Conceptual model and cluster analysis of behavioral symptoms in two cohorts of adults with traumatic brain injuries

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Study developed and tested a conceptual model that is specific to behavioral symptoms after traumatic brain injury (TBI), to serve as a basis for better assessment and treatment. Data were collected from two cohorts of adults with moderate-to-severe TBI: 79 adults with data collected at 6 months post-injury and 62 adults with data collected more than 6 months post-injury. Model-based cluster analyses was conducted to explore the face validity of the conceptual model by evaluating how participants clustered with regard to emotional, cognitive, and frontal behavioral symptoms. In each cohort, unique clusters of participants emerged that differed significantly with regard to emotional state, cognition, and behavior. Those 6-months post-injury clustered along a general continuum of symptom severity in emotional and behavioral symptom domains, from no impairment to severe impairment. Clusters in the chronic cohort (>6 months) demonstrated a more complex pattern of symptoms; the most severe behavioral symptoms occurred in the context of severe emotional symptoms, even in the absence of cognitive impairment. However, problematic behavioral symptoms were also present in the context of severe cognitive impairment, even in the absence of emotional symptoms. Emotional, cognitive, and behavioral characteristics were represented as expected, based on the proposed conceptual model of behavior. This conceptual model provides the basis for evaluating behavioral changes after moderate-to-severe TBI and identifying modifiable targets and relevant subpopulations for behavioral intervention, with the goal of improved evidence-based personalized medicine for this population.

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