A Novel Visually Graded CT Biomarker of Preinjury Brain Structure to Improve Prediction of Cognitive Decline After Mild Traumatic Brain Injury
Abstract
Cognitive outcome after mild traumatic brain injury (mTBI, defined as presenting Glasgow Coma Scale 13-15) is extremely heterogeneous. There is an urgent need for better prognostic indicators to guide acute care, rehabilitation, and identify those at highest risk of poor cognitive outcome, cognitive decline, and eventual Alzheimer's Disease/Alzheimer's Disease Related Disorders (AD/ADRD). We hypothesized that biological brain reserve would be an important predictor of cognitive outcome after mTBI. We therefore developed and validated a visually-rated Brain Reserve Score (BRS) to quantify health of the underlying brain parenchyma visible on head CTs routinely obtained to rule out intracranial trauma in adults presenting acutely with mTBI. We leveraged data from 3 prospective cohort studies of acute TBI: Transforming Research And Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI], TRACK-Geriatric TBI Pilot [TRACK-GERI Pilot], and TRACK-Geriatric TBI [TRACK-GERI]). First we developed, refined, and established intra-rater and inter-rater reliability of the BRS in random sub-sets of TRACK-TBI cohort baseline head CTs from adults of all ages. The final BRS ranges from 0 to 10 where 10 is the worst. It includes 3 visually-rated sub-scores that together quantify global brain volume, hippocampal volume, and white matter disease. We established concurrent validity of the BRS by demonstrating that BRS is significantly associated with pre-injury cognitive status in the TRACK-GERI Pilot and TRACK-GERI cohorts comprised of adults age 65y+ in whom informants provide a Clinical Dementia Rating semi-structured interview that permits categorization as preinjury normal cognition, mild cognitive impairment, or dementia. Next we developed and validated a clinically relevant definition of poor cognitive outcome one year after mTBI and developed a prediction model to predict poor cognitive outcome using only routinely available clinical variables minus BRS score.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2023
- Accession Number
- AD1207382
Entities
People
- Adam R. Ferguson
- Andrea Schneider
- Esther Yuh
- Geoffrey T. Manley
- Kristine Yaffe
- Matthew Pease
- Raquel C Gardner
- Russell Huie
Organizations
- Northern California Institute for Research and Education