Lariboisière Cognitive Assessment: Evaluation of the 1-year Outcomes

Study Overview
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Brief Summary
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Cognitive sequelae are common following acquired brain injuries. However, their detection can be challenging, particularly in acute care units such as neurosurgery. Specific screening in acute phase is critical for early detection and proper orientation. The Lariboisière cognitive assessment (Cog-First) is a brief cognitive evaluation conducted on a touch-screen tablet for patients with acquired brain injuries in the acute phase, which is integrated into routine care in Lariboisière. The objective of this project is to evaluate the one-year cognitive and functional outcomes of patients who have undergone hospitalization in neuro-surgery. The primary aim is to assess whether the systematic pre-discharge assessment (Cog-First) performed as part of routine care can predict a poor functional prognosis and help identify at-risk patients earlier and more effectively.

Detailed Description
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Traumatic brain injuries (TBI) are responsible for about 262 hospitalizations per 100,000 inhabitants in Europe each year. After a traumatic brain injury, 704 out of 100,000 individuals experience long-term consequences, including motor and/or balance disorders, fatigue, chronic pain, psychological disorders, and cognitive impairments such as memory problems, difficulties in comprehension, attentional deficits, and impairment of working memory. Without adequate rehabilitation, cognitive impairments can persist for several years, leading to significant socio-professional consequences such as job loss and social isolation, as well as medical and economic consequences. The Paris TBI study showed that upon discharge from acute care services, only 45% of patients who had suffered severe traumatic brain injuries were referred to specialized rehabilitation facilities, while 30% returned directly home. Additionally, there is a lack of cognitive assessment in acute care services. For instance, in services that treat stroke patients, only 61% of patients will meet with a rehabilitation professional before their discharge. Short cognitive screening batteries typically used in the acute phase to guide patients' discharge from the hospital include the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE). However, these scores are not very specific or sensitive, are examiner-dependent, and require trained personnel. Currently, there are few validated digital cognitive assessment batteries available for acute-phase evaluation and routine use in traumatic brain injury patients. Furthermore, evaluating cognitive impairments early after a traumatic brain injury can be challenging due to various confounding factors (e.g., fatigue, stressful hospitalization context) and organizational factors. Nevertheless, early assessment of cognitive impairments remains essential in order to appropriately refer patients, if necessary, to specialized rehabilitation facilities. To address the need for better early detection of cognitive impairment following brain injuries, we have developed the Cognitive Evaluation of Lariboisière (also known as Cog-First), a screening battery for cognitive impairments on a tablet device that can be quickly and independently completed by patients. Cog-First is now integrated into routine care in Lariboisière as a systematic pre-discharge assessment for patients discharged home without rehabilitation plan. The main goal of this project is to identify patients who are at risk of experiencing cognitive impairments that could significantly impact their long-term functional prognosis. We will evaluate whether the initial results obtained through the systematic evaluation using Cog-First at the time of discharge can accurately predict the functional and cognitive outcomes at one year. This could enable us to identify at-risk patients before discharge from acute care and refer them to specialized rehabilitation units earlier, leading to improved future outcomes for these individuals. During the 1-year follow-up consultation after hospital discharge, eligible patients will be offered the opportunity to participate in the study. If they consent, their functional and cognitive abilities will be assessed using a set of tests and questionnaires. The assessments will include the modified Rankin score, IADL questionnaire, MoCA, Bref, Rivermead questionnaire, SF-36 questionnaire, CIQ-R questionnaire, and PCL-5 questionnaire.

Official Title
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Study of the One-year Outcomes of Patients Hospitalized in the Lariboisière Neurosurgery Department

Conditions
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Brain Injuries

Intervention / Treatment
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* Other: Tests and questionnaires


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient over 18 years of age Patient hospitalized in neurosurgery unit at Lariboisière hospital between February 2023 and February 2024 Patient discharged home Patient affiliated to the social security system Patient having expressed no opposition Exclusion Criteria: Patient transferred to a rehabilitation facility following hospitalization in neurosurgery History of neurological or psychiatric illness Severe uncorrected visual impairment and/or aphasia Non-French-speaking patients Patients receiving State Medical Aid (AME) Patients under guardianship/curatorship

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Tests and questionnaires|1 year after discharge from neurosurgery department, included patients will answer to the: Modified Rankin Scale; Instrumental Activities of Daily Living (IADL) questionnaire; Montreal Cognitive Assessment (MoCA); Frontal assessment battery (BREF); Rivermead questionnaire; Short Form (36) Health Survey (SF-36) Community Integration Questionnaire - Revised (CIQ-R) Posttraumatic stress disorder CheckList (PCL-5)|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of the functional outcome at 1 year of patients who were hospitalized in the Lariboisière neurosurgery department compared with the initial systematic cognitive assessment (Cog-First) | The Modified Rankin Scale (MRS) will be used during the systematic follow-up consultation. The MRS is a score allowing functional independence level notation from 0 (no symptoms or incapacity) to 5 (severe disability). | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of the independence of patients in their daily life. | The Instrumental Activities of Daily Living (IADL) questionnaire will be submitted to patients. | 1 year | 
| Mesure of different cognitive functions of patients (language, memory, visio-spatial functions, attention, concentration, orientation in time and space). | Montreal Cognitive Assessment (MoCA) will be the used tool to answer this outcome. | 1 year | 
| Assess various cognitive functions in patients, including language, memory and visio-spatial abilities | The Batterie Rapide d'Efficience Frontale (BREF) test is a frontal assessment battery which will be used to question patients. | 1 year | 
| Rivermead questionnaire | Assessment of the post-concussion syndrome | 1 year after discharge from Neurosurgery department of Lariboisière | 
| Short Form (36) Health Survey (SF-36) | Assessment of quality of life | 1 year after discharge from Neurosurgery department of Lariboisière | 
| Community Integration Questionnaire - Revised (CIQ-R) | Assessment of socio-professional reintegration | 1 year after discharge from Neurosurgery department of Lariboisière | 
| Posttraumatic stress disorder CheckList (PCL-5) | Assessment of post-traumatic stress | 1 year after discharge from Neurosurgery department of Lariboisière | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Brain injuries, Prognosis, Cognitive impairment, Cognition, Executive Function, Neuropsychological tests, Neuro-rehabilitation