Course of Post-Traumatic Amnesia: Three Little Words
Schwartz, F. Carruth, M.A. Binns, C. Brandys, R. Moulton, W.G.
Snow and D.T. Stuss
Objective: To provide a simple means of "real time"
recognition of emergence from post-traumatic amnesia (PTA).
Methods: Ninety-one patients with traumatic brain
injury (PBI); 53 minor (GCS 13-15), 19 moderate (GCS 9-12),
18 severe (GCS 3-8). Twenty-seven control subjects treated at
two regional trauma units for their acute phase and followed
in a hospital-based research institute were studied prospectively.
Subjects were examined repeatedly following injury with the
Galveston Orientation and Amnesia Test (GOAT) and tests of their
ability to learn and retain new information. Word triplets balanced
for concreteness and frequency were presented. Immediate and
24-hour recall were tested. If 24-hour recall was imperfect,
recognition was tested by presenting the 3 target words and
6 distracters. The target words were then re-presented and recall
was tested the next day. The time intervals to first perfect
recognition and first free perfect recall were compared with
the patients' first GOAT score of 75 or greater on 2 successive
days. Simple line drawings of common objects were also presented
to the subjects using an identical paradigm. The outcome measures
were GOAT, 3-word recognition and recall, 3 picture recognition
and recall. Results: For all categories of head
injury severity, the median interval to perfect free recall
of words followed the achievement GOAT criterion by a significant
interval. The mean GOAT scores for perfect 3-word recall and
recognition corresponding to minor, moderate and severe injuries
were 97, 90 and 88, and 97, 76 and 68 respectively. The recognition
and recall of pictures preceded the recognition and recall of
words by approximately 1 day. Conclusions: The
orientation measures of the GOAT that contain material that
the patient knew prior to injury obscure the determination of
recovery of continuous memory and should be tested separately.
Three-word recall which is simpler to administer than the GOAT
is a more reliable measure of emergence from PTA. For patients
who are dysphasic or who do not share a common language with
the examiner, 3-picture recognition and recall may substitute
for word recognition and recall.
J. Neurol. Sci. 1998; 25: 108-116