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Larry A. Abel, Andrea Phillipou, Jacinta M. Douglas; Uncorrected Antisaccade Errors Predict Cognitive Problems After Mild Traumatic Brain Injury In Younger Children. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5606.
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To determine whether performance on reflexive and saccadic eye movement tasks could be predictive of ongoing cognitive difficulties following mild traumatic brain injury (mTBI) in children.
45 patients and 44 age-matched controls (aged 8-15) were enrolled at baseline, to be tested at 3 and 6 months post injury. Patients met criteria for mTBI of severity not requiring neuroimaging or hospital admission. Testing was carried out at patients’ homes with a portable video eyetracker, evaluating reflexive, self-paced and antisaccades. Cognitive testing was done with the ImPACT concussion assessment software, evaluating attention, verbal and visual memory, processing speed and reaction time. Reflexive and antisaccade latency, gain and peak velocity was assessed, as were corrected and uncorrected antisaccade errors and self-paced saccade rate/30 s. Saccadic and cognitive measures were compared between groups and correlations examined at baseline and 3 months (6 month follow-up is ongoing).
For most measures no differences were found but uncorrected antisaccade errors showed different behaviour between groups. As expected, these significantly correlated with age for both groups (Spearman’s rho = -0.642 patients, -0.346, controls). Patients, but not controls, also showed significant correlations (rho from 0.361 to 0.614) on 6 measures of verbal and visual memory and processing speed. Their uncorrected errors also correlated with antisaccade, but not reflexive saccade, latency. Outlier identification on box plots of uncorrected errors revealed that nearly all of the patient outliers were our youngest children, aged 8 and 9. This group (N=8) was compared on the cognitive measures with age-matched controls (N=10) in a MANOVA. Significant group differences were found on 3 speed measures of verbal and spatial memory at baseline; importantly, these persisted at the 3 month follow-up.
Uncorrected antisaccade errors stood out as being markedly elevated in the youngest children who suffered mild TBI. This measure, which has been associated with inhibitory control and intelligence (Michel and Anderson, 2008) identified a subgroup of patients who showed significant impairments of processing speed which persisted for at least 3 months. Young children may thus be at risk of subtle cognitive sequelae from even very mild TBI.
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