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Merceur M, Reilly KT, Bonan I, Holé J, Hummel E, Cogné M, Jacquin-Courtois S. A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: Different programs at different times? Ann Phys Rehabil Med 2024; 67:101832. [PMID: 38537525 DOI: 10.1016/j.rehab.2024.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 12/04/2023] [Accepted: 02/10/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND "Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway. METHODS We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome. RESULTS Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies). CONCLUSION CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation. DATABASE REGISTRATION The review was recorded on Prospero (01-03-2020), with the registration number 135,627.
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Affiliation(s)
- Marianne Merceur
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.
| | - Karen T Reilly
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, 95 Boulevard Pinel, 69500 Bron, France
| | - Isabelle Bonan
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Julie Holé
- Physical Medicine and Rehabilitation Department, Henry Gabrielle Hospital, Hospices Civils de Lyon, 20 route de Vourles, 69230 Saint Genis Laval, France
| | - Emilie Hummel
- Hybrid team, Inria, Campus de Beaulieu, 263 Av. Général Leclerc, 35042 Rennes, France
| | - Mélanie Cogné
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Sophie Jacquin-Courtois
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, 95 Boulevard Pinel, 69500 Bron, France; Hybrid team, Inria, Campus de Beaulieu, 263 Av. Général Leclerc, 35042 Rennes, France
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Fry L, Logemann A, Waldron E, Holker E, Porter J, Eskridge C, Naini S, Basso MR, Taylor SE, Melnik T, Whiteside DM. Emotional functioning in long COVID: Comparison to post-concussion syndrome using the Personality Assessment Inventory. Clin Neuropsychol 2024; 38:963-983. [PMID: 37838973 DOI: 10.1080/13854046.2023.2264546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
Objective: Recent studies on Long COVID found that patients report prominent emotional distress and significant correlations between distress and cognitive performance have been identified, raising the question of how to manage or treat these issues. To understand psychological functioning in Long COVID further, this study examined personality responses on the Personality Assessment Inventory (PAI) to compare psychological functioning in a Long COVID group with a post-concussion syndrome (PCS) group, a syndrome with a significant psychological component. Participants and methods: Participants included 201 consecutive Long COVID outpatients (Mean age = 48.87 years, mean education = 14.82, 71.6% Female, 82.6% White) and a comparison group of 102 consecutively referred PCS outpatients (Mean age = 46.08, mean education = 14.17, 63.7% Female, 88.2% White). Effect sizes and t-tests were calculated using the PAI validity, clinical, interpersonal, and treatment consideration scales as well as clinical subscales. Results: The results replicated earlier findings on the PAI in Long COVID by demonstrating that both Long COVID and PCS groups had the highest mean elevations on SOM and DEP scales but no statistically significant between group differences in mean scale elevations. Results support similarities in psychological functioning between Long COVID and PCS patients emphasizing the importance of evaluating psychological functioning in neuropsychological evaluations for these populations. Further, results suggest that psychological treatment strategies for PCS patients may be helpful for Long COVID patients, but more research is needed.
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Affiliation(s)
- Laura Fry
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Allison Logemann
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Eric Waldron
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Erin Holker
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jim Porter
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Courtney Eskridge
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Savana Naini
- Graduate School of Professional Psychology, University of St Thomas, Saint Paul, MN, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, NY, USA
| | - Sarah E Taylor
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tanya Melnik
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Douglas M Whiteside
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
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Chaytor NS, Trapani VR, Braffett BH, Fonseca LM, Lorenzi GM, Gubitosi-Klug RA, Hitt S, Farrell K, Jacobson AM, Ryan CM. Utility of the NIH Toolbox Cognition Battery in middle to older aged adults with longstanding type 1 diabetes: The DCCT/EDIC study. Clin Neuropsychol 2024; 38:1007-1027. [PMID: 37814481 PMCID: PMC11001788 DOI: 10.1080/13854046.2023.2266876] [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: 04/11/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43-74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations (r = 0.36-0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed.
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Affiliation(s)
- Naomi S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | - Luciana M Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Gayle M Lorenzi
- Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rose A Gubitosi-Klug
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Hitt
- Ophthalmology, University of Missouri, Columbia, MO, USA
| | - Kaleigh Farrell
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Alan M Jacobson
- NYU Langone Long Island Hospital, NYU Long Island School of Medicine, Mineola, NY, USA
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Wickens CM, Mann RE, Stoduto G, Toccalino D, Colantonio A, Chan V. Work-related and non-work-related mild traumatic brain injury: Associations with mental health and substance use challenges in a Canadian population-level survey. Work 2024:WOR230418. [PMID: 38393873 DOI: 10.3233/wor-230418] [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: 02/25/2024] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) can profoundly impact overall health, employment, and family life. Incidence of mTBI in the workplace represents an important subgroup with poorer outcomes. Mental health (MH) and substance use (SU) challenges are a primary correlate of TBI, but are rarely assessed among individuals with a work-related (wr)-mTBI, particularly at a population-level. OBJECTIVE This study aimed to assess the association between lifetime wr-mTBI and non-wr-mTBI and the experience of MH and SU challenges. METHODS The 2019 Centre for Addiction and Mental Health (CAMH) Monitor is a cross-sectional telephone survey of adults aged≥18 years in Ontario, Canada, employing a stratified (six regions) two-stage (telephone number, respondent) list-assisted random digit dialing probability selection procedure (N = 1792). Adjusting for sociodemographic variables, binary logistic regression was conducted to assess the association between lifetime wr-mTBI and non-wr-mTBI (relative to no TBI) and four outcomes: hazardous use of alcohol and of cannabis, psychological distress, and fair/poor mental health. RESULTS Adjusting for sociodemographic variables, non-wr-mTBI demonstrated increased odds of hazardous alcohol (AOR = 2.12, 95% CI = 1.41, 3.19) and cannabis use (AOR = 1.61, 95% CI = 1.05, 2.45), psychological distress (AOR = 1.68, 95% CI = 1.14, 2.49), and fair/poor mental health (AOR = 1.70, 95% CI = 1.11, 2.59). Lifetime wr-mTBI demonstrated increased odds of reporting psychological distress (AOR = 3.40, 95% CI = 1.93, 5.97) and fair/poor mental health (AOR = 2.16, 95% CI = 1.12, 4.19) only. CONCLUSIONS Non-wr-mTBI was associated with both MH and SU, whereas wr-mTBI was associated with MH only. MH outcomes were more strongly associated with wr-mTBI than non-wr-mTBI. Physicians, employers, and insurers need to consider the potential association between wr-mTBI and MH, and provide care accordingly.
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Affiliation(s)
- Christine M Wickens
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Gina Stoduto
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Kite-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Vincy Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Kite-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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5
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Ashton Rennison VL, Chovaz CJ, Zirul S. Cognition and psychological well-being in adults with post COVID-19 condition and analyses of symptom sequelae. Clin Neuropsychol 2024; 38:326-353. [PMID: 37350239 DOI: 10.1080/13854046.2023.2227407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE As the coronavirus disease 2019 (COVID-19) pandemic moves into its fourth year, gaining a better clinical understanding of individuals with post COVID-19 condition is paramount. The current study examined the neurocognitive and psychological status of adults with post COVID-19 condition, as well as explored the impact of high psychological burden on objective neurocognitive functioning and the relationship between subjective cognitive concerns and objective neurocognitive findings. METHOD Valid neuropsychological assessments were completed with 51 symptomatic adults who were 297.55 days, on average, following a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Participants completed brief self-report depression, anxiety, and PTSD questionnaires, a questionnaire with subjective ratings of cognitive abilities, and standardized neurocognitive tests that examined performance validity, attention, processing speed, verbal learning and memory, naming, visual construction, and executive functioning. RESULTS The participants were mostly Caucasian (80.39%), middle-aged (average 47.37 years), women (82.35%), who were never hospitalized (86.27%). Despite all individuals reporting cognitive problems in daily life, mean performances on objective testing did not reveal any neurocognitive deficits (at or below the 8th percentile) at a group level. Approximately half (49.02%) of the participants reported co-occurring mental health symptoms that were considered clinically elevated based on questionnaire results. High psychological symptom burden was associated with greater subjective cognitive difficulties but did not result in neurocognitive dysfunction on objective testing. CONCLUSIONS This study contributes to the literature regarding post COVID-19 condition in adults including the relationship between the cognitive and psychological symptoms. Results are summarized in key clinical learning points.
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Affiliation(s)
- V Lynn Ashton Rennison
- Psychology Department, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine & Dentistry Department of Psychiatry, Western University, London, ON, Canada
| | - Cathy J Chovaz
- Psychology Department, King's University College at Western University, London, ON, Canada
| | - Sandra Zirul
- Psychology Department, London Health Sciences Centre, London, ON, Canada
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Mollusky A, Reynolds-Lallement N, Lee D, Zhong JY, Magnusson KR. Investigating the effects of age and prior military service on fluid and crystallized cognitive functions using virtual morris water maze (vMWM) and NIH Toolbox tasks. Arch Gerontol Geriatr 2024; 116:105156. [PMID: 37604015 DOI: 10.1016/j.archger.2023.105156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
Much of current knowledge of aging involves war veterans and research about age-related cognitive changes in veterans involves generalized or single function tests or health or neurological disorders. The current study examined military service within the context of comparisons of young and old humans involving generally healthy individuals to address normal age-associated cognitive changes. Adult participants included 11 young females (8 non-veterans; 3 veterans; 21-31 years), 5 young males (non-veterans, 21-24 years), 9 older females (non-veterans, 62-80 years), and 21 older males (11 non-veterans; 10 veterans; 60-86 years). They were tested in virtual Morris water maze (vMWM) tasks, which were designed to test spatial learning, cognitive flexibility and working memory, similar to rodent studies, and were validated by correlations with specific NIH Toolbox (NIH-TB) Cognitive Battery or Wechsler Memory Scale (WMS) Logical Memory I and II tests. Significant age-related deficits were seen on multiple vMWM tasks and NIH-TB fluid cognition tasks. Among older males, vMWM tasks appeared to be more sensitive, based on finding statistical differences, to prior military service than NIH Toolbox tasks. Compared with male non-veterans of comparable age and younger, older male veterans exhibited significant deficits in spatial learning, cognitive flexibility, and working memory on vMWM tasks. Our findings support continued development and characterization of vMWM tasks that are comparable between rodents and humans for translating aging interventions between species, and provide impetus for larger investigations examining the extent to which prior military service can serve as a "hidden" variable in normal biological declines of cognitive functions.
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Affiliation(s)
- Adina Mollusky
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States
| | - Nadjalisse Reynolds-Lallement
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States
| | - Dylan Lee
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States
| | - Jimmy Y Zhong
- Department of Psychology, School of Social and Health Sciences, James Cook University, Australia (Singapore campus), Singapore 387380, Singapore; College of Healthcare Sciences, James Cook University, Australia (Singapore campus), Singapore 387380, Singapore; Georgia State/Georgia Tech Center for Advanced Brain Imaging (CABI), Georgia Institute of Technology, Atlanta, GA 30318, United States
| | - Kathy R Magnusson
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, United States; Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, United States.
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Anderson JFI, Higson L, Wu MH, Seal ML, Yang JYM. Cerebral microhaemorrhage count is related to processing speed, but not level of symptom reporting, independently of age, psychological status and premorbid functioning, after first-ever mild traumatic brain injury. Brain Imaging Behav 2023; 17:608-618. [PMID: 37386315 PMCID: PMC10733206 DOI: 10.1007/s11682-023-00788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Cerebral microhaemorrhage is a commonly identified neuropathological consequence of mild traumatic brain injury (mTBI) and can be identified in vivo using susceptibility weighted imaging (SWI). This study aimed to determine whether SWI-detected microhaemorrhages are more common in individuals after a single, first-ever, mTBI event relative to trauma controls (TC) and to investigate whether a linear relationship exists between microhaemorrhage numbers and cognition or symptom reporting in the post-acute period after injury, independently of age, psychological status and premorbid level of functioning. Microhaemorrhagic lesions were identified by expert clinical examination of SWI for 78 premorbidly healthy adult participants who were admitted to hospital after a traumatic injury and had suffered a first-ever mTBI (n = 47) or no head strike (n = 31). Participants underwent objective cognitive examination of processing speed, attention, memory, and executive function as well as self-reported post-concussion symptomatology. Bootstrapping analyses were used as data were not normally distributed. Analyses revealed that the mTBI group had significantly more microhaemorrhages than the TC group (Cohen's d = 0.559). These lesions were only evident in 28% of individuals. The mTBI participants demonstrated a significant linear association between number of microhaemorrhages and processing speed, independently of age, psychological status, or premorbid level of functioning. This study shows that a single mTBI causes cerebral microhaemorrhages to occur in a minority of premorbidly healthy individuals. Greater microhaemorrhage count is independently associated with slower processing speed, but not symptom reporting, during the post-acute injury period.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
- Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Lana Higson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Michelle H Wu
- Medical Imaging, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
| | - Marc L Seal
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Neuroscience research, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
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Picon EL, Wardell V, Palombo DJ, Todd RM, Aziz B, Bedi S, Silverberg ND. Factors perpetuating functional cognitive symptoms after mild traumatic brain injury. J Clin Exp Neuropsychol 2023; 45:988-1002. [PMID: 37602857 DOI: 10.1080/13803395.2023.2247601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI. METHODS A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group. RESULTS Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group. CONCLUSIONS This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca M Todd
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bilal Aziz
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sanjana Bedi
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
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9
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Hungerford L, Agtarap S, Ettenhofer M. Impact of depression and post-traumatic stress on manual and oculomotor performance in service members with a history of mild TBI. Brain Inj 2023; 37:680-688. [PMID: 37204183 DOI: 10.1080/02699052.2023.2210293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/03/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To determine the impact of depression and post-traumatic stress on an automated oculomotor and manual measure of visual attention, compared to conventional neuropsychological assessment. Setting: Military traumatic brain injury (TBI) rehabilitation program. PARTICIPANTS 188 Active Duty Service Members (ADSM) with a history of mild TBI. DESIGN A cross-sectional and correlational study with data obtained through an IRB-approved data registry study. Main measures: Bethesda Eye & Attention Measure (BEAM); brief neuropsychological battery; self-reported symptom surveys including Neurobehavioral Symptom Inventory (NSI), Patient Health Questionnaire-8 (PHQ-8), and PTSD Checklist-5 (PCL-5). RESULTS Small effect sizes were found for partial correlations between both depression and post-traumatic stress and key BEAM metrics. In contrast, small-to-medium effects sizes were found across all traditional neuropsychological test measures. CONCLUSION This study illustrates the profile of impairments associated with depression and post-traumatic stress on saccadic eye movements and manual responses to BEAM relative to conventional neuropsychological tests. Results demonstrated that among ADSM seen for mTBI, depression and PTS exert a significant negative impact on measures of processing speed, attention, executive function, and memory across saccadic, manual, and conventional neuropsychological tests. However, the unique psychometric features of each of these assessment approaches may assist in distinguishing the effects of psychiatric comorbidities within this population.
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Affiliation(s)
- Lars Hungerford
- Traumatic Brain Injury Center of Excellence TBICoE, Bethesda, MD, USA
- Department of Clinical Support Services, Naval Medical Center San Diego, San Diego, CA, USA
| | - Stephanie Agtarap
- Traumatic Brain Injury Center of Excellence TBICoE, Bethesda, MD, USA
- Department of Clinical Support Services, Naval Medical Center San Diego, San Diego, CA, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Lyda Hill Institute for Human Resilience, Craig Hospital, Englewood, Colorado, USA
| | - Mark Ettenhofer
- Traumatic Brain Injury Center of Excellence TBICoE, Bethesda, MD, USA
- Department of Clinical Support Services, Naval Medical Center San Diego, San Diego, CA, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Department of Psychiatry, University of California, San Diego,CA, USA
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Chen PY, Su IC, Shih CY, Liu YC, Su YK, Wei L, Luh HT, Huang HC, Tsai PS, Fan YC, Chiu HY. Effects of Neurofeedback on Cognitive Function, Productive Activity, and Quality of Life in Patients With Traumatic Brain Injury: A Randomized Controlled Trial. Neurorehabil Neural Repair 2023:15459683231170539. [PMID: 37125901 DOI: 10.1177/15459683231170539] [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: 05/02/2023]
Abstract
BACKGROUND Cognitive impairment is common in patients with traumatic brain injury (TBI). Studies that have examined the effectiveness of neurofeedback (NFB) on cognitive function following TBI have had poor study designs and small sample sizes. OBJECTIVES This randomized controlled trial assessed the effects of low-resolution tomography Z-score NFB (LZNFB) and theta/beta NFB on cognitive impairment, return to productive activity, and quality of life in patients with TBI. METHODS We randomly assigned 87 patients with TBI with cognitive impairment to LZNFB, theta/beta NFB, or usual care (UC) groups. Patients in both NFB groups received weekly 60-minute treatment for 10 weeks, and those in the control group received UC and telephone interviews for 10 weeks. The primary outcome was cognitive function as measured by performance on cognitive tasks; the secondary outcomes included productive activity and quality of life based on the Community Integration Questionnaire-revised (CIQ-R) and the Quality of Life after Brain Injury (QOLIBRI), respectively, at baseline and immediately after the last intervention. RESULTS The LZNFB group exhibited significantly greater improvements in immediate recall, delayed recall, recognition memory, and selective attention compared with the UC group; the theta/beta NFB group exhibited improvements in only immediate memory and selective attention (P < .05). The total CIQ-R scores of the LZNFB group after treatment were significantly improved than those of the UC group were. CONCLUSION Consecutive LZNFB achieved therapeutic effects in memory, attention, and productive activity, whereas theta/beta NFB improved memory and attention in patients with TBI.This trial was prospectively registered at ClinicalTrial.gov (registration number: NCT03515317; https://clinicaltrials.gov/ct2/show/NCT03515317).
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Affiliation(s)
- Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Keelung Branch, Keelung City, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan
| | - I-Chang Su
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chun-Ying Shih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yen-Chun Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yu-Kai Su
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li Wei
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan
| | - Hui-Tzung Luh
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei City, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
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11
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Silverberg ND, Mikolić A. Management of Psychological Complications Following Mild Traumatic Brain Injury. Curr Neurol Neurosci Rep 2023; 23:49-58. [PMID: 36763333 DOI: 10.1007/s11910-023-01251-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW It has been clear for decades that psychological factors often contribute to mild traumatic brain injury (mTBI) outcome, but an emerging literature has begun to clarify which specific factors are important, when, for whom, and how they impact recovery. This review aims to summarize the contemporary evidence on psychological determinants of recovery from mTBI and its implications for clinical management. RECENT FINDINGS Comorbid mental health disorders and specific illness beliefs and coping behaviors (e.g., fear avoidance) are associated with worse recovery from mTBI. Proactive assessment and intervention for psychological complications can improve clinical outcomes. Evidence-based treatments for primary mental health disorders are likely also effective for treating mental health disorders after mTBI, and can reduce overall post-concussion symptoms. Broad-spectrum cognitive-behavioral therapy may modestly improve post-concussion symptoms, but tailoring delivery to individual psychological risk factors and/or symptoms may improve its efficacy. Addressing psychological factors in treatments delivered primarily by non-psychologists is a promising and cost-effective approach for enhancing clinical management of mTBI. Recent literature emphasizes a bio-psycho-socio-ecological framework for understanding mTBI recovery and a precision rehabilitation approach to maximize recovery. Integrating psychological principles into rehabilitation and tailoring interventions to specific risk factors may improve clinical management of mTBI.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada.
| | - Ana Mikolić
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada
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12
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Gopi Y, Wilding E, Madan CR. Memory rehabilitation: restorative, specific knowledge acquisition, compensatory, and holistic approaches. Cogn Process 2022; 23:537-557. [PMID: 35790619 PMCID: PMC9553770 DOI: 10.1007/s10339-022-01099-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
Memory impairment following an acquired brain injury can negatively impact daily living and quality of life—but can be reduced by memory rehabilitation. Here, we review the literature on four approaches for memory rehabilitation and their associated strategies: (1) the restorative approach, aimed at a return to pre-morbid functioning, (2) the knowledge acquisition approach, involving training on specific information relevant to daily life, (3) the compensatory approach, targeted at improving daily functioning, and (4) the holistic approach, in which social, emotional, and behavioral deficits are addressed alongside cognitive consequences of acquired brain injury. Each memory rehabilitation approach includes specific strategies such as drill and practice (restorative), spaced retrieval (knowledge acquisition), memory aids (compensatory), or a combination of psychotherapy and cognitive strategies (holistic). Past research has demonstrated mixed support for the use of restorative strategies to improve memory function, whereas knowledge acquisition strategies show promising results on trained tasks but little generalization to untrained tasks and activities of daily living. Compensatory strategies remain widely used but require intensive training to be effectively employed. Finally, the holistic approach is becoming more widespread due to improvements in psychosocial wellbeing, yet there are considerable resource and cost requirements. Several factors can influence rehabilitation outcomes including metacognition and emotional disturbances. Considerations for future research to improve the applicability of strategies for memory rehabilitation include assessing memory impairment severity, examining memory needs in daily life, and exploring the long-term effects of memory rehabilitation.
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Affiliation(s)
- Yashoda Gopi
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Edward Wilding
- School of Psychology, University of Birmingham, Birmingham, UK
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13
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Silverberg ND, Otamendi T, Brasher PM, Brubacher JR, Li LC, Lizotte PP, Panenka WJ, Scheuermeyer FX, Archambault P. Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial. BMJ Open 2022; 12:e062527. [PMID: 35728892 PMCID: PMC9214410 DOI: 10.1136/bmjopen-2022-062527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mental health problems frequently interfere with recovery from mild traumatic brain injury (mTBI) but are under-recognised and undertreated. Consistent implementation of clinical practice guidelines for proactive detection and treatment of mental health complications after mTBI will require evidence-based knowledge translation strategies. This study aims to determine if a guideline implementation tool can reduce the risk of mental health complications following mTBI. If effective, our guideline implementation tool could be readily scaled up and/or adapted to other healthcare settings. METHODS AND ANALYSIS We will conduct a triple-blind cluster randomised trial to evaluate a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care. We will recruit 535 adults (aged 18-69 years) with mTBI from six emergency departments and two urgent care centres in the Greater Vancouver Area, Canada. Upon enrolment at 2 weeks post-injury, they will complete mental health symptom screening tools and designate a general practitioner (GP) or primary care clinic where they plan to seek follow-up care. Primary care clinics will be randomised into one of two arms. In the guideline implementation tool arm, GPs will receive actionable mental health screening test results tailored to their patient and their patients will receive written education about mental health problems after mTBI and treatment options. In the usual care control arm, GPs and their patients will receive generic information about mTBI. Patient participants will complete outcome measures remotely at 2, 12 and 26 weeks post-injury. The primary outcome is rate of new or worsened mood, anxiety or trauma-related disorder on the Mini International Neuropsychiatric Interview at 26 weeks. ETHICS AND DISSEMINATION Study procedures were approved by the University of British Columbia's research ethics board (H20-00562). The primary report for the trial results will be published in a peer-reviewed journal. Our knowledge user team members (patients, GPs, policymakers) will co-create a plan for public dissemination. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04704037).
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Thalia Otamendi
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Penelope Ma Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Patrick Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, Québec, Canada
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14
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Rioux M, Wardell V, Palombo DJ, Picon EL, Le ML, Silverberg ND. Memory for forgetting in adults with persistent symptoms following concussion. J Clin Exp Neuropsychol 2022; 44:19-30. [PMID: 35536243 DOI: 10.1080/13803395.2022.2067326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Persistent memory complaints following concussion often do not coincide with evidence of objective memory impairment. To the extent this clinical presentation represents Functional Cognitive Disorder (FCD), we would expect preservation or even enhancement of memory for instances of forgetting, based on two lines of prior evidence. First, emotional arousal enhances autobiographical memory. People who experience memory lapses as worrisome may better remember them. Second, individuals with FCD can paradoxically provide detailed accounts of memory lapses compared to patients with neurodegenerative disease, who tend to provide vague examples. The current study aimed to better characterize the recall of forgetting events in people with subjective memory problems following concussion. METHODS The study sample consisted of adults with chronic post-concussion symptoms (N = 37, M = 42.7 years old; 70.27% women; M = 24.9 months post-injury) and normal-range performance on conventional neuropsychological tests. Participants completed a measure of memory complaint severity and the Autobiographical Interview (AI). The AI was used to quantify the richness of narrative recollections of recent instances when they forgot something and (control) personal events that did not involve forgetting. Linear regression modeling assessed the relationship between memory complaint severity and AI variables, including narrative details, valence, arousal, and rehearsal of memories. RESULTS There was no association between memory complaint severity and memory for forgetting vs. control events. We further found no association between memory complaint severity and AI performance overall (collapsing across forgetting and control events). Participants with greater memory complaints experienced past memory lapses as more negative than control memories, but did not consistently differ on other AI phenomenological variables. CONCLUSION Autobiographical recall of memory lapses appears preserved but not selectively heightened in people who report experiencing severe memory problems long after concussion. This inconsistency supports conceptualization of persistent memory complaints after concussion as FCD.
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Affiliation(s)
- Mathilde Rioux
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - M Lindy Le
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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15
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The Relationship Between Cognitive Functioning and Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder in Adults with a Traumatic Brain Injury: a Meta-Analysis. Neuropsychol Rev 2021; 32:758-806. [PMID: 34694543 DOI: 10.1007/s11065-021-09524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.
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16
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Anderson JFI, Cockle E. Investigating the Effect of Fatigue and Psychological Distress on Information Processing Speed in the Postacute Period After Mild Traumatic Brain Injury in Premorbidly Healthy Adults. Arch Clin Neuropsychol 2021; 36:918-920. [PMID: 33388744 DOI: 10.1093/arclin/acaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 11/14/2022] Open
Abstract
Impairments in processing speed under conditions of increasing cognitive load have been reported in individuals with mild traumatic brain injury (mTBI). In other conditions that are also associated with white matter disruption, both psychological distress and fatigue have been shown to underlie this impairment. OBJECTIVE the current study aimed to investigate whether slowing of processing abilities under conditions of greater cognitive load is independent of fatigue and psychological status in premorbidly healthy individuals with subacute mTBI. METHOD using a prospective observational design, we examined 84 individuals with mTBI approximately 8 weeks after injury and 47 healthy control (HC) participants. They were assessed with the Symbol Digit Modality Test, an n-back task and a rate of gain of information choice reaction time task that conforms to Hick's law. Participants were also assessed with measures of fatigue and psychological status. RESULTS as expected, findings revealed no group differences on simple reaction time tasks, but as task complexity increased, the mTBI group performed more slowly than the HC group. This group difference occurred independently of fatigue and psychological distress levels and was associated with a moderate effect size. CONCLUSIONS during the subacute period after mTBI, premorbidly healthy individuals demonstrate impairment in their ability to rapidly process information as the cognitive load of the task increases beyond simple reaction time requirements. Examination of whether these changes affect resumption of premorbid roles is warranted.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria 3010, Australia.,Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, Victoria, 3181, Australia
| | - Emily Cockle
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria 3010, Australia
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17
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Fortier-Lebel O, Jobin B, Lécuyer-Giguère F, Gaubert M, Giguère JF, Gagnon JF, Boller B, Frasnelli J. Verbal Episodic Memory Alterations and Hippocampal Atrophy in Acute Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:1506-1514. [PMID: 33724054 DOI: 10.1089/neu.2020.7475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Episodic memory deficit is a symptom frequently observed after a mild traumatic brain injury (mTBI). However, few studies have investigated the impact of a single and acute mTBI on episodic memory and structural cerebral changes. To do so, we conducted two experiments. In the first, we evaluated verbal episodic memory by using a word recall test, in 52 patients with mTBI (mean age 33.1 [12.2] years) 2-4 weeks after a first mTBI, compared with 54 healthy controls (31.3 [9.2] years) and followed both groups up for 6 months. In the second, we measured hippocampal volume in a subset of 40 participants (20 patients with mTBI, 20 controls) from Experiment 1 using magnetic resonance imaging (MRI; T1-weighted images) and correlated memory performance scores to hippocampal volume. Experiment 1 showed significantly reduced verbal episodic memory within the first month after an mTBI and a tendency for a reduction 6 months later, more pronounced for men. In Experiment 2, patients with mTBI exhibited a generally reduced hippocampal volume; however, we did not observe any linear correlation between hippocampal volume and memory scores. These results suggest that one single mTBI is associated with both episodic memory alteration and reduced volume of the hippocampus in the acute phase. Future studies are needed to elucidate the link between both measures.
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Affiliation(s)
- Olivier Fortier-Lebel
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.,Research Centre of the Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Benoît Jobin
- Research Centre of the Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.,Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Fanny Lécuyer-Giguère
- Research Centre of the Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Malo Gaubert
- Research Centre of the Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.,Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Jean-François Gagnon
- Research Centre of the Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.,Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Benjamin Boller
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.,Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Johannes Frasnelli
- Research Centre of the Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.,Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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18
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Cherevatenko RF, Antsiferov OV, Skachilova SY, Pokrovsky MV, Gureev VV, Banchuk II, Banchuk AY, Golubinskaya MI, Syromyatnikova AA, Rozhkov IS, Mostovykh AA. THE SEARCH FOR NEUROPROTECTIVE COMPOUNDS AMONG NEW ETHYLTHIADIAZOLE DERIVATIVES. PHARMACY & PHARMACOLOGY 2021. [DOI: 10.19163/2307-9266-2019-8-4-263-272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of the study is to search compounds with neuroprotective properties among new ethylthiadiazole derivatives in simulated traumatic brain injury.Materials and methods. The experiment was carried out on 78 white male rats 270±20 g line “Wistar” 5–6 months of age and 120 outbred sexually mature mice weighing 20±2 grams. The article describes the search for compounds with neuroprotective properties among new ethylthiadiazole derivatives under the codes LKHT 4–15, LKHT 10–18, LKHT 11–18, and LKHT 12–18 in experimental traumatic brain injury in rats. Acute toxicity of the compounds was studied. Pharmacological screening was performed using behavioral and neurological research methods. The McGraw stroke score scale modified by I.V. Gannushkina and the mNSS psychometric scale were used in the study. The open field and Rota-rod tests were used to assess the behavioral status of the animals.Results. The compound-LKHT 12–18 at a dose of 50 mg/kg was detected as a leader. In pharmacological correction of pathology, this compound had the lowest percentage of fatality among the studied compounds (8%), the severity of neurological deficit was significantly reduced, the lowest scores and a higher level of motor activity of the limbs were registered. The number of rearing in the group of animals receiving the compound LKHT 12–18 at the dose of 50 mg/kg increased by 1.5 times, statistically significant (p<0.05) in comparison with the control group. Based on the results of the “Rota-rod” test, the total time of holding animals on the rod for 3 attempts was statistically significantly different in the groups administered with LKHT 12–18 derivatives (1.5 times longer) at the dose of 50 mg/kg compared with the control (p<0.05).Conclusion. Based on the results obtained in this study, it is planned to study in more detail the compound LKHT 12–18 at the dose of 50 mg/kg.
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Affiliation(s)
| | | | - S. Y. Skachilova
- Russian Scientific Center for the Safety of Biologically Active Substances
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Anderson JFI. Cognitive complaint and objective cognition during the post-acute period after mild traumatic brain injury in pre-morbidly healthy adults. Brain Inj 2021; 35:103-113. [PMID: 33459065 DOI: 10.1080/02699052.2020.1859613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary Objective:The most widely used proxies of cognitive complaint after mTBI are post-concussion syndrome (PCS) symptom checklists, which do not have a clear relationship with cognition. This study investigated whether an mTBI-specific cognitive complaint measure would have clearer associations with objective cognition than a widely used PCS symptom checklist.Research Design:An observational design was used. A sample of 109 participants (52 mTBI and 57 healthy controls) completed a PCS symptom checklist, a cognitive complaint measure, and measures of information processing speed, attention, memory, executive function, depression and anxiety.Main Outcomes and Results:In the healthy control group, cognitive complaint was significantly associated with objective cognitive performance and was not associated with psychological status. In contrast, PCS endorsement was unrelated to objective cognition but was associated with psychological status. For the mTBI group, neither PCS endorsement nor cognitive complaint was associated with cognitive performance, but both measures were associated with psychological status.Conclusions:This study indicates that neither cognitive nor PCS symptom measures are reliable indicators of underlying cognitive function in the post-acute period after mTBI. Further, suffering an mTBI may affect the linear relationship that exists between cognitive symptom endorsement and cognitive function in healthy adults.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Psychology Department, The Alfred Hospital, Melbourne, Australia
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20
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Young G. Thirty Complexities and Controversies in Mild Traumatic Brain Injury and Persistent Post-concussion Syndrome: a Roadmap for Research and Practice. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09395-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Abstract
Optimizing transcranial magnetic stimulation (TMS) treatments in traumatic brain injury (TBI) and co-occurring conditions may benefit from neuroimaging-based customization. PARTICIPANTS Our total sample (N = 97) included 58 individuals with TBI (49 mild, 8 moderate, and 1 severe in a state of disordered consciousness), of which 24 had co-occurring conditions (depression in 14 and alcohol use disorder in 10). Of those without TBI, 6 individuals had alcohol use disorder and 33 were healthy controls. Of our total sample, 54 were veterans and 43 were civilians. DESIGN Proof-of-concept study incorporating data from 5 analyses/studies that used multimodal approaches to integrate neuroimaging with TMS. MAIN MEASURES Multimodal neuroimaging methods including structural magnetic resonance imaging (MRI), MRI-guided TMS navigation, functional MRI, diffusion MRI, and TMS-induced electric fields. Outcomes included symptom scales, neuropsychological tests, and physiological measures. RESULTS It is feasible to use multimodal neuroimaging data to customize TMS targets and understand brain-based changes in targeted networks among people with TBI. CONCLUSIONS TBI is an anatomically heterogeneous disorder. Preliminary evidence from the 5 studies suggests that using multimodal neuroimaging approaches to customize TMS treatment is feasible. To test whether this will lead to increased clinical efficacy, studies that integrate neuroimaging and TMS targeting data with outcomes are needed.
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22
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Silverberg ND, Panenka WJ, Lizotte PP, Bayley MT, Dance D, Li LC. Promoting early treatment for mild traumatic brain injury in primary care with a guideline implementation tool: a pilot cluster randomised trial. BMJ Open 2020; 10:e035527. [PMID: 33082178 PMCID: PMC7577038 DOI: 10.1136/bmjopen-2019-035527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES New clinical practice guidelines for the management of mild traumatic brain injury (mTBI) emphasise that family physicians should proactively screen and initiate treatment for depression/anxiety, insomnia and headaches. This study aimed to evaluate the feasibility of delivering an implementation intervention to family physicians. DESIGN Pilot cluster randomised controlled trial. SETTING Specialty outpatient clinic (recruitment) and primary care (implementation). PARTICIPANTS 114 primary care clinics were randomised. These clinics were associated with 137 unique family physicians caring for 148 adult patients who sustained an mTBI within the previous 3 months and were seeking care for persistent symptoms. INTERVENTIONS Patients completed self-report screening measures for depression/anxiety, insomnia and headaches. A tailored letter that incorporates the patient's screening test results and associated treatment algorithms was sent to their family physician (or walk-in clinic). Physicians at clinics assigned to the control condition received a generic letter, without the screening test results. PRIMARY OUTCOME MEASURES Feasibility outcomes included the frequency of primary care follow-up, retention rates and reliability of patient recall of their physicians' actions (primary mechanistic outcome). The primary efficacy outcome was the Rivermead Post-Concussion Symptom Questionnaire (RPQ). RESULTS Most patients (97.8%; 128 of 131) followed up at the primary care clinic they planned to. Retention rates were 88% (131 of 148) and 78% (116 of 148) at the 1-month and 3-month assessments, respectively. Agreement between patient recall of their physicians' actions and medical chart audits was moderate (intraclass correlation coefficient=0.48-0.65). Patients in the experimental group reported fewer symptoms on the RPQ compared with those in the control group, whose physician received a general letter (B=-4.0, 95% CI: -7.3 to -0.7). CONCLUSIONS A larger trial will need to address minor feasibility challenges to evaluate the effectiveness of this guideline implementation tool for improving mTBI clinical outcomes and confirm the mechanism(s) of intervention benefit. TRIAL REGISTRATION NUMBER NCT03221218.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
- BC Neuropsychiatry Program, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Mark T Bayley
- Hull-Ellis Concussion Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Derry Dance
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Acquired Brain Injury Program, GF Strong Rehabilitation Hospital, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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Faulkner JW, Theadom A, Mahon S, Snell DL, Barker-Collo S, Cunningham K. Psychological flexibility: A psychological mechanism that contributes to persistent symptoms following mild traumatic brain injury? Med Hypotheses 2020; 143:110141. [DOI: 10.1016/j.mehy.2020.110141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
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24
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Esterov D, Lennon RJ, Bergquist T, Brown A. Predictors of neurobehavioral symptom reporting in a community based sample with mild traumatic brain injury. NeuroRehabilitation 2020; 47:65-77. [DOI: 10.3233/nre-203082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Ryan J. Lennon
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Thomas Bergquist
- Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Allen Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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25
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Sanborn V, Gunstad J, Shrestha R, Mistler CB, Copenhaver MM. Cognitive profiles in persons with opioid use disorder enrolled in methadone treatment. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:462-468. [PMID: 32463730 DOI: 10.1080/23279095.2020.1769099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cognitive impairment is common in persons with opioid use disorder and associated with poor treatment outcomes, including elevated risk for relapse. Much less is known about the underlying structure of these deficits and the possible presence of cognitive phenotypes. A total of 177 adults (average 42.2 years of age, 52.0% male, 65.5% Caucasian) enrolled in a methadone maintenance treatment program completed the NIH Toolbox as part of a larger project. Cluster analyses revealed a 2-cluster solution-persons with intact cognitive function in all domains (n = 93; Intact) and those with impairments on tests of attention and executive function (n = 83; Impaired). Follow-up analyses revealed that the Impaired group was slightly older, more likely to self-identify as a racial/ethnic minority, and less likely to report consuming alcohol four or more times per week. These findings suggest the existence of distinct cognitive profiles in persons with opioid use disorder and encourage further examination, particularly studies to examine the possible benefits of routine screening for cognitive impairment as part of substance use treatment.
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Affiliation(s)
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH, USA
| | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.,Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Colleen B Mistler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael M Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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26
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Cassetta BD, Menon M, Carrion PB, Pearce H, DeGraaf A, Leonova O, White RF, Stowe RM, Honer WG, Woodward TS, Torres IJ. Preliminary examination of the validity of the NIH toolbox cognition battery in treatment-resistant psychosis. Clin Neuropsychol 2019; 34:981-1003. [PMID: 31782350 DOI: 10.1080/13854046.2019.1694072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Prior research has suggested that treatment-resistant psychosis (TRP) may be a categorically distinct subtype from treatment-responsive psychotic disorders. However, relatively few studies have investigated the cognitive profile of individuals with TRP. Moreover, no prior studies have investigated the effectiveness of using the NIH Toolbox Cognition Battery (NTCB) for assessing cognition among psychiatric inpatients despite its promising efficiency and practicality in such settings. The current study aimed to investigate the validity of the NTCB and the associated cognitive profile of inpatients with TRP.Methods: Participants (N = 38) were administered the NTCB and a neuropsychological test battery. The Positive and Negative Syndrome Scale and the Routine Assessment of Patient Progress measured psychosis symptomatology and daily functioning, respectively.Results: Results showed deficits relative to normative values in fluid cognitive abilities using the NTCB, as predicted. There was strong convergent validity and adequate divergent validity between the NTCB subtests and corresponding neuropsychological measures, though no NTCB subtest correlated with performance on the Wisconsin Card Sorting Task. NTCB performance correlated with positive and disorganized symptoms of psychosis as well as daily functioning.Conclusions: Taken together, the NTCB appears to be a relatively strong tool for cognitive screening among psychiatric inpatients and may be used to identify which patients might benefit from further neuropsychological evaluation.
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Affiliation(s)
- Briana D Cassetta
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Vancouver Coastal Health, Vancouver, BC, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Prescilla B Carrion
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Hadley Pearce
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ashley DeGraaf
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Robert M Stowe
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
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27
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Silverberg ND, Panenka WJ. Antidepressants for depression after concussion and traumatic brain injury are still best practice. BMC Psychiatry 2019; 19:100. [PMID: 30917802 PMCID: PMC6438030 DOI: 10.1186/s12888-019-2076-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/12/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Depression is a common complication of traumatic brain injury (TBI). New evidence suggests that antidepressant medication may be no more effective than placebo in this population. MAIN BODY Selective serotonin reuptake inhibitors are recommended as first-line treatment for depression in contemporary expert consensus clinical practice guidelines for management of TBI. This recommendation is based on multiple prior meta-analyses of clinical trials in depression after TBI as well as depression in the general population. The evidence is mixed. A recent clinical trial and new meta-analysis including that trial found no benefit of antidepressants for depression following TBI. We argue that this finding should not change practice, i.e., patients who present with depression after TBI should still be considered for antidepressant treatment, because they may (1) benefit from robust placebo effects, (2) benefit from an alternative or adjunctive medication if the agent prescribed first does not achieve a depression remission, and (3) make improvements that are not captured well by traditional depression outcome measures, which are confounded by TBI sequelae. Patients with mild TBI are especially appropriate for antidepressant therapy because they, on average, more closely resemble patients with no known TBI history enrolled in typical primary Major Depressive Disorder clinical trials than patients enrolled in TBI trials in placebo-controlled trials published to date. CONCLUSION TBI, and especially mild TBI, is not a contraindication for antidepressant therapy. Health providers should routinely screen and initiate treatment for depression after TBI.
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Affiliation(s)
- Noah D. Silverberg
- 0000 0001 2288 9830grid.17091.3eDivision of Physical Medicine and Rehabilitation, University of British Columbia, 4255 Laurel St, Vancouver, BC V5Z 2G9 Canada ,0000 0004 0384 4428grid.417243.7Rehabilitation Research Program, Vancouver Coastal Health Research Institute, GF Strong Rehab Centre, 4255 Laurel St, Vancouver, British Columbia V5Z 2G9 Canada
| | - William J. Panenka
- 0000 0001 2288 9830grid.17091.3eDivision of Physical Medicine and Rehabilitation, University of British Columbia, 4255 Laurel St, Vancouver, BC V5Z 2G9 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada; 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, British Columbia Mental Health and Addictions Research Institute, University of British Columbia, Vancouver, Canada; 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
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28
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Review of the Management of Pediatric Post-Concussion Syndrome-a Multi-Disciplinary, Individualized Approach. Curr Rev Musculoskelet Med 2019; 12:57-66. [PMID: 30758705 DOI: 10.1007/s12178-019-09533-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Post-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS. RECENT FINDINGS There is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms. Vestibular-ocular dysfunction should be evaluated and managed appropriately. Neuropsychological recovery is expected, but requires appropriate attention to Return to Learn. Emotional symptoms are common in PCS and the evidence supports treatment with cognitive behavioral therapy. PCS presents a unique therapeutic challenge affecting multiple domains for patients-physical, sleep, cognitive, and emotional. Successful management of PCS requires a multi-disciplinary and individualized approach. There remains a significant need for further research, specifically looking into the outcomes and effective interventions in pediatric PCS.
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29
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Li F, Wang X, Deng Z, Zhang X, Gao P, Liu H. Dexmedetomidine reduces oxidative stress and provides neuroprotection in a model of traumatic brain injury via the PGC-1α signaling pathway. Neuropeptides 2018; 72:58-64. [PMID: 30396595 DOI: 10.1016/j.npep.2018.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 01/19/2023]
Abstract
The protective effects of dexmedetomidine (DEX) mediated by reductions of oxidative stress, mitochondrial damage and disintegration have been demonstrated in many injury models. However, whether DEX has a beneficial effect on traumatic brain injury (TBI) remains unknown. In this study, the neuroprotective effect of DEX and its potential mechanism were assessed in a model of TBI. DEX treatment relieved encephala edema and neuron cell apoptosis and increased behavioral function. These protective effects were accompanied by upregulation of peroxisome proliferator-activated receptor gamma coactivator-1 (PGC-1α) expression. These findings imply that DEX protects neurons following TBI, possibly by activating the PGC-1α pathway. The data will help clarify the mechanisms responsible for the anti-apoptosis effect of DEX with possible involvement of the PGC-1α pathway.
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Affiliation(s)
- Fayin Li
- Department of Anesthesiology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223002, Jiangsu, China
| | - Xiaodong Wang
- Department of Neurosurgery, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223002, Jiangsu, China
| | - Zhikui Deng
- Department of Central Laboratory, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223002, Jiangsu, China
| | - Xianlong Zhang
- Department of Anesthesiology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223002, Jiangsu, China
| | - Pengfei Gao
- Department of Anesthesiology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223002, Jiangsu, China
| | - Hailin Liu
- Department of Anesthesiology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223002, Jiangsu, China.
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30
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Ito M, Seo E, Maeno T, Ogawa R, Maeno T. Relationship Between Depression and Stress Coping Ability Among Residents in Japan: A Two-Year Longitudinal Study. J Clin Med Res 2018; 10:715-721. [PMID: 30116442 PMCID: PMC6089576 DOI: 10.14740/jocmr3512w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/05/2018] [Indexed: 12/21/2022] Open
Abstract
Background Depression among medical residents is a critical issue. The early detection of depression and provision of appropriate care is necessary for fostering healthy conditions during clinical training. To investigate whether Sense of Coherence (SOC), an indicator of stress coping ability, could be a predictor of depression 2 years after the start of clinical training, we conducted a national longitudinal study. Methods We distributed self-administered questionnaires to residents in 251 postgraduate educational hospitals just before the start of their clinical training. The questionnaire contained the Center for Epidemiologic Studies Depression (CES-D) scale (a screening tool for depression), the SOC scale, and demographic factors. After 2 years, we distributed questionnaires to residents who responded to the first survey. The second questionnaire contained the CES-D scale and questions about working conditions. We categorized respondents into three groups according to their SOC score and analyzed the relationship between SOC groups (low, middle, high) and depressive symptoms on the follow-up survey. Results In total, 1,738 of 2,935 residents (59.2%) responded to the first survey. Of these, 1,169 residents (67.3%) also responded to the follow-up survey. A total of 169 residents were excluded because they screened positive for depressive symptoms at the time of the first survey. On the follow-up survey, 187 residents (19.5%) had new-onset depressive symptoms: 33.3% in the low SOC group, 18.2% in the middle SOC group, and 11.4% in the high SOC group (P < 0.01). Compared with the high SOC group, the odds ratio for new-onset depressive symptoms in the low SOC group was 2.04 (95% confidence interval, 1.02 - 4.05) after adjusting for demographic factors, baseline CES-D score, and mean working time. Conclusions SOC score is significantly associated with future depressive symptoms among residents after 2 years. Residents in the low SOC group had a 2-fold higher risk of future depressive symptoms than those in the high SOC group. The SOC scale might be a useful predictor of future depression and allow for the provision of appropriate support to residents during clinical training.
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Affiliation(s)
- Makoto Ito
- Wakaba Home Care Clinic, Tsuchiura, Ibaraki, Japan.,Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Emiko Seo
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Center for Medical Education and Training, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryoko Ogawa
- Center for Medical Education and Training, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Center for Medical Education and Training, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
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