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Willman J, Kurian AL, Lucke-Wold B. Mechanisms of vascular injury in neurotrauma: A critical review of the literature. World J Meta-Anal 2024; 12:95417. [DOI: 10.13105/wjma.v12.i3.95417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/20/2024] [Accepted: 07/29/2024] [Indexed: 09/13/2024] Open
Abstract
One in every two individuals will experience a traumatic brain injury in their lifetime with significant impacts on the global economy and healthcare system each year. Neurovascular injury is a key aspect of neurotrauma to both the brain and the spinal cord and an important avenue of current and future research seeking innovative therapies. In this paper, we discuss primary and secondary neurotrauma, mechanisms of injury, the glymphatic system, repair and recovery. Each of these topics are directly connected to the vasculature of the central nervous system, affecting severity of injury and recovery. Consequently, neurovascular injury in trauma represents a promising target for future therapeutics and innovation.
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Affiliation(s)
- Jonathan Willman
- College of Medicine, University of Florida, Gainesville, FL 32610, United States
| | - Annu Lisa Kurian
- College of Medicine, Florida State University, Tallahassee, FL 32304, United States
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, United States
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2
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Horvat L, Foschini A, Grinias JP, Waterhouse BD, Devilbiss DM. Repetitive mild traumatic brain injury impairs norepinephrine system function and psychostimulant responsivity. Brain Res 2024; 1839:149040. [PMID: 38815643 DOI: 10.1016/j.brainres.2024.149040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
Traumatic brain injury (TBI) is a complex pathophysiological process that results in a variety of neurotransmitter, behavioral, and cognitive deficits. The locus coeruleus-norepinephrine (LC-NE) system is a critical regulator of arousal levels and higher executive processes affected by TBI including attention, working memory, and decision making. LC-NE axon injury and impaired signaling within the prefrontal cortex (PFC) is a potential contributor to the neuropsychiatric symptoms after single, moderate to severe TBI. The majority of TBIs are mild, yet long-term cognitive deficits and increased susceptibility for further injury can accumulate after each repetitive mild TBI. As a potential treatment for restoring cognitive function and daytime sleepiness after injury psychostimulants, including methylphenidate (MPH) that increase levels of NE within the PFC, are being prescribed "off-label". The impact of mild and repetitive mild TBI on the LC-NE system remains limited. Therefore, we determined the extent of LC-NE and arousal dysfunction and response to therapeutic doses of MPH in rats following experimentally induced single and repetitive mild TBI. Microdialysis measures of basal NE efflux from the medial PFC and arousal measures were significantly lower after repetitive mild TBI. Females showed higher baseline PFC-NE efflux than males following single and repetitive mild TBI. In response to MPH challenge, males exhibited a blunted PFC-NE response and persistent arousal levels following repetitive mild TBI. These results provide critical insight into the role of catecholamine system dysfunction associated with cognitive deficits following repeated injury, outcome differences between sex/gender, and lack of success of MPH as an adjunctive therapy to improve cognitive function following injury.
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Affiliation(s)
- Leah Horvat
- Rowan University, Department of Chemistry and Biochemistry, Science Hall 301G, 230 Meditation Walk, Glassboro, NJ 08028, USA
| | - Alexis Foschini
- Rowan University, Department of Cell Biology and Neuroscience, Science Center 220, 2 Medical Center Drive, Stratford, NJ, 08084, USA
| | - James P Grinias
- Rowan University, Department of Chemistry and Biochemistry, Science Hall 301G, 230 Meditation Walk, Glassboro, NJ 08028, USA
| | - Barry D Waterhouse
- Rowan University, Department of Cell Biology and Neuroscience, Science Center 220, 2 Medical Center Drive, Stratford, NJ, 08084, USA
| | - David M Devilbiss
- Rowan University, Department of Cell Biology and Neuroscience, Science Center 220, 2 Medical Center Drive, Stratford, NJ, 08084, USA.
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Stiekema APM, Rauwenhoff JCC, Bierlaagh D, Donkervoort M, Jansen N, Jurrius KHM, Zadoks J, van Heugten CM. Case management for people with acquired brain injury: feasibility and effectiveness of a two-year pragmatic randomized controlled trial. Brain Inj 2024:1-12. [PMID: 39245982 DOI: 10.1080/02699052.2024.2399070] [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: 07/19/2023] [Revised: 05/22/2024] [Accepted: 08/21/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Case management (CM) aims to facilitate access to and integration of health care and social services. We investigated the feasibility and effectiveness of CM. METHODS Randomized controlled trial with 219 patients and 114 caregivers randomly allocated to CM (109/59) or care as usual (110/55). CM was based on early and continuous online monitoring of problems and needs. Outcomes were assessed every 6 months with the Hospital Anxiety and Depression Scale (HADS). Secondary outcome domains were participant restrictions, life satisfaction, self-efficacy, caregiver burden, and needs. Multilevel modeling was used. Feasibility aspects were protocol delivery, participants' and case managers' satisfaction, and factors affecting implementation. RESULTS There were no significant differences between groups. Participation restrictions and unmet needs decreased in both groups within 6 months. Monitoring was successful in 38, and 10 participants asked the CM for support. CM consisted mostly of providing information. DISCUSSION CM based on early and continuous online monitoring does not have benefit in identifying and addressing problems early after relatively mild injury. Unsuccessful monitoring may have hindered access to the case manager and prevented us from evaluating CM as a complex intervention. It remains a challenge to early identify those who could benefit from care coordination.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
| | - Johanne C C Rauwenhoff
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
| | | | - Mireille Donkervoort
- Health Care and Social Work Division, Windesheim University of Applied Sciences, Almere, The Netherlands
- Mevrouw Slimmer Werken Social Innovation in Health Care and Well-Being, Drogteropslagen, Netherlands
| | - Natska Jansen
- Brain Injury Team, Brain Injury Network, Overijssel, Netherlands
| | | | - Judith Zadoks
- In-Tussen Foundation, Utrecht, the Netherlands
- BreinDok Innovation in Care, Utrecht, the Netherlands
| | - Caroline M van Heugten
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Livernoche Leduc C, Roy SJ, Paradis V, Potvin MJ. Cognitive profiles in the acute phase of traumatic brain injury according to injury severity. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:766-776. [PMID: 35611614 DOI: 10.1080/23279095.2022.2071615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although several studies have documented the chronic phase of traumatic brain injury (TBI), few verified the nature and severity of cognitive impairments during the acute phase. Among the studies carried out during the acute phase, instrumental functions were rarely examined compared to attention, memory, and executive functions. This study aimed to compare the nature and intensity of cognitive problems in the acute phase according to TBI severity and age. It was hypothesized that cognitive impairments would increase in line with TBI severity and age, and that instrumental functions would be less affected in victims of mild or moderate TBI than in those with severe TBI. The Brief Cognitive Exam in Traumatology (EXACT), a new and reliable test specifically designed and validated to briefly assess global cognitive functioning during the acute phase, was administered to 319 mild to severe TBI victims (aged 16 to 96 years), within three months post-accident. The EXACT evaluates five domains: Language, Instrumental functions (other than language), Attention and working memory, Episodic memory, and Executive functions and behavioral regulation. Results confirmed the negative influence of TBI severity and age on global cognitive functioning. Also, compared to victims with a mild or moderate TBI, a higher proportion of those with a severe TBI presented impaired instrumental functions (calculation, praxis, and gnosis). Thus, during the acute phase, the nature and severity of cognitive impairments vary according to TBI severity.
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Affiliation(s)
| | - Sarah-Jade Roy
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Véronique Paradis
- Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, Canada
| | - Marie-Julie Potvin
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
- Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, Canada
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DeGroot A, Huber DL, Leddy JJ, Raff H, McCrea MA, Johnson BD, Nelson LD. Use of the Buffalo Concussion Treadmill Test in community adult patients with mild traumatic brain injury. PM R 2024; 16:826-835. [PMID: 38411367 PMCID: PMC11323219 DOI: 10.1002/pmrj.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND The Buffalo Concussion Treadmill Test (BCTT) is used to establish exercise tolerance for rehabilitation and identify injury subtypes for youth athletes after mild traumatic brain injury (mTBI). Its utility in adult community members is unknown. OBJECTIVE Primary: To describe how adults with and without mTBI tolerate the BCTT. Secondary: To explore relationships between baseline factors, mTBI-related symptoms, and BCTT duration. DESIGN Prospective, observational, longitudinal. SETTING Academic medical center. PARTICIPANTS Thirty-seven adults treated in a level 1 trauma center emergency department with mTBI; 24 uninjured controls (UC). INTERVENTIONS N/A. MAIN MEASURES Participants completed two visits 3 weeks apart (1 week and 1 month after mTBI) including a 15-minute BCTT, the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and preinjury International Physical Activity Questionnaire. Analyses characterized BCTT response and associations between baseline factors, RPQ scores, and BCTT duration. RESULTS Persons with mTBI discontinued earlier than UC at 1-week postinjury using standard discontinuation criteria for exercise intolerance. The percentage of mTBI participants with signs of possible mTBI-related intolerance was 55.6% at 1 week (36.1% for mTBI-related symptom exacerbation, 19.4% for exertion/fatigue before reaching 85% of one's age-predicted maximum heart rate [HR]) and 48.0% at 1 month (40.0% mTBI-related symptom exacerbation, 8.0% exertion without reaching the target HR). Thirty percent of UCs completed the BCTT at both assessments. UCs met discontinuation criteria for increased nonspecific symptoms (eg, pain/general discomfort and increased Visual Analog Scale ratings; 39-61%) and physical exertion (9-26%). Shorter duration was associated with higher body mass index (r = -0.42 - -0.45), shorter height (r = 0.22-0.29), female gender (r = -0.26 - -0.27), and greater RPQ symptoms (r = -0.28 - -0.47). CONCLUSION The BCTT exacerbates mTBI-related symptoms in adult community members. Participant characteristics and noninjury factors influence performance. The findings imply the BCTT could be useful in clinical assessments of adults with mTBI. Interpretation should account for the unique characteristics of nonathletes.
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Affiliation(s)
- Andrew DeGroot
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Hershel Raff
- Department of Medicine, Surgery, and Physiology, Medical College of Wisconsin, Milwaukee WI and the Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Advocate Aurora Research Institute, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Blair D Johnson
- Department of Kinesiology, Indiana University, Bloomington, Indiana, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Xu H, Xu C, Guo Y, Hu Y, Fang Q, Yang D, Niu X, Bai G. Abnormal longitudinal changes of structural covariance networks of cortical thickness in mild traumatic brain injury with posttraumatic headache. Prog Neuropsychopharmacol Biol Psychiatry 2024; 133:111012. [PMID: 38641235 DOI: 10.1016/j.pnpbp.2024.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND It is widely acknowledged that mild traumatic brain injury (MTBI) leads to either functionally or anatomically abnormal brain regions. Structural covariance networks (SCNs) that depict coordinated regional maturation patterns are commonly employed for investigating brain structural abnormalities. However, the dynamic nature of SCNs in individuals with MTBI who suffer from posttraumatic headache (PTH) and their potential as biomarkers have hitherto not been investigated. METHODS This study included 36 MTBI patients with PTH and 34 well-matched healthy controls (HCs). All participants underwent magnetic resonance imaging scans and were assessed with clinical measures during the acute and subacute phases. Structural covariance matrices of cortical thickness were generated for each group, and global as well as nodal network measures of SCNs were computed. RESULTS MTBI patients with PTH demonstrated reduced headache impact and improved cognitive function from the acute to subacute phase. In terms of global network metrics, MTBI patients exhibited an abnormal normalized clustering coefficient compared to HCs during the acute phase, although no significant difference in the normalized clustering coefficient was observed between the groups during the subacute phase. Regarding nodal network metrics, MTBI patients displayed alterations in various brain regions from the acute to subacute phase, primarily concentrated in the prefrontal cortex (PFC). CONCLUSIONS These findings indicate that the cortical thickness topography in the PFC determines the typical structural-covariance topology of the brain and may serve as an important biomarker for MTBI patients with PTH.
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Affiliation(s)
- Hui Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou 325035, China; The Affiliated Kangning Hospital of Wenzhou Medical University, Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou 325007, China.
| | - Cheng Xu
- School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China
| | - Yunyu Guo
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Yike Hu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Qiaofang Fang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Dandan Yang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xuan Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China; Wenzhou Key Laboratory of Structural and Functional Imaging, Wenzhou 325027, Zhejiang, China.
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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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Lovette BC, Kanaya MR, Grunberg VA, McKinnon E, Vranceanu AM, Greenberg J. "Alone in the dark": A qualitative study of treatment experiences among young adults with a recent concussion and anxiety. Neuropsychol Rehabil 2024; 34:781-801. [PMID: 37497984 PMCID: PMC10818011 DOI: 10.1080/09602011.2023.2238950] [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: 02/07/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Young adults with anxiety are vulnerable to developing persistent symptoms following concussions. In order to develop psychosocial interventions to prevent persistent post-concussion symptoms, we need to understand patients' 1) experiences with treatments offered by health care providers; 2) experiences with attempted concussion management strategies; and 3) needs after their injury. METHODS We conducted in-depth interviews with 17 young adults with recent (≤ 10 weeks) concussions who have at least mild anxiety (Generalized Anxiety Disorder Assessment-7 ≥ 5). We used a hybrid deductive-inductive approach to thematic analysis. RESULTS Findings provide insight into recommended treatments (e.g., active/avoidant strategies, accommodations, referrals), attempted strategies (e.g., lifestyle changes, pacing, relationships, acceptance-based coping skills), and patient needs (e.g., education, accommodations, referrals for cognitive and emotional skills). Participants frequently expressed that treatment recommendations were confusing and difficult to implement. They initiated non-prescribed strategies that helped promote recovery and expressed a desire for more interdisciplinary treatment and education on concussions. CONCLUSION Patients' perceptions of health care provider recommendations after concussions did not fully meet patients' perceived needs. Young adults with concussions and anxiety would benefit from more education, guidance, and psychosocial and rehabilitation services. Addressing these gaps may help align treatments with patients' needs and therefore help optimize their recovery.
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Affiliation(s)
- Brenda C. Lovette
- MGH Institute of Health Professions, Boston, MA, USA
- Center for Health Outcomes and Interdisciplinary Research
(CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA,
USA
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital,
Concord, MA, USA
| | - Millan R. Kanaya
- Center for Health Outcomes and Interdisciplinary Research
(CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA,
USA
| | - Victoria A Grunberg
- Center for Health Outcomes and Interdisciplinary Research
(CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA,
USA
- Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, MassGeneral Hospital for
Children, Boston, MA, USA
| | - Ellen McKinnon
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital,
Concord, MA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research
(CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA,
USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research
(CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA,
USA
- Harvard Medical School, Boston, MA, USA
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Thuss NS, Rakers SE, Bittencourt M, Balart-Sánchez SA, Spikman JM, van der Naalt J. The Cognitive Profile of Elderly Patients With Mild Traumatic Brain Injury: A Role for Cognitive Reserve? J Head Trauma Rehabil 2024; 39:E182-E189. [PMID: 37870444 DOI: 10.1097/htr.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To assess cognitive status in elderly patients with mild traumatic brain injury (mTBI) in the subacute phase, examine the role of cognitive reserve, and investigate associations with cognitive complaints, mental distress, and functional outcomes. SETTING A level 1 trauma center in the Netherlands. PARTICIPANTS A total of 52 individuals with mTBI and 42 healthy controls. DESIGN A prospective observational cohort study. MAIN MEASURES Neuropsychological assessment in the subacute phase (2 weeks to 6 months post-injury) to objectively measure the cognitive functioning, the Head Injury Symptom Checklist for subjective cognitive complaints, the Hospital Anxiety and Depression Scale for anxiety and depression, the Cognitive Reserve Index questionnaire for cognitive reserve, the Community Integration Questionnaire for community integration, and the Glasgow Outcome Scale Extended for functional outcome. RESULTS Cognitive impairments were observed in memory ( P < .001) and attention, processing speed and executive control ( P < .001). Cognitive reserve was not associated with neuropsychological test performance, except for one test measuring working memory. The relationship between injury severity and cognitive outcome was not moderated by cognitive reserve. Elderly patients reported significantly more complains than healthy controls regarding forgetfulness, concentration problems, and slowness. Complaints of concentration were associated with cognitive impairment. All cognitive complaints were significantly correlated with mental distress. CONCLUSIONS Cognitive impairments may be present in elderly patients in the subacute phase after mTBI, and these impairments were not significantly associated with cognitive reserve. This suggests that cognitive reserve might not serve as a protective factor against the effects of mTBI in the elderly. Concentration complaints may serve as a specific indicator for cognitive impairment, while complaints of memory and mental slowness may represent more generic indicators of mental distress. These findings highlight the importance of careful screening in older adults with mTBI, guiding clinicians toward specific treatment targets encompassing cognitive impairment, diminished mental well-being, or both.
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Affiliation(s)
- Nikki S Thuss
- Department of Neurology, Subdepartment of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Ms Thuss and Drs Rakers and Spikman); and Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Ms Thuss, Drs Rakers, Bittencourt, Spikman, and van der Naalt, and Mr Balart-Sánchez)
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Potvin MJ, Tétreault G, Audy J, Roy SJ, Rouleau I. Factors Influencing Objective and Subjective Prospective Memory Measures in Traumatic Brain Injury. Arch Clin Neuropsychol 2024:acae048. [PMID: 38915139 DOI: 10.1093/arclin/acae048] [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: 07/06/2023] [Revised: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE To accurately assess prospective memory (PM) functioning in patients who sustained a traumatic brain injury (TBI), it is important to use both subjective (questionnaires) and objective (tests) measures. However, which factors have the most significant effect on each PM measure remains unknown. This observational study aims to verify whether TBI severity or psychological status has the most influence on patients' objective and subjective PM measures. METHOD Fifteen healthy control (HC) participants (n = 15), 19 patients with a mild TBI (n = 19) and 30 patients with a moderate-to-severe TBI (n = 30) were recruited during the post-acute phase. For almost every participant, a relative was also recruited (n = 62). The Test écologique de mémoire prospective (TEMP), an objective computerized PM measure consisting of naturalistic stimuli, was administered to all participants along with anxiety (BAI) and depression inventories (BDI). Participants and their relatives also completed a questionnaire, the comprehensive assessment of PM (CAPM), a subjective PM measure assessing everyday failures. RESULTS Results on the objective PM measure were predicted by TBI severity, while psychological symptoms (BAI and BDI) predicted scores on the subjective PM measure. In addition, relatives in the moderate-to-severe TBI group reported more PM failures on the subjective measure and their perception was significantly correlated with results on the objective PM measure, which was not the case for the other two groups of relatives. CONCLUSIONS Objective PM measures are related to TBI severity and appear more robust against the influence of psychological factors than subjective PM measures.
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Affiliation(s)
- Marie-Julie Potvin
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
- Traumatology Program, Montreal Sacré-Coeur Hospital, CIUSSS Nord-de-l'île-de-Montréal, 5400 Boulevard Gouin West, Montreal, Quebec, H4J 1C5, Canada
| | - Gabrielle Tétreault
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
| | - Julie Audy
- Regional Geriatric Ambulatory Program, CISSS de Laval, 1515 Chomedey Boulevard, Laval, Quebec, H7V 3Y7, Canada
| | - Sarah-Jade Roy
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
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Joannides AJ, Korhonen TK, Clark D, Gnanakumar S, Venturini S, Mohan M, Bashford T, Baticulon R, Bhagavatula ID, Esene I, Fernández-Méndez R, Figaji A, Gupta D, Khan T, Laeke T, Martin M, Menon D, Paiva W, Park KB, Pattisapu JV, Rubiano AM, Sekhar V, Shabani HK, Sichizya K, Solla D, Tirsit A, Tripathi M, Turner C, Depreitere B, Iaccarino C, Lippa L, Reisner A, Rosseau G, Servadei F, Trivedi RA, Waran V, Kolias A, Hutchinson P. Consensus-Based Development of a Global Registry for Traumatic Brain Injury: Establishment, Protocol, and Implementation. Neurosurgery 2024; 94:278-288. [PMID: 37747225 DOI: 10.1227/neu.0000000000002661] [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: 02/20/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Global disparity exists in the demographics, pathology, management, and outcomes of surgically treated traumatic brain injury (TBI). However, the factors underlying these differences, including intervention effectiveness, remain unclear. Establishing a more accurate global picture of the burden of TBI represents a challenging task requiring systematic and ongoing data collection of patients with TBI across all management modalities. The objective of this study was to establish a global registry that would enable local service benchmarking against a global standard, identification of unmet need in TBI management, and its evidence-based prioritization in policymaking. METHODS The registry was developed in an iterative consensus-based manner by a panel of neurotrauma professionals. Proposed registry objectives, structure, and data points were established in 2 international multidisciplinary neurotrauma meetings, after which a survey consisting of the same data points was circulated within the global neurotrauma community. The survey results were disseminated in a final meeting to reach a consensus on the most pertinent registry variables. RESULTS A total of 156 professionals from 53 countries, including both high-income countries and low- and middle-income countries, responded to the survey. The final consensus-based registry includes patients with TBI who required neurosurgical admission, a neurosurgical procedure, or a critical care admission. The data set comprised clinically pertinent information on demographics, injury characteristics, imaging, treatments, and short-term outcomes. Based on the consensus, the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry was established. CONCLUSION The GEO-TBI registry will enable high-quality data collection, clinical auditing, and research activity, and it is supported by the World Federation of Neurosurgical Societies and the National Institute of Health Research Global Health Program. The GEO-TBI registry ( https://geotbi.org ) is now open for participant site recruitment. Any center involved in TBI management is welcome to join the collaboration to access the registry.
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Affiliation(s)
- Alexis J Joannides
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Tommi K Korhonen
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Neurocenter, Neurosurgery, Oulu University Hospital & University of Oulu, Oulu , Finland
| | - David Clark
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sujit Gnanakumar
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sara Venturini
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Midhun Mohan
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Thomas Bashford
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
- Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge , UK
| | - Ronnie Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital & University of the Philippines Manila, Manila , Philippines
| | - Indira Devi Bhagavatula
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru , Karnataka , India
| | - Ignatius Esene
- Division of Neurosurgery, Faculty of Health Sciences, The University of Bamenda, Bambili , Cameroon
| | - Rocío Fernández-Méndez
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Anthony Figaji
- Division of Neurosurgery, Neurosciences Institute, University of Cape Town, Cape Town , South Africa
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi , India
| | - Tariq Khan
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar , Pakistan
| | - Tsegazeab Laeke
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Michael Martin
- Orion MedTech Ltd. CIC, Cambridge , Cambridgeshire , UK
- Obex Technologies Ltd., Cambridge , Cambridgeshire , UK
| | - David Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
| | - Wellingson Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Kee B Park
- Department of Global Health and Social Medicine, Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Harvard Medical School, Boston , Massachusetts , USA
| | - Jogi V Pattisapu
- University of Central Florida College of Medicine, Orlando , Florida , USA
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
| | - Andres M Rubiano
- Neurosciences Institute, El Bosque University, Bogotá , Colombia
| | - Vijaya Sekhar
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
- Current Affiliation: Department of Neurosurgery, Government General Hospital & Rangaraya Medical College, Kakinada , Andhra Pradesh , India
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam , Tanzania
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka , Zambia
| | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Abenezer Tirsit
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Carole Turner
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | | | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, School of Neurosurgery, University of Modena and Reggio Emilia, Modena , Italy
- Division of Neurosurgery, University Hospital of Modena, Modena , Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia , Italy
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milan , Italy
| | - Andrew Reisner
- Departments of Neurosurgery and Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta , Georgia , USA
| | - Gail Rosseau
- Barrow Global, Barrow Neurological Institute, Phoenix , Arizona , USA
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan , Italy
| | - Rikin A Trivedi
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur , Malaysia
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Peter Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
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Pinkowski NJ, Fish B, Mehos CJ, Carlson VL, Hess BR, Mayer AR, Morton RA. Spreading Depolarizations Contribute to the Acute Behavior Deficits Associated With a Mild Traumatic Brain Injury in Mice. J Neurotrauma 2024; 41:271-291. [PMID: 37742105 PMCID: PMC11071091 DOI: 10.1089/neu.2023.0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Abstract
Concussions or mild traumatic brain injuries (mTBIs) are often described and diagnosed by the acute signs and symptoms of neurological dysfunction including weakness, dizziness, disorientation, headaches, and altered mental state. The cellular and physiological mechanisms of neurological dysfunction and acute symptoms are unclear. Spreading depolarizations (SDs) occur after severe TBIs and have recently been identified in closed-skull mouse models of mTBIs. SDs are massive waves of complete depolarization that result in suppression of cortical activity for multiple minutes. Despite the clear disruption of brain physiology after SDs, the role of SDs in the acute neurological dysfunction and acute behavioral deficits following mTBIs remains unclear. We used a closed-skull mouse model of mTBI and a series of behavioral tasks collectively scored as the neurological severity score (NSS) to assess acute behavior. Our results indicate that mTBIs are associated with significant behavioral deficits in the open field and NSS tasks relative to sham-condition animals. The behavioral deficits associated with the mTBI recovered within 3 h. We show here that the presence of mTBI-induced bilateral SDs were significantly associated with the acute behavioral deficits. To identify the role of SDs in the acute behavioral deficits, we used exogenous potassium and optogenetic approaches to induce SDs in the absence of the mTBI. Bilateral SDs alone were associated with similar behavioral deficits in the open field and NSS tasks. Collectively, these studies demonstrate that bilateral SDs are linked to the acute behavioral deficits associated with mTBIs.
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Affiliation(s)
- Natalie J Pinkowski
- Department of Neurosciences, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Center for Brain Recovery and Repair, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Betty Fish
- Department of Neurosciences, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Center for Brain Recovery and Repair, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Carissa J Mehos
- Department of Neurosciences, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Center for Brain Recovery and Repair, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Victoria L Carlson
- Department of Neurosciences, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
| | - Brandi R Hess
- Department of Neurosciences, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Center for Brain Recovery and Repair, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Andrew R Mayer
- Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
| | - Russell A Morton
- Department of Neurosciences, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Center for Brain Recovery and Repair, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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13
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Machado CA, Oliveira BDS, Dias TL, Barros JLVMD, Ferreira GMF, Cordeiro TM, Feracin V, Alexandre CH, Abreu LKS, Silva WND, Carvalho BC, Fernandes HDB, Vieira ÉLM, Castro PR, Ferreira RN, Kangussu LM, Franco GR, Guatimosim C, Barcelos LDS, Simões E Silva AC, Toscano ECDB, Rachid MA, Teixeira AL, Miranda ASD. Weight-drop model as a valuable tool to study potential neurobiological processes underlying behavioral and cognitive changes secondary to mild traumatic brain injury. J Neuroimmunol 2023; 385:578242. [PMID: 37951202 DOI: 10.1016/j.jneuroim.2023.578242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/27/2023] [Accepted: 11/05/2023] [Indexed: 11/13/2023]
Abstract
The pathophysiology of post-traumatic brain injury (TBI) behavioral and cognitive changes is not fully understood, especially in its mild presentation. We designed a weight drop TBI model in mice to investigate the role of neuroinflammation in behavioral and cognitive sequelae following mild TBI. C57BL/6 mice displayed depressive-like behavior at 72 h after mild TBI compared with controls, as indicated by a decrease in the latency to first immobility and climbing time in the forced swim test. Additionally, anxiety-like behavior and hippocampal-associated spatial learning and memory impairment were found in the elevated plus maze and in the Barnes maze, respectively. Levels of a set of inflammatory mediators and neurotrophic factors were analyzed at 6 h, 24 h, 72 h, and 30 days after injury in ipsilateral and contralateral hemispheres of the prefrontal cortex and hippocampus. Principal components analysis revealed two principal components (PC), which represented 59.1% of data variability. PC1 (cytokines and chemokines) expression varied between both hemispheres, while PC2 (neurotrophic factors) expression varied only across the investigated brain areas. Our model reproduces mild TBI-associated clinical signs and pathological features and might be a valuable tool to broaden the knowledge regarding mild TBI pathophysiology as well as to test potential therapeutic targets.
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Affiliation(s)
- Caroline Amaral Machado
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bruna da Silva Oliveira
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Thomaz Lüscher Dias
- Department of Biochemistry and Immunology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Thiago Macedo Cordeiro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Victor Feracin
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cristian Henrique Alexandre
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Larissa Katharina Sabino Abreu
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Walison Nunes da Silva
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Brener Cunha Carvalho
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Heliana de Barros Fernandes
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Érica Leandro Marciano Vieira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Pollyana Ribeiro Castro
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo Novaes Ferreira
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucas Miranda Kangussu
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gloria Regina Franco
- Department of Biochemistry and Immunology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cristina Guatimosim
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucíola da Silva Barcelos
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Milene Alvarenga Rachid
- Department of Pathology, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Antônio Lúcio Teixeira
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX.
| | - Aline Silva de Miranda
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
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14
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Rivera-Lara L, Videtta W, Calvillo E, Mejia-Mantilla J, March K, Ortega-Gutierrez S, Obrego GC, Paranhos JE, Suarez JI. Reducing the incidence and mortality of traumatic brain injury in Latin America. Eur J Trauma Emerg Surg 2023; 49:2381-2388. [PMID: 36637481 DOI: 10.1007/s00068-022-02214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/26/2022] [Indexed: 01/14/2023]
Abstract
Traumatic brain injury (TBI) represents a considerable portion of the global injury burden. The incidence of TBI will continue to increase in view of an increase in population density, an aging population, and the increased use of motor vehicles, motorcycles, and bicycles. The most common causes of TBI are falls and road traffic injuries. Deaths related to road traffic injury are three times higher in low-and middle-income countries (LMIC) than in high-income countries (HIC). The Latin American Caribbean region has the highest incidence of TBI worldwide, primarily caused by road traffic injuries. Data from HIC indicates that road traffic injuries can be successfully prevented through concerted efforts at the national level, with coordinated and multisector responses to the problem. Such actions require implementation of proven measures to address the safety of road users and the vehicles themselves, road infrastructure, and post-crash care. In this review, we focus on the epidemiology of TBI in Latin America and the implementation of solutions and preventive measures to decrease mortality and long-term disability.
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Affiliation(s)
- Lucia Rivera-Lara
- Department of Neurology, School of Medicine, Center for Academic Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Walter Videtta
- Department of National Hospital, Alejandro Posadas, Buenos Aires, Argentina
| | - Eusebia Calvillo
- Departments of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | | | - Karen March
- Clinical Development at Integra Life Sciences, Seattle, WA, USA
| | | | | | - Jorge E Paranhos
- Santa Casa da Misericordia de São João del Rey, Minas Gerais, Brazil
| | - Jose I Suarez
- Departments of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
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Soltani A, Chugaeva UY, Ramadan MF, Saleh EAM, Al-Hasnawi SS, Romero-Parra RM, Alsaalamy A, Mustafa YF, Zamanian MY, Golmohammadi M. A narrative review of the effects of dexamethasone on traumatic brain injury in clinical and animal studies: focusing on inflammation. Inflammopharmacology 2023; 31:2955-2971. [PMID: 37843641 DOI: 10.1007/s10787-023-01361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
Traumatic brain injury (TBI) is a type of brain injury resulting from a sudden physical force to the head. TBI can range from mild, such as a concussion, to severe, which might result in long-term complications or even death. The initial impact or primary injury to the brain is followed by neuroinflammation, excitotoxicity, and oxidative stress, which are the hallmarks of the secondary injury phase, that can further damage the brain tissue. Dexamethasone (DXM) has neuroprotective effects. It reduces neuroinflammation, a critical factor in secondary injury-associated neuronal damage. DXM can also suppress the microglia activation and infiltrated macrophages, which are responsible for producing pro-inflammatory cytokines that contribute to neuroinflammation. Considering the outcomes of this research, some of the effects of DXM on TBI include: (1) DXM-loaded hydrogels reduce apoptosis, neuroinflammation, and lesion volume and improves neuronal cell survival and motor performance, (2) DXM treatment elevates the levels of Ndufs2, Gria3, MAOB, and Ndufv2 in the hippocampus following TBI, (3) DXM decreases the quantity of circulating endothelial progenitor cells, (4) DXM reduces the expression of IL1, (5) DXM suppresses the infiltration of RhoA + cells into primary lesions of TBI and (6) DXM treatment led to an increase in fractional anisotropy values and a decrease in apparent diffusion coefficient values, indicating improved white matter integrity. According to the study, the findings show that DXM treatment has neuroprotective effects in TBI. This indicates that DXM is a promising therapeutic approach to treating TBI.
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Affiliation(s)
- Afsaneh Soltani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Uliana Y Chugaeva
- Department of Pediatric, Preventive Dentistry and Orthodontics, Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Ebraheem Abdu Musad Saleh
- Department of Chemistry, Prince Sattam Bin Abdulaziz University, College of Arts and Science, 11991, Wadi Al-Dawasir, Saudi Arabia
| | | | | | - Ali Alsaalamy
- College of Technical Engineering, Imam Ja'afar Al-Sadiq University, Al-Muthanna, 66002, Iraq
| | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul, 41001, Iraq
| | - Mohammad Yasin Zamanian
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, 6718773654, Iran.
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, 6718773654, Iran.
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, 6718773654, Iran.
| | - Maryam Golmohammadi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bryant AM, Rose NB, Temkin NR, Barber JK, Manley GT, McCrea MA, Nelson LD. Profiles of Cognitive Functioning at 6 Months After Traumatic Brain Injury Among Patients in Level I Trauma Centers: A TRACK-TBI Study. JAMA Netw Open 2023; 6:e2349118. [PMID: 38147333 PMCID: PMC10751593 DOI: 10.1001/jamanetworkopen.2023.49118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Importance Cognitive dysfunction is common after traumatic brain injury (TBI), with a well-established dose-response relationship between TBI severity and likelihood or magnitude of persistent cognitive impairment. However, patterns of cognitive dysfunction in the long-term (eg, 6-month) recovery period are less well known. Objective To characterize the prevalence of cognitive dysfunction within and across cognitive domains (processing speed, memory, and executive functioning) 6 months after injury in patients with TBI seen at level I trauma centers. Design, Setting, and Participants This prospective longitudinal cohort study used data from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) and included patients aged 17 years or older presenting at 18 US level I trauma center emergency departments or inpatient units within 24 hours of head injury, control individuals with orthopedic injury recruited from the same centers, and uninjured friend and family controls. Participants were enrolled between March 2, 2014, and July 27, 2018. Data were analyzed from March 5, 2020, through October 3, 2023. Exposures Traumatic brain injury (Glasgow Coma Scale score of 3-15) or orthopedic injury. Main Outcomes and Measures Performance on standard neuropsychological tests, including premorbid cognitive ability (National Institutes of Health Toolbox Picture Vocabulary Test), verbal memory (Rey Auditory Verbal Learning Test), processing speed (Wechsler Adult Intelligence Scale [4th edition] Processing Speed Index), and executive functioning (Trail Making Test). Results The sample included 1057 persons with TBI (mean [SD] age, 39.3 [16.4] years; 705 [67%] male) and 327 controls without TBI (mean [SD] age, 38.4 [15.1] years; 222 [68%] male). Most persons with TBI demonstrated performance within 1.5 SDs or better of the control group (49.3% [95% CI, 39.5%-59.2%] to 67.5% [95% CI, 63.7%-71.2%] showed no evidence of impairment). Similarly, 64.4% (95% CI, 54.5%-73.4%) to 78.8% (95% CI, 75.4%-81.9%) of participants demonstrated no evidence of cognitive decline (defined as performance within 1.5 SDs of estimated premorbid ability). For individuals with evidence of either cognitive impairment or decline, diverse profiles of impairment across memory, speed, and executive functioning domains were observed (ie, the prevalence was >0 in each of the 7 combinations of impairment across these 3 cognitive domains for most TBI subgroups). Conclusions and Relevance In this cohort study of patients seen at level I trauma centers 6 months after TBI, many patients with TBI demonstrated no cognitive impairment. Impairment was more prevalent in persons with more severe TBI and manifested in variable ways across individuals. The findings may guide future research and treatment recommendations.
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Affiliation(s)
- Andrew M. Bryant
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, The Ohio State University, Columbus
| | - Nathan B. Rose
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Jason K. Barber
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
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17
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Picon EL, Wardell V, Palombo DJ, Todd RM, Aziz B, Bedi S, Silverberg ND. Factors perpetuating functional cognitive symptoms after mild traumatic brain injury. J Clin Exp Neuropsychol 2023; 45:988-1002. [PMID: 37602857 DOI: 10.1080/13803395.2023.2247601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI. METHODS A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group. RESULTS Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group. CONCLUSIONS This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca M Todd
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bilal Aziz
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sanjana Bedi
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
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18
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Itälinna V, Kaltiainen H, Forss N, Liljeström M, Parkkonen L. Using normative modeling and machine learning for detecting mild traumatic brain injury from magnetoencephalography data. PLoS Comput Biol 2023; 19:e1011613. [PMID: 37943963 PMCID: PMC10662745 DOI: 10.1371/journal.pcbi.1011613] [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: 03/23/2023] [Revised: 11/21/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
New biomarkers are urgently needed for many brain disorders; for example, the diagnosis of mild traumatic brain injury (mTBI) is challenging as the clinical symptoms are diverse and nonspecific. EEG and MEG studies have demonstrated several population-level indicators of mTBI that could serve as objective markers of brain injury. However, deriving clinically useful biomarkers for mTBI and other brain disorders from EEG/MEG signals is hampered by the large inter-individual variability even across healthy people. Here, we used a multivariate machine-learning approach to detect mTBI from resting-state MEG measurements. To address the heterogeneity of the condition, we employed a normative modeling approach and modeled MEG signal features of individual mTBI patients as deviations with respect to the normal variation. To this end, a normative dataset comprising 621 healthy participants was used to determine the variation in power spectra across the cortex. In addition, we constructed normative datasets based on age-matched subsets of the full normative data. To discriminate patients from healthy control subjects, we trained support-vector-machine classifiers on the quantitative deviation maps for 25 mTBI patients and 20 controls not included in the normative dataset. The best performing classifier made use of the full normative data across the entire age and frequency ranges. This classifier was able to distinguish patients from controls with an accuracy of 79%. Inspection of the trained model revealed that low-frequency activity in the theta frequency band (4-8 Hz) is a significant indicator of mTBI, consistent with earlier studies. The results demonstrate the feasibility of using normative modeling of MEG data combined with machine learning to advance diagnosis of mTBI and identify patients that would benefit from treatment and rehabilitation. The current approach could be applied to a wide range of brain disorders, thus providing a basis for deriving MEG/EEG-based biomarkers.
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Affiliation(s)
- Veera Itälinna
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
| | - Hanna Kaltiainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Nina Forss
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Mia Liljeström
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Lauri Parkkonen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- Aalto NeuroImaging, Aalto University School of Science, Aalto, Finland
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Hacker D, Jones CA, Yasin E, Preece S, Davies H, Hawkins A, Belli A, Paton E. Cognitive Outcome After Complicated Mild Traumatic Brain Injury: A Literature Review and Meta-Analysis. J Neurotrauma 2023; 40:1995-2014. [PMID: 36964755 DOI: 10.1089/neu.2023.0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
Cognitive outcome for mild traumatic brain injury (mTBI) with positive brain imaging (complicated mTBI) was compared with that for mTBI with normal imaging (uncomplicated mTBI) and with moderate to severe TBI, using meta-analysis. Twenty-three studies utilizing objective neurocognitive tests were included in the analysis. At less than 3 months post-injury, complicated mTBI was associated with poorer cognitive outcomes than uncomplicated mTBI, but deficits were not comparable to those with moderate-severe TBI. After 3 months post-injury, a similar pattern was detected. Beyond 3 months, deficits in complicated mTBI relative to those with uncomplicated mTBI were present in processing speed, memory, executive function, and language, although the latter may be the result of reduced semantic fluency. The effect size of deficits in these domains was more marked in moderate-severe TBI. The available data support the use of complicated mTBI as a distinct classification in the prediction of cognitive outcome. The extent of cognitive deficit in complicated mTBI was small and unlikely to cause significant disability. However, patients with complicated mTBI constitute a broad category encompassing individuals who may differ markedly in the nature and extent of intracranial imaging abnormality, and further studies are warranted. Limitations of the available studies include small, selected samples; variations in TBI severity classification; absence of validity ("effort") testing; differing imaging methodology; and lack of long-term follow-up.
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Affiliation(s)
- David Hacker
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher A Jones
- School of Psychology, The University of Birmingham, Birmingham, United Kingdom
| | - Eyrsa Yasin
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sophie Preece
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Holly Davies
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Hawkins
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antonio Belli
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Emily Paton
- Clinical Neuropsychology Department, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Laskowitz DT, Van Wyck DW. ApoE Mimetic Peptides as Therapy for Traumatic Brain Injury. Neurotherapeutics 2023; 20:1496-1507. [PMID: 37592168 PMCID: PMC10684461 DOI: 10.1007/s13311-023-01413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
The lack of targeted therapies for traumatic brain injury (TBI) remains a compelling clinical unmet need. Although knowledge of the pathophysiologic cascades involved in TBI has expanded rapidly, the development of novel pharmacological therapies has remained largely stagnant. Difficulties in creating animal models that recapitulate the different facets of clinical TBI pathology and flaws in the design of clinical trials have contributed to the ongoing failures in neuroprotective drug development. Furthermore, multiple pathophysiological mechanisms initiated early after TBI that progress in the subacute and chronic setting may limit the potential of traditional approaches that target a specific cellular pathway for acute therapeutic intervention. We describe a reverse translational approach that focuses on translating endogenous mechanisms known to influence outcomes after TBI to develop druggable targets. In particular, numerous clinical observations have demonstrated an association between apolipoprotein E (apoE) polymorphism and functional recovery after brain injury. ApoE has been shown to mitigate the response to acute brain injury by exerting immunomodulatory properties that reduce secondary tissue injury as well as protecting neurons from excitotoxicity. CN-105 represents an apoE mimetic peptide that can effectively penetrate the CNS compartment and retains the neuroprotective properties of the intact protein.
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Affiliation(s)
- Daniel T Laskowitz
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, 27710, USA
- AegisCN LLC, 701 W Main Street, Durham, NC, 27701, USA
| | - David W Van Wyck
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA.
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21
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Hetzer SM, Casagrande A, Qu’d D, Dobrozsi N, Bohnert J, Biguma V, Evanson NK, McGuire JL. Early Measures of TBI Severity Poorly Predict Later Individual Impairment in a Rat Fluid Percussion Model. Brain Sci 2023; 13:1230. [PMID: 37759831 PMCID: PMC10526292 DOI: 10.3390/brainsci13091230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Multiple measures of injury severity are suggested as common data elements in preclinical traumatic brain injury (TBI) research. The robustness of these measures in characterizing injury severity is unclear. In particular, it is not known how reliably they predict individual outcomes after experimental TBI. METHODS We assessed several commonly used measures of initial injury severity for their ability to predict chronic cognitive outcomes in a rat lateral fluid percussion (LFPI) model of TBI. At the time of injury, we assessed reflex righting time, neurologic severity scores, and 24 h weight loss. Sixty days after LFPI, we evaluated working memory using a spontaneous alternation T-maze task. RESULTS We found that righting time and weight loss had no correlation to chronic T-maze performance, while neurologic severity score correlated weakly. DISCUSSION Taken together, our results indicate that commonly used early measures of injury severity do not robustly predict longer-term outcomes. This finding parallels the uncertainty in predicting individual outcomes in TBI clinical populations.
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Affiliation(s)
- Shelby M. Hetzer
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Andrew Casagrande
- College of Arts and Sciences Interdisciplinary Program—Neuroscience, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Dima Qu’d
- Applied Pharmacology & Drug Toxicology Program, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Nicholas Dobrozsi
- College of Arts and Sciences Interdisciplinary Program—Neuroscience, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Judy Bohnert
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (J.B.); (J.L.M.)
| | - Victor Biguma
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Nathan K. Evanson
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Jennifer L. McGuire
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (J.B.); (J.L.M.)
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Déry J, de Guise É, Lamontagne ME. Identifying prioritization criteria for patients with mtbi waiting for multidisciplinary rehabilitation services: A Delphi study. Brain Inj 2023; 37:563-571. [PMID: 37114975 DOI: 10.1080/02699052.2023.2205662] [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: 04/29/2023]
Abstract
INTRODUCTION Rehabilitation service providers must take into account prognostic factors when making clinical decisions, which includes using these factors as prioritization criteria. The goal of this study was to establish consensus on patient prioritization criteria based on prognostic factors related to persistent symptoms for patients with mild traumatic brain injury (mTBI) waiting for outpatient specialized rehabilitation services. MATERIALS AND METHODS We conducted a Delphi survey involving clinicians, researchers, decision makers, and patients. Before the survey, we presented the results of an overview of systematic reviews summarizing the evidence on prognostic factors related to post-concussion symptoms. RESULTS After two rounds, the 17 experts reached consensus on the inclusion of 12 prioritization criteria: acute stress disorder, anxiety and depression, baseline mental and physical health, functional impacts and difficulties in performing daily habits after the trauma, motivation to receive services, multiple concussions, prior neurological problems, PTSD, quality of sleep, return to work failures, somatic complaints, suicidal ideation. CONCLUSION Healthcare stakeholders must consider a wide range of factors to guide clinical decision-making, including about access to care and patient prioritization. This study shows that the Delphi technique can be used to reach consensus on such decisions regarding patients with mTBI who are waiting for outpatient specialized rehabilitation services.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale,Québec, Canada
| | - Élaine de Guise
- Department of Psychology, Université de Montréal, Montréal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale,Québec, Canada
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23
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S. The influence of psychological flexibility on persistent post concussion symptoms and functional status after mild traumatic brain injury. Disabil Rehabil 2023; 45:1192-1201. [PMID: 35382660 DOI: 10.1080/09638288.2022.2055167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes. METHOD Adults with mTBI (N = 147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N = 102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors. RESULTS The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury. CONCLUSION The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.Implications for RehabilitationPersistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI) can have a significant impact on wellbeing, functional status, and quality of life.In this study, psychological flexibility early in recovery, was associated with higher levels of psychological distress and more severe post-concussion symptoms six months later.Psychological flexibility at six months post-injury also mediated the relationship between psychological distress and functional disability.A context specific measure of psychological flexibility may predict poorer long-term outcomes following mTBI.
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Affiliation(s)
| | - Deborah L Snell
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
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24
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von Steinbuechel N, Hahm S, Muehlan H, Arango-Lasprilla JC, Bockhop F, Covic A, Schmidt S, Steyerberg EW, Maas AIR, Menon D, Andelic N, Zeldovich M. Impact of Sociodemographic, Premorbid, and Injury-Related Factors on Patient-Reported Outcome Trajectories after Traumatic Brain Injury (TBI). J Clin Med 2023; 12:jcm12062246. [PMID: 36983247 PMCID: PMC10052290 DOI: 10.3390/jcm12062246] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
Traumatic brain injury (TBI) remains one of the leading causes of death and disability worldwide. To better understand its impact on various outcome domains, this study pursues the following: (1) longitudinal outcome assessments at three, six, and twelve months post-injury; (2) an evaluation of sociodemographic, premorbid, and injury-related factors, and functional recovery contributing to worsening or improving outcomes after TBI. Using patient-reported outcome measures, recuperation trends after TBI were identified by applying Multivariate Latent Class Mixed Models (MLCMM). Instruments were grouped into TBI-specific and generic health-related quality of life (HRQoL; QOLIBRI-OS, SF-12v2), and psychological and post-concussion symptoms (GAD-7, PHQ-9, PCL-5, RPQ). Multinomial logistic regressions were carried out to identify contributing factors. For both outcome sets, the four-class solution provided the best match between goodness of fit indices and meaningful clinical interpretability. Both models revealed similar trajectory classes: stable good health status (HRQoL: n = 1944; symptoms: n = 1963), persistent health impairments (HRQoL: n = 442; symptoms: n = 179), improving health status (HRQoL: n = 83; symptoms: n = 243), and deteriorating health status (HRQoL: n = 86; symptoms: n = 170). Compared to individuals with stable good health status, the other groups were more likely to have a lower functional recovery status at three months after TBI (i.e., the GOSE), psychological problems, and a lower educational attainment. Outcome trajectories after TBI show clearly distinguishable patterns which are reproducible across different measures. Individuals characterized by persistent health impairments and deterioration require special attention and long-term clinical monitoring and therapy.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
- Correspondence:
| | - Stefanie Hahm
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Holger Muehlan
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Juan Carlos Arango-Lasprilla
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, 907 Floyd Ave., Richmond, VA 23284, USA
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
| | - Silke Schmidt
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Ewout W. Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 RC Leiden, The Netherlands
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, 2650 Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge/Addenbrooke’s Hospital, Box 157, Cambridge CB2 0QQ, UK
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models, Faculty of Medicine, Univeristy of Oslo, 0373 Oslo, Norway
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
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25
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Teng J, Mi C, Liu W, Shi J, Li N. mTBI-DSANet: A deep self-attention model for diagnosing mild traumatic brain injury using multi-level functional connectivity networks. Comput Biol Med 2023; 152:106354. [PMID: 36481760 DOI: 10.1016/j.compbiomed.2022.106354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 11/26/2022]
Abstract
The main approach for analyzing resting-state functional magnetic resonance imaging (rs-fMRI) is the low-order functional connectivity network (LoFCN) based on the correlation between two brain regions. Based on LoFCN, researchers recently proposed the topographical high-order FCN (tHoFCN) and the associated high-order FCN (aHoFCN) to explore the high-order interactions among brain regions. In this work, we designed a Deep Self-Attention (DSA) framework called mTBI-DSANet to diagnose mild traumatic brain injury (mTBI) using multi-level FCNs, including LoFCN, tHoFCN, and aHoFCN. The multilayer perceptron and self-attention mechanism in mTBI-DSANet were designed to capture important features for the mTBI diagnosis. We evaluated the mTBI-DSANet's performance on the real rs-fMRI dataset, which was collected by Third Xiangya Hospital of Central South University from April 2014 to February 2021. We compared the performance of mTBI-DSANet with distinct FCNs and their combinations under 10-fold cross-validation. Based on the LoFCN+aHoFCN combination, the average performance of mTBI-DSANet achieved the best accuracy of 0.834, which is significantly better than peer methods. The experiments demonstrated the potential of the mTBI-DSANet in assisting mTBI diagnosis.
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Affiliation(s)
- Jing Teng
- School of Control and Computer Engineering, North China Electric Power University, Beijing, China.
| | - Chunlin Mi
- School of Control and Computer Engineering, North China Electric Power University, Beijing, China.
| | - Wuyi Liu
- School of Control and Computer Engineering, North China Electric Power University, Beijing, China.
| | - Jian Shi
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Na Li
- Department of Radiology, The Third Xiangya Hospital of Central South University, Changsha, China.
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26
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Fiorini MR, Dilliott AA, Farhan SMK. Sex-stratified RNA-seq analysis reveals traumatic brain injury-induced transcriptional changes in the female hippocampus conducive to dementia. Front Neurol 2022; 13:1026448. [PMID: 36619915 PMCID: PMC9813497 DOI: 10.3389/fneur.2022.1026448] [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: 08/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Traumatic brain injury (TBI), resulting from a violent force that causes functional changes in the brain, is the foremost environmental risk factor for developing dementia. While previous studies have identified specific candidate genes that may instigate worse outcomes following TBI when mutated, TBI-induced changes in gene expression conducive to dementia are critically understudied. Additionally, biological sex seemingly influences TBI outcomes, but the discrepancies in post-TBI gene expression leading to progressive neurodegeneration between the sexes have yet to be investigated. Methods We conducted a whole-genome RNA sequencing analysis of post-mortem brain tissue from the parietal neocortex, temporal neocortex, frontal white matter, and hippocampus of 107 donors characterized by the Aging, Dementia, and Traumatic Brain Injury Project. Our analysis was sex-stratified and compared gene expression patterns between TBI donors and controls, a subset of which presented with dementia. Results We report three candidate gene modules from the female hippocampus whose expression correlated with dementia in female TBI donors. Enrichment analyses revealed that the candidate modules were notably enriched in cardiac processes and the immune-inflammatory response, among other biological processes. In addition, multiple candidate module genes showed a significant positive correlation with hippocampal concentrations of monocyte chemoattractant protein-1 in females with post-TBI dementia, which has been previously described as a potential biomarker for TBI and susceptibility to post-injury dementia. We concurrently examined the expression profiles of these candidate modules in the hippocampus of males with TBI and found no apparent indicator that the identified candidate modules contribute to post-TBI dementia in males. Discussion Herein, we present the first sex-stratified RNA sequencing analysis of TBI-induced changes within the transcriptome that may be conducive to dementia. This work contributes to our current understanding of the pathophysiological link between TBI and dementia and emphasizes the growing interest in sex as a biological variable affecting TBI outcomes.
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Affiliation(s)
- Michael R. Fiorini
- Department of Human Genetics, McGill University, Montreal, QC, Canada,*Correspondence: Michael R. Fiorini ✉
| | - Allison A. Dilliott
- Department of Neurology and Neurosurgery, The Neuro, McGill University, Montreal, QC, Canada,Allison A. Dilliott ✉
| | - Sali M. K. Farhan
- Department of Human Genetics, McGill University, Montreal, QC, Canada,Department of Neurology and Neurosurgery, The Neuro, McGill University, Montreal, QC, Canada,Sali M. K. Farhan ✉
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27
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Moreira CG, Hofmann P, Müllner A, Baumann CR, Ginde VR, Kollarik S, Morawska MM, Noain D. Down-phase auditory stimulation is not able to counteract pharmacologically or physiologically increased sleep depth in traumatic brain injury rats. J Sleep Res 2022; 31:e13615. [PMID: 35474362 PMCID: PMC9786351 DOI: 10.1111/jsr.13615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 12/30/2022]
Abstract
Modulation of slow-wave activity, either via pharmacological sleep induction by administering sodium oxybate or sleep restriction followed by a strong dissipation of sleep pressure, has been associated with preserved posttraumatic cognition and reduced diffuse axonal injury in traumatic brain injury rats. Although these classical strategies provided promising preclinical results, they lacked the specificity and/or translatability needed to move forward into clinical applications. Therefore, we recently developed and implemented a rodent auditory stimulation method that is a scalable, less invasive and clinically meaningful approach to modulate slow-wave activity by targeting a particular phase of slow waves. Here, we assessed the feasibility of down-phase targeted auditory stimulation of slow waves and evaluated its comparative modulatory strength in relation to the previously employed slow-wave activity modulators in our rat model of traumatic brain injury. Our results indicate that, in spite of effectively reducing slow-wave activity in both healthy and traumatic brain injury rats via down-phase targeted stimulation, this method was not sufficiently strong to counteract the boost in slow-wave activity associated with classical modulators, nor to alter concomitant posttraumatic outcomes. Therefore, the usefulness and effectiveness of auditory stimulation as potential standalone therapeutic strategy in the context of traumatic brain injury warrants further exploration.
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Affiliation(s)
- Carlos G. Moreira
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Pascal Hofmann
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Adrian Müllner
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Christian R. Baumann
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland,University Center of Competence Sleep & Health Zurich (CRPP)University of ZurichZurichSwitzerland,Neuroscience Center Zurich (ZNZ)ZurichSwitzerland
| | - Varun R. Ginde
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Sedef Kollarik
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Marta M. Morawska
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Daniela Noain
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland,University Center of Competence Sleep & Health Zurich (CRPP)University of ZurichZurichSwitzerland,Neuroscience Center Zurich (ZNZ)ZurichSwitzerland
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28
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Linking Rivermead Post Concussion Symptoms Questionnaire (RPQ) and Sport Concussion Assessment Tool (SCAT) scores with item response theory. J Int Neuropsychol Soc 2022:1-8. [PMID: 36325632 PMCID: PMC10154437 DOI: 10.1017/s1355617722000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite the public health burden of traumatic brain injury (TBI) across broader society, most TBI studies have been isolated to a distinct subpopulation. The TBI research literature is fragmented further because often studies of distinct populations have used different assessment procedures and instruments. Addressing calls to harmonize the literature will require tools to link data collected from different instruments that measure the same construct, such as civilian mild traumatic brain injury (mTBI) and sports concussion symptom inventories. METHOD We used item response theory (IRT) to link scores from the Rivermead Post Concussion Symptoms Questionnaire (RPQ) and the Sport Concussion Assessment Tool (SCAT) symptom checklist, widely used instruments for assessing civilian and sport-related mTBI symptoms, respectively. The sample included data from n = 397 patients who suffered a sports-related concussion, civilian mTBI, orthopedic injury control, or non-athlete control and completed the SCAT and/or RPQ. RESULTS The results of several analyses supported sufficient unidimensionality to treat the RPQ + SCAT combined item set as measuring a single construct. Fixed-parameter IRT was used to create a cross-walk table that maps RPQ total scores to SCAT symptom severity scores. Linked and observed scores were highly correlated (r = .92). Standard errors of the IRT scores were slightly higher for civilian mTBI patients and orthopedic controls, particularly for RPQ scores linked from the SCAT. CONCLUSION By linking the RPQ to the SCAT we facilitated efforts to effectively combine samples and harmonize data relating to mTBI.
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29
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Honig MG, Del Mar NA, Moore BM, Reiner A. Raloxifene Mitigates Emotional Deficits after Mild Traumatic Brain Injury in Mice. Neurotrauma Rep 2022; 3:534-544. [DOI: 10.1089/neur.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Marcia G. Honig
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nobel A. Del Mar
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Bob M. Moore
- Department of Pharmaceutical Sciences, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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30
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Fox AJ, Filmer HL, Dux PE. The influence of self-reported history of mild traumatic brain injury on cognitive performance. Sci Rep 2022; 12:16999. [PMID: 36220885 PMCID: PMC9554181 DOI: 10.1038/s41598-022-21067-w] [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: 04/22/2022] [Accepted: 09/22/2022] [Indexed: 12/29/2022] Open
Abstract
The long-term cognitive consequences of mild traumatic brain injury (mTBI) are poorly understood. Studies investigating cognitive performance in the chronic stage of injury in both hospital-based and population-based samples have revealed inconsistent findings. Importantly, population-based mTBI samples remain under-studied in the literature. This study investigated cognitive performance among individuals with a history of self-reported mTBI using a battery of cognitively demanding behavioural tasks. Importantly, more than half of the mTBI participants had experienced multiple mild head injuries. Compared to control participants (n = 49), participants with a history of mTBI (n = 30) did not demonstrate deficits in working memory, multitasking ability, cognitive flexibility, visuospatial ability, response inhibition, information processing speed or social cognition. There was moderate evidence that the mTBI group performed better than control participants on the visual working memory measure. Overall, these findings suggest that even multiple instances of mTBI do not necessarily lead to long-term cognitive impairment at the group level. Thus, we provide important evidence of the impact of chronic mTBI across a number of cognitive processes in a population-based sample. Further studies are necessary to determine the impact that individual differences in injury-related variables have on cognitive performance in the chronic stage of injury.
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Affiliation(s)
- Amaya J. Fox
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Hannah L. Filmer
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Paul E. Dux
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
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31
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Prakash SK, Reddy RP, Mathulla AR, Rajeswaran J, Shukla DP. Neuropsychological Profile of Traumatic Brain Injury Patients with Medicolegal Cases: A Pilot Study. INDIAN JOURNAL OF NEUROTRAUMA 2022. [DOI: 10.1055/s-0041-1740943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Introduction Traumatic brain injury (TBI) is a global health problem and is a silent epidemic of the modern times. Studies indicate litigation is a prominent factor that accounts for poor outcome and prolonged recovery from mild TBI. Depression is the most frequently diagnosed psychiatric disorder after TBI. Postconcussion symptoms, litigation, and suboptimal effort could contribute to the neuropsychological functioning of TBI patients medicolegal cases (MLCs). With increase in TBI and medicolegal cases, there is a requirement for comprehensive neuropsychological assessment.
Method The aim of the study was to evaluate the cognitive functions, postconcussion, and depressive symptoms in TBI patients with MLC and without MLCs (non-MLC). Patients were also assessed on electrophysiological parameters. An observational cross-sectional design was adopted, the sample size was 30 TBI patients in total, 15 (MLC) and 15 (non-MLC), and 11 patients from each group for electrophysiological assessment. The patients were in the age range of 18 to 50 years.
Results The MLC group had poor performance compared with the non-MLC group on both neuropsychological and electrophysiological measures. There was evidence of significant difference in verbal working memory, verbal learning, and memory and visuoconstructive ability. In the MLC group, postconcussion and depressive scores were negatively correlated with visuospatial span.
Conclusion Findings from this study indicate differences in the neuropsychological performance and electroencephalographic measures in between MLC and non-MLC groups. The results could be indicative of persistent cognitive problems associated with TBI for patients pursuing litigation. Poor performance could also be attributed to suboptimal level of effort. However, being a preliminary study with a small sample size, the findings need to be treated with caution.
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Affiliation(s)
- Simi K. Prakash
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajakumari P. Reddy
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anna R. Mathulla
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval P. Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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32
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Couch JR, Stewart KE. Persistence of headache and its relation to other major sequelae following traumatic brain injury at 2–8 years after deployment‐related traumatic brain injury in veterans of Afghanistan and Iraq wars. Headache 2022; 62:700-717. [DOI: 10.1111/head.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Affiliation(s)
- James R. Couch
- Department of Neurology University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
| | - Kenneth E. Stewart
- Department of Surgery University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
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Satyadev N, Warman PI, Seas A, Kolls BJ, Haglund MM, Fuller AT, Dunn TW. Machine Learning for Predicting Discharge Disposition After Traumatic Brain Injury. Neurosurgery 2022; 90:768-774. [PMID: 35319523 DOI: 10.1227/neu.0000000000001911] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current traumatic brain injury (TBI) prognostic calculators are commonly used to predict the mortality and Glasgow Outcome Scale, but these outcomes are most relevant for severe TBI. Because mild and moderate TBI rarely reaches severe outcomes, there is a need for novel prognostic endpoints. OBJECTIVE To generate machine learning (ML) models with a strong predictive capacity for trichotomized discharge disposition, an outcome not previously used in TBI prognostic models. The outcome can serve as a proxy for patients' functional status, even in mild and moderate patients with TBI. METHODS Using a large data set (n = 5292) of patients with TBI from a quaternary care center and 84 predictors, including vitals, demographics, mechanism of injury, initial Glasgow Coma Scale, and comorbidities, we trained 6 different ML algorithms using a nested-stratified-cross-validation protocol. After optimizing hyperparameters and performing model selection, isotonic regression was applied to calibrate models. RESULTS When maximizing the microaveraged area under the receiver operating characteristic curve during hyperparameter optimization, a random forest model exhibited top performance. A random forest model was also selected when maximizing the microaveraged area under the precision-recall curve. For both models, the weighted average area under the receiver operating characteristic curves was 0.84 (95% CI 0.81-0.87) and the weighted average area under the precision-recall curves was 0.85 (95% CI 0.82-0.88). CONCLUSION Our group presents high-performing ML models to predict trichotomized discharge disposition. These models can assist in optimization of patient triage and treatment, especially in cases of mild and moderate TBI.
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Affiliation(s)
- Nihal Satyadev
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Pranav I Warman
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Andreas Seas
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Brad J Kolls
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Timothy W Dunn
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
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"Can differences in hospitalised mild traumatic brain injury (mTBI) outcomes at 12 months be predicted?". Acta Neurochir (Wien) 2022; 164:1435-1443. [PMID: 35348896 DOI: 10.1007/s00701-022-05183-0] [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: 11/21/2020] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To identify risk factors for poor outcome one year post-mild traumatic brain injury (mTBI). DESIGN This study was a prospective observational study using consecutive adult hospital admissions with mTBI. SUBJECTS A total of 869 consecutive mTBI patients were enrolled in this study. METHODS All patients were reviewed by the specialist TBI rehabilitation team at six weeks and one year following mTBI. Demographic and injury data collected included: age, gender, TBI severity and Glasgow Coma Scale (GCS). At twelve months, global outcome was assessed by the Extended Glasgow Outcome Score (GOSE) and participation restriction by the Rivermead Head Injury Follow-up Questionnaire (RHFUQ) via semi-structured interview. An ordinal regression (OR) was used to identify associated factors for poor GOSE outcome and a linear regression for a poor RHFUQ outcome. RESULTS In the GOSE analysis, lower GCS (p < 0.001), medical comorbidity (p = 0.027), depression (p < 0.001) and male gender (p = 0.008) were identified as risk factors for poor outcome. The RHFUQ analysis identified: lower GCS (p = 0.002), female gender (p = 0.001) and injuries from assault (p = 0.003) were variables associated with worse social functioning at one year. CONCLUSION mTBI is associated with a significant impact upon the physical health and psychosocial function of affected individuals. The results of this study demonstrate that differences in mTBI outcome can be identified at twelve months post-mTBI and that certain features, particularly GCS, are associated with poorer outcomes.
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35
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Vorn R, Naunheim R, Lai C, Wagner C, Gill JM. Elevated Axonal Protein Markers Following Repetitive Blast Exposure in Military Personnel. Front Neurosci 2022; 16:853616. [PMID: 35573288 PMCID: PMC9099432 DOI: 10.3389/fnins.2022.853616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Blast exposures that occur during training are common in military personnel; however, the biomarkers that relate to these subtle injuries is not well understood. Therefore, the purpose of this study is to identify the acute biomarkers related to blast injury in a cohort of military personnel exposure to blast-related training. Thirty-four military personnel who participated in the training program were included in this study. Blood samples were collected before and after repetitive blast-related training on days 2 (n = 19) and days 7 (n = 15). Serum concentration (pg/mL) of tau, glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and phosphorylated tau181 (p-tau181) were measured using an ultrasensitive immunoassay platform. We observed that serum p-tau181 concentrations were elevated after exposed to repetitive blast on days 2 (z = −2.983, p = 0.003) and days 7 (z = −2.158, p = 0.031). Serum tau (z = −2.272, p = 0.023) and NfL (z = −2.158, p = 0.031) levels were significantly elevated after exposure to repetitive blasts on days 7. Our findings indicate that blast exposure affects serum biomarkers indicating axonal injury.
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Affiliation(s)
- Rany Vorn
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Rany Vorn,
| | - Rosanne Naunheim
- Department of Emergency Medicine, Washington University Barnes Jewish Medical Center, St. Louis, MO, United States
| | - Chen Lai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Chelsea Wagner
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Jessica M. Gill
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
- School of Nursing and Medicine, Johns Hopkins University, Baltimore, MD, United States
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36
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Acute and Delayed Effects of Mechanical Injury on Calcium Homeostasis and Mitochondrial Potential of Primary Neuroglial Cell Culture: Potential Causal Contributions to Post-Traumatic Syndrome. Int J Mol Sci 2022; 23:ijms23073858. [PMID: 35409216 PMCID: PMC8998891 DOI: 10.3390/ijms23073858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023] Open
Abstract
In vitro models of traumatic brain injury (TBI) help to elucidate the pathological mechanisms responsible for cell dysfunction and death. To simulate in vitro the mechanical brain trauma, primary neuroglial cultures were scratched during different periods of network formation. Fluorescence microscopy was used to measure changes in intracellular free Ca2+ concentration ([Ca2+]i) and mitochondrial potential (ΔΨm) a few minutes later and on days 3 and 7 after scratching. An increase in [Ca2+]i and a decrease in ΔΨm were observed ~10 s after the injury in cells located no further than 150–200 µm from the scratch border. Ca2+ entry into cells during mechanical damage of the primary neuroglial culture occurred predominantly through the NMDA-type glutamate ionotropic channels. MK801, an inhibitor of this type of glutamate receptor, prevented an acute increase in [Ca2+]i in 99% of neurons. Pathological changes in calcium homeostasis persisted in the primary neuroglial culture for one week after injury. Active cell migration in the scratch area occurred on day 11 after neurotrauma and was accompanied by a decrease in the ratio of live to dead cells in the areas adjacent to the injury. Immunohistochemical staining of glial fibrillary acidic protein and β-III tubulin showed that neuronal cells migrated to the injured area earlier than glial cells, but their repair potential was insufficient for survival. Mitochondrial Ca2+ overload and a drop in ΔΨm may cause delayed neuronal death and thus play a key role in the development of the post-traumatic syndrome. Preventing prolonged ΔΨm depolarization may be a promising therapeutic approach to improve neuronal survival after traumatic brain injury.
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37
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Kaplan AD, Cheng Q, Mohan KA, Nelson LD, Jain S, Levin H, Torres-Espin A, Chou A, Huie JR, Ferguson AR, McCrea M, Giacino J, Sundaram S, Markowitz AJ, Manley GT. Mixture Model Framework for Traumatic Brain Injury Prognosis Using Heterogeneous Clinical and Outcome Data. IEEE J Biomed Health Inform 2022; 26:1285-1296. [PMID: 34310331 PMCID: PMC8789941 DOI: 10.1109/jbhi.2021.3099745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Prognoses of Traumatic Brain Injury (TBI) outcomes are neither easily nor accurately determined from clinical indicators. This is due in part to the heterogeneity of damage inflicted to the brain, ultimately resulting in diverse and complex outcomes. Using a data-driven approach on many distinct data elements may be necessary to describe this large set of outcomes and thereby robustly depict the nuanced differences among TBI patients' recovery. In this work, we develop a method for modeling large heterogeneous data types relevant to TBI. Our approach is geared toward the probabilistic representation of mixed continuous and discrete variables with missing values. The model is trained on a dataset encompassing a variety of data types, including demographics, blood-based biomarkers, and imaging findings. In addition, it includes a set of clinical outcome assessments at 3, 6, and 12 months post-injury. The model is used to stratify patients into distinct groups in an unsupervised learning setting. We use the model to infer outcomes using input data, and show that the collection of input data reduces uncertainty of outcomes over a baseline approach. In addition, we quantify the performance of a likelihood scoring technique that can be used to self-evaluate the extrapolation risk of prognosis on unseen patients.
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Affiliation(s)
- Alan D. Kaplan
- Lawrence Livermore National Laboratory, Livermore, CA, USA
| | - Qi Cheng
- Lawrence Livermore National Laboratory, Livermore, CA, USA
| | | | | | - Sonia Jain
- University of California, San Diego, La Jolla, CA, USA
| | | | | | - Austin Chou
- University of California, San Francisco, CA, USA
| | | | | | - Michael McCrea
- Medical College of Wisconsin, Milwaukee, Wisconsin, WI, USA
| | - Joseph Giacino
- Massachusetts General Hospital, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, USA
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38
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Howlett JR, Nelson LD, Stein MB. Mental Health Consequences of Traumatic Brain Injury. Biol Psychiatry 2022; 91:413-420. [PMID: 34893317 PMCID: PMC8849136 DOI: 10.1016/j.biopsych.2021.09.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023]
Abstract
Traumatic brain injury (TBI) is associated with a host of psychiatric and neurobehavioral problems. As mortality rates have declined for severe TBI, attention has turned to the cognitive, affective, and behavioral sequelae of injuries across the severity spectrum, which are often more disabling than residual physical effects. Moderate and severe TBI can cause personality changes including impulsivity, severe irritability, affective instability, and apathy. Mild TBI, once considered a largely benign phenomenon, is now known to be associated with a range of affective symptoms, with suicidality, and with worsening or new onset of several psychiatric disorders including posttraumatic stress disorder and major depressive disorder. Repetitive head impacts, often in athletic contexts, are now believed to be associated with a number of emotional and behavioral sequelae. The nature and etiology of mental health manifestations of TBI (including a combination of brain dysfunction and psychological trauma and interrelationships between cognitive, affective, and physical symptoms) are complex and have been a focus of recent epidemiological and mechanistic studies. This paper will review the epidemiology of psychiatric and neurobehavioral problems after TBI in military, civilian, and athletic contexts.
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Affiliation(s)
- Jonathon R Howlett
- VA San Diego Healthcare System, San Diego, La Jolla, California; Department of Psychiatry, University of California San Diego, La Jolla, California.
| | - Lindsay D Nelson
- Department of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Murray B Stein
- VA San Diego Healthcare System, San Diego, La Jolla, California; Department of Psychiatry, University of California San Diego, La Jolla, California; School of Public Health, University of California San Diego, La Jolla, California
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39
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Machamer J, Temkin N, Dikmen S, Nelson LD, Barber J, Hwang P, Boase K, Stein MB, Sun X, Giacino J, McCrea MA, Taylor SR, Jain S, Manley G. Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2022; 39:358-370. [PMID: 35078327 PMCID: PMC8892966 DOI: 10.1089/neu.2021.0348] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Symptom endorsement after traumatic brain injury (TBI) is common acutely post-injury and is associated with other adverse outcomes. Prevalence of persistent symptoms has been debated, especially in mild TBI (mTBI). A cohort of participants ≥17 years with TBI (n = 2039), 257 orthopedic trauma controls (OTCs), and 300 friend controls (FCs) were enrolled in the TRACK-TBI study and evaluated at 2 weeks and 3, 6, and 12 months post-injury using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). TBI participants had significantly higher symptom burden than OTCs or FCs at all times, with average scores more than double. TBI cases showed significant decreases in RPQ score between each evaluation (p < 0.001), decreasing ∼1.7 points per month between 2 weeks and 3 months and 0.2 points per month after that. More than 50% of the TBI sample, including >50% of each of the mild and moderate/severe TBI subsamples, continued to endorse three or more symptoms as worse than pre-injury through 12 months post-injury. A majority of TBI participants who endorsed a symptom at 3 months or later did so at the next evaluation as well. Contrary to reviews that report symptom resolution by 3 months post-injury among those with mTBI, this study of participants treated at level 1 trauma centers and having a computed tomography ordered found that persistent symptoms are common to at least a year after TBI. Additionally, although symptom endorsement was not specific to TBI given that they were also reported by OTC and FC participants, TBI participants endorsed over twice the symptom burden compared with the other groups.
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Affiliation(s)
- Joan Machamer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Phillip Hwang
- Department of Anatomy and Neurobiology, Boston University, Boston, Massachusetts, USA
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Murray B Stein
- Department of Psychiatry and Herbert Wertheim School of Public Health, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Joseph Giacino
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Michael A McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabrina R Taylor
- Brain and Spinal Injury Center, San Francisco, California, USA.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Geoff Manley
- Brain and Spinal Injury Center, San Francisco, California, USA.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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40
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Eapen BC, Bowles AO, Sall J, Lang AE, Hoppes CW, Stout KC, Kretzmer T, Cifu DX. The management and rehabilitation of post-acute mild traumatic brain injury. Brain Inj 2022; 36:693-702. [DOI: 10.1080/02699052.2022.2033848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Blessen C. Eapen
- Physical Medicine and Rehabilitation Service Va Greater Los Angeles Healthcare System, Division of Physical Medicine and Rehabilitation David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Amy O. Bowles
- Physical Medicine and Rehabilitation Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - James Sall
- Clinical Quality Program Specialist, Quality and Patient Safety, Veterans Administration Central Office, Washington, District of Columbia, USA
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, Virginia, USA
| | - Carrie W. Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Army Medical Center of Excellence, Fort Sam Houston, Texas, USA
| | - Katharine C. Stout
- Defense Health Agency Research and Development (J-9), Director of Clinical Affairs Division Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Tracy Kretzmer
- Neuropsychology, Mental Health and Behavioral Sciences Inpatient Polytrauma, Rehabilitation, Post-Deployment Rehabilitation and Evaluation Program (PREP), James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - David X. Cifu
- Physical Medicine and Rehabilitation, Senior TBI Specialist, Department of Veterans Affairs Associate Dean of Innovation and System Integration, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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41
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Li W, Wittmann RA, Farias DR, Bigler ED, Martin RM. Cognitive profile of mild traumatic brain injury patients requiring acute hospitalization - A UC davis cognitive screener (UCD-Cog) study. Brain Inj 2022; 36:59-71. [PMID: 35143336 DOI: 10.1080/02699052.2022.2034968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Identification of patients with mTBI at risk for developing persistent-post concussive syndromes should begin during the ED/inpatient evaluation due to frequent lack of post-discharge follow-up. The best method for evaluating cognitive deficits in these acute settings and how to utilize this information to optimize follow-up care is a matter of ongoing research. In this descriptive study, we present the cognitive profile of 214 hospitalized patients with mTBI using a novel cognitive and behavioral screener, the UCD-Cog. METHOD A retrospective review of patients with mTBI requiring hospitalization who were enrolled in the UC Davis TBI Registry over the course of 1 year. RESULTS Reasoning, executive function, and delayed recall were the most frequently impaired cognitive domains. GCS 13-14 was associated with higher numbers of impaired cognitive domains and frequencies of impairments in domains traditionally associated with post-concussive symptoms. Patients with abnormal UCD-Cog results, regardless of GCS, were recommended higher levels of post-discharge care and supervision. CONCLUSION Inpatient cognitive profiles using the UCD-Cog were consistent with evaluations during the subacute/chronic phase of mTBI and supports the clinical utility of acute cognitive screeners for mTBI management. Future studies will determine how the acute cognitive assessments correlate with long-term mTBI outcomes.
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Affiliation(s)
- Wentao Li
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, University of California Davis, Sacramento, California, USA
| | - Rejane A Wittmann
- Department of Speech Pathology, University of California Davis, Sacramento, California, USA
| | - Dana R Farias
- Department of Speech Pathology, University of California Davis, Sacramento, California, USA
| | - Erin D Bigler
- Department of Neurology, University of California Davis, Sacramento, California, USA.,Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, Union Territory, USA.,Departments of Neurology and Psychiatry, University of Utah, Salt Lake City, Union Territory USA
| | - Ryan M Martin
- Department of Neurology, University of California Davis, Sacramento, California, USA.,Department of Neurosurgery, University of California Davis, Sacramento, California, USA
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42
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Vorn R, Suarez M, White JC, Martin CA, Kim HS, Lai C, Yun SJ, Gill JM, Lee H. Exosomal microRNA Differential Expression in Plasma of Young Adults with Chronic Mild Traumatic Brain Injury and Healthy Control. Biomedicines 2021; 10:biomedicines10010036. [PMID: 35052715 PMCID: PMC8773035 DOI: 10.3390/biomedicines10010036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic mild traumatic brain injury (mTBI) has long-term consequences, such as neurological disability, but its pathophysiological mechanism is unknown. Exosomal microRNAs (exomiRNAs) may be important mediators of molecular and cellular changes involved in persistent symptoms after mTBI. We profiled exosomal microRNAs (exomiRNAs) in plasma from young adults with or without a chronic mTBI to decipher the underlying mechanisms of its long-lasting symptoms after mTBI. We identified 25 significantly dysregulated exomiRNAs in the chronic mTBI group (n = 29, with 4.48 mean years since the last injury) compared to controls (n = 11). These miRNAs are associated with pathways of neurological disease, organismal injury and abnormalities, and psychological disease. Dysregulation of these plasma exomiRNAs in chronic mTBI may indicate that neuronal inflammation can last long after the injury and result in enduring and persistent post-injury symptoms. These findings are useful for diagnosing and treating chronic mTBIs.
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Affiliation(s)
- Rany Vorn
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20814, USA; (R.V.); (C.A.M.); (H.-S.K.); (C.L.)
| | - Maiko Suarez
- School of Medicine, University of Nevada, Las Vegas, NV 89102, USA;
| | - Jacob C. White
- College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA;
| | - Carina A. Martin
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20814, USA; (R.V.); (C.A.M.); (H.-S.K.); (C.L.)
| | - Hyung-Suk Kim
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20814, USA; (R.V.); (C.A.M.); (H.-S.K.); (C.L.)
| | - Chen Lai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20814, USA; (R.V.); (C.A.M.); (H.-S.K.); (C.L.)
| | | | - Jessica M. Gill
- School of Nursing and Medicine, Johns Hopkins University, Baltimore, MD 21205, USA;
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | - Hyunhwa Lee
- School of Nursing, University of Nevada, Las Vegas, NV 89154, USA
- Correspondence:
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Cornwell RE, Arango JI, Eagye CB, Hill-Pearson C, Schwab K, Souvignier AR, Pazdan RM. Mild Traumatic Brain Injury and Postconcussive Symptom Endorsement: A Parallel Comparison Between Two Nonclinical Cohorts. Mil Med 2021; 186:e1191-e1198. [PMID: 33269800 DOI: 10.1093/milmed/usaa504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/14/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The prevalence of mild traumatic brain injury (mTBI) is commonly estimated based on indirect metrics such as emergency department visits and self-reporting tools. The study of postconcussive symptoms faces similar challenges because of their unspecific character and indistinct causality. In this article, we compare two nonclinical, epidemiological studies that addressed these two elements and were performed within a relatively narrow period in the state of Colorado. MATERIALS AND METHODS De-identified datasets were obtained from a random digit-dialed survey study conducted by the Craig Hospital and a study surveying soldiers returning from deployment by Defense and Veteran Traumatic Brain Injury Center. Information pertinent to participants' demographics, a history of mTBI, and symptom endorsement was extracted and homogenized in order to establish a parallel comparison between the populations of the two studies. RESULTS From the 1,558 (Warrior Strong, 679; Craig Hospital, 879) records selected for analysis, 43% reported a history of at least one mTBI. The prevalence was significantly higher among individuals from the Defense and Veteran Traumatic Brain Injury Center study independent of gender or race. Repetitive injuries were reported by 15% of the total combined cohort and were more prevalent among males. Symptom endorsement was significantly higher in individuals with a positive history of mTBI, but over 80% of those with a negative history of mTBI endorsed at least one of the symptoms interrogated. Significant differences were observed between the military and the civilian populations in terms of the types and frequencies of the symptoms endorsed. CONCLUSIONS The prevalence of mTBI and associated symptoms identified in the two study populations is higher than that of previously reported. This suggests that not all individuals sustaining concussion seek medical care and highlights the limitations of using clinical reports to assess such estimates. The lack of appropriate mechanisms to determine symptom presence and causality remains a challenge. However, the differences observed in symptom reporting between cohorts raise questions about the nature of the symptoms, the impact on the quality of life for different individuals, and the effects on military health and force readiness.
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Affiliation(s)
- R Elisabeth Cornwell
- Despite being in Colorado Springs, The location of the Defense and Veterans Brain Injury Center should be Fort Carson, CO 80913, USA.,Karen Schwab's affiliation with General Dynamics is correct, but the Defense and Veterans Brain Injury Center she is affiliated to isn't the one at Fort Carson but the one in Silver Spring, MD 20910, USA
| | - Jorge I Arango
- Despite being in Colorado Springs, The location of the Defense and Veterans Brain Injury Center should be Fort Carson, CO 80913, USA.,Karen Schwab's affiliation with General Dynamics is correct, but the Defense and Veterans Brain Injury Center she is affiliated to isn't the one at Fort Carson but the one in Silver Spring, MD 20910, USA
| | - C B Eagye
- Craig Hospital, Englewood, CO 80113, USA
| | - Candace Hill-Pearson
- Despite being in Colorado Springs, The location of the Defense and Veterans Brain Injury Center should be Fort Carson, CO 80913, USA.,Karen Schwab's affiliation with General Dynamics is correct, but the Defense and Veterans Brain Injury Center she is affiliated to isn't the one at Fort Carson but the one in Silver Spring, MD 20910, USA
| | - Karen Schwab
- Despite being in Colorado Springs, The location of the Defense and Veterans Brain Injury Center should be Fort Carson, CO 80913, USA.,Karen Schwab's affiliation with General Dynamics is correct, but the Defense and Veterans Brain Injury Center she is affiliated to isn't the one at Fort Carson but the one in Silver Spring, MD 20910, USA
| | - Alicia R Souvignier
- Despite being in Colorado Springs, The location of the Defense and Veterans Brain Injury Center should be Fort Carson, CO 80913, USA.,Warrior Recovery Center, Evans Army Community Hospital, Fort Carson, CO 80913, USA
| | - Renee M Pazdan
- Despite being in Colorado Springs, The location of the Defense and Veterans Brain Injury Center should be Fort Carson, CO 80913, USA.,Warrior Recovery Center, Evans Army Community Hospital, Fort Carson, CO 80913, USA
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Chiang HS, Motes M, O'Hair R, Vanneste S, Kraut M, Hart J. Baseline delayed verbal recall predicts response to high definition transcranial direct current stimulation targeting the superior medial frontal cortex. Neurosci Lett 2021; 764:136204. [PMID: 34478816 DOI: 10.1016/j.neulet.2021.136204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022]
Abstract
Anodal high definition transcranial direct current stimulation (HD-tDCS) targeting the pre-supplementary motor area/dorsal anterior cingulate cortex (pre-SMA/dACC) has recently been shown to improve verbal retrieval deficits in veterans with chronic traumatic brain injury (TBI) (Motes et al., 2020), but predictors of treatment response are unclear. We hypothesized that baseline delayed verbal recall, a sensitive measure for post-TBI chronic cognitive decline, would predict therapeutic effects of HD-tDCS targeting the pre-SMA/dACC for verbal retrieval deficits. Standardized verbal retrieval measures were administered at baseline, immediately after and 8 weeks after treatment completion. We applied mixed generalized linear modeling as a post-hoc subgroup analysis to the verbal retrieval scores that showed significant improvement in Motes at el. (2020) to examine effects of active stimulation across the groups with baseline-intact delayed recall (N = 10) and baseline-impaired delayed recall (N = 8), compared to sham (N = 7). Individuals with impaired baseline delayed recall showed significant improvement (compared to baseline) in both category fluency and color-word inhibition/switch, while individuals with intact delayed recall showed significant improvement only in color-word inhibition/switch. Baseline delayed verbal recall may therefore be considered as a predictor for future electromodulation studies targeting frontal structures to treat TBI-related verbal deficits.
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Affiliation(s)
- Hsueh-Sheng Chiang
- Department of Neurology, The University of Texas Southwestern Medical Center, USA; School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA.
| | - Michael Motes
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA
| | - Rachel O'Hair
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA; Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Michael Kraut
- Department of Radiology, The Johns Hopkins University School of Medicine, USA
| | - John Hart
- Department of Neurology, The University of Texas Southwestern Medical Center, USA; School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center, USA
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Fordal L, Stenberg J, Iverson GL, Saksvik SB, Karaliute M, Vik A, Olsen A, Skandsen T. Trajectories of Persistent Postconcussion Symptoms and Factors Associated with Symptom Reporting after Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 103:313-322. [PMID: 34695386 DOI: 10.1016/j.apmr.2021.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the trajectories of persistent postconcussion symptoms (PPCS) after mild traumatic brain injury (MTBI) and to investigate which injury-related and personal factors are associated with symptom reporting. DESIGN Prospective longitudinal cohort study. Follow-up at 3 and 12 months postinjury. SETTING A level 1 trauma center and an emergency outpatient clinic. PARTICIPANTS Patients with MTBI (n=358), trauma controls (n=75), and community controls (n=78). MAIN OUTCOME MEASURES Symptoms were assessed with the British Columbia Postconcussion Symptom Inventory. Participants were categorized as having moderate to severe PPCS (msPPCS) when reporting ≥3 moderate/severe symptoms or a BC-PSI total score of ≥13. BC-PSI total scores were compared between the groups and were further used to create cut-offs for reliable change by identifying uncommon and very uncommon change in symptoms in the community control group. Associations between symptom reporting and 25 injury-related and personal factors were examined. RESULTS The MTBI group had a similar prevalence of msPPCS at 3 and 12 months (21%), and reported more symptoms than the control groups. Analyses of individual trajectories, however, revealed considerable change in both msPPCS and BC-PSI total scores in the MTBI group, where both worsening and improvement was common. Intracranial lesions on CT were associated with a greater likelihood of improving from 3 to 12 months. Those with msPPCS at both assessments were more likely to be women and to have these personal preinjury factors: reduced employment, pain, poor sleep, low resilience, high neuroticism and pessimism, and a psychiatric history. CONCLUSIONS Group analyses suggest a stable prevalence of msPPCS the first year postinjury. However, there was considerable intra-individual change. Several personal factors were associated with maintaining symptoms throughout the first year.
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Affiliation(s)
- Linda Fordal
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jonas Stenberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, USA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
| | - Simen B Saksvik
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Migle Karaliute
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alexander Olsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Agtarap S, Kramer MD, Campbell-Sills L, Yuh E, Mukherjee P, Manley GT, McCrea MA, Dikmen S, Giacino JT, Stein MB, Nelson LD. Invariance of the Bifactor Structure of Mild Traumatic Brain Injury (mTBI) Symptoms on the Rivermead Postconcussion Symptoms Questionnaire Across Time, Demographic Characteristics, and Clinical Groups: A TRACK-TBI Study. Assessment 2021; 28:1656-1670. [PMID: 32326739 PMCID: PMC7584771 DOI: 10.1177/1073191120913941] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to elucidate the structure of the Rivermead Postconcussion Symptoms Questionnaire (RPQ) and evaluate its longitudinal and group variance. Factor structures were developed and compared in 1,011 patients with mild traumatic brain injury (mTBI; i.e., Glasgow Coma Scale score 13-15) from the Transforming Research and Clinical Knowledge in TBI study, using RPQ data collected at 2 weeks, and 3, 6, and 12 months postinjury. A bifactor model specifying a general factor and emotional, cognitive, and visual symptom factors best represented the latent structure of the RPQ. The model evinced strict measurement invariance over time and across sex, age, race, psychiatric history, and mTBI severity groups, indicating that differences in symptom endorsement were completely accounted for by these latent dimensions. While highly unidimensional, the RPQ has multidimensional features observable through a bifactor model, which may help differentiate symptom expression patterns in the future.
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Affiliation(s)
- Stephanie Agtarap
- Defense and Veterans Brain Injury Center, Naval Medical Center, San Diego, CA, USA
| | | | - Laura Campbell-Sills
- Defense and Veterans Brain Injury Center, Naval Medical Center, San Diego, CA, USA
| | - Esther Yuh
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | - Murray B Stein
- Defense and Veterans Brain Injury Center, Naval Medical Center, San Diego, CA, USA
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Voelbel GT, Lindsey HM, Mercuri G, Bushnik T, Rath J. The effects of neuroplasticity-based auditory information processing remediation in adults with chronic traumatic brain injury. NeuroRehabilitation 2021; 49:267-278. [PMID: 34420987 DOI: 10.3233/nre-218025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adults with chronic traumatic brain injury (TBI) may experience long-term deficits in multiple cognitive domains. Higher-order functions, such as verbal memory, are impacted by deficits in the ability to acquire verbal information. OBJECTIVE This study investigated the effects of a neuroplasticity-based computerized cognitive remediation program for auditory information processing in adults with a chronic TBI. METHODS Forty-eight adults with TBI were randomly assigned to an intervention or control group. Both groups underwent a neuropsychological assessment at baseline and post-training. The Intervention group received 40 one-hour cognitive training sessions with the Brain Fitness Program. RESULTS The intervention group improved in performance on measures of the Woodcock-Johnson-III Understanding Directions subtest and Trail Making Test Part-A. They also reported improvement on the cognitive domain of the Cognitive Self-Report Questionnaire. CONCLUSIONS The present study demonstrated that a neuroplasticity-based computerized cognitive remediation program may improve objective and subjective cognitive function in adults with TBI several years post-injury.
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Affiliation(s)
- Gerald T Voelbel
- Department of Occupational Therapy, New York University, New York, NY, USA.,Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Hannah M Lindsey
- Department of Psychology, New York University, New York, NY, USA.,Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Giulia Mercuri
- Department of Psychology, New York University, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Joseph Rath
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
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48
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Haarbauer-Krupa J, Pugh MJ, Prager EM, Harmon N, Wolfe J, Yaffe K. Epidemiology of Chronic Effects of Traumatic Brain Injury. J Neurotrauma 2021; 38:3235-3247. [PMID: 33947273 PMCID: PMC9122127 DOI: 10.1089/neu.2021.0062] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although many patients diagnosed with traumatic brain injury (TBI), particularly mild TBI, recover from their symptoms within a few weeks, a small but meaningful subset experience symptoms that persist for months or years after injury and significantly impact quality of life for the person and their family. Factors associated with an increased likelihood of negative TBI outcomes include not only characteristics of the injury and injury mechanism, but also the person’s age, pre-injury status, comorbid conditions, environment, and propensity for resilience. In this article, as part of the Brain Trauma Blueprint: TBI State of the Science framework, we examine the epidemiology of long-term outcomes of TBI, including incidence, prevalence, and risk factors. We identify the need for increased longitudinal, global, standardized, and validated assessments on incidence, recovery, and treatments, as well as standardized assessments of the influence of genetics, race, ethnicity, sex, and environment on TBI outcomes. By identifying how epidemiological factors contribute to TBI outcomes in different groups of persons and potentially impact differential disease progression, we can guide investigators and clinicians toward more-precise patient diagnosis, along with tailored management, and improve clinical trial designs, data evaluation, and patient selection criteria.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, Utah, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, San Francisco, California, USA
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49
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S, Skirrow P. Psychological flexibility in mild traumatic brain injury: an evaluation of measures. Brain Inj 2021; 35:1103-1111. [PMID: 34334064 DOI: 10.1080/02699052.2021.1959062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE In this study, we examined the psychometric properties of measures of psychological flexibility in a mild traumatic brain injury (mTBI) sample. METHOD AND PROCEDURES Adults who sustained a mTBI (n = 112) completed the Acceptance and Action Questionnaire - Acquired Brain Injury reactive avoidance subscale (AAQ-ABI (RA). Exploratory factor analysis and Rasch analysis were conducted to evaluate the facture structure, dimensionality, and differential item functioning. Construct validity was determined by correlating the AAQ-ABI (RA) with the Acceptance and Action Questionnaire-Revised (AAQ-II) and Fear Avoidance after Traumatic Brain Injury (FAB-TBI). MAIN OUTCOME AND RESULTS The AAQ-ABI (RA) was found to have strong internal consistency (Cronbach's α = 0.87). Consistent with previous findings, the AAQ-ABI (RA) had one distinct factor. Fit to the unidimensional Rasch model was adequate (χ2 (18) = 22.5, p = .21) with no evidence of differential item functioning across person factors examined. The AAQ-ABI (RA) also had expected relationships with theoretically relevant constructs. CONCLUSIONS The AAQ-ABI (RA) appears to be a psychometrically sound measure of psychological flexibility in mTBI.
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Affiliation(s)
- Josh W Faulkner
- School of Psychology, Massey University, Wellington, New Zealand
| | - Deborah L Snell
- University of Otago Christchurch, University of Otago, Christchurch
| | - Alice Theadom
- TBI Network, Auckland University of Technology, TBI Network, Auckland University of Technology, University of Technology, Northcote, Auckland
| | - Susan Mahon
- TBI Network, Auckland University of Technology, TBI Network, Auckland University of Technology, University of Technology, Northcote, Auckland
| | | | - Paul Skirrow
- University of Otago Wellington, University of Otago, Newtown, Wellington
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50
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D'Silva LJ, Chalise P, Obaidat S, Rippee M, Devos H. Oculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain Injury. Front Neurol 2021; 12:642457. [PMID: 34381408 PMCID: PMC8350131 DOI: 10.3389/fneur.2021.642457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA (p < 0.001), higher symptom severity on the PCSS (p < 0.001), and higher DHI scores (p < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns (p = 0.002), walking with vertical head tilts (p < 0.001), walking with eyes closed (p = 0.003), and stair climbing (p = 0.001). FGA performance was correlated with weeks since concussion (r = −0.67, p < 0.001), depth perception (r = −0.5348, p < 0.001), near point convergence (r = −0.4717, p = 0.001), baseline visual acuity (r = −0.4435, p = 0.002); as well as with symptoms on the PCSS (r = −0.668, p < 0.001), and DHI (r = −0.811, p < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.
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Affiliation(s)
- Linda J D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Prabhakar Chalise
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO, United States
| | - Sakher Obaidat
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Health System, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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