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Sanchez-Molano J, Blaya MO, Padgett KR, Moreno WJ, Zhao W, Dietrich WD, Bramlett HM. Multimodal magnetic resonance imaging after experimental moderate and severe traumatic brain injury: A longitudinal correlative assessment of structural and cerebral blood flow changes. PLoS One 2023; 18:e0289786. [PMID: 37549175 PMCID: PMC10406285 DOI: 10.1371/journal.pone.0289786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
Traumatic brain injury (TBI) is a worldwide problem that results in death or disability for millions of people every year. Progressive neurological complications and long-term impairment can significantly disrupt quality of life. We demonstrated the feasibility of multiple magnetic resonance imaging (MRI) modalities to investigate and predict aberrant changes and progressive atrophy of gray and white matter tissue at several acute and chronic time points after moderate and severe parasagittal fluid percussion TBI. T2-weighted imaging, diffusion tensor imaging (DTI), and perfusion weighted imaging (PWI) were performed. Adult Sprague-Dawley rats were imaged sequentially on days 3, 14, and 1, 4, 6, 8, and 12 months following surgery. TBI caused dynamic white and gray matter alterations with significant differences in DTI values and injury-induced alterations in cerebral blood flow (CBF) as measured by PWI. Regional abnormalities after TBI were observed in T2-weighted images that showed hyperintense cortical lesions and significant cerebral atrophy in these hyperintense areas 1 year after TBI. Temporal DTI values indicated significant injury-induced changes in anisotropy in major white matter tracts, the corpus callosum and external capsule, and in gray matter, the hippocampus and cortex, at both early and chronic time points. These alterations were primarily injury-severity dependent with severe TBI exhibiting a greater degree of change relative to uninjured controls. PWI evaluating CBF revealed sustained global reductions in the cortex and in the hippocampus at most time points in an injury-independent manner. We next sought to investigate prognostic correlations across MRI metrics, timepoints, and cerebral pathology, and found that diffusion abnormalities and reductions in CBF significantly correlated with specific vulnerable structures at multiple time points, as well as with the degree of cerebral atrophy observed 1 year after TBI. This study further supports using DTI and PWI as a means of prognostic imaging for progressive structural changes after TBI and emphasizes the progressive nature of TBI damage.
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Affiliation(s)
- Juliana Sanchez-Molano
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Meghan O. Blaya
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Kyle R. Padgett
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - William J. Moreno
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Weizhao Zhao
- Department of Biomedical Engineering, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - W. Dalton Dietrich
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Helen M. Bramlett
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, United States of America
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Carmichael J, Hicks AJ, Gould KR, Spitz G, Ponsford J. Network analysis of anxiety and depressive symptoms one year after traumatic brain injury. Psychiatry Res 2023; 326:115310. [PMID: 37356251 DOI: 10.1016/j.psychres.2023.115310] [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] [Received: 01/21/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
We used network analysis to explore interrelationships between anxiety and depressive symptoms after traumatic brain injury (TBI). At one year post-injury, 882 adult civilians who received inpatient rehabilitation for moderate-severe TBI self-reported anxiety and depressive symptoms (Hospital Anxiety and Depression Scale). The severity of TBI was characterized acutely by the duration of post-traumatic amnesia (PTA), and TBI-related functional disability was rated by an examiner at one year post-injury using a structured interview (Glasgow Outcome Scale - Extended). We estimated two cross-sectional, partial correlation networks. In the first network, anxiety and depressive symptoms were densely interconnected yet formed three distinct, data-driven communities: Hyperarousal, Depression, and General Distress. Worrying thoughts and having difficulty relaxing were amongst the most central symptoms, showing strong connections with other symptoms within and between communities. In the second network, TBI severity was directly negatively associated with hyperarousal symptoms but indirectly positively associated with depressive symptoms via greater functional disability. The results highlight the potential utility of simultaneous, transdiagnostic assessment and treatment of anxiety and depressive symptoms after moderate-severe TBI. Worrying thoughts, having difficulty relaxing, and the experience of disability may be important targets for treatment, although future studies examining symptom dynamics within individuals and over time are required.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia; Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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Parsons N, Irimia A, Amgalan A, Ugon J, Morgan K, Shelyag S, Hocking A, Poudel G, Caeyenberghs K. Structural-functional connectivity bandwidth predicts processing speed in mild traumatic brain Injury: A multiplex network analysis. Neuroimage Clin 2023; 38:103428. [PMID: 37167841 PMCID: PMC10196722 DOI: 10.1016/j.nicl.2023.103428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
An emerging body of work has revealed alterations in structural (SC) and functional (FC) brain connectivity following mild TBI (mTBI), with mixed findings. However, these studies seldom integrate complimentary neuroimaging modalities within a unified framework. Multilayer network analysis is an emerging technique to uncover how white matter organization enables functional communication. Using our novel graph metric (SC-FC Bandwidth), we quantified the information capacity of synchronous brain regions in 53 mild TBI patients (46 females; age mean = 40.2 years (y), σ = 16.7 (y), range: 18-79 (y). Diffusion MRI and resting state fMRI were administered at the acute and chronic post-injury intervals. Moreover, participants completed a cognitive task to measure processing speed (30 Seconds and Counting Task; 30-SACT). Processing speed was significantly increased at the chronic, relative to the acute post-injury intervals (p = <0.001). Nonlinear principal components of direct (t = -1.84, p = 0.06) and indirect SC-FC Bandwidth (t = 3.86, p = <0.001) predicted processing speed with a moderate effect size (R2 = 0.43, p < 0.001), while controlling for age. A subnetwork of interhemispheric edges with increased SC-FC Bandwidth was identified at the chronic, relative to the acute mTBI post-injury interval (pFDR = 0.05). Increased interhemispheric SC-FC Bandwidth of this network corresponded with improved processing speed at the chronic post-injury interval (partial r = 0.32, p = 0.02). Our findings revealed that mild TBI results in complex reorganization of brain connectivity optimized for maximum information flow, supporting improved cognitive performance as a compensatory mechanism. Moving forward, this measurement may complement clinical assessment as an objective marker of mTBI recovery.
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Affiliation(s)
- Nicholas Parsons
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia; BrainCast Neurotechnologies, Australia; School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Julien Ugon
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Kerri Morgan
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Sergiy Shelyag
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Alex Hocking
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Govinda Poudel
- BrainCast Neurotechnologies, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia
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Keatley ES, Bombardier CH, Watson E, Kumar RG, Novack T, Monden KR, Dams-O'Connor K. Cognitive Performance, Depression, and Anxiety 1 Year After Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E195-E202. [PMID: 36730989 PMCID: PMC10102243 DOI: 10.1097/htr.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate associations between depression, anxiety, and cognitive impairment among individuals with complicated mild to severe traumatic brain injury (TBI) 1 year after injury. SETTING Multiple inpatient rehabilitation units across the United States. PARTICIPANTS A total of 498 adults 16 years and older who completed inpatient rehabilitation for complicated mild to severe TBI. DESIGN Secondary analysis of a prospective, multicenter, cross-sectional observational cohort study. MAIN MEASURES Assessments of depression (Traumatic Brain Injury Quality of Life [TBI-QOL] Depression) and anxiety (TBI-QOL Anxiety) as well as a telephone-based brief screening measure of cognitive functioning (Brief Test of Adult Cognition by Telephone [BTACT]). RESULTS We found an inverse relationship between self-reported depression symptoms and the BTACT Composite score (β = -0.18, P < .01) and anxiety symptoms and the BTACT Composite score (β = -0.20, P < .01). There was no evidence this relationship varied by injury severity. Exploratory analyses showed depression and anxiety were negatively correlated with both BTACT Executive Function factor score and BTACT Memory factor score. CONCLUSIONS Both depression and anxiety have a small but significant negative association with cognitive performance in the context of complicated mild to severe TBI. These findings highlight the importance of considering depression and anxiety when interpreting TBI-related neuropsychological impairments, even among more severe TBI.
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Affiliation(s)
- Eva S Keatley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland (Dr Keatley); Department of Physical Medicine and Rehabilitation, University of Washington, Seattle (Dr Bombardier); Departments of Rehabilitation and Human Performance (Drs Watson, Kumar, and Dams-O'Connor) and Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham (Dr Novack); and Research Department, Craig Hospital, Englewood, Colorado, and Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis (Dr Monden)
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5
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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Spitz G, Hicks AJ, Roberts C, Rowe CC, Ponsford J. Brain age in chronic traumatic brain injury. Neuroimage Clin 2022; 35:103039. [PMID: 35580421 PMCID: PMC9117693 DOI: 10.1016/j.nicl.2022.103039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022]
Abstract
Traumatic brain injury (TBI) is associated with greater 'brain age' that may be caused by atrophy in grey and white matter. Here, we investigated 'brain age' in a chronic TBI (≥10 years) sample. We examined whether 'brain age' increases with years post injury, and whether it is associated with injury severity, cognition and functional outcome. We recruited 102 participants with moderate to severe TBI aged between 40 and 85 years. TBI participants were assessed on average 22 years post-injury. Seventy-seven healthy controls were also recruited. Participants' 'brain age' was determined using T1-weighted MRI images. TBI participants were estimated to have greater 'brain age' compared to healthy controls. 'Brain age' gap was unrelated to time since injury or long-term functional outcome on the Glasgow Outcome Scale-Extended. Greater brain age was associated with greater injury severity measured by post traumatic amnesia duration and Glasgow Coma Scale. 'Brain age' was significantly and inversely associated with verbal memory, but unrelated to visual memory/ability and cognitive flexibility and processing speed. A longitudinal study is required to determine whether TBI leads to a 'one-off' change in 'brain age' or progressive ageing of the brain over time.
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Affiliation(s)
- Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton 3168, Australia.
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton 3168, Australia
| | - Caroline Roberts
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton 3168, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg 3084, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton 3168, Australia
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7
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El-Khatib H, Sanchez E, Arbour C, Van Der Maren S, Duclos C, Blais H, Carrier J, Simonelli G, Hendryckx C, Paquet J, Gosselin N. Slow wave activity moderates the association between new learning and traumatic brain injury severity. Sleep 2021; 44:5992297. [PMID: 33211874 DOI: 10.1093/sleep/zsaa242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/16/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep-wake complaints and difficulties in making new learning are among the most persistent and challenging long-term sequelea following moderate to severe traumatic brain injury (TBI). Yet, it is unclear whether, and to what extent, sleep characteristics during the chronic stage of TBI contribute to sleep-wake and cognitive complaints. We aimed to characterize sleep architecture in chronic moderate to severe TBI adults and assess whether non-rapid eye movement slow wave activity (SWA) is associated to next day performance in episodic memory tasks according to TBI severity. METHODS Forty-two moderate to severe TBI participants, 12-47 months post-injury, and 38 healthy controls were tested with one night of in-laboratory polysomnography, followed the next morning by questionnaires (sleep quality, fatigue, and sleepiness) and neuropsychological assessment. We used multiple regression analyses to assess the moderator effect of SWA power on TBI severity and next-day memory performance. RESULTS We found that TBI participants reported worse sleep quality and fatigue, and had worse cognitive performance than controls. No between group differences were found on macro- and micro-architecture of sleep. However, SWA significantly interacted with TBI severity to explain next-day memory performance: higher SWA was more strongly associated to better memory performance in more severe TBI compared to milder TBI. CONCLUSIONS This study provides evidence that the injured brain is able to produce macro- and micro-architecture of sleep comparable to what is seen in healthy controls. However, with increasing TBI severity, lower non-rapid eye movement SWA power is associated with reduced ability to learn and memorise new information the following day.
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Affiliation(s)
- Héjar El-Khatib
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Erlan Sanchez
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada
| | - Caroline Arbour
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Solenne Van Der Maren
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Catherine Duclos
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Guido Simonelli
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Charlotte Hendryckx
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Paquet
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
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8
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Ponsford J, Carrier S, Hicks A, McKay A. Assessment and Management of Patients in the Acute Stages of Recovery after Traumatic Brain Injury in Adults: A Worldwide Survey. J Neurotrauma 2020; 38:1060-1067. [PMID: 33121375 DOI: 10.1089/neu.2020.7299] [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] [Indexed: 12/17/2022] Open
Abstract
Most individuals with traumatic brain injury (TBI) experience a period of confusion after emergence from coma, termed post-traumatic amnesia, post-traumatic confusional state, or delirium. Recent guidelines suggest the importance of assessment and consistent management during this phase, but current practice worldwide remains unknown. This survey aimed to elucidate current international practice in assessment and treatment of patients in the acute stages of recovery after TBI. The web-based survey was distributed to clinicians working with patients with acute TBI. There were 400 participants (68.8% females), from 41 countries, mostly neuropsychologists, rehabilitation physicians, and occupational therapists (OTs), with an average 12.8 years of experience. Of those working with adults (n = 376, 94%), most described this acute period as post-traumatic amnesia and used its duration to indicate injury severity. More than 85% used a tool to assess patients; in order of frequency, the Glasgow Coma Scale (GCS), Westmead PTA Scale (WPTAS), Galveston Orientation and Amnesia Test, Rancho Los Amigos Scale, and O-Log. Meeting criteria on the assessment tool or clinical judgment determined emergence from this phase, indicated by recovery of orientation, day-to-day memories, and ability to follow commands or participate in rehabilitation. Most patients had physiotherapy, OT, speech therapy, and environmental changes, with a third of participants indicating sedating medication was prescribed during this phase. Findings suggest that, consistent with guidelines, PTA is a widely recognized and measured TBI recovery phase, used to determine injury severity and readiness for therapy.
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Affiliation(s)
- Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah Carrier
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Amelia Hicks
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Adam McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
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9
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Meysami S, Raji CA, Merrill DA, Porter VR, Mendez MF. MRI Volumetric Quantification in Persons with a History of Traumatic Brain Injury and Cognitive Impairment. J Alzheimers Dis 2020; 72:293-300. [PMID: 31561375 DOI: 10.3233/jad-190708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND While traumatic brain injury (TBI) is recognized as a risk factor for dementia, there is lack of clinical tools to identify brain changes that may confer such vulnerability. Brain MRI volumetric quantification can sensitively identify brain atrophy. OBJECTIVE To characterize regional brain volume loss in persons with TBI presenting with cognitive impairment. METHODS IRB approved review of medical records in patients with cognitive decline focused on those who had documented TBI histories and brain MRI scans after TBI (n = 40, 67.7±14.5 years) with volumetric quantification by applying an FDA cleared software program. TBI documentation included head trauma mechanism. Brain volumes were compared to a normative database to determine the extent of atrophy. Correlations between these regions and global tests of cognition (MMSE in n = 17, MoCA in n = 27, n = 14 in both) were performed. RESULTS Multiple regions demonstrated volume loss in TBI, particularly ventral diencephalon, putamen, and pallidum with smaller magnitude of atrophy in temporal lobes and brainstem. Lobar structures showed strongest correlations between atrophy and lower scores on MMSE and MoCA. The hippocampus, while correlated to tests of cognitive function, was the least atrophic region as a function of TBI history. CONCLUSION Persons with TBI history exhibit show regional brain atrophy. Several of these areas, such as thalamus and temporal lobes, also correlate with cognitive function. Alzheimer's disease atrophy was less likely given relative sparing of the hippocampi. Volumetric quantification of brain MRI in TBI warrants further investigation to further determine its clinical potential in TBI and differentiating causes of cognitive impairment.
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Affiliation(s)
- Somayeh Meysami
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cyrus A Raji
- Mallinckrodt Institute of Radiology, Division of Neuroradiology, Washington University, St. Louis, MO, USA
| | - David A Merrill
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,The John Wayne Cancer Institute and Pacific Neuroscience Institute, Providence and St. Johns Health Center, Santa Monica, CA, USA
| | - Verna R Porter
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,The John Wayne Cancer Institute and Pacific Neuroscience Institute, Providence and St. Johns Health Center, Santa Monica, CA, USA
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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10
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Hart T, Ferraro M, Rabinowitz A, Fitzpatrick DeSalme E, Nelson L, Marcy E, Farm S, Turkstra L. Improving communication with patients in post-traumatic amnesia: development and impact of a clinical protocol. Brain Inj 2020; 34:1518-1524. [PMID: 32835514 DOI: 10.1080/02699052.2020.1809710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the impact of staff training focused on improved treatment and communication with patients in post-traumatic amnesia (PTA) or other disorders of explicit (declarative) memory. A major aim was to minimize questions demanding recall from explicit memory, e.g., orientation quizzing, and personal/medical history questions, which may produce unreliable information and exacerbate patient frustration and anxiety. METHODS Mixed-methods design. Inpatients with impairments of explicit memory were observed before (n = 4) and after (n = 4) training, with staff interactions recorded verbatim. Records were coded for types of questions and patient responses. Clinicians who worked before and after training were surveyed regarding perceived changes in practice, team functioning, and patient behavior. RESULTS Explicit memory questions decreased significantly, as did irrelevant or "don't know" responses from patients, with large nonparametric effect sizes noted. The frequency of questions not relying on explicit memory remained stable. Most clinicians reported positive effects on their own and others' practice with memory impaired patients, and one-quarter noted less patient frustration or agitation. CONCLUSIONS Although questioning patients is a natural part of medical care, targeted staff training can result in positive changes in communication practice and should be considered for facilities treating patients in PTA.
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Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute , Elkins Park, Pennsylvania, USA
| | - Mary Ferraro
- Moss Rehabilitation Research Institute , Elkins Park, Pennsylvania, USA.,Drucker Brain Injury Center, MossRehab Hospital , Elkins Park, Pennsylvania, USA
| | - Amanda Rabinowitz
- Moss Rehabilitation Research Institute , Elkins Park, Pennsylvania, USA
| | | | - Lauren Nelson
- Drexel University College of Medicine , Philadelphia, Pennsylvania, USA
| | - Elizabeth Marcy
- Drucker Brain Injury Center, MossRehab Hospital , Elkins Park, Pennsylvania, USA
| | - Stephanie Farm
- Drucker Brain Injury Center, MossRehab Hospital , Elkins Park, Pennsylvania, USA
| | - Lyn Turkstra
- School of Rehabilitation Science, McMaster University , Ontario, California, USA
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Bigler ED, Abildskov TJ, Eggleston B, Taylor BA, Tate DF, Petrie JA, Newsome MR, Scheibel RS, Levin H, Walker WC, Goodrich‐Hunsaker N, Tustison NJ, Stone JR, Mayer AR, Duncan TD, York GE, Wilde EA. Structural neuroimaging in mild traumatic brain injury: A chronic effects of neurotrauma consortium study. Int J Methods Psychiatr Res 2019; 28:e1781. [PMID: 31608535 PMCID: PMC6877164 DOI: 10.1002/mpr.1781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The chronic effects of neurotrauma consortium (CENC) observational study is a multisite investigation designed to examine the long-term longitudinal effects of mild traumatic brain injury (mTBI). All participants in this initial CENC cohort had a history of deployment in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and/or their follow-on conflicts (Operation Freedom's Sentinel). All participants undergo extensive medical, neuropsychological, and neuroimaging assessments and either meet criteria for any lifetime mTBI or not. These assessments are integrated into six CENC core studies-Biorepository, Biostatistics, Data and Study Management, Neuroimaging, and Neuropathology. METHODS The current study outlines the quantitative neuroimaging methods managed by the Neuroimaging Core using FreeSurfer automated software for image quantification. RESULTS At this writing, 319 participants from the CENC observational study have completed all baseline assessments including the imaging protocol and tertiary data quality assurance procedures. CONCLUSIONS/DISCUSSION The preliminary findings of this initial cohort are reported to describe how the Neuroimaging Core manages neuroimaging quantification for CENC studies.
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Affiliation(s)
- Erin D. Bigler
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Tracy J. Abildskov
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Barry Eggleston
- Biostatistics and EpidemiologyRTI InternationalDurhamNorth Carolina
| | - Brian A. Taylor
- Biomedical EngineeringVirginia Commonwealth UniversityRichmondVirginia
| | - David F. Tate
- Missouri Institute of Mental HealthUniversity of Missouri‐St. LouisSt. LouisMissouri
| | - Jo Ann Petrie
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Mary R. Newsome
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - Randall S. Scheibel
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - Harvey Levin
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - William C. Walker
- Biomedical EngineeringVirginia Commonwealth UniversityRichmondVirginia
| | - Naomi Goodrich‐Hunsaker
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - Nicholas J. Tustison
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - James R. Stone
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - Andrew R. Mayer
- Neurology and Brain and Behavioral Health InstituteUniversity of New MexicoAlbuquerqueNew Mexico
| | - Timothy D. Duncan
- Medical Imaging and RadiologyVA Portland Health Care SystemPortlandOregon
| | - Gerry E. York
- Alaska Radiology AssociatesTBI Imaging and ResearchAnchorageAlaska
| | - Elisabeth A. Wilde
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
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12
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Mild, moderate and severe: terminology implications for clinical and experimental traumatic brain injury. Curr Opin Neurol 2019; 31:672-680. [PMID: 30379702 DOI: 10.1097/wco.0000000000000624] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW When describing clinical or experimental traumatic brain injury (TBI), the adjectives 'mild,' 'moderate' and 'severe' are misleading. 'Mild' clinical TBI frequently results in long-term disability. 'Severe' rodent TBI actually resembles mild or complicated mild clinical TBI. RECENT FINDINGS Many mild TBI patients appear to have recovered completely but have postconcussive symptoms, deficits in cognitive and executive function and reduced cerebral blood flow. After moderate TBI, 31.8% of patients died or were discharged to skilled nursing or hospice. Among survivors of moderate and severe TBI, 44% were unable to return to work. On MRI, 88% of mild TBI patients have evidence of white matter damage, based on measurements of fractional anisotropy and mean diffusivity/apparent diffusion coefficient. After sports concussion, clinically recovered patients have abnormalities in functional connectivity on functional MRI. Methylphenidate improved fatigue and cognitive impairment and, combined with cognitive rehabilitation, improved memory and executive functioning. In comparison to clinical TB, because the entire spectrum of experimental rodent TBI, although defined as moderate or severe, more closely resembles mild or complicated mild clinical TBI. SUMMARY Many patients after mild or moderate TBI suffer long-term sequelae and should be considered a major target for translational research. Treatments that improve outcome in rodent TBI, even when the experimental injuries are defined as severe, might be most applicable to mild or moderate TBI.
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Svingos AM, Asken BM, Jaffee MS, Bauer RM, Heaton SC. Predicting long-term cognitive and neuropathological consequences of moderate to severe traumatic brain injury: Review and theoretical framework. J Clin Exp Neuropsychol 2019; 41:775-785. [DOI: 10.1080/13803395.2019.1620695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Adrian M. Svingos
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Breton M. Asken
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S. Jaffee
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Russell M. Bauer
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shelley C. Heaton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
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14
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Roberts CM, Spitz G, Mundy M, Ponsford JL. Prospective evaluation of first and last memory reports following moderate to severe traumatic brain injury. J Clin Exp Neuropsychol 2018; 41:109-117. [DOI: 10.1080/13803395.2018.1490392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Caroline M. Roberts
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - Gershon Spitz
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - Matthew Mundy
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jennie L. Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
- Epworth Healthcare, Richmond, VIC, Australia
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15
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McKay A, Love J, Trevena-Peters J, Gracey J, Ponsford J. The relationship between agitation and impairments of orientation and memory during the PTA period after traumatic brain injury. Neuropsychol Rehabil 2018; 30:579-590. [DOI: 10.1080/09602011.2018.1479276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Adam McKay
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
- Department of Psychology, Epworth HealthCare, Melbourne, Australia
| | - Jasmine Love
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jessica Trevena-Peters
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jacinta Gracey
- Department of Psychology, Epworth HealthCare, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
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16
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Misquitta K, Dadar M, Tarazi A, Hussain MW, Alatwi MK, Ebraheem A, Multani N, Khodadadi M, Goswami R, Wennberg R, Tator C, Green R, Colella B, Davis KD, Mikulis D, Grinberg M, Sato C, Rogaeva E, Louis Collins D, Tartaglia MC. The relationship between brain atrophy and cognitive-behavioural symptoms in retired Canadian football players with multiple concussions. Neuroimage Clin 2018; 19:551-558. [PMID: 29984163 PMCID: PMC6029563 DOI: 10.1016/j.nicl.2018.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 10/31/2022]
Abstract
Multiple concussions, particularly in contact sports, have been associated with cognitive deficits, psychiatric impairment and neurodegenerative diseases like chronic traumatic encephalopathy. We used volumetric and deformation-based morphometric analyses to test the hypothesis that repeated concussions may be associated with smaller regional brain volumes, poorer cognitive performance and behavioural symptoms among former professional football players compared to healthy controls. This study included fifty-three retired Canadian Football League players, 25 age- and education-matched healthy controls, and controls from the Cambridge Centre for Aging and Neuroscience database for validation. Volumetric analyses revealed greater hippocampal atrophy than expected for age in former athletes with multiple concussions than controls and smaller left hippocampal volume was associated with poorer verbal memory performance in the former athletes. Deformation-based morphometry confirmed smaller bilateral hippocampal volume that was associated with poorer verbal memory performance in athletes. Repeated concussions may lead to greater regional atrophy than expected for age.
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Affiliation(s)
- Karen Misquitta
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Mahsa Dadar
- McConnell Brain Imaging Centre, Montreal Neurological Institute, 3801 Rue Universite, Montreal, QC H3A 2B4, Canada
| | - Apameh Tarazi
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Mohammed W Hussain
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Mohammed K Alatwi
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Ahmed Ebraheem
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Namita Multani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada; Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Ruma Goswami
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Richard Wennberg
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Charles Tator
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Department of Surgery, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Robin Green
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON M5G 2A2, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Brenda Colella
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON M5G 2A2, Canada
| | - Karen Deborah Davis
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - David Mikulis
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Department of Medical Imaging, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Mark Grinberg
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, Montreal Neurological Institute, 3801 Rue Universite, Montreal, QC H3A 2B4, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada; Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada.
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17
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Ponsford JL, Spitz G, McKenzie D. Using Post-Traumatic Amnesia To Predict Outcome after Traumatic Brain Injury. J Neurotrauma 2016; 33:997-1004. [DOI: 10.1089/neu.2015.4025] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jennie L. Ponsford
- School of Psychological Sciences, Monash University, and Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Gershon Spitz
- School of Psychological Sciences, Monash University, and Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Dean McKenzie
- Research Development & Governance, Epworth Healthcare, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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18
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Impact of neonatal anoxia on adult rat hippocampal volume, neurogenesis and behavior. Behav Brain Res 2016; 296:331-338. [DOI: 10.1016/j.bbr.2015.08.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/26/2015] [Accepted: 08/30/2015] [Indexed: 01/02/2023]
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Abstract
Retrograde amnesia is described as condition which can occur after direct brain damage, but which occurs more frequently as a result of a psychiatric illness. In order to understand the amnesic condition, content-based divisions of memory are defined. The measurement of retrograde memory is discussed and the dichotomy between "organic" and "psychogenic" retrograde amnesia is questioned. Briefly, brain damage-related etiologies of retrograde amnesia are mentioned. The major portion of the review is devoted to dissociative amnesia (also named psychogenic or functional amnesia) and to the discussion of an overlap between psychogenic and "brain organic" forms of amnesia. The "inability of access hypothesis" is proposed to account for most of both the organic and psychogenic (dissociative) patients with primarily retrograde amnesia. Questions such as why recovery from retrograde amnesia can occur in retrograde (dissociative) amnesia, and why long-term new learning of episodic-autobiographic episodes is possible, are addressed. It is concluded that research on retrograde amnesia research is still in its infancy, as the neural correlates of memory storage are still unknown. It is argued that the recollection of episodic-autobiographic episodes most likely involves frontotemporal regions of the right hemisphere, a region which appears to be hypometabolic in patients with dissociative amnesia.
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Affiliation(s)
- H J Markowitsch
- Department of Physiological Psychology, University of Bielefeld, Bielefeld, Germany.
| | - A Staniloiu
- Department of Physiological Psychology, University of Bielefeld, Bielefeld, Germany; Department of Psychiatry, Sunnybrook Hospital, Toronto, ON, Canada
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20
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Fang SC, Schnurr PP, Kulish AL, Holowka DW, Marx BP, Keane TM, Rosen R. Psychosocial Functioning and Health-Related Quality of Life Associated with Posttraumatic Stress Disorder in Male and Female Iraq and Afghanistan War Veterans: The VALOR Registry. J Womens Health (Larchmt) 2015. [DOI: 10.1089/jwh.2014.5096] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shona C. Fang
- Division of Epidemiology, New England Research Institutes, Inc., Watertown, Massachusetts
| | - Paula P. Schnurr
- Executive Division, National Center for PTSD, VA Medical Center, White River Junction, Vermont
- Department of Psychiatry, Geisel School of Medicine of Dartmouth, Hanover, New Hampshire
| | - Andrea L. Kulish
- Behavioral Science Division, National Center for PTSD at VA Boston, Boston, Massachusetts
| | - Darren W. Holowka
- Behavioral Science Division, National Center for PTSD at VA Boston, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Brian P. Marx
- Behavioral Science Division, National Center for PTSD at VA Boston, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Terence M. Keane
- Behavioral Science Division, National Center for PTSD at VA Boston, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Raymond Rosen
- Division of Epidemiology, New England Research Institutes, Inc., Watertown, Massachusetts
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21
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Amyot F, Arciniegas DB, Brazaitis MP, Curley KC, Diaz-Arrastia R, Gandjbakhche A, Herscovitch P, Hinds SR, Manley GT, Pacifico A, Razumovsky A, Riley J, Salzer W, Shih R, Smirniotopoulos JG, Stocker D. A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. J Neurotrauma 2015; 32:1693-721. [PMID: 26176603 PMCID: PMC4651019 DOI: 10.1089/neu.2013.3306] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.
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Affiliation(s)
- Franck Amyot
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David B. Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, Texas
- Brain Injury Research, TIRR Memorial Hermann, Houston, Texas
| | | | - Kenneth C. Curley
- Combat Casualty Care Directorate (RAD2), U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Amir Gandjbakhche
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Peter Herscovitch
- Positron Emission Tomography Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sidney R. Hinds
- Defense and Veterans Brain Injury Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Silver Spring, Maryland
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Anthony Pacifico
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | | | - Jason Riley
- Queens University, Kingston, Ontario, Canada
- ArcheOptix Inc., Picton, Ontario, Canada
| | - Wanda Salzer
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | - Robert Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James G. Smirniotopoulos
- Department of Radiology, Neurology, and Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Derek Stocker
- Walter Reed National Military Medical Center, Bethesda, Maryland
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Abstract
OBJECTIVE The current study examines the demographics, injury characteristics, and outcomes associated with the presence of postconcussion amnesia in young concussion clinic patients. DESIGN Cross-sectional, retrospective clinical cohort. SETTING Concussion services clinic. PATIENTS Pediatric and adolescent concussion services program patients, presenting within 10 days postinjury, aged 10-18 years, with the goal of returning to sport (n = 245). ASSESSMENT OF RISK FACTORS Age, gender, race, head trauma history, injury mechanism, loss of consciousness (LOC), injury-related visit to an emergency department, cognitive and balance scores, symptoms, and management recommendations. MAIN OUTCOME MEASURES Univariate and multivariate analyses determined adjusted odds ratios for reported presence of any postconcussion amnesia (anterograde or retrograde). RESULTS Factors associated with amnesia (univariate, P < 0.10) and included in the multivariate model were race, head trauma history, mechanism of injury, LOC, injury-related visit to an emergency department, management recommendations and time of injury and initial visit symptom severity. Age and gender were also included in the model due to biological significance. Of the 245 patients, 181 had data for all model variables. Of the 181 patients, 58 reported amnesia. History of head trauma [odds ratio (OR), 2.7; 95% confidence interval (CI), 1.3-5.7]; time of injury (TOI) symptom severity >75th percentile (OR, 2.6; 95% CI, 1.2-5.3) and LOC (OR, 2.2; 95% CI, 1.1-4.6) were found to have significant and independent relationships with amnesia in the multivariate model. CONCLUSIONS This study illustrates that patients presenting with postconcussion amnesia are more likely to have a history of head trauma, LOC, and greater symptom severity. Future research is needed to better understand amnesia following concussion. CLINICAL RELEVANCE Amnesia presence, previous head trauma, LOC, and increased symptom severity may aid in identifying patients with a greater initial injury burden who warrant closer observation and more conservative management.
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Abstract
Acute loss of consciousness poses a fascinating scenario for theoretical and clinical research. This chapter introduces a simple yet powerful framework to investigate altered states of consciousness. We then explore the different disorders of consciousness that result from acute brain injury, and techniques used in the acute phase to predict clinical outcome in different patient populations in light of models of acute loss of consciousness. We further delve into post-traumatic amnesia as a model for predicting cognitive sequels following acute loss of consciousness. We approach the study of acute loss of consciousness from a theoretical and clinical perspective to conclude that clinicians in acute care centers must incorporate new measurements and techniques besides the classic coma scales in order to assess their patients with loss of consciousness.
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24
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Bigler ED, Stern Y. Traumatic brain injury and reserve. HANDBOOK OF CLINICAL NEUROLOGY 2015; 128:691-710. [DOI: 10.1016/b978-0-444-63521-1.00043-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Ponsford J, Janzen S, McIntyre A, Bayley M, Velikonja D, Tate R. INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part I. J Head Trauma Rehabil 2014; 29:307-20. [DOI: 10.1097/htr.0000000000000074] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Bigler ED. Neuroimaging biomarkers in mild traumatic brain injury (mTBI). Neuropsychol Rev 2013; 23:169-209. [PMID: 23974873 DOI: 10.1007/s11065-013-9237-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 08/07/2013] [Indexed: 12/14/2022]
Abstract
Reviewed herein are contemporary neuroimaging methods that detect abnormalities associated with mild traumatic brain injury (mTBI). Despite advances in demonstrating underlying neuropathology in a subset of individuals who sustain mTBI, considerable disagreement persists in neuropsychology about mTBI outcome and metrics for evaluation. This review outlines a thesis for the select use of sensitive neuroimaging methods as potential biomarkers of brain injury recognizing that the majority of individuals who sustain an mTBI recover without neuroimaging signs or neuropsychological sequelae detected with methods currently applied. Magnetic resonance imaging (MRI) provides several measures that could serve as mTBI biomarkers including the detection of hemosiderin and white matter abnormalities, assessment of white matter integrity derived from diffusion tensor imaging (DTI), and quantitative measures that directly assess neuroanatomy. Improved prediction of neuropsychological outcomes in mTBI may be achieved with the use of targeted neuroimaging markers.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University, 1001 SWKT, Provo, UT 84602, USA.
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Bigler ED. Traumatic brain injury, neuroimaging, and neurodegeneration. Front Hum Neurosci 2013; 7:395. [PMID: 23964217 PMCID: PMC3734373 DOI: 10.3389/fnhum.2013.00395] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 07/05/2013] [Indexed: 12/14/2022] Open
Abstract
Depending on severity, traumatic brain injury (TBI) induces immediate neuropathological effects that in the mildest form may be transient but as severity increases results in neural damage and degeneration. The first phase of neural degeneration is explainable by the primary acute and secondary neuropathological effects initiated by the injury; however, neuroimaging studies demonstrate a prolonged period of pathological changes that progressively occur even during the chronic phase. This review examines how neuroimaging may be used in TBI to understand (1) the dynamic changes that occur in brain development relevant to understanding the effects of TBI and how these relate to developmental stage when the brain is injured, (2) how TBI interferes with age-typical brain development and the effects of aging thereafter, and (3) how TBI results in greater frontotemporolimbic damage, results in cerebral atrophy, and is more disruptive to white matter neural connectivity. Neuroimaging quantification in TBI demonstrates degenerative effects from brain injury over time. An adverse synergistic influence of TBI with aging may predispose the brain injured individual for the development of neuropsychiatric and neurodegenerative disorders long after surviving the brain injury.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University Provo, UT, USA ; Neuroscience Center, Brigham Young University Provo, UT, USA ; Department of Psychiatry, University of Utah Salt Lake City, UT, USA ; The Brain Institute of Utah, University of Utah Salt Lake City, UT, USA
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Bigler ED, Farrer TJ, Pertab JL, James K, Petrie JA, Hedges DW. Reaffirmed Limitations of Meta-Analytic Methods in the Study of Mild Traumatic Brain Injury: A Response to Rohling et al. Clin Neuropsychol 2013; 27:176-214. [DOI: 10.1080/13854046.2012.693950] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Erin D. Bigler
- a Department of Psychology , Brigham Young University , Provo , UT , USA
- b Neuroscience Center, Brigham Young University , Provo , UT , USA
- c Department of Psychiatry , University of Utah , Salt Lake City , UT , USA
- d The Brain Institute of Utah, University of Utah , Salt Lake City , UT , USA
| | - Thomas J. Farrer
- a Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Jon L. Pertab
- a Department of Psychology , Brigham Young University , Provo , UT , USA
- e Veterans Administration Hospital , Salt Lake City , UT , USA
| | - Kelly James
- a Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Jo Ann Petrie
- a Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Dawson W. Hedges
- a Department of Psychology , Brigham Young University , Provo , UT , USA
- b Neuroscience Center, Brigham Young University , Provo , UT , USA
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Bigler ED, Maxwell WL. Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings. Brain Imaging Behav 2012; 6:108-36. [PMID: 22434552 DOI: 10.1007/s11682-011-9145-0] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Neuroimaging identified abnormalities associated with traumatic brain injury (TBI) are but gross indicators that reflect underlying trauma-induced neuropathology at the cellular level. This review examines how cellular pathology relates to neuroimaging findings with the objective of more closely relating how neuroimaging findings reveal underlying neuropathology. Throughout this review an attempt will be made to relate what is directly known from post-mortem microscopic and gross anatomical studies of TBI of all severity levels to the types of lesions and abnormalities observed in contemporary neuroimaging of TBI, with an emphasis on mild traumatic brain injury (mTBI). However, it is impossible to discuss the neuropathology of mTBI without discussing what occurs with more severe injury and viewing pathological changes on some continuum from the mildest to the most severe. Historical milestones in understanding the neuropathology of mTBI are reviewed along with implications for future directions in the examination of neuroimaging and neuropathological correlates of TBI.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, UT, USA.
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Shenton ME, Hamoda HM, Schneiderman JS, Bouix S, Pasternak O, Rathi Y, Vu MA, Purohit MP, Helmer K, Koerte I, Lin AP, Westin CF, Kikinis R, Kubicki M, Stern RA, Zafonte R. A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging Behav 2012; 6:137-92. [PMID: 22438191 PMCID: PMC3803157 DOI: 10.1007/s11682-012-9156-5] [Citation(s) in RCA: 605] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mild traumatic brain injury (mTBI), also referred to as concussion, remains a controversial diagnosis because the brain often appears quite normal on conventional computed tomography (CT) and magnetic resonance imaging (MRI) scans. Such conventional tools, however, do not adequately depict brain injury in mTBI because they are not sensitive to detecting diffuse axonal injuries (DAI), also described as traumatic axonal injuries (TAI), the major brain injuries in mTBI. Furthermore, for the 15 to 30 % of those diagnosed with mTBI on the basis of cognitive and clinical symptoms, i.e., the "miserable minority," the cognitive and physical symptoms do not resolve following the first 3 months post-injury. Instead, they persist, and in some cases lead to long-term disability. The explanation given for these chronic symptoms, i.e., postconcussive syndrome, particularly in cases where there is no discernible radiological evidence for brain injury, has led some to posit a psychogenic origin. Such attributions are made all the easier since both posttraumatic stress disorder (PTSD) and depression are frequently co-morbid with mTBI. The challenge is thus to use neuroimaging tools that are sensitive to DAI/TAI, such as diffusion tensor imaging (DTI), in order to detect brain injuries in mTBI. Of note here, recent advances in neuroimaging techniques, such as DTI, make it possible to characterize better extant brain abnormalities in mTBI. These advances may lead to the development of biomarkers of injury, as well as to staging of reorganization and reversal of white matter changes following injury, and to the ability to track and to characterize changes in brain injury over time. Such tools will likely be used in future research to evaluate treatment efficacy, given their enhanced sensitivity to alterations in the brain. In this article we review the incidence of mTBI and the importance of characterizing this patient population using objective radiological measures. Evidence is presented for detecting brain abnormalities in mTBI based on studies that use advanced neuroimaging techniques. Taken together, these findings suggest that more sensitive neuroimaging tools improve the detection of brain abnormalities (i.e., diagnosis) in mTBI. These tools will likely also provide important information relevant to outcome (prognosis), as well as play an important role in longitudinal studies that are needed to understand the dynamic nature of brain injury in mTBI. Additionally, summary tables of MRI and DTI findings are included. We believe that the enhanced sensitivity of newer and more advanced neuroimaging techniques for identifying areas of brain damage in mTBI will be important for documenting the biological basis of postconcussive symptoms, which are likely associated with subtle brain alterations, alterations that have heretofore gone undetected due to the lack of sensitivity of earlier neuroimaging techniques. Nonetheless, it is noteworthy to point out that detecting brain abnormalities in mTBI does not mean that other disorders of a more psychogenic origin are not co-morbid with mTBI and equally important to treat. They arguably are. The controversy of psychogenic versus physiogenic, however, is not productive because the psychogenic view does not carefully consider the limitations of conventional neuroimaging techniques in detecting subtle brain injuries in mTBI, and the physiogenic view does not carefully consider the fact that PTSD and depression, and other co-morbid conditions, may be present in those suffering from mTBI. Finally, we end with a discussion of future directions in research that will lead to the improved care of patients diagnosed with mTBI.
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Affiliation(s)
- M E Shenton
- Clinical Neuroscience Laboratory, Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA.
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Rosen RC, Marx BP, Maserejian NN, Holowka DW, Gates MA, Sleeper LA, Vasterling JJ, Kang HK, Keane TM. Project VALOR: design and methods of a longitudinal registry of post-traumatic stress disorder (PTSD) in combat-exposed veterans in the Afghanistan and Iraqi military theaters of operations. Int J Methods Psychiatr Res 2012; 21:5-16. [PMID: 22095917 PMCID: PMC6878467 DOI: 10.1002/mpr.355] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 03/10/2011] [Accepted: 04/04/2011] [Indexed: 11/06/2022] Open
Abstract
Few studies have investigated the natural history of post-traumatic stress disorder (PTSD). Project VALOR (Veterans' After-discharge Longitudinal Registry) was designed as a longitudinal patient registry assessing the course of combat-related PTSD among 1600 male and female Veterans who served in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF). Aims of the study include investigating patterns and predictors of progression or remission of PTSD and treatment utilization. The study design was based on recommendations from the Agency for Healthcare Quality and Research for longitudinal disease registries and used a pre-specified theoretical model to select the measurement domains for data collection and interpretation of forthcoming results. The registry will include 1200 male and female Veterans with a recent diagnosis of PTSD in the Department of Veteran Affairs (VA) electronic medical record and a comparison group of 400 Veterans without a medical record-based PTSD diagnosis, to also allow for case-control analyses. Data are collected from administrative databases, electronic medical records, a self-administered questionnaire, and a semi-structured diagnostic telephone interview. Project VALOR is a unique and timely registry study that will evaluate the clinical course of PTSD, psychosocial correlates, and health outcomes in a carefully selected cohort of returning OEF/OIF Veterans.
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Affiliation(s)
- Raymond C Rosen
- New England Research Institutes, Inc., Watertown, MA 02472, USA.
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Hunter JV, Wilde EA, Tong KA, Holshouser BA. Emerging imaging tools for use with traumatic brain injury research. J Neurotrauma 2012; 29:654-71. [PMID: 21787167 PMCID: PMC3289847 DOI: 10.1089/neu.2011.1906] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This article identifies emerging neuroimaging measures considered by the inter-agency Pediatric Traumatic Brain Injury (TBI) Neuroimaging Workgroup. This article attempts to address some of the potential uses of more advanced forms of imaging in TBI as well as highlight some of the current considerations and unresolved challenges of using them. We summarize emerging elements likely to gain more widespread use in the coming years, because of 1) their utility in diagnosis, prognosis, and understanding the natural course of degeneration or recovery following TBI, and potential for evaluating treatment strategies; 2) the ability of many centers to acquire these data with scanners and equipment that are readily available in existing clinical and research settings; and 3) advances in software that provide more automated, readily available, and cost-effective analysis methods for large scale data image analysis. These include multi-slice CT, volumetric MRI analysis, susceptibility-weighted imaging (SWI), diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), arterial spin tag labeling (ASL), functional MRI (fMRI), including resting state and connectivity MRI, MR spectroscopy (MRS), and hyperpolarization scanning. However, we also include brief introductions to other specialized forms of advanced imaging that currently do require specialized equipment, for example, single photon emission computed tomography (SPECT), positron emission tomography (PET), encephalography (EEG), and magnetoencephalography (MEG)/magnetic source imaging (MSI). Finally, we identify some of the challenges that users of the emerging imaging CDEs may wish to consider, including quality control, performing multi-site and longitudinal imaging studies, and MR scanning in infants and children.
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Affiliation(s)
- Jill V Hunter
- Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas 77030, USA.
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Schönberger M, Ponsford J, Reutens D, Beare R, O'Sullivan R. The Relationship between age, injury severity, and MRI findings after traumatic brain injury. J Neurotrauma 2010; 26:2157-67. [PMID: 19624261 DOI: 10.1089/neu.2009.0939] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Age and injury severity are among the most significant predictors of outcome after traumatic brain injury (TBI). However, only a few studies have investigated the association between, age, injury severity, and the extent of brain damage in TBI. The purpose of this study was to investigate the association between age, measures of injury severity, and brain lesion volumes, as well as viable brain volumes, following TBI. Ninety-eight individuals with mild to very severe TBI (75.5% male, mean age at injury 34.5 years) underwent a structural MRI scan, performed with a 1.5-Tesla machine, on average 2.3 years post-injury. Lesion volumes were highly skewed in their distribution and were dichotomized for statistical purposes. Measures of injury severity were Glasgow Coma Scale score (GCS) and duration of post-traumatic amnesia (PTA). Logistic regression analyses predicting lesion volumes, controlling for participants' gender, cause of injury, time from injury to MRI scan, and total brain volume, revealed that both older age and longer PTA were associated with larger lesion volumes in both grey and white matter in almost all brain regions. Older age was also associated with smaller viable grey matter volumes in most neo-cortical brain regions, while longer PTA was associated with smaller viable white matter volumes in most brain regions. The results suggest that older age worsens the impact of TBI on the brain. They also indicate the validity of duration of PTA as a measure of injury severity that is not just related to one particular injury location.
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Affiliation(s)
- Michael Schönberger
- School of Psychology, Psychiatry, and Psychological Medicine, Monash University Melbourne , Clayton Campus, and Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Clayton, Victoria, Australia.
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Brown AW, Malec JF, Mandrekar J, Diehl NN, Dikmen SS, Sherer M, Hart T, Novack TA. Predictive utility of weekly post-traumatic amnesia assessments after brain injury: A multicentre analysis. Brain Inj 2010; 24:472-8. [DOI: 10.3109/02699051003610466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ghosh A, Wilde EA, Hunter JV, Bigler ED, Chu Z, Li X, Vasquez AC, Menefee D, Yallampalli R, Levin HS. The relation between Glasgow Coma Scale score and later cerebral atrophy in paediatric traumatic brain injury. Brain Inj 2009; 23:228-33. [PMID: 19205959 DOI: 10.1080/02699050802672789] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVE To examine initial Glasgow Coma Scale (GCS) score and its relationship with later cerebral atrophy in children with traumatic brain injury (TBI) using Quantitative Magnetic Resonance Imaging (QMRI) at 4 months post-injury. It was hypothesized that a lower GCS score would predict later generalized atrophy. As a guide in assessing paediatric TBI patients, the probability of developing chronic cerebral atrophy was determined based on the initial GCS score. METHODS AND PROCEDURES The probability model used data from 45 paediatric patients (mean age = 13.6) with mild-to-severe TBI and 41 paediatric (mean age = 12.4) orthopaedically-injured children. RESULTS This study found a 24% increase in the odds of developing an abnormal ventricle-to-brain ratio (VBR) and a 27% increase in the odds of developing reduced white matter percentage on neuroimaging with each numerical drop in GCS score. Logistic regression models with cut-offs determined by normative QMRI data confirmed that a lower initial GCS score predicts later atrophy. CONCLUSION GCS is a commonly used measure of injury severity. It has proven to be a prognostic indicator of cognitive recovery and functional outcome and is also predictive of later parenchymal change.
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Affiliation(s)
- Alokananda Ghosh
- E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX, USA
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Ding K, Marquez de la Plata C, Wang JY, Mumphrey M, Moore C, Harper C, Madden CJ, McColl R, Whittemore A, Devous MD, Diaz-Arrastia R. Cerebral atrophy after traumatic white matter injury: correlation with acute neuroimaging and outcome. J Neurotrauma 2009; 25:1433-40. [PMID: 19072588 DOI: 10.1089/neu.2008.0683] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Traumatic brain injury (TBI) is a pathologically heterogeneous disease, including injury to both neuronal cell bodies and axonal processes. Global atrophy of both gray and white matter is common after TBI. This study was designed to determine the relationship between neuroimaging markers of acute diffuse axonal injury (DAI) and cerebral atrophy months later. We performed high-resolution magnetic resonance imaging (MRI) at 3 Tesla (T) in 20 patients who suffered non-penetrating TBI, during the acute (within 1 month after the injury) and chronic stage (at least 6 months after the injury). Volume of abnormal fluid-attenuated inversion-recovery (FLAIR) signal seen in white matter in both acute and follow-up scans was quantified. White and gray matter volumes were also quantified. Functional outcome was measured using the Functional Status Examination (FSE) at the time of the chronic scan. Change in brain volumes, including whole brain volume (WBV), white matter volume (WMV), and gray matter volume (GMV), correlates significantly with acute DAI volume (r = -0.69, -0.59, -0.58, respectively; p <0.01 for all). Volume of acute FLAIR hyperintensities correlates with volume of decreased FLAIR signal in the follow-up scans (r = -0.86, p < 0.001). FSE performance correlates with acute hyperintensity volume and chronic cerebral atrophy (r = 0.53, p = 0.02; r = -0.45, p = 0.03, respectively). Acute axonal lesions measured by FLAIR imaging are strongly predictive of post-traumatic cerebral atrophy. Our findings suggest that axonal pathology measured as white matter lesions following TBI can be identified using MRI, and may be a useful measure for DAI-directed therapies.
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Affiliation(s)
- Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9036, USA
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Ruttan L, Martin K, Liu A, Colella B, Green RE. Long-term cognitive outcome in moderate to severe traumatic brain injury: a meta-analysis examining timed and untimed tests at 1 and 4.5 or more years after injury. Arch Phys Med Rehabil 2009; 89:S69-76. [PMID: 19081444 DOI: 10.1016/j.apmr.2008.07.007] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/22/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine long-term outcome of moderate to severe traumatic brain injury (TBI) on timed and untimed cognitive tests using meta-analysis. DESIGN Meta-analysis examining outcome at 2 epochs, 6 to 18 months postinjury (epoch 1) and 4.5 to 11 years postinjury (epoch 2). SETTING Data source was published articles (1966-2007) identified through electronic and manual search. PARTICIPANTS A total of 1380 subjects with moderate to severe TBI participated in the 16 studies meeting inclusion criteria. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Timed and untimed neuropsychologic tests with quantitative results (means, SDs, t, and df tests) from studies containing a healthy comparison group and a mean time since injury falling within 1 of the 2 epochs. RESULTS Patient versus control weighted effect sizes were medium to large at epoch 1 for both untimed tasks (r=-.46; confidence interval [CI], -.32 to -.65) and timed tasks (r=-.46; CI, -.35 to -.59). At epoch 2, effect sizes were slightly smaller for untimed tasks (r=-.38; CI, -.25 to -.60) and timed tasks (r=-.40; CI, -.32 to -.62). CONCLUSIONS Patients showed robust, persisting impairments on both timed and untimed tests at recovery plateau (ie, 6-18mo postinjury) and many years later. These findings converge with previous studies, though using an alternative approach that obviates some of the methodologic problems of longitudinal studies, such as selective attrition.
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Affiliation(s)
- Lesley Ruttan
- Toronto Rehabilitation Institute, Toronto, ON, Canada.
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Nakase-Richardson R, Sepehri A, Sherer M, Yablon SA, Evans C, Mani T. Classification Schema of Posttraumatic Amnesia Duration-Based Injury Severity Relative to 1-Year Outcome: Analysis of Individuals with Moderate and Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2009; 90:17-9. [DOI: 10.1016/j.apmr.2008.06.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 06/19/2008] [Accepted: 06/25/2008] [Indexed: 10/21/2022]
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Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc 2008; 14:1-22. [PMID: 18078527 DOI: 10.1017/s135561770808017x] [Citation(s) in RCA: 261] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 08/16/2007] [Accepted: 08/16/2007] [Indexed: 01/17/2023]
Abstract
On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion.
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Plantier D, Bussy E, Rimbot A, Maszelin P, Tournebise H. [Neuroradiological investigations in mild brain injuries: state of the art and practical recommendations]. ACTA ACUST UNITED AC 2006; 107:218-32. [PMID: 17003757 DOI: 10.1016/s0035-1768(06)77044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To clarify the contribution of each technique of neuroradiological and nuclear medicine investigations after mild brain injuries. To analyze the pathophysiological mechanisms of the lesions. To update indications for imaging techniques in the short or long term management. To define the practical recommendations. METHOD The international databases were consulted for each neuroradiological technique; the most valuable articles were retained for study (PubMed, ). RESULTS AND DISCUSSION Standard skull X-rays are obsolete. Craniofacial (bony windows) and brain CT-scan (parenchymal windows) is the most efficient diagnosis tool in the acute phase because of its accessibility. Brain MRI is less accessible in the emergency setting but is feasible in some centers. It is the best choice in the first weeks following mild brain injury but may be normal. Taking into account the limitations of morphological imaging, functional imaging techniques (SPECT, fMRI, PET-scan) are necessary as they may show axonal damage or brain atrophy. There is however the problem of availability. SPECT is the most accessible. Spectro-MRI is promising. In spite of progress in neuroradiological investigation methods, the neuropsychological evaluation and multi-disciplinary treatment of these patients by a skilled team remains of utmost importance.
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Affiliation(s)
- D Plantier
- Service de Médecine Physique et Réadaptation Adulte, Hôpital Renée Sabran, Giens, Hyères, France.
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