Prevent the Hidden Costs of Head Trauma with Early, Effective Cognitive Testing

The costs of traumatic brain injuries (TBIs) — one of the leading causes of death and disability worldwide, with an estimated 69 million people newly affected each year — are enormous and often go unnoticed. In fact, TBIs are often referred to as “the silent epidemic” because the symptoms of brain injuries aren’t always apparent after an incident occurs.

Here are a few statistics revealing the toll of traumatic brain and head injuries around the world:

• In the United Kingdom, about 1.3 million people live with a disability caused by a head injury.
• In the United States, there are 1.5 million cases of TBI each year and an estimated 5.3 million people living with a TBI-related disability.
• In Europe, an estimated 6.3 million people live with a TBI-related disability.
• Across the globe, there are 4.7 million TBI-related deaths each year, with 90% estimated to occur in low- and middle-income countries.

While illuminating, even these statistics fall short of showing the less measurable, far-reaching consequences of head traumas in patients’ everyday lives. Below, we dive into the different types of traumatic brain and head injuries, the impacts they have on different patient populations, and the role treatment and diagnostics play in improving outcomes.

Effects on cognition, mental health, and more  

TBIs are typically broken into two categories: closed-brain injuries and penetrating injuries. They can also be mild, moderate or severe. Mild TBIs generally involve memory loss or a confused state lasting for less than 24 hours, while moderate and severe TBIs last longer and can cause significantly more damage, especially if the injury was penetrative. The most common type of TBIs are concussions, frequently the result of sports-related injuries.

Brain injuries can cause unpredictable consequences depending on which area of the brain was harmed. Six months after the occurence of mild TBI, more than 50% of patients still report limited cognitive functions.

Impacts of head trauma may include:

• Post-traumatic amnesia: Post-traumatic amnesia, or memory loss following a TBI, can last for anywhere from a few minutes to several months. Often, patients will be unable to recall the traumatic event or will have difficulty making new memories.
• Attention: Attention deficits are the most common cognitive impairment after TBI. Difficulties with focus and attention may manifest as restlessness or inability to carry on long conversations and complete tasks.
• Aphasia: Patients may experience brain damage that affects their ability to understand or express speech. This can be fleeting or permanent depending on the severity of the injury.
• Psychiatric disorders: Studies have shown high incidence of major depression among TBI survivors, as well as higher-than-average prevalence of mania and post-traumatic stress.

Head trauma in vulnerable populations  

In addition to the immediate impacts on concentration, memory, and mood, head trauma can impair brain development. This can have a profound impact on children and teens whose brains are still developing. Concussions, for instance, can cause children and teens to fall behind in school, experience social isolation, and undergo behavioral changes. The consequences can be even more dire for children with existing learning or developmental disabilities, and those who receive a second concussion while still recovering from the first. While most children fully recover from concussions in one to three months, others may take longer or have life-long cognitive effects.

Head trauma is also common among the elderly, who are more prone to serious injury after falls and accidents. People over the age of 75 have the highest rate of hospitalizations and deaths due to TBI. For elderly patients who are taking blood thinners, including anticoagulants and antiplatelet medications, head injuries are more likely to cause bleeding in the brain, making a quick diagnosis of TBI critical. However, it’s not uncommon for head traumas to go misdiagnosed in this population, as symptoms such as confusion and memory loss often overlap with diseases like dementia and Alzheimer’s. Cognitive screening can be a useful tool for healthcare providers evaluating elderly patients who may be dealing with head injury, whether in the absence or presence of other cognitive conditions.

MoCA for head trauma

Head trauma can have serious implications for patients young and old. When working with patients who have experienced head injury, it’s important to look out for immediate and delayed-onset cognitive symptoms in order to give patients the assistance they need as soon as possible.

Research suggests 56% to 89% of mild TBI cases are missed or misdiagnosed. As a result, the clinical management of patients is affected. Left unattended, head injuries can lead to undetected brain bleeding or problems with memory and focus known as Post-Concussion Syndrome.

Cognitive screening with MoCA can help you accurately assess patients in the aftermath of a traumatic event.

The following peer-reviewed studies have validated the effectiveness of MoCA in screening patients with varying levels of TBI:

• “[MoCA] reliably detects impairment in mild TBI and differentiates cognitive disabilities between mild to severe TBI.” In this mini review of MoCA, researchers found the screening test easily administrable, useful for screening in an outpatient setting, and reliable in identifying impairment in mild TBI, as well as in differentiating cognitive disabilities between mild to severe TBI.¹
• “The results showed that patients with severe TBI had lower scores on the MoCA compared with patients with mild and moderate TBI… This information can enable clinicians to predict early cognitive impairments and plan cognitive rehabilitation earlier in the recovery process.” Investigating how patients with TBI perform on the MoCA, researchers compared test results among patients with severe TBI to patients with mild and moderate TBI. They found that those with severe TBI scored lower, pointing to the test’s useful clinical applications.²
• “In screening post-TBI cognitive impairment, MoCA tends to be more sensitive than MMSE.” In this study, researchers compared the sensitivities of MoCA and MMSE in patients with chronic TBI. They found MoCA to be more sensitive than MMSE in identifying cognitive impairment among this population.³
• “The MoCA may be clinically useful to acutely screen cognition following mTBI.” Researchers investigated MoCA’s efficacy in screening the early cognitive status of survivors of mild TBI. They found that patients with complicated TBI had much lower scores than those with uncomplicated TBI, pointing to applications for MoCA in screening this patient population.⁴

• “In the appropriate clinical context, cognitive screening with the MoCA may benefit clinical care in athletes with multiple previous SRC.” This study looked at how sports-related concussions (SRCs) impact cognition in athletes, using MoCA as a means of evaluation. It found that MoCA scores decreased among athletes with a history of multiple concussions, showing the test’s utility in caring for this patient population.⁵

As the silent epidemic continues, it’s critical that you stay on alert for latent symptoms of traumatic brain and head injuries. Learn more about MoCA and our adapted testing content in over 100 languages and dialects to screen for head trauma, along with a number of other conditions and diseases.

References: https://www.mocatest.org/reference/

1 Mishra K, Purohit D, Sharma S, Gonçalves MVM. Montreal cognitive Assessment Score: A Screening Tool for Cognitive Function in Traumatic Brain Injury (TBI) Population. J Neurol Neuromedicine (2020) 5(3): 35-39

2 Elaine de Guise, Abdulrahman Yaqub Alturki, Joanne LeBlanc, Marie-Claude Champoux, Céline Couturier, Julie Lamoureux, Monique Desjardins, Judith Marcoux, Mohammed Maleki & Mitra Feyz (2014) The Montreal Cognitive Assessment in Persons with Traumatic Brain Injury, Applied Neuropsychology: Adult, 21:2, 128-135, DOI: 10.1080/09084282.2013.778260

3 Zhang H, Zhang XN, Zhang HL, Huang L, Chi QQ, Zhang X, Yun XP. Differences in cognitive profiles between traumatic brain injury and stroke: A comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination. Chin J Traumatol. 2016 Oct 1;19(5):271-274. doi: 10.1016/j.cjtee.2015.03.007. PMID: 27780506; PMCID: PMC5068208.

4 Frenette LC, Tinawi S, Correa JA, Alturki AY, LeBlanc J, Feyz M, de Guise E. Early detection of cognitive impairments with the Montreal Cognitive Assessment in patients with uncomplicated and complicated mild traumatic brain injury. Brain Inj. 2018 Nov 2:1-9. doi: 10.1080/02699052.2018.1542506. Epub ahead of print. PMID: 30388898.

5 Debert CT, Stilling J, Wang M, Sajobi T, Kowalski K, Benson BW, Yeates K, Dukelow SP. The Montreal Cognitive Assessment as a Cognitive Screening Tool in Athletes. Can J Neurol Sci. 2019 May;46(3):311-318. doi: 10.1017/cjn.2019.18. PMID: 31084666.

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