Neuropsychiatric, Cognitive, and Behavioral Sequelae
Core concepts
Know the cognitive domains affected after TBI: attention/processing speed, executive function, memory, and social cognition, with frontal lobe vulnerability. Understand post-traumatic amnesia (PTA) as a marker of severity and its assessment (e.g., orientation questions). Recognize neuropsychiatric sequelae: depression, anxiety, irritability/aggression, apathy, impulsivity, and personality change - depression is common and treatable. Understand post-concussion syndrome (persistent symptoms: headache, dizziness, cognitive fogginess, sleep disturbance, mood) and that symptoms are often multifactorial (sleep, pain, anxiety). Know that cognitive rehabilitation targets compensatory strategies and metacognition.
Traps
Questions test whether you attribute symptoms to "brain damage" when sleep, pain, and mood are drivers. Do not assume cognitive deficits are static - they evolve. Distinguish depression (anhedonia, guilt, suicidality) from apathy (reduced drive without dysphoria). Remember that irritability after TBI is often disinhibition, not necessarily depression.
Rule of thumb
"Treat the treatable": screen for depression, sleep apnea, pain, and substance use before labeling cognitive complaints as irreversible.
Worked example
A patient months after mild TBI reports poor concentration and fatigue. Before assuming permanent cognitive impairment, screen for insomnia, depression, and pain - treating these often resolves the "cognitive" complaint.