Cognitive Disorders Following Traumatic Brain Injury

What is a traumatic brain injury?

  • A traumatic brain injury is also called a TBI. A TBI can be caused by an accident, fall, or being hit on the head by a hard object. When a person's head is moved forcefully, the brain can hit against the inside of the skull and be damaged. The skull is made up of the bones of the head, which enclose and protect the brain. Falls and other accidents can cause skull bones to break. If the brain hits against broken pieces of the skull, it can be damaged.

  • A TBI may be mild, moderate, or severe (very bad). This rating depends on if and how long there was loss of consciousness and problems with thinking or remembering after the TBI. Signs and symptoms of a TBI may include headaches, nausea (feeling sick), dizziness, confusion, or loss of consciousness. With loss of consciousness, a person may be less aware of events and others around him, but still be awake. Loss of consciousness can also mean being in a sleep-like state where the person cannot be woken up.

What is a cognitive disorder?

A TBI can damage the parts of the brain that help a person think and remember, causing a cognitive disorder. The front part of the brain is often injured in a TBI, which is the part of the brain used for thinking and memory. Cognitive disorders are common after a TBI. A TBI can cause many kinds of cognitive problems and symptoms. Signs and symptoms can get better, stay the same, or worsen over time. They may go away and come back again at a later date. Your TBI symptoms may be different from another person's TBI symptoms. You may find it hard to do the same things that you did before the TBI. The three most common groups of cognitive disorders are mental, physical, and emotional.

What mental problems might I have with a cognitive disorder?

You may have one or more of the following after a TBI:

  • Trouble paying attention: A TBI can damage the parts of the brain that help you pay attention. You may have trouble doing two tasks at the same time. You may have a hard time thinking clearly. For example, if you are in a noisy room, you may have trouble with focus. If you hear people talking, their words may distract you. You may have trouble talking with other people because it is hard to follow the conversation. Problems with paying attention or thinking can keep you from remembering words easily. Your child may have a hard time doing work for some classes in school. He may need help with homework.

  • Poor memory: Memory problems are common with a cognitive disorder. You may have trouble remembering facts about your life after a TBI. It may also be hard for you to remember your accident. Some of the details may come back with time. Caregivers call this posttraumatic amnesia (PTA). The longer PTA lasts, the harder it may be to recover. Memory problems can make some things hard for you or your child. Your child may not remember to do his homework or behave. You or your child may forget things more quickly than before the TBI. Memory problems may make it hard for you to go back to work right away. You may have a hard time remembering to do things like brush your teeth or make appointments.

  • Decreased learning speed and ability: A cognitive disorder can make it hard to understand things quickly. Your child may not learn facts in school as quickly as he did before the TBI. You or your child may also have a hard time with change. For example, a change in the order of your daily tasks may make it hard for you to remember to do each task.

What physical problems might I have with a cognitive disorder?

You may have one or more of the following after a TBI:

  • Decreased level of alertness: You may feel more tired than usual, or have problems sleeping at night.

  • Appetite changes: You may want to eat more or less than you did before the TBI.

  • Poor balance: You may be dizzy, feel clumsy, or lose your balance.

  • Pain and headaches: Headaches are the most common symptom of a TBI. You may have a very bad headache, or chronic (long-term) pain in an area of your body.

  • Problems with seeing, hearing, smelling or tasting: You may have blurred vision or poor hearing. Your ability to smell or taste may also change.

  • Poor body temperature control: You may find it hard to stay warm or cool.

What emotional problems might I have with a cognitive disorder?

You may have one or more of the following after a TBI:

  • Anxiety (worry).

  • Depression (deep sadness).

  • Impatience. You may have trouble waiting for people or events.

  • Trouble controlling your actions and behavior. A child may have trouble keeping friends because he has trouble controlling his actions.

  • Trouble controlling your feelings. You may get angry more easily than before your injury.

What should I know about children and traumatic brain injuries?

  • Children and teenagers can get traumatic brain injuries. A young child can get a TBI from a fall. An older child can get a TBI if he falls off of a bicycle, or hits his head while playing sports. Children get TBI's more easily than adults. This is because a child's head is large compared to the rest of his body. Children also have weaker neck muscles and thinner skulls than adults. A child's brain does not sit as tight to the skull as an adult's brain. This leaves more room for his brain to move around and get damaged.

  • If you know or think that your child has had a TBI, call caregivers right away. Children can recover from a TBI. Their brains may heal. Some parts of the brain can start to do things the damaged parts can no longer do. Children may fracture (break) their skull when they get a TBI. If your child fractures his skull, caregivers may measure the size of your child's head over the next few months. Skull growth is a sign of brain swelling. Swelling of the brain is serious, and must be treated right away. Since young children may not be able to tell caregivers that they have a headache, a larger than normal skull size can give caregivers more information about your child's TBI.

How are cognitive disorders diagnosed?

Your brain can keep healing for many months after your TBI. As it heals, your symptoms may change or even go away. Caregivers may need to test you more than once to learn about your cognitive disorder. They may use any of the following to learn how your brain is doing:

  • Awareness test: Caregivers may use a test called the Glasgow Coma Scale (GCS) when you are injured or when you arrive at the hospital. The GCS tests how well you can open your eyes, speak, and move. Caregivers may use this test or one like it to learn how well your brain is working. Different parts of the brain control these actions. An injury to certain areas of the brain can make it hard for you to move or speak.

  • Self-report: Caregivers will ask you questions to learn more about your signs and symptoms. You may be asked if you know where you are, and other questions that test your memory and focus. Some problems can make it hard for caregivers to learn about your cognitive disorder. Medications can make you too sleepy to answer questions or remember easily. The accident that caused your TBI may have injured parts of your body. This will make it difficult for you to move well. If you drank alcohol (such as beer, wine, or whiskey) before your accident, you may have trouble remembering or speaking. Caregivers will work with you to learn as much as they can about your condition.

  • Computed tomography: This test may be called a CT scan. This test gives caregivers a good picture of problems in your brain. The scan will show a contusion (bruise), hematoma (pooled blood), hemorrhage (bleeding), fractures (breaks) in the skull, or swelling of the brain.

  • Magnetic resonance imaging: This scan is also called an MRI. During this test, pictures are taken of the brain that may show damaged areas. Never enter the MRI room with any metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.

How are cognitive disorders treated?

  • Caregivers learn if and how long you were unconscious after your TBI. They also learn how long your posttraumatic amnesia lasted after the injury. This information, combined with your test results, allows caregivers to predict how well you may heal. Not every person who has a TBI will have the same symptoms. Your caregivers will plan your treatment as they learn about your cognitive disorder.

  • You may need to take medicine and do exercises to help you get better (rehabilitation). Your brain injury will change with time. Most people who have a mild TBI get well within six months after the injury. Some people have mental, physical, or emotional problems for a long time. Your signs and symptoms may decrease or go away in the years following a traumatic brain injury.

What can I do to help myself when I have a cognitive disorder?

The following are some ways to help yourself or your child get better:

  • Take your medicine as ordered. You may be given medicine to decrease your signs and symptoms. The medicine may help take away headaches and pain. It may also help you be more alert, think faster, or pay attention better. Do not give your child any medicine without asking his caregiver first.

  • Drink enough liquids. Caregivers may tell you to drink at least eight glasses of water or sports drinks every day. These liquids can help your muscles work well. Do not drink alcohol (such as beer, wine, or whiskey). Drinking alcohol increases your risk of having another TBI. If you drink alcohol, you are at a higher risk of abusing substances such as alcohol after having a TBI. Substance abuse means drinking too much alcohol too often, or using illegal (street) drugs.

  • Get enough sleep and rest. Make sure you get a lot of sleep at night. Rest during the day. Do not rush to go back to your regular activities. If your child had a TBI, talk with his caregiver about when to send him back to school.

  • Keep all appointments with your caregivers. You may need physical, occupational, and other types of therapy. You may also need to see a mental health worker (talk therapist). This caregiver will help you cope with new feelings of sadness, anger, and worry that can come after having a TBI.

  • Help prevent another TBI. Avoid activities that might cause a TBI. A person who has more than one concussion can have problems later, such as remembering and doing activities. Playing sports, driving a car, and climbing a ladder can put you at risk of getting injured. Move slowly and carefully after your injury and while you are getting better.

  • Do your rehabilitation program. Caregivers will help you learn to take care of yourself as much as possible. Caregivers may help you improve your speech and your ability to walk. You may also learn ways to pay attention and remember things better. Skills learned in rehabilitation can be used at home. The following tips may help you if you have a poor memory:

    • Write things down if you have trouble remembering.

    • Use an appointment book to remind you what to do each day.

    • Set up a routine and follow it daily to avoid forgetting to do a task.

Where can I find support and more information?

  • Brain Injury Association
    1608 Spring Hill Road
    Vienna , VA 22182
    Phone: 1- 703 - 761-0750
    Phone: 1- 800 - 444-6443
    Web Address: http://www.biausa.org

When should I call my caregiver?

Call caregivers if:

  • You are sleepier or harder to wake up than usual.

  • Your signs or symptoms get worse during the first few days after the injury.

  • You have new headaches that are very bad, or that get worse after the injury.

  • You still have signs and symptoms of a concussion, such as headaches and dizziness, more than six weeks after the TBI.

When should I seek immediate care?

Call 911 or seek care immediately if:

  • You are vomiting very hard, or you cannot stop vomiting. You may also have a headache that is quickly getting worse.

  • You are confused, or you or others notice changes in your personality or actions. You may not know people you should know, or where you are.

  • You have blood or clear fluid coming out of your ears or nose.

  • Your pupils (black part in the center of the eye) are unequal in size, and this is new for you. Seek immediate help if you have new problems with vision, such as blurry or double vision.

  • Your speech is slurred (unclear), or does not make sense.

  • Your arms or legs feel weak, or you lose feeling in a body part.

  • You have new problems with coordination (balance and movement).

  • You stop responding to others, or you faint. Get immediate help if you have a seizure (convulsion).

  • You want to hurt or kill yourself.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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