in:
   • Activities of daily living
   • Driving
   • Instrumental activities of daily living
   • Social, leisure, financial, vocational, and academic functioning 4

Critical Timing of Assessment

Cognitive assessment should be performed at key transition points:

• During acute care stay, particularly if cognitive concerns are noted
• During rehabilitation in inpatient, outpatient, and home-based settings
• Following hospital discharge to outpatient or community-based settings 4

The Neurological Monitoring and Management Guidelines emphasize that:

• Standardized neurological monitoring with clinical assessment is essential for optimal outcomes 4
• Neurological consultation should be obtained for acute neurological changes 4

Comprehensive Assessment Approach

A comprehensive approach to cognitive assessment should include:

1. Cognitive symptoms - Changes in cognition noticed by the individual or observer 4
2. Cognitive performance testing - Using validated assessment tools 4
3. Evidence of brain injury - Through neurological investigations when available 4

Common Pitfalls to Avoid

1. Relying solely on general cognitive screening tools - Comprehensive assessment of specific cognitive domains is necessary
2. Assuming cognitive recovery follows physical recovery - Cognitive deficits often persist after physical symptoms resolve
3. Overlooking mild ABI cases - Even mild injuries can result in significant cognitive impairment requiring intervention
4. Failing to involve communication partners - Including family members or caregivers in assessment provides crucial information 3
5. Not considering environmental factors during assessments - Attempt to maximize privacy, minimize noise and distractions 4

Evidence-Based Interventions Following Assessment

When cognitive impairments are identified through proper assessment, evidence supports:

1. Multi-disciplinary rehabilitation - Strong evidence shows benefit from formal intervention for moderate to severe injury 5
2. Early rehabilitation - Limited evidence indicates that commencing rehabilitation early after injury results in better outcomes 5
3. Intensive rehabilitation programs - Strong evidence reveals that more intensive programs are associated with earlier functional gains 5
4. Continued outpatient therapy - Moderate evidence suggests this helps sustain gains made in early post-acute rehabilitation 5
5. Milieu-oriented rehabilitation model - Strong evidence supports this approach for patients with severe brain injury 5

By implementing standardized cognitive assessment protocols in all ABI cases, outcomes can be significantly improved through early identification of deficits and appropriate intervention planning.