Cognition generally refers to the way we use our brains to take care of business. This covers many facets of function associated with the brain: knowledge, attention, memory, judgement, reasoning, problem solving, speaking, comprehension, etc. The brain has many unique and brilliant ways it achieves this and it also coordinate these functions with information coming in from your senses. A lot of this happens subconsciously, that is, you do not have to consciously think of every single thing you do in a day.
Many of the cognitive consequences and corresponding rest strategies were generally described above in the section “Executive functioning and rest strategies”, however, let’s take a moment to discuss this area a bit further.
Cognitive changes related to a concussion can sometimes be hard to identify as they may only happen under certain circumstances (e.g., when distracted in class) or may be assumed to be caused by post-concussive mood changes, fatigue or other distracting symptoms. For example, we are all aware of how difficult it can be to do a task if we have a pounding headache or if our vision is blurry. It is a good idea to carry a journal describing how you fare in your daily tasks to help identify the factors that help and those that don’t.
Neurocognitive testing is an objective tool that can be used to estimate cognitive deficits. It can be computerized – a quicker, economical screening test – or be of the more traditional paper-and-pencil type which is occasionally required for patients who have prolonged or severe cognitive symptoms. One of the advantages of using objective measures like these, especially if you have taken a prior neurocognitive test (i.e., baseline test) to serve as a point of reference, is that it can identify deficits that a patient did not notice. Positive findings on these tests can foster respect for the condition, compliance with treatment recommendations and an additional method to track recovery.
Cognitive deficits may be amongst the last areas to improve. Firstly, they are heavily dependent on all the factors discussed in this handbook and as such will be optimized after the resolution of other potential issues. Secondly, one may need to retrain their executive functioning skills, which may take time.
There are some common areas of cognitive complaints in concussed patients. These have been well put in the the Ontario Neurotrauma Foundation Concussion Guidelines and are provided below:
1. Having more trouble than usual with attention & concentration
No one can concentrate well when they are tired, so it is not surprising that many people have trouble concentrating for a while after they have had a mild brain injury. Maybe you cannot even concentrate well enough to read the newspaper. If you really need to, just read for a short time, and then come back to it when you have had a break. The same thing applies to other areas where concentration is needed. Leave things that need your complete concentration until you are feeling better. If you need to concentrate on something important, do it when you are feeling fresh.
2. Having more trouble than usual with remembering things
You cannot expect your brain to be as good at remembering things as it usually is. Don’t worry if you can’t think of a name or a phone number that you ought to know, or if you go to get something, and then can’t remember what it is. Your memory is only going to be a problem until you recover. In the meantime, get your family and friends to remind you of important dates and appointments, or write things down.
3. Feeling vague, slowed or ‘foggy’ thinking
Some people who have sustained a mild brain injury find their thinking is a bit slower. This means they might have some difficulty keeping up with conversations or following directions, and things take longer to get done. Encourage others to slow down by asking questions and having them repeat what they have said. Allow yourself extra time to complete tasks and avoid situations where you are under pressure to do things quickly.
Finally, it should be mentioned that some patients have no demonstrable cognitive issues after a concussion; this does not mean that they do not have a concussion. It simply means that if they have a concussion, it has affected different neurological process or they are so subtle that they are hard to detect.