Journal of the International Neuropsychological Society

Research Articles

Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury

TARYN B. FAYa1a2, KEITH OWEN YEATESa2a3 c1, H. GERRY TAYLORa4a5, BARBARA BANGERTa6, ANN DIETRICHa2a7, KATHRYN E. NUSSa2a7, JEROME RUSINa8 and MARTHA WRIGHTa4a5

a1 Department of Psychology, Ohio State University, Columbus, Ohio

a2 Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio

a3 The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio

a4 Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

a5 Rainbow Babies and Children’s Hospital, Cleveland, Ohio

a6 Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio

a7 Department of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio

a8 Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio

Abstract

The occurrence of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children may depend on cognitive reserve capacity. This prospective, longitudinal study examined whether the relationship between mild TBI and PCS is moderated by cognitive ability, which served as a proxy for cognitive reserve. Participants included 182 children with mild TBI and 99 children with orthopedic injuries (OI), ranging from 8 to 15 years of age when injured. Mild TBI were classified as complicated (n = 32) or uncomplicated (n = 150) depending on whether they were associated with trauma-related intracranial abnormalities on magnetic resonance imaging. PCS were assessed initially within 3 weeks of injury, and again at 1, 3, and 12 months post injury. The initial assessment also included standardized tests of children’s cognitive skills and retrospective parent ratings of pre-injury symptoms. Hierarchical linear modeling indicated that ratings of PCS were moderated jointly by cognitive ability and injury severity. Children of lower cognitive ability with a complicated mild TBI were especially prone to cognitive symptoms across time according to parents and to high acute levels of PCS according to children’s self-ratings. Cognitive reserve is an important moderator of the outcomes of mild TBI in children and adolescents. (JINS, 2010, 16, 94–105.)

(Received March 31 2009)

(Reviewed September 14 2009)

(Accepted September 14 2009)

Correspondence:

c1 Correspondence and reprint requests to: Keith Owen Yeates, Ph.D., Department of Psychology, Nationwide Children’s Hospital, 700 Children’s Dr., Columbus, OH 43205. E-mail: keith.yeates@nationwidechildrens.org

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