Research Article

A Scoping Review of Cognitive Assessment in

Adults With Acute Traumatic Brain Injury
Leslie W. Johnsona and Kellyn D. Halla
a
Department of Communication Sciences and Disorders, North Carolina Central University, Durham

ARTICLE INFO ABSTRACT

Article History:
Received May 9, 2021
Revision received August 17, 2021
Accepted October 11, 2021
Editor-in-Chief: Katherine C. Hustad
Editor: Therese M. O’Neil-Pirozzi
https://doi.org/10.1044/2021_AJSLP-21-00132
Purpose: The purpose of this study was to describe and synthesize the current
research regarding the prevailing cognitive domains impacted by acute traumatic
brain injury (TBI) in adults. Standardized and nonstandardized assessments of
cognitive function and comorbidities influencing cognitive function during the
initial stages of recovery are presented to help guide clinical assessment.
Method: A scoping review, guided by the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses framework, was used to explore four electronic
databases. Searches identified peer-reviewed empirical literature addressing aspects
of cognitive domains impacted after TBI, cognitive assessment, and comorbidities
impacting assessment in adults after acute TBI.
Results: A total of 1,072 records were identified and reduced to 75 studies
based on inclusion criteria. The cognitive domains most impacted in acute TBI
were memory and executive function. The Glasgow Coma Scale (GCS) was the
most frequently used tool to assess cognitive abilities, despite it being a
measurement of consciousness, not of cognition. Psychological changes were
the most commonly noted comorbidity impacting cognitive assessment.
Conclusions: Assessment of cognition after acute TBI requires a multifaceted
approach that considers the typical profile of cognitive impairment, as well as
patient-specific factors influencing cognitive abilities following initial brain injury.
The present results support the generally held view that memory and executive
function deficits are common cognitive difficulties associated with acute TBI in
adults. The GCS remains the most widely used tool to assess function, though
numerous tools are available that specifically address cognitive domains. Acute
medical comorbidities common within this stage of injury are highlighted, as
well as gaps of clinical knowledge that remain.
Supplemental Material: https://doi.org/10.23641/asha.18372086

Traumatic brain injury (TBI) is a growing cause of
death and disability in the United States (Centers for
Disease Control and Prevention, 2014; Defense and
Veterans Brain Injury Center, 2019), with a worldwide
estimation of 69 million individuals sustaining a TBI each
year (Dewan et al., 2018). A TBI denotes injury to the
brain from an external force that leads to temporary or
permanent impairment of cognitive, physical, and/or psy-
chosocial functioning (National Academies of Sciences,
Correspondence to Leslie W. Johnson: ljohn169@nccu.edu. Disclosure:
Leslie W. Johnson serves on the Brain Injury Association of North Caroli-
na’s Board of Directors. The other author has declared that no other compet-
ing financial or nonfinancial interests existed at the time of publication.
Engineering, and Medicine, 2019). Collaborators with the
global burden of diseases, injuries, and risk factors study
(James et al., 2019) linked recent increases in TBI to rising
population density; population aging; and use of motor
vehicles, motorcycles, and bicycles. In geographic regions
where population census is high, the prevalence of TBI is
increasing (Dewan et al., 2018). Although TBI is a major
cause of death among young adults, in both military per-
sonnel and civilians, the prevalence of TBI in the elderly
population is increasing and is linked to falls (Stein et al.,
2018). Furthermore, Dewan et al. (2018) reported a health
disparity related to socioeconomic status and increased
risk for individuals with TBI in low- and middle-income
countries. Overall, the rate of new cases of TBI is

American Journal of Speech-Language Pathology • Vol. 31 • 739–756 • March 2022 • Copyright © 2022 American Speech-Language-Hearing Association 739