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Garcia-Cordero I, Vasilevskaya A, Taghdiri F, Khodadadi M, Mikulis D, Tarazi A, Mushtaque A, Anssari N, Colella B, Green R, Rogaeva E, Sato C, Grinberg M, Moreno D, Hussain MW, Blennow K, Zetterberg H, Davis KD, Wennberg R, Tator C, Tartaglia MC. Functional connectivity changes in neurodegenerative biomarker-positive athletes with repeated concussions. J Neurol 2024; 271:4180-4190. [PMID: 38589629 DOI: 10.1007/s00415-024-12340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
Multimodal biomarkers may identify former contact sports athletes with repeated concussions and at risk for dementia. Our study aims to investigate whether biomarker evidence of neurodegeneration in former professional athletes with repetitive concussions (ExPro) is associated with worse cognition and mood/behavior, brain atrophy, and altered functional connectivity. Forty-one contact sports athletes with repeated concussions were divided into neurodegenerative biomarker-positive (n = 16) and biomarker-negative (n = 25) groups based on positivity of serum neurofilament light-chain. Six healthy controls (negative for biomarkers) with no history of concussions were also analyzed. We calculated cognitive and mood/behavior composite scores from neuropsychological assessments. Gray matter volume maps and functional connectivity of the default mode, salience, and frontoparietal networks were compared between groups using ANCOVAs, controlling for age, and total intracranial volume. The association between the connectivity networks and sports characteristics was analyzed by multiple regression analysis in all ExPro. Participants presented normal-range mean performance in executive function, memory, and mood/behavior tests. The ExPro groups did not differ in professional years played, age at first participation in contact sports, and number of concussions. There were no differences in gray matter volume between groups. The neurodegenerative biomarker-positive group had lower connectivity in the default mode network (DMN) compared to the healthy controls and the neurodegenerative biomarker-negative group. DMN disconnection was associated with increased number of concussions in all ExPro. Biomarkers of neurodegeneration may be useful to detect athletes that are still cognitively normal, but with functional connectivity alterations after concussions and at risk of dementia.
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Affiliation(s)
- Indira Garcia-Cordero
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Anna Vasilevskaya
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - David Mikulis
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Apameh Tarazi
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Asma Mushtaque
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Neda Anssari
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
- Brain Vision and Concussion Clinic, Winnipeg, Canada
| | - Brenda Colella
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Robin Green
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Mark Grinberg
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Mohammed W Hussain
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Karen D Davis
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
- Krembil Brain Institute, University Health Network, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Richard Wennberg
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Charles Tator
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Maria C Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada.
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada.
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2
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de Souza DN, Jarmol M, Bell CA, Marini C, Balcer LJ, Galetta SL, Grossman SN. Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery. Brain Sci 2023; 13:1352. [PMID: 37759953 PMCID: PMC10526525 DOI: 10.3390/brainsci13091352] [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: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These types of reports may be influenced by a variety of factors for each individual, such as preexisting mental health conditions, headache disorders, and sleep conditions, among other factors. This can all be contributory to non-specific and potentially misleading clinical manifestations in the aftermath of a concussion. This review aimed to conduct an examination of the existing literature on emerging approaches for objectively evaluating potential concussion, as well as to highlight current gaps in understanding where further research is necessary. Objective assessments of visual and ocular motor concussion symptoms, specialized imaging techniques, and tissue-based concentrations of specific biomarkers have all shown promise for specifically characterizing diffuse brain injuries, and will be important to the future of concussion diagnosis and management. The consolidation of these approaches into a comprehensive examination progression will be the next horizon for increased precision in concussion diagnosis and treatment.
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Affiliation(s)
- Daniel N. de Souza
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Mitchell Jarmol
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Carter A. Bell
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Christina Marini
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Laura J. Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Steven L. Galetta
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Scott N. Grossman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
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Anderson ED, Talukdar T, Goodwin G, Di Pietro V, Yakoub KM, Zwilling CE, Davies D, Belli A, Barbey AK. Assessing blood oxygen level-dependent signal variability as a biomarker of brain injury in sport-related concussion. Brain Commun 2023; 5:fcad215. [PMID: 37649639 PMCID: PMC10465085 DOI: 10.1093/braincomms/fcad215] [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: 04/07/2022] [Revised: 07/02/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
Mild traumatic brain injury is a complex neurological disorder of significant concern among athletes who play contact sports. Athletes who sustain sport-related concussion typically undergo physical examination and neurocognitive evaluation to determine injury severity and return-to-play status. However, traumatic disruption to neurometabolic processes can occur with minimal detectable anatomic pathology or neurocognitive alteration, increasing the risk that athletes may be cleared for return-to-play during a vulnerable period and receive a repetitive injury. This underscores the need for sensitive functional neuroimaging methods to detect altered cerebral physiology in concussed athletes. The present study compared the efficacy of Immediate Post-concussion Assessment and Cognitive Testing composite scores and whole-brain measures of blood oxygen level-dependent signal variability for classifying concussion status and predicting concussion symptomatology in healthy, concussed and repetitively concussed athletes, assessing blood oxygen level-dependent signal variability as a potential diagnostic tool for characterizing functional alterations to cerebral physiology and assisting in the detection of sport-related concussion. We observed significant differences in regional blood oxygen level-dependent signal variability measures for concussed athletes but did not observe significant differences in Immediate Post-concussion Assessment and Cognitive Testing scores of concussed athletes. We further demonstrate that incorporating measures of functional brain alteration alongside Immediate Post-concussion Assessment and Cognitive Testing scores enhances the sensitivity and specificity of supervised random forest machine learning methods when classifying and predicting concussion status and post-concussion symptoms, suggesting that alterations to cerebrovascular status characterize unique variance that may aid in the detection of sport-related concussion and repetitive mild traumatic brain injury. These results indicate that altered blood oxygen level-dependent variability holds promise as a novel neurobiological marker for detecting alterations in cerebral perfusion and neuronal functioning in sport-related concussion, motivating future research to establish and validate clinical assessment protocols that can incorporate advanced neuroimaging methods to characterize altered cerebral physiology following mild traumatic brain injury.
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Affiliation(s)
- Evan D Anderson
- Decision Neuroscience Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- Air Force Research Laboratory, Wright-Patterson AFB, OH 45433, USA
| | - Tanveer Talukdar
- Decision Neuroscience Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Grace Goodwin
- Decision Neuroscience Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- Department of Psychology, University of Nevada, Las Vegas, NV 89557, USA
| | - Valentina Di Pietro
- Decision Neuroscience Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Kamal M Yakoub
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Christopher E Zwilling
- Decision Neuroscience Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - David Davies
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Antonio Belli
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Aron K Barbey
- Decision Neuroscience Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- Department of Psychology, University of Illinois, Urbana, IL 61801, USA
- Department of Bioengineering, University of Illinois, Urbana, IL 61801, USA
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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Campbell KR, Scanlan KT, Wilhelm JL, Brumbach BH, Pettigrew NC, Neilson A, Parrington L, King LA. Assessment of balance in people with mild traumatic brain injury using a balance systems model approach. Gait Posture 2023; 100:107-113. [PMID: 36516644 DOI: 10.1016/j.gaitpost.2022.12.005] [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: 07/07/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Measuring persistent imbalance after mTBI is challenging and may include subjective symptom-reporting as well as clinical scales. Clinical assessments for quantifying balance following mTBI have focused on sensory orientation. It is theorized that balance control goes beyond sensory orientation and also includes subdomains of anticipatory postural adjustments, reactive postural control, and dynamic gait. The Mini Balance Evaluation Systems Test (Mini-BESTest) is a validated balance test that measures balance according to these subdomains for a more comprehensive assessment. The purpose of this study was to compare Mini-BESTest total and subdomain scores after subacute mTBI with healthy controls. METHODS Symptomatic mTBI (n = 90, 20 % male, age=36.0 ± 12.0, 46.3.4 ± 22.1 days since injury) and healthy control (n = 45, 20 % male, age=35.4 ± 12.5) participants completed the Mini-BESTest for balance. Mini-BESTest between-group differences were evaluated using Wilcoxon rank-sum tests. RESULTS The mTBI group (Median[minimum,maximum]) had a significantly worse Mini-BESTest total score than the healthy controls (24[18,28] vs 27[23-28], p < 0.001). The mTBI group performed significantly worse in 3 of the 4 subdomains compared to the healthy controls: reactive postural control: 5[2-6] vs 6[3-6], p = 0.003; sensory orientation: 6[5,6] vs 6[6], p = 0.005; dynamic gait: 8[5-10] vs 9[8-10], p < 0.001. There was no significance difference between groups in the anticipatory postural adjustments domain (5[3-6] vs 5[3-6], p = 0.12). CONCLUSIONS The Mini-BESTest identified deficits in people with subacute mTBI in the total score and 3 out of 4 subdomains, suggesting it may be helpful to use in the clinic to identify balance subdomain deficits in the subacute mTBI population. In combination with self-reported assessments, the mini-BESTest may identify balance domain deficits in the subacute mTBI population and help guide treatment for this population.
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Affiliation(s)
- Kody R Campbell
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA.
| | - Kathleen T Scanlan
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA
| | - Jennifer L Wilhelm
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA
| | - Barbara H Brumbach
- Biostatistics & Design Program, Oregon Health & Science University, Portland, USA
| | - Natalie C Pettigrew
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA; Department of Neurology, Center for Regenerative Medicine, Oregon Health & Science University, Portland, USA
| | - Akira Neilson
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA
| | - Lucy Parrington
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; Department of Dietetics, Human Nutrition and Sport, School of Sport and Exercise Science, La Trobe University, Melbourne, Australia
| | - Laurie A King
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA
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Rauchman SH, Albert J, Pinkhasov A, Reiss AB. Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System. Neurol Int 2022; 14:453-470. [PMID: 35736619 PMCID: PMC9227114 DOI: 10.3390/neurolint14020038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.
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Affiliation(s)
- Steven H. Rauchman
- The Fresno Institute of Neuroscience, Fresno, CA 93730, USA
- Correspondence:
| | - Jacqueline Albert
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Allison B. Reiss
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
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7
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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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Ramage AE, Ray KL, Franz HM, Tate DF, Lewis JD, Robin DA. Cingulo-Opercular and Frontoparietal Network Control of Effort and Fatigue in Mild Traumatic Brain Injury. Front Hum Neurosci 2022; 15:788091. [PMID: 35221951 PMCID: PMC8866657 DOI: 10.3389/fnhum.2021.788091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Neural substrates of fatigue in traumatic brain injury (TBI) are not well understood despite the considerable burden of fatigue on return to productivity. Fatigue is associated with diminishing performance under conditions of high cognitive demand, sense of effort, or need for motivation, all of which are associated with cognitive control brain network integrity. We hypothesize that the pathophysiology of TBI results in damage to diffuse cognitive control networks, disrupting coordination of moment-to-moment monitoring, prediction, and regulation of behavior. We investigate the cingulo-opercular (CO) and frontoparietal (FP) networks, which are engaged to sustain attention for task and maintain performance. A total of 61 individuals with mild TBI and 42 orthopedic control subjects participated in functional MRI during performance of a constant effort task requiring altering the amount of effort (25, 50, or 75% of maximum effort) utilized to manually squeeze a pneumostatic bulb across six 30-s trials. Network-based statistics assessed within-network organization and fluctuation with task manipulations by group. Results demonstrate small group differences in network organization, but considerable group differences in the evolution of task-related modulation of connectivity. The mild TBI group demonstrated elevated CO connectivity throughout the task with little variation in effort level or time on task (TOT), while CO connectivity diminished over time in controls. Several interregional CO connections were predictive of fatigue in the TBI group. In contrast, FP connectivity fluctuated with task manipulations and predicted fatigue in the controls, but connectivity fluctuations were delayed in the mild traumatic brain injury (mTBI) group and did not relate to fatigue. Thus, the mTBI group's hyper-connectivity of the CO irrespective of task demands, along with hypo-connectivity and delayed peak connectivity of the FP, may allow for attainment of task goals, but also contributes to fatigue. Findings are discussed in relation to performance monitoring of prediction error that relies on internal cues from sensorimotor feedback during task performance. Delay or inability to detect and respond to prediction errors in TBI, particularly evident in bilateral insula-temporal CO connectivity, corresponds to day-to-day fatigue and fatigue during task performance.
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Affiliation(s)
- Amy E. Ramage
- Interdisciplinary Program in Behavioral Neuroscience, Department of Communication Sciences and Disorders and Biological Sciences, University of New Hampshire, Durham, NH, United States
| | - Kimberly L. Ray
- Department of Psychology, University of Texas, Austin, TX, United States
| | - Hannah M. Franz
- Interdisciplinary Program in Behavioral Neuroscience, Department of Communication Sciences and Disorders and Biological Sciences, University of New Hampshire, Durham, NH, United States
| | - David F. Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jeffrey D. Lewis
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Dayton, OH, United States
| | - Donald A. Robin
- Interdisciplinary Program in Behavioral Neuroscience, Department of Communication Sciences and Disorders and Biological Sciences, University of New Hampshire, Durham, NH, United States
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9
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Bergauer A, van Osch R, van Elferen S, Gyllvik S, Venkatesh H, Schreiber R. The diagnostic potential of fluid and imaging biomarkers in chronic traumatic encephalopathy (CTE). Pharmacotherapy 2022; 146:112602. [PMID: 35062068 DOI: 10.1016/j.biopha.2021.112602] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/25/2021] [Indexed: 12/19/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by cognitive, affective, and motor dysfunction. The main pathophysiological mechanisms are chronic neuroinflammation, hyper-phosphorylated tau (p-tau) accumulation and neurodegeneration. CTE is mostly caused by exposure to multiple mild traumatic brain injuries, placing people participating in, for example, high contact sports at increased risk. Currently, CTE can solely be diagnosed post mortem based on the spatial pattern of tau-accumulation. Herein, we review candidate imaging and molecular biomarkers for their sensitivity and specificity and we look whether these are sufficient for reliable ante mortem diagnosis. Of the imaging biomarkers, PET appears to have the best potential. Candidate fluid biomarkers consist of genes and proteins found in brain derived extracellular vesicles, as well as cerebrospinal fluid (CSF) p-tau levels. However, neither these biomarkers nor the imaging biomarkers have the discriminatory power to differentiate between CTE and other tauopathies, highlighting the need for further validation. Future research could incorporate machine learning methodologies to differentiate between the tau accumulation patterns detected by PET/fMRI in Alzheimer's and CTE patients. Additionally, proteomic and metabolomic profiling of CSF and plasma associated with chronic mild traumatic brain injuries could highlight potential biomarkers for identifying at risk patients.
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Affiliation(s)
- Anna Bergauer
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, The Netherlands
| | - Robin van Osch
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, The Netherlands
| | - Silke van Elferen
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, The Netherlands
| | - Sofia Gyllvik
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, The Netherlands
| | - Hrishikesh Venkatesh
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, The Netherlands
| | - Rudy Schreiber
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, The Netherlands.
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10
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Lirani-Silva E, Stuart S, Parrington L, Campbell K, King L. Saccade and Fixation Eye Movements During Walking in People With Mild Traumatic Brain Injury. Front Bioeng Biotechnol 2021; 9:701712. [PMID: 34805104 PMCID: PMC8602343 DOI: 10.3389/fbioe.2021.701712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Clinical and laboratory assessment of people with mild traumatic brain injury (mTBI) indicate impairments in eye movements. These tests are typically done in a static, seated position. Recently, the use of mobile eye-tracking systems has been proposed to quantify subtle deficits in eye movements and visual sampling during different tasks. However, the impact of mTBI on eye movements during functional tasks such as walking remains unknown. Objective: Evaluate differences in eye-tracking measures collected during gait between healthy controls (HC) and patients in the sub-acute stages of mTBI recovery and to determine if there are associations between eye-tracking measures and gait speed. Methods: Thirty-seven HC participants and 67individuals with mTBI were instructed to walk back and forth over 10-m, at a comfortable self-selected speed. A single 1-min trial was performed. Eye-tracking measures were recorded using a mobile eye-tracking system (head-mounted infra-red Tobbii Pro Glasses 2, 100 Hz, Tobii Technology Inc. VA, United States). Eye-tracking measures included saccadic (frequency, mean and peak velocity, duration and distance) and fixation measurements (frequency and duration). Gait was assessed using six inertial sensors (both feet, sternum, right wrist, lumbar vertebrae and the forehead) and gait velocity was selected as the primary outcome. General linear model was used to compare the groups and association between gait and eye-tracking outcomes were explored using partial correlations. Results: Individuals with mTBI showed significantly reduced saccade frequency (p = 0.016), duration (p = 0.028) and peak velocity (p = 0.032) compared to the HC group. No significant differences between groups were observed for the saccade distance, fixation measures and gait velocity (p > 0.05). A positive correlation was observed between saccade duration and gait velocity only for participants with mTBI (p = 0.025). Conclusion: Findings suggest impaired saccadic eye movement, but not fixations, during walking in individuals with mTBI. These findings have implications in real-world function including return to sport for athletes and return to duty for military service members. Future research should investigate whether or not saccade outcomes are influenced by the time after the trauma and rehabilitation.
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Affiliation(s)
- Ellen Lirani-Silva
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom.,Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
| | - Lucy Parrington
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
| | - Kody Campbell
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
| | - Laurie King
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
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11
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Lees B, Earls NE, Meares S, Batchelor J, Oxenham V, Rae CD, Jugé L, Cysique LA. Diffusion Tensor Imaging in Sport-Related Concussion: A Systematic Review Using an a priori Quality Rating System. J Neurotrauma 2021; 38:3032-3046. [PMID: 34309410 DOI: 10.1089/neu.2021.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diffusion tensor imaging (DTI) of brain white matter (WM) may be useful for characterizing the nature and degree of brain injury after sport-related concussion (SRC) and assist in establishing objective diagnostic and prognostic biomarkers. This study aimed to conduct a systematic review using an a priori quality rating strategy to determine the most consistent DTI-WM changes post-SRC. Articles published in English (until June 2020) were retrieved by standard research engine and gray literature searches (N = 4932), using PRISMA guidelines. Eligible studies were non-interventional naturalistic original studies that conducted DTI within 6 months of SRC in current athletes from all levels of play, types of sports, and sex. A total of 29 articles were included in the review, and after quality appraisal by two raters, data from 10 studies were extracted after being identified as high quality. High-quality studies showed widespread moderate-to-large WM differences when SRC samples were compared to controls during the acute to early chronic stage (days to weeks) post-SRC, including both increased and decreased fractional anisotropy and axial diffusivity and decreased mean diffusivity and radial diffusivity. WM differences remained stable in the chronic stage (2-6 months post-SRC). DTI metrics were commonly associated with SRC symptom severity, although standardized SRC diagnostics would improve future research. This indicates that microstructural recovery is often incomplete at return to play and may lag behind clinically assessed recovery measures. Future work should explore interindividual trajectories to improve understanding of the heterogeneous and dynamic WM patterns post-SRC.
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Affiliation(s)
- Briana Lees
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicola E Earls
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Susanne Meares
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer Batchelor
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Vincent Oxenham
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Caroline D Rae
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lucette A Cysique
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,St. Vincent's Hospital Applied Medical Research Centre, Peter Duncan Neuroscience, Sydney, New South Wales, Australia.,School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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12
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Koerte IK, Esopenko C, Hinds SR, Shenton ME, Bonke EM, Bazarian JJ, Bickart KC, Bigler ED, Bouix S, Buckley TA, Choe MC, Echlin PS, Gill J, Giza CC, Hayes J, Hodges CB, Irimia A, Johnson PK, Kenney K, Levin HS, Lin AP, Lindsey HM, Lipton ML, Max JE, Mayer AR, Meier TB, Merchant-Borna K, Merkley TL, Mills BD, Newsome MR, Porfido T, Stephens JA, Tartaglia MC, Ware AL, Zafonte RD, Zeineh MM, Thompson PM, Tate DF, Dennis EL, Wilde EA, Baron D. The ENIGMA sports injury working group:- an international collaboration to further our understanding of sport-related brain injury. Brain Imaging Behav 2021; 15:576-584. [PMID: 32720179 PMCID: PMC7855299 DOI: 10.1007/s11682-020-00370-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sport-related brain injury is very common, and the potential long-term effects include a wide range of neurological and psychiatric symptoms, and potentially neurodegeneration. Around the globe, researchers are conducting neuroimaging studies on primarily homogenous samples of athletes. However, neuroimaging studies are expensive and time consuming, and thus current findings from studies of sport-related brain injury are often limited by small sample sizes. Further, current studies apply a variety of neuroimaging techniques and analysis tools which limit comparability among studies. The ENIGMA Sports Injury working group aims to provide a platform for data sharing and collaborative data analysis thereby leveraging existing data and expertise. By harmonizing data from a large number of studies from around the globe, we will work towards reproducibility of previously published findings and towards addressing important research questions with regard to diagnosis, prognosis, and efficacy of treatment for sport-related brain injury. Moreover, the ENIGMA Sports Injury working group is committed to providing recommendations for future prospective data acquisition to enhance data quality and scientific rigor.
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Affiliation(s)
- Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität München, Waltherstr. 23, 80337, Munich, Germany.
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Science, Rutgers Biomedical Health Sciences, Newark, NJ, USA
- School of Graduate Studies, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Sidney R Hinds
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Elena M Bonke
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität München, Waltherstr. 23, 80337, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - Jeffrey J Bazarian
- Departments of Emergency Medicine & Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Kevin C Bickart
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Neurology and Neuropsychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, 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
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Meeryo C Choe
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, ON, Canada
| | - Jessica Gill
- Department of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jasmeet Hayes
- Psychology Department, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, 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
| | - Paula K Johnson
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, 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
| | - 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
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Michael L Lipton
- Departments of Radiology, Psychiatry and Behavioral Sciences and The Dominick P. Purpura Department of Neuroscience, The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Radiology, Montefiore Medicine, Bronx, NY, USA
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, Rady Children's Hospital, San Diego, CA, USA
| | - Andrew R Mayer
- Mind Research Network, Albuquerque, NM, USA
- Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kian Merchant-Borna
- Departments of Emergency Medicine & Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Tricia L Merkley
- 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
| | - Brian D Mills
- Department of Radiology, Stanford University, Stanford, CA, 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
| | - Tara Porfido
- School of Graduate Studies, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Jaclyn A Stephens
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Maria Carmela Tartaglia
- Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross D Zafonte
- 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
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - 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
| | - 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
| | - David Baron
- Western University of Health Sciences, Pomona, CA, USA
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13
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Abstract
Objective Current clinical guidelines provide a unitary approach to manage sport-related concussion (SRC), while heterogeneity in the presentation of symptoms suggests that subtypes of SRC may exist. We systematically reviewed the available evidence on SRC subtypes and associated clinical outcomes. Data Sources Ovid Medline, Embase, PsycINFO, and SPORTDiscus Eligibility Criteria for Selecting Studies Electronic databases were searched for studies: (i) identifying SRC symptom clusters using classification methodology; or (ii) associating symptom clusters to clinical outcome variables. A total of 6,146 unique studies were identified, of which 75 full texts were independently assessed by two authors for eligibility. A total of 22 articles were included for systematic review. Data Extraction Two independent authors performed data extraction and risk of bias analysis using the Cochrane Collaboration tool. Data Synthesis Six studies found evidence for existence of SRC symptom clusters. Combining the available literature through Multiple Correspondence Analysis (MCA) provided evidence for the existence of a migraine cluster, a cognitive–emotional cluster, a sleep–emotional cluster, a neurological cluster, and an undefined feelings cluster. Nineteen studies found meaningful associations between SRC symptom clusters and clinical outcomes. Clusters mapping to the migraine cluster were most frequently reported in the literature and were most strongly related to aspects of clinical outcome. Conclusions The available literature provides evidence for the existence of at least five subtypes in SRC symptomatology, with clear relevance to clinical outcome. Systematically embedding the differentiation of SRC subtypes into prognosis, clinical management, and intervention strategies may optimize the recovery from SRC. Electronic supplementary material The online version of this article (10.1007/s40279-020-01321-9) contains supplementary material, which is available to authorized users.
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14
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Rauterkus G, Moncrieff D, Stewart G, Skoe E. Baseline, retest, and post-injury profiles of auditory neural function in collegiate football players. Int J Audiol 2021; 60:650-662. [PMID: 33439060 DOI: 10.1080/14992027.2020.1860261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Recent retrospective studies report differences in auditory neurophysiology between concussed athletes and uninjured controls using the frequency-following response (FFR). Adopting a prospective design in college football players, we compared FFRs before and after a concussion and evaluated test-retest reliability in non-concussed teammates. DESIGN Testing took place in a locker room. We analysed the FFR to the fundamental frequency (F0) (FFR-F0) of a speech stimulus, previously identified as a potential concussion biomarker. Baseline FFRs were obtained during the football pre-season. In athletes diagnosed with concussions during the season, FFRs were measured days after injury and compared to pre-season baseline. In uninjured controls, comparisons were made between pre- and post-season. STUDY SAMPLE Participants were Tulane University football athletes (n = 65). RESULTS In concussed athletes, there was a significant group-level decrease in FFR-F0 from baseline (26% decrease on average). By contrast, the control group's change from baseline was not statistically significant, and comparisons of pre- and post-season had good repeatability (intraclass correlation coefficient = 0.75). CONCLUSIONS Results converge with previous work to evince suppressed neural function to the FFR-F0 following concussion. This preliminary study paves the way for larger-scale clinical evaluation of the specificity and reliability of the FFR as a concussion diagnostic.HighlightsThis prospective study reveals suppressed neural responses to sound in concussed athletes compared to baseline.Neural responses to sound show good repeatability in uninjured athletes tested in a locker-room setting.Results support the feasibility of recording frequency-following responses in non-laboratory conditions.
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Affiliation(s)
- Grant Rauterkus
- Center for Sport, Tulane University School of Medicine, New Orleans, LA, USA
| | - Deborah Moncrieff
- School of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA
| | - Gregory Stewart
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Erika Skoe
- Department of Speech, Language, and Hearing Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, USA
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15
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Prien A, Feddermann-Demont N, Verhagen E, Twisk J, Junge A. Neurocognitive performance and mental health of retired female football players compared to non-contact sport athletes. BMJ Open Sport Exerc Med 2020; 6:e000952. [PMID: 33312682 PMCID: PMC7716672 DOI: 10.1136/bmjsem-2020-000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Adverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date, no studies have evaluated such effects in women. Aims To (1) compare neurocognitive performance, cognitive symptoms and mental health in retired elite female football players (FB) with retired elite female non-contact sport athletes (CON), and to (2) assess whether findings are related to history of concussion and/or heading exposure in FB. Methods Neurocognitive performance, mental health and cognitive symptoms were assessed using computerised tests (CNS-vital signs), paper pen tests (Category fluency, Trail-Making Test, Digit Span, Paced Auditory Serial Addition Test), questionnaires (Hospital Anxiety and Depression Scale, SF-36v2 Health Survey) and a symptom checklist. Heading exposure and concussion history were self-reported in an online survey and in a clinical interview, respectively. Linear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders. Results FB (n=66) performed similar to CON (n=45) on neurocognitive tests, except for significantly lower scores on verbal memory (mean difference (MD)=−7.038, 95% CI −12.98 to –0.08, p=0.038) and verbal fluency tests (MD=−7.534, 95% CI –13.75 to –0.46, p=0.016). Among FB weaker verbal fluency performance was significantly associated with ≥2 concussions (MD=−10.36, 95% CI –18.48 to –2.83, p=0.017), and weaker verbal memory performance with frequent heading (MD=−9.166, 95% CI –17.59 to –0.123, p=0.041). The depression score differed significantly between study populations, and was significantly associated with frequent heading but not with history of concussion in FB. Conclusion Further studies should investigate the clinical relevance of our findings and whether the observed associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health.
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Affiliation(s)
- Annika Prien
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Human Biology, Division of Exercise Science and Sports Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jos Twisk
- Epidemiology and Biostatistics, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Astrid Junge
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
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16
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de Souza NL, Dennis EL, Brown AM, Singh S, Wilde EA, Buckman JF, Esopenko C. Relation between Isometric Neck Strength and White Matter Organization in Collegiate Athletes. Neurotrauma Rep 2020; 1:232-240. [PMID: 34223543 PMCID: PMC8240886 DOI: 10.1089/neur.2020.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Soccer athletes frequently experience repetitive head impacts (RHI) during games and practices, which may affect neural integrity over time and lead to altered brain structure. Neck strength is hypothesized to limit the transfer of force to the brain and decrease the effect of RHI on brain structure. The goal of our work was to examine whether greater neck strength is associated with more intact white matter organization (WMO) in collegiate athletes exposed to RHI. Collegiate soccer (n = 17) and limited/non-contact sport (n = 39) athletes were assessed prior to their athletic seasons. Participants completed neck strength assessments using handheld dynamometry in six test positions and diffusion tensor imaging. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated for 20 white matter (WM) regions. A multi-variate approach was used to examine the relationship between neck strength and diffusion measures in soccer and limited/non-contact athletes. Neck strength was positively associated with FA and negatively associated with RD across several WM regions in soccer players only. Neck strength was not significantly associated with MD or AD in either group. Greater neck strength was related to more intact WMO in athletes with high exposure to RHI, particularly in regions prone to damage from brain trauma such as the basal ganglia, superior longitudinal fasciculus, and frontoparietal WM. Future studies should examine neck strength as a factor to moderate neural outcomes in athletes with exposure to RHI.
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Affiliation(s)
- Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Allison M Brown
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Sasha Singh
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, Piscataway, New Jersey, USA
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
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17
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Morris A, Cassidy B, Pelo R, Fino NF, Presson AP, Cushman DM, Monson NE, Dibble LE, Fino PC. Reactive Postural Responses After Mild Traumatic Brain Injury and Their Association With Musculoskeletal Injury Risk in Collegiate Athletes: A Study Protocol. Front Sports Act Living 2020; 2:574848. [PMID: 33345138 PMCID: PMC7739642 DOI: 10.3389/fspor.2020.574848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Deficits in neuromuscular control are widely reported after mild traumatic brain injury (mTBI). These deficits are speculated to contribute to the increased rate of musculoskeletal injuries after mTBI. However, a concrete mechanistic connection between post-mTBI deficits and musculoskeletal injuries has yet to be established. While impairments in some domains of balance control have been linked to musculoskeletal injuries, reactive balance control has received little attention in the mTBI literature, despite the inherent demand of balance recovery in athletics. Our central hypothesis is that the high rate of musculoskeletal injuries after mTBI is in part due to impaired reactive balance control necessary for balance recovery. The purpose of this study is to (1) characterize reactive postural responses to recover balance in athletes with recent mTBI compared to healthy control subjects, (2) determine the extent to which reactive postural responses remain impaired in athletes with recent mTBI who have been cleared to return to play, and (3) determine the relationship between reactive postural responses and acute lower extremity musculoskeletal injuries in a general sample of healthy collegiate athletes. Methods: This two-phase study will take place at the University of Utah in coordination with the University of Utah Athletics Department. Phase 1 will evaluate student-athletes who have sustained mTBI and teammate-matched controls who meet all the inclusion criteria. The participants will be assessed at multiple time points along the return-to-play progress of the athlete with mTBI. The primary outcome will be measures of reactive postural response derived from wearable sensors during the Push and Release (P&R) test. In phase 2, student-athletes will undergo a baseline assessment of postural responses. Acute lower extremity musculoskeletal injuries for each participant will be prospectively tracked for 1 year from the date of first team activity. The primary outcomes will be the measures of reactive postural responses and the time from first team activity to lower extremity injury. Discussion: Results from this study will further our understanding of changes in balance control, across all domains, after mTBI and identify the extent to which postural responses can be used to assess injury risk in collegiate athletes.
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Affiliation(s)
- Amanda Morris
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Benjamin Cassidy
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Ryan Pelo
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Nora F Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Daniel M Cushman
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Nicholas E Monson
- Department of Orthopaedic Surgery Operations, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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Lefebvre G, Guay S, Chamard E, Theaud G, de Guise E, Bacon BA, Descoteaux M, De Beaumont L, Théoret H. Diffusion Tensor Imaging in Contact and Non-Contact University-Level Sport Athletes. J Neurotrauma 2020; 38:529-537. [PMID: 32640880 DOI: 10.1089/neu.2020.7170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Subconcussive hits to the head and physical fitness both have been associated with alterations in white matter (WM) microstructure in partly overlapping areas of the brain. The aim of the present study was to determine whether WM damage associated with repeated exposure to subconcussive hits to the head in university level contact sports athletes is modulated by high levels of fitness. To this end, 72 students were recruited: 24 athletes practicing a varsity contact sport (A-CS), 24 athletes practicing a varsity non-contact sport (A-NCS), and 24 healthy non-athletes (NA). Participants underwent a magnetic resonance imaging session that included diffusion-weighted imaging. Between-groups, statistical analyses were performed with diffusion tensor imaging measures extracted by tractometry of sections of the corpus callosum and the corticospinal tract. Most significant effects were found in A-NCS who exhibited higher fractional anisotropy (FA) values than A-CS in almost all segments of the corpus callosum and in the corticospinal tract. The A-NCS also showed higher FA compared with NA in the anterior regions of the corpus callosum and the corticospinal tracts. No group difference was found between the A-CS and the NA groups. These data suggest that repeated subconcussive hits to the head lead to anisotropic changes in the WM that may counteract the beneficial effects associated with high levels of fitness.
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Affiliation(s)
- Geneviève Lefebvre
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | - Samuel Guay
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | - Emilie Chamard
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Elaine de Guise
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | | | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis De Beaumont
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Hugo Théoret
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada.,Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
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Mills BD, Goubran M, Parivash SN, Dennis EL, Rezaii P, Akers C, Bian W, Mitchell LA, Boldt B, Douglas D, Sami S, Mouchawar N, Wilson EW, DiGiacomo P, Parekh M, Do H, Lopez J, Rosenberg J, Camarillo D, Grant G, Wintermark M, Zeineh M. Longitudinal alteration of cortical thickness and volume in high-impact sports. Neuroimage 2020; 217:116864. [DOI: 10.1016/j.neuroimage.2020.116864] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023] Open
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Abstract
PURPOSE OF REVIEW Between 1.6 and 3.6 million concussions, or mild traumatic brain injuries (mTBI), occur each year, nearly half of which go unreported and untreated. Despite the high incidence, practitioners currently lack both objective gold-standard diagnostic tools and evidence-based treatments to enable optimal care of concussed individuals. RECENT FINDINGS This article aims to review recent research on the topic, emphasizing the role of the autonomic nervous system (ANS) in concussion. Current data suggests that ANS dysfunction is often evident following mTBI and accounts for many of the symptoms commonly seen in concussed patients. This link suggests several objective biomarkers that could be used to diagnose and monitor recovery following mTBI. Contrary to conventional wisdom, symptoms and biomarkers of ANS function improve when individuals are exposed to a program of graded exercise as treatment within the first week following concussion. SUMMARY ANS dysfunction contributes to concussion symptomatology, an effect likely mediated through diffuse axonal injury, including brainstem structures and pathways mediating normal cerebrovascular autoregulation. Exercise, which enhances ANS function, is a well tolerated and effective method of treatment for both acute concussion patients and those suffering from postconcussion syndrome (PCS). The relationship between the ANS, exercise, and concussion creates an opportunity for the identification of objective biomarkers that can facilitate the diagnosis and treatment of mTBI.
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Li W, Chang C, Liang S, Bigler ED. Radiographic and neurobehavioral profile of sports-related concussion associated with scholastic wrestling: a case report. Neurocase 2020; 26:147-155. [PMID: 32412324 DOI: 10.1080/13554794.2020.1764977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sports-related concussions (SRCs) are typically characterized by transient neurologic deficits due to physiologic and metabolic brain injury. However, following an SRC, subsequent insults may lead to severe and permanent injury in the affected brain cells. We present the case of a 15-year-old female scholastic wrestler who developed acute encephalopathy, macroscopic white matter injury on imaging, and chronic behavioral changes from inadequate neuro-recovery after a documented SRC. We also compare her case with established SRC data, demonstrating that wrestling-related concussions and repetitive head impacts can produce similar degrees of diffuse neuroinflammation, myelinated axonopathy, blood-brain barrier disruption, and post-concussive symptoms.
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Affiliation(s)
- Wentao Li
- Department of Neurology, University of California Davis , Sacramento, USA
| | - Celia Chang
- Department of Neurology, Division of Pediatric Neurology, University of California Davis , Sacramento, USA
| | - Shannon Liang
- Department of Neurology, Division of Pediatric Neurology, University of California Davis , Sacramento, USA
| | - Erin D Bigler
- Department of Neurology, University of California Davis , Sacramento, USA.,Department of Psychology and Neuroscience, Magnetic Resonance Imaging (MRI) Research Facility, Brigham Young University , Provo, USA.,Department of Neurology and Department of Psychiatry, University of Utah , Salt Lake City, USA
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22
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Mild traumatic brain injury: The effect of age at trauma onset on brain structure integrity. NEUROIMAGE-CLINICAL 2019; 23:101907. [PMID: 31233955 PMCID: PMC6595074 DOI: 10.1016/j.nicl.2019.101907] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022]
Abstract
Mounting evidence suggests that mild traumatic brain injuries (mTBI) have long-term effects that interact with the aging process to precipitate cognitive decline. This line of research predicts that early exposure to brain trauma is particularly detrimental to long-term brain integrity. However, a second line of research into the effects of age at trauma onset predict that older brains are more vulnerable to the effects of mTBI than younger brains. We sought to determine whether patients who sustain a mTBI earlier in life fare better than patients who sustain a mTBI at an older age. We conducted a multi-cohort, case-control study, with participants randomly sampled from a population of patients with a history of mTBI. We recruited two cohorts of aging participants (N = 74, mean [SD] = 61.16 [6.41]) matched in age and education levels that differed in only one respect: age at mTBI onset. One cohort sustained their concussion in their early twenties (24.60 [6.34] y/o), the other in their early sixties (61.05 [4.90] y/o). Each mTBI cohort had its own matched control group. Participants underwent high-resolution MRI at 3 Tesla for T1 and diffusion-weighted images (DWI) acquisition. Images were processed and analyzed using Deformation-Based Morphometry and DWI Tract-Based Spatial Statistics to identify group differences in a 2 × 2 ANOVA design. Results showed a significant interaction on DWI measures of white matter integrity indicating larger anomalies in participants who sustained a mTBI at a younger age (F1,70, P < .05, FDR corrected). These findings suggest that mTBI initiates a lifelong neurodegeneration process that outweighs the risks associated with sustaining a mTBI at an older age. Implications are important for young athletes' populations exposed to the risk of mTBI in the practice of their sports and for retired athletes aging with a history of concussions sustained at a younger age. In aging adults, early-life mTBI leads to worst brain outcome than late-life mTBI. Brain anomalies are mostly visible using DWI measures of white matter integrity. Brain anomalies are visible even in neurologically normal individuals.
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Abstract
The underlying mechanisms that result in neurophysiological changes and cognitive sequelae in the context of repetitive mild traumatic brain injury (rmTBI) remain poorly understood. Animal models provide a unique opportunity to examine cellular and molecular responses using histological assessment, which can give important insights on the neurophysiological changes associated with the evolution of brain injury. To better understand the potential cumulative effects of multiple concussions, the focus of animal models is shifting from single to repetitive head impacts. With a growing body of literature on this subject, a review and discussion of current findings is valuable to better understand the neuropathology associated with rmTBI, to evaluate the current state of the field, and to guide future research efforts. Despite variability in experimental settings, existing animal models of rmTBI have contributed to our understanding of the underlying mechanisms following repeat concussion. However, how to reconcile the various impact methods remains one of the major challenges in the field today.
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Affiliation(s)
- Wouter S Hoogenboom
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Clinical Investigation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA.
| | - Craig A Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Physiology and Biophysics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
| | - Michael L Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Departments of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
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Benou I, Veksler R, Friedman A, Raviv TR. Combining white matter diffusion and geometry for tract-specific alignment and variability analysis. Neuroimage 2019; 200:674-689. [PMID: 31096057 DOI: 10.1016/j.neuroimage.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 02/01/2023] Open
Abstract
We present a framework for along-tract analysis of white matter (WM) fiber bundles based on diffusion tensor imaging (DTI) and tractography. We introduce the novel concept of fiber-flux density for modeling fiber tracts' geometry, and combine it with diffusion-based measures to define vector descriptors called Fiber-Flux Diffusion Density (FFDD). The proposed model captures informative features of WM tracts at both the microscopic (diffusion-related) and macroscopic (geometry-related) scales, thus enabling improved sensitivity to subtle structural abnormalities that are not reflected by either diffusion or geometrical properties alone. A key step in this framework is the construction of an FFDD dissimilarity measure for sub-voxel alignment of fiber bundles, based on the fast marching method (FMM). The obtained aligned WM tracts enable meaningful inter-subject comparisons and group-wise statistical analysis. Moreover, we show that the FMM alignment can be generalized in a straight forward manner to a single-shot co-alignment of multiple fiber bundles. The proposed alignment technique is shown to outperform a well-established, commonly used DTI registration algorithm. We demonstrate the FFDD framework on the Human Connectome Project (HCP) diffusion MRI dataset, as well as on two different datasets of contact sports players. We test our method using longitudinal scans of a basketball player diagnosed with a traumatic brain injury, showing compatibility with structural MRI findings. We further perform a group study comparing mid- and post-season scans of 13 active football players exposed to repetitive head trauma, to 17 non-player control (NPC) subjects. Results reveal statistically significant FFDD differences (p-values<0.05) between the groups, as well as increased abnormalities over time at spatially-consistent locations within several major fiber tracts of football players.
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Affiliation(s)
- Itay Benou
- Department of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ronel Veksler
- Department of Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Friedman
- Department of Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Departments of Medical Neuroscience and Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, Canada
| | - Tammy Riklin Raviv
- Department of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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