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Rantins P, Ly M, Clark AL, Weigand AJ, Durazo AA, Merritt VC, Bangen KJ, Thomas KR. Research Letter: TBI Severity Moderates the Association Between Subjective and Objective Attention in Older Veterans. J Head Trauma Rehabil 2024; 39:239-246. [PMID: 37712765 PMCID: PMC10920393 DOI: 10.1097/htr.0000000000000897] [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: 09/16/2023]
Abstract
OBJECTIVE This study examined the moderating effect of traumatic brain injury (TBI) history on subjective and objective cognition across multiple cognitive domains. SETTING, PARTICIPANTS, AND DESIGN Participants included 242 Vietnam-era veterans with a history of no TBI (n = 86), mild TBI (n = 74), or moderate-to-severe TBI (n = 82) from the observational Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study. MAIN MEASURES Objective cognition was the outcome and was measured using neuropsychological measures in the domains of memory, attention/executive functioning, and language. Subjective cognition was measured using the memory, divided attention, and language subscales from the Everyday Cognition (ECog) measure. TBI severity status was the moderating variable. RESULTS Veterans with a history of moderate-to-severe TBI had a stronger negative association between subjective and objective attention relative to participants without a TBI ( P = .002). Although this association did not differ between mild TBI and no TBI history groups ( P = .100), the association between subjective and objective attention for the mild TBI group was intermediate to the no TBI and moderate-to-severe TBI history groups. TBI status did not moderate associations between subjective and objective memory or language. CONCLUSION Results highlight the importance of assessing subjective and objective cognition in older veterans and the relevance of attention in the context of TBI history. More work is needed to better understand the intersection of TBI and aging and how these factors may be used to guide individualized assessment and treatment approaches for older veterans.
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Affiliation(s)
- Peter Rantins
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Monica Ly
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin,
Austin, TX, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Alin Alshaheri Durazo
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Victoria C. Merritt
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH),
VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
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Klinkhammer S, Duits AA, Deckers K, Horn J, Slooter AJC, Verwijk E, van Heugten CM, Visser-Meily JMA. A Biopsychosocial Approach to Persistent Post-COVID-19 Fatigue and Cognitive Complaints: Results of the Prospective Multicenter NeNeSCo Study. Arch Phys Med Rehabil 2024; 105:826-834. [PMID: 38228250 DOI: 10.1016/j.apmr.2023.12.014] [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: 07/19/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints. DESIGN Prospective, multicenter cohort study. SETTING Six Dutch hospitals. PARTICIPANTS 205 initially hospitalized (March-June 2020), confirmed patients with SARS-CoV-2, aged ≥18 years, physically able to visit the hospital, without prior cognitive deficit, magnetic resonance imaging (MRI) contraindication, or severe neurologic damage post-hospital discharge (N=205). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences after Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: (1) Demographic and premorbid factors (sex, age, education, comorbidities), (2) Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), (3) Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), (4) Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), and (5) Fatigue or cognitive complaints. RESULTS The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (P=.01), lower PROMIS-PF (P<.001), higher HADS-Depression (P=.03), and CLC-high (P=.04). Greater odds of CLC-high were observed in individuals perceiving more social support (OR=1.07, P<.05). CONCLUSIONS Results show that psychological and social factors add to biomedical factors in explaining persistent post-COVID-19 fatigue and cognitive complaints. Objective neuro-cognitive factors were not associated with symptoms. Findings highlight the importance of multidomain treatment, including psychosocial care, which may not target biologically-rooted symptoms directly but may reduce associated distress.
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Affiliation(s)
- Simona Klinkhammer
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Annelien A Duits
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen J C Slooter
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels Health Campus, Jette, Belgium
| | - Esmée Verwijk
- Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, the Netherlands; Center of Excellence for Rehabilitation Medicine and De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht, the Netherlands
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3
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Harris C, Tang Y, Birnbaum E, Cherian C, Mendhe D, Chen MH. Digital Neuropsychology beyond Computerized Cognitive Assessment: Applications of Novel Digital Technologies. Arch Clin Neuropsychol 2024; 39:290-304. [PMID: 38520381 DOI: 10.1093/arclin/acae016] [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: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
Compared with other health disciplines, there is a stagnation in technological innovation in the field of clinical neuropsychology. Traditional paper-and-pencil tests have a number of shortcomings, such as low-frequency data collection and limitations in ecological validity. While computerized cognitive assessment may help overcome some of these issues, current computerized paradigms do not address the majority of these limitations. In this paper, we review recent literature on the applications of novel digital health approaches, including ecological momentary assessment, smartphone-based assessment and sensors, wearable devices, passive driving sensors, smart homes, voice biomarkers, and electronic health record mining, in neurological populations. We describe how each digital tool may be applied to neurologic care and overcome limitations of traditional neuropsychological assessment. Ethical considerations, limitations of current research, as well as our proposed future of neuropsychological practice are also discussed.
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Affiliation(s)
- Che Harris
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Yingfei Tang
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Eliana Birnbaum
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Christine Cherian
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Dinesh Mendhe
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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4
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Klinkhammer S, Duits AA, Horn J, Slooter AJC, Verwijk E, Van Santen S, Visser-Meily JMA, Van Heugten C. Prevalence and trajectories of neuropsychological post-COVID-19 symptoms in initially hospitalized patients. J Rehabil Med 2024; 56:jrm25315. [PMID: 38470168 PMCID: PMC10949081 DOI: 10.2340/jrm.v56.25315] [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: 11/07/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To investigate the prevalence and trajectories of post-COVID-19 neuropsychological symptoms. DESIGN Prospective longitudinal multicentre cohort study. SUBJECTS A total of 205 patients initially hospitalized with SARS-CoV-2 (COVID-19). METHODS Validated questionnaires were administered at 9 months (T1) and 15 months (T2) post-hospital discharge to assess fatigue, cognitive complaints, insomnia, anxiety, depression, and post-traumatic stress symptoms. RESULTS Analyses included 184 out of 205 patients. Approximately 50% experienced high cognitive complaints at T1 and T2, while severe fatigue affected 52.5% at T1 and 55.6% at T2. Clinically relevant insomnia scores were observed in 25% of patients at both time-points. Clinically relevant anxiety scores were present in 18.3% at T1 and 16.7% at T2, depression in 15.0% at T1 and 18.9% at T2, and PTSD in 12.4% at T1 and 11.8% at T2. Most symptoms remained stable, with 59.2% of patients experiencing at least 1 persistent symptom. In addition, 31.5% of patients developed delayed-onset symptoms. CONCLUSION Post-COVID-19 cognitive complaints and fatigue are highly prevalent and often persist. A subgroup develops delayed symptoms. Emotional distress is limited. Screening can help identify most patients experiencing long-term problems. Future research should determine risk factors for persistent and delayed onset symptoms.
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Affiliation(s)
- Simona Klinkhammer
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Annelien A Duits
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen J C Slooter
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels Health Campus, Jette, Belgium
| | - Esmée Verwijk
- Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Susanne Van Santen
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, the Netherlands; Center of Excellence for Rehabilitation Medicine and De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Caroline Van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
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5
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Juengst SB, Wright B, Vos L, Perna R, Williams M, Dudek E, DeMello A, Taiwo Z, Novelo LL. Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E83-E94. [PMID: 37582176 PMCID: PMC10864677 DOI: 10.1097/htr.0000000000000887] [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: 08/17/2023]
Abstract
OBJECTIVES To determine the association between self-reported emotional and cognitive symptoms and participation outcomes in chronic traumatic brain injury (TBI) and to explore the relative contribution of self-reported versus performance-based cognition to participation outcomes. SETTING Community. PARTICIPANTS Community-dwelling adults ( n = 135) with a lifetime history of mild to severe TBI. DESIGN Secondary analysis of a cross-sectional study on neurobehavioral symptoms in chronic TBI. MAIN MEASURES Behavioral Assessment Screening Tool (BAST) (Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, Substance Abuse subscales) measured self-reported neurobehavioral symptoms; Participation Assessment with Recombined Tools (Productivity, Social Relations, and Out and About) measured self-reported participation outcomes; and Brief Test of Adult Cognition by Telephone (BTACT) measured performance-based cognition (Episodic Memory and Executive Function summary scores) in a subsample ( n = 40). RESULTS The BAST Executive Dysfunction was significantly associated with less frequent participation and had the strongest effect on participation in all participation domains. No other BAST subscales were associated with participation, after adjusting for all subscale scores and age, with the exception of BAST Impulsivity, which was associated with more frequent Social Relationships. Exploratory analysis in the sample including the BTACT revealed that, after accounting for subjective Executive Dysfunction using the BAST, performance-based Executive Function was associated with Productivity and Working Memory was associated with Social Relations, but neither was associated with being Out and About; the BAST Executive Dysfunction remained significant in all models even after including BTACT scores. CONCLUSIONS Self-reported Executive Dysfunction contributed to participation outcomes after mild to severe TBI in community-dwelling adults, whereas self-reported emotional and fatigue symptoms did not. Performance-based cognition measures may capture different variability in participation after injury.
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Affiliation(s)
- Shannon B Juengst
- Author Affiliations: TIRR Memorial Hermann, Houston, Texas (Drs Juengst, Perna, and Taiwo); Departments of Physical Medicine & Rehabilitation (Dr Juengst) and Biostatistics and Data Science (Dr Novelo), The University of Texas Health Science Center at Houston; Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Drs Juengst and Wright); Spectrum Health Medical Group, Neurosciences, Grand Rapids, Michigan (Dr Vos); Department of Psychology, University of Houston, Houston, Texas (Dr Williams and Ms Dudek); School of Nursing, The University of Texas Medical Branch, Galveston (Dr DeMello); and Department of Neurology, Section of Neuropsychology, Baylor College of Medicine, Houston, Texas (Dr Taiwo)
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6
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Cherian KN, Keynan JN, Anker L, Faerman A, Brown RE, Shamma A, Keynan O, Coetzee JP, Batail JM, Phillips A, Bassano NJ, Sahlem GL, Inzunza J, Millar T, Dickinson J, Rolle CE, Keller J, Adamson M, Kratter IH, Williams NR. Magnesium-ibogaine therapy in veterans with traumatic brain injuries. Nat Med 2024; 30:373-381. [PMID: 38182784 PMCID: PMC10878970 DOI: 10.1038/s41591-023-02705-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/10/2023] [Indexed: 01/07/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of disability. Sequelae can include functional impairments and psychiatric syndromes such as post-traumatic stress disorder (PTSD), depression and anxiety. Special Operations Forces (SOF) veterans (SOVs) may be at an elevated risk for these complications, leading some to seek underexplored treatment alternatives such as the oneirogen ibogaine, a plant-derived compound known to interact with multiple neurotransmitter systems that has been studied primarily as a treatment for substance use disorders. Ibogaine has been associated with instances of fatal cardiac arrhythmia, but coadministration of magnesium may mitigate this concern. In the present study, we report a prospective observational study of the Magnesium-Ibogaine: the Stanford Traumatic Injury to the CNS protocol (MISTIC), provided together with complementary treatment modalities, in 30 male SOVs with predominantly mild TBI. We assessed changes in the World Health Organization Disability Assessment Schedule from baseline to immediately (primary outcome) and 1 month (secondary outcome) after treatment. Additional secondary outcomes included changes in PTSD (Clinician-Administered PTSD Scale for DSM-5), depression (Montgomery-Åsberg Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). MISTIC resulted in significant improvements in functioning both immediately (Pcorrected < 0.001, Cohen's d = 0.74) and 1 month (Pcorrected < 0.001, d = 2.20) after treatment and in PTSD (Pcorrected < 0.001, d = 2.54), depression (Pcorrected < 0.001, d = 2.80) and anxiety (Pcorrected < 0.001, d = 2.13) at 1 month after treatment. There were no unexpected or serious adverse events. Controlled clinical trials to assess safety and efficacy are needed to validate these initial open-label findings. ClinicalTrials.gov registration: NCT04313712 .
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Affiliation(s)
- Kirsten N Cherian
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jackob N Keynan
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Lauren Anker
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Afik Faerman
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | | | - Ahmed Shamma
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Or Keynan
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - John P Coetzee
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
- Polytrauma Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jean-Marie Batail
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Angela Phillips
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nicholas J Bassano
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Gregory L Sahlem
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jose Inzunza
- Ambio Life Sciences, Vancouver, British Columbia, Canada
| | - Trevor Millar
- Ambio Life Sciences, Vancouver, British Columbia, Canada
| | | | - C E Rolle
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jennifer Keller
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Maheen Adamson
- WRIISC-WOMEN & Department of Rehabilitation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Ian H Kratter
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nolan R Williams
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA.
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA.
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7
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Vargas GO, Neaves S, Pham T, Huang M, Turki AF, Wang C, Bell KR, Juengst SB, Zhang R, Li M, Driver S, Behbehani K, Hynan LS, Ding K. Community-based exercise program, self-reported health-related symptoms, and quality of life in persons with traumatic brain injury 45 + years old. NeuroRehabilitation 2024; 54:373-381. [PMID: 38457158 DOI: 10.3233/nre-230223] [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: 03/09/2024]
Abstract
BACKGROUND Individuals with moderate to severe traumatic brain injury (msTBI) have reported a lack of motivation, lack of time, and fatigue as perceived barriers to exercise. OBJECTIVE To evaluate the effects of an exercise program on self-reported health-related symptoms and quality of life in persons 45-years and older with msTBI. METHODS Post-hoc analysis of a prospective community-based 12-week exercise program of 20 adults, age 45-80 years, with msTBI. Ten were in aerobic exercise training (AET) program and 10 in a stretching and toning (SAT) program. The AET group was instructed to exercise based on their estimated maximal heart rate (HR) for 150 minutes weekly. The SAT group was to stretch for the same target time without significantly increasing HR or level of exertion. Outcome measures were Traumatic Brain Injury Quality of Life (TBI-QOL) for global, cognitive, emotional, and social health, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, and Pittsburgh Sleep Quality Index (PSQI) for sleep quality. RESULTS AET was associated with improved self-reported cognitive health and sleep compared to SAT. Moderate to large, positive effect sizes were also observed in the AET group in the QOL categories of global, emotional, and social health, and depressive symptoms. CONCLUSIONS This study offers preliminary evidence that AET may improve health-related QOL, especially for cognition and sleep, in middle-aged and older adults with msTBI.
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Affiliation(s)
- Gary O Vargas
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephanie Neaves
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Perot Foundation Neuroscience Translational Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tri Pham
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Mu Huang
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Office of Science, Medicine, and Health, American Heart Association, Dallas, TX, USA
| | - Ahmad Fawzi Turki
- Department of Bioengineering, University of Arlington, Arlington, TX, USA
- Electrical and Computer Engineering Department (ECE), King Abdulaziz University, Jeddah, Saudi Arabia
- Center of Excellence in Intelligent Engineering Systems (CEIES), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Chaowei Wang
- Department of Computer Science, University of Arlington, Arlington, TX, USA
| | - Kathleen R Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| | - Rong Zhang
- Cerebrovascular Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ming Li
- Department of Computer Science, University of Arlington, Arlington, TX, USA
| | - Simon Driver
- Traumatic Brain Injury Research, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Khosrow Behbehani
- Department of Bioengineering, University of Arlington, Arlington, TX, USA
| | - Linda S Hynan
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kan Ding
- Center of Excellence in Intelligent Engineering Systems (CEIES), King Abdulaziz University, Jeddah, Saudi Arabia
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8
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Ly MT, Merritt VC, Ozturk ED, Clark AL, Hanson KL, Delano-Wood LM, Sorg SF. Subjective memory complaints are associated with decreased cortical thickness in Veterans with histories of mild traumatic brain injury. Clin Neuropsychol 2023; 37:1745-1765. [PMID: 36883430 DOI: 10.1080/13854046.2023.2184720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
Objective: Memory problems are frequently endorsed in Veterans following mild traumatic brain injury (mTBI), but subjective complaints are poorly associated with objective memory performance. Few studies have examined associations between subjective memory complaints and brain morphometry. We investigated whether self-reported memory problems were associated with objective memory performance and cortical thickness in Veterans with a history of mTBI. Methods: 40 Veterans with a history of remote mTBI and 29 Veterans with no history of TBI completed the Prospective-Retrospective Memory Questionnaire (PRMQ), PTSD Checklist (PCL), California Verbal Learning Test-2nd edition (CVLT-II), and 3 T T1 structural magnetic resonance imaging. Cortical thickness was estimated in 14 a priori frontal and temporal regions. Multiple regressions adjusting for age and PCL scores examined associations between PRMQ, CVLT-II scores, and cortical thickness within each Veteran group. Results: Greater subjective memory complaints on the PRMQ were associated with lower cortical thickness in the right middle temporal gyrus (β = 0.64, q = .004), right inferior temporal gyrus (β = 0.56, q = .014), right rostral middle frontal gyrus (β = 0.45, q = .046), and right rostral anterior cingulate gyrus (β = 0.58, q = .014) in the mTBI group but not the control group (q's > .05). These associations remained significant after adjusting for CVLT-II learning. CVLT-II performance was not associated with PRMQ score or cortical thickness in either group. Conclusions: Subjective memory complaints were associated with lower cortical thickness in right frontal and temporal regions, but not with objective memory performance, in Veterans with histories of mTBI. Subjective complaints post-mTBI may indicate underlying brain morphometry independently of objective cognitive testing.
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Affiliation(s)
- Monica T Ly
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, CA, USA
| | - Victoria C Merritt
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Erin D Ozturk
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA
- San Diego Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Karen L Hanson
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, CA, USA
| | - Lisa M Delano-Wood
- Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Scott F Sorg
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
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9
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Boone KB, Sweet JJ, Byrd DA, Denney RL, Hanks RA, Kaufmann PM, Kirkwood MW, Larrabee GJ, Marcopulos BA, Morgan JE, Paltzer JY, Rivera Mindt M, Schroeder RW, Sim AH, Suhr JA. Official position of the American Academy of Clinical Neuropsychology on test security. Clin Neuropsychol 2022; 36:523-545. [DOI: 10.1080/13854046.2021.2022214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Desiree A. Byrd
- Department of Psychiatry, Queens College and The Graduate Center, City University of New York, Queens, NY
| | - Robert L. Denney
- Missouri Memory Center, Citizens Memorial Healthcare, Bolivar, MO
| | - Robin A. Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
| | - Paul M. Kaufmann
- Office of the General Counsel, Health Law Section, University of Texas System, Austin, TX
| | - Michael W. Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | | | - Bernice A. Marcopulos
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
- Department of Graduate Psychology, James Madison University, Harrisonburg, VA
| | - Joel E. Morgan
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
- Independent Practice, Morristown, NJ
| | - June Yu Paltzer
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA
| | - Monica Rivera Mindt
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
- Department of Psychology, Latin American Studies Institute, and African and African American Studies Icahn School of Medicine at Mount Sinai, Department of Neurology, Fordham University, Bronx, NY
| | - Ryan W. Schroeder
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
- School of Medicine, University of Kansas, Wichita, KS
| | - Anita H. Sim
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
- Minneapolis VA Health Care System, Minneapolis, MN
| | - Julie A. Suhr
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
- Department of Psychology, Ohio University, Athens, OH
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10
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Klinkhammer S, Horn J, Visser-Meilij JMA, Verwijk E, Duits A, Slooter AJC, van Heugten CM. Dutch multicentre, prospective follow-up, cohort study comparing the neurological and neuropsychological sequelae of hospitalised non-ICU- and ICU-treated COVID-19 survivors: a study protocol. BMJ Open 2021; 11:e054901. [PMID: 34620676 PMCID: PMC8507410 DOI: 10.1136/bmjopen-2021-054901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Owing to the novelty of COVID-19, there are still large knowledge gaps concerning its effect on the brain and the resulting impact on peoples' lives. This large-scale prospective follow-up study investigates COVID-19-associated brain damage, neuropsychological dysfunction and long-term impact on the well-being of patients and their close ones. It is hypothesised that structural brain damage and cognitive dysfunction primarily occur in severely ill patients, as compared with moderately ill patients. Cognitive complaints, emotional distress and impact on well-being are hypothesised to be less dependent on illness severity. METHODS AND ANALYSIS For this multicentre study, 200 patients with COVID-19 (100 intensive care unit (ICU) patients and 100 non-ICU patients) formerly hospitalised in one of the six recruiting hospitals during the first European infection wave (ie, March to June 2020) and their close ones will be recruited. At minimally 6 months posthospital discharge, patients will perform a set of neuropsychological tests and are subjected to a 3T MRI scan. Patients and close ones will fill out a set of questionnaires, also at minimally 6 months posthospital discharge and again another 6 months thereafter. Data related to COVID-19 hospitalisation will be extracted from the patients' medical records. MRI abnormalities will ultimately be related to neuropsychological test performance and questionnaire outcomes. ETHICS AND DISSEMINATION Ethics approval was granted by the medical research ethics committee of Maastricht University Medical Centre and Maastricht University (NL75102.068.20). The project is sponsored by The Brain Foundation Netherlands. Findings will be presented at national and international conferences, as well as published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04745611.
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Affiliation(s)
- Simona Klinkhammer
- Department of Psychiatry and Neuropsychology, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Johanna M A Visser-Meilij
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
| | - Esmée Verwijk
- Department of Medical Psychology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Annelien Duits
- Department of Psychiatry and Neuropsychology, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht UMC+, Maastricht, The Netherlands
| | - Arjen J C Slooter
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
- Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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11
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Sabelli AG, Messa I, Giromini L, Lichtenstein JD, May N, Erdodi LA. Symptom Versus Performance Validity in Patients with Mild TBI: Independent Sources of Non-credible Responding. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09400-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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