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Wang R, Muresanu D, Hösl K, Hilz MJ. Cardiovascular autonomic regulation correlates with cognitive performance in patients with a history of traumatic brain injury. Neurol Sci 2023; 44:3535-3544. [PMID: 37227563 PMCID: PMC10495484 DOI: 10.1007/s10072-023-06857-y] [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: 03/06/2023] [Accepted: 05/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Traumatic brain injury (TBI) may afflict brain areas contributing to both cardiovascular autonomic regulation and cognitive performance. To evaluate possible associations between both functions in patients with a history of TBI (post-TBI-patients), we determined correlations between cardiovascular autonomic regulation and cognitive function in post-TBI-patients. METHODS In 86 post-TBI-patients (33.1 ± 10.8 years old, 22 women, 36.8 ± 28.9 months after injury), we monitored RR intervals (RRI), systolic and diastolic blood pressures (BPsys, BPdia), and respiration (RESP) at rest. We calculated parameters of total cardiovascular autonomic modulation (RRI-standard-deviation (RRI-SD), RRI-coefficient-of-variation (RRI-CV), RRI-total-powers), sympathetic (RRI-low-frequency-powers (RRI-LF), normalized (nu) RRI-LF-powers, BPsys-LF-powers) and parasympathetic modulation (root-mean-square-of-successive-RRI-differences (RMSSD), RRI-high-frequency-powers (RRI-HF), RRI-HFnu-powers), sympathetic-parasympathetic balance (RRI-LF/HF-ratios), and baroreflex sensitivity (BRS). We used the Mini-Mental State Examination and Clock Drawing Test (CDT) to screen the general global and visuospatial cognitive function, and applied the standardized Trail Making Test (TMT)-A assessing visuospatial abilities and TMT-B assessing executive function. We calculated correlations between autonomic and cognitive parameters (Spearman's rank correlation test; significance: P < 0.05). RESULTS CDT values positively correlated with age (P = 0.013). TMT-A values inversely correlated with RRI-HF-powers (P = 0.033) and BRS (P = 0.043), TMT-B values positively correlated with RRI-LFnu-powers (P = 0.015), RRI-LF/HF-ratios (P = 0.036), and BPsys-LF-powers (P = 0.030), but negatively with RRI-HFnu-powers (P = 0.015). CONCLUSIONS In patients with a history of TBI, there is an association between decreased visuospatial and executive cognitive performance and reduced parasympathetic cardiac modulation and baroreflex sensitivity with relatively increased sympathetic activity. Altered autonomic control bears an increased cardiovascular risk; cognitive impairment compromises quality of life and living conditions. Thus, both functions should be monitored in post-TBI-patients.
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Affiliation(s)
- Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Dafin Muresanu
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania
| | - Katharina Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Pinasco C, Oviedo M, Goldfeder M, Bruno D, Lischinsky A, Torralva T, Roca M. Sensitivity and specificity of the INECO frontal screening (IFS) in the detection of patients with traumatic brain injury presenting executive deficits. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:289-296. [PMID: 34156897 DOI: 10.1080/23279095.2021.1937170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Executive dysfunction (EF) is a common feature of adult traumatic brain injury (TBI), especially in moderate to severe cases. Assessing EF usually requires the administration of an extensive neuropsychological battery, which is time consuming and expensive. The INECO frontal screening (IFS) is a brief, easy-to-administer screening test which has previously shown to be useful in the detection of executive deficits in different psychiatric and neurological populations. The aim of the present study was to assess the usefulness of the IFS in the detection of executive dysfunction in TBI patients. Twenty-eight TBI patients and thirty-two healthy controls were assessed with a battery that included classical executive tests and the IFS. Our results indicated that with a cutoff score of 26.25 points, the IFS showed good sensitivity and specificity in the detection of executive impairments in TBI patients. It also showed good positive and negative predicted values. Our results suggest that the IFS can be considered a useful tool for identifying executive dysfunction in patients with TBI.
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Affiliation(s)
- Clara Pinasco
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Psicología y Psicopedagogía, Universidad Católica Argentina, Buenos Aires, Argentina
| | - Mercedes Oviedo
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Neurociencias INECO Oroño, Rosario, Argentina
| | - María Goldfeder
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Diana Bruno
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Instituto de investigaciones en Psicología Básica y Aplicada (IIPBA), Facultad de Filosofía y Humanidades, Universidad Católica de Cuyo, Rivadavia, San Juan
| | - Alicia Lischinsky
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Directora del Departamento de Salud Mental y Psiquiatría de la Facultad de Medicina, Universidad Favaloro, Buenos Aires, Argentina
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - María Roca
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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3
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Caron L, Ouellet MC, Hudon C, Predovan D, Sirois MJ, de Guise É, Lamontagne MÈ, Émond M, Le Sage N, Beaulieu-Bonneau S. Cognitive functioning following traumatic brain injury in older adults: associations with social participation and health-related quality of life. Brain Inj 2022; 36:1099-1108. [PMID: 35994259 DOI: 10.1080/02699052.2022.2110284] [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: 11/02/2022]
Abstract
OBJECTIVES To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation. METHOD The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderate/severe TBI). On average 15 months post-injury, they completed measures of objective and subjective cognitive functioning (Telephone Interview for Cognitive Status-Modified, Alphaflex, Medical Outcomes Study Cognitive Functioning Scale), HRQoL (SF-12), and social participation (Participation Assessment with Recombined Tools - Objective). RESULTS Mean score for objective cognitive functioning was lower than normative values, while mean scores for executive functioning and subjective cognitive functioning were comparable to normative values. There was no relationship between objective and subjective measures. Subjective cognitive functioning and (to a lesser extent) global objective cognitive functioning were significantly associated with mental HRQoL but not with physical HRQoL or social participation. CONCLUSION These results underscore the importance of considering both subjective perception and objective performance when assessing and intervening on cognition to promote better mental HRQoL in older adults with TBI.
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Affiliation(s)
- Laurence Caron
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
| | - Marie-Christine Ouellet
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Carol Hudon
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre de Recherche CERVO Brain Research Center, Québec, QC, Canada
| | - David Predovan
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
| | - Marie-Josée Sirois
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Élaine de Guise
- Département de Psychologie, Université de Montréal, Québec, QC, Canada
| | - Marie-Ève Lamontagne
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.,Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Natalie Le Sage
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
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Kouvatsou Z, Masoura E, Kimiskidis V. Working Memory Deficits in Multiple Sclerosis: An Overview of the Findings. Front Psychol 2022; 13:866885. [PMID: 35572228 PMCID: PMC9097870 DOI: 10.3389/fpsyg.2022.866885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Although working memory (WM) and information processing speed (IPS) impairments in multiple sclerosis (MS) have been widely investigated, several questions, regarding the nature of these impairments and their relationship, remain unclear. The aim of this short communication article is to present an overview of our recent research findings regarding (a) the characteristics of WM impairment in MS patients and, more precisely, the degree of impairment observed in each WM's component, i.e., phonological loop, visuospatial sketchpad, central executive, and episodic buffer and (b) the relationship between IPS and each of the four WM components, in an attempt to expand the existing rather narrow understanding of the interconnection between reduced IPS and WM impairment. Two studies of our research team are presented here and their findings are briefly discussed, highlighting the importance of further research on a specific component, namely the episodic buffer component among MS patients.
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Affiliation(s)
- Zoe Kouvatsou
- Department of Experimental Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elvira Masoura
- Department of Experimental Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Kimiskidis
- First Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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A Systematic Review of Cognitive Functioning After Traumatic Brain Injury in Individuals Aged 10-30 Years. Cogn Behav Neurol 2021; 33:233-252. [PMID: 33264151 DOI: 10.1097/wnn.0000000000000236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Given the importance of the period of life from 10 to 30 years in terms of cognitive development and education, combined with the high incidence of traumatic brain injury (TBI) during this period, and limited consensus as to the pattern and degree of cognitive impairment post TBI during this period, we conducted a systematic review to investigate cognitive performance across a range of domains among individuals between the ages of 10 and 30 years who had sustained a TBI. We searched five databases and identified 799 unique records; 52 met our inclusion criteria. These studies reported cognitive function for intelligence, attention, memory, processing speed, and executive function. The majority of the studies reported significant effects, suggesting that TBI is associated with cognitive impairments in these domains. Nine of the studies used physiological tests (EEG and fMRI), the outcomes of which supported behaviorally demonstrated cognitive deficits. In the studies we reviewed, individuals aged 10-30 years who had experienced a TBI performed worse than healthy controls on cognitive function measures-specifically for attention, memory, processing speed, and executive function. In the studies that subjected the individuals with TBI to EEG and fMRI, atypical activation in associated brain regions was demonstrated while the individuals were undergoing cognitive tasks. However, caution should be taken when interpreting the overall results due to the high risk of bias across the majority of the studies. The broader implications of reduced cognitive performance after TBI across this age range are yet to be fully understood.
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6
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Galovski TE, Werner KB, Iverson KM, Kaplan S, Fortier CB, Fonda JR, Currao A, Salat D, McGlinchey RE. A Multi-Method Approach to a Comprehensive Examination of the Psychiatric and Neurological Consequences of Intimate Partner Violence in Women: A Methodology Protocol. Front Psychiatry 2021; 12:569335. [PMID: 33679466 PMCID: PMC7933589 DOI: 10.3389/fpsyt.2021.569335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/21/2021] [Indexed: 01/07/2023] Open
Abstract
The number of women in the United States that experience blows to the head during assaults by intimate partners is substantial. The number of head blows that result in a traumatic brain injury (TBI) is virtually unknown, but estimates far exceed numbers of TBI in parallel populations (e.g., blast exposure, accidents, sports) combined. Research on the impact of TBI on post-traumatic stress disorder (PTSD) in survivors of intimate partner violence (IPV) is sparse. This methodology paper describes the comprehensive, multi-method approach used by a multi-disciplinary team of investigators from several different fields of expertise to assess the interaction of psychiatric, cognitive, psychological, and physical conditions that result from IPV. Using state-of-the-art instruments, a comprehensive assessment of lifetime trauma exposure, lifetime history of TBI, psychiatric history, and a full assessment of current cognitive, neuropsychological and biomedical function was conducted with 51 female survivors of IPV who screened positive for PTSD. This multi-method assessment included clinician-administered diagnostic interviews modified to specifically assess the sequelae of IPV, standardized self-report surveys, neuropsychological tests, structural, diffusion, and functional neuroimaging and blood-based biomarkers. The specific details and full report of the results of the full study are beyond the scope of this methodology paper. Descriptive characteristics of the complex clinical presentation observed in this unique sample are described. The sample reported high rates of trauma exposure across the lifespan and 80% met full criteria for current PTSD. Women also reported high rates of lifetime subconcussive head injury (88.2%) and TBI (52.9%) from various etiologies (35.3% secondary to IPV). Descriptive findings from the methodological protocol described here have begun to reveal information that will advance our understanding of the impact of subconcussive head injury and TBI on recovery from mental injury among IPV survivors.
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Affiliation(s)
- Tara E. Galovski
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Kimberly B. Werner
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Katherine M. Iverson
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Stephanie Kaplan
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Catherine B. Fortier
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, United States
| | - Jennifer R. Fonda
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Alyssa Currao
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - David Salat
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Regina E. McGlinchey
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, United States
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7
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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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8
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Al-Adawi S, Al-Naamani A, Jaju S, Al-Farsi YM, Dorvlo ASS, Al-Maashani A, Al-Adawi SSH, Moustafa AA, Al-Sibani N, Essa MM, Burke DT, Qoronfleh MW. Methylphenidate improves executive functions in patients with traumatic brain injuries: a feasibility trial via the idiographic approach. BMC Neurol 2020; 20:103. [PMID: 32192470 PMCID: PMC7081568 DOI: 10.1186/s12883-020-01663-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Road traffic accidents are known to be the main cause of traumatic brain injury (TBI). TBI is also a leading cause of death and disability. This study, by means of the idiographic approach (single-case experimental designs using multiple-baseline designs), has examined whether methylphenidate (MPH - trade name Ritalin) had a differential effect on cognitive measures among patients with TBI with the sequel of acute and chronic post-concussion syndromes. The effect on gender was also explored. METHODS In comparison with healthy controls, patients with TBI (acute and chronic) and accompanying mild cognitive impairment (MCI) were screened for their integrity of executive functioning. Twenty-four patients exhibiting executive dysfunction (ED) were then instituted with the pharmacological intervention methylphenidate (MPH). The methylphenidate was administered using an uncontrolled, open label design. RESULTS The administration of methylphenidate impacted ED in the TBI group but had no effect on mood. Attenuation of ED was more apparent in the chronic phases of TBI. The effect on gender was not statistically significant with regard to the observed changes. CONCLUSIONS To our knowledge, this is the first feasibility trial from the Arabian Gulf to report the performance of a TBI population with mild cognitive impairment according to the IQCODE Arabic version. This investigation confirms anecdotal observations of methylphenidate having the potential to attenuate cognitive impairment; particularly those functions that are critically involved in the integrity of executive functioning. The present feasibility trial should be followed by nomothetic studies such as those that adhere to the protocol of the randomized controlled trial. This evidence-based research is the foundation for intervention and future resource allocation by policy- or public health decision-makers.
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Affiliation(s)
- Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Aziz Al-Naamani
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjay Jaju
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Yahya M. Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Atsu S. S. Dorvlo
- Department of Mathematics and Statistics, College of Science, Sultan Qaboos University, Muscat, Oman
| | - Ali Al-Maashani
- Department of Neurosurgery, Khoula Hospital, Ministry of Health, Muscat, Oman
| | | | - Ahmed A. Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, Western Sydney University, Penrith, NSW Australia
| | - Nasser Al-Sibani
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Musthafa M. Essa
- Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman
| | - David T. Burke
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - M. Walid Qoronfleh
- Research & Policy Department, World Innovation Summit for Health (WISH), Qatar Foundation, P.O. Box 5825, Doha, Qatar
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Grossner EC, Bernier RA, Brenner EK, Chiou KS, Hillary FG. Prefrontal gray matter volume predicts metacognitive accuracy following traumatic brain injury. Neuropsychology 2019; 32:484-494. [PMID: 29809035 DOI: 10.1037/neu0000446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To examine metacognitive ability (MC) following moderate to severe traumatic brain injury (TBI) using an empirical assessment approach and to determine the relationship between alterations in gray matter volume (GMV) and MC. METHOD A sample of 62 individuals (TBI n = 34; healthy control [HC] n = 28) were included in the study. Neuroimaging and neuropsychological data were collected for all participants during the same visit. MC was quantified using an approach borrowed from signal detection theory (Type II area under the receiver operating characteristic curve calculation) to evaluate judgments during a modified version of the 3rd edition of the Wechsler Adult Intelligence Scale's Matrix Reasoning subtest where half of the items were presented randomly and half were presented in the order of increasing difficulty. Retrospective confidence judgments were collected on an item-by-item basis. Brain volumetric analyses were conducted using FreeSurfer software. RESULTS Analyses of the modified Matrix Reasoning task data demonstrated that HCs significantly outperformed TBIs (ordered: d = .63; random: d = .58). There was a significant difference between groups for MC for the randomly presented stimuli (d = .54) but not the ordered stimuli. There was an association between GMV and MC in the TBI group between the right orbital region and MC (R2 = .11). In the HC group, there were associations between the left posterior (R2 = .17), left orbital (R2 = .29), and left dorsolateral (R2 = .21) regions and MC. CONCLUSIONS These results are consistent with those of previous research on MC in the cognitive neurosciences, but this study demonstrates that injury may moderate the regional contributions to MC. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Kathy S Chiou
- Department of Psychology, University of Nebraska Lincoln
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10
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Executive (dys)function after traumatic brain injury: special considerations for behavioral pharmacology. Behav Pharmacol 2019; 29:617-637. [PMID: 30215621 PMCID: PMC6155367 DOI: 10.1097/fbp.0000000000000430] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Executive function is an umbrella term that includes cognitive processes such as decision-making, impulse control, attention, behavioral flexibility, and working memory. Each of these processes depends largely upon monoaminergic (dopaminergic, serotonergic, and noradrenergic) neurotransmission in the frontal cortex, striatum, and hippocampus, among other brain areas. Traumatic brain injury (TBI) induces disruptions in monoaminergic signaling along several steps in the neurotransmission process - synthesis, distribution, and breakdown - and in turn, produces long-lasting deficits in several executive function domains. Understanding how TBI alters monoamingeric neurotransmission and executive function will advance basic knowledge of the underlying principles that govern executive function and potentially further treatment of cognitive deficits following such injury. In this review, we examine the influence of TBI on the following measures of executive function - impulsivity, behavioral flexibility, and working memory. We also describe monoaminergic-systems changes following TBI. Given that TBI patients experience alterations in monoaminergic signaling following injury, they may represent a unique population with regard to pharmacotherapy. We conclude this review by discussing some considerations for pharmacotherapy in the field of TBI.
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Kouvatsou Z, Masoura E, Kiosseoglou G, Kimiskidis VK. Working memory profiles of patients with multiple sclerosis: Where does the impairment lie? J Clin Exp Neuropsychol 2019; 41:832-844. [PMID: 31204607 DOI: 10.1080/13803395.2019.1626805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Previous studies have mostly provided general estimations regarding Working Memory impairment in patients with Multiple Sclerosis. The aim of the present study was to investigate the relative degree of impairment in the four Working Memory components in Multiple Sclerosis. Method: Thirty-eight patients diagnosed with MS and 27 matched controls were assessed using 12 different cognitive tasks of the four components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. More precisely, Greek translated and adapted versions of the following tasks were administered: Digit recall, Word recall, Non-word recall, Block recall, Mazes recall, Visual Patterns recall, Backward Digit recall, Backward Block recall, Listening recall, Logical Memory I-Immediate Story recall and Greek Verbal Learning Test, which is based on the California Verbal Learning Test. Results: The phonological loop, the central executive and the spatial subcomponent of the visuospatial sketchpad were found to be equally disrupted in MS patients. The episodic buffer was found to be more heavily affected. On the other hand, the visual subcomponent of the visuospatial sketchpad proved to be preserved. Conclusions: WM subcomponents are differentially affected in patients with MS. This novel finding is discussed within the framework of existing knowledge regarding WM impairment in MS.
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Affiliation(s)
- Zoe Kouvatsou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Elvira Masoura
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Grigoris Kiosseoglou
- a School of Psychology, Department of Experimental Cognitive Psychology, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Vasilios K Kimiskidis
- b Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Chiou KS, Jiang T, Chiaravalloti N, Hoptman MJ, DeLuca J, Genova H. Longitudinal examination of the relationship between changes in white matter organization and cognitive outcome in chronic TBI. Brain Inj 2019; 33:846-853. [DOI: 10.1080/02699052.2019.1606449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kathy S. Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Tony Jiang
- Kessler Foundation, East Hanover, NJ, USA
| | - Nancy Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Helen Genova
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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Jurick SM, Hoffman SN, Sorg S, Keller AV, Evangelista ND, DeFord NE, Sanderson-Cimino M, Bangen KJ, Delano-Wood L, Deoni S, Jak AJ. Pilot investigation of a novel white matter imaging technique in Veterans with and without history of mild traumatic brain injury. Brain Inj 2018; 32:1256-1265. [DOI: 10.1080/02699052.2018.1493225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah M. Jurick
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Scott Sorg
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amber V. Keller
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Nicole E. DeFord
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark Sanderson-Cimino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sean Deoni
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Amy J. Jak
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Jurick SM, Bangen KJ, Evangelista ND, Sanderson-Cimino M, Delano-Wood L, Jak AJ. Advanced neuroimaging to quantify myelin in vivo: Application to mild TBI. Brain Inj 2018; 30:1452-1457. [PMID: 27834545 DOI: 10.1080/02699052.2016.1219064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Difficulty providing accurate diagnosis and prognosis, especially after mild forms of traumatic brain injury (TBI), has increased efforts to detect changes in white matter microstructure using advanced neuroimaging techniques. Although methods such as diffusion tensor imaging (DTI) have greatly increased knowledge of white matter changes resulting from TBI, several shortcomings limit the utility of these techniques particularly when applied to populations with mild TBI (mTBI) history. In vivo imaging of myelin may be particularly well suited to detect changes in white matter microstructure resulting from mTBI. REVIEW This manuscript will briefly review the animal and histological data supporting the important role of myelin following TBI, contributions and shortcomings of the use of diffusion tensor imaging (DTI) in mild TBI and the utility of multi-component relaxometry (MCR) techniques as a method for improved visualizing of white matter microstructural integrity in myelin. CONCLUSION The use of MCR-based techniques has potential as a clinical and research tool to assess and track changes in myelin as well as the common behavioural changes such as slowed processing speed following TBI.
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Affiliation(s)
- S M Jurick
- a San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA.,b Veterans Medical Research Foundation , San Diego , CA , USA
| | - K J Bangen
- c Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,d Research Service
| | - N D Evangelista
- b Veterans Medical Research Foundation , San Diego , CA , USA.,d Research Service
| | | | - L Delano-Wood
- b Veterans Medical Research Foundation , San Diego , CA , USA.,c Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,d Research Service.,e Psychology Service, VA San Diego Healthcare System , San Diego , CA , USA
| | - A J Jak
- b Veterans Medical Research Foundation , San Diego , CA , USA.,c Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,d Research Service.,e Psychology Service, VA San Diego Healthcare System , San Diego , CA , USA
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Frequência de déficits neuropsicológicos após traumatismo cranioencefálico. ACTA COLOMBIANA DE PSICOLOGIA 2016. [DOI: 10.14718/acp.2016.19.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
O traumatismo cranioencefálico (TCE) pode acarretar mudanças no cotidiano e prejuízos social laboral comunicativo e cognitivo (dificuldades atencionais mnemônicas e executivas). Este estudo buscou caracterizar a ocorrência de déficits neuropsicológicos após o TCE em uma amostra de adultos e verificar se há impacto do nível de severidade do trauma no desempenho cognitivo dos pacientes. Participaram 96 adultos divididos em dois grupos: TCE leve (n=39) e grave (n=57). A gravidade do trauma foi classificada pela Escala de Coma de Glasgow pela duração da perda de consciência. ou pela amnésia pós-traumática. Não houve diferença nas variáveis sociodemográficas idade e escolaridade entre os grupos. Para a comparação entre grupos quanto a ocorrência de déficits neuropsicológicos. utilizou-se o Qui-quadrado. Tarefas verbais e visuoespaciais de funções executivas habilidades linguísticas. mnemônicas verbais compuseram uma bateria neuropsicológica flexível.Os pacientes com TCE leve tiveram menos déficits comparados aos com TCE grave (erros e categorias completadas do Wisconsin Teste de Classificação de Cartas; erros da parte B do Teste Hayling; e na interferência pró e retroativa do teste de aprendizagem verbal de Rey). A severidade do trauma parece diferenciar indivíduos no desempenho de memória episódica no contexto de maior sobrecarga de informações novas e no controle da interferência entre memórias; o mesmo se aplica às funções de flexibilidade e inibição. Fazse necessário um maior investimento em ações de políticas públicas de saúde priorizando intervenção neurognitiva remediativa e métodos de prevenção para acidentes relacionados a lesões traumáticas com alta ocorrência de sequelas.
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The relationship between executive dysfunction, depression, and mental health-related quality of life in survivors of critical illness: Results from the BRAIN-ICU investigation. J Crit Care 2016; 37:72-79. [PMID: 27652496 DOI: 10.1016/j.jcrc.2016.08.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/27/2016] [Accepted: 08/25/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Although executive dysfunction and depression are common among intensive care unit (ICU) survivors, their relationship has not been evaluated in this population. We sought to determine (1) if executive dysfunction is independently associated with severity of depressive symptoms or worse mental health-related quality of life (HRQOL) in ICU survivors, and (2) if age modifies these associations. METHODS In a prospective cohort (n=136), we measured executive dysfunction by the Behavior Rating Inventory of Executive Function-Adult, depression by the Beck Depression Inventory-II, and mental HRQOL by the Short-Form 36. We used multiple linear regression models, adjusting for potential confounders. We included age as an interaction term to test for effect modification. RESULTS Executive dysfunction 3 months post-ICU was independently associated with more depressive symptoms and worse mental HRQOL 12 months post-ICU (25th vs 75th percentile of executive functioning scored 4.3 points worse on the depression scale [95% confidence interval, 1.3-7.4; P=.015] and 5 points worse on the Short-Form 36 [95% confidence interval, 1.7-8.3; P=.006]). Age did not modify these associations (depression: P=.12; mental HRQOL: P=.80). CONCLUSION Regardless of age, executive dysfunction was independently associated with subsequent worse severity of depressive symptoms and worse mental HRQOL. Executive dysfunction may have a key role in the development of depression.
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Hanson KL, Schiehser DM, Clark AL, Sorg SF, Kim RT, Jacobson MW, Werhane ML, Jak AJ, Twamley EW, Delano-Wood L. Problem alcohol use in veterans with mild traumatic brain injury: Associations with cognitive performance and psychiatric symptoms. J Clin Exp Neuropsychol 2016; 38:1115-30. [PMID: 27430280 DOI: 10.1080/13803395.2016.1198468] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Given that little is known about the associations between alcohol use, cognition, and psychiatric symptoms among veterans with a history of mild traumatic brain injury (mTBI), we aimed to (a) characterize how they differ from veteran controls on a measure of problem drinking; (b) investigate whether problem drinking is associated with demographic or mTBI characteristics; and (c) examine the associations between alcohol use, mTBI history, psychiatric functioning, and cognition. METHOD We assessed 59 veterans (n = 32 with mTBI history; n = 27 military controls) for problem alcohol use (Alcohol Use Disorders Identification Test: AUDIT), psychiatric symptoms, and neuropsychological functioning. RESULTS Compared to controls, veterans with mTBI history were more likely to score above the AUDIT cutoff score of 8 (p = .016), suggesting a higher rate of problem drinking. Participants with mTBI history also showed elevated psychiatric symptoms (ps < .001) and lower cognitive scores (ps < .05 to < .001). Veterans with higher AUDIT scores were younger (p = .05) and had less education (p < .01) and more psychiatric symptoms (ps < .01), but mTBI characteristics did not differ. After controlling for combat and mTBI history (R(2) = .04, ns) and posttraumatic stress disorder (PTSD) symptoms (ΔR(2) = .08, p = .05), we found that higher AUDIT scores were associated with poorer attention/processing speed, F(9, 37) = 2.55, p = .022; ΔR(2) = .26, p = .03. CONCLUSIONS This preliminary study suggested that veterans with mTBI history may be at increased risk for problem drinking. Problem alcohol use was primarily associated with more severe PTSD symptoms and poorer attention/processing speed, though not with combat or mTBI characteristics per se. Importantly, findings emphasize the importance of assessing for and treating problematic alcohol use and comorbid psychiatric symptoms among veterans, including those with a history of neurotrauma.
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Affiliation(s)
- Karen L Hanson
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Dawn M Schiehser
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Alexandra L Clark
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,e San Diego State University Joint Doctoral Program in Clinical Psychology , University of California San Diego , San Diego , CA , USA
| | - Scott F Sorg
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA
| | - Russell T Kim
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA
| | - Mark W Jacobson
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Madeleine L Werhane
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,e San Diego State University Joint Doctoral Program in Clinical Psychology , University of California San Diego , San Diego , CA , USA
| | - Amy J Jak
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Elizabeth W Twamley
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Lisa Delano-Wood
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
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Gilmore CS, Camchong J, Davenport ND, Nelson NW, Kardon RH, Lim KO, Sponheim SR. Deficits in Visual System Functional Connectivity after Blast-Related Mild TBI are Associated with Injury Severity and Executive Dysfunction. Brain Behav 2016; 6:e00454. [PMID: 27257516 PMCID: PMC4873652 DOI: 10.1002/brb3.454] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Approximately, 275,000 American service members deployed to Iraq or Afghanistan have sustained a mild traumatic brain injury (mTBI), with 75% of these incidents involving an explosive blast. Visual processing problems and cognitive dysfunction are common complaints following blast-related mTBI. METHODS In 127 veterans, we examined resting fMRI functional connectivity (FC) of four key nodes within the visual system: lateral geniculate nucleus (LGN), primary visual cortex (V1), lateral occipital gyrus (LO), and fusiform gyrus (FG). Regression analyses were performed (i) to obtain correlations between time-series from each seed and all voxels in the brain, and (ii) to identify brain regions in which FC variability was related to blast mTBI severity. Blast-related mTBI severity was quantified as the sum of the severity scores assigned to each of the three most significant blast-related injuries self-reported by subjects. Correlations between FC and performance on executive functioning tasks were performed across participants with available behavioral data (n = 94). RESULTS Greater blast mTBI severity scores were associated with lower FC between: (A) LGN seed and (i) medial frontal gyrus, (ii) lingual gyrus, and (iii) right ventral anterior nucleus of thalamus; (B) V1 seed and precuneus; (C) LO seed and middle and superior frontal gyri; (D) FG seed and (i) superior and medial frontal gyrus, and (ii) left middle frontal gyrus. Finally, lower FC between visual network regions and frontal cortical regions predicted worse performance on the WAIS digit-symbol coding task. CONCLUSION These are the first published results that directly illustrate the relationship between blast-related mTBI severity, visual pathway neural networks, and executive dysfunction - results that highlight the detrimental relationship between blast-related brain injury and the integration of visual sensory input and executive processes.
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Affiliation(s)
- Casey S. Gilmore
- Defense and Veterans Brain Injury CenterMinneapolisMinnesota
- Minneapolis Veterans Affairs Health Care SystemMinneapolisMinnesota
| | - Jazmin Camchong
- Department of PsychiatryUniversity of MinnesotaMinneapolisMinnesota
| | - Nicholas D. Davenport
- Minneapolis Veterans Affairs Health Care SystemMinneapolisMinnesota
- Department of PsychiatryUniversity of MinnesotaMinneapolisMinnesota
| | - Nathaniel W. Nelson
- Minneapolis Veterans Affairs Health Care SystemMinneapolisMinnesota
- Univ. of St. ThomasGraduate School of Professional PsychologyMinneapolisMinnesota
| | - Randy H. Kardon
- Department of Ophthalmology & Visual ScienceUniversity of IowaIowa CityIowa
- Iowa City Veterans Affairs Health Care SystemIowa CityIowa
| | - Kelvin O. Lim
- Defense and Veterans Brain Injury CenterMinneapolisMinnesota
- Minneapolis Veterans Affairs Health Care SystemMinneapolisMinnesota
- Department of PsychiatryUniversity of MinnesotaMinneapolisMinnesota
| | - Scott R. Sponheim
- Minneapolis Veterans Affairs Health Care SystemMinneapolisMinnesota
- Department of PsychiatryUniversity of MinnesotaMinneapolisMinnesota
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Adjorlolo S. Diagnostic Accuracy, Sensitivity, and Specificity of Executive Function Tests in Moderate Traumatic Brain Injury in Ghana. Assessment 2016; 25:498-512. [PMID: 27121081 DOI: 10.1177/1073191116646445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The sociocultural differences between Western and sub-Saharan African countries make it imperative to standardize neuropsychological tests in the latter. However, Western-normed tests are frequently administered in sub-Saharan Africa because of challenges hampering standardization efforts. Yet a salient topical issue in the cross-cultural neuropsychology literature relates to the utility of Western-normed neuropsychological tests in minority groups, non-Caucasians, and by extension Ghanaians. Consequently, this study investigates the diagnostic accuracy, sensitivity, and specificity of executive function (EF) tests (The Stroop Test, Trail Making Test, and Controlled Oral Word Association Test), and a Revised Quick Cognitive Screening Test (RQCST) in a sample of 50 patients diagnosed with moderate traumatic brain injury and 50 healthy controls in Ghana. The EF test scores showed good diagnostic accuracy, with area under the curve (AUC) values of the Trail Making Test scores ranging from .746 to .902. With respect to the Stroop Test scores, the AUC values ranged from .793 to .898, while Controlled Oral Word Association Test had AUC value of .787. The RQCST scores discriminated between the groups, with AUC values ranging from .674 to .912. The AUC values of composite EF score and a neuropsychological score created from EF and RQCST scores were .936 and. 942, respectively. Additionally, the Stroop Test, Trail Making Test, EF composite score, and RQCST scores showed good to excellent sensitivities and specificities. In general, this study has shown that commonly used EF tests in Western countries have diagnostic accuracy, sensitivity, and specificity when administered in Ghanaian samples. The findings and implications of the study are discussed.
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Raju B, Lukose S, Raj P, Reddy K. Clinically providing psycho-social care for caregivers in emergency and trauma care setting: Scope for medical and psychiatric social workers. Int J Crit Illn Inj Sci 2016; 6:206-210. [PMID: 28149828 PMCID: PMC5225766 DOI: 10.4103/2229-5151.195452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traumatic brain injury is the leading cause of death and disability in young people. TBI is associated with increased mortality, morbidity, and socioeconomic loss, especially in developing countries such as India. It is creating damage to the psychosocial well–being of caregiver and their family members significantly. Caregivers’ informational, educational, psychosocial problems are still overlooked and unaddressed. Providing psychosocial interventions such as educating caregivers about TBI-related consequences, increasing social support, mobilization of resources for the needy, and dealing with psychological stress will be beneficial to reduce the caregiver burden. Medical and psychiatric social workers (MPSWs) have important role in providing psychosocial care and decreasing caregiver burden of TBI survivors. This case report highlights the role of MPSWs in the emergency and trauma care setting.
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Affiliation(s)
- Birudu Raju
- Department of Psychiatric Social Work, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Lukose
- Department of Psychiatric Social Work, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabu Raj
- Department of Psychiatric Social Work, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Krishna Reddy
- Department of Neuro-Surgery, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Self- and Informant Ratings of Executive Functioning After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:E30-9. [DOI: 10.1097/htr.0000000000000120] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Woods DL, Wyma JM, Herron TJ, Yund EW. The Effects of Aging, Malingering, and Traumatic Brain Injury on Computerized Trail-Making Test Performance. PLoS One 2015; 10:e0124345. [PMID: 26060999 PMCID: PMC4465490 DOI: 10.1371/journal.pone.0124345] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/27/2015] [Indexed: 12/18/2022] Open
Abstract
The trail making test (TMT) is widely used to assess speed of processing and executive function. However, normative data sets gathered at different sites show significant inconsistencies. Here, we describe a computerized version of the TMT (C-TMT) that increases the precision and replicability of the TMT by permitting a segment-by-segment analysis of performance and separate analyses of dwell-time, move-time, and error time. Experiment 1 examined 165 subjects of various ages and found that completion times on both the C-TMT-A (where subjects connect successively numbered circles) and the C-TMT-B (where subjects connect circles containing alternating letters and numbers) were strongly influenced by age. Experiment 2 examined 50 subjects who underwent three test sessions. The results of the first test session were well fit by the normative data gathered in Experiment 1. Sessions 2 and 3 demonstrated significant learning effects, particularly on the C-TMT-B, and showed good test-retest reliability. Experiment 3 examined performance in subjects instructed to feign symptoms of traumatic brain injury: 44% of subjects produced abnormal completion times on the C-TMT-A, and 18% on the C-TMT-B. Malingering subjects could be distinguished from abnormally slow controls based on (1) disproportionate increases in dwell-time on the C-TMT-A, and (2) greater deficits on the C-TMT-A than on the C-TMT-B. Experiment 4 examined the performance of 28 patients with traumatic brain injury: C-TMT-B completion times were slowed, and TBI patients showed reduced movement velocities on both tests. The C-TMT improves the reliability and sensitivity of the trail making test of processing speed and executive function.
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Affiliation(s)
- David L. Woods
- Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America
- University of California Davis, Department of Neurology, 4860 Y St., Suite 3700, Sacramento, CA, 95817, United States of America
- Center for Neurosciences, University of California Davis, 1544 Newton Ct., Davis, CA, 95616, United States of America
- Center for Mind and Brain, University of California Davis, 202 Cousteau Place, Suite 201, Davis, CA, 95616, United States of America
- * E-mail:
| | - John M. Wyma
- Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America
| | - Timothy J. Herron
- Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America
| | - E. William Yund
- Human Cognitive Neurophysiology Laboratory, Veterans Affairs Northern California Heath Care System, 150 Muir Rd., Martinez, CA, 95553, United States of America
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Zimmermann N, Pereira N, Hermes-Pereira A, Holz M, Joanette Y, Fonseca RP. Executive functions profiles in traumatic brain injury adults: Implications for rehabilitation studies. Brain Inj 2015; 29:1071-81. [DOI: 10.3109/02699052.2015.1015613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Utilization of Biomechanics to Understand and Manage the Acute and Long-term Effects of Concussion. ACTA ACUST UNITED AC 2015. [DOI: 10.1123/kr.2014-0080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The acute and long-term effects of concussive and subconcussive head impacts on brain health have gained tremendous attention over the past five years. The treatment and management of concussion involves multiple providers from multiple disciplines and backgrounds. Varied backgrounds and approaches to assessing cognitive and motor function before and post-concussion are limiting factors in the efficient and effective management of concussion as discipline-specific rating scales and assessments serve as a barrier to effective patient hand-offs between providers. Combining principles of motor behavior with biomechanical approaches to data analysis has the potential to improve the continuity of care across the multiple providers managing athletes with concussion. Biomechanical measures have been developed and validated using mobile devices to provide objective and quantitative assessments of information processing, working memory, set switching, and postural stability. These biomechanical outcomes are integral to a clinical management algorithm, the Concussion Care Path, currently used across the Cleveland Clinic Health System. The objective outcomes provide a common data set that all providers in the spectrum of care can access which facilitates communication and the practice of medicine and in understanding the acute and long-term effects of concussion and subconcussive exposure on neurological function.
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Larson MJ, Clayson PE, Clawson A. Making sense of all the conflict: A theoretical review and critique of conflict-related ERPs. Int J Psychophysiol 2014; 93:283-97. [DOI: 10.1016/j.ijpsycho.2014.06.007] [Citation(s) in RCA: 253] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 06/06/2014] [Accepted: 06/10/2014] [Indexed: 01/06/2023]
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Pape TLB, High WM, St Andre J, Evans C, Smith B, Shandera-Ochsner AL, Wingo J, Moallem I, Baldassarre M, Babcock-Parziale J. Diagnostic accuracy studies in mild traumatic brain injury: a systematic review and descriptive analysis of published evidence. PM R 2014; 5:856-81. [PMID: 24160300 DOI: 10.1016/j.pmrj.2013.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 06/17/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To synthesize evidence and report findings from a systematic search and descriptive analysis of peer-reviewed published evidence of the accuracy of tests used for diagnosing mild traumatic brain injury (mTBI). The article also summarizes points of concurrence and divergence regarding case definitions of mTBI identified during the review. TYPE: Systematic review and descriptive analysis of published evidence. LITERATURE SURVEY A search of PubMed, PsychInfo, and the Cochrane Library for peer-reviewed publications between 1990 and July 6, 2011, identified 1218 abstracts; 277 articles were identified for full review, and 13 articles met the criteria for evaluation. METHODOLOGY Manuscript inclusion criteria were (1) reported sensitivity (Se) and specificity (Sp), or reported data were sufficient to compute Se and Sp; (2) >1 participant in the study; (3) at least 80% of the study cohort was ≥18 years of age; and (4) written in English. Articles describing clinical practice guidelines, opinions, theories, or clinical protocols were excluded. Seven investigators independently evaluated each article according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. SYNTHESIS Findings indicate that all 13 studies involved civilian noncombat populations. In 7 studies, authors examined acute mTBI, and in 4 studies, historical remote mTBI was examined. In the 13 studies, Se ranged from 13%-92% and Sp ranged from 72%-99%, but confidence in these findings is problematic because the STARD review indicates opportunities for bias in each study. CONCLUSIONS Findings indicate that no well-defined definition or clinical diagnostic criteria exist for mTBI and that diagnostic accuracy is currently insufficient for discriminating between mTBI and co-occurring mental health conditions for acute and historic mTBI. Findings highlight the need for research examining the diagnostic accuracy for acute and historic mTBI.
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Affiliation(s)
- Theresa L-B Pape
- Center for Innovation in Complex Chronic Healthcare & Research, The Department of Veterans Affairs (VA), Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL 60141; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL∗.
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King PR, Donnelly KT, Wade M, Donnelly JP, Dunnam M, Warner G, Kittleson CJ, Bradshaw CB, Alt M. The Relationships Among Premilitary Vocational Aptitude Assessment, Traumatic Brain Injury, and Postdeployment Cognitive Functioning in Combat Veterans. Arch Clin Neuropsychol 2014; 29:391-402. [DOI: 10.1093/arclin/acu011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Thaler NS, Linck JF, Heyanka DJ, Pastorek NJ, Miller B, Romesser J, Sim A, Allen DN. Heterogeneity in Trail Making Test performance in OEF/OIF/OND veterans with mild traumatic brain injury. Arch Clin Neuropsychol 2013; 28:798-807. [PMID: 24145667 DOI: 10.1093/arclin/act080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study used cluster analysis to examine variability in Trail Making Test (TMT) performance in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans referred for mild traumatic brain injury (mTBI). Three clusters were extracted, two of which were characterized by level of performance and the third with a unique performance pattern characterized by slow performance on the TMT B (Low B). Clusters did not differ on demographic or psychiatric variables. The Above Average cluster had better performance on measures of processing speed, working memory, and phonemic fluency compared with the Low B cluster. Results suggest that a subset of patients with mTBI perform poorly on TMT B, which subsequently predicts poorer cognitive functioning on several other neuropsychological measures. This subset may be vulnerable to cognitive changes in the context of mTBI and multiple comorbidities while a number of other patients remain cognitively unaffected under the same circumstances.
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Affiliation(s)
- Nicholas S Thaler
- Oklahoma City Department of Veteran Affairs Medical Center, Oklahoma City, OK, USA
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Chiaravalloti ND, Stojanovic-Radic J, DeLuca J. The role of speed versus working memory in predicting learning new information in multiple sclerosis. J Clin Exp Neuropsychol 2013; 35:180-91. [PMID: 23350959 DOI: 10.1080/13803395.2012.760537] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The most common cognitive impairments in multiple sclerosis (MS) have been documented in specific domains, including new learning and memory, working memory, and information processing speed. However, little attempt has been made to increase our understanding of their relationship to one another. While recent studies have shown that processing speed impacts new learning and memory abilities in MS, the role of working memory in this relationship has received less attention. The present study examines the relative contribution of impaired working memory versus processing speed in new learning and memory functions in MS. Participants consisted of 51 individuals with clinically definite MS. Participants completed two measures of processing speed, two measures of working memory, and two measures of episodic memory. Data were analyzed via correlational and multiple regression analysis. Results indicate that the variance in new learning abilities in this sample was primarily associated with processing speed, with working memory exerting much less of an influence. Results are discussed in terms of the role of cognitive rehabilitation of new learning and memory abilities in persons with MS.
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Affiliation(s)
- Nancy D Chiaravalloti
- Kessler Foundation Research Center, Neuropsychology and Neuroscience Laboratory, West Orange, NJ, USA.
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Krishnan M, Smith N, Donders J. Use of the Tower of London – Drexel University, Second Edition (TOLDX) in Adults With Traumatic Brain Injury. Clin Neuropsychol 2012; 26:951-64. [DOI: 10.1080/13854046.2012.708166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thaler NS, Allen DN, Hart JS, Boucher JR, McMurray JC, Mayfield J. Neurocognitive Correlates of the Trail Making Test for Older Children in Patients with Traumatic Brain Injury. Arch Clin Neuropsychol 2012; 27:446-52. [DOI: 10.1093/arclin/acs042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicholas S Thaler
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV 89073-5030, USA
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Dolan S, Martindale S, Robinson J, Kimbrel NA, Meyer EC, Kruse MI, Morissette SB, Young KA, Gulliver SB. Neuropsychological sequelae of PTSD and TBI following war deployment among OEF/OIF veterans. Neuropsychol Rev 2012; 22:21-34. [PMID: 22350690 PMCID: PMC5032645 DOI: 10.1007/s11065-012-9190-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent among Veterans of the conflicts in Iraq and Afghanistan. These conditions are associated with common and unique neuropsychological and neuroanatomical changes. This review synthesizes neuropsychological and neuroimaging studies for both of these disorders and studies examining their co-occurrence. Recommendations for future research, including use of combined neuropsychological and advanced neuroimaging techniques to study these disorders alone and in concert, are presented. It is clear from the dearth of literature that addiitonal studies are required to examine and understand the impact of specific factors on neurocognitive outcome. Of particular relevance are temporal relationships between PTSD and mTBI, risk and resilience factors associated with both disorders and their co-occurrence, and mTBI-specific factors such as time since injury and severity of injury, utilizing comprehensive, yet targeted cognitive tasks.
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Affiliation(s)
- Sara Dolan
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
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