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Terry G, Pagulayan KF, Muzi M, Mayer C, Murray DR, Schindler AG, Richards TL, McEvoy C, Crabtree A, McNamara C, Means G, Muench P, Powell JR, Mihalik JP, Thomas RG, Raskind MA, Peskind ER, Meabon JS. Increased [ 18F]Fluorodeoxyglucose Uptake in the Left Pallidum in Military Veterans with Blast-Related Mild Traumatic Brain Injury: Potential as an Imaging Biomarker and Mediation with Executive Dysfunction and Cognitive Impairment. J Neurotrauma 2024. [PMID: 38661540 DOI: 10.1089/neu.2023.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Blast-related mild traumatic brain injury (blast-mTBI) can result in a spectrum of persistent symptoms leading to substantial functional impairment and reduced quality of life. Clinical evaluation and discernment from other conditions common to military service can be challenging and subject to patient recall bias and the limitations of available assessment measures. The need for objective biomarkers to facilitate accurate diagnosis, not just for symptom management and rehabilitation but for prognostication and disability compensation purposes is clear. Toward this end, we compared regional brain [18F]fluorodeoxyglucose-positron emission tomography ([18F]FDG-PET) intensity-scaled uptake measurements and motor, neuropsychological, and behavioral assessments in 79 combat Veterans with retrospectively recalled blast-mTBI with 41 control participants having no lifetime history of TBI. Using an agnostic and unbiased approach, we found significantly increased left pallidum [18F]FDG-uptake in Veterans with blast-mTBI versus control participants, p < 0.0001; q = 3.29 × 10-9 [Cohen's d, 1.38, 95% confidence interval (0.96, 1.79)]. The degree of left pallidum [18F]FDG-uptake correlated with the number of self-reported blast-mTBIs, r2 = 0.22; p < 0.0001. Greater [18F]FDG-uptake in the left pallidum provided excellent discrimination between Veterans with blast-mTBI and controls, with a receiver operator characteristic area under the curve of 0.859 (p < 0.0001) and likelihood ratio of 21.19 (threshold:SUVR ≥ 0.895). Deficits in executive function assessed using the Behavior Rating Inventory of Executive Function-Adult Global Executive Composite T-score were identified in Veterans with blast-mTBI compared with controls, p < 0.0001. Regression-based mediation analyses determined that in Veterans with blast-mTBI, increased [18F]FDG-uptake in the left pallidum-mediated executive function impairments, adjusted causal mediation estimate p = 0.021; total effect estimate, p = 0.039. Measures of working and prospective memory (Auditory Consonant Trigrams test and Memory for Intentions Test, respectively) were negatively correlated with left pallidum [18F]FDG-uptake, p < 0.0001, with mTBI as a covariate. Increased left pallidum [18F]FDG-uptake in Veterans with blast-mTBI compared with controls did not covary with dominant handedness or with motor activity assessed using the Unified Parkinson's Disease Rating Scale. Localized increased [18F]FDG-uptake in the left pallidum may reflect a compensatory response to functional deficits following blast-mTBI. Limited imaging resolution does not allow us to distinguish subregions of the pallidum; however, the significant correlation of our data with behavioral but not motor outcomes suggests involvement of the ventral pallidum, which is known to regulate motivation, behavior, and emotions through basal ganglia-thalamo-cortical circuits. Increased [18F]FDG-uptake in the left pallidum in blast-mTBI versus control participants was consistently identified using two different PET scanners, supporting the generalizability of this finding. Although confirmation of our results by single-subject-to-cohort analyses will be required before clinical deployment, this study provides proof of concept that [18F]FDG-PET bears promise as a readily available noninvasive biomarker for blast-mTBI. Further, our findings support a causative relationship between executive dysfunction and increased [18F]FDG-uptake in the left pallidum.
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Affiliation(s)
- Garth Terry
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Kathleen F Pagulayan
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Cynthia Mayer
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel R Murray
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
| | - Abigail G Schindler
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
| | - Todd L Richards
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Cory McEvoy
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Adam Crabtree
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Chris McNamara
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Gary Means
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Peter Muench
- United States Army Special Operations Command, Fort Liberty, North Carolina, USA
| | - Jacob R Powell
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Stallings-Evans Sports Medicine Center, Chapel Hill, North Carolina, USA
| | - Jason P Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Stallings-Evans Sports Medicine Center, Chapel Hill, North Carolina, USA
| | - Ronald G Thomas
- Division of Biostatistics, Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, USA
| | - Murray A Raskind
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Elaine R Peskind
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - James S Meabon
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System (VA Puget Sound), Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Powell WR, Vilen L, Zuelsdorff M, Goutman SA, Salamat S, Rissman RA, Bendlin BB, Kind AJH. Association between military service and Alzheimer's disease neuropathology at autopsy. Alzheimers Dement 2024; 20:1468-1474. [PMID: 37965965 PMCID: PMC10917028 DOI: 10.1002/alz.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/14/2023] [Accepted: 10/01/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Anti-amyloid therapies are at the forefront of efforts to treat Alzheimer's disease (AD). Identifying amyloid risk factors may aid screening and intervention strategies. While veterans face increased exposure to risk factors, whether they face a greater neuropathologic amyloid burden is not well understood. METHODS Male decedents donating to two Alzheimer's Disease Research Center (ADRC) brain banks from 1986 to 2018 with categorized neuritic plaque density and neurofibrillary tangles (n = 597) were included. Using generalized ordered logistic regression we modeled each outcome's association with military history adjusting for age and death year. RESULTS Having served in the military (60% of sample) is associated with post mortem neuritic amyloid plaque (for each comparison of higher to lower C scores OR = 1.26; 95% confidence interval [CI] = 1.06-1.49) and tau pathology (B score OR = 1.10; 95% CI = 1.08-1.12). DISCUSSION This is the first study, to our knowledge, finding increased levels of verified AD neuropathology in those with military service. Targeted veteran AD therapies is a pressing need.
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Affiliation(s)
- W. Ryan Powell
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineGeriatrics DivisionUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Leigha Vilen
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- University of Wisconsin School of NursingMadisonWisconsinUSA
| | | | - Shahriar Salamat
- Department of Neurological SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Robert A. Rissman
- Department of Physiology and NeuroscienceAlzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
- VA San Diego Healthcare SystemLa JollaCaliforniaUSA
| | - Barbara B. Bendlin
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineGeriatrics DivisionUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Amy J. H. Kind
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineGeriatrics DivisionUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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Double Blast Wave Primary Effect on Synaptic, Glymphatic, Myelin, Neuronal and Neurovascular Markers. Brain Sci 2023; 13:brainsci13020286. [PMID: 36831830 PMCID: PMC9954059 DOI: 10.3390/brainsci13020286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Explosive blasts are associated with neurological consequences as a result of blast waves impact on the brain. Yet, the neuropathologic and molecular consequences due to blast waves vs. blunt-TBI are not fully understood. An explosive-driven blast-generating system was used to reproduce blast wave exposure and examine pathological and molecular changes generated by primary wave effects of blast exposure. We assessed if pre- and post-synaptic (synaptophysin, PSD-95, spinophilin, GAP-43), neuronal (NF-L), glymphatic (LYVE1, podoplanin), myelin (MBP), neurovascular (AQP4, S100β, PDGF) and genomic (DNA polymerase-β, RNA polymerase II) markers could be altered across different brain regions of double blast vs. sham animals. Twelve male rats exposed to two consecutive blasts were compared to 12 control/sham rats. Western blot, ELISA, and immunofluorescence analyses were performed across the frontal cortex, hippocampus, cerebellum, and brainstem. The results showed altered levels of AQP4, S100β, DNA-polymerase-β, PDGF, synaptophysin and PSD-95 in double blast vs. sham animals in most of the examined regions. These data indicate that blast-generated changes are preferentially associated with neurovascular, glymphatic, and DNA repair markers, especially in the brainstem. Moreover, these changes were not accompanied by behavioral changes and corroborate the hypothesis for which an asymptomatic altered status is caused by repeated blast exposures.
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Hart de Ruyter FJ, Morrema THJ, den Haan J, Twisk JWR, de Boer JF, Scheltens P, Boon BDC, Thal DR, Rozemuller AJ, Verbraak FD, Bouwman FH, Hoozemans JJM. Phosphorylated tau in the retina correlates with tau pathology in the brain in Alzheimer's disease and primary tauopathies. Acta Neuropathol 2023; 145:197-218. [PMID: 36480077 DOI: 10.1007/s00401-022-02525-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
The retina is a potential source of biomarkers for the detection of neurodegenerative diseases. Accumulation of phosphorylated tau (p-tau) in the brain is a pathological feature characteristic for Alzheimer's disease (AD) and primary tauopathies. In this study the presence of p-tau in the retina in relation to tau pathology in the brain was assessed. Post-mortem eyes and brains were collected through the Netherlands Brain Bank from donors with AD (n = 17), primary tauopathies (n = 8), α-synucleinopathies (n = 13), other neurodegenerative diseases including non-tau frontotemporal lobar degeneration (FTLD) (n = 9), and controls (n = 15). Retina cross-sections were assessed by immunohistochemistry using antibodies directed against total tau (HT7), 3R and 4R tau isoforms (RD3, RD4), and phospho-epitopes Ser202/Thr205 (AT8), Thr217 (anti-T217), Thr212/Ser214 (AT100), Thr181 (AT270), Ser396 (anti-pS396) and Ser422 (anti-pS422). Retinal tau load was compared to p-tau Ser202/Thr205 and p-tau Thr217 load in various brain regions. Total tau, 3R and 4R tau isoforms were most prominently present in the inner plexiform layer (IPL) and outer plexiform layer (OPL) of the retina and were detected in all cases and controls as a diffuse and somatodendritic signal. Total tau, p-tau Ser202/Thr205 and p-tau Thr217 was observed in amacrine and horizontal cells of the inner nuclear layer (INL). Various antibodies directed against phospho-epitopes of tau showed immunoreactivity in the IPL, OPL, and INL. P-tau Ser202/Thr205 and Thr217 showed significant discrimination between AD and other tauopathies, and non-tauopathy cases including controls. Whilst immunopositivity was observed for p-tau Thr212/Ser214, Thr181 and Ser396, there were no group differences. P-tau Ser422 did not show any immunoreactivity in the retina. The presence of retinal p-tau Ser202/Thr205 and Thr217 correlated with Braak stage for NFTs and with the presence of p-tau Ser202/Thr205 in hippocampus and cortical brain regions. Depending on the phospho-epitope, p-tau in the retina is a potential biomarker for AD and primary tauopathies.
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Affiliation(s)
- Frederique J Hart de Ruyter
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, The Netherlands.
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
| | - Tjado H J Morrema
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jurre den Haan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Johannes F de Boer
- Vrije Universiteit Amsterdam, LaserLaB, Physics and Astronomy, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Baayla D C Boon
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, The Netherlands
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Mayo Clinic, Neuroscience, Jacksonville, FL, USA
| | - Dietmar R Thal
- Laboratory for Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute, O&N IV Herestraat 49, 3000, Louvain, Belgium
- Department of Pathology, University Hospitals Leuven, 3000, Louvain, Belgium
| | - Annemieke J Rozemuller
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frank D Verbraak
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Femke H Bouwman
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Jeroen J M Hoozemans
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
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Al-Rousan T, Kamalyan L, Bernstein Sideman A, Miller B, AlHeresh R, Moore A, Marquine MJ, Argeros G, Ajrouch KJ. Migration and Cognitive Health Disparities: The Arab American and Refugee Case. J Gerontol B Psychol Sci Soc Sci 2023; 78:111-123. [PMID: 36056890 PMCID: PMC9890904 DOI: 10.1093/geronb/gbac129] [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: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES This study investigates whether the year of arrival to the United States (U.S.) and birthplace relate to postmigration cognitive difficulties among foreign- and U.S.-born Arab Americans in later life. METHODS We analyzed 19 years (2000-2019) of data from the American Community Survey Public Use Microdata Samples (weighted N = 393,501; ages ≥ 50 years). Cognitive difficulty was based on self-reported data, and weighted means, percentages, adjusted prevalence estimates, and adjusted odds ratio were calculated. RESULTS Controlling only for demographics, foreign-born Arabs reported higher odds of cognitive difficulty compared to U.S.-born Arabs across all arrival cohorts (p < .001). After accounting for economic and integration factors, those who arrived between 1991 and 2000 had higher odds (odds ratio [OR] = 1.06, 95% confidence interval [CI] =1.00, 1.19, p < .01), while those who arrived after 2001 had lower odds (OR = 0.87, 95% CI = 0.78, 0.97, p < .001) of cognitive difficulty. Lacking English proficiency (OR = 1.90, 95% CI = 1.82, 1.98, p < .001) was related to higher odds, whereas not being a U.S. citizen was significantly associated with lower odds (OR = 0.89, 95% CI = 0.52, 0.94, p < .001) of cognitive difficulty. Yet, results varied by birthplace. Migrants born in Iraq consistently reported the highest odds of cognitive difficulty across all arrival cohorts. DISCUSSION Migration history and birthplace may be important factors explaining cognitive disparities among the diverse group of Arab migrants and Arab Americans. Future research examining mechanisms underlying these associations and the impact of migration on cognitive health is needed to address cognitive disparities in migrants.
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Affiliation(s)
- Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Global Brain Health Institute, University of California, San Francisco, California, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, California, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Bruce Miller
- Global Brain Health Institute, University of California, San Francisco, California, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Rawan AlHeresh
- Mass General Health Institute of Health Professions, Boston, Massachusetts, USA
| | - Alison Moore
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, California, USA
| | - María J Marquine
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, California, USA
| | - Grigoris Argeros
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Kristine J Ajrouch
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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6
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Gibbons LE, Power MC, Walker RL, Kumar RG, Murphy A, Latimer CS, Nolan AL, Melief EJ, Beller A, Bogdani M, Keene CD, Larson EB, Crane PK, Dams-O'Connor K. Association of Traumatic Brain Injury with Late Life Neuropathological Outcomes in a Community-Based Cohort. J Alzheimers Dis 2023; 93:949-961. [PMID: 37125552 DOI: 10.3233/jad-221224] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND Prior studies into the association of head trauma with neuropathology have been limited by incomplete lifetime neurotrauma exposure characterization. OBJECTIVE To investigate the neuropathological sequelae of traumatic brain injury (TBI) in an autopsy sample using three sources of TBI ascertainment, weighting findings to reflect associations in the larger, community-based cohort. METHODS Self-reported head trauma with loss of consciousness (LOC) exposure was collected in biennial clinic visits from 780 older adults from the Adult Changes in Thought study who later died and donated their brain for research. Self-report data were supplemented with medical record abstraction, and, for 244 people, structured interviews on lifetime head trauma. Neuropathology outcomes included Braak stage, CERAD neuritic plaque density, Lewy body distribution, vascular pathology, hippocampal sclerosis, and cerebral/cortical atrophy. Exposures were TBI with or without LOC. Modified Poisson regressions adjusting for age, sex, education, and APOE ɛ4 genotype were weighted back to the full cohort of 5,546 participants. RESULTS TBI with LOC was associated with the presence of cerebral cortical atrophy (Relative Risk 1.22, 95% CI 1.02, 1.42). None of the other outcomes was associated with TBI with or without LOC. CONCLUSION TBI with LOC was associated with increased risk of cerebral cortical atrophy. Despite our enhanced TBI ascertainment, we found no association with the Alzheimer's disease-related neuropathologic outcomes among people who survived to at least age 65 without dementia. This suggests the pathophysiological processes underlying post-traumatic neurodegeneration are distinct from the hallmark pathologies of Alzheimer's disease.
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Affiliation(s)
- Laura E Gibbons
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Melinda C Power
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alia Murphy
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Caitlin S Latimer
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Amber L Nolan
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erica J Melief
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Allison Beller
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Marika Bogdani
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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van Dongen DHE, Havermans D, Deckers K, Olff M, Verhey F, Sobczak S. A first insight into the clinical manifestation of posttraumatic stress disorder in dementia: a systematic literature review. Psychogeriatrics 2022; 22:509-520. [PMID: 35474626 DOI: 10.1111/psyg.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent disorder worldwide and often co-occurs in dementia. Both have a major impact on disease burden and quality of life. PTSD may be difficult to recognize in dementia and a structured diagnostic method is lacking. In order to get insight into the clinical diagnostics of PTSD in dementia, this systematic literature review evaluates the clinical presentation of PTSD and other relevant symptoms in people with dementia. PubMed, PsycINFO, Embase, and CINAHL were searched for all publications through 30 December 2021. Articles were included which met the following criteria: (i) description of at least one case with a current diagnosis of dementia and co-morbid PTSD; (ii) clinical presentation of symptoms being adequately described; (iii) no difference being made between chronic PTSD, PTSD with re-activation, and delayed onset PTSD. Of the 947 identified abstracts, 13 papers met the inclusion criteria and were included (describing 30 cases). Based on our rating, only one case completely fulfilled the DSM-5 criteria of PTSD. Avoidance was only described in three cases. Most commonly described symptoms were irritability and anger (E1, 9%), persistent negative emotional state (D4, 9%), and sleep disturbances (E6, 8%). In 93% of the case reports, other symptoms were also described, i.e. memory problems (58%), screaming (33.3%), and wandering (22.2%). People with dementia who have experienced a traumatic event seem to present, based on our rating method, with insufficient symptoms to meet all criteria for a PTSD DSM-5 diagnosis. The DSM-5 core symptom of avoidance was absent in most of the cases. Clinical presentation consists mainly of symptoms of irritability, anger, persistent negative emotional state, and sleep disturbances, often accompanied by other symptoms. These findings suggest that older people with dementia may have other symptom presentations than people without dementia.
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Affiliation(s)
- Dorien H E van Dongen
- Department of clinical geriatrics, Zuyderland Medical Hospital, Sittard-Heerlen, The Netherlands
| | - Demi Havermans
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,Department of psychotrauma, ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sjacko Sobczak
- Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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8
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Brett BL, Gardner RC, Godbout J, Dams-O’Connor K, Keene CD. Traumatic Brain Injury and Risk of Neurodegenerative Disorder. Biol Psychiatry 2022; 91:498-507. [PMID: 34364650 PMCID: PMC8636548 DOI: 10.1016/j.biopsych.2021.05.025] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/26/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI), particularly of greater severity (i.e., moderate to severe), has been identified as a risk factor for all-cause dementia and Parkinson's disease, with risk for specific dementia subtypes being more variable. Among the limited studies involving neuropathological (postmortem) confirmation, the association between TBI and risk for neurodegenerative disease increases in complexity, with polypathology often reported on examination. The heterogeneous clinical and neuropathological outcomes associated with TBI are likely reflective of the multifaceted postinjury acute and chronic processes that may contribute to neurodegeneration. Acutely in TBI, axonal injury and disrupted transport influences molecular mechanisms fundamental to the formation of pathological proteins, such as amyloid-β peptide and hyperphosphorylated tau. These protein deposits may develop into amyloid-β plaques, hyperphosphorylated tau-positive neurofibrillary tangles, and dystrophic neurites. These and other characteristic neurodegenerative disease pathologies may then spread across brain regions. The acute immune and neuroinflammatory response involves alteration of microglia, astrocytes, oligodendrocytes, and endothelial cells; release of downstream pro- and anti-inflammatory cytokines and chemokines; and recruitment of peripheral immune cells. Although thought to be neuroprotective and reparative initially, prolongation of these processes may promote neurodegeneration. We review the evidence for TBI as a risk factor for neurodegenerative disorders, including Alzheimer's dementia and Parkinson's disease, in clinical and neuropathological studies. Further, we describe the dynamic interactions between acute response to injury and chronic processes that may be involved in TBI-related pathogenesis and progression of neurodegeneration.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Medical College of
Wisconsin,Corresponding author: Benjamin L.
Brett, 414-955-7316, , Medical College of
Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Raquel C. Gardner
- Department of Neurology, Memory and Aging Center, Weill
Institute for Neurosciences, University of California San Francisco and the San
Francisco Veterans Affairs Medical Center
| | - Jonathan Godbout
- Department of Neuroscience, Chronic Brain Injury Program,
The Ohio State Wexner Medical Center, Columbus, OH
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance,
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York NY
| | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University
of Washington School of Medicine, Seattle, WA
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9
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Dismuke-Greer CE, Esmaeili A, Karmarkar AM, Davis B, Garcia C, Pugh MJ, Yaffe K. Economic impact of comorbid TBI-dementia on VA facility and non-VA facility costs, 2000-2020. Brain Inj 2022; 36:673-682. [PMID: 35099349 DOI: 10.1080/02699052.2022.2034045] [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: 11/02/2022]
Abstract
OBJECTIVE There is evidence Traumatic Brain Injury (TBI) is associated with increased risk of dementia (D). We compared VA and non-VA facility costs associated with TBI+D and each diagnosis alone, relative to neither diagnosis, annually and over time, 2000-2020. METHODS We estimated adjusted panel models of annual VHA costs in VA and non-VA facilities, stratified by age, and by TBI-dementia status. We also estimated cost for the TBI+D cohort by time since TBI and dementia diagnoses. All costs were 2021 inflation adjusted. RESULTS Veterans <65 ($30,736) and ≥65 ($15,650) with TBI+D, while veterans <65 ($3,379) and ≥65 ($4,252) with TBI-only had higher annual total VHA costs, relative to neither diagnosis. Veterans with TBI+D < 65 ($42,864) and ≥65 ($72,424) had higher costs in years≥15 after TBI diagnosis, while <65 ($36,431) and ≥65 ($37,589) had higher costs in years ≥10 after dementia diagnosis. CONCLUSIONS The main cost driver was inpatient non-VA facility costs. Veterans had continuously increasing inpatient care costs in non-VA facilities over time since their TBI and dementia diagnoses. Given budget constraints on the VA system, quality of care in non-VA facilities warrants comparison with VA facilities to make informed decisions regarding referrals to non-VA facilities.
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Affiliation(s)
- Clara E Dismuke-Greer
- Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Aryan Esmaeili
- Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Amol M Karmarkar
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Sheltering Arms Institute, and Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Boyd Davis
- Department of English, College of Liberal Arts & Sciences, The University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Carla Garcia
- Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Mary Jo Pugh
- Department of Medicine, Division of Epidemiology, School Medicine, University of Utah, and Salt Lake City Veterans Healthcare System, Salt Lake City, Utah, USA
| | - Kristine Yaffe
- School of Medicine, University of California, San Francisco VA Healthcare System, and San Francisco VA Medical Center, San Francisco, California, USA
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10
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Cimino N, Kang MS, Honig LS, Rutherford BR. Blood-Based Biomarkers for Alzheimer’s Disease in Older Adults with Posttraumatic Stress Disorder. J Alzheimers Dis Rep 2022; 6:49-56. [PMID: 35360274 PMCID: PMC8925121 DOI: 10.3233/adr-210048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is associated with cognitive decline and risk for dementia, but the neuropathology involved is unclear. Objective: The aim of this study was to determine whether PTSD is associated with increased levels of Alzheimer’s disease (AD) blood-based biomarkers. Methods: Individuals aged 50 years and older with PTSD were compared to trauma-exposed healthy controls (TEHCs) at baseline on serum measures of amyloid-β (Aβ) 42 and 40 levels, the Aβ 42/Aβ 40 ratio, and total tau. Serum was analyzed using ultrasensitive Simoa Human Neurology 3-Plex A assay (N3PA). Linear regressions modeling each AD biomarker as a function of group were used to investigate between-group differences, controlling for age, sex, and educational attainment (years). Results: TEHC participants (N = 26) were 53.8% male with mean age 66.8±10.7, whereas PTSD participants (N = 44) were 47.7% male and aged 62.5±9.1 years. No between-group differences were noted on demographic characteristics or cognitive performance measured with the NIH Toolbox Cognition Battery. There were no significant between-group differences in serum Aβ 40 (TEHC 105.8±51.6 versus PTSD 93.2±56.1, p = 0.46), Aβ 42 (TEHC 8.1±4.6 versus PTSD 7.8±4.6, p = 0.63), Aβ 42/Aβ 40 (TEHC 0.08±0.03 versus PTSD 0.09±0.03, p = 0.27), or total tau (TEHC 0.5±0.3 versus PTSD 0.5±0.4, p = 0.77). Likewise, there were no significant interaction effects of amyloid or tau serum concentrations and PTSD group status on cognitive functioning. Conclusion: Findings from cognitive assessments and serum analyses do not support PTSD-induced neurodegeneration of the Alzheimer’s type as a pathway linking PTSD to increased incidence of dementia in older adults.
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Affiliation(s)
| | - Min Suk Kang
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lawrence S. Honig
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Bret R. Rutherford
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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11
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Troyanskaya M, Pastorek NJ, Wilde EA, Tombridge KA, Day AM, Levin HS, Scheibel RS. Risk factors for decline in cognitive performance following deployment-related mild traumatic brain injury: A preliminary report. Neurocase 2021; 27:457-461. [PMID: 34783300 DOI: 10.1080/13554794.2021.2002912] [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: 10/19/2022]
Abstract
Thorough identification of risk factors for delayed decline in cognitive performance following combat-related mild traumatic brain injury (mTBI) is important for guiding comprehensive post-deployment rehabilitation. In a sample of veterans who reported at least one deployment-related mTBI, preliminary results indicate that factors including a history of loss of consciousness over 1 min, current obesity and hypertension, and Black race were more prevalent in those with decreased scores on a measure of memory function. These factors should be considered by clinicians and researchers working with current and former military personnel.
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Affiliation(s)
- Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA
| | - Nicholas J Pastorek
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA
| | - Elisabeth A Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA.,Department of Neurology, University of Utah School of Medicine. Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Medical Center. Salt Lake City, Ut, USA
| | | | - Alyssa M Day
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,Department of Psychology. Houston, University of Houston, TX, USA
| | - Harvey S Levin
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA.,Department of Neurology, Baylor College of Medicine. Houston, Tx, USA.,Department of Neurosurgery, Baylor College of Medicine. Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine. Houston, Tx, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Houston, TX, USA
| | - Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA
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12
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Pugh MJ, Kennedy E, Prager EM, Humpherys J, Dams-O'Connor K, Hack D, McCafferty MK, Wolfe J, Yaffe K, McCrea M, Ferguson AR, Lancashire L, Ghajar J, Lumba-Brown A. Phenotyping the Spectrum of Traumatic Brain Injury: A Review and Pathway to Standardization. J Neurotrauma 2021; 38:3222-3234. [PMID: 33858210 PMCID: PMC8917880 DOI: 10.1089/neu.2021.0059] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
It is widely appreciated that the spectrum of traumatic brain injury (TBI), mild through severe, contains distinct clinical presentations, variably referred to as subtypes, phenotypes, and/or clinical profiles. As part of the Brain Trauma Blueprint TBI State of the Science, we review the current literature on TBI phenotyping with an emphasis on unsupervised methodological approaches, and describe five phenotypes that appear similar across reports. However, we also find the literature contains divergent analysis strategies, inclusion criteria, findings, and use of terms. Further, whereas some studies delineate phenotypes within a specific severity of TBI, others derive phenotypes across the full spectrum of severity. Together, these facts confound direct synthesis of the findings. To overcome this, we introduce PhenoBench, a freely available code repository for the standardization and evaluation of raw phenotyping data. With this review and toolset, we provide a pathway toward robust, data-driven phenotypes that can capture the heterogeneity of TBI, enabling reproducible insights and targeted care.
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Affiliation(s)
- 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
| | - Eamonn Kennedy
- 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
| | | | - Jeffrey Humpherys
- 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
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dallas Hack
- Cohen Veterans Bioscience, New York, New York, USA
| | - Mary Katherine McCafferty
- 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, California, USA.,Department of Psychiatry, University of California San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee Wisconsin, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California San Francisco, California, USA.,San Francisco Veterans Affairs Health System, San Francisco, California, USA
| | | | - Jamshid Ghajar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.,Brain Performance Center, Stanford University School of Medicine, Stanford, California, USA
| | - Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.,Brain Performance Center, Stanford University School of Medicine, Stanford, California, USA
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13
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Perez Garcia G, De Gasperi R, Gama Sosa MA, Perez GM, Otero-Pagan A, Pryor D, Abutarboush R, Kawoos U, Hof PR, Dickstein DL, Cook DG, Gandy S, Ahlers ST, Elder GA. Laterality and region-specific tau phosphorylation correlate with PTSD-related behavioral traits in rats exposed to repetitive low-level blast. Acta Neuropathol Commun 2021; 9:33. [PMID: 33648608 PMCID: PMC7923605 DOI: 10.1186/s40478-021-01128-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022] Open
Abstract
Military veterans who experience blast-related traumatic brain injuries often suffer from chronic cognitive and neurobehavioral syndromes. Reports of abnormal tau processing following blast injury have raised concerns that some cases may have a neurodegenerative basis. Rats exposed to repetitive low-level blast exhibit chronic neurobehavioral traits and accumulate tau phosphorylated at threonine 181 (Thr181). Using data previously reported in separate studies we tested the hypothesis that region-specific patterns of Thr181 phosphorylation correlate with behavioral measures also previously determined and reported in the same animals. Elevated p-tau Thr181 in anterior neocortical regions and right hippocampus correlated with anxiety as well as fear learning and novel object localization. There were no correlations with levels in amygdala or posterior neocortical regions. Particularly striking were asymmetrical effects on the right and left hippocampus. No systematic variation in head orientation toward the blast wave seems to explain the laterality. Levels did not correlate with behavioral measures of hyperarousal. Results were specific to Thr181 in that no correlations were observed for three other phospho-acceptor sites (threonine 231, serine 396, and serine 404). No consistent correlations were linked with total tau. These correlations are significant in suggesting that p-tau accumulation in anterior neocortical regions and the hippocampus may lead to disinhibited amygdala function without p-tau elevation in the amygdala itself. They also suggest an association linking blast injury with tauopathy, which has implications for understanding the relationship of chronic blast-related neurobehavioral syndromes in humans to neurodegenerative diseases.
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14
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Bieniek KF, Cairns NJ, Crary JF, Dickson DW, Folkerth RD, Keene CD, Litvan I, Perl DP, Stein TD, Vonsattel JP, Stewart W, Dams-O’Connor K, Gordon WA, Tripodis Y, Alvarez VE, Mez J, Alosco ML, McKee AC. The Second NINDS/NIBIB Consensus Meeting to Define Neuropathological Criteria for the Diagnosis of Chronic Traumatic Encephalopathy. J Neuropathol Exp Neurol 2021; 80:210-219. [PMID: 33611507 PMCID: PMC7899277 DOI: 10.1093/jnen/nlab001] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with exposure to head trauma. In 2015, a panel of neuropathologists funded by the NINDS/NIBIB defined preliminary consensus neuropathological criteria for CTE, including the pathognomonic lesion of CTE as "an accumulation of abnormal hyperphosphorylated tau (p-tau) in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci and in an irregular pattern," based on review of 25 tauopathy cases. In 2016, the consensus panel met again to review and refine the preliminary criteria, with consideration around the minimum threshold for diagnosis and the reproducibility of a proposed pathological staging scheme. Eight neuropathologists evaluated 27 cases of tauopathies (17 CTE cases), blinded to clinical and demographic information. Generalized estimating equation analyses showed a statistically significant association between the raters and CTE diagnosis for both the blinded (OR = 72.11, 95% CI = 19.5-267.0) and unblinded rounds (OR = 256.91, 95% CI = 63.6-1558.6). Based on the challenges in assigning CTE stage, the panel proposed a working protocol including a minimum threshold for CTE diagnosis and an algorithm for the assessment of CTE severity as "Low CTE" or "High CTE" for use in future clinical, pathological, and molecular studies.
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Affiliation(s)
- Kevin F Bieniek
- Department of Pathology, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas
| | - Nigel J Cairns
- Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri
| | - John F Crary
- Departments of Pathology & Neuroscience, Ronald M. Loeb Center for Alzheimer’s Disease, Freidman Brain Institute, Icahn School of Medicine at Mount Sinai School, New York, New York
| | | | - Rebecca D Folkerth
- New York City Office of Chief Medical Examiner and Department of Forensic Medicine, New York University School of Medicine, New York, New York
| | - C Dirk Keene
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, California
| | - Daniel P Perl
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Thor D Stein
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Pathology, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
- Alzheimer's Disease Center, CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
| | - Jean-Paul Vonsattel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York
| | - William Stewart
- Department of Neuropathology, University of Glasgow Institute of Neuroscience and Psychology and Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Kristen Dams-O’Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Neurology (KD-O), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wayne A Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yorghos Tripodis
- Alzheimer's Disease Center, CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
| | - Victor E Alvarez
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
- Alzheimer's Disease Center, CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
- Alzheimer's Disease Center, CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
| | - Michael L Alosco
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
- Alzheimer's Disease Center, CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
| | - Ann C McKee
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Pathology, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
- Alzheimer's Disease Center, CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Veteran Affairs Medical Center, Bedford, Massachusetts
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15
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Heyburn L, Abutarboush R, Goodrich S, Urioste R, Batuure A, Wheel J, Wilder DM, Arun P, Ahlers ST, Long JB, Sajja VS. Repeated Low-Level Blast Acutely Alters Brain Cytokines, Neurovascular Proteins, Mechanotransduction, and Neurodegenerative Markers in a Rat Model. Front Cell Neurosci 2021; 15:636707. [PMID: 33679327 PMCID: PMC7933446 DOI: 10.3389/fncel.2021.636707] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Exposure to the repeated low-level blast overpressure (BOP) periodically experienced by military personnel in operational and training environments can lead to deficits in behavior and cognition. While these low-intensity blasts do not cause overt changes acutely, repeated exposures may lead to cumulative effects in the brain that include acute inflammation, vascular disruption, and other molecular changes, which may eventually contribute to neurodegenerative processes. To identify these acute changes in the brain following repeated BOP, an advanced blast simulator was used to expose rats to 8.5 or 10 psi BOP once per day for 14 days. At 24 h after the final BOP, brain tissue was collected and analyzed for inflammatory markers, astrogliosis (GFAP), tight junction proteins (claudin-5 and occludin), and neurodegeneration-related proteins (Aβ40/42, pTau, TDP-43). After repeated exposure to 8.5 psi BOP, the change in cytokine profile was relatively modest compared to the changes observed following 10 psi BOP, which included a significant reduction in several inflammatory markers. Reduction in the tight junction protein occludin was observed in both groups when compared to controls, suggesting cerebrovascular disruption. While repeated exposure to 8.5 psi BOP led to a reduction in the Alzheimer’s disease (AD)-related proteins amyloid-β (Aβ)40 and Aβ42, these changes were not observed in the 10 psi group, which had a significant reduction in phosphorylated tau. Finally, repeated 10 psi BOP exposures led to an increase in GFAP, indicating alterations in astrocytes, and an increase in the mechanosensitive ion channel receptor protein, Piezo2, which may increase brain sensitivity to injury from pressure changes from BOP exposure. Overall, cumulative effects of repeated low-level BOP may increase the vulnerability to injury of the brain by disrupting neurovascular architecture, which may lead to downstream deleterious effects on behavior and cognition.
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Affiliation(s)
- Lanier Heyburn
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Rania Abutarboush
- Neurotrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, United States
| | - Samantha Goodrich
- Neurotrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, United States
| | - Rodrigo Urioste
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Andrew Batuure
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Jaimena Wheel
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Donna M Wilder
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Peethambaran Arun
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Stephen T Ahlers
- Neurotrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, United States
| | - Joseph B Long
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Venkatasivasai Sujith Sajja
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
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16
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Kempuraj D, Ahmed ME, Selvakumar GP, Thangavel R, Raikwar SP, Zaheer SA, Iyer SS, Burton C, James D, Zaheer A. Psychological Stress-Induced Immune Response and Risk of Alzheimer's Disease in Veterans from Operation Enduring Freedom and Operation Iraqi Freedom. Clin Ther 2020; 42:974-982. [PMID: 32184013 PMCID: PMC7308186 DOI: 10.1016/j.clinthera.2020.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Psychological stress is a significant health problem in veterans and their family members. Traumatic brain injury (TBI) and stress lead to the onset, progression, and worsening of several inflammatory and neurodegenerative diseases in veterans and civilians. Alzheimer's disease (AD) is a progressive, irreversible neuroinflammatory disease that causes problems with memory, thinking, and behavior. TBIs and chronic psychological stress cause and accelerate the pathology of neuroinflammatory diseases such as AD. However, the precise molecular and cellular mechanisms governing neuroinflammation and neurodegeneration are currently unknown, especially in veterans. The purpose of this review article was to advance the hypothesis that stress and TBI-mediated immune response substantially contribute and accelerate the pathogenesis of AD in veterans and their close family members and civilians. METHODS The information in this article was collected and interpreted from published articles in PubMed between 1985 and 2020 using the key words stress, psychological stress, Afghanistan war, Operation Enduring Freedom (OEF), Iraq War, Operation Iraqi Freedom (OIF), Operation New Dawn (OND), traumatic brain injury, mast cell and stress, stress and neuroimmune response, stress and Alzheimer's disease, traumatic brain injury, and Alzheimer's disease. FINDINGS Chronic psychological stress and brain injury induce the generation and accumulation of beta-amyloid peptide, amyloid plaques, neurofibrillary tangles, and phosphorylation of tau in the brain, thereby contributing to AD pathogenesis. Active military personnel and veterans are under enormous psychological stress due to various war-related activities, including TBIs, disabilities, fear, new environmental conditions, lack of normal life activities, insufficient communications, explosions, military-related noise, and health hazards. Brain injury, stress, mast cell, and other immune cell activation can induce headache, migraine, dementia, and upregulate neuroinflammation and neurodegeneration in veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. TBIs, posttraumatic stress disorder, psychological stress, pain, glial activation, and dementia in active military personnel, veterans, or their family members can cause AD several years later in their lives. We suggest that there are increasing numbers of veterans with TBIs and stress and that these veterans may develop AD late in life if no appropriate therapeutic intervention is available. IMPLICATIONS Per these published reports, the fact that TBIs and psychological stress can accelerate the pathogenesis of AD should be recognized. Active military personnel, veterans, and their close family members should be evaluated regularly for stress symptoms to prevent the pathogenesis of neurodegenerative diseases, including AD.
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Affiliation(s)
- Duraisamy Kempuraj
- Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA.
| | - Mohammad Ejaz Ahmed
- Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Govindhasamy Pushpavathi Selvakumar
- Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Ramasamy Thangavel
- Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sudhanshu P Raikwar
- Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Smita A Zaheer
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Shankar S Iyer
- Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | | | | | - Asgar Zaheer
- Harry S. Truman Memorial Veterans Hospital, US Department of Veterans Affairs, Columbia, MO, USA; Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA; Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA.
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