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Waters AB, Bottari SA, Jones LC, Lamb DG, Lewis GF, Williamson JB. Regional associations of white matter integrity and neurological, post-traumatic stress disorder and autonomic symptoms in Veterans with and without history of loss of consciousness in mild TBI. FRONTIERS IN NEUROIMAGING 2024; 2:1265001. [PMID: 38268858 PMCID: PMC10806103 DOI: 10.3389/fnimg.2023.1265001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Background Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) share overlapping symptom presentations and are highly comorbid conditions among Veteran populations. Despite elevated presentations of PTSD after mTBI, mechanisms linking the two are unclear, although both have been associated with alterations in white matter and disruptions in autonomic regulation. The present study aimed to determine if there is regional variability in white matter correlates of symptom severity and autonomic functioning in a mixed sample of Veterans with and without PTSD and/or mTBI (N = 77). Methods Diffusion-weighted images were processed to extract fractional anisotropy (FA) values for major white matter structures. The PTSD Checklist-Military version (PCL-M) and Neurobehavioral Symptom Inventory (NSI) were used to determine symptom domains within PTSD and mTBI. Autonomic function was assessed using continuous blood pressure and respiratory sinus arrythmia during a static, standing angle positional test. Mixed-effect models were used to assess the regional specificity of associations between symptom severity and white matter, with FA, global symptom severity (score), and white matter tract (tract) as predictors. Additional interaction terms of symptom domain (i.e., NSI and PCL-M subscales) and loss of consciousness (LoC) were added to evaluate potential moderating effects. A parallel analysis was conducted to explore concordance with autonomic functioning. Results Results from the two-way Score × Tract interaction suggested that global symptom severity was associated with FA in the cingulum angular bundle (positive) and uncinate fasciculus (negative) only, without variability by symptom domain. We also found regional specificity in the relationship between FA and autonomic function, such that FA was positively associated with autonomic function in all tracts except the cingulum angular bundle. History of LoC moderated the association for both global symptom severity and autonomic function. Conclusions Our findings are consistent with previous literature suggesting that there is significant overlap in the symptom presentation in TBI and PTSD, and white matter variability associated with LoC in mTBI may be associated with increased PTSD-spectra symptoms. Further research on treatment response in patients with both mTBI history and PTSD incorporating imaging and autonomic assessment may be valuable in understanding the role of brain injury in treatment outcomes and inform treatment design.
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Affiliation(s)
- Abigail B. Waters
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Sarah A. Bottari
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Laura C. Jones
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Damon G. Lamb
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Gregory F. Lewis
- Socioneural Physiology Lab, Kinsey Institute, Indiana University, Bloomington, IN, United States
| | - John B. Williamson
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
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2
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Kim SY, Yeh PH, Ollinger JM, Morris HD, Hood MN, Ho VB, Choi KH. Military-related mild traumatic brain injury: clinical characteristics, advanced neuroimaging, and molecular mechanisms. Transl Psychiatry 2023; 13:289. [PMID: 37652994 PMCID: PMC10471788 DOI: 10.1038/s41398-023-02569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a significant health burden among military service members. Although mTBI was once considered relatively benign compared to more severe TBIs, a growing body of evidence has demonstrated the devastating neurological consequences of mTBI, including chronic post-concussion symptoms and deficits in cognition, memory, sleep, vision, and hearing. The discovery of reliable biomarkers for mTBI has been challenging due to under-reporting and heterogeneity of military-related mTBI, unpredictability of pathological changes, and delay of post-injury clinical evaluations. Moreover, compared to more severe TBI, mTBI is especially difficult to diagnose due to the lack of overt clinical neuroimaging findings. Yet, advanced neuroimaging techniques using magnetic resonance imaging (MRI) hold promise in detecting microstructural aberrations following mTBI. Using different pulse sequences, MRI enables the evaluation of different tissue characteristics without risks associated with ionizing radiation inherent to other imaging modalities, such as X-ray-based studies or computerized tomography (CT). Accordingly, considering the high morbidity of mTBI in military populations, debilitating post-injury symptoms, and lack of robust neuroimaging biomarkers, this review (1) summarizes the nature and mechanisms of mTBI in military settings, (2) describes clinical characteristics of military-related mTBI and associated comorbidities, such as post-traumatic stress disorder (PTSD), (3) highlights advanced neuroimaging techniques used to study mTBI and the molecular mechanisms that can be inferred, and (4) discusses emerging frontiers in advanced neuroimaging for mTBI. We encourage multi-modal approaches combining neuropsychiatric, blood-based, and genetic data as well as the discovery and employment of new imaging techniques with big data analytics that enable accurate detection of post-injury pathologic aberrations related to tissue microstructure, glymphatic function, and neurodegeneration. Ultimately, this review provides a foundational overview of military-related mTBI and advanced neuroimaging techniques that merit further study for mTBI diagnosis, prognosis, and treatment monitoring.
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Affiliation(s)
- Sharon Y Kim
- School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John M Ollinger
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Herman D Morris
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Maureen N Hood
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Vincent B Ho
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kwang H Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA.
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD, USA.
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA.
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3
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Mohamed AZ, Lagopoulos J, Nasrallah FA, Shan Z. Self-reported Fatigue was Associated with Increased White-matter Alterations in Long-term Traumatic Brain Injury and Posttraumatic Stress Disorder Patients. Neuroscience 2023; 520:46-57. [PMID: 37080447 PMCID: PMC10357124 DOI: 10.1016/j.neuroscience.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/12/2023] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
Fatigue is a long-lasting problem in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), with limited research that investigated the fatigue-related white-matter changes within TBI and/or PTSD cohorts. This exploratory cross-sectional study used diffusion tensor imaging (DTI) and neuropsychological data collected from 153 male Vietnam War veterans, as part of the Alzheimer's Disease Neuroimaging Initiative - Department of Defense, and were divided clinically into control veterans, PTSD, TBI, and with both TBI and PTSD (TBI + PTSD). The existence of fatigue was defined by the question "Do you often feel tired, fatigued, or sleepy during the daytime?". DTI data were compared between fatigue and non-fatigue subgroups in each clinical group using tract-based spatial statistics voxel-based differences. Fatigue was reported in controls (29.55%), slightly higher in TBI (52.17%, PBenf = 0.06), and significantly higher in both TBI + PTSD (66.67%, PBenf = 0.001) and PTSD groups (79.25%, PBenf < 0.001). Compared to non-fatigued subgroups, no white-matter differences were observed in the fatigued subgroups of control or TBI, while the fatigued PTSD subgroup only showed increased diffusivity measures (i.e., radial and axial), and the fatigued TBI + PTSD subgroup showed decreased fractional anisotropy and increased diffusivity measures (PFWE ≤ 0.05). The results act as preliminary findings suggesting fatigue to be significantly reported in TBI + PTSD and PTSD decades post-trauma with a possible link to white-matter microstructural differences in both PTSD and TBI + PTSD. Future studies with larger cohorts and detailed fatigue assessments would be required to identify the white-matter changes associated with fatigue in these cohorts.
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Affiliation(s)
- Abdalla Z Mohamed
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia.
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia
| | - Fatima A Nasrallah
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Zack Shan
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia
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4
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Rojczyk P, Seitz-Holland J, Kaufmann E, Sydnor VJ, Kim CL, Umminger LF, Wiegand TLT, Guenette JP, Zhang F, Rathi Y, Bouix S, Pasternak O, Fortier CB, Salat D, Hinds SR, Heinen F, O’Donnell LJ, Milberg WP, McGlinchey RE, Shenton ME, Koerte IK. Sleep Quality Disturbances Are Associated with White Matter Alterations in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury. J Clin Med 2023; 12:2079. [PMID: 36902865 PMCID: PMC10004675 DOI: 10.3390/jcm12052079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Sleep disturbances are strongly associated with mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). PTSD and mTBI have been linked to alterations in white matter (WM) microstructure, but whether poor sleep quality has a compounding effect on WM remains largely unknown. We evaluated sleep and diffusion magnetic resonance imaging (dMRI) data from 180 male post-9/11 veterans diagnosed with (1) PTSD (n = 38), (2) mTBI (n = 25), (3) comorbid PTSD+mTBI (n = 94), and (4) a control group with neither PTSD nor mTBI (n = 23). We compared sleep quality (Pittsburgh Sleep Quality Index, PSQI) between groups using ANCOVAs and calculated regression and mediation models to assess associations between PTSD, mTBI, sleep quality, and WM. Veterans with PTSD and comorbid PTSD+mTBI reported poorer sleep quality than those with mTBI or no history of PTSD or mTBI (p = 0.012 to <0.001). Poor sleep quality was associated with abnormal WM microstructure in veterans with comorbid PTSD+mTBI (p < 0.001). Most importantly, poor sleep quality fully mediated the association between greater PTSD symptom severity and impaired WM microstructure (p < 0.001). Our findings highlight the significant impact of sleep disturbances on brain health in veterans with PTSD+mTBI, calling for sleep-targeted interventions.
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Affiliation(s)
- Philine Rojczyk
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Elisabeth Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Valerie J. Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
| | - Cara L. Kim
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Lisa F. Umminger
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Tim L. T. Wiegand
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Jeffrey P. Guenette
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Fan Zhang
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Software Engineering and IT, École de Technologie Supérieure, Montreal, QC H3C 1K3, Canada
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - David Salat
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, 02115 MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Boston, MA 02129, USA
| | - Sidney R. Hinds
- Department of Neurology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University, 80337 Munich, Germany
| | - Lauren J. O’Donnell
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, 02115 MA, USA
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, 02115 MA, USA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Inga K. Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02145, USA
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, 80336 Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University, 82152 Munich, Germany
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5
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Lippa SM, Yeh PH, Ollinger J, Brickell TA, French LM, Lange RT. White Matter Integrity Relates to Cognition in Service Members and Veterans after Complicated Mild, Moderate, and Severe Traumatic Brain Injury, But Not Uncomplicated Mild Traumatic Brain Injury. J Neurotrauma 2023; 40:260-273. [PMID: 36070443 DOI: 10.1089/neu.2022.0276] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The extant literature investigating the relationship between diffusion tensor imaging (DTI) and cognition following traumatic brain injury (TBI) is limited by small sample sizes and inappropriate control groups. The present study examined DTI metric differences between service members and veterans (SMVs) with bodily injury (Trauma Control; TC), uncomplicated mild TBI (mTBI), complicated mild TBI (compTBI), and severe-moderate TBI combined (smTBI), and how DTI metrics related to cognition within each group. Participants were 226 SMVs (56 TC, 112 mTBI, 29 compTBI, 29 smTBI) with valid neuropsychological testing and DTI at least 11 months post-injury. The smTBI group demonstrated decreased fractional anisotropy (FA) and increased axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) of the cerebral white matter (CWM) and several individual white matter tracts compared with the TC, mTBI, and compTBI groups (all ps < 0.05; rs = 0.17 to 0.49). The TC, mTBI, and compTBI groups did not differ in terms of any DTI metrics. Within the smTBI group, FA, AD, MD, and RD of the total CWM and several white matter tracts were related to Processing Speed (|rs|: 0.43 to 0.66; ps < 0.05), and/or Delayed Memory (|rs|: 0.41 to 0.67; ps < 0.05). In the compTBI group, Processing Speed was related to left arcuate fasciculus and superior longitudinal fasciculus (SLF) FA, MD, and RD, as well as left uncinate fasciculus MD and RD. In contrast, there were no significant relationships between DTI metrics and cognition/emotional functioning within the mTBI or TC groups. Overall, findings suggest a dose-response relationship between TBI severity and the strength of the relationship between white matter integrity and cognitive performance, with essentially no relationship in mTBI, some findings in compTBI, and several strongly significant relationships in smTBI. In contrast to previously reported findings, there were no differences in DTI metrics between controls, mTBI, and compTBI, and DTI metrics were unrelated to cognition in our relatively large mTBI group.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tracey A Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, in support of the Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, in support of the Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Contractor, in support of the Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Fixel-based analysis of the diffusion properties of the patients with brain injury and chronic health symptoms. Neurosci Res 2023:S0168-0102(23)00009-3. [PMID: 36682692 DOI: 10.1016/j.neures.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
The diffusion properties from diffusion tensor imaging (DTI) are sensitive to white matter (WM) abnormalities and could serve as indicators of diffuse axonal damages incurred during a traumatic brain injury (TBI). Analyses of diffusion metrics in the regions of interest (ROIs) were used to compare the differences in the 18 major fiber tracts in 46 participants, between TBI participants with (n = 17) or without (n = 16) chronic symptoms (CS) and a control group (CG, n = 13). In addition to the widely used diffusion metrics, such as fractional anisotropy (FA), mean (MD), axial (AD) and radial (RD) diffusivities, apparent fiber density (AFD), complexity (CX) and fixel number (FN) derived from Mrtrix3 software package were used to characterize WM tracts and compare between participant groups in the ROIs defined by the fixel numbers. Significant differences were found in FA, AFD, MD, RD and CX in ROIs with different FNs in the corpus callosum forceps minor, left and right inferior longitudinal fasciculus, and left and right uncinate fasciculus for both TBI groups compared to controls. Diffusion properties in ROIs with different FNs can serve as detailed biomarkers of WM abnormalities, especially for individuals with chronic TBI related symptoms.
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7
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Bouchard HC, Sun D, Dennis EL, Newsome MR, Disner SG, Elman J, Silva A, Velez C, Irimia A, Davenport ND, Sponheim SR, Franz CE, Kremen WS, Coleman MJ, Williams MW, Geuze E, Koerte IK, Shenton ME, Adamson MM, Coimbra R, Grant G, Shutter L, George MS, Zafonte RD, McAllister TW, Stein MB, Thompson PM, Wilde EA, Tate DF, Sotiras A, Morey RA. Age-dependent white matter disruptions after military traumatic brain injury: Multivariate analysis results from ENIGMA brain injury. Hum Brain Mapp 2022; 43:2653-2667. [PMID: 35289463 PMCID: PMC9057089 DOI: 10.1002/hbm.25811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/18/2021] [Accepted: 02/10/2022] [Indexed: 01/27/2023] Open
Abstract
Mild Traumatic brain injury (mTBI) is a signature wound in military personnel, and repetitive mTBI has been linked to age-related neurogenerative disorders that affect white matter (WM) in the brain. However, findings of injury to specific WM tracts have been variable and inconsistent. This may be due to the heterogeneity of mechanisms, etiology, and comorbid disorders related to mTBI. Non-negative matrix factorization (NMF) is a data-driven approach that detects covarying patterns (components) within high-dimensional data. We applied NMF to diffusion imaging data from military Veterans with and without a self-reported TBI history. NMF identified 12 independent components derived from fractional anisotropy (FA) in a large dataset (n = 1,475) gathered through the ENIGMA (Enhancing Neuroimaging Genetics through Meta-Analysis) Military Brain Injury working group. Regressions were used to examine TBI- and mTBI-related associations in NMF-derived components while adjusting for age, sex, post-traumatic stress disorder, depression, and data acquisition site/scanner. We found significantly stronger age-dependent effects of lower FA in Veterans with TBI than Veterans without in four components (q < 0.05), which are spatially unconstrained by traditionally defined WM tracts. One component, occupying the most peripheral location, exhibited significantly stronger age-dependent differences in Veterans with mTBI. We found NMF to be powerful and effective in detecting covarying patterns of FA associated with mTBI by applying standard parametric regression modeling. Our results highlight patterns of WM alteration that are differentially affected by TBI and mTBI in younger compared to older military Veterans.
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Affiliation(s)
- Heather C. Bouchard
- Duke‐UNC Brain Imaging and Analysis CenterDuke UniversityDurhamNorth CarolinaUSA
- Mid‐Atlantic Mental Illness Research Education and Clinical CenterDurham VA Medical CenterDurhamNorth CarolinaUSA
- Center for Brain, Biology & BehaviorUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Delin Sun
- Duke‐UNC Brain Imaging and Analysis CenterDuke UniversityDurhamNorth CarolinaUSA
- Mid‐Atlantic Mental Illness Research Education and Clinical CenterDurham VA Medical CenterDurhamNorth CarolinaUSA
| | - Emily L. Dennis
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Mary R. Newsome
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- H. Ben Taub Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonTexasUSA
| | - Seth G. Disner
- Minneapolis VA Health Care SystemMinneapolisMinnesotaUSA
- Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Jeremy Elman
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Annelise Silva
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - Carmen Velez
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Andrei Irimia
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Biomedical Engineering, Viterbi School of EngineeringUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nicholas D. Davenport
- Minneapolis VA Health Care SystemMinneapolisMinnesotaUSA
- Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Scott R. Sponheim
- Minneapolis VA Health Care SystemMinneapolisMinnesotaUSA
- Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Carol E. Franz
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - William S. Kremen
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
- Center of Excellence for Stress and Mental HealthVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Michael J. Coleman
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - M. Wright Williams
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Elbert Geuze
- Department of PsychiatryUniversity Medical CenterUtrechtNetherlands
- Brain Research & Innovation CentreMinistry of DefenceUtrechtNetherlands
| | - Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - Martha E. Shenton
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - Maheen M. Adamson
- Rehabilitation ServiceVA Palo AltoPalo AltoCaliforniaUSA
- NeurosurgeryStanford School of MedicineStanfordCaliforniaUSA
| | - Raul Coimbra
- Department of SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Gerald Grant
- Department of NeurosurgeryStanford University Medical CenterPalo AltoCaliforniaUSA
| | - Lori Shutter
- Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Mark S. George
- Department of PsychiatryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Ross D. Zafonte
- Spaulding Rehabilitation HospitalMassachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Murray B. Stein
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics InstituteKeck School of Medicine of USCMarina del ReyCaliforniaUSA
- Department of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and OphthalmologyUniversity of Southern California (USC), Los AngelesCaliforniaUSA
- Department of PediatricsUSCLos AngelesCaliforniaUSA
- Department of PsychiatryUSCLos AngelesCaliforniaUSA
- Department of RadiologyUSCLos AngelesCaliforniaUSA
- Department of EngineeringUSCLos AngelesCaliforniaUSA
- Department of OphthalmologyUSCLos AngelesCaliforniaUSA
- Department of Radiology and Institute for Informatics, School of MedicineWashington University St. LouisSt. LouisMissouriUSA
| | - Elisabeth A. Wilde
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - David F. Tate
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, School of MedicineWashington University St. LouisSt. LouisMissouriUSA
| | - Rajendra A. Morey
- Duke‐UNC Brain Imaging and Analysis CenterDuke UniversityDurhamNorth CarolinaUSA
- Mid‐Atlantic Mental Illness Research Education and Clinical CenterDurham VA Medical CenterDurhamNorth CarolinaUSA
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8
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Detection of Chronic Blast-Related Mild Traumatic Brain Injury with Diffusion Tensor Imaging and Support Vector Machines. Diagnostics (Basel) 2022; 12:diagnostics12040987. [PMID: 35454035 PMCID: PMC9030428 DOI: 10.3390/diagnostics12040987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/13/2023] Open
Abstract
Blast-related mild traumatic brain injury (bmTBI) often leads to long-term sequalae, but diagnostic approaches are lacking due to insufficient knowledge about the predominant pathophysiology. This study aimed to build a diagnostic model for future verification by applying machine-learning based support vector machine (SVM) modeling to diffusion tensor imaging (DTI) datasets to elucidate white-matter features that distinguish bmTBI from healthy controls (HC). Twenty subacute/chronic bmTBI and 19 HC combat-deployed personnel underwent DTI. Clinically relevant features for modeling were selected using tract-based analyses that identified group differences throughout white-matter tracts in five DTI metrics to elucidate the pathogenesis of injury. These features were then analyzed using SVM modeling with cross validation. Tract-based analyses revealed abnormally decreased radial diffusivity (RD), increased fractional anisotropy (FA) and axial/radial diffusivity ratio (AD/RD) in the bmTBI group, mostly in anterior tracts (29 features). SVM models showed that FA of the anterior/superior corona radiata and AD/RD of the corpus callosum and anterior limbs of the internal capsule (5 features) best distinguished bmTBI from HCs with 89% accuracy. This is the first application of SVM to identify prominent features of bmTBI solely based on DTI metrics in well-defined tracts, which if successfully validated could promote targeted treatment interventions.
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9
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Weis CN, Webb EK, deRoon-Cassini TA, Larson CL. Emotion Dysregulation Following Trauma: Shared Neurocircuitry of Traumatic Brain Injury and Trauma-Related Psychiatric Disorders. Biol Psychiatry 2022; 91:470-477. [PMID: 34561028 PMCID: PMC8801541 DOI: 10.1016/j.biopsych.2021.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 11/02/2022]
Abstract
The psychological trauma associated with events resulting in traumatic brain injury (TBI) is an important and frequently overlooked factor that may impede brain recovery and worsen mental health following TBI. Indeed, individuals with comorbid posttraumatic stress disorder (PTSD) and TBI have significantly poorer clinical outcomes than individuals with a sole diagnosis. Emotion dysregulation is a common factor leading to poor cognitive and affective outcomes following TBI. Here, we synthesize how acute postinjury molecular processes stemming from either physical or emotional trauma may adversely impact circuitry subserving emotion regulation and ultimately yield long-term system-level functional and structural changes that are common to TBI and PTSD. In the immediate aftermath of traumatic injury, glucocorticoids stimulate excess glutamatergic activity, particularly in prefrontal cortex-subcortical circuitry implicated in emotion regulation. In human neuroimaging work, assessing this same circuitry well after the acute injury, TBI and PTSD show similar impacts on prefrontal and subcortical connectivity and activation. These neural profiles indicate that emotion regulation may be a useful target for treatment and early intervention to prevent the adverse sequelae of TBI. Ultimately, the success of future TBI and PTSD early interventions depends on the fields' ability to address both the physical and emotional impact of physical injury.
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10
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Medeiros GC, Twose C, Weller A, Dougherty JW, Goes FS, Sair HI, Smith GS, Roy D. Neuroimaging correlates of depression after traumatic brain injury: A systematic review. J Neurotrauma 2022; 39:755-772. [PMID: 35229629 DOI: 10.1089/neu.2021.0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Depression is the most frequent neuropsychiatric complication after traumatic brain injury (TBI) and is associated with poorer outcomes. Neuroimaging has the potential to improve our understanding of the neural correlates of depression after TBI and may improve our capacity to accurately predict and effectively treat this condition. We conducted a systematic review of structural and functional neuroimaging studies that examined the association between depression after TBI, and neuroimaging measures. Electronic searches were conducted in four databases and were complemented by manual searches. In total, 2,035 citations were identified and, ultimately, 38 articles were included totaling 1,793 individuals (median [25%-75%] sample size of 38.5 (21.8-54.3) individuals). The most frequently used modality was structural magnetic resonance imaging (MRI) (n=17, 45%), followed by diffusion tensor imaging (n=11, 29%), resting-state functional MRI (n=10, 26%), task-based functional MRI (n=4, 8%), and positron emission tomography (n=2, 4%). Most studies (n=27, 71%) were cross-sectional. Overall, depression after TBI was associated with lower grey matter measures (volume, thickness, and/or density) and greater white matter damage. However, identification of specific brain areas was somewhat inconsistent. Findings that were replicated in more than one study included reduced grey matter in the rostral anterior cingulate cortex, prefrontal cortex and hippocampus, and damage in five white matter tracts (cingulum, internal capsule, superior longitudinal fasciculi, anterior, and posterior corona radiata). This systematic review found that the available data did not converge on a clear neuroimaging biomarker for depression after TBI. However, there are promising targets that warrant further study.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexandra Weller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John W Dougherty
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Weis CN, Huggins AA, Miskovich TA, Fitzgerald JM, Bennett KP, Krukowski JL, Webb EK, deRoon-Cassini TA, Larson CL. Acute White Matter Integrity Post-trauma and Prospective Posttraumatic Stress Disorder Symptoms. Front Hum Neurosci 2021; 15:742198. [PMID: 34658821 PMCID: PMC8511512 DOI: 10.3389/fnhum.2021.742198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Little is known about what distinguishes those who are resilient after trauma from those at risk for developing posttraumatic stress disorder (PTSD). Previous work indicates white matter integrity may be a useful biomarker in predicting PTSD. Research has shown changes in the integrity of three white matter tracts-the cingulum bundle, corpus callosum (CC), and uncinate fasciculus (UNC)-in the aftermath of trauma relate to PTSD symptoms. However, few have examined the predictive utility of white matter integrity in the acute aftermath of trauma to predict prospective PTSD symptom severity in a mixed traumatic injury sample. Method: Thus, the current study investigated acute brain structural integrity in 148 individuals being treated for traumatic injuries in the Emergency Department of a Level 1 trauma center. Participants underwent diffusion-weighted magnetic resonance imaging 2 weeks post-trauma and completed several self-report measures at 2-weeks (T1) and 6 months (T2), including the Clinician Administered PTSD Scale for DSM-V (CAPS-5), post-injury. Results: Consistent with previous work, T1 lesser anterior cingulum fractional anisotropy (FA) was marginally related to greater T2 total PTSD symptoms. No other white matter tracts were related to PTSD symptoms. Conclusions: Results demonstrate that in a traumatically injured sample with predominantly subclinical PTSD symptoms at T2, acute white matter integrity after trauma is not robustly related to the development of chronic PTSD symptoms. These findings suggest the timing of evaluating white matter integrity and PTSD is important as white matter differences may not be apparent in the acute period after injury.
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Affiliation(s)
- Carissa N. Weis
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Ashley A. Huggins
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | | | | | | | | | - E. Kate Webb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Terri A. deRoon-Cassini
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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12
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McCunn P, Richardson JD, Jetly R, Dunkley B. Diffusion Tensor Imaging Reveals White Matter Differences in Military Personnel Exposed to Trauma with and without Post-traumatic Stress Disorder. Psychiatry Res 2021; 298:113797. [PMID: 33582526 DOI: 10.1016/j.psychres.2021.113797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a debilitating mental health condition that develops in response to exposure to a traumatic event. The purpose of this study was to investigate white matter differences using diffusion tensor imaging (DTI) in trauma exposed military personnel with and without PTSD. METHODS Data were acquired in compliance with the Hospital for Sick Children and Canadian Armed Forces Research Ethics Boards for the following groups: military personnel with PTSD (PTSD, n = 23), trauma exposed military personnel with no PTSD diagnosis (TE, n = 25) and civilian controls (CC, n =13) . All participants were male. DTI was acquired on a Siemens Trio 3T MRI. Maps of Fractional Anisotropy (FA), Mean Diffusivity (MD), Axial Diffusivity (AD), and Radial Diffusivity (RD) were analyzed using Tract-Based Spatial Statistics (TBSS). RESULTS In the PTSD and TE groups, FA was significantly greater within the hippocampus, corpus callosum, cingulum, and several associated white matter tracts. Elevated FA was shown to be largely due to reduced RD suggesting a possible structural substrate that underscores neurophysiological connectivity. CONCLUSIONS This study reinforces previous findings showing differences in DTI metrics within the limbic system in military personnel exposed to trauma with and without PTSD.
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Affiliation(s)
- Patrick McCunn
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario.
| | - J Don Richardson
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario; Department of Psychiatry, Western University, London, Ontario; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario; Operational Stress Injury Clinic, St. Joseph's Health Care, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces Health Services Group HQ, Department of National Defence, Ottawa, Ontario
| | - Benjamin Dunkley
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario; Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto, Ontario; Department of Medical Imaging, University of Toronto, Toronto, Ontario
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13
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Tate DF, Dennis EL, Adams JT, Adamson MM, Belanger HG, Bigler ED, Bouchard HC, Clark AL, Delano-Wood LM, Disner SG, Eapen BC, Franz CE, Geuze E, Goodrich-Hunsaker NJ, Han K, Hayes JP, Hinds SR, Hodges CB, Hovenden ES, Irimia A, Kenney K, Koerte IK, Kremen WS, Levin HS, Lindsey HM, Morey RA, Newsome MR, Ollinger J, Pugh MJ, Scheibel RS, Shenton ME, Sullivan DR, Taylor BA, Troyanskaya M, Velez C, Wade BS, Wang X, Ware AL, Zafonte R, Thompson PM, Wilde EA. Coordinating Global Multi-Site Studies of Military-Relevant Traumatic Brain Injury: Opportunities, Challenges, and Harmonization Guidelines. Brain Imaging Behav 2021; 15:585-613. [PMID: 33409819 PMCID: PMC8035292 DOI: 10.1007/s11682-020-00423-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Traumatic brain injury (TBI) is common among military personnel and the civilian population and is often followed by a heterogeneous array of clinical, cognitive, behavioral, mood, and neuroimaging changes. Unlike many neurological disorders that have a characteristic abnormal central neurologic area(s) of abnormality pathognomonic to the disorder, a sufficient head impact may cause focal, multifocal, diffuse or combination of injury to the brain. This inconsistent presentation makes it difficult to establish or validate biological and imaging markers that could help improve diagnostic and prognostic accuracy in this patient population. The purpose of this manuscript is to describe both the challenges and opportunities when conducting military-relevant TBI research and introduce the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Military Brain Injury working group. ENIGMA is a worldwide consortium focused on improving replicability and analytical power through data sharing and collaboration. In this paper, we discuss challenges affecting efforts to aggregate data in this patient group. In addition, we highlight how "big data" approaches might be used to understand better the role that each of these variables might play in the imaging and functional phenotypes of TBI in Service member and Veteran populations, and how data may be used to examine important military specific issues such as return to duty, the late effects of combat-related injury, and alteration of the natural aging processes.
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Affiliation(s)
- David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
| | - John T Adams
- Western University of Health Sciences, Pomona, CA, USA
| | - Maheen M Adamson
- Defense and Veterans Brain Injury Center, VA Palo Alto, Palo Alto, CA, USA
- Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Heather G Belanger
- United States Special Operations Command (USSOCOM), Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- St Michaels Inc, Tampa, FL, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Heather C Bouchard
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Alexandra L Clark
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa M Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Seth G Disner
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol E Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Elbert Geuze
- University Medical Center Utrecht, Utrecht, Netherlands
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
| | - Naomi J Goodrich-Hunsaker
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Kihwan Han
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jasmeet P Hayes
- Psychology Department, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Sidney R Hinds
- Department of Defense/United States Army Medical Research and Materiel Command, Fort Detrick, Frederick, MD, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Elizabeth S Hovenden
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - William S Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mary Jo Pugh
- Information Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, UT, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Randall S Scheibel
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Brockton Division, VA Boston Healthcare System, Brockton, MA, USA
| | - Danielle R Sullivan
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Brian A Taylor
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Carmen Velez
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Benjamin Sc Wade
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital/Brigham & Women's Hospital, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Department of Neurology, USC, Los Angeles, CA, USA
- Department of Pediatrics, USC, Los Angeles, CA, USA
- Department of Psychiatry, USC, Los Angeles, CA, USA
- Department of Radiology, USC, Los Angeles, CA, USA
- Department of Engineering, USC, Los Angeles, CA, USA
- Department of Ophthalmology, USC, Los Angeles, CA, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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14
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Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Active-Duty Service Members Improves Depressive Symptoms. J ECT 2020; 36:279-284. [PMID: 32205738 PMCID: PMC7676465 DOI: 10.1097/yct.0000000000000680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Current research on the efficacy of repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex as a noninvasive therapy for treatment-resistant depression is largely settled science. However, little is known about its efficacy with active-duty service members (ADSMs) with major depressive disorder. In a retrospective chart review, we examined depressive symptom ratings in ADSMs seeking treatment at the US Army Outpatient Behavioral Health Service Clinic at Eisenhower Army Medical Center, Fort Gordon, Ga. METHODS We reviewed 121 consecutive outpatient charts, which yielded 61 ADSMs who completed a minimum of 20 rTMS sessions for refractory depression, and for whom both pretreatment and posttreatment depressive symptom ratings were available. Pre- and post-Patient Health Questionnaire 9 (PHQ-9) scores were subjected to a paired t test, and Reliable Change Indices were calculated to determine both reliable and clinical significance. RESULTS Average (SD) pretreatment and posttreatment PHQ-9 scores were 15.8 (6.2) and 12.6 (7.6), respectively. Statistically significant reduction in post-PHQ-9 was demonstrated (P < 0.001), with 69% of patients lowering their ratings and 31% demonstrating reliable change (improvement >5.64). Additionally, 20% demonstrated a reliable change that placed them in the nondysfunctional range (post-PHQ-9 <9.6), demonstrating clinical significance. CONCLUSIONS These data confirm a course of standard rTMS to ADSMs with major depression is promising in reducing depressive symptoms. Given that success and completion rates from this clinic are similar to those reported in civilian populations (80%), rTMS may be an adequate additional treatment or augmentation strategy for refractory depression in ADSMs.
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15
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Vakhtin AA, Zhang Y, Wintermark M, Massaband P, Robinson MT, Ashford JW, Furst AJ. White Matter Asymmetry: A Reflection of Pathology in Traumatic Brain Injury. J Neurotrauma 2020; 37:373-381. [DOI: 10.1089/neu.2019.6487] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Andrei A. Vakhtin
- War Related Illness and Injury Study Center, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Yu Zhang
- War Related Illness and Injury Study Center, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
| | - Max Wintermark
- War Related Illness and Injury Study Center, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
- Department of Neuroradiology, Stanford University School of Medicine, Stanford, California
| | - Payam Massaband
- Department of Radiology, Stanford University School of Medicine, Stanford, California
- Departments of Radiology, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
| | - Miguel T. Robinson
- War Related Illness and Injury Study Center, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
| | - John W. Ashford
- War Related Illness and Injury Study Center, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Ansgar J. Furst
- War Related Illness and Injury Study Center, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
- Polytrauma, System of Care, Veterans Affairs Palo Alto, Palo Alto, California
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16
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Alterations in the fronto-limbic network and corpus callosum in borderline-personality disorder. Brain Cogn 2019; 138:103596. [PMID: 31877433 DOI: 10.1016/j.bandc.2019.103596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023]
Abstract
Neuroimaging research provides evidence of grey matter changes in the prefrontal-limbic network in borderline personality disorder (BPD), yet research scarcely examines the white matter (WM) within this circuitry. The present study aimed to explore WM in prefrontal-limbic brain networks within BPD. Quantitative diffusion tensor imaging (DTI-MRI) measures of fractional anisotropy (FA) and mean diffusion (MD) were used to analyze the neural pathways in fifteen individuals with BPD (M = 25, SD = 6.76), in comparison to thirteen healthy individuals (M = 27.92, SD = 8.41). Quantitative DTI-MRI measures of FA and MD were evaluated for the cingulum, the fornix, the corpus callosum (CC), the inferior longitudinal fasciculus (ILF), the superior longitudinal fasciculus (SLF) and the uncinate fasciculus (UF). Lower FA values for both the left and the right cingulum, the genu, body, and splenium of the CC, left ILF and right SLF were found in BPD, compared to healthy individuals. MD values were higher for the genu and splenium of the CC in BPD. The findings indicate that a large-scale emotional brain network is affected in BPD with alterations in MD and FA of WM prefrontal-limbic pathways of the heteromodal association cortex involved in emotion processing and emotion regulation.
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17
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Ware AL, Biekman B, Hachey R, MacLeod M, Bird W, Pathak S, Clarke E, Borrasso A, Puccio AM, Glavin K, Pomiecko K, Moretti P, Beers SR, Levin HS, Schneider W, Okonkwo DO, Wilde EA. A Preliminary High-Definition Fiber Tracking Study of the Executive Control Network in Blast-Induced Traumatic Brain Injury. J Neurotrauma 2018; 36:686-701. [PMID: 30070176 DOI: 10.1089/neu.2018.5725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Blast-induced traumatic brain injury (bTBI) is common in veterans of the Iraq- and Afghanistan-era conflicts. However, the typical subtlety of neural alterations and absence of definitive biomarkers impede clinical detection on conventional imaging. This preliminary study examined the structure and functional correlates of executive control network (ECN) white matter in veterans to investigate the clinical utility of using high-definition fiber tracking (HDFT) to detect chronic bTBI. Demographically similar male veterans (N = 38) with and without bTBI (ages 24 to 50 years) completed standardized neuropsychological testing and magnetic resonance imaging. Quantitative HDFT metrics of subcortical-dorsolateral prefrontal cortex (DLPFC) tracts were derived. Moderate-to-large group effects were observed on HDFT metrics. Relative to comparisons, bTBI demonstrated elevated quantitative anisotropy (QA) and reduced right hemisphere volume of all examined tracts, and reduced fiber count and increased generalized fractional anisotropy in the right DLPFC-putamen tract and DLPFC-thalamus, respectively. The Group × Age interaction effect on DLPFC-caudate tract volume was large; age negatively related to volume in the bTBI group, but not comparison group. Groups performed similarly on the response inhibition measure. Performance (reaction time and commission errors) robustly correlated with HDFT tract metrics (QA and tract volume) in the comparison group, but not bTBI group. Results support anomalous density and integrity of ECN connectivity, particularly of the right DLPFC-putamen pathway, in bTBI. Results also support exacerbated aging in veterans with bTBI. Similar ECN function despite anomalous microstructure could reflect functional compensation in bTBI, although alternate interpretations are explored.
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Affiliation(s)
- Ashley L Ware
- 1 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston , Houston, Texas.,2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - Brian Biekman
- 1 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston , Houston, Texas.,2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - Rebecca Hachey
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Marianne MacLeod
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - William Bird
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Sudhir Pathak
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Emily Clarke
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Allison Borrasso
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Ava M Puccio
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kelly Glavin
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kristopher Pomiecko
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Paolo Moretti
- 5 Department of Neurology, Baylor College of Medicine , Houston, Texas.,6 Neurology Service, Michael E. DeBakey VA Medical Center , Houston, Texas.,7 Department of Neurology, University of Utah School of Health Sciences , Salt Lake City, Utah.,8 Department of Human and Molecular Genetics, University of Utah School of Health Sciences , Salt Lake City, Utah.,9 Neurology Service, George E. Wahlen VA Medical Center , Salt Lake City, Utah
| | - Sue R Beers
- 10 Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, PA
| | - Harvey S Levin
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,11 Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Walter Schneider
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania.,12 Department of Psychology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - David O Okonkwo
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Elisabeth A Wilde
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,5 Department of Neurology, Baylor College of Medicine , Houston, Texas.,6 Neurology Service, Michael E. DeBakey VA Medical Center , Houston, Texas.,7 Department of Neurology, University of Utah School of Health Sciences , Salt Lake City, Utah.,9 Neurology Service, George E. Wahlen VA Medical Center , Salt Lake City, Utah.,13 Department of Radiology, Baylor College of Medicine , Houston, Texas
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18
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Jurick SM, Hoffman SN, Sorg S, Keller AV, Evangelista ND, DeFord NE, Sanderson-Cimino M, Bangen KJ, Delano-Wood L, Deoni S, Jak AJ. Pilot investigation of a novel white matter imaging technique in Veterans with and without history of mild traumatic brain injury. Brain Inj 2018; 32:1256-1265. [DOI: 10.1080/02699052.2018.1493225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah M. Jurick
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Scott Sorg
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amber V. Keller
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Nicole E. DeFord
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark Sanderson-Cimino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sean Deoni
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Amy J. Jak
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Holly KS, Fitz-Gerald JS, Barker BJ, Murcia D, Daggett R, Ledbetter C, Gonzalez-Toledo E, Sun H. Differentiation of High-Grade Glioma and Intracranial Metastasis Using Volumetric Diffusion Tensor Imaging Tractography. World Neurosurg 2018; 120:e131-e141. [PMID: 30165214 DOI: 10.1016/j.wneu.2018.07.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A reliable, noninvasive method to differentiate high-grade glioma (HGG) and intracranial metastasis (IM) has remained elusive. The aim of this study was to differentiate between HGG and IM using tumoral and peritumoral diffusion tensor imaging characteristics. METHODS A semiautomated script generated volumetric regions of interest (ROIs) for the tumor and a peritumoral shell at a predetermined voxel thickness. ROI differences in diffusion tensor imaging-related metrics between HGG and IM groups were estimated, including fractional anisotropy, mean diffusivity, total fiber tract counts, and tract density. RESULTS The HGG group (n = 46) had a significantly higher tumor-to-brain volume ratio than the IM group (n = 35) (P < 0.001). The HGG group exhibited significantly higher mean fractional anisotropy and significantly lower mean diffusivity within peritumoral ROI than the IM group (P < 0.05). The HGG group exhibited significantly higher total tract count and higher tract density in tumoral and peritumoral ROIs than the IM group (P < 0.05). Tumoral tract count and peritumoral tract density were the most optimal metrics to differentiate the groups based on receiver operating characteristic curve analysis. Predictive analysis using receiver operating characteristic curve thresholds was performed on 13 additional participants. Compared with correct clinical diagnoses, the 2 thresholds exhibited equal specificities (66.7%), but the tumoral tract count (85.7%) seemed more sensitive in differentiating the 2 groups. CONCLUSIONS Tract count and tract density were significantly different in tumoral and peritumoral regions between HGG and IM. Differences in microenvironmental interactions between the tumor types may cause these tract differences.
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Affiliation(s)
- Kevin S Holly
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Joseph S Fitz-Gerald
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Benjamin J Barker
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Derrick Murcia
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Rebekah Daggett
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Christina Ledbetter
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Eduardo Gonzalez-Toledo
- Department of Radiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Hai Sun
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
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20
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Averill CL, Averill LA, Wrocklage KM, Scott JC, Akiki TJ, Schweinsburg B, Southwick SM, Krystal JH, Abdallah CG. Altered White Matter Diffusivity of the Cingulum Angular Bundle in Posttraumatic Stress Disorder. MOLECULAR NEUROPSYCHIATRY 2018; 4:75-82. [PMID: 30397595 DOI: 10.1159/000490464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/28/2018] [Indexed: 01/08/2023]
Abstract
Purpose of the Study Prior studies showed posttraumatic stress disorder (PTSD)-related alterations in white matter integrity, but most of these studies have used region-based approaches. We address this limitation by investigating the relationship between PTSD severity and fractional anisotropy (FA) using a tract-based approach. Procedures Structural and diffusion magnetic resonance imaging were acquired from 67 combat-exposed US Veterans and processed using FSL/FreeSurfer TRActs Constrained by UnderLying Anatomy. Partial correlations were conducted between PTSD severity and FA of the cingulum and uncinate fasciculi covarying for age, sex, and head motion. Results Only FA of the left cingulum angular bundle (CAB) was positively correlated with PTSD symptom severity (r = 0.433, p = 0.001, df = 57) and remained significant after Bonferroni correction. Conclusions This finding may imply greater organization of the CAB with increasing PTSD severity. The CAB connects directly to the cingulate cortex and the hippocampal subiculum, critical nodes of the default mode network, as well as being implicated in neurodegeneration pathology, decision-making, and executive functions, which may help explain previously shown alterations in this network in PTSD. Message of the Paper Further study of white matter tract integrity in PTSD is warranted, particularly to investigate whether the CAB connections with both higher-order cognitive functioning and emotion processing regions contribute to the pathophysiology and comorbidity of PTSD.
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Affiliation(s)
- Christopher L Averill
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lynnette A Averill
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kristen M Wrocklage
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Gaylord Specialty Healthcare, Department of Psychology, Wallingford, Connecticut, USA
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,VISN4 Mental Illness Research, Education, and Clinical Center, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Teddy J Akiki
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian Schweinsburg
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Steven M Southwick
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John H Krystal
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chadi G Abdallah
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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21
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Vandekerckhove M. Neural networks in bottom up 'experiential emotion regulation'. Behav Brain Res 2018; 383:111242. [PMID: 29454977 DOI: 10.1016/j.bbr.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 12/28/2017] [Accepted: 01/01/2018] [Indexed: 12/11/2022]
Abstract
Emotion regulation influences how and when we experience emotion, impacting our sense of self and well being. While previous brain research on emotion regulation has focused on gray matter correlates of emotion regulation, this study represents a first exploratory study on white matter integrity of brain networks of 'emotional approach' as a bottom up experiential emotion regulation-strategy. Responding to the gap between cognitive and affective approaches of emotion regulation, pertaining to some of the daily emotional stressors, the present study investigates brain pathways of individual differences in 'emotional approach', or the tendency to affectively acknowledge, understand and express emotional experience (cf. [1]). Diffusion tensor magnetic resonance imaging (DTI-MRI) measures of fractional anisotropy (FA) and mean diffusion (MD) evaluated dispositional emotion regulation in a group of 21 women with a 'high emotional approach' (HEA) (N = 11) and a 'low emotional approach' (LEA) (N = 10). HEA exhibited more FA of the cingulum, supporting emotion processing and emotion regulation, whereas LEA correlated to a higher FA in the right corticospinal tracts, supporting automatic action tendencies and a higher FA in the superior longitudinal fasciculus (SLF), supporting cognitive control and monitoring of emotion. LEA also correlated with an increase in MD in the body (p. = 0.05) and in the splenium of the corpus callosum (CC). A higher FA in the inferior longitudinal fasciculus (IFL) may indicate higher visual- affective integration within emotion processing, whereas more MD in the body and splenium of the CC decreases interhemispheric integration of emotional information within emotion processing and emotion regulation.
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Affiliation(s)
- Marie Vandekerckhove
- Research group of Biological Psychology, Faculty of Psychology and Pedagogical Sciences, Department of Clinical and Lifespan psychology, Vrije Universiteit Brussel (VUB) Brussels, Belgium; Department of Imaging and Clinical Studies, University Clinic, UZ-Jette, Laarbeeklaan 2, 1090 Jette, Belgium.
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22
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Kosari-Nasab M, Shokouhi G, Ghorbanihaghjo A, Abbasi MM, Salari AA. Anxiolytic- and antidepressant-like effects of Silymarin compared to diazepam and fluoxetine in a mouse model of mild traumatic brain injury. Toxicol Appl Pharmacol 2018; 338:159-173. [DOI: 10.1016/j.taap.2017.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 12/31/2022]
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23
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Han KM, Won E, Kang J, Choi S, Kim A, Lee MS, Tae WS, Ham BJ. TESC gene-regulating genetic variant (rs7294919) affects hippocampal subfield volumes and parahippocampal cingulum white matter integrity in major depressive disorder. J Psychiatr Res 2017; 93:20-29. [PMID: 28575645 DOI: 10.1016/j.jpsychires.2017.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/13/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022]
Abstract
Two recent genome-wide association studies have suggested that rs7294919 is associated with changes in hippocampal volume. rs7294919 regulates the transcriptional products of the TESC gene, which is involved in neuronal proliferation and differentiation. We investigated the interactive effect of rs7294919 and major depressive disorder (MDD) on the volume of the hippocampal subfields and the integrity of the parahippocampal cingulum (PHC). We also investigated the correlation of these structural changes with the DNA methylation status of rs7294919. A total of 105 patients with MDD and 85 healthy control subjects underwent T1-weighted structural magnetic resonance imaging and diffusion tensor imaging. The rs7294919 was genotyped and its DNA methylation status was assessed in all the participants. We analyzed the hippocampal subfield volumes and PHC integrity using FreeSurfer and the Tracts Constrained by Underlying Anatomy (TRACULA) respectively. Significant interactive effects of rs7294919 and MDD were observed in the volumes of the dentate gyrus and CA4. The patients with MDD had increased methylation in two of the three CpG loci of rs7294919, and the methylation of CpG3 was significantly correlated with right PHC integrity in the MDD group. Our results provide neurobiological evidence for the association of rs7294919 with brain structural changes in MDD.
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Affiliation(s)
- Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eunsoo Won
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - June Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Choi
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Aram Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Brain Convergence Research Center, Korea University Anam Hospital, Seoul, Republic of Korea.
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.
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24
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Dretsch MN, Lange RT, Katz JS, Goodman A, Daniel TA, Deshpande G, Denney TS, Iverson GL, Robinson JL. Examining Microstructural White Matter in Active Duty Soldiers with a History of Mild Traumatic Brain Injury and Traumatic Stress. Open Neuroimag J 2017; 11:46-57. [PMID: 28979609 PMCID: PMC5611700 DOI: 10.2174/1874440001711010046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 06/20/2017] [Accepted: 08/10/2017] [Indexed: 11/22/2022] Open
Abstract
Background: There is a high comorbidity of posttraumatic stress (PTS) and mild traumatic brain injury (mTBI), with largely overlapping symptomatology, in military service members. Objective: To examine white matter integrity associated with PTS and mTBI as assessed using diffusion tensor imaging (DTI). Method: Seventy-four active-duty U.S. soldiers with PTS (n = 16) and PTS with co-morbid history of mTBI (PTS/mTBI; n = 28) were compared to a military control group (n = 30). Participants received a battery of neurocognitive and clinical symptom measures. The number of abnormal DTI values was determined (>2 SDs from the mean of the control group) for fractional anisotropy (FA) and mean diffusivity (MD), and then compared between groups. In addition, mean DTI values from white matter tracts falling into three categories were compared between groups: (i) projection tracts: superior, middle, and inferior cerebellar peduncles, pontine crossing tract, and corticospinal tract; (ii) association tracts: superior longitudinal fasciculus; and (iii) commissure tracts: cingulum bundle (cingulum-cingulate gyrus and cingulum-hippocampus), and corpus callosum. Results: The comorbid PTS/mTBI group had significantly greater traumatic stress, depression, anxiety, and post-concussive symptoms, and they performed worse on neurocognitive testing than those with PTS alone and controls. The groups differed greatly on several clinical variables, but contrary to what we hypothesized, they did not differ greatly on primary and exploratory analytic approaches of hetero-spatial whole brain DTI analyses. Conclusion: The findings suggest that psychological health conditions rather than pathoanatomical changes may be contributing to symptom presentation in this population.
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Affiliation(s)
- Michael N Dretsch
- US Army Aeromedical Research Laboratory, Fort Rucker, AL; Human Dimension Division, Headquarters Training and Doctrine Command, 950 Jefferson Ave, Fort Eustis, VA, 23612, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Palmer Road, Bethesda, MD, 20814, USA
| | - Jeffery S Katz
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Adam Goodman
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA
| | - Thomas A Daniel
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA
| | - Gopikrishna Deshpande
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Thomas S Denney
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 First Avenue, Harvard Medical School, Boston, MA 02129; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program; and Defense and Veterans Brain Injury Center, Bethesda, MD, USA
| | - Jennifer L Robinson
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
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25
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Koch SB, van Zuiden M, Nawijn L, Frijling JL, Veltman DJ, Olff M. Decreased uncinate fasciculus tract integrity in male and female patients with PTSD: a diffusion tensor imaging study. J Psychiatry Neurosci 2017; 42:331-342. [PMID: 28452713 PMCID: PMC5573575 DOI: 10.1503/jpn.160129] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder that has been associated with lower white matter integrity of tracts connecting the prefrontal cortex with limbic regions. However, previous diffusion tensor imaging (DTI) findings have been inconsistent, showing high variability in the exact location and direction of effects. METHODS We performed probabilistic tractography of the bilateral uncinate fasciculus, cingulum and superior longitudinal fasciculus (both temporal and parietal projections) in male and female police officers with and without PTSD. RESULTS We included 38 (21 men) police officers with and 39 (20 men) without PTSD in our analyses. Compared with trauma-exposed controls, patients with PTSD showed significantly higher mean diffusivity of the right uncinate fasciculus, the major white matter tract connecting the amygdala to the prefrontal cortex (p = 0.012). No other significant between-group or group × sex differences were observed. Mean diffusivity of the right uncinate fasciculus was positively associated with anxiety symptoms (r = 0.410, p = 0.013) in patients with PTSD as well as with amygdala activity (r = 0.247, p = 0.038) and ventromedial prefrontal cortex (vmPFC) activity (r = 0.283, p = 0.016) in all participants in response to happy and neutral faces. LIMITATIONS Our specific sample of trauma-exposed police officers limits the generalizability of our findings to other PTSD patient groups (e.g., civilian trauma). CONCLUSION Patients with PTSD showed diminished structural connectivity between the amygdala and vmPFC, which was correlated with higher anxiety symptoms and increased functional activity of these brain regions. Our findings provide additional evidence for the prevailing neurocircuitry model of PTSD, postulating that ineffective communication between the amygdala and vmPFC underlies decreased top-down control over fear responses.
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Affiliation(s)
- Saskia B.J. Koch
- Correspondence to: S. Koch, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands;
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26
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Main KL, Soman S, Pestilli F, Furst A, Noda A, Hernandez B, Kong J, Cheng J, Fairchild JK, Taylor J, Yesavage J, Wesson Ashford J, Kraemer H, Adamson MM. DTI measures identify mild and moderate TBI cases among patients with complex health problems: A receiver operating characteristic analysis of U.S. veterans. Neuroimage Clin 2017; 16:1-16. [PMID: 28725550 PMCID: PMC5503837 DOI: 10.1016/j.nicl.2017.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 06/10/2017] [Accepted: 06/23/2017] [Indexed: 01/10/2023]
Abstract
Standard MRI methods are often inadequate for identifying mild traumatic brain injury (TBI). Advances in diffusion tensor imaging now provide potential biomarkers of TBI among white matter fascicles (tracts). However, it is still unclear which tracts are most pertinent to TBI diagnosis. This study ranked fiber tracts on their ability to discriminate patients with and without TBI. We acquired diffusion tensor imaging data from military veterans admitted to a polytrauma clinic (Overall n = 109; Age: M = 47.2, SD = 11.3; Male: 88%; TBI: 67%). TBI diagnosis was based on self-report and neurological examination. Fiber tractography analysis produced 20 fiber tracts per patient. Each tract yielded four clinically relevant measures (fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity). We applied receiver operating characteristic (ROC) analyses to identify the most diagnostic tract for each measure. The analyses produced an optimal cutpoint for each tract. We then used kappa coefficients to rate the agreement of each cutpoint with the neurologist's diagnosis. The tract with the highest kappa was most diagnostic. As a check on the ROC results, we performed a stepwise logistic regression on each measure using all 20 tracts as predictors. We also bootstrapped the ROC analyses to compute the 95% confidence intervals for sensitivity, specificity, and the highest kappa coefficients. The ROC analyses identified two fiber tracts as most diagnostic of TBI: the left cingulum (LCG) and the left inferior fronto-occipital fasciculus (LIF). Like ROC, logistic regression identified LCG as most predictive for the FA measure but identified the right anterior thalamic tract (RAT) for the MD, RD, and AD measures. These findings are potentially relevant to the development of TBI biomarkers. Our methods also demonstrate how ROC analysis may be used to identify clinically relevant variables in the TBI population.
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Key Words
- AD, axial diffusivity
- Axon degeneration
- CC, corpus callosum
- Concussion
- DAI, diffuse axonal injury
- DTI, diffusion tensor imaging
- FA, fractional anisotropy
- GN, genu
- Imaging
- LAT, left anterior thalamic tract
- LCG, left cingulum
- LCH, left cingulum – hippocampus
- LCS, left cortico-spinal tract
- LIF, left inferior fronto-occipital fasciculus
- LIL, left inferior longitudinal fasciculus
- LSL, left superior longitudinal fasciculus
- LST, left superior longitudinal fasciculus – temporal
- LUN, left uncinate
- MD, mean diffusivity
- Neurodegeneration
- PTSD, post-traumatic stress disorder
- RAT, right anterior thalamic tract
- RCG, right cingulum
- RCH, right cingulum – Hippocampus
- RCS, right cortico-spinal tract
- RD, radial diffusivity
- RIF, right inferior fronto-occipital fasciculus
- RIL, right inferior longitudinal fasciculus
- ROC, receiver operating characteristic
- RSL, right superior longitudinal fasciculus
- RST, right superior longitudinal fasciculus – temporal
- RUN, right uncinate
- SP, splenium
- TBI, traumatic brain injury
- Traumatic brain injury
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Affiliation(s)
- Keith L. Main
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Defense and Veterans Brain Injury Center (DVBIC), Silver Spring, MD, United States
- General Dynamics Health Solutions (GDHS), Fairfax, VA, United States
| | - Salil Soman
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Ansgar Furst
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Art Noda
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Beatriz Hernandez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer Kong
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
| | - Jauhtai Cheng
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
| | - Jennifer K. Fairchild
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Joy Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jerome Yesavage
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helena Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Maheen M. Adamson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, United States
- Defense and Veterans Brain Injury Center (DVBIC), Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
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27
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Lavoie S, Sechrist S, Quach N, Ehsanian R, Duong T, Gotlib IH, Isaac L. Depression in Men and Women One Year Following Traumatic Brain Injury (TBI): A TBI Model Systems Study. Front Psychol 2017; 8:634. [PMID: 28529492 PMCID: PMC5418333 DOI: 10.3389/fpsyg.2017.00634] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/09/2017] [Indexed: 11/30/2022] Open
Abstract
In the general population, females experience depression at significantly higher rates than males. Individuals with traumatic brain injury (TBI) are at substantially greater risk for depression compared to the overall population. Treatment of, and recovery from, TBI can be hindered by depression; comorbid TBI and depression can lead to adverse outcomes and negatively affect multiple aspects of individuals’ lives. Gender differences in depression following TBI are not well understood, and relevant empirical findings have been mixed. Utilizing the Patient Health Questionnaire-9 (PHQ-9) 1 year after TBI, we examined whether women would experience more severe depressive symptoms, and would endorse higher levels of depression within each category of depression severity, than would men. Interestingly, and contrary to our hypothesis, men and women reported mild depression at equal rates; PHQ-9 total scores were slightly lower in women than in men. Men and women did not differ significantly in any PHQ-9 depression severity category. Item analyses, yielded significant gender differences on the following items: greater concentration difficulties (cognitive problems) in men and more sleep disturbances (psychosomatic issues) in women per uncorrected two-sample Z-test for proportions analyses; however, these results were not significant after the family-wise Bonferroni correction. Our results indicate that, in contrast to the general population, mild depression in persons with moderate to severe TBI may not be gender-specific. These findings underscore the need for early identification, active screening, and depression treatment equally for men and women to improve emotional well-being, promote recovery, and enhance quality of life following TBI.
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Affiliation(s)
- Sarah Lavoie
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA
| | - Samantha Sechrist
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA
| | - Nhung Quach
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA
| | - Reza Ehsanian
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA.,Department of Neurosurgery, Stanford University, StanfordCA, USA
| | - Thao Duong
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA.,Department of Physical Medicine and Rehabilitation, Stanford University, StanfordCA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, StanfordCA, USA
| | - Linda Isaac
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA.,Department of Physical Medicine and Rehabilitation, Stanford University, StanfordCA, USA
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28
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Olson EA, Cui J, Fukunaga R, Nickerson LD, Rauch SL, Rosso IM. Disruption of white matter structural integrity and connectivity in posttraumatic stress disorder: A TBSS and tractography study. Depress Anxiety 2017; 34:437-445. [PMID: 28294462 PMCID: PMC5407943 DOI: 10.1002/da.22615] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/15/2017] [Accepted: 02/18/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Most studies of brain white matter (WM) in posttraumatic stress disorder (PTSD) have focused on combat trauma, and often were confounded by neurological and substance dependence comorbidity. This study used tract-based spatial statistics (TBSS) and probabilistic tractography to characterize WM microstructure in a mixed-sex community sample of PTSD patients exposed to diverse and multiple traumas, and in trauma-exposed normal comparison (TENC) subjects. METHODS TBSS compared diffusion measures between 20 adults with DSM-IV PTSD and 17 TENC, using a whole-brain voxel-wise approach. Probabilistic tractography using Freesurfer's TRACULA was employed to measure diffusion tensor imaging (DTI) metrics within anatomically defined pathways. DTI metrics were compared between groups and correlated with PTSD symptom severity and trauma load. RESULTS Controlling for age, sex, and motion, PTSD subjects had significantly reduced fractional anisotropy (FA) in a left frontal lobe cluster compared with TENC, at p < .05, family-wise error corrected. Tractography identified significant group differences in the inferior longitudinal fasciculus (ILF), including lower FA and higher radial diffusivity in PTSD compared with TENC. Within the PTSD group, FA values were not correlated with symptom severity or trauma load. Results remained significant after removing participants using psychotropic medication or those with comorbid major depression. CONCLUSIONS PTSD patients had reduced WM integrity in left hemisphere frontal WM and temporal-occipital WM tracts, compared to trauma-exposed controls. Reduced frontal FA is consistent with compromised top-down attentional control and emotion regulation in PTSD, while reduced ILF FA may be related to sensory processing and gating abnormalities in this disorder.
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Affiliation(s)
- Elizabeth A. Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Jiaolong Cui
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA
| | - Rena Fukunaga
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Lisa D. Nickerson
- Department of Psychiatry, Harvard Medical School, Boston, MA,McLean Imaging Center, McLean Hospital, Belmont, MA
| | - Scott L. Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Isabelle M. Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Corresponding author: Isabelle M. Rosso, Ph.D., Anxiety and Traumatic Stress Disorders Laboratory, McLean Hospital, Mailstop 334, 115 Mill Street, Belmont, MA 02478,
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29
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Asken BM, DeKosky ST, Clugston JR, Jaffee MS, Bauer RM. Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI): a systematic critical review. Brain Imaging Behav 2017; 12:585-612. [DOI: 10.1007/s11682-017-9708-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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30
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Advanced neuroimaging applied to veterans and service personnel with traumatic brain injury: state of the art and potential benefits. Brain Imaging Behav 2016; 9:367-402. [PMID: 26350144 DOI: 10.1007/s11682-015-9444-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Traumatic brain injury (TBI) remains one of the most prevalent forms of morbidity among Veterans and Service Members, particularly for those engaged in the conflicts in Iraq and Afghanistan. Neuroimaging has been considered a potentially useful diagnostic and prognostic tool across the spectrum of TBI generally, but may have particular importance in military populations where the diagnosis of mild TBI is particularly challenging, given the frequent lack of documentation on the nature of the injuries and mixed etiologies, and highly comorbid with other disorders such as post-traumatic stress disorder, depression, and substance misuse. Imaging has also been employed in attempts to understand better the potential late effects of trauma and to evaluate the effects of promising therapeutic interventions. This review surveys the use of structural and functional neuroimaging techniques utilized in military studies published to date, including the utilization of quantitative fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), volumetric analysis, diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), positron emission tomography (PET), magnetoencephalography (MEG), task-based and resting state functional MRI (fMRI), arterial spin labeling (ASL), and magnetic resonance spectroscopy (MRS). The importance of quality assurance testing in current and future research is also highlighted. Current challenges and limitations of each technique are outlined, and future directions are discussed.
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31
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Fang S, Wang Y, Jiang T. The Influence of Frontal Lobe Tumors and Surgical Treatment on Advanced Cognitive Functions. World Neurosurg 2016; 91:340-6. [PMID: 27072331 DOI: 10.1016/j.wneu.2016.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/01/2016] [Accepted: 04/02/2016] [Indexed: 11/25/2022]
Abstract
Brain cognitive functions affect patient quality of life. The frontal lobe plays a crucial role in advanced cognitive functions, including executive function, meta-cognition, decision-making, memory, emotion, and language. Therefore, frontal tumors can lead to serious cognitive impairments. Currently, neurosurgical treatment is the primary method to treat brain tumors; however, the effects of the surgical treatments are difficult to predict or control. The treatment may both resolve the effects of the tumor to improve cognitive function or cause permanent disabilities resulting from damage to healthy functional brain tissue. Previous studies have focused on the influence of frontal lesions and surgical treatments on patient cognitive function. Here, we review cognitive impairment caused by frontal lobe brain tumors.
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Affiliation(s)
- Shengyu Fang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Institute for Brain Disorders, Brain Tumor Center, Beijing, China.
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