Authors :
Presenting Author: Suzanne Lenz, MA, CCRP – Dartmouth-Hitchcock Medical Center
Sarah Kaden, BA – Dartmouth-Hitchcock Medical Center
Barbara Jobst, MD, PhD – Dartmouth-Hitchcock Medical Center
Maureen Quigley, APRN – Dartmouth-Hitchcock Medical Center
Lisa Sackett, Ph.D – Dartmouth-Hitchcock Medical Center
Anna Graefe, PhD – Dartmouth-Hitchcock Medical Center
Trina Dawson, BA, CHW – Dartmouth-Hitchcock Medical Center
Edward Camp, BA – HOBSCOTCH Institute
Laura De Muro, MS, CHW – Dartmouth-Hitchcock Medical Center
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth-Hitchcock Medical Center
Rationale:
Rationale Cognitive dysfunction, encompassing difficulties with memory and attention represents one key comorbid challenge for patients with post traumatic epilepsy (PwPTE) that requires innovative solutions to enable patients to feel more in control of their day to day lives. Prior studies have revealed cognitive function as a significant predictor of self-evaluation of quality of life in people with epilepsy. The ability to manage a chronic disease, reach education and employment goals, foster healthy relationships, and function confidently in society are all at risk when a person’s cognitive function is impaired. This project examines the efficacy of the adapted intervention, HOBSCOTCH-PTE (
HOme Based Self-Management and COgnitive Training CHanges Lives in Post Traumatic Epilepsy) on objective and subjective cognition.
Methods:
Methods This analysis uses data from US adults (n=54; Table 1) with PTE and cognitive dysfunction enrolled in the HOBSCOTCH-PTE randomized controlled trial (3/22-5/24). Study subjects were screened using the OSU TBI Screening Tool. Subjective cognition was assessed using the patient reported outcome measure, Quality of Life in Neurological Disorders (NEURO-QOL) Cognitive Function subscale. Objective cognition was assessed using the validated telephone-based Montreal Cognitive Assessment (MoCA) tool, administered by a study coordinator. Differences between baseline and 3-month scores in intervention (n=26) and waitlist control (n=28) groups were assessed with paired t-tests. Data were analyzed in SAS 9.3 and the R programming language.
Results:
Results In the intervention group, 84.0% of PwPTE reported having been admitted to the emergency room or hospital because of their head injury, and 72.0% reported their head injury included a loss of consciousness(LOC); 75.0% of the waitlist group reported admission to the emergency room or hospital, and 75.0% said they had LOC with their head injury. Baseline MoCA showed a mid-to-moderately impaired sample (
μ=17.78,
SD=2.22), with 40.0% of intervention and 32.1% of waitlist group participants screening as impaired. Analysis demonstrated a significant improvement in MoCA scores (p=0.018) in the intervention group (Fig 1). Additionally, the intervention group experienced a clinically significant change (baseline: 18.12 ± 0.45, 3-month: 19.68 ±0.42). Waitlist group participants demonstrated no significant change in MoCA scores in the 3 months prior to intervention (
p =.135). Intervention group participants had a significant improvement in their NEURO-QOL (Fig 2; p=0.001), while waitlist group participants had no significant change (p =.809).
Conclusions:
Conclusion There is a critical need for post traumatic epilepsy care systems to develop a more comprehensive approach to integrating ESM that empowers patients to manage their cognitive challenges from day to day. These interim data show promise for the HOBSCOTCH-PTE intervention to improve cognition for people with PTE, and as a telehealth deliverable intervention it allows for broad dissemination and access.
Funding:
Funding Source: Department of Defense W81XWH2110279