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Özcan F, Gürçay E, Kalem Özgen AN, Demir Y. Outcomes and predictors of stress among Turkish family caregivers of patients with acquired brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36075221 DOI: 10.1080/23279095.2022.2115909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study examined family caregiver stress and factors predicting the stress among caregivers of patients with acquired brain injury (ABI). METHODS Sixty caregivers of patients with ABI took part in this study. All participants completed assessments of Caregiver Strain Index, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, Nottingham Health Profile (NHP), and Satisfaction with Life Scale (SWLS). The patients with ABI were also assessed on the Functional Independence Measure, Disability Rating Scale, Rancho Los Amigos Cognitive Scale-revised, Functional Ambulation Classification Scale, and Neurobehavioral Rating Scale-revised. Relationship between caregiver's stress and clinical outcomes was analyzed, together with factors significantly associated with stress. RESULTS Elevated levels of stress were determined in 40% of caregivers. Higher stress was seen in caregivers of patients with shorter disease duration, worse functioning, who had more depression and anxiety, poorer perceived health status particularly for pain and emotional reaction domains, and less life satisfaction. Linear regression analysis demonstrated that caregiver's stress was predicted by NHP pain domain (β = 0.062, p = 0.016) and SWLS (β = -0.133, p = 0.040). CONCLUSION Caregivers with more pain and less life satisfaction are at higher risk of developing stress. In order to overcome this difficult process and improve the quality of care, it would be appropriate to reveal predictors of stress and produce appropriate interventions/approaches.
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Affiliation(s)
- Fatma Özcan
- Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Eda Gürçay
- Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ayşe Naz Kalem Özgen
- Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yasin Demir
- Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Beresford T, Ronan PJ, Hipp D, Schmidt B, Thumm EB, Temple B, Wortzel H, Weitzenkamp D, Emrick C, Kelly J, Arciniegas DB. A Double-Blind Placebo-Controlled, Randomized Trial of Divalproex Sodium for Posttraumatic Irritability Greater Than 1 Year After Mild to Moderate Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2022; 34:224-232. [PMID: 35272494 DOI: 10.1176/appi.neuropsych.19070159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posttraumatic irritability after traumatic brain injury (TBI) may become a chronic problem and contribute to impaired everyday function, either alone or in combination with alcohol use disorder. The authors hypothesized that divalproex sodium (VPA) would improve posttraumatic irritability and result in lessened alcohol use. METHODS This randomized, placebo-controlled double-blind clinical trial recruited participants with an index TBI occurring 1 or more years prior to enrollment, a history of alcohol use disorder, and posttraumatic irritability corroborated by a knowledgeable informant. An 8-item subset of the Agitated Behavior Scale served as the primary outcome measure of VPA efficacy. Doses of VPA were titrated to standard serum concentrations of 50 µg/ml to 100 µg/ml. RESULTS Forty-eight persons completed this clinical trial (VPA, N=22; placebo, N=26). At baseline, participants rated their posttraumatic irritability as less severe than did their informants (p<0.05). During the trial, informants reported significant and sustained reduction of posttraumatic irritability (p=0.03) in the study participants. Biweekly averages during drug exposure confirmed this (p<0.03, Cohen's d=0.44). Treatment efficacy was not related to measures of anxiety, posttraumatic stress disorder, sedation, or veteran versus nonveteran status. Alcohol use did not change as a result of treatment. There were no serious adverse events. CONCLUSIONS This study demonstrated an effect of VPA on posttraumatic irritability, and VPA was well tolerated. Further definition of treatment efficacy and safety requires a large-scale multisite trial, using a randomized, double-blind placebo-controlled design.
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Affiliation(s)
- Thomas Beresford
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Patrick J Ronan
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Daniel Hipp
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Brandon Schmidt
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - E Brie Thumm
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Benjamin Temple
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Hal Wortzel
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - David Weitzenkamp
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - Chad Emrick
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - James Kelly
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
| | - David B Arciniegas
- Laboratory for Clinical and Translational Research in Psychiatry, Mental Health Service, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Beresford, Ronan, Hipp, Schmidt, Thumm, Temple, Emrick); Departments of Psychiatry (Beresford, Hipp, Schmidt, Thumm, Wortzel, Emrick, Arciniegas) and Neurology (Wortzel, Kelly, Arciniegas), University of Colorado School of Medicine, Aurora; Research Service, Sioux Falls VA Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls (Ronan); VISN 19 Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colo. (Wortzel); Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Denver, Aurora (Weitzenkamp); Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora (Kelly); and Division of Behavioral Health Consultation & Integration, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Arciniegas)
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Russo M, Bonanno C, Profazio C, La Foresta S, Faraone C, Lizio A, Vita GL, Sframeli M, Aricò I, Ruggeri P, Toscano A, Vita G, Lunetta C, Messina S. Which are the factors influencing NIV adaptation and tolerance in ALS patients? Neurol Sci 2020; 42:1023-1029. [PMID: 32710206 DOI: 10.1007/s10072-020-04624-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a multisystemic disease compromising both the neuromuscular system and the cognitive status. Non-invasive ventilation (NIV) has been shown to improve survival and quality of life in ALS patients with respiratory failure, but scanty literature investigated which are the predictors of NIV tolerance. The aim of this study was to evaluate the impact of functional, cognitive, neurobehavioral, and respiratory status on NIV compliance and tolerance in patients with ALS. We retrospectively evaluated clinical data of ALS patients who consecutively underwent a NIV trial during hospitalization. Cognitive and neurobehavioral assessments have been performed using the Edinburgh Cognitive and Behavioral ALS Screen (ECAS), the Hospital Anxiety and Depression Scale (HADS), the Frontal Assessment Battery (FAB), the Raven's 47 Colored Progressive Matrices (PM47), and the Neurobehavioral Rating Scale Revised (NRSR). Seventy-two patients (mean age ± SD; 63.9 ± 10.6 years) were included. Patients adapted were 63/72 (87.5%). The average time of adaptation was 7.82 ± 5.27 days. The time required to reach a satisfying NIV adaptation was significantly related to the presence of sialorrhea (p = 0.02), respiratory status (Borg Dyspnoea Scale, p = 0.006, and ALS-FRS-R respiratory subscore, p = 0.03) and behavioral and cognitive impairment (NRSR-F1, p = 0.04, NRSR- F5, p = 0.04). Presence of sialorrhea and neurobehavioral impairment, and absence of respiratory symptoms are negative predictors of NIV adaptation. This study highlights the need of a multidisciplinary patient-tailored approach including cognitive-behavioral assessment and a psychological support program to optimize patient's training and compliance to NIV.
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Affiliation(s)
- Massimo Russo
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmen Bonanno
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudia Profazio
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Stefania La Foresta
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Cristina Faraone
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Andrea Lizio
- NEuroMuscular Omnicenter, Serena Onlus Foundation, Milan, Italy
| | - Gian Luca Vita
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Maria Sframeli
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Irene Aricò
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Paolo Ruggeri
- Pulmonology Unit, Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Toscano
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. .,Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy.
| | | | - Sonia Messina
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
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4
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Hammond FM, Ketchum J, Dams-O'Connor K, Corrigan JD, Miller C, Haarbauer-Krupa J, Faul M, Trexler LE, Harrison-Felix C. Mortality Secondary to Unintentional Poisoning after Inpatient Rehabilitation among Individuals with Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2020; 37:2507-2516. [PMID: 32438850 DOI: 10.1089/neu.2020.7038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Studies have shown reduced life expectancy following moderate-severe traumatic brain injury (TBI) with death from unintentional poisoning (UP) being 11 times higher following TBI than in the general population. The characteristics of those who die of unintentional poisoning are compared with the characteristics of those who die of other causes (OC) in a retrospective cohort who received inpatient rehabilitation following TBI and enrolled in the TBI Model Systems National Database between 1989 and 2017 (n = 15,835 cases with 2,238 deaths recorded). Seventy-eight cases (3.5%) of deaths were the result of UP, 76% were the result of OC, and 20.5% were from an unknown cause. Among the UP deaths, 90% involved drugs (of these, 67% involved narcotic drugs and 14% involved psychostimulants), and 8% involved alcohol. Age-adjusted risk for UP death was associated with: white/non-Hispanic race/ethnicity, living alone, non-institutionalization, pre- and post-injury illicit drug use and alcohol/drug problem use, any alcohol use at last follow-up, better Functional Independence MeasureTM (FIM) scores, history of arrest, moderate disability (vs. severe disability or good recovery), less supervision needed, and greater anxiety. Adults who receive inpatient rehabilitation for TBI who die from UP are distinguishable from those who die of OC. Factors such as pre-injury substance use in the context of functional independence may be regarded as targets for prevention and/or intervention to reduce substance use and substance-related mortality among survivors of moderate-severe TBI. The current findings may have implications for medical care, surveillance, prevention, and health promotion.
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Affiliation(s)
- Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Jessica Ketchum
- Research Department, Craig Hospital, Englewood, Colorado, USA.,Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, Colorado, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, Ohio State University, Columbus, Ohio, USA
| | - Cate Miller
- National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, Department of Health and Human Services, Washington, DC, USA
| | - Juliet Haarbauer-Krupa
- Traumatic Brain Injury Team, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark Faul
- Traumatic Brain Injury Team, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lance E Trexler
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Cynthia Harrison-Felix
- Research Department, Craig Hospital, Englewood, Colorado, USA.,Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, Colorado, USA
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5
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Mellett K, Ren D, Alexander S, Osier N, Beers SR, Okonkwo DO, Puccio AM, Conley YP. Genetic Variation in the TP53 Gene and Patient Outcomes Following Severe Traumatic Brain Injury. Biol Res Nurs 2020; 22:334-340. [PMID: 32207313 DOI: 10.1177/1099800420912335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability, with more than 5 million people in the United States living with long-term complications related to TBI. This study examined the relationship between TP53, the gene that codes for the protein p53, and outcome variability following severe TBI. The p53 protein impacts neuronal apoptosis following TBI, thus investigation into TP53 genetic variability as a prognosticator for TBI outcomes (mortality, Glasgow Outcome Scale [GOS], Neurobehavioral Rating Scale [NRS], and Disability Rating Scale [DRS]) is warranted. Participants (N = 429) with severe TBI (Glasgow Coma Scale score ≤8) were enrolled into a prospective study with outcomes assessed over 24 months following injury. The single-nucleotide polymorphism Arg72Pro (rs1042522), a functional missense polymorphism for which the CC homozygous genotype is most efficient at inducing apoptosis, was investigated. Individuals with the CC genotype (arginine homozygotes) were more likely to have poorer outcomes at 24 months following TBI compared to individuals with CG/GG genotypes (GOS: p = .048, DRS: p = .022). These findings add to preliminary evidence that p53 plays a role in recovery following TBI and, if further replicated, could support investigations into p53-based therapies for treating TBI.
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Affiliation(s)
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, PA, USA
| | | | - Nicole Osier
- School of Nursing, University of Texas at Austin, TX, USA.,Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Sue R Beers
- Department of Psychiatry, University of Pittsburgh, PA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, PA, USA
| | - Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh, PA, USA
| | - Yvette P Conley
- Department of Human Genetics, School of Nursing, University of Pittsburgh, PA, USA
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6
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Manoli R, Delecroix H, Daveluy W, Moroni C. Impact of cognitive and behavioural functioning on vocational outcome following traumatic brain injury: a systematic review. Disabil Rehabil 2019; 43:2531-2540. [DOI: 10.1080/09638288.2019.1706105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Romina Manoli
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
| | - Helene Delecroix
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
- UEROS, UGECAM Hauts-de-France, Lille, France
| | - Walter Daveluy
- UEROS, UGECAM Hauts-de-France, Lille, France
- Service de Rééducation Neurologique Cérébrolésion, Hopital Swynghedauw, CHRU de Lille, Lille, France
| | - Christine Moroni
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
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7
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Inter-rater agreement of the Turkish version of the Neurobehavioral Rating Scale-Revised form. Turk J Phys Med Rehabil 2017; 63:133-142. [PMID: 31453441 DOI: 10.5606/tftrd.2017.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/22/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to adapt the Neurobehavioral Rating Scale-revised form (NBRS-R) for Turkish traumatic brain injury (TBI) patients and to investigate the inter-rater agreement of the Turkish revised scale. Patients and methods A total of 45 patients (36 males, 9 females; mean age 31.1±13.0 years; range 18 to 60 years) with TBI were included in this study between September 2013 and August 2014. A semi-structured interview was set up for Turkish patients using a multidisciplinary approach (physiatrist, psychiatrist, neurologist and psychologist) with the participation of four rehabilitation centers. Questions were prepared for each of the 29 items, based on the recommendations of the original NBRS-R form. Four different interviewers from the four centers applied this form to a total of 45 TBI patients. Results The items evaluated by intra-class correlation coefficient showed satisfactory stability and the reliability of the items ranged from moderate to very good. Conclusion The NBRS-R form can be suggested to provide a reliable and easily reproducible evaluation method of neurobehavioral deficits in TBI patients who speak Turkish.
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8
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Bayen E, Jourdan C, Ghout I, Pradat-Diehl P, Darnoux E, Nelson G, Vallat-Azouvi C, Charenton J, Aegerter P, Ruet A, Azouvi P. Negative impact of litigation procedures on patient outcomes four years after severe traumatic brain injury: results from the PariS-traumatic brain injury study. Disabil Rehabil 2017; 40:2040-2047. [PMID: 28508698 DOI: 10.1080/09638288.2017.1325522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To analyze the effect of litigation procedures on long-term outcomes in severe traumatic brain injury. MATERIALS AND METHODS Prospective observational follow-up of an inception cohort including 504 adults with severe traumatic brain injury recruited in 2005-2007 in the Parisian area, France, with initial, one- and four-year outcomes measures. RESULTS Four years after the traumatic brain injury, 147 patients, out of 257 who survived the acute phase, were assessed. Among these patients, 53 patients declared being litigants and 78 nonlitigants (litigation status was unknown in 16 cases). Sociodemographic characteristics, type of injury and initial severity did not differ significantly between litigants and nonlitigants, except for Injury Severity Score (worse in litigants) and the proportion of road traffic accidents (higher in litigants). One- and four-year outcomes were significantly worse in litigants for autonomy, participation, psychiatric and cognitive function but not quality of life (measured with the Glasgow Outcome Scale-Extended, the working activity status, the Brain Injury Community Rehabilitation Outcome, the Hospital Anxiety and Depression scale, the Neurobehavioral Rating Scale-revised and the Quality of Life after Brain Injury, respectively). Multivariate analyses highlighted litigation procedure as an independent significant predictor of lower autonomy, participation and psychiatric function and tended to predict lower cognitive function, but not lower quality of life, after adjustment for pretrauma characteristics, Injury Severity Score, road traffic accidents and work-related accident status. CONCLUSIONS Patients with severe traumatic brain injury have a worse prognosis when involved in a litigation procedure and require special attention in clinical practice. Implications for rehabilitation The influence of litigation procedure on health and social outcomes in severe traumatic brain injury is a major issue that entail numerous levels of complexities. A wide range of interactions and factors related to the prolonged process of litigation against a third party may influence recovery. Results from the PariS-Traumatic Brain Injury study suggest that patients with a severe Traumatic Brain Injury who are involved in a litigation procedure within French jurisdiction compensation scheme have a worse prognosis than patients who do not. Health professionals should be aware of the potential adverse effects of litigation procedures on recovery, and provide appropriate interventions and information to patients and families in such cases.
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Affiliation(s)
- Eléonore Bayen
- a Physical Medicine and Rehabilitation Department , Pitie-Salpetriere Hospital, APHP , Paris , France ; Health Economics Department LEDa-LEGOS , University Paris-Dauphine , Paris , France
| | - Claire Jourdan
- b Physical Medicine and Rehabilitation Department , Lapeyronie Hospital, CHRU , Montpellier , France
| | - Idir Ghout
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Pascale Pradat-Diehl
- d Physical Medicine and Rehabilitation Department , Pitie-Salpetriere Hospital, APHP , Paris , France ; Laboratoire d'Imagerie Biomédicale Inserm U1146 Sorbonne Universités University Pierre et Marie Curie UMCR2 - CNRS UMR7371
| | - Emmanuelle Darnoux
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Gaëlle Nelson
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Claire Vallat-Azouvi
- e Physical Medicine and Rehabilitation Department , AP-HP, Raymond-Poincaré Hospital , Garches , France ; EA4047 , University of Versailles Saint Quentin , France
| | - James Charenton
- f Regional Reference Center for Bain Injury in the Parisan area, CRFTC , Paris , France
| | - Philippe Aegerter
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Alexis Ruet
- g Physical Medicine and Rehabilitation Department , CHU Caen , France and INSERM U1077 , France
| | - Philippe Azouvi
- e Physical Medicine and Rehabilitation Department , AP-HP, Raymond-Poincaré Hospital , Garches , France ; EA4047 , University of Versailles Saint Quentin , France
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Rochat L, Billieux J, Gagnon J, Van der Linden M. A multifactorial and integrative approach to impulsivity in neuropsychology: insights from the UPPS model of impulsivity. J Clin Exp Neuropsychol 2017; 40:45-61. [PMID: 28398126 DOI: 10.1080/13803395.2017.1313393] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Risky and excessive behaviors, such as aggressive and compulsive behaviors, are frequently described in patients with brain damage and have dramatic psychosocial consequences. Although there is strong evidence that impulsivity constitutes a key factor at play in these behaviors, the literature about impulsivity in neuropsychology is to date scarce. In addition, examining and understanding these problematic behaviors requires the assumption that impulsivity is a multidimensional construct. Consequently, this article aims at shedding light on frequent risky and excessive behaviors in patients with brain damage by focusing on a unified, comprehensive, and well-validated model, namely, the UPPS model of impulsivity. This model considers impulsivity as a multidimensional construct that includes four facets: urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Furthermore, we discuss the psychological mechanisms underlying the dimensions of impulsivity, as well as the laboratory tasks designed to assess each mechanism and their neural bases. We then present a scale specifically designed to assess these four dimensions of impulsivity in patients with brain damage and examine the data regarding this multidimensional approach to impulsivity in neuropsychology. This review supports the need to adopt a multifactorial and integrative approach toward impulsive behaviors, and the model presented provides a valuable rationale to disentangle the nature of brain systems and mechanisms underlying impulsive behaviors in patients with brain damage. It may also foster further relevant research in the field of impulsivity and improve assessment and rehabilitation of impulsive behaviors in clinical settings.
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Affiliation(s)
- Lucien Rochat
- a Department of Psychology and Educational Sciences, Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,b Swiss Centre for Affective Sciences , University of Geneva , Geneva , Switzerland
| | - Joël Billieux
- c Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE) , University of Luxembourg , Esch-sur-Alzette , Luxembourg.,d Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute , Université catholique de Louvain , Louvain-La-Neuve , Belgium
| | - Jean Gagnon
- e Department of Psychology , University of Montreal , Montreal , Canada.,f Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Canada.,g Centre de recherche en neuropsychologie et cognition (CERNEC) , Montreal , Canada
| | - Martial Van der Linden
- a Department of Psychology and Educational Sciences, Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland.,b Swiss Centre for Affective Sciences , University of Geneva , Geneva , Switzerland
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10
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Azouvi P, Ghout I, Bayen E, Darnoux E, Azerad S, Ruet A, Vallat-Azouvi C, Pradat-Diehl P, Aegerter P, Charanton J, Jourdan C. Disability and health-related quality-of-life 4 years after a severe traumatic brain injury: A structural equation modelling analysis. Brain Inj 2016; 30:1665-1671. [DOI: 10.1080/02699052.2016.1201593] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Philippe Azouvi
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
| | - Idir Ghout
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
| | - Eleonore Bayen
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation, Paris, France Université Pierre et Marie Curie, Paris, France
| | - Emmanuelle Darnoux
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Sylvie Azerad
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
| | - Alexis Ruet
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
| | - Claire Vallat-Azouvi
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
- Antenne UEROS-SAMSAH 92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
| | - Pascale Pradat-Diehl
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation, Paris, France Université Pierre et Marie Curie, Paris, France
| | - Philippe Aegerter
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
| | - James Charanton
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Claire Jourdan
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
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11
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Bayen E, Laigle-Donadey F, Prouté M, Hoang-Xuan K, Joël ME, Delattre JY. The multidimensional burden of informal caregivers in primary malignant brain tumor. Support Care Cancer 2016; 25:245-253. [PMID: 27624465 DOI: 10.1007/s00520-016-3397-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Informal caregivers (ICs) provide care and improve the quality of life of patients with malignant brain tumor. We analyze the impact of their involvement on themselves from a triple perspective. METHODS Home-dwelling patients with primary malignant brain tumor underwent a medical examination. ICs burden was evaluated by a self-administered postal questionnaire. Objective burden (Informal Care Time, ICT), subjective burden (Zarit Burden Inventory, ZBI), and financial burden (valuation of lost earnings using the Replacement and Opportunity Cost Methods, RCM, OCM) were evaluated. RESULTS ICs (N = 84) were principally women (87 %) and spouses (64 %), of mean age 55 years, who assisted patients of mean age 53 years and with a mean KPS score of 61 (range = 30-90, med = 60). Subjective burden was moderate (mean ZBI = 30). Objective burden was high (mean ICT = 11.7 h/day), mostly consisting of supervision time. Higher subjective and objective burden were associated with poorer functional status (KPS) but not with a higher level of cognitive disorders in multivariate analyses. Other independent associated factors were bladder dysfunction and co-residency for objective burden and working and a poor social network for subjective burden. The 56 working ICs made work arrangements (75 %) that impacted their wages (36 %) and careers (30 %). Financial burden due to uncompensated caregiving hours for Activities of Daily Living had a mean monetary value from Є677(RCM) to Є1683(OCM) per month (i.e., ranging from Є8124 to Є20196 per year). CONCLUSIONS IC burden is multidimensional. Greater provision of formal care, more IC support programs, and economic interventions targeting IC employment and finances are needed.
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Affiliation(s)
- Eléonore Bayen
- Department of Neuro-Rehabilitation, Pitié-Salpêtrière Hospital, Paris, France. .,Health Economics Department LEDa-LEGOS, PSL University Paris-Dauphine, Paris, France.
| | | | - Myrtille Prouté
- Health Economics Department LEDa-LEGOS, PSL University Paris-Dauphine, Paris, France
| | - Khê Hoang-Xuan
- Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University UPMC Paris 06, CRICM, Paris, France.,INSERM U1127, Paris, France.,CNRS, UMR 7225, Paris, France
| | - Marie-Eve Joël
- Health Economics Department LEDa-LEGOS, PSL University Paris-Dauphine, Paris, France
| | - Jean-Yves Delattre
- Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University UPMC Paris 06, CRICM, Paris, France.,INSERM U1127, Paris, France.,CNRS, UMR 7225, Paris, France
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12
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Azouvi P, Vallat-Azouvi C, Millox V, Darnoux E, Ghout I, Azerad S, Ruet A, Bayen E, Pradat-Diehl P, Aegerter P, Weiss JJ, Jourdan C. Ecological validity of the Dysexecutive Questionnaire: Results from the PariS-TBI study. Neuropsychol Rehabil 2014; 25:864-78. [DOI: 10.1080/09602011.2014.990907] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Conley YP, Okonkwo DO, Deslouches S, Alexander S, Puccio AM, Beers SR, Ren D. Mitochondrial polymorphisms impact outcomes after severe traumatic brain injury. J Neurotrauma 2013; 31:34-41. [PMID: 23883111 DOI: 10.1089/neu.2013.2855] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Patient outcomes are variable following severe traumatic brain injury (TBI); however, the biological underpinnings explaining this variability are unclear. Mitochondrial dysfunction after TBI is well documented, particularly in animal studies. The aim of this study was to investigate the role of mitochondrial polymorphisms on mitochondrial function and patient outcomes out to 1 year after a severe TBI in a human adult population. The Human MitoChip V2.0 was used to evaluate mitochondrial variants in an initial set of n=136 subjects. SNPs found to be significantly associated with patient outcomes [Glasgow Outcome Scale (GOS), Neurobehavioral Rating Scale (NRS), Disability Rating Scale (DRS), in-hospital mortality, and hospital length of stay] or neurochemical level (lactate:pyruvate ratio from cerebrospinal fluid) were further evaluated in an expanded sample of n=336 subjects. A10398G was associated with DRS at 6 and 12 months (p=0.02) and a significant time by SNP interaction for DRS was found (p=0.0013). The A10398 allele was associated with greater disability over time. There was a T195C by sex interaction for GOS (p=0.03) with the T195 allele associated with poorer outcomes in females. This is consistent with our findings that the T195 allele was associated with mitochondrial dysfunction (p=0.01), but only in females. This is the first study associating mitochondrial DNA variation with both mitochondrial function and neurobehavioral outcomes after TBI in humans. Our findings indicate that mitochondrial DNA variation may impact patient outcomes after a TBI potentially by influencing mitochondrial function, and that sex of the patient may be important in evaluating these associations in future studies.
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Affiliation(s)
- Yvette P Conley
- 1 School of Nursing, University of Pittsburgh , Pittsburgh, Pennsylvania
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14
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McCauley SR, Wilde EA, Moretti P, Macleod MC, Pedroza C, Drever P, Fourwinds S, Frisby ML, Beers SR, Scott JN, Hunter JV, Traipe E, Valadka AB, Okonkwo DO, Zygun DA, Puccio AM, Clifton GL. Neurological outcome scale for traumatic brain injury: III. Criterion-related validity and sensitivity to change in the NABIS hypothermia-II clinical trial. J Neurotrauma 2013; 30:1506-11. [PMID: 23617608 DOI: 10.1089/neu.2013.2925] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The neurological outcome scale for traumatic brain injury (NOS-TBI) is a measure assessing neurological functioning in patients with TBI. We hypothesized that the NOS-TBI would exhibit adequate concurrent and predictive validity and demonstrate more sensitivity to change, compared with other well-established outcome measures. We analyzed data from the National Acute Brain Injury Study: Hypothermia-II clinical trial. Participants were 16-45 years of age with severe TBI assessed at 1, 3, 6, and 12 months postinjury. For analysis of criterion-related validity (concurrent and predictive), Spearman's rank-order correlations were calculated between the NOS-TBI and the glasgow outcome scale (GOS), GOS-extended (GOS-E), disability rating scale (DRS), and neurobehavioral rating scale-revised (NRS-R). Concurrent validity was demonstrated through significant correlations between the NOS-TBI and GOS, GOS-E, DRS, and NRS-R measured contemporaneously at 3, 6, and 12 months postinjury (all p<0.0013). For prediction analyses, the multiplicity-adjusted p value using the false discovery rate was <0.015. The 1-month NOS-TBI score was a significant predictor of outcome in the GOS, GOS-E, and DRS at 3 and 6 months postinjury (all p<0.015). The 3-month NOS-TBI significantly predicted GOS, GOS-E, DRS, and NRS-R outcomes at 6 and 12 months postinjury (all p<0.0015). Sensitivity to change was analyzed using Wilcoxon's signed rank-sum test of subsamples demonstrating no change in the GOS or GOS-E between 3 and 6 months. The NOS-TBI demonstrated higher sensitivity to change, compared with the GOS (p<0.038) and GOS-E (p<0.016). In summary, the NOS-TBI demonstrated adequate concurrent and predictive validity as well as sensitivity to change, compared with gold-standard outcome measures. The NOS-TBI may enhance prediction of outcome in clinical practice and measurement of outcome in TBI research.
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Affiliation(s)
- Stephen R McCauley
- Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, Texas 77030, USA
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15
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Ellis JA, Orr L, II PCM, Anderson RCE, Feldstein NA, Meyers PM. Cognitive and functional status after vein of Galen aneurysmal malformation endovascular occlusion. World J Radiol 2012; 4:83-9. [PMID: 22468188 PMCID: PMC3314932 DOI: 10.4329/wjr.v4.i3.83] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/02/2012] [Accepted: 01/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the clinical outcomes of treating vein of Galen aneurysmal malformations (VGAM), we assessed our patient cohort using standardized cognitive and functional measures.
METHODS: A retrospective review of patients with VGAM treated by a single practitioner between 2003 and 2009 was performed for this study. In addition to routine clinical assessment, all patients were evaluated for cognitive and functional impairment using validated measures including the Neurobehavioral Rating Scale-Revised, the Bicêtre outcome score, and the Barthel index.
RESULTS: Five patients underwent combined transarterial and transvenous embolization of their VGAM during the study period. VGAMs were classified based on angioarchitecture as either choroidal (1/5) or mural (4/5) according to the classification scheme of Lasjaunias. In total, 13 embolization procedures were performed consisting of 1 to 3 treatment stages per patient. Complete or near complete occlusion was achieved in 4 patients, while subtotal occlusion was achieved in 1 patient. During follow-up (median 62.6 mo), all patients were either unchanged or cognitively and neurologically intact.
CONCLUSION: VGAM can be safely and effectively treated by staged transarterial and transvenous embolization. Using this strategy, excellent long-term cognitive and functional outcomes can be achieved.
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16
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Shah S, Yallampalli R, Merkley TL, McCauley SR, Bigler ED, MacLeod M, Chu Z, Li X, Troyanskaya M, Hunter JV, Levin HS, Wilde EA. Diffusion tensor imaging and volumetric analysis of the ventral striatum in adults with traumatic brain injury. Brain Inj 2012; 26:201-10. [DOI: 10.3109/02699052.2012.654591] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Arciniegas DB, Frey KL, Newman J, Wortzel HS. Evaluation and Management of Posttraumatic Cognitive Impairments. Psychiatr Ann 2010; 40:540-552. [PMID: 21270968 DOI: 10.3928/00485713-20101022-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Psychiatrists are increasingly called upon to care for individuals with cognitive, emotional, and behavioral disturbances after TBI, especially in settings serving military service personnel and Veterans. In both the early and late post-injury periods, cognitive impairments contribute to disability among persons with TBI and are potentially substantial sources of suffering for persons with TBI and their families. In this article, the differential diagnosis, evaluation, and management of posttraumatic cognitive complaints is reviewed. The importance of pre-treatment evaluation as well as consideration of non-cognitive contributors to cognitive problems and functional limitations is emphasized first. The course of recovery after TBI, framed as a progression through posttraumatic encephalopathy, is reviewed next and used to anchor the evaluation and treatment of posttraumatic cognitive impairments in relation to injury severity as well as time post-injury. Finally, pharmacologic and rehabilitative interventions that may facilitate cognitive and functional recovery at each stage of posttraumatic encephalopathy are presented.
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Affiliation(s)
- David B Arciniegas
- Neurobehavioral Disorders Program, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
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18
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Chuang PY, Conley YP, Poloyac SM, Okonkwo DO, Ren D, Sherwood PR, Hravnak M, Alexander SA. Neuroglobin genetic polymorphisms and their relationship to functional outcomes after traumatic brain injury. J Neurotrauma 2010; 27:999-1006. [PMID: 20345238 PMCID: PMC2943497 DOI: 10.1089/neu.2009.1129] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neuroglobin has shown rich neuroprotective effects against cerebral hypoxia, and therefore has the potential to impact outcomes after traumatic brain injury (TBI). However, to date an association between genetic variation within the human neuroglobin (NGB) gene and recovery post-TBI has not been reported. The purpose of this study was to explore the relationship between NGB genotypes and outcomes (as assessed by the Glasgow Outcome Scale [GOS], the Disability Rating Scale [DRS], and the Neurobehavioral Rating Scale-Revised [NRS-R]) after severe TBI. Genotyping using TaqMan allele discrimination for two tagging single nucleotide polymorphisms (tSNPs) that represent the two haplotype blocks for NGB (rs3783988 and rs10133981) was completed on DNA obtained from 196 Caucasian patients recovering from severe TBI. Patients were dichotomized based on the presence of the variant allele for each tSNP. Chi-square and Fisher's exact tests were used to compare characteristics between groups. Multivariate linear regression was used to examine NGB tSNPs and recovery from severe TBI. Subjects with the TT genotype (wild-type) for rs3783988 were more likely to have better GOS and DRS scores at 3, 6, 12, and 24 months, while rs10133981 genotype was not significantly related to functional outcome. After controlling for age, gender, and Glasgow Coma Scale (GCS) score, those subjects with the rs3783988 TT genotype had more than a 2.65-times greater likelihood of better functional outcomes than individuals with genotypes harboring a variant allele. Data suggest that the haplotype block represented by rs3783988 in NGB appears to influence recovery after severe TBI. Represented within this haplotype block of NGB is the region that codes for the oxygen-binding portion of NGB.
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Affiliation(s)
- Pei-Ying Chuang
- Acute/Tertiary Care Department, Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Frank B, Schlote A, Hasenbein U, Wallesch CW. Prognosis and prognostic factors in ADL-dependent stroke patients during their first in-patient rehabilitation – a prospective multicentre study. Disabil Rehabil 2009; 28:1311-8. [PMID: 17083179 DOI: 10.1080/09638280600633597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE This prospective longitudinal study aimed at a description of ADL-functioning and at an analysis, which clinical instruments predict independency 6 months after discharge from in-patient rehabilitation following disabling first stroke. METHOD A total of 147 patients with disabling first stroke were recruited from three neurological rehabilitation centres. They were assessed during their first in-patient rehabilitation with the NIH Stroke Scale, Hemispheric Stroke Scale (HSS), Activity Index, Barthel Index, Neurobehavioural Rating Scale, Cornell Depression Scale, and the prognostic prediction of the rehabilitation neurologist. The 6 months outcome was established with the Nottingham Extended ADL Scale (NEADL) and by the legal dependency status. RESULTS The best prediction of 6 months outcome as measured by the NEADL was obtained by the HSS and a multivariate model that also included the physician's prognostic prediction, both early in rehabilitation and at discharge. The dependency status was best predicted by the HSS and patient's sex. CONCLUSION Clinical scales performed during rehabilitation such as the HSS are valid for prediction of ADL-dependency 6 months after discharge.
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Affiliation(s)
- B Frank
- Institute of Neurological/Neurosurgical Rehabilitation Research at the Otto-von Guericke-University, Magdeburg, Germany
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20
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McCauley SR, Boake C, Pedroza C, Brown SA, Levin HS, Goodman HS, Merritt SG. Correlates of persistent postconcussional disorder: DSM-IV criteria versus ICD-10. J Clin Exp Neuropsychol 2007; 30:360-79. [PMID: 17852608 DOI: 10.1080/13803390701416635] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Controversy surrounding the causation of symptom complaints after mild traumatic brain injury (MTBI) is reflected by the existence of alternative diagnostic criteria for postconcussional syndrome (PCS) in the International Classification of Diseases (ICD) and postconcussional disorder (PCD) in the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV). Previous studies of persisting symptoms have employed various symptom checklists rather than uniform criteria-based diagnoses. This is the first prospective study of persisting symptom complaints using the formal diagnostic criteria for PCD and PCS and comparing these criteria sets in terms of prevalence, relationship to potential compensation, and emotional/functional status. In this prospective study, an unselected series of adults with uncomplicated MTBI (N = 139) was assessed at 6 months postinjury with a brief neuropsychological battery and measures of psychiatric symptoms/disorders, social support/community integration, health-related quality of life, and global outcome. In parallel analyses, participants with PCD/PCS were compared to those without the disorder. Potential compensation was an equally significant factor in both criteria sets. Persistent PCS criteria were met 3.1 times more frequently than persistent PCD criteria. Significant racial differences in fulfilling PCD/PCS criteria were found. No differences in emotional/functional status patterns or global outcome were found between the criteria sets except for minor dissimilarities in the social/community integration domain. The results demonstrate that despite large differences in the frequency of patients meeting the two diagnostic criteria sets, a clear basis for preferring either the PCD or PCS criteria remains to be determined.
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Affiliation(s)
- Stephen R McCauley
- Cognitive Neuroscience Laboratory, Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine, 1709 Dryden Rd., Ste. 725, Houston, TX 77030, USA.
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McCauley SR, Levin HS, Vanier M, Mazaux JM, Boake C, Goldfader PR, Rockers D, Butters M, Kareken DA, Lambert J, Clifton GL. The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment. J Neurol Neurosurg Psychiatry 2001; 71:643-51. [PMID: 11606677 PMCID: PMC1737597 DOI: 10.1136/jnnp.71.5.643] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the factor structure and psychometric properties of the neurobehavioural rating scale-revised (NRS-R) and to determine its usefulness in clinical trials. METHODS A consecutive series of patients sustaining severe closed head injury were evacuated to one of 11 large regional North American trauma centres and entered into a randomised, phase III, multicentre clinical trial investigating the therapeutic use of moderate hypothermia. Acute care personnel were blinded to outcome and outcome personnel were blinded to treatment condition. The Glasgow outcome scale (GOS) was the primary outcome measure. Secondary outcome measures included the disability rating scale (DRS) and the NRS-R. RESULTS Exploratory factor analysis of NRS-R data collected at 6 months after injury (n=210) resulted in a five factor model including: (1) executive/cognition, (2) positive symptoms, (3) negative symptoms, (4) mood/affect, and (5) oral/motor. These factors showed acceptable internal consistency (0.62 to 0.88), low to moderate interfactor correlations (0.19 to 0.61), and discriminated well between GOS defined groups. Factor validity was demonstrated by significant correlations with specific neuropsychological domains. Significant change was measured from 3 to 6 months after injury for the total score (sum of all 29 item ratings) and all factor scores except mood/affect and positive symptoms. The total score and all factor scores correlated significantly with concurrent GOS and DRS scores. CONCLUSIONS The NRS-R is well suited as a secondary outcome measure for clinical trials as its completion rate exceeds that of neuropsychological assessment and it provides important neurobehavioural information complementary to that provided by global outcome and neuropsychological measures.
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Affiliation(s)
- S R McCauley
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 6560 Fannin, Ste 1144, Houston, TX 77030, USA
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