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Detecting cognitive impairment in TBI patients can be difficult. But now one study suggests that “gist reasoning” may be the key to identifying TBI patients who will struggle with cognitive disability in everyday life.
You may not realize it, but you use gist reasoning every day. When someone tells you a story, you may summarize it in your head. When you are preparing to cook a meal, you may develop a grocery list of items you need ahead of time. Or when you meet a person, you may create a profile for her in your mind to remember later.
People with traumatic brain injuries (TBIs) have difficulty with these sorts of complex cognitive tasks. Brain injuries can interfere with a person’s ability to solve problems, understand instructions, or even maintain friendships.
But this kind of cognitive disability has been difficult to detect using traditional neuroscience tests. Concrete “yes or no” answers often provide enough contextual clues for many TBI patients to get by. In fact, most traditional tests only detect 42.3 to 67.5 percent of brain injuries.
To improve those odds, Dr. Ahsa Vas at the Center for BrainHealth at the University of Texas Dallas has developed a new test that relies on gist reasoning. Rather than laying out concrete questions, the test asks TBI patients to complete four different tests that measure abstract thinking.
Vas explains using the example of Shakespeare’s “Romeo and Juliet”:
“There are no right or wrong answers. The test relies on your ability to derive meaning from important story details and arrive at a high-level summary: Two young lovers from rival families scheme to build a life together and it ends tragically. . . . You integrate existing knowledge, such as the concept of love and sacrifice, to create a meaning from your perspective. Perhaps, in this case, ‘true love does not conquer all.’”
Because gist reasoning tests require TBI patients to use multiple cognitive functions at once, they tend to more correctly identify cognitive disability. The study tested 70 participants, 30 of whom had a history of moderate to severe TBI over 1 year ago. The gist reasoning test, called the Test of Strategic Learning correctly identified 84.7% of the TBI patients.
Whether a head injury is caused by a fall or an auto accident, its effects on everyday life can be dramatic. Some symptoms, like dizziness and nausea, are easy to track and treat. But cognitive impairment can mask itself as shock immediately after the injury. Then, later, a person may not realize that his TBI is behind his having trouble at work or problems keeping a romantic partner. Proper screening is needed to get TBI patients the treatment they need to better perform daily life functions.