Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury

Lindsay Wilson*, Lindsay Horton, the CENTER-TBI Participants and Investigators, Kevin Kunzmann, Barbara J Sahakian, Virginia Fj Newcombe, Emmanuel A Stamatakis, Nicole von Steinbuechel, Katrin Cunitz, Amra Covic, Andrew Maas, Dominique Van Praag, David Menon

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

45 Citations (Scopus)


Objective Cognitive impairment is a key cause of disability after traumatic brain injury (TBI) but relationships with overall functioning in daily life are often modest. The aim is to examine cognition at different levels of function and identify domains associated with disability. Methods 1554 patients with mild-to-severe TBI were assessed at 6 months post injury on the Glasgow Outcome Scale - Extended (GOSE), the Short Form-12v2 and a battery of cognitive tests. Outcomes across GOSE categories were compared using analysis of covariance adjusting for age, sex and education. Results Overall effect sizes were small to medium, and greatest for tests involving processing speed (I • p 2 0.057-0.067) and learning and memory (I • p 2 0.048-0.052). Deficits in cognitive performance were particularly evident in patients who were dependent (GOSE 3 or 4) or who were unable to participate in one or more major life activities (GOSE 5). At higher levels of function (GOSE 6-8), cognitive performance was surprisingly similar across categories. There were decreases in performance even in patients reporting complete recovery without significant symptoms. Medium to large effect sizes were present for summary measures of cognition (I • p 2 0.111), mental health (I • p 2 0.131) and physical health (I • p 2 0.252). Conclusions This large-scale study provides novel insights into cognitive performance at different levels of disability and highlights the importance of processing speed in function in daily life. At upper levels of outcome, any influence of cognition on overall function is markedly attenuated and differences in mental health are salient.

Original languageEnglish
Pages (from-to)407-417
Number of pages11
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number4
Early online date12 Mar 2021
Publication statusPublished - 1 Apr 2021

Bibliographical note

Funding Information:
Contributors Study concept: LW, DM, LH, KK, BJS, VFJN and EAS. Analysis and interpretation of data: LW, LH, KK, BJS, VFJN, NvS, AM and DM. Drafting the manuscript: LW, DM, BJS and VFJN. Critical revision of the manuscript for intellectual content: LW, LH, KK, BJS, VFJN, EAS, NvS, KC, AC, AM and DM. All authors read and approved the final draft of the manuscript. Funding Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Union 7th Framework programme (EC grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA). Data for the CENTER-TBI study have been collected through the Quesgen e-CRF (Quesgen Systems, USA), hosted on the INCF platform and extracted via the INCF Neurobot tool (INCF, Sweden).

Funding Information:
Competing interests LW, LH, KK, NvS, DvP, AM and DM report funding from the EU FP7 programme during the course of the study. LW reports grants and personal fees from Vasopharm, outside the submitted work; BJS reports personal fees from Cassava Sciences, Greenfield BioVentures, and Cambridge Cognition, outside the submitted work; VFJN reports grants from Roche, outside the submitted work. DM reports grants, personal fees and non-financial support from GlaxoSmithKline, grants and personal fees from NeuroTrauma Sciences, Lantmannen AB and Integra Neurosciences, and personal fees from Pfizer, Calico and PressuraNeuro, outside the submitted work.

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