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Cogan AM, Pape TLB, Yeaw J, DeKoven M, Anupindi R, Jordan N. Health Care Resource Utilization and Costs for Adults With Mild Traumatic Brain Injury With Chronic Vestibular Impairment. Arch Phys Med Rehabil 2021; 103:90-97.e8. [PMID: 34634230 DOI: 10.1016/j.apmr.2021.08.017] [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: 04/27/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To quantify the economic burden of all-cause health care resource utilization (HCRU) among adults with and without chronic vestibular impairment (CVI) after a mild traumatic brain injury (mTBI). DESIGN Retrospective matched cohort study. SETTING IQVIA Integrated Data Warehouse. PARTICIPANTS People with mTBI+CVI (n=20,441) matched on baseline age, sex, year of mTBI event, and Charlson Comorbidity Index (CCI) score to people with mTBI only (n=20,441) (N=40,882). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES All-cause health HCRU and costs at 12 and 24 months post mTBI diagnosis. RESULTS People with mTBI+CVI had significantly higher all-cause HCRU and costs at both time points than those with mTBI only. Multivariable regression analysis showed that, when controlling for baseline variables, costs of care were 1.5 times higher for mTBI+CVI than mTBI only. CONCLUSIONS People who developed CVI after mTBI had greater overall HCRU and costs for up to 2 years after the injury event compared with people who did not develop CVI after controlling for age, sex, region, and CCI score. Further research on access to follow-up services and effectiveness of interventions to address CVI is warranted.
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Affiliation(s)
- Alison M Cogan
- Washington DC VA Medical Center, Physical Medicine and Rehabilitation Service, Washington, DC.
| | - Theresa L Bender Pape
- Department of Veterans Affairs, Center for Innovation in Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Neil Jordan
- Department of Veterans Affairs, Center for Innovation in Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois; Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Behavioral Sciences and Preventive Medicine, Chicago, Illinois
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Hoffman JR, Zuckerman A, Ram O, Sadot O, Cohen H. Changes in Hippocampal Androgen Receptor Density and Behavior in Sprague-Dawley Male Rats Exposed to a Low-Pressure Blast Wave. Brain Plast 2020; 5:135-145. [PMID: 33282677 PMCID: PMC7685673 DOI: 10.3233/bpl-200107] [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] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this study was to examine the effect of exposure of a low-intensity blast wave on androgen receptor (AR) density in the hippocampus and the potential influence on behavioral and cognitive responses. Methods Sprague-Dawley rats were randomly assigned to either a blast exposed group (n = 27) or an unexposed (control) group (n = 10). Animals were treated identically, except that rats within the control group were not exposed to any of the characteristics of the blast wave. Behavior measures were conducted on day seven post-exposure. The rats were initially assessed in the elevated plus maze followed by the acoustic startle response paradigm. Spatial memory performance using the Morris water-maze test was assessed at 8-days post-exposure, for seven consecutive days. Following all behavioral tests AR immunofluorescence staining was performed in different hippocampal subregions. Results A significant elevation in anxiety index (p < 0.001) and impaired learning (p < 0.015) and spatial memory (p < 0.0015) were noted in exposed rats. In addition, a significant attenuation of the AR was noted in the CA1 (p = 0.006) and dentate gyrus (p = 0.031) subregions of the hippocampus in blast exposed animals. Correlational analyses revealed significant associations between AR and both anxiety index (r = -.36, p = 0.031) and memory (r = -0.38, p = 0.019). Conclusions The results of this study demonstrate that exposure to a low-pressure blast wave resulted in a decrease in AR density, which was associated with significant behavioral and cognitive changes.
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Affiliation(s)
- Jay R Hoffman
- Department of Physical Therapy, Ariel University, Ariel, Israel
| | - Amitai Zuckerman
- Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Faculty of Health Sciences, Division of Psychiatry, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Omri Ram
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Oren Sadot
- Department of Mechanical Engineering, Ben-Gurion University, Israel
| | - Hagit Cohen
- Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Faculty of Health Sciences, Division of Psychiatry, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hicks SD, Onks C, Kim RY, Zhen KJ, Loeffert J, Loeffert AC, Olympia RP, Fedorchak G, DeVita S, Rangnekar A, Leddy J, Haider MN, Gagnon Z, McLoughlin CD, Badia M, Randall J, Madeira M, Yengo‐Kahn AM, Wenzel J, Heller M, Zwibel H, Roberts A, Johnson S, Monteith C, Dretsch MN, Campbell TR, Mannix R, Neville C, Middleton F. Diagnosing mild traumatic brain injury using saliva RNA compared to cognitive and balance testing. Clin Transl Med 2020; 10:e197. [PMID: 33135344 PMCID: PMC7533415 DOI: 10.1002/ctm2.197] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Early, accurate diagnosis of mild traumatic brain injury (mTBI) can improve clinical outcomes for patients, but mTBI remains difficult to diagnose because of reliance on subjective symptom reports. An objective biomarker could increase diagnostic accuracy and improve clinical outcomes. The aim of this study was to assess the ability of salivary noncoding RNA (ncRNA) to serve as a diagnostic adjunct to current clinical tools. We hypothesized that saliva ncRNA levels would demonstrate comparable accuracy for identifying mTBI as measures of symptom burden, neurocognition, and balance. METHODS This case-control study involved 538 individuals. Participants included 251 individuals with mTBI, enrolled ≤14 days postinjury, from 11 clinical sites. Saliva samples (n = 679) were collected at five time points (≤3, 4-7, 8-14, 15-30, and 31-60 days post-mTBI). Levels of ncRNAs (microRNAs, small nucleolar RNAs, and piwi-interacting RNAs) were quantified within each sample using RNA sequencing. The first sample from each mTBI participant was compared to saliva samples from 287 controls. Samples were divided into testing (n = 430; mTBI = 201 and control = 239) and training sets (n = 108; mTBI = 50 and control = 58). The test set was used to identify ncRNA diagnostic candidates and create a diagnostic model. Model accuracy was assessed in the naïve test set. RESULTS A model utilizing seven ncRNA ratios, along with participant age and chronic headache status, differentiated mTBI and control participants with a cross-validated area under the curve (AUC) of .857 in the training set (95% CI, .816-.903) and .823 in the naïve test set. In a subset of participants (n = 321; mTBI = 176 and control = 145) assessed for symptom burden (Post-Concussion Symptom Scale), as well as neurocognition and balance (ClearEdge System), these clinical measures yielded cross-validated AUC of .835 (95% CI, .782-.880) and .853 (95% CI, .803-.899), respectively. A model employing symptom burden and four neurocognitive measures identified mTBI participants with similar AUC (.888; CI, .845-.925) as symptom burden and four ncRNAs (.932; 95% CI, .890-.965). CONCLUSION Salivary ncRNA levels represent a noninvasive, biologic measure that can aid objective, accurate diagnosis of mTBI.
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Affiliation(s)
- Steven D. Hicks
- Department of PediatricsPenn State College of MedicineHersheyPennsylvania
| | - Cayce Onks
- Department of Family MedicinePenn State College of MedicineHersheyPennsylvania
| | - Raymond Y. Kim
- Department of Orthopedics and RehabilitationPenn State College of MedicineHersheyPennsylvania
| | - Kevin J. Zhen
- Department of PediatricsPenn State College of MedicineHersheyPennsylvania
| | - Jayson Loeffert
- Department of Family MedicinePenn State College of MedicineHersheyPennsylvania
| | - Andrea C. Loeffert
- Department of PediatricsPenn State College of MedicineHersheyPennsylvania
| | - Robert P. Olympia
- Department of Emergency MedicinePenn State College of MedicineHersheyPennsylvania
| | | | | | | | - John Leddy
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical SciencesState University of New YorkBuffaloNew York
| | - Mohammad N. Haider
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical SciencesState University of New YorkBuffaloNew York
| | - Zofia Gagnon
- Department of Biomedical ScienceMarist CollegePoughkeepsieNew York
| | | | - Matthew Badia
- Department of Biomedical ScienceMarist CollegePoughkeepsieNew York
| | - Jason Randall
- Department of Environmental ScienceSchool of ScienceMarist CollegePoughkeepsieNew York
| | - Miguel Madeira
- Department of Biology, School of ScienceMarist CollegePoughkeepsieNew York
| | - Aaron M. Yengo‐Kahn
- Vanderbilt Sports Concussion CenterVanderbilt University Medical CenterNashvilleTennessee
| | - Justin Wenzel
- Vanderbilt Sports Concussion CenterVanderbilt University Medical CenterNashvilleTennessee
| | - Matthew Heller
- Department of Family MedicineNew York Institute of Technology College of Osteopathic MedicineOld WestburyNew York
| | - Hallie Zwibel
- Department of Family MedicineNew York Institute of Technology College of Osteopathic MedicineOld WestburyNew York
| | - Aaron Roberts
- Adena Bone and Joint CenterAdena Regional Medical CenterChillicotheOhio
| | - Samantha Johnson
- Adena Bone and Joint CenterAdena Regional Medical CenterChillicotheOhio
| | - Chuck Monteith
- Athletic Training DepartmentColgate UniversityHamiltonNew York
| | - Michael N. Dretsch
- US Army Medical Research Directorate‐WestWalter Reed Army Institute of ResearchJoint Base Lewis–McChordWashington
| | | | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's HospitalHarvard Medical SchoolBostonMassachusetts
| | - Christopher Neville
- Department of PT Education, Orthopedics, and NeuroscienceSUNY Upstate Medical UniversitySyracuseNew York
| | - Frank Middleton
- Department of Neuroscience and PhysiologySUNY Upstate Medical UniversitySyracuseNew York
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Pradeep T, Bray MJC, Arun S, Richey LN, Jahed S, Bryant BR, LoBue C, Lyketsos CG, Kim P, Peters ME. History of traumatic brain injury interferes with accurate diagnosis of Alzheimer's dementia: a nation-wide case-control study. Int Rev Psychiatry 2020; 32:61-70. [PMID: 31707905 PMCID: PMC6952566 DOI: 10.1080/09540261.2019.1682529] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/16/2019] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) and Alzheimer's disease (AD) bear a complex relationship, potentially increasing risk of one another reciprocally. However, recent evidence suggests post-TBI dementia exists as a distinct neurodegenerative syndrome, confounding AD diagnostic accuracy in clinical settings. This investigation sought to evaluate TBI's impact on the accuracy of clinician-diagnosed AD using gold standard neuropathological criteria. In this preliminary analysis, data were acquired from the National Alzheimer's Coordinating Centre (NACC), which aggregates clinical and neuropathologic information from Alzheimer's disease centres across the United States. Modified National Institute on Aging-Reagan criteria were applied to confirm AD by neuropathology. Among participants with clinician-diagnosed AD, TBI history was associated with misdiagnosis (false positives) (OR = 1.351 [95% CI: 1.091-1.674], p = 0.006). Among participants without clinician-diagnosed AD, TBI history was not associated with false negatives. TBI moderates AD diagnostic accuracy. Possible AD misdiagnosis can mislead patients, influence treatment decisions, and confound research study designs. Further work examining the influence of TBI on dementia diagnosis is warranted.
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Affiliation(s)
- Tejus Pradeep
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michael J. C. Bray
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Siddharth Arun
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Lisa N. Richey
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sahar Jahed
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Barry R. Bryant
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Christian LoBue
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Paul Kim
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Matthew E. Peters
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Herrold AA, Smith B, Aaronson AL, Coleman J, Pape TLB. Relationships and Evidence-Based Theoretical Perspectives on Persisting Symptoms and Functional Impairment Among Mild Traumatic Brain Injury and Behavioral Health Conditions. Mil Med 2019; 184:138-147. [PMID: 30901443 DOI: 10.1093/milmed/usy306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/15/2018] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study is to characterize and describe the relationships between symptoms and functional impairment following mild traumatic brain injury (mTBI) and behavioral health conditions (BHCs) in order to inform evidence-based theories on why symptoms and functional impairments persist in some individuals but not others. This is a retrospective, multi-site, cross-sectional study utilizing data collected from a total of 289 Operation Iraqi Freedom/Operation Enduring Freedom Veterans who were classified into diagnostic groups using the symptom attribution and classification algorithm and the VA clinical reminder and comprehensive traumatic brain injury evaluation. The Neurobehavioral Symptom Inventory was used to assess mTBI symptom number and severity. The World Health Organization Disability Assessment Schedule 2.0 was used to assess functional impairment. Symptom profiles differed between diagnostic groups irrespective of symptom attribution method used. Veterans with both mTBI and BHCs and those with BHCs alone had consistently greater number of symptoms and more severe symptoms relative to no symptom and symptoms resolved groups. Symptom number and severity were significantly associated with functional impairment. Both symptom number and functional impairment were significantly associated with the number of mTBI exposures. Together, these results informed evidence-based theories on understanding why symptoms and functional impairment persist among some OEF/OIF Veterans.
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Affiliation(s)
- Amy A Herrold
- Research Service & Center for Innovation and Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, 5000 S 5th Ave, MC 151 H, Hines, IL.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, 710 N Lakeshore Dr., Chicago, IL
| | - Bridget Smith
- Research Service & Center for Innovation and Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, 5000 S 5th Ave, MC 151 H, Hines, IL.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, 310 E. Superior St., Morton 4-685, Chicago, IL
| | - Alexandra L Aaronson
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, 710 N Lakeshore Dr., Chicago, IL.,Mental Health Service Line, Edward Hines Jr., VA Hospital, 5000 S. 5th Ave, Hines, IL
| | - John Coleman
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX
| | - Theresa L-B Pape
- Research Service & Center for Innovation and Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, 5000 S 5th Ave, MC 151 H, Hines, IL.,Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, 710 N Lakeshore Dr., Chicago, IL
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Pape TLB, Smith B, Babcock-Parziale J, Evans CT, Herrold AA, Phipps Maieritsch K, High WM. Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen. Arch Phys Med Rehabil 2018; 99:1370-1382. [DOI: 10.1016/j.apmr.2017.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 11/02/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
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Increased Rates of Mild Traumatic Brain Injury Among Older Adults in US Emergency Departments, 2009-2010. J Head Trauma Rehabil 2018; 31:E1-7. [PMID: 26479396 DOI: 10.1097/htr.0000000000000190] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate rates of emergency department (ED) visits for mild traumatic brain injury (TBI) among older adults. We defined possible mild TBI cases to assess underdiagnoses. DESIGN Cross-sectional. SETTING National sample of ED visits in 2009-2010 captured by the National Hospital Ambulatory Medical Care Survey. PARTICIPANTS Aged 65 years and older. MEASUREMENTS Mild TBI defined by International Classification of Diseases, Ninth Revision, Clinical Modification, codes (800.0x-801.9x, 803.xx, 804.xx, 850.xx-854.1x, 950.1x-950.3x, 959.01) and a Glasgow Coma Scale score of 14 or more or missing, excluding those admitted to the hospital. Possible mild TBI was defined similarly among those without mild TBI and with a fall or motor vehicle collision as cause of injury. We calculated rates of mild TBI and examined factors associated with a diagnosis of mild TBI. RESULTS Rates of ED visits for mild TBI were 386 per 100 000 among those aged 65 to 74 years, 777 per 100 000 among those aged 75 to 84 years, and 1205 per 100 000 among those older than 84 years. Rates for women (706/100 000) were higher than for men (516/100 000). Compared with a possible mild TBI, a diagnosis of mild TBI was more likely in the West (odds ratio = 2.31; 95% confidence interval, 1.02-5.24) and less likely in the South/Midwest (odds ratio = 0.52; 95% confidence interval, 0.29-0.96) than in the Northeast. CONCLUSIONS This study highlights an upward trend in rates of ED visits for mild TBI among older adults.
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Trifan G, Gattu R, Haacke EM, Kou Z, Benson RR. MR imaging findings in mild traumatic brain injury with persistent neurological impairment. Magn Reson Imaging 2017; 37:243-251. [DOI: 10.1016/j.mri.2016.12.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/26/2022]
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Behavioral and inflammatory response in animals exposed to a low-pressure blast wave and supplemented with β-alanine. Amino Acids 2017; 49:871-886. [PMID: 28161798 PMCID: PMC5383715 DOI: 10.1007/s00726-017-2383-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/18/2017] [Indexed: 12/30/2022]
Abstract
This study investigated the benefit of β-alanine (BA) supplementation on behavioral and cognitive responses relating to mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) in rats exposed to a low-pressure blast wave. Animals were fed a normal diet with or without (PL) BA supplementation (100 mg kg−1) for 30-day, prior to being exposed to a low-pressure blast wave. A third group of animals served as a control (CTL). These animals were fed a normal diet, but were not exposed to the blast. Validated cognitive-behavioral paradigms were used to assess both mTBI and PTSD-like behavior on days 7–14 following the blast. Brain-derived neurotrophic factor (BDNF), neuropeptide Y, glial fibrillary acidic protein (GFAP) and tau protein expressions were analyzed a day later. In addition, brain carnosine and histidine content was assessed as well. The prevalence of animals exhibiting mTBI-like behavior was significantly lower (p = 0.044) in BA than PL (26.5 and 46%, respectively), but no difference (p = 0.930) was noted in PTSD-like behavior between the groups (10.2 and 12.0%, respectively). Carnosine content in the cerebral cortex was higher (p = 0.048) for BA compared to PL, while a trend towards a difference was seen in the hippocampus (p = 0.058) and amygdala (p = 0.061). BDNF expression in the CA1 subregion of PL was lower than BA (p = 0.009) and CTL (p < 0.001), while GFAP expression in CA1 (p = 0.003) and CA3 (p = 0.040) subregions were higher in PL than other groups. Results indicated that BA supplementation for 30-day increased resiliency to mTBI in animals exposed to a low-pressure blast wave.
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Algorithm for Symptom Attribution and Classification Following Possible Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:E10-E22. [DOI: 10.1097/htr.0000000000000220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cheng JS, Craft R, Yu GQ, Ho K, Wang X, Mohan G, Mangnitsky S, Ponnusamy R, Mucke L. Tau reduction diminishes spatial learning and memory deficits after mild repetitive traumatic brain injury in mice. PLoS One 2014; 9:e115765. [PMID: 25551452 PMCID: PMC4281043 DOI: 10.1371/journal.pone.0115765] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/01/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Because reduction of the microtubule-associated protein Tau has beneficial effects in mouse models of Alzheimer's disease and epilepsy, we wanted to determine whether this strategy can also improve the outcome of mild traumatic brain injury (TBI). METHODS We adapted a mild frontal impact model of TBI for wildtype C57Bl/6J mice and characterized the behavioral deficits it causes in these animals. The Barnes maze, Y maze, contextual and cued fear conditioning, elevated plus maze, open field, balance beam, and forced swim test were used to assess different behavioral functions. Magnetic resonance imaging (MRI, 7 Tesla) and histological analysis of brain sections were used to look for neuropathological alterations. We also compared the functional effects of this TBI model and of controlled cortical impact in mice with two, one or no Tau alleles. RESULTS Repeated (2-hit), but not single (1-hit), mild frontal impact impaired spatial learning and memory in wildtype mice as determined by testing of mice in the Barnes maze one month after the injury. Locomotor activity, anxiety, depression and fear related behaviors did not differ between injured and sham-injured mice. MRI imaging did not reveal focal injury or mass lesions shortly after the injury. Complete ablation or partial reduction of tau prevented deficits in spatial learning and memory after repeated mild frontal impact. Complete tau ablation also showed a trend towards protection after a single controlled cortical impact. Complete or partial reduction of tau also reduced the level of axonopathy in the corpus callosum after repeated mild frontal impact. INTERPRETATION Tau promotes or enables the development of learning and memory deficits and of axonopathy after mild TBI, and tau reduction counteracts these adverse effects.
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Affiliation(s)
- Jason S. Cheng
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States of America
| | - Ryan Craft
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Gui-Qiu Yu
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Kaitlyn Ho
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Xin Wang
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Geetha Mohan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Sergey Mangnitsky
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Ravikumar Ponnusamy
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Lennart Mucke
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
- Department of Neurology, University of California San Francisco, California, United States of America
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Herrold AA, Kletzel SL, Harton BC, Chambers RA, Jordan N, Pape TLB. Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders. Neural Regen Res 2014; 9:1712-30. [PMID: 25422632 PMCID: PMC4238159 DOI: 10.4103/1673-5374.143408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/13/2022] Open
Abstract
Alcohol use disorder (AUD), mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD) commonly co-occur (AUD + mTBI + PTSD). These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation (rTMS) is non-invasive and may be an ideal treatment for co-occurring AUD + mTBI + PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD + mTBI + PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD + mTBI + PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD + mTBI + PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.
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Affiliation(s)
- Amy A. Herrold
- Edward Hines Jr. VA Hospital, Research Service PO Box 5000 (M/C 151H), Hines, IL, USA
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, #7-200, Chicago, IL, USA
| | - Sandra L. Kletzel
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
| | - Brett C. Harton
- Chicago Association for Research and Education in Science, Hines, IL, USA
| | - R. Andrew Chambers
- Department of Psychiatry, Laboratory for Translational Neuroscience of Dual Diagnosis & Development, Neuroscience Research Center, Indiana University School of Medicine, 320 West 15 Street, Indianapolis, IN, USA
| | - Neil Jordan
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, #7-200, Chicago, IL, USA
| | - Theresa Louise-Bender Pape
- Edward Hines Jr. VA Hospital, Research Service PO Box 5000 (M/C 151H), Hines, IL, USA
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, Office of Medical Educ. (1574), 345 E. Superior St., Chicago, IL, USA
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