Soluble tumor necrosis factor receptors are associated with severity of kidney dysfunction in pediatric chronic kidney disease.

BACKGROUND: In adult chronic kidney disease (CKD) patients, there is a positive association between inflammation and progressive renal dysfunction. Higher levels of soluble receptors of tumor necrosis factor (sTNFR) have been related to worst prognosis of adult CKD patients. Therefore, the present study aimed to evaluate soluble TNF receptors in children and adolescents with CKD and to search for an association with clinical and laboratory features. METHODS: Demographic, clinical, anthropometric, and laboratory data were evaluated in 34 pediatric patients with CKD and in 34 healthy sex- and age-matched controls. Blood samples were collected in both groups to measure sTNFR by enzyme-linked immunosorbent assay. The modified Schwartz formula was used to estimate glomerular filtration rate (GFR). RESULTS: Pediatric patients with CKD had significantly higher plasma concentrations of soluble TNF receptors types 1 and 2 (sTNFR1 and sTNFR2) in comparison to sex- and age-matched healthy controls. Plasma levels of sTNFR1 and sTNFR2 increased progressively as renal function worsened, being inversely and significantly correlated with GFR (r = - 0.853 for sTNFR1 and GFR, r = - 0.729 for sTNFR2 and GFR). CONCLUSIONS: Children and adolescents with CKD exhibited higher plasma levels of sTNFR1 and sTNFR2 than healthy controls, which increased in relation to renal function deterioration. Plasma levels of sTNFR1 and sTNFR2 emerge as markers of progressive CKD in pediatric patients.

The association of openness personality trait with stress-related salivary biomarkers in burning mouth syndrome.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic disorder defined as a burning sensation in the oral mucosa without evidence of pathological findings. Its pathophysiology is largely unknown, but psychiatric disorders and personality traits have been implicated. OBJECTIVE: This study investigated whether there is any association between salivary biomarkers and personality traits in BMS patients. METHODS: It was a cross-sectional, controlled study that evaluated 30 individuals with BMS and 32 controls. All subjects were assessed with a structured psychiatric interview (Mini International Neuropsychiatric Interview) and the Big Five inventory. Salivary levels of brain-derived neurotrophic factor (BDNF), neural growth factor, tumor necrosis factor-α, interleukin (IL)-6, IL-10 and cortisol were determined. RESULTS: We found that BMS patients exhibited more traits of neuroticism and lower openness than controls. Openness showed a moderate and negative correlation with cortisol, BDNF and IL-6. CONCLUSION: Personality traits are associated with salivary biomarkers in BMS.

Anxiety, depression, resilience and quality of life in children and adolescents with pre-dialysis chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is a risk factor for psychosocial impairment and psychiatric symptoms. Children and adolescents on dialysis frequently have compromised daily life activities and a worse quality of life (QoL) compared with healthy peers. However, few studies have investigated these aspects of CKD in pediatric pre-dialysis CKD patients. Therefore, we have analyzed resilience, QoL and anxiety and depressive symptoms in children and adolescents with pre-dialysis CKD and compared these to the values of healthy controls. METHODS: Demographic and clinical data were collected from 28 children and adolescents with pre-dialysis CKD and 28 healthy sex- and age-matched controls. Psychological assessment of the participants was performed using the Wagnild and Young Resilience Scale, Pediatric Quality of Life (QoL) Inventory 4.0 , Child Depression Inventory and Self-report for Childhood Anxiety Related Disorders scales. RESULTS: Of the 56 children enrolled in our study, the CKD patients were referred to mental health professionals more frequently than the controls. Patients exhibited higher scores for separation anxiety and a higher frequency of clinically significant depressive symptoms. They also had lower overall QoL scores, as well as poorer scores for the psychological, educational and psychosocial subdomains of QoL instruments. There was a negative correlation between anxiety and depressive symptoms and all domains of QoL. Resilience was similar in both groups, but lower in patients with significant depressive symptoms. No significant association was found between clinical or laboratory findings and psychological variables in CKD patients. CONCLUSION: Although patients and controls exhibited similar scores of resilience, CKD negatively impacted the QoL of pediatric patients, contributing to a higher frequency of depression and separation anxiety.

Changes in adipokine levels in autism spectrum disorders.

BACKGROUND AND OBJECTIVE: The etiopathogenesis of autism spectrum disorders (ASD) is largely unknown, but it seems to involve dysfunction in several biological systems. Among many possible biological pathways, the immune system has emerged as potentially involved. Recent studies have shown association between cytokines (molecules that mediate immune cell interaction) and ASD. Adipokines are cytokines secreted mainly by adipose tissue and may have systemic effects. The main objective of this study was to compare the plasma levels of three adipokines between patients with ASD and healthy controls. Another aim was to correlate the levels of these adipokines and the severity of autistic symptoms as measured by the Social Responsiveness Scale (SRS). METHODS: We collected plasma from 30 patients and 19 controls and measured the levels of adiponectin, leptin and resistin using a commercially available kit. We also used the SRS as a tool to assess the severity of autistic symptoms. RESULTS: We found decreased levels of resistin, increased levels of leptin and unaltered levels of adiponectin in plasma from ASD subjects in comparison with controls. There was also a negative correlation between the levels of adiponectin and the severity of symptoms as assessed by the SRS. CONCLUSION: There are significant changes in the plasma levels of adipokines from patients with ASDs. They suggest the occurrence of systemic changes in ASD and may be hallmarks of the disease.

Circulating levels of neurotrophic factors in autism spectrum disorders.

OBJECTIVES: Evaluate the levels of a neurotrophic factor and some neurotrophins in the plasma of patients with Autism Spectrum Disorders (ASD). DESIGN: This study enrolled 30 children with ASD and 19 healthy children. Plasma levels of the neurotrophins BDNF, NGF, NT3, NT4 and of the neurotrophic factor GDNF were measured by Enzyme-Linked Immunosorbent Assay. SETTING: The etiopathogenesis of ASD is largely unknown, but it seems to involve dysfunction in several biological systems. One of these systems comprises the neurotrophic factors, which are molecules involved in many processes in the central nervous system, including neuronal survival, synaptogenesis and synaptic plasticity. Recent studies have shown association between neurotrophic factors and ASD. RESULTS: No differences in plasma BDNF, NGF, NT3, NT4 and GDNF were found between ASD and control. Neurotrophic factors are not altered in ASD. CONCLUSIONS: These molecules may play a minor role in ASD.

Burning mouth syndrome: a therapeutic approach involving mechanical salivary stimulation.

OBJECTIVE: The study aimed to evaluate the effects of salivary stimulation therapy on the salivary flow, quality of saliva, and symptoms in patients with burning mouth syndrome (BMS). BACKGROUND: BMS is a chronic disorder characterized by a burning sensation. Some reports have proposed a role for saliva in the pathogenesis of BMS. METHODS: Twenty-six BMS patients underwent treatment with salivary mechanical stimulation. Resting and stimulated saliva were collected before and after therapy. Salivary levels of total protein, brain-derived neurotrophic factor, interleukin-10, tumor necrosis factor-α, interleukin-6, and nerve growth factor were assessed before and 90 days after therapy by enzyme-linked immunosorbent assay. RESULTS: A significant reduction in the burning sensation and number of burning sites as well as an improvement of taste disturbances and xerostomia were observed after therapy. The salivary flow was not significantly modified. However, the therapy resulted in a significant decrease in salivary levels of total protein and an increase of tumor necrosis factor-α. CONCLUSION: Salivary mechanical stimulation therapy is effective in reducing clinical symptoms of BMS.

A critical and descriptive approach to interictal behavior with the Neurobehavior Inventory (NBI).

PURPOSE: The purpose of this study was to test the psychometric properties of the Neurobehavior Inventory (NBI) in a group of temporal lobe epilepsy (TLE) patients from a tertiary care center, correlating its scores with the presence of psychiatric symptoms. METHODS: Clinical and sociodemographic data from ninety-six TLE outpatients were collected, and a neuropsychiatric evaluation was performed with the following instruments: Mini-Mental State Examination (MMSE), structured psychiatric interview (MINI-PLUS), Neurobehavior Inventory (NBI), and Hamilton Depression Rating Scale (HAM-D). RESULTS: Some traits evaluated by the NBI showed adequate internal consistency (mean inter-item correlation between 0.2 and 0.4) and were frequent, such as religiosity (74%) and repetitiveness (60.4%). Principal component analysis showed three factors, named here as emotions (Factor 1), hyposexuality (Factor 2), and unusual ideas (Factor 3). Depressive symptoms on HAM-D showed a strong association with emotions and hyposexuality factors. When patients with left TLE and right TLE were compared, the former exhibited more sadness (p=0.017), and the latter, a greater tendency toward sense of personal destiny (p=0.028). CONCLUSION: Depression influences NBI scoring, mainly emotionality and hyposexuality traits. Neurobehavior Inventory subscales can be better interpreted with an appropriate evaluation of comorbid mood and anxiety disorders. Compromise in left temporal mesial structures is associated with increased tendency toward sad affect, whereas right temporal pathology is associated with increased beliefs in personal destiny.

Psychiatric comorbidities of chronic migraine in community and tertiary care clinic samples.

Although the association between episodic migraine and psychiatric comorbidities is well documented, few studies have focused on the comorbidity with chronic migraine (CM) and discrepancies exist between population-based and clinic-based data. The objective of this study is to compare demographic and psychiatric comorbidity correlates between CM samples drawn from the community and tertiary care. All inhabitants from a city borough were interviewed for the presence of headaches occurring 15 or more days per month. CM was diagnosed after subjects had been interviewed and examined by a headache doctor. Participants were also assessed with a structured interview by a psychiatrist, who assigned diagnoses based on the DSM-IV. The same investigators assessed all patients consecutively seen in a university-based outpatient headache center over a 4-month period. The samples consist of 41 individuals from the community and 43 from the headache center. Sociodemographic profiles were similar between groups with the exception of the mean number of years of formal education. Among individuals from the community, psychiatric diagnoses were present in 65.9 % of cases, relative to 83.7 % in those from the headache center (p = 0.06). Phobias (41.9 vs. 29.3 %) and depression (32.6 vs. 29.3 %) were more frequent in patients from the headache center, but this difference did not reach statistical significance. Thus the frequency of psychiatric disorders in patients with CM was elevated in both settings, being higher in the specialty care clinic.

Suicidality in temporal lobe epilepsy: measuring the weight of impulsivity and depression.

OBJECTIVE: The aim of the work described here was to measure the role of psychopathological features, specifically impulsivity and depression, in suicidality in patients with temporal lobe epilepsy (TLE). METHODS: Neuropsychiatric evaluation of 66 outpatients with TLE was performed with the following instruments: a structured clinical interview (Mini International Neuropsychiatric Interview Plus), the Barratt Impulsiveness Scale, the Hamilton Anxiety Scale, the Beck Depression Inventory, and the Brief Psychiatric Rating Scale. RESULTS: A current Axis I psychiatric diagnosis, mainly mood and anxiety disorders, was assigned to 37 subjects (56.1%) Presence of suicide risk was identified in 19 patients (28.8%), and 14 (21.2%) had attempted suicide. Frequency of seizures (P=0.012), current major depression (P=0.001), and motor impulsivity (P=0.005) were associated with suicide risk on univariate analysis. Logistic regression stressed the main relevance of major depression (OR=12.82, 95% CI=2.58-63.76, P=0.002) and motor impulsivity (OR=1.21, 95% CI=1.06-1.38, P=0.005) to suicide risk. CONCLUSION: Depression has a major influence on suicidality in epilepsy. Motor impulsivity is also relevant and may be an important component of depression in TLE associated with suicide risk.

The impact of burning mouth syndrome on health-related quality of life.

BACKGROUND: Burning mouth syndrome is a chronic disorder that is characterized by a burning sensation and a normal clinical appearance of the oral mucosa. This condition often affects the health-related quality of life in patients. As such, the aim of this study was to compare the health-related quality of life of patients with BMS and healthy controls, using the validated Portuguese versions of the SF-36 and OHIP-49 questionnaires. METHODS: A calculated sample of Brazilian patients with BMS (n = 26) was compared with a control group (n = 27), paired for gender and age. Sociodemographic information and clinical characteristics were obtained, and interviews were conducted using the SF-36 and OHIP-49. To evaluate the normality of the variables, we used the Kolmogorov-Smirnov test. The chi-square test, Fisher exact test and Mann-Whitney U-Test were used to compare sociodemographic and clinical characteristics of individuals with BMS and controls Mann-Whitney U-test were carried out to compare SF-36 and OHIP-49 between BMS patients and controls. The significance level was set at 0.05. To compare the dimensions of the SF-36 and OHIP-49 between BMS patients and controls, we considered Bonferroni correction. So for comparison of the dimensions, the significance level was set at 0.00625 for SF-36 and at 0.00714 for OHIP-49. RESULTS: The clinical and demographic data were similar in both groups (P > 0.05). SF-36 scores were significantly lower in all domains for patients with BMS (P < 0.00625). OHIP-49 scores were higher for individuals with BMS (P < 0.00714). CONCLUSIONS: BMS has a negative impact on the health-related quality of life of individuals, as can be shown by instruments such as the SF-36 and OHIP-49. So, the evaluation of quality of life might be useful for more information about the nature and severity of BMS, to evaluate the effects of treatment protocols, in order to improve their outcomes by means a humanized clinical practice.

Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E).

OBJECTIVE: The purpose of this research was to evaluate the Brazilian-Portuguese version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and to assess its psychometric properties. METHODS: This study involved 98 outpatients who underwent psychopathological evaluation with the Mini International Neuropsychiatric Interview-Plus Version, Hamilton Depression Scale (HAM-D), and a Portuguese version of the NDDI-E. RESULTS: The NDDI-E was easily understood and quickly administered to most of the patients. At a cutoff score >15, NDDI-E had a sensitivity of 81.5%, a specificity of 83.1%, and a negative predictive value of 92.2% for diagnosis of major depression. Internal consistency reliability of the NDDI-E was 0.79, and there was also a positive correlation between the NDDI-E and the HAM-D (P<0.001). CONCLUSION: The Brazilian-Portuguese version of NDDI-E can be used as a practical screening tool to improve recognition of depression in Brazilian people with epilepsy.

Serum levels of brain-derived neurotrophic factor in Sydenham's chorea.

Sydenham's chorea (SC) is the neurologic manifestation of rheumatic fever. In addition to involuntary movements, SC patients show behavioral changes, such as hyperactivity, obsessions, and compulsions. Brain-derived neurotrophic factor (BDNF) is related to neuronal development and differentiation. Since BDNF serum levels are altered in a series of neuropsychiatric disorders, such as schizophrenia and Huntington's disease, we investigated the serum levels of BDNF in SC patients. Eighteen patients with acute SC, 4 with persistent SC and 27 control subjects were included in this study. BDNF was determined by ELISA. There was no significant difference between BDNF serum levels of control and acute SC groups (P = 0.12). Persistent SC patients presented decreased BDNF levels when compared to both control and acute SC groups (P < 0.001). Our results suggest that the persistence of symptoms in SC may be related to structural changes in the central nervous system as expressed by altered BDNF levels.

Low frequency of bipolar disorder, dopamine dysregulation syndrome, and punding in Brazilian patients with Parkinson's disease.

OBJECTIVE: To investigate the frequency of bipolar disorder, dopamine dysregulation syndrome and punding in Parkinson's disease patients from a Brazilian movement disorders clinic. METHOD: One hundred patients underwent a comprehensive psychiatric examination composed of MINI-plus and specific questionnaires to investigate dopamine dysregulation syndrome and punding. RESULTS: We identified, respectively, one and five Parkinson's disease patients with bipolar disorder type I and type II. All manic/hypomanic episodes occurred before Parkinson's disease onset. No patient was identified with dopamine dysregulation syndrome or punding. CONCLUSION: The frequency of manic/hypomanic episodes seems to decrease with Parkinson's disease onset, and local environmental factors (e.g. drug availability) may be responsible for the low frequency of dopamine dysregulation syndrome and punding in Brazilian Parkinson's disease patients.

Neuro-transmitters in the central nervous system & their implication in learning and memory processes.

This review article gives an overview of a number of central neuro-transmitters, which are essential for integrating many functions in the central nervous system (CNS), such as learning, memory, sleep cycle, body movement, hormone regulation and many others. Neurons use neuro-transmitters to communicate, and a great variety of molecules are known to fit the criteria to be classified as such. A process shared by all neuro-transmitters is their release by excocytosis, and we give an outline of the molecular events and protein complexes involved in this mechanism. Synthesis, transport, inactivation, and cellular signaling can be very diverse when different neuro-transmitters are compared, and these processes are described separately for each neuro-transmitter system. Here we focus on the most well known neuro-transmitters: acetyl-choline, catechol-amines (dopamine and nor-adrenalin), indole-amine (serotonin), glutamate, and gamma-amino-butyric acid (GABA). Glutamate is the major excitatory neuro-transmitter in the brain and its actions are counter-balanced by GABA, which is the major inhibitory substance in the CNS. A balance of neuronal transmission between these two neuro-transmitters is essential to normal brain function. Acetyl-choline, serotonin and catechol-amines have a more modulatory function in the brain, being involved in many neuronal circuits. Apart from summarizing the current knowledge about the synthesis, release and receptor signaling of these transmitters, some disease states due to alteration of their normal neuro-transmission are also described.

Loss of libido in Parkinson's disease.

INTRODUCTION: Sexual dysfunction is a frequent but neglected problem in Parkinson's disease (PD). Decreased sexual desire in PD correlates with reduced general satisfaction from life. Many variables might be related to the loss of libido in PD and they have not been carefully investigated yet. AIM: To assess the frequency of loss of libido in PD and its relation to neurological symptoms, depression, anxiety, fatigue, and cognitive performance. METHODS: The response of 90 PD patients of both genders to item "loss of libido" from the Beck Depression Inventory (BDI) was analyzed. A structured psychiatric interview (MINI-Plus) evaluated the presence of major depression and generalized anxiety disorder. Clinical assessment also comprised neurological examination, which included all sections of the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr and Schwab-England Scale (SES). The Frontal Assessment Battery (FAB), the Mini Mental State Examination (MMSE), and the PD Fatigue Scale (PDFS) were also performed. MAIN OUTCOME MEASURES: Frequency of loss of libido and its main predictors. RESULTS: The frequency of loss of libido was 65.6%, and 42.6% of men also complained of erectile dysfunction. Ageing (P = 0.012), female gender (P < 0.001), lower education (P < 0.001), and depression (P = 0.006) associated with decreased sexual desire. Higher BDI scores (P < 0.001) correlated with a greater loss of libido. Decreased interest in sex was not associated with antidepressants. Neurological features associated with higher loss of libido were predominance of motor symptoms on the left side of the body (P = 0.026), autonomic dysfunction (P = 0.012), higher UPDRS scores (P = 0.006), and lower scores on SES (P = 0.003). In men, erectile dysfunction associated with decreased interest in sex (P < 0.001). Patients with lower performance on FAB (P < 0.001) and MMSE (P = 0.002), and with higher scores on PDFS (P < 0.001) also had less interest in sex. A multiple regression analysis indicated age, gender and BDI score as the main predictors of loss of libido. CONCLUSIONS: Loss of libido is frequent in PD and depression may be its main predictor. However, decreased interest in sex was not associated with antidepressant therapy. Thus, loss of libido resulting from depression may be effectively treated, and physicians should be encouraged to assess these symptoms in their patients.

Frequency of psychiatric disorders in young-onset Parkinson's disease does not differ from typical-onset Parkinson's disease.

Psychiatric disorders are very common in Parkinson's disease (PD). Whether these disorders are more prevalent in young-onset or typical-onset PD remains a matter of debate. The objective of this study was to assess systematically and to compare the range of psychiatric disorders between 50 patients with young-onset PD and 40 patients with typical-onset PD. Despite both groups having presented a remarkably high occurrence of psychiatric disorders, their frequencies did not differ.

Suicidal ideation in Parkinson's disease.

OBJECTIVE: To assess the frequency of suicidal ideation and suicide attempts in patients with Parkinson's disease. METHODS: The Mini International Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI), and Hamilton Rating Scale for Depression (HAM-D) were administered to 90 consecutive, non-demented Parkinson's disease patients. They were also submitted to a complete neurologic examination which included brief cognitive batteries, the Mini Mental Status Exam, and Frontal Assessment Battery. We analyzed the scores of the section of the MINI related to the risk of suicide as well as the specific questions of BDI and HAM-D concerning suicidal ideation. RESULTS: No patient had ever attempted suicide. According to MINI, suicidal ideation was present in 13 patients (14.4%) with Parkinson's disease. All instruments assessed the risk of suicide in a similar way. Suicidal ideation was associated only with lower age (P=.022), lower age of Parkinson's disease onset (P=.021), panic disorder (P=.004), social anxiety disorder (P=.007), and major depression (P<.001). Logistic regression analysis indicated that major depression was the main predictor of suicidal ideation. CONCLUSION: Suicide attempts seem to be uncommon in Parkinson's disease, despite the fact that the rates of suicidal ideation are possibly elevated. Depression seems to be the most important predictor of suicidal ideation in Parkinson's disease.

Depression impairs executive functioning in Parkinson disease patients with low educational level.

OBJECTIVE: To assess overall cognitive performance and executive functioning of nondemented Parkinson disease (PD) patients, and the influence of variables such as depression and education on cognition. BACKGROUND: Cognitive dysfunction in PD is common even in early stages. Different variables have been identified as potential risk factors for cognitive decline in PD. Some of these variables, such as depression and educational level, are complexly interrelated. METHODS: Eighty-two (male:female 52:30) subjects underwent clinical assessment which included the Unified Parkinson's Disease Rating Scale, Schwab-England Scale, Hoehn-Yahr Scale, Beck Depression Inventory, the Frontal Assessment Battery (FAB), and the Mini-Mental State Examination (MMSE). RESULTS: Patients with higher education, younger age, and who had a younger age at disease onset performed better on both the FAB and MMSE. Severity of disease correlated with worse cognitive performance. Performance on the FAB, but not the MMSE, worsened with increased severity of depressive symptoms. When patients were divided into groups with lower (< or =4 y of schooling) and higher (> or =5 y of schooling) education, the FAB and Beck Depression Inventory correlated negatively only in the group with lower educational level. CONCLUSIONS: Patients with PD present with cognitive impairment even when nondemented. Depression may exacerbate executive dysfunction, especially in subjects with lower educational level.

Personality disorders are associated with more severe forms of migraine.

To investigate the clinical manifestation, disease course, and prognosis of migraine patients with or without personality disorders. This cross-sectional study evaluated 61 patients with migraine diagnosed according to the criteria of the International Headache Society (IHS). Personality disorders were assessed with the Structured Clinical Interview for DSM-IV (SCID-II). Migraine severity was assessed with the Headache Impact Test-6 (HIT-6). We also used a structured clinical interview to diagnose comorbid mood disorders. Of the 61 patients, 20 (32.8%) had personality disorders. Personality disorders included obsessive-compulsive 14/61 (23.0%), avoidant 6/61 (9.8%), borderline 6/61 (9.8%), paranoid 6/61 (9.8%), schizoid 2/61 (3.3%), histrionic 1/61 (1.6%) and dependent 1/61 (1.6%) types. Compared to migraine patients without personality disorders, comorbidity with any personality disorders was associated with an increased frequency of chronic migraine (p < 0.001) and more severe headache as assessed by the HIT-6 (p < 0.001). Comorbidity with personality disorders was associated with more severe forms of migraine symptoms.

Cognitive Impairment Following Acute Mild Traumatic Brain Injury.

Patients with mild traumatic brain injury (mTBI) may present cognitive deficits within the first 24 h after trauma, herein called "acute phase," which in turn may lead to long-term functional impairment and decrease in quality of life. Few studies investigated cognition in mTBI patients during the acute phase. The objectives of this study were to investigate the cognitive profile of patients with mTBI during the acute phase, compared to controls and normative data, and whether loss of consciousness (LOC), previous TBI and level of education influence cognition at this stage. Fifty-three patients with mTBI (aged 19-64 years) and 28 healthy controls participated in the study. All patients were evaluated at bedside within 24 h post-injury. Demographic and clinical data were registered. Cognitive function was assessed with the Mini-mental state examination (MMSE), the Frontal Assessment Battery (FAB), Digit Span (working memory), and the Visual Memory Test/Brief Cognitive Battery (for episodic memory). The clinical sample was composed mainly by men (58.5%). The mean age was 39 years-old and 64.3% of the patients had more than 8 years of education. The most common causes of mTBI were fall from own height (28.3%), aggression (24.5%), and fall from variable heights (24.5%). Compared to controls, mTBI patients exhibited significantly worse performance on MMSE, FAB, naming, incidental memory, immediate memory, learning, and delayed recall. Compared to normative data, 26.4% of patients had reduced global cognition as measured by the MMSE. Episodic memory impairment (13.2%) was more frequent than executive dysfunction (9.4%). No significant differences were found in cognitive performance when comparing patients with or without LOC or those with or without history of previous TBI. Patients with lower educational level had higher rates of cognitive impairment (VMT naming-28.6 vs. 4.2%; VMT immediate memory-32 vs. 4.2%; VMT learning-39.3 vs. 4.2%, all p < 0.05). In sum, we found significant cognitive impairment in the acute phase of mTBI, which was not associated with LOC or history of TBI, but appeared more frequently in patients with lower educational level.