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Lippa SM, Bailie JM, French LM, Brickell TA, Lange RT. Lifetime blast exposure is not related to cognitive performance or psychiatric symptoms in US military personnel. Clin Neuropsychol 2024:1-23. [PMID: 38494345 DOI: 10.1080/13854046.2024.2328881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Objective: The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs). Method: Participants were 282 SMVs, with and without history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (n = 61), Blast + Low Risk MOS (n = 96), Blast + High Risk MOS (n = 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Results: There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (Fs < 1.75, ps > .1, ηp2s < .032) or in General Cognition (Fs < 0.95, ps > .3, ηp2s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (F(18,542) = 1.77, p = .026, ηp2 = .055), Somatic/Cognitive (F(10,550) = 1.99, p = .033, ηp2 = .035), and Externalizing Scales (F(8,552) = 2.17, p = .028, ηp2 = .030); however, these relationships did not remain significant after correction for covariates (Fs < 1.53, ps > .145, ηp2s < .032). Conclusions: We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- Naval Hospital Camp Pendleton, Oceanside, CA, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
| | - Tracey A Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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2
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Li G, Xu S, Xiong T, Li K, Qiu J. Characteristics of head frequency response in blunt impacts: a biomechanical modeling study. Front Bioeng Biotechnol 2024; 12:1364741. [PMID: 38468687 PMCID: PMC10925751 DOI: 10.3389/fbioe.2024.1364741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
Existing evaluation criteria for head impact injuries are typically based on time-domain features, and less attention has been paid to head frequency responses for head impact injury assessment. The purpose of the current study is, therefore, to understand the characteristics of human body head frequency response in blunt impacts via finite element (FE) modeling and the wavelet packet analysis method. FE simulation results show that head frequency response in blunt impacts could be affected by the impact boundary condition. The head energy peak and its frequency increase with the increase in impact; a stiffer impact block is associated with a higher head energy peak, and a bigger impact block could result in a high proportion of the energy peak. Regression analysis indicates that only the head energy peak has a high correlation with exiting head injury criteria, which implies that the amplitude-frequency aggregation characteristic but not the frequency itself of the head acceleration response has predictability for head impact injury in blunt impacts. The findings of the current study may provide additional criteria for head impact injury evaluation and new ideas for head impact injury protection.
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Affiliation(s)
- Guibing Li
- School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, China
| | - Shengkang Xu
- School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, China
| | - Tao Xiong
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Kui Li
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Vehicle/Biological Crash Safety, Chongqing, China
| | - Jinlong Qiu
- Chongqing Key Laboratory of Vehicle/Biological Crash Safety, Chongqing, China
- Institute of Traffic Medicine, Army Military Medical University, Chongqing, China
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Waters AB, Bottari SA, Jones LC, Lamb DG, Lewis GF, Williamson JB. Regional associations of white matter integrity and neurological, post-traumatic stress disorder and autonomic symptoms in Veterans with and without history of loss of consciousness in mild TBI. FRONTIERS IN NEUROIMAGING 2024; 2:1265001. [PMID: 38268858 PMCID: PMC10806103 DOI: 10.3389/fnimg.2023.1265001] [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: 07/21/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Background Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) share overlapping symptom presentations and are highly comorbid conditions among Veteran populations. Despite elevated presentations of PTSD after mTBI, mechanisms linking the two are unclear, although both have been associated with alterations in white matter and disruptions in autonomic regulation. The present study aimed to determine if there is regional variability in white matter correlates of symptom severity and autonomic functioning in a mixed sample of Veterans with and without PTSD and/or mTBI (N = 77). Methods Diffusion-weighted images were processed to extract fractional anisotropy (FA) values for major white matter structures. The PTSD Checklist-Military version (PCL-M) and Neurobehavioral Symptom Inventory (NSI) were used to determine symptom domains within PTSD and mTBI. Autonomic function was assessed using continuous blood pressure and respiratory sinus arrythmia during a static, standing angle positional test. Mixed-effect models were used to assess the regional specificity of associations between symptom severity and white matter, with FA, global symptom severity (score), and white matter tract (tract) as predictors. Additional interaction terms of symptom domain (i.e., NSI and PCL-M subscales) and loss of consciousness (LoC) were added to evaluate potential moderating effects. A parallel analysis was conducted to explore concordance with autonomic functioning. Results Results from the two-way Score × Tract interaction suggested that global symptom severity was associated with FA in the cingulum angular bundle (positive) and uncinate fasciculus (negative) only, without variability by symptom domain. We also found regional specificity in the relationship between FA and autonomic function, such that FA was positively associated with autonomic function in all tracts except the cingulum angular bundle. History of LoC moderated the association for both global symptom severity and autonomic function. Conclusions Our findings are consistent with previous literature suggesting that there is significant overlap in the symptom presentation in TBI and PTSD, and white matter variability associated with LoC in mTBI may be associated with increased PTSD-spectra symptoms. Further research on treatment response in patients with both mTBI history and PTSD incorporating imaging and autonomic assessment may be valuable in understanding the role of brain injury in treatment outcomes and inform treatment design.
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Affiliation(s)
- Abigail B. Waters
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Sarah A. Bottari
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Laura C. Jones
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Damon G. Lamb
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
| | - Gregory F. Lewis
- Socioneural Physiology Lab, Kinsey Institute, Indiana University, Bloomington, IN, United States
| | - John B. Williamson
- Brain Rehabilitation Research Center, North Florida/South Georgia VAMC, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, Center for OCD and Anxiety Related Disorders, University of Florida, Gainesville, FL, United States
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Parsey CM, Kang HJ, Eaton JC, McGrath ME, Barber J, Temkin NR, Donald CLM. Chronic frontal neurobehavioural symptoms in combat-deployed military personnel with and without a history of blast-related mild traumatic brain injury. Brain Inj 2023; 37:1127-1134. [PMID: 37165638 PMCID: PMC10524397 DOI: 10.1080/02699052.2023.2209740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/02/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study evaluated frontal behavioural symptoms, via the FrSBe self-report, in military personnel with and without a history of blast-related mild traumatic brain injury (mild TBI). METHODS Prospective observational cohort study of combat-deployed service members leveraging 1-year and 5-year demographic and follow up clinical outcome data. RESULTS The blast mild TBI group (n = 164) showed greater frontal behavioural symptoms, including clinically elevated apathy, disinhibition, and executive dysfunction, during a 5-year follow-up, compared to a group of combat-deployed controls (n = 107) without mild TBI history or history of blast exposure. We also explored changes inbehaviourall symptoms over a 4-year span, which showed clinically significant increases in disinhibition in the blast mild TBI group, whereas the control group did not show significant increases in symptoms over time. CONCLUSION Our findings add to the growing evidence that a proportion of individuals who sustain mild TBI experience persistent behavioural symptoms. We also offer a demonstration of a novel use of the FrSBe as a tool for longitudinal symptom monitoring in a military mild TBI population.
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Affiliation(s)
- Carolyn M. Parsey
- Department of Neurology, University of Washington, School of Medicine, Seattle, WA USA
| | | | - Jessica C. Eaton
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Margaret E. McGrath
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
- Department of Biostatistics, University of Washington, School of Public Health, Seattle, WA USA
| | - Christine L. Mac Donald
- Harborview Medical Center, Seattle WA USA
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
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5
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Barczak-Scarboro NE, Hernández LM, Taylor MK. Military Exposures Predict Mental Health Symptoms in Explosives Personnel but Not Always as Expected. Mil Med 2023; 188:e646-e652. [PMID: 34520546 DOI: 10.1093/milmed/usab379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the unique and combined associations of various military stress exposures with positive and negative mental health symptoms in active duty service members. MATERIALS AND METHODS We investigated 87 male U.S. Navy Explosive Ordnance Disposal (EOD) technicians (age M ± SE, range 33.7 ± 0.6, 22-47 years). Those who endorsed a positive traumatic brain injury diagnosis were excluded to eliminate the confounding effects on mental health symptoms. Using a survey platform on a computer tablet, EOD technicians self-reported combat exposure, deployment frequency (total number of deployments), blast exposure (vehicle crash/blast or 50-m blast involvement), depression, anxiety, posttraumatic stress, perceived stress, and life satisfaction during an in-person laboratory session. RESULTS When controlling for other military stressors, EOD technicians with previous involvement in a vehicle crash/blast endorsed worse mental health than their nonexposed counterparts. The interactions of vehicle crash/blast with deployment frequency and combat exposure had moderate effect sizes, and combat and deployment exposures demonstrated protective, rather than catalytic, effects on negative mental health scores. CONCLUSIONS Military stressors may adversely influence self-reported symptoms of negative mental health, but deployment experience and combat exposure may confer stress inoculation.
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Affiliation(s)
- Nikki E Barczak-Scarboro
- Leidos Inc., San Diego, CA 92121, USA
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Lisa M Hernández
- Leidos Inc., San Diego, CA 92121, USA
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Marcus K Taylor
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
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Merritt VC, Chanfreau-Coffinier C, Sakamoto MS, Jak AJ, Delano-Wood L. Characterizing Sex Differences in Clinical and Functional Outcomes Among Military Veterans with a Comprehensive Traumatic Brain Injury Evaluation (CTBIE): A Million Veteran Program (MVP) Study. Clin Psychol Sci 2022; 2022:10.1177/21677026221100230. [PMID: 36714216 PMCID: PMC9881235 DOI: 10.1177/21677026221100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using a diverse sample of military Veterans enrolled in the VA's Million Veteran Program (N=14,378; n=1,361 females [9.5%]; all previously deployed), we examined sex differences on the Comprehensive Traumatic Brain Injury Evaluation (CTBIE), a structured traumatic brain injury (TBI) interview routinely administered within the VA. Confirmed TBI diagnoses were more frequent among males than females (65% vs. 58%). Additionally, when compared to females, a greater proportion of males with CTBIE-confirmed TBI histories experienced blast-related injuries and were employed. In contrast, a greater proportion of females reported experiencing falls, sustaining a TBI since deployment, and having more severe neurobehavioral symptoms (particularly affective-related symptoms). Results indicate that males and females experience differential clinical and functional outcomes in the aftermath of military TBI. Findings underscore the need to increase female representation in TBI research to increase understanding of sex-specific experiences with TBI and to improve the clinical care targeted to this vulnerable population.
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Affiliation(s)
- Victoria C. Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - McKenna S. Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Amy J. Jak
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
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7
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Lange RT, French LM, Bailie JM, Merritt VC, Pattinson CL, Hungerford LD, Lippa SM, Brickell TA. Clinical utility of PTSD, resilience, sleep, and blast as risk factors to predict poor neurobehavioral functioning following traumatic brain injury: A longitudinal study in U.S. military service members. Qual Life Res 2022; 31:2411-2422. [PMID: 35076825 DOI: 10.1007/s11136-022-03092-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI). METHODS Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up. RESULTS Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to predict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue, Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3-72.4). However, poor sleep and low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1-29.8). CONCLUSION PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used clinically for targeted early interventions.
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Affiliation(s)
- Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA. .,Walter Reed National Military Medical Center, Bethesda, MD, USA. .,National Intrepid Center of Excellence, Bethesda, MD, USA. .,University of British Columbia, Vancouver, BC, Canada. .,General Dynamics Information Technology, Falls Church, VA, USA.
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Naval Hospital Camp Pendleton, Oceanside, CA, USA.,General Dynamics Information Technology, Falls Church, VA, USA
| | - Victoria C Merritt
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
| | | | - Lars D Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Naval Medical Center San Diego, San Diego, CA, USA.,General Dynamics Information Technology, Falls Church, VA, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,General Dynamics Information Technology, Falls Church, VA, USA
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8
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Belding JN, Khokhar B, Englert RM, Fitzmaurice S, Thomsen CJ. The Persistence of Blast- Versus Impact-Induced Concussion Symptomology Following Deployment. J Head Trauma Rehabil 2021; 36:E397-E405. [PMID: 34320556 DOI: 10.1097/htr.0000000000000715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the persistence of concussion-related symptoms following injury as a function of mechanism of injury (high-level blast [HLB] vs impact) and low-level blast (LLB) exposure among Marines. SETTING Upon return from deployment and approximately 6 months later, respectively, Marines completed the Post-Deployment Health Assessment and Post-Deployment Health Re-Assessment in an operational or clinic setting. PARTICIPANTS Data from active duty enlisted Marines who completed both assessments (n = 102 075) and who reported a potentially mild traumatic brain injury (mTBI)-inducing event and completed an mTBI screen (n = 8106) were analyzed. DESIGN This was a retrospective cohort study of Marines deployed between 2008 and 2012. Marines were categorized into groups with relatively high versus low risk for occupational risk of LLB exposure. A mixed model analysis of variance was used to examine the number of symptoms Marines reported experiencing during deployment as a function of probable concussion, HLB exposure, occupational risk, type of symptom, and time of measurement. MAIN MEASURES Self-reported deployment exposures including HLB, probable mTBIs, and occupational risk of LLB exposure were identified. Outcomes included the proportion of neurological, musculoskeletal, and immunological symptoms for which Marines reported seeking care during and following deployment were analyzed. RESULTS Probable HLB-induced mTBIs (vs impact-induced) were associated with significantly more neurological symptoms at return from deployment and approximately 6 months later. Although symptom reporting decreased at statistically equivalent rates regardless of mechanism of injury, those with a probable HLB-induced concussion continued to report elevated symptomology post-deployment. Additionally, Marines with probable concussion working in occupations with LLB exposure reported elevated levels of persistent neurological symptoms. Both HLB and LLB exposure were associated with neurological symptoms that persisted following deployment. CONCLUSION These findings suggest that blast-induced brain injuries may be fundamentally different from impact-induced injuries, and that additional screening and symptomatic treatment for blast-exposed patients may be warranted.
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Affiliation(s)
- Jennifer N Belding
- Leidos, San Diego, California (Dr Belding and Mss Englert and Fitzmaurice); Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California (Drs Belding and Thomsen and Mss Englert and Fitzmaurice); and Traumatic Brain Injury Center of Excellence, Silver Spring, and General Dynamics Information Technology, Silver Spring, Maryland (Dr Khokhar)
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9
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Teel EF, Caron JG, Gagnon IJ. Higher parental stress is significantly related to longer clinical recovery times in concussed children: A mixed-methods study. J Sci Med Sport 2021; 25:108-114. [PMID: 34518082 DOI: 10.1016/j.jsams.2021.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Parental stress and anxiety negatively influences a child's recovery following traumatic brain injury, but these relationships are largely unexplored in a concussion-specific sample. We hypothesized that children with parents experiencing high stress or with pre-existing anxiety would take significantly longer to recover from concussion. DESIGN Mixed-methods. METHODS Forty-nine concussed children (13.8 ± 2.3 years, nfemales = 27) and their parents were recruited. Quantitative data were collected using the Perceived Stress Scale (10-item). Qualitative data (n = 12) were collected through a semi-structured interview with the parent. Kaplan-Meier curves and Cox proportional hazard models analyzed the effect of parental stress and anxiety on time in clinic (days between clinic presentation and discharge) and recovery time (days between concussion and clinic discharge). Thematic analysis was used to analyze interview data. RESULTS Parental anxiety was not significantly related to either the child's time in clinic (P = 0.27) or recovery time (P = 0.41). Conversely, higher perceived parental stress was related to longer recovery time (Hazard Ratio: 2.162, 95% CI: 1.075, 4.348; p = 0.03) for the injured child, with similar results for time in clinic (Hazard Ratio: 1.883, 95% CI: 0.966, 3.668, p = 0.06). During the interview, parents expressed their stress was directly tied to their child's symptoms and overall functioning and varied throughout recovery. CONCLUSIONS Recovery time is significantly longer in concussed children whose parents are experiencing higher levels of stress, but not pre-existing anxiety, following injury. Parental stress varies throughout recovery, with stress generally higher in the acute post-injury period. Clinicians should monitor parental stress post-concussion when possible.
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Affiliation(s)
- Elizabeth F Teel
- School of Physical and Occupational Therapy, McGill University, Canada.
| | - Jeffrey G Caron
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Canada; Center for Interdisciplinary Research in Rehabilitation, Canada.
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Canada; Trauma Center, Montreal Children's Hospital, McGill University Health Center, Canada.
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Mahncke HW, DeGutis J, Levin H, Newsome MR, Bell MD, Grills C, French LM, Sullivan KW, Kim SJ, Rose A, Stasio C, Merzenich MM. A randomized clinical trial of plasticity-based cognitive training in mild traumatic brain injury. Brain 2021; 144:1994-2008. [PMID: 34312662 PMCID: PMC8370402 DOI: 10.1093/brain/awab202] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/04/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
Clinical practice guidelines support cognitive rehabilitation for people with a history of mild traumatic brain injury (mTBI) and cognitive impairment, but no class I randomized clinical trials have evaluated the efficacy of self-administered computerized cognitive training. The goal of this study was to evaluate the efficacy of a self-administered computerized plasticity-based cognitive training programmes in primarily military/veteran participants with a history of mTBI and cognitive impairment. A multisite randomized double-blind clinical trial of a behavioural intervention with an active control was conducted from September 2013 to February 2017 including assessments at baseline, post-training, and after a 3-month follow-up period. Participants self-administered cognitive training (experimental and active control) programmes at home, remotely supervised by a healthcare coach, with an intended training schedule of 5 days per week, 1 h per day, for 13 weeks. Participants (149 contacted, 83 intent-to-treat) were confirmed to have a history of mTBI (mean of 7.2 years post-injury) through medical history/clinician interview and persistent cognitive impairment through neuropsychological testing and/or quantitative participant reported measure. The experimental intervention was a brain plasticity-based computerized cognitive training programme targeting speed/accuracy of information processing, and the active control was composed of computer games. The primary cognitive function measure was a composite of nine standardized neuropsychological assessments, and the primary directly observed functional measure a timed instrumental activities of daily living assessment. Secondary outcome measures included participant-reported assessments of cognitive and mental health. The treatment group showed an improvement in the composite cognitive measure significantly larger than that of the active control group at both the post-training [+6.9 points, confidence interval (CI) +1.0 to +12.7, P = 0.025, d = 0.555] and the follow-up visit (+7.4 points, CI +0.6 to +14.3, P = 0.039, d = 0.591). Both large and small cognitive function improvements were seen twice as frequently in the treatment group than in the active control group. No significant between-group effects were seen on other measures, including the directly-observed functional and symptom measures. Statistically equivalent improvements in both groups were seen in depressive and cognitive symptoms.
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Affiliation(s)
| | - Joseph DeGutis
- VA Boston Healthcare System, and Harvard Medical School, Boston, MA, USA
| | - Harvey Levin
- Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, TX, USA
| | - Mary R Newsome
- Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, TX, USA
| | - Morris D Bell
- VA Connecticut Healthcare System, and Yale University School of Medicine, West Haven, CT, USA
| | - Chad Grills
- Desmond T. Doss Health Clinic, Schofield Barracks, Oahu, HI, USA
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Katherine W Sullivan
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Annika Rose
- Posit Science Corporation, San Francisco, CA, USA
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Haarbauer-Krupa J, Pugh MJ, Prager EM, Harmon N, Wolfe J, Yaffe K. Epidemiology of Chronic Effects of Traumatic Brain Injury. J Neurotrauma 2021; 38:3235-3247. [PMID: 33947273 PMCID: PMC9122127 DOI: 10.1089/neu.2021.0062] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although many patients diagnosed with traumatic brain injury (TBI), particularly mild TBI, recover from their symptoms within a few weeks, a small but meaningful subset experience symptoms that persist for months or years after injury and significantly impact quality of life for the person and their family. Factors associated with an increased likelihood of negative TBI outcomes include not only characteristics of the injury and injury mechanism, but also the person’s age, pre-injury status, comorbid conditions, environment, and propensity for resilience. In this article, as part of the Brain Trauma Blueprint: TBI State of the Science framework, we examine the epidemiology of long-term outcomes of TBI, including incidence, prevalence, and risk factors. We identify the need for increased longitudinal, global, standardized, and validated assessments on incidence, recovery, and treatments, as well as standardized assessments of the influence of genetics, race, ethnicity, sex, and environment on TBI outcomes. By identifying how epidemiological factors contribute to TBI outcomes in different groups of persons and potentially impact differential disease progression, we can guide investigators and clinicians toward more-precise patient diagnosis, along with tailored management, and improve clinical trial designs, data evaluation, and patient selection criteria.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, Utah, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, San Francisco, California, USA
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12
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Association of Lifetime TBI and Military Employment with Late-Life ADL Functioning: A Population-Based Prospective Cohort Study. Arch Phys Med Rehabil 2021; 102:2316-2324.e1. [PMID: 34283993 DOI: 10.1016/j.apmr.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/11/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine associations of traumatic brain injury (TBI) and military employment with activities of daily living (ADL) in late life. SETTING Community-based integrated healthcare delivery system. PARTICIPANTS Male (n=2066) and female (n=2887), aged 65+ and dementia-free. DESIGN Population-based prospective cohort study with biennial follow-up and censoring at time of dementia diagnosis. MAIN OUTCOME MEASURES ADL difficulties at baseline and accumulation during follow-up. RESULTS TBI with loss of consciousness (LOC) before age 40 was associated with slightly higher ADL difficulty at baseline for females (RR=1.44, 95% CI: 1.08-1.93, p=0.01). For males, TBI with LOC at any age was associated with greater ADL difficulty at baseline (age <40: RR=1.58, 95% CI: 1.20 - 2.08, p = 0.001; age 40+: RR=2.14, 95% CI: 1.24 - 3.68, p = 0.006). TBI with LOC was not associated with the rate of accumulation of ADL difficulties over time in males or females. There was no evidence of an association between military employment and either outcome, nor of an interaction between military employment and TBI with LOC. Findings were consistent across a variety of sensitivity analyses. CONCLUSION Further investigation into factors underlying greater late-life functional impairment among TBI survivors is warranted.
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13
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Schwerin SC, Chatterjee M, Hutchinson EB, Djankpa FT, Armstrong RC, McCabe JT, Perl DP, Juliano SL. Expression of GFAP and Tau Following Blast Exposure in the Cerebral Cortex of Ferrets. J Neuropathol Exp Neurol 2021; 80:112-128. [PMID: 33421075 DOI: 10.1093/jnen/nlaa157] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Blast exposures are a hallmark of contemporary military conflicts. We need improved preclinical models of blast traumatic brain injury for translation of pharmaceutical and therapeutic protocols. Compared with rodents, the ferret brain is larger, has substantial sulci, gyri, a higher white to gray matter ratio, and the hippocampus in a ventral position; these attributes facilitate comparison with the human brain. In this study, ferrets received compressed air shock waves and subsequent evaluation of glia and forms of tau following survival of up to 12 weeks. Immunohistochemistry and Western blot demonstrated altered distributions of astrogliosis and tau expression after blast exposure. Many aspects of the astrogliosis corresponded to human pathology: increased subpial reactivity, gliosis at gray-white matter interfaces, and extensive outlining of blood vessels. MRI analysis showed numerous hypointensities occurring in the 12-week survival animals, appearing to correspond to luminal expansions of blood vessels. Changes in forms of tau, including phosphorylated tau, and the isoforms 3R and 4R were noted using immunohistochemistry and Western blot in specific regions of the cerebral cortex. Of particular interest were the 3R and 4R isoforms, which modified their ratio after blast. Our data strongly support the ferret as an animal model with highly translational features to study blast injury.
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Affiliation(s)
- Susan C Schwerin
- From the Department of Anatomy Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | | | - Elizabeth B Hutchinson
- Quantitative Medical Imaging Section, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA
| | - Francis T Djankpa
- From the Department of Anatomy Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Department of Physiology, School of Medical Sciences, University of Cape Coast, Ghana
| | - Regina C Armstrong
- From the Department of Anatomy Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Joseph T McCabe
- From the Department of Anatomy Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Daniel P Perl
- Program in Neuroscience, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Department of Pathology, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Sharon L Juliano
- From the Department of Anatomy Physiology and Genetics, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Program in Neuroscience, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
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14
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DeGraba TJ, Williams K, Koffman R, Bell JL, Pettit W, Kelly JP, Dittmer TA, Nussbaum G, Grammer G, Bleiberg J, French LM, Pickett TC. Efficacy of an Interdisciplinary Intensive Outpatient Program in Treating Combat-Related Traumatic Brain Injury and Psychological Health Conditions. Front Neurol 2021; 11:580182. [PMID: 33536993 PMCID: PMC7848806 DOI: 10.3389/fneur.2020.580182] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/27/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Since 2000, over 413,000 US service members (SM) experienced at least one traumatic brain injury (TBI), and 40% of those with in-theater TBIs later screened positive for comorbid psychological health (PH) conditions, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many SMs with these persistent symptoms fail to achieve a recovery that results in a desirable quality of life or return to full duty. Limited information exists though to guide treatment for SMs with a history of mild TBI (mTBI) and comorbid PH conditions. This report presents the methods and outcomes of an interdisciplinary intensive outpatient program (IOP) in the treatment of SMs with combat-related mTBI and PH comorbidities. The IOP combines conventional rehabilitation therapies and integrative medicine techniques with the goal of reducing morbidity in multiple neurological and behavioral health domains and enhancing military readiness. Methods: SMs (n = 1,456) with residual symptoms from mTBI and comorbid PH conditions were treated in a 4-week IOP at the National Intrepid Center of Excellence (NICoE) at Walter Reed National Military Medical Center (WRNMMC). The IOP uses an interdisciplinary, holistic, and patient-centric rehabilitative care model. Interdisciplinary teams provide a diagnostic workup of neurological, psychiatric, and existential injuries, and from these assessments, individualized care plans are developed. Treatment response was assessed using the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Satisfaction With Life Scale (SWLS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Epworth Sleepiness Scale (ESS), and Headache Impact Test-6 (HIT-6) and administered at admission, discharge, and at 1, 3, and 6 months post-discharge. Findings: Following treatment in the IOP, the symptomatic patients had statistically significant and clinically meaningful improvements across all outcome measures. The largest effect size was seen with GAD-7 (r = 0.59), followed by PHQ-8 (r = 0.56), NSI (r = 0.55), PCL-M (r = 0.52), ESS (r = 0.50), SWLS (r = 0.49), and HIT-6 (r = 0.42). In cross-sectional follow ups, the significant improvements were sustained at 1, 3, and 6 months post-discharge. Interpretation: This report demonstrates that an interdisciplinary IOP achieves significant and sustainable symptom recovery in SMs with combat-related mTBI and comorbid PH conditions and supports the further study of this model of care in complex medical conditions.
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Affiliation(s)
- Thomas J. DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Kathy Williams
- Credence Management Solutions, Vienna, VA, United States
| | - Robert Koffman
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Jennifer L. Bell
- Psychological Health Center of Excellence, J9, Defense Health Agency, McClean, VA, United States
| | - Wendy Pettit
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - James P. Kelly
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Neurology, University of Colorado School of Medicine, Marcus Institute for Brain Health, Aurora, CO, United States
| | | | - George Nussbaum
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Geoffrey Grammer
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Joseph Bleiberg
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Treven C. Pickett
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
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15
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Barczak-Scarboro NE, Roby PR, Kiefer AW, Bailar-Heath M, Burke RJ, DeLellis SM, Kane SF, Lynch JH, Means GE, Depenbrock PJ, Mihalik JP. The relationship between resilience and neurophysiological stress in Special Operations Forces combat service members. Eur J Neurosci 2021; 55:2804-2812. [PMID: 33432647 DOI: 10.1111/ejn.15109] [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: 10/26/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Military resilience research is increasing due to the growing literature associating resilience with stress adaptation. This study aimed to investigate which physiological stress adaptation components were associated with resilience in Special Operations Forces combat service members. Special Operations Forces combat service members (n = 117) self-reported resilience (ER89) and lifetime clinician-confirmed mild traumatic brain injury history. Participants also underwent transcranial Doppler ultrasonography to measure middle cerebral artery velocity during rest and a breath-holding task. Neither resilience nor mild traumatic brain injury history was significantly associated with middle cerebral artery velocity percent increase following breath-holding; younger Special Operations Forces combat service members had a higher percent increase in middle cerebral artery velocity following a breath-holding task. Resilience was negatively associated with time to return to baseline middle cerebral artery velocity following peak velocity; whereas, mild traumatic brain injury history did not have a significant association. The Special Operations Forces combat service members that scored higher in resilience tended to return to baseline middle cerebral artery velocity following peak velocity faster than their less resilient counterparts. More resilient Special Operations Forces combat service members recovered faster from physiological stress (breath-holding) than less resilient counterparts. This is the first study to investigate resilience and cerebrovascular stress response and recovery in this population. Our initial findings indicated that the Ego Resiliency Scale may be an optimal resilience psychometric and should be used to evaluate effective military resilience trainings, which aim to improve performance and mental health.
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Affiliation(s)
- Nikki E Barczak-Scarboro
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia R Roby
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam W Kiefer
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Riley J Burke
- Air Force Special Operations Command, Fort Bragg, NC, USA
| | | | - Shawn F Kane
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James H Lynch
- United States Army Special Operations Command, Fort Bragg, NC, USA
| | - Gary E Means
- United States Army Special Operations Command, Fort Bragg, NC, USA
| | | | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Human Movement Science Curriculum, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Lange RT, Lippa SM, Brickell TA, Yeh PH, Ollinger J, Wright M, Driscoll A, Sullivan J, Braatz S, Gartner R, Barnhart E, French LM. Post-Traumatic Stress Disorder Is Associated with Neuropsychological Outcome but Not White Matter Integrity after Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:63-73. [PMID: 33395374 DOI: 10.1089/neu.2019.6852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to examine neuropsychological functioning and white matter integrity, in service members and veterans (SMVs) after mild traumatic brain injury (MTBI), with versus without post-traumatic stress disorder (PTSD). Participants were 116 U.S. military SMVs, prospectively enrolled from the Walter Reed National Military Medical Center (Bethesda, MD), who had sustained an MTBI (n = 86) or an injury without TBI (i.e., Injured Control [IC]; n = 30). Participants completed a battery of neuropsychological measures (neurobehavioral and -cognitive), as well as diffusion tensor imaging (DTI) of the brain, on average 6 years post-injury. Based on diagnostic criteria for PTSD, participants in the MTBI group were classified into two subgroups: MTBI/PTSD-Present (n = 21) and MTBI/PTSD-Absent (n = 65). Participants in the IC group were included only if they were classified as PTSD-Absent. The MTBI/PTSD-Present group had a significantly higher number of self-reported symptoms on all neurobehavioral measures (e.g., depression), and lower scores on more than half of the neurocognitive domains (e.g., processing speed), compared to the MTBI/PTSD-Absent and IC/PTSD-Absent groups. There were no significant group differences for the vast majority of DTI measures, with the exception of a handful of regions (i.e., superior longitudinal fascicle and superior thalamic radiation). These results suggest that there is 1) a strong relationship between PTSD and poor neuropsychological outcome after MTBI and 2) a lack of a relationship between PTSD and white matter integrity, as measured by DTI, after MTBI. Concurrent PTSD and MTBI should be considered a risk factor for poor neuropsychological outcome that requires early intervention.
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Affiliation(s)
- Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, 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
| | - Megan Wright
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Angela Driscoll
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jamie Sullivan
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Samantha Braatz
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rachel Gartner
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth Barnhart
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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17
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Barczak-Scarboro NE, Cole WR, DeLellis SM, Means GE, Kane SF, Lynch JH, Mihalik JP. Mental Health Symptoms Are Associated With Mild Traumatic Brain Injury History in Active Special Operations Forces (SOF) Combat and Combat Support Soldiers. Mil Med 2020; 185:e1946-e1953. [PMID: 32676649 DOI: 10.1093/milmed/usaa167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Special Operations Forces (SOF) combat arms and combat support Soldiers are at risk for impaired mental health, such as mood- and stress-related disorders, due to operational and training demands. Additionally, these individuals experience high risk for sustaining mild traumatic brain injury (mTBI). These mTBIs have also been linked to negative psychological outcomes, such as anxiety and depressive symptoms. Studying mental illnesses and their related symptoms alone does not fully address mental health, which may be better understood by 2 separate but overlapping continua measuring both mental illness and subjective well-being (ie, emotional, psychological, and social well-being). Due to the lack of research in this area, current mental health symptoms in active SOF combat Soldiers in relation to mTBI warrants investigation. MATERIALS AND METHODS In this study, 113 SOF combat and combat support Soldiers completed self-report psychological and mTBI history measures during an in-person laboratory setting. These psychometric measures included (1) psychological distress (Brief Symptom Inventory 18), (2) anxiety (Generalized Anxiety Disorder 7-item), (3) posttraumatic stress (PTSD Checklist for DSM-5), (4) somatization (Patient Health Questionnaire-15), and (5) subjective well-being (Mental Health Continuum Short Form). RESULTS On average, SOF combat Soldiers endorsed moderate well-being and low psychological distress, somatization, posttraumatic stress, and anxiety. Most SOF combat Soldiers had sustained 1 or more mTBI. We observed mTBI history had significant effects on each dependent variable in the expected directions. History of more mTBIs, controlling for age, was associated with lower subjective well-being as well as higher psychological distress, somatization, posttraumatic stress, and anxiety symptoms. CONCLUSION Although SOF combat Soldiers reported relatively adaptive mental health symptoms across participants, there was considerable variance in the measures reported. Some of the variance in mental health symptoms was accounted for by mTBI history while controlling for age, with reporting higher numbers of lifetime mTBIs and older age being associated with worse mental health symptoms. Longitudinal investigations into these associations and their impact on Soldier performance is warranted.
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Affiliation(s)
- Nikki E Barczak-Scarboro
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 2201 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599.,Human Movement Science Curriculum, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, Campus Box 7120, Chapel Hill, NC 27599
| | - Wesley R Cole
- Intrepid Spirit Center, Womack Army Medical Center, 3908 Longstreet Road, Building #3-403, Fort Bragg, NC 28310
| | - Stephen M DeLellis
- Defense Medical Strategies, LLC, 136 Timberlake Drive, Fayetteville, NC 28314
| | - Gary E Means
- United States Army Special Operations Command, E-2929 Desert Storm Drive, Fort Bragg, NC 28310
| | - Shawn F Kane
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 2201 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599.,Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27514
| | - James H Lynch
- United States Army Special Operations Command, E-2929 Desert Storm Drive, Fort Bragg, NC 28310
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 2201 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599.,Human Movement Science Curriculum, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, Campus Box 7120, Chapel Hill, NC 27599
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18
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Phipps H, Mondello S, Wilson A, Dittmer T, Rohde NN, Schroeder PJ, Nichols J, McGirt C, Hoffman J, Tanksley K, Chohan M, Heiderman A, Abou Abbass H, Kobeissy F, Hinds S. Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review. Front Neurol 2020; 11:559318. [PMID: 33224086 PMCID: PMC7667277 DOI: 10.3389/fneur.2020.559318] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022] Open
Abstract
As a result of armed conflict, head trauma from exposure to blasts is an increasing critical health issue, particularly among military service members. Whilst numerous studies examined the burden of blast-related brain injuries on service members', few systematic reviews have been published. This work provides a comprehensive summary of the evidence on blast-related mild traumatic brain injury (mTBI) burden in active U.S. military service members and inactive Veterans, describing characteristics and outcomes. Records published up to April 2017 were identified through a search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and Cochrane Library. Records-based and original research reporting on U.S. military service members and Veterans with mild blast TBI were included. Data on subject characteristics, exposure, diagnostic criterion, and outcomes were extracted from included studies using a standardized extraction form and were presented narratively. Of the 2,290 references identified by the search, 106 studies with a total of 37,515 participants met inclusion criteria for blast-related mTBI. All but nine studies were based out of military or Veteran medical facilities. Unsurprisingly, men were over-represented (75–100%). The criteria used to define blast-related mTBI were consistent; however, the methodology used to ascertain whether individuals met those criteria for diagnosis were inconsistent. The diagnosis, most prevalent among the Army, heavily relied on self-reported histories. Commonly reported adverse outcomes included hearing disturbances and headaches. The most frequently associated comorbidities were post-traumatic stress disorder, depression, anxiety, sleep disorders, attention disorders, and cognitive disorders. The primary objective of this review was to provide a summary of descriptive data on blast-related mTBI in a U.S. military population. Low standardization of the methods for reaching diagnosis and problems in the study reporting emphasize the importance to collect high-quality data to fill knowledge gaps pertaining to blast-related mTBI.
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Affiliation(s)
- Helen Phipps
- Booz Allen Hamilton, San Antonio, TX, United States
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | | | | | | | | | | | | | | | | | | | | | - Hussein Abou Abbass
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Psychiatry, Center for Neuroproteomics and Biomarkers Research, University of Florida, Gainesville, FL, United States
| | - Sidney Hinds
- Medical Research and Development Command, Ft Detrick, MD, United States
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19
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Vu PA, McNamara EH, Liu J, Tucker LB, Fu AH, McCabe JT. Behavioral responses following repeated bilateral frontal region closed head impacts and fear conditioning in male and female mice. Brain Res 2020; 1750:147147. [PMID: 33091394 DOI: 10.1016/j.brainres.2020.147147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 02/01/2023]
Abstract
The frontal lobes are among the most vulnerable sites in traumatic brain injuries. In the current study, a balanced 2 × 2 × 2 design (n = 18 mice/group), female and male C57Bl/6J mice received repeated bilateral frontal concussive brain injury (frCBI) and underwent fear conditioning (FC) to assess how injured mice respond to adverse conditions. Shocks received during FC impacted behavior on all subsequent tests except the tail suspension test. FC resulted in more freezing behavior in all mice that received foot shocks when evaluated in subsequent context and cue tests and induced hypoactivity in the open field (OF) and elevated zero maze (EZM). Mice that sustained frCBI learned the FC association between tone and shock. Injured mice froze less than sham controls during context and cue tests, which could indicate memory impairment, but could also suggest that frCBI resulted in hyperactivity that overrode the rodent's natural freezing response to threat, as injured mice were also more active in the OF and EZM. There were notable sex differences, where female mice exhibited more freezing behavior than male mice during FC context and cue tests. The findings suggest frCBI impaired, but did not eliminate, FC retention and resulted in an overall increase in general activity. The injury was characterized pathologically by increased inflammation (CD11b staining) in cortical regions underlying the injury site and in the optic tracts. The performance of male and female mice after injury suggested the complexity of possible sex differences for neuropsychiatric symptoms.
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Affiliation(s)
- Patricia A Vu
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Graduate Program in Neuroscience, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States
| | - Eileen H McNamara
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Graduate Program in Neuroscience, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States
| | - Jiong Liu
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States
| | - Laura B Tucker
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States
| | - Amanda H Fu
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States
| | - Joseph T McCabe
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Graduate Program in Neuroscience, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States.
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20
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Kornblith ES, Yaffe K, Langa KM, Gardner RC. Prevalence of Lifetime History of Traumatic Brain Injury among Older Male Veterans Compared with Civilians: A Nationally Representative Study. J Neurotrauma 2020; 37:2680-2685. [PMID: 32762279 DOI: 10.1089/neu.2020.7062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) is common among older adults as well as among veterans in the United States and can increase risk for dementia. We compared prevalence of TBI in older male veterans and civilians using a nationally representative sample. We examined data from 599 male respondents to the 2014 wave of the Health and Retirement Study (HRS), a nationally representative survey of older adults, randomly selected to participate in a comprehensive TBI survey. Respondents self-reported no injury, non-TBI head/neck injury (NTI), or TBI. We used weighted analyses to examine prevalence of injury and relative risk of injury subtypes. Among male veterans, we found a national prevalence of more than 70% for lifetime history of any head/neck injury (TBI plus NTI), 14.3% for multiple NTI, and 36% for lifetime history of at least one TBI. In contrast, prevalence estimates for male civilians were 58% for lifetime history of head/neck injury, 4.8% for multiple NTI, and 45% for lifetime history of at least one TBI (all comparisons, p < 0.001). Male civilians have higher self-reported TBI prevalence, whereas male veterans have higher self-reported NTI and multiple-NTI prevalence. Further research on drivers of the unexpectedly higher prevalence of lifetime history of TBI in male civilians, as well as on mechanisms and sequelae of the highly prevalent non-TBI head/neck injuries among older male veterans, is warranted.
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Affiliation(s)
- Erica S Kornblith
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.,Department of Neurology, University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kenneth M Langa
- Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.,Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan, USA.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.,Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Raquel C Gardner
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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21
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Aravind A, Kosty J, Chandra N, Pfister BJ. Blast exposure predisposes the brain to increased neurological deficits in a model of blast plus blunt traumatic brain injury. Exp Neurol 2020; 332:113378. [PMID: 32553593 DOI: 10.1016/j.expneurol.2020.113378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
Soldiers are often exposed to more than one traumatic brain injury (TBI) over the course of their service. In recent years, more attention has been drawn to the increased risk of neurological deficits caused by the 'blast plus' polytrauma, which typically is a blast trauma combined with other forms of TBI. In this study, we investigated the behavioral and neuronal deficits resulting from a blast plus injury involving a mild-moderate blast followed by a mild blunt trauma using the fluid percussion injury model. We identified that the blast injury predisposed the brain to increased cognitive deficits, chronic ventricular enlargement, increased neurodegeneration at acute time points and chronic neuronal loss. Interestingly, a single blast and single blunt injury differed in their onset and manifestation of cognitive and regional neuronal loss. We also identified the presence of cleaved RIP1 from caspase 8 mediated apoptosis in the blunt injury while the blast injury did not activate immediate apoptosis but led to decreased hilar neuronal survival over time.
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Affiliation(s)
- Aswati Aravind
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Dr M.L.K. Jr. Blvd, Newark, NJ 07102, USA
| | - Julianna Kosty
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Dr M.L.K. Jr. Blvd, Newark, NJ 07102, USA
| | - Namas Chandra
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Dr M.L.K. Jr. Blvd, Newark, NJ 07102, USA
| | - Bryan J Pfister
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Dr M.L.K. Jr. Blvd, Newark, NJ 07102, USA.
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22
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Logsdon AF, Schindler AG, Meabon JS, Yagi M, Herbert MJ, Banks WA, Raskind MA, Marshall DA, Keene CD, Perl DP, Peskind ER, Cook DG. Nitric oxide synthase mediates cerebellar dysfunction in mice exposed to repetitive blast-induced mild traumatic brain injury. Sci Rep 2020; 10:9420. [PMID: 32523011 PMCID: PMC7287110 DOI: 10.1038/s41598-020-66113-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/16/2020] [Indexed: 02/02/2023] Open
Abstract
We investigated the role of nitric oxide synthase (NOS) in mediating blood-brain barrier (BBB) disruption and peripheral immune cell infiltration in the cerebellum following blast exposure. Repetitive, but not single blast exposure, induced delayed-onset BBB disruption (72 hours post-blast) in cerebellum. The NOS inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) administered after blast blocked BBB disruption and prevented CD4+ T-cell infiltration into cerebellum. L-NAME also blocked blast-induced increases in intercellular adhesion molecule-1 (ICAM-1), a molecule that plays a critical role in regulating blood-to-brain immune cell trafficking. Blocking NOS-mediated BBB dysfunction during this acute/subacute post-blast interval (24-71 hours after the last blast) also prevented sensorimotor impairment on a rotarod task 30 days later, long after L-NAME cleared the body. In postmortem brains from Veterans/military Servicemembers with blast-related TBI, we found marked Purkinje cell dendritic arbor structural abnormalities, which were comparable to neuropathologic findings in the blast-exposed mice. Taken collectively, these results indicate that blast provokes delayed-onset of NOS-dependent pathogenic cascades that can later emerge as behavioral dysfunction. These results also further implicate the cerebellum as a brain region vulnerable to blast-induced mTBI.
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Affiliation(s)
- Aric F. Logsdon
- 0000 0004 0420 6540grid.413919.7Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA ,0000000122986657grid.34477.33Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - Abigail G. Schindler
- 0000 0004 0420 6540grid.413919.7Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA ,0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - James S. Meabon
- 0000 0004 0420 6540grid.413919.7VA Northwest Mental Illness Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA ,0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - Mayumi Yagi
- 0000 0004 0420 6540grid.413919.7Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA
| | - Melanie J. Herbert
- 0000 0004 0420 6540grid.413919.7Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA
| | - William A. Banks
- 0000 0004 0420 6540grid.413919.7Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA ,0000000122986657grid.34477.33Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - Murray A. Raskind
- 0000 0004 0420 6540grid.413919.7VA Northwest Mental Illness Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA ,0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - Desiree A. Marshall
- 0000000122986657grid.34477.33Department of Pathology, University of Washington, Seattle, WA 98195 USA
| | - C. Dirk Keene
- 0000000122986657grid.34477.33Department of Pathology, University of Washington, Seattle, WA 98195 USA
| | - Daniel P. Perl
- 0000 0001 0421 5525grid.265436.0Department of Pathology, Center for Neuroscience and Regenerative Medicine, School of Medicine, Uniformed Services University, Bethesda, MD 20814 USA
| | - Elaine R. Peskind
- 0000 0004 0420 6540grid.413919.7VA Northwest Mental Illness Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA ,0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - David G. Cook
- 0000 0004 0420 6540grid.413919.7Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 USA ,0000000122986657grid.34477.33Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195 USA
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23
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Lange RT, French LM, Lippa SM, Bailie JM, Brickell TA. Posttraumatic Stress Disorder is a Stronger Predictor of Long-Term Neurobehavioral Outcomes Than Traumatic Brain Injury Severity. J Trauma Stress 2020; 33:318-329. [PMID: 32379932 DOI: 10.1002/jts.22480] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 04/05/2019] [Indexed: 11/11/2022]
Abstract
Concurrent posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) is common in military populations. The purpose of this study was to examine long-term neurobehavioral outcomes in service members and veterans (SMVs) with versus without PTSD symptoms following TBI of all severities. Participants were 536 SMVs prospectively enrolled from three military medical treatment facilities who were recruited into three experimental groups: TBI, injured controls (IC), and noninjured controls (NIC). Participants completed the PTSD Checklist, Neurobehavioral Symptom Inventory, and the TBI-Quality of Life (TBI-QOL) and were divided into six subgroups based on the three experimental categories, two PTSD categories (i.e., present vs. absent), and two broad TBI severity categories (unMTBI, which included uncomplicated mild TBI; and smcTBI, which included severe TBI, moderate TBI, and complicated mild TBI): (a) NIC/PTSD-absent, (b) IC/PTSD-absent, (c) unMTBI/PTSD-absent, (d) unMTBI/PTSD-present, (e) smcTBI/PTSD-absent, and (f) smcTBI/PTSD-present. There were significant main effects across the six groups for all TBI-QOL measures, ps < .001. Select pairwise comparisons revealed significantly lower scores, p < .001, on all TBI-QOL measures in the PTSD-present groups when compared to the PTSD-absent groups within the same TBI severity classification, ds = 0.90-2.11. In contrast, when controlling for PTSD, there were no significant differences among the TBI severity groups for any TBI-QOL measures. These results provide support for the strong influence of PTSD but not TBI severity on neurobehavioral outcomes following TBI. Concurrent PTSD and TBI of all severities should be considered a risk factor for poor long-term neurobehavioral outcomes that require ongoing monitoring.
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Affiliation(s)
- Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sara M Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Jason M Bailie
- Defense and Veterans Brain Injury Center, Naval Hospital Camp Pendleton, California, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Contractor, Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
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24
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Waid-Ebbs JK, Wen PS, Graham DP, Leroux AJ, O’Connor MK, Helmer DA. Measurement Properties of the MPAI-4 in Veterans With mTBI. Arch Phys Med Rehabil 2020; 101:789-796. [DOI: 10.1016/j.apmr.2019.10.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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25
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Vasterling JJ, Aslan M, Proctor SP, Ko J, Leviyah X, Concato J. Long-term negative emotional outcomes of warzone TBI. Clin Neuropsychol 2020; 34:1088-1104. [PMID: 32301397 DOI: 10.1080/13854046.2020.1749935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Many veterans of the Iraq and Afghanistan Wars have experienced traumatic brain injury (TBI). Although prior work has examined associations between TBI and development of psychiatric syndromes, less is known about associations between TBI and component emotions constituting these syndromes, especially in the long term. The purpose of this study was to examine the long-term emotional consequences of deployment-related TBI. METHODS As part of VA Cooperative Studies Program #566, we assessed a sample of n = 456 US Army soldiers prior to an index deployment to Iraq, and again an average of 8.3 years (SD = 2.4 years) after their deployment for a long-term follow-up assessment. In this report, we used adjusted regression analyses to examine the relationship of deployment TBI to depression, anxiety, and stress symptom severity measured at the long-term follow-up assessment. A structured interview was used to determine TBI history; the Depression, Anxiety, and Stress Scale, 21-item version (DASS-21) was used to determine emotional status at the follow-up evaluation. RESULTS Warzone TBI events, particularly when greater than mild in severity, were independently associated with depression, anxiety, and stress severity at long-term follow-up, even after taking into account variance attributable to pre-deployment emotional distress and war-zone stress. Post-hoc analyses did not detect independent associations of either number of events or injury mechanism with outcomes. CONCLUSIONS These findings highlight the potentially enduring and multi-faceted emotional effects of deployment TBI, underscoring the need for early assessment of negative affectivity in warzone veterans reporting TBI.
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Affiliation(s)
- Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA.,Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Susan P Proctor
- U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA.,Research Service, VA Boston Healthcare System, Boston, MA, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA
| | - Xenia Leviyah
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - John Concato
- Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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26
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A Systematic Review and Meta-analysis on PTSD Following TBI Among Military/Veteran and Civilian Populations. J Head Trauma Rehabil 2020; 35:E21-E35. [DOI: 10.1097/htr.0000000000000514] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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27
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Prevalence and Severity of Psychiatric Disorders and Suicidal Behavior in Service Members and Veterans With and Without Traumatic Brain Injury: Systematic Review. J Head Trauma Rehabil 2020; 35:1-13. [DOI: 10.1097/htr.0000000000000478] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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28
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Mac Donald CL, Barber J, Andre J, Panks C, Zalewski K, Temkin N. Longitudinal neuroimaging following combat concussion: sub-acute, 1 year and 5 years post-injury. Brain Commun 2019; 1:fcz031. [PMID: 31915753 PMCID: PMC6935683 DOI: 10.1093/braincomms/fcz031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/07/2019] [Accepted: 10/17/2019] [Indexed: 12/25/2022] Open
Abstract
Questions remain regarding the long-term impact of combat concussive blast exposure. While efforts have begun to highlight the clinical impact, less is known about neuroimaging trajectories that may inform underlying pathophysiological changes post-injury. Through collaborative efforts in combat, following medical evacuation, and at universities in the USA, this study followed service members both with and without blast concussion from the sub-acute to 1-year and 5-year outcomes with quantitative neuroimaging. The following two primary and two exploratory groups were examined: combat-deployed controls without blast exposure history ‘non-blast control’ and concussive blast patients (primary) and combat concussion arising not from blast ‘non-blast concussion’ and combat-deployed controls with blast exposure history ‘blast control’ (exploratory). A total of 575 subjects were prospectively enrolled and imaged; 347 subjects completed further neuroimaging examination at 1 year and 342 subjects completed further neuroimaging examination at 5 years post-injury. At each time point, MRI scans were completed that included high-resolution structural as well as diffusion tensor imaging acquisitions processed for quantitative volumetric and diffusion tensor imaging changes. Longitudinal evaluation of the number of abnormal diffusion tensor imaging and volumetric regions in patients with blast concussion revealed distinct trends by imaging modality. While the presence of abnormal volumetric regions remained quite stable comparing our two primary groups of non-blast control to blast concussion, the diffusion tensor imaging abnormalities were observed to have varying trajectories. Most striking was the fractional anisotropy ‘U-shaped’ curve observed for a proportion of those that, if we had only followed them to 1 year, would look like trajectories of recovery. However, by continuing the follow-up to 5 years in these very same patients, a secondary increase in the number of reduced fractional anisotropy regions was identified. Comparing non-blast controls to blast concussion at each time point revealed significant differences in the number of regions with reduced fractional anisotropy at both the sub-acute and 5-year time points, which held after adjustment for age, education, gender, scanner and subsequent head injury exposure followed by correction for multiple comparisons. The secondary increase identified in patients with blast concussion may be the earliest indications of microstructural changes underlying the ‘accelerated brain aging’ theory recently reported from chronic, cross-sectional studies of veterans following brain injury. These varying trajectories also inform potential prognostic neuroimaging biomarkers of progression and recovery.
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Affiliation(s)
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Jalal Andre
- Department of Radiology, University of Washington, Seattle, WA 98104, USA
| | - Chris Panks
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA.,Department of Biostatistics, University of Washington, Seattle, WA 98104, USA
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29
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Brungart D, Kruger S, Kwiatkowski T, Heil T, Highland KB, Cohen J, Kokx-Ryan M, Schurman J, Zaleski-King A, Zion D. The Effects of Blast-Related Neurotrauma on Aurally Aided Visual Search While Standing and Walking. J Neurotrauma 2019; 36:2443-2453. [PMID: 30696345 DOI: 10.1089/neu.2018.5630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Service members (SMs) who have suffered mild traumatic brain injury due to blast exposure (b/TBI) often report post-concussive symptoms consistent with auditory, visual, or vestibular impairments even when they score within the normal range on traditional clinical tests of sensory function. One possible explanation for this discrepancy is that patients who score in the low normal range in more than one sensory modality may be severely impaired in tasks that require multisensory integration. This study evaluated unimodal and multimodal sensory performance in SMs with b/TBI and healthy controls by having them conduct four tasks while walking or standing in an immersive virtual environment: an Auditory Localization task (AL) where they moved a cursor to the perceived location of a sound; a Visual Discrimination task (VD) where they distinguished between two visual targets; an Aurally-Aided Visual Search Task (AAVS) where they used an auditory cue to locate and identify a visual target hidden in a field of visual distractors; and a Visual-Only Visual Search task (VOVS) where they located and identified a visual target in a field of distractors with no auditory cue. The results show the b/TBI and healthy control groups performed equivalently in the AL and VD tasks, but that the b/TBI group responded roughly 15% slower in the AAVS task and 50% slower in the VOVS task. Walking had no effect on performance in the visual-only tasks, but both groups responded faster while walking in the AL and AAVS tasks without any reduction in accuracy.
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Affiliation(s)
- Douglas Brungart
- 1National Military Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sarah Kruger
- 2National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Krista Beth Highland
- 5Uniformed Services University, Bethesda, Maryland.,6Defense and Veterans Center for Integrative Pain Management, Bethesda, Maryland
| | - Julie Cohen
- 3Henry M. Jackson Foundation, Bethesda, Maryland
| | - Melissa Kokx-Ryan
- 2National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Ashley Zaleski-King
- 1National Military Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, Maryland
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30
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Lange RT, Lippa SM, French LM, Bailie JM, Gartner RL, Driscoll AE, Wright MM, Sullivan JK, Varbedian NV, Barnhart EA, Holzinger JB, Schaper AL, Reese MA, Brandler BJ, Camelo-Lopez V, Brickell TA. Long-term neurobehavioural symptom reporting following mild, moderate, severe, and penetrating traumatic brain injury in U.S. military service members. Neuropsychol Rehabil 2019; 30:1762-1785. [DOI: 10.1080/09602011.2019.1604385] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rael T. Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Sara M. Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Louis M. French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Naval Hospital Camp Pendleton, CA, USA
| | - Rachel L. Gartner
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Angela E. Driscoll
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Megan M. Wright
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Jamie K. Sullivan
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Nicole V. Varbedian
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Elizabeth A. Barnhart
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Jayne B. Holzinger
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Ashley L. Schaper
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Maryetta A. Reese
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Brian J. Brandler
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Vanessa Camelo-Lopez
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Tracey A. Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Contractor, Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
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Snyder HM, Carare RO, DeKosky ST, de Leon MJ, Dykxhoorn D, Gan L, Gardner R, Hinds SR, Jaffee M, Lamb BT, Landau S, Manley G, McKee A, Perl D, Schneider JA, Weiner M, Wellington C, Yaffe K, Bain L, Pacifico AM, Carrillo MC. Military-related risk factors for dementia. Alzheimers Dement 2018; 14:1651-1662. [PMID: 30415806 PMCID: PMC6281800 DOI: 10.1016/j.jalz.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In recent years, there has been growing discussion to better understand the pathophysiological mechanisms of traumatic brain injury and post-traumatic stress disorder and how they may be linked to an increased risk of neurodegenerative diseases including Alzheimer's disease in veterans. METHODS Building on that discussion, and subsequent to a special issue of Alzheimer's & Dementia published in June 2014, which focused on military risk factors, the Alzheimer's Association convened a continued discussion of the scientific community on December 1, 2016. RESULTS During this meeting, participants presented and evaluated progress made since 2012 and identified outstanding knowledge gaps regarding factors that may impact veterans' risk for later life dementia. DISCUSSION The following is a summary of the invited presentations and moderated discussions of both the review of scientific understanding and identification of gaps to inform further investigations.
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Affiliation(s)
- Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA.
| | - Roxana O Carare
- Clinical Neuroanatomy, Equality and Diversity Lead, University of Southampton, Southampton, United Kingdom
| | - Steven T DeKosky
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Mony J de Leon
- Department of Psychiatry, New York University Medical Center, New York City, NY, USA
| | - Derek Dykxhoorn
- Department of Microbiology and Immunology, Miami University, Miami, FL, USA
| | - Li Gan
- Gladstone Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Raquel Gardner
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Sidney R Hinds
- Blast Injury Research Program Coordinating Office, United States Army Medical Research and Material Command, Frederick, MD, USA
| | - Michael Jaffee
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Bruce T Lamb
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA
| | - Susan Landau
- Helen Willis Neuroscience Institute, University of California, Berkley, Berkley, CA, USA
| | - Geoff Manley
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Ann McKee
- Department of Neurology and Pathology, Boston University, Boston, MA, USA
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, MD, USA
| | - Julie A Schneider
- Neurology Department, Rush University Medical Center, Chicago, IL, USA
| | - Michael Weiner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristine Yaffe
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa Bain
- Independent Science Writer, Philadelphia, PA, USA
| | | | - Maria C Carrillo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
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Logsdon AF, Meabon JS, Cline MM, Bullock KM, Raskind MA, Peskind ER, Banks WA, Cook DG. Blast exposure elicits blood-brain barrier disruption and repair mediated by tight junction integrity and nitric oxide dependent processes. Sci Rep 2018; 8:11344. [PMID: 30054495 PMCID: PMC6063850 DOI: 10.1038/s41598-018-29341-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/25/2018] [Indexed: 12/14/2022] Open
Abstract
Mild blast-induced traumatic brain injury (TBI) is associated with blood-brain barrier (BBB) disruption. However, the mechanisms whereby blast disrupts BBB integrity are not well understood. To address this issue BBB permeability to peripherally injected 14C-sucrose and 99mTc-albumin was quantified in ten brain regions at time points ranging from 0.25 to 72 hours. In mice, repetitive (2X) blast provoked BBB permeability to 14C-sucrose that persisted in specific brain regions from 0.25 to 72 hours. However, 99mTc-albumin revealed biphasic BBB disruption (open-closed-open) over the same interval, which was most pronounced in frontal cortex and hippocampus. This indicates that blast initiates interacting BBB disruption and reparative processes in specific brain regions. Further investigation of delayed (72 hour) BBB disruption revealed that claudin-5 (CLD5) expression was disrupted specifically in the hippocampus, but not in dorsal striatum, a brain region that showed no blast-induced BBB permeability to sucrose or albumin. In addition, we found that delayed BBB permeability and disrupted CLD5 expression were blocked by the nitric oxide synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME). These data argue that latent nitric oxide-dependent signaling pathways initiate processes that result in delayed BBB disruption, which are manifested in a brain-region specific manner.
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Affiliation(s)
- Aric F Logsdon
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - James S Meabon
- Veterans Affairs Northwest Network, Mental Illness Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Marcella M Cline
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA.,Department of Molecular and Cellular Biology, University of Washington, Seattle, WA, 98195, USA
| | - Kristin M Bullock
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Murray A Raskind
- Veterans Affairs Northwest Network, Mental Illness Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Elaine R Peskind
- Veterans Affairs Northwest Network, Mental Illness Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - William A Banks
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - David G Cook
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA. .,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA.
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Armistead-Jehle P, Soble JR, Cooper DB, Belanger HG. Unique Aspects of Traumatic Brain Injury in Military and Veteran Populations. Phys Med Rehabil Clin N Am 2018; 28:323-337. [PMID: 28390516 DOI: 10.1016/j.pmr.2016.12.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury (TBI), in particular mild TBI (mTBI), is a relatively common injury experienced by service members across both deployed and nondeployed environments. Although many of the principles and practices used by civilian health care providers for identifying and treating this injury apply to military settings, there are unique factors that impact mTBI-related care in service members and Veterans. This article reviews several of these factors, including the epidemiology of TBI in the military/Veteran population, the influence of military culture on this condition, and identification and treatment of mTBI in the war zone.
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Affiliation(s)
- Patrick Armistead-Jehle
- Concussion Clinic, Munson Army Health Center, 550 Pope Avenue, Fort Leavenworth, KS 66027, USA.
| | - Jason R Soble
- Psychology Service, South Texas Veterans Healthcare System, 7400 Merton Minter, San Antonio, TX 78229, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center, Department of Neurology, San Antonio Military Medical Center, Joint Base San Antonio, MCHE-ZDM-N, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234-4504, USA; Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Heather G Belanger
- HSR&D, Tampa VA TBI/Polytrauma Rehabilitation Center, Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard - 116A, Tampa, FL 33612, USA; Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33612, USA; Defense and Veterans Brain Injury Center, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA
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Laksari K, Kurt M, Babaee H, Kleiven S, Camarillo D. Mechanistic Insights into Human Brain Impact Dynamics through Modal Analysis. PHYSICAL REVIEW LETTERS 2018; 120:138101. [PMID: 29694192 DOI: 10.1103/physrevlett.120.138101] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 10/26/2017] [Indexed: 06/08/2023]
Abstract
Although concussion is one of the greatest health challenges today, our physical understanding of the cause of injury is limited. In this Letter, we simulated football head impacts in a finite element model and extracted the most dominant modal behavior of the brain's deformation. We showed that the brain's deformation is most sensitive in low frequency regimes close to 30 Hz, and discovered that for most subconcussive head impacts, the dynamics of brain deformation is dominated by a single global mode. In this Letter, we show the existence of localized modes and multimodal behavior in the brain as a hyperviscoelastic medium. This dynamical phenomenon leads to strain concentration patterns, particularly in deep brain regions, which is consistent with reported concussion pathology.
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Affiliation(s)
- Kaveh Laksari
- Department of Bioemedical Engineering, University of Arizona, Tucson, Arizona 95719, USA
| | - Mehmet Kurt
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, New Jersey 07030, USA
| | - Hessam Babaee
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH-Royal Institute of Technology, Huddinge 114 28, Sweden
| | - David Camarillo
- Department of Bioengineering, Stanford University, Stanford, California 94305, USA
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Traumatic Brain Injury, Sleep, and Mental Health: A Longitudinal Study of Air Force Personnel Pre- and Postdeployment to Iraq. J Head Trauma Rehabil 2018; 32:25-33. [PMID: 27120293 DOI: 10.1097/htr.0000000000000237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We investigated the complex relationships between traumatic brain injury (TBI), sleep, and mental health problems longitudinally among US service members (SMs) pre- and postdeployment to Iraq. PARTICIPANTS One hundred sixty-eight SMs enrolled in a 4-week Air Force Basic Combat Convoy Course predeployment. DESIGN Self-report data were collected at the beginning and end of training and then at 1, 3, 6, and 12 months postdeployment. Regression analyses were implemented, and participants were categorized into 4 groups based on TBI history for further statistical analysis. RESULTS Positive TBI history was associated with greater symptoms of insomnia and posttraumatic stress predeployment and persistence of insomnia symptoms, posttraumatic stress, and depression postdeployment. Positive TBI history and posttraumatic stress served as risk factors for head injury in Iraq, and SMs who reported a head injury during deployment also endorsed greater posttraumatic stress postdeployment than those without head injury. SMs with positive TBI history who also reported a new TBI in Iraq endorsed the greatest sleep and mental health problems across the study period. CONCLUSIONS This study provides valuable information regarding temporal relationships between TBI, sleep, and mental health problems among a combat military population. Findings have important implications from both prevention and clinical perspectives.
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Cernak I. Understanding blast-induced neurotrauma: how far have we come? Concussion 2017; 2:CNC42. [PMID: 30202583 PMCID: PMC6093818 DOI: 10.2217/cnc-2017-0006] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/08/2017] [Indexed: 12/14/2022] Open
Abstract
Blast injuries, including blast-induced neurotrauma (BINT), are caused by blast waves generated during an explosion. Accordingly, their history coincides with that of explosives. Hence, it is intriguing that, after more than 1000 years of using explosives, our understanding of the pathological consequences of blast and body/brain interactions is extremely limited. Postconflict recovery mechanisms seemingly include the suppression of painful experiences, such as explosive injuries. Unfortunately, ignoring the knowledge generated by previous generations of scientists retards research progress, leading to superfluous and repetitive studies. This article summarizes clinical and experimental findings published about blast injuries and BINT following the wars of the 20th and 21th centuries. Moreover, it offers a personal view on potential factors interfering with the progress of BINT research working toward providing better diagnosis, treatment and rehabilitation for military personnel affected by blast exposure.
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Affiliation(s)
- Ibolja Cernak
- Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall 3–48, Edmonton Alberta, T6G 2G4, Canada
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Moderate blast exposure results in increased IL-6 and TNFα in peripheral blood. Brain Behav Immun 2017; 65:90-94. [PMID: 28232173 PMCID: PMC5537025 DOI: 10.1016/j.bbi.2017.02.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022] Open
Abstract
A unique cohort of military personnel exposed to isolated blast was studied to explore acute peripheral cytokine levels, with the aim of identifying blast-specific biomarkers. Several cytokines, including interleukin (IL) 6, IL-10 and tumor necrosis factor alpha (TNFα) have been linked to pre-clinical blast exposure, but remained unstudied in clinical blast exposure. To address this gap, blood samples from 62 military personnel were obtained at baseline, and daily, during a 10-day blast-related training program; changes in the peripheral concentrations of IL-6, IL-10 and TNFα were evaluated using an ultrasensitive assay. Two groups of trainees were matched on age, duration of military service, and previous history of blast exposure(s), resulting in moderate blast cases and no/low blast controls. Blast exposures were measured using helmet sensors that determined the average peak pressure in pounds per square inch (psi). Moderate blast cases had significantly elevated concentrations of IL-6 (F1,60=18.81, p<0.01) and TNFα (F1,60=12.03, p<0.01) compared to no/low blast controls; levels rebounded to baseline levels the day after blast. On the day of the moderate blast exposure, the extent of the overpressure (psi) in those exposed correlated with IL-6 (r=0.46, p<0.05) concentrations. These findings indicate that moderate primary blast exposure results in changes, specifically acute and transient increases in peripheral inflammatory markers which may have implications for neuronal health.
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Gray M, Chung J, Aguila F, Williams TG, Teraoka JK, Harris OA. Long-Term Functional Outcomes in Military Service Members and Veterans After Traumatic Brain Injury/Polytrauma Inpatient Rehabilitation. Arch Phys Med Rehabil 2017; 99:S33-S39. [PMID: 28866009 DOI: 10.1016/j.apmr.2017.08.465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the effect of the established polytrauma/traumatic brain injury (TBI) infrastructure on immediate posttreatment functional gains, the long-term sustainability of any gains, and participation-related community reintegration outcomes in a baseline cohort of patients 8 years postadmission. DESIGN Retrospective review and prospective repeated measures of an inception cohort. SETTING Polytrauma rehabilitation center (PRC). PARTICIPANTS Patients consecutively admitted to the PRC inpatient rehabilitation unit during its first full fiscal year, 2006 (N=44). INTERVENTIONS The PRC infrastructure and formalized rehabilitation for polytrauma/TBI. MAIN OUTCOME MEASURES FIM scores at admission, discharge, 3 months, and 8 years postdischarge; participation-related socioeconomic factors reflecting community reintegration 8 years after admission. RESULTS Functional gains were statistically significantly increased from admission to discharge. Improvements were maintained at both 3 months postdischarge and 8 years postdischarge. The socioeconomic data collected at 8-year follow-up showed >50% either competitively employed or continuing their education and 100% living in a noninstitutionalized setting. CONCLUSIONS This study addresses a concern regarding the long-term functional outcomes of rehabilitation patients treated by the established infrastructure of the Polytrauma System of Care inpatient rehabilitation centers. The results suggest that polytrauma/TBI rehabilitation care using a comprehensive, integrated approach is effective and durable in achieving functional gains and successful community reintegration within our initial PRC cohort. Follow-up of subsequent fiscal year cohorts would add to the validity of these outcome findings.
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Affiliation(s)
- Max Gray
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Joyce Chung
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Fatima Aguila
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - T Gavin Williams
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey K Teraoka
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
| | - Odette A Harris
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; The Defense and Veterans Brain Injury Center, Palo Alto, CA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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Cold Environment Exacerbates Brain Pathology and Oxidative Stress Following Traumatic Brain Injuries: Potential Therapeutic Effects of Nanowired Antioxidant Compound H-290/51. Mol Neurobiol 2017; 55:276-285. [DOI: 10.1007/s12035-017-0740-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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40
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Merz ZC, Roskos PT, Gfeller JD, Bucholz RD. Impact of psychiatric symptomatology on neuropsychological assessment performance in persons with TBI: A comparison of OEF/OIF veteran and civilian samples. Brain Inj 2017; 31:1422-1428. [DOI: 10.1080/02699052.2017.1339124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Zachary C. Merz
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - P. Tyler Roskos
- Department of Physical Medicine and Rehabilitation Oakwood, Wayne State University School of Medicine, Dearborn, MI, USA
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Mac Donald CL, Barber J, Jordan M, Johnson AM, Dikmen S, Fann JR, Temkin N. Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury. JAMA Neurol 2017; 74:821-829. [PMID: 28459953 PMCID: PMC5732492 DOI: 10.1001/jamaneurol.2017.0143] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance The long-term clinical effects of wartime traumatic brain injuries (TBIs), most of which are mild, remain incompletely described. Current medical disability cost estimates from world conflicts continually surpass projections. Additional information regarding long-term functional trajectory is needed to reduce this extensive public health burden. Objectives To examine 5-year clinical outcomes leveraging existing clinical data collected at 1 year after injury in the same patients and to identify early risk factors for long-term disability. Design, Setting, and Participants This prospective, longitudinal study enrolled active-duty US military after concussive blast injury (n = 50) in the acute to subacute stage and combat-deployed control individuals (n = 44) in Afghanistan or after medical evacuation to Germany from November 1, 2008, through July 1, 2013. One- and 5-year clinical evaluations were completed in the United States. All concussive blast injuries met the Department of Defense definition of mild, uncomplicated TBI. In-person clinical evaluations included standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden that were essentially identical to the evaluations completed at 1-year follow-up. Data were analyzed from October 1 through November 30, 2016. Main Outcomes and Measures Changes in the in-person standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden from the 1- to 5-year follow-up. Predictive modeling was used to identify early risk factors for long-term disability. Results Among the 94 participants (87 men [93%] and 7 women [7%]; mean [SD] age, 34 [8] years), global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI compared with combat-deployed controls, whereas performance on cognitive measures was no different between groups at the 5-year evaluation. Logistic regression on the dichotomized Extended Glasgow Outcome Scale (GOS-E) at 5 years as a measure of overall disability identified brain injury diagnosis, preinjury intelligence, motor strength, verbal fluency, and neurobehavioral symptom severity at 1 year as risk factors for a poor outcome at 5 years, with an area under the curve of 0.92 indicating excellent prediction strength. Thirty-six of 50 patients with concussive blast TBI (72%) had a decline in the GOS-E from the 1- to 5-year evaluations, in contrast with only 5 of 44 combat-deployed controls (11%). Worsening of symptoms in concussive blast TBI was also observed on measures of posttraumatic stress disorder and depression. Service members with concussive blast TBI experienced evolution, not resolution, of symptoms from the 1- to 5-year outcomes. Conclusions and Relevance Considerable decline was observed in military service members with concussive blast TBI when comparing 1- and 5-year clinical outcomes. These results advocate for new treatment strategies to combat the long-term and extremely costly effect of these wartime injuries.
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Affiliation(s)
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Mary Jordan
- Department of Neurological Surgery, University of Washington, Seattle
| | - Ann M Johnson
- Center for Clinical Studies, Washington University, St Louis, Missouri
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Jesse R Fann
- Department of Psychiatry, University of Washington, Seattle
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle5Department of Biostatistics, University of Washington, Seattle
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Miller AP, Shah AS, Aperi BV, Kurpad SN, Stemper BD, Glavaski-Joksimovic A. Acute death of astrocytes in blast-exposed rat organotypic hippocampal slice cultures. PLoS One 2017; 12:e0173167. [PMID: 28264063 PMCID: PMC5338800 DOI: 10.1371/journal.pone.0173167] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/16/2017] [Indexed: 01/06/2023] Open
Abstract
Blast traumatic brain injury (bTBI) affects civilians, soldiers, and veterans worldwide and presents significant health concerns. The mechanisms of neurodegeneration following bTBI remain elusive and current therapies are largely ineffective. It is important to better characterize blast-evoked cellular changes and underlying mechanisms in order to develop more effective therapies. In the present study, our group utilized rat organotypic hippocampal slice cultures (OHCs) as an in vitro system to model bTBI. OHCs were exposed to either 138 ± 22 kPa (low) or 273 ± 23 kPa (high) overpressures using an open-ended helium-driven shock tube, or were assigned to sham control group. At 2 hours (h) following injury, we have characterized the astrocytic response to a blast overpressure. Immunostaining against the astrocytic marker glial fibrillary acidic protein (GFAP) revealed acute shearing and morphological changes in astrocytes, including clasmatodendrosis. Moreover, overlap of GFAP immunostaining and propidium iodide (PI) indicated astrocytic death. Quantification of the number of dead astrocytes per counting area in the hippocampal cornu Ammonis 1 region (CA1), demonstrated a significant increase in dead astrocytes in the low- and high-blast, compared to sham control OHCs. However only a small number of GFAP-expressing astrocytes were co-labeled with the apoptotic marker Annexin V, suggesting necrosis as the primary type of cell death in the acute phase following blast exposure. Moreover, western blot analyses revealed calpain mediated breakdown of GFAP. The dextran exclusion additionally indicated membrane disruption as a potential mechanism of acute astrocytic death. Furthermore, although blast exposure did not evoke significant changes in glutamate transporter 1 (GLT-1) expression, loss of GLT-1-expressing astrocytes suggests dysregulation of glutamate uptake following injury. Our data illustrate the profound effect of blast overpressure on astrocytes in OHCs at 2 h following injury and suggest increased calpain activity and membrane disruption as potential underlying mechanisms.
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Affiliation(s)
- Anna P. Miller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, United States of America
| | - Alok S. Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, United States of America
| | - Brandy V. Aperi
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, United States of America
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, United States of America
| | - Brian D. Stemper
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, United States of America
| | - Aleksandra Glavaski-Joksimovic
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, United States of America
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Mac Donald CL, Barber J, Andre J, Evans N, Panks C, Sun S, Zalewski K, Elizabeth Sanders R, Temkin N. 5-Year imaging sequelae of concussive blast injury and relation to early clinical outcome. NEUROIMAGE-CLINICAL 2017; 14:371-378. [PMID: 28243574 PMCID: PMC5320067 DOI: 10.1016/j.nicl.2017.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/27/2022]
Abstract
Current imaging diagnostic techniques are often insensitive to the underlying pathological changes following mild traumatic brain injury (TBI) or concussion so much so that the explicit definition of these uncomplicated mild brain injuries includes the absence of radiological findings. In the US military, this is complicated by the natural tendency of service members to down play symptoms for fear of removal from their unit particularly in combat making it challenging for clinicians to definitively diagnose and determine course of treatment. Questions remain regarding the long-term impact of these war-time brain injuries. The objective of the current study was to evaluate the long-term imaging sequelae of blast concussion in active-duty US military and leverage previous longitudinal data collected in these same patients to identify predictors of sustained DTI signal change indicative of chronic neurodegeneration. In total, 50 blast TBI and 44 combat-deployed controls were evaluated at this 5-year follow up by advanced neuroimaging techniques including diffusion tensor imaging and quantitative volumetry. While cross-sectional analysis of regions of white matter on DTI images did not reveal significant differences across groups after statistical correction, an approach flexible to the heterogeneity of brain injury at the single-subject level identified 74% of the concussive blast TBI cohort to have reductions in fractional anisotropy indicative of chronic brain injury. Logistic regression leveraging clinical and demographic data collected in the acute/sub-acute and 1-year follow up to determine predictors of these long-term imaging changes determined that brain injury diagnosis, older age, verbal memory and verbal fluency best predicted the presence of DTI abnormalities 5 years post injury with an AUC of 0.78 indicating good prediction strength. These results provide supporting evidence for the evolution not resolution of this brain injury pathology, adding to the growing body of literature describing imaging signatures of chronic neurodegeneration even after mild TBI and concussion. Design: prospective, observational, longitudinal research study Patients: concussive blast (n = 50), combat-deployed control (n = 44) Diffusion tensor imaging analyzed 5 yr post-injury, highly predicted by 1 yr outcomes. Imaging abnormalities appear to evolve from sub-acute, to 1-year, to 5-year scan. Findings indicate chronic neurodegeneration in majority of blast concussion patients.
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Key Words
- A-P, anterior–posterior
- Concussion
- DR-BUDDI, Diffeomorphic Registration for Blip-Up blip-Down Diffusion Imaging
- DTI, Diffusion Tensor Imaging
- Diffusion tensor imaging
- EPI, Echo Planar Imaging
- EPV, events-per-variable
- FA, Fractional Anisotropy
- FLAIR, Fluid attenuation inversion recovery
- MPRAGE, Magnetization prepared rapid gradient-echo
- Neurodegeneration
- TBI, Traumatic Brain Injury
- TORTOISE, Tolerably Obsessive Registration and Tensor Optimization Indolent Software Ensemble
- Traumatic brain injury
- US, United States
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Affiliation(s)
| | - Jason Barber
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Jalal Andre
- University of Washington, Department of Radiology, Seattle, WA, USA
| | - Nicole Evans
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Chris Panks
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Samantha Sun
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Kody Zalewski
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | | | - Nancy Temkin
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA; University of Washington, Department of Biostatistics, Seattle, WA, USA
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44
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45
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Future Developments in the Management of Explosive Incidents. Ann Emerg Med 2016; 69:S46-S51. [PMID: 27955763 DOI: 10.1016/j.annemergmed.2016.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Liao KH, Sung CW, Chu SF, Chiu WT, Chiang YH, Hoffer B, Ou JC, Chen KY, Tsai SH, Lin CM, Chen GS, Li WJ, Wang JY. Reduced power spectra of heart rate variability are correlated with anxiety in patients with mild traumatic brain injury. Psychiatry Res 2016; 243:349-56. [PMID: 27449003 DOI: 10.1016/j.psychres.2016.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/25/2016] [Accepted: 07/01/2016] [Indexed: 02/06/2023]
Abstract
Anxiety is one of the most frequently diagnosed emotional disorders after a mild traumatic brain injury (mTBI); however, predictors of anxiety after an mTBI remain uncertain. Recent research indicated that anxiety is associated with abnormalities in the autonomic nervous system (ANS) which can be evaluated by a power spectral analysis of heart rate variability (HRV). In this study, we investigated whether a frequency-domain analysis of HRV could correlate with the occurrence of anxiety in mTBI patients. We recruited 165 Taiwanese patients diagnosed with an mTBI and 82 volunteer healthy controls from three affiliated hospitals of Taipei Medical University during 2010-2014. The Beck Anxiety Inventory (BAI) was assessed at the 1st, 6th, and 12th weeks. We found that mTBI patients were more vulnerable to anxiety compared to healthy controls. The power spectral density of HRV was significantly lower in mTBI patients than in healthy controls. A correlation analysis indicated that anxiety was negatively significantly correlated with low- and high-frequency power at the 6th week. Our study suggests the clinical usefulness of HRV as a potential noninvasive tool for evaluating later anxiety in mTBI patients.
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Affiliation(s)
- Kuo-Hsing Liao
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Sung
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Fen Chu
- Graduate Institute of Injury and Prevention, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ta Chiu
- Graduate Institute of Injury and Prevention, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Division of Neurosurgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Program on Neuroregeneration, College of Medical Science and Technology, and Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei, Taiwan
| | - Barry Hoffer
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ju-Chi Ou
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kai-Yun Chen
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shin-Han Tsai
- Graduate Institute of Injury and Prevention, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chien-Min Lin
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Gunng-Shinng Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Orthodontics & Dentofacial Orthopedics and Pedodontics, Department of Dentistry, Tri-Service General Hospital, Taipei, Taiwan
| | - Wei-Jiun Li
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jia-Yi Wang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Leung A, Shukla S, Yang E, Canlas B, Kadokana M, Heald J, Davani A, Song D, Lin L, Polston G, Tsai A, Lee R. Diminished supraspinal pain modulation in patients with mild traumatic brain injury. Mol Pain 2016; 12:12/0/1744806916662661. [PMID: 27531671 PMCID: PMC4989585 DOI: 10.1177/1744806916662661] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/12/2016] [Indexed: 12/13/2022] Open
Abstract
Background Chronic pain conditions are highly prevalent in patients with mild traumatic brain injury. Supraspinal diffuse axonal injury is known to dissociate brain functional connectivity in these patients. The effect of this dissociated state on supraspinal pain network is largely unknown. A functional magnetic resonance imaging study was conducted to compare the supraspinal pain network in patients with mild traumatic brain injury to the gender and age-matched healthy controls with the hypothesis that the functional connectivities of the medial prefrontal cortices, a supraspinal pain modulatory region to other pain-related sensory discriminatory and affective regions in the mild traumatic brain injury subjects are significantly reduced in comparison to healthy controls. Results The mild traumatic brain injury group (N = 15) demonstrated significantly (P < 0.01, cluster threshold > 150 voxels) less activities in the thalamus, pons, anterior cingulate cortex, insula, dorsolateral prefrontal cortex, and medial prefrontal cortices than the healthy control group (N = 15). Granger Causality Analyses (GCA) indicated while the left medial prefrontal cortices of the healthy control group cast a noticeable degree of outward (to affect) causality inference to multiple pain processing related regions, this outward inference pattern was not observed in the mild traumatic brain injury group. On the other hand, only patients’ bilateral anterior cingulate cortex received multiple inward (to be affected) causality inferences from regions including the primary and secondary somatosensory cortices and the inferior parietal lobe. Resting state functional connectivity analyses indicated that the medial prefrontal cortices of the mild traumatic brain injury group demonstrated a significantly (P < 0.01, F = 3.6, cluster size > 150 voxels) higher degree of functional connectivity to the inferior parietal lobe, premotor and secondary somatosensory cortex than the controls. Conversely, the anterior cingulate cortex of the healthy group demonstrated significantly (P < 0.01, F = 3.84, cluster size > 150 voxels) less degree of functional connectivities to the inferior parietal lobe and secondary somatosensory cortex than their mild traumatic brain injury counterparts. Conclusions In short, the current study demonstrates that patients with mild traumatic brain injury and headaches appear to have an altered state of supraspinal modulatory and affective functions related to pain perception.
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Affiliation(s)
- Albert Leung
- Department of Anesthesiology, The University of California, San Diego, CA, USA Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Shivshil Shukla
- Department of Anesthesiology, The University of California, San Diego, CA, USA Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Eric Yang
- The University of California, San Diego, USA
| | | | | | - Jason Heald
- Drexel University, College of Medicine, Philadelphia, PA, USA
| | - Ariea Davani
- St. Louis School of Medicine, St. Louis, MO, USA
| | - David Song
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA Department of Neuroscience, The University of California, San Diego, CA, USA
| | - Lisa Lin
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Greg Polston
- Department of Anesthesiology, The University of California, San Diego, CA, USA Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Alice Tsai
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA
| | - Roland Lee
- Veteran Administration San Diego Healthcare System, San Diego, CA, USA Department of Radiology, The University of California, San Diego, CA, USA
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48
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Mac Donald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC, Werner NJ, Adam OR, Rivet DJ, Flaherty SF, Oh JS, Zonies D, Fang R, Brody DL. Outcome Trends after US Military Concussive Traumatic Brain Injury. J Neurotrauma 2016; 34:2206-2219. [PMID: 27198861 DOI: 10.1089/neu.2016.4434] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Care for US military personnel with combat-related concussive traumatic brain injury (TBI) has substantially changed in recent years, yet trends in clinical outcomes remain largely unknown. Our prospective longitudinal studies of US military personnel with concussive TBI from 2008-2013 at Landstuhl Regional Medical Center in Germany and twp sites in Afghanistan provided an opportunity to assess for changes in outcomes over time and analyze correlates of overall disability. We enrolled 321 active-duty US military personnel who sustained concussive TBI in theater and 254 military controls. We prospectively assessed clinical outcomes 6-12 months later in 199 with concussive TBI and 148 controls. Global disability, neurobehavioral impairment, depression severity, and post-traumatic stress disorder (PTSD) severity were worse in concussive TBI groups in comparison with controls in all cohorts. Global disability primarily reflected a combination of work-related and nonwork-related disability. There was a modest but statistically significant trend toward less PTSD in later cohorts. Specifically, there was a decrease of 5.9 points of 136 possible on the Clinician Administered PTSD Scale (-4.3%) per year (95% confidence interval, 2.8-9.0 points, p = 0.0037 linear regression, p = 0.03 including covariates in generalized linear model). No other significant trends in outcomes were found. Global disability was more common in those with TBI, those evacuated from theater, and those with more severe depression and PTSD. Disability was not significantly related to neuropsychological performance, age, education, self-reported sleep deprivation, injury mechanism, or date of enrollment. Thus, across multiple cohorts of US military personnel with combat-related concussion, 6-12 month outcomes have improved only modestly and are often poor. Future focus on early depression and PTSD after concussive TBI appears warranted. Adverse outcomes are incompletely explained, however, and additional studies with prospective collection of data on acute injury severity and polytrauma, as well as reduced attrition before follow-up will be required to fully address the root causes of persistent disability after wartime injury.
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Affiliation(s)
- Christine L Mac Donald
- 1 Washington University School of Medicine , St. Louis, Missouri.,2 Department of Neurological Surgery, University of Washington , Seattle, Washington
| | - Ann M Johnson
- 1 Washington University School of Medicine , St. Louis, Missouri
| | | | | | | | - Elliot C Nelson
- 1 Washington University School of Medicine , St. Louis, Missouri
| | - Nicole J Werner
- 1 Washington University School of Medicine , St. Louis, Missouri
| | - Octavian R Adam
- 4 Naval Medical Center Portsmouth , Portsmouth, Virginia.,5 Department of Neurology, Berkshire Medical Center , Pittsfield, Massachusetts
| | - Dennis J Rivet
- 4 Naval Medical Center Portsmouth , Portsmouth, Virginia.,6 Department of Neurosurgery, Virginia Commonwealth University , Richmond, Virginia
| | - Stephen F Flaherty
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,7 Acute Surgical Care Specialists , El Paso, Texas
| | - John S Oh
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,8 Trauma, Critical Care, and Acute Care Surgery, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David Zonies
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,9 Trauma and Critical Care, Oregon Health and Sciences University , Portland, Oregon
| | - Raymond Fang
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,10 US Air Force Center for Sustainment of Trauma & Readiness Skills, R. Adams Cowley Shock Trauma Center, University of Maryland , Baltimore, Maryland
| | - David L Brody
- 1 Washington University School of Medicine , St. Louis, Missouri
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Haarbauer-Krupa J, Taylor CA, Yue JK, Winkler EA, Pirracchio R, Cooper SR, Burke JF, Stein MB, Manley GT. Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury. J Neurotrauma 2016; 34:50-58. [PMID: 26936513 DOI: 10.1089/neu.2015.4158] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69-7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42-4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79-0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- 1 Division of Unintentional Injury, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Christopher A Taylor
- 1 Division of Unintentional Injury, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - John K Yue
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Ethan A Winkler
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Romain Pirracchio
- 4 Department of Anesthesia and Perioperative Care, University of California , San Francisco, San Francisco, California
| | - Shelly R Cooper
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California.,5 Department of Psychology, Washington University in St. Louis , St. Louis, Missouri
| | - John F Burke
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Murray B Stein
- 6 Department of Psychiatry, University of California , San Diego, San Diego, California.,7 Department of Family and Preventive Medicine, University of California , San Diego, San Diego, California
| | - Geoffrey T Manley
- 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
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50
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Laksari K, Wu LC, Kurt M, Kuo C, Camarillo DC. Resonance of human brain under head acceleration. J R Soc Interface 2016; 12:20150331. [PMID: 26063824 DOI: 10.1098/rsif.2015.0331] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although safety standards have reduced fatal head trauma due to single severe head impacts, mild trauma from repeated head exposures may carry risks of long-term chronic changes in the brain's function and structure. To study the physical sensitivities of the brain to mild head impacts, we developed the first dynamic model of the skull-brain based on in vivo MRI data. We showed that the motion of the brain can be described by a rigid-body with constrained kinematics. We further demonstrated that skull-brain dynamics can be approximated by an under-damped system with a low-frequency resonance at around 15 Hz. Furthermore, from our previous field measurements, we found that head motions in a variety of activities, including contact sports, show a primary frequency of less than 20 Hz. This implies that typical head exposures may drive the brain dangerously close to its mechanical resonance and lead to amplified brain-skull relative motions. Our results suggest a possible cause for mild brain trauma, which could occur due to repetitive low-acceleration head oscillations in a variety of recreational and occupational activities.
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Affiliation(s)
- Kaveh Laksari
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Lyndia C Wu
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Mehmet Kurt
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Calvin Kuo
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
| | - David C Camarillo
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
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