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Gimbel SI, Wang CC, Hungerford L, Twamley EW, Ettenhofer ML. Associations of mTBI and post-traumatic stress to amygdala structure and functional connectivity in military Service Members. FRONTIERS IN NEUROIMAGING 2023; 2:1129446. [PMID: 37554633 PMCID: PMC10406312 DOI: 10.3389/fnimg.2023.1129446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/07/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is one of the highest public health priorities, especially among military personnel where comorbidity with post-traumatic stress symptoms and resulting consequences is high. Brain injury and post-traumatic stress symptoms are both characterized by dysfunctional brain networks, with the amygdala specifically implicated as a region with both structural and functional abnormalities. METHODS This study examined the structural volumetrics and resting state functional connectivity of 68 Active Duty Service Members with or without chronic mild TBI (mTBI) and comorbid symptoms of Post-Traumatic Stress (PTS). RESULTS AND DISCUSSION Structural analysis of the amygdala revealed no significant differences in volume between mTBI and healthy comparison participants with and without post-traumatic stress symptoms. Resting state functional connectivity with bilateral amygdala revealed decreased anterior network connectivity and increased posterior network connectivity in the mTBI group compared to the healthy comparison group. Within the mTBI group, there were significant regions of correlation with amygdala that were modulated by PTS severity, including networks implicated in emotional processing and executive functioning. An examination of a priori regions of amygdala connectivity in the default mode network, task positive network, and subcortical structures showed interacting influences of TBI and PTS, only between right amygdala and right putamen. These results suggest that mTBI and PTS are associated with hypo-frontal and hyper-posterior amygdala connectivity. Additionally, comorbidity of these conditions appears to compound these neural activity patterns. PTS in mTBI may change neural resource recruitment for information processing between the amygdala and other brain regions and networks, not only during emotional processing, but also at rest.
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Affiliation(s)
- Sarah I. Gimbel
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
| | - Cailynn C. Wang
- Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
| | - Elizabeth W. Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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Hu L, Yang S, Jin B, Wang C. Advanced Neuroimaging Role in Traumatic Brain Injury: A Narrative Review. Front Neurosci 2022; 16:872609. [PMID: 35495065 PMCID: PMC9043279 DOI: 10.3389/fnins.2022.872609] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is a common source of morbidity and mortality among civilians and military personnel. Initial routine neuroimaging plays an essential role in rapidly assessing intracranial injury that may require intervention. However, in the context of TBI, limitations of routine neuroimaging include poor visualization of more subtle changes of brain parenchymal after injury, poor prognostic ability and inability to analyze cerebral perfusion, metabolite and mechanical properties. With the development of modern neuroimaging techniques, advanced neuroimaging techniques have greatly boosted the studies in the diagnosis, prognostication, and eventually impacting treatment of TBI. Advances in neuroimaging techniques have shown potential, including (1) Ultrasound (US) based techniques (contrast-enhanced US, intravascular US, and US elastography), (2) Magnetic resonance imaging (MRI) based techniques (diffusion tensor imaging, magnetic resonance spectroscopy, perfusion weighted imaging, magnetic resonance elastography and functional MRI), and (3) molecular imaging based techniques (positron emission tomography and single photon emission computed tomography). Therefore, in this review, we aim to summarize the role of these advanced neuroimaging techniques in the evaluation and management of TBI. This review is the first to combine the role of the US, MRI and molecular imaging based techniques in TBI. Advanced neuroimaging techniques have great potential; still, there is much to improve. With more clinical validation and larger studies, these techniques will be likely applied for routine clinical use from the initial research.
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Affiliation(s)
- Ling Hu
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou, China
| | - Siyu Yang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Jin
- Department of Neurology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Chao Wang,
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Mayer AR, Quinn DK. Neuroimaging Biomarkers of New-Onset Psychiatric Disorders Following Traumatic Brain Injury. Biol Psychiatry 2022; 91:459-469. [PMID: 34334188 PMCID: PMC8665933 DOI: 10.1016/j.biopsych.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 02/07/2023]
Abstract
Traumatic brain injury (TBI) has traditionally been associated with cognitive and behavioral changes during both the acute and chronic phases of injury. Because of its noninvasive nature, neuroimaging has the potential to provide unique information on underlying macroscopic and microscopic biological mechanisms that may serve as causative agents for these neuropsychiatric sequelae. This broad scoping review identifies at least 4 common macroscopic pathways that exist between TBI and new-onset psychiatric disorders, as well as several examples of how neuroimaging is currently being utilized in clinical research. The review then critically examines the strengths and limitations of neuroimaging for elucidating TBI-related microscopic pathology, such as microstructural changes, neuroinflammation, proteinopathies, blood-brain barrier damage, and disruptions in cellular signaling. A summary is then provided for how neuroimaging is currently being used to investigate TBI-related pathology in new-onset neurocognitive disorders, depression, and posttraumatic stress disorder. Identified gaps in the literature include a lack of prospective studies to definitively associate imaging findings with the development of new-onset psychiatric disorders, as well as antemortem imaging studies subsequently confirmed with postmortem correlates in the same study cohort. Although the spatial resolution and specificity of imaging biomarkers has greatly improved over the last 2 decades, we conclude that neuroimaging biomarkers do not yet exist for the definitive in vivo diagnosis of cellular pathology. This represents a necessary next step for further elucidating causal relationships between TBI and new-onset psychiatric disorders.
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Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM 87106,Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131,Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131,Department of Psychology, University of New Mexico, Albuquerque, NM 87131,Corresponding author: Andrew Mayer, Ph.D., The Mind Research Network, Pete & Nancy Domenici Hall, 1101 Yale Blvd. NE, Albuquerque, NM 87106 USA; Tel: 505-272-0769; Fax: 505-272-8002;
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131
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Kong LZ, Zhang RL, Hu SH, Lai JB. Military traumatic brain injury: a challenge straddling neurology and psychiatry. Mil Med Res 2022; 9:2. [PMID: 34991734 PMCID: PMC8740337 DOI: 10.1186/s40779-021-00363-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022] Open
Abstract
Military psychiatry, a new subcategory of psychiatry, has become an invaluable, intangible effect of the war. In this review, we begin by examining related military research, summarizing the related epidemiological data, neuropathology, and the research achievements of diagnosis and treatment technology, and discussing its comorbidity and sequelae. To date, advances in neuroimaging and molecular biology have greatly boosted the studies on military traumatic brain injury (TBI). In particular, in terms of pathophysiological mechanisms, several preclinical studies have identified abnormal protein accumulation, blood-brain barrier damage, and brain metabolism abnormalities involved in the development of TBI. As an important concept in the field of psychiatry, TBI is based on organic injury, which is largely different from many other mental disorders. Therefore, military TBI is both neuropathic and psychopathic, and is an emerging challenge at the intersection of neurology and psychiatry.
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Affiliation(s)
- Ling-Zhuo Kong
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Rui-Li Zhang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Shao-Hua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China. .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou, 310003, China. .,Brain Research Institute of Zhejiang University, Hangzhou, 310003, China. .,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, 310003, China. .,MOE Frontier Science Center for Brain Science and Brain-Machine Integration, Zhejiang University, Hangzhou, 310003, China.
| | - Jian-Bo Lai
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China. .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou, 310003, China. .,Brain Research Institute of Zhejiang University, Hangzhou, 310003, China. .,Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, 310003, China. .,MOE Frontier Science Center for Brain Science and Brain-Machine Integration, Zhejiang University, Hangzhou, 310003, China.
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Lewis JD, Knutson KM, Gotts SJ, Tierney M, Ramage A, Tate DF, Clauw D, Williams DA, Robin DA, Wassermann EM. Resting-State Correlations of Fatigue Following Military Deployment. J Neuropsychiatry Clin Neurosci 2021; 33:337-341. [PMID: 34392692 DOI: 10.1176/appi.neuropsych.20100255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Persistent fatigue is common among military servicemembers returning from deployment, especially those with a history of mild traumatic brain injury (mTBI). The purpose of this study was to characterize fatigue following deployment using the Multidimensional Fatigue Inventory (MFI), a multidimensional self-report instrument. The study was developed to test the hypothesis that if fatigue involves disrupted effort/reward processing, this should manifest as altered basal ganglia functional connectivity as observed in other amotivational states. METHODS Twenty-eight current and former servicemembers were recruited and completed the MFI. All 28 participants had a history of at least one mTBI during deployment. Twenty-six participants underwent resting-state functional MRI. To test the hypothesis that fatigue was associated with basal ganglia functional connectivity, the investigators measured correlations between MFI subscale scores and the functional connectivity of the left and right caudate, the putamen, and the globus pallidus with the rest of the brain, adjusting for the presence of depression. RESULTS The investigators found a significant correlation between functional connectivity of the left putamen and bilateral superior frontal gyri and mental fatigue scores. No correlations with the other MFI subscales survived multiple comparisons correction. CONCLUSIONS This exploratory study suggests that mental fatigue in military servicemembers with a history of deployment with at least one mTBI may be related to increased striatal-prefrontal functional connectivity, independent of depression. A finding of effort/reward mismatch may guide future treatment approaches.
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Affiliation(s)
- Jeffrey D Lewis
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - Kristine M Knutson
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - Stephen J Gotts
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - Michael Tierney
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - Amy Ramage
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - David F Tate
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - Daniel Clauw
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - David A Williams
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - Donald A Robin
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
| | - Eric M Wassermann
- Mental Health Clinic, Wright Patterson Medical Center, Wright Patterson Air Force Base, Ohio (Lewis); Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Knutson, Tierney, Wassermann); National Institute of Mental Health, Bethesda, Md. (Gotts); Department of Communication Science and Disorders, University of New Hampshire, Durham (Ramage, Robin); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Tate); and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor (Clauw, Williams)
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Song C, Yeh PH, Ollinger J, Sours Rhodes C, Lippa SM, Riedy G, Bonavia GH. Altered Metabolic Interrelationships in the Cortico-Limbic Circuitry in Military Service Members with Persistent Post-Traumatic Stress Disorder Symptoms Following Mild Traumatic Brain Injury. Brain Connect 2021; 12:602-616. [PMID: 34428937 DOI: 10.1089/brain.2021.0036] [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: 11/12/2022] Open
Abstract
Introduction: Comorbid mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) are common in military service members. The aim of this study is to investigate brain metabolic interrelationships in service members with and without persistent PTSD symptoms after mTBI by using 18F-fluorodeoxyglucose (FDG) positron emission tomography. Methods: Service members (n = 408) diagnosed with mTBI were studied retrospectively. Principal component analysis was applied to identify latent metabolic systems, and the associations between metabolic latent systems and self-report measures of post-concussive and PTSD symptoms were evaluated. Participants were divided into two groups based on DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, fourth edition-Text Revision) criteria for PTSD, and structural equation modeling was performed to test a priori hypotheses on metabolic interrelationships among the brain regions in the cortico-limbic circuitry responsible for top-down control and bottom-up emotional processing. The differences in metabolic interrelationships between age-matched PTSD-absent (n = 204) and PTSD-present (n = 204) groups were evaluated. Results: FDG uptake in the temporo-limbic system was positively correlated with post-concussive and hyperarousal symptoms. For the bottom-up emotional processing, the insula and amygdala-hippocampal complex in the PTSD-present group had stronger metabolic interrelationships with the bilateral rostral anterior cingulate, left lingual, right lateral occipital, and left superior temporal cortices, but a weaker relationship with the right precuneus cortex, compared with the PTSD-absent group. For the top-down control, the PTSD-present group had decreased metabolic engagements of the dorsolateral prefrontal cortex on the amygdala. Discussion: Our results suggest altered metabolic interrelationships in the cortico-limbic circuitry in mTBI subjects with persistent PTSD symptoms, which may underlie the pathophysiological mechanisms of comorbid mTBI and PTSD. Impact statement This is the first 18F-fluorodeoxyglucose positron emission tomography study to investigate brain metabolic interrelationships in service members with persistent post-traumatic stress disorder (PTSD) symptoms after mild traumatic brain injury (mTBI). We identified that the temporo-limbic metabolic system was associated with post-concussive and hyperarousal symptoms. Further, brain metabolic interrelationships in the cortico-limbic circuitry were altered in mTBI subjects with significant PTSD symptoms compared with those without them.
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Affiliation(s)
- Chihwa Song
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Chandler Sours Rhodes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Gerard Riedy
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Grant H Bonavia
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Fee C, Prevot T, Misquitta K, Banasr M, Sibille E. Chronic Stress-induced Behaviors Correlate with Exacerbated Acute Stress-induced Cingulate Cortex and Ventral Hippocampus Activation. Neuroscience 2020; 440:113-129. [PMID: 32473277 DOI: 10.1016/j.neuroscience.2020.05.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022]
Abstract
Altered activity of corticolimbic brain regions is a hallmark of stress-related illnesses, including mood disorders, neurodegenerative diseases, and substance abuse disorders. Acute stress adaptively recruits brain region-specific functions for coping, while sustained activation under chronic stress may overwhelm feedback mechanisms and lead to pathological cellular and behavioral responses. The neural mechanisms underlying dysregulated stress responses and how they contribute to behavioral deficits are poorly characterized. Here, we tested whether prior exposure to chronic restraint stress (CRS) or unpredictable chronic mild stress (UCMS) in mice could alter functional response to acute stress and whether these changes are associated with chronic stress-induced behavioral deficits. More specifically, we assessed acute stress-induced functional activation indexed by c-Fos+ cell counts in 24 stress- and mood-related brain regions, and determined if changes in functional activation were linked to chronic stress-induced behavioral impairments, summarized across dimensions through principal component analysis (PCA). Results indicated that CRS and UCMS led to convergent physiological and anxiety-like deficits, whereas working and short-term memory were impaired only in UCMS mice. CRS and UCMS exposure exacerbated functional activation by acute stress in anterior cingulate cortex (ACC) area 24b and ventral hippocampal (vHPC) CA1, CA3, and subiculum. In dysregulated brain regions, levels of functional activation were positively correlated with principal components reflecting variance across behavioral deficits relevant to stress-related disorders. Our data supports an association between a dysregulated stress response, altered functional corticolimbic excitation/inhibition balance, and the expression of maladaptive behaviors.
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Affiliation(s)
- Corey Fee
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Thomas Prevot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Keith Misquitta
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Mounira Banasr
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Etienne Sibille
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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8
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Bhattrai A, Irimia A, Van Horn JD. Neuroimaging of traumatic brain injury in military personnel: An overview. J Clin Neurosci 2019; 70:1-10. [PMID: 31331746 PMCID: PMC6861663 DOI: 10.1016/j.jocn.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of blunt-force traumatic brain injury (TBI) is especially prevalent in the military, where the emergency care admission rate has been reported to be 24.6-41.8 per 10,000 soldier-years. Given substantial advancements in modern neuroimaging techniques over the past decade in terms of structural, functional, and connectomic approaches, this mode of exploration can be viewed as best suited for understanding the underlying pathology and for providing proper intervention at effective time-points. APPROACH Here we survey neuroimaging studies of mild-to-severe TBI in military veterans with the intent to aid the field in the creation of a roadmap for clinicians and researchers whose aim is to understand TBI progression. DISCUSSION Recent advancements on the quantification of neurocognitive dysfunction, cellular dysfunction, intracranial pressure, cerebral blood flow, inflammation, post-traumatic neuropathophysiology, on blood serum biomarkers and on their correlation to neuroimaging findings are reviewed to hypothesize how they can be used in conjunction with one another. This may allow clinicians and scientists to comprehensively study TBI in military service members, leading to new treatment strategies for both currently-serving as well as veteran personnel, and to improve the study of TBI more broadly.
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Affiliation(s)
- Avnish Bhattrai
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, 2025 Zonal Avenue, SHN, Los Angeles, CA 90033, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., Room 228C, Los Angeles, CA 90089-0191, USA.
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, 2025 Zonal Avenue, SHN, Los Angeles, CA 90033, USA.
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9
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Clark AL, Sorg SF, Holiday K, Bigler ED, Bangen KJ, Evangelista ND, Bondi MW, Schiehser DM, Delano-Wood L. Fatigue Is Associated With Global and Regional Thalamic Morphometry in Veterans With a History of Mild Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:382-392. [PMID: 29385016 PMCID: PMC6066453 DOI: 10.1097/htr.0000000000000377] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Fatigue is a complex, multidimensional phenomenon that commonly occurs following traumatic brain injury (TBI). The thalamus-a structure vulnerable to both primary and secondary injuries in TBI-is thought to play a pivotal role in the manifestation of fatigue. We explored how neuroimaging markers of local and global thalamic morphometry relate to the subjective experience of fatigue post-TBI. METHODS Sixty-three Veterans with a history of mild TBI underwent structural magnetic resonance imaging and completed questionnaires related to fatigue and psychiatric symptoms. FMRIB's Software (FSL) was utilized to obtain whole brain and thalamic volume estimates, as well as to perform regional thalamic morphometry analyses. RESULTS Independent of age, sex, intracranial volume, posttraumatic stress disorder, and depressive symptoms, greater levels of self-reported fatigue were significantly associated with decreased right (P = .026) and left (P = .046) thalamic volumes. Regional morphometry analyses revealed that fatigue was significantly associated with reductions in the anterior and dorsomedial aspects of the right thalamic body (P < .05). Similar trends were observed for the left thalamic body (P < .10). CONCLUSIONS Both global and regional thalamic morphometric changes are associated with the subjective experience of fatigue in Veterans with a history of mild TBI. These findings support a theory in which disruption of thalamocorticostriatal circuitry may result in the manifestation of fatigue in individuals with a history of neurotrauma.
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Affiliation(s)
- Alexandra L. Clark
- San Diego State University/University of California, San Diego
(SDSU/UCSD) Joint Doctoral Program in Clinical Psychology
- VA San Diego Healthcare System (VASDHS)
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS)
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | - Kelsey Holiday
- San Diego State University/University of California, San Diego
(SDSU/UCSD) Joint Doctoral Program in Clinical Psychology
- VA San Diego Healthcare System (VASDHS)
| | - Erin D. Bigler
- Department of Psychology and the Neuroscience Center, Brigham and
Young University
| | - Katherine J. Bangen
- VA San Diego Healthcare System (VASDHS)
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | | | - Mark W. Bondi
- VA San Diego Healthcare System (VASDHS)
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS)
- Center of Excellence for Stress and Mental Health, VASDHS
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS)
- Center of Excellence for Stress and Mental Health, VASDHS
- University of California San Diego, School of Medicine, Department
of Psychiatry
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Dretsch MN, Rangaprakash D, Katz JS, Daniel TA, Goodman AM, Denney TS, Deshpande G. Strength and Temporal Variance of the Default Mode Network to Investigate Chronic Mild Traumatic Brain Injury in Service Members with Psychological Trauma. J Exp Neurosci 2019; 13:1179069519833966. [PMID: 30911222 PMCID: PMC6423682 DOI: 10.1177/1179069519833966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/05/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is a significant number of military personnel with a history of mild traumatic brain injury (mTBI) who suffer from comorbid posttraumatic stress symptoms (PTS). Although there is evidence of disruptions of the default mode network (DMN) associated with PTS and mTBI, previous studies have only studied static connectivity while ignoring temporal variability of connectivity. OBJECTIVE To assess DMN disrupted or dysregulated neurocircuitry, cognitive functioning, and psychological health of active-duty military with mTBI and PTS. METHOD U.S. Army soldiers with PTS (n = 14), mTBI + PTS (n = 25), and healthy controls (n = 21) voluntarily completed a cognitive and symptom battery. In addition, participants had magnetic resonance imaging (MRI) to assess both static functional connectivity (SFC) and variance of dynamic functional connectivity (vDFC) of the DMN. RESULTS Both the PTS and mTBI + PTS groups had significant symptoms, but only the comorbid group had significant decrements in cognitive functioning. Both groups showed less stable and disrupted neural signatures of the DMN, mainly constituting the cingulate-frontal-temporal-parietal attention network. Specifically, the PTS group showed a combination of both reduced contralateral strength and reduced unilateral variability of frontal-cingulate-temporal connectivities, as well as increased variability of frontal-parietal connectivities. The mTBI + PTS group had fewer abnormal connectives than the PTS group, all of which included reduced strength of frontal-temporal regions and reduced variability frontal-cingulate-temporal regions. Greater SFC and vDFC connectivity of the left dorsolateral prefrontal cortex (dlPFC) ↔ precuneus was associated with higher cognitive scores and lower symptom scores. CONCLUSIONS Findings suggest that individuals with PTS and mTBI + PTS have a propensity for accentuated generation of thoughts, feelings, sensations, and/or images while in a resting state. Compared with controls, only the PTS group was associated with accentuated variability of the frontal-parietal attention network. While there were no significant differences in DMN connectivity strength between the mTBI + PTS and PTS groups, variability of connectivity was able to distinguish them.
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Affiliation(s)
- Michael N Dretsch
- U.S. Army Aeromedical Research
Laboratory, Fort Rucker, AL, USA
- Department of Psychology, Auburn
University, Auburn, AL, USA
- U.S. Army Medical Research
Directorate-West, Walter Reed Army Institute for Research, Joint Base Lewis-McChord,
WA, USA
| | - D Rangaprakash
- Department of Psychiatry and
Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA,
USA
- AU MRI Research Center, Department of
Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | - Jeffrey S Katz
- Department of Psychology, Auburn
University, Auburn, AL, USA
- AU MRI Research Center, Department of
Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
- Alabama Advanced Imaging Consortium,
Auburn University and The University of Alabama at Birmingham, Birmingham, AL,
USA
| | - Thomas A Daniel
- Department of Psychology, Auburn
University, Auburn, AL, USA
| | - Adam M Goodman
- Department of Psychology, Auburn
University, Auburn, AL, USA
- Alabama Advanced Imaging Consortium,
Auburn University and The University of Alabama at Birmingham, Birmingham, AL,
USA
| | - Thomas S Denney
- AU MRI Research Center, Department of
Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
- Alabama Advanced Imaging Consortium,
Auburn University and The University of Alabama at Birmingham, Birmingham, AL,
USA
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of
Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
- Alabama Advanced Imaging Consortium,
Auburn University and The University of Alabama at Birmingham, Birmingham, AL,
USA
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Walker MS, Stamper AM, Nathan DE, Riedy G. Art therapy and underlying fMRI brain patterns in military TBI: A case series. INTERNATIONAL JOURNAL OF ART THERAPY 2018. [DOI: 10.1080/17454832.2018.1473453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Hoot MR, Levin HS, Smith AN, Goldberg G, Wilde EA, Walker WC, Eapen BC, Nolen T, Pugh NL. Pain and chronic mild traumatic brain injury in the US military population: a Chronic Effects of Neurotrauma Consortium study. Brain Inj 2018; 32:1169-1177. [PMID: 29883191 DOI: 10.1080/02699052.2018.1482427] [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: 10/14/2022]
Abstract
PRIMARY OBJECTIVES To describe the association between mild traumatic brain injury (mTBI) and pain intensity and pain interference outcomes while accounting for potential confounders and mediators including environmental factors and comorbidities in a cohort of US Veterans of the Iraq and Afghanistan wars. RESEARCH DESIGN Cross-sectional snapshot of baseline data from a prospective, longitudinal study. METHODS Effects of mTBI on pain intensity and pain interference were compared between participants with or without mTBI exposure. Data were analysed using covariate-adjusted regression analyses as well as structural equation modelling (SEM) methods to assess the robustness of findings across different modelling assumptions. As results of the two approaches were consistent with respect to the overall association between mTBI exposure and pain, the results focus primarily on the SEM findings. RESULTS The mTBI exposed group reported significantly greater indices of post-traumatic stress disorder (PTSD), depression, anxiety and sleep disturbance. After accounting for other factors, mTBI exposure was significantly, but indirectly associated with the pain interference and pain intensity outcomes. CONCLUSIONS mTBI is strongly associated with pain intensity and pain interference in this sample. However, the effect appears to be mediated by other common mTBI comorbidities: PTSD, depression, anxiety and sleep disturbance.
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Affiliation(s)
- Michelle R Hoot
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,b Defense and Veterans Brain Injury Center , Richmond , VA , USA
| | - Harvey S Levin
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - Austin N Smith
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,b Defense and Veterans Brain Injury Center , Richmond , VA , USA
| | - Gary Goldberg
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA
| | - Elisabeth A Wilde
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - William C Walker
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,b Defense and Veterans Brain Injury Center , Richmond , VA , USA.,e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA
| | - Blessen C Eapen
- f Physical Medicine and Rehabilitation Services, South Texas Veterans Health Care System , San Antonio , TX , USA
| | - T Nolen
- g Biostatistics and Epidemiology Division, RTI International, Research Triangle Park , NC , USA
| | - N L Pugh
- g Biostatistics and Epidemiology Division, RTI International, Research Triangle Park , NC , USA
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13
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Gordon EM, Scheibel RS, Zambrano-Vazquez L, Jia-Richards M, May GJ, Meyer EC, Nelson SM. High-Fidelity Measures of Whole-Brain Functional Connectivity and White Matter Integrity Mediate Relationships between Traumatic Brain Injury and Post-Traumatic Stress Disorder Symptoms. J Neurotrauma 2018; 35:767-779. [PMID: 29179667 PMCID: PMC8117405 DOI: 10.1089/neu.2017.5428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Traumatic brain injury (TBI) disrupts brain communication and increases risk for post-traumatic stress disorder (PTSD). However, mechanisms by which TBI-related disruption of brain communication confers PTSD risk have not been successfully elucidated in humans. This may be in part because functional MRI (fMRI), the most common technique for measuring functional brain communication, is unreliable for characterizing individual patients. However, this unreliability can be overcome with sufficient within-individual data. Here, we examined whether relationships could be observed among TBI, structural and functional brain connectivity, and PTSD severity by collecting ∼3.5 hours of resting-state fMRI and diffusion tensor imaging (DTI) data in each of 26 United States military veterans. We observed that a TBI history was associated with decreased whole-brain resting-state functional connectivity (RSFC), while the number of lifetime TBIs was associated with reduced whole-brain fractional anisotropy (FA). Both RSFC and FA explained independent variance in PTSD severity, with RSFC mediating the TBI-PTSD relationship. Finally, we showed that large amounts of per-individual data produced highly reliable RSFC measures, and that relationships among TBI, RSFC/FA, and PTSD could not be observed with typical data quantities. These results demonstrate links among TBI, brain connectivity, and PTSD severity, and illustrate the need for precise characterization of individual patients using high-data fMRI scanning.
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Affiliation(s)
- Evan M. Gordon
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
| | - Randall S. Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
| | | | | | - Geoffrey J. May
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
- Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, College Station, TX
| | - Eric C. Meyer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, College Station, TX
| | - Steven M. Nelson
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
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