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Aspects of Cognitive Impairment Associated with Agitated Behaviour during Post-traumatic Amnesia

Published online by Cambridge University Press:  17 May 2021

Courtney J. Spiteri Open the ORCID record for Courtney J. Spiteri [Opens in a new window] ,
Jennie L. Ponsford ,
Caroline M. Roberts  and
Adam McKay
Courtney J. Spiteri
Affiliation:
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
Jennie L. Ponsford
Affiliation:
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia Epworth Healthcare, Richmond, Victoria, Australia
Caroline M. Roberts
Affiliation:
Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia Epworth Healthcare, Richmond, Victoria, Australia
Adam McKay*
Affiliation:
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia Epworth Healthcare, Richmond, Victoria, Australia
*
*Correspondence and reprint requests to: Dr Adam McKay, School of Psychological Sciences, Monash University, Clayton, Victoria, 3800, Australia. E-mail: adam.mckay@monash.edu
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Abstract

Objectives:

Post-traumatic amnesia (PTA) is a transient period of recovery following traumatic brain injury (TBI) characterised by disorientation, amnesia, and cognitive disturbance. Agitation is common during PTA and presents as a barrier to patient outcome. A relationship between cognitive impairment and agitation has been observed. This prospective study aimed to examine the different aspects of cognition associated with agitation.

Methods:

The sample comprised 82 participants (75.61% male) admitted to an inpatient rehabilitation hospital in PTA. All patients had sustained moderate to extremely severe brain injury as assessed using the Westmead Post-Traumatic Amnesia Scale (WPTAS) (mean duration = 42.30 days, SD = 35.10). Participants were assessed daily using the Agitated Behaviour Scale and WPTAS as part of routine clinical practice during PTA. The Confusion Assessment Protocol was administered two to three times per week until passed criterion was achieved (mean number assessments = 3.13, SD = 3.76). Multilevel mixed modelling was used to investigate the association between aspects of cognition and agitation using performance on items of mental control, orientation, memory free recall, memory recognition, vigilance, and auditory comprehension.

Results:

Findings showed that improvement in orientation was significantly associated with lower agitation levels. A nonsignificant trend was observed between improved recognition memory and lower agitation.

Conclusions:

Current findings suggest that the presence of disorientation in PTA may interfere with a patient’s ability to understand and engage with the environment, which in turn results in agitated behaviours. Interventions aimed at maximizing orientation may serve to minimize agitation during PTA.

Keywords

AgitationPost-traumatic amnesiaRehabilitationCognitionTraumatic brain injury
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 28 , Issue 4 , April 2022 , pp. 382 - 390
Copyright
Copyright © INS. Published by Cambridge University Press, 2021

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