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Cox AW, Fernandes MA. Long-term cognitive and affective consequences of mild traumatic brain injury: comparison with older adults. Brain Inj 2024:1-14. [PMID: 38994705 DOI: 10.1080/02699052.2024.2376769] [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: 02/02/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Memory and affective processing were compared in young adults with a remote mild traumatic brain injury (mTBI), to healthy younger and older adults. We evaluated memory performance when encoding was done under multi-tasking (divided attention) conditions, likely to exacerbate cognitive and psychological symptoms in mTBI. METHODS Participants studied pairs of unrelated words under either full or divided attention conditions. Memory for single words (item memory) and for pairs of words (associative memory) was then assessed in sequential independent recognition tests, under full attention. RESULTS Associative memory was poorer than item memory, and worse when encoding was done under divided than full attention. The decline in recognition accuracy from full to divided attention conditions on the associative memory test was significantly greater in mTBI compared to young adults and was similar in magnitude to that observed in older adults under full attention. Self-reported mental and total fatigue increased significantly as performance on the memory tests, following the divided attention condition, decreased, but only in the mTBI group. CONCLUSIONS Results show lingering memory deficits, and suggest that cognitive tasks may be experienced as psychologically more demanding in those with a mTBI, even months or years after injury.
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Affiliation(s)
- Adam William Cox
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Myra A Fernandes
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
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Ivins B, Risling M, Wisén N, Schwab K, Rostami E. Mild Traumatic Brain Injury in the Maturing Brain: An Investigation of Symptoms and Cognitive Performance in Soldiers Returning From Afghanistan and Iraq. J Head Trauma Rehabil 2024; 39:304-317. [PMID: 38059837 DOI: 10.1097/htr.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The majority of traumatic brain injuries (TBIs) are classified as mild and occur in young individuals. The course of recovery varies but can result in chronic or troubling outcomes. The impact of age on TBI outcomes in young adults before complete brain maturation is not well studied. METHODS In this study, we compared the effects of mild TBI on cognitive performance and self-reported TBI symptoms and posttraumatic stress disorder (PTSD) in 903 soldiers in 3 different age groups: 24 years or younger, 25 to 27 years, and 28 to 40 years. The soldiers had returned from war zones in Iraq and were screened for TBI within a few days of return. Cognitive performance was measured with the Automated Neuropsychological Assessment Metrics of Military TBI Version 4 (ANAM4). Symptoms associated with mild TBI were self-reported on the Neurobehavioral Symptom Inventory, and the PTSD Checklist-Civilian Version (PCL-C). RESULTS Soldiers with TBI in every age group had significantly higher prevalence of most symptoms than those with no TBI. Soldiers with TBI also reported more chronic pain sites, regardless of age. Soldiers aged 28 to 40 years with TBI had the lowest cognitive performance scores (ANAM) across several subtests, both unadjusted and adjusted. The Global Deficit Score was significantly higher for soldiers aged 28 to 40 years and 25 to 27 years with TBI than for soldiers younger than 24 years with no TBI. After adjusting for PTSD symptoms, education, and number of lifetime TBIs, the overall test battery mean for soldiers aged 28 to 40 years with TBI was significantly lower than for soldiers younger than 24 years with no TBI. CONCLUSION Soldiers with mild TBI in the younger age group show more symptoms associated to frontal lobe function while soldiers in the older group suffer more cognitive impairment. This may warrant further study as it may indicate a propensity to later cognitive decline among soldiers who were older at the time of injury.
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Affiliation(s)
- Brian Ivins
- Author Affiliations: Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Mr Ivins); GDIT, Fairfax, Virginia (Mr Ivins); Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Schwab); Department of Neuroscience, Karolinska Institute, Stockholm, Sweden (Drs Risling and Rostami, and Mr Wisén); and Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden (Dr Rostami)
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de Geus EQJ, Milders MV, van Horn JE, Jonker FA, Fassaert T, Hutten JC, Kuipers F, Grimbergen C, Noordermeer SDS. A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:311-338. [PMID: 38527155 DOI: 10.1002/cbm.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.
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Affiliation(s)
- Esther Q J de Geus
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten V Milders
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Frank A Jonker
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Altrecht, Vesalius, Amsterdam, The Netherlands
| | | | | | | | | | - Siri D S Noordermeer
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Schaffert J, LoBue C, Chiang HS, Peters ME, Hart Jr J, Cullum CM. Traumatic Brain Injury Characteristics Are Not Related to Neurocognitive Decline in Older Adults: A Nationwide Longitudinal Cohort Study. Arch Clin Neuropsychol 2024; 39:325-334. [PMID: 38332549 PMCID: PMC11042919 DOI: 10.1093/arclin/acae003] [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: 10/23/2023] [Revised: 12/13/2023] [Accepted: 01/17/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE Evaluate whether traumatic brain injury (TBI) characteristics, age of injury, or recency of injury predicts the course of neurocognitive decline and/or increases conversion rates to mild cognitive impairment (MCI) or dementia. METHODS Data were obtained from the National Alzheimer's Coordinating Center for participants 50-85 years old with 3-5 visits from 2015 to 2022, with or without TBI history (TBI+ = 508; TBI- = 2,382). Groups were stratified by self-reported TBI history (i.e., single TBI without loss of consciousness [LOC], single TBI with LOC, multiple TBI without LOC, and multiple TBI with LOC), age of most recent TBI, and recency of TBI. Mixed linear models compared neuropsychological composite trajectories (executive functioning/attention/speed, language, memory, and global), co-varying for age, gender, education, apolipoprotein E4 status, race/ethnicity, and baseline diagnosis (normal aging n = 1,720, MCI n = 749, or dementia n = 417). Logistic binary regression examined MCI/dementia conversion rates. RESULTS There was a slightly higher frequency of MCI/dementia in those with multiple TBIs (50% to 60% with and without LOC, compared to 39% with no TBI) at baseline, but longitudinal trajectories were similar. TBI history, age of injury, or recency of injury did not impact neurocognitive trajectories or conversion rates to MCI/dementia (all p's > .01). CONCLUSIONS TBI history, regardless of injury characteristics, age of injury, or recency of injury, did not worsen neurocognitive decline or MCI/dementia conversion. Additional longitudinal research in more diverse cohorts with a wider range of TBI severity is needed to evaluate the specific factors and possible mechanisms in which TBI may increase dementia risk.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Christian LoBue
- Departments of Psychiatry and Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Hsueh-Sheng Chiang
- Department of Neurology, UT Southwestern Dallas Medical Center, Dallas, TX 75390, USA
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - John Hart Jr
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX 75080, USA
- Departments of Neurology and Psychiatry, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
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Schwartz CE, Borowiec K, Rapkin BD. Reserve-building as a buffer for depression among individuals living with disability: a longitudinal study of current activities related to brain health. Front Psychol 2024; 15:1330437. [PMID: 38455115 PMCID: PMC10919219 DOI: 10.3389/fpsyg.2024.1330437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/19/2024] [Indexed: 03/09/2024] Open
Abstract
Aims This study examined whether reserve-building activities are associated with attenuated reported depression among people who were disabled from work due to a medical condition as compared to employed, retired, and unemployed participants. Methods This secondary analysis included 771 individuals who provided data at three time points: baseline (late Spring 2020), follow-up 1 (Spring 2021), and follow-up 2 (Fall 2021). The DeltaQuest Reserve-Building Measure assessed current activities related to brain health. An analysis of variance and Pearson correlation coefficients assessed group differences in reserve-building activity scores. Classification and regression tree (CART) modeling investigated factors associated with higher and lower reported depression by employment group. The random effects (RE) models tested two buffering hypotheses: (1) comparing all groups to the employed group and (2) examining within-group effects. Results Engaging in outdoor activities, exercise, and religious/spiritual activities was associated with reduced depression over time in the overall sample. While disabled participants endorsed lower levels of being Active in the World, Outdoor activities, and Exercise and higher levels of Inner Life and Passive Media Consumption than the other employment groups, more reserve-building activities distinguished depression levels in the disabled group's CART models compared to the others. Among the disabled, unemployed, and retired participants, engaging in any reserve-building activities was also associated with lower depression scores, which was distinct from the employed participants. In the RE models that used the employed group as the reference category, only the disabled group's level of depression was buffered by engaging in creative activities. In the within-group RE models, the disabled group's engagement in Religious/Spiritual, Outdoors, and Games was associated with substantially reduced within-group depression, which was different from the other employment groups. In contrast, reserve-building activities were not implicated at all as buffers for employed participants. Conclusion This study revealed a beneficial effect of reserve-building activities on buffering depression over time during the COVID-19 pandemic, particularly for disabled people. It documented that even if such individuals engaged in lesser amounts of such activities as compared to other employment groups, the buffering effect was substantial. Given the low-cost and accessible nature of reserve-building activities, it would be worthwhile to encourage such activities for disabled individuals.
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Affiliation(s)
- Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA, United States
- Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, United States
| | - Katrina Borowiec
- DeltaQuest Foundation, Inc., Concord, MA, United States
- Department of Measurement, Evaluation, Statistics, and Assessment, Boston College Lynch School of Education and Human Development, Chestnut Hill, MA, United States
| | - Bruce D. Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
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Pinto JO, Peixoto B, Dores AR, Barbosa F. Measures of cognitive reserve: An umbrella review. Clin Neuropsychol 2024; 38:42-115. [PMID: 37073431 DOI: 10.1080/13854046.2023.2200978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
Objective: Recently, there has been a growing interest in operationalizing and measuring cognitive reserve (CR) for clinical and research purposes. This umbrella review aims to summarize the existing systematic and meta-analytic reviews about measures of CR. Method: A literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the guidelines of Aromataris et al. (2015) to identify the systematic reviews and meta-analysis involving the assessment of CR. The methodological quality of the papers included in this umbrella review was assessed with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) and Specialist Unit for Review Evidence (SURE). Results: Thirty-one reviews were identified, sixteen of which were systematic reviews, and fifteen were meta-analyses. Most of the reviews had a critically low quality, according to AMSTAR-2. The reviews included between two and 135 studies. Most of the papers focused on older adults, mainly those with dementia. CR was measured using one to six proxies, but most considered each proxy separately. The most assessed proxies of CR were education on its own, combined with occupation and/or engagement in activities or combined with parental education, bilingualism, and engagement in activities when four CR proxies were studied. Most of the studies included in higher quality reviews focused on three proxies, with education and engagement in activities being the most evaluated using CR questionnaires. Conclusion: Despite the growing interest in measuring CR, its operationalization did not improve since the last umbrella review in this field.
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Affiliation(s)
- Joana O Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- CESPU, University Institute of Health Sciences, Gandra, Portugal
| | - Bruno Peixoto
- CESPU, University Institute of Health Sciences, Gandra, Portugal
- NeuroGen - Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- TOXRUN - Toxicology Research Unit, University Institute of Health Sciences, CESPU, Gandra, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Alvsåker K, Hanoa R, Olasveengen TM. Selecting patients for early interdisciplinary rehabilitation during neurointensive care after moderate to severe traumatic brain injury. Acta Anaesthesiol Scand 2023; 67:1069-1078. [PMID: 37259274 DOI: 10.1111/aas.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/05/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Early interdisciplinary rehabilitation (EIR) in neurointensive care is a limited resource reserved for patients with moderate to severe traumatic brain injury (TBI) believed to profit from treatment. We evaluated how key parameters related to injury severity and patient characteristics were predictive of receiving EIR, and whether these parameters changed over time. METHODS Among 1003 adult patients with moderate to severe TBI admitted over 72 h to neurointensive care unit during four time periods between 2005 and 2020, EIR was given to 578 and standard care to 425 patients. Ten selection criteria thought to best represent injury severity and patient benefit were evaluated (Glasgow Coma Scale, Head Abbreviated Injury Scale, New-Injury-Severity-Scale, intracranial pressure monitoring, neurosurgery, age, employment, Charlson Comorbidity Index, severe psychiatric disease, and chronic substance abuse). RESULTS In multivariate regression analysis, patients who were employed (adjOR 1.99 [95% CI 1.41, 2.80]), had no/mild comorbidity (adjOR 3.15 [95% CI 1.72, 5.79]), needed neurosurgery, had increasing injury severity and were admitted by increasing time period were more likely to receive EIR, whereas receiving EIR was less likely with increasing age (adjOR 0.97 [95% CI 0.96, 0.98]) and chronic substance abuse. Overall predictive ability of the model was 71%. Median age and comorbidity increased while employment decreased from 2005 to 2020, indicating patient selection became less restrictive with time. CONCLUSION Injury severity and need for neurosurgery remain important predictors for receiving EIR, but the importance of age, employment, and comorbidity have changed over time. Moderate prediction accuracy using current clinical criteria suggest unrecognized factors are important for patient selection.
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Affiliation(s)
- Kristin Alvsåker
- Postoperative and Intensive Care Department, Oslo University Hospital, Oslo, Norway
- Department of Physical medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Rolf Hanoa
- Neurosurgical Department, Oslo University Hospital, Oslo, Norway
| | - Theresa M Olasveengen
- Department of Anaesthesia and Intensive Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Scurfield AK, Wilson MD, Gurkoff G, Martin R, Shahlaie K. Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage. Neurocrit Care 2023; 38:149-157. [PMID: 36050537 PMCID: PMC9957945 DOI: 10.1007/s12028-022-01587-z] [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: 03/18/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome. METHODS In this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model. RESULTS Our study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13-0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09-1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06-1.56, p = 0.01) was a significant predictor in the GCS model. CONCLUSIONS This study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.
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Affiliation(s)
- Abby K Scurfield
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, 830 Orange Street, New Haven, CT, 06511, USA
| | - Machelle D Wilson
- Division of Biostatistics, Department of Public Health Sciences, Davis Clinical and Translational Science Center, University of California, 2921 Stockton Blvd., Suite 1400, Sacramento, CA, 95817, USA
| | - Gene Gurkoff
- Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA
| | - Ryan Martin
- Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA
- Department of Neurology, University of California, 4860 Y Street, Suite 3740,, Davis, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA.
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Hakiki B, Pancani S, Romoli AM, Draghi F, Maccanti D, Mannini A, Cecchi F. Cognitive reserve index and long-term disability in patients with severe traumatic brain injury discharged from the intensive rehabilitation unit. Front Neurol 2023; 14:1106989. [PMID: 37213897 PMCID: PMC10197115 DOI: 10.3389/fneur.2023.1106989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/21/2023] [Indexed: 05/23/2023] Open
Abstract
Objectives The "cognitive reserve" (CR) theory posits that higher premorbid cognitive activities can mitigate the effects of brain damage. This study aimed to investigate the association between CR and long-term functional autonomy in patients surviving a severe traumatic brain injury (sTBI). Setting Data were collected from the database of inpatients with severe acquired brain injury in a rehabilitation unit admitted from August 2012 to May 2020. Participants Patients that had incurred an sTBI, aged 18+ years, completing the phone Glasgow Outcome Scale-Expanded at follow-up (pGOS-E) in absence of previous brain trauma or neurological disease, or cognitive disorders were included. Patients with severe brain injury from non-traumatic etiologies were not included in the study. Design In this longitudinal study, all patients underwent a multidimensional assessment including the cognitive reserve index questionnaire (CRIq), the coma recovery scale-revised, the level of cognitive functioning, the Disability Rating Scale (DRS), and the Galveston Orientation and Amnesia Test at admission. At discharge, functional scales were administered again together with the Glasgow Outcome Scale. The pGOS-E was assessed at follow-up. Main measures pGOS-E. Results A total of 106 patients/caregivers underwent the pGOS-E after 5.8 [3.6] years from the event. Among them, 46 (43.4%) died after discharge, and 60 patients [men: 48 (80%); median age: 54 years; median time post-onset: 37 days; median education level: 10 years; median CRIq total score: 91] were included in the analysis exploring the association between pGOS-E and demographic data, cognitive reserve surrogates, and clinical variables at admission and discharge from the rehabilitation unit. A younger age (B = -0.035, p = 0.004) and a lower DRS category at discharge (B = -0.392, p = 0.029) were significantly related to a higher long-term functional autonomy in the multivariate analysis. Conclusion Long-term functional autonomy was not influenced by CR as assessed through the educational level and the CRIq.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- *Correspondence: Silvia Pancani
| | | | | | | | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Tabet S, Tinawi S, Frenette LC, Abouassaly M, de Guise E. Relationships between predisposing, precipitating, and perpetuating factors and executive functioning following mild traumatic brain injury. Brain Inj 2022; 36:1247-1257. [PMID: 36093900 DOI: 10.1080/02699052.2022.2120208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to determine the sociodemographic and MTBI-related variables associated with executive functioning (EF). METHODS Based on the theoretical model of Hou and colleagues, data on predisposing (age, education, premorbid IQ), precipitating (post-traumatic amnesia, loss of consciousness, presence of frontal lesions, post-accident time to evaluation) and perpetuating (anxious and depressive affects and post-concussive symptoms) factors were retrospectively collected from the medical records of 172 patients with MTBI. EF data based on the 3 processes included in Miyake's prediction model (2000) (updating, cognitive flexibility and inhibition) were collected using respectively the Digit span task of the Weschler - 4th edition, the Trails A and B as well as the initiation time on the Tower of London- Drexel University. RESULTS Updating was significantly associated with education, premorbid IQ, age, anxiety, and depressive affect. Inhibition was associated with education and age. No variable was associated with cognitive flexibility. CONCLUSIONS Following a MTBI, clinicians should consider that level of education and pre-morbid IQ may "predispose" patients to higher EF performances. They should also measure level of anxiety and depressive affect knowing that these may "perpetuate" some EF impairments (specifically the updating process).
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Affiliation(s)
- Sabrina Tabet
- Department of Psychology, Université de Montréal, Quebec, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Quebec, Canada
| | - Simon Tinawi
- Traumatic brain injury program, McGill University Health Center, Quebec, Canada
| | - Lucie C Frenette
- Department of Psychology, Université de Montréal, Quebec, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Quebec, Canada
| | - Michel Abouassaly
- Traumatic brain injury program, McGill University Health Center, Quebec, Canada
| | - Elaine de Guise
- Department of Psychology, Université de Montréal, Quebec, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Quebec, Canada.,Research Institute-McGill University Health Center, Quebec, Canada
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Gu L, Xu H. Effect of cognitive reserve on cognitive function in Parkinson’s disease. Neurol Sci 2022; 43:4185-4192. [DOI: 10.1007/s10072-022-05985-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022]
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Minchew HM, Ferren SL, Christian SK, Hu J, Keselman P, Brooks WM, Andrews BT, Harris JL. Comparing Imaging Biomarkers of Cerebral Edema after TBI in Young Adult Male and Female Rats. Brain Res 2022; 1789:147945. [PMID: 35595066 DOI: 10.1016/j.brainres.2022.147945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/16/2022] [Accepted: 05/13/2022] [Indexed: 11/02/2022]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. Cerebral edema following TBI is known to play a critical role in injury severity and prognosis. In the current study we used multimodal magnetic resonance imaging (MRI) to assess cerebral edema 24 hours after unilateral contusive TBI in male and female rats. We then directly quantified brain water content in the same subjectsex vivo.We found that both males and females had similarly elevated T2 values after TBI compared with sham controls. Apparent diffusion coefficient (ADC) was more variable than T2 and did not show significant injury effects in males or females. Brain water was elevated in male TBI rats compared with sham controls, but there was no difference between female TBI and sham groups. Notably, MRI biomarkers of edema were more closely correlated with brain water in male rats; female rats did not show any relationship between brain water and T2 or ADC. These observations raise questions about the interpretation of radiological findings traditionally interpreted as edema in female TBI patients. A better understanding of sex differences and similarities in the pathophysiology of post-traumatic edema is needed to help improve patient management and the development of effective treatment strategies for men and women.
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Affiliation(s)
- Heather M Minchew
- University of Kansas School of Medicine, Kansas City, KS, United States
| | - Sadie L Ferren
- Department of Anatomy and Cell Biology, KUMC, Kansas City, KS, United States
| | - Sarah K Christian
- Department of Anatomy and Cell Biology, KUMC, Kansas City, KS, United States
| | - Jinxiang Hu
- Department of Biostatistics, KUMC, Kansas City, KS, United States
| | - Paul Keselman
- Hoglund Biomedical Imaging Center, KUMC, Kansas City, KS, United States
| | - William M Brooks
- Hoglund Biomedical Imaging Center, KUMC, Kansas City, KS, United States; Depatment of Neurology, KUMC, Kansas City, KS, United States
| | - Brian T Andrews
- Department of Otolaryngology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Janna L Harris
- Department of Anatomy and Cell Biology, KUMC, Kansas City, KS, United States; Hoglund Biomedical Imaging Center, KUMC, Kansas City, KS, United States.
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13
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Nunes I, Silva Nunes MV. The influence of cognitive reserve in the protection of the cognitive status after an acquired brain injury: A systematic review. J Clin Exp Neuropsychol 2022; 43:839-860. [PMID: 35014599 DOI: 10.1080/13803395.2021.2014788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cognitive Reserve (CR) hypothesis was introduced to account for the variability in cognitive performance of patients with similar degrees of brain injury or pathology. The individual variability of CR is modulated by the interaction of innate capacities and exposures throughout life, which can act as protectors against neuropathology's clinical effects. Individuals with higher CR appear to have better cognitive performance after a brain injury. The present review aimed to identify and map the scientific evidence available in literature regarding CR's influence in protecting the cognitive status after an Acquired Brain Injury (ABI). METHOD A systematic review was performed for published studies until October 2020 in PubMed, Scopus, and CINAHL electronic databases. Studies regarding CR's influence in protecting the cognitive status after an ABI were included in this review. The Newcastle-Ottawa Scale was used to assess risk of bias in the included studies. This systematic review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021236594. RESULTS Twenty-one studies published between 2003 and 2020 were selected and analyzed. The literature analysis showed that CR has a positive effect on cognitive status after an ABI. Various proxies were used to estimate CR, including estimated premorbid IQ, education, occupation attainment, socioeconomic status, leisure activities, bilingualism, and social integration. CR proxies constitute a set of variables that may have a significant influence on cognitive status. Higher CR levels were associated with lower cognitive impairment after an ABI. CONCLUSIONS Although more research is necessary for a complete understanding of CR's impact on cognition, the synthesis of these studies confirmed that there is evidence on the beneficial impact of CR on cognitive status after an ABI. These findings support CR's cognitive status role following an ABI and may provide additional information for prognosis and rehabilitation plans.
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Affiliation(s)
- Inês Nunes
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Maria Vânia Silva Nunes
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Centre for Interdisciplinary Research in Health, Lisbon, Portugal
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14
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Bedard M, Taler V. Social Support Buffers Against Cognitive Decline in Single Mild Traumatic Brain Injury With Loss of Consciousness: Results From the Canadian Longitudinal Study on Aging. J Gerontol B Psychol Sci Soc Sci 2021; 76:1777-1787. [PMID: 33254227 PMCID: PMC8557842 DOI: 10.1093/geronb/gbaa213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES We investigated rates of cognitive decline at 3-year follow-up from initial examination in people reporting mild traumatic brain injury (mTBI) with loss of consciousness (LOC) more than a year prior to initial examination. We examined the role of social support as predictor of preserved cognitive function in this sample. METHOD Analyses were conducted on 440 participants who had self-reported LOC of <1 min, 350 with LOC of 1-20 min, and 10,712 healthy controls, taken from the Canadian Longitudinal Study on Aging (CLSA), a nationwide study on health and aging. RESULTS People who reported at baseline that they had experienced mTBI with LOC of 1-20 min more than a year prior were 60% more likely to have experienced global cognitive decline than controls at three-year follow-up. Cognitive decline was most apparent on measures of executive functioning. Logistic regression identified increased social support as predictors of relatively preserved cognitive function. DISCUSSION mTBI with longer time spent unconscious (i.e., LOC 1-20 min) is associated with greater cognitive decline years after the head injury. Perceived social support, particularly emotional support, may help buffer against this cognitive decline.
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Affiliation(s)
- Marc Bedard
- School of Psychology, University of Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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15
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Venkatesan UM, Rabinowitz AR, Wolfert SJ, Hillary FG. Duration of post-traumatic amnesia is uniquely associated with memory functioning in chronic moderate-to-severe traumatic brain injury. NeuroRehabilitation 2021; 49:221-233. [PMID: 34397431 DOI: 10.3233/nre-218022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Disrupted memory circuitry may contribute to post-traumatic amnesia (PTA) after traumatic brain injury (TBI). It is unclear whether duration of PTA (doPTA) uniquely impacts memory functioning in the chronic post-injury stage. OBJECTIVE To examine the relationship between doPTA and memory functioning, independent of other cognitive abilities, in chronic moderate-to-severe TBI. METHODS Participants were 82 individuals (median chronicity = 10.5 years) with available doPTA estimates and neuropsychological data. Composite memory, processing speed (PS), and executive functioning (EF) performance scores, as well as data on subjective memory (SM) beliefs, were extracted. DoPTA-memory associations were evaluated via linear modeling of doPTA with memory performance and clinical memory status (impaired/unimpaired), controlling for PS, EF and demographic covariates. Interrelationships between doPTA, objective memory functioning, and SM were assessed. RESULTS DoPTA was significantly related to memory performance, even after covariate adjustment. Impairment in memory, but not PS or EF, was associated with a history of longer doPTA. SM was associated with memory performance, but unrelated to doPTA. CONCLUSIONS Findings suggest a specific association between doPTA-an acute injury phenomenon-and chronic memory deficits after TBI. Prospective studies are needed to understand how underlying mechanisms of PTA shape distinct outcome trajectories, particularly functional abilities related to memory processing.
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Affiliation(s)
- Umesh M Venkatesan
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Amanda R Rabinowitz
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Stephanie J Wolfert
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Frank G Hillary
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
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16
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Requena-Ocaña N, Araos P, Flores M, García-Marchena N, Silva-Peña D, Aranda J, Rivera P, Ruiz JJ, Serrano A, Pavón FJ, Suárez J, Rodríguez de Fonseca F. Evaluation of neurotrophic factors and education level as predictors of cognitive decline in alcohol use disorder. Sci Rep 2021; 11:15583. [PMID: 34341419 PMCID: PMC8328971 DOI: 10.1038/s41598-021-95131-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023] Open
Abstract
Cognitive reserve (CR) is the capability of an individual to cope with a brain pathology through compensatory mechanisms developed through cognitive stimulation by mental and physical activity. Recently, it has been suggested that CR has a protective role against the initiation of substance use, substance consumption patterns and cognitive decline and can improve responses to treatment. However, CR has never been linked to cognitive function and neurotrophic factors in the context of alcohol consumption. The present cross-sectional study aims to evaluate the association between CR (evaluated by educational level), cognitive impairment (assessed using a frontal and memory loss assessment battery) and circulating levels of brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) in patients with alcohol use disorder (AUD). Our results indicated that lower educational levels were accompanied by earlier onset of alcohol consumption and earlier development of alcohol dependence, as well as impaired frontal cognitive function. They also suggest that CR, NT-3 and BDNF may act as compensatory mechanisms for cognitive decline in the early stages of AUD, but not in later phases. These parameters allow the identification of patients with AUD who are at risk of cognitive deterioration and the implementation of personalized interventions to preserve cognitive function.
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Affiliation(s)
- Nerea Requena-Ocaña
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain.
- School of Psychology, Complutense University of Madrid, Madrid, Spain.
- Laboratorio de Investigación, IBIMA, Hospital Universitario Regional de Málaga, Avenida Carlos Haya 82, 29010, Málaga, Spain.
| | - Pedro Araos
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, School of Psychology, University of Málaga, 29010, Málaga, Spain
| | - María Flores
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
| | - Nuria García-Marchena
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
| | - Daniel Silva-Peña
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
| | - Jesús Aranda
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
- School of Medicine, University of Málaga, 29071, Málaga, Spain
| | - Patricia Rivera
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
| | - Juan Jesús Ruiz
- Provincial Drug Addiction Center of Málaga, Provincial Council of Málaga, Málaga, Spain
| | - Antonia Serrano
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
| | - Francisco Javier Pavón
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain
- Cardiac Clinical Management Unit, IBIMA, University Hospital Virgen de la Victoria, 29010, Málaga, Spain
| | - Juan Suárez
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain.
- Department of Human Anatomy, Legal Medicine and History of Science, IBIMA, Facultad de Medicina, University of Málaga, Bulevar Louis Pausteur, 29071, Málaga, Spain.
| | - Fernando Rodríguez de Fonseca
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga-IBIMA, Regional University Hospital of Málaga, 29010, Málaga, Spain.
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17
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Cognitive Reserve in Individuals Aging With Traumatic Brain Injury: Independent and Interactive Effects on Cognitive Functioning. J Head Trauma Rehabil 2021; 37:E196-E205. [PMID: 34145164 DOI: 10.1097/htr.0000000000000697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the influence of 2 temporal factors-age and injury chronicity-on the relationship between cognitive reserve (CR) and cognitive functioning in older adults with chronic traumatic brain injury (TBI). SETTING Outpatient research laboratory. PARTICIPANTS Adults, 50 years or older, with a 1- to 45-year history of moderate or severe TBI (N = 108). DESIGN Cross-sectional observational study. MAIN MEASURES CR was estimated using demographically corrected performance on a word-reading test (an approximation of premorbid IQ). Injury chronicity was operationalized as number of years since the date of injury. Composite cognitive scores were computed from performances on neuropsychological tests of processing speed, executive functioning, and memory. RESULTS CR was positively and significantly related to all cognitive performances independent of age, injury chronicity, and injury severity. Greater injury chronicity significantly attenuated the effect of CR on processing speed such that individuals more distal from their injury date evidenced a weaker positive relationship between CR and performance. CONCLUSION Temporal factors may modify associations between CR and cognition. Findings suggest that the protective effects of CR are temporally delimited, potentially contending with declines in brain reserve. The prognostic value of traditional outcome determinants should be considered in the context of injury chronicity.
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18
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Pettemeridou E, Constantinidou F. The Association Between Brain Reserve, Cognitive Reserve, and Neuropsychological and Functional Outcomes in Males With Chronic Moderate-to-Severe Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:883-893. [PMID: 33630655 DOI: 10.1044/2020_ajslp-20-00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Moderate-to-severe traumatic brain injury (TBI) leads to significant neural and cognitive impairment, affecting functional outcome. This study investigated the chronic effects of moderate-to-severe TBI on brain reserve (BR), cognitive reserve (CR), and neuropsychological and functional outcome. Method The group with TBI consisted of 41 male participants with a primary diagnosis of moderate-to-severe closed head injury (time since injury [TSI], M = 6.12 years, range: 1-23, SD = 5.99, Mdn = 4). TBI survivors were compared to 24 neurotypical male participants, matched on age and education. Magnetic resonance imaging T1 anatomical images were used to calculate gray and white matter and cerebrospinal fluid volume. BR was calculated using the ventricle-to-brain ratio. CR was assessed using two hold measures: the Peabody Picture Vocabulary Test and the Pseudowords task. Functional outcome was measured using the Glasgow Outcome Scale-Extended. Results Neuropsychological performance of TBI survivors was significantly lower than their neurotypical controls, as measured by theoretically driven composites of verbal and visual memory, executive functions, attention, and CR. They presented greater ventricle-to-brain ratio volume, compared to noninjured controls, with higher scores indicating lower BR levels. Both BR and TSI were significantly associated with CR. Also, a median-split analysis revealed a TSI effect on CR. Significant associations were evident between the Glasgow Outcome Scale-Extended and the BR and CR measures. Conclusions Lingering neuropsychological deficits in chronic TBI support the role of BR and CR in functional outcome. Furthermore, TSI interferes with CR supporting the notion that TBI sets off a chronic neurodegenerative and progressive course that interferes with semantic knowledge. Supplemental Material https://doi.org/10.23641/asha.14049923.
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Affiliation(s)
- Eva Pettemeridou
- Center for Applied Neuroscience, University of Cyprus, Nicosia
- KIOS Innovation and Research Center of Excellence, University of Cyprus, Nicosia
| | - Fofi Constantinidou
- Center for Applied Neuroscience, University of Cyprus, Nicosia
- Department of Psychology, University of Cyprus, Nicosia
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19
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Pastorino R, Loreti C, Giovannini S, Ricciardi W, Padua L, Boccia S. Challenges of Prevention for a Sustainable Personalized Medicine. J Pers Med 2021; 11:jpm11040311. [PMID: 33923579 PMCID: PMC8073054 DOI: 10.3390/jpm11040311] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
The development and implementation of the approaches of personalized medicine for disease prevention are still at infancy, although preventive activities in healthcare represent a key pillar to guarantee health system sustainability. There is an increasing interest in finding informative markers that indicate the disease risk before the manifestation of the disease (primary prevention) or for early disease detection (secondary prevention). Recently, the systematic collection and study of clinical phenotypes and biomarkers consented to the advance of Rehabilomics in tertiary prevention. It consents to identify relevant molecular and physiological factors that can be linked to plasticity, treatment response, and natural recovery. Implementation of these approaches would open avenues to identify people at high risk and enable new preventive lifestyle interventions or early treatments targeted to their individual genomic profile, personalizing prevention and rehabilitation. The integration of personalized medicine into prevention may benefit citizens, patients, healthcare professionals, healthcare authorities, and industry, and ultimately will seek to contribute to better health and quality of life for Europe’s citizens.
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Affiliation(s)
- Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (S.B.)
| | - Claudia Loreti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
- Correspondence:
| | - Silvia Giovannini
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
| | - Walter Ricciardi
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Luca Padua
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (L.P.)
- Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefania Boccia
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.P.); (S.B.)
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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20
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Bourassa ME, Dumel G, Charlebois-Plante C, Gagnon JF, De Beaumont L. Persistent implicit motor learning alterations following a mild traumatic brain injury sustained during late adulthood. J Clin Exp Neuropsychol 2021; 43:105-115. [PMID: 33563109 DOI: 10.1080/13803395.2021.1879735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The neurocognitive outcomes of sustaining a mild traumatic brain injury (mTBI) during late adulthood are vastly understudied. In young, asymptomatic adults, mTBI-related synaptic plasticity alterations have been associated with persistent implicit motor sequence learning impairments outlasting the usual cognitive recovery period. The current study examined whether uncomplicated mTBI sustained during late adulthood could exert persistent deleterious consequences on implicit motor sequence learning.Method: Thirty participants (aged 50-70 years) who experienced an uncomplicated mTBI within 3 to 24 months of testing, and 40 age-, sex- and education-equivalent healthy controls performed an implicit serial reaction time task (SRT task). The SRT task consisted of 10 blocks of a repeating sequence embedded among 4 random blocks. Participants also completed a battery of standardized neuropsychological tests of attention, memory and executive functioning.Results: While both mTBI participants and controls showed significant implicit motor sequence learning effects, the mTBI group achieved a lower level of competence at performing the SRT task as evidenced by smaller gains in reaction times across the 10 training blocks of the repeating sequence. The time elapsed since the injury was unrelated to implicit motor learning effects. There was no evidence of a persistent effect of mTBI on any neuropsychological domain compared to controls.Conclusions: Findings from this study suggest that a single mTBI sustained during older age may have persistent repercussions on training-dependent motor sequence learning capacity outlasting the recovery of mTBI symptoms and gold-standard neuropsychological tests performance.
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Affiliation(s)
- Marie-Eve Bourassa
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, CIUSSS du nord-de-l'Île-de-Montréal, Montréal, QC, Canada.,Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Gaëlle Dumel
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, CIUSSS du nord-de-l'Île-de-Montréal, Montréal, QC, Canada.,Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Camille Charlebois-Plante
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, CIUSSS du nord-de-l'Île-de-Montréal, Montréal, QC, Canada.,Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, CIUSSS du nord-de-l'Île-de-Montréal, Montréal, QC, Canada.,Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Louis De Beaumont
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, CIUSSS du nord-de-l'Île-de-Montréal, Montréal, QC, Canada.,Département de Chirurgie, Université de Montréal, Montréal, QC, Canada
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21
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Coffman CA, Harrison AT, Kay JJM, Holloway JP, LaFountaine MF, Moore RD. The Influence of Family History of Neurodegenerative Disease on Adolescent Concussion Outcomes. J Clin Med 2021; 10:528. [PMID: 33540525 PMCID: PMC7867167 DOI: 10.3390/jcm10030528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 12/04/2022] Open
Abstract
Evidence suggests that factors associated with a family history of neurodegenerative disease (fhNDD) may influence outcomes following a concussion. However, the relevance of these findings in adolescent populations has not been fully explored. Therefore, the present study sought to evaluate the relationship between fhNDD and neurological outcomes following an adolescent concussion. Data from a local pediatric concussion clinic were used to compare adolescents with (n = 22) and without (n = 44) an fhNDD. Clinical symptom burden, emotional health, cardio-autonomic function, and cognitive performance were assessed at initial (~2 weeks) and follow-up (~5 weeks) post-injury evaluations. Cardio-autonomic function was assessed at rest and during isometric handgrip contraction (IHGC). Results indicated no significant group differences in emotional health or cognitive performance. Across evaluations, those with an fhNDD exhibited greater somatic symptom severity, alterations in HRV at rest, and early blunted cardio-autonomic reactivity during IHGC compared to those without an fhNDD. These findings suggest that positive fhNDD is negatively associated with clinical symptomology and cardio-autonomic functioning following an adolescent concussion. Further, these findings encourage clinicians to utilize a comprehensive neurological evaluation to monitor concussion recovery. Future studies should look into exploring the role of specific neurodegenerative processes and conditions on concussion outcomes in adolescents.
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Affiliation(s)
- Colt A. Coffman
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Adam T. Harrison
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Jacob J. M. Kay
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Jeffrey P. Holloway
- Department of Pediatrics—School of Medicine, University of South Carolina, Columbia, SC 29209, USA;
| | - Michael F. LaFountaine
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ 07110, USA;
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Robert Davis Moore
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
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22
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de Guise E, Degré C, Beaujean O, Julien J, Lague-Beauvais M, Dagher J, Marcoux J. Comparison of executive functions and functional outcome between older patients with traumatic brain injury and normal older controls. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1174-1187. [DOI: 10.1080/23279095.2020.1862118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Elaine de Guise
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Centre de Recherche Interdisciplinaire en Readaptation du Montreal Metropolitain, Montreal, Quebec, Canada
| | - Catherine Degré
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Océane Beaujean
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Jessica Julien
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Maude Lague-Beauvais
- Traumatic Brain Injury Program-McGill University Health Center, Montreal, Canada
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23
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Tabet S, LeBlanc J, Frenette LC, Seresova A, Laberge-Poirier A, Alturki AY, Marcoux J, Maleki M, de Guise E. Early reading comprehension and speed of reading impairments in individuals with uncomplicated and complicated mild traumatic brain injury. JOURNAL OF COMMUNICATION DISORDERS 2020; 88:106047. [PMID: 33035943 DOI: 10.1016/j.jcomdis.2020.106047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Several studies have investigated cognitive-communication disorders affecting oral expression skills following TBI but very few have dealt with reading comprehension abilities. The current study aims to measure reading comprehension and speed of reading in adults with uncomplicated and complicated mild traumatic brain injury (TBI) and to determine which demographic and TBI-related variables are predictive of their performance. METHOD The performances of three groups of participants were compared on the Chapman-Cook Speed of Reading Test (CCSRT). The CCSRT was administered in an acute care setting to 85 hospitalized participants with mild TBI showing traumatic cerebral lesions (complicated mild TBI), to 15 hospitalized participants with uncomplicated mild TBI (no cerebral lesions) and to 68 adults without TBI. Linear regression analyses were performed to determine which variables among sex, age, education, TBI severity (measured by the Glasgow Coma Scale score), speed of processing skills, and site of cerebral lesions significantly predicted CCSRT performances. RESULTS The control group showed a lower percentage of errors than both TBI groups. On the total score of the CCSRT, the uncomplicated and complicated TBI groups performed worse than the control group. Moreover, as age and speed of processing skills increased, and education decreased, the odds of having a lower score on the CCSRT increased. CONCLUSION These findings suggest that reading abilities are compromised after mild TBI. Furthermore, the CCSRT may be a useful bedside tool for clinicians who work with individuals with mild TBI.
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Affiliation(s)
- Sabrina Tabet
- Department of Psychology, Université de Montréal, 1700, Jacques-Tétreault, Laval, Qc, H7N 0B6, Laval, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), 6363, Hudson Road, Montreal, Qc, H3S 1M9, Montréal, Canada.
| | - Joanne LeBlanc
- Traumatic Brain Injury Program-McGill University Health Center, 1650 Cedar, Montréal, Qc, H3G 1A4, Montréal, Canada.
| | - Lucie C Frenette
- Department of Psychology, Université de Montréal, 1700, Jacques-Tétreault, Laval, Qc, H7N 0B6, Laval, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), 6363, Hudson Road, Montreal, Qc, H3S 1M9, Montréal, Canada.
| | - Alena Seresova
- Traumatic Brain Injury Program-McGill University Health Center, 1650 Cedar, Montréal, Qc, H3G 1A4, Montréal, Canada.
| | - Andréanne Laberge-Poirier
- Traumatic Brain Injury Program-McGill University Health Center, 1650 Cedar, Montréal, Qc, H3G 1A4, Montréal, Canada.
| | - Abdulrahman Yaqub Alturki
- Department of Neurology and Neurosurgery, McGill University, 1650 Avenue Cedar, Montréal, Qc, H3G 1A4, Montréal, Canada; Adult Neurosurgery Department, National Neurosciences Institute, King Fahad Medical City P.O. Box. 59046, Riyadh 11525, Saudi Arabia.
| | - Judith Marcoux
- Department of Neurology and Neurosurgery, McGill University, 1650 Avenue Cedar, Montréal, Qc, H3G 1A4, Montréal, Canada.
| | - Mohammed Maleki
- Department of Neurology and Neurosurgery, McGill University, 1650 Avenue Cedar, Montréal, Qc, H3G 1A4, Montréal, Canada.
| | - Elaine de Guise
- Department of Psychology, Université de Montréal, 1700, Jacques-Tétreault, Laval, Qc, H7N 0B6, Laval, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), 6363, Hudson Road, Montreal, Qc, H3S 1M9, Montréal, Canada; Research Institute-McGill University Health Center, 2155, Guy street, Montreal, Qc, H3H 2R9, Montréal, Canada.
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Lucca LF, Lofaro D, Leto E, Ursino M, Rogano S, Pileggi A, Vulcano S, Conforti D, Tonin P, Cerasa A. The Impact of Medical Complications in Predicting the Rehabilitation Outcome of Patients With Disorders of Consciousness After Severe Traumatic Brain Injury. Front Hum Neurosci 2020; 14:570544. [PMID: 33192402 PMCID: PMC7641612 DOI: 10.3389/fnhum.2020.570544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
In this study, we sought to assess the predictors of outcome in patients with disorders of consciousness (DOC) after severe traumatic brain injury (TBI) during neurorehabilitation stay. In total, 96 patients with DOC (vegetative state, minimally conscious state, or emergence from minimally conscious state) were enrolled (69 males; mean age 43.6 ± 20.8 years) and the improvement of the degree of disability, as assessed by the Disability Rating Scale, was considered the main outcome measure. To define the best predictor, a series of demographical and clinical factors were modeled using a twofold approach: (1) logistic regression to evaluate a possible causal effect among variables; and (2) machine learning algorithms (ML), to define the best predictive model. Univariate analysis demonstrated that disability in DOC patients statistically decreased at the discharge with respect to admission. Genitourinary was the most frequent medical complication (MC) emerging during the neurorehabilitation period. The logistic model revealed that the total amount of MCs is a risk factor for lack of functional improvement. ML discloses that the most important prognostic factors are the respiratory and hepatic complications together with the presence of the upper gastrointestinal comorbidities. Our study provides new evidence on the most adverse short-term factors predicting a functional recovery in DOC patients after severe TBI. The occurrence of medical complications during neurorehabilitation stay should be considered to avoid poor outcomes.
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Affiliation(s)
| | - Danilo Lofaro
- Eng, deHealth Lab-DIMEG, UNICAL, Arcavata di Rende, Italy
| | | | | | | | | | | | | | | | - Antonio Cerasa
- S. Anna Institute, Crotone, Italy.,Institute for Biomedical Research and Innovation (IRIB-CNR), Mangone, Italy
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Bertoni D, Petraglia F, Basagni B, Pedrazzi G, De Gaetano K, Costantino C, De Tanti A. Cognitive reserve index and functional and cognitive outcomes in severe acquired brain injury: A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:684-694. [DOI: 10.1080/23279095.2020.1804910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Federica Petraglia
- Rehabilitation Medicine Service, Rehabilitation Geriatrics Department, NHS-University Hospital of Parma, Parma, Italy
| | | | - Giuseppe Pedrazzi
- Department of Medicine and Surgery, Unit of Neuroscience Interdepartmental Centre of Robust Statistics (Ro.S.A). University of Parma, Parma, Italy
| | | | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Schoentgen B, Gagliardi G, Défontaines B. Environmental and Cognitive Enrichment in Childhood as Protective Factors in the Adult and Aging Brain. Front Psychol 2020; 11:1814. [PMID: 32793081 PMCID: PMC7385286 DOI: 10.3389/fpsyg.2020.01814] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
Some recent studies have highlighted a link between a favorable childhood environment and the strengthening of neuronal resilience against the changes that occur in natural aging neurodegenerative disease. Many works have assessed the factors – both internal and external – that can contribute to delay the phenotype of an ongoing neurodegenerative brain pathology. At the crossroads of genetic, environmental and lifestyle factors, these relationships are unified by the concept of cognitive reserve (CR). This review focuses on the protective effects of maintaining this CR through the cognitive aging process, and emphasizes the most essential time in life for the development and strengthening of this CR. The in-depth study of this research shows that early stimulation with regard to social and sensory interactions, contributes to the proper development of cognitive, affective and psychosocial capacities. Childhood thus appears to be the most active phase in the development of CR, and as such we hypothesize that this constitutes the first essential period of primary prevention of pathological aging and loss of cognitive capacities. If this hypothesis is correct, early stimulation of the environment would therefore be considered as a true primary prevention and a public health issue. The earlier identification of neurodevelopmental disorders, which can affect personal and professional development across the lifespan, could therefore have longer-term impacts and provide better protection against aging.
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Affiliation(s)
- Bertrand Schoentgen
- Réseau Aloïs Pôle Enfant (Pediatric Aloïs Network), Paris, France.,Réseau Aloïs (Aloïs Network), Paris, France
| | - Geoffroy Gagliardi
- Réseau Aloïs (Aloïs Network), Paris, France.,UPMC Univ Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle (ICM) - Hôpital Pitié-Salpêtrière, Sorbonne Universités, Paris, France
| | - Bénédicte Défontaines
- Réseau Aloïs Pôle Enfant (Pediatric Aloïs Network), Paris, France.,Réseau Aloïs (Aloïs Network), Paris, France
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Saber M, Giordano KR, Hur Y, Ortiz JB, Morrison H, Godbout JP, Murphy SM, Lifshitz J, Rowe RK. Acute peripheral inflammation and post-traumatic sleep differ between sexes after experimental diffuse brain injury. Eur J Neurosci 2020; 52:2791-2814. [PMID: 31677290 PMCID: PMC7195243 DOI: 10.1111/ejn.14611] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022]
Abstract
Identifying differential responses between sexes following traumatic brain injury (TBI) can elucidate the mechanisms behind disease pathology. Peripheral and central inflammation in the pathophysiology of TBI can increase sleep in male rodents, but this remains untested in females. We hypothesized that diffuse TBI would increase inflammation and sleep in males more so than in females. Diffuse TBI was induced in C57BL/6J mice and serial blood samples were collected (baseline, 1, 5, 7 days post-injury [DPI]) to quantify peripheral immune cell populations and sleep regulatory cytokines. Brains and spleens were harvested at 7DPI to quantify central and peripheral immune cells, respectively. Mixed-effects regression models were used for data analysis. Female TBI mice had 77%-124% higher IL-6 levels than male TBI mice at 1 and 5DPI, whereas IL-1β and TNF-α levels were similar between sexes at all timepoints. Despite baseline sex differences in blood-measured Ly6Chigh monocytes (females had 40% more than males), TBI reduced monocytes by 67% in TBI mice at 1DPI. Male TBI mice had 31%-33% more blood-measured and 31% more spleen-measured Ly6G+ neutrophils than female TBI mice at 1 and 5DPI, and 7DPI, respectively. Compared with sham, TBI increased sleep in both sexes during the first light and dark cycles. Male TBI mice slept 11%-17% more than female TBI mice, depending on the cycle. Thus, sex and TBI interactions may alter the peripheral inflammation profile and sleep patterns, which might explain discrepancies in disease progression based on sex.
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Affiliation(s)
- Maha Saber
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | - Katherine R. Giordano
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | - Yerin Hur
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | - J. Bryce Ortiz
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | | | - Jonathan P. Godbout
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USA
| | - Sean M. Murphy
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | - Jonathan Lifshitz
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
| | - Rachel K. Rowe
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
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Sreedharan S, Veeramuthu V, Hariri F, Hamzah N, Ramli N, Narayanan V. Cerebral white matter microstructural changes in isolated maxillofacial trauma and associated neuropsychological outcomes. Int J Oral Maxillofac Surg 2020; 49:1183-1192. [PMID: 32224001 DOI: 10.1016/j.ijom.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 02/15/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022]
Abstract
Isolated traumatic maxillofacial injury without concomitant brain injury may cause delayed post-concussive symptoms. Early identification allows optimal diagnosis, prognostication, and therapeutic intervention. The aim of this prospective observational study was to investigate longitudinal microstructural changes of the white matter (WM) tracts based on diffusion tensor imaging (DTI) indices in patients with isolated maxillofacial injuries, immediately and 6 months post-trauma, and to correlate these DTI indices with neuropsychological changes observed. Twenty-one patients with isolated maxillofacial injuries and 21 age-matched controls were recruited. DTI was performed and indices were calculated for 50 WM tracts. The neuropsychological evaluation was done using the screening module of the Neuropsychological Assessment Battery. Patients were subjected to repeat DTI and neuropsychological evaluation at 6 months post-trauma. Reduced fractional anisotropy (FA) and increased median (MD) and radial diffusivity (RD) in the acute phase were seen in major association, projection, and commissural fibre bundles, indicative of vasogenic oedema. These changes correlated with attention and executive function deficits in the acute phase, as well as improvement in memory and visuospatial function in the chronic phase. Isolated maxillofacial trauma patients develop WM microstructural damage, which may impair cognitive performance acutely and over time. DTI indices can serve as predictive imaging biomarkers for long-term cognitive deficits in isolated maxillofacial injuries.
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Affiliation(s)
- S Sreedharan
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - V Veeramuthu
- ReGen Rehabilitation International Hospital, Petaling Jaya, Selangor, Malaysia; Department of Psychology, University of Reading Malaysia, Iskandar, Malaysia.
| | - F Hariri
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - N Hamzah
- Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N Ramli
- University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - V Narayanan
- Division of Neurosurgery, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
The concept of cognitive reserve (CR) was proposed to account for the discrepancy between levels of brain pathologic process or damage and clinical and cognitive function. We provide a detailed review of prospective longitudinal studies that have investigated the interaction between CR and Alzheimer disease (AD) biomarkers on clinical and cognitive outcomes among individuals with normal cognition at baseline. Current evidence is consistent with the view that higher levels of CR are associated with a delay in the onset of symptoms of mild cognitive impairment and that there may be multiple pathways by which CR exerts its protective effects.
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30
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Cognitive Reserve Moderates Cognitive Outcome After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 101:72-80. [PMID: 31562876 DOI: 10.1016/j.apmr.2019.08.477] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/21/2019] [Accepted: 08/24/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate whether cognitive reserve moderates differences in cognitive functioning between patients with mild traumatic brain injury (MTBI) and controls without MTBI and to examine whether patients with postconcussion syndrome have lower cognitive functioning than patients without postconcussion syndrome at 2 weeks and 3 months after injury. DESIGN Trondheim MTBI follow-up study is a longitudinal controlled cohort study with cognitive assessments 2 weeks and 3 months after injury. SETTING Recruitment at a level 1 trauma center and at a general practitioner-run, outpatient clinic. PARTICIPANTS Patients with MTBI (n=160) according to the World Health Organization criteria, trauma controls (n=71), and community controls (n=79) (N=310). MAIN OUTCOME MEASURES A cognitive composite score was used as outcome measure. The Vocabulary subtest was used as a proxy of cognitive reserve. Postconcussion syndrome diagnosis was assessed at 3 months with the British Columbia Postconcussion Symptom Inventory. RESULTS Linear mixed models demonstrated that the effect of vocabulary scores on the cognitive composite scores was larger in patients with MTBI than in community controls at 2 weeks and at 3 months after injury (P=.001). Thus, group differences in the cognitive composite score varied as a function of vocabulary scores, with the biggest differences seen among participants with lower vocabulary scores. There were no significant differences in the cognitive composite score between patients with (n=29) and without (n=131) postconcussion syndrome at 2 weeks or 3 months after injury. CONCLUSION Cognitive reserve, but not postconcussion syndrome, was associated with cognitive outcome after MTBI. This supports the cognitive reserve hypothesis in the MTBI context and suggests that persons with low cognitive reserve are more vulnerable to reduced cognitive functioning if they sustain an MTBI.
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Bigler ED, Abildskov TJ, Eggleston B, Taylor BA, Tate DF, Petrie JA, Newsome MR, Scheibel RS, Levin H, Walker WC, Goodrich‐Hunsaker N, Tustison NJ, Stone JR, Mayer AR, Duncan TD, York GE, Wilde EA. Structural neuroimaging in mild traumatic brain injury: A chronic effects of neurotrauma consortium study. Int J Methods Psychiatr Res 2019; 28:e1781. [PMID: 31608535 PMCID: PMC6877164 DOI: 10.1002/mpr.1781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The chronic effects of neurotrauma consortium (CENC) observational study is a multisite investigation designed to examine the long-term longitudinal effects of mild traumatic brain injury (mTBI). All participants in this initial CENC cohort had a history of deployment in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and/or their follow-on conflicts (Operation Freedom's Sentinel). All participants undergo extensive medical, neuropsychological, and neuroimaging assessments and either meet criteria for any lifetime mTBI or not. These assessments are integrated into six CENC core studies-Biorepository, Biostatistics, Data and Study Management, Neuroimaging, and Neuropathology. METHODS The current study outlines the quantitative neuroimaging methods managed by the Neuroimaging Core using FreeSurfer automated software for image quantification. RESULTS At this writing, 319 participants from the CENC observational study have completed all baseline assessments including the imaging protocol and tertiary data quality assurance procedures. CONCLUSIONS/DISCUSSION The preliminary findings of this initial cohort are reported to describe how the Neuroimaging Core manages neuroimaging quantification for CENC studies.
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Affiliation(s)
- Erin D. Bigler
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Tracy J. Abildskov
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Barry Eggleston
- Biostatistics and EpidemiologyRTI InternationalDurhamNorth Carolina
| | - Brian A. Taylor
- Biomedical EngineeringVirginia Commonwealth UniversityRichmondVirginia
| | - David F. Tate
- Missouri Institute of Mental HealthUniversity of Missouri‐St. LouisSt. LouisMissouri
| | - Jo Ann Petrie
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Mary R. Newsome
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - Randall S. Scheibel
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - Harvey Levin
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - William C. Walker
- Biomedical EngineeringVirginia Commonwealth UniversityRichmondVirginia
| | - Naomi Goodrich‐Hunsaker
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - Nicholas J. Tustison
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - James R. Stone
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - Andrew R. Mayer
- Neurology and Brain and Behavioral Health InstituteUniversity of New MexicoAlbuquerqueNew Mexico
| | - Timothy D. Duncan
- Medical Imaging and RadiologyVA Portland Health Care SystemPortlandOregon
| | - Gerry E. York
- Alaska Radiology AssociatesTBI Imaging and ResearchAnchorageAlaska
| | - Elisabeth A. Wilde
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
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Steward KA, Kennedy R, Novack TA, Crowe M, Marson DC, Triebel KL. The Role of Cognitive Reserve in Recovery From Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:E18-E27. [PMID: 28520675 PMCID: PMC5693786 DOI: 10.1097/htr.0000000000000325] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether cognitive reserve (CR) attenuates the initial impact of traumatic brain injury (TBI) on cognitive performance (neural reserve) and results in faster cognitive recovery rates in the first year postinjury (neural compensation), and whether the advantage of CR differs on the basis of the severity of TBI. SETTING Inpatient/outpatient clinics at an academic medical center. PARTICIPANTS Adults with mild TBI (mTBI; n = 28), complicated mild TBI (cmTBI; n = 24), and moderate to severe TBI (msevTBI; n = 57), and demographically matched controls (n = 66). DESIGN Retrospective, longitudinal cohort assessed at 1, 6, and 12 months postinjury. MAIN MEASURES Outcomes were 3 cognitive domains: processing speed/executive function, verbal fluency, and memory. Premorbid IQ, estimated with the Wechsler Test of Adult Reading, served as CR proxy. RESULTS Higher premorbid IQ was associated with better performance on cognitive domains at 1 month postinjury, and the effect of IQ was similarly beneficial for all groups. Cognitive recovery rate was moderated only by TBI severity; those with more severe TBI had faster recovery in the first year. CONCLUSION Results support only the neural reserve theory of CR within a TBI population and indicate that CR is neuroprotective, regardless of the degree of TBI. Higher premorbid CR does not allow for more rapid adaptation and recovery from injury.
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Affiliation(s)
- Kayla A. Steward
- Department of Psychology, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Richard Kennedy
- Department of Medicine, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Thomas A. Novack
- Department of Physical Medicine and Rehabilitation, University of
Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Daniel C. Marson
- Department of Neurology, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Kristen L. Triebel
- Department of Neurology, University of Alabama at Birmingham,
Birmingham, AL, USA
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Mandalaywala MD, Crawford KM, Pinto SM. Management of Traumatic Brain Injury: Special Considerations for Older Adults. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Donders J, Stout J. The Influence of Cognitive Reserve on Recovery from Traumatic Brain Injury. Arch Clin Neuropsychol 2019; 34:206-213. [PMID: 29659665 DOI: 10.1093/arclin/acy035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/24/2018] [Indexed: 11/14/2022] Open
Abstract
Objective we sought to determine the degree to which cognitive reserve, as assessed by the Test of Premorbid Functioning in combination with demographic variables, could act as a buffer against the effect of traumatic brain injury (TBI) on cognitive test performance. Method retrospective analysis of a cohort of 121 persons with TBI who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) within 1-12 months after injury. Results regression analyses indicated that cognitive reserve was a statistically significant predictor of all postinjury WAIS-IV factor index scores, after controlling for various premorbid and comorbid confounding variables. Only for Processing Speed did injury severity make an additional statistically significant contribution to the prediction model. Conclusions cognitive reserve has a protective effect with regard to the impact of TBI on cognitive test performance but this effect is imperfect and does not completely negate the effect of injury severity.
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Affiliation(s)
- Jacobus Donders
- Psychology Service, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Jacob Stout
- Department of Psychology, Calvin College, Grand Rapids, MI, USA
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Abstract
OBJECTIVES Traumatic brain injury can result in cognitive impairments in children. The objective of this retrospective study was to determine to what extent such outcomes are moderated by cognitive reserve, as indexed by parental education. METHODS Sixty 6- to 16-year-old children completed the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) within 30-360 days after having sustained a traumatic brain injury (TBI). Their Full-Scale IQ and factor index scores were compared to those of demographically matched controls. In addition, regression analysis was used to investigate in the TBI group the influence of injury severity in addition to parental education on WISC-V factor index scores. RESULTS Cognitive reserve moderated the effect of TBI on WISC-V Full Scale IQ, Verbal Comprehension, and Visual Spatial. In the TBI group, it also had a protective effect with regard to performance on the Verbal Comprehension, Visual Spatial, and Fluid Reasoning indices. At the same time, greater injury severity was predictive of lower Visual Spatial and Processing Speed index scores in the TBI group. CONCLUSIONS Cognitive reserve as reflected in parental education has a moderating effect with regard to children's performance on the WISC-V after TBI, such that higher cognitive reserve is associated with greater preservation of acquired word knowledge and understanding of visual relationships. Measures that emphasize speed of processing remain affected by severity of TBI, even after accounting for the protective effect associated with cognitive reserve. (JINS, 2019, 25, 355-361).
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Cognitive Performance, Aerobic Fitness, Motor Proficiency, and Brain Function Among Children Newly Diagnosed With Craniopharyngioma. J Int Neuropsychol Soc 2019; 25:413-425. [PMID: 31050329 PMCID: PMC6499492 DOI: 10.1017/s1355617718001170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Craniopharyngioma survivors experience cognitive deficits that negatively impact quality of life. Aerobic fitness is associated with cognitive benefits in typically developing children and physical exercise promotes recovery following brain injury. Accordingly, we investigated cognitive and neural correlates of aerobic fitness in a sample of craniopharyngioma patients. METHODS Patients treated for craniopharyngioma [N=104, 10.0±4.6 years, 48% male] participated in fitness, cognitive and fMRI (n=51) assessments following surgery but before proton radiation therapy. RESULTS Patients demonstrated impaired aerobic fitness [peak oxygen uptake (PKVO2)=23.9±7.1, 41% impaired (i.e., 1.5 SD<normative mean)], motor proficiency [Bruininks-Oseretsky (BOT2)=38.6±9.0, 28% impaired], and executive functions (e.g., WISC-IV Working Memory Index (WMI)=96.0±15.3, 11% impaired). PKVO2 correlated with better executive functions (e.g., WISC-IV WMI r=.27, p=.02) and academic performance (WJ-III Calculation r=.24, p=.04). BOT2 correlated with better attention (e.g., CPT-II omissions r=.26, p=.04) and executive functions (e.g., WISC-IV WMI r=.32, p=.01). Areas of robust neural activation during an n-back task included superior parietal lobule, dorsolateral prefrontal cortex, and middle and superior frontal gyri (p<.05, corrected). Higher network activation was associated with better working memory task performance and better BOT2 (p<.001). CONCLUSIONS Before adjuvant therapy, children with craniopharyngioma demonstrate significantly reduced aerobic fitness, motor proficiency, and working memory. Better aerobic fitness and motor proficiency are associated with better attention and executive functions, as well as greater activation of a well-established working memory network. These findings may help explain differential risk/resiliency with respect to acute cognitive changes that may portend cognitive late effects. (JINS, 2019, 25, 413-425).
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de Freitas Cardoso MG, Faleiro RM, de Paula JJ, Kummer A, Caramelli P, Teixeira AL, de Souza LC, Miranda AS. Cognitive Impairment Following Acute Mild Traumatic Brain Injury. Front Neurol 2019; 10:198. [PMID: 30906278 PMCID: PMC6418036 DOI: 10.3389/fneur.2019.00198] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/15/2019] [Indexed: 01/28/2023] Open
Abstract
Patients with mild traumatic brain injury (mTBI) may present cognitive deficits within the first 24 h after trauma, herein called "acute phase," which in turn may lead to long-term functional impairment and decrease in quality of life. Few studies investigated cognition in mTBI patients during the acute phase. The objectives of this study were to investigate the cognitive profile of patients with mTBI during the acute phase, compared to controls and normative data, and whether loss of consciousness (LOC), previous TBI and level of education influence cognition at this stage. Fifty-three patients with mTBI (aged 19-64 years) and 28 healthy controls participated in the study. All patients were evaluated at bedside within 24 h post-injury. Demographic and clinical data were registered. Cognitive function was assessed with the Mini-mental state examination (MMSE), the Frontal Assessment Battery (FAB), Digit Span (working memory), and the Visual Memory Test/Brief Cognitive Battery (for episodic memory). The clinical sample was composed mainly by men (58.5%). The mean age was 39 years-old and 64.3% of the patients had more than 8 years of education. The most common causes of mTBI were fall from own height (28.3%), aggression (24.5%), and fall from variable heights (24.5%). Compared to controls, mTBI patients exhibited significantly worse performance on MMSE, FAB, naming, incidental memory, immediate memory, learning, and delayed recall. Compared to normative data, 26.4% of patients had reduced global cognition as measured by the MMSE. Episodic memory impairment (13.2%) was more frequent than executive dysfunction (9.4%). No significant differences were found in cognitive performance when comparing patients with or without LOC or those with or without history of previous TBI. Patients with lower educational level had higher rates of cognitive impairment (VMT naming-28.6 vs. 4.2%; VMT immediate memory-32 vs. 4.2%; VMT learning-39.3 vs. 4.2%, all p < 0.05). In sum, we found significant cognitive impairment in the acute phase of mTBI, which was not associated with LOC or history of TBI, but appeared more frequently in patients with lower educational level.
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Affiliation(s)
- Maíra Glória de Freitas Cardoso
- Neuroscience Program, Laboratório Interdisciplinar em Investigação Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo Moreira Faleiro
- Faculdade de Ciências Médicas de Minas Gerais, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil
| | | | - Arthur Kummer
- Laboratório Interdisciplinar em Investigação Médica, Eli Lilly and Company do Brasil, São Paulo, Brazil
| | - Paulo Caramelli
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio Lúcio Teixeira
- Santa Casa BH Ensino e Pesquisa, Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Leonardo Cruz de Souza
- Laboratório Interdisciplinar em Investigação Médica, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Silva Miranda
- Laboratório Interdisciplinar em Investigação Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Cognitive Reserve Protects Against Memory Decrements Associated With Neuropathology in Traumatic Brain Injury. J Head Trauma Rehabil 2019; 34:E57-E65. [PMID: 30829821 DOI: 10.1097/htr.0000000000000472] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether cognitive reserve (CR) moderates the relationship between neuropathology and cognitive outcomes after traumatic brain injury (TBI). SETTING Outpatient research organization. PARTICIPANTS Patients with complicated mild (n = 8), moderate (n = 9), and severe (n = 44) TBI. DESIGN Prospective, cross-sectional study. MAIN MEASURES Cognitive reserve was estimated using a test of word reading (Wechsler Test of Adult Reading). Diffusion tensor imaging (functional anisotropy) was used to quantify neuropathology. Neuropsychological test scores were submitted to principal components analyses to create cognitive composites for memory, attention, executive function, and processing speed domains. RESULTS At lower levels of neuropathology, people with higher CR exhibited better memory than those with lower CR. This benefit diminished as neuropathology increased and disappeared at the highest levels of neuropathology. Cognitive reserve ceased exerting a protective effect at premorbid intelligence levels below average. CONCLUSION Cognitive reserve may differentially protect some cognitive domains against neuropathology relative to others. A clinical cutoff below which CR is no longer protective, together with a possible neuropathology ceiling effect, may be instructive for prognostication and clinical decision-making in cognitive rehabilitation.
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Stocker RA. Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection. Med Sci (Basel) 2019; 7:medsci7030037. [PMID: 30813644 PMCID: PMC6473302 DOI: 10.3390/medsci7030037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/01/2019] [Accepted: 02/14/2019] [Indexed: 12/20/2022] Open
Abstract
Moderate to severe traumatic brain injuries (TBI) require treatment in an intensive care unit (ICU) in close collaboration of a multidisciplinary team consisting of different medical specialists such as intensivists, neurosurgeons, neurologists, as well as ICU nurses, physiotherapists, and ergo-/logotherapists. Major goals include all measurements to prevent secondary brain injury due to secondary brain insults and to optimize frame conditions for recovery and early rehabilitation. The distinction between moderate and severe is frequently done based on the Glascow Coma Scale and therefore often is just a snapshot at the early time of assessment. Due to its pathophysiological pathways, an initially as moderate classified TBI may need the same sophisticated surveillance, monitoring, and treatment as a severe form or might even progress to a severe and difficult to treat affection. As traumatic brain injury is rather a syndrome comprising a range of different affections to the brain and as, e.g., age-related comorbidities and treatments additionally may have a great impact, individual and tailored treatment approaches based on monitoring and findings in imaging and respecting pre-injury comorbidities and their therapies are warranted.
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Affiliation(s)
- Reto A Stocker
- Institute for Anesthesiology and Intensive Care Medicine, Klinik Hirslanden, CH-8032 Zurich, Switzerland.
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Abstract
Paradoxical enhancement and paradoxical recovery of function after brain injury harmonize well with the concept of "ultrabilitation" and its focus on novel forms of flourishing in rehabilitation settings. I consider three sets of paradoxes which may impact on brain injury rehabilitation. Firstly, I consider post-traumatic growth after brain injury and its key determinants. Secondly, I review the role of illusions in rehabilitation and the paradox that some clinical conditions may be improved by invoking perceptual distortions. Thirdly, I consider paradoxical recovery profiles after brain injury, since knowledge of such paradoxical profiles may help inform attempts at rehabilitation of some patients. Finally, I consider how some of these paradoxes relate to components of ultrabilitation, and in addition to the nascent field of positive neuropsychology and the concept of resilience after brain injury.Implications for rehabilitationIllusions can sometimes be harnessed as a therapeutic tool in rehabilitation.There may be spontaneous, positive outcomes of an injury or illness, in the form of "post-traumatic growth", and these should be considered as part of a holistic therapeutic approach in rehabilitation.Some patients make an exceptional recovery from a severe brain insult, and lessons could be learned from such cases, such as disciplined use of compensatory strategies, which could have broader implications for neurorehabilitation.
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Affiliation(s)
- Narinder Kapur
- Research Department of Clinical Psychology, University College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK.,Elysium Neurological Services, Daventry, England
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize current conceptual models of cognitive reserve (CR) and related concepts and to discuss evidence for these concepts within the context of aging and Alzheimer's disease. RECENT FINDINGS Evidence to date supports the notion that higher levels of CR, as measured by proxy variables reflective of lifetime experiences, are associated with better cognitive performance, and with a reduced risk of incident mild cognitive impairment/dementia. However, the impact of CR on longitudinal cognitive trajectories is unclear and may be influenced by a number of factors. Although there is promising evidence that some proxy measures of CR may influence structural brain measures, more research is needed. The protective effects of CR may provide an important mechanism for preserving cognitive function and cognitive well-being with age, in part because it can be enhanced throughout the lifespan. However, more research on the mechanisms by which CR is protective is needed.
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Affiliation(s)
- Corinne Pettigrew
- Department of Neurology, Johns Hopkins University School of Medicine, 1620 McElderry St., Reed Hall 1-West, Baltimore, MD, 21205, USA
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, 1620 McElderry St., Reed Hall 1-West, Baltimore, MD, 21205, USA.
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Cutuli D, de Guevara-Miranda DL, Castilla-Ortega E, Santín L, Sampedro-Piquero P. Highlighting the Role of Cognitive and Brain Reserve in the Substance use Disorder Field. Curr Neuropharmacol 2019; 17:1056-1070. [PMID: 31204624 PMCID: PMC7052825 DOI: 10.2174/1570159x17666190617100707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/17/2019] [Accepted: 05/31/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cognitive reserve (CR) refers to the ability of an individual to cope with brain pathology remaining free of cognitive symptoms. This protective factor has been related to compensatory and more efficient brain mechanisms involved in resisting brain damage. For its part, Brain reserve (BR) refers to individual differences in the structural properties of the brain which could also make us more resilient to suffer from neurodegenerative and mental diseases. OBJECTIVE This review summarizes how this construct, mainly mediated by educational level, occupational attainment, physical and mental activity, as well as successful social relationships, has gained scientific attention in the last years with regard to diseases, such as neurodegenerative diseases, stroke or traumatic brain injury. Nevertheless, although CR has been studied in a large number of disorders, few researches have addressed the role of this concept in drug addiction. METHODS We provide a selective overview of recent literature about the role of CR and BR in preventing substance use onset. Likewise, we will also discuss how variables involved in CR (healthy leisure, social support or job-related activities, among others) could be trained and included as complementary activities of substance use disorder treatments. RESULTS Evidence about this topic suggests a preventive role of CR and BR on drug use onset and when drug addiction is established, these factors led to less severe addiction-related problems, as well as better treatment outcomes. CONCLUSION CR and BR are variables not taken yet into account in drug addiction. However, they could give us a valuable information about people at risk, as well as patient's prognosis.
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Affiliation(s)
| | | | | | - L.J. Santín
- Address correspondence to these authors at the Instituto de Investigación Biomédica de Málaga (IBIMA), Doctor Miguel Díaz Recio, 28 Málaga 29010, Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos S/N, 29071 Málaga, Spain; E-mails: (P. Sampedro-Piquero) and (L.J. Santín)
| | - P. Sampedro-Piquero
- Address correspondence to these authors at the Instituto de Investigación Biomédica de Málaga (IBIMA), Doctor Miguel Díaz Recio, 28 Málaga 29010, Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos S/N, 29071 Málaga, Spain; E-mails: (P. Sampedro-Piquero) and (L.J. Santín)
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Mollayeva T, Mollayeva S, Colantonio A. Traumatic brain injury: sex, gender and intersecting vulnerabilities. Nat Rev Neurol 2018; 14:711-722. [DOI: 10.1038/s41582-018-0091-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Wardlaw C, Hicks AJ, Sherer M, Ponsford JL. Psychological Resilience Is Associated With Participation Outcomes Following Mild to Severe Traumatic Brain Injury. Front Neurol 2018; 9:563. [PMID: 30061858 PMCID: PMC6054998 DOI: 10.3389/fneur.2018.00563] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/22/2018] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) causes physical and cognitive-behavioral impairments that reduce participation in employment, leisure, and social relationships. Demographic and injury-related factors account for a small proportion of variance in participation post-injury. Personal factors such as resilience may also impact outcomes. This study aimed to examine the association of resilience alongside demographic, injury-related, cognitive, emotional, and family factors with participation following TBI. It was hypothesized that resilience would make an independent contribution to participation outcomes after TBI. Participants included 245 individuals with mild-severe TBI [Mage = 44.41, SDage = 16.09; post traumatic amnesia (PTA) duration M 24.95 days, SD 45.99] who completed the Participation Assessment with Recombined Tools-Objective (PART-O), TBI Quality of Life Resilience scale, Family Assessment Device General Functioning Scale, Rey Auditory Verbal Learning Test, National Adult Reading Test, and Hospital Anxiety and Depression Scale an average 4.63 years post-injury (SD 3.02, R 0.5-13). Multiple regression analyses were used to examine predictors of PART-O scores as the participation measure. Variables in the model accounted for a significant 38% of the variability in participation outcomes, F(13, 211) = 9.93, p < 0.05, R2 = 0.38, adjusted R2 = 0.34. Resilience was a significant predictor of higher participation, along with shorter PTA duration, more years since injury, higher education and IQ, and younger age. Mediation analyses revealed depression mediated the relationship between resilience and participation. As greater resilience may protect against depression and enhance participation this may be a focus of intervention.
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Affiliation(s)
- Carla Wardlaw
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Amelia J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Mark Sherer
- TIRR Memorial Hermann, Houston, TX, United States
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
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Späni CB, Braun DJ, Van Eldik LJ. Sex-related responses after traumatic brain injury: Considerations for preclinical modeling. Front Neuroendocrinol 2018; 50:52-66. [PMID: 29753798 PMCID: PMC6139061 DOI: 10.1016/j.yfrne.2018.03.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 12/18/2022]
Abstract
Traumatic brain injury (TBI) has historically been viewed as a primarily male problem, since men are more likely to experience a TBI because of more frequent participation in activities that increase risk of head injuries. This male bias is also reflected in preclinical research where mostly male animals have been used in basic and translational science. However, with an aging population in which TBI incidence is increasingly sex-independent due to falls, and increasing female participation in high-risk activities, the attention to potential sex differences in TBI responses and outcomes will become more important. These considerations are especially relevant in designing preclinical animal models of TBI that are more predictive of human responses and outcomes. This review characterizes sex differences following TBI with a special emphasis on the contribution of the female sex hormones, progesterone and estrogen, to these differences. This information is potentially important in developing and customizing TBI treatments.
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Affiliation(s)
- Claudia B Späni
- Sanders-Brown Center on Aging, University of Kentucky, 101 Sanders-Brown Bldg., 800 S. Limestone Street, Lexington, KY 40536, USA.
| | - David J Braun
- Sanders-Brown Center on Aging, University of Kentucky, 101 Sanders-Brown Bldg., 800 S. Limestone Street, Lexington, KY 40536, USA.
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, 101 Sanders-Brown Bldg., 800 S. Limestone Street, Lexington, KY 40536, USA; Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky, B481, BBSRB, 741 S. Limestone Street, Lexington, KY 40536, USA; Department of Neuroscience, College of Medicine, University of Kentucky, UK Medical Center MN 150, Lexington, KY 40536, USA.
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Mas MF, Mathews A, Gilbert-Baffoe E. Rehabilitation Needs of the Elder with Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2018; 28:829-842. [PMID: 29031347 DOI: 10.1016/j.pmr.2017.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of traumatic brain injury (TBI) in older adults is increasing. As the expected life expectancy increases, there is a heightened need for comprehensive rehabilitation for this population. Elderly patients with TBI benefit from rehabilitation interventions at all stages of injury and can achieve functional gains during acute inpatient rehabilitation. Clinicians should be vigilant of unique characteristics of this population during inpatient rehabilitation, including vulnerability to polypharmacy, posttraumatic hydrocephalus, neuropsychiatric sequelae, sleep disturbances, and sensory deficits. Long-term care should include fall prevention, assessment of cognitive deficits, aerobic activity, community reintegration, and caretaker support. Life expectancy is reduced after TBI.
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Affiliation(s)
- Manuel F Mas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030, USA.
| | - Amy Mathews
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, TX 77030, USA
| | - Ekua Gilbert-Baffoe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, TX 77030, USA
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Oyegbile TO, Delasobera BE, Zecavati N. Postconcussive Symptoms After Single and Repeated Concussions in 10- to 20-Year-Olds: A Cross-Sectional Study. J Child Neurol 2018; 33:383-388. [PMID: 29552934 DOI: 10.1177/0883073818759436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective was to characterize cognitive deficits and postconcussive symptoms in a pediatric population with no concussion, a single concussion, and ≥2 concussions, using a cross-sectional design. Cognitive function and postconcussive symptoms were assessed in participants (age 10-20) with no concussion (n = 1118), single concussion (n = 368), and repeated (≥2) concussions (n = 252). Analyses were adjusted for age and gender. Individuals with ≥2 concussions exhibited more total postconcussive symptoms; more loss of consciousness, amnesia and confusion; more headaches; and poorer cognitive function compared to no concussion and single concussion. Postconcussive symptoms may play a modulatory role in cognitive dysfunction after repeated concussions as those with loss of consciousness, amnesia, confusion, or headaches exhibited worse verbal memory, visual memory, visual-motor processing, and poorer impulse control compared to those without these symptoms. This analysis demonstrates that repeated concussions is associated with poorer cognitive function and postconcussive symptoms compared to a single concussion.
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Affiliation(s)
| | | | - Nassim Zecavati
- 1 Medicine & Epilepsy, MedStar Georgetown University Hospital, Washington, DC, USA
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Gardner RC, Dams-O'Connor K, Morrissey MR, Manley GT. Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions. J Neurotrauma 2018; 35:889-906. [PMID: 29212411 PMCID: PMC5865621 DOI: 10.1089/neu.2017.5371] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.
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Affiliation(s)
- Raquel C. Gardner
- Department of Neurology, University of California San Francisco, and San Francisco VA Medical Center, San Francisco, California
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, California
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Molly Rose Morrissey
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Geoffrey T. Manley
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, California
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California
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Soldan A, Pettigrew C, Albert M. Evaluating Cognitive Reserve Through the Prism of Preclinical Alzheimer Disease. Psychiatr Clin North Am 2018; 41:65-77. [PMID: 29412849 PMCID: PMC5806143 DOI: 10.1016/j.psc.2017.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The concept of cognitive reserve (CR) was proposed to account for the discrepancy between levels of brain pathologic features or damage and clinical and cognitive function. This article provides a detailed review of prospective longitudinal studies that have investigated the interaction between CR and Alzheimer's disease (AD) biomarkers on clinical and cognitive outcomes among individuals with preclinical AD. Current evidence shows that higher levels of CR are associated with a delay in the onset of symptoms of mild cognitive impairment and that there may be multiple pathways by which CR exerts its protective effects.
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Affiliation(s)
- Anja Soldan
- Department of Neurology, Johns Hopkins School of Medicine, 1620 McElderry Street, Reed Hall West - 1, Baltimore, MD 21205, USA.
| | - Corinne Pettigrew
- Research Associate, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Professor, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Forero DA, López-León S, González-Giraldo Y, Dries DR, Pereira-Morales AJ, Jiménez KM, Franco-Restrepo JE. APOE gene and neuropsychiatric disorders and endophenotypes: A comprehensive review. Am J Med Genet B Neuropsychiatr Genet 2018; 177:126-142. [PMID: 27943569 DOI: 10.1002/ajmg.b.32516] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/07/2016] [Indexed: 12/14/2022]
Abstract
The Apolipoprotein E (APOE) gene is one of the main candidates in neuropsychiatric genetics, with hundreds of studies carried out in order to explore the possible role of polymorphisms in the APOE gene in a large number of neurological diseases, psychiatric disorders, and related endophenotypes. In the current article, we provide a comprehensive review of the structural and functional aspects of the APOE gene and its relationship with brain disorders. Evidence from genome-wide association studies and meta-analyses shows that the APOE gene has been significantly associated with several neurodegenerative disorders. Cellular and animal models show growing evidence of the key role of APOE in mechanisms of brain plasticity and behavior. Future analyses of the APOE gene might find a possible role in other neurological diseases and psychiatric disorders and related endophenotypes. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Diego A Forero
- Laboratory of Neuropsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia.,PhD Program in Health Sciences, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
| | | | - Yeimy González-Giraldo
- Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Daniel R Dries
- Chemistry Department, Juniata College, Huntingdon, Pennsylvania
| | - Angela J Pereira-Morales
- Laboratory of Neuropsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
| | - Karen M Jiménez
- Laboratory of Neuropsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
| | - Juan E Franco-Restrepo
- PhD Program in Health Sciences, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
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