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Kawas MI, Atcheson KM, Flood WC, Sheridan CA, Barcus RA, Flashman LA, McAllister TW, Lipford ME, Kim J, Urban JE, Davenport EM, Vaughan CG, Sai KKS, Stitzel JD, Maldjian JA, Whitlow CT. Cognitive and Salience Network Connectivity Changes following a Single Season of Repetitive Head Impact Exposure in High School Football. AJNR Am J Neuroradiol 2024; 45:1116-1123. [PMID: 39054293 DOI: 10.3174/ajnr.a8294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND PURPOSE During a season of high school football, adolescents with actively developing brains experience a considerable number of head impacts. Our aim was to determine whether repetitive head impacts in the absence of a clinically diagnosed concussion during a season of high school football produce changes in cognitive performance or functional connectivity of the salience network and its central hub, the dorsal anterior cingulate cortex. MATERIALS AND METHODS Football players were instrumented with the Head Impact Telemetry System during all practices and games, and the helmet sensor data were used to compute a risk-weighted exposure metric (RWEcp), accounting for the cumulative risk during the season. Participants underwent MRI and a cognitive battery (ImPACT) before and shortly after the football season. A control group of noncontact/limited-contact-sport athletes was formed from 2 cohorts: one from the same school and protocol and another from a separate, nearly identical study. RESULTS Sixty-three football players and 34 control athletes were included in the cognitive performance analysis. Preseason, the control group scored significantly higher on the ImPACT Visual Motor (P = .04) and Reaction Time composites (P = .006). These differences increased postseason (P = .003, P < .001, respectively). Additionally, the control group had significantly higher postseason scores on the Visual Memory composite (P = .001). Compared with controls, football players showed significantly less improvement in the Verbal (P = .04) and Visual Memory composites (P = .01). A significantly greater percentage of contact athletes had lower-than-expected scores on the Verbal Memory (27% versus 6%), Visual Motor (21% versus 3%), and Reaction Time composites (24% versus 6%). Among football players, a higher RWEcp was significantly associated with greater increments in ImPACT Reaction Time (P = .03) and Total Symptom Scores postseason (P = .006). Fifty-seven football players and 13 control athletes were included in the imaging analyses. Postseason, football players showed significant decreases in interhemispheric connectivity of the dorsal anterior cingulate cortex (P = .026) and within-network connectivity of the salience network (P = .018). These decreases in dorsal anterior cingulate cortex interhemispheric connectivity and within-network connectivity of the salience network were significantly correlated with deteriorating ImPACT Total Symptom (P = .03) and Verbal Memory scores (P = .04). CONCLUSIONS Head impact exposure during a single season of high school football is negatively associated with cognitive performance and brain network connectivity. Future studies should further characterize these short-term effects and examine their relationship with long-term sequelae.
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Affiliation(s)
- Mohammad I Kawas
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
- Department of Physiology (M.I.K.), Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Kyle M Atcheson
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - William C Flood
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Christopher A Sheridan
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Richard A Barcus
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Laura A Flashman
- Department of Neuropsychology (L.A.F.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Thomas W McAllister
- Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Megan E Lipford
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Jeongchul Kim
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Jillian E Urban
- Department of Biomedical Engineering (J.E.U., J.D.S.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elizabeth M Davenport
- Department of Radiology (E.M.D., J.A.M), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher G Vaughan
- Division of Pediatric Neuropsychology (C.G.V.), Children's National Hospital, Washington, DC
| | - Kiran K Solingapuram Sai
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Joel D Stitzel
- Department of Biomedical Engineering (J.E.U., J.D.S.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A Maldjian
- Department of Radiology (E.M.D., J.A.M), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher T Whitlow
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Singh A, Gong S, Vu A, Li S, Obenaus A. Social deficits mirror delayed cerebrovascular dysfunction after traumatic brain injury. Acta Neuropathol Commun 2024; 12:126. [PMID: 39107831 PMCID: PMC11304659 DOI: 10.1186/s40478-024-01840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/28/2024] [Indexed: 08/10/2024] Open
Abstract
Traumatic brain injury (TBI) survivors face debilitating long-term psychosocial consequences, including social isolation and depression. TBI modifies neurovascular physiology and behavior but the chronic physiological implications of altered brain perfusion on social interactions are unknown. Adult C57/BL6 male mice received a moderate cortical TBI, and social behaviors were assessed at baseline, 3-, 7-, 14-, 30-, and 60-days post injury (dpi). Magnetic resonance imaging (MRI, 9.4T) using dynamic susceptibility contrast perfusion weighted MRI were acquired. At 60dpi mice underwent histological angioarchitectural mapping. Analysis utilized standardized protocols followed by cross-correlation metrics. Social behavior deficits at 60dpi emerged as reduced interactions with a familiar cage-mate (partner) that mirrored significant reductions in cerebral blood flow (CBF) at 60dpi. CBF perturbations were dynamic temporally and across brain regions including regions known to regulate social behavior such as hippocampus, hypothalamus, and rhinal cortex. Social isolation in TBI-mice emerged with a significant decline in preference to spend time with a cage mate. Cortical vascular density was also reduced corroborating the decline in brain perfusion and social interactions. Thus, the late emergence of social interaction deficits mirrored the reduced vascular density and CBF in regions known to be involved in social behaviors. Vascular morphology and function improved prior to the late decrements in social function and our correlations strongly implicate a linkage between vascular density, cerebral perfusion, and social interactions. Our study provides a clinically relevant timeline of alterations in social deficits alongside functional vascular recovery that can guide future therapeutics.
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Affiliation(s)
- Aditya Singh
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
- Department of Neurology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, 120 Walter P Martin Research Center, Torrance, California, 90502, USA
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, 90095, USA
| | - Steven Gong
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
| | - Anh Vu
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
| | - Scott Li
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
| | - Andre Obenaus
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA.
- Division of Biomedical Sciences, 206 SOM Research Bldg, University of California Riverside, Riverside, CA, 92521, USA.
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Kureshi N, Nunes A, Feng C, Clarke DB, Abidi SSR. Risk stratification of new-onset psychiatric disorders using clinically distinct traumatic brain injury phenotypes. Arch Public Health 2024; 82:116. [PMID: 39095846 PMCID: PMC11295665 DOI: 10.1186/s13690-024-01346-w] [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: 05/06/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Patients with traumatic brain injury (TBI) constitute a highly heterogeneous population, with varying risks for New-onset Psychiatric Disorders (NPDs). The objectives of this study were to identify TBI phenotypes and determine how NPDs differ among these phenotypes. METHODS Hospitalized TBI patients from 2003 to 2019 were obtained from the provincial trauma registry. Propensity score matching was conducted to balance covariates among patients with TBI and controls. To uncover heterogeneity in TBI, latent class analysis (LCA)-based clustering was applied. LCA was conducted separately for two TBI cohorts: those with and without pre-injury psychiatric conditions The effect of classes on NPDs was assessed using log binomial regression models. RESULTS A total of 3,453 patients with TBI and 13,112 controls were included in the analysis. In a conditional regression involving propensity matched patients with TBI and controls, TBI was significantly associated with the development of NPD-A (OR: 2.78; 95% CI: 2.49-3.09), as well as NPD-P (OR: 2.36; 95% CI: 2.07-2.70). Eight distinct latent classes were identified which differed in the incidence of NPDs. Four classes displayed a 53% (RR:1.53; 95% CI: 1.31-1.78), 48% (RR:1.48; 95% CI: 1.26-1.74), 28% (RR:1.28; 95% CI: 1.08-1.54), and 20% (RR: 1.20, 95%CI: 1.03-1.39), increased NPD risk. CONCLUSION TBI is a significant predictor of NPDs. There are clinically distinguishable phenotypes with different patterns of NPD risk among patients with TBI. Identifying individuals with respect to their phenotype may improve risk stratification of patients with TBI and promote early intervention for psychiatric care in this vulnerable population.
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Affiliation(s)
- Nelofar Kureshi
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada.
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.
| | - Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Cindy Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - David B Clarke
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
- Brain Repair Centre, Dalhousie University, Halifax, NS, Canada
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Carmichael J, Ponsford J, Gould KR, Tiego J, Forbes MK, Kotov R, Fornito A, Spitz G. A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI). J Neurotrauma 2024. [PMID: 38970424 DOI: 10.1089/neu.2024.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024] Open
Abstract
Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jeggan Tiego
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Miriam K Forbes
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Roman Kotov
- Stony Brook University, New York, New York, USA
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Jiao M, Li X, Liu H, Cai P, Yang X, McHugh KJ, Zheng B, Sun J, Zhang P, Luo X, Jing L. Aqueous Grown Quantum Dots with Robust Near-Infrared Fluorescence for Integrated Traumatic Brain Injury Diagnosis and Surgical Monitoring. ACS NANO 2024; 18:19038-19053. [PMID: 38979966 DOI: 10.1021/acsnano.4c03123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Surgical intervention is the most common first-line treatment for severe traumatic brain injuries (TBIs) associated with high intracranial pressure, while the complexity of these surgical procedures often results in complications. Surgeons often struggle to comprehensively evaluate the TBI status, making it difficult to select the optimal intervention strategy. Here, we introduce a fluorescence imaging-based technology that uses high-quality silver indium selenide-based quantum dots (QDs) for integrated TBI diagnosis and surgical guidance. These engineered, poly(ethylene glycol)-capped QDs emit in the near-infrared region, are resistant to phagocytosis, and importantly, are ultrastable after the epitaxial growth of an aluminum-doped zinc sulfide shell in the aqueous phase that renders the QDs resistant to long-term light irradiation and complex physiological environments. We found that intravenous injection of QDs enabled both the precise diagnosis of TBI in a mouse model and, more importantly, the comprehensive evaluation of the TBI status before, during, and after an operation to distinguish intracranial from superficial hemorrhages, provide real-time monitoring of the secondary hemorrhage, and guide the decision making on the evacuation of intracranial hematomas. This QD-based diagnostic and monitoring system could ultimately complement existing clinical tools for treating TBI, which may help surgeons improve patient outcomes and avoid unnecessary procedures.
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Affiliation(s)
- Mingxia Jiao
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
| | - Xiaoqi Li
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
| | - Hui Liu
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
| | - Peng Cai
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
| | - Xiling Yang
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
| | - Kevin J McHugh
- Departments of Bioengineering and Chemistry, Rice University, Houston, Texas 77005, United States
| | - Bowen Zheng
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
| | - Jiachen Sun
- CAS Key Laboratory of Colloid, Interface and Chemical Thermodynamics, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Center for Carbon Neutral Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Bei Yi Jie 2, Zhong Guan Cun, Beijing 100190, China
| | - Peisen Zhang
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
- CAS Key Laboratory of Colloid, Interface and Chemical Thermodynamics, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Center for Carbon Neutral Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Bei Yi Jie 2, Zhong Guan Cun, Beijing 100190, China
| | - Xiliang Luo
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Zhengzhou Road 53, Qingdao 266042, China
| | - Lihong Jing
- CAS Key Laboratory of Colloid, Interface and Chemical Thermodynamics, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Center for Carbon Neutral Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Bei Yi Jie 2, Zhong Guan Cun, Beijing 100190, China
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Altuwairqi Y. Bipolar Disorder Due to Traumatic Brain Injury: A Case Report. Cureus 2023; 15:e51292. [PMID: 38288174 PMCID: PMC10824366 DOI: 10.7759/cureus.51292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
I report an unusual case in Saudi Arabia of a 28-year-old man who had bipolar disorder due to a traumatic brain injury suffered 10 years previously. He had been evaluated and diagnosed with schizoaffective disorder as well as amphetamine and hash use disorder until recently, when the team noticed a poor response to treatment and the continuation of his cognitive features. After a reevaluation of the history and evidence of the brain lesions on the MRI, the diagnosis was changed to bipolar disorder due to a traumatic brain injury. The patient had shown a fair response to valproate and risperidone. This report emphasizes the significance of ruling out the medical factors contributing to the manifestation of any novel psychiatric symptom, necessitating greater attention to the account of cranial trauma and periods of unconsciousness. Psychiatrists should be aware of these overlooked cases and encourage colleagues in the field to maintain a high index of suspicion and to take a good relevant history of brain injury insults, especially when there are cognitive features and a poor response to medications. The patient exhibited symptoms of inattention, memory difficulties, reasoning deficits, and poor judgment, but he did not meet the criteria for a minor or major cognitive disorder.
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