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Relationship Satisfaction and Depression After Traumatic Brain Injury: An Actor-Partner Interdependence Model of Patients and Caregivers in Mexico and Colombia. Am J Phys Med Rehabil 2020; 99:1032-1038. [PMID: 32452881 DOI: 10.1097/phm.0000000000001474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Traumatic brain injury represents a major public health concern, particularly in low- and middle-income countries like in Latin America. Family members are often caregivers for individuals with traumatic brain injury, which can result in significant stress. Research is needed to examine depression and quality of the caregiving relationship in these dyads. This study examined relationship quality and depression longitudinally after traumatic brain injury within the caregiving relationship. DESIGN Dyads (N = 109) composed of individuals with traumatic brain injury and their caregivers were recruited from three hospitals in Mexico and Colombia. They self-reported depression and relationship satisfaction during hospitalization and at 2 and 4 mos after hospitalization. RESULTS A 2-lag Actor Partner Interdependence Model demonstrated that patients and caregivers reporting high relationship satisfaction at baseline experienced lower depression 2 mos later, which then predicted higher caregiver relationship satisfaction at 4 mos. Moreover, patients with high relationship satisfaction at baseline had caregivers with lower depression at 2 mos, which was then associated with patients' higher satisfaction at 4 mos. CONCLUSIONS Within individuals with traumatic brain injury and caregivers, depression and relationship satisfaction seem to be inversely related. Furthermore, patients' and caregivers' depression and relationship satisfaction impact each other over time, demonstrating interdependence within the caregiving relationship.
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Ozga-Hess JE, Whirtley C, O'Hearn C, Pechacek K, Vonder Haar C. Unilateral parietal brain injury increases risk-taking on a rat gambling task. Exp Neurol 2020; 327:113217. [PMID: 32014440 DOI: 10.1016/j.expneurol.2020.113217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury (TBI) affects millions of individuals every year. Many of these injuries lead to lasting effects, particularly impairments in domains broadly classified as executive functions, such as impulse control and decision-making. While these impairments have been historically associated with frontal brain damage, other injuries such as concussion or parietal injury also contribute to similar dysfunction. However, it is unknown whether animal models of TBI would replicate these broad effects that are observed in human patients. In the current study, we delivered a unilateral parietal controlled cortical impact injury and assessed the performance of rats on a motoric task (rotarod) and a test of decision-making and impulsivity (rodent gambling task). TBI rats demonstrated significant motor impairments on the rotarod task; however, this did not extend to difficulties inhibiting motor actions (impulsivity). In addition, TBI caused chronic alterations to risk-based decision-making, extending out to 12 weeks post-injury. Specifically, rats with TBI preferred the riskiest, and most suboptimal option over all others. The current data suggest that models of unilateral TBI are sufficient for replicating some aspects of executive dysfunction (risky decision-making), while others are limited to frontal damage (impulsivity). These models may be used to develop therapeutics targeted at the chronic post-injury period when these symptoms often manifest in patients, a critically understudied area in preclinical TBI research.
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Affiliation(s)
- Jenny E Ozga-Hess
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cory Whirtley
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Christopher O'Hearn
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Kristen Pechacek
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA; Department of Neuroscience, West Virginia University, Morgantown, WV, USA.
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Wittholz K, Fetterplace K, Clode M, George ES, MacIsaac CM, Judson R, Presneill JJ, Deane AM. Measuring nutrition-related outcomes in a cohort of multi-trauma patients following intensive care unit discharge. J Hum Nutr Diet 2019; 33:414-422. [PMID: 31788891 DOI: 10.1111/jhn.12719] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Functional recovery is an important outcome for those who survive critical illness. The present study aimed to assess nutrition provision and nutrition-related outcomes in a multi-trauma cohort following intensive care unit (ICU) discharge. METHODS The present study investigated a prospective cohort of patients discharged from an ICU, who had been admitted because of major trauma and required mechanical ventilation for at least 48 h. Nutrition-related outcomes, including body weight, quadriceps muscle layer thickness (QMLT), handgrip strength and subjective global assessment, were recorded on ICU discharge, days 5-7 post-ICU discharge and then weekly until hospital discharge. Nutrition intake was recorded for 5 days post-ICU discharge. Unless otherwise stated, data are presented as the mean (SD). RESULTS Twenty-eight patients [75% males, 55 (22.5) years] were included. Intake met 64% (28%) of estimated energy and 72% (32%) of protein requirements over the 5 days post-ICU discharge, which was similar to over the ICU admission. From ICU admission to hospital discharge, the mean reduction in weight was 4.2 kg (95% confidence interval = 2.2-6.3, P < 0.001) and after ICU discharge, the mean reduction in weight and QMLT was 2.6 kg (95% confidence interval = 1.0-4.2, P = 0.004) and 0.23 cm (95% confidence interval = 0.06-0.4, P = 0.01), respectively. CONCLUSIONS Patients received less energy and protein than estimated requirements after ICU discharge. Weight loss and reduction in QMLT also occurred during this period.
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Affiliation(s)
- K Wittholz
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - K Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia
| | - M Clode
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - E S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - C M MacIsaac
- Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia.,Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - R Judson
- Department of Trauma, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J J Presneill
- Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia.,Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - A M Deane
- Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia.,Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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Hoffman AN, Lam J, Hovda DA, Giza CC, Fanselow MS. Sensory sensitivity as a link between concussive traumatic brain injury and PTSD. Sci Rep 2019; 9:13841. [PMID: 31554865 PMCID: PMC6761112 DOI: 10.1038/s41598-019-50312-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the most common injuries to military personnel, a population often exposed to stressful stimuli and emotional trauma. Changes in sensory processing after TBI might contribute to TBI-post traumatic stress disorder (PTSD) comorbidity. Combining an animal model of TBI with an animal model of emotional trauma, we reveal an interaction between auditory sensitivity after TBI and fear conditioning where 75 dB white noise alone evokes a phonophobia-like phenotype and when paired with footshocks, fear is robustly enhanced. TBI reduced neuronal activity in the hippocampus but increased activity in the ipsilateral lateral amygdala (LA) when exposed to white noise. The white noise effect in LA was driven by increased activity in neurons projecting from ipsilateral auditory thalamus (medial geniculate nucleus). These data suggest that altered sensory processing within subcortical sensory-emotional circuitry after TBI results in neutral stimuli adopting aversive properties with a corresponding impact on facilitating trauma memories and may contribute to TBI-PTSD comorbidity.
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Affiliation(s)
- Ann N Hoffman
- UCLA, Neurosurgery; Brain Injury Research Center, Los Angeles, USA.
- UCLA, Psychology, Los Angeles, USA.
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, USA.
- Staglin Center for Brain and Behavioral Health, Life Sciences, UCLA, Los Angeles, USA.
| | | | - David A Hovda
- UCLA, Neurosurgery; Brain Injury Research Center, Los Angeles, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, USA
- UCLA, Medical and Molecular Pharmacology, Los Angeles, USA
| | - Christopher C Giza
- UCLA, Neurosurgery; Brain Injury Research Center, Los Angeles, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, USA
- UCLA Mattel Children's Hospital, Los Angeles, USA
| | - Michael S Fanselow
- UCLA, Psychology, Los Angeles, USA
- UCLA, Psychiatry and Biobehavioral Sciences, Los Angeles, USA
- Staglin Center for Brain and Behavioral Health, Life Sciences, UCLA, Los Angeles, USA
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Executive (dys)function after traumatic brain injury: special considerations for behavioral pharmacology. Behav Pharmacol 2019; 29:617-637. [PMID: 30215621 PMCID: PMC6155367 DOI: 10.1097/fbp.0000000000000430] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Executive function is an umbrella term that includes cognitive processes such as decision-making, impulse control, attention, behavioral flexibility, and working memory. Each of these processes depends largely upon monoaminergic (dopaminergic, serotonergic, and noradrenergic) neurotransmission in the frontal cortex, striatum, and hippocampus, among other brain areas. Traumatic brain injury (TBI) induces disruptions in monoaminergic signaling along several steps in the neurotransmission process - synthesis, distribution, and breakdown - and in turn, produces long-lasting deficits in several executive function domains. Understanding how TBI alters monoamingeric neurotransmission and executive function will advance basic knowledge of the underlying principles that govern executive function and potentially further treatment of cognitive deficits following such injury. In this review, we examine the influence of TBI on the following measures of executive function - impulsivity, behavioral flexibility, and working memory. We also describe monoaminergic-systems changes following TBI. Given that TBI patients experience alterations in monoaminergic signaling following injury, they may represent a unique population with regard to pharmacotherapy. We conclude this review by discussing some considerations for pharmacotherapy in the field of TBI.
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Oyesanya TO, Arulselvam K, Thompson N, Norelli J, Seel RT. Health, wellness, and safety concerns of persons with moderate-to-severe traumatic brain injury and their family caregivers: a qualitative content analysis. Disabil Rehabil 2019; 43:685-695. [PMID: 31298958 DOI: 10.1080/09638288.2019.1638456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Persons with moderate-to-severe traumatic brain injury (TBI) face issues with health, wellness, and safety that affect their ability to independently manage their care, even for individuals who are ≥75% independent in activities of daily living. These issues often lead to increased family involvement in managing the person's condition after discharge home. PURPOSE We explored health, wellness, and safety concerns after discharge home from inpatient rehabilitation from the perspectives of persons with TBI who are ≥75% independent in activities of daily living and their family caregivers. MATERIALS AND METHODS We interviewed 27 persons with TBI and family caregivers and used conventional content analysis to analyse the data. RESULTS Seven themes related to health, wellness, and safety encompassed participants' experience. Health themes included: (1) attempting to manage medications and (2) navigating mental health difficulties. Wellness themes included: (1) working to stay physically active, (2) dealing with sleep and sleeplessness, and (3) adjusting to changing social relationships. Safety themes were: (1) addressing mobility challenges and (2) compensating for complications with cognitive functioning. CONCLUSIONS Findings can guide the development of tools, supports, and resources to promote health, wellness, and safety of persons with TBI as they recover after discharge home.Implications for rehabilitationFindings on numerous concerns related to health, wellness, and safety suggest the need for implementation or development and testing of tools, supports, and resources to promote health, wellness, and safety of persons with traumatic brain injury as they recover after discharge home.Our findings can be used to educate healthcare providers and increase awareness of the nuanced challenges patients and families face after discharge home.Findings can also be used by providers to educate patients and families on realistic expectations for life after discharge.
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Affiliation(s)
- Tolu O Oyesanya
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA.,School of Nursing, Duke University, Durham, NC, USA
| | | | - Nicole Thompson
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA
| | - Jenna Norelli
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA
| | - Ronald T Seel
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA.,Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Science and Engineering, VCU School of Medicine, Richmond, VA, USA
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McGuire JL, Ngwenya LB, McCullumsmith RE. Neurotransmitter changes after traumatic brain injury: an update for new treatment strategies. Mol Psychiatry 2019; 24:995-1012. [PMID: 30214042 DOI: 10.1038/s41380-018-0239-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI) is a pervasive problem in the United States and worldwide, as the number of diagnosed individuals is increasing yearly and there are no efficacious therapeutic interventions. A large number of patients suffer with cognitive disabilities and psychiatric conditions after TBI, especially anxiety and depression. The constellation of post-injury cognitive and behavioral symptoms suggest permanent effects of injury on neurotransmission. Guided in part by preclinical studies, clinical trials have focused on high-yield pathophysiologic mechanisms, including protein aggregation, inflammation, metabolic disruption, cell generation, physiology, and alterations in neurotransmitter signaling. Despite successful treatment of experimental TBI in animal models, clinical studies based on these findings have failed to translate to humans. The current international effort to reshape TBI research is focusing on redefining the taxonomy and characterization of TBI. In addition, as the next round of clinical trials is pending, there is a pressing need to consider what the field has learned over the past two decades of research, and how we can best capitalize on this knowledge to inform the hypotheses for future innovations. Thus, it is critically important to extend our understanding of the pathophysiology of TBI, particularly to mechanisms that are associated with recovery versus development of chronic symptoms. In this review, we focus on the pathology of neurotransmission after TBI, reflecting on what has been learned from both the preclinical and clinical studies, and we discuss new directions and opportunities for future work.
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Affiliation(s)
- Jennifer L McGuire
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA.
| | - Laura B Ngwenya
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA.,Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA.,Neurotrauma Center, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, 45219, USA
| | - Robert E McCullumsmith
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA.,Department of Psychiatry, Cincinnati Veterans Administration Medical Center, Cincinnati, OH, USA
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Roy D, Peters ME, Everett A, Leoutsakos JM, Yan H, Rao V, Bechtold K, Sair H, Van Meter TE, Falk H, Vassila A, Hall A, Ofoche U, Akbari F, Lyketsos CG, Korley F. Loss of consciousness and altered mental state predicting depressive and post-concussive symptoms after mild traumatic brain injury. Brain Inj 2019; 33:1064-1069. [DOI: 10.1080/02699052.2019.1606447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allen Everett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris Sair
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hayley Falk
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Anna Hall
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uju Ofoche
- Department of Forensic Science, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Freshta Akbari
- Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fredrick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. J Neurosurg 2019; 130:1080-1097. [PMID: 29701556 DOI: 10.3171/2017.10.jns17352] [Citation(s) in RCA: 1160] [Impact Index Per Article: 232.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/18/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups. METHODS Open-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global Burden of Disease Study 2015 was applied to these two ratios to generate the incidence and estimated case volume of TBI for each WHO region and WB income group. RESULTS Relevant articles and registries were identified via systematic review; study quality was higher in the high-income countries (HICs) than in the low- and middle-income countries (LMICs). Sixty-nine million (95% CI 64-74 million) individuals worldwide are estimated to sustain a TBI each year. The proportion of TBIs resulting from road traffic collisions was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). The incidence of RTI was similar in Southeast Asia (1.5% of the population per year) and Europe (1.2%). The overall incidence of TBI per 100,000 people was greatest in North America (1299 cases, 95% CI 650-1947) and Europe (1012 cases, 95% CI 911-1113) and least in Africa (801 cases, 95% CI 732-871) and the Eastern Mediterranean (897 cases, 95% CI 771-1023). The LMICs experience nearly 3 times more cases of TBI proportionally than HICs. CONCLUSIONS Sixty-nine million (95% CI 64-74 million) individuals are estimated to suffer TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease. Head injury following road traffic collision is more common in LMICs, and the proportion of TBIs secondary to road traffic collision is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions with higher-quality data, specifically in North America and Europe.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 2Department of Neurological Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center
| | - Abbas Rattani
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 3Meharry Medical College, School of Medicine, Nashville, Tennessee
| | | | - Ronnie E Baticulon
- 5University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Ya-Ching Hung
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
| | - Maria Punchak
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 6David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amit Agrawal
- 7Department of Neurosurgery, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Amos O Adeleye
- 8Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan
- 9Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Mark G Shrime
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 10Office of Global Surgery and Health, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Andrés M Rubiano
- 11Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia
| | - Jeffrey V Rosenfeld
- 12Department of Neurosurgery, Alfred Hospital
- 13Department of Surgery, Monash University, Melbourne, Australia; and
- 14Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kee B Park
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
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Nash RP, Weinberg MS, Laughon SL, McCall RC, Bateman JR, Rosenstein DL. Acute Pharmacological Management of Behavioral and Emotional Dysregulation Following a Traumatic Brain Injury: A Systematic Review of the Literature. PSYCHOSOMATICS 2019; 60:139-152. [DOI: 10.1016/j.psym.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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Vonder Haar C, Ferland JMN, Kaur S, Riparip LK, Rosi S, Winstanley CA. Cocaine self-administration is increased after frontal traumatic brain injury and associated with neuroinflammation. Eur J Neurosci 2018; 50:2134-2145. [PMID: 30118561 DOI: 10.1111/ejn.14123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022]
Abstract
Traumatic brain injury (TBI) has been linked to the development of numerous psychiatric diseases, including substance use disorder. However, it can be difficult to ascertain from clinical data whether the TBI is cause or consequence of increased addiction vulnerability. Surprisingly few studies have taken advantage of animal models to investigate the causal nature of this relationship. In terms of a plausible neurobiological mechanism through which TBI could magnify the risk of substance dependence, numerous studies indicate that TBI can cause widespread disruption to monoaminergic signaling in striatal regions, and also increases neuroinflammation. In the current study, male Long-Evans rats received either a mild or severe TBI centered over the frontal cortex via controlled cortical impact, and were subsequently trained to self-administer cocaine over 10 6-hour sessions. At the end of the study, markers of striatal dopaminergic function, and levels of inflammatory cytokine levels in the frontal lobes, were assessed via western blot and multiplex ELISA, respectively. There was significantly higher cocaine intake in a subset of animals with either mild or severe TBI. However, many animals within both TBI groups failed to acquire self-administration. Principal components analysis suggested that both dopaminergic and neuroinflammatory proteins were associated with overall cocaine intake, yet only an inflammatory component was associated with acquisition of self-administration, suggesting neuroinflammation may make a more substantial contribution to the likelihood of drug-taking. Should neuroinflammation play a causal role in mediating TBI-induced addiction risk, anti-inflammatory therapy may reduce the likelihood of substance abuse in TBI populations.
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Affiliation(s)
- Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, PO Box 6040, 53 Campus Drive, Morgantown, WV, 26505, USA.,Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jacqueline-Marie N Ferland
- Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sukhbir Kaur
- Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lara-Kirstie Riparip
- Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Susanna Rosi
- Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Catharine A Winstanley
- Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
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Shaver TK, Ozga JE, Zhu B, Anderson KG, Martens KM, Vonder Haar C. Long-term deficits in risky decision-making after traumatic brain injury on a rat analog of the Iowa gambling task. Brain Res 2018; 1704:103-113. [PMID: 30296430 DOI: 10.1016/j.brainres.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/28/2018] [Accepted: 10/04/2018] [Indexed: 12/20/2022]
Abstract
Traumatic brain injury (TBI) affects 2.8 million people annually in the United States, with significant populations suffering from ongoing cognitive dysfunction. Impairments in decision-making can have major implications for patients and their caregivers, often enduring for years to decades, yet are rarely explored in experimental TBI. In the current study, the Rodent Gambling Task (RGT), an Iowa Gambling Task analog, was used to assess risk-based decision-making and motor impulsivity after TBI. During testing, rats chose between options associated with different probabilities of reinforcement (sucrose) or punishment (timeout). To determine effects of TBI on learned behaviors versus the learning process, rats were trained either before, or after, a bilateral frontal controlled cortical impact TBI, and then assessed for 12 weeks. To evaluate the degree to which monoamine systems, such as dopamine, were affected by TBI, rats were given an amphetamine challenge, and behavior recorded. Injury immediately and chronically decreased optimal decision-making, and biased rats towards both riskier, and safer (but suboptimal) choices, regardless of prior learning history. TBI also increased motor impulsivity across time, reflecting ongoing neural changes. Despite these similarities in trained and acquisition rats, those that learned the task after injury demonstrated reduced effects of amphetamine on optimal decision-making, suggesting a lesser role of monoamines in post-injury learning. Amphetamine also dose-dependently reduced motor impulsivity in injured rats. This study opens up the investigation of psychiatric-like dysfunction in animal models of TBI and tasks such as the RGT will be useful in identifying therapeutics for the chronic post-injury period.
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Affiliation(s)
- Trinity K Shaver
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Jenny E Ozga
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Binxing Zhu
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Karen G Anderson
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Kris M Martens
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cole Vonder Haar
- Department of Psychology, West Virginia University, Morgantown, WV, USA.
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Du J, Yin J, Liu L, Chen J, He M. Clinical observation of 60 cases of treating cognitive disorder after cerebral injury in combination with scalp acupuncture and cognitive training. Medicine (Baltimore) 2018; 97:e12420. [PMID: 30290598 PMCID: PMC6200546 DOI: 10.1097/md.0000000000012420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To observe the clinical effect of scalp acupuncture combined with cognitive training on cognitive disorder after cerebral injury.Around 60 cases of cerebral injury patients for hospitalization in rehabilitation department of Chongqing Three Gorges Central Hospital from July in 2015 to June in 2017 are divided into control group and treatment group of 30 cases for each at random. The control group received routine treatment and cognitive rehabilitation training for 12 weeks. The treatment group received conventional treatment, cognitive rehabilitation training, and scalp acupuncture. Acupuncture with a scalp acupuncture is provided for the treatment group besides adopting above conventional treatment and rehabilitation training method.Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score of both groups increases obviously after treatment compared with that before treatment, and there is difference (P < .01) through contrast. And LOTCA score of treatment group is higher than that of control group (P < .05) after treatment.Scalp acupuncture in combination with cognitive training can effectively improve cognitive disorder degree of patients with cerebral injury, and the effect is more significant compared with simple cognitive rehabilitation training, thus it is worth of research and application.
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64
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Scott TL, Vonder Haar C. Frontal brain injury chronically impairs timing behavior in rats. Behav Brain Res 2018; 356:408-414. [PMID: 30213663 DOI: 10.1016/j.bbr.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/18/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023]
Abstract
Traumatic brain injury (TBI) affects over 2.8 million people annually, and has been shown to increase motor impulsivity in both humans and animals. However, the root cause of this behavioral disinhibition is not fully understood. The goal of the current study was to evaluate whether timing behavior is disrupted after TBI, which could potentially explain increases in impulsive responding. Twenty-one male three-month old Long-Evans rats were trained on a fixed interval-18 s schedule. Following training, rats were placed on the Peak Interval Procedure, with intermittent peak trials. On peak trials, no behaviors were reinforced and response rates were recorded to determine timing ability. After reaching a stable baseline, rats received bilateral frontal TBI (n = 12) using controlled cortical impact or sham procedures (n = 9). After one week recovery, rats were re-assessed on the Peak Procedure for six weeks. An amphetamine challenge was carried out after behavior reached stable post-injury performance. TBI caused a chronic decrease/acceleration in peak time, increase in response variability, and reduction in response rate. The shifted peak time suggests that altered perception of time may contribute to impairments in response inhibition after TBI. Amphetamine significantly increased response variability, with TBI animals demonstrating greater sensitivity, but did not affect peak time in either group. These data suggest that timing may not be the sole factor explaining impulsive action after TBI given that amphetamine reduced motor impulsivity in prior studies. Further investigations will be needed to dissociate the effects of amphetamine on TBI with regard to timing behavior.
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Affiliation(s)
- Taylor L Scott
- Injury and Recovery Laboratory, USA; Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, USA; Department of Psychology, West Virginia University, Morgantown, WV, USA.
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65
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Effects of Mild Blast Traumatic Brain Injury on Cognitive- and Addiction-Related Behaviors. Sci Rep 2018; 8:9941. [PMID: 29967344 PMCID: PMC6028456 DOI: 10.1038/s41598-018-28062-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/07/2018] [Indexed: 12/30/2022] Open
Abstract
Traumatic brain injury (TBI) commonly results in cognitive and psychiatric problems. Cognitive impairments occur in approximately 30% of patients suffering from mild TBI (mTBI), and correlational evidence from clinical studies indicates that substance abuse may be increased following mTBI. However, understanding the lasting cognitive and psychiatric problems stemming from mTBI is difficult in clinical settings where pre-injury assessment may not be possible or accurate. Therefore, we used a previously characterized blast model of mTBI (bTBI) to examine cognitive- and addiction-related outcomes. We previously demonstrated that this model leads to bilateral damage of the medial prefrontal cortex (mPFC), a region critical for cognitive function and addiction. Rats were exposed to bTBI and tested in operant learning tasks several weeks after injury. bTBI rats made more errors during acquisition of a cue discrimination task compared to sham treated rats. Surprisingly, we observed no differences between groups in set shifting and delayed matching to sample, tasks known to require the mPFC. Separate rats performed cocaine self-administration. No group differences were found in intake or extinction, and only subtle differences were observed in drug-primed reinstatement 3-4 months after injury. These findings indicate that bTBI impairs acquisition of a visual discrimination task and that bTBI does not significantly increase the ability of cocaine exposure to trigger drug seeking.
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66
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Verberne DPJ, Spauwen PJJ, van Heugten CM. Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review. Neuropsychol Rehabil 2018; 29:1509-1542. [DOI: 10.1080/09602011.2018.1433049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daan P. J. Verberne
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Peggy J. J. Spauwen
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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67
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de la Tremblaye PB, O'Neil DA, LaPorte MJ, Cheng JP, Beitchman JA, Thomas TC, Bondi CO, Kline AE. Elucidating opportunities and pitfalls in the treatment of experimental traumatic brain injury to optimize and facilitate clinical translation. Neurosci Biobehav Rev 2018; 85:160-175. [PMID: 28576511 PMCID: PMC5709241 DOI: 10.1016/j.neubiorev.2017.05.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/12/2017] [Indexed: 12/19/2022]
Abstract
The aim of this review is to discuss the research presented in a symposium entitled "Current progress in characterizing therapeutic strategies and challenges in experimental CNS injury" which was presented at the 2016 International Behavioral Neuroscience Society annual meeting. Herein we discuss diffuse and focal traumatic brain injury (TBI) and ensuing chronic behavioral deficits as well as potential rehabilitative approaches. We also discuss the effects of stress on executive function after TBI as well as the response of the endocrine system and regulatory feedback mechanisms. The role of the endocannabinoids after CNS injury is also discussed. Finally, we conclude with a discussion of antipsychotic and antiepileptic drugs, which are provided to control TBI-induced agitation and seizures, respectively. The review consists predominantly of published data.
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Affiliation(s)
- Patricia B de la Tremblaye
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Darik A O'Neil
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Megan J LaPorte
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jeffrey P Cheng
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joshua A Beitchman
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States; Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, United States; Midwestern University, Glendale, AZ, United States
| | - Theresa Currier Thomas
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States; Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, United States; Phoenix VA Healthcare System, Phoenix, AZ, United States
| | - Corina O Bondi
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony E Kline
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States.
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68
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Liu Q, Zhang H, Xu J, Zhao D. Neuritin provides neuroprotection against experimental traumatic brain injury in rats. Int J Neurosci 2018; 128:811-820. [PMID: 29334295 DOI: 10.1080/00207454.2018.1424155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Neuritin is a neurotrophic factor that regulates neural growth and development. However, the role of neuritin in alleviating TBI has not been investigated. METHODS In this study, Sprague Dawley rats (n = 144) weighing 300 ± 50 g were categorized into control, sham, TBI and TBI + neuritin groups. The neurological scores and the ultrastructure of cortical neurons, apoptotic cells and caspase-3 were measured by using Garcia scoring system, transmission electron microscopy, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling, Western blot analysis and real-time RT-PCR at various time points post-TBI. CONCLUSIONS Our findings indicated that neuritin plays a protective role in TBI by improving neurological scores, repairing injured neurons and protecting the cortical neurons against apoptosis through inhibition of caspase-3 expression. Further investigation of the molecular mechanisms underlying caspase-3 inhibition by neuritin will provide a research avenue for potential TBI therapeutics.
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Affiliation(s)
- Qi Liu
- a Department of Neurosurgery , First Affiliated Hospital of Medical College, Shihezi University , Shihezi , Xinjiang , China.,b The Key Laboratory of Xinjiang Endemic and Ethnic Diseases , Medical College of Shihezi University , Shihezi , Xinjiang , China
| | - Hang Zhang
- a Department of Neurosurgery , First Affiliated Hospital of Medical College, Shihezi University , Shihezi , Xinjiang , China.,b The Key Laboratory of Xinjiang Endemic and Ethnic Diseases , Medical College of Shihezi University , Shihezi , Xinjiang , China
| | - Jian Xu
- a Department of Neurosurgery , First Affiliated Hospital of Medical College, Shihezi University , Shihezi , Xinjiang , China.,b The Key Laboratory of Xinjiang Endemic and Ethnic Diseases , Medical College of Shihezi University , Shihezi , Xinjiang , China
| | - Dong Zhao
- a Department of Neurosurgery , First Affiliated Hospital of Medical College, Shihezi University , Shihezi , Xinjiang , China.,b The Key Laboratory of Xinjiang Endemic and Ethnic Diseases , Medical College of Shihezi University , Shihezi , Xinjiang , China
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69
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Schwerin SC, Chatterjee M, Imam-Fulani AO, Radomski KL, Hutchinson EB, Pierpaoli CM, Juliano SL. Progression of histopathological and behavioral abnormalities following mild traumatic brain injury in the male ferret. J Neurosci Res 2018; 96:556-572. [PMID: 29360208 DOI: 10.1002/jnr.24218] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/20/2017] [Accepted: 01/02/2018] [Indexed: 12/11/2022]
Abstract
White matter damage is an important consequence of traumatic brain injury (TBI) in humans. Unlike rodents, ferrets have a substantial amount of white matter and a gyrencephalic brain; therefore, they may represent an ideal small mammal model to study human-pertinent consequences of TBI. Here we report immunohistochemical and behavioral results after a controlled cortical impact (CCI) injury to the sensorimotor cortex of adult male ferrets. We assessed inflammation in the neocortex and white matter, and behavior at 1 day post injury and 1, 4, and 16 weeks post injury (WPI). CCI in the ferret produced inflammation that originated in the neocortex near the site of the injury and progressed deep into the white matter with time. The density of microglia and astrocytes increased in the neocortex near the injury, peaking at 4WPI and remaining elevated at 16WPI. Microglial morphology in the neocortex was significantly altered in the first 4 weeks, but showed a return toward normal at 16 weeks. Clusters of microglial cells in the white matter persisted until 16WPI. We assessed motor and cognitive behavior using the open field, novel object recognition, T-maze, and gait tests. A transient deficit in memory occurred at 4WPI, with a reduction of rearing and motor ability at 12 and 16WPI. Behavioral impairments coincide with features of the inflammatory changes in the neocortex revealed by immunohistochemistry. The ferret represents an important animal model to explore ongoing damage in the white matter and cerebral cortex after TBI.
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Affiliation(s)
- Susan C Schwerin
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland.,Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Mitali Chatterjee
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Aminat O Imam-Fulani
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Kryslaine L Radomski
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland.,Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Elizabeth B Hutchinson
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland.,Quantitative Medical Imaging Section, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland
| | - Carlo M Pierpaoli
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland.,Quantitative Medical Imaging Section, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland
| | - Sharon L Juliano
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland.,Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland.,Program in Neuroscience, Uniformed Services University of Health Sciences, Bethesda, Maryland
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70
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Salehi A, Zhang JH, Obenaus A. Response of the cerebral vasculature following traumatic brain injury. J Cereb Blood Flow Metab 2017; 37:2320-2339. [PMID: 28378621 PMCID: PMC5531360 DOI: 10.1177/0271678x17701460] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The critical role of the vasculature and its repair in neurological disease states is beginning to emerge particularly for stroke, dementia, epilepsy, Parkinson's disease, tumors and others. However, little attention has been focused on how the cerebral vasculature responds following traumatic brain injury (TBI). TBI often results in significant injury to the vasculature in the brain with subsequent cerebral hypoperfusion, ischemia, hypoxia, hemorrhage, blood-brain barrier disruption and edema. The sequalae that follow TBI result in neurological dysfunction across a host of physiological and psychological domains. Given the importance of restoring vascular function after injury, emerging research has focused on understanding the vascular response after TBI and the key cellular and molecular components of vascular repair. A more complete understanding of vascular repair mechanisms are needed and could lead to development of new vasculogenic therapies, not only for TBI but potentially vascular-related brain injuries. In this review, we delineate the vascular effects of TBI, its temporal response to injury and putative biomarkers for arterial and venous repair in TBI. We highlight several molecular pathways that may play a significant role in vascular repair after brain injury.
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Affiliation(s)
- Arjang Salehi
- 1 Cell, Molecular and Developmental Biology Program, University of California, Riverside, CA, USA.,2 Department of Pediatrics, Loma Linda University, Loma Linda, CA, USA
| | - John H Zhang
- 3 Department of Physiology and Pharmacology Loma Linda University School of Medicine, CA, USA.,4 Department of Anesthesiology Loma Linda University School of Medicine, CA, USA.,5 Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Andre Obenaus
- 1 Cell, Molecular and Developmental Biology Program, University of California, Riverside, CA, USA.,2 Department of Pediatrics, Loma Linda University, Loma Linda, CA, USA.,6 Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
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71
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Vonder Haar C, Martens KM, Riparip LK, Rosi S, Wellington CL, Winstanley CA. Frontal Traumatic Brain Injury Increases Impulsive Decision Making in Rats: A Potential Role for the Inflammatory Cytokine Interleukin-12. J Neurotrauma 2017; 34:2790-2800. [PMID: 28376700 DOI: 10.1089/neu.2016.4813] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with the development of numerous psychiatric diseases. Of particular concern for TBI patients is the impact of chronic impulsivity on daily functioning. Despite the scope of the human problem, little has been done to address impulsivity in animal models of brain injury. In the current study, we examined the effects of either a severe or a milder bilateral frontal controlled cortical impact injury on impulsivity using the Delay Discounting Task (DDT), in which preference for smaller-sooner over larger-later rewards is indicative of greater impulsive choice. Both milder and severe TBI caused a significant, chronic increase in impulsive decision making. Despite these pronounced changes in performance of the DDT, memory function, as assessed by the Morris Water Maze, was not impaired in more mildly injured rats and only transiently impacted in the severe TBI group. Whereas a significant lesion was only evident in severely injured rats, analysis of cytokine levels within the frontal cortex revealed a selective increase in interleukin (IL)-12 that was associated with the magnitude of the change in impulsive choice caused by both milder and severe TBI. These findings suggest that tissue loss alone cannot explain the increased impulsivity observed, and that inflammatory pathways mediated by IL-12 may be a contributing factor. The findings from this study highlight the sensitivity of sophisticated behavioral measures designed to assess neuropsychiatric dysfunction in the detection of TBI-induced cognitive impairments and their utility in identifying potential mechanistic pathways and therapeutic targets.
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Affiliation(s)
- Cole Vonder Haar
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Kris M Martens
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Lara-Kirstie Riparip
- 2 Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco , San Francisco, California
| | - Susanna Rosi
- 2 Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco , San Francisco, California
| | - Cheryl L Wellington
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Catharine A Winstanley
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
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72
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Gardner AJ, Shih SL, Adamov EV, Zafonte RD. Research Frontiers in Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2017; 28:413-431. [DOI: 10.1016/j.pmr.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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73
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De Guzman E, Ament A. Neurobehavioral Management of Traumatic Brain Injury in the Critical Care Setting: An Update. Crit Care Clin 2017; 33:423-440. [PMID: 28601130 DOI: 10.1016/j.ccc.2017.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force. TBI is a major cause of disability and mortality worldwide. Post-traumatic amnesia, or the interval from injury until the patient is oriented and able to form and later recall new memories, is an important index of TBI severity and functional outcome. This article will discuss the updates in the epidemiology, definition and classification, pathophysiology, diagnosis, and management of common acute neuropsychiatric sequelae of traumatic brain injury that the critical care specialist may encounter.
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Affiliation(s)
- Earl De Guzman
- Psychosomatic Medicine, Department of Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, USA
| | - Andrea Ament
- Psychosomatic Medicine, Department of Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, USA.
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74
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Rao V, Syeda A, Roy D, Peters ME, Vaishnavi S. Neuropsychiatric aspects of concussion: acute and chronic sequelae. ACTA ACUST UNITED AC 2017; 2:CNC29. [PMID: 30202570 PMCID: PMC6094361 DOI: 10.2217/cnc-2016-0018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 01/05/2023]
Abstract
Concussion – also known as mild traumatic brain injury – is a transient disturbance of neurological function resulting from traumatic forces imparted to the brain that often produce cognitive, behavioral and systemic symptoms. In this review of the literature, we discuss the pathophysiology of both acute and chronic neuropsychiatric sequelae of concussions, followed by a brief overview of evaluation and management of these sequelae.
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Affiliation(s)
- Vani Rao
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Arshiya Syeda
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Durga Roy
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Matthew E Peters
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Sandeep Vaishnavi
- The Preston Robert Tisch Brain Tumor Center, Duke Medicine; Department of Psychiatry & Behavioral Sciences & Community & Family Medicine, Duke University Medical Center, Durham, NC, USA; The Neuropsychiatric Clinic at Carolina Partners, Raleigh, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke Medicine; Department of Psychiatry & Behavioral Sciences & Community & Family Medicine, Duke University Medical Center, Durham, NC, USA; The Neuropsychiatric Clinic at Carolina Partners, Raleigh, NC, USA
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75
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Ogier M, Belmeguenai A, Lieutaud T, Georges B, Bouvard S, Carré E, Canini F, Bezin L. Cognitive Deficits and Inflammatory Response Resulting from Mild-to-Moderate Traumatic Brain Injury in Rats Are Exacerbated by Repeated Pre-Exposure to an Innate Stress Stimulus. J Neurotrauma 2017; 34:1645-1657. [PMID: 27901414 DOI: 10.1089/neu.2016.4741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury (TBI) is common in both military and civilian populations, and often results in neurobehavioral sequelae that impair quality of life in both patients and their families. Although individuals who are chronically exposed to stress are more likely to experience TBI, it is still unknown whether pre-injury stress influences the outcome after TBI. The present study tested whether behavioral and cognitive long-term outcome after TBI in rats is affected by prior exposure to an innate stress stimulus. Young adult male Sprague-Dawley rats were exposed to the predator odor 2,5-dihydro-2,4,5-trimethylthiazoline (TMT) or to water (WAT); exposure was repeated eight times at irregular intervals over a 2-week period. Rats were subsequently subjected to either mild-to-moderate bilateral brain injury (lateral fluid percussion [LFP]) or sham surgery (Sham). Four experimental groups were studied: Sham-WAT, Sham-TMT, LFP-WAT and LFP-TMT. Compared with Sham-WAT rats, LFP-WAT rats exhibited transient locomotor hyperactivity without signs of anxiety, minor spatial learning acquisition and hippocampal long-term potentiation deficits, and lower baseline activity of the hypothalamic-pituitary-adrenal axis with slightly stronger reactivity to restraint stress. Exposure to TMT had only negligible effects on Sham rats, whereas it exacerbated all deficits in LFP rats except for locomotor hyperactivity. Early brain inflammatory response (8 h post-trauma) was aggravated in rats pre-exposed to TMT, suggesting that increased brain inflammation may sustain functional deficits in these rats. Hence, these data suggest that pre-exposure to stressful conditions can aggravate long-term deficits induced by TBI, leading to severe stress response deficits, possibly due to dysregulated inflammatory response.
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Affiliation(s)
- Michaël Ogier
- 1 Institut de Recherche Biomédicale des Armées , Brétigny-sur-Orge, France .,2 Université Claude Bernard Lyon 1 , Bron, France .,3 Institute for Epilepsy , IDÉE, Bron, France
| | - Amor Belmeguenai
- 2 Université Claude Bernard Lyon 1 , Bron, France .,3 Institute for Epilepsy , IDÉE, Bron, France
| | - Thomas Lieutaud
- 2 Université Claude Bernard Lyon 1 , Bron, France .,3 Institute for Epilepsy , IDÉE, Bron, France
| | - Béatrice Georges
- 2 Université Claude Bernard Lyon 1 , Bron, France .,3 Institute for Epilepsy , IDÉE, Bron, France
| | - Sandrine Bouvard
- 2 Université Claude Bernard Lyon 1 , Bron, France .,3 Institute for Epilepsy , IDÉE, Bron, France
| | - Emilie Carré
- 1 Institut de Recherche Biomédicale des Armées , Brétigny-sur-Orge, France
| | - Frédéric Canini
- 1 Institut de Recherche Biomédicale des Armées , Brétigny-sur-Orge, France .,4 Ecole du Val de Grâce , Paris, France
| | - Laurent Bezin
- 2 Université Claude Bernard Lyon 1 , Bron, France .,3 Institute for Epilepsy , IDÉE, Bron, France
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76
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Abou-El-Hassan H, Sukhon F, Assaf EJ, Bahmad H, Abou-Abbass H, Jourdi H, Kobeissy FH. Degradomics in Neurotrauma: Profiling Traumatic Brain Injury. Methods Mol Biol 2017; 1598:65-99. [PMID: 28508358 DOI: 10.1007/978-1-4939-6952-4_4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Degradomics has recently emerged as a subdiscipline in the omics era with a focus on characterizing signature breakdown products implicated in various disease processes. Driven by promising experimental findings in cancer, neuroscience, and metabolomic disorders, degradomics has significantly promoted the notion of disease-specific "degradome." A degradome arises from the activation of several proteases that target specific substrates and generate signature protein fragments. Several proteases such as calpains, caspases, cathepsins, and matrix metalloproteinases (MMPs) are involved in the pathogenesis of numerous diseases that disturb the physiologic balance between protein synthesis and protein degradation. While regulated proteolytic activities are needed for development, growth, and regeneration, uncontrolled proteolysis initiated under pathological conditions ultimately culminates into apoptotic and necrotic processes. In this chapter, we aim to review the protease-substrate repertoires in neural injury concentrating on traumatic brain injury. A striking diversity of protease substrates, essential for neuronal and brain structural and functional integrity, namely, encryptic biomarker neoproteins, have been characterized in brain injury. These include cytoskeletal proteins, transcription factors, cell cycle regulatory proteins, synaptic proteins, and cell junction proteins. As these substrates are subject to proteolytic fragmentation, they are ceaselessly exposed to activated proteases. Characterization of these molecules allows for a surge of "possible" therapeutic approaches of intervention at various levels of the proteolytic cascade.
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Affiliation(s)
- Hadi Abou-El-Hassan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Fares Sukhon
- Faculty of Medicine, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Edwyn Jeremy Assaf
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hisham Bahmad
- Faculty of Medical, Neuroscience Research Center, Beirut Arab University, Beirut, Lebanon
- Faculty of Medicine, Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussein Abou-Abbass
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Hussam Jourdi
- Faculty of Science¸ Department of Biology, University of Balamand, Souk-el-Gharb Campus, Aley, Lebanon
| | - Firas H Kobeissy
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon.
- Department of Psychiatry, Center for Neuroproteomics and Biomarkers Research, University of Florida, Gainesville, FL, USA.
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77
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Williamson DR, Frenette AJ, Burry L, Perreault MM, Charbonney E, Lamontagne F, Potvin MJ, Giguère JF, Mehta S, Bernard F. Pharmacological interventions for agitation in patients with traumatic brain injury: protocol for a systematic review and meta-analysis. Syst Rev 2016; 5:193. [PMID: 27855720 PMCID: PMC5114826 DOI: 10.1186/s13643-016-0374-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a worldwide leading cause of mortality and disability. Among TBI complications, agitation is a frequent behavioural problem. Agitation causes potential harm to patients and caregivers, interferes with treatments, leads to unnecessary chemical and physical restraints, increases hospital length of stay, delays rehabilitation, and impedes functional independence. Pharmacological treatments are often considered for agitation management following TBI. Several types of agents have been proposed for the treatment of agitation. However, the benefit and safety of these agents in TBI patients as well as their differential effects and interactions are uncertain. In addition, animal studies and observational studies have suggested impaired cognitive function with the use of certain antipsychotics and benzodiazepines. Hence, a safe and effective treatment for agitation, which does not interfere with neurological recovery, remains to be identified. METHODS/DESIGN With the help of Health Sciences librarian, we will design a search strategy in the following databases: PubMed, Ovid MEDLINE®, EMBASE, CINAHL, PsycINFO, Cochrane Library, Google Scholar, Directory of Open Access Journals, LILACS, Web of Science, and Prospero. A grey literature search will be performed using the resources suggested in CADTH's Grey Matters. We will include all randomized controlled, quasi-experimental, and observational studies with control groups. The population of interest is all patients, including children and adults, who have suffered a TBI. We will include studies in which agitation, not further defined, was the presenting symptom or one of the presenting symptoms. We will also include studies where agitation was not the presenting symptom but was measured as an outcome variable and studies assessing the safety of these pharmacological interventions in TBI patients. We will include studies evaluating all pharmacological interventions including beta-adrenergic blockers, typical and atypical antipsychotics, anticonvulsants, dopamine agonists, psychostimulants, antidepressants, alpha-2-adrenergic agonists, hypnotics, and anxiolytics. DISCUSSION Although agitation is frequent following TBI and pharmacological agents that are often used, there is no consensus on the most efficacious and safest strategy to treat these complications. There is a need for an updated systematic review to summarize the evidence in order to inform practice and future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033140.
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Affiliation(s)
- David R Williamson
- Pharmacy Department and Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin West, Montreal, Quebec, H4J 1C5, Canada. .,Faculté de pharmacie, Université de Montréal, Montréal, Canada.
| | - Anne Julie Frenette
- Pharmacy Department and Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin West, Montreal, Quebec, H4J 1C5, Canada.,Faculté de pharmacie, Université de Montréal, Montréal, Canada
| | - Lisa Burry
- Department of Pharmacy and Medicine, Mount Sinai Hospital, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Marc M Perreault
- Faculté de pharmacie, Université de Montréal, Montréal, Canada.,Department of Pharmacy, McGill University Health Center, Montréal, Canada
| | - Emmanuel Charbonney
- Department of Critical Care and Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - François Lamontagne
- Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.,Faculté de Médecine, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Julie Potvin
- Department of Psychology, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Jean-François Giguère
- Faculté de Médecine, Université de Montréal, Montréal, Canada.,Department of Neurosurgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | - Sangeeta Mehta
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Francis Bernard
- Department of Critical Care and Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
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78
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Haar CV, Lam FC, Adams WA, Riparip LK, Kaur S, Muthukrishna M, Rosi S, Winstanley CA. Frontal Traumatic Brain Injury in Rats Causes Long-Lasting Impairments in Impulse Control That Are Differentially Sensitive to Pharmacotherapeutics and Associated with Chronic Neuroinflammation. ACS Chem Neurosci 2016; 7:1531-1542. [PMID: 27525447 PMCID: PMC9487719 DOI: 10.1021/acschemneuro.6b00166] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Traumatic brain injury (TBI) affects millions yearly, and is increasingly associated with chronic neuropsychiatric symptoms. We assessed the long-term effects of different bilateral frontal controlled cortical impact injury severities (mild, moderate, and severe) on the five-choice serial reaction time task, a paradigm with relatively independent measurements of attention, motor impulsivity, and motivation. Moderately- and severely injured animals exhibited impairments across all cognitive domains that were still evident 14 weeks postinjury, while mild-injured animals only demonstrated persistent deficits in impulse control. However, recovery of function varied considerably between subjects such that some showed no impairment ("TBI-resilient"), some demonstrated initial deficits that recovered ("TBI-vulnerable"), and some never recovered ("chronically-impaired"). Three clinically relevant treatments for impulse-control or TBI, amphetamine, atomoxetine, and amantadine, were assessed for efficacy in treating injury-induced deficits. Susceptibility to TBI affected the response to pharmacological challenge with amphetamine. Whereas sham and TBI-resilient animals showed characteristic impairments in impulse control at higher doses, amphetamine had the opposite effect in chronically impaired rats, improving task performance. In contrast, atomoxetine and amantadine reduced premature responding but increased omissions, suggesting psychomotor slowing. Analysis of brain tissue revealed that generalized neuroinflammation was associated with impulsivity even when accounting for the degree of brain damage. This is one of the first studies to characterize psychiatric-like symptoms in experimental TBI. Our data highlight the importance of testing pharmacotherapies in TBI models in order to predict efficacy, and suggest that neuroinflammation may represent a treatment target for impulse control problems following injury.
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Affiliation(s)
- Cole Vonder Haar
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of British Columbia, Vancouver, BC, Canada,Corresponding author: Cole Vonder Haar or Catharine A. Winstanley, CV: Department of Psychology, 53 Campus Dr, Morgantown, WV, 26506, Tel: 1-304-293-1787, , CAW: Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, Tel: 1-604-822-2024,
| | - Frederick C.W. Lam
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Wendy A. Adams
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Lara-Kirstie Riparip
- Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sukhbir Kaur
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Susanna Rosi
- Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Catharine A. Winstanley
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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79
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Gaudet CE, Weyandt LL. Immediate Post-Concussion and Cognitive Testing (ImPACT): a systematic review of the prevalence and assessment of invalid performance. Clin Neuropsychol 2016; 31:43-58. [DOI: 10.1080/13854046.2016.1220622] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Charles E. Gaudet
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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80
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Hoffman AN, Paode PR, May HG, Ortiz JB, Kemmou S, Lifshitz J, Conrad CD, Currier Thomas T. Early and Persistent Dendritic Hypertrophy in the Basolateral Amygdala following Experimental Diffuse Traumatic Brain Injury. J Neurotrauma 2016; 34:213-219. [PMID: 27306143 DOI: 10.1089/neu.2015.4339] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In the pathophysiology of traumatic brain injury (TBI), the amygdala remains understudied, despite involvement in processing emotional and stressful stimuli associated with anxiety disorders, such as post-traumatic stress disorder (PTSD). Because the basolateral amygdala (BLA) integrates inputs from sensory and other limbic structures coordinating emotional learning and memory, injury-induced changes in circuitry may contribute to psychiatric sequelae of TBI. This study quantified temporal changes in dendritic complexity of BLA neurons after experimental diffuse TBI, modeled by midline fluid percussion injury. At post-injury days (PIDs) 1, 7, and 28, brain tissue from sham and brain-injured adult, male rats was processed for Golgi, glial fibrillary acidic protein (GFAP), or silver stain and analyzed to quantify BLA dendritic branch intersections, activated astrocytes, and regional neuropathology, respectively. Compared to sham, brain-injured rats at all PIDs showed enhanced dendritic branch intersections in both pyramidal and stellate BLA neuronal types, as evidenced by Sholl analysis. GFAP staining in the BLA was significantly increased at PID1 and 7 in comparison to sham. However, the BLA was relatively spared from neuropathology, demonstrated by an absence of argyrophilic accumulation over time, in contrast to other brain regions. These data suggest an early and persistent enhancement of dendritic complexity within the BLA after a single diffuse TBI. Increased dendritic complexity would alter information processing into and through the amygdala, contributing to emotional symptoms post-TBI, including PTSD.
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Affiliation(s)
- Ann N Hoffman
- 1 Department of Psychology, Arizona State University , Tempe, Arizona.,5 Department of Psychology, UCLA , Los Angeles, California.,6 Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Pooja R Paode
- 1 Department of Psychology, Arizona State University , Tempe, Arizona
| | - Hazel G May
- 2 Department of Child Health, University of Arizona College of Medicine-Phoenix , Phoenix, Arizona.,3 Barrow Neurological Institute at Phoenix Children's Hospital , Phoenix, Arizona.,7 Department of Biology and Biochemistry, University of Bath , Bath, United Kingdom
| | - J Bryce Ortiz
- 1 Department of Psychology, Arizona State University , Tempe, Arizona
| | - Salma Kemmou
- 1 Department of Psychology, Arizona State University , Tempe, Arizona
| | - Jonathan Lifshitz
- 1 Department of Psychology, Arizona State University , Tempe, Arizona.,2 Department of Child Health, University of Arizona College of Medicine-Phoenix , Phoenix, Arizona.,3 Barrow Neurological Institute at Phoenix Children's Hospital , Phoenix, Arizona.,4 Phoenix VA Healthcare System , Phoenix, Arizona
| | - Cheryl D Conrad
- 1 Department of Psychology, Arizona State University , Tempe, Arizona
| | - Theresa Currier Thomas
- 2 Department of Child Health, University of Arizona College of Medicine-Phoenix , Phoenix, Arizona.,3 Barrow Neurological Institute at Phoenix Children's Hospital , Phoenix, Arizona.,4 Phoenix VA Healthcare System , Phoenix, Arizona
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81
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Büchele F, Morawska MM, Schreglmann SR, Penner M, Muser M, Baumann CR, Noain D. Novel Rat Model of Weight Drop-Induced Closed Diffuse Traumatic Brain Injury Compatible with Electrophysiological Recordings of Vigilance States. J Neurotrauma 2016; 33:1171-80. [DOI: 10.1089/neu.2015.4001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabian Büchele
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Marta M. Morawska
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich ZNZ, University of Zurich, Zurich, Switzerland
| | | | - Marco Penner
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Markus Muser
- Working Group on Accident Mechanics, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Daniela Noain
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
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82
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Lamotrigine Treatment for Agitation Following Traumatic Brain Injury. PSYCHOSOMATICS 2016; 57:330-3. [DOI: 10.1016/j.psym.2016.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/11/2016] [Accepted: 01/11/2016] [Indexed: 11/23/2022]
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83
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Barman A, Chatterjee A, Bhide R. Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury. Indian J Psychol Med 2016; 38:172-81. [PMID: 27335510 PMCID: PMC4904751 DOI: 10.4103/0253-7176.183086] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Traumatic brain injury (TBI) is among the significant causes of morbidity and mortality in the present world. Around 1.6 million persons sustain TBI, whereas 200,000 die annually in India, thus highlighting the rising need for appropriate cognitive rehabilitation strategies. This literature review assesses the current knowledge of various cognitive rehabilitation training strategies. The entire spectrum of TBI severity; mild to severe, is associated with cognitive deficits of varying degree. Cognitive insufficiency is more prevalent and longer lasting in TBI persons than in the general population. A multidisciplinary approach with neuropsychiatric evaluation is warranted. Attention process training and tasks for attention deficits, compensatory strategies and errorless learning training for memory deficits, pragmatic language skills and social behavior guidance for cognitive-communication disorder, meta-cognitive strategy, and problem-solving training for executive disorder are the mainstay of therapy for cognitive deficits in persons with TBI. Cognitive impairments following TBI are common and vary widely. Different cognitive rehabilitation techniques and combinations in addition to pharmacotherapy are helpful in addressing various cognitive deficits.
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Affiliation(s)
- Apurba Barman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ahana Chatterjee
- Formerly Clinical Fellow, Division of Physiatry, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Rohit Bhide
- Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
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84
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Wolters Gregório G, Ponds RW, Smeets SM, Jonker F, Pouwels CG, van Heugten CM. How Stable Is Coping in Patients with Neuropsychiatric Symptoms after Acquired Brain Injury? Changes in Coping Styles and Their Predictors in the Chronic Phase. J Neurotrauma 2016; 33:696-704. [DOI: 10.1089/neu.2015.3900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gisela Wolters Gregório
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department Acquired Brain Injury Huize Padua, GGZ Oost Brabant, Boekel, the Netherlands
| | - Rudolf W.H.M. Ponds
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Adelante, Rehabilitation Centre, Hoensbroek, the Netherlands
| | - Sanne M.J. Smeets
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Frank Jonker
- Department Vesalius, Altrecht GGZ, Den Dolder, the Netherlands
| | - Climmy G.J.G. Pouwels
- Department Acquired Brain Injury Huize Padua, GGZ Oost Brabant, Boekel, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
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85
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Vonder Haar C, Winstanley CA. Minor Functional Deficits in Basic Response Patterns for Reinforcement after Frontal Traumatic Brain Injury in Rats. J Neurotrauma 2016; 33:1892-1900. [PMID: 26756392 DOI: 10.1089/neu.2015.4276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is a major contributor to numerous psychiatric conditions and chronic behavioral dysfunction. Recent studies in experimental brain injury have begun to adopt operant methodologies to assess these deficits, all of which rely on the process of reinforcement. No studies have directly examined how reinforced behaviors are affected by TBI, however. The current study assessed performance under the four most common schedules of reinforcement (fixed ratio, variable ratio, fixed interval, variable interval) and one higher order schedule assessing motivation (progressive ratio) after bilateral, pre-frontal controlled cortical impact injury. TBI-induced differences on the basic schedules were minor, with the exception of the variable ratio, where increased efficacy (more reinforcers, higher response rates, lower interresponse times) at higher requirements was observed as a result of brain injury. Performance on the progressive ratio schedule showed some gross differences between the groups, in that sham rats became more efficient under this schedule while injured rats perseverated in lever pressing. Further, injured rats were specifically impaired at lower response requirements on the progressive ratio. Taken together, these findings indicate that simple reinforced behaviors are mostly unaffected after TBI, except in the case of variable ratio schedules, but the altered performance on the higher-order progressive ratio schedule suggests changes involving motivation or potentially perseveration. These findings validate operant measures of more complex behaviors for brain injury, all of which rely on reinforcement and can be taken into consideration when adapting and developing novel functional assessments.
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Affiliation(s)
- Cole Vonder Haar
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Catharine A Winstanley
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
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86
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Luo L, Chai Y, Jiang R, Chen X, Yan T. Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury. Aging Dis 2015; 6:418-25. [PMID: 26618043 DOI: 10.14336/ad.2015.0507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/07/2015] [Indexed: 11/01/2022] Open
Abstract
Depression is one of the most prevalent psychiatric disorders in people with Traumatic brain injury (TBI). Depression after TBI is closely related with social and psychological factors and hypothalamic-pituitary -adrenal (HPA) axis dysfunction. However, there is a lack of evidence regarding effective treatment approaches for depression. A total of 68 patients with depression following closed TBI were recruited. Glasgow Coma Scale score (GCS) was employed to demonstrate the severity of neurological deficits and Glasgow Outcome Scale (GOS) was employed to measure functional outcome after TBI. The severity of depression was quantified using the Beck Depression Inventory-II (BDI-II) in line with DSM-IV. Citalopram and Prednisone were administered to subjects with normal cortisol levels or hypocortisolism separately, based on psychotherapeutic interventions. We investigated the relationship between degree of depression of TBI patients and the severity and progression of TBI with the therapeutic effects of Citalopram in combination with psychotherapeutic and Prednisone in depressed patients. There was no relationship between the severity of depression and the severity and progression of TBI. The basic treatment of psychotherapeutic interventions could partially relieve depressive symptoms. Combination of psychotherapeutic support and Citalopram significantly improved depressive symptoms in patients with normal cortisol levels, but not in hypocortisolic patients. Combination of Prednisone administration with psychotherapeutic treatment and Citalopram significantly improved depression outcome in hypocortisolic patients after TBI. Hypocortisolism after TBI may regulate depression. Combination of Prednisone with psychotherapeutic treatment and Citalopram may provide better therapeutic effects in depression patients with hypocortisolism after TBI.
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Affiliation(s)
- Lanlan Luo
- 1 Neurology of Tianjin Medical University General Hospital, Tianjin, China ; 2 Tianjin Neurological Institute, Tianjin, China
| | - Yan Chai
- 2 Tianjin Neurological Institute, Tianjin, China
| | - Rongcai Jiang
- 2 Tianjin Neurological Institute, Tianjin, China ; 3 Neurosurgery of Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Chen
- 2 Tianjin Neurological Institute, Tianjin, China ; 3 Neurosurgery of Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Yan
- 1 Neurology of Tianjin Medical University General Hospital, Tianjin, China ; 2 Tianjin Neurological Institute, Tianjin, China
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87
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Life after Adolescent and Adult Moderate and Severe Traumatic Brain Injury: Self-Reported Executive, Emotional, and Behavioural Function 2-5 Years after Injury. Behav Neurol 2015; 2015:329241. [PMID: 26549936 PMCID: PMC4621342 DOI: 10.1155/2015/329241] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/01/2015] [Indexed: 12/16/2022] Open
Abstract
Survivors of moderate-severe Traumatic Brain Injury (TBI) are at risk for long-term cognitive, emotional, and behavioural problems. This prospective cohort study investigated self-reported executive, emotional, and behavioural problems in the late chronic phase of moderate and severe TBI, if demographic characteristics (i.e., age, years of education), injury characteristics (Glasgow Coma Scale score, MRI findings such as traumatic axonal injury (TAI), or duration of posttraumatic amnesia), symptoms of depression, or neuropsychological variables in the first year after injury predicted long-term self-reported function. Self-reported executive, emotional, and behavioural functioning were assessed among individuals with moderate and severe TBI (N = 67, age range 15–65 years at time of injury) 2–5 years after TBI, compared to a healthy matched control group (N = 72). Results revealed significantly more attentional, emotional regulation, and psychological difficulties in the TBI group than controls. Demographic and early clinical variables were associated with poorer cognitive and emotional outcome. Fewer years of education and depressive symptoms predicted greater executive dysfunction. Younger age at injury predicted more aggressive and rule-breaking behaviour. TAI and depressive symptoms predicted Internalizing problems and greater executive dysfunction. In conclusion, age, education, TAI, and depression appear to elevate risk for poor long-term outcome, emphasising the need for long-term follow-up of patients presenting with risk factors.
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88
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Wilson A, Wills P, Pretorius C, Swartz L. Cognitive rehabilitation groups: A thematic analysis of feasibility and perceived benefits for clients with moderate to severe traumatic brain injury living in the Western Cape. Afr J Disabil 2015; 4:175. [PMID: 28730032 PMCID: PMC5433481 DOI: 10.4102/ajod.v4i1.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/24/2015] [Indexed: 11/26/2022] Open
Abstract
Background Traumatic brain injury (TBI) has a significant impact on the burden of care within the South African setting, impacting on the individual, the family, and the community as a whole. Often the consequences of TBI are permanent, resulting in numerous financial and emotional stressors. Objective This research focusses on the experience of outpatient cognitive rehabilitation groups for individuals who have suffered moderate to severe brain injuries within the South African setting. Method Participants with moderate to severe brain injury were required to attend five cognitive rehabilitation groups and engage in a semistructured interview. Qualitative data were examined via thematic analysis, to determine participants’ subjective experiences of group participation. Results There is a need within the South African setting for cognitive rehabilitation and support groups for individuals who have experienced a TBI. The benefits were notable for both the individuals attending and their support systems. In spite of the benefits there were notable limitations to attendance, including financial restrictions and transport limitations. Conclusion According to participants and their families, there is a scarcity of resources within the Western Cape for clients who have sustained a TBI. Despite limitations in capacity to attend there appears to be a need for structured outpatient cognitive rehabilitation programmes integrating the complex cognitive and emotional challenges faced by individuals with TBI and their families.
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Affiliation(s)
- Abigail Wilson
- Department of Psychology, Stellenbosch University, South Africa
| | - Peta Wills
- Department of Psychology, Stellenbosch University, South Africa.,Western Cape Rehabilitation Centre, Cape Town, South Africa
| | | | - Leslie Swartz
- Department of Psychology, Stellenbosch University, South Africa
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89
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Purohit MP, Zafonte RD, Sherman LM, Davis RB, Giwerc MY, Shenton ME, Yeh GY. Neuropsychiatric symptoms and expenditure on complementary and alternative medicine. J Clin Psychiatry 2015; 76:e870-6. [PMID: 26231014 PMCID: PMC4729567 DOI: 10.4088/jcp.13m08682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/14/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms affect 37% of US adults. These symptoms are often refractory to standard therapies, and patients may consequently opt for complementary and alternative medicine therapies (CAM). We sought to determine the demand for CAM by those with neuropsychiatric symptoms compared to those without neuropsychiatric symptoms as measured by out-of-pocket expenditure. METHOD We compared CAM expenditure between US adults with and without neuropsychiatric symptoms (n = 23,393) using the 2007 National Health Interview Survey. Symptoms included depression, anxiety, insomnia, attention deficits, headaches, excessive sleepiness, and memory loss. CAM was defined per guidelines from the National Institutes of Health as mind-body therapies, biological therapies, manipulation therapies, or alternative medical systems. Expenditure on CAM by those without neuropsychiatric symptoms was compared to those with neuropsychiatric symptoms. RESULTS Of the adults surveyed, 37% had ≥ 1 neuropsychiatric symptom and spent $14.8 billion out-of-pocket on CAM. Those with ≥ 1 neuropsychiatric symptom were more likely than those without neuropsychiatric symptoms to spend on CAM (27.4% vs 20.3%, P < .001). Likelihood to spend on CAM increased with number of symptoms (27.2% with ≥ 3 symptoms, P < .001). After adjustment was made for confounders using logistic regression, those with ≥ 1 neuropsychiatric symptom remained more likely to spend on CAM (odds ratio [OR] = 1.34; 95% CI, 1.22-1.48), and the likelihood increased to 1.55 (95% CI, 1.34-1.79) for ≥ 3 symptoms. Anxiety (OR = 1.40 [95% CI, 1.22-1.60]) and excessive sleepiness (OR = 1.36 [95% CI, 1.21-1.54]) were the most closely associated with CAM expenditure. CONCLUSIONS Those with ≥ 1 neuropsychiatric symptom had disproportionately higher demand for CAM than those without symptoms. Research regarding safety, efficacy, and cost-effectiveness of CAM is limited; therefore, future research should evaluate these issues given the tremendous demand for these treatments.
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Affiliation(s)
- Maulik P Purohit
- Spaulding Rehabilitation Hospital Network, 300 First Ave, Charlestown, MA 02129
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90
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Amen DG, Raji CA, Willeumier K, Taylor D, Tarzwell R, Newberg A, Henderson TA. Functional Neuroimaging Distinguishes Posttraumatic Stress Disorder from Traumatic Brain Injury in Focused and Large Community Datasets. PLoS One 2015; 10:e0129659. [PMID: 26132293 PMCID: PMC4488529 DOI: 10.1371/journal.pone.0129659] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/12/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are highly heterogeneous and often present with overlapping symptomology, providing challenges in reliable classification and treatment. Single photon emission computed tomography (SPECT) may be advantageous in the diagnostic separation of these disorders when comorbid or clinically indistinct. METHODS Subjects were selected from a multisite database, where rest and on-task SPECT scans were obtained on a large group of neuropsychiatric patients. Two groups were analyzed: Group 1 with TBI (n=104), PTSD (n=104) or both (n=73) closely matched for demographics and comorbidity, compared to each other and healthy controls (N=116); Group 2 with TBI (n=7,505), PTSD (n=1,077) or both (n=1,017) compared to n=11,147 without either. ROIs and visual readings (VRs) were analyzed using a binary logistic regression model with predicted probabilities inputted into a Receiver Operating Characteristic analysis to identify sensitivity, specificity, and accuracy. One-way ANOVA identified the most diagnostically significant regions of increased perfusion in PTSD compared to TBI. Analysis included a 10-fold cross validation of the protocol in the larger community sample (Group 2). RESULTS For Group 1, baseline and on-task ROIs and VRs showed a high level of accuracy in differentiating PTSD, TBI and PTSD+TBI conditions. This carefully matched group separated with 100% sensitivity, specificity and accuracy for the ROI analysis and at 89% or above for VRs. Group 2 had lower sensitivity, specificity and accuracy, but still in a clinically relevant range. Compared to subjects with TBI, PTSD showed increases in the limbic regions, cingulum, basal ganglia, insula, thalamus, prefrontal cortex and temporal lobes. CONCLUSIONS This study demonstrates the ability to separate PTSD and TBI from healthy controls, from each other, and detect their co-occurrence, even in highly comorbid samples, using SPECT. This modality may offer a clinical option for aiding diagnosis and treatment of these conditions.
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Affiliation(s)
- Daniel G. Amen
- Department of Research, Amen Clinics, Inc., Costa Mesa, California, United States of America
| | - Cyrus A. Raji
- Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, California, United States of America
| | - Kristen Willeumier
- Department of Research, Amen Clinics, Inc., Costa Mesa, California, United States of America
| | - Derek Taylor
- Department of Research, Amen Clinics, Inc., Costa Mesa, California, United States of America
| | - Robert Tarzwell
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Lions Gate Hospital, North Vancouver, British Columbia, Canada
| | - Andrew Newberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Theodore A. Henderson
- The Synaptic Space, Denver, Colorado, United States of America
- The International Society of Applied Neuroimaging, Denver, Colorado, United States of America
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91
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Bigler ED. Neuroimaging as a biomarker in symptom validity and performance validity testing. Brain Imaging Behav 2015; 9:421-44. [DOI: 10.1007/s11682-015-9409-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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92
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Archer KR, Coronado RA, Haislip LR, Abraham CM, Vanston SW, Lazaro AE, Jackson JC, Ely EW, Guillamondegui OD, Obremskey WT. Telephone-based goal management training for adults with mild traumatic brain injury: study protocol for a randomized controlled trial. Trials 2015; 16:244. [PMID: 26031289 PMCID: PMC4454274 DOI: 10.1186/s13063-015-0775-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 1 million individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Many trauma survivors with mild TBI have debilitating and long-term physical, emotional, and cognitive impairments that are unrecognized at trauma centers. Early intervention studies are needed to address these impairments, especially cognitive deficits in executive functioning. Goal management training (GMT) is a structured cognitive rehabilitation program that has been found to improve executive functioning in patients with moderate to severe TBI. The current study adapted the GMT program for telephone delivery in order to improve the accessibility of rehabilitation services in a patient population with multiple barriers to care and significant yet unrecognized cognitive impairment. The primary objective of this study is to examine the efficacy of telephone-based GMT for improving executive functioning, functional status, and psychological health in trauma survivors with mild TBI. METHODS/DESIGN This study is a three-group randomized controlled trial being conducted at a Level I trauma center. Ninety trauma survivors with mild TBI and cognitive deficits in executive functioning will be randomized to receive telephone-based GMT, telephone-based education, or usual care. GMT and education programs will be delivered by a physical therapist. The first in-person session is 1 h and the remaining six telephone sessions are 30 min. A battery of well-established cognitive tests will be conducted and validated questionnaires will be collected that measure executive functioning, functional status, and depressive and posttraumatic stress disorder symptoms at 6 weeks, 4 months, and 7 months following hospital discharge. DISCUSSION This study supports a telephone-delivery approach to rehabilitation services in order to broaden the availability of evidence-based cognitive strategies. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov on 10 October 2012, registration number: NCT01714531.
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Affiliation(s)
- Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. .,Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA.
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Lori R Haislip
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Christine M Abraham
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Susan W Vanston
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
| | - Anthony E Lazaro
- School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN, 37208, USA.
| | - James C Jackson
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. .,Department of Psychiatry, Vanderbilt University School of Medicine, 1601 23rd Avenue, Nashville, TN, 37212, USA. .,Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA.
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. .,Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA.
| | - Oscar D Guillamondegui
- Division of Trauma and Surgical Critical Care, Department of Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, 404 MAB 1750, Nashville, TN, 37232, USA.
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA.
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93
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Technology-adaptable interventions for treating depression in adults with cognitive impairments: protocol for a systematic review. Syst Rev 2015; 4:42. [PMID: 25875655 PMCID: PMC4393573 DOI: 10.1186/s13643-015-0032-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/12/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Depression is a common comorbidity in individuals with cognitive impairment. Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression, and may have poorer outcomes in areas such as recovery and quality of life. However, the stigmatization of mental health disorders, cost barriers and physical disabilities may prevent these individuals from seeking mental health care. An online, self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population. We aim to inform the design of such an intervention through a systematic review by answering the following research question: among adults with cognitive impairment (including those with acquired brain injuries or neurodegenerative diseases), which technology-amenable interventions have been shown to effectively decrease symptoms of depression? Specifically, psychotherapeutic and/or behavioural interventions that could be delivered in a self-guided, online system will be included. METHODS Comprehensive electronic searches will be conducted in MEDLINE, EMBASE, PsycINFO and CINAHL. Additional studies will be obtained through manually searching the references of relevant systematic reviews, contacting primary authors of select articles and tracking conference proceedings and trial registries. Article titles and abstracts will be screened using predefined eligibility criteria, and then judged for their amenability to the proposed self-help, technology-based intervention. The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion. Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-randomized trials, controlled before-after studies and interrupted time series. The primary outcome will be a change in score on a validated depression scale, and adverse events will be documented as a secondary outcome. After data extraction from selected articles, pooling of data and meta-analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified. Alternatively, plain language summaries will be developed. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014417.
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94
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Albrecht JS, Kiptanui Z, Tsang Y, Khokhar B, Smith GS, Zuckerman IH, Simoni-Wastila L. Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury. J Neurotrauma 2015; 32:1223-9. [PMID: 25526613 DOI: 10.1089/neu.2014.3651] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are no clinical guidelines addressing the management of depression after traumatic brain injury (TBI). The objectives of this study were to (1) describe depression treatment patterns among Medicare beneficiaries with a diagnosis of depression post-TBI; (2) compare them with depression treatment patterns among beneficiaries with a diagnosis of depression pre-TBI; and (3) quantify the difference in prevalence of use. We conducted a retrospective analysis of Medicare beneficiaries hospitalized with TBI during 2006-2010. We created two cohorts: beneficiaries with a new diagnosis of depression pre-TBI (n=4841) and beneficiaries with a new diagnosis of depression post-TBI (n=4668). We searched for antidepressant medications in Medicare Part D drug event files and created variables indicating antidepressant use in each 30-day period after diagnosis of depression. We used provider specialty and current procedural terminology to identify psychotherapy in any location. We used generalized estimating equations to quantify the effect of TBI on receipt of depression treatment during the year after diagnosis of depression. Average monthly prevalence of antidepressant use was 42% among beneficiaries with a diagnosis of depression pre-TBI and 36% among those with a diagnosis post-TBI (p<0.001). Beneficiaries with a diagnosis of depression post-TBI were less likely to receive antidepressants compared with a depression diagnosis pre-TBI (adjusted odds ratio [OR] 0.87; 95% confidence interval [CI] 0.82, 0.92). There was no difference in receipt of psychotherapy between the two groups (OR 1.08; 95% CI 0.93, 1.26). Depression after TBI is undertreated among older adults. Knowledge about reasons for this disparity and its long-term effects on post-TBI outcomes is limited and should be examined in future work.
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Affiliation(s)
- Jennifer S Albrecht
- 1 Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland
| | | | - Yuen Tsang
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Bilal Khokhar
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Gordon S Smith
- 4 Shock, Trauma and Anesthesiology Research (STAR)-Organized Research Center, National Study Center for Trauma and Emergency Medical Services, University of Maryland , Baltimore, Maryland
| | - Ilene H Zuckerman
- 2 IMPAQ International , LLC, Columbia, Maryland.,3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Linda Simoni-Wastila
- 3 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, Maryland
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95
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Garrelfs SF, Donker-Cools BHPM, Wind H, Frings-Dresen MHW. Return-to-work in patients with acquired brain injury and psychiatric disorders as a comorbidity: A systematic review. Brain Inj 2015; 29:550-7. [PMID: 25625788 DOI: 10.3109/02699052.2014.995227] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the association between psychiatric disorders as a comorbidity and return-to-work (RTW) in individuals with acquired brain injury (ABI). METHODS A systematic review was performed. The search strategy (2002-2012) contained terms related to ABI, psychiatric comorbidity and keywords adapted to the outcome measure RTW. Selection and review were performed by two authors independently. In the case of uncertainty, a third author was consulted to reach consensus on inclusion or exclusion. The methodological quality of included studies was determined and evidence was classified. RESULTS Seven studies were included. Strong evidence was found for a negative association between psychiatric disorders as a comorbidity (like depression, anxiety and post-traumatic stress disorder) and RTW of patients with ABI. Patients with a previous history of psychiatric disorders were at considerably higher risk for a new episode and lower RTW rates following ABI. CONCLUSION AND IMPLICATIONS Psychiatric disorders as a comorbidity after ABI are strong negatively associated with RTW. The heightened frequency of psychiatric disorders as a comorbidity after ABI and more important their amenability to treatment implicates that more attention should be paid to diagnosing and treating psychiatric disorders as a comorbidity in patients with ABI in order to further improve re-integration in work.
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Affiliation(s)
- Sander F Garrelfs
- Academic Medical Center, University of Amsterdam, Amsterdam, Coronel Institute of Occupational Health , the Netherlands
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96
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Irimia A, Van Horn JD. Functional neuroimaging of traumatic brain injury: advances and clinical utility. Neuropsychiatr Dis Treat 2015; 11:2355-65. [PMID: 26396520 PMCID: PMC4576900 DOI: 10.2147/ndt.s79174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Functional deficits due to traumatic brain injury (TBI) can have significant and enduring consequences upon patients' life quality and expectancy. Although functional neuroimaging is essential for understanding TBI pathophysiology, an insufficient amount of effort has been dedicated to the task of translating functional neuroimaging findings into information with clinical utility. The purpose of this review is to summarize the use of functional neuroimaging techniques - especially functional magnetic resonance imaging, diffusion tensor imaging, positron emission tomography, magnetic resonance spectroscopy, and electroencephalography - for advancing current knowledge of TBI-related brain dysfunction and for improving the rehabilitation of TBI patients. We focus on seven core areas of functional deficits, namely consciousness, motor function, attention, memory, higher cognition, personality, and affect, and, for each of these, we summarize recent findings from neuroimaging studies which have provided substantial insight into brain function changes due to TBI. Recommendations are also provided to aid in setting the direction of future neuroimaging research and for understanding brain function changes after TBI.
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Affiliation(s)
- Andrei Irimia
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John Darrell Van Horn
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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97
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Lauterbach MD, Notarangelo PL, Nichols SJ, Lane KS, Koliatsos VE. Diagnostic and treatment challenges in traumatic brain injury patients with severe neuropsychiatric symptoms: insights into psychiatric practice. Neuropsychiatr Dis Treat 2015; 11:1601-7. [PMID: 26170672 PMCID: PMC4494623 DOI: 10.2147/ndt.s80457] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Traumatic brain injury (TBI) causes a variety of neuropsychiatric problems that pose diagnostic and treatment challenges for providers. In this report, we share our experience as a referral neuropsychiatry program to assist the general psychiatrist when adult TBI patients with psychiatric symptoms present for evaluation and treatment. We completed a retrospective study of patients with moderate-to-severe TBI and severe neuropsychiatric impairments. We collected information on demographics, nature of injury, symptomatology, diagnoses, and treatments. Data analysis indicates that mood stabilization was a key concern, often requiring aggressive pharmacological management. Cognitive dysfunction was a problem for the majority of patients, but was only medicated in a third, due to poor efficacy or behavioral side effects. The co-occurrence of multiple TBI-related symptoms and diagnoses in this patient cohort emphasizes the need for individualized psychopharmacological approaches and interventions.
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Affiliation(s)
- Margo D Lauterbach
- The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Paula L Notarangelo
- The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Stephen J Nichols
- Department of Emergency Medicine, The University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Kristy S Lane
- The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Vassilis E Koliatsos
- The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, Baltimore, MD, USA
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98
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Rao V, McCann U, Han D, Bergey A, Smith MT. Does acute TBI-related sleep disturbance predict subsequent neuropsychiatric disturbances? Brain Inj 2014; 28:20-6. [PMID: 24328797 DOI: 10.3109/02699052.2013.847210] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To determine whether sleep disturbance in the acute post-traumatic brain injury (TBI) period predicts symptoms of depression, anxiety or apathy measured 6 and 12 months after TBI. RESEARCH DESIGN Longitudinal, observational study. METHODS AND PROCEDURES First time closed-head injury patients (n = 101) were recruited and evaluated within 3 months of injury and followed longitudinally, with psychiatric evaluations at 6 and 12 months post-injury. Pre- and post-injury sleep disturbances were measured via the Medical Outcome Scale (MOS) for Sleep. Subjects were also assessed for anxiety, depression, apathy, medical comorbidity and severity of TBI. MAIN OUTCOMES AND RESULTS Sleep disturbance in the acute TBI period was associated with increased symptoms of depression, anxiety and apathy 12 months post-injury. CONCLUSIONS Sleep disturbances experienced soon after trauma (i.e. <3 months after injury) predicted neuropsychiatric symptoms 1 year after injury, raising two important clinical questions: (1) Is sleep disturbance soon after trauma a prognostic marker of subsequent neuropsychiatric symptoms? and (2) Can early treatment of sleep disturbance during the post-TBI period reduce subsequent development of neuropsychiatric symptoms? Future studies with larger sample sizes and appropriate control groups could help to answer these questions, using evidence-based methods for evaluating and treating sleep disturbances.
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Affiliation(s)
- Vani Rao
- Division of Geriatric Psychiatry & Neuropsychiatry and
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99
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Neuberger EJ, Wahab RA, Jayakumar A, Pfister BJ, Santhakumar V. Distinct effect of impact rise times on immediate and early neuropathology after brain injury in juvenile rats. J Neurosci Res 2014; 92:1350-1361. [PMID: 24799156 DOI: 10.1002/jnr.23401] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 12/31/2022]
Abstract
Traumatic brain injury (TBI) can occur from physical trauma from a wide spectrum of insults ranging from explosions to falls. The biomechanics of the trauma can vary in key features, including the rate and magnitude of the insult. Although the effect of peak injury pressure on neurological outcome has been examined in the fluid percussion injury (FPI) model, it is unknown whether differences in rate of rise of the injury waveform modify cellular and physiological changes after TBI. Using a programmable FPI device, we examined juvenile rats subjected to a constant peak pressure at two rates of injury: a standard FPI rate of rise and a faster rate of rise to the same peak pressure. Immediate postinjury assessment identified fewer seizures and relatively brief loss of consciousness after fast-rise injuries than after standard-rise injuries at similar peak pressures. Compared with rats injured at standard rise, fewer silver-stained injured neuronal profiles and degenerating hilar neurons were observed 4-6 hr after fast-rise FPI. However, 1 week postinjury, both fast- and standard-rise FPI resulted in hilar cell loss and enhanced perforant path-evoked granule cell field excitability compared with sham controls. Notably, the extent of neuronal loss and increase in dentate excitability were not different between rats injured at fast and standard rates of rise to peak pressure. Our data indicate that reduced cellular damage and improved immediate neurological outcome after fast rising primary concussive injuries mask the severity of the subsequent cellular and neurophysiological pathology and may be unreliable as a predictor of prognosis.
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Affiliation(s)
- Eric J Neuberger
- Department of Neurology and Neurosciences, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Radia Abdul Wahab
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Archana Jayakumar
- Department of Neurology and Neurosciences, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Bryan J Pfister
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Vijayalakshmi Santhakumar
- Department of Neurology and Neurosciences, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Pharmacology and Physiology, Rutgers New Jersey Medical School, Newark, New Jersey
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100
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Choi MS, Seo SJ, Oh CH, Kim SH, Cho JM. Incidence of post-traumatic stress disorder after a mild traumatic brain injury: preliminary investigation using the brief neuropsychological screening test. J Korean Neurosurg Soc 2014; 55:190-4. [PMID: 25024821 PMCID: PMC4094742 DOI: 10.3340/jkns.2014.55.4.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/18/2014] [Accepted: 04/15/2014] [Indexed: 11/28/2022] Open
Abstract
Objective Post-traumatic stress disorder (PTSD) is a group of diseases that are observed in patients who had experienced a serious trauma or accident. However, some experienced it even after only a mild traumatic brain injury (TBI), and they are easily ignored due to the relatively favorable course of mild TBI. Herein, the authors investigated the incidence of PTSD in mild TBI using brief neuropsychological screening test (PTSD checklist, PCL). Methods This study was conducted on patients with mild TBI (Glasgow coma scale ≥13) who were admitted from January 2012 to December 2012. As for PCL, it was done on patients who showed no difficulties in communication upon admission and agreed to participate in this study. By using sum of PCL, the patients were divided into high-risk group and low-risk group. PTSD was diagnosed as the three major symptoms of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, fourth-edifion. Results A total of 314 TBI patients were admitted and 71 of them met the criteria and were included in this study. The mean age was 52.9 years-old (range: 15-94). The mean PCL score was 28.8 (range: 17-68), and 10 patients were classified as high-risk group. During follow-up, 2 patients (2.7%) of high risk group, were confirmed as PTSD and there was no patient who was suspected of PTSD in the low-risk group (p=0.017). Conclusion PTSD is observed 2.8% in mild TBI. Although PTSD after mild TBI is rare, PCL could be considered as a useful tool for screening of PTSD after mild TBI.
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Affiliation(s)
- Mi Sun Choi
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea
| | - Sook Jin Seo
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea
| | - Chang Hyun Oh
- Department of Neurosurgery, Teun Teun Research Institute, Seoul, Korea
| | - Se-Hyuk Kim
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea
| | - Jin Mo Cho
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea
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