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Cox AW, Fernandes MA. Long-term cognitive and affective consequences of mild traumatic brain injury: comparison with older adults. Brain Inj 2024:1-14. [PMID: 38994705 DOI: 10.1080/02699052.2024.2376769] [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: 02/02/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Memory and affective processing were compared in young adults with a remote mild traumatic brain injury (mTBI), to healthy younger and older adults. We evaluated memory performance when encoding was done under multi-tasking (divided attention) conditions, likely to exacerbate cognitive and psychological symptoms in mTBI. METHODS Participants studied pairs of unrelated words under either full or divided attention conditions. Memory for single words (item memory) and for pairs of words (associative memory) was then assessed in sequential independent recognition tests, under full attention. RESULTS Associative memory was poorer than item memory, and worse when encoding was done under divided than full attention. The decline in recognition accuracy from full to divided attention conditions on the associative memory test was significantly greater in mTBI compared to young adults and was similar in magnitude to that observed in older adults under full attention. Self-reported mental and total fatigue increased significantly as performance on the memory tests, following the divided attention condition, decreased, but only in the mTBI group. CONCLUSIONS Results show lingering memory deficits, and suggest that cognitive tasks may be experienced as psychologically more demanding in those with a mTBI, even months or years after injury.
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Affiliation(s)
- Adam William Cox
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Myra A Fernandes
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
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Roh H, Kim W, Hwang SY, Lee MS, Kim JH. Altered pattern of theta and gamma oscillation to visual stimuli in patients with postconcussion syndrome. J Neurophysiol 2024; 131:1240-1249. [PMID: 38691013 DOI: 10.1152/jn.00253.2023] [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: 07/03/2023] [Revised: 03/18/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024] Open
Abstract
Although many patients with mild traumatic brain injury (mTBI) suffer from postconcussional syndrome (PCS) including abnormal emotional responses, most conventional imaging studies fail to detect any causative brain lesion. We hypothesized that event-related electroencephalography (EEG) recordings with time-frequency analysis would show a distinguishable pattern in patients with mTBI with PCS compared with normal healthy controls. EEG signals were collected from a total of 18 subjects: eight patients with mTBI with PCS and 10 healthy control subjects. The signals were recorded while the subjects were presented with affective visual stimuli, including neutral, pleasant, and unpleasant emotional cues. Event-related spectral perturbation analysis was performed to calculate frontal midline theta activity and posterior midline gamma activity, followed by statistical analysis to identify whether patients with mTBI with PCS have distinct patterns of theta or gamma oscillations in response to affective stimuli. Compared with the healthy control group, patients with mTBI with PCS did not show a significant increase in the power of frontal theta activity in response to the pleasant stimuli, indicating less susceptibility toward pleasant cues. Moreover, the patient group showed attenuated gamma oscillatory activity, with no clear alteration in gamma oscillations in response to either pleasant or unpleasant cues. This study demonstrates that patients with mTBI with PCS exhibited altered patterns of oscillatory activities in the theta and gamma bands in response to affective visual stimuli compared with the normal control group. The current finding implicates that these distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.NEW & NOTEWORTHY Patients with mild traumatic brain injury (mTBI) with postconcussional syndrome (PCS) exhibited altered patterns of changes in oscillatory activities in the theta and gamma bands in response to visual affective stimuli. Distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.
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Affiliation(s)
- Haewon Roh
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Won Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Soon-Young Hwang
- The Department of Biostatistics, Korea University of Medicine, Seoul, Korea
| | - Moon Soo Lee
- The Department of Psychiatry, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
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3
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Hacker BJ, Imms PE, Dharani AM, Zhu J, Chowdhury NF, Chaudhari NN, Irimia A. Identification and Connectomic Profiling of Concussion Using Bayesian Machine Learning. J Neurotrauma 2024. [PMID: 38482793 DOI: 10.1089/neu.2023.0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024] Open
Abstract
Accurate early diagnosis of concussion is useful to prevent sequelae and improve neurocognitive outcomes. Early after head impact, concussion diagnosis may be doubtful in persons whose neurological, neuroradiological, and/or neurocognitive examinations are equivocal. Such individuals can benefit from novel accurate assessments that complement clinical diagnostics. We introduce a Bayesian machine learning classifier to identify concussion through cortico-cortical connectome mapping from magnetic resonance imaging in persons with quasi-normal cognition and without neuroradiological findings. Classifier features are generated from connectivity matrices specifying the mean fractional anisotropy of white matter connections linking brain structures. Each connection's saliency to classification was quantified by training individual classifier instantiations using a single feature type. The classifier was tested on a discovery sample of 92 healthy controls (HCs; 26 females, age μ ± σ: 39.8 ± 15.5 years) and 471 adult mTBI patients (158 females, age μ ± σ: 38.4 ± 5.9 years). Results were replicated in an independent validation sample of 256 HCs (149 females, age μ ± σ: 55.3 ± 12.1 years) and 126 patients with concussion (46 females, age μ ± σ: 39.0 ± 17.7 years). Classifier accuracy exceeds 99% in both samples, suggesting robust generalizability to new samples. Notably, 13 bilateral cortico-cortical connection pairs predict diagnostic status with accuracy exceeding 99% in both discovery and validation samples. Many such connection pairs are between prefrontal cortex structures, fronto-limbic and fronto-subcortical structures, and occipito-temporal structures in the ventral ("what") visual stream. This and related connectivity form a highly salient network of brain connections that is particularly vulnerable to concussion. Because these connections are important in mediating cognitive control, memory, and attention, our findings explain the high frequency of cognitive disturbances after concussion. Our classifier was trained and validated on concussed participants with cognitive profiles very similar to those of HCs. This suggests that the classifier can complement current diagnostics by providing independent information in clinical contexts where patients have quasi-normal cognition but where concussion diagnosis stands to benefit from additional evidence.
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Affiliation(s)
- Benjamin J Hacker
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
- Mork Family Department of Chemical Engineering and Materials Science, Viterbi School of Engineering, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Phoebe E Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Ammar M Dharani
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Jessica Zhu
- Corwin D. Denney Research Center, Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Nahian F Chowdhury
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Nikhil N Chaudhari
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
- Corwin D. Denney Research Center, Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
- Corwin D. Denney Research Center, Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
- Department of Quantitative and Computational Biology, Dana and David Dornsife College of Arts and Sciences, University of Southern California, Los Angeles, California, USA
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Jotie JM, Gustafson JA, Fonda JR, Fortier CB, Milberg WP, Fortenbaugh FC. Association of mild traumatic brain injury, post-traumatic stress disorder, and other comorbidities on photosensitivity. Optom Vis Sci 2024; 101:90-98. [PMID: 38408306 DOI: 10.1097/opx.0000000000002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
SIGNIFICANCE Photosensitivity is common after mild traumatic brain injury. However, this study demonstrates that photosensitivity is also impacted by common comorbidities that often occur with mild traumatic brain injury. Understanding how physical and psychological traumas impact photosensitivity can help improve provider care to trauma survivors and guide novel therapeutic interventions. PURPOSE This study aimed to characterize the association between mild traumatic brain injury and common comorbidities on photosensitivity in post-9/11 veterans. METHODS Existing data from the Translational Research Center for TBI and Stress Disorders cohort study were analyzed including traumatic brain injury history and post-traumatic stress disorder clinical diagnostic interviews; sleep quality, anxiety, and depression symptoms self-report questionnaires; and photosensitivity severity self-report from the Neurobehavioral Symptom Inventory. Analysis of covariance and multiple ordinal regression models were used to assess associations between mild traumatic brain injury and common comorbidities with photosensitivity severity. RESULTS Six hundred forty-one post-9/11 veterans were included in this study. An initial analysis showed that both mild traumatic brain injury and current post-traumatic stress disorder diagnosis were independently associated with higher photosensitivity ratings compared with veterans without either condition, with no interaction observed between these two conditions. Results of the ordinal regression models demonstrated positive associations between degree of photosensitivity and the number of mild traumatic brain injuries during military service and current post-traumatic stress disorder symptom severity, particularly hyperarousal symptoms, even when controlling for other factors. In addition, the degree of sleep disturbances and current anxiety symptoms were both positively associated with photosensitivity ratings, whereas depression symptoms, age, and sex were not. CONCLUSIONS Repetitive mild traumatic brain injury, post-traumatic stress disorder, anxiety, and sleep disturbances were all found to significantly impact photosensitivity severity and are therefore important clinical factors that eye care providers should consider when managing veterans with a history of deployment-related trauma reporting photosensitivity symptoms.
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van der Horn HJ, de Koning ME, Visser K, Kok MGJ, Spikman JM, Scheenen ME, Renken RJ, Calhoun VD, Vergara VM, Cabral J, Mayer AR, van der Naalt J. Dynamic phase-locking states and personality in sub-acute mild traumatic brain injury: An exploratory study. PLoS One 2023; 18:e0295984. [PMID: 38100479 PMCID: PMC10723684 DOI: 10.1371/journal.pone.0295984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Research has shown that maladaptive personality characteristics, such as Neuroticism, are associated with poor outcome after mild traumatic brain injury (mTBI). The current exploratory study investigated the neural underpinnings of this process using dynamic functional network connectivity (dFNC) analyses of resting-state (rs) fMRI, and diffusion MRI (dMRI). Twenty-seven mTBI patients and 21 healthy controls (HC) were included. After measuring the Big Five personality dimensions, principal component analysis (PCA) was used to obtain a superordinate factor representing emotional instability, consisting of high Neuroticism, moderate Openness, and low Extraversion, Agreeableness, and Conscientiousness. Persistent symptoms were measured using the head injury symptom checklist at six months post-injury; symptom severity (i.e., sum of all items) was used for further analyses. For patients, brain MRI was performed in the sub-acute phase (~1 month) post-injury. Following parcellation of rs-fMRI using independent component analysis, leading eigenvector dynamic analysis (LEiDA) was performed to compute dynamic phase-locking brain states. Main patterns of brain diffusion were computed using tract-based spatial statistics followed by PCA. No differences in phase-locking state measures were found between patients and HC. Regarding dMRI, a trend significant decrease in fractional anisotropy was found in patients relative to HC, particularly in the fornix, genu of the corpus callosum, anterior and posterior corona radiata. Visiting one specific phase-locking state was associated with lower symptom severity after mTBI. This state was characterized by two clearly delineated communities (each community consisting of areas with synchronized phases): one representing an executive/saliency system, with a strong contribution of the insulae and basal ganglia; the other representing the canonical default mode network. In patients who scored high on emotional instability, this relationship was even more pronounced. Dynamic phase-locking states were not related to findings on dMRI. Altogether, our results provide preliminary evidence for the coupling between personality and dFNC in the development of long-term symptoms after mTBI.
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Affiliation(s)
- Harm J. van der Horn
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, NM, United States of America
| | | | - Koen Visser
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marius G. J. Kok
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jacoba M. Spikman
- Department of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Myrthe E. Scheenen
- Department of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Remco J. Renken
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research (TReNDS), Georgia State, Georgia Tech, Emory, Atlanta, GA, United States of America
| | - Victor M. Vergara
- Tri-institutional Center for Translational Research (TReNDS), Georgia State, Georgia Tech, Emory, Atlanta, GA, United States of America
| | - Joana Cabral
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, NM, United States of America
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
- Department of Psychology, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sultana T, Hasan MA, Kang X, Liou-Johnson V, Adamson MM, Razi A. Neural mechanisms of emotional health in traumatic brain injury patients undergoing rTMS treatment. Mol Psychiatry 2023; 28:5150-5158. [PMID: 37414927 DOI: 10.1038/s41380-023-02159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
Emotional dysregulation such as that seen in depression, are a long-term consequence of mild traumatic brain injury (TBI), that can be improved by using neuromodulation treatments such as repetitive transcranial magnetic stimulation (rTMS). Previous studies provide insights into the changes in functional connectivity related to general emotional health after the application of rTMS procedures in patients with TBI. However, these studies provide little understanding of the underlying neuronal mechanisms that drive the improvement of the emotional health in these patients. The current study focuses on inferring the effective (causal) connectivity changes and their association with emotional health, after rTMS treatment of cognitive problems in TBI patients (N = 32). Specifically, we used resting state functional magnetic resonance imaging (fMRI) together with spectral dynamic causal model (spDCM) to investigate changes in brain effective connectivity, before and after the application of high frequency (10 Hz) rTMS over left dorsolateral prefrontal cortex. We investigated the effective connectivity of the cortico-limbic network comprised of 11 regions of interest (ROIs) which are part of the default mode, salience, and executive control networks, known to be implicated in emotional processing. The results indicate that overall, among extrinsic connections, the strength of excitatory connections decreased while that of inhibitory connections increased after the neuromodulation. The cardinal region in the analysis was dorsal anterior cingulate cortex (dACC) which is considered to be the most influenced during emotional health disorders. Our findings implicate the altered connectivity of dACC with left anterior insula and medial prefrontal cortex, after the application of rTMS, as a potential neural mechanism underlying improvement of emotional health. Our investigation highlights the importance of these brain regions as treatment targets in emotional processing in TBI.
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Affiliation(s)
- Tajwar Sultana
- Department of Computer and Information Systems Engineering, NED University of Engineering & Technology, Karachi, 75270, Pakistan
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, 75270, Pakistan
- Neurocomputation Laboratory, National Centre of Artificial Intelligence, Peshawar, Pakistan
| | - Muhammad Abul Hasan
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, 75270, Pakistan
- Neurocomputation Laboratory, National Centre of Artificial Intelligence, Peshawar, Pakistan
| | - Xiaojian Kang
- WRIISC-WOMEN, VA Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
- Rehabilitation Service, Veterans Affairs Palo Alto Healthcare System (VAPAHCS), 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - Victoria Liou-Johnson
- Rehabilitation Service, Veterans Affairs Palo Alto Healthcare System (VAPAHCS), 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Maheen Mausoof Adamson
- WRIISC-WOMEN, VA Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
- Rehabilitation Service, Veterans Affairs Palo Alto Healthcare System (VAPAHCS), 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Adeel Razi
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, 3800, Australia.
- Wellcome Centre for Human Neuroimaging, University College London, WC1N 3AR, London, United Kingdom.
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, Canada.
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Gottfredson RK, Becker WJ. How past trauma impacts emotional intelligence: Examining the connection. Front Psychol 2023; 14:1067509. [PMID: 37275697 PMCID: PMC10234103 DOI: 10.3389/fpsyg.2023.1067509] [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: 10/11/2022] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Backed by both research and practice, the organizational psychology field has come to value emotional intelligence (EI) as being vital for leader and employee effectiveness. While this field values EI, it has paid little attention to the antecedents of emotional intelligence, leaving the EI domain without clarity on (1) why EI might vary across individuals, and (2) how to best develop EI. In this article, we rely on neuroscience and psychology research to make the case that past psychological trauma impacts later EI capabilities. Specifically, we present evidence that psychological trauma impairs the brain areas and functions that support EI. Establishing psychological trauma has valuable theoretical and practical implications that include providing an explanation of why EI might vary across individuals and providing a focus for improving EI: healing from past trauma. Further theoretical and practical implications for the field of organizational psychology are provided.
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Affiliation(s)
- Ryan K Gottfredson
- Department of Management, College of Business and Economics, California State University, Fullerton, CA, United States
| | - William J Becker
- Department of Management, Pamplin College of Business, Virginia Tech, Blacksburg, VA, United States
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Terpstra AR, Louie DR, Iverson GL, Yeates KO, Picon E, Leddy JJ, Silverberg ND. Psychological Contributions to Symptom Provocation Testing After Concussion. J Head Trauma Rehabil 2023; 38:E146-E155. [PMID: 35687896 DOI: 10.1097/htr.0000000000000796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Following concussion, symptoms such as headache, dizziness, and fatigue may transiently worsen or reemerge with increased exertion or activity. Standardized tests have been developed to assess symptom increases following aerobic, cognitive, or vestibular/oculomotor challenge. Although neurophysiological mechanisms are proposed to underlie symptom increases following exertion, psychological factors such as anxiety and misinterpretation of normal bodily sensations may also play a role. In this study, we examined the contribution of psychological factors to symptom provocation testing outcomes. SETTING Two outpatient concussion clinics in British Columbia, Canada. PARTICIPANTS Adults with persistent symptoms following concussion ( N = 79; 62% women). DESIGN In a single session, participants completed self-report questionnaires measuring the psychological factors of interest and underwent symptom provocation testing including aerobic (Buffalo Concussion Bike Test; BCBT), cognitive (National Institutes of Health Toolbox-Cognition Battery; NIHTB-CB), and vestibular/oculomotor (Vestibular/Ocular Motor Screening for Concussion; VOMS) challenge. MAIN MEASURES Psychological factors of interest included premorbid and current anxiety (Generalized Anxiety Disorder-7; GAD-7), catastrophizing (Pain Catastrophizing Scale-Adapted; PCS-A), fear avoidance behavior (Fear Avoidance Behavior after Traumatic Brain Injury; FAB-TBI), and somatization (Patient Health Questionnaire-15; PHQ-15). Our primary outcome variables were self-reported symptom change during each symptom provocation test. RESULTS We found that current anxiety ( B = 0.034; 95% CI = 0.003, 0.065), symptom catastrophizing ( B = 0.013; 95% CI = 0.000, 0.026), fear avoidance behavior ( B = 0.029; 95% CI = 0.008, 0.050), and somatization ( B = 0.041; 95% CI = 0.007, 0.075) were associated with increased symptoms during the VOMS in univariate models adjusted for time postinjury but not in a multivariable model that included all covariates. The psychological variables of interest were not significantly related to symptom change during the BCBT or NIHTB-CB. CONCLUSION Our findings suggest that symptom provocation test failure should be interpreted with caution because it might indicate psychological maladjustment rather than lingering brain injury or incomplete neurophysiological recovery.
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Affiliation(s)
- Alex R Terpstra
- Departments of Psychology (Mr Terpstra, Ms Picon, and Dr Silverberg) and Physical Therapy (Dr Louie), University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada (Drs Louie and Silverberg); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Iverson); Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts (Dr Iverson); MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts (Dr Iverson); and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts (Dr Iverson); Department of Psychology, University of Calgary (Dr Yeates), Alberta Children's Hospital Research Institute (Dr Yeates), and Hotchkiss Brain Institute (Dr Yeates), Calgary, Alberta, Canada; and UBMD Orthopaedics and Sports Medicine, SUNY Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (Dr Leddy)
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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Influence of Mild Traumatic Brain Injury History and Mental Health Status on Alcohol and Cannabis Use in University Athletes. Clin J Sport Med 2023; 33:145-150. [PMID: 36730293 DOI: 10.1097/jsm.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the relationship between mild traumatic brain injury (mTBI) history, mental health, and sex with single and polysubstance use in university athletes. DESIGN Observational study. SETTING University in Ontario, Canada. PARTICIPANTS Participants were identified from a dataset of 416 university athletes ages 18 to 21. Participants were classified based on their substance use habits and, 153 met criteria for the nonsubstance group, 195 for the alcohol use (AU) only group, and 64 polysubstance use group [ie, a combined substance use (AU+) group]. INDEPENDENT VARIABLES Athletes received baseline assessments and completed self-reported questions regarding alcohol, cannabis, or other recreational substance use, the Patient Health Questionnaire-9, self-reported mTBI history, and self-reported anxiety, and/or panic disorder endorsement information. MAIN OUTCOME MEASURES Comparison of mTBI history and mental health status between individuals in the alcohol only or polysubstance use group. RESULTS Mild traumatic brain injury history was a significant predictor of AU ( P < 0.001) and AU+ ( P < 0.001). Anxiety endorsement was also a significant predictor of polysubstance use ( P < 0.001) and there was a small but nonsignificant association of polysubstance use in men ( P = 0.057). CONCLUSIONS University athletes who experience mTBI are more likely to engage in single or polysubstance use and athletes who experience anxiety are more likely to engage in polysubstance use. Consideration of mTBI history and mental health may inform clinical concussion management for identifying potential high-risk behavior such as polysubstance use in university athletes and tailoring intervention strategies (eg, incorporating education about substance use).
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Aychman MM, Goldman DL, Kaplan JS. Cannabidiol's neuroprotective properties and potential treatment of traumatic brain injuries. Front Neurol 2023; 14:1087011. [PMID: 36816569 PMCID: PMC9932048 DOI: 10.3389/fneur.2023.1087011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Cannabidiol (CBD) has numerous pharmacological targets that initiate anti-inflammatory, antioxidative, and antiepileptic properties. These neuroprotective benefits have generated interest in CBD's therapeutic potential against the secondary injury cascade from traumatic brain injury (TBI). There are currently no effective broad treatment strategies for combating the damaging mechanisms that follow the primary injury and lead to lasting neurological consequences or death. However, CBD's effects on different neurotransmitter systems, the blood brain barrier, oxidative stress mechanisms, and the inflammatory response provides mechanistic support for CBD's clinical utility in TBI. This review describes the cascades of damage caused by TBI and CBD's neuroprotective mechanisms to counter them. We also present challenges in the clinical treatment of TBI and discuss important future clinical research directions for integrating CBD in treatment protocols. The mechanistic evidence provided by pre-clinical research shows great potential for CBD as a much-needed improvement in the clinical treatment of TBI. Upcoming clinical trials sponsored by major professional sport leagues are the first attempts to test the efficacy of CBD in head injury treatment protocols and highlight the need for further clinical research.
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Craine TJ, Race NS, Kutash LA, Iouchmanov AL, Moschonas EH, O'Neil DA, Sunleaf CR, Patel A, Patel N, Grobengeiser KO, Marshall IP, Magdelinic TN, Cheng JP, Bondi CO. Milnacipran Ameliorates Executive Function Impairments following Frontal Lobe Traumatic Brain Injury in Male Rats: A Multimodal Behavioral Assessment. J Neurotrauma 2023; 40:112-124. [PMID: 35979888 PMCID: PMC10024072 DOI: 10.1089/neu.2022.0289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Traumatic brain injuries (TBIs) affect more than 10 million patients annually worldwide, causing long-term cognitive and psychosocial impairments. Frontal lobe TBIs commonly impair executive function, but laboratory models typically focus primarily on spatial learning and declarative memory. We implemented a multi-modal approach for clinically relevant cognitive-behavioral assessments of frontal lobe function in rats with TBI and assessed treatment benefits of the serotonin-norepinephrine reuptake inhibitor, milnacipran (MLN). Two attentional set-shifting tasks (AST) evaluated cognitive flexibility via the rats' ability to locate food-based rewards by learning, unlearning, and relearning sequential rule sets with shifting salient cues. Adult male rats reached stable pre-injury operant AST (oAST) performance in 3-4 weeks, then were isoflurane-anesthetized, subjected to a unilateral frontal lobe controlled cortical impact (2.4 mm depth, 4 m/sec velocity) or Sham injury, and randomized to treatment conditions. Milnacipran (30 mg/kg/day) or vehicle (VEH; 10% ethanol in saline) was administered intraperitoneally via implanted osmotic minipumps (continuous infusions post-surgery, 60 μL/h). Rats had a 10-day recovery post-TBI/Sham before performing light/location-based oAST for 10 days and, subsequently, odor/media-based digging AST (dAST) on the last test day (26-27 days post-injury) before sacrifice. Both AST tests revealed significant deficits in TBI+VEH rats, seen as elevated total trials and errors (p < 0.05), which generally normalized in MLN-treated rats (p < 0.05). This first simultaneous dual AST assessment demonstrates oAST and dAST are sufficiently sensitive and robust to detect subtle attentional and cognitive flexibility executive impairments after frontal lobe TBI in rats. Chronic MLN administration shows promise for attenuation of post-TBI executive function deficits, thus meriting further investigation.
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Affiliation(s)
- Timothy J. Craine
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- University of Bath, Claverton Down, Bath, United Kingdom
| | - Nicholas S. Race
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Association of Academic Physiatrists Rehabilitation Medicine Scientist Training Program, Owings Mills, Maryland, USA
| | - Lindsay A. Kutash
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna L. Iouchmanov
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eleni H. Moschonas
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darik A. O'Neil
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carlson R. Sunleaf
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aarti Patel
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nima Patel
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Katherine O. Grobengeiser
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ian P. Marshall
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Taylor N. Magdelinic
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P. Cheng
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Corina O. Bondi
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Neurobiology, and University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Children's Neuroscience Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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13
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Bai L, Yin B, Lei S, Li T, Wang S, Pan Y, Gan S, Jia X, Li X, Xiong F, Yan Z, Bai G. Reorganized Hubs of Brain Functional Networks after Acute Mild Traumatic Brain Injury. J Neurotrauma 2023; 40:63-73. [PMID: 35747994 DOI: 10.1089/neu.2021.0450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Mild traumatic brain injury (mTBI)-associated damage to hub regions can lead to disrupted modular structures of functional brain networks and may result in widespread cognitive and behavioral deficits. The spatial layout of brain connections and modules is essential for understanding the reorganization of brain networks to trauma. We investigated the roles of hubs in inter-subnetwork information coordination and integration using participation coefficients (PCs) in 74 patients with acute mTBI and 51 matched healthy controls. In some brain networks, such as default mode network (DMN) and frontoparietal network (FPN), mild TBI patients had decreased PC levels, while this measure was saliently increased in patients in other networks, such as the visual network. The hub disruption index was defined as the gradient of a straight line fitted to scatterplots of individual mTBI in participation coefficient versus mean participation coefficient of healthy groups. There was a trend of radical reorganization of some efficient "hub" nodes in patients (κ = -0.15), compared with controls (κ close to 0). The PC of brain hubs can also differentiate mTBI patients from controls with an 88% accuracy, and decreased PC levels in FPN can predict patient' s worse cognitive information processing speed (r = 0.36, p < 0.002) and working memory performance (r = 0.35, p < 0.002). Reduced PC within the DMN was associated with patients' complaints of post-concussion symptoms (r = -0.35, p < 0.002). This evidence suggests a trend of spatial transition of hub profiles in acute mTBI, and graph metrics of PC measures can be used as potential diagnostic biomarkers.
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Affiliation(s)
- Lijun Bai
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Bo Yin
- Department of Neurosurgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuoyan Lei
- School of Electronic Information and Artificial Intelligence, Shaanxi University of Science and Technology, Xi'an, China
| | - Tianhui Li
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yizhen Pan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Shuoqiu Gan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyan Jia
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Li
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Feng Xiong
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Zhihan Yan
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanghui Bai
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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14
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Hudac CM, Wallace JS, Ward VR, Friedman NR, Delfin D, Newman SD. Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods. Front Neurol 2022; 13:918075. [PMID: 36619932 PMCID: PMC9812645 DOI: 10.3389/fneur.2022.918075] [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: 05/19/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Concussive events and other brain injuries are known to reduce cognitive inhibition, a key aspect of cognition that supports ones' behaviors and impacts regulation of mood or affect. Our primary objective is to investigate how induction of negative affect (such as frustration) impacts cognitive inhibition and the dynamic process by which youth athletes modulate responses. Secondary objective is to address the lack of Black representation in the scientific literature that promotes brain health and investigates pediatric sports-related brain injury. In particular, neuroscience studies predominantly include White participants despite broad racial representation in sport, in part due to technological hurdles and other obstacles that challenge research access for Black participants. Methods Using electroencephalography (EEG), we evaluate the dynamic brain processes associated with cognitive inhibition in the context of frustration induction in adolescent athletes during pre-season conditioning (i.e., prior to contact; N = 23) and a subset during post-season (n = 17). Results The N2 component was sensitive to frustration induction (decreased N2 amplitude, slower N2 latency), although effects were less robust at postseason. Trial-by-trial changes indicated a steady decrease of the N2 amplitude during the frustration block during the preseason visit, suggesting that affective interference had a dynamic effect on cognitive inhibition. Lastly, exploratory analyses provide preliminary evidence that frustration induction was less effective for athletes with a previous history of concussion or migraines (trending result) yet more effective for athletes endorsing a history with mental health disorders. Discussion We emphasize the urgent need to improve representation in cognitive neuroscience, particularly as it pertains to brain health. Importantly, we provide detailed guides to our methodological framework and practical suggestions to improve representative participation in studies utilizing high-density mobile EEG.
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Affiliation(s)
- Caitlin M. Hudac
- Department of Psychology, University of South Carolina, Columbia, SC, United States,Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, United States,Department of Psychology, University of Alabama, Tuscaloosa, AL, United States,Center for Autism and Neurodevelopment Research Center, University of South Carolina, Columbia, SC, United States,*Correspondence: Caitlin M. Hudac
| | - Jessica S. Wallace
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, AL, United States
| | - Victoria R. Ward
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, United States,Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
| | - Nicole R. Friedman
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, United States,Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
| | - Danae Delfin
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, AL, United States
| | - Sharlene D. Newman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States,Alabama Life Research Institute, University of Alabama, Tuscaloosa, AL, United States
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15
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Li F, Liu Y, Lu L, Li H, Xing C, Chen H, Yuan F, Yin X, Chen YC. Causal interactions with an insular-cortical network in mild traumatic brain injury. Eur J Radiol 2022; 157:110594. [DOI: 10.1016/j.ejrad.2022.110594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
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16
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Adolescents with a concussion have altered brain network functional connectivity one month following injury when compared to adolescents with orthopedic injuries. Neuroimage Clin 2022; 36:103211. [PMID: 36182818 PMCID: PMC9668608 DOI: 10.1016/j.nicl.2022.103211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
Concussion is a mild traumatic brain injury (mTBI) with increasing prevalence among children and adolescents. Functional connectivity (FC) within and between the default mode network (DMN), central executive network (CEN) and salience network (SN) has been shown to be altered post-concussion. Few studies have investigated connectivity within and between these 3 networks following a pediatric concussion. The present study explored whether within and between-network FC differs between a pediatric concussion and orthopedic injury (OI) group aged 10-18. Participants underwent a resting-state functional magnetic resonance imaging (rs-fMRI) scan at 4 weeks post-injury. One-way ANCOVA analyses were conducted between groups with the seed-based FC of the 3 networks. A total of 55 concussion and 27 OI participants were included in the analyses. Increased within-network FC of the CEN and decreased between-network FC of the DMN-CEN was found in the concussion group when compared to the OI group. Secondary analyses using spherical SN regions of interest revealed increased within-network FC of the SN and increased between-network FC of the DMN-SN and CEN-SN in the concussion group when compared to the OI group. This study identified differential connectivity patterns following a pediatric concussion as compared to an OI 4 weeks post-injury. These differences indicate potential adaptive brain mechanisms that may provide insight into recovery trajectories and appropriate timing of treatment within the first month following a concussion.
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17
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Omer M, Posti JP, Gissler M, Merikukka M, Bärnighausen T, Wilson ML. Birth order and pediatric traumatic brain injury. Sci Rep 2022; 12:14451. [PMID: 36002560 PMCID: PMC9402548 DOI: 10.1038/s41598-022-18742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 08/18/2022] [Indexed: 11/22/2022] Open
Abstract
Pediatric traumatic brain injury (TBI) is a significant problem of public health importance worldwide. Large population-based studies on the effect of birth order on health phenomena are exceedingly rare. This study examines the relationship between birth order and risk for pediatric TBI among sibling groups. We performed a retrospective cohort study following 59,469 Finnish newborns from 1987 until age 18 years. Data on first diagnosis of TBI was recorded within the 1987 Finnish Birth Cohort (FBC). Compared with first born siblings, later born siblings had an increased risk of TBI during the follow-up period (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.91–1.14 for second born, HR 1.09; 95% CI 0.95 1.26 for third born, HR 1.28; 95% CI 1.08–1.53 for fourth or higher). When adjusted for sex and maternal age at child’s birth, HRs (95% CIs) for TBI during the follow-up period were 1.12 (0.99–1.26) for second born, 1.31 (1.12–1.53) for third born and 1.61 (1.33–1.95) for fourth born or higher children, respectively. Within this large register-based population-wide study, order of birth modified risk for pediatric TBI among sibling groups. Taken together, these study findings may serve to stimulate further inquiry into genetic, psychological, or psychosocial factors which underlie differences in risk and depth of effect within and between sibling groups.
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Affiliation(s)
- Mazin Omer
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. .,Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, National Institute for Health and Welfare (THL), Helsinki, Finland.,Academic Primary Health Care Centre, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Marko Merikukka
- Children, Adolescents and Families, National Institute for Health and Welfare (THL), Oulu, Finland.,ITLA Children's Foundation, Helsinki, Finland
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
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18
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The ‘Rippling’ Waves of Wellbeing: A Mixed Methods Evaluation of a Surf-Therapy Intervention on Patients with Acquired Brain Injury. SUSTAINABILITY 2022. [DOI: 10.3390/su14159605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dominant psychological models of wellbeing neglect the role that nature connection and other key factors, such as positive health behaviours and behaviour change, play in determining wellbeing. The present mixed-methods evaluation explores the impact of ”Surf-Ability”, an adapted surf therapy intervention delivered in collaboration with a UK neurorehabilitation service, on individuals with acquired brain injury (ABI) as part of an effort to design interventions based on advances in wellbeing science. Following five surf-therapy sessions, within-subjects analysis (n= 15) revealed significant improvements on the Warwick–Edinburgh mental wellbeing scale (t (15) = −2.164, p = 0.048), as well as in anxiety and happiness as measured via a brief visual analogue. No significant changes occurred in the Hospital Anxiety and Depression Scale (HADS) or resting heart rate variability (HRV). A ripple effects mapping (REM) session at 6–10 months follow-up (n = 6) revealed that the physical and psychological experience of a nature-based challenge initiated a mindset shift in participants, which ultimately led to them adopting wellbeing-promoting long-term behaviour changes. These changes occurred at the scale of (1) individual wellbeing—increased mindfulness and physical activity; (2) collective wellbeing—improved relationships, community participation and contribution to organisations; and (3) planetary wellbeing—connection to nature. These findings align with the GENIAL theoretical framework, which defines wellbeing from a biopsychosocial ecological perspective across multiple levels of scale. The findings support the need for healthcare providers—including neurorehabilitation services—to enhance interventions for patients by incorporating novel factors that improve wellbeing, such as nature-connection.
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19
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Hubertus V, Finger T, Drust R, Al Hakim S, Schaumann A, Schulz M, Gratopp A, Thomale UW. Severe Traumatic Brain Injury in children-paradigm of decompressive craniectomy compared to a historic cohort. Acta Neurochir (Wien) 2022; 164:1421-1434. [PMID: 35305153 PMCID: PMC9061678 DOI: 10.1007/s00701-022-05171-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/21/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Traumatic brain injury (TBI) is one of the leading causes of death and disability in children. Medical therapy remains limited, and decompressive craniectomy (DC) is an established rescue therapy in case of elevated intracranial pressure (ICP). Much discussion deals with clinical outcome after severe TBI treated with DC, while data on the pediatric population is rare. We report our experience of treating severe TBI in two different treatment setups at the same academic institution. METHODS Forty-eight patients (≤ 16 years) were hospitalized with severe TBI (GCS ≤ 8 points) between 2008 and 2018 in a pediatric intensive care unit (ICU) at a specialized tertiary pediatric care center. Data on treatment, clinical status, and outcome was retrospectively analyzed. Outcome data included Glasgow Outcome Scale (GOS) at 3-, 12-, and 36-month follow-up. Data was compared to a historic cohort with 53 pediatric severe TBI patients treated at the same institution in a neurointensive care unit between 1996 and 2007. Ethical approval was granted (EA2/076/21). RESULTS Between 2008 and 2018, 11 patients were treated with DC. Compared to the historic cohort, patients were younger and GCS was worse, while in-hospital mortality and clinical outcome remained similar. A trend towards more aggressive EVD placement and the internal paradigm change for treatment in a specialized pediatric ICU was observed. CONCLUSIONS In children with severe TBI treated over two decades, clinical outcome was comparable and mostly favorable in two different treatment setups. Consequent therapy is warranted to maintain the positive potential for favorable outcome in children with severe TBI.
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20
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Léonard C, Desaulniers-Simon JM, Tat D, De Beaumont L, Gosselin N. Effects of Music Intervention on Stress in Concussed and Non-Concussed Athletes. Brain Sci 2021; 11:brainsci11111501. [PMID: 34827500 PMCID: PMC8615872 DOI: 10.3390/brainsci11111501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/24/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Sport-related concussion is a serious public health issue affecting millions of individuals each year. Among the many negative side effects, emotional symptoms, such as stress, are some of the most common. Stress management is repeatedly cited by expert groups as an important intervention for this population. It was shown that music has relaxing effects, reducing stress through the activation of brain areas involved in emotions and pleasure. The objective of this study was to explore the effects of a music-listening intervention compared with silence on experimentally induced stress in concussed and non-concussed athletes. To this aim, four groups of athletes (non-concussed music, non-concussed silence, concussed music, and concussed silence) performed the Trier Social Stress Test, for which both physiological (skin conductance level) and self-reported stress measurements were taken. No significant difference was found in the pattern of stress recovery for self-reported measurements. However, the skin conductance results showed greater and faster post-stress recovery after listening to music compared with silence for concussed athletes only. Taken together, these results suggest that music could be an efficient stress management tool to implement in the everyday life of concussed athletes to help them prevent stress accumulation.
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Affiliation(s)
- Camille Léonard
- Department of Psychology, Université de Montréal, Montreal, QC H3T 1J4, Canada; (C.L.); (D.T.)
- International Laboratory for Brain, Music and Sound Research (BRAMS), Outremont, QC H2V 2S9, Canada;
- Music, Emotions and Cognition Research Laboratory (MUSEC), Université de Montréal, Montreal, QC H2V 2S9, Canada
| | - Jeanne Marie Desaulniers-Simon
- International Laboratory for Brain, Music and Sound Research (BRAMS), Outremont, QC H2V 2S9, Canada;
- Music, Emotions and Cognition Research Laboratory (MUSEC), Université de Montréal, Montreal, QC H2V 2S9, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Diana Tat
- Department of Psychology, Université de Montréal, Montreal, QC H3T 1J4, Canada; (C.L.); (D.T.)
- International Laboratory for Brain, Music and Sound Research (BRAMS), Outremont, QC H2V 2S9, Canada;
- Music, Emotions and Cognition Research Laboratory (MUSEC), Université de Montréal, Montreal, QC H2V 2S9, Canada
| | - Louis De Beaumont
- Department of Surgery, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- CIUSSS Nord-de-l’Ile-de Montréal Research Center, Hôpital du Sacré-Cœur-de-Montréal, Montreal, QC H4J 1C5, Canada
| | - Nathalie Gosselin
- Department of Psychology, Université de Montréal, Montreal, QC H3T 1J4, Canada; (C.L.); (D.T.)
- International Laboratory for Brain, Music and Sound Research (BRAMS), Outremont, QC H2V 2S9, Canada;
- Music, Emotions and Cognition Research Laboratory (MUSEC), Université de Montréal, Montreal, QC H2V 2S9, Canada
- Center for Research on Brain, Language and Music (CRBLM), McGill University, Montreal, QC H3G 2A8, Canada
- Correspondence: ; Tel.: +1-514-343-6111 (ext. 3448)
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21
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Brown J, Ackley K, Knollman-Porter K. Collaborative Goal Setting: A Clinical Approach for Adults With Mild Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2394-2413. [PMID: 34529919 DOI: 10.1044/2021_ajslp-21-00078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Speech-language pathologists (SLPs) have many available procedural options when setting treatment goals. Extant literature supports goal setting protocols that include and value the perspectives of the client; however, in practice, rehabilitation professionals may lean toward expert models of care when planning treatment. Our purpose is to describe a newly developed approach for SLPs and individuals with mild traumatic brain injury (mTBI) to work together to build meaningful, relevant goals. Method We utilized a multiple case study format to exemplify goal setting procedures. Specifically, we describe procedures and outcomes for a 29-year-old female 28 days postinjury and a 70-year-old male 9 months postinjury. Results Clients who engaged in this protocol worked collaboratively with a clinician to identify strengths and challenges postinjury, select and prioritize goal areas, and discuss and develop meaningful, personalized treatment activities. For both participants, use of the proposed protocol resulted in meaningful goals that addressed their self-reported deficits as well as their respective cognitive-linguistic deficits noted on objective, standardized measures. Conclusions Clinician and client collaboration during treatment goal development can facilitate increased client motivation and functional outcomes. The described approach is feasible from a clinical resource standpoint and promotes a systematic approach to placing the client at the forefront of clinical decision making to enhance therapeutic gains. Such client-centered approaches may be particularly valuable for individuals with mTBI who experience substantial cognitive and communicative challenges but may maintain high levels of self-awareness postinjury.
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Affiliation(s)
- Jessica Brown
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ
| | - Kristen Ackley
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ
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22
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Song J, Li J, Chen L, Lu X, Zheng S, Yang Y, Cao B, Weng Y, Chen Q, Ding J, Huang R. Altered gray matter structural covariance networks at both acute and chronic stages of mild traumatic brain injury. Brain Imaging Behav 2021; 15:1840-1854. [PMID: 32880075 DOI: 10.1007/s11682-020-00378-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive and emotional impairments observed in mild traumatic brain injury (mTBI) patients may reflect variances of brain connectivity within specific networks. Although previous studies found altered functional connectivity (FC) in mTBI patients, the alterations of brain structural properties remain unclear. In the present study, we analyzed structural covariance (SC) for the acute stages of mTBI (amTBI) patients, the chronic stages of mTBI (cmTBI) patients, and healthy controls. We first extracted the mean gray matter volume (GMV) of seed regions that are located in the default-mode network (DMN), executive control network (ECN), salience network (SN), sensorimotor network (SMN), and the visual network (VN). Then we determined and compared the SC for each seed region among the amTBI, the cmTBI and the healthy controls. Compared with healthy controls, the amTBI patients showed lower SC for the ECN, and the cmTBI patients showed higher SC for the both DMN and SN but lower SC for the SMN. The results revealed disrupted ECN in the amTBI patients and disrupted DMN, SN and SMN in the cmTBI patients. These alterations suggest that early disruptions in SC between bilateral insula and the bilateral prefrontal cortices may appear in amTBI and persist into cmTBI, which might be potentially related to the cognitive and emotional impairments.
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Affiliation(s)
- Jie Song
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Jie Li
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Lixiang Chen
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Xingqi Lu
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Senning Zheng
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Ying Yang
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Bolin Cao
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Yihe Weng
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Qinyuan Chen
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.,Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, 510631, China
| | - Jianping Ding
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China. .,School of Medicine, Hangzhou Normal University, Hangzhou, 310015, China.
| | - Ruiwang Huang
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China. .,School of Psychology, South China Normal University, Guangzhou, 510631, China. .,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.
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23
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Race NS, Andrews KD, Lungwitz EA, Vega Alvarez SM, Warner TR, Acosta G, Cao J, Lu KH, Liu Z, Dietrich AD, Majumdar S, Shekhar A, Truitt WA, Shi R. Psychosocial impairment following mild blast-induced traumatic brain injury in rats. Behav Brain Res 2021; 412:113405. [PMID: 34097900 DOI: 10.1016/j.bbr.2021.113405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 01/30/2023]
Abstract
Traumatic brain injury (TBI) is associated with increased risk for mental health disorders, impacting post-injury quality of life and societal reintegration. TBI is also associated with deficits in psychosocial processing, defined as the cognitive integration of social and emotional behaviors, however little is known about how these deficits manifest and their contributions to post-TBI mental health. In this pre-clinical investigation using rats, a single mild blast TBI (mbTBI) induced impairment of psychosocial processing in the absence of confounding physical polytrauma, post-injury motor deficits, affective abnormalities, or deficits in non-social behavior. Impairment severity correlated with acute upregulations of a known oxidative stress metabolite, 3-hydroxypropylmercapturic acid (3-HPMA), in urine. Resting state fMRI alterations in the acute post-injury period implicated key brain regions known to regulate psychosocial behavior, including orbitofrontal cortex (OFC), which is congruent with our previous report of elevated acrolein, a marker of neurotrauma and 3-HPMA precursor, in this region following mbTBI. OFC of mbTBI-exposed rats demonstrated elevated mRNA expression of metabotropic glutamate receptors 1 and 5 (mGluR1/5) and injection of mGluR1/5-selective agonist in OFC of uninjured rats approximated mbTBI-induced psychosocial processing impairment, demonstrating a novel role for OFC in this psychosocial behavior. Furthermore, OFC may serve as a hotspot for TBI-induced disruption of psychosocial processing and subsequent mental health disorders.
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Affiliation(s)
- Nicholas S Race
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; Medical Scientist Training Program, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katharine D Andrews
- Medical Scientist Training Program, Indiana University School of Medicine, Indianapolis, IN, USA; Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Program in Medical Neuroscience, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth A Lungwitz
- Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Program in Medical Neuroscience, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sasha M Vega Alvarez
- PULSe Interdisciplinary Life Science Program, Purdue University, West Lafayette, IN, USA
| | - Timothy R Warner
- Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy, Cellular Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Glen Acosta
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Jiayue Cao
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA
| | - Kun-Han Lu
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA; School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Zhongming Liu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA; School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Amy D Dietrich
- Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy, Cellular Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sreeparna Majumdar
- Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Program in Medical Neuroscience, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anantha Shekhar
- Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William A Truitt
- Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy, Cellular Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; PULSe Interdisciplinary Life Science Program, Purdue University, West Lafayette, IN, USA; Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA; Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA; Center for Paralysis Research, West Lafayette, IN, USA.
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24
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van der Horn HJ, Mangina NR, Rakers SE, Kok JG, Timmerman ME, Leemans A, Spikman JM, van der Naalt J. White matter microstructure of the neural emotion regulation circuitry in mild traumatic brain injury. Eur J Neurosci 2021; 53:3463-3475. [PMID: 33759227 PMCID: PMC8251942 DOI: 10.1111/ejn.15199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 12/30/2022]
Abstract
Emotion regulation is related to recovery after mild traumatic brain injury (mTBI). This longitudinal tractography study examined white matter tracts subserving emotion regulation across the spectrum of mTBI, with a focus on persistent symptoms. Four groups were examined: (a) symptomatic (n = 33) and (b) asymptomatic (n = 20) patients with uncomplicated mTBI (i.e., no lesions on computed tomography [CT]), (c) patients with CT-lesions in the frontal areas (n = 14), and (d) healthy controls (HC) (n = 20). Diffusion and conventional MRI were performed approximately 1- and 3-months post-injury. Whole-brain deterministic tractography followed by region of interest analyses was used to identify forceps minor (FM), uncinate fasciculus (UF), and cingulum bundle as tracts of interest. An adjusted version of the ExploreDTI Atlas Based Tractography method was used to obtain reliable tracts for every subject. Mean fractional anisotropy (FA), mean, radial and axial diffusivity (MD, RD, AD), and number of streamlines were studied per tract. Linear mixed models showed lower FA, and higher MD, and RD of the right UF in asymptomatic patients with uncomplicated mTBI relative to symptomatic patients and HC. Diffusion alterations were most pronounced in the group with frontal lesions on CT, particularly in the FM and UF; these effects increased over time. Within the group of patients with uncomplicated mTBI, there were no associations of diffusion measures with the number of symptoms nor with lesions on conventional MRI. In conclusion, mTBI can cause microstructural changes in emotion regulation tracts, however, no explanation was found for the presence of symptoms.
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Affiliation(s)
| | - Namrata R. Mangina
- Department of NeurologyUniversity Medical Center GroningenGroningenthe Netherlands
| | - Sandra E. Rakers
- Department of NeurologyUniversity Medical Center GroningenGroningenthe Netherlands
| | - Jelmer G. Kok
- Department of NeurologyUniversity Medical Center GroningenGroningenthe Netherlands
| | - Marieke E. Timmerman
- Department of Psychometrics and StatisticsUniversity of GroningenGroningenthe Netherlands
| | - Alexander Leemans
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Jacoba M. Spikman
- Department of NeurologyUniversity Medical Center GroningenGroningenthe Netherlands
| | - Joukje van der Naalt
- Department of NeurologyUniversity Medical Center GroningenGroningenthe Netherlands
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25
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Bittencourt-Villalpando M, van der Horn HJ, Maurits NM, van der Naalt J. Disentangling the effects of age and mild traumatic brain injury on brain network connectivity: A resting state fMRI study. Neuroimage Clin 2020; 29:102534. [PMID: 33360020 PMCID: PMC7770973 DOI: 10.1016/j.nicl.2020.102534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/20/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cognitive complaints are common shortly after mild traumatic brain injury (mTBI) but may persist up to years. Age-related cognitive decline can worsen these symptoms. However, effects of age on mTBI sequelae have scarcely been investigated. METHODS Fifty-four mTBI patients (median age: 35 years, range 19-64 years, 67% male) and twenty age- and sex-matched healthy controls were studied using resting state functional magnetic resonance imaging in the sub-acute phase. Independent component analysis was used to identify intrinsic connectivity networks (ICNs). A multivariate approach was adopted to evaluate the effects of age and group on the ICNs in terms of (static) functional network connectivity (FNC), intensities of spatial maps (SMs) and time-course spectral power (TC). RESULTS We observed significant age-related changes for a) FNC: changes between 10 pairs of ICNs, mostly involving the default mode (DM) and/or the cognitive-control (CC) domains; b) SMs: intensity decrease in clusters across three domains and intensity increase in clusters across two domains, including the CC but not the DM and c) TC: spectral power decrease within the 0-0.15 Hz range and increase within the 0.20-0.25 Hz range for increasing age within networks located in frontal areas, including the anterior DM. Groups only differed for TC within the 0.065-0.10 Hz range in the cerebellar ICN and no age × group interaction effect was found. CONCLUSIONS We showed robust effects of age on connectivity between and within ICNs that are associated with cognitive functioning. Differences between mTBI patients and controls were only found for activity in the cerebellar network, increasingly recognized to participate in cognition. Our results suggest that to allow for capturing the true effects related to mTBI and its effects on cognitive functioning, age should be included as a covariate in mTBI studies, in addition to age-matching groups.
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Affiliation(s)
- M Bittencourt-Villalpando
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands.
| | - H J van der Horn
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands
| | - N M Maurits
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands
| | - J van der Naalt
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands
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26
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Radomski MV, Giles GM, Owens J, Showers M, Rabusch S, Kreiger R, Zola J, Kath K. Can service members with mild traumatic brain injury learn to develop implementation intentions for self-identified goals? Disabil Rehabil 2020; 44:2640-2647. [PMID: 33147426 DOI: 10.1080/09638288.2020.1841309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Goal achievement relies heavily on executive functions, which may be compromised following mild traumatic brain injury (mTBI). Implementation intentions (II) have been found to help people act in accordance with their goals. II are written statements that describe a behavior that a person plans to enact when they encounter some form of anticipated trigger or stimulus. We evaluated the feasibility of teaching participants with mTBI to develop II for self-identified goals within the context of cognitive rehabilitation. METHODS Soldiers with mTBI were recruited from a traumatic brain injury clinic. During the intervention, participants were assigned to develop an II for one of three self-identified goals every day. Descriptive methods were used to examine implementability and acceptability of the II training protocol as well as the extent to which participants learned to develop II for their own goals. RESULTS The II training protocol was found to be highly implementable and acceptable to participants. Overall, participants (n = 16) were able to develop II related to their self-identified goals, which primarily focused on managing cognitive problems. For the most part, participants developed II that involved event- rather than time- or somatic/feeling-based triggers. CONCLUSION AND IMPLICATIONS Participants with mTBI were able to learn to develop II for their self-identified goals. Further study is needed to determine whether adding II to cognitive rehabilitation advances patient goal achievement.IMPLICATIONS FOR REHABILITATIONIt is feasible to incorporate training in implementation intentions (predetermined "if/when-then" plans that are intended to link specific situational triggers with actions) in metacognitive strategy instruction for patients with mild traumatic brain injury.Participants with mild traumatic brain injury in this study demonstrated that they were able to develop implementation intentions for multiple self-identified rehabilitation goals, which holds promise for also teaching patients with mild cognitive impairment from other conditions.Learning to develop implementation intentions may help patients with mild traumatic brain injury initiate a range of other cognitive strategies in their everyday lives.Implementation intentions have the potential to help patients enact goal behaviors associated with their rehabilitation goals, making cognitive rehabilitation more "customizable" and relevant to clients' specific needs.
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Affiliation(s)
| | - Gordon Muir Giles
- Occupational Therapy Programs, Samuel Merritt University, Oakland, CA, USA.,Neurobehavioral Services, Crestwood Behavioral Health, Inc, Sacramento, CA, USA
| | - Jenny Owens
- Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Mark Showers
- Fort Campbell Intrepid Spirit, Fort Campbell, KY, USA
| | - Stacey Rabusch
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Rob Kreiger
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Joette Zola
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Kristina Kath
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
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27
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Calvillo M, Irimia A. Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury. Front Psychol 2020; 11:1423. [PMID: 32733322 PMCID: PMC7358255 DOI: 10.3389/fpsyg.2020.01423] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) can be serious partly due to the challenges of assessing and treating its neurocognitive and affective sequelae. The effects of a single TBI may persist for years and can limit patients’ activities due to somatic complaints (headaches, vertigo, sleep disturbances, nausea, light or sound sensitivity), affective sequelae (post-traumatic depressive symptoms, anxiety, irritability, emotional instability) and mild cognitive impairment (MCI, including social cognition disturbances, attention deficits, information processing speed decreases, memory degradation and executive dysfunction). Despite a growing amount of research, study comparison and knowledge synthesis in this field are problematic due to TBI heterogeneity and factors like injury mechanism, age at or time since injury. The relative lack of standardization in neuropsychological assessment strategies for quantifying sequelae adds to these challenges, and the proper administration of neuropsychological testing relative to the relationship between TBI, MCI and neuroimaging has not been reviewed satisfactorily. Social cognition impairments after TBI (e.g., disturbed emotion recognition, theory of mind impairment, altered self-awareness) and their neuroimaging correlates have not been explored thoroughly. This review consolidates recent findings on the cognitive and affective consequences of TBI in relation to neuropsychological testing strategies, to neurobiological and neuroimaging correlates, and to patient age at and assessment time after injury. All cognitive domains recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are reviewed, including social cognition, complex attention, learning and memory, executive function, language and perceptual-motor function. Affect and effort are additionally discussed owing to their relationships to cognition and to their potentially confounding effects. Our findings highlight non-negligible cognitive and affective impairments following TBI, their gravity often increasing with injury severity. Future research should study (A) language, executive and perceptual-motor function (whose evolution post-TBI remains under-explored), (B) the effects of age at and time since injury, and (C) cognitive impairment severity as a function of injury severity. Such efforts should aim to develop and standardize batteries for cognitive subdomains—rather than only domains—with high ecological validity. Additionally, they should utilize multivariate techniques like factor analysis and related methods to clarify which cognitive subdomains or components are indeed measured by standardized tests.
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Affiliation(s)
- Maria Calvillo
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States.,Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
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28
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Reducing Inappropriate Drug Use in Older Patients by Use of Clinical Decision Support in Community Pharmacy: A Mixed-Methods Evaluation. Drugs Aging 2019; 37:115-123. [DOI: 10.1007/s40266-019-00728-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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29
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Poltavski D, Bernhardt K, Mark C, Biberdorf D. Frontal theta-gamma ratio is a sensitive index of concussion history in athletes on tasks of visuo-motor control. Sci Rep 2019; 9:17565. [PMID: 31772237 PMCID: PMC6879532 DOI: 10.1038/s41598-019-54054-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/07/2019] [Indexed: 11/22/2022] Open
Abstract
Patients with mTBI often show deficits in executive function and changes in neural activity. Similar changes in those with a history of mTBI (i.e. concussion), however, have not been consistently reported. Frontal theta-to-gamma frequency ratio has shown promise in EEG research in predicting performance on working memory tasks. In the present study we explored the sensitivity of the frontal theta-to-gamma relative power spectral density (PSD) ratio to the history of concussion in 81 youth athletes (18 with a history of concussion, ages 13–18) during the tests of the Nike Sensory Training Station that vary in working memory and processing speed demands and motor output requirements. The results showed that the theta-to-gamma relative PSD ratio was significantly lower in the concussion history group on the tests of target capture, perception span and hand reaction time. A principle component analysis further indicated that this metric reflects an underlying dimension shared by several visuo-motor control tests of the Nike battery. The results suggested persistent deficits in psychomotor ability in the athletes with a history of concussion that may have implications for diagnosis, rehabilitation and athletic training.
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Affiliation(s)
- Dmitri Poltavski
- Department of Psychology, 501 N Columbia Rd, Stop 8380, University of North Dakota, Grand Forks, 58202-8380, ND, USA.
| | - Kyle Bernhardt
- Department of Psychology, 501 N Columbia Rd, Stop 8380, University of North Dakota, Grand Forks, 58202-8380, ND, USA
| | - Christopher Mark
- Department of Psychology, Salem State University, 352 Lafayette St., Salem, MA, 01970, USA
| | - David Biberdorf
- Valley Vision Clinic, 2200 S. Washington St., Grand Forks, 58201, ND, USA
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30
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Welton T, Indja BE, Maller JJ, Fanning JP, Vallely MP, Grieve SM. Replicable brain signatures of emotional bias and memory based on diffusion kurtosis imaging of white matter tracts. Hum Brain Mapp 2019; 41:1274-1285. [PMID: 31773802 PMCID: PMC7268065 DOI: 10.1002/hbm.24874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022] Open
Abstract
Diffusion MRI (dMRI) is sensitive to anisotropic diffusion within bundles of nerve axons and can be used to make objective measurements of brain networks. Many brain disorders are now recognised as being caused by network dysfunction or are secondarily associated with changes in networks. There is therefore great potential in using dMRI measures that reflect network integrity as a future clinical tool to help manage these conditions. Here, we used dMRI to identify replicable, robust and objective markers that meaningfully reflect cognitive and emotional performance. Using diffusion kurtosis analysis and a battery of cognitive and emotional tests, we demonstrated strong relationships between white matter structure across networks of anatomically and functionally specific brain regions with both emotional bias and emotional memory performance in a large healthy cohort. When the connectivity of these regions was examined using diffusion tractography, the terminations of the identified tracts overlapped precisely with cortical loci relating to these domains, drawn from an independent spatial meta‐analysis of available functional neuroimaging literature. The association with emotional bias was then replicated using an independently acquired healthy cohort drawn from the Human Connectome Project. These results demonstrate that, even in healthy individuals, white matter dMRI structural features underpin important cognitive and emotional functions. Our robust cross‐correlation and replication supports the potential of structural brain biomarkers from diffusion kurtosis MRI to characterise early neurological changes and risk in individuals with a reduced threshold for cognitive dysfunction, with further testing required to demonstrate clinical utility.
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Affiliation(s)
- Thomas Welton
- Sydney Translational Imaging Laboratory, Heart Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ben E Indja
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jerome J Maller
- Sydney Translational Imaging Laboratory, Heart Research Institute, The University of Sydney, Camperdown, New South Wales, Australia.,GE Healthcare, Richmond, Victoria, Australia
| | - Jonathon P Fanning
- Faculty of Medicine, The University of Queensland, Brisbane, New South Wales, Australia.,The Critical Care Research Group, The Prince Charles Hospital, Brisbane, New South Wales, Australia
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Cardiothoracic Surgery, The Northern Beaches Hospital, Sydney, New South Wales, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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31
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Li F, Lu L, Chen H, Wang P, Chen YC, Zhang H, Yin X. Disrupted brain functional hub and causal connectivity in acute mild traumatic brain injury. Aging (Albany NY) 2019; 11:10684-10696. [PMID: 31754082 PMCID: PMC6914439 DOI: 10.18632/aging.102484] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/08/2019] [Indexed: 12/19/2022]
Abstract
There have been an increasing number of functional magnetic resonance imaging (fMRI) reports on brain abnormalities in mild traumatic brain injury (mTBI) at different phases. However, the neural bases and cognitive impairment after acute mTBI are unclear. This study aimed to identify brain functional hubs and connectivity abnormalities in acute mTBI patients and their correlations with deficits in cognitive performance. Within seven days after brain injury, mTBI patients (n=55) and age-, sex-, and educational -matched healthy controls (HCs) (n=41) underwent resting-state fMRI scans and cognitive assessments. We derived functional connectivity (FC) strength of the whole-brain network using degree centrality (DC) and performed Granger causality analysis (GCA) to analyze causal connectivity patterns in acute mTBI. Compared with HCs, acute mTBI patients had significantly decreased network centrality in the left middle frontal gyrus (MFG). Additionally, acute mTBI showed decreased inflows from the left MFG to bilateral middle temporal gyrus (MTG), left medial superior frontal gyrus (mSFG), and left anterior cingulate cortex (ACC). Correlation analyses revealed that changes in network centrality and causal connectivity were associated with deficits in cognitive performance in mTBI. Our findings may help to provide a new perspective for understanding the neuropathophysiological mechanism of acute cognitive impairment after mTBI.
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Affiliation(s)
- Fengfang Li
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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32
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Mapping brain recovery after concussion: From acute injury to 1 year after medical clearance. Neurology 2019; 93:e1980-e1992. [PMID: 31619480 DOI: 10.1212/wnl.0000000000008523] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/27/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To test the hypothesis that concussion-related brain alterations seen at symptomatic injury and medical clearance to return to play (RTP) will have dissipated by 1 year after RTP. METHODS For this observational study, 24 athletes with concussion were scanned longitudinally within 1 week after injury, at RTP, and 1 year after RTP. A large control cohort of 122 athletes were also scanned before the season. Each imaging session assessed global functional connectivity (Gconn) and cerebral blood flow (CBF), along with white matter fractional anisotropy (FA) and mean diffusivity (MD). The main effects of concussion on MRI parameters were evaluated at each postinjury time point. In addition, covariation was assessed between MRI parameters and clinical measures of acute symptom severity and time to RTP. RESULTS Different aspects of brain physiology showed different patterns of recovery over time. Both Gconn and FA displayed no significant effects at 1 year after RTP, whereas CBF and MD exhibited persistent long-term effects. The effects of concussion on MRI parameters were also dependent on acute symptom severity and time to RTP for all postinjury time points. CONCLUSION This study provides the first longitudinal evaluation of concussion focused on time of RTP and 1 year after medical clearance, using multiple different MRI measures to assess brain structure and function. These findings significantly enhance our understanding of the natural course of brain recovery after a concussion.
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Affiliation(s)
- Nathan W Churchill
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michael G Hutchison
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Simon J Graham
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tom A Schweizer
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Abstract
Objectives: Traumatic brain injury continue to be a public health issue, mainly as a result of road accidents and falls. Current epidemiological studies appear to be necessary for a better understanding and monitoring of this problem. This paper analyzes the evolution of these cases in Portugal from the late 1990s to 2014. Methods: The number of hospital admissions and of total mortality in the country were analyzed regarding 2011 and 2014. The results were compared with values obtained previously, for 1997. Results: Incidence rate decreased, being 137/100 000 in 1997 and 65/100 000 in 2014. The mortality rate has also decreased from 17/100 000 to 10/100 000. However, between 2011 and 2014, there was a trend to increase the total number of cases. The incidence rate by age group also differs, with fewer cases in the young adult population in 2014 contrasting with a very high mortality among people aged 80 or older, of 57/100 000. Men continue to show a greater incidence, presenting more hospitalization cases (1.4:1), and higher mortality (2.3:1). Conclusions: The results are consistent with other studies, revealing a decrease in cases, but a high mortality in the elderly population, and the need of more preventive measures.
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Affiliation(s)
- Maria Emilia Santos
- Universidade Católica Portuguesa Ringgold standard institution, Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences , Lisbon , Portugal
| | - Nicole Agrela
- Universidade Católica Portuguesa Ringgold standard institution, Institute of Health Sciences , Lisbon , Portugal
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Relationships Between Subcortical Shape Measures and Subjective Symptom Reporting in US Service Members With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2019. [PMID: 29517591 DOI: 10.1097/htr.0000000000000379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess interactions of subcortical structure with subjective symptom reporting associated with mild traumatic brain injury (mTBI), using advanced shape analysis derived from volumetric MRI. PARTICIPANTS Seventy-six cognitively symptomatic individuals with mTBI and 59 service members sustaining only orthopedic injury. DESIGN Descriptive cross-sectional study. MAIN MEASURES Self-report symptom measures included the PTSD Checklist-Military, Neurobehavioral Symptom Inventory, and Symptom Checklist-90-Revised. High-dimensional measures of shape characteristics were generated from volumetric MRI for 7 subcortical structures in addition to standard volume measures. RESULTS Several significant interactions between group status and symptom measures were observed across the various shape measures. These interactions were revealed in the right thalamus and globus pallidus for each of the shape measures, indicating differences in structure thickness and expansion/contraction for these regions. No relationships with volume were observed. CONCLUSION Results provide evidence for the sensitivity of shape measures in differentiating symptomatic mTBI individuals from controls, while volumetric measures did not exhibit this same sensitivity. Disruptions to thalamic nuclei identified here highlight the role of the thalamus in the spectrum of symptoms associated with mTBI. Additional work is needed to prospectively, and longitudinally, assess these measures along with cognitive performance and advanced multimodal imaging methods to extend the utility of shape analysis in relation to functional outcomes in this population.
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Mantua J, Ready RE. Emotion habituation is accelerated in chronic mild traumatic brain injury. Brain Inj 2019; 33:1467-1475. [DOI: 10.1080/02699052.2019.1646434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Janna Mantua
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Rebecca E. Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Stephens JA, Liu P, Lu H, Suskauer SJ. Cerebral Blood Flow after Mild Traumatic Brain Injury: Associations between Symptoms and Post-Injury Perfusion. J Neurotrauma 2019; 35:241-248. [PMID: 28967326 DOI: 10.1089/neu.2017.5237] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Arterial spin labeling (ASL) has emerged as a technique for assessing mild traumatic brain injury (mTBI), as it can noninvasively evaluate cerebrovascular physiology. To date, there is substantial variability in methodology and findings of ASL studies of mTBI. While both increased and decreased perfusion are reported after mTBI, more consistency is emerging when perfusion is examined with regard to symptomology. We evaluated 15 teenage athletes two and six weeks after sports-related concussion (SRC group) using pseudo-continuous ASL. We acquired comparison data from 15 matched controls from a single time point. At each time point, we completed whole-brain contrasts to evaluate differences between the SRC group and controls in relative cerebral blood flow (rCBF). Cluster-level findings directed region of interest (ROI) analyses to test for group differences in rCBF across the left dorsal anterior cingulate cortex (ACC) and left insula. Finally, we evaluated ROI rCBF and symptomology in the SRC group. At two weeks post-injury, the SRC group had significantly higher rCBF in the left dorsal ACC and left insula than controls; at six weeks post-injury, elevated rCBF persisted in the SRC group in the left dorsal ACC. Perfusion in the left dorsal ACC was higher in athletes reporting physical symptoms six weeks post-injury compared with asymptomatic athletes and controls. Overall, these findings are inconsistent with reports of reduced rCBF after mTBI but coherent with studies that report increased perfusion in persons with greater or persistent mTBI-related symptomology. Future work should continue to assess how CBF perfusion relates to symptomology and recovery after mTBI.
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Affiliation(s)
- Jaclyn A Stephens
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,2 Department of Occupational Therapy at Colorado State University , Fort Collins, Colorado.,3 Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Peiying Liu
- 4 Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Hanzhang Lu
- 4 Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Stacy J Suskauer
- 1 Kennedy Krieger Institute , Baltimore, Maryland.,3 Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine , Baltimore, Maryland.,5 Department of Pediatrics, Johns Hopkins School of Medicine , Baltimore, Maryland
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van Kalleveen MW, Noordhuis EJ, Lasham C, Plötz FB. Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain. Pediatr Gastroenterol Hepatol Nutr 2019; 22:225-232. [PMID: 31110955 PMCID: PMC6506428 DOI: 10.5223/pghn.2019.22.3.225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. METHODS The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. RESULTS A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35-0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. CONCLUSION We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.
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Affiliation(s)
| | | | - Carole Lasham
- Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands
| | - Frans B. Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands
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38
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An integrated perspective linking physiological and psychological consequences of mild traumatic brain injury. J Neurol 2019; 267:2497-2506. [PMID: 31030257 PMCID: PMC7420827 DOI: 10.1007/s00415-019-09335-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 01/13/2023]
Abstract
Despite the often seemingly innocuous nature of a mild traumatic brain injury (mTBI), its consequences can be devastating, comprising debilitating symptoms that interfere with daily functioning. Currently, it is still difficult to pinpoint the exact cause of adverse outcome after mTBI. In fact, extensive research suggests that the underlying etiology is multifactorial. In the acute and early sub-acute stages, the pathophysiology of mTBI is likely to be dominated by complex physiological alterations including cellular injury, inflammation, and the acute stress response, which could lead to neural network dysfunction. In this stage, patients often report symptoms such as fatigue, headache, unstable mood and poor concentration. When time passes, psychological processes, such as coping styles, personality and emotion regulation, become increasingly influential. Disadvantageous, maladaptive, psychological mechanisms likely result in chronic stress which facilitates the development of long-lasting symptoms, possibly via persistent neural network dysfunction. So far, a systemic understanding of the coupling between these physiological and psychological factors that in concert define outcome after mTBI is lacking. The purpose of this narrative review article is to address how psychophysiological interactions may lead to poor outcome after mTBI. In addition, a framework is presented that may serve as a template for future studies on this subject.
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39
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Kim S, Zemon V, Lehrer P, McCraty R, Cavallo MM, Raghavan P, Ginsberg JJ, Foley FW. Emotion regulation after acquired brain injury: a study of heart rate variability, attentional control, and psychophysiology. Brain Inj 2019; 33:1012-1020. [PMID: 30907142 DOI: 10.1080/02699052.2019.1593506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Primary objective: To examine the efficacy of heart rate variability biofeedback (HRV-BF) to treat emotional dysregulation in persons with acquired brain injury. Design: A secondary analysis of a quasi-experimental study which enrolled 13 individuals with severe chronic acquired brain injury participating in a community-based programme. Response-to-treatment was measured with two HRV resonance indices (low frequency activity [LF] and low frequency/high frequency ratio [LF/HF]). Main outcome: Behavior Rating Inventory of Executive Function-informant report (emotional control subscale [EC]). Results: Results show significant correlation between LF and EC with higher LF activity associated with greater emotional control; the association between LF/HF pre-post-change score and EC is not statistically significant. A moderation model, however, demonstrates a significant influence of attention on the relation between LF/HF change and EC when attention level is high, with an increase in LF/HF activity associated with greater emotional control. Conclusions: HRV-BF is associated with large increases in HRV, and it appears to be useful for the treatment of emotional dysregulation in individuals with severe acquired brain injury. Attention training may enhance an individual's emotional control.
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Affiliation(s)
- Sonya Kim
- a Department of Neurology and Department of Rehabilitation Medicine , NYU School of Medicine , New York , NY , USA
| | - Vance Zemon
- b Ferkauf Graduate School of Psychology , Albert Einstein College of Medicine Yeshiva University , New York , NY , USA
| | - Paul Lehrer
- c Rutgers- Robert Wood Johnson Medical School , Piscataway , NJ , USA
| | | | | | - Preeti Raghavan
- f Rusk Institute of Rehabilitation Medicine NYU Langone Medical Center , New York , NY , USA
| | | | - Frederick W Foley
- b Ferkauf Graduate School of Psychology , Albert Einstein College of Medicine Yeshiva University , New York , NY , USA.,h Multiple Sclerosis Comprehensive Care Multiple Sclerosis Center , Holy Name Hospital , New York , NY , USA
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40
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Worts PR, Burkhart SO, Kim JS. A Physiologically Based Approach to Prescribing Exercise Following a Sport-Related Concussion. Sports Med 2019; 49:683-706. [DOI: 10.1007/s40279-019-01065-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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41
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Kramer AH, Couillard PL, Zygun DA, Aries MJ, Gallagher CN. Continuous Assessment of "Optimal" Cerebral Perfusion Pressure in Traumatic Brain Injury: A Cohort Study of Feasibility, Reliability, and Relation to Outcome. Neurocrit Care 2019; 30:51-61. [PMID: 29987688 DOI: 10.1007/s12028-018-0570-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Guidelines recommend maintaining cerebral perfusion pressure (CPP) between 60 and 70 mmHg in patients with severe traumatic brain injury (TBI), but acknowledge that optimal CPP may vary depending on cerebral blood flow autoregulation. Previous retrospective studies suggest that targeting CPP where the pressure reactivity index (PRx) is optimized (CPPopt) may be associated with improved recovery. METHODS We performed a retrospective cohort study involving TBI patients who underwent PRx monitoring to assess issues of feasibility relevant to future interventional studies: (1) the proportion of time that CPPopt could be detected; (2) inter-observer variability in CPPopt determination; and (3) agreement between manual and automated CPPopt estimates. CPPopt was determined for consecutive 6-h epochs during the first week following TBI. Sixty PRx-CPP tracings were randomly selected and independently reviewed by six critical care professionals. We also assessed whether greater deviation between actual CPP and CPPopt (ΔCPP) was associated with poor outcomes using multivariable models. RESULTS In 71 patients, CPPopt could be manually determined in 985 of 1173 (84%) epochs. Inter-observer agreement for detectability was moderate (kappa 0.46, 0.23-0.68). In cases where there was consensus that it could be determined, agreement for the specific CPPopt value was excellent (weighted kappa 0.96, 0.91-1.00). Automated CPPopt was within 5 mmHg of manually determined CPPopt in 93% of epochs. Lower PRx was predictive of better recovery, but there was no association between ΔCPP and outcome. Percentage time spent below CPPopt increased over time among patients with poor outcomes (p = 0.03). This effect was magnified in patients with impaired autoregulation (defined as PRx > 0.2; p = 0.003). CONCLUSION Prospective interventional clinical trials with regular determination of CPPopt and corresponding adjustment of CPP goals are feasible, but measures to maximize consistency in CPPopt determination are necessary. Although we could not confirm a clear association between ΔCPP and outcome, time spent below CPPopt may be particularly harmful, especially when autoregulation is impaired.
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Affiliation(s)
- Andreas H Kramer
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada. .,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
| | - Philippe L Couillard
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - David A Zygun
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
| | - Marcel J Aries
- Department of Intensive Care, University of Maastricht, Maastricht, The Netherlands
| | - Clare N Gallagher
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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42
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Scheier LM. The Spurious Chicken and the Confounding Egg: Commentary on Cumulative Head Impact Exposure and Youth Football (Re: DOI: 10.1089/neu.2016.4413). J Neurotrauma 2019; 36:408-410. [PMID: 30180782 DOI: 10.1089/neu.2017.5465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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43
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Wu J, Wang X, Wang Q, Lou Z, Li S, Zhu Y, Qin L, Wei H. Nanomaterials with enzyme-like characteristics (nanozymes): next-generation artificial enzymes (II). Chem Soc Rev 2019; 48:1004-1076. [DOI: 10.1039/c8cs00457a] [Citation(s) in RCA: 1628] [Impact Index Per Article: 325.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An updated comprehensive review to help researchers understand nanozymes better and in turn to advance the field.
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Affiliation(s)
- Jiangjiexing Wu
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
| | - Xiaoyu Wang
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
| | - Quan Wang
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
| | - Zhangping Lou
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
| | - Sirong Li
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
| | - Yunyao Zhu
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
| | - Li Qin
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
| | - Hui Wei
- Department of Biomedical Engineering, College of Engineering and Applied Sciences
- Nanjing National Laboratory of Microstructures
- Jiangsu Key Laboratory of Artificial Functional Materials
- Nanjing University
- Nanjing
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Sadowska-Bartosz I, Bartosz G. Redox nanoparticles: synthesis, properties and perspectives of use for treatment of neurodegenerative diseases. J Nanobiotechnology 2018; 16:87. [PMID: 30390681 PMCID: PMC6215349 DOI: 10.1186/s12951-018-0412-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/15/2018] [Indexed: 12/31/2022] Open
Abstract
Oxidative stress (OS) and nitrative stress (NS) accompany many diseases, including Alzheimer's disease (AD) and Parkinson's disease (PD). Antioxidants have been proposed to counteract OS/NS in these diseases. Nevertheless, the effects of antioxidants are limited and new, more efficient antioxidants are searched for. Redox-active nanoparticles (RNPs), containing antioxidants create a new therapeutical perspective. This review examines the recent literature describing synthesis and potential applications of cerium oxide RNPs, boron cluster-containing and silica containing RNPs, Gd3N@C80 encapsulated RNPs, and concentrates on nitroxide-containing RNPs. Nitroxides are promising antioxidants, preventing inter alia glycation and nitration, but their application poses several problems. It can be expected that application of RNPs containing covalently bound nitroxides, showing low toxicity and able to penetrate the blood-brain barrier will be more efficient in the treatment of neurodegenerative disease, in particular AD and PD basing on their effects in cellular and animal models of neurodegenerative diseases.
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Affiliation(s)
- Izabela Sadowska-Bartosz
- Department of Analytical Biochemistry, Faculty of Biology and Agriculture, University of Rzeszow, Zelwerowicza Street 4, 35-601, Rzeszow, Poland.
| | - Grzegorz Bartosz
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska Street 141/143, 90-236, Lodz, Poland
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45
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Bay E, Chan RR. Mindfulness-Based Versus Health Promotion Group Therapy After Traumatic Brain Injury. J Psychosoc Nurs Ment Health Serv 2018; 57:26-33. [PMID: 30272810 DOI: 10.3928/02793695-20180924-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/08/2018] [Indexed: 01/15/2023]
Abstract
The current pre- and posttest intervention study is designed for individuals with chronic symptoms and stress associated with mild-to-moderate traumatic brain injury (TBI). The researchers' intent was to evaluate whether an 8-week mindfulness-based group therapy compared to health promotion active control group therapy reduces chronic stress, TBI symptoms, and depressive symptoms. Significant mean reductions in chronic stress and TBI depressive and general symptoms for individuals in the mindfulness group compared to the active control group were present, according to paired t test analyses. Further, while controlling for baseline scores, the mindfulness-based intervention group change score was greater compared to the control group using regression analyses. Results suggest that mindfulness-based group intervention for individuals with chronic difficulties after TBI is feasible and effective. Further study of this cost-effective and self-management approach to stress and symptom management is warranted and has the potential to be a broad-based intervention for early therapy after injury. [Journal of Psychosocial Nursing and Mental Health Services, 57(1), 26-33.].
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46
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Stout DM, Buchsbaum MS, Spadoni AD, Risbrough VB, Strigo IA, Matthews SC, Simmons AN. Multimodal canonical correlation reveals converging neural circuitry across trauma-related disorders of affect and cognition. Neurobiol Stress 2018; 9:241-250. [PMID: 30450388 PMCID: PMC6234282 DOI: 10.1016/j.ynstr.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
Trauma-related disorders of affect and cognition (TRACs) are associated with a high degree of diagnostic comorbidity, which may suggest that these disorders share a set of underlying neural mechanisms. TRACs are characterized by aberrations in functional and structural circuits subserving verbal memory and affective anticipation. Yet, it remains unknown how the neural circuitry underlying these multiple mechanisms contribute to TRACs. Here, in a sample of 47 combat Veterans, we measured affective anticipation using functional magnetic resonance imaging (fMRI), verbal memory with fluorodeoxyglucose positron emission tomography (FDG-PET), and grey matter volume with structural magnetic resonance imaging (sMRI). Using a voxel-based multimodal canonical correlation analysis (mCCA), the set of neural measures were statistically integrated, or fused, with a set of TRAC symptom measures including mild traumatic brain injury (mTBI), posttraumatic stress, and depression severity. The first canonical correlation pair revealed neural convergence in clusters encompassing the middle frontal gyrus and supplemental motor area, regions implicated in top-down cognitive control and affect regulation. These results highlight the potential of leveraging multivariate neuroimaging analysis for linking neurobiological mechanisms associated with TRACs, paving the way for transdiagnostic biomarkers and targets for treatment.
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Affiliation(s)
- Daniel M Stout
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Monte S Buchsbaum
- Department of Psychiatry, University of California, San Diego, USA.,Department of Radiology, University of California, San Diego, USA
| | - Andrea D Spadoni
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Victoria B Risbrough
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, & San Francisco VA Health Care System, USA
| | - Scott C Matthews
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
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47
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Sun MK. Executive functioning: perspectives on neurotrophic activity and pharmacology. Behav Pharmacol 2018; 29:592-604. [PMID: 30179884 DOI: 10.1097/fbp.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Executive functioning is a high-level cognitive ability, regulating other abilities and behaviors to achieve desired goals. A typical executive task can be defined as the capacity to maintain one's attention on the current task, that is, responding only to the correct but not to distractive stimuli. Impairments of executive functions, or executive dysfunctions, have a growing impact on everyday life and academic achievement and are usually an early feature, and one of the core features, in brain injury and memory and behavioral disorders. Furthermore, emerging evidence indicates that memory therapeutics cannot achieve their clinical benefits in cognition if executive dysfunction is not effectively and simultaneously treated. Improvement of executive functions might be achieved through targeting some signaling pathways in the brain, including the brain-derived neurotrophic factor signaling pathways. These agents may be useful either as stand-alone interventions for patients with executive dysfunction and/or psychiatric and memory disorders or as essential adjuncts to drugs that target the underlying pathology in various brain injury and memory and behavioral disorders.
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Affiliation(s)
- Miao-Kun Sun
- Blanchette Rockefeller Neurosciences Institute, Morgantown, West Virginia, USA
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48
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Stevens RD, Hannawi Y. Coma Prognostication: Looks That Count. Crit Care Med 2018; 44:2292-2293. [PMID: 27858819 DOI: 10.1097/ccm.0000000000002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Robert D Stevens
- Division of Neurosciences Critical Care Departments of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, and Radiology Johns Hopkins University School of Medicine Baltimore, MDDivision of the Cerebrovascular Diseases and Neurocritical Care Department of Neurology The Ohio State University Columbus, OH
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Kinnunen L, Niemelä M, Hakko H, Miettunen J, Merikukka M, Karttunen V, Ristikari T, Gissler M, Räsänen S. Psychiatric diagnoses of children affected by their parents’ traumatic brain injury: the 1987 Finnish Birth Cohort study. Brain Inj 2018; 32:933-940. [DOI: 10.1080/02699052.2018.1470331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lotta Kinnunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mika Niemelä
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marko Merikukka
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | - Vesa Karttunen
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Tiina Ristikari
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sami Räsänen
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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O'Phelan KH, Otoshi CK, Ernst T, Chang L. Common Patterns of Regional Brain Injury Detectable by Diffusion Tensor Imaging in Otherwise Normal-Appearing White Matter in Patients with Early Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:739-749. [PMID: 29228858 PMCID: PMC5831746 DOI: 10.1089/neu.2016.4944] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) alters the lives of millions of people every year. Although mortality rates have improved, attributed to better pre-hospital care and reduction of secondary injury in the critical care setting, improvements in functional outcomes post-TBI have been difficult to achieve. Diffusion-tensor imaging (DTI) allows detailed measurement of microstructural damage in regional brain tissue post-TBI, thus improving our understanding of the extent and severity of TBI. Twenty subjects were recruited from a neurological intensive care unit and compared to 18 healthy control subjects. Magnetic resonance imaging (MRI) scanning was performed on a 3.0-Tesla Siemens TIM Trio Scanner (Siemens Medical Solutions, Erlangen, Germany) including T1- and T2-weighted sequences and DTI. Images were processed using DTIStudio software. SAS (SAS Institute Inc., Cary, NC) was used for statistical analysis of group differences in 14 brain regions (25 regions of interests [ROIs]). Seventeen TBI subjects completed scanning. TBI and control subjects did not differ in age or sex. All TBI subjects had visible lesions on structural MRI. TBI subjects had seven brain regions (nine ROIs) that showed significant group differences on DTI metrics (fractional anisotropy, radial diffusion, or mean diffusion) compared to noninjured subjects, including the corpus callosum (genu and splenium), superior longitudinal fasciculus, internal capsule, right retrolenticular internal capsule, posterior corona radiata, and thalamus. However, 16 ROIs showed relatively normal DTI measures. Quantitative DTI demonstrates multiple areas of microstructual injury in specific normal-appearing white matter brain regions. DTI may be useful for assessing the extent of brain injury in patients with early moderate to severe TBI.
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Affiliation(s)
- Kristine H. O'Phelan
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Chad K. Otoshi
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Thomas Ernst
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Linda Chang
- Department of Medicine, Neuroscience and MRI Research Program, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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