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Chuaykarn U, Thato R, Crago EA. Nonpharmacological interventions to improve the cognitive function among persons with traumatic brain injury: A systematic review. J Nurs Scholarsh 2024. [PMID: 38798031 DOI: 10.1111/jnu.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The systematic review aimed to evaluate the effectiveness of nonpharmacological interventions (NPIs) for improving cognitive function among persons with traumatic brain injury. DESIGN A systematic review. METHODS This systematic review was registered in PROSPERO and followed the PRISMA guideline. PubMed, ScienceDirect, Scopus, SpringerLink, Wiley Online Library, JSTOR, and Taylor & Francis were systematically searched for relevant articles of peer-reviewed studies published between 2008 and 2022. Two independent researchers conducted study selection, data extraction, and data quality assessment. FINDINGS Twenty-one studies met inclusion criteria, numbering a total of 757 participants. Six groups of NPIs were effective in improving cognitive functioning among persons with traumatic brain injury, including multimodal cognitive training, technology innovation, memory training, executive function training, physical activity, and sensory stimulation programs. Pooled evidence revealed that NPIs had a large effect on memory (d = 0.80, p < 0.05 to d = 2.03, p < 0.000), processing speed (d = 1.58, p < 0.05), and cognitive behavior (d = 1.63, p < 0.001 to d = 8.91, p 0.003). There was a medium effect on executive function (d = 0.5, p < 0.01 to d = 0.62, p < 0.05), attention (d = 0.5, p < 0.01), and intelligence (d = 0.57 to d = 0.59, p = 0.000). For visuospatial function and language, there was a significant increase post-intervention. CONCLUSION Evidence from this systematic review indicates that NPIs, specifically the use of multimodal cognitive training and sensory stimulation programs, were effective in improving cognitive function outcomes among persons with traumatic brain injury, with medium to large effect sizes. CLINICAL RELEVANCE Nonpharmacological interventions (NPIs) can enhance cognitive function in individuals with traumatic brain injury. These findings can guide healthcare professionals in clinical settings and support the development of technology applications for cognitive rehabilitation using NPIs.
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Affiliation(s)
- Uraporn Chuaykarn
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Boromarajonnani College of Nursing, Nakhon Si Thammarat, Faculty of Nursing, Praboromarajchanok Institute, Bangkok, Thailand
| | - Ratsiri Thato
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Elizabeth A Crago
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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2
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Correlation between preoperative psychological personality traits of glioma patients and psychological distress in their primary caregivers. Clin Neurol Neurosurg 2022; 214:107144. [DOI: 10.1016/j.clineuro.2022.107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022]
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3
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Weyer-Jamora C, Brie MS, Luks TL, Smith EM, Hervey-Jumper SL, Taylor JW. Postacute Cognitive Rehabilitation for Adult Brain Tumor Patients. Neurosurgery 2021; 89:945-953. [PMID: 33586764 PMCID: PMC8600173 DOI: 10.1093/neuros/nyaa552] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
Intrinsic brain tumors often occur within functional neural networks, leading to neurological impairment and disability of varying degrees. Advances in our understanding of tumor-network integration, human cognition and language processing, and multiparametric imaging, combined with refined intraoperative tumor resection techniques, have enhanced surgical management of intrinsic brain tumors within eloquent areas. However, cognitive symptoms impacting health-related quality of life, particularly processing speed, attention, concentration, working memory, and executive function, often persist after the postoperative recovery period and treatment. Multidisciplinary cognitive rehabilitation is the standard of care for addressing cognitive impairments in many neurological diseases. There is promising research to support the use of cognitive rehabilitation in adult brain tumor patients. In this review, we summarize the history and usefulness of postacute cognitive rehabilitation for adult brain tumor patients.
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Affiliation(s)
- Christina Weyer-Jamora
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Melissa S Brie
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Tracy L Luks
- Department of Radiology and Biomedical Imaging, University of CaliforniaSan Francisco, San Francisco, California
| | - Ellen M Smith
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
| | - Jennie W Taylor
- Department of Neurological Surgery, University of CaliforniaSan Francisco, San Francisco, California
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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4
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Voelbel GT, Lindsey HM, Mercuri G, Bushnik T, Rath J. The effects of neuroplasticity-based auditory information processing remediation in adults with chronic traumatic brain injury. NeuroRehabilitation 2021; 49:267-278. [PMID: 34420987 DOI: 10.3233/nre-218025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adults with chronic traumatic brain injury (TBI) may experience long-term deficits in multiple cognitive domains. Higher-order functions, such as verbal memory, are impacted by deficits in the ability to acquire verbal information. OBJECTIVE This study investigated the effects of a neuroplasticity-based computerized cognitive remediation program for auditory information processing in adults with a chronic TBI. METHODS Forty-eight adults with TBI were randomly assigned to an intervention or control group. Both groups underwent a neuropsychological assessment at baseline and post-training. The Intervention group received 40 one-hour cognitive training sessions with the Brain Fitness Program. RESULTS The intervention group improved in performance on measures of the Woodcock-Johnson-III Understanding Directions subtest and Trail Making Test Part-A. They also reported improvement on the cognitive domain of the Cognitive Self-Report Questionnaire. CONCLUSIONS The present study demonstrated that a neuroplasticity-based computerized cognitive remediation program may improve objective and subjective cognitive function in adults with TBI several years post-injury.
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Affiliation(s)
- Gerald T Voelbel
- Department of Occupational Therapy, New York University, New York, NY, USA.,Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Hannah M Lindsey
- Department of Psychology, New York University, New York, NY, USA.,Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Giulia Mercuri
- Department of Psychology, New York University, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Joseph Rath
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
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5
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Hawley L, Hammond FM, Cogan AM, Juengst S, Mumbower R, Pappadis MR, Waldman W, Dams-OʼConnor K. Ethical Considerations in Chronic Brain Injury. J Head Trauma Rehabil 2020; 34:433-436. [PMID: 31688380 PMCID: PMC6986275 DOI: 10.1097/htr.0000000000000538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A growing number of individuals are living with chronic traumatic brain injury. As these individuals and their families attempt to reintegrate into their communities, several ethical questions arise for clinicians and researchers. These include issues around alignment of perspectives and priorities, as well as responsibilities for ongoing treatment, education, community outreach, and research. An action plan for addressing these questions is outlined.
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Affiliation(s)
- Lenore Hawley
- Craig Hospital, Englewood, Colorado (Ms Hawley); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Washington DC VA Medical Center, Washington, District of Columbia (Dr Cogan); Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (Dr Juengst); Capstone College of Nursing, The University of Alabama, Tuscaloosa (Dr Mumbower); Division of Rehabilitation Sciences, School of Health Professions, The University of Texas Medical Branch, Galveston and Brain Injury Research Center, TIRR Memorial Hermann, Houston (Dr Pappadis); Resource Facilitation Program, RHI-Neuro Rehab Center, Indianapolis, Indiana (Ms Waldman); and Brain Injury Research Center, Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (Dr Dams-O'Connor)
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6
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Fernández López R, Antolí A. Computer-based cognitive interventions in acquired brain injury: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0235510. [PMID: 32645046 PMCID: PMC7347178 DOI: 10.1371/journal.pone.0235510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Acquired brain injury (ABI) leads to cognitive deficits in a great variety of cognitive functions. Interventions aimed at reducing such deficits include the use of computer-based cognitive interventions. The present work synthetizes and quantitively analyses the effect of computer-based cognitive interventions in ABI. Methods PubMed, Scopus, Web of Science, ProQuest and Ovid databases were searched for randomized controlled trials (RCT) addressing this issue. A total number of 8 randomized-controlled trials were included for systematic review and meta-analysis. Univariate meta-analyses were conducted for every cognitive function, producing aggregates when a study contributed more than one effect size per cognitive domain. Results Random-effects meta-analyses showed an improvement of Visual and Verbal working memory, while other domains like Attention, Processing speed, Executive functions and Memory were not benefited by the interventions. Conclusions Computer-based cognitive interventions might be a beneficial intervention for ABI population to improve Visual and Verbal working memory, although no effect was found in other cognitive domains. Implications and possible future directions of the research are discussed.
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Affiliation(s)
| | - Adoración Antolí
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
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Recla M, Molteni E, Manfredi V, Arrigoni F, Nordio A, Galbiati S, Pastore V, Modat M, Strazzer S. Feasibility Randomized Trial for an Intensive Memory-Focused Training Program for School-Aged Children with Acquired Brain Injury. Brain Sci 2020; 10:E430. [PMID: 32645968 PMCID: PMC7407971 DOI: 10.3390/brainsci10070430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Memory deficits are common sequelae of pediatric Acquired Brain Injury (ABI). Only methods for non-focused cognitive remediation are available to the pediatric field. The aims of this feasibility trial are the description, implementation, and test of an intensive program specific to the training and re-adaptation of memory function in children, called Intensive Memory-Focused Training Program (IM-FTP); (2) Methods: Eleven children and adolescents with ABI (mean age at injury = 12.2 years, brain tumor survivors excluded) were clinically assessed and rehabilitated over 1-month through IM-FTP, including physio-kinesis/occupational, speech, and neuropsychology treatments. Each patient received a psychometric evaluation and a brain functional MRI at enrollment and at discharge. Ten pediatric controls with ABI (mean age at injury = 13.8 years) were clinically assessed, and rehabilitated through a standard program; (3) Results: After treatment, both groups had marked improvement in both immediate and delayed recall. IM-FTP was associated with better learning of semantically related and unrelated words, and larger improvement in immediate recall in prose memory. Imaging showed functional modification in the left frontal inferior cortex; (4) Conclusions: We described an age-independent reproducible multidisciplinary memory-focused rehabilitation protocol, which can be adapted to single patients while preserving inter-subject comparability, and is applicable up to a few months after injury. IM-FTP will now be employed in a powered clinical trial.
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Affiliation(s)
- Monica Recla
- Neurophysiatric Department, Neuropsychological and Cognitive-behavioral Service, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.M.); (S.G.); (V.P.)
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, and Centre for Medical Engineering, King’s College, London SE1 7EU, UK; (E.M.); (M.M.)
| | - Valentina Manfredi
- Neurophysiatric Department, Neuropsychological and Cognitive-behavioral Service, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.M.); (S.G.); (V.P.)
| | - Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.A.); (A.N.)
| | - Andrea Nordio
- Neuroimaging Lab, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.A.); (A.N.)
| | - Susanna Galbiati
- Neurophysiatric Department, Neuropsychological and Cognitive-behavioral Service, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.M.); (S.G.); (V.P.)
| | - Valentina Pastore
- Neurophysiatric Department, Neuropsychological and Cognitive-behavioral Service, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.M.); (S.G.); (V.P.)
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, and Centre for Medical Engineering, King’s College, London SE1 7EU, UK; (E.M.); (M.M.)
| | - Sandra Strazzer
- Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy;
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Psychological Intervention in Traumatic Brain Injury Patients. Behav Neurol 2019; 2019:6937832. [PMID: 31191738 PMCID: PMC6525953 DOI: 10.1155/2019/6937832] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/20/2018] [Accepted: 03/19/2019] [Indexed: 01/25/2023] Open
Abstract
Objective To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury. Methods A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables. Results The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%). Conclusions CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.
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Murray CE, Lundgren K, Olson LN, Hunnicutt G. Practice Update: What Professionals Who Are Not Brain Injury Specialists Need to Know About Intimate Partner Violence-Related Traumatic Brain Injury. TRAUMA, VIOLENCE & ABUSE 2016; 17:298-305. [PMID: 25951838 DOI: 10.1177/1524838015584364] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There is growing recognition of the risk for traumatic brain injury (TBI) among victims and survivors of intimate partner violence (IPV). A wide range of physically abusive behaviors may lead to injuries to the head or neck and place an individual at risk for a TBI. The purpose of this article is to consolidate current research and present practical guidelines for professionals, who are not brain injury specialists, but work with clients who may have sustained a TBI in the context of IPV. Recommendations are provided for TBI risk screening, making appropriate referrals, and providing services in light of a potential TBI.
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Affiliation(s)
| | | | - Loreen N Olson
- The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Gwen Hunnicutt
- The University of North Carolina at Greensboro, Greensboro, NC, USA
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10
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Livelli A, Orofino GC, Calcagno A, Farenga M, Penoncelli D, Guastavigna M, Carosella S, Caramello P, Pia L. Evaluation of a Cognitive Rehabilitation Protocol in HIV Patients with Associated Neurocognitive Disorders: Efficacy and Stability Over Time. Front Behav Neurosci 2015; 9:306. [PMID: 26635558 PMCID: PMC4644912 DOI: 10.3389/fnbeh.2015.00306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/30/2015] [Indexed: 11/13/2022] Open
Abstract
The primary aim of the present study was to evaluate the efficacy and stability over time of a cognitive rehabilitation protocol (restorative and compensatory approach) in HIV/AIDS patients with HIV-associated Neurocognitive Disorder (HAND). At baseline, 32 HIV/AIDS patients (16 with and 16 without HAND) were assessed with a neuropsychological battery (i.e., pre-assessment) consisting of 22 tests covering eight cognitive domains. Then, the experimental group was administered over 4 months a cognitive rehabilitation protocol aimed at improving four cognitive domains by means of eight paper and pencil/computer-based exercises. The control group received guideline-adherent clinical care (i.e., standard of care). At the end of the cognitive treatment, both groups were re-administered the neuropsychological battery (i.e., post-assessment). Additionally, 6 months after post-assessment, the experimental group was given the same neuropsychological battery (i.e., follow up-assessment). In order to test the efficacy of the cognitive rehabilitation protocol, we compared between groups the results of the neuropsychological battery at the pre- and post-assessments. In order to evaluate the stability over time, the effects of the cognitive rehabilitation protocol was examined comparing within the experimental group the results of the neuropsychological battery at post- and follow up-assessments. Our results show that the two groups did not differ at the pre-assessment, but differed at post-assessment. Specifically, the experimental group showed a significant improvement in five domains (Learning and memory, Abstraction/executive functioning, Verbal fluency, Attention/working memory, and Functional), whereas the control group significantly worsened in the same domains. The improvement of the experimental group did not change in the follow up-assessment in two domains (Abstraction/executive functioning, Attention/working memory, and Functional). Overall, these findings support the efficacy and, to some extent, the stability over time of our cognitive rehabilitation protocol.
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Affiliation(s)
- Alessandro Livelli
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy ; SpAtial, Motor and Bodily Awareness Research Group, Department of Psychology, University of Torino Torino, Italy
| | - Gian Carlo Orofino
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino Torino, Italy
| | - Mariana Farenga
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | | | - Marta Guastavigna
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | | | - Pietro Caramello
- Division A of Infectious Diseases, Amedeo of Savoia Hospital Torino, Italy
| | - Lorenzo Pia
- SpAtial, Motor and Bodily Awareness Research Group, Department of Psychology, University of Torino Torino, Italy
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Virk S, Williams T, Brunsdon R, Suh F, Morrow A. Cognitive remediation of attention deficits following acquired brain injury: A systematic review and meta-analysis. NeuroRehabilitation 2015; 36:367-77. [DOI: 10.3233/nre-151225] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sohaib Virk
- Department of Kids Rehab, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Tracey Williams
- Department of Kids Rehab, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Ruth Brunsdon
- Department of Kids Rehab, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Flora Suh
- Department of Kids Rehab, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Angie Morrow
- Department of Kids Rehab, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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12
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Boele FW, Rooney AG, Grant R, Klein M. Psychiatric symptoms in glioma patients: from diagnosis to management. Neuropsychiatr Dis Treat 2015; 11:1413-20. [PMID: 26089669 PMCID: PMC4467748 DOI: 10.2147/ndt.s65874] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with primary intrinsic brain tumors can experience neurological, cognitive, and psychiatric symptoms that greatly affect daily life. In this review, we focus on changes in personality and behavior, mood issues, hallucinations, and psychosis, because these are either difficult to recognize, to treat, or are understudied in scientific literature. Neurobehavioral symptoms are common, often multiple, and causation can be multifactorial. Although different symptoms sometimes require a different treatment approach, we advise a comprehensive treatment approach, including pharmacological treatment and/or psychotherapy where appropriate. Further research is needed to obtain a better estimate of the prevalence of psychiatric symptoms in glioma patients, and the extent to which these affect everyday functioning and family life.
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Affiliation(s)
- Florien W Boele
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Alasdair G Rooney
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Martin Klein
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
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Fecteau S, Levasseur-Moreau J, García-Molina A, Kumru H, Vergara RP, Bernabeu M, Roig T, Pascual-Leone A, Tormos JM. Risk taking in hospitalized patients with acute and severe traumatic brain injury. PLoS One 2013; 8:e83598. [PMID: 24386232 PMCID: PMC3873371 DOI: 10.1371/journal.pone.0083598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/05/2013] [Indexed: 11/26/2022] Open
Abstract
Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients’ characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury.
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Affiliation(s)
- Shirley Fecteau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Quebec city, Quebec, Canada
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Jean Levasseur-Moreau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche Universitaire en Santé Mentale de Quebec, Medical School, Laval University, Quebec city, Quebec, Canada
| | - Alberto García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Hatiche Kumru
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Raúl Pelayo Vergara
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Monste Bernabeu
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Teresa Roig
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - José Maria Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Zhao W, Ho L, Varghese M, Yemul S, Dams-O'Connor K, Gordon W, Knable L, Freire D, Haroutunian V, Pasinetti GM. Decreased level of olfactory receptors in blood cells following traumatic brain injury and potential association with tauopathy. J Alzheimers Dis 2013; 34:417-429. [PMID: 23241557 DOI: 10.3233/jad-121894] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability among children and young adults in the United States. In this study, we explored whether changes in the gene expression profile of peripheral blood mononuclear cells (PBMC) may provide a clinically assessable "window" into the brain, reflecting molecular alterations following TBI that might contribute to the onset and progression of TBI clinical complications. We identified three olfactory receptor (OR) TBI biomarkers that are aberrantly down-regulated in PBMC specimens from TBI subjects. Down-regulation of these OR biomarkers in PBMC was correlated with the severity of brain injury and TBI-specific symptoms. A two- biomarker panel comprised of OR11H1 and OR4M1 provided the best criterion for segregating the TBI and control cases with 90% accuracy, 83.3% sensitivity, and 100% specificity. We found that the OR biomarkers are ectopically expressed in multiple brain regions, including the entorhinal-hippocampus system known to play an important role in memory formation and consolidation. Activation of OR4M1 led to attenuation of abnormal tau phosphorylation, possibly through JNK signaling pathway. Our results suggested that addition of the two-OR biomarker model to current diagnostic criteria may lead to improved TBI detection for clinical trials, and decreased expression of OR TBI biomarkers might be associated with TBI-induced tauopathy. Future studies exploring the physiological relevance of OR TBI biomarkers in the normal brain and in the brain following TBI will provide a better understanding of the biological mechanisms underlying TBI and insights into novel therapeutic targets for TBI.
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Affiliation(s)
- Wei Zhao
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Lap Ho
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Merina Varghese
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Shrishailam Yemul
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA.,GRECC, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | | | - Wayne Gordon
- Department of Rehabilitation, Mount Sinai School of Medicine, New York, NY, USA
| | - Lindsay Knable
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Daniel Freire
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Vahram Haroutunian
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Giulio Maria Pasinetti
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA.,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.,GRECC, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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Evaluation of the short-term executive plus intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization. Arch Phys Med Rehabil 2013; 95:1-9.e3. [PMID: 23988395 DOI: 10.1016/j.apmr.2013.08.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/07/2013] [Accepted: 08/10/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether the Short-Term Executive Plus (STEP) cognitive rehabilitation program improves executive dysfunction after traumatic brain injury (TBI). DESIGN Randomized, waitlist controlled trial with minimization and blinded outcome assessment. SETTING Community. PARTICIPANTS Participants with TBI and executive dysfunction (N=98; TBI severity 50% moderate/severe; mean time since injury ± SD, 12±14y; mean age ± SD, 45±14y; 62% women; 76% white). INTERVENTION STEP program: 12 weeks (9h/wk) of group training in problem solving and emotional regulation and individual sessions of attention and compensatory strategies training. MAIN OUTCOME MEASURES Factor analysis was used to create a composite executive function measure using the Problem Solving Inventory, Frontal Systems Behavior Scale, Behavioral Assessment of the Dysexecutive Syndrome, and Self-Awareness of Deficits Interview. Emotional regulation was assessed with the Difficulties in Emotion Regulation Scale. The primary attention measure was the Attention Rating and Monitoring Scale. Secondary measures included neuropsychological measures of executive function, attention, and memory and measures of affective distress, self-efficacy, social participation, and quality of life. RESULTS Intention-to-treat mixed-effects analyses revealed significant treatment effects for the composite executive function measure (P=.008) and the Frontal Systems Behavior Scale (P=.049) and Problem Solving Inventory (P=.016). We found no between-group differences on the neuropsychological measures or on measures of attention, emotional regulation, self-awareness, affective distress, self-efficacy, participation, or quality of life. CONCLUSIONS The STEP program is efficacious in improving self-reported post-TBI executive function and problem solving. Further research is needed to identify the roles of the different components of the intervention and its effectiveness with different TBI populations.
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Ho L, Zhao W, Dams-O'Connor K, Tang CY, Gordon W, Peskind ER, Yemul S, Haroutunian V, Pasinetti GM. Elevated plasma MCP-1 concentration following traumatic brain injury as a potential "predisposition" factor associated with an increased risk for subsequent development of Alzheimer's disease. J Alzheimers Dis 2013; 31:301-13. [PMID: 22543850 DOI: 10.3233/jad-2012-120598] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We explored whether changes in the expression profile of peripheral blood plasma proteins may provide a clinical, readily accessible "window" into the brain, reflecting molecular alterations following traumatic brain injury (TBI) that might contribute to TBI complications. We recruited fourteen TBI and ten control civilian participants for the study, and also analyzed banked plasma specimens from 20 veterans with TBI and 20 control cases. Using antibody arrays and ELISA assays, we explored differentially-regulated protein species in the plasma of TBI compared to healthy controls from the two independent cohorts. We found three protein biomarker species, monocyte chemotactic protein-1 (MCP-1), insulin-like growth factor-binding protein-3, and epidermal growth factor receptor, that are differentially regulated in plasma specimens of the TBI cases. A three-biomarker panel using all three proteins provides the best potential criterion for separating TBI and control cases. Plasma MCP-1 contents are correlated with the severity of TBI and the index of compromised axonal fiber integrity in the frontal cortex. Based on these findings, we evaluated postmortem brain specimens from 7 mild cognitive impairment (MCI) and 7 neurologically normal cases. We found elevated MCP-1 expression in the frontal cortex of MCI cases that are at high risk for developing Alzheimer's disease. Our findings suggest that additional application of the three-biomarker panel to current diagnostic criteria may lead to improved TBI detection and more sensitive outcome measures for clinical trials. Induction of MCP-1 in response to TBI might be a potential predisposing factor that may increase the risk for development of Alzheimer's disease.
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Affiliation(s)
- Lap Ho
- Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA
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Gordon AL, di Maggio A. Rehabilitation for children after acquired brain injury: current and emerging approaches. Pediatr Neurol 2012; 46:339-44. [PMID: 22633627 DOI: 10.1016/j.pediatrneurol.2012.02.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 02/23/2012] [Indexed: 11/26/2022]
Abstract
Evidence is emerging of diverse, chronic, cumulative disabilities experienced by children in the months and years after acquired brain injury. The long-held assumption that younger children recover better from brain injury than older children or adults has been challenged by recent studies. Populations with acquired brain injury include children with traumatic brain injury and stroke, and a proportion of children with cerebral palsy. Although characteristics of brain injury in children vary, subgroups of this population offer the potential to inform our understanding of developing brain structure-function relationships in response to intervention. Limited evidence and few controlled rehabilitation trials exist regarding children with neurologic conditions. A number of rehabilitation approaches produced benefits in adult stroke, and cerebral palsy populations may be applied to children with other acquired brain injuries. Rehabilitation approaches that have been applied to children with acquired brain injuries, or hold promise for future applications, are reviewed.
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Affiliation(s)
- Anne L Gordon
- Department of Paediatric Neuroscience, Evelina Children's Hospital, King's Health Partners, London, United Kingdom.
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