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da Silva Fiorin F, Cunha do Espírito Santo C, Santos do Nascimento R, França AP, Freire Royes LF. Behavioral deficits after mild traumatic brain injury by fluid percussion in rats. Neurosci Lett 2024; 818:137550. [PMID: 37926292 DOI: 10.1016/j.neulet.2023.137550] [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: 09/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
Mild traumatic brain injury (TBI) can lead to various disorders, encompassing cognitive and psychiatric complications. While pre-clinical studies have long investigated behavioral alterations, the fluid percussion injury (FPI) model still lacks a comprehensive behavioral battery that includes psychiatric-like disorders. To address this gap, we conducted multiple behavioral tasks over two months in adult male Wistar rats, focusing on mild FPI. Statistical analyses revealed that both naive and sham animals exhibited an increase in sweet liquid consumption over time. In contrast, the TBI group did not show any temporal changes, although mild FPI did induce a statistically significant decrease in sucrose consumption compared to control groups during the chronic phase. Additionally, social interaction tasks indicated reduced contact time in TBI animals. The elevated plus maze task demonstrated an increase in open-arm exploration following fluid percussion. Nonetheless, no significant differences were observed in the acute and chronic phases for the forced swim and light-dark box tasks. Evaluation of three distinct memory tasks in the chronic phase revealed that mild FPI led to long-term memory deficits, as assessed by the object recognition task, while the surgical procedure itself resulted in short-term spatial memory deficits, as evaluated by the Y-maze task. Conversely, working memory remained unaffected in the water maze task. Collectively, these findings provide a nuanced characterization of behavioral deficits induced by mild FPI.
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Affiliation(s)
- Fernando da Silva Fiorin
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Laboratório de Neurobiologia da Dor e Inflamação, Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Laboratório de Bioquímica do Exercício, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
| | - Caroline Cunha do Espírito Santo
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Laboratório de Neurobiologia da Dor e Inflamação, Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Raphael Santos do Nascimento
- Instituto de Engenharia Biomédica, Departamento de Engenharia Elétrica e Eletrônica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Angela Patricia França
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Luiz Fernando Freire Royes
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Laboratório de Bioquímica do Exercício, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Chen YT, Nyam TTE, Tsai LC, Chang CH, Su CL, Ho CH, Chio CC, Gean PW, Kuo JR. Pretreatment with Lovastatin Improves Depression-Like Behavior After Traumatic Brain Injury Through Activation of the AMPK Pathway. World Neurosurg 2023; 180:e350-e363. [PMID: 37757945 DOI: 10.1016/j.wneu.2023.09.071] [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: 06/02/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The beneficial effect of pretreatment with statins on traumatic brain injury (TBI)-induced depression and anxiety and its mechanism of action remain unclear. In this study, we combined epidemiological and experimental animal data to clarify this issue. METHODS We used the Taiwan National Health Insurance database to identify patients who were diagnosed with TBI from 2000 to 2013 and compared patients with and without statin treatment matched by age, sex, and underlying comorbidities in a 1:1 ratio. The risk of developing depression and/or anxiety was compared between patients with and without a statin using Cox proportional hazards regression. We also used a rat model to assess the effect of lovastatin pretreatment on neurobehavioral and neuropathological changes following TBI. RESULTS The risk of developing depression was lower in the 41,803 patients in the statin cohort than nonstatin cohort (adjusted hazard ratio, 0.91 [95% confidence interval, 0.83-0.99]). In animal models, the lovastatin group had significantly reduced infarct volume, decreased immobility time and latency to eat, a reduced number of Fluoro- Jade-positive cells and levels of glial fibrillary acidic protein and tumor necrosis factor-alpha, and increased adenosine monophosphate -activated protein kinase (AMPK) and its upstream kinase liver kinase B1 in the hippocampal dentate gyrus. These effects were blocked in AMPK inhibitor-pretreated TBI rats. CONCLUSIONS Our epidemiological data showed that a decreased risk of depression was associated with statin pretreatment, which was supported by an animal study. The underlying mechanism for this appears to involve AMPK activation in the statin pretreatment-induced alleviation of TBI.
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Affiliation(s)
- Yu-Ting Chen
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | | | - Li-Chen Tsai
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chih-Hua Chang
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chun-Lin Su
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-Wu Gean
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
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Chui A, Seaton S, Kirsh B, Dawson DR, Colquhoun H. Representation in rehabilitation research of adults with traumatic brain injury and depression: A scoping review. Brain Inj 2021; 35:645-654. [PMID: 33720788 DOI: 10.1080/02699052.2021.1894481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To determine how well comorbid depression is described, defined, and measured in the rehabilitation literature that pertains to TBI and depression.Method: Scoping review of the rehabilitation sciences literature. Six databases were searched (to October 17, 2018) using the three core concepts of TBI, depression, and rehabilitation, as was for gray literature. Two independent reviewers reviewed documents for eligibility.Results: 3737 records were reviewed and 137 documents were analyzed. Primary studies (n = 126) were most prevalent and of quantitative descriptive design (n = 102). The number of participants with TBI and comorbid depression could only be determined for 81/126 (64%) of primary studies, in which they are the minority (median of 30% of sample). Depression reporting was heterogeneous and individuals with TBI and depression were not analyzed as a subgroup in most studies (n = 68, 55%). Depression self-report instruments are commonly used (14 instruments used in 111 studies). Few studies (n = 14, 19%) have participant samples with discrete severity levels of TBI and depression.Conclusions: Better participant representation and reporting of TBI and depression variables are needed to enhance comparability across studies and improve rehabilitation outcomes.
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Affiliation(s)
- Adora Chui
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest, Toronto, Canada
| | - Samantha Seaton
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Bonnie Kirsh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Deirdre R Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Lim SW, Sung KC, Shiue YL, Wang CC, Chio CC, Kuo JR. Hyperbaric Oxygen Effects on Depression-Like Behavior and Neuroinflammation in Traumatic Brain Injury Rats. World Neurosurg 2017; 100:128-137. [PMID: 28065873 DOI: 10.1016/j.wneu.2016.12.118] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/27/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether hyperbaric oxygen (HBO) therapy causes attenuation of traumatic brain injury (TBI)-induced depression-like behavior and its associated anti-neuroinflammatory effects after fluid percussion injury. METHODS Anesthetized male Sprague-Dawley rats were divided into 3 groups: sham operation plus normobaric air (NBA) (21% oxygen at 1 absolute atmosphere [ATA]), TBI plus NBA, and TBI plus HBO (100% oxygen at 2.0 ATA). HBO was applied immediately for 60 min/d after TBI for 3 days. Depression-like behavior was tested by a forced swimming test, motor function was tested by an inclined plane test, and infarction volume was tested by triphenyltetrazolium chloride (TTC) staining on days 4, 8, and 15. Neuronal apoptosis (terminal deoxynucleotidyl transferase dUTP nick-end labeling assay), microglial (marker OX42) activation, and tumor necrosis factor (TNF)-α expression in microglia in the hippocampus CA3 were measured by immunofluorescence methods. RESULTS Compared with the TBI controls, without significant changes in TTC staining or in the motor function test, TBI-induced depression-like behavior was significantly attenuated by HBO therapy by day 15 after TBI. Simultaneously, TBI-induced neuronal apoptosis, microglial (marker OX42) activation, and TNF-α expression in the microglia in the hippocampus CA3 were significantly reduced by HBO. CONCLUSIONS Our results suggest that HBO treatment may ameliorate TBI-induced depression-like behavior in rats by attenuating neuroinflammation, representing one possible mechanism by which depression-like behavior recovery might occur. We also recommend HBO as a potential treatment for TBI-induced depression-like behavior if early intervention is possible.
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Affiliation(s)
- Sher-Wei Lim
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Kuan-Chin Sung
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Child Care, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2016; 33:1969-1994. [PMID: 26729611 DOI: 10.1089/neu.2015.4252] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review examined pre- and post-injury prevalence of, and risk factors for, anxiety disorders and depressive disorders after traumatic brain injury (TBI), based on evidence from structured diagnostic interviews. A systematic literature search was conducted in EMBASE, MEDLINE, Cochrane Central, PubMed, PsycINFO, and Google Scholar. We identified studies in civilian adults with TBI reporting on the prevalence of anxiety and depressive disorders using structured diagnostic interviews and assessed their quality. Pooled pre- and post-injury prevalence estimates of anxiety disorders and depressive disorders were computed. A total of 34 studies described in 68 publications were identified, often assessing anxiety disorders (n = 9), depressive disorders (n = 7), or a combination of disorders (n = 6). Prevalence rates of psychiatric disorders varied widely. Pooled prevalence estimates of anxiety and depressive disorders were 19% and 13% before TBI and 21% and 17% in the first year after TBI. Pooled prevalence estimates increased over time and indicated high long-term prevalence of Axis I disorders (54%), including anxiety disorders (36%) or depressive disorders (43%). Females, those without employment, and those with a psychiatric history before TBI were at higher risk for anxiety and depressive disorders after TBI. We conclude that a substantial number of patients encounter anxiety and depressive disorders after TBI, and that these problems persist over time. All health care settings should pay attention to the occurrence of psychiatric symptoms in the aftermath of TBI to enable early identification and treatment of these disorders and to enhance the recovery and quality of life of TBI survivors.
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Affiliation(s)
- Annemieke C Scholten
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Juanita A Haagsma
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Maryse C Cnossen
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Miranda Olff
- 2 Department of Psychiatry, Center for Psychological Trauma, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Ed F van Beeck
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Suzanne Polinder
- 1 Department of Public Health, Erasmus University Medical Center , Rotterdam, The Netherlands
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Taslimitehrani V, Dong G, Pereira NL, Panahiazar M, Pathak J. Developing EHR-driven heart failure risk prediction models using CPXR(Log) with the probabilistic loss function. J Biomed Inform 2016; 60:260-9. [PMID: 26844760 PMCID: PMC4886658 DOI: 10.1016/j.jbi.2016.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 01/12/2016] [Accepted: 01/20/2016] [Indexed: 11/30/2022]
Abstract
Computerized survival prediction in healthcare identifying the risk of disease mortality, helps healthcare providers to effectively manage their patients by providing appropriate treatment options. In this study, we propose to apply a classification algorithm, Contrast Pattern Aided Logistic Regression (CPXR(Log)) with the probabilistic loss function, to develop and validate prognostic risk models to predict 1, 2, and 5year survival in heart failure (HF) using data from electronic health records (EHRs) at Mayo Clinic. The CPXR(Log) constructs a pattern aided logistic regression model defined by several patterns and corresponding local logistic regression models. One of the models generated by CPXR(Log) achieved an AUC and accuracy of 0.94 and 0.91, respectively, and significantly outperformed prognostic models reported in prior studies. Data extracted from EHRs allowed incorporation of patient co-morbidities into our models which helped improve the performance of the CPXR(Log) models (15.9% AUC improvement), although did not improve the accuracy of the models built by other classifiers. We also propose a probabilistic loss function to determine the large error and small error instances. The new loss function used in the algorithm outperforms other functions used in the previous studies by 1% improvement in the AUC. This study revealed that using EHR data to build prediction models can be very challenging using existing classification methods due to the high dimensionality and complexity of EHR data. The risk models developed by CPXR(Log) also reveal that HF is a highly heterogeneous disease, i.e., different subgroups of HF patients require different types of considerations with their diagnosis and treatment. Our risk models provided two valuable insights for application of predictive modeling techniques in biomedicine: Logistic risk models often make systematic prediction errors, and it is prudent to use subgroup based prediction models such as those given by CPXR(Log) when investigating heterogeneous diseases.
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Affiliation(s)
- Vahid Taslimitehrani
- Department of Computer Science and Engineering, Kno.e.sis Center, Wright State University, Dayton, OH, USA; Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA.
| | - Guozhu Dong
- Department of Computer Science and Engineering, Kno.e.sis Center, Wright State University, Dayton, OH, USA
| | - Naveen L Pereira
- Division of Cardiovascular Diseases and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Maryam Panahiazar
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University, CA, USA
| | - Jyotishman Pathak
- Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA
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Stéfan A, Mathé JF. What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices. Ann Phys Rehabil Med 2016; 59:5-17. [DOI: 10.1016/j.rehab.2015.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022]
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A Meta-Analytic Review of Minnesota Multiphasic Personality Inventory—2nd Edition (MMPI-2) Profile Elevations Following Traumatic Brain Injury. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9236-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Osborn A, Mathias J, Fairweather-Schmidt A. Depression following adult, non-penetrating traumatic brain injury: A meta-analysis examining methodological variables and sample characteristics. Neurosci Biobehav Rev 2014; 47:1-15. [DOI: 10.1016/j.neubiorev.2014.07.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 06/16/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
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Valk-Kleibeuker L, Heijenbrok-Kal MH, Ribbers GM. Mood after moderate and severe traumatic brain injury: a prospective cohort study. PLoS One 2014; 9:e87414. [PMID: 24503864 PMCID: PMC3913594 DOI: 10.1371/journal.pone.0087414] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/25/2013] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the course of mood and identify its determinants up to 3 years after moderate to severe traumatic brain injury (TBI). Design Prospective cohort study. Patients Patients hospitalised with moderate to severe TBI, who survived until hospital discharge. Methods At 3, 6, 12, 18, 24, and 36 months post-injury, mood was assessed with the Wimbledon Self-Report Scale (WSRS) in the home environment. Motor and cognitive outcome were assessed with the Functional Independence Measure (FIM), and the Functional Assessment Measure (FAM), respectively. Repeated measurements analysis was performed to determine the course of mood over time and its determinants. Results A total of 98 patients (72% men), aged 33 (SD 12.9) years, 78% with severe TBI, was included. Mood did not change until 18 months post TBI, after which it significantly improved (p = 0.016). The FIM score significantly improved up to 18 months post-TBI (p = 0.012) and the FAM score up to 12 months post-TBI (p = 0.000), after which both remained stable. In univariable analyses, time post TBI (β = −0.04, p = 0.008), initial discharge destination (β = 2.13, p = 0.010), FIM (β = −0.22, p<0.001) and FAM (β = −0.29, p<0.001) were significant predictors of mood. In a multivariable mixed model, time post TBI, FAM score, and discharge destination were the strongest predictors of mood. Higher FAM scores were related to better mood scores (β = −0.28, p<0.001). Patients initially discharged home tended to have better mood scores over time than patients first treated in inpatient rehabilitation centers or nursing homes (β = 1.27; p = 0.071). Conclusion Mood starts to improve 18 months after TBI when motor and cognitive outcome have stabilized. Time post TBI, cognitive outcome and initial discharge destination are the strongest predictors of mood up to 3 years after TBI. These data suggest that mood scores of patients with moderate and severe TBI should be frequently monitored, especially in rehabilitation centers and nursing homes.
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Affiliation(s)
- Linda Valk-Kleibeuker
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, University Medical Center Rotterdam, and Rijndam Rehabilitation Center, Rotterdam, The Netherlands
- * E-mail:
| | - Majanka H. Heijenbrok-Kal
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, University Medical Center Rotterdam, and Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Gerard M. Ribbers
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, University Medical Center Rotterdam, and Rijndam Rehabilitation Center, Rotterdam, The Netherlands
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Kuo JR, Cheng YH, Chen YS, Chio CC, Gean PW. Involvement of extracellular signal regulated kinases in traumatic brain injury-induced depression in rodents. J Neurotrauma 2013; 30:1223-31. [PMID: 23360216 DOI: 10.1089/neu.2012.2689] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Traumatic brain injury (TBI) is the most common cause of death and acquired disability among children and young adults in the developed countries. In clinical studies, the incidence of depression is high after TBI, and the mechanisms behind TBI-induced depression remain unclear. In the present study, we subjected rats to a moderate fluid percussion into the closed cranial cavity to induce TBI. After 3 days of recovery, injured rats were given a forced swim test (FST) and novelty-suppressed feeding tests. We found that TBI rats exhibited increased duration of immobility and longer latency to begin chewing food in a new environment compared with sham-operated rats. Western blot analysis showed that TBI led to a decrease in the phosphorylated levels of extracellular signal regulated kinases (ERK1/2) and p38 mitogen-activated protein kinase (p38 MAPK). Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), significantly reduced the duration of immobility when administered once per day for 14 days. Consistent with behavioral tests, fluoxetine treatment reversed TBI-induced decrease in p-ERK1/2 and p-p38 MAPK levels. Pre-treatment with a selective tryptophan hydroxylase inhibitor para-chlorophenylalanine (PCPA) blocked the antidepressant effect of fluoxetine. PCPA also prevented the effect of fluoxetine on ERK1/2 phosphorylation without affecting p38 MAPK phosphorylation. Pre-treatment with ERK inhibitor SL327 but not p38 MAPK inhibitor SB203580 prevented the antidepressant effect of fluoxetine. These results suggest that ERK1/2 plays a critical role in TBI-induced depression.
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Affiliation(s)
- Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Taiwan University of Science and Technology, Tainan, Taiwan
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A Longitudinal Study of Major and Minor Depression Following Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:1343-9. [DOI: 10.1016/j.apmr.2012.03.036] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 11/19/2022]
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Arango-Lasprilla JC, Ketchum JM, Drew A, Hammond F, Powell JM, Kreutzer J, Lim PC, Carr C. Neurobehavioural symptoms 1 year after traumatic brain injury: a preliminary study of the relationship between race/ethnicity and symptoms. Brain Inj 2012; 26:814-24. [PMID: 22583172 DOI: 10.3109/02699052.2012.655360] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate whether White, African American and Hispanic individuals with a traumatic brain injury (TBI) express differences in neurobehavioural symptoms at 1 year post-injury after adjusting for demographic and injury characteristics. DESIGN Retrospective study. PARTICIPANTS One thousand, three hundred and thirty-nine individuals from the TBI Model Systems National Database with primarily moderate-to-severe TBI (978 White, 288 African American and 73 Hispanic) hospitalized between 1996 and 2001. MAIN OUTCOME MEASURES Neurobehavioural Functioning Inventory (NFI) at 1 year post-injury. RESULTS There were significant differences in NFI scores among the races/ethnicities for the depression, somatic, memory/attention, communication and motor subscales, after adjusting for demographic and injury characteristics; there were not significant differences in the aggression sub-scale. Hispanics had higher levels of symptom reporting than African Americans and Whites, while differences between African Americans and Whites were not significant. CONCLUSIONS Hispanics scored significantly higher than Whites and African Americans on the sub-scales of the NFI, indicating more problems in these areas. Future research should focus on identifying factors that may contribute to the difference between the groups and treatment interventions should be implemented accordingly.
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Hart T, Brenner L, Clark AN, Bogner JA, Novack TA, Chervoneva I, Nakase-Richardson R, Arango-Lasprilla JC. Major and minor depression after traumatic brain injury. Arch Phys Med Rehabil 2011; 92:1211-9. [PMID: 21807140 DOI: 10.1016/j.apmr.2011.03.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 02/28/2011] [Accepted: 03/02/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine minor as well as major depression at 1 year posttraumatic brain injury (TBI), with particular attention to the contribution of depression severity to levels of societal participation. DESIGN Observational prospective study with a 2-wave longitudinal component. SETTING Inpatient rehabilitation centers, with 1-year follow up conducted primarily by telephone. PARTICIPANTS Persons with TBI (N=1570) enrolled in the TBI Model System database and followed up at 1-year postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM, Patient Health Questionnaire-9, Participation Assessment with Recombined Tools-Objective, Glasgow Outcome Scale-Extended, and the Satisfaction With Life Scale. RESULTS Twenty-two percent of the sample reported minor depression, and 26% reported major depression at 1-year post-TBI. Both levels of depression were associated with sex (women), age (younger), preinjury mental health treatment and substance abuse, and cause of injury (intentional). There was a monotonic dose-response relationship between severity of depression and all 1-year outcomes studied, including level of cognitive and physical disability, global outcome, and satisfaction with life. With other predictors controlled, depression severity remained significantly associated with the level of societal participation at 1-year post-TBI. CONCLUSIONS Minor depression may be as common as major depression after TBI and should be taken seriously for its association to negative outcomes related to participation and quality of life. Findings suggest that, as in other populations, minor and major depression are not separate entities, but exist on a continuum. Further research should determine whether people with TBI traverse between the 2 diagnoses as in other patient groups.
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Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute, 50 Township Line Rd., Elkins Park, PA 19027, USA.
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Clinical Considerations for the Diagnosis of Major Depression After Moderate to Severe TBI. J Head Trauma Rehabil 2010; 25:99-112. [DOI: 10.1097/htr.0b013e3181ce3966] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Metacognitive unawareness correlates with executive function impairment after severe traumatic brain injury. J Int Neuropsychol Soc 2010; 16:360-8. [PMID: 20109243 DOI: 10.1017/s135561770999141x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED The aim of this study was to evaluate clinical, neuropsychological, and functional differences between severe traumatic brain injury (TBI) outpatients with good and/or heightened metacognitive self-awareness (SA) and those with impaired metacognitive SA, assessed by the Patient Competency Rating Scale (PCRS). Fifty-two outpatients were recruited from a neurorehabilitation hospital based on the following inclusion criteria: 1) age > or = 15 years; 2) diagnosis of severe TBI; 3) availability of neuroimaging data; 4) post-traumatic amnesia resolution; 5) provision of informed consent. MEASURES A neuropsychological battery was used to evaluate attention, memory and executive functions. SA was assessed by the PCRS, which was administered to patients and close family members. Patients were divided into two groups representing those with and without SA. Patients with poor SA had more problems than those with good SA in some components of the executive system, as indicated by the high percentage of perseverative errors and responses they made on the Wisconsin Card Sorting Test. Moreover, a decrease in metacognitive SA correlated significantly with time to follow commands (TFC). This study suggests the importance of integrating an overall assessment of cognitive functions with a specific evaluation of SA to treat self-awareness and executive functions together during the rehabilitation process.
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The efficacy of a scheduled telephone intervention for ameliorating depressive symptoms during the first year after traumatic brain injury. J Head Trauma Rehabil 2009; 24:230-8. [PMID: 19625862 DOI: 10.1097/htr.0b013e3181ad65f0] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether an intervention designed to improve functioning after traumatic brain injury (TBI) also ameliorates depressive symptoms. DESIGN Single-blinded, randomized controlled trial comparing a scheduled telephone intervention to usual care. PARTICIPANTS One hundred seventy-one persons with TBI discharged from an inpatient rehabilitation unit. METHODS The treatment group received up to 7 scheduled telephone sessions over 9 months designed to elicit current concerns, provide information, and facilitate problem solving in domains relevant to TBI recovery. OUTCOME MEASURES Brief Symptom Inventory-Depression (BSI-D) subscale, Neurobehavioral Functioning Inventory-Depression subscale, and Mental Health Index-5 from the Short-Form-36 Health Survey. RESULTS Baseline BSI-D subscale and outcome data were available on 126 (74%) participants. Randomization was effective except for greater severity of depressive symptoms in the usual care (control) group at baseline. Outcome analyses were adjusted for these differences. Overall, control participants developed greater depressive symptom severity from baseline to 1 year than did the treatment group. The treated group reported significantly lower depression symptom severity on all outcome measures. For those more depressed at baseline, the treated group demonstrated greater improvement in symptoms than did the controls. CONCLUSIONS Telephone-based interventions using problem-solving and behavioral activation approaches may be effective in ameliorating depressive symptoms following TBI. Proactive telephone calls, motivational interviewing, and including significant others in the intervention may have contributed to its effectiveness.
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Ownsworth T, Little T, Turner B, Hawkes A, Shum D. Assessing emotional status following acquired brain injury: The clinical potential of the depression, anxiety and stress scales. Brain Inj 2009; 22:858-69. [DOI: 10.1080/02699050802446697] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Demir SO, Altinok N, Aydin G, Köseoğlu F. Functional and cognitive progress in aphasic patients with traumatic brain injury during post-acute phase. Brain Inj 2009; 20:1383-90. [PMID: 17378230 DOI: 10.1080/02699050601081844] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the relationship between language functions and cognitive and functional outcome and to evaluate the effects of a conventional language rehabilitation programme on aphasic adult patients in the post-acute stage of traumatic brain injury (TBI). DESIGN Non-concurrent prospective study. Patients were assessed pre-treatment and post-treatment with standardized assessment tools. SUBJECTS Sixty-one aphasic patients with TBI who were admitted to a rehabilitation centre in the post-acute phase for a late inpatient rehabilitation programme. METHODS The motor sub-scales of the Functional Independence Measures and Disability Rating Scale were used to assess functional status and disability. Cognitive status was evaluated with the Mini-Mental Status Examination and the Functional Independence Measure cognitive sub-scale. The language function was evaluated with the Gülhane Aphasia Test. RESULTS All functional, cognitive and language scores increased significantly during the rehabilitation programme. Language functions at admission were correlated with the Functional Independence Measure motor change scores and the Mini-Mental Status Examination change scores. Regression analyses revealed that auditory comprehension at admission was the most important independent determinant of functional and cognitive gain during rehabilitation. CONCLUSION Post-acute language functions after late admission to a rehabilitation centre appear to be related to measures of cognitive and functional progress in patients with TBI. Functional and cognitive outcome is mainly affected by auditory comprehension. Results also showed the effectiveness of post-acute conventional rehabilitation in improving language functions.
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Affiliation(s)
- Sibel Ozbudak Demir
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital of Ministry of Health, Ankara, Turkey.
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Krull KR, Gioia G, Ness KK, Ellenberg L, Recklitis C, Leisenring W, Huang S, Stovall M, Robison LL, Zeltzer L. Reliability and validity of the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Cancer 2008; 113:2188-97. [PMID: 18792068 DOI: 10.1002/cncr.23809] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Up to 40% of childhood cancer survivors may experience neurocognitive impairment in 1 or more specific domains. As such, regular monitoring has been recommended for patients exposed to cranial irradiation and/or antimetabolite chemotherapy. This study reports the results of a questionnaire developed to identify those survivors who may be experiencing neurocognitive problems. METHODS Participants for this study were 7121 members of the Childhood Cancer Survivor Study cohort (6739 survivors and 382 siblings). These participants completed a new neurocognitive questionnaire designed to assess functions commonly affected by cancer therapy, as well as a standard measure of emotional functioning. A measure of cognitive and emotional functioning was also completed on a subset of the patients roughly 7 years before the current questionnaire. Responses to the questionnaires among subgroups of survivors were then analyzed to examine the reliability and validity of the new neurocognitive questionnaire. RESULTS Four reliable factors were identified that assessed task efficiency, emotional regulation, organization, and memory skills. These neurocognitive factors accurately discriminated survivors who were at "high risk" for neurocognitive dysfunction, because of neurologic abnormalities or a history of intensive focal cranial irradiation, from healthy "low-risk" survivors and siblings. CONCLUSIONS The questionnaire demonstrated excellent reliability, as well as construct and discriminative validity. It appears to be a practical and efficient tool for monitoring neurocognitive outcomes in adult survivors of pediatric cancer.
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Affiliation(s)
- Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
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Crooks CY, Zumsteg JM, Bell KR. Traumatic Brain Injury: A Review of Practice Management and Recent Advances. Phys Med Rehabil Clin N Am 2007; 18:681-710, vi. [DOI: 10.1016/j.pmr.2007.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bay E, Hagerty BM, Williams RA. Depressive symptomatology after mild-to-moderate traumatic brain injury: a comparison of three measures. Arch Psychiatr Nurs 2007; 21:2-11. [PMID: 17258103 DOI: 10.1016/j.apnu.2006.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2005] [Revised: 06/16/2006] [Accepted: 07/25/2006] [Indexed: 10/23/2022]
Abstract
Measurement of posttraumatic brain injury depression is problematic. Disagreement exists about the best screening measure, and symptoms of brain injury often overlap those of depression. In an outpatient sample of 75 persons, we compared aspects of Criterion A of the Diagnostic and Statistical Manual of Mental Disorders--Fourth Revision, Text Revision (2000), with three depression subscales: the Neurobehavioral Functioning (NFI-D), Profile of Moods State (POMS-D), and Center for Epidemiologic Studies (CES-D). Nearly 40% of this outpatient sample had significant levels of depressive symptoms. All measures were internally consistent, reliable, and highly correlated. For persons with mild-to-moderate traumatic brain injury, the CES-D was the best screening instrument because of its ease in administration, sensitivity in detecting probable major depressive disorders, its established categories of severity, and its comprehensiveness. Further effort in the establishment of depression severity categories using the NFI-D is needed.
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Affiliation(s)
- Esther Bay
- Michigan State University, College of Nursing, Howell, MI 48843, USA
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