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Karr JE, Ingram EO. Base rates of healthy community-dwelling adults meeting criteria for traumatic encephalopathy syndrome and levels of chronic traumatic encephalopathy certainty. Clin Neuropsychol 2024:1-25. [PMID: 39256925 DOI: 10.1080/13854046.2024.2399797] [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: 05/18/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024]
Abstract
Objective: The National Institute of Neurological Disorders and Stroke (NINDS) recently revised criteria for Traumatic Encephalopathy Syndrome (TES) (Katz et al.), aiming to improve the specificity of former TES criteria (Montenigro et al.) and adding methods to gauge certainty of underlying Chronic Traumatic Encephalopathy (CTE). This study examined base rates of Montenigro et al. and Katz et al. TES criteria in healthy community-dwelling adults. Method: Participants consisted of healthy adults (n = 835; M = 48.1 ± 18.2 years-old, range = 18-85; 37.1% male; 64.1% White) without known history of neurotrauma or psychiatric or neurological conditions. The former and current TES criteria were operationalized using the NIH Toolbox Cognition, Motor, and Emotion batteries and PROMIS-29. Results: Per Katz et al. criteria, 36.9% had symptoms Suggestive of CTE (i.e. either cognitive impairment or neurobehavioral dysregulation), 4.1% had Possible CTE (i.e. requiring cognitive impairment and two additional criteria), and 0.8% had Probable CTE (i.e. requiring cognitive impairment and three additional criteria). The requirement of cognitive impairment for Possible CTE certainty decreased the base rate of Possible CTE tenfold from Montenigro et al. criteria (40.1%). Conclusion: The Katz et al. criteria were met less frequently by healthy adults than the Montenigro et al. criteria. Requiring cognitive impairment and more supportive TES features when gauging CTE certainty may reduce false-positive diagnoses. This finding supports the role of neuropsychologists in the diagnosis and monitoring of patients in TES research studies. To assess specificity, future research should examine base rates of Katz et al. criteria in other psychiatric and neurological conditions.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Eric O Ingram
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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2
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Terry G, Pagulayan KF, Muzi M, Mayer C, Murray DR, Schindler AG, Richards TL, McEvoy C, Crabtree A, McNamara C, Means G, Muench P, Powell JR, Mihalik JP, Thomas RG, Raskind MA, Peskind ER, Meabon JS. Increased [ 18F]Fluorodeoxyglucose Uptake in the Left Pallidum in Military Veterans with Blast-Related Mild Traumatic Brain Injury: Potential as an Imaging Biomarker and Mediation with Executive Dysfunction and Cognitive Impairment. J Neurotrauma 2024; 41:1578-1596. [PMID: 38661540 PMCID: PMC11339557 DOI: 10.1089/neu.2023.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Blast-related mild traumatic brain injury (blast-mTBI) can result in a spectrum of persistent symptoms leading to substantial functional impairment and reduced quality of life. Clinical evaluation and discernment from other conditions common to military service can be challenging and subject to patient recall bias and the limitations of available assessment measures. The need for objective biomarkers to facilitate accurate diagnosis, not just for symptom management and rehabilitation but for prognostication and disability compensation purposes is clear. Toward this end, we compared regional brain [18F]fluorodeoxyglucose-positron emission tomography ([18F]FDG-PET) intensity-scaled uptake measurements and motor, neuropsychological, and behavioral assessments in 79 combat Veterans with retrospectively recalled blast-mTBI with 41 control participants having no lifetime history of TBI. Using an agnostic and unbiased approach, we found significantly increased left pallidum [18F]FDG-uptake in Veterans with blast-mTBI versus control participants, p < 0.0001; q = 3.29 × 10-9 [Cohen's d, 1.38, 95% confidence interval (0.96, 1.79)]. The degree of left pallidum [18F]FDG-uptake correlated with the number of self-reported blast-mTBIs, r2 = 0.22; p < 0.0001. Greater [18F]FDG-uptake in the left pallidum provided excellent discrimination between Veterans with blast-mTBI and controls, with a receiver operator characteristic area under the curve of 0.859 (p < 0.0001) and likelihood ratio of 21.19 (threshold:SUVR ≥ 0.895). Deficits in executive function assessed using the Behavior Rating Inventory of Executive Function-Adult Global Executive Composite T-score were identified in Veterans with blast-mTBI compared with controls, p < 0.0001. Regression-based mediation analyses determined that in Veterans with blast-mTBI, increased [18F]FDG-uptake in the left pallidum-mediated executive function impairments, adjusted causal mediation estimate p = 0.021; total effect estimate, p = 0.039. Measures of working and prospective memory (Auditory Consonant Trigrams test and Memory for Intentions Test, respectively) were negatively correlated with left pallidum [18F]FDG-uptake, p < 0.0001, with mTBI as a covariate. Increased left pallidum [18F]FDG-uptake in Veterans with blast-mTBI compared with controls did not covary with dominant handedness or with motor activity assessed using the Unified Parkinson's Disease Rating Scale. Localized increased [18F]FDG-uptake in the left pallidum may reflect a compensatory response to functional deficits following blast-mTBI. Limited imaging resolution does not allow us to distinguish subregions of the pallidum; however, the significant correlation of our data with behavioral but not motor outcomes suggests involvement of the ventral pallidum, which is known to regulate motivation, behavior, and emotions through basal ganglia-thalamo-cortical circuits. Increased [18F]FDG-uptake in the left pallidum in blast-mTBI versus control participants was consistently identified using two different PET scanners, supporting the generalizability of this finding. Although confirmation of our results by single-subject-to-cohort analyses will be required before clinical deployment, this study provides proof of concept that [18F]FDG-PET bears promise as a readily available noninvasive biomarker for blast-mTBI. Further, our findings support a causative relationship between executive dysfunction and increased [18F]FDG-uptake in the left pallidum.
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Affiliation(s)
- Garth Terry
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Kathleen F. Pagulayan
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Cynthia Mayer
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel R. Murray
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
| | - Abigail G. Schindler
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
| | - Todd L. Richards
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Cory McEvoy
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Adam Crabtree
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Chris McNamara
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Gary Means
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Peter Muench
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Jacob R. Powell
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Stallings-Evans Sports Medicine Center, Chapel Hill, North Carolina, USA
| | - Jason P. Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Stallings-Evans Sports Medicine Center, Chapel Hill, North Carolina, USA
| | - Ronald G. Thomas
- Division of Biostatistics, Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, USA
| | - Murray A. Raskind
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Elaine R. Peskind
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - James S. Meabon
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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3
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Zhou Y, Song Y, Zhu L. Activation of autophagy after blast-induced traumatic brain injury in mice. Neuroreport 2023; 34:759-766. [PMID: 37695596 DOI: 10.1097/wnr.0000000000001951] [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: 09/12/2023]
Abstract
Injury mechanism and treatment of blast-induced traumatic brain injury (bTBI) has not made a breakthrough so far. Previous reports demonstrate autophagy is involved in regulating the pathophysiological process after TBI. Therefore, this study explored whether autophagy was activated after bTBI. A total of 108 mice were divided randomly into six groups: 6 h, 1 d, 3 d, 7 d, 14 d after bTBI groups and sham group. The protein levels of anti-microtubule associated protein 1 light chain 3B (LC3B, hereafter referred to as LC3), beclin1 and p62 were detected using western blot. Moreover, HO-1 and Nrf2 were localized using histologic staining. Immunofluorescence of LC3 and immunohistochemistry of beclin1 were performed. The autophagy-related ultrastructure was observed by TEM. LC3-II and beclin1 reached their peak on day 3 after bTBI, while p62 showed a continuous downward trend. Immunofluorescence and immunohistochemistry also confirmed that the expression levels of LC3 and beclin1 were the highest at 3 days after bTBI. Autophagic vesicles containing lysosomes or digestive residual structures were observed then. Autophagy was induced in the frontal lobe tissues of bTBI mice induced by moderate-intensity explosion, with a peak at 3d and a gradual decline thereafter.
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Affiliation(s)
- Yuan Zhou
- Department of Neurosurgery, Jinling Hospital, Nanjing Univ, Nanjing, Jiangsu, China
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4
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Parsey CM, Kang HJ, Eaton JC, McGrath ME, Barber J, Temkin NR, Donald CLM. Chronic frontal neurobehavioural symptoms in combat-deployed military personnel with and without a history of blast-related mild traumatic brain injury. Brain Inj 2023; 37:1127-1134. [PMID: 37165638 PMCID: PMC10524397 DOI: 10.1080/02699052.2023.2209740] [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: 11/21/2022] [Revised: 03/02/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study evaluated frontal behavioural symptoms, via the FrSBe self-report, in military personnel with and without a history of blast-related mild traumatic brain injury (mild TBI). METHODS Prospective observational cohort study of combat-deployed service members leveraging 1-year and 5-year demographic and follow up clinical outcome data. RESULTS The blast mild TBI group (n = 164) showed greater frontal behavioural symptoms, including clinically elevated apathy, disinhibition, and executive dysfunction, during a 5-year follow-up, compared to a group of combat-deployed controls (n = 107) without mild TBI history or history of blast exposure. We also explored changes inbehaviourall symptoms over a 4-year span, which showed clinically significant increases in disinhibition in the blast mild TBI group, whereas the control group did not show significant increases in symptoms over time. CONCLUSION Our findings add to the growing evidence that a proportion of individuals who sustain mild TBI experience persistent behavioural symptoms. We also offer a demonstration of a novel use of the FrSBe as a tool for longitudinal symptom monitoring in a military mild TBI population.
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Affiliation(s)
- Carolyn M. Parsey
- Department of Neurology, University of Washington, School of Medicine, Seattle, WA USA
| | | | - Jessica C. Eaton
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Margaret E. McGrath
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
- Department of Biostatistics, University of Washington, School of Public Health, Seattle, WA USA
| | - Christine L. Mac Donald
- Harborview Medical Center, Seattle WA USA
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
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5
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Bell T, Crowe M, Novack T, Davis RD, Stavrinos D. Severity and correlates of brain fog in people with traumatic brain injury. Res Nurs Health 2023; 46:136-147. [PMID: 36504287 PMCID: PMC10851910 DOI: 10.1002/nur.22280] [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] [Received: 04/12/2022] [Revised: 11/03/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Brain fog is one symptom that has been underexplored in traumatic brain injury (TBI). We explored the cognitive and affective correlates of brain fog in people with symptomatic mild TBI (n = 15), moderate-to-severe TBI (n = 15), and a healthy control group (n = 16). Measures across the studies assessed "brain fog" (Mental Clutter Scale), objective cognition (Useful Field of View® and Cogstate Brief Battery®), post-concussive symptoms (Post-Concussion Symptom Scale), and depressive symptoms (Profile of Moods Scale). Brain fog was higher in symptomatic mild TBI and moderate-to-severe TBI compared with healthy controls. Greater brain fog corresponded to greater depressive symptoms in symptomatic mild TBI. Greater brain fog corresponded to poorer episodic memory and working memory in moderate-to-severe TBI. Brain fog appears to reflect challenges in recovery, including depressive symptoms and worse cognitive function. Screening for brain fog might be worthwhile in people with brain injuries.
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Affiliation(s)
- Tyler Bell
- Department of Psychiatry, University of California, San Diego
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham
| | - Thomas Novack
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham
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6
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Jurick SM, McCabe CT, Watrous JR, Walker LE, Stewart IJ, Galarneau MR. Prevalence and correlates of self-reported cognitive difficulties in deployment-injured U.S. military personnel. J Trauma Stress 2022; 35:1343-1356. [PMID: 35394076 DOI: 10.1002/jts.22833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 11/11/2022]
Abstract
Cognitive difficulties typically resolve within days to weeks following mild traumatic brain injury (mTBI); however, a sizable proportion of individuals continue to report cognitive symptoms months to years later that are often associated with posttraumatic stress disorder (PTSD) and depression to a greater degree than a history of mTBI. The current study sought to evaluate the prevalence of self-reported cognitive difficulties as well as the relative contributions of demographic, injury-related, and mental health variables in a large study of U.S. military personnel injured during deployment since 2001. Slightly fewer than half (42.0%) of participants reported elevated cognitive difficulties compared with a normative population; however, this was driven primarily by those who screened positive for PTSD or depression. Hierarchical linear regression revealed that various demographic and injury factors, including lower educational attainment, retired or separated military status, enlisted rank, and a history of deployment-related mTBI, were associated with more self-reported cognitive difficulties, f2 = 0.07. Screening positive for PTSD or depression accounted for 32.1% of the variance in self-reported cognitive symptoms, f2 = 0.63, whereas injury variables, including a history of deployment-related mTBI, albeit significant in the model, accounted for 1.6%. The current findings add to the growing body of literature underscoring the importance of screening for and treating mental health conditions in injured military personnel.
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Affiliation(s)
- Sarah M Jurick
- Leidos, San Diego, California, USA.,Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Cameron T McCabe
- Leidos, San Diego, California, USA.,Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Jessica R Watrous
- Leidos, San Diego, California, USA.,Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | | | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Michael R Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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7
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Fink SJ, Davey DK, Sakamoto MS, Chanfreau-Coffinier C, Clark AL, Delano-Wood L, Merritt VC. Subjective cognitive and psychiatric well-being in U.S. Military Veterans screened for deployment-related traumatic brain injury: A Million Veteran Program Study. J Psychiatr Res 2022; 151:144-149. [PMID: 35483132 PMCID: PMC9406238 DOI: 10.1016/j.jpsychires.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine subjective cognitive and psychiatric functioning in post-deployed military Veterans who underwent the Veterans Health Administration's Traumatic Brain Injury (TBI) Screening and Evaluation Program and enrolled in the VA's Million Veteran Program (MVP). Veterans (N = 7483) were classified into three groups based on outcomes from the TBI Screening and Evaluation Program: (1) negative TBI screen ('Screen-'), (2) positive TBI screen but no TBI diagnosis ('Screen+/TBI-'), or (3) positive TBI screen and TBI diagnosis ('Screen+/TBI+'). Chi-square analyses revealed significant group differences across all self-reported cognitive and psychiatric health conditions (e.g., memory loss, depression), and ANCOVAs similarly showed a significant association between group and subjective symptom reporting. Specifically, the relationship between TBI group and clinical outcome (i.e., health conditions and symptoms) was such that the Screen+/TBI+ group fared the worst, followed by the Screen+/TBI- group, and finally the Screen- group. However, evaluation of effect sizes suggested that Veterans in the two Screen+ groups (Screen+/TBI+ and Screen+/TBI-) are faring similarly to one another on subjective cognitive and psychiatric functioning, but that both Screen+ groups are faring significantly worse than the Screen- group. Our results have meaningful clinical implications and suggest that Veterans who screen positive for TBI, regardless of ultimate TBI diagnosis, be eligible for similar clinical services so that both groups can benefit from valuable treatments and therapeutics. Finally, this research sets the stage for follow-up work to be conducted within MVP that will address the neurobiological underpinnings of cognitive and psychiatric distress in this population.
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Affiliation(s)
- Shayna J Fink
- Veterans Medical Research Foundation, San Diego, CA, United States
| | - Delaney K Davey
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - McKenna S Sakamoto
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Victoria C Merritt
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
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8
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Siedhoff HR, Chen S, Song H, Cui J, Cernak I, Cifu DX, DePalma RG, Gu Z. Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury. Front Neurol 2022; 12:818169. [PMID: 35095749 PMCID: PMC8794583 DOI: 10.3389/fneur.2021.818169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022] Open
Abstract
Most traumatic brain injuries (TBIs) during military deployment or training are clinically "mild" and frequently caused by non-impact blast exposures. Experimental models were developed to reproduce the biological consequences of high-intensity blasts causing moderate to severe brain injuries. However, the pathophysiological mechanisms of low-intensity blast (LIB)-induced neurological deficits have been understudied. This review provides perspectives on primary blast-induced mild TBI models and discusses translational aspects of LIB exposures as defined by standardized physical parameters including overpressure, impulse, and shock wave velocity. Our mouse LIB-exposure model, which reproduces deployment-related scenarios of open-field blast (OFB), caused neurobehavioral changes, including reduced exploratory activities, elevated anxiety-like levels, impaired nesting behavior, and compromised spatial reference learning and memory. These functional impairments associate with subcellular and ultrastructural neuropathological changes, such as myelinated axonal damage, synaptic alterations, and mitochondrial abnormalities occurring in the absence of gross- or cellular damage. Biochemically, we observed dysfunctional mitochondrial pathways that led to elevated oxidative stress, impaired fission-fusion dynamics, diminished mitophagy, decreased oxidative phosphorylation, and compensated cell respiration-relevant enzyme activity. LIB also induced increased levels of total tau, phosphorylated tau, and amyloid β peptide, suggesting initiation of signaling cascades leading to neurodegeneration. We also compare translational aspects of OFB findings to alternative blast injury models. By scoping relevant recent research findings, we provide recommendations for future preclinical studies to better reflect military-operational and clinical realities. Overall, better alignment of preclinical models with clinical observations and experience related to military injuries will facilitate development of more precise diagnosis, clinical evaluation, treatment, and rehabilitation.
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Affiliation(s)
- Heather R. Siedhoff
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Shanyan Chen
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Hailong Song
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Jiankun Cui
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
| | - Ibolja Cernak
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA, United States
| | - David X. Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Ralph G. DePalma
- Office of Research and Development, Department of Veterans Affairs, Washington, DC, United States
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Zezong Gu
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
- Harry S. Truman Memorial Veterans' Hospital Research Service, Columbia, MO, United States
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9
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Baskin B, Lee SJ, Skillen E, Wong K, Rau H, Hendrickson RC, Pagulayan K, Raskind MA, Peskind ER, Phillips PEM, Cook DG, Schindler AG. Repetitive Blast Exposure Increases Appetitive Motivation and Behavioral Inflexibility in Male Mice. Front Behav Neurosci 2022; 15:792648. [PMID: 35002648 PMCID: PMC8727531 DOI: 10.3389/fnbeh.2021.792648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
Blast exposure (via detonation of high explosives) represents a major potential trauma source for Servicemembers and Veterans, often resulting in mild traumatic brain injury (mTBI). Executive dysfunction (e.g., alterations in memory, deficits in mental flexibility, difficulty with adaptability) is commonly reported by Veterans with a history of blast-related mTBI, leading to impaired daily functioning and decreased quality of life, but underlying mechanisms are not fully understood and have not been well studied in animal models of blast. To investigate potential underlying behavioral mechanisms contributing to deficits in executive functioning post-blast mTBI, here we examined how a history of repetitive blast exposure in male mice affects anxiety/compulsivity-like outcomes and appetitive goal-directed behavior using an established mouse model of blast mTBI. We hypothesized that repetitive blast exposure in male mice would result in anxiety/compulsivity-like outcomes and corresponding performance deficits in operant-based reward learning and behavioral flexibility paradigms. Instead, results demonstrate an increase in reward-seeking and goal-directed behavior and a congruent decrease in behavioral flexibility. We also report chronic adverse behavioral changes related to anxiety, compulsivity, and hyperarousal. In combination, these data suggest that potential deficits in executive function following blast mTBI are at least in part related to enhanced compulsivity/hyperreactivity and behavioral inflexibility and not simply due to a lack of motivation or inability to acquire task parameters, with important implications for subsequent diagnosis and treatment management.
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Affiliation(s)
- Britahny Baskin
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States
| | - Suhjung Janet Lee
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Emma Skillen
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Katrina Wong
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Holly Rau
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Rebecca C Hendrickson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Kathleen Pagulayan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Murray A Raskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Elaine R Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Paul E M Phillips
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Department of Pharmacology, University of Washington, Seattle, WA, United States
| | - David G Cook
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Department of Pharmacology, University of Washington, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States
| | - Abigail G Schindler
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States
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10
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Assessment of Executive Function in Patients with Traumatic Brain Injury with the Wisconsin Card-Sorting Test. Brain Sci 2020; 10:brainsci10100699. [PMID: 33019772 PMCID: PMC7600451 DOI: 10.3390/brainsci10100699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
This review aimed at providing a brief and comprehensive summary of recent research regarding the use of the Wisconsin Card-Sorting Test (WCST) to assess executive function in patients with traumatic brain injury (TBI). A bibliographical search, performed in PubMed, Web of Science, Scopus, Cochrane Library, and PsycInfo, targeted publications from 2010 to 2020, in English or Spanish. Information regarding the studies’ designs, sample features and use of the WCST scores was recorded. An initial search eliciting 387 citations was reduced to 47 relevant papers. The highest proportion of publications came from the United States of America (34.0%) and included adult patients (95.7%). Observational designs were the most frequent (85.1%), the highest proportion being cross-sectional or case series studies. The average time after the occurrence of the TBI ranged from 4 to 62 years in single case studies, and from 6 weeks up to 23.5 years in the studies with more than one patient. Four studies compared groups of patients with TBI according to the severity (mild, moderate and/or severe), and in two cases, the studies compared TBI patients with healthy controls. Randomized control trials were seven in total. The noncomputerized WCST version including 128 cards was the most frequently used (78.7%). Characterization of the clinical profile of participants was the most frequent purpose (34.0%). The WCST is a common measure of executive function in patients with TBI. Although shorter and/or computerized versions are available, the original WCST with 128 cards is still used most often. The WCST is a useful tool for research and clinical purposes, yet a common practice is to report only one or a few of the possible scores, which prevents further valid comparisons across studies. Results might be useful to professionals in the clinical and research fields to guide them in assessment planning and proper interpretation of the WCST scores.
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Merritt VC, Jurick SM, Crocker LD, Sullan MJ, Sakamoto MS, Davey DK, Hoffman SN, Keller AV, Jak AJ. Associations Between Multiple Remote Mild TBIs and Objective Neuropsychological Functioning and Subjective Symptoms in Combat-Exposed Veterans. Arch Clin Neuropsychol 2020; 35:491-505. [PMID: 32128559 DOI: 10.1093/arclin/acaa006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate relationships between multiple mild traumatic brain injuries (mTBIs) and objective and subjective clinical outcomes in a sample of combat-exposed Veterans, adjusting for psychiatric distress and combat exposure. METHOD In this cross-sectional study, 73 combat-exposed Iraq/Afghanistan Veterans were divided into three groups based on mTBI history: 0 mTBIs (n = 31), 1-2 mTBIs (n = 21), and 3+ mTBIs (n = 21). Veterans with mTBI were assessed, on average, 7.78 years following their most recent mTBI. Participants underwent neuropsychological testing and completed self-report measures assessing neurobehavioral, sleep, and pain symptoms. RESULTS MANCOVAs adjusting for psychiatric distress and combat exposure showed no group differences on objective measures of attention/working memory, executive functioning, memory, and processing speed (all p's > .05; ηp2 = .00-.06). In contrast, there were significant group differences on neurobehavioral symptoms (p's = < .001-.036; ηp2 = .09-.43), sleep difficulties (p = .037; ηp2 = .09), and pain symptoms (p < .001; ηp2 = .21). Pairwise comparisons generally showed that the 3+ mTBI group self-reported the most severe symptoms, followed by comparable symptom reporting between the 0 and 1-2 mTBI groups. CONCLUSIONS History of multiple, remote mTBIs is associated with elevated subjective symptoms but not objective neuropsychological functioning in combat-exposed Veterans. These results advance understanding of the long-term consequences of repetitive mTBI in this population and suggest that Veterans with 3+ mTBIs may especially benefit from tailored treatments aimed at ameliorating specific neurobehavioral, sleep, and pain symptoms.
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Affiliation(s)
- Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Sarah M Jurick
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Laura D Crocker
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Molly J Sullan
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Delaney K Davey
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Samantha N Hoffman
- San Diego Joint Doctoral Program in Clinical Psychology, State University/University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Amber V Keller
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Amy J Jak
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
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12
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Silveira K, Garcia-Barrera MA, Smart CM. Neuropsychological Impact of Trauma-Related Mental Illnesses: A Systematic Review of Clinically Meaningful Results. Neuropsychol Rev 2020; 30:310-344. [PMID: 32700085 DOI: 10.1007/s11065-020-09444-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 06/22/2020] [Indexed: 01/13/2023]
Abstract
A trauma history is present in approximately 90% of adults in the United States. Comparatively, lifetime post-traumatic stress disorder (PTSD) prevalence is only 8.3% (Kilpatrick et al. Journal of Traumatic Stress, 26, 537-547, 2013). A neuropsychological understanding of trauma is essential to effective trauma-informed assessments and treatments. Prior reviews have focused on PTSD, specific neuropsychological domains, and statistically rather than clinically significant results. The current systematic review investigated standardized test performance across neuropsychological domains in participants with trauma histories and any psychiatric diagnosis. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 2350 records, the search returned 21 eligible studies: 8 for combat trauma, 2 for childhood trauma, 2 for intimate partner violence and sexual assault, 2 for accidental trauma, 1 for refugee trauma, and 6 for unspecified trauma. Mean neuropsychological scores ranged from low to high average, with one mean verbal memory score in the borderline range. These findings diverge from reports of between-group differences or experimental task performance, which suggest greater levels of static cognitive impairment. Current results are limited by lack of distinction between trauma types in the literature, a dearth of cognitive domains examined, wide use of self-report trauma measures, and publication and outcome reporting biases. Clinical implications for assessment and rehabilitation are discussed in relation to clinical significance, state versus trait based changes, intra-individual variability, changes from pre- to post-trauma, and within-group variability in resilience. Future directions are recommended in consideration of cultural factors, prospective and follow-up designs, and psychiatric diagnosis.
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Affiliation(s)
- Kristen Silveira
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
| | - Mauricio A Garcia-Barrera
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, V8W 2Y2, Canada
| | - Colette M Smart
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, V8W 2Y2, Canada
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13
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Holiday KA, Clark AL, Merritt VC, Nakhla MZ, Sorg S, Delano-Wood L, Schiehser DM. Response inhibition in Veterans with a history of mild traumatic brain injury: The role of self-reported complaints in objective performance. J Clin Exp Neuropsychol 2020; 42:556-568. [PMID: 32657255 DOI: 10.1080/13803395.2020.1776847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although objective deficits in response inhibition (RI) have been detected in civilians with mild traumatic brain injury (mTBI), it remains unclear whether objective RI is worse in military Veterans with mTBI despite the prevalence of self-reported disinhibition. Assessing RI in Veterans is critical due to their unique characteristics, including combat and blast exposure, in addition to the prevalence of psychiatric comorbidity. Therefore, the aims of this study were to (1) examine RI performance in Veterans with mTBI compared to non-mTBI Veterans and (2) compare RI performance in well-defined subgroups of mTBI Veterans with and without self-reported complaints of disinhibition to non-mTBI Veterans. METHOD 53 mTBI Veterans and 37 non-mTBI Veterans completed a Go/No-Go RI task and measures of self-reported disinhibition (Frontal Systems Behavior Scale) and psychiatric symptoms. ANCOVAs covarying for mood and demographics compared RI performances of the non-mTBI Veterans to (1) the total sample of mTBI Veterans (n= 53) and to (2) mTBI Veterans with elevated (t-score ≥ 60; mTBI-SubjDis; n= 23) and low (t-score < 60; mTBI-NoSubjDis; n= 30) levels of self-reported disinhibition. RESULTS There were no significant differences in RI between the mTBI group as a whole and the non-mTBI Veterans group. However, when Veterans with mTBI were divided into groups by clinically-significant concern about their disinhibition, the mTBI-SubjDis group demonstrated significantly worse RI than the mTBI-NoSubjDis and non-mTBI Veteran groups. No significant differences in RI performance were observed between the mTBI-NoSubjDis and non-mTBI Veteran groups. CONCLUSIONS Results indicate that mTBI Veterans with elevated levels of self-reported disinhibition show diminished performance on objective measures of RI, independent of mood. Findings highlight the unique contribution of subjective complaints on executive functioning in mTBI, and they underscore the importance of assessing cognitive complaints in order to identify those most at risk for poor-long term outcomes.
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Affiliation(s)
- Kelsey A Holiday
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA.,Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Alexandra L Clark
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Victoria C Merritt
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Marina Z Nakhla
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA.,Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Scott Sorg
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA.,Department of Psychiatry, University of California , San Diego, CA, USA
| | - Lisa Delano-Wood
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA.,Department of Psychiatry, University of California , San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Dawn M Schiehser
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA.,Department of Psychiatry, University of California , San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
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14
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Belanger HG, Wortzel HS, Vanderploeg RD, Cooper DB. A model for intervening with veterans and service members who are concerned about developing Chronic Traumatic Encephalopathy (CTE). Clin Neuropsychol 2019; 34:1105-1123. [DOI: 10.1080/13854046.2019.1699166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Heather G. Belanger
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- James A, Haley Veterans Hospital, United States Special Operations Command, 9Line LLC, Tampa, FL, USA
| | - Hal S. Wortzel
- Rocky Mountain MIRECC, Rocky Mountain Regional Medical Center, Aurora, CO, USA
- Departments of Psychiatry, Neurology, and PM&R, University of Colorado, Aurora, CO, USA
| | - Rodney D. Vanderploeg
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Douglas B. Cooper
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Polytrauma Rehabilitation Center, Audie Murphy Memorial VA Hospital, San Antonio, TX, USA
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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