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Chiang HS, Motes M, Afkhami-Rohani B, Adhikari A, LoBue C, Kraut M, Cullum CM, Hart J. Verbal retrieval deficits due to traumatic brain injury are associated with changes in event related potentials during a Go-NoGo task. Clin Neurophysiol 2024; 163:1-13. [PMID: 38663098 PMCID: PMC11216819 DOI: 10.1016/j.clinph.2024.04.002] [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] [Received: 02/02/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Verbal retrieval (VR) deficits often occur after traumatic brain injury (TBI), but the mechanisms remain unclear. We examined how event-related potentials (ERPs) during a Go-NoGo task were associated with VR deficits. METHODS Sixty veterans with a history of TBI underwent a neuropsychological battery and a Go-NoGo task with concurrent EEG recording. We compared task performance and ERP measures (N2, P3) between those with and those without persistent injury-related VR deficits. We then used generalized linear modeling to examine the relationship between ERP measures and scores on measures of executive function and processing speed. RESULTS Go-NoGo task performance was comparable between the groups. Those with VR deficits had larger N2 amplitude in NoGo than in Go conditions. In participants with VR deficits, larger NoGo N2/P3 amplitude predicted faster processing speed. Furthermore, larger P3 amplitude and shorter P3 latency of the difference wave (NoGo - Go) predicted faster processing speed in those with VR deficits. CONCLUSIONS Despite no difference in Go-NoGo task performance, ERP amplitude and latency measures associated with cognitive control during Go-NoGo distinguished TBI individuals with VR deficits from those without. SIGNIFICANCE This study furthers our understanding of VR deficits in TBI and implicates potential application of ERP measures in monitoring and treating such deficits.
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Affiliation(s)
- Hsueh-Sheng Chiang
- University of Texas Southwestern Medical Center, Department of Neurology, USA; The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Michael Motes
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Borna Afkhami-Rohani
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Ashna Adhikari
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Christian LoBue
- University of Texas Southwestern Medical Center, Department of Psychiatry, USA; University of Texas Southwestern Medical Center, Department of Neurological Surgery, USA.
| | - Michael Kraut
- The Johns Hopkins School of Medicine, Department of Radiology, USA.
| | - C Munro Cullum
- University of Texas Southwestern Medical Center, Department of Neurology, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, USA; University of Texas Southwestern Medical Center, Department of Neurological Surgery, USA.
| | - John Hart
- University of Texas Southwestern Medical Center, Department of Neurology, USA; The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, USA.
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Theadom A, Barker-Collo S, Parag V, Caspi A, Moffitt TE, Hogan S, Ramrakha S, Poulton R. Mild Traumatic Brain Injury Does Not Significantly Affect Midlife Cognitive Functioning Within the General Population: Findings From a Prospective Longitudinal Birth Cohort Study. J Head Trauma Rehabil 2024; 39:E70-E82. [PMID: 37335217 DOI: 10.1097/htr.0000000000000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To determine whether differences exist in mid-adulthood cognitive functioning in people with and without history of mild traumatic brain injury (mTBI). SETTING Community-based study. PARTICIPANTS People born between April 1, 1972, and March 31, 1973, recruited into the Dunedin Multidisciplinary Health and Development Longitudinal Study, who completed neuropsychological assessments in mid-adulthood. Participants who had experienced a moderate or severe TBI or mTBI in the past 12 months were excluded. DESIGN Longitudinal, prospective, observational study. MAIN MEASURES Data were collected on sociodemographic characteristics, medical history, childhood cognition (between 7 and 11 years), and alcohol and substance dependence (from 21 years of age). mTBI history was determined from accident and medical records (from birth to 45 years of age). Participants were classified as having 1 mTBI and more in their lifetime or no mTBI. The Wechsler Adult Intelligence Scale (WAIS-IV) and Trail Making Tests A and B (between 38 and 45 years of age) were used to assess cognitive functioning. T tests and effect sizes were used to identify any differences on cognitive functioning domains between the mTBI and no mTBI groups. Regression models explored the relative contribution of number of mTBIs and age of first mTBI and sociodemographic/lifestyle variables on cognitive functioning. RESULTS Of the 885 participants, 518 (58.5%) had experienced at least 1 mTBI over their lifetime, with a mean number of 2.5 mTBIs. The mTBI group had significantly slower processing speed ( P < .01, d = 0.23) in mid-adulthood than the no TBI controls, with a medium effect size. However, the relationship no longer remained significant after controlling for childhood cognition, sociodemographic and lifestyle factors. No significant differences were observed for overall intelligence, verbal comprehension, perceptual reasoning, working memory, attention, or cognitive flexibility. Childhood cognition was not linked to likelihood of sustaining mTBI later in life. CONCLUSION mTBI histories in the general population were not associated with lower cognitive functioning in mid-adulthood once sociodemographic and lifestyle factors were taken into account.
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Affiliation(s)
- Alice Theadom
- Author Affiliations: Traumatic Brain Injury Network (TBIN), School of Clinical Sciences, Faculty of Health and Environment Sciences, Auckland University of Technology, Auckland, New Zealand (Dr Theadom); School of Psychology, University of Auckland, Auckland, New Zealand (Dr Barker-Collo); National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (Dr Parag); Dunedin Multidisciplinary Health & Development Research Unit, University of Otago, Otago, New Zealand (Mr Hogan and Drs Ramrakha and Poulton); and Department of Psychology and Neuroscience, Duke University, Durham, North Carolina (Drs Caspi and Moffitt)
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Papesh MA, Koerner T. Clinical Gaps-in-Noise Measures in Blast-Exposed Veterans: Associations with Electrophysiological and Behavioral Responses. Semin Hear 2024; 45:83-100. [PMID: 38370515 PMCID: PMC10872670 DOI: 10.1055/s-0043-1770139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
It has been established that blast exposure and brain injury can result in self-reported and measured auditory processing deficits in individuals with normal or near-normal hearing sensitivity. However, the impaired sensory and/or cognitive mechanisms underlying these auditory difficulties are largely unknown. This work used a combination of behavioral and electrophysiological measures to explore how neural stimulus discrimination and processing speed contribute to impaired temporal processing in blast-exposed Veterans measured using the behavioral Gaps-in-Noise (GIN) Test. Results confirm previous findings that blast exposure can impact performance on the GIN and effect neural auditory discrimination, as measured using the P3 auditory event-related potential. Furthermore, analyses revealed correlations between GIN thresholds, P3 responses, and a measure of behavioral reaction time. Overall, this work illustrates that behavioral responses to the GIN are dependent on both auditory-specific bottom-up processing beginning with the neural activation of the cochlea and auditory brainstem as well as contributions from complex neural networks involved in processing speed and task-dependent target detection.
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Affiliation(s)
- Melissa A. Papesh
- VA National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Tess Koerner
- VA National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Lu HC, Gevirtz R, Yang CC, Hauson AO. Heart Rate Variability Biofeedback for Mild Traumatic Brain Injury: A Randomized-Controlled Study. Appl Psychophysiol Biofeedback 2023; 48:405-421. [PMID: 37335413 PMCID: PMC10582136 DOI: 10.1007/s10484-023-09592-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
To determine whether heart rate variability biofeedback (HRV-BF) training, compared to a psychoeducation control condition can strengthen the integration of the central and autonomic nervous systems as measured by neuropsychological measures in patients with mild traumatic brain injury (mTBI). Participants were recruited from two university hospitals in Taipei, Taiwan. A total of 49 participants with mTBI were recruited for this study. Forty-one participants completed the study, 21 in the psychoeducation group and 20 in the HRV-BF group. Randomized controlled study. The Taiwanese Frontal Assessment Battery, the Semantic Association of Verbal Fluency Test, the Taiwanese version of the Word Sequence Learning Test, the Paced Auditory Serial Addition Test-Revised, and the Trail Making Test were used as performance-based neuropsychological functioning measures. The Checklist of Post-concussion Symptoms, the Taiwanese version of the Dysexecutive Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, and the National Taiwan University Irritability Scale were used as self-report neuropsychological functioning measures. Furthermore, heart rate variability pre- vs. post-training was used to measure autonomic nervous system functioning. Executive, information processing, verbal memory, emotional neuropsychological functioning, and heart rate variability (HRV) were improved significantly in the HRV-BF group at the posttest whereas the psychoeducation group showed no change. HRV biofeedback is a feasible technique following mild TBI that can improve neuropsychological and autonomic nervous system functioning. HRV-BF may be clinically feasible for the rehabilitation of patients with mTBI.
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Affiliation(s)
- Hsueh Chen Lu
- California School of Professional Psychology at Alliant International University, Clinical Psychology PhD Program, San Diego, CA, USA
| | - Richard Gevirtz
- California School of Professional Psychology at Alliant International University, Clinical Psychology PhD Program, San Diego, CA, USA.
| | - Chi Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Alexander O Hauson
- California School of Professional Psychology at Alliant International University, Clinical Psychology PhD Program, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.Org), San Diego, CA, USA
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Anderson JFI, Higson L, Wu MH, Seal ML, Yang JYM. Cerebral microhaemorrhage count is related to processing speed, but not level of symptom reporting, independently of age, psychological status and premorbid functioning, after first-ever mild traumatic brain injury. Brain Imaging Behav 2023; 17:608-618. [PMID: 37386315 PMCID: PMC10733206 DOI: 10.1007/s11682-023-00788-0] [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] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Cerebral microhaemorrhage is a commonly identified neuropathological consequence of mild traumatic brain injury (mTBI) and can be identified in vivo using susceptibility weighted imaging (SWI). This study aimed to determine whether SWI-detected microhaemorrhages are more common in individuals after a single, first-ever, mTBI event relative to trauma controls (TC) and to investigate whether a linear relationship exists between microhaemorrhage numbers and cognition or symptom reporting in the post-acute period after injury, independently of age, psychological status and premorbid level of functioning. Microhaemorrhagic lesions were identified by expert clinical examination of SWI for 78 premorbidly healthy adult participants who were admitted to hospital after a traumatic injury and had suffered a first-ever mTBI (n = 47) or no head strike (n = 31). Participants underwent objective cognitive examination of processing speed, attention, memory, and executive function as well as self-reported post-concussion symptomatology. Bootstrapping analyses were used as data were not normally distributed. Analyses revealed that the mTBI group had significantly more microhaemorrhages than the TC group (Cohen's d = 0.559). These lesions were only evident in 28% of individuals. The mTBI participants demonstrated a significant linear association between number of microhaemorrhages and processing speed, independently of age, psychological status, or premorbid level of functioning. This study shows that a single mTBI causes cerebral microhaemorrhages to occur in a minority of premorbidly healthy individuals. Greater microhaemorrhage count is independently associated with slower processing speed, but not symptom reporting, during the post-acute injury period.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
- Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Lana Higson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Michelle H Wu
- Medical Imaging, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
| | - Marc L Seal
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Neuroscience research, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
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Alnawmasi MM, Khuu SK. Deficits in the pupillary response associated with abnormal visuospatial attention allocation in mild traumatic brain injury. J Clin Exp Neuropsychol 2023; 45:855-873. [PMID: 38368620 DOI: 10.1080/13803395.2024.2314727] [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: 02/21/2023] [Accepted: 11/25/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The ability to allocate visual attention is known to be impaired in patients with mild traumatic brain injury (mTBI). In the present study, we investigated a possible neural correlate of this cognitive deficit by examining the pupil response of patients with mTBI whilst performing a modified Posner visual search task. METHOD Two experiments were conducted in which the target location was either not cued (Experiment 1) or cued (Experiment 2). Additionally, in Experiment 2, the type of cue (endogenous vs exogenous cue) and cue validity were treated as independent variables. In both experiments, search efficiency was varied by changing shape similarity between target and distractor patterns. The reaction time required to judge whether the target was present or absent and pupil dilation metrics, particularly the pupil dilation latency (PDL) and amplitude (PDA), were measured. Thirteen patients with chronic mTBI and 21 age-, sex-, and IQ -matched controls participated in the study. RESULTS In Experiment 1, patients with mTBI displayed a similar PDA for both efficient and inefficient search conditions, while control participants had a significantly larger PDA in inefficient search conditions compared to efficient search conditions. As cognitive load is positively correlated with PDA, our findings suggest that mTBI patients were unable to apply more mental effort whilst performing visual search, particularly if the task is difficult when visual search is inefficient. In Experiment 2, when the target location was cued, patients with mTBI displayed no significant pupil dilation response to the target regardless of the efficiency of the search, nor whether the cue was valid or invalid. These results contrasted with control participants, who were additionally sensitive to the validity of the cue in which PDA was smaller for cue-valid conditions than invalid conditions, particularly for efficient search conditions. CONCLUSION Pupillometry provided further evidence of attention allocation deficits following mTBI.
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Affiliation(s)
- Mohammed M Alnawmasi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Hacker D, Jones CA, Yasin E, Preece S, Davies H, Hawkins A, Belli A, Paton E. Cognitive Outcome After Complicated Mild Traumatic Brain Injury: A Literature Review and Meta-Analysis. J Neurotrauma 2023; 40:1995-2014. [PMID: 36964755 DOI: 10.1089/neu.2023.0020] [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] [Indexed: 03/26/2023] Open
Abstract
Cognitive outcome for mild traumatic brain injury (mTBI) with positive brain imaging (complicated mTBI) was compared with that for mTBI with normal imaging (uncomplicated mTBI) and with moderate to severe TBI, using meta-analysis. Twenty-three studies utilizing objective neurocognitive tests were included in the analysis. At less than 3 months post-injury, complicated mTBI was associated with poorer cognitive outcomes than uncomplicated mTBI, but deficits were not comparable to those with moderate-severe TBI. After 3 months post-injury, a similar pattern was detected. Beyond 3 months, deficits in complicated mTBI relative to those with uncomplicated mTBI were present in processing speed, memory, executive function, and language, although the latter may be the result of reduced semantic fluency. The effect size of deficits in these domains was more marked in moderate-severe TBI. The available data support the use of complicated mTBI as a distinct classification in the prediction of cognitive outcome. The extent of cognitive deficit in complicated mTBI was small and unlikely to cause significant disability. However, patients with complicated mTBI constitute a broad category encompassing individuals who may differ markedly in the nature and extent of intracranial imaging abnormality, and further studies are warranted. Limitations of the available studies include small, selected samples; variations in TBI severity classification; absence of validity ("effort") testing; differing imaging methodology; and lack of long-term follow-up.
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Affiliation(s)
- David Hacker
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher A Jones
- School of Psychology, The University of Birmingham, Birmingham, United Kingdom
| | - Eyrsa Yasin
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sophie Preece
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Holly Davies
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Hawkins
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antonio Belli
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Emily Paton
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Levy AM, Saling MM, Anderson JFI. Frequency and extent of cognitive complaint following adult civilian mild traumatic brain injury: a systematic review and meta-analysis. BRAIN IMPAIR 2023; 24:309-332. [PMID: 38167200 DOI: 10.1017/brimp.2022.19] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cognitive symptoms are associated with return to work, healthcare use and quality of life after mild traumatic brain injury (mTBI). Additionally, while overall 'post-concussion' symptoms are often present at similar levels in mTBI and control groups, cognitive complaints may be specifically elevated in mTBI. A systematic review and meta-analysis was conducted to investigate the frequency and extent of cognitive complaints following adult civilian mTBI, and compare it to the frequency and extent of complaints in control populations (PROSPERO: CRD42020151284). METHOD This review included studies published up to March 2022. Thirteen studies were included in the systematic review, and six were included in the meta-analysis. Data extraction and quality assessment were conducted by two independent reviewers. RESULTS Cognitive complaints are common after mTBI, although reported rates differed greatly across studies. Results suggested that mTBI groups report cognitive complaints to a significantly greater extent than control groups (Hedges' g = 0.85, 95% CI 0.31-1.40, p = .0102). Heterogeneity between studies was high (τ2 = 0.20, 95% CI 0.04-1.58; I2 = 75.0%, 95% CI 43.4%-89.0%). Between-group differences in symptom reporting were most often found when healthy rather than injured controls were employed. CONCLUSIONS Cognitive complaints are consistently reported after mTBI, and are present at greater levels in mTBI patients than in controls. Despite the importance of these complaints, including in regards to return to work, healthcare use and quality of life, there has been limited research in this area, and heterogeneity in research methodology is common.
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Affiliation(s)
- Arielle M Levy
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
- Psychology Department, The Alfred Hospital, Melbourne, VIC3004, Australia
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Halliday DWR, Karr JE, Shahnazian D, Gordon I, Sanchez Escudero JP, MacDonald SWS, Macoun SJ, Hundza SR, Garcia-Barrera MA. Electrophysiological variability during tests of executive functioning: A comparison of athletes with and without concussion and sedentary control participants. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 37598380 DOI: 10.1080/23279095.2023.2247512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Sport participation may benefit executive functioning (EF), but EF can also be adversely affected by concussion, which can occur during sport participation. Neural variability is an emerging proxy of brain health that indexes the brain's range of possible responses to incoming stimuli (i.e., dynamic range) and interconnectedness, but has yet to be characterized following concussion among athletes. This study examined whether neural variability was enhanced by athletic participation and attenuated by concussion. METHOD Seventy-seven participants (18-25 years-old) were classified as sedentary controls (n = 33), athletes with positive concussion history (n = 21), or athletes without concussion (n = 23). Participants completed tests of attention switching, response inhibition, and updating working memory while undergoing electroencephalography recordings to index neural variability. RESULTS Compared to sedentary controls and athletes without concussion, athletes with concussion exhibited a restricted whole-brain dynamic range of neural variability when completing a test of inhibitory control. There were no group differences observed for either the switching or working memory tasks. CONCLUSIONS A history of concussion was related to reduced dynamic range of neural activity during a task of response inhibition in young adult athletes. Neural variability may have value for evaluating brain health following concussion.
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Affiliation(s)
- Drew W R Halliday
- Department of Psychology, University of Victoria, Victoria, Canada
- CORTEX Laboratory, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Iris Gordon
- Department of Psychology, University of Victoria, Victoria, Canada
- CORTEX Laboratory, University of Victoria, Victoria, Canada
| | | | - Stuart W S MacDonald
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
| | - Sarah J Macoun
- Department of Psychology, University of Victoria, Victoria, Canada
| | - Sandra R Hundza
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
| | - Mauricio A Garcia-Barrera
- Department of Psychology, University of Victoria, Victoria, Canada
- CORTEX Laboratory, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
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Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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11
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Wang Y, Zhou Y, Zhang X, Wang K, Chen X, Cheng H. Orienting network impairment of attention in patients with mild traumatic brain injury. Behav Brain Res 2023; 437:114133. [PMID: 36179805 DOI: 10.1016/j.bbr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022]
Abstract
The incomplete understanding of mild traumatic brain injury (MTBI)-related cognitive impairment in the acute stage and the low cognitive needs of patients in the later stage might be the main reasons for the neglect of clinical symptoms in patients with MTBI. Patients often experience attention deficits; however, it is unclear whether these patients suffer from general deficits or selective impairment of the brain attention network. Therefore, we investigated deficits in the attention function of patients with mild brain traumatic injury. Patients (n = 50) and matched healthy controls (n = 49) completed a general neuropsychological background test and the Attention Network Test, which provided an independent assessment of the three attention networks (alerting, orienting, and executive control). We found that patients had significant deficits in the orienting network but none in the alerting and executive control networks. Furthermore, patients' cognitive task scores in attention, memory, and information processing tasks were significantly lower than the scores of the controls. Our results demonstrated that patients with MTBI had selective impairment in the orienting network and extensive cognitive impairments, including those related to general attention, memory, and information processing speed.
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Affiliation(s)
- Yuyang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yuwei Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyu Zhang
- Department of Neurosurgery, Funan County People's Hospital, Fuyang, China
| | - Kai Wang
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingui Chen
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Sekely A, Makani A, Dhillon S, Zakzanis KK. Return to work following mild traumatic brain injury: Psychological and cognitive factors in a litigating sample in the post acute stage of recovery. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 36716500 DOI: 10.1080/23279095.2023.2171293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to investigate return to work (RTW) rates following a single uncomplicated mild Traumatic Brain Injury (mTBI) in the post-acute stage in the context of active litigation. More specifically, we sought to determine what psychological and/or cognitive factors predict a RTW after mTBI. Archival data were obtained from a random sample of litigating patients (n = 125; 54% female; mean age: 42.96 (SD = 12.74) who were referred to a private practice for a neuropsychological examination regarding their disability status following a single uncomplicated mTBI. A hierarchical regression analysis was used to assess the predictive value of emotional symptoms and cognition with respect to RTW status. Approximately 50% of the sample did not RTW. Attentional deficits (rs = -0.248) and depressive symptoms (rs = 0.248) were significantly associated with RTW. A hierarchical regression analysis found that depressive symptoms (p < .05) were associated with RTW outcomes. These findings suggest that individuals with increased depressive symptoms are more likely to demonstrate poor RTW outcomes in the post-acute stages of mTBI. These results are of interest to clinicians as they underscore the importance of screening and early intervention for depressive symptoms following a single uncomplicated mTBI in the post-acute stages in litigating samples.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | - Aalim Makani
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Sonya Dhillon
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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13
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Lennon MJ, Brooker H, Creese B, Thayanandan T, Rigney G, Aarsland D, Hampshire A, Ballard C, Corbett A, Raymont V. Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study. J Neurotrauma 2023. [PMID: 36716779 DOI: 10.1089/neu.2022.0360] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = -0.163, p < 0.001), executive scores (B = -0.151, p = 0.004), and processing speed (B = -0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = -0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = -0.149, p = 0.025) and attention scores (B = -0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = -0.135, p < 0.001), processing speed (B = -0.072, p = 0.009), and working memory (B = -0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.
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Affiliation(s)
- Matthew J Lennon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Tony Thayanandan
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, IoPPN, Kings College London, London, United Kingdom.,Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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14
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Alnawmasi MM, Walz JA, Khuu SK. Deficits in visuospatial attentional cueing following mild traumatic brain injury. Neuropsychologia 2022; 177:108422. [PMID: 36370825 DOI: 10.1016/j.neuropsychologia.2022.108422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
Visual attentional deficits are frequently reported in patients with mild traumatic brain injury (TBI). In the present study, the ability to orient visual attention (i.e., the use of endogenous and exogenous visual cues) was investigated using a modified Posner visual search task, in which the participant was required to search for a target shape (radial frequency patterns) amongst distractor shapes. Participants were required to determine whether a target radial frequency pattern was present or absent from an array of distractors. Attention to the target location was cued using central or peripheral cueing procedures to investigate endogenous or exogenous attention allocation. Predictability was not manipulated between central and peripheral cues. Search difficulty was varied by systematically changing the radial frequency difference between target and distractors (and thereby shape difference), and cues could be valid or invalid in that they correctly or incorrectly indicated the position of the target shape. Both target discriminability (i.e., identifying the presence or absence of the target) and reaction times were measured. Thirteen patients with chronic mild TBI and 21 age-, sex-, and IQ -matched healthy controls participated in the study. For control participants, both discrimination accuracy and reaction times improved with visual search efficiency, and they were sensitive to the type of cue, with performance worst for cue invalid conditions than valid conditions. However, the results for TBI patients were strikingly different; we find that discrimination accuracy slightly improved with visual search difficulty (compared to controls), but not reaction times, and TBI patients were largely insensitive to the type of visual cue, and did not show a selective deficit for central or peripheral cues, suggesting an impairment in both endogenous and exogenous visual attention. In conclusion, patients with mild TBI exhibit a poor ability to orient visual attention.
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Affiliation(s)
- Mohammed M Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia; College of Applied Medical Science, Department of Optometry, Qassim University, Saudi Arabia.
| | - Jacinta A Walz
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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15
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Fox AJ, Filmer HL, Dux PE. The influence of self-reported history of mild traumatic brain injury on cognitive performance. Sci Rep 2022; 12:16999. [PMID: 36220885 PMCID: PMC9554181 DOI: 10.1038/s41598-022-21067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/22/2022] [Indexed: 12/29/2022] Open
Abstract
The long-term cognitive consequences of mild traumatic brain injury (mTBI) are poorly understood. Studies investigating cognitive performance in the chronic stage of injury in both hospital-based and population-based samples have revealed inconsistent findings. Importantly, population-based mTBI samples remain under-studied in the literature. This study investigated cognitive performance among individuals with a history of self-reported mTBI using a battery of cognitively demanding behavioural tasks. Importantly, more than half of the mTBI participants had experienced multiple mild head injuries. Compared to control participants (n = 49), participants with a history of mTBI (n = 30) did not demonstrate deficits in working memory, multitasking ability, cognitive flexibility, visuospatial ability, response inhibition, information processing speed or social cognition. There was moderate evidence that the mTBI group performed better than control participants on the visual working memory measure. Overall, these findings suggest that even multiple instances of mTBI do not necessarily lead to long-term cognitive impairment at the group level. Thus, we provide important evidence of the impact of chronic mTBI across a number of cognitive processes in a population-based sample. Further studies are necessary to determine the impact that individual differences in injury-related variables have on cognitive performance in the chronic stage of injury.
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Affiliation(s)
- Amaya J. Fox
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Hannah L. Filmer
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Paul E. Dux
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
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16
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Close proximity to blast: No long-term or lasting effect on cognitive performance in service members with and without TBI during blast exposure. J Int Neuropsychol Soc 2022:1-10. [PMID: 36200831 DOI: 10.1017/s1355617722000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Blast related characteristics may contribute to the diversity of findings on whether mild traumatic brain injury sustained during war zone deployment has lasting cognitive effects. This study aims to evaluate whether a history of blast exposure at close proximity, defined as exposure within 30 feet, has long-term or lasting influences on cognitive outcomes among current and former military personnel. METHOD One hundred participants were assigned to one of three groups based on a self-report history of blast exposure during combat deployments: 47 close blast, 14 non-close blast, and 39 comparison participants without blast exposure. Working memory, processing speed, verbal learning/memory, and cognitive flexibility were evaluated using standard neuropsychological tests. In addition, assessment of combat exposure and current post-concussive, posttraumatic stress, and depressive symptoms, and headache was performed via self-report measures. Variables that differed between groups were controlled as covariates. RESULTS No group differences survived Bonferroni correction for family-wise error rate; the close blast group did not differ from non-close blast and comparison groups on measures of working memory, processing speed, verbal learning/memory, or cognitive flexibility. Controlling for covariates did not alter these results. CONCLUSION No evidence emerged to suggest that a history of close blast exposure was associated with decreased cognitive performance when comparisons were made with the other groups. Limited characterization of blast contexts experienced, self-report of blast distance, and heterogeneity of injury severity within the groups are the main limitations of this study.
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17
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Prakash SK, Reddy RP, Mathulla AR, Rajeswaran J, Shukla DP. Neuropsychological Profile of Traumatic Brain Injury Patients with Medicolegal Cases: A Pilot Study. INDIAN JOURNAL OF NEUROTRAUMA 2022. [DOI: 10.1055/s-0041-1740943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Introduction Traumatic brain injury (TBI) is a global health problem and is a silent epidemic of the modern times. Studies indicate litigation is a prominent factor that accounts for poor outcome and prolonged recovery from mild TBI. Depression is the most frequently diagnosed psychiatric disorder after TBI. Postconcussion symptoms, litigation, and suboptimal effort could contribute to the neuropsychological functioning of TBI patients medicolegal cases (MLCs). With increase in TBI and medicolegal cases, there is a requirement for comprehensive neuropsychological assessment.
Method The aim of the study was to evaluate the cognitive functions, postconcussion, and depressive symptoms in TBI patients with MLC and without MLCs (non-MLC). Patients were also assessed on electrophysiological parameters. An observational cross-sectional design was adopted, the sample size was 30 TBI patients in total, 15 (MLC) and 15 (non-MLC), and 11 patients from each group for electrophysiological assessment. The patients were in the age range of 18 to 50 years.
Results The MLC group had poor performance compared with the non-MLC group on both neuropsychological and electrophysiological measures. There was evidence of significant difference in verbal working memory, verbal learning, and memory and visuoconstructive ability. In the MLC group, postconcussion and depressive scores were negatively correlated with visuospatial span.
Conclusion Findings from this study indicate differences in the neuropsychological performance and electroencephalographic measures in between MLC and non-MLC groups. The results could be indicative of persistent cognitive problems associated with TBI for patients pursuing litigation. Poor performance could also be attributed to suboptimal level of effort. However, being a preliminary study with a small sample size, the findings need to be treated with caution.
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Affiliation(s)
- Simi K. Prakash
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajakumari P. Reddy
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anna R. Mathulla
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval P. Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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18
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Cairncross M, Gindwani H, Rita Egbert A, Torres IJ, Hutchison JS, Dams O'Connor K, Panenka WJ, Brubacher JR, Meddings L, Kwan L, Yeates KO, Green R, Silverberg ND. Criterion validity of the brief test of adult cognition by telephone (BTACT) for mild traumatic brain injury. Brain Inj 2022; 36:1228-1236. [PMID: 36099151 DOI: 10.1080/02699052.2022.2109744] [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: 12/14/2022]
Abstract
OBJECTIVES There is a growing demand for remote assessment options for measuring cognition after mild traumatic brain injury (mTBI). The current study evaluated the criterion validity of the Brief Test of Adult Cognition by Telephone (BTACT) in distinguishing between adults with mTBI and trauma controls (TC) who sustained injuries not involving the head or neck. METHODS The BTACT was administered to the mTBI (n = 46) and TC (n = 35) groups at 1-2 weeks post-injury. Participants also completed the Rivermead Post Concussion Symptoms Questionnaire. RESULTS The BTACT global composite score did not significantly differ between the groups (t(79) = -1.04, p = 0.30); the effect size was small (d = 0.23). In receiver operating characteristic curve analyses, the BTACT demonstrated poor accuracy in differentiating between the groups (AUC = 0.567, SE = 0.065, 95% CI [0.44, 0.69]). The BTACT's ability to discriminate between mTBI and TCs did not improve after excluding mTBI participants (n = 15) who denied ongoing cognitive symptoms (AUC = 0.567, SE = 0.072, 95% CI [0.43, 0.71]). CONCLUSIONS The BTACT may lack sensitivity to subacute cognitive impairment attributable to mTBI (i.e., not explained by bodily pain, post-traumatic stress, and other nonspecific effects of injury).
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Affiliation(s)
- Molly Cairncross
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Psychology, University of British Columbia, Vancouver, Canada.,Department of Psychology, Simon Fraser University, Vancouver, Canada
| | - Hiresh Gindwani
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Anna Rita Egbert
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health and Substance Use Services Research Institute; Vancouver, Canada
| | - James S Hutchison
- Department of Critical Care and Neuroscience and Mental Health Research Program, The Hospital for Sick Children, the Institute for Medical Science and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Kristen Dams O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health and Substance Use Services Research Institute; Vancouver, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Louise Meddings
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lexynn Kwan
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Keith O Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Robin Green
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Noah D Silverberg
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Psychology, University of British Columbia, Vancouver, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada
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19
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English JV. Efficacy of several statistical methods in differentiating TBI and co-occurring conditions: A replication study. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35984307 DOI: 10.1080/23279095.2022.2109028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES (1) Cross-validation of neuropsychological test data sets of moderate-severe TBI (N = 30) with test data from moderate-severe (N = 74); somatization (N = 24) and PCS (N = 22) cases in a database, (2) Determine if cognitive test data sets alone differentiated TBI from other groups, and (3) Evaluate the efficacy of measures in comparisons: Kullback-Leibler, Correlation, Patterns, Cohen's d, and MNB. MATERIALS AND METHODS Meyer's Neuropsychological System; Comparison groups -TBI sample with structural evidence of brain injury (CT/MRI); comparison of 5 statistical measures' efficacy in test data analysis comparing a community sample of moderate TBI (N=30) with a data base containing moderate-severe TBI (N = 74) + co-occurring groups (PCS N = 22) + Somatization (N = 24). Measures utilized: Correlation, Kullbeck-Leibler divergence, Cohen's d, MNB code, Configuration. RESULTS Combining the five measures most accurately matched the TBI sample (30/30 cases) with MNB comparison groups of similar TBI severity while differentiating those cases from PCS and Somatoform cognitive testdata. Both Kullback Leibler & Cohens' d reduced false positive errors in comparison with the other measures.
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Affiliation(s)
- James V English
- Department of Neuroscience, Mesa View Regional Hospital, Mesquite, NV, USA
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20
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Revels-Strother O, Suhr JA. Relationship of psychological/mild traumatic brain injury (mTBI) history and invalid reporting to self-reported executive function. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-5. [PMID: 35948008 DOI: 10.1080/23279095.2022.2109029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Individuals with mild traumatic brain injury (mTBI) often complain of executive functioning (EF) difficulties. There is a discrepancy between self-reported EF impairment and EF deficits on neuropsychological tests, with some arguing that self-report EF is more related to real-world functioning than EF tests. However, research suggests that self-reported EF may be related more to emotional distress and is vulnerable to invalid reporting. We examined the vulnerability of the short form Barkley Deficits in Executive Functioning Scale (BDEFS) to invalid reporting, using a simulated mTBI paradigm. We included four groups: individuals simulating mTBI with (N = 24) and without (N = 21) histories of mTBI/other psychological conditions and controls with (N = 21) and without (N = 25) histories of mTBI/other psychological conditions. As hypothesized, simulators performed worse on the BDEFS Total Score and EF Symptom Count relative to controls; however, this effect was larger within those who had no self-reported history of mTBI/other psychological conditions. We identified a preliminary cutoff on the EF Symptom Count that detected 42.8% of simulators, with 95% specificity relative to the controls with histories of mTBI/other psychological conditions. The present study emphasizes the need for validity scales on self-report EF measures such as the BDEFS.
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Affiliation(s)
| | - Julie A Suhr
- Department of Psychology, Ohio University, Athens, OH, USA
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21
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Abstract
OBJECTIVE Older age is often identified as a risk factor for poor outcome from traumatic brain injury (TBI). However, this relates predominantly to mortality following moderate-severe TBI. It remains unclear whether increasing age exerts risk on the expected recovery from mild TBI (mTBI). In this systematic review of mTBI in older age (60+ years), a focus was to identify outcome through several domains - cognition, psychological health, and life participation. METHODS Fourteen studies were identified for review, using PRISMA guidelines. Narrative synthesis is provided for all outcomes, from acute to long-term time points, and a meta-analysis was conducted for data investigating life participation. RESULTS By 3-month follow-up, preliminary findings indicate that older adults continue to experience selective cognitive difficulties, but given the data it is possible these difficulties are due to generalised trauma or preexisting cognitive impairment. In contrast, there is stronger evidence across time points that older adults do not experience elevated levels of psychological distress following injury and endorse fewer psychological symptoms than younger adults. Meta-analysis, based on the Glasgow Outcome Scale at 6 months+ post-injury, indicates that a large proportion (67%; 95% CI 0.569, 0.761) of older adults can achieve good functional recovery, similar to younger adults. Nevertheless, individual studies using alternative life participation measures suggest more mixed rates of recovery. CONCLUSIONS Although our initial review suggests some optimism in recovery from mTBI in older age, there is an urgent need for more investigations in this under-researched but growing demographic. This is critical for ensuring adequate health service provision, if needed.
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Ly MT, Scarneo-Miller SE, Lepley AS, Coleman K, Hirschhorn R, Yeargin S, Casa DJ, Chen CM. Combining MRI and cognitive evaluation to classify concussion in university athletes. Brain Imaging Behav 2022; 16:2175-2187. [PMID: 35639240 DOI: 10.1007/s11682-022-00687-w] [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] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Abstract
Current methods of concussion assessment lack the objectivity and reliability to detect neurological injury. This multi-site study uses combinations of neuroimaging (diffusion tensor imaging and resting state functional MRI) and cognitive measures to train algorithms to detect the presence of concussion in university athletes. Athletes (29 concussed, 48 controls) completed symptom reports, brief cognitive evaluation, and MRI within 72 h of injury. Hierarchical linear regression compared groups on cognitive and neuroimaging measures while controlling for sex and data collection site. Logistic regression and support vector machine models were trained using cognitive and neuroimaging measures and evaluated for overall accuracy, sensitivity, and specificity. Concussed athletes reported greater symptoms than controls (∆R2 = 0.32, p < .001), and performed worse on tests of concentration (∆R2 = 0.07, p < .05) and delayed memory (∆R2 = 0.17, p < .001). Concussed athletes showed lower functional connectivity within the frontoparietal and primary visual networks (p < .05), but did not differ on mean diffusivity and fractional anisotropy. Of the cognitive measures, classifiers trained using delayed memory yielded the best performance with overall accuracy of 71%, though sensitivity was poor at 46%. Of the neuroimaging measures, classifiers trained using mean diffusivity yielded similar accuracy. Combining cognitive measures with mean diffusivity increased overall accuracy to 74% and sensitivity to 64%, comparable to the sensitivity of symptom report. Trained algorithms incorporating both MRI and cognitive performance variables can reliably detect common neurobiological sequelae of acute concussion. The integration of multi-modal data can serve as an objective, reliable tool in the assessment and diagnosis of concussion.
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Affiliation(s)
- Monica T Ly
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, School of Medicine, San Diego, CA, USA.
| | - Samantha E Scarneo-Miller
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
- Division of Athletic Training, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Adam S Lepley
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
- School of Kinesiology, Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - Kelly Coleman
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
- Department of Health & Movement Sciences, Southern Connecticut State University, New Haven, CT, USA
| | - Rebecca Hirschhorn
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | - Susan Yeargin
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Douglas J Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Chi-Ming Chen
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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23
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Singh S, Tripathi A, Gupta B, Rani Sarraf S, Agarwal G, Ojha B, Dalal PK. Executive functioning in early and middle age adult patients operated for epidural hematoma: A comparative study. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-10. [PMID: 35311441 DOI: 10.1080/23279095.2022.2048831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Epidural Hematoma (EDH) is a common condition of traumatic brain injury. It has a good prognosis if prompt surgical intervention is conducted. There is a dearth of studies on neuropsychological assessment of executive functioning exclusively in post-operative EDH patients. Moreover, age as a variable in determining executive functions in patients post-head injury, has been studied mostly in the older adults. This cross-sectional case-control study assessed Executive Functions (EF) in 62 post-surgery patients with EDH and compared 57 healthy controls (HC) using standardized assessment tools of sustained attention, speed, working memory, fluency, set-shifting, perseveration, planning, and response inhibition. Further, executive functions in two phases of adulthood, viz. Early Adulthood (20-39 years) and Middle Adulthood (40-60 years) were compared in the EDH group (E-EDH and M-EDH) and HC (E-HC and M-HC). A two-way Analysis of Variance (ANOVA) and correlational analysis was conducted. Results showed a trend where the M-EDH group performed significantly poorer on executive function tests (viz a viz., time taken, errors, and correct responses), followed by E-EDH, M-HC, and E-HC. The main effect of age was found significant on Digit Symbol, Color Trail 1, N-Back 2, Animal Naming, and Stroop Effect (p < 0.01 level) while N-Back 1, WCST-PE, and Tower of London (p < 0.05 level). The findings have significant clinical and therapeutic implications. In addition, it gives guidance regarding planning specific neuropsychological tests and rehabilitation targeting specific areas of executive functions decline due to age in EDH post-surgery patients.
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Affiliation(s)
- Shweta Singh
- Department of Psychaitry, King George's Medical University, Lucknow, India
| | - Adarsh Tripathi
- Department of Psychaitry, King George's Medical University, Lucknow, India
| | - Bandna Gupta
- Department of Psychaitry, King George's Medical University, Lucknow, India
| | - Seema Rani Sarraf
- Department of Psychaitry, King George's Medical University, Lucknow, India
| | - Girdhar Agarwal
- Department of Statistics, University of Lucknow, Lucknow, India
| | - Balkrishna Ojha
- Department of Neurosurgery, King George's Medical University, Lucknow, India
| | - P K Dalal
- Department of Psychaitry, King George's Medical University, Lucknow, India
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O'Brien KH, Wallace T, Kemp AM, Pei Y. Cognitive-Communication Complaints and Referrals for Speech-Language Pathology Services Following Concussion. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:790-807. [PMID: 35041792 DOI: 10.1044/2021_ajslp-21-00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Speech-language pathologists are increasingly being recognized as key members of concussion management teams. This study investigates whether self-report of communication problems postconcussion may be useful in identifying clients who could benefit from speech-language pathology services. METHOD Participants included 41 adolescents and adults from an outpatient specialty concussion clinic. All completed the La Trobe Communication Questionnaire (LCQ) at admission, and 23 repeated this measure at discharge. Participants were prospectively enrolled, with chart reviews providing demographic, injury, and medical factors. The analysis considered (a) communication complaints and resolution over time, including comparison to two previously published LCQ studies of typical adults and adults with and without traumatic brain injury (TBI); (b) the relationship between communication complaints, participant factors, and common concussion assessments; and (c) factors related to speech-language pathology service referral for rehabilitation. RESULTS At first visit, 12 of 41 participants (29%) reported communication problems, although 19 (46%) reported difficulty with greater than half of LCQ items. At a group level, compared to published reference data of both people with chronic mixed severity TBI and controls, participants in this study reported more problems at first visit with communication overall, as well as greater difficulty with the LCQ Initiation/Conversation Flow subscale. Partner Sensitivity subscale scores at first visit were also greater than published control data. LCQ subscale scores of Initiation/Conversation Flow and Partner Sensitivity decreased from first visit to last visit, demonstrating resolution over time. Only concussion symptom scales and not demographic, injury, or cognitive screenings were related to LCQ scores. The same two LCQ subscales, Initiation/Conversation Flow and Partner Sensitivity, predicted referral for speech-language pathology services, along with symptom scales and being injured due to motor vehicle crash. DISCUSSION A subset of people recovering from concussion report experiencing communication problems. Reporting of particular communication problems was related to referral for speech-language pathology rehabilitation services and may be useful in directing care after concussion.
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Affiliation(s)
- Katy H O'Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Tracey Wallace
- Complex Concussion Clinic, Shepherd Center, Atlanta, GA
- SHARE Military Initiative, Shepherd Center, Atlanta, GA
| | - Amy M Kemp
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Yalian Pei
- Department of Communication Sciences and Special Education, University of Georgia, Athens
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Norman RS, Mueller KD, Huerta P, Shah MN, Turkstra LS, Power E. Discourse Performance in Adults With Mild Traumatic Brain Injury, Orthopedic Injuries, and Moderate to Severe Traumatic Brain Injury, and Healthy Controls. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:67-83. [PMID: 34694868 PMCID: PMC9135020 DOI: 10.1044/2021_ajslp-20-00299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/22/2021] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Adults with mild traumatic brain injury (mTBI) are at risk for communication disorders, yet studies exploring cognitive-communication performance are currently lacking. AIMS This aim of this study was to characterize discourse-level performance by adults with mTBI on a standardized elicitation task and compare it to (a) healthy adults, (b) adults with orthopedic injuries (OIs), and (c) adults with moderate to severe TBI. METHOD This study used a cross-sectional design. The participants included mTBI and OI groups recruited prospectively from an emergency medicine department. Moderate to severe TBI and healthy data were acquired from TalkBank. One-way analyses of variance were used to compare mean linguistic scores. RESULTS Seventy participants across all groups were recruited. Groups did not differ on demographic variables. The study found significant differences in both content and productivity measures among the groups. Variables did not appear sensitive to differentiate between mTBI and OI groups. DISCUSSION Cognitive and language performance of adults with mTBI is a pressing clinical issue. Studies exploring language with carefully selected control groups can influence the development of sensitive measures to identify individuals with cognitive-communication deficits.
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Affiliation(s)
- Rocío S. Norman
- Department of Communication Sciences and Disorders, The University of Texas Health Science Center at San Antonio
| | - Kimberly D. Mueller
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
| | - Paola Huerta
- Department of Communication Sciences and Disorders, The University of Texas Health Science Center at San Antonio
| | - Manish N. Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Lyn S. Turkstra
- Speech-Language Pathology Program, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Emma Power
- Speech Pathology, Graduate School of Health, University of Technology Sydney, New South Wales, Australia
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Bauer RM, Jaffee MS. Behavioral and Cognitive Aspects of Concussion. Continuum (Minneap Minn) 2021; 27:1646-1669. [PMID: 34881730 DOI: 10.1212/con.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This review provides the reader with an overview of concussion and mild traumatic brain injury (TBI). Key aspects of the pathophysiology, signs, and symptoms, treatment and rehabilitation, and recovery from concussion/mild TBI are reviewed with an emphasis on the variety of factors that may contribute to cognitive concerns following injury. RECENT FINDINGS Concussion remains a clinical diagnosis based on symptoms that occur in the immediate aftermath of an applied force and in the hours, days, and weeks thereafter. Although advances have been made in advanced diagnostics, including neuroimaging and fluid biomarkers in hopes of developing objective indicators of injury, such markers currently lack sufficient specificity to be used in clinical diagnostics. The symptoms of concussion are heterogeneous and may be seen to form subtypes, each of which suggests a targeted rehabilitation by the interdisciplinary team. Although the majority of patients with concussion recover within the first 30 to 90 days after injury, some have persistent disabling symptoms. The concept of postconcussion syndrome, implying a chronic syndrome of injury-specific symptoms, is replaced by a broader concept of persistent symptoms after concussion. This concept emphasizes the fact that most persistent symptoms have their basis in complex somatic, cognitive, psychiatric, and psychosocial factors related to risk and resilience. This framework leads to the important conclusion that concussion is a treatable injury from which nearly all patients can be expected to recover. SUMMARY Concussion/mild TBI is a significant public health problem in civilian, military, and organized athletic settings. Recent advances have led to a better understanding of underlying pathophysiology and symptom presentation and efficacious treatment and rehabilitation of the resulting symptoms. An interdisciplinary team is well-positioned to provide problem-oriented, integrated care to facilitate recovery and to advance the evidence base supporting effective practice in diagnosis, treatment, and prevention.
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Darshini JK, Afsar M, Vandana VP, Shukla D, Rajeswaran J. The Triad of Cognition, Language, and Communication in Traumatic Brain Injury: A Correlational Study. J Neurosci Rural Pract 2021; 12:666-672. [PMID: 34737500 PMCID: PMC8559081 DOI: 10.1055/s-0041-1734008] [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] [Indexed: 10/30/2022] Open
Abstract
Objectives Traumatic brain injury (TBI) is associated with deficits in cognition, language, and communication along with physical and psychosocial consequences. This study aimed at evaluating the association between cognition, language, and communication in a cohort of patients with TBI in southern India using standardized language specific assessment tools. Materials and Methods The present correlational study included 30 patients with TBI of any severity, that is, mild, moderate, and severe within the postinjury period of 6 to 36 months. Comprehensive evaluation of cognition, language, and communication was done using National Institute of Mental Health and Neurosciences Neuropsychology Battery, Indian adapted versions of Western Aphasia Battery and La Trobe Communication Questionnaire (LCQ) respectively. Data Analysis Measures of descriptive statistics, that is, mean, median, percentages, and frequencies, were used. Raw scores, that is, aphasia quotient (AQ), and subdomain scores for LCQ, that is, LCQ-quality, quantity, relation, manner, and cognition, were calculated. Composite scores for the three neuropsychological domains, that is, attention and processing speed, executive function, learning and memory, were evaluated. Partial correlation was computed for identifying the association between the three variables by controlling for age, education, duration, and severity of injury. Results A significant correlation was found between AQ and measures of attention and executive functioning and all measures of LCQ except LCQ-manner. Further, a significant correlation was found between executive functioning and LCQ-total, LCQ-quantity, and LCQ cognition. No correlation was found between measures of attention and memory with communication. Conclusion A good language and executive functioning are associated with better communication abilities in patients with TBI thus emphasizing on the importance of a multidisciplinary team for the management of cognitive-communication impairments following a TBI.
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Affiliation(s)
- Jeevendra Kumar Darshini
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mohammed Afsar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Ettenhofer ML, Hungerford LD, Agtarap S. Multimodal Neurocognitive Screening of Military Personnel With a History of Mild Traumatic Brain Injury Using the Bethesda Eye & Attention Measure. J Head Trauma Rehabil 2021; 36:447-455. [PMID: 33935223 DOI: 10.1097/htr.0000000000000683] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate a neurocognitive eye tracking task, the Bethesda Eye & Attention Measure (BEAM), for use in cognitive screening of patients with a history of mild traumatic brain injury (TBI). SETTING US military TBI rehabilitation clinic. DESIGN/PARTICIPANTS Cross-sectional study of 191 military personnel receiving outpatient services related to history of mild TBI. Main measures: BEAM; neuropsychological screening measures of attention, processing speed, executive function, and memory. RESULTS Medium effect sizes were found for partial correlations (controlling for age) between key BEAM metrics and neuropsychological screening tests. Linear regression analyses demonstrated that BEAM saccadic eye movements and manual (button press) metrics each provided complementary value in measurement of cognitive performance, above and beyond effects of demographic factors and clinical characteristics. CONCLUSION This study provides initial support for the use of BEAM neurocognitive eye tracking in cognitive screening of adults with a history of mild TBI. BEAM saccadic metrics appear to be particularly well-suited for the assessment of visual attention. Study findings also highlight opportunities for greater cognitive sensitivity or testing efficiency that may be missed by tests measuring only one response modality at a time.
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Affiliation(s)
- Mark L Ettenhofer
- DHA Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Drs Ettenhofer, Hungerford, and Agtarap); Naval Medical Center San Diego, San Diego, California (Drs Ettenhofer, Hungerford, and Agtarap); General Dynamics Information Technology, Falls Church, Virginia (Drs Ettenhofer, Hungerford, and Agtarap); University of California, San Diego, La Jolla, California (Dr Ettenhofer); and Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Ettenhofer)
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Wang T, Hu Y, Wang D, Liu J, Sun J, Wei C, Dai H, Li Y. Arcuate Fasciculus Subsegment Impairments Distinctly Associated with Memory and Language Deficits in Acute Mild Traumatic Brain Injury Patients. J Neurotrauma 2021; 38:3279-3287. [PMID: 34605664 DOI: 10.1089/neu.2021.0267] [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] [Indexed: 11/12/2022] Open
Abstract
In acute mild traumatic brain injury (mTBI), the injury-related axonal swelling leads to white matter fiber bundle impairments, closely related to the memory and language deficits commonly shown in the patients. The arcuate fasciculus (AF) plays a central role in verbal learning and language function but could be functionally heterogeneous along the fiber tract. In this study, 25 patients with acute mTBI (<48 h after trauma) and 33 age- and sex-matched healthy controls (HCs) were included. Impaired verbal memory and language functions were shown in the patient group compared with the HCs. Combined diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) were applied to investigate the altered diffusion measure profiles of the AF tracts and the associated functional features. The fractional anisotropy (FA) in the right AF temporal subsegment of the mTBI group was negatively associated with the patient verbal memory function, whereas a positive correlation was found in the HC group. On the other hand, the correlation between the FA in the right AF frontal subsegment and the language function in HCs diminished in the patient group. Moreover, the functional connectivity between the inferior frontal gyrus and the middle occipital gyrus decreased, and its correlation with language function in HCs was absent in the patients with mTBI. Our work provides new insights into the understanding of the structural and functional heterogeneity of the AF tracts as well as the distinct associations of its subsegment impairments with verbal memory and language function deficits in patients with acute mTBI.
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Affiliation(s)
- Tianyao Wang
- Department of Radiology and Shanghai Fifth People's Hospital, Fudan University, Shanghai, P.R. China
| | - Yujie Hu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Danni Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Jun Liu
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Jiahua Sun
- Department of Neurosurgery, Shanghai Fifth People's Hospital, Fudan University, Shanghai, P.R. China
| | - Chunxiao Wei
- Department of Radiology and Shanghai Fifth People's Hospital, Fudan University, Shanghai, P.R. China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China.,Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu Province, P.R. China.,Suzhou Key Laboratory of Intelligent Medicine and Equipment, Suzhou, Jiangsu Province, P.R. China
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, P.R. China
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Anderson JFI, Cockle E. Investigating the Effect of Fatigue and Psychological Distress on Information Processing Speed in the Postacute Period After Mild Traumatic Brain Injury in Premorbidly Healthy Adults. Arch Clin Neuropsychol 2021; 36:918-920. [PMID: 33388744 DOI: 10.1093/arclin/acaa123] [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: 06/16/2020] [Revised: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 11/14/2022] Open
Abstract
Impairments in processing speed under conditions of increasing cognitive load have been reported in individuals with mild traumatic brain injury (mTBI). In other conditions that are also associated with white matter disruption, both psychological distress and fatigue have been shown to underlie this impairment. OBJECTIVE the current study aimed to investigate whether slowing of processing abilities under conditions of greater cognitive load is independent of fatigue and psychological status in premorbidly healthy individuals with subacute mTBI. METHOD using a prospective observational design, we examined 84 individuals with mTBI approximately 8 weeks after injury and 47 healthy control (HC) participants. They were assessed with the Symbol Digit Modality Test, an n-back task and a rate of gain of information choice reaction time task that conforms to Hick's law. Participants were also assessed with measures of fatigue and psychological status. RESULTS as expected, findings revealed no group differences on simple reaction time tasks, but as task complexity increased, the mTBI group performed more slowly than the HC group. This group difference occurred independently of fatigue and psychological distress levels and was associated with a moderate effect size. CONCLUSIONS during the subacute period after mTBI, premorbidly healthy individuals demonstrate impairment in their ability to rapidly process information as the cognitive load of the task increases beyond simple reaction time requirements. Examination of whether these changes affect resumption of premorbid roles is warranted.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria 3010, Australia.,Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, Victoria, 3181, Australia
| | - Emily Cockle
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria 3010, Australia
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Long-term effects of concussion on relevancy-based modulation of somatosensory-evoked potentials. Clin Neurophysiol 2021; 132:2431-2439. [PMID: 34454270 DOI: 10.1016/j.clinph.2021.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/15/2021] [Accepted: 06/12/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this investigation was to better understand the effects of concussions on the ability to selectively up or down-regulate incoming somatosensory information based on relevance. METHODS Median nerve somatosensory-evoked potentials (SEPs) were elicited from electrical stimulation and recorded from scalp electrodes while participants completed tasks that altered the relevance of specific somatosensory information being conveyed along the stimulated nerve. RESULTS Within the control group, SEP amplitudes for task-relevant somatosensory information were significantly greater than for non-relevant somatosensory information at the earliest cortical processing potentials (N20-P27). Alternatively, the concussion history group showed similar SEP amplitudes for all conditions at early processing potentials, however a pattern similar to controls emerged later in the processing stream (P100) where both movement-related gating and facilitation of task-relevant information were present. CONCLUSIONS Previously concussed participants demonstrated impairments in the ability to up-regulate relevant somatosensory information at early processing stages. These effects appear to be chronic, as this pattern was observed on average several years after participants' most recent concussion. SIGNIFICANCE Given the role of the prefrontal cortex in relevancy-based facilitation during movement-related gating, these findings lend support to the notion that this brain area may be particularly vulnerable to concussive forces.
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Walz JA, Mani R, Alnawmasi MM, Khuu SK. Visuospatial Attention Allocation as an Indicator of Cognitive Deficit in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2021; 15:675376. [PMID: 34354575 PMCID: PMC8329082 DOI: 10.3389/fnhum.2021.675376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 01/02/2023] Open
Abstract
Traumatic Brain Injury (TBI) is defined by changes in brain function resulting from external forces acting on the brain and is typically characterized by a host of physiological and functional changes such as cognitive deficits including attention problems. In the present study, we focused on the effect of TBI on the ability to allocate attention in vision (i.e., the use of endogenous and exogenous visual cues) by systematically reviewing previous literature on the topic. We conducted quantitative synthesis of 16 selected studies of visual attention following TBI, calculating 80 effect size estimates. The combined effect size was large (g = 0.79, p < 0.0001) with medium heterogeneity (I2 = 68.39%). Subgroup analyses revealed an increase in deficit with moderate-to-severe and severe TBI as compared to mild TBI [F(2, 76) = 24.14, p < 0.0001]. Task type was another key source of variability and subgroup analyses indicated that higher order attention processes were severely affected by TBI [F(2, 77) = 5.66, p = 0.0051). Meta-regression analyses revealed significant improvement in visual attention deficit with time [p(mild) = 0.031, p(moderate-to-severe) = 0.002, p(severe) < 0.0001]. Taken together, these results demonstrate that visual attention is affected by TBI and that regular assessment of visual attention, using a systematic attention allocation task, may provide a useful clinical measure of cognitive impairment and change after TBI.
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Affiliation(s)
- Jacinta A Walz
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Revathy Mani
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Mohammed M Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
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Effect of blast-related mTBI on the working memory system: a resting state fMRI study. Brain Imaging Behav 2021; 14:949-960. [PMID: 30519997 DOI: 10.1007/s11682-018-9987-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Reduced working memory is frequently reported by Veterans with a history of blast-related mild traumatic brain injury (mTBI), but can be difficult to quantify on neuropsychological measures. This study aimed to improve our understanding of the impact of blast-related mTBI on the working memory system by using resting state functional magnetic resonance imaging (fMRI) to explore differences in functional connectivity between OEF/OIF/OND Veterans with and without a history of mTBI. Participants were twenty-four Veterans with a history of blast-related mTBI and 17 Veterans who were deployed but had no lifetime history of TBI. Working memory ability was evaluated with the Auditory Consonants Trigrams (ACT) task. Resting state fMRI was used to evaluate intrinsic functional connectivity from frontal seed regions that are known components of the working memory network. No significant group differences were found on the ACT, but the imaging analyses revealed widespread hyper-connectivity from the frontal seed regions in the Veterans with a history of mTBI relative to the deployed control group. Further, within the mTBI group, but not the control group, better performance on the ACT was associated with increased functional connectivity to multiple brain regions, including cerebellar components of the working memory network. These results were present after controlling for age, PTSD symptoms, and estimated premorbid IQ, and suggest that long-term alterations in the functional connectivity of the working memory network following blast-related mTBI may reflect a compensatory change that contributes to intact performance on an objective measure of working memory.
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Covington NV, Duff MC. Heterogeneity Is a Hallmark of Traumatic Brain Injury, Not a Limitation: A New Perspective on Study Design in Rehabilitation Research. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:974-985. [PMID: 33556261 DOI: 10.1044/2020_ajslp-20-00081] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose In both basic science and intervention research in traumatic brain injury (TBI), heterogeneity in the patient population is frequently cited as a limitation and is often interpreted as a factor reducing certainty in the generalizability of research findings and as a source of conflicting findings across studies. Historically, much of TBI research in rehabilitation and cognition has relied upon case-control studies, with small to modest sample sizes. In this context, heterogeneity is indeed a significant limitation. Here, however, we argue that heterogeneity in patient profiles is a hallmark characteristic of TBI and therefore cannot be avoided or ignored. We argue that this inherent heterogeneity must be acknowledged and accounted for prior to study design. Fortunately, advances in statistical methods and computing power allow researchers to leverage heterogeneity, rather than be constrained by it. Method In this article, we review sources of heterogeneity that contribute to challenges in TBI research, highlight methodological advances in statistical analysis and in other fields with high degrees of heterogeneity (e.g., psychiatry) that may be fruitfully applied to decomposing heterogeneity in TBI, and offer an example from our research group incorporating this approach. Conclusion Only by adopting new methodological approaches can we advance the science of rehabilitation following TBI in ways that will impact clinical practice and inform decision making, allowing us to understand and respond to the range of individual differences that are a hallmark in this population.
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Affiliation(s)
- Natalie V Covington
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa C Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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35
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Anderson JFI. Cognitive complaint and objective cognition during the post-acute period after mild traumatic brain injury in pre-morbidly healthy adults. Brain Inj 2021; 35:103-113. [PMID: 33459065 DOI: 10.1080/02699052.2020.1859613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary Objective:The most widely used proxies of cognitive complaint after mTBI are post-concussion syndrome (PCS) symptom checklists, which do not have a clear relationship with cognition. This study investigated whether an mTBI-specific cognitive complaint measure would have clearer associations with objective cognition than a widely used PCS symptom checklist.Research Design:An observational design was used. A sample of 109 participants (52 mTBI and 57 healthy controls) completed a PCS symptom checklist, a cognitive complaint measure, and measures of information processing speed, attention, memory, executive function, depression and anxiety.Main Outcomes and Results:In the healthy control group, cognitive complaint was significantly associated with objective cognitive performance and was not associated with psychological status. In contrast, PCS endorsement was unrelated to objective cognition but was associated with psychological status. For the mTBI group, neither PCS endorsement nor cognitive complaint was associated with cognitive performance, but both measures were associated with psychological status.Conclusions:This study indicates that neither cognitive nor PCS symptom measures are reliable indicators of underlying cognitive function in the post-acute period after mTBI. Further, suffering an mTBI may affect the linear relationship that exists between cognitive symptom endorsement and cognitive function in healthy adults.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Psychology Department, The Alfred Hospital, Melbourne, Australia
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36
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de Munter L, Polinder S, Havermans RJM, Steyerberg EW, de Jongh MAC. Prognostic factors for recovery of health status after injury: a prospective multicentre cohort study. BMJ Open 2021; 11:e038707. [PMID: 33408198 PMCID: PMC7789437 DOI: 10.1136/bmjopen-2020-038707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To determine prognostic factors for health status and recovery patterns during the first 2 years after injury in the clinical trauma population. DESIGN A prospective longitudinal cohort study. SETTING Ten participating hospitals in Brabant, the Netherlands. PARTICIPANTS Injured adult patients admitted to a hospital between August 2015 and November 2016 were followed: 4883 (50%) patients participated. MAIN OUTCOME MEASURES Primary outcome was health status, measured with the EuroQol-5-dimensions-3-levels (EQ-5D), including a cognition item and the EuroQol Visual Analogue Scale. Health status was collected at 1 week, 1, 3, 6, 12 and 24 months after injury. Potential prognostic factors were based on literature and clinical experience (eg, age, sex, pre-injury frailty (Groningen Frailty Index), pre-injury EQ-5D). RESULTS Health status increased mainly during the first 6 months after injury with a mean EQ-5D utility score at 1 week of 0.49 and 0.79 at 24 months. The dimensions mobility, pain/discomfort and usual activities improved up to 2 years after injury. Lower pre-injury health status, frailty and longer length of stay at the hospital were important prognostic factors for poor recovery. Spine injury, lower and upper extremity injury showed to be prognostic factors for problems after injury. Traumatic brain injury was a prognostic factor for cognitive problems. CONCLUSION This study contributes to the increase in knowledge of health recovery after injury. It could be a starting point to develop prediction models for specific injury classifications and implementation of personalised medicine. TRIAL REGISTRATION NUMBER NCT02508675.
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Affiliation(s)
- Leonie de Munter
- Trauma TopCare, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Suzanne Polinder
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roos J M Havermans
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| | - Ewout W Steyerberg
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariska A C de Jongh
- Trauma TopCare, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
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Wilson L, Horton L, Kunzmann K, Sahakian BJ, Newcombe VF, Stamatakis EA, von Steinbuechel N, Cunitz K, Covic A, Maas A, Van Praag D, Menon D. Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-324492. [PMID: 33268472 DOI: 10.1136/jnnp-2020-324492] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Cognitive impairment is a key cause of disability after traumatic brain injury (TBI) but relationships with overall functioning in daily life are often modest. The aim is to examine cognition at different levels of function and identify domains associated with disability. METHODS 1554 patients with mild-to-severe TBI were assessed at 6 months post injury on the Glasgow Outcome Scale-Extended (GOSE), the Short Form-12v2 and a battery of cognitive tests. Outcomes across GOSE categories were compared using analysis of covariance adjusting for age, sex and education. RESULTS Overall effect sizes were small to medium, and greatest for tests involving processing speed (ηp 2 0.057-0.067) and learning and memory (ηp 2 0.048-0.052). Deficits in cognitive performance were particularly evident in patients who were dependent (GOSE 3 or 4) or who were unable to participate in one or more major life activities (GOSE 5). At higher levels of function (GOSE 6-8), cognitive performance was surprisingly similar across categories. There were decreases in performance even in patients reporting complete recovery without significant symptoms. Medium to large effect sizes were present for summary measures of cognition (ηp 2 0.111), mental health (ηp 2 0.131) and physical health (ηp 2 0.252). CONCLUSIONS This large-scale study provides novel insights into cognitive performance at different levels of disability and highlights the importance of processing speed in function in daily life. At upper levels of outcome, any influence of cognition on overall function is markedly attenuated and differences in mental health are salient.
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Affiliation(s)
- Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Lindsay Horton
- Division of Psychology, University of Stirling, Stirling, UK
| | - Kevin Kunzmann
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | - Virginia Fj Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen and Georg-August-University, Goettingen, Germany
| | - Katrin Cunitz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen and Georg-August-University, Goettingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen and Georg-August-University, Goettingen, Germany
| | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Dominique Van Praag
- Department of Psychology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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38
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Cavanagh JF, Rieger RE, Wilson JK, Gill D, Fullerton L, Brandt E, Mayer AR. Joint analysis of frontal theta synchrony and white matter following mild traumatic brain injury. Brain Imaging Behav 2020; 14:2210-2223. [PMID: 31368085 PMCID: PMC6992511 DOI: 10.1007/s11682-019-00171-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Some of the most disabling aspects of mild traumatic brain injury (mTBI) include lingering deficits in executive functioning. It is known that mTBI can damage white matter tracts, but it remains unknown how this structural brain damage translates into cognitive deficits. This experiment utilized theta band phase synchrony to identify the dysfunctional neural operations that contribute to cognitive problems following mTBI. Sub-acute stage (< 2 weeks) mTBI patients (N = 52) and healthy matched controls (N = 32) completed a control-demanding task with concurrent EEG. Structural MRI was also collected. While there were no performance-specific behavioral differences between groups in the dot probe expectancy task, the degree of theta band phase synchrony immediately following injury predicted the degree of symptom recovery two months later. Although there were no differences in fractional anisotropy (FA) between groups, joint independent components analysis revealed that a smaller network of lower FA-valued voxels contributed to a diminished frontal theta phase synchrony network in the mTBI group. This finding suggests that frontal theta band markers of cognitive control are sensitive to sub-threshold structural aberrations following mTBI.
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Affiliation(s)
- James F Cavanagh
- Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA.
| | - Rebecca E Rieger
- Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA
- Department of Neuroscience, University of New Mexico Health Sciences Center, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131, USA
| | - J Kevin Wilson
- Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA
- Department of Neuroscience, University of New Mexico Health Sciences Center, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131, USA
| | - Darbi Gill
- Department of Neuroscience, University of New Mexico Health Sciences Center, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131, USA
| | - Lynne Fullerton
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, 1101 Yale Blvd, University of New Mexico, MSC 116025, Albuquerque, NM, 87131, USA
| | - Emma Brandt
- Department of Neuroscience, University of New Mexico Health Sciences Center, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131, USA
| | - Andrew R Mayer
- Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA
- Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM, 87106, USA
- Departments of Neurology and Psychiatry, University of New Mexico Health Sciences Center, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131, USA
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39
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Snowden TM, Hinde AK, Reid HM, Christie BR. Does Mild Traumatic Brain Injury Increase the Risk for Dementia? A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 78:757-775. [DOI: 10.3233/jad-200662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Mild traumatic brain injury (mTBI) is a putative risk factor for dementia; however, despite having apparent face validity, the evidence supporting this hypothesis remains inconclusive. Understanding the role of mTBI as a risk factor is becoming increasingly important given the high prevalence of mTBI, and the increasing societal burden of dementia. Objective: Our objective was to use the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format to determine if an association exists between mTBI and dementia and related factors, and to quantify the degree of risk. Methods: In this format, two authors conducted independent database searches of PubMed, PsycInfo, and CINAHL using three search blocks to find relevant papers published between 2000 and 2020. Relevant studies were selected using pre-defined inclusion/exclusion criteria, and bias scoring was performed independently by the two authors before a subset of studies was selected for meta-analysis. Twenty-one studies met the inclusion criteria for this systematic review. Results: The meta-analysis yielded a pooled odds ratio of 1.96 (95% CI 1.698–2.263), meaning individuals were 1.96 times more likely to be diagnosed with dementia if they had a prior mTBI. Most studies examining neuropsychiatric and neuroimaging correlates of dementia found subtle, persistent changes after mTBI. Conclusion: These results indicate that mTBI is a risk factor for the development of dementia and causes subtle changes in performance on neuropsychiatric testing and brain structure in some patients.
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Affiliation(s)
- Taylor M. Snowden
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Anthony K. Hinde
- Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | - Hannah M.O. Reid
- Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | - Brian R. Christie
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Island Medical Program, University of British Columbia, Victoria, BC, Canada
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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40
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McGlennon TW, Buchwald JN, Pories WJ, Yu F, Roberts A, Ahnfeldt EP, Menon R, Buchwald H. Bypassing TBI: Metabolic Surgery and the Link between Obesity and Traumatic Brain Injury-a Review. Obes Surg 2020; 30:4704-4714. [PMID: 33125676 DOI: 10.1007/s11695-020-05065-3] [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] [Received: 10/05/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be a most effective therapy for TBI.
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Affiliation(s)
- T W McGlennon
- Statistics Division, McGlennon MotiMetrics, Maiden Rock, WI, USA
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Eric P Ahnfeldt
- Uniformed Services University of the Health Sciences, Bethesda, MA, USA
| | - Rukmini Menon
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Henry Buchwald
- Surgery and Biomedical Engineering, Owen H. & Sarah Davidson Wangensteen Chair in Experimental Surgery, Emeritus, University of Minnesota Medical School, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
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41
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Karlsen RH, Saksvik SB, Stenberg J, Lundervold AJ, Olsen A, Rautio I, Folvik L, Håberg AK, Vik A, Karr JE, Iverson GL, Skandsen T. Examining the Subacute Effects of Mild Traumatic Brain Injury Using a Traditional and Computerized Neuropsychological Test Battery. J Neurotrauma 2020; 38:74-85. [PMID: 32948095 DOI: 10.1089/neu.2019.6922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study investigates subacute cognitive effects of mild traumatic brain injury (MTBI) in the Trondheim Mild TBI Study, as measured, in part, by the neuropsychological test battery of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) program, including computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and traditional paper-and-pencil tests. We investigated whether cognitive function was associated with injury severity: intracranial traumatic lesions on neuroimaging, witnessed loss of consciousness (LOC), or post-traumatic amnesia (PTA) >1 h. Further, we explored which of the tests in the CENTER-TBI battery might be associated with the largest subacute effects of MTBI (i.e., at 2 weeks post-injury). We recruited 177 patients with MTBI (16-59 years of age) from a regional trauma center and an outpatient clinic,79 trauma control participants, and 81 community control participants. The MTBI group differed from community controls only on one traditional test of processing speed (coding; p = 0.009, Cliff's delta [Δ] = 0.20). Patients with intracranial abnormalities performed worse than those without on a traditional test (phonemic verbal fluency; p = 0.043, Δ = 0.27), and patients with LOC performed differently on the Attention Switching Task from the CANTAB (p = 0.020, Δ = -0.20). Patients with PTA >1 h performed worse than those with <1 h on 10 measures, from traditional tests and the CANTAB (Δ = 0.33-0.20), likely attributable, at least in part, to pre-existing differences in intellectual functioning between groups. In general, those with MTBI had good neuropsychological outcome 2 weeks after injury and no particular CENTER-TBI computerized or traditional tests seemed to be more sensitive to subtle cognitive deficits.
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Affiliation(s)
- Rune Hatlestad Karlsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Simen Berg Saksvik
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jonas Stenberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Alexander Olsen
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ida Rautio
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Line Folvik
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Justin E Karr
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Home Base Program, Red Sox Foundation and Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Home Base Program, Red Sox Foundation and Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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42
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K. SP, Reddy RP, Mathulla AR, Rajeswaran J, Shukla DP. Traumatic Brain Injury: Effect of Litigation Status on Executive Functioning—A Pilot Study. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1717214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractTraumatic brain injury (TBI) is associated with a wide range of physiological, behavioral, emotional, and cognitive sequelae. Litigation status is one of the many factors that has an impact on recovery. The aim of this study was to compare executive functions, postconcussion, and depressive symptoms in TBI patients with and without litigation. A sample of 30 patients with TBI, 15 patients with litigation (medicolegal case [MLC]), and 15 without litigation (non-MLC) was assessed. The tools used were sociodemographic and clinical proforma, executive function tests, Rivermead Post-Concussion Symptom Questionnaire, and Beck Depression Inventory. Assessment revealed that more than 50% of patients showed deficits in category fluency, set shifting, and concept formation. The MLC group showed significant impairment on verbal working memory in comparison to the non-MLC group. The performance of both groups was comparable on tests of semantic fluency, visuospatial working memory, concept formation, set shifting, planning, and response inhibition. The MLC group showed more verbal working memory deficits in the absence of significant postconcussion and depressive symptoms on self-report measures.
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Affiliation(s)
- Simi Prakash K.
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Rajakumari P. Reddy
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Anna R. Mathulla
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Dhaval P. Shukla
- Neurosurgery, National Institute of Mental Health & Neurosciences, Karnataka, India
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43
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Ragsdale KA, Sprang Jones KR, Nichols A, Watkins LE, Penna S, Rauch SA, Rothbaum BO. Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Lysenko-Martin MR, Hutton CP, Sparks T, Snowden T, Christie BR. Multiple Object Tracking Scores Predict Post-Concussion Status Years after Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:1777-1787. [DOI: 10.1089/neu.2019.6842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | - Craig P. Hutton
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Taya Sparks
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Taylor Snowden
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Brian R. Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
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45
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Predictors of Intervention Adherence in Compensatory Cognitive Training for Veterans With a History of Mild Traumatic Brain Injury. J Head Trauma Rehabil 2020; 36:20-24. [PMID: 32769826 DOI: 10.1097/htr.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine modifiable predictors of intervention adherence in a study of group-based Compensatory Cognitive Training (CCT) for Iraq/Afghanistan War veterans with a history of mild traumatic brain injury (mTBI). METHODS One hundred twenty-three veterans enrolled in a randomized controlled trial of a 10-week CCT intervention (54 assigned to CCT) and were evaluated at baseline, 5 weeks, 10 weeks, and 15 weeks. CCT adherence was determined by the number of CCT sessions attended, with more sessions indicative of greater adherence. Baseline demographic and clinical characteristics, and subjective and objective neuropsychological performance, were examined in relation to CCT session attendance. RESULTS Older age and worse attention performance at baseline were associated with higher CCT attendance rates. CONCLUSIONS This study generates preliminary evidence for potential modifiable neuropsychological factors that may improve engagement in CCT interventions.
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46
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Cognitive Complaints in Motor Functional Neurological (Conversion) Disorders: A Focused Review and Clinical Perspective. Cogn Behav Neurol 2020; 33:77-89. [DOI: 10.1097/wnn.0000000000000218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Ettenhofer ML, Gimbel SI, Cordero E. Clinical validation of an optimized multimodal neurocognitive assessment of chronic mild TBI. Ann Clin Transl Neurol 2020; 7:507-516. [PMID: 32207241 PMCID: PMC7187705 DOI: 10.1002/acn3.51020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Previous laboratory-based studies have shown that neurocognitive eye-tracking metrics are sensitive to chronic effects of mild traumatic brain injury (mTBI), even in individuals with normal performance on traditional neuropsychological measures. In this study, we sought to replicate and extend these findings in a military medical environment. We expected that metrics from the multimodal Fusion n-Back test would successfully distinguish chronic mTBI participants from controls, particularly eye movement metrics from the more cognitively challenging "1-Back" subtest. METHODS We compared performance of participants with chronic mTBI (n = 46) and controls (n = 33) on the Fusion n-Back test and a battery of conventional neuropsychological tests. Additionally, we examined test reliability and the impact of potential confounds to neurocognitive assessment. RESULTS Our results supported hypotheses; Fusion 1-Back metrics were successful in multimodal (saccadic and manual) classification of chronic mTBI versus control. In contrast, conventional neuropsychological measures could not distinguish these groups. Additional findings demonstrated the reliability of Fusion n-Back test metrics and provided evidence that saccadic metrics are resistant to confounding influences of age, intelligence, and psychiatric symptoms. INTERPRETATION The Fusion n-Back test could provide advantages in differential diagnosis for complex brain injury populations. Additionally, the rapid administration of this test could be valuable for screening patients in clinical settings where longer test batteries are not feasible.
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Affiliation(s)
- Mark L Ettenhofer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Defense and Veterans Brain Injury Center, Silver Spring, Maryland.,Naval Medical Center San Diego, San Diego, California.,University of California, San Diego, California
| | - Sarah I Gimbel
- Naval Medical Center San Diego, San Diego, California.,General Dynamics Information Technology, Falls Church, Virginia
| | - Evelyn Cordero
- Naval Medical Center San Diego, San Diego, California.,Henry M. Jackson Foundation, Bethesda, Maryland
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48
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Bedard M, Steffener J, Taler V. Long-term cognitive impairment following single mild traumatic brain injury with loss of consciousness: Findings from the Canadian Longitudinal Study on Aging. J Clin Exp Neuropsychol 2020; 42:344-351. [PMID: 31984839 DOI: 10.1080/13803395.2020.1714552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: We examined the extent to which loss of consciousness (LOC) following mild traumatic brain injury (mTBI) may be associated with impairments in executive functions and declarative memory more than a year after brain injury.Method: Analyses were run on 548 participants who had self-reported LOC of <1 min, 441 with LOC of 1-20 min, and 13,609 no brain injury comparison participants, taken from the Canadian Longitudinal Study on Aging (CLSA), a nationwide study on health and aging.Results: Those that had mTBI with LOC of 1-20 min were more likely than no head injury comparisons to be impaired on measures of executive functioning and declarative memory. Impairments were evident when examining for single- and two-test impairment rates on measures of executive functioning and declarative memory.Conclusions: A subset of people that had reported a single mTBI with LOC more than 12 months ago may experience impairments in executive functioning and declarative memory, particularly those who spent more time unconscious.
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Affiliation(s)
- Marc Bedard
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason Steffener
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Vanessa Taler
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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49
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Tanev KS, Federico LE, Greenberg MS, Orr SP, Goetter EM, Resick PA, Pitman RK. Baseline Cognitive Performance and Treatment Outcomes From Cognitive-Behavioral Therapies for Posttraumatic Stress Disorder: A Naturalistic Study. J Neuropsychiatry Clin Neurosci 2020; 32:286-293. [PMID: 31948321 PMCID: PMC8887025 DOI: 10.1176/appi.neuropsych.19020032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Approximately 5%-20% of U.S. troops returning from Iraq and Afghanistan have posttraumatic stress disorder (PTSD), and another 11%-23% have traumatic brain injury (TBI). Cognitive-behavioral therapies (CBTs) are empirically validated treatment strategies for PTSD. However, cognitive limitations may interfere with an individual's ability to adhere to as well as benefit from such therapies. Comorbid TBI has not been systematically taken into consideration in PTSD outcome research or in treatment planning guidance. The authors hypothesized that poorer pretreatment cognitive abilities would be associated with poorer treatment outcomes from CBTs for PTSD. METHODS This study was designed as a naturalistic examination of treatment as usual in an outpatient clinic that provides manualized CBTs for PTSD to military service members and veterans. Participants were 23 veterans, aged 18-50 years, with combat-related PTSD and a symptom duration of more than 1 year. Of these, 16 participants had mild TBI (mTBI). Predictor variables were well-normed objective tests of cognitive ability measured at baseline. Outcome variables were individual slopes of change of the PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) over weeks of treatment, and of pretreatment-to-posttreatment change in PCL-5 and CAPS-5 (ΔPCL-5 and ΔCAPS-5, respectively). RESULTS Contrary to prediction, neither pretreatment cognitive performance nor the presence of comorbid mTBI predicted poorer response to CBTs for PTSD. CONCLUSIONS These results discourage any notion of excluding patients with PTSD and poorer cognitive ability from CBTs.
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Affiliation(s)
- Kaloyan S. Tanev
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston,Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Lydia E. Federico
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston,Department of Psychiatry, Massachusetts General Hospital, Boston
| | | | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Elizabeth M. Goetter
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston,Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, N.C
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Boston
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50
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Nelson NW, Disner SG, Anderson CR, Doane BM, McGuire K, Lamberty GJ, Hoelzle J, Sponheim SR. Blast concussion and posttraumatic stress as predictors of postcombat neuropsychological functioning in OEF/OIF/OND veterans. Neuropsychology 2020; 34:116-126. [PMID: 31545626 PMCID: PMC6940504 DOI: 10.1037/neu0000594] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Many combat veterans exhibit cognitive limitations of uncertain origin. In this study, we examined factors that predict cognitive functioning by considering effects of blast-related concussion (BRC), non-blast-related concussion (NBRC), and posttraumatic stress disorder (PTSD) symptoms. Analyses specifically tested whether (a) BRC and NBRC were distinct in their prediction of cognitive performance; (b) a dose-response relationship existed between recurrent concussion (BRC and NBRC) and cognitive impairment; and (c) PTSD symptoms mediated the relationship between BRC and cognitive performance. METHOD Two hundred eighty veterans with combat zone deployment histories completed semistructured clinical interviews to define BRC and NBRC histories, current and past mental health disorders, and dimensional ratings of PTSD symptomatology. Participants were also administered a number of neuropsychological measures to appraise cognitive functioning. RESULTS A structural equation model (SEM) suggested that BRC and NBRC were not distinct in their prediction of cognitive performance, and there was no evidence that recurrent concussion (blast or nonblast) was directly associated with cognitive performance. BRC was significantly associated with PTSD symptoms (r = .24), PTSD symptoms were significantly associated with cognitive performance in the SEM (r = -.27), and PTSD symptoms significantly mediated the link between BRC and cognitive performance (p = .03). CONCLUSIONS These results suggest that concussion history fails to directly contribute to cognitive performance, regardless of mechanism (blast or nonblast) and recurrence. BRC is nonetheless unique in its contribution to PTSD and PTSD-related cognitive deficits. Results support interventions specific to PTSD management in the interest of promoting neuropsychological functioning among war veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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