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Traumatic Brain Injuries Continued

Rudolph C. Hatfield, PhD., edited by Kathryn Patricelli, MA

The DSM-5 defines two types of neurocognitive disorders. A mild neurocognitive disorder is diagnosed when a person experiences a change in their cognition (thinking), but the change in their cognitive abilities is not severe enough to cause them significant impairment or distress in their daily functioning. These individuals can typically deal with these mild changes. A major neurocognitive disorder occurs when the change in cognition significantly affects the person's daily functioning and they need some form of assistance or intervention to function normally (or cannot function normally even if they have assistance).

brain image The DSM-5 has diagnostic criteria for a mild or major neurocognitive disorder due to traumatic brain injury. The criteria include:

  • Cognitive Problems: The person must have a diagnosis of a mild or moderate neurocognitive disorder.
  • Evidence of a Traumatic Brain Injury (TBI): There must be evidence that the person has experienced a head injury. In addition, the head injury must produce one or more of the following:
    • Having experienced a loss of consciousness (there is no limit on the duration).
    • Being confused or disoriented (difficulty relating the date, time, place, etc. where a person is).
    • Neurological signs that include brain scan results, seizures, problems with vision, problems with paralysis, etc. that suggest a TBI.
    • The experience of posttraumatic amnesia (memory loss following the head injury).
  • Persistence: The neurocognitive disorder must occur right after the head injury or immediately after a person regains consciousness from a TBI. It must continue for significant length of time following the head injury (this is rather loosely defined).

Other diagnostic specifiers can also be included that further describe the actual type of injury, the actual effects of the TBI, and so forth. Most often people who receive a diagnosis of a mild neurocognitive disorder due to TBI are not considered to have dementia because of a TBI. Having a major neurocognitive disorder due to TBI would often qualify for a diagnosis of dementia because of a TBI, depending on the symptoms being shown.

The symptoms that happen because of a TBI can be quite variable depending on:

  • the severity of the TBI
  • the length of time a person was unconscious
  • whether the person has had many TBI's
  • the location of the TBI.

TBI symptoms typically are present very soon after the person has had the TBI. However, in some cases, many of the emotional factors associated with having a TBI may not occur until much later. In addition, people who suffer from CTE may not begin to experience significant issues for some time following their last concussion and these issues may progressively get worse.

Some of the early symptoms associated with having a TBI range from:

  • Having headaches that can last for a short time, come and go, or in some cases, be constant.
  • Mild problems with attention to major problems with paying attention.
  • Problems with confusion which typically go away in mild to moderate head injuries, but may be long-lasting in moderate to severe head injuries.
  • Problems with vision.
  • Ringing in the ears.
  • Dry mouth or an unpleasant taste in the mouth.
  • Nausea and even vomiting.
  • Problems with sleep.

Longer-term issues can include thinking problems that can range from being mild to severe. Most often TBI's produce problems with attention and concentration as well as problems with memory. Other changes are also common including:

  • problems with decision-making
  • producing language
  • understanding language
  • visual problems
  • controlling one's body movements
  • many other problems that depend on the severity and location of the brain injury.

Longer-term issues can also include issues with mood. This can include people becoming apathetic (don't really care about things), suffering many bouts of depression, having issues with anxiety, and in some cases, becoming suicidal. In moderate to severe cases, people may display personality changes. This might include being very aggressive, impulsive, quick to anger, having problems controlling their emotions, etc. Again, the actual types of issues that any person will experience depend on the person's psychological history, the location and severity of the head injury, and the type of treatment they get following their head injury.

Approaches to treating people who suffer TBI's will be discussed in the next section.