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Neale AC, Aase DM, Soble JR, Baker JC, Phan KL. Disentangling subjective symptom complaints and objective cognitive performance in veterans: Impact of posttraumatic stress disorder and lifetime traumatic brain injury burden. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:948-963. [PMID: 35819927 DOI: 10.1080/23279095.2022.2096452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Self-reported histories of mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) symptoms are prevalent among post-9/11 veterans. Both are associated with subjective and often overlapping symptom complaints, but variably with objective neuropsychological test performances. These outcomes are seldom explored in relation to lifetime mTBI burden. This cross-sectional study examined associations of PTSD and lifetime mTBI with subjective (persistent symptoms after concussion and cognitive complaints) and objective (performances across five cognitive domains) measures among 46 veterans. Within this sample, 20 veterans had Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) confirmed PTSD (PTSD+), whereas 26 demographically-similar participants did not meet criteria (PTSD-). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) yielded total mTBI scores ranging from 0 to 8. Regressions showed PTSD was associated with increased subjective symptoms/cognitive complaints, along with reduced verbal fluency, visuospatial memory, and processing speed performances. Lifetime mTBI burden was associated with subjective symptoms, but not with objective cognitive test performance, after controlling for PTSD. No significant interactions were observed. Exploratory correlations suggested that all PTSD symptom clusters were generally associated with the subjective and objective measures. However, fewer significant associations emerged within the PTSD+/- groups separately, with each group yielding somewhat different patterns of relationships. PTSD and increasing mTBI burden are consistently associated with negative subjective symptoms, including cognitive complaints. Each condition likely explains some degree of unique variance in symptom reporting. PTSD is associated with poorer objective cognition on some tasks, including processing speed, executive functioning, and learning/memory. Implications are explored.
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Affiliation(s)
- Alec C Neale
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Darrin M Aase
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Jason R Soble
- Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
- Neurology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Justin C Baker
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - K Luan Phan
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Campbell JK, Howland J, Insalaco B, Lawrence-Soto G. Knowledge, Perceived Competence, and Behaviors Relative to Traumatic Brain Injury Among a Sample of Domestic Violence Emergency Shelter Advocates in a New England State. Violence Against Women 2024; 30:2808-2827. [PMID: 36942449 PMCID: PMC11316340 DOI: 10.1177/10778012231163577] [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: 03/23/2023]
Abstract
This cross-sectional study describes knowledge, perceived competence, and behaviors relative to intimate partner violence (IPV)-related brain injury (BI) among staff in residential domestic violence shelter programs across a New England state. A 23-item questionnaire was administered to registrants of an online IPV-related BI training series. Within this sample, knowledge about IPV-related BI was high, but relative to providing screening, accommodations, and specialized referrals to survivors with BI, perceived competence was low, and behaviors were infrequent. IPV shelter agencies should facilitate IPV-related BI training programs for staff and prioritize developing and implementing BI screening, accommodation, and referral policies and procedures.
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Affiliation(s)
- Julia K. Campbell
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Jonathan Howland
- Department of Emergency Medicine, Injury Prevention Center, Boston Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Boston University School of Medicine, Boston, USA
| | - Brie Insalaco
- Statewide Head Injury Program, Massachusetts Rehabilitation Commission, Boston, MA, USA
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Dudek E, Williams MW, Lin Novelle Kew C, DeMello A, Wright B, Holland AB, Day-Gorman A, Gonzalez AS, Leon-Novelo L, Liu X, Juengst SB. A Directed Content Analysis for Greatest Problems Among People With and Without Traumatic Brain Injury. Arch Phys Med Rehabil 2024:S0003-9993(24)01186-9. [PMID: 39187005 DOI: 10.1016/j.apmr.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE To characterize the greatest problem or need among individuals with a history of traumatic brain injury (TBI), as compared to individuals with a history of other neurological conditions, mental health conditions, and no history of neurological or mental health conditions. DESIGN A directed content analysis of open-text responses to a single online survey question using a framework guided by the Mayo-Portland Adaptability Inventory-4. SETTING Community. PARTICIPANTS 2,861 community-dwelling adults (n = 274 with TBI; n = 289 with other neurological conditions besides TBI; n = 454 with mental health conditions but no neurological conditions; n = 1,844 controls). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Open-text responses to the survey prompt: "What was your greatest problem or need over the past 2 weeks?" RESULTS The Participation index comprised the greatest proportion of responses across all four participant groups. A quarter (25.4%) of controls reported None (no problem/need), whereas only 7.9 -10.7% of participants in all other groups reported None. Among all groups, individuals with TBI reported the greatest proportion of problems in the Adjustment and Ability indices. Among people with TBI, Money Management (19.7%), None (10.6%), and Anxiety (7.7%) were the three most frequently reported problems. Compared to individuals with mild TBI (mTBI), individuals with moderate-to-severe TBI (msTBI) reported a higher proportion of problems in the Ability and Adjustment indices. Among individuals with msTBI, the Adjustment index accounted for the greatest proportion of problems. CONCLUSIONS This study employed a person-centered approach to understanding the greatest needs among individuals with TBI. Qualitative differences were observed between individuals with and without a TBI, between people with mTBI and msTBI, and across genders among people with TBI. These findings can help guide research and policy towards addressing challenges perceived as highly important by people living in the community with TBI.
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Affiliation(s)
- Emily Dudek
- Department of Psychology, University of Houston, Houston, TX
| | | | - Chung Lin Novelle Kew
- Department of Health Behavior Center for Community Health and Aging, School of Public Health, Texas A&M University, College Station, TX
| | - Annalyn DeMello
- School of Nursing, The University of Texas Medical Branch, Galveston, TX
| | - Brittany Wright
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | - Alexandra B Holland
- Department of Population Health and Health Disparities, University of Texas Medical Branch, Galveston, TX
| | | | | | - Luis Leon-Novelo
- Department of Data Science, University of Texas Health Sciences Center at Houston, Houston, TX
| | - Xiangyi Liu
- Department of Data Science, University of Texas Health Sciences Center at Houston, Houston, TX
| | - Shannon B Juengst
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX; Department of Physical Medicine & Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, TX; Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX
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Moody JN, Howard E, Nolan KE, Prieto S, Logue MW, Hayes JP. Traumatic Brain Injury and Genetic Risk for Alzheimer's Disease Impact Cerebrospinal Fluid β-Amyloid Levels in Vietnam War Veterans. Neurotrauma Rep 2024; 5:760-769. [PMID: 39184178 PMCID: PMC11342050 DOI: 10.1089/neur.2024.0048] [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: 08/27/2024] Open
Abstract
Traumatic brain injuries (TBIs) may increase the risk for Alzheimer's disease (AD) and its neuropathological correlates, although the mechanisms of this relationship are unclear. The current study examined the synergistic effects of TBI and genetic risk for AD on β-amyloid (Aβ) levels among Vietnam War Veterans. We hypothesized that the combination of TBI and higher polygenic risk score (PRS) for AD would be associated with lower cerebrospinal fluid (CSF) Aβ42/40. Data were obtained from the Department of Defense Alzheimer's Disease Neuroimaging Initiative. Participants included Vietnam War Veterans without dementia who identified as White non-Hispanic/Latino and had available demographic, clinical assessment, genetic, and CSF biomarker data. Lifetime TBI history was assessed using The Ohio State University TBI Identification Method. Participants were categorized into those with and without TBI. Among those with a prior TBI, injury severity was defined as either mild or moderate/severe. CSF Aβ42/40 ratios were calculated. Genetic propensity for AD was assessed using PRSs. Hierarchical linear regression models examined the interactive effects of TBI and PRS for AD on Aβ42/40. Exploratory analyses examined the interaction between TBI severity and PRS. The final sample included 88 male Vietnam War Veterans who identified as White non-Hispanic/Latino (M age = 68.3 years), 49 of whom reported a prior TBI. There was a significant interaction between TBI and PRS, such that individuals with TBI and higher PRS for AD had lower Aβ42/40 (B = -0.45, 95% CI: -0.86 to -0.05, p = 0.03). This relationship may be stronger with increasing TBI severity (p = 0.05). Overall, TBI was associated with lower Aβ42/40, indicating greater amyloid deposition in the brain, in the context of greater polygenic risk for AD. These findings highlight who may be at increased risk for AD neuropathology following TBI.
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Affiliation(s)
- Jena N. Moody
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Erica Howard
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Kate E. Nolan
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Sarah Prieto
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Mark W. Logue
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Psychiatry and Biomedical Genetics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jasmeet P. Hayes
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, Ohio, USA
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Darr AJ, Babakhanyan I, Caswell M, Alia Westphal B, Bailie JM. Efficacy of Computerized vs. Traditional Cognitive Interventions for the Treatment of Chronic mTBI Symptoms Among Service Members. Mil Med 2024; 189:530-538. [PMID: 39160812 DOI: 10.1093/milmed/usae180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Military service members (SMs) with mild traumatic brain injury (mTBI or concussion) frequently report cognitive and behavioral difficulties. Currently, military clinical guidelines recommend clinician-run, manualized cognitive rehabilitation (CR) to treat these symptoms; however, it is unclear whether this approach adequately addresses the unique needs of warfighters. Computerized cognitive training (CCT) programs represent an innovative, promising approach to treating cognitive difficulties; however, whether these programs can effectively remediate cognitive impairment in individuals with mTBI remains unclear. MATERIALS AND METHODS A total of 65 SMs with a history of at least 1 diagnosed mTBI were recruited from a military hospital. Participants received 1 of 2 interventions: Clinician-run, manualized CR (Study of Cognitive Rehabilitation Effectiveness [SCORE]; n = 37), consisting of 60 total intervention hours over 6 weeks, or CCT (n = 28), in which participants trained with either a commercial CCT (n = 14) or noncommercial CCT (n = 14), for a total of 12 hours over 4 weeks. Participants were assessed pre- and postintervention, using a combination of self-report and objective outcome measures: Key Behaviors Change Inventory (KBCI), a self-report measure of functional difficulties; Paced Auditory Serial Addition Test (PASAT), an objective cognitive assessment that measures both information processing speed and sustained and divided attention; and Symbol Digit Modalities Test (SDMT), an objective cognitive assessment that measures information processing speed. RESULTS Mixed ANOVA revealed no interaction effect between intervention type and time (pre- and postassessment) on the PASAT (P = .643, ηp2 = 0.003), SDMT (P = .423, ηp2 = 0.010), or KBCI (P = .434, ηp2 = 0.010); however, there was a significant within-group main effect (time) on all 3 outcome measures (PASAT P < .001, ηp2 = 0.54; SDMT P < .001, ηp2 = 0.25; and KBCI P = .001, ηp2 = 0.15). On average, participants showed improvement over baseline on the PASAT (SCORE delta = 6.98, SD = 7.25, P < .001; CCT delta = 7.79, SD = 6.45, P < .001), SDMT (SCORE delta = 4.62, SD = 8.82, P = .003; CCT delta = 6.58, SD = 10.81, P = .003), and KBCI (SCORE delta = -3.22, SD = 7.09, P = .009; CCT delta = -2.00, SD = 4.72, P = .033). Additional analysis comparing the relative effectiveness of the 2 different CCTs revealed that while training with either program resulted in improved performance on the PASAT (P < .001, ηp2 = 0.627), SDMT (P = .003, ηp2 = 0.286), and KBCI (P = .036, ηp2 = 0.158), there was no interaction effect of CCT program type and change over time for any measure (PASAT P = .102, ηp2 = 1.00; SDMT P = .317, ηp2 = 0.038; and KBCI P = .719, ηp2 = 0.005). CONCLUSIONS We showed that CCT programs do not differ in efficacy compared to clinician-run, manualized CR for treating symptoms associated with mTBI; however, exploratory analyses suggest that each approach may have distinct advantages for treating specific symptoms. Additionally, we showed that the improvement in the CCT intervention did not differ between those who trained using the commercial program vs. those who trained with the noncommercial program.
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Affiliation(s)
- Andrew J Darr
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Silver Spring, MD 20910, USA
- Intrepid Spirit Center, Naval Hospital Camp Pendleton, Oceanside, CA 92058, USA
| | - Ida Babakhanyan
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Silver Spring, MD 20910, USA
- Intrepid Spirit Center, Naval Hospital Camp Pendleton, Oceanside, CA 92058, USA
| | - Melissa Caswell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Silver Spring, MD 20910, USA
- Intrepid Spirit Center, Naval Hospital Camp Pendleton, Oceanside, CA 92058, USA
| | - Bs Alia Westphal
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Silver Spring, MD 20910, USA
- Intrepid Spirit Center, Naval Hospital Camp Pendleton, Oceanside, CA 92058, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD 20910, USA
- General Dynamics Information Technology, Silver Spring, MD 20910, USA
- Intrepid Spirit Center, Naval Hospital Camp Pendleton, Oceanside, CA 92058, USA
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Nishat E, Scratch SE, Ameis SH, Wheeler AL. Disrupted Maturation of White Matter Microstructure After Concussion Is Associated With Internalizing Behavior Scores in Female Children. Biol Psychiatry 2024; 96:300-308. [PMID: 38237797 DOI: 10.1016/j.biopsych.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Some children who experience concussions, particularly females, develop long-lasting emotional and behavioral problems. Establishing the potential contribution of preexisting behavioral problems and disrupted white matter maturation has been challenging due to a lack of preinjury data. METHODS From the Adolescent Brain Cognitive Development cohort, 239 (90 female) children age 12.1 ± 0.6 years who experienced a concussion after study entry at 10.0 ± 0.6 years were compared to 6438 (3245 female) children without head injuries who were age 9.9 ± 0.6 years at baseline and 12.0 ± 0.6 years at follow-up. The Child Behavior Checklist was used to assess internalizing and externalizing behavior at study entry and follow-up. In the children with magnetic resonance imaging data available (concussion n = 134, comparison n = 3520), deep and superficial white matter was characterized by neurite density from restriction spectrum image modeling of diffusion magnetic resonance imaging. Longitudinal ComBat harmonization removed scanner effects. Linear regressions modeled 1) behavior problems at follow-up controlling for baseline behavior, 2) impact of concussion on white matter maturation, and 3) contribution of deviations in white matter maturation to postconcussion behavior problems. RESULTS Only female children with concussion had higher internalizing behavior problem scores. The youngest children with concussion showed less change in superficial white matter neurite density over 2 years than children with no concussion. In females with concussion, less change in superficial white matter neurite density was correlated with increased internalizing behavior problem scores. CONCLUSIONS Concussions in female children are associated with emotional problems beyond preinjury levels. Injury to superficial white matter may contribute to persistent internalizing behavior problems in females.
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Affiliation(s)
- Eman Nishat
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shannon E Scratch
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Stephanie H Ameis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Lippa SM, Gillow KC, Hungerford LD, Bailie JM, French LM, Brickell TA, Lange RT. Research Letter: Retrograde Amnesia and Posttraumatic Amnesia in Service Members and Veterans With Remote History of TBI. J Head Trauma Rehabil 2024:00001199-990000000-00189. [PMID: 39133112 DOI: 10.1097/htr.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
OBJECTIVE The recently updated American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury (mTBI) removed retrograde amnesia (RA) as a main criterion for mTBI, recommending it be included as a substitute criterion only when posttraumatic amnesia (PTA) cannot be reliably assessed. This study aimed to investigate the evidence base for this recommendation. SETTING Military treatment facility. PARTICIPANTS A total of 752 US military service members/veterans (mean age = 36.1 years, SD = 9.4 years) with a history of TBI prospectively enrolled in the Defense and Veterans Brain Injury Center-Traumatic Brain Injury Center of Excellence 15-Year Longitudinal TBI study who sustained a total of 1015 TBIs with substantiated RA and PTA. Most participants were male (93.6%), not of Hispanic Origin (84.7%), and White (84.5%). Evaluations were conducted on average 7.6 years (SD = 6.9 years) after injury. DESIGN Case series. MAIN MEASURES Presence and duration of RA and PTA; and ratio of PTA and RA (PTA:RA). RESULTS There were no TBIs where RA was present but PTA was absent. Within the 1015 TBIs, 896 (88.3%) involved both RA and PTA, 65 (6.4%) involved PTA only, and 54 (5.3%) did not involve RA or PTA. For the 635 TBI events with substantiated recorded minutes of RA and PTA both >0, the mean ratio of PTA:RA was 31:1. In only one instance was the ratio of PTA:RA <1. CONCLUSION There were no TBIs where RA was present without PTA. RA tended to be much shorter than PTA. Findings support the American Congress of Rehabilitation Medicine's decision to remove RA as a main criterion for mTBI.
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Affiliation(s)
- Sara M Lippa
- Author Affiliations: National Intrepid Center of Excellence, Walter Reed National Military Medical Center (Dr Lippa, Ms Gillow, Drs French, Brickell, and Lange); Departments of Neuroscience (Dr Lippa), Psychiatry (Dr Brickell), Physical Medicine and Rehabilitation (Drs French and Lange), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Ms Gillow, Drs Hungerford, Bailie, French, Brickell, and Lange); General Dynamics Information Technology, Fairfax, Virginia (Ms Gillow, Drs Hungerford, Bailie, Brickell, and Lange); Naval Medical Center, San Diego, California (Dr Hungerford); 33 Area Branch Clinic Camp Pendleton, California (Dr Bailie); and Department of Psychiatry University of British Columbia, Vancouver, British Columbia (Dr Lange)
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Caccese JB, Smith CR, Edwards NA, Emerson AM, Le Flao E, Wing JJ, Hagen J, Paur S, Walters J, Onate JA. Silent Struggles: Traumatic Brain Injuries and Mental Health in Law Enforcement. J Head Trauma Rehabil 2024:00001199-990000000-00187. [PMID: 39106530 DOI: 10.1097/htr.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To determine the prevalence of head injuries (HIs), posttraumatic stress disorder (PTSD), and depressive symptoms in law enforcement officers (LEOs) and (2) the association between HIs and psychological health conditions. SETTING County-level survey administered via Research Electronic Data Capture. PARTICIPANTS A total of 381 LEOs completed the survey (age = 43 ± 11 years; 40 [11%] females; time as LEO = 1-50 years, median = 15 years). DESIGN Cross-sectional study. MAIN MEASURES We examined the prevalence of HIs (the Ohio State University Traumatic Brain Injury Identification Method), PTSD (PTSD Checklist-Civilian [PCL-C]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). We used Mann-Whitney U and chi-square analyses to compare PTSD and depressive symptoms between those with and without a HI history. RESULTS There were 282 (74%) participants who reported a lifetime history of 1 or more HIs; 116 (30%) sustained 1 or more HIs on the job. PCL-C scores ranged 17 to 85 (median = 27); 33 (10%) participants met or exceeded the clinical cutoff score of 50 to indicate a positive PTSD screening. Participants with a HI history (median = 29) had higher PCL-C scores than those with no HI history (median = 24; P < .001), but the proportion of participants who met the clinical cutoff for PTSD was not different between those with (n = 28, 11%) and without (n = 5, 5%) a HI history (X2 = 2.52, P = .112, odds ratio = 2.18; 95% confidence interval, 0.82-5.83). PHQ-9 scores ranged 0 to 20 (median = 3); 124 (36%) participants reported mild or greater depressive symptoms. Participants with a HI history (median = 3) had higher depressive symptoms than those with no HI history (median = 2; P = .012). The proportion of participants with mild or greater depressive symptoms was higher among those with a HI history (n = 99, 39%) than without (n = 25, 27%; X2 = 4.34, odds ratio = 1.74; 95% confidence interval, 1.03-2.93). CONCLUSION HIs are prevalent in LEOs, which may have consequences for their performance, well-being, and career longevity. PTSD and depressive symptoms are higher in those with a HI history, suggesting LEOs need better traumatic brain injuries and mental health resources.
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Affiliation(s)
- Jaclyn B Caccese
- Author Affiliations: Chronic Brain Injury Program (Dr Caccese); School of Health and Rehabilitation Sciences (Drs Caccese, Smith, Onate, and Le Flao), Human Performance Collaborative (Dr Edwards, Emerson, Drs Hagen, and Le Flao), and Department of Epidemiology (Dr Wing), The Ohio State University, Columbus, Ohio; and Franklin County Sheriff's Office (Mrs Paur and Walters), Columbus, Ohio
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Omar S, Williams CC, Bugg LB, Colantonio A. "If you do not have Black futures in mind…then what's guiding the steps": anti-racist recommendations for traumatic brain injury rehabilitations' investments in hopeful Black futures. Disabil Rehabil 2024:1-20. [PMID: 39089328 DOI: 10.1080/09638288.2024.2367604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE The need for specialized rehabilitation considerations to address racial health disparities and optimize functional outcomes such as participation in daily life for Black people with traumatic brain injury (TBI) has been acknowledged. This study uses anti-racism as an entry point for addressing institutional racism by examining what the experiences of Black survivors of TBI, rehabilitation providers, and family caregivers tell us about imagined possibilities for rehabilitation to promote Black futures. MATERIAL AND METHODS A constructivist-informed narrative inquiry using critical race theory and in-depth narrative interviewing was applied across ten women and four men. Reflexive thematic analysis within and across groups of participants led to conceptualizing two main themes and five sub-themes. RESULTS Conceptualized themes captured requirements for TBI rehabilitations' investments in Black futures: (1) the need for critical information and specialized educational supports and particular requirements for supporting participation in meaningful life situations, and (2) responsibilities of delivering rehabilitation care for Black service users. CONCLUSION TBI rehabilitation must be tailored to the realities of living while being Black, integrate personal values, beliefs, interests, and equitable supports to maximize optimal functioning and participation if the goal of rehabilitation is community integration for all persons living with the impacts of TBI.
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Affiliation(s)
- Samira Omar
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Laura Beth Bugg
- Global and Community Health, University of CA Santa Cruz, CA, USA
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Miller LR, Divers R, Reed C, Cherry J, Patrick A, Calamia M. Value-consistent rehabilitation is associated with long-term psychological flexibility and quality of life after traumatic brain injury. Neuropsychol Rehabil 2024; 34:955-973. [PMID: 37708399 DOI: 10.1080/09602011.2023.2256964] [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: 02/22/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
Meaningful steps have been taken toward using holistic approaches in outpatient rehabilitation for traumatic brain injury (TBI) (i.e., treating the whole individual); however, research and practice continue to disproportionately focus on adapting to physical and cognitive changes. Research suggests treatment focusing on individual values may be important for psychological adjustment after TBI. The current study sought to explore individual values across multiple life domains in those with TBI as well as what values outpatient rehabilitation was helpful for, and to examine discrepancies between these factors (i.e., value-consistent rehabilitation) in relation to important long-term treatment outcomes. 215 adults with a history of TBI who had participated in outpatient rehabilitation completed online surveys assessing how consistent outpatient rehabilitation was with individual values, psychological flexibility, and quality of life. The life domains with the greatest discrepancies between individual importance and rehabilitation helpfulness were spirituality, intimate relations, and family relations. Greater value-consistent rehabilitation was associated with higher levels of psychological flexibility and quality of life beyond demographics and injury characteristics. Our findings provide further support in favour of holistic, client-centred approaches that are facilitated by neurological rehabilitation programs.
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Affiliation(s)
- Luke R Miller
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Ross Divers
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Christopher Reed
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Jared Cherry
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Abihail Patrick
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
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French LM, Brickell TA, Lippa SM, Rogers AA, Cristaudo KE, Walker TT, Higgins M, Bailie JM, Kennedy J, Hungerford L, Lange RT. Clinical relevance of subthreshold PTSD versus full criteria PTSD following traumatic brain injury in U.S. service members and veterans. J Affect Disord 2024; 358:408-415. [PMID: 38705525 DOI: 10.1016/j.jad.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The purpose of this cross-sectional study was to examine the influence of subthreshold posttraumatic stress disorder (PTSD) and full PTSD on quality of life following mild traumatic brain injury (mTBI). METHODS Participants were 734 service members and veterans (SMV) classified into two injury groups: uncomplicated mild TBI (MTBI; n = 596) and injured controls (IC, n = 139). Participants completed a battery of neurobehavioral measures, 12-or-more months post-injury, that included the PTSD Checklist Civilian version, Neurobehavioral Symptom Inventory, and select scales from the TBI-QOL and MPAI. The MTBI group was divided into three PTSD subgroups: No-PTSD (n = 266), Subthreshold PTSD (n = 139), and Full-PTSD (n = 190). RESULTS There was a linear relationship between PTSD severity and neurobehavioral functioning/quality of life in the MTBI sample. As PTSD severity increased, significantly worse scores were found on 11 of the 12 measures (i.e. , MTBI Full-PTSD > Sub-PTSD > No-PTSD). When considering the number of clinically elevated scores, a linear relationship between PTSD severity and neurobehavioral functioning/quality of life was again observed in the MTBI sample (e.g., 3-or-more elevated scores: Full-PTSD = 92.1 %, Sub-PTSD = 61.9 %, No-PTSD = 19.9 %). LIMITATIONS Limitations included the use of a self-report measure to determine diagnostic status that may under/overcount or mischaracterize individuals. CONCLUSION PTSD symptoms, whether at the level of diagnosable PTSD, or falling short of that because of the intensity or characterization of symptoms, have a significant negative impact on one's quality of life following MTBI. Clinicians' treatment targets should focus on the symptoms that are most troubling for an individual and the individual's perception of quality of life, regardless of the diagnosis itself.
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Affiliation(s)
- Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alicia A Rogers
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Kendal E Cristaudo
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Thomas T Walker
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Molly Higgins
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; University of Colorado, Colorado Springs, CO, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; 33 Area Branch Clinic Camp Pendleton, CA, USA
| | - Jan Kennedy
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Brooke Army Medical Center, Joint Base San Antonio, TX, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Naval Medical Center San Diego, CA, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; University of British Columbia, Vancouver, BC, Canada; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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12
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Miller AR, Martindale SL, Rowland JA, Walton S, Talmy T, Walker WC. Blast-related mild TBI: LIMBIC-CENC focused review with implications commentary. NeuroRehabilitation 2024:NRE230268. [PMID: 39093081 DOI: 10.3233/nre-230268] [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: 08/04/2024]
Abstract
BACKGROUND A significant factor for the high prevalence of traumatic brain injury (TBI) among U.S. service members is their exposure to explosive munitions leading to blast-related TBI. Our understanding of the specific clinical effects of mild TBI having a component of blast mechanism remains limited compared to pure blunt mechanisms. OBJECTIVE The purpose of this review is to provide a synopsis of clinical research findings on the long-term effects of blast-related mild TBI derived to date from the Long-Term Impact of Military-Relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC). METHODS Publications on blast-related mild TBI from LIMBIC-CENC and the LIMBIC-CENC prospective longitudinal study (PLS) cohort were reviewed and their findings summarized. Findings from the broader literature on blast-related mild TBI that evaluate similar outcomes are additionally reviewed for a perspective on the state of the literature. RESULTS The most consistent and compelling evidence for long-term effects of blast-related TBI is for poorer psychological health, greater healthcare utilization and disability levels, neuroimaging impacts on brain structure and function, and greater headache impact on daily life. To date, evidence for chronic cognitive performance deficits from blast-related mild TBI is limited, but futher research including crucial longitudinal data is needed. CONCLUSION Commentary is provided on: how LIMBIC-CENC findings assimilate with the broader literature; ongoing research gaps alongside future research needs and priorities; how the scientific community can utilize the LIMBIC-CENC database for independent or collaborative research; and how the evidence from the clinical research should be assimilated into clinical practice.
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Affiliation(s)
| | - Sarah L Martindale
- Research and Academic Affairs, W.G. (Bill) Hefner Veterans Affairs Healthcare System, Salisbury, NC, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jared A Rowland
- Research and Academic Affairs, W.G. (Bill) Hefner Veterans Affairs Healthcare System, Salisbury, NC, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samuel Walton
- Department of Physical Medicine and Rehabilitation (PM& R), School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Tomer Talmy
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - William C Walker
- Department of Physical Medicine and Rehabilitation (PM& R), School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, USA
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13
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Omar S, Williams CC, Bugg LB, Colantonio A. "Somewhere along the line, your mask isn't going to be fitting right": institutional racism in Black narratives of traumatic brain injury rehabilitation across the practice continuum. BMC Health Serv Res 2024; 24:834. [PMID: 39049041 PMCID: PMC11270842 DOI: 10.1186/s12913-024-10986-1] [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: 09/04/2023] [Accepted: 04/11/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Over two decades of research about traumatic brain injury (TBI) rehabilitation emphasized the persistence of racial health disparities in functional outcomes that disproportionately impact Black populations without naming or addressing racism as the root problem. Further, the experiences of Black people with TBI have yet to be documented and accounted for in scientific scholarship from the perspectives of Black persons in Canada. PURPOSE This study intended to examine the rehabilitation narratives of Black TBI survivors, family caregivers, and rehabilitation providers and use critical race theory as a conceptual framework to understand how anti-Black racism manifests in those experiences. METHODS Through critical narrative inquiry informed by a critical constructivist paradigm and a critical race theory lens, in-depth narrative interviewing were conducted with seven survivors, three family caregivers, and four rehabilitation providers. Data were analyzed using reflexive thematic analysis within and across groups of participants to conceptualize themes and sub-themes. FINDINGS Themes captured how racism becomes institutionalized in TBI rehabilitation: (1) the institutional construction of deficient Black bodies, (2) the institutional construction of rehabilitation access, (3) the institutional investment in resisting and approximating whiteness in rehabilitation practice, and (4) the institutional construction of deficient Black futures. CONCLUSION Study findings point to the dire need to ensure rehabilitation programs, services, and the delivery of care are not determined based on inequitable practices, racial biases and assumptions about Black people, which determine who deserves to get into rehabilitation and have opportunities to be supported in working towards living a full and meaningful life.
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Affiliation(s)
- Samira Omar
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Laura B Bugg
- Global and Community Health, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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14
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Yue JK, Etemad LL, Elguindy MM, van Essen TA, Belton PJ, Nelson LD, McCrea MA, Vreeburg RJG, Gotthardt CJ, Tracey JX, Coskun BC, Krishnan N, Halabi C, Eagle SR, Korley FK, Robertson CS, Duhaime AC, Satris GG, Tarapore PE, Huang MC, Madhok DY, Giacino JT, Mukherjee P, Yuh EL, Valadka AB, Puccio AM, Okonkwo DO, Sun X, Jain S, Manley GT, DiGiorgio AM, Badjatia N, Barber J, Bodien YG, Fabian B, Ferguson AR, Foreman B, Gardner RC, Gopinath S, Grandhi R, Russell Huie J, Dirk Keene C, Lingsma HF, MacDonald CL, Markowitz AJ, Merchant R, Ngwenya LB, Rodgers RB, Schneider ALC, Schnyer DM, Taylor SR, Temkin NR, Torres-Espin A, Vassar MJ, Wang KKW, Wong JC, Zafonte RD. Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study. Trauma Surg Acute Care Open 2024; 9:e001501. [PMID: 39081460 PMCID: PMC11287071 DOI: 10.1136/tsaco-2024-001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024] Open
Abstract
ABSTRACT Objectives An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort. Methods Data from hospitalized subjects with Glasgow Coma Scale score of 3-12 were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (enrollment period: 2014-2019). Prior TBI with amnesia or alteration of consciousness was assessed using the Ohio State University TBI Identification Method. Competing risk regressions adjusting for age, sex, psychiatric history, cranial injury and extracranial injury severity examined the associations between prior TBI and in-hospital mortality, with hospital discharged alive as the competing risk. Adjusted HRs (aHR (95% CI)) were reported. Multivariable logistic regressions assessed the associations between prior TBI, mortality, and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-3 (vs. 4-8)) at 3, 6, and 12 months after injury. Results Of 405 acute msTBI subjects, 21.5% had prior TBI, which was associated with male sex (87.4% vs. 77.0%, p=0.037) and psychiatric history (34.5% vs. 20.7%, p=0.010). In-hospital mortality was 10.1% (prior TBI: 17.2%, no prior TBI: 8.2%, p=0.025). Competing risk regressions indicated that prior TBI was associated with likelihood of in-hospital mortality (aHR=2.06 (1.01-4.22)), but not with hospital discharged alive. Prior TBI was not associated with mortality or unfavorable outcomes at 3, 6, and 12 months. Conclusions After acute msTBI, prior TBI history is independently associated with in-hospital mortality but not with mortality or unfavorable outcomes within 12 months after injury. This selective association underscores the importance of collecting standardized prior TBI history data early after acute hospitalization to inform risk stratification. Prospective validation studies are needed. Level of evidence IV. Trial registration number NCT02119182.
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Affiliation(s)
- John K Yue
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Leila L Etemad
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Mahmoud M Elguindy
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Thomas A van Essen
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Patrick J Belton
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lindsay D Nelson
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rick J G Vreeburg
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Christine J Gotthardt
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Joye X Tracey
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Bukre C Coskun
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Nishanth Krishnan
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Cathra Halabi
- Neurology, University of California San Francisco, San Francisco, California, USA
| | - Shawn R Eagle
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Gabriela G Satris
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Phiroz E Tarapore
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael C Huang
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Debbie Y Madhok
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joseph T Giacino
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pratik Mukherjee
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Esther L Yuh
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Alex B Valadka
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ava M Puccio
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - David O Okonkwo
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Geoffrey T Manley
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Anthony M DiGiorgio
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Neeraj Badjatia
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Jason Barber
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Yelena G Bodien
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Brian Fabian
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Adam R Ferguson
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Brandon Foreman
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Raquel C Gardner
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Shankar Gopinath
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Ramesh Grandhi
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - J Russell Huie
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - C Dirk Keene
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Hester F Lingsma
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Christine L MacDonald
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Amy J Markowitz
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Randall Merchant
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Laura B Ngwenya
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Richard B Rodgers
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Andrea L C Schneider
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - David M Schnyer
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sabrina R Taylor
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Nancy R Temkin
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Abel Torres-Espin
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Mary J Vassar
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Kevin K W Wang
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Justin C Wong
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Ross D Zafonte
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
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15
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Guberman GI, Theaud G, Hawes SW, Ptito A, Descoteaux M, Hodgins S. White matter microstructure, traumatic brain injury, and disruptive behavior disorders in girls and boys. Front Neurosci 2024; 18:1391407. [PMID: 39099631 PMCID: PMC11295658 DOI: 10.3389/fnins.2024.1391407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/11/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction Girls and boys presenting disruptive behavior disorders (DBDs) display differences in white matter microstructure (WMM) relative to typically developing (TD) sex-matched peers. Boys with DBDs are at increased risk for traumatic brain injuries (TBIs), which are also known to impact WMM. This study aimed to disentangle associations of WMM with DBDs and TBIs. Methods The sample included 673 children with DBDs and 836 TD children, aged 9-10, from the Adolescent Brain Cognitive Development Study. Thirteen white matter bundles previously associated with DBDs were the focus of study. Analyses were undertaken separately by sex, adjusting for callous-unemotional traits (CU), attention-deficit hyperactivity disorder (ADHD), age, pubertal stage, IQ, ethnicity, and family income. Results Among children without TBIs, those with DBDs showed sex-specific differences in WMM of several tracts relative to TD. Most differences were associated with ADHD, CU, or both. Greater proportions of girls and boys with DBDs than sex-matched TD children had sustained TBIs. Among girls and boys with DBDs, those who had sustained TBIs compared to those not injured, displayed WMM alterations that were robust to adjustment for all covariates. Across most DBD/TD comparisons, axonal density scores were higher among children presenting DBDs. Discussion In conclusion, in this community sample of children, those with DBDs were more likely to have sustained TBIs that were associated with additional, sex-specific, alterations of WMM. These additional alterations further compromise the future development of children with DBDs.
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Affiliation(s)
- Guido I. Guberman
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Guillaume Theaud
- Department of Computer Science, Sherbrooke University, Sherbrooke, QC, Canada
| | - Samuel W. Hawes
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, United States
| | - Alain Ptito
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Maxime Descoteaux
- Department of Computer Science, Sherbrooke University, Sherbrooke, QC, Canada
| | - Sheilagh Hodgins
- Département de Psychiatrie et Addictologie, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC, Canada
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16
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Kang X, Yoon BC, Grossner E, Adamson MM. Characteristics of the Structural Connectivity in Patients with Brain Injury and Chronic Health Symptoms: A Pilot Study. Neuroinformatics 2024:10.1007/s12021-024-09681-7. [PMID: 38990502 DOI: 10.1007/s12021-024-09681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
Diffusion properties from diffusion tensor imaging (DTI) are exquisitely sensitive to white matter abnormalities incurred during traumatic brain injury (TBI), especially for those patients with chronic post-TBI symptoms such as headaches, dizziness, fatigue, etc. The evaluation of structural and functional connectivity using DTI has become a promising method for identifying subtle alterations in brain connectivity associated with TBI that are otherwise not visible with conventional imaging. This study assessed whether TBI patients with (n = 17) or without (n = 16) chronic symptoms (TBIcs/TBIncs) exhibit any changes in structural connectivity (SC) and mean fractional anisotropy (mFA) of intra- and inter-hemispheric connections when compared to a control group (CG) (n = 13). Reductions in SC and mFA were observed for TBIcs compared to CG, but not for TBIncs. More connections were found to have mFA reductions than SC reductions. On the whole, SC is dominated by ipsilateral connections for all the groups after the comparison of contralateral and ipsilateral connections. More contra-ipsi reductions of mFA were found for TBIcs than TBIncs compared to CG. These findings suggest that TBI patients with chronic symptoms not only demonstrate decreased global and regional mFA but also reduced structural network connectivity.
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Affiliation(s)
- Xiaojian Kang
- WRIISC-Women, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA.
- Rehabilitation Service, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA.
| | - Byung C Yoon
- Department of Radiology, Stanford University School of Medicine, VA Palo Alto Heath Care System, Palo Alto, CA, 94304, USA
| | - Emily Grossner
- Department of Psychology, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - Maheen M Adamson
- WRIISC-Women, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
- Rehabilitation Service, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
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17
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Chiang HS, Motes M, Afkhami-Rohani B, Adhikari A, LoBue C, Kraut M, Cullum CM, Hart J. Verbal retrieval deficits due to traumatic brain injury are associated with changes in event related potentials during a Go-NoGo task. Clin Neurophysiol 2024; 163:1-13. [PMID: 38663098 PMCID: PMC11216819 DOI: 10.1016/j.clinph.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Verbal retrieval (VR) deficits often occur after traumatic brain injury (TBI), but the mechanisms remain unclear. We examined how event-related potentials (ERPs) during a Go-NoGo task were associated with VR deficits. METHODS Sixty veterans with a history of TBI underwent a neuropsychological battery and a Go-NoGo task with concurrent EEG recording. We compared task performance and ERP measures (N2, P3) between those with and those without persistent injury-related VR deficits. We then used generalized linear modeling to examine the relationship between ERP measures and scores on measures of executive function and processing speed. RESULTS Go-NoGo task performance was comparable between the groups. Those with VR deficits had larger N2 amplitude in NoGo than in Go conditions. In participants with VR deficits, larger NoGo N2/P3 amplitude predicted faster processing speed. Furthermore, larger P3 amplitude and shorter P3 latency of the difference wave (NoGo - Go) predicted faster processing speed in those with VR deficits. CONCLUSIONS Despite no difference in Go-NoGo task performance, ERP amplitude and latency measures associated with cognitive control during Go-NoGo distinguished TBI individuals with VR deficits from those without. SIGNIFICANCE This study furthers our understanding of VR deficits in TBI and implicates potential application of ERP measures in monitoring and treating such deficits.
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Affiliation(s)
- Hsueh-Sheng Chiang
- University of Texas Southwestern Medical Center, Department of Neurology, USA; The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Michael Motes
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Borna Afkhami-Rohani
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Ashna Adhikari
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA.
| | - Christian LoBue
- University of Texas Southwestern Medical Center, Department of Psychiatry, USA; University of Texas Southwestern Medical Center, Department of Neurological Surgery, USA.
| | - Michael Kraut
- The Johns Hopkins School of Medicine, Department of Radiology, USA.
| | - C Munro Cullum
- University of Texas Southwestern Medical Center, Department of Neurology, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, USA; University of Texas Southwestern Medical Center, Department of Neurological Surgery, USA.
| | - John Hart
- University of Texas Southwestern Medical Center, Department of Neurology, USA; The University of Texas at Dallas, School of Behavioral and Brain Sciences, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, USA.
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18
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Ivins B, Risling M, Wisén N, Schwab K, Rostami E. Mild Traumatic Brain Injury in the Maturing Brain: An Investigation of Symptoms and Cognitive Performance in Soldiers Returning From Afghanistan and Iraq. J Head Trauma Rehabil 2024; 39:304-317. [PMID: 38059837 DOI: 10.1097/htr.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The majority of traumatic brain injuries (TBIs) are classified as mild and occur in young individuals. The course of recovery varies but can result in chronic or troubling outcomes. The impact of age on TBI outcomes in young adults before complete brain maturation is not well studied. METHODS In this study, we compared the effects of mild TBI on cognitive performance and self-reported TBI symptoms and posttraumatic stress disorder (PTSD) in 903 soldiers in 3 different age groups: 24 years or younger, 25 to 27 years, and 28 to 40 years. The soldiers had returned from war zones in Iraq and were screened for TBI within a few days of return. Cognitive performance was measured with the Automated Neuropsychological Assessment Metrics of Military TBI Version 4 (ANAM4). Symptoms associated with mild TBI were self-reported on the Neurobehavioral Symptom Inventory, and the PTSD Checklist-Civilian Version (PCL-C). RESULTS Soldiers with TBI in every age group had significantly higher prevalence of most symptoms than those with no TBI. Soldiers with TBI also reported more chronic pain sites, regardless of age. Soldiers aged 28 to 40 years with TBI had the lowest cognitive performance scores (ANAM) across several subtests, both unadjusted and adjusted. The Global Deficit Score was significantly higher for soldiers aged 28 to 40 years and 25 to 27 years with TBI than for soldiers younger than 24 years with no TBI. After adjusting for PTSD symptoms, education, and number of lifetime TBIs, the overall test battery mean for soldiers aged 28 to 40 years with TBI was significantly lower than for soldiers younger than 24 years with no TBI. CONCLUSION Soldiers with mild TBI in the younger age group show more symptoms associated to frontal lobe function while soldiers in the older group suffer more cognitive impairment. This may warrant further study as it may indicate a propensity to later cognitive decline among soldiers who were older at the time of injury.
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Affiliation(s)
- Brian Ivins
- Author Affiliations: Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Mr Ivins); GDIT, Fairfax, Virginia (Mr Ivins); Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Schwab); Department of Neuroscience, Karolinska Institute, Stockholm, Sweden (Drs Risling and Rostami, and Mr Wisén); and Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden (Dr Rostami)
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19
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Babakhanyan I, Brickell TA, Bailie JM, Hungerford L, Lippa SM, French LM, Lange RT. Gender Disparities in Neurobehavioral Symptoms and the Role of Post-Traumatic Symptoms in US Service Members Following Mild Traumatic Brain Injury. J Neurotrauma 2024; 41:e1687-e1696. [PMID: 38581428 DOI: 10.1089/neu.2022.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
Women are more directly involved in combat operations today than ever before, currently making up 18.6% of officers and 16.8% of enlisted personnel in the United States military. However, women continue to be under-represented in military research. Studies that do consider gender differences in traumatic brain injury (TBI) outcomes have shown that women report significantly more post-concussive symptoms than men. Conclusions for true gender differences related to TBI are hard to make without controlling for non-TBI factors. The effects previously identified in the literature may be an artifact of how men and women differ in their response to injury, unrelated to the neurological recovery process associated with TBI. The objective of this study was to examine the effects of gender specifics on mild TBI (mTBI) sequelae on injured and uninjured control groups, and to investigate the role of post-traumatic stress disorder (PTSD) on symptom reporting. It should be noted that the terms "gender" and "men/women" are used in this article in place of "sex" or "males/females" given that we are not discussing biological attributes. A total of 966 United States military service members and veterans were included in the study. Of the total sample, 455 men and 46 women were in the mTBI group, 285 men and 31 women were in the injured controls group (IC), and 111 men and 38 women in the non-injured controls group (NIC). Post-concussive and quality of life symptoms were compared for men and women while controlling for combat exposure. MTBI and IC groups were also stratified by PTSD presentation. Measures used included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist (PCL-C), Traumatic Brain Injury Quality of Life (TBI-QOL), and Combat Exposure Scale. In the mTBI group, women had worse scores on NSI total, NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety, Fatigue, and Headache scales (n2 = 0.018-0.032, small to small-medium effect sizes). When PTSD was present, women had worse scores on the NSI Somatosensory cluster only (n2 = 0.029, small-medium effect size). In contrast, when PTSD was absent, women had worse scores than men on the NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety and Headache scales (n2 = 0.032-0.063, small to medium effect sizes). In the IC group, women had worse scores on the NSI Cognitive cluster and the TBI-QOL Fatigue and Pain Interference scales (n2 = 0.024-0.042, small to small-medium effect sizes). However, group differences were no longer found when stratified by PTSD sub-groups. In the NIC group, there were no significant group differences for any analyses. We were able to identify symptoms unique to women recovering from mTBI that were not present following other forms of physical injury or in healthy controls. However, the impact of PTSD exacerbates the symptom profile and its comorbidity with mTBI equates to most of the noted gender differences.
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Affiliation(s)
- Ida Babakhanyan
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Hospital Camp Pendleton, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Hospital Camp Pendleton, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
- Naval Medical Center San Diego, California, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- National Intrepid Center of Excellence, Bethesda, Maryland, USA
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Wynn JK, Green MF. An EEG-Based Neuroplastic Approach to Predictive Coding in People With Schizophrenia or Traumatic Brain Injury. Clin EEG Neurosci 2024; 55:445-454. [PMID: 38711326 DOI: 10.1177/15500594241252897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite different etiologies, people with schizophrenia (SCZ) or with traumatic brain injury (TBI) both show aberrant neuroplasticity. One neuroplastic mechanism that may be affected is prediction error coding. We used a roving mismatch negativity (rMMN) paradigm which uses different lengths of standard tone trains and is optimized to assess predictive coding. Twenty-five SCZ, 22 TBI (mild to moderate), and 25 healthy controls were assessed. We used a frequency-deviant rMMN in which the number of standards preceding the deviant was either 2, 6, or 36. We evaluated repetition positivity to the standard tone immediately preceding a deviant tone (repetition positivity [RP], to assess formation of the memory trace), deviant negativity to the deviant stimulus (deviant negativity [DN], which reflects signaling of a prediction error), and the difference wave between the 2 (the MMN). We found that SCZ showed reduced DN and MMN compared with healthy controls and with people with mild to moderate TBI. We did not detect impairments in any index (RP, DN, or MMN) in people with TBI compared to controls. Our findings suggest that prediction error coding assessed with rMMN is aberrant in SCZ but intact in TBI, though there is a suggestion that severity of head injury results in poorer prediction error coding.
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Affiliation(s)
- Jonathan K Wynn
- Center on Enhancement of Community Integration for Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michael F Green
- Center on Enhancement of Community Integration for Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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21
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Adhikari SP, Daugherty JC, Quiroz Molinares N, Maldonado-Rodriguez N, Wallace C, Smirl J, Perez-García M, De Los Reyes-Aragón CJ, Hidalgo-Ruzzante N, van Donkelaar P, Valera EM. A Four-Country Study of Strangulation-Related Alterations in Consciousness in Women Who Have Experienced Intimate Partner Violence: Co-Occurrence with Traumatic Brain Injuries and Measures of Psychological Distress. J Neurotrauma 2024; 41:e1666-e1677. [PMID: 38666734 DOI: 10.1089/neu.2023.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (n = 213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, the United States, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and post-traumatic stress disorder at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann-Whitney U tests and chi-square tests were conducted to examine differences between women with and without experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately, 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a subsample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate-to-severe BI than those who had not sustained an S-AIC (BISA severity subscale: U = 3939, p = 0.006). In addition, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared with women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries and, therefore, highlight IPV-related BIs as a global issue that needs to be aggressively studied with policies established and then implemented to address findings.
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Affiliation(s)
| | - Julia C Daugherty
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
| | | | | | - Colin Wallace
- Department of Kinesiology, Okanagan College, Kelowna, Canada
| | - Jonathan Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Miguel Perez-García
- Mind, Brain and Behavior Research Center, (CIMCYC), University of Granada, Granada, Spain
| | | | | | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| | - Eve M Valera
- Psychiatry, Harvard Medical School and Massachusetts General Hospital, Charlestown, Massachusetts, USA
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22
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Milillo MM, Neumann CS, Maurer JM, Jin C, Commerce E, Reynolds BL, Harenski CL, Kiehl KA. Association Between Traumatic Brain Injury and Psychopathic Traits Among Justice-Involved Adolescents. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01212-x. [PMID: 38922463 DOI: 10.1007/s10802-024-01212-x] [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] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
Traumatic brain injury (TBI) is a global public health problem and is highly prevalent among justice-involved populations. Pediatric TBI is linked with long-term negative outcomes and is correlated with substance use, criminal behavior, psychiatric disorders, and disruptions in neurocognition. These same TBI correlates are evident among youth with psychopathic traits. Given ongoing neurobiological and social development in adolescence, understanding the link between psychopathic traits and TBI in justice-involved youth is critical. A sample of 263 male adolescents were recruited from a maximum-security juvenile justice facility. Using a structural equation modeling (SEM) framework, measurement invariance of psychopathic traits (TBI ±) was tested, and psychopathy scores were accounted for in terms of TBI variables (severity, age of first TBI, total number), participant's age, IQ, substance use, and internalizing psychopathology. There was evidence of strong invariance across TBI status and those with TBI had higher affective and impulsive lifestyle psychopathic traits than adolescents without TBI. The SEM indicated that TBI severity was associated with lower IQ scores, which in turn were associated with increased lifestyle/antisocial (Factor 2) psychopathic traits. Total number of TBIs was associated with higher substance use, which was associated with both increased interpersonal/affective (Factor 1) and Factor 2 psychopathic traits. These TBI variables also had indirect associations with psychopathic traits through IQ and substance use. The findings indicate that TBI is associated with psychopathic traits and suggest that disturbances in cognition and substance use may be treatment targets for youth with TBI and psychopathic traits.
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Affiliation(s)
- Michaela M Milillo
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA.
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87106, USA.
| | - Craig S Neumann
- Department of Psychology, University of North Texas, Denton, TX, 76201, USA
| | - J Michael Maurer
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Christine Jin
- Department of Psychology, University of North Texas, Denton, TX, 76201, USA
| | - Ella Commerce
- Department of Psychology, University of North Texas, Denton, TX, 76201, USA
| | - Brooke L Reynolds
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Carla L Harenski
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Kent A Kiehl
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA.
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87106, USA.
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23
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de Souza NL, Lindsey HM, Dorman K, Dennis EL, Kennedy E, Menefee DS, Parrott JS, Jia Y, Pugh MJV, Walker WC, Tate DF, Cifu DX, Bailie JM, Davenport ND, Martindale SL, O'Neil M, Rowland JA, Scheibel RS, Sponheim SR, Troyanskaya M, Wilde EA, Esopenko C. Neuropsychological Profiles of Deployment-Related Mild Traumatic Brain Injury: A LIMBIC-CENC Study. Neurology 2024; 102:e209417. [PMID: 38833650 PMCID: PMC11226312 DOI: 10.1212/wnl.0000000000209417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date. METHODS We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership. RESULTS The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators (p < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD. DISCUSSION Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.
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Affiliation(s)
- Nicola L de Souza
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Hannah M Lindsey
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Katherine Dorman
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Emily L Dennis
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Eamonn Kennedy
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Deleene S Menefee
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - J Scott Parrott
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Yuane Jia
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Mary Jo V Pugh
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - William C Walker
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - David F Tate
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - David X Cifu
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Jason M Bailie
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Nicholas D Davenport
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Sarah L Martindale
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Maya O'Neil
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Jared A Rowland
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Randall S Scheibel
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Scott R Sponheim
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Maya Troyanskaya
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Elisabeth A Wilde
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
| | - Carrie Esopenko
- From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN
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24
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Saadi A, Asfour J, Vassimon De Assis M, Wilson T, Haar RJ, Heisler M. Head Injury and Associated Sequelae in Individuals Seeking Asylum in the United States: A Retrospective Mixed-Methods Review of Medico-Legal Affidavits. Brain Sci 2024; 14:599. [PMID: 38928599 PMCID: PMC11201586 DOI: 10.3390/brainsci14060599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
People seeking asylum are susceptible to head injury (HI) due to exposure to various forms of violence including war, torture, or interpersonal violence. Yet, the extents to which clinicians assess HI, and if so, what the associated characteristics are, are not well known. We analyzed 200 U.S.-based medico-legal affidavits using descriptive, multivariate regression, and thematic analysis. Head injury was documented in 38% of affidavits. Those who experienced physical violence were eight times likelier to experience HI than those who did not experience physical violence. Five themes emerged: (1) HI occurred commonly in the context of interpersonal violence (44%), followed by militarized violence (33%); (2) mechanisms of HI included direct blows to the head and asphyxiation, suggesting potential for both traumatic brain injury and brain injury from oxygen deprivation; (3) HI was often recurrent and concurrent with other physical injuries; (4) co-morbid psychiatric and post-concussive symptoms made it challenging to assess neurological and psychiatric etiologies; and (5) overall, there was a paucity of assessments and documentation of HI and sequelae. Among individuals assessed for asylum claims, HI is common, often recurrent, occurring in the context of interpersonal violence, and concurrent with psychological and other physical trauma. Physical violence is an important risk factor for HI, which should be assessed when physical violence is reported.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Julia Asfour
- School of Arts and Sciences, Tufts University, Boston, MA 02155, USA;
| | | | - Tessa Wilson
- Physicians for Human Rights, New York, NY 10018, USA; (T.W.); (M.H.)
| | - Rohini J. Haar
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA 94704, USA;
| | - Michele Heisler
- Physicians for Human Rights, New York, NY 10018, USA; (T.W.); (M.H.)
- Department of Internal Medicine, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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25
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Burklund LJ, Davies CD, Niles A, Torre JB, Brown L, Vinograd M, Lieberman MD, Craske MG. Affect labeling: a promising new neuroscience-based approach to treating combat-related PTSD in veterans. Front Psychol 2024; 15:1270424. [PMID: 38911954 PMCID: PMC11192197 DOI: 10.3389/fpsyg.2024.1270424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/24/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction A significant portion of individuals exposed to combat-related trauma will develop posttraumatic stress disorder (PTSD), a severe, debilitating disorder with adverse impacts on both mental and physical functioning. Current treatments are effective for many individuals, however, there is a need for new treatment approaches to improve outcomes in PTSD and address the many existing barriers to seeking or completing treatment. Methods In this open trial pilot study, we tested a novel, brief, computer-based intervention for PTSD utilizing "affect labeling" that was inspired by recent advances in neuroscience with U.S. veterans. Results As expected, pre-intervention clinical and fMRI neuroimaging data indicated that U.S. veterans with combat-related PTSD (N = 20) had significantly higher PTSD symptoms, depression symptoms, and amygdala reactivity to trauma cues than trauma-exposed healthy control veterans (N = 20). Veterans with PTSD who completed the affect labeling intervention (N = 13) evidenced reduced PTSD symptoms and these reductions were correlated with reductions in amygdala reactivity. Discussion Results from this initial proof-of-concept study are intriguing and suggest that affect labeling training offers significant potential as a novel, cost-effective, computer-based intervention for PTSD. Implications and next steps for further developing affect labeling interventions for PTSD are discussed. Clinical Trial Registration https://clinicaltrials.gov/, identifier NCT05924399.
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Affiliation(s)
- Lisa J. Burklund
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- NeuroGen Technologies Inc., Los Angeles, CA, United States
| | - Carolyn D. Davies
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Andrea Niles
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jared B. Torre
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lily Brown
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Meghan Vinograd
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matthew D. Lieberman
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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26
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Tan CO, Grashow R, Thorpe R, Miller KK, Nathan DM, Izzy S, Radmanesh F, Kim JH, Weisskopf MG, Taylor HA, Zafonte RD, Baggish AL. Concussion burden and later-life cardiovascular risk factors in former professional American-style football players. Ann Clin Transl Neurol 2024; 11:1604-1614. [PMID: 38808967 PMCID: PMC11187967 DOI: 10.1002/acn3.52045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Mid-life cardiovascular risk factors are associated with later cognitive decline. Whether repetitive head injury among professional athletes impacts cardiovascular risk is unknown. We investigated associations between concussion burden and postcareer hypertension, high cholesterol, and diabetes among former professional American-style football (ASF) players. METHODS In a cross-sectional study of 4080 professional ASF players conducted between January 2015 and March 2022, we used an mulitsymptom concussion symptom score (CSS) and the number of loss-of-consciousness (LOC) episodes as a single severe symptom to quantify football-related concussion exposure. Primary outcomes were hypertension, dyslipidemia, and diabetes, defined by current or recommended prescription medication use. RESULTS The prevalence of hypertension, high cholesterol, and diabetes among former players (52 ± 14 years of age) was 37%, 34%, and 9%. Concussion burden was significantly associated with hypertension (lowest vs. highest CSS quartile, odds ratio (OR) = 1.99; 95%CI: 1.33-2.98; p < 0.01) and high cholesterol (lowest vs. moderate CSS, OR = 1.46, 95%CI, 1.11-1.91; p < 0.01), but not diabetes. In fully adjusted models, the prevalence of multiple CVD was associated with CSS. These results were driven by younger former players (≤ 40 year of age) in which the odds of hypertension were over three times higher in those in the highest CSS quartile (OR = 3.29, 95%CI: 1.39-7.61; p = 0.01). Results were similar for LOC analyses. INTERPRETATION Prior concussion burden is associated with postcareer atherogenic cardiovascular risk profiles among former professional American football players.
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Affiliation(s)
- Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer ScienceUniversity of Twentethe Netherlands
| | - Rachel Grashow
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Roland Thorpe
- Program of Research on Men's Health, Hopkins Center for Health Disparities SolutionsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Health Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging ResearchBaltimoreMarylandUSA
| | - Karen K. Miller
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBoston02114MassachusettsUSA
| | - David M. Nathan
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Diabetes Research CenterMassachusetts General Hospital and Harvard Medical SchoolBoston02114MassachusettsUSA
| | - Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Farid Radmanesh
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Neurocritical Care, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Jonathan H. Kim
- Emory Clinical Cardiovascular Research InstituteEmory University School of MedicineAtlantaGeorgiaUSA
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Herman A. Taylor
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Cardiovascular Research InstituteMorehouse School of MedicineAtlantaGeorgiaUSA
| | - Ross D. Zafonte
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalCharlestownMassachusettsUSA
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Aaron L. Baggish
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyUniversity of LausanneLausanneSwitzerland
- Department of Sports ScienceUniversity of LausanneLausanneSwitzerland
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27
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Culhane JE, Jackson CE, Tripodis Y, Nowinski CJ, Dams-O'Connor K, Pettway E, Uretsky M, Abdolmohammadi B, Nair E, Martin B, Palmisano J, Katz DI, Dwyer B, Daneshvar DH, Goldstein LE, Kowall NW, Cantu RC, Stern RA, Huber BR, Crary JF, Mez J, Stein TD, McKee AC, Alosco ML. Lack of Association of Informant-Reported Traumatic Brain Injury and Chronic Traumatic Encephalopathy. J Neurotrauma 2024; 41:1399-1408. [PMID: 38445389 PMCID: PMC11339554 DOI: 10.1089/neu.2023.0391] [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: 03/07/2024] Open
Abstract
Repetitive head impacts (RHIs) from football are associated with the neurodegenerative tauopathy chronic traumatic encephalopathy (CTE). It is unclear whether a history of traumatic brain injury (TBI) is sufficient to precipitate CTE neuropathology. We examined the association between TBI and CTE neuropathology in 580 deceased individuals exposed to RHIs from football. TBI history was assessed using a modified version of the Ohio State University TBI Identification Method Short Form administered to informants. There were 22 donors who had no TBI, 213 who had at least one TBI without loss of consciousness (LOC), 345 who had TBI with LOC, and, of those with a history of TBI with LOC, 36 who had at least one moderate-to-severe TBI (msTBI, LOC >30 min). CTE neuropathology was diagnosed in 405. There was no association between CTE neuropathology status or severity and TBI with LOC (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.64-1.41; OR = 1.22, 95% CI = 0.71-2.09) or msTBI (OR = 0.70, 95% CI = 0.33-1.50; OR = 1.01, 95% CI = 0.30-3.41). There were no associations with other neurodegenerative or cerebrovascular pathologies examined. TBI with LOC and msTBI were not associated with CTE neuropathology in this sample of brain donors exposed to RHIs from American football.
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Affiliation(s)
- Julia E. Culhane
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Colleen E. Jackson
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christopher J. Nowinski
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Concussion Legacy Foundation, Boston, Massachusetts, USA
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erika Pettway
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Bobak Abdolmohammadi
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Evan Nair
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Douglas I. Katz
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brigid Dwyer
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Daniel H. Daneshvar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Lee E. Goldstein
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, Massachusetts, USA
| | - Neil W. Kowall
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
| | - Robert C. Cantu
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Concussion Legacy Foundation, Boston, Massachusetts, USA
| | - Robert A. Stern
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- National Center for PTSD, VA Boston Healthcare, Boston, Massachusetts, USA
| | - John F. Crary
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pathology, Molecular, and Cell-Based Medicine, Nash Family Department of Neuroscience, Friedman Brain Institute, Mount Sinai, New York, New York, USA
- Department of Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Thor D. Stein
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ann C. McKee
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, Massachusetts, USA
- VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Michael L. Alosco
- Boston University Alzheimer's Disease Research Center, BU CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Sullan MJ, Kinney AR, Stearns-Yoder KA, Reis DJ, Saldyt EG, Forster JE, Cogan CM, Bahraini NH, Brenner LA. A randomized clinical trial for a self-guided sleep intervention following moderate-severe traumatic brain injury: Study protocol. Contemp Clin Trials 2024; 141:107525. [PMID: 38604497 DOI: 10.1016/j.cct.2024.107525] [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: 05/08/2023] [Revised: 11/10/2023] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Individuals with a history of moderate-severe traumatic brain injury (TBI) experience a significantly higher prevalence of insomnia compared to the general population. While individuals living with TBI have been shown to benefit from traditional insomnia interventions (e.g., face-to-face [F2F]), such as Cognitive Behavioral Therapy for Insomnia (CBTI), many barriers exist that limit access to F2F evidence-based treatments. Although computerized CBT-I (CCBT-I) is efficacious in terms of reducing insomnia symptoms, individuals with moderate-severe TBI may require support to engage in such treatment. Here we describe the rationale, design, and methods of a randomized controlled trial (RCT) assessing the efficacy of a guided CCBT-I program for reducing insomnia symptoms for participants with a history of moderate-severe TBI. METHODS This is an RCT of a guided CCBT-I intervention for individuals with a history of moderate-severe TBI and insomnia. The primary outcome is self-reported insomnia severity, pre- to post-intervention. Exploratory outcomes include changes in sleep misperception following CCBT-I and describing the nature of guidance needed by the Study Clinician during the intervention. CONCLUSION This study represents an innovative approach to facilitating broader engagement with an evidence-based online treatment for insomnia among those with a history of moderate-severe TBI. Findings will provide evidence for the level and nature of support needed to implement guided CCBT-I. Should findings be positive, this study would provide support for a strategy by which to deliver guided CCBT-I to individuals with a history of moderate-severe TBI.
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Affiliation(s)
- Molly J Sullan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Adam R Kinney
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kelly A Stearns-Yoder
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel J Reis
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emerald G Saldyt
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Chelsea M Cogan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, United States; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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Allendorfer JB, Nenert R, Goodman AM, Kakulamarri P, Correia S, Philip NS, LaFrance WC, Szaflarski JP. Brain network entropy, depression, and quality of life in people with traumatic brain injury and seizure disorders. Epilepsia Open 2024; 9:969-980. [PMID: 38507279 PMCID: PMC11145610 DOI: 10.1002/epi4.12926] [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: 05/26/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Traumatic brain injury (TBI) often precedes the onset of epileptic (ES) or psychogenic nonepileptic seizures (PNES) with depression being a common comorbidity. The relationship between depression severity and quality of life (QOL) may be related to resting-state network complexity. We investigated these relationships in adults with TBI-only, TBI + ES, or TBI + PNES using Sample Entropy (SampEn), a measure of physiologic signals complexity. METHODS Adults with TBI-only (n = 60), TBI + ES (n = 21), or TBI + PNES (n = 56) completed the Beck Depression Inventory-II (BDI-II; depression symptom severity) and QOL in Epilepsy (QOLIE-31) assessments and underwent resting-state functional magnetic resonance imaging (rs-fMRI). SampEn values derived from six resting state functional networks were calculated per participant. Effects of group, network, and group-by-network-interactions for SampEn were investigated with a mixed-effects model. We examined relationships between BDI-II, QOL, and SampEn of each of the networks. RESULTS Groups did not differ in age, but there was a higher proportion of women with TBI + PNES (p = 0.040). TBI + ES and TBI-only groups did not differ in BDI-II or QOLIE-31 scores, while the TBI + PNES group scored worse on both measures. The fixed effects of the model revealed significant differences in SampEn values across networks (lower SampEn for the frontoparietal network compared to other networks). The likelihood ratio test for group-by-network-interactions was significant (p = 0.033). BDI-II was significantly negatively associated with Overall QOL scale scores in all groups, and significantly negatively associated with network SampEn values only in the TBI + PNES group. SIGNIFICANCE Only TBI + PNES had significant relationships between depression symptom severity and network SampEn values indicating that the resting state network complexity is related to depression severity in this group but not in TBI + ES or TBI-only. PLAIN LANGUAGE SUMMARY The brain has a complex network of internal connections. How well these connections work may be affected by TBI and seizures and may underlie mental health symptoms including depression; the worse the depression, the worse the quality of life. Our study compared brain organization in people with TBI, people with epilepsy after TBI, and people with nonepileptic seizures after TBI. Only people with nonepileptic seizures after TBI showed a relationship between how organized their brain connections were and how bad was their depression. We need to better understand these relationships to develop more impactful, effective treatments.
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Affiliation(s)
- Jane B. Allendorfer
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurobiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rodolphe Nenert
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Adam M. Goodman
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Pranav Kakulamarri
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Stephen Correia
- VA RR&D Center for Neurorestoration and NeurotechnologyVA Providence Healthcare SystemProvidenceRhode IslandUSA
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and NeurotechnologyVA Providence Healthcare SystemProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorBrown UniversityProvidenceRhode IslandUSA
| | - W. Curt LaFrance
- VA RR&D Center for Neurorestoration and NeurotechnologyVA Providence Healthcare SystemProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorBrown UniversityProvidenceRhode IslandUSA
- Department of NeurologyBrown UniversityProvidenceRhode IslandUSA
- Division of Neuropsychiatry and Behavioral NeurologyRhode Island HospitalProvidenceRhode IslandUSA
| | - Jerzy P. Szaflarski
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurobiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Remigio-Baker RA, Hungerford LD, Bailie JM, Ivins BJ, Lopez J, Ettenhofer ML. The Patient Global Impression of Change as a complementary tool to account for neurobehavioral and mental health symptom improvement for patients with concussion. Disabil Rehabil 2024:1-9. [PMID: 38821113 DOI: 10.1080/09638288.2024.2346233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/17/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE The purpose of this study was to determine the extent to which patient's perspective of symptom improvement, as indexed by the Patient Global Impression of Change (PGIC) survey, is associated with symptom improvement on common measures of neurobehavioral and mental health symptoms following concussion. MATERIALS AND METHODS Data were from 449 US active duty service members receiving treatment in interdisciplinary programs for their concussion. PGIC rating (range = 1-7) was evaluated for compatibility in assessing improvement in or clinically-elevated neurobehavioral (using Neurobehavioral Symptom Inventory [NSI]) and mental health (using Post-traumatic Stress Disorder Checklist, DSM-5 [PCL-5] and Patient Health Questionnaire [PHQ-8]) symptoms. RESULTS Higher PGIC scores were related to a higher prevalence of clinically-relevant decrease in NSI, PCL-5 or PHQ-8 scores. Participants with a PGIC rating of 3+ (vs.<3) were about 2.2 (CI = 1.4-3.5), 1.6 (CI = 1.1-1.3), and 2.7 (CI = 1.4-5.1) times more likely to report clinically-relevant decrease in NSI, PCL-5 and PHQ-8 symptoms, respectively. CONCLUSION PGIC may help providers incorporate patients' perspectives on symptom improvement achieved during rehabilitation. An approach combining PGIC with surveys such as NSI, PCL-5 and PHQ-8 may provide a more comprehensive understanding of symptom improvement and realistic view of expectations for what would be deemed recovery to pre-injury symptom levels.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- Compass Government Solutions, Annapolis, MD, USA
| | - Lars D Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Brian J Ivins
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Juan Lopez
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Mark L Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
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Nikolova S, Chong C, Li J, Wu T, Dumkrieger G, Ross K, Starling A, Schwedt TJ. Brain structural and functional abnormalities associated with acute post-traumatic headache: iron deposition and functional connectivity. J Headache Pain 2024; 25:88. [PMID: 38807070 PMCID: PMC11134688 DOI: 10.1186/s10194-024-01797-0] [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: 03/25/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The purpose of this study was to interrogate brain iron accumulation in participants with acute post-traumatic headache (PTH) due to mild traumatic brain injury (mTBI), and to determine if functional connectivity is affected in areas with iron accumulation. We aimed to examine the correlations between iron accumulation and headache frequency, post-concussion symptom severity, number of mTBIs, and time since most recent TBI. METHODS Sixty participants with acute PTH and 60 age-matched healthy controls (HC) underwent 3T magnetic resonance imaging including quantitative T2* maps and resting-state functional connectivity imaging. Between group T2* differences were determined using T-tests (p < 0.005, cluster size threshold of 90 voxels). For regions with T2* differences, two analyses were conducted. First, the correlations with clinical variables including headache frequency, number of lifetime mTBIs, time since most recent mTBI, and Sport Concussion Assessment Tool (SCAT) symptom severity scale scores were investigated using linear regression. Second, the functional connectivity of these regions with the rest of the brain was examined (significance of p < 0.05 with family wise error correction for multiple comparisons). RESULTS The acute PTH group consisted of 60 participants (22 male, 38 female) with average age of 42 ± 14 years. The HC group consisted of 60 age-matched controls (17 male, 43 female, average age of 42 ± 13). PTH participants had lower T2* values compared to HC in the left posterior cingulate and the bilateral cuneus. Stronger functional connectivity was observed between bilateral cuneus and right cerebellar areas in PTH compared to HC. Within the PTH group, linear regression showed negative associations of T2* in the left posterior cingulate with SCAT symptom severity score (p = 0.05) and T2* in the left cuneus with headache frequency (p = 0.04). CONCLUSIONS Iron accumulation in posterior cingulate and cuneus was observed in those with acute PTH relative to HC; stronger functional connectivity was detected between the bilateral cuneus and the right cerebellum. The correlations of decreased T2* (suggesting higher iron content) with headache frequency and post mTBI symptom severity suggest that the iron accumulation that results from mTBI might reflect the severity of underlying mTBI pathophysiology and associate with post-mTBI symptom severity including PTH.
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Affiliation(s)
- Simona Nikolova
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
| | - Catherine Chong
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
- ASU-Mayo Center for Innovative Imaging, Tempe, AZ, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Phoenix, AZ, USA
| | - Jing Li
- School of Industrial and Systems Engineering, Georgia Tech, Georgia, GA, USA
| | - Teresa Wu
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
- ASU-Mayo Center for Innovative Imaging, Tempe, AZ, USA
| | - Gina Dumkrieger
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
| | | | - Amaal Starling
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA
| | - Todd J Schwedt
- Department of Neurology, Mayo Clinic, 5777 East Mayo Blvd Phoenix, Phoenix, AZ, 85054, USA.
- ASU-Mayo Center for Innovative Imaging, Tempe, AZ, USA.
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de Aquino Costa Sousa T, Gagnon IJ, Li KZH, McFadyen BJ, Lamontagne A. Exploring the challenges of avoiding collisions with virtual pedestrians using a dual-task paradigm in individuals with chronic moderate to severe traumatic brain injury. J Neuroeng Rehabil 2024; 21:80. [PMID: 38755606 PMCID: PMC11097498 DOI: 10.1186/s12984-024-01378-x] [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: 03/01/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Individuals with a moderate-to-severe traumatic brain injury (m/sTBI), despite experiencing good locomotor recovery six months post-injury, face challenges in adapting their locomotion to the environment. They also present with altered cognitive functions, which may impact dual-task walking abilities. Whether they present collision avoidance strategies with moving pedestrians that are altered under dual-task conditions, however, remains unclear. This study aimed to compare between individuals with m/sTBI and age-matched control individuals: (1), the locomotor and cognitive costs associated with the concurrent performance of circumventing approaching virtual pedestrians (VRPs) while attending to an auditory-based cognitive task and; (2) gaze behaviour associated with the VRP circumvention task in single and dual-task conditions. METHODOLOGY Twelve individuals with m/sTBI (age = 43.3 ± 9.5 yrs; >6 mo. post injury) and 12 healthy controls (CTLs) (age = 41.8 ± 8.3 yrs) were assessed while walking in a virtual subway station viewed in a head-mounted display. They performed a collision avoidance task with VRPs, as well as auditory-based cognitive tasks (pitch discrimination and auditory Stroop), both under single and dual-task conditions. Dual-task cost (DTC) for onset distance of trajectory deviation, minimum distance from the VRP, maximum lateral deviation, walking speed, gaze fixations and cognitive task accuracy were contrasted between groups using generalized estimating equations. RESULTS In contrast to CTLs who showed locomotor DTCs only, individuals with m/sTBI displayed both locomotor and cognitive DTCs. While both groups walked slower under dual-task conditions, only individuals with m/sTBI failed to modify their onset distance of trajectory deviation and maintained smaller minimum distances and smaller maximum lateral deviation compared to single-task walking. Both groups showed shorter gaze fixations on the approaching VRP under dual-task conditions, but this reduction was less pronounced in the individuals with m/sTBI. A reduction in cognitive task accuracy under dual-task conditions was found in the m/sTBI group only. CONCLUSION Individuals with m/sTBI present altered locomotor and gaze behaviours, as well as altered cognitive performances, when executing a collision avoidance task involving moving pedestrians in dual-task conditions. Potential mechanisms explaining those alterations are discussed. Present findings highlight the compromised complex walking abilities in individuals with m/sTBI who otherwise present a good locomotor recovery.
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Affiliation(s)
- Thiago de Aquino Costa Sousa
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital - CISSS Laval, Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 3205 Place Alton-Goldbloom, Laval, QC, H7V 1R2, Canada.
| | - Isabelle J Gagnon
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
- Trauma/Child Development, Montreal Children's Hospital, Montreal, QC, Canada
| | - Karen Z H Li
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Bradford J McFadyen
- School of Rehabilitation Sciences, Université Laval, Quebec City, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS Capitale Nationale, Quebec City, QC, Canada
| | - Anouk Lamontagne
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital - CISSS Laval, Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 3205 Place Alton-Goldbloom, Laval, QC, H7V 1R2, Canada
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Saadi A, Choi KR, Khan T, Tang JT, Iverson GL. Examining the Association Between Adverse Childhood Experiences and Lifetime History of Head or Neck Injury and Concussion in Children From the United States. J Head Trauma Rehabil 2024; 39:E113-E121. [PMID: 37582185 DOI: 10.1097/htr.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Our objective was to determine whether there is an association between adverse childhood experiences (ACEs) and lifetime history of early childhood mild head or neck injury and concussion in a nationally representative US cohort. SETTING AND DESIGN This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) Study (data release 3.0), a prospective investigation of child brain development and health. PARTICIPANTS There were 11 878 children aged 9 or 10 years at baseline, recruited from 21 school-based sites in the United States. After excluding children with missing questionnaires for the primary exposure variable and children with severe brain injuries involving more than 30-minute loss of consciousness, the final sample size was 11 230 children. MEASURES The primary exposure variable was ACEs. We measured eight ACEs: sexual abuse, physical abuse, emotional neglect, parent domestic violence, parent substance use disorder, parental mental illness, parent criminal involvement, and parent divorce. The primary outcomes were head or neck injury and concussion, measured using the Ohio State University Traumatic Brain Injury Screen-Identification Method Short Form. RESULTS The sample ( N = 11 230) was 52% boys with a mean age of 9.9 years (SD = 0.62 years). The racial and ethnic makeup was reflective of national demographics. Having a higher overall ACE count was associated with higher odds of head or neck injury, with greater odds with more ACEs reported. Children with 2 ACEs had 24% greater odds of head or neck injury (AOR = 1.24, 95% confidence interval [CI] = 1.06-1.45) and 64% greater odds of concussion (AOR = 1.64, 95% CI = 1.18-2.22), and children with 4 or more ACEs had 70% greater odds of head or neck injury (AOR = 1.7, 95% CI = 1.14, 2.49) and 140% greater odds of concussion (AOR = 2.4, 95% CI = 1.15-4.47). The individual ACE categories of sexual abuse, parent domestic violence, parental mental illness, and parent criminal involvement were significantly associated with increased risk of head or neck injury and parental mental illness with increased risk of concussion. CONCLUSIONS AND RELEVANCE ACEs are associated with early childhood mild head or neck injury and concussion and should be integrated in head injury prevention and intervention efforts.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, Massachusetts (Dr Saadi); School of Nursing, University of California, Los Angeles (Dr Choi and Ms Tang); Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (Dr Choi); Boston Medical Center and Boston Children's Hospital, Boston, Massachusetts (Dr Khan); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Iverson); and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Boston, Massachusetts (Dr Iverson)
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Lange RT, Gill JM, Lippa SM, Hungerford L, Walker T, Kennedy J, Brickell TA, French LM. Elevated Serum Tau and UCHL-1 Concentrations Within 12 Months of Injury Predict Neurobehavioral Functioning 2 or More Years Following Traumatic Brain Injury: A Longitudinal Study. J Head Trauma Rehabil 2024; 39:196-206. [PMID: 37335195 DOI: 10.1097/htr.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Blood-based biomarkers have received considerable attention for their diagnostic and prognostic value in the acute and postacute period following traumatic brain injury (TBI). The purpose of this study was to examine whether blood-based biomarker concentrations within the first 12 months of TBI can predict neurobehavioral outcome in the chronic phase of the recovery trajectory. SETTING Inpatient and outpatient wards from 3 military medical treatment facilities. PARTICIPANTS A total of 161 service members and veterans classified into 3 groups: ( a ) uncomplicated mild TBI (MTBI; n = 37), ( b ) complicated mild, moderate, severe, penetrating TBI combined (STBI; n = 46), and ( c ) controls (CTRL; n = 78). DESIGN Prospective longitudinal. MAIN MEASURES Participants completed 6 scales from the Traumatic Brain Injury Quality of Life (ie, Anger, Anxiety, Depression, Fatigue, Headaches, and Cognitive Concerns) within 12 months (baseline) and at 2 or more years (follow-up) post-injury. Serum concentrations of tau, neurofilament light, glial fibrillary acidic protein, and UCHL-1 at baseline were measured using SIMOA. RESULTS Baseline tau was associated with worse anger, anxiety, and depression in the STBI group at follow-up ( R2 = 0.101-0.127), and worse anxiety in the MTBI group ( R2 = 0.210). Baseline ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) was associated with worse anxiety and depression at follow-up in both the MTBI and STBI groups ( R2 Δ = 0.143-0.207), and worse cognitive concerns in the MTBI group ( R2 Δ = 0.223). CONCLUSIONS A blood-based panel including these biomarkers could be a useful tool for identifying individuals at risk of poor outcome following TBI.
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Affiliation(s)
- Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Drs Lange, Hungerford, Kennedy, Brickell, and French and Mr Walker); Walter Reed National Military Medical Center, Bethesda, Maryland (Drs Lange, Lippa, Brickell, and French); National Intrepid Center of Excellence, Bethesda, Maryland (Drs Lange, Lippa, Brickell, and French); General Dynamics Information Technology, Falls Church, Virginia (Drs Lange, Hungerford, Kennedy, and Brickell); Department of Psychiatry, University of British Columbia, Vancouver, Canada (Dr Lange); Department of Physical Medicine and Rehabilitation, University of the Health Sciences, Bethesda, Maryland (Drs Lange, Brickell, and French); Department of Neuroscience, University of the Health Sciences, Bethesda, Maryland (Dr Lippa); San Antonio Military Medical Center, San Antonio, Texas (Dr Kennedy); Naval Medical Center San Diego, San Diego, California (Dr Hungerford and Mr Walker); and Johns Hopkins University, Baltimore, Maryland (Dr Gill)
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Harper BA, Soangra R. Assessing Brain Processing Deficits Using Neuropsychological and Vision-Specific Tests for Concussion. Sports (Basel) 2024; 12:125. [PMID: 38786994 PMCID: PMC11125887 DOI: 10.3390/sports12050125] [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] [Received: 03/31/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Since verbal memory and visual processing transpire within analogous cerebral regions, this study assessed (i) if a visual function can predict verbal memory performance. It also hypothesized whether neurocognitive (e.g., ImPACT) tests focusing on the Visual Memory and Cognitive Efficacy Index will predict Verbal Memory scores and (ii) if vision metrics and age can identify individuals with a history of concussion. Finally, it also hypothesized that King-Devick and near point of convergence scores alongside age considerations will identify candidates with a prior reported history of concussion. MATERIALS AND METHODS This observational cohort assessed 25 collegiate ice hockey players prior to the competitive season considering age (19.76 ± 1.42 years) and BMI (25.9 ± 3.0 kg/cm2). Hypothesis 1 was assessed using a hierarchical (sequential) multiple regression analysis, assessing the predictive capacity of Visual Memory and Cognitive Efficacy Index scores in relation to Verbal Memory scores. Hypothesis 2 utilized a binomial logistic regression to determine if King-Devick and near point of convergence scores predict those with a prior history of concussion. RESULTS Hypothesis 1 developed two models, where Model 1 included Visual Memory as the predictor, while Model 2 added the Cognitive Efficacy Index as a predictor for verbal memory scores. Model 1 significantly explained 41% of the variance. Results from Model 2 suggest that the Cognitive Efficacy Index explained an additional 24.4%. Thus, Model 2 was interpreted where only the Cognitive Efficacy Index was a significant predictor (p = 0.001). For every 1 unit increase in the Cognitive Efficacy Index, Verbal Memory increased by 41.16. Hypothesis 2's model was significant, accounting for 37.9% of the variance in those with a history of concussion. However, there were no significant unique predictors within the model as age (Wald = 1.26, p = 0.261), King-Devick (Wald = 2.31, p = 0.128), and near point of convergence (Wald = 2.43, p = 0.119) were not significant predictors individually. CONCLUSIONS The conflicting findings of this study indicate that baseline data for those with a history of concussion greater than one year may not be comparable to the same metrics during acute concussion episodes. Young athletes who sustain a concussion may be able to overcompensate via the visual system. Future prospective studies with larger sample sizes are required using the proposed model's objective metrics.
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Affiliation(s)
- Brent A. Harper
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
- Department of Physical Therapy, Radford University, Roanoke, VA 24013, USA
| | - Rahul Soangra
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
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Zimmerman KA, Hain JA, Graham NSN, Rooney EJ, Lee Y, Del-Giovane M, Parker TD, Friedland D, Cross MJ, Kemp S, Wilson MG, Sylvester RJ, Sharp DJ. Prospective cohort study of long-term neurological outcomes in retired elite athletes: the Advanced BiomaRker, Advanced Imaging and Neurocognitive (BRAIN) Health Study protocol. BMJ Open 2024; 14:e082902. [PMID: 38663922 PMCID: PMC11043776 DOI: 10.1136/bmjopen-2023-082902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Although limited, recent research suggests that contact sport participation might have an adverse long-term effect on brain health. Further work is required to determine whether this includes an increased risk of neurodegenerative disease and/or subsequent changes in cognition and behaviour. The Advanced BiomaRker, Advanced Imaging and Neurocognitive Health Study will prospectively examine the neurological, psychiatric, psychological and general health of retired elite-level rugby union and association football/soccer players. METHODS AND ANALYSIS 400 retired athletes will be recruited (200 rugby union and 200 association football players, male and female). Athletes will undergo a detailed clinical assessment, advanced neuroimaging, blood testing for a range of brain health outcomes and neuropsychological assessment longitudinally. Follow-up assessments will be completed at 2 and 4 years after baseline visit. 60 healthy volunteers will be recruited and undergo an aligned assessment protocol including advanced neuroimaging, blood testing and neuropsychological assessment. We will describe the previous exposure to head injuries across the cohort and investigate relationships between biomarkers of brain injury and clinical outcomes including cognitive performance, clinical diagnoses and psychiatric symptom burden. ETHICS AND DISSEMINATION Relevant ethical approvals have been granted by the Camberwell St Giles Research Ethics Committee (Ref: 17/LO/2066). The study findings will be disseminated through manuscripts in clinical/academic journals, presentations at professional conferences and through participant and stakeholder communications.
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Affiliation(s)
- Karl A Zimmerman
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Jessica A Hain
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Neil S N Graham
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Erin Jane Rooney
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Ying Lee
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Martina Del-Giovane
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Thomas D Parker
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Neurodegenerative Disease, The Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Daniel Friedland
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Matthew J Cross
- Carnegie Applied Rugby Research Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Premiership Rugby, London, UK
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Mathew G Wilson
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- HCA Healthcare Research Institute, London, UK
| | - Richard J Sylvester
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- Acute Stroke and Brain Injury Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Sharp
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
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Asken BM, Tanner JA, Vandevrede L, Apple A, Chapleau M, Gaynor LS, Lane-Donovan C, Lenio S, Yadollahikhales G, Lee S, Gontrum E, Knudtson M, Iaccarino L, La Joie R, Cobigo Y, Staffaroni AM, Casaletto KB, Gardner RC, Grinberg LT, Gorno-Tempini ML, Rosen HJ, Seeley WW, Miller BL, Kramer J, Rabinovici GD. Linking Type and Extent of Head Trauma to Cavum Septum Pellucidum in Older Adults With and Without Alzheimer Disease and Related Dementias. Neurology 2024; 102:e209183. [PMID: 38489566 PMCID: PMC11033989 DOI: 10.1212/wnl.0000000000209183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/18/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cavum septum pellucidum (CSP) is a common but nonspecific MRI finding in individuals with prior head trauma. The type and extent of head trauma related to CSP, CSP features specific to head trauma, and the impact of brain atrophy on CSP are unknown. We evaluated CSP cross-sectionally and longitudinally in healthy and clinically impaired older adults who underwent detailed lifetime head trauma characterization. METHODS This is an observational cohort study of University of California, San Francisco Memory and Aging Center participants (healthy controls [HCs], those with Alzheimer disease or related dementias [ADRDs], subset with traumatic encephalopathy syndrome [TES]). We characterized traumatic brain injury (TBI) and repetitive head impacts (RHI) through contact/collision sports. Study groups were no RHI/TBI, prior TBI only, prior RHI only, and prior RHI + TBI. We additionally looked within TBI (1, 2, or 3+) and RHI (1-4, 5-10, and 11+ years). All underwent baseline MRI, and 67% completed a second MRI (median follow-up = 5.4 years). CSP measures included grade (0-4) and length (millimeters). Groups were compared on likelihood of CSP (logistic regression, odds ratios [ORs]) and whether CSP length discriminated groups (area under the curve [AUC]). RESULTS Our sample included 266 participants (N = 160 HCs, N = 106 with ADRD or TES; age 66.8 ± 8.2 years, 45.3% female). Overall, 123 (49.8%) participants had no RHI/TBI, 52 (21.1%) had TBI only, 41 (16.6%) had RHI only, 31 (12.6%) had RHI + TBI, and 20 were classified as those with TES (7.5%). Compared with no RHI/TBI, RHI + TBI (OR 3.11 [1.23-7.88]) and TES (OR 11.6 [2.46-54.8]) had greater odds of CSP. Approximately 5-10 years (OR 2.96 [1.13-7.77]) and 11+ years of RHI (OR 3.14 [1.06-9.31]) had higher odds of CSP. CSP length modestly discriminated participants with 5-10 years (AUC 0.63 [0.51-0.75]) and 11+ years of prior RHI (AUC 0.69 [0.55-0.84]) from no RHI/TBI (cut point = 6 mm). Strongest effects were noted in analyses of American football participation. Longitudinally, CSP grade was unchanged in 165 (91.7%), and length was unchanged in 171 (95.5%) participants. DISCUSSION Among older adults with and without neurodegenerative disease, risk of CSP is driven more by duration (years) of RHI, especially American football, than number of TBI. CSP length (≥6 mm) is relatively specific to individuals who have had substantial prior RHI. Neurodegenerative disease and progressive atrophy do not clearly influence development or worsening of CSP.
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Affiliation(s)
- Breton M Asken
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Jeremy A Tanner
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Lawren Vandevrede
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Alexandra Apple
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Marianne Chapleau
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Leslie S Gaynor
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Courtney Lane-Donovan
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Steven Lenio
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Golnaz Yadollahikhales
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Shannon Lee
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Eva Gontrum
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Marguerite Knudtson
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Leonardo Iaccarino
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Renaud La Joie
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Yann Cobigo
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Adam M Staffaroni
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Kaitlin B Casaletto
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Raquel C Gardner
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Lea T Grinberg
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Maria Luisa Gorno-Tempini
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Howard J Rosen
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - William W Seeley
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Bruce L Miller
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Joel Kramer
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
| | - Gil D Rabinovici
- From the Department of Clinical and Health Psychology (B.M.A.), University of Florida, Gainesville; Department of Neurology (J.A.T.), Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio, TX; Department of Neurology (L.V., M.C., C.L.-D., G.Y., S. Lee, E.G., M.K., L.I., R.L.J., Y.C., A.M.S., K.B.C., L.T.G., M.L.G.-T., H.J.R., W.W.S., B.L.M., J.K., G.D.R.), Weill Institute for Neurosciences, Memory and Aging Center, and Department of Psychiatry (A.A.), University of California, San Francisco; Department of Geriatrics (L.S.G.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (S. Lenio), Boston University Medical Center, MA; and Sheba Medical Center at Tel Hashomer (R.C.G.), Ramat Gan, Israel
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Juengst SB, Wright B, DeMello A, Vos L, Biney F, Novelo LL, Williams M. Neurobehavioral Symptom Profiles for the Behavioral Assessment Screening Tool in Chronic Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00144. [PMID: 38652671 DOI: 10.1097/htr.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify neurobehavioral symptom profiles among persons with chronic traumatic brain injury (TBI) using the Behavioral Assessment Screening Tool (BAST) and to consider participant characteristics that differ between profile groups. SETTING Community. PARTICIPANTS Participants (n = 615) were English-speaking adults (≥18) and had a self-reported history of at least one TBI of any severity. DESIGN Secondary analysis of cross-sectional data. MAIN MEASURES The BAST measures neurobehavioral symptoms in the domains of Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, and Substance Misuse. RESULTS Using latent profile analysis (LPA), we identified 3 different neurobehavioral profiles. Overall symptom frequency and differences in the pattern of symptom frequency across domains differentiated the profile groups. Average domain scores differed significantly across the profiles (P < .001) for all domains except Fatigue (P = .076). Those in profile 3 (High-Risk group) reported the most frequent symptoms across all domains (similar Negative Affect frequency as profile 1). Substance Misuse was especially high in this group. Compared to profile 2 (High Negative Affect group), participants in profile 1 (Moderate-Risk group) endorsed significantly more frequent (and more variable) symptoms across all BAST domains, particularly Impulsivity and Substance Misuse. Participants in profile 2 endorsed the least frequent symptoms across all domains. Demographic comparison showed that groups differed based on gender, age, and injury severity (mild vs moderate-severe), with profile 3 composed of the most men and the most persons in early adulthood, and profile 2 composed of the most women and those with mild TBI. CONCLUSIONS We differentiated 3 neurobehavioral symptom profiles among persons with chronic TBI and determined differences in sociodemographic factors between the groups. Future research should focus on validating these profiles in another sample of individuals with chronic TBI. Characterizing persons according to multidimensional symptom profiles could allow for more tailored approaches to predict and prevent long-term negative outcomes.
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Affiliation(s)
- Shannon B Juengst
- Author Affiliations: TIRR Memorial Hermann (Dr Juengst), Houston, TX; Department of Physical Medicine & Rehabilitation (Dr Juengst), Department of Biostatistics and Data Science (Dr Novelo), University of Texas Health Sciences Center at Houston, Houston, TX; Department of Physical Medicine & Rehabilitation (Drs Juengst and Wright), University of Texas Southwestern Medical Center, Dallas, TX; School of Nursing (Dr DeMello), University of Texas Medical Branch, Galveston, TX; Spectrum Health Medical Group, Neurosciences (Dr Vos), Grand Rapids, MI; Department of Physical Medicine & Rehabilitation (Dr Biney), University of Alabama at Birmingham, Birmingham, AL; and Department of Psychology (Dr Williams), University of Houston, Houston, TX
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Esopenko C, Jain D, Adhikari SP, Dams-O'Connor K, Ellis M, Haag HL, Hovenden ES, Keleher F, Koerte IK, Lindsey HM, Marshall AD, Mason K, McNally JS, Menefee DS, Merkley TL, Read EN, Rojcyk P, Shultz SR, Sun M, Toccalino D, Valera EM, van Donkelaar P, Wellington C, Wilde EA. Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps. J Neurotrauma 2024. [PMID: 38323539 DOI: 10.1089/neu.2023.0543] [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: 02/08/2024] Open
Abstract
Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shambhu Prasad Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Halina Lin Haag
- Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada
| | - Elizabeth S Hovenden
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Finian Keleher
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy D Marshall
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury through Research (SOAR), Kelowna, British Columbia, Canada
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Emma N Read
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philine Rojcyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Sandy R Shultz
- Health Sciences, Vancouver Island University, Nanaimo, Canada
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen ,VA Salt Lake City Heathcare System, Salt Lake City, Utah, USA
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Gimbel SI, Hungerford LD, Twamley EW, Ettenhofer ML. White Matter Organization and Cortical Thickness Differ Among Active Duty Service Members With Chronic Mild, Moderate, and Severe Traumatic Brain Injury. J Neurotrauma 2024; 41:818-835. [PMID: 37800726 PMCID: PMC11005384 DOI: 10.1089/neu.2023.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Abstract This study compared findings from whole-brain diffusion tensor imaging (DTI) and volumetric magnetic resonance imaging (MRI) among 90 Active Duty Service Members with chronic mild traumatic brain injury (TBI; n = 52), chronic moderate-to-severe TBI (n = 17), and TBI-negative controls (n = 21). Data were collected on a Philips Ingenia 3T MRI with DTI in 32 directions. Results demonstrated that history of TBI was associated with differences in white matter microstructure, white matter volume, and cortical thickness in both mild TBI and moderate-to-severe TBI groups relative to controls. However, the presence, pattern, and distribution of these findings varied substantially depending on the injury severity. Spatially-defined forms of DTI fractional anisotropy (FA) analyses identified altered white matter organization within the chronic moderate-to-severe TBI group, but they did not provide clear evidence of abnormalities within the chronic mild TBI group. In contrast, DTI FA "pothole" analyses identified widely distributed areas of decreased FA throughout the white matter in both the chronic mild TBI and chronic moderate-to-severe TBI groups. Additionally, decreased white matter volume was found in several brain regions for the chronic moderate-to-severe TBI group compared with the other groups. Greater number of DTI FA potholes and reduced cortical thickness were also related to greater severity of self-reported symptoms. In sum, this study expands upon a growing body of literature using advanced imaging techniques to identify potential effects of brain injury in military Service Members. These findings may differ from work in other TBI populations due to varying mechanisms and frequency of injury, as well as a potentially higher level of functioning in the current sample related to the ability to maintain continued Active Duty status after injury. In conclusion, this study provides DTI and volumetric MRI findings across the spectrum of TBI severity. These results provide support for the use of DTI and volumetric MRI to identify differences in white matter microstructure and volume related to TBI. In particular, DTI FA pothole analysis may provide greater sensitivity for detecting subtle forms of white matter injury than conventional DTI FA analyses.
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Affiliation(s)
- Sarah I. Gimbel
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Elizabeth W. Twamley
- University of California, San Diego, San Diego, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
- University of California, San Diego, San Diego, California, USA
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Nikolova S, Chong C, Li J, Wu T, Dumkrieger G, Ross K, Starling A, Schwedt TJ. Brain Structural and Functional Abnormalities Associated with Acute Post-Traumatic Headache: Iron Deposition and Functional Connectivity. RESEARCH SQUARE 2024:rs.3.rs-4165756. [PMID: 38585756 PMCID: PMC10996812 DOI: 10.21203/rs.3.rs-4165756/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background The purpose of this study was to interrogate brain iron accumulation in participants with acute post-traumatic headache (PTH) due to mild traumatic brain injury (mTBI), and to determine if functional connectivity is affected in areas with iron accumulation. We aimed to examine the correlations between iron accumulation and headache frequency, post-concussion symptom severity, number of mTBIs and time since most recent TBI. Methods Sixty participants with acute PTH and 60 age-matched healthy controls (HC) underwent 3T magnetic resonance imaging including quantitative T2* maps and resting-state functional connectivity imaging. Between group T2* differences were determined using T-tests (p < 0.005, cluster size threshold of 10 voxels). For regions with T2* differences, two analyses were conducted. First, the correlations with clinical variables including headache frequency, number of lifetime mTBIs, time since most recent mTBI, and Sport Concussion Assessment Tool (SCAT) symptom severity scale scores were investigated using linear regression. Second, the functional connectivity of these regions with the rest of the brain was examined (significance of p < 0.05 with family wise error correction for multiple comparisons). Results The acute PTH group consisted of 60 participants (22 male, 38 female) with average age of 42 ± 14 years. The HC group consisted of 60 age-matched controls (17 male, 43 female, average age of 42 ± 13). PTH participants had lower T2* values compared to HC in the left posterior cingulate and the bilateral cuneus. Stronger functional connectivity was observed between bilateral cuneus and right cerebellar areas in PTH compared to HC. Within the PTH group, linear regression showed negative associations of T2* and SCAT symptom severity score in the left posterior cingulate (p = 0.05) and with headache frequency in the left cuneus (p = 0.04). Conclusions Iron accumulation in posterior cingulate and cuneus was observed in those with acute PTH relative to HC; stronger functional connectivity was detected between the bilateral cuneus and the right cerebellum. The correlations of decreased T2* (suggesting higher iron content) with headache frequency and post mTBI symptom severity suggest that the iron accumulation that results from mTBI might reflect the severity of underlying mTBI pathophysiology and associate with post-mTBI symptom severity including PTH.
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Wright TJ, Elliott TR, Randolph KM, Pyles RB, Masel BE, Urban RJ, Sheffield-Moore M. Prevalence of fatigue and cognitive impairment after traumatic brain injury. PLoS One 2024; 19:e0300910. [PMID: 38517903 PMCID: PMC10959386 DOI: 10.1371/journal.pone.0300910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/06/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Following traumatic brain injury (TBI) some patients develop lingering comorbid symptoms of fatigue and cognitive impairment. The mild cognitive impairment self-reported by patients is often not detected with neurocognitive tests making it difficult to determine how common and severe these symptoms are in individuals with a history of TBI. This study was conducted to determine the relative prevalence of fatigue and cognitive impairment in individuals with a history of TBI. METHODS The Fatigue and Altered Cognition Scale (FACs) digital questionnaire was used to assess self-reported fatigue and cognitive impairment. Adults aged 18-70 were digitally recruited for the online anonymous study. Eligible participants provided online consent, demographic data, information about lifetime TBI history, and completed the 20 item FACs questionnaire. RESULTS A total of 519 qualifying participants completed the online digital study which included 204 participants with a history of TBI of varied cause and severity and 315 with no history of TBI. FACs Total Score was significantly higher in the TBI group (57.7 ± 22.2) compared to non-TBI (39.5 ± 23.9; p<0.0001) indicating more fatigue and cognitive impairment. When stratified by TBI severity, FACs score was significantly higher for all severity including mild (53.9 ± 21.9, p<0.0001), moderate (54.8 ± 24.4, p<0.0001), and severe (59.7 ± 20.9, p<0.0001) TBI. Correlation analysis indicated that more severe TBI was associated with greater symptom severity (p<0.0001, r = 0.3165). Ancillary analysis also suggested that FACs scores may be elevated in participants with prior COVID-19 infection but no history of TBI. CONCLUSIONS Adults with a history of even mild TBI report significantly greater fatigue and cognitive impairment than those with no history of TBI, and symptoms are more profound with greater TBI severity.
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Affiliation(s)
- Traver J. Wright
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Timothy R. Elliott
- Department of Educational Psychology, Texas A&M University, College Station, Texas, United States of America
| | - Kathleen M. Randolph
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Richard B. Pyles
- Department of Pediatrics, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Brent E. Masel
- Department of Neurology, The University of Texas Medical Branch, Galveston, Texas, United States of America
- Centre for Neuro Skills, Bakersfield, California, United States of America
| | - Randall J. Urban
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Melinda Sheffield-Moore
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, United States of America
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Sidhu A, Uiga L, Langley B, Masters RSW. Reduced influence of perceptual context in mild traumatic brain injury is not an illusion. Sci Rep 2024; 14:6434. [PMID: 38499578 PMCID: PMC10948892 DOI: 10.1038/s41598-024-56713-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
Perceptual grouping is impaired following mild traumatic brain injury (mTBI). This may affect visual size perception, a process influenced by perceptual grouping abilities. We conducted two experiments to evaluate visual size perception in people with self-reported history of mTBI, using two different size-contrast illusions: the Ebbinghaus Illusion (Experiment 1) and the Müller-Lyer illusion (Experiment 2). In Experiment 1, individuals with mTBI and healthy controls were asked to compare the size of two target circles that were either the same size or different sizes. The target circles appeared by themselves (no-context condition), or were surrounded by smaller or larger circles (context condition). Similar levels of accuracy were evident between the groups in the no-context condition. However, size judgements by mTBI participants were more accurate in the context condition, suggesting that they processed the target circles separately from the surrounding circles. In Experiment 2, individuals with mTBI and healthy controls judged the length of parallel lines that appeared with arrowheads (context condition) or without arrowheads (no context condition). Consistent with Experiment 1, size judgements by mTBI participants were more accurate than size judgements by control participants in the context condition. These findings suggest that mTBI influences size perception by impairing perceptual grouping of visual stimuli in near proximity.
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Affiliation(s)
- A Sidhu
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, 3240, New Zealand.
| | - L Uiga
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - B Langley
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, 3240, New Zealand
| | - R S W Masters
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, 3240, New Zealand
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Betz AK, Cetin-Karayumak S, Bonke EM, Seitz-Holland J, Zhang F, Pieper S, O'Donnell LJ, Tripodis Y, Rathi Y, Shenton ME, Koerte IK. Executive functioning, behavior, and white matter microstructure in the chronic phase after pediatric mild traumatic brain injury: results from the adolescent brain cognitive development study. Psychol Med 2024:1-11. [PMID: 38497117 DOI: 10.1017/s0033291724000229] [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: 03/19/2024]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is common in children. Long-term cognitive and behavioral outcomes as well as underlying structural brain alterations following pediatric mTBI have yet to be determined. In addition, the effect of age-at-injury on long-term outcomes is largely unknown. METHODS Children with a history of mTBI (n = 406; Mage = 10 years, SDage = 0.63 years) who participated in the Adolescent Brain Cognitive Development (ABCD) study were matched (1:2 ratio) with typically developing children (TDC; n = 812) and orthopedic injury (OI) controls (n = 812). Task-based executive functioning, parent-rated executive functioning and emotion-regulation, and self-reported impulsivity were assessed cross-sectionally. Regression models were used to examine the effect of mTBI on these domains. The effect of age-at-injury was assessed by comparing children with their first mTBI at either 0-3, 4-7, or 8-10 years to the respective matched TDC controls. Fractional anisotropy (FA) and mean diffusivity (MD), both MRI-based measures of white matter microstructure, were compared between children with mTBI and controls. RESULTS Children with a history of mTBI displayed higher parent-rated executive dysfunction, higher impulsivity, and poorer self-regulation compared to both control groups. At closer investigation, these differences to TDC were only present in one respective age-at-injury group. No alterations were found in task-based executive functioning or white matter microstructure. CONCLUSIONS Findings suggest that everyday executive function, impulsivity, and emotion-regulation are affected years after pediatric mTBI. Outcomes were specific to the age at which the injury occurred, suggesting that functioning is differently affected by pediatric mTBI during vulnerable periods. Groups did not differ in white matter microstructure.
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Affiliation(s)
- Anja K Betz
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Suheyla Cetin-Karayumak
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena M Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Lauren J O'Donnell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lippa SM, Bailie JM, French LM, Brickell TA, Lange RT. Lifetime blast exposure is not related to cognitive performance or psychiatric symptoms in US military personnel. Clin Neuropsychol 2024:1-23. [PMID: 38494345 DOI: 10.1080/13854046.2024.2328881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Objective: The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs). Method: Participants were 282 SMVs, with and without history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (n = 61), Blast + Low Risk MOS (n = 96), Blast + High Risk MOS (n = 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Results: There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (Fs < 1.75, ps > .1, ηp2s < .032) or in General Cognition (Fs < 0.95, ps > .3, ηp2s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (F(18,542) = 1.77, p = .026, ηp2 = .055), Somatic/Cognitive (F(10,550) = 1.99, p = .033, ηp2 = .035), and Externalizing Scales (F(8,552) = 2.17, p = .028, ηp2 = .030); however, these relationships did not remain significant after correction for covariates (Fs < 1.53, ps > .145, ηp2s < .032). Conclusions: We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- Naval Hospital Camp Pendleton, Oceanside, CA, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
| | - Tracey A Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Van Patten R, Chan L, Tocco K, Mordecai K, Altalib H, Cotton E, Correia S, Gaston TE, Grayson LP, Martin A, Fry S, Goodman A, Allendorfer JB, Szaflarski J, LaFrance WC. Reduced Subjective Cognitive Concerns With Neurobehavioral Therapy in Functional Seizures and Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2024; 36:197-205. [PMID: 38481168 DOI: 10.1176/appi.neuropsych.20230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Functional seizures are common among people with traumatic brain injury (TBI). Subjective cognitive concerns refer to a person's own perception of problems with cognitive functioning in everyday life. The authors investigated the presence and correlates of subjective cognitive concerns and the response to neurobehavioral therapy among adults with TBI and functional seizures (TBI+FS group). METHODS In this observational study, participants in the TBI+FS group (N=47) completed a 12-session neurobehavioral therapy protocol for seizures, while participants in the comparison group (TBI without seizures) (N=50) received usual treatment. Subjective cognitive concerns, objective cognition, mental health, and quality of life were assessed before and after treatment. Data collection occurred from 2018 to 2022. RESULTS Baseline subjective cognitive concerns were reported for 37 (79%) participants in the TBI+FS group and 20 (40%) participants in the comparison group. In a multivariable regression model in the TBI+FS group, baseline global mental health (β=-0.97) and obsessive-compulsive symptoms (β=-1.01) were associated with subjective cognitive concerns at baseline. The TBI+FS group had fewer subjective cognitive concerns after treatment (η2=0.09), whereas the TBI comparison group showed a nonsignificant increase in subjective cognitive concerns. CONCLUSIONS Subjective cognitive concerns are common among people with TBI and functional seizures and may be related to general mental health and obsessive-compulsive symptoms. Evidence-based neurobehavioral therapy for functional seizures is a reasonable treatment option to address such concerns in this population, although additional studies in culturally diverse samples are needed. In addition, people with functional seizures would likely benefit from rehabilitation specifically targeted toward cognitive functioning.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Lawrence Chan
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Krista Tocco
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Kristen Mordecai
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Hamada Altalib
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Erica Cotton
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Stephen Correia
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Tyler E Gaston
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Leslie P Grayson
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Amber Martin
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Samantha Fry
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Adam Goodman
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Jane B Allendorfer
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Jerzy Szaflarski
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
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Krch D, Lequerica AH, Arango-Lasprilla JC, Corrigan JD. Neurobehavioral Symptoms in Spanish-Speaking Individuals With Subconcussive Injuries. J Head Trauma Rehabil 2024:00001199-990000000-00127. [PMID: 38456793 DOI: 10.1097/htr.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To examine whether exposure to high-risk events causing injury to the head or neck has an effect on neurobehavioral symptoms in the absence of an alteration of consciousness in Spanish-speakers. SETTING Web-based survey. PARTICIPANTS Seven hundred forty-eight individuals from Spain and Latin America, aged 18 to 65 years, with 10 years or more of education. Thirty-nine participants failed quality checks and were excluded. Seven hundred nine participants were included in the analyses. DESIGN Cross-sectional study. Subconcussive exposure was defined as endorsing exposure to one or more high-risk scenarios in the absence of any alteration of consciousness. Three injury groups were derived: No Head Injury, Subconcussive Exposure, and traumatic brain injury (TBI). The Subconcussive Exposure group was further divided into Single and Multiple Exposures. Two analyses were conducted: the effect of lifetime exposure to injury (No Head Injury, Subconcussive Exposure, TBI) on neurobehavioral symptoms; the effect of Subconcussive Exposure Frequency (No Head Injury, Single Exposure, Multiple Exposures) on neurobehavioral symptoms. MAIN MEASURES Spanish Ohio State University Traumatic Brain Injury Identification Method Self-Administered-Brief (OSU TBI-ID SAB); Neurobehavioral Symptom Inventory (NSI). RESULTS There was a significant effect for Injury group on the NSI partial eta-squared (ηp2 = 0.053) and a significant effect of Exposure Frequency group on the NSI (ηp2 = 0.40). Individuals with subconcussive exposures reported significantly more neurobehavioral symptoms than those with no history of head injury and significantly less symptoms than those with TBI. Individuals with multiple subconcussive exposures reported significantly more neurobehavioral symptoms than those with single and no exposure. CONCLUSION This research expands the utility of the OSU-TBI-ID SAB as a lifetime TBI history assessment tool to one capable of evaluating subconcussive exposure dosing effects in Spanish-speakers. Such an index may facilitate establishment of subconcussive exposure prevalence rates worldwide, leading to improved understanding of the chronic effects of high-risk exposures.
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Affiliation(s)
- Denise Krch
- Author Affiliations: Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, and Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey (Drs Krch and Lequerica); Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (Dr Arango-Lasprilla); and Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio (Dr Corrigan)
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Bailie JM, Lippa SM, Hungerford L, French LM, Brickell TA, Lange RT. Cumulative Blast Exposure During a Military Career Negatively Impacts Recovery from Traumatic Brain Injury. J Neurotrauma 2024; 41:604-612. [PMID: 37675903 DOI: 10.1089/neu.2022.0192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Sub-concussive injuries have emerged as an important factor in the long-term brain health of athletes and military personnel. The objective of this study was to explore the relationship between service member and veterans (SMVs) lifetime blast exposure and recovery from a traumatic brain injury (TBI). A total of 558 SMVs with a history of TBI were examined. Lifetime blast exposure (LBE) was based on self-report (M = 79.4, standard deviation = 392.6; range = 0-7500) categorized into three groups: Blast Naive (n = 121), Low LBE (n = 223; LBE range 1-9), and High LBE (n = 214; LBE >10). Dependent variables were the Neurobehavioral Symptom Inventory (NSI) and Post-traumatic Stress Disorder Checklist-Civilian (PCL-C) and the Traumatic Brain Injury Quality of Life (TBI-QOL). Analyses controlled for demographic factors (age, gender, and race) as well as TBI factors (months since index TBI, index TBI severity, and total number lifetime TBIs). The Blast Naive group had significantly lower NSI and PCL-C scores compared with the Low LBE group and High LBE group, with small to medium effect sizes. On the TBI-QOL, the Blast Naïve group had better quality life on 10 of the 14 scales examined. The Low LBE did not differ from the High LBE group on the PCL-C, NSI, or TBI-QOL. Blast exposure over an SMV's career was associated with increased neurobehavioral and post-traumatic stress symptoms following a TBI. The influence of psychological trauma associated with blasts may be an important factor influencing symptoms as well as the accuracy of self-reported estimates of LBE.
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Affiliation(s)
- Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- Naval Medical Center San Diego, San Diego, California, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, Canada
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, Canada
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Kowalski MA, Campagna M, Wright Steiner EM, Spohn R. Type of Victimization Exposure, Perpetrator Type, and Timing of Victimization: The Impact on Behavioral Health Outcomes. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1132-1160. [PMID: 37804154 DOI: 10.1177/08862605231203609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
The effect of abuse victimization in correctional samples has been researched previously, particularly with an eye toward these experiences on justice-involved youth and prison samples' offending and recidivism behavior. The role of this type of victimization, including physical abuse, sexual abuse, and polyvictimization, is less studied in jail populations. The effect of abuse victimization is also less researched among other outcomes, including behavioral health disorders (BHDs) and substance use disorder (SUD). While the effect of abuse, generally, has been examined, less is known about how abuse perpetrator type and timing of abuse impact justice-involved individuals' outcomes. Using logistic regressions, we examined the influence of abuse perpetrator type (non-stranger or stranger) and timing (before childhood, after childhood, or before and after childhood) in a population of jailed adults from one state (n = 4,713). Outcomes studied included internalizing BHDs, externalizing BHDs, and severe SUD. Results indicated that abuse perpetrated by a non-stranger yielded a greater impact on mental illness compared to abuse perpetrated by a stranger. In contrast to abuse experienced as an adult, childhood abuse was more consistently associated with internalizing and externalizing disorders but was not related to severe SUD, with an exception of physical abuse. Further, BHDs and SUD were strongly associated with each other. Overall, polyvictimization had the strongest effect on the outcomes compared to either physical abuse or sexual abuse alone. Our findings suggest that screening for abuse experiences as a potential destabilizing factor in justice-involved populations could improve case management and interventions for people incarcerated in jails. Results also highlight the importance of distinguishing between the perpetrator type of abuse and timing of abuse.
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Affiliation(s)
| | | | | | - Ryan Spohn
- University of Nebraska Omaha, Omaha, USA
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Rajaram SS, Reisher P, Garlinghouse M, Chiou KS. IPV survivors' and service providers' perspectives on brain injury screening/evaluation process and impact. Neuropsychol Rehabil 2024:1-23. [PMID: 38372576 DOI: 10.1080/09602011.2024.2314873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
This study explores the perspectives of intimate partner violence (IPV) survivors and staff of brain injury (BI) screening, and the neuropsychological evaluation (NPE) process. We gathered qualitative data from 17 participants - 10 IPV survivors, at risk for a BI, who had received BI screening and a NPE and a total of 7 staff in IPV-serving organizations. Interviews were recorded, transcribed verbatim and analysed for key themes using thematic analysis. Survivors were over 18 years of age; the majority were between 19 and 45 years old, unemployed, unmarried, and had children. Survivors were angry, scared, and embarrassed to learn that they might have an IPV-related BI. They were thankful to have an explanation for some of their cognitive symptoms, which disrupted their daily activities, social relationships, and overall quality of life. Staff were pleased to be able to provide valuable information to their clients that could have a positive impact on their wellbeing. Overall, screening for a BI and participation in the NPE were well tolerated by IPV survivors with a possible BI. Inclusion of the perspectives of IPV survivors and support staff is an essential first step to better understanding their needs so interventions can be developed to aid their recovery.
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Affiliation(s)
- Shireen S Rajaram
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peggy Reisher
- Brain Injury Alliance of Nebraska, Lincoln, Nebraska, USA
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