Postcritical Cognitive Impairments in Combat Trauma and the Mutual Influence of the Stress Response during Hostilities

Purpose of the study was to determine the degree of mutual influence of chronic stress caused by participation in hostilities, and the severity of cognitive disorders that occur in acute period in the wounded. Materials and methods. 57 patients with severe combat trauma (20 people) and peacetime trauma (37 people) were examined. We studied cognitive functions (examined using scales MMSE and CFQ) and severity of stress response (examined using IES-R scale). Results of the IES-R were classified into five levels: 0-15 – minimal; 16-30 – low; 31-45 – moderate psychological tension; 46-60 – pronounced psychological tension; 61 and upper – posttraumatic stress disorder. Status of cognitive functions before trauma was researched by the CFQ on the second day after trauma (all patients were instructed that they had to answer to the CFQ according to the state before trauma accidence happened). Results and discussion. According to the ISS patients of both groups had comparable traumas by severity. Severities of the psycho-somatic state of the both groups' patients were not differed statistically, according to the SAPS II score. In both groups, cognitive dysfunction was noted, beginning with the 2nd day and continuing during at least 3 months. In patients with combat trauma, the response to the stress was significantly higher statistically (11.6±0.9 points vs 15.4±1.5 points in the group with the peacetime and combat trauma correspondingly, p<0.0001), and over time this difference became even greater (14.8±0.9 points vs 19.9±1.5 points in the group with the peacetime and combat trauma correspondingly, p<0.0001), although it corresponds to the level from minimal to low. A pronounced negative correlation between cognitive impairment and response to stress was noted. Conclusions: Severe trauma, obtained in peace time and during combat, caused cognitive dysfunction even in the absence of brain damage, and this dysfunction lasted for at least 3 months. There is usually a minimal response to stress in traumatized in peacetime and those injured during hostilities during the period of inpatient treatment. This reaction is significantly enhanced in the distant period, especially in people wounded during hostilities. Cognitive impairment and response to stress have mutual negative influences, which are more manifested in people with peacetime trauma in hospital. In case of traumatic injury cognitive dysfunction and response to stress can be determined only after 3 months.