A pilot study of neuropsychological testing in a civilian traumatic brain injury clinic: Neurocognitive profiles, temporal trends and cognitive screening.

This exploratory pilot study examined the prevalence of neurocognitive disorder and differences in neuropsychological battery components following traumatic brain injury (TBI), while characterizing real-world delivery of cognitive testing and longitudinal screening trends in an outpatient TBI clinic. Fifty-four patients with TBI and cognitive symptoms were referred for standardized neuropsychological evaluation; 31 completed testing, and 24 met inclusion criteria. One-third (8/24) were diagnosed with a neurocognitive disorder. Compared to those without a cognitive disorder, affected patients scored lower on the Working Memory Index (90.57 vs 102.75, p = .042), Processing Speed Index (81.88 vs 103.31, p = .002), and Trail Making Test-A percentiles (13.00 vs 38.67, p = .040). Montreal Cognitive Assessment (MoCA) scores were also lower in the neurocognitive disorder group (23.60 vs 27.17, p = .010). Higher body mass index (31.43 vs 24.30, p = .007) and lower Glasgow Outcome Scale-Extended scores (4.88 vs 5.88, p = .047) were observed in the cognitive-disorder group. No differences in sex, race, education, or insurance status were found between those who completed testing and those lost to follow-up. Testing occurred a median of 17 months post-injury with 43% attrition, underscoring challenges to timely comprehensive assessment even in a specialized clinic. Serial MoCA tracking showed that 55% (11/21) of mild TBI patients improved over six months, yet 50% (12/24) remained below the impairment threshold (<26). The MoCA differentiated diagnostic groups and detected change over time, supporting its role as a pragmatic screening and monitoring tool. Processing speed and working memory differences warrant confirmation in larger studies.