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Izzy S, Grashow R, Radmanesh F, Chen P, Taylor H, Formisano R, Wilson F, Wasfy M, Baggish A, Zafonte R. Long-term risk of cardiovascular disease after traumatic brain injury: screening and prevention. Lancet Neurol 2023; 22:959-970. [PMID: 37739576 PMCID: PMC10863697 DOI: 10.1016/s1474-4422(23)00241-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 09/24/2023]
Abstract
Traumatic brain injury (TBI) is highly prevalent among individuals participating in contact sports, military personnel, and in the general population. Although it is well known that brain injury can cause neurological and psychiatric complications, evidence from studies on individuals exposed to a single or repetitive brain injuries suggests an understudied association between TBI and the risk of developing chronic cardiovascular diseases and risk factors for cardiovascular disease. Several studies have shown that people without pre-existing comorbidities who sustain a TBI have a significantly higher risk of developing chronic cardiovascular disease, than people without TBI. Similar observations made in military and professional American-style football cohorts suggest causal pathways through which modifiable cardiovascular risk factors might mediate the relationship between brain injury and chronic neurological diseases. A better understanding of cardiovascular disease risk after TBI combined with a proactive, targeted screening programme might mitigate long-term morbidity and mortality in individuals with TBI, and improve their quality of life.
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Affiliation(s)
- Saef Izzy
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Football Players Health Study at Harvard University, Boston, MA, USA
| | - Rachel Grashow
- Department of Environmental Health, T H Chan School of Public Health, Harvard University, Boston, MA, USA; Football Players Health Study at Harvard University, Boston, MA, USA
| | - Farid Radmanesh
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Division of Neurocritical Care, University of New Mexico, Albuquerque, NM, USA
| | - Patrick Chen
- Department of Neurology, University of California Irvine, Orange, CA, USA
| | - Herman Taylor
- Football Players Health Study at Harvard University, Boston, MA, USA; Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Fiona Wilson
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Meagan Wasfy
- Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Boston, MA, USA; Institute for Sport Science and Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ross Zafonte
- Harvard Medical School, Boston, MA, USA; Football Players Health Study at Harvard University, Boston, MA, USA; Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA.
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Giannopoulos AE, Zioga I, Papageorgiou P, Pervanidou P, Makris G, Chrousos GP, Stachtea X, Capsalis C, Papageorgiou C. Evaluating the Modulation of the Acoustic Startle Reflex in Children and Adolescents via Vertical EOG and EEG: Sex, Age, and Behavioral Effects. Front Neurosci 2022; 16:798667. [PMID: 35464323 PMCID: PMC9019526 DOI: 10.3389/fnins.2022.798667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
Acoustic startle reflex (ASR) constitutes a reliable, cross-species indicator of sensorimotor and inhibitory mechanisms, showing distinct signature in cognitive aging, sex, and psychopathological characterization. ASR can be modulated by the prepulse inhibition (PPI) paradigm, which comprises the suppression of reactivity to a startling stimulus (pulse) following a weak prepulse (30- to 500-ms time difference), being widely linked to inhibitory capabilities of the sensorimotor system. If the prepulse–pulse tones are more clearly separated (500–2,000 ms), ASR amplitude is enhanced, termed as prepulse facilitation (PPF), reflecting sustained or selective attention. Our study aimed to investigate early-life sensorimotor sex/age differences using Electroencephalographic recordings to measure muscular and neural ASR in a healthy young population. Sixty-three children and adolescents aged 6.2–16.7 years (31 females) took part in the experiment. Neural ASR was assessed by two different analyses, namely, event-related potentials (ERPs) and first-derivative potentials (FDPs). As expected, PPF showed enhanced responses compared with PPI, as indicated by eyeblink, ERP and FDP measures, confirming the gating effect hypothesis. Sex-related differences were reflected in FDPs, with females showing higher ASR than males, suggesting increased levels of poststartle excitability. Intragroup age effects were evaluated via multipredictor regression models, noticing positive correlation between age versus eyeblink and ERP responses. Attention-related ERPs (N100 and P200) showed distinct patterns in PPI versus PPF, potentially indicative for alternative attentional allocation and block-out of sensory overload. Screening measures of participants’ neurodevelopmental (assessed by Wechsler Intelligence Scale for Children) and behavioral (assessed by Child Behavior Checklist) markers were also associated with increased N100/P200 responses, presumably indexing synergy between perceptual consistency, personality profiling, and inhibitory performance. Conclusively, modulation of ASR by PPI and PPF is associated with biological sex and internal/external personality traits in childhood and adolescence, potentially useful to guide symptomatology and prevention of psychopathology.
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Affiliation(s)
- Anastasios E. Giannopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
- *Correspondence: Anastasios E. Giannopoulos,
| | - Ioanna Zioga
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, Netherlands
- First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Panos Papageorgiou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Makris
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George P. Chrousos
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Xanthi Stachtea
- Neurosciences and Precision Medicine Research Institute “COSTAS STEFANIS” (UMHRI), University Mental Health, Athens, Greece
| | - Christos Capsalis
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Charalabos Papageorgiou
- Neurosciences and Precision Medicine Research Institute “COSTAS STEFANIS” (UMHRI), University Mental Health, Athens, Greece
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Kponee-Shovein KZ, Weisskopf MG, Grashow R, Rotem RS, Coull BA, Schnaas L, Hernández-Chávez MDC, Sanchez B, Peterson K, Hu H, Téllez-Rojo MM. Estimating the causal effect of prenatal lead exposure on prepulse inhibition deficits in children and adolescents. Neurotoxicology 2020; 78:116-126. [PMID: 32126243 DOI: 10.1016/j.neuro.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/20/2022]
Abstract
During pregnancy, maternal lead from earlier exposures mobilizes and crosses placental barriers, placing the developing fetus at risk for lead exposure and neurodevelopmental deficits. Some neuronal circuits known to be affected in neurodevelopment disorders can be probed with simple physiological behavioral paradigms. One such neural biomarker is Pre-Pulse Inhibition (PPI), an indicator of adequate sensorimotor gating processing. In clinical studies, deficits in PPI have been associated with neurodevelopmental disorders in human subjects. To our knowledge, no studies have examined the use of PPI as a biomarker of toxicant effects on the brain in epidemiological studies. We aimed to estimate the causal effect of prenatal lead exposure, assessed by maternal cortical bone lead concentrations, on PPI in 279 children from Mexico City. in vivo maternal cortical bone lead measurements were taken at four weeks postpartum at the mid-tibia shaft using a K-Shell X-ray fluorescence instrument. PPI recording occurred in an isolated clinical setting and eye blink responses were measured using electromyography. We assessed if the conditions for causal inference held in our study and used the results of our assessment to estimate the causal effect of prenatal lead exposure on PPI using an ordinary least squares regression model, a marginal structural model, and the parametric g-formula. Results were consistent across the three modeling approaches. For the parametric g-formula, a one standard deviation (10.0 μg/g) increase in prenatal lead significantly reduced PPI by approximately 19.0 % (95 % CI: 5.4 %, 34.3 %). This decrease is similar in magnitude to clinical studies on schizophrenia, which have observed PPI impairments in patients with schizophrenia as compared to controls. Our results are consistent with findings from other studies establishing an association between lead exposure and neurodevelopmental disorders in children and suggest that PPI may be useful as an objective biomarker of toxicant effects on the brain.
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Affiliation(s)
- Kalé Z Kponee-Shovein
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Marc G Weisskopf
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ran S Rotem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brent A Coull
- Departments of Biostatistics and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lourdes Schnaas
- Division of Research in Community Interventions, Instituto Nacional De Perinatología Isidro Espinosa De Los Reyes, Miguel Hidalgo, Mexico
| | - Maria Del Carmen Hernández-Chávez
- Division of Research in Community Interventions, Instituto Nacional De Perinatología Isidro Espinosa De Los Reyes, Miguel Hidalgo, Mexico
| | - Brisa Sanchez
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Karen Peterson
- Departments of Global Public Health and Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Howard Hu
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Mexico
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Fulcher N, Azzopardi E, De Oliveira C, Hudson R, Schormans AL, Zaman T, Allman BL, Laviolette SR, Schmid S. Deciphering midbrain mechanisms underlying prepulse inhibition of startle. Prog Neurobiol 2019; 185:101734. [PMID: 31863802 DOI: 10.1016/j.pneurobio.2019.101734] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/19/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022]
Abstract
Prepulse inhibition (PPI) is an operational measure of sensorimotor gating. Deficits of PPI are a hallmark of schizophrenia and associated with several other psychiatric illnesses such as e.g. autism spectrum disorder, yet the mechanisms underlying PPI are still not fully understood. There is growing evidence contradicting the long-standing hypothesis that PPI is mediated by a short feed-forward midbrain circuitry including inhibitory cholinergic projections from the pedunculopontine tegmental nucleus (PPTg) to the startle pathway. Here, we employed a chemogenetic approach to explore the involvement of the PPTg in general, and cholinergic neurons specifically, in PPI. Activation of inhibitory DREADDs (designer receptors exclusively activated by designer drugs) in the PPTg by systemic administration of clozapine-N-oxide (CNO) disrupted PPI, confirming the involvement of the PPTg in PPI. In contrast, chemogenetic inhibition of specifically cholinergic PPTg neurons had no effect on PPI, but inhibited morphine-induced conditioned place preference (CPP) in the same animals, showing that the DREADDs were effective in modulating behavior. These findings support a functional role of the PPTg and/or neighboring structures in PPI in accordance with previous lesion studies, but also provide strong evidence against the hypothesis that specifically cholinergic PPTg neurons are involved in mediating PPI, implicating rather non-cholinergic midbrain neurons.
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Affiliation(s)
- Niveen Fulcher
- University of Western Ontario, Schulich School of Medicine & Dentistry, Neuroscience Graduate Program, London, ON, N6A 5C1 Canada
| | - Erin Azzopardi
- University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Anatomy & Cell Biology, London, ON, N6A 5C1 Canada
| | - Cleusa De Oliveira
- University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Anatomy & Cell Biology, London, ON, N6A 5C1 Canada
| | - Roger Hudson
- University of Western Ontario, Schulich School of Medicine & Dentistry, Neuroscience Graduate Program, London, ON, N6A 5C1 Canada
| | - Ashley L Schormans
- University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Anatomy & Cell Biology, London, ON, N6A 5C1 Canada
| | - Tariq Zaman
- University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Anatomy & Cell Biology, London, ON, N6A 5C1 Canada
| | - Brian L Allman
- University of Western Ontario, Schulich School of Medicine & Dentistry, Neuroscience Graduate Program, London, ON, N6A 5C1 Canada; University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Anatomy & Cell Biology, London, ON, N6A 5C1 Canada
| | - Steven R Laviolette
- University of Western Ontario, Schulich School of Medicine & Dentistry, Neuroscience Graduate Program, London, ON, N6A 5C1 Canada; University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Anatomy & Cell Biology, London, ON, N6A 5C1 Canada
| | - Susanne Schmid
- University of Western Ontario, Schulich School of Medicine & Dentistry, Neuroscience Graduate Program, London, ON, N6A 5C1 Canada; University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Anatomy & Cell Biology, London, ON, N6A 5C1 Canada.
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