Objectives Cognitive dysfunction is the most frequent sequalae post TBI¹ with a prevalence of 25–70%² and has been implicated in poorer patient outcomes such as greater difficulties in employment, maintaining relationships, pursuing leisure activities and quality of life,³ with impairments in attention, concentration, memory, language, executive functions and reduced speed of information processing.⁴ Brief screening instruments may not identify frontal lobe disorders with impairments in executive and social function. Here we looked at the Free-Cog, a novel, hybrid, cognitive screening instrument that assess both cognitive and executive function in a single instrument⁵ and comparing it to a known standard, the ACE III.

Methods A cohort of 10 males with moderate to severe TBI admitted in a neuropsychiatry unit between 2021 and 2022 were assessed with both an ACE III and the Free Cog.

Results Patients varied in age (20–71), TBI site and of differing chronicity. Z scores were calculated using published normative data. Spearman’s rho showed positive correlation between the two data sets (Correlation Coefficient 0.81818, p(2-tailed) = 0.00381).

Therefore, there was a statistically significant agreement between the subjective total Free Cog scores and the ACE III.

Conclusions These findings indicate that the Free Cog may be a useful brief screening in TBI patients and is consistent with the Free-Cog index study which showed high correlation and similar diagnostic accuracy in old age memory clinics where it was compared with Mini Mental Screening Examination, Montreal Cognitive Assessment and the ACE-III.⁶ These preliminary findings indicate further assessment of the Free Cog is warranted with examination of outcomes in different domains and in a wider range of TBI severity.

References

1. McAllister TW. Neurobehavioral sequelae of traumatic brain injury: evaluation and management. World Psychiatry 2008;7(1):3–10.

2. Vaishnavi S, Rao V, Fann JR. Neuropsychiatric problems after traumatic brain injury: unraveling the silent epidemic. Psychosomatics 2009;50(3):198–205.

3. Zhang J, Feinstein A. Screening for cognitive impairments after traumatic brain injury: a comparison of a brief computerized battery with the montreal cognitive assessment. J Neuropsychiatry Clin Neurosci. 2016;28:328–331; doi: 10.1176/appi.neuropsych.16010005

4. Rao V, Lyketsos C. Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics 2000;41(2):95–103. Review.

5. Burns A, Larner AJ. Do we need yet another cognitive test? Free-Cog, a novel, hybrid, cognitive screening instrument. J Neurol Neurosurg Psychiatry 2021;92:1359–1360.

6. Burns A, Harrison JR, Symonds C, et al. A novel hybrid scale for the assessment of cognitive and executive function: the Free-Cog. Int J Geriatr Psychiatry 2020;14.