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Porter KE, Stein MB, Grau PP, Kim HM, Powell C, Hoge CW, Venners MR, Smith ER, Martis B, Simon NM, Liberzon I, Rauch SAM. Impact of PTSD treatment on postconcussive symptoms in veterans: A comparison of sertraline, prolonged exposure, and their combination. J Psychiatr Res 2024; 173:64-70. [PMID: 38503135 DOI: 10.1016/j.jpsychires.2024.03.011] [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: 11/30/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
Many Veterans who served in Iraq and Afghanistan struggle with posttraumatic stress disorder (PTSD) and the effects of traumatic brain injuries (TBI). Some people with a history of TBI report a constellation of somatic, cognitive, and emotional complaints that are often referred to as postconcussive symptoms (PCS). Research suggests these symptoms may not be specific to TBI. This study examined the impact of PTSD treatment on PCS in combat Veterans seeking treatment for PTSD. As part of a larger randomized control trial, 198 Operation Iraqi Freedom, Operation Enduring Freedom, Operation New Dawn (OIF/OEF/OND) Veterans with PTSD received Prolonged Exposure Therapy, sertraline, or the combination. Potential deployment related TBI, PCS, PTSD and depression symptoms were assessed throughout treatment. Linear mixed models were used to predict PCS change over time across the full sample and treatment arms, and the association of change in PTSD and depression symptoms on PCS was also examined. Patterns of change for the full sample and the subsample of those who reported a head injury were examined. Results showed that PCS decreased with treatment. There were no significant differences across treatments. No significant differences were found in the pattern of symptom change based on TBI screening status. Shifts in PCS were predicted by change PTSD and depression. Results suggest that PCS reduced with PTSD treatment in this population and are related to shift in depression and PTSD severity, further supporting that reported PCS symptoms may be better understood as non-specific symptoms.
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Affiliation(s)
- Katherine E Porter
- Mental Health Service Line, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Mental Health Service Care VA San Diego Healthcare System, San Diego, CA, USA
| | - Peter P Grau
- Mental Health Service Line, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA
| | - H Myra Kim
- University of Michigan, Consulting for Statistics, Computing and Analytics Research, Ann Arbor, MI, USA
| | - Corey Powell
- University of Michigan, Consulting for Statistics, Computing and Analytics Research, Ann Arbor, MI, USA
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Margaret R Venners
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo, Park, CA, USA; Research Service Line, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Erin R Smith
- Mental Health Service Line, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian Martis
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Mental Health Service Care VA San Diego Healthcare System, San Diego, CA, USA
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Israel Liberzon
- Department of Psychiatry & Behavioral Science, Texas A&M Health, Bryan, TX, USA
| | - Sheila A M Rauch
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, USA; Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, USA; Emory University School of Medicine, Atlanta, GA, USA
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2
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Toma CL, Hwang J, Kakonge L, Morrow EL, Turkstra LS, Mutlu B, Duff MC. Does Facebook Use Provide Social Benefits to Adults with Traumatic Brain Injury? CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024; 27:214-220. [PMID: 38466929 PMCID: PMC10924117 DOI: 10.1089/cyber.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Drawing on the social compensation hypothesis, this study investigates whether Facebook use facilitates social connectedness for individuals with traumatic brain injury (TBI), a common and debilitating medical condition that often results in social isolation. In a survey (N = 104 participants; n = 53 with TBI, n = 51 without TBI), individuals with TBI reported greater preference for self-disclosure on Facebook (vs. face-to-face) compared to noninjured individuals. For noninjured participants, a preference for Facebook self-disclosure was associated with the enactment of relational maintenance behaviors on Facebook, which was then associated with greater closeness with Facebook friends. However, no such benefits emerged for individuals with TBI, whose preference for Facebook self-disclosure was not associated with relationship maintenance behaviors on Facebook, and did not lead to greater closeness with Facebook friends. These findings show that the social compensation hypothesis has partial utility in the novel context of TBI, and suggest the need for developing technological supports to assist this vulnerable population on social media platforms.
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Affiliation(s)
- Catalina L. Toma
- Department of Communication Arts, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Juwon Hwang
- School of Media and Strategic Communications, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Lisa Kakonge
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Emily L. Morrow
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lyn S. Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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MacLean MA, Muradov JH, Greene R, Van Hameren G, Clarke DB, Dreier JP, Okonkwo DO, Friedman A. Memantine inhibits cortical spreading depolarization and improves neurovascular function following repetitive traumatic brain injury. SCIENCE ADVANCES 2023; 9:eadj2417. [PMID: 38091390 PMCID: PMC10848720 DOI: 10.1126/sciadv.adj2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023]
Abstract
Cortical spreading depolarization (CSD) is a promising target for neuroprotective therapy in traumatic brain injury (TBI). We explored the effect of NMDA receptor antagonism on electrically triggered CSDs in healthy and brain-injured animals. Rats received either one moderate or four daily repetitive mild closed head impacts (rmTBI). Ninety-three animals underwent craniectomy with electrocorticographic (ECoG) and local blood flow monitoring. In brain-injured animals, ketamine or memantine inhibited CSDs in 44 to 88% and 50 to 67% of cases, respectively. Near-DC/AC-ECoG amplitude was reduced by 44 to 75% and 52 to 67%, and duration by 39 to 87% and 61 to 78%, respectively. Daily memantine significantly reduced spreading depression and oligemia following CSD. Animals (N = 31) were randomized to either memantine (10 mg/kg) or saline with daily neurobehavioral testing. Memantine-treated animals had higher neurological scores. We demonstrate that memantine improved neurovascular function following CSD in sham and brain-injured animals. Memantine also prevented neurological decline in a blinded, preclinical randomized rmTBI trial.
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Affiliation(s)
- Mark A. MacLean
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Jamil H. Muradov
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Ryan Greene
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Gerben Van Hameren
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - David B. Clarke
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Jens P. Dreier
- Center for Stroke Research Berlin, Charite University, Berlin, Germany
| | - David O. Okonkwo
- Division of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alon Friedman
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
- Departments of Brain and Cognitive Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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4
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Boyko M, Gruenbaum BF, Oleshko A, Merzlikin I, Zlotnik A. Diet's Impact on Post-Traumatic Brain Injury Depression: Exploring Neurodegeneration, Chronic Blood-Brain Barrier Destruction, and Glutamate Neurotoxicity Mechanisms. Nutrients 2023; 15:4681. [PMID: 37960334 PMCID: PMC10649677 DOI: 10.3390/nu15214681] [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: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Traumatic brain injury (TBI) has a profound impact on cognitive and mental functioning, leading to lifelong impairment and significantly diminishing the quality of life for affected individuals. A healthy blood-brain barrier (BBB) plays a crucial role in guarding the brain against elevated levels of blood glutamate, making its permeability a vital aspect of glutamate regulation within the brain. Studies have shown the efficacy of reducing excess glutamate in the brain as a treatment for post-TBI depression, anxiety, and aggression. The purpose of this article is to evaluate the involvement of dietary glutamate in the development of depression after TBI. We performed a literature search to examine the effects of diets abundant in glutamate, which are common in Asian populations, when compared to diets low in glutamate, which are prevalent in Europe and America. We specifically explored these effects in the context of chronic BBB damage after TBI, which may initiate neurodegeneration and subsequently have an impact on depression through the mechanism of chronic glutamate neurotoxicity. A glutamate-rich diet leads to increased blood glutamate levels when contrasted with a glutamate-poor diet. Within the context of chronic BBB disruption, elevated blood glutamate levels translate to heightened brain glutamate concentrations, thereby intensifying neurodegeneration due to glutamate neurotoxicity.
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Affiliation(s)
- Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna Oleshko
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Igor Merzlikin
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
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Jurick SM, McCabe CT, Watrous JR, MacGregor AJ, Walton SR, Stewart IJ, Walker LE, Galarneau MR. Associations between health-related behaviors and self-reported cognitive symptoms in U.S. military personnel injured on deployment. J Psychiatr Res 2023; 165:48-55. [PMID: 37459778 DOI: 10.1016/j.jpsychires.2023.07.001] [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] [Received: 04/05/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/03/2023]
Abstract
Health behaviors may be core contributors to cognition and mental health following mild traumatic brain injury (TBI). The aims of the present study examined: (1) whether health behaviors including sleep duration, alcohol use, and physical activity differed in injured military personnel with and without deployment-related mild TBI history and (2) the relative contributions of health behaviors and deployment-related mild TBI history to self-reported cognitive, posttraumatic stress disorder (PTSD), and depressive symptoms. Participants included 3076 military personnel injured on deployment participating in the Wounded Warrior Recovery Project, an ongoing web-based study. Military personnel with deployment-related mild TBI history reported similar rates of physical activity and levels of alcohol problems as those without, but were less likely to report receiving the recommended duration of sleep. When adjusting for demographic and injury variables, all three health behaviors were associated with cognitive, PTSD, and depressive symptoms. Alcohol problems demonstrated significant but small effects across all outcomes measures (ηp2=.01) whereas physical activity was associated with slightly larger effects albeit still within the small range (ηp2=.02-0.04). Duration of sleep bordered a medium effect for cognitive symptoms (ηp2=.05) and was in the medium range for PTSD and depressive symptoms (ηp2=.06). Although deployment-related mild TBI history was significant in all models, effect sizes were small (ηp2=.01). Findings from the present study provide support that health behaviors have stronger effects with regard to cognitive, PTSD, and depressive symptoms compared to deployment-related mild TBI history in military personnel and, given their modifiable nature, may represent treatment targets in this population.
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Affiliation(s)
- Sarah M Jurick
- Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| | - Cameron T McCabe
- Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA; Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Jessica R Watrous
- Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA; Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Andrew J MacGregor
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Samuel R Walton
- School of Medicine Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Ian J Stewart
- Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Lauren E Walker
- David Grant USAF Medical Center, 101 Bodin Circle, Bldg. 777, Travis AFB, CA, 94535, USA
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6
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Simonovic M, Nedovic B, Radisavljevic M, Stojanovic N. The Co-Occurrence of Post-Traumatic Stress Disorder and Depression in Individuals with and without Traumatic Brain Injury: A Comprehensive Investigation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1467. [PMID: 37629756 PMCID: PMC10456657 DOI: 10.3390/medicina59081467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder that often occurs following war trauma. Despite its high prevalence, there is still a lack of comprehensive understanding regarding the mechanisms underlying its progression and treatment resistance. Recent research has shed light on the biological basis of PTSD, with neuroimaging studies revealing altered brain connectivity patterns in affected individuals. In war contexts, traumatic brain injury (TBI) is a common occurrence and is associated with a high prevalence of PTSD. This study aimed to compare the severity of PTSD and depression in patients with and without a history of TBI to shed light on the impact of comorbid TBI on the presentation of PTSD symptoms. To achieve this goal, a cross-sectional study was conducted involving a sample of 60 outpatients who were diagnosed with both PTSD and Depressive Disorder. The inclusion criteria required participants to meet the diagnostic criteria for both disorders using validated tools. The severities of PTSD and depressive symptoms were assessed using scales that have been widely used and validated in previous research. By utilizing these standardized assessment tools, this study aimed to ensure the reliability and validity of the obtained data. The results of this study revealed that patients with comorbid PTSD and TBI exhibited a significantly higher severity of PTSD symptoms compared to those with PTSD only. Specifically, the comorbid group demonstrated higher ratings of symptom intensity across all symptom clusters. These findings are consistent with previous research that has highlighted the impact of comorbid TBI on the intensity and persistence of PTSD symptoms. When controlling for PTSD severity, no significant differences were observed in the severity of depressive symptoms between the two groups. This suggests that the increased depressive symptoms observed in the comorbid group may be primarily driven by the presence of more intense PTSD symptoms rather than TBI per se. The findings highlight the need for an accurate diagnosis of TBI in individuals with PTSD to guide appropriate treatment interventions. Further research is warranted to delve into the underlying mechanisms that contribute to the interaction between TBI and PTSD and to develop targeted interventions for individuals with comorbid PTSD and TBI.
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Affiliation(s)
- Maja Simonovic
- Faculty of Medicine, University of Nis, Nis 18000, Serbia; (B.N.)
- Center for Mental Health, University Clinical Center, Nis 18000, Serbia
| | - Bojan Nedovic
- Faculty of Medicine, University of Nis, Nis 18000, Serbia; (B.N.)
| | - Misa Radisavljevic
- Faculty of Medicine, University of Nis, Nis 18000, Serbia; (B.N.)
- Clinic for Neurosurgery, University Clinical Center, Nis 18000, Serbia
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7
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Mavroudis I, Ciobica A, Luca AC, Balmus IM. Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies. J Clin Med 2023; 12:4233. [PMID: 37445267 DOI: 10.3390/jcm12134233] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Post-traumatic headache (PTH) is a common and debilitating consequence of mild traumatic brain injury (mTBI) that can occur over one year after the head impact event. Thus, better understanding of the underlying pathophysiology and risk factors could facilitate early identification and management of PTH. There are several factors that could influence the reporting of PTH prevalence, including the definition of concussion and PTH. The main risk factors for PTHs include a history of migraines or headaches, female gender, younger age, greater severity of the head injury, and co-occurring psychological symptoms, such as anxiety and depression. PTH clinical profiles vary based on onset, duration, and severity: tension-type headache, migraine headaches, cervicogenic headache, occipital neuralgia, and new daily persistent headache. Pharmacological treatments often consist of analgesics and non-steroidal anti-inflammatory drugs, tricyclic antidepressants, or antiepileptic medication. Cognitive behavioral therapy, relaxation techniques, biofeedback, and physical therapy could also be used for PTH treatment. Our work highlighted the need for more rigorous studies to better describe the importance of identifying risk factors and patient-centered treatments and to evaluate the effectiveness of the existing treatment options. Clinicians should consider a multidisciplinary approach to managing PTH, including pharmacotherapy, cognitive behavioral therapy, and lifestyle changes.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 700506 Iasi, Romania
- Centre of Biomedical Research, Romanian Academy, B dul Carol I, No. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Splaiul Independentei nr. 54, Sector 5, 050094 Bucuresti, Romania
| | - Alina Costina Luca
- Department of Mother and Child, Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, "Alexandru Ioan Cuza" University of Iasi, 700057 Iasi, Romania
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8
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Penn C, Katnik C, Cuevas J, Mohapatra SS, Mohapatra S. Multispectral optoacoustic tomography (MSOT): Monitoring neurovascular changes in a mouse repetitive traumatic brain injury model. J Neurosci Methods 2023; 393:109876. [PMID: 37150303 PMCID: PMC10388337 DOI: 10.1016/j.jneumeth.2023.109876] [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: 03/21/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Evidence suggests that mild TBI injuries, which comprise > 75% of all TBIs, can cause chronic post-concussive symptoms, especially when experienced repetitively (rTBI). rTBI is a major cause of cognitive deficit in athletes and military personnel and is associated with neurovascular changes. Current methods to monitor neurovascular changes in detail are prohibitively expensive and invasive for patients with mild injuries. NEW METHOD We evaluated the potential of multispectral optoacoustic tomography (MSOT) to monitor neurovascular changes and assess therapeutic strategies in a mouse model of rTBI. Mice were subjected to rTBI or sham via controlled cortical impact and administered pioglitazone (PG) or vehicle. Oxygenated and deoxygenated hemoglobin were monitored using MSOT. Indocyanine green clearance was imaged via MSOT to evaluate blood-brain-barrier (BBB) integrity. RESULTS Mice subjected to rTBI show a transient increase in oxygenated/total hemoglobin ratio which can be mitigated by PG administration. rTBI mice also show BBB disruption shortly after injury and reduction of oxygenated/total hemoglobin in the chronic stage, neither of which were affected by PG intervention. COMPARISON WITH EXISTING METHODS MSOT imaging has the potential as a noninvasive in vivo imaging method to monitor neurovascular changes and assess therapeutics in mouse models of rTBI. In comparison to standard methods of tracking inflammation and BBB disruption, MSOT can be used multiple times throughout the course of injury without the need for surgery. Thus, MSOT is especially useful in research of rTBI models for screening therapeutics, and with further technological improvements may be extended for use in rTBI patients.
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Affiliation(s)
- Courtney Penn
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA; Department of Molecular Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Chris Katnik
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Javier Cuevas
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Shyam S Mohapatra
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA; Department of Internal Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Subhra Mohapatra
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA; Department of Molecular Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA.
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9
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Berman R, Spencer H, Boese M, Kim S, Radford K, Choi K. Loss of Consciousness and Righting Reflex Following Traumatic Brain Injury: Predictors of Post-Injury Symptom Development (A Narrative Review). Brain Sci 2023; 13:brainsci13050750. [PMID: 37239222 DOI: 10.3390/brainsci13050750] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Identifying predictors for individuals vulnerable to the adverse effects of traumatic brain injury (TBI) remains an ongoing research pursuit. This is especially important for patients with mild TBI (mTBI), whose condition is often overlooked. TBI severity in humans is determined by several criteria, including the duration of loss of consciousness (LOC): LOC < 30 min for mTBI and LOC > 30 min for moderate-to-severe TBI. However, in experimental TBI models, there is no standard guideline for assessing the severity of TBI. One commonly used metric is the loss of righting reflex (LRR), a rodent analogue of LOC. However, LRR is highly variable across studies and rodents, making strict numeric cutoffs difficult to define. Instead, LRR may best be used as predictor of symptom development and severity. This review summarizes the current knowledge on the associations between LOC and outcomes after mTBI in humans and between LRR and outcomes after experimental TBI in rodents. In clinical literature, LOC following mTBI is associated with various adverse outcome measures, such as cognitive and memory deficits; psychiatric disorders; physical symptoms; and brain abnormalities associated with the aforementioned impairments. In preclinical studies, longer LRR following TBI is associated with greater motor and sensorimotor impairments; cognitive and memory impairments; peripheral and neuropathology; and physiologic abnormalities. Because of the similarities in associations, LRR in experimental TBI models may serve as a useful proxy for LOC to contribute to the ongoing development of evidence-based personalized treatment strategies for patients sustaining head trauma. Analysis of highly symptomatic rodents may shed light on the biological underpinnings of symptom development after rodent TBI, which may translate to therapeutic targets for mTBI in humans.
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Affiliation(s)
- Rina Berman
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD 20814, USA
| | - Haley Spencer
- Program in Neuroscience, Uniformed Services University, Bethesda, MD 20814, USA
| | - Martin Boese
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - Sharon Kim
- F. E. Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Kennett Radford
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - Kwang Choi
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD 20814, USA
- Program in Neuroscience, Uniformed Services University, Bethesda, MD 20814, USA
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
- F. E. Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
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10
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Kim SY, Soumoff AA, Raiciulescu S, Kemezis PA, Spinks EA, Brody DL, Capaldi VF, Ursano RJ, Benedek DM, Choi KH. Association of Traumatic Brain Injury Severity and Self-Reported Neuropsychiatric Symptoms in Wounded Military Service Members. Neurotrauma Rep 2023; 4:14-24. [PMID: 36726873 PMCID: PMC9886188 DOI: 10.1089/neur.2022.0063] [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: 01/12/2023] Open
Abstract
The impact of traumatic brain injury (TBI) severity and loss of consciousness (LOC) on the development of neuropsychiatric symptoms was studied in injured service members (SMs; n = 1278) evacuated from combat settings between 2003 and 2012. TBI diagnoses of mild TBI (mTBI) or moderate-to-severe TBI (MS-TBI) along with LOC status were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and the Defense and Veterans Brain Injury Center Standard Surveillance Case Definition for TBI. Self-reported psychiatric symptoms were evaluated for post-traumatic stress disorder (PTSD) with the PTSD Checklist, Civilian Version for PTSD, the Patient Health Questionnaire-9 for major depressive disorder (MDD), and the Patient Health Questionnaire-15 for somatic symptom disorder (SSD) in two time periods post-injury: Assessment Period 1 (AP1, 0.0-2.5 months) and Assessment Period 2 (AP2, 3-12 months). mTBI, but not MS-TBI, was associated with increased neuropsychiatric symptoms: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP2. A subgroup analysis of mTBI with and without LOC revealed that mTBI with LOC, but not mTBI without LOC, was associated with increased symptoms as compared to non-TBI: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP1 and AP2. Moreover, mTBI with LOC was associated with increased MDD symptoms in AP2, and SSD symptoms in AP1 and AP2, compared to mTBI without LOC. These findings reinforce the need for the accurate characterization of TBI severity and a multi-disciplinary approach to address the devastating impacts of TBI in injured SMs.
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Affiliation(s)
- Sharon Y. Kim
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
| | - Alyssa A. Soumoff
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Biostatistics Consulting Center, Uniformed Services University, Bethesda, Maryland, USA
| | - Patricia A. Kemezis
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Elizabeth A. Spinks
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David L. Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Maryland, USA.,Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA
| | - Vincent F. Capaldi
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Robert J. Ursano
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - David M. Benedek
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Kwang H. Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Address correspondence to: Kwang H. Choi, PhD, Department of Psychiatry, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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11
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White MR, VandeVord PJ. Regional variances depict a unique glial-specific inflammatory response following closed-head injury. Front Cell Neurosci 2023; 17:1076851. [PMID: 36909284 PMCID: PMC9996631 DOI: 10.3389/fncel.2023.1076851] [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: 10/22/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
Mild traumatic brain injuries (mTBI) constitute a significant health concern with clinical symptoms ranging from headaches to cognitive deficits. Despite the myriad of symptoms commonly reported following this injury, there is still a lack of knowledge on the various pathophysiological changes that occur. Preclinical studies are at the forefront of discovery delineating the changes that occur within this heterogeneous injury, with the emergence of translational models such as closed-head impact models allowing for further exploration of this injury mechanism. In the current study, male rats were subjected to a closed-head controlled cortical impact (cCCI), producing a concussion (mTBI). The pathological effects of this injury were then evaluated using immunoflourescence seven days following. The results exhibited a unique glial-specific inflammatory response, with both the ipsilateral and contralateral sides of the cortex and hippocampus showing pathological changes following impact. Overall these findings are consistent with glial changes reported following concussions and may contribute to subsequent symptoms.
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Affiliation(s)
- Michelle R White
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Pamela J VandeVord
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States.,Salem VA Medical Center, Salem, VA, United States
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12
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Coffman C, Reyes D, Hess MC, Giakas AM, Thiam M, Sico JJ, Seng E, Renthal W, Rhoades C, Cai G, Androulakis XM. Relationship Between Headache Characteristics and a Remote History of TBI in Veterans: A 10-Year Retrospective Chart Review. Neurology 2022; 99:e187-e198. [PMID: 35470141 PMCID: PMC9280992 DOI: 10.1212/wnl.0000000000200518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this work was to examine the association between deployment-related traumatic brain injury (TBI) severity, frequency, and other injury characteristics with headache outcomes in veterans evaluated at a Veterans Administration (VA) polytrauma support clinic. METHODS We conducted a retrospective chart review of 594 comprehensive TBI evaluations between 2011 and 2021. Diagnostic criteria were based on the Department of Defense/VA Consensus-Based Classification of Closed TBI. Adjusted odds ratios (AORs) and 95% CIs were estimated for headache prevalence (logistic), headache severity (ordinal), and prevalence of migraine-like features (logistic) with multiple regression analysis. Regression models were adjusted for age, sex, race/ethnicity, time since injury, and mental health diagnoses. RESULTS TBI severity groups were classified as sub concussive exposure (n = 189) and mild (n = 377), moderate (n = 28), and severe TBI (n = 0). Increased headache severity was reported in veterans with mild TBI (AOR 1.72 [95% CI 1.15, 2.57]) and moderate TBI (AOR 3.89 [1.64, 9.15]) compared to those with subconcussive exposure. A history of multiple mild TBIs was associated with more severe headache (AOR 2.47 [1.34, 4.59]) and migraine-like features (AOR 5.95 [2.55, 13.77]). No differences were observed between blast and nonblast injuries; however, greater headache severity was reported in veterans with both primary and tertiary blast effects (AOR 2.56 [1.47, 4.49]). Alteration of consciousness (AOC) and posttraumatic amnesia (PTA) >30 minutes were associated with more severe headache (AOR 3.37 [1.26, 9.17] and 5.40 [2.21, 13.42], respectively). The length of time between the onset of last TBI and the TBI evaluation was associated with headache severity (AOR 1.09 [1.02, 1.17]) and prevalence of migraine-like features (AOR 1.27 [1.15, 1.40]). Last, helmet use was associated with less severe headache (AOR 0.42 [0.23, 0.75]) and lower odds of migraine-like features (AOR 0.45 [0.21, 0.98]). DISCUSSION Our data support the notion of a dose-response relationship between TBI severity and headache outcomes. A history of multiple mild TBIs and longer duration of AOC and PTA are unique risk factors for poor headache outcomes in veterans. Furthermore, this study sheds light on the poor headache outcomes associated with subconcussive exposure. Past TBI characteristics should be considered when developing headache management plans for veterans.
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Affiliation(s)
- Colt Coffman
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Deborah Reyes
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Mary Catherine Hess
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Alec M Giakas
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Melinda Thiam
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Jason Jonathon Sico
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Elizabeth Seng
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - William Renthal
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Charles Rhoades
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Guoshuai Cai
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - X Michelle Androulakis
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC.
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13
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Marquardt CA, Pokorny VJ, Disner SG, Nelson NW, McGuire KA, Sponheim SR. Inefficient Attentional Control Explains Verbal-Memory Deficits Among Military Veterans With Posttraumatic Reexperiencing Symptoms. Clin Psychol Sci 2022; 10:499-513. [PMID: 38020495 PMCID: PMC10663645 DOI: 10.1177/21677026211025018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 05/16/2021] [Indexed: 12/01/2023]
Abstract
Among individuals with posttraumatic stress disorder (PTSD), verbal learning and memory are areas of weakness compared with other cognitive domains (e.g., visuospatial memory). In this study, previously deployed military veterans completed clinical assessments of word memory and vocabulary (n = 243) and a laboratory task measuring encoding, free recall, repetition priming, and recognition of words (n = 147). Impaired verbal memory was selectively related to reexperiencing symptoms of PTSD but was not associated with other symptom groupings or blast-induced traumatic brain injury. Implicit priming of response times following word repetition was also unrelated to clinical symptoms. Instead, slowed response times during encoding explained associations between reexperiencing and memory performance. These findings are consistent with alterations in attentional control explaining PTSD-related verbal-memory deficits. Such findings have implications for understanding trauma-focused psychotherapy and recovery, which may depend on efficient attentional processing of words to alter posttraumatic reexperiencing symptoms.
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Affiliation(s)
- Craig A. Marquardt
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Victor J. Pokorny
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
- Department of Psychology, University of Minnesota–Twin Cities
| | - Seth G. Disner
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | | | | | - Scott R. Sponheim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
- Department of Psychology, University of Minnesota–Twin Cities
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14
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Jurick SM, Crocker LD, Merritt VC, Sanderson-Cimino ME, Keller AV, Glassman LH, Twamley EW, Rodgers CS, Schiehser DM, Aupperle RL, Jak AJ. Independent and Synergistic Associations Between TBI Characteristics and PTSD Symptom Clusters on Cognitive Performance and Postconcussive Symptoms in Iraq and Afghanistan Veterans. J Neuropsychiatry Clin Neurosci 2022; 33:98-108. [PMID: 33441014 DOI: 10.1176/appi.neuropsych.20050128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators sought to evaluate the independent and interactive associations between mild traumatic brain injury (mTBI) characteristics and posttraumatic stress disorder (PTSD) symptoms with regard to postconcussive symptoms and cognition among treatment-seeking veterans of the U.S. conflicts in Iraq and Afghanistan. METHODS Sixty-seven Iraq and Afghanistan veterans who had a history of mTBI and comorbid PTSD were grouped based on injury mechanism (blast versus nonblast) and number of lifetime mTBIs (one to two versus three or more). Independent associations between mTBI characteristics and PTSD symptom clusters were evaluated with regard to cognition and postconcussive symptoms. Follow-up analyses were conducted to determine any interactive associations between TBI characteristics and PTSD symptom clusters. RESULTS Higher PTSD symptoms, particularly hyperarousal, were associated with poorer executive functioning and higher postconcussive symptoms. No direct relationships were observed between PTSD symptom clusters and memory or processing speed. The relationship between hyperarousal and processing speed was moderated by lifetime mTBIs, such that those with a history of at least three mTBIs demonstrated a negative association between hyperarousal and processing speed. Blast-related mTBI history was associated with reduced processing speed, compared with non-blast-related mTBI. However, an interaction was observed such that among those with blast-related mTBI history, higher re-experiencing symptoms were associated with poorer processing speed, whereas veterans without history of blast-related mTBI did not demonstrate an association between processing speed and re-experiencing symptoms. CONCLUSIONS Higher hyperarousal and re-experiencing symptoms were associated with reduced processing speed among veterans with repetitive and blast-related mTBI history, respectively. PTSD symptoms, specifically hyperarousal, were associated with poorer executive functioning and higher postconcussive symptoms. Limited associations were found between injury characteristics and cognition chronically following mTBI. However, these results support synergistic effects of specific PTSD symptom clusters and TBI characteristics.
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Affiliation(s)
- Sarah M Jurick
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Laura D Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Victoria C Merritt
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Mark E Sanderson-Cimino
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Amber V Keller
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Lisa H Glassman
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Carie S Rodgers
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Robin L Aupperle
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Amy J Jak
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
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15
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Wright WG, Handy JD, Haskell A, Servatius L, Servatius R. History of Mild Traumatic Brain Injury Affects Static Balance Under Complex Multisensory Manipulations. J Neurotrauma 2022; 39:821-828. [PMID: 35229645 DOI: 10.1089/neu.2020.7600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A recent study in active duty military in the Coast Guard suggested lifetime experience with mTBI was associated with subtle deficits in postural control when exposed to multisensory discordance (i.e. rotating visual stimulation). The present study extended postural assessments to veterans recruited from the community. Service veterans completed the Defense Veteran Brain Injury Center (DVBIC) TBI Screening Tool, PTSD Checklist (PCL-5), and neurobehavioral symptom inventory (NSI). Postural control was assessed using a custom designed virtual reality based device, which assessed center of pressure (COP) sway in response to six conditions designed to test sensory integration by systematically combining three visual conditions (eyes open, eyes closed, and rotating scene) with two somatosensory conditions (firm or foam surface). Veterans screening positive for lifetime experience of mTBI (mTBI+) displayed similar postural sway to veterans without lifetime experience of mTBI (mTBI-) on basic assessment of eyes open or closed on firm and foam surface. mTBI+ veterans displayed greater sway than mTBI- veterans in response to the rotating visual stimuli while on a foam surface. Similar to previous research the degree of sway was affected by the number of lifetime experiences of mTBI. Increased postural sway was not related to PTSD, NSI, or, balance-specific symptom expression. In summary, veterans who experienced mTBI over their lifetime exhibited dysfunction in balance control as revealed by challenging conditions with multisensory discordance. These balance-related signs were independent of self-reported balance-related symptoms or other symptom domains measured by the NSI, which can provide a method for exposing otherwise covert dysfunction long after experience of mTBI.
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Affiliation(s)
- W Geoffrey Wright
- Temple University College of Public Health, 16043, Health and Rehabilitation Sciences, Philadelphia, Pennsylvania, United States;
| | - Justin D Handy
- Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Amanda Haskell
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Labeeby Servatius
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Richard Servatius
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,SUNY Upstate Medical University, 12302, Psychiatry, Syracuse, New York, United States;
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16
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O'Neil ME, Cameron D, Shirley K, Sano E, Twamley E, Williams R, Turner A, Pagulayan K, Roost M, Jak A, Storzbach D, Huckans M. Change in Learning and Memory Partially Mediates Effects of Compensatory Cognitive Training on Self-Reported Cognitive Symptoms. J Head Trauma Rehabil 2021; 36:429-436. [PMID: 33656484 DOI: 10.1097/htr.0000000000000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine associations among compensatory cognitive training (CCT), objective cognitive functioning, and self-reported cognitive symptoms. We examined whether change in objective cognitive functioning associated with participation in CCT at 10-week follow-up mediates change in self-reported cognitive symptoms associated with CCT at 15-week follow-up. SETTING Three VA outpatient mental health clinics. PARTICIPANTS Veterans with a history of mild traumatic brain injury who reported cognitive deficits. DESIGN Randomized controlled trial post hoc causal mediation analysis. MAIN MEASURES Self-reported cognitive symptoms were measured by the Prospective-Retrospective Memory Questionnaire and the Multiple Sclerosis Neuropsychological Screening Questionnaire. Objective cognitive functioning was measured using a battery of neuropsychological tests. RESULTS Improvement on the Hopkins Verbal Learning Test-Revised (HVLT-R) Delayed Recall test mediated the association between participation in CCT and decrease in the Prospective-Retrospective Memory Questionnaire total score. Improvement on the HVLT-R Total Recall and HVLT-R Delayed Recall tests both meditated the association between participation in CCT and decrease in the Multiple Sclerosis Neuropsychological Screening Questionnaire total score. No other measures of objective cognitive functioning were significant mediators. CONCLUSION Patients' perceptions of cognitive symptom improvement due to CCT are partially mediated by learning and memory, though these subjective improvements occur regardless of other changes in objective cognitive functioning associated with CCT.
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Affiliation(s)
- Maya Elin O'Neil
- VA Portland Health Care System, Portland, Oregon (Drs O'Neil, Roost, Storzbach, and Huckans, Mr Cameron, and Mss Shirley and Sano); Departments of Psychiatry (Drs O'Neil, Storzbach, and Huckans), Medical Informatics and Clinical Epidemiology (Dr O'Neil), and Neurology (Dr Storzbach), Oregon Health & Science University, Portland; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California (Drs Twamley and Jak); Department of Psychiatry, University of California San Diego, La Jolla (Drs Twamley and Jak); VA Puget Sound Health Care System, Seattle, Washington (Drs Williams, Turner, and Pagulayan); and Departments of Rehabilitation Medicine (Drs Williams and Turner) and Psychiatry and Behavioral Sciences (Dr Pagulayan), University of Washington School of Medicine, Seattle
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17
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McDonald SD, Walker WC, Cusack SE, Yoash-Gantz RE, Pickett TC, Cifu DX, Mid-Atlantic Mirecc Workgroup V, Tupler LA. Health symptoms after war zone deployment-related mild traumatic brain injury: contributions of mental disorders and lifetime brain injuries. Brain Inj 2021; 35:1338-1348. [PMID: 34543115 DOI: 10.1080/02699052.2021.1959058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE To gain a better understanding of the complex relationship between combat deployment-related mild traumatic brain injury (mTBI) and persistent post-concussive symptoms (PPCSs), taking into consideration a wide range of potentially mediating and confounding factors. RESEARCH DESIGN Cross-sectional. METHODS AND PROCEDURES Subjects were 613 U. S. military Veterans and Service Members who served during operations Enduring Freedom, Iraqi Freedom, or New Dawn (OEF/OIF/OND) and completed a structured interview of mental disorders and a battery of questionnaires. Hierarchical binary logistic regression analyses were used to test the hypotheses. MAIN OUTCOMES AND RESULTS After accounting for mental disorders, lifetime mTBIs outside of OEF/OIF/OND deployment, medical conditions, and injury/demographic characteristics, deployment-related mTBI continued to be associated with several PPCSs (headaches, sleep disturbance, and difficulty making decisions). Deployment-related mTBI was also associated with two symptoms not normally associated with mTBI (nausea/upset stomach and numbness/tingling). CONCLUSIONS After adjusting for a wide range of factors, OEF/OIF/OND deployment-related mTBI was still associated with PPCSs on average 10 years after the injury. These findings suggest that mTBI sustained during OEF/OIF/OND deployment may have enduring negative health effects. More studies are needed that prospectively and longitudinally track health and mental health outcomes after TBI.
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Affiliation(s)
- Scott D McDonald
- Mental Health Service, Hunter Holmes McGuire Va Medical Center, Richmond, VA, USA.,Department Of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department Of Physical Medicine And Rehabilitation, School Of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - William C Walker
- Mental Health Service, Hunter Holmes McGuire Va Medical Center, Richmond, VA, USA.,Department Of Physical Medicine And Rehabilitation, School Of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Shannon E Cusack
- Department Of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Virginia Institute for Psychiatric and Behavioral Genetics (Vipbg), School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ruth E Yoash-Gantz
- Va Mid-Atlantic Mental Illness, Research, And Clinical Center, Durham, NC, USA
| | | | - David X Cifu
- Mental Health Service, Hunter Holmes McGuire Va Medical Center, Richmond, VA, USA.,Department Of Physical Medicine And Rehabilitation, School Of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Larry A Tupler
- Va Mid-Atlantic Mental Illness, Research, And Clinical Center, Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA
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18
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Association Between Traumatic Brain Injury and Dementia in Veterans: A Rapid Systematic Review. J Head Trauma Rehabil 2021; 35:198-208. [PMID: 31996602 DOI: 10.1097/htr.0000000000000549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To systematically review the prevalence of dementia in Veterans versus civilians and the association between previous traumatic brain injuries (TBIs) and the risk and timing of dementia onset in Veterans. DESIGN We systematically searched MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials from database inception to October 2018. One reviewer assessed articles for inclusion, evaluated study quality, graded strength of evidence, and extracted data, with second reviewer checking. RESULTS Forty articles were included, among which 10 presented the best evidence. Evidence suggests that dementia rates are likely similar between Veterans and civilians (10.7% vs 8.8%-11.6%, respectively). Dementia prevalence is likely higher in those with TBI (6%-16%) than in those without (3%-10%), with a possible dose-response relationship between the two. There may also be an association between TBI and early-onset dementia, although this evidence has important limitations. No studies evaluated whether dementia prevalence varied on the basis of combat deployment history or era of conflict. CONCLUSION Dementia prevalence is likely similar in Veteran and civilian populations, and the risk of dementia is likely increased by TBI. To inform development of screening, prevention, and rehabilitation efforts, research is still needed addressing the mechanism of association and timing of dementia onset. PROTOCOL PROSPERO; CRD42018107926.
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19
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Chen Y, Herrold AA, Gallagher V, Martinovich Z, Bari S, Vike NL, Vesci B, Mjaanes J, McCloskey LR, Reilly JL, Breiter HC. Preliminary Report: Localized Cerebral Blood Flow Mediates the Relationship between Progesterone and Perceived Stress Symptoms among Female Collegiate Club Athletes after Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:1809-1820. [PMID: 33470158 PMCID: PMC8336258 DOI: 10.1089/neu.2020.7217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Female athletes are under-studied in the field of concussion research, despite evidence of higher injury prevalence and longer recovery time. Hormonal fluctuations caused by the natural menstrual cycle (MC) or hormonal contraceptive (HC) use impact both post-injury symptoms and neuroimaging findings, but the relationships among hormone, symptoms, and brain-based measures have not been jointly considered in concussion studies. In this preliminary study, we compared cerebral blood flow (CBF) measured with arterial spin labeling between concussed female club athletes 3-10 days after mild traumatic brain injury (mTBI) and demographic, HC/MC matched controls (CON). We tested whether CBF statistically mediates the relationship between progesterone serum levels and post-injury symptoms, which may support a hypothesis for progesterone's role in neuroprotection. We found a significant three-way relationship among progesterone, CBF, and perceived stress score (PSS) in the left middle temporal gyrus for the mTBI group. Higher progesterone was associated with lower (more normative) PSS, as well as higher (more normative) CBF. CBF mediates 100% of the relationship between progesterone and PSS (Sobel p value = 0.017). These findings support a hypothesis for progesterone having a neuroprotective role after concussion and highlight the importance of controlling for the effects of sex hormones in future concussion studies.
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Affiliation(s)
- Yufen Chen
- Center for Translational Imaging, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Virginia Gallagher
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zoran Martinovich
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sumra Bari
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicole L. Vike
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Vesci
- Northwestern Health Services Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Jeffrey Mjaanes
- Northwestern Health Services Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Leanne R. McCloskey
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James L. Reilly
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hans C. Breiter
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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20
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Hardy MS, Kennedy JE, Cooper DB. Patient Attribution of Posttraumatic Symptoms to Brain Injury Versus PTSD in Military-Related Mild TBI. J Neuropsychiatry Clin Neurosci 2021; 32:252-258. [PMID: 32054399 DOI: 10.1176/appi.neuropsych.19090202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Persistent cognitive, somatic, and neuropsychiatric symptoms following mild traumatic brain injury (TBI) are influenced by posttraumatic stress disorder (PTSD), particularly in military patients. The authors evaluated the degree to which military service members with a history of mild TBI attributed posttraumatic symptoms to TBI versus PTSD. METHODS Service members (N=372) with mild TBI were surveyed about the severity of posttraumatic symptoms across four symptom clusters (cognitive, affective, somatosensory, and vestibular) with the Neurobehavioral Symptom Inventory (NSI). Participants rated the degree to which they believed TBI, PTSD, or other conditions contributed to their symptoms. Differences in cognitive, affective, somatosensory, and vestibular symptom severity were evaluated across participants with TBI, PTSD, or combined TBI-PTSD attribution. Logistic regression was used to evaluate the association between symptom profiles and attribution. RESULTS Participants attributed symptoms mostly to TBI, followed by insufficient sleep, PTSD, chronic pain, depression, and deployment-readjustment stress. PTSD and combined TBI-PTSD attribution were associated with higher total NSI scores (39.5 and 51.6, respectively), compared with TBI attribution only (31.4) (F=29.08, df=3, 358, p<0.01), as well as higher scores in every symptom category. More severe affective symptoms were associated with decreased odds of TBI attribution (odds ratio=0.90, 95% CI=0.83-0.97) and increased odds of PTSD attribution (odds ratio=1.14, 95% CI=1.03-1.26). A PTSD diagnosis was highly associated with PTSD attribution (odds ratio=2.44, 95% CI=1.07-5.58). CONCLUSIONS The nature and severity of posttraumatic symptoms appear to play a role in patient beliefs about the causes of symptoms, whether from TBI or PTSD.
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Affiliation(s)
- Morgan S Hardy
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Tex. (Hardy); the Department of Psychiatry, University of Texas Health San Antonio, San Antonio, Tex. (Hardy, Cooper); the Defense and Veterans Brain Injury Center, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Tex. (Kennedy); General Dynamics Information Technology, Falls Church, Va. (Kennedy, Cooper); and the Defense and Veterans Brain Injury Center, San Antonio Polytrauma Rehabilitation Center, Audie L. Murphy Memorial VA Hospital, San Antonio, Tex. (Cooper)
| | - Jan E Kennedy
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Tex. (Hardy); the Department of Psychiatry, University of Texas Health San Antonio, San Antonio, Tex. (Hardy, Cooper); the Defense and Veterans Brain Injury Center, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Tex. (Kennedy); General Dynamics Information Technology, Falls Church, Va. (Kennedy, Cooper); and the Defense and Veterans Brain Injury Center, San Antonio Polytrauma Rehabilitation Center, Audie L. Murphy Memorial VA Hospital, San Antonio, Tex. (Cooper)
| | - Douglas B Cooper
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Tex. (Hardy); the Department of Psychiatry, University of Texas Health San Antonio, San Antonio, Tex. (Hardy, Cooper); the Defense and Veterans Brain Injury Center, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Tex. (Kennedy); General Dynamics Information Technology, Falls Church, Va. (Kennedy, Cooper); and the Defense and Veterans Brain Injury Center, San Antonio Polytrauma Rehabilitation Center, Audie L. Murphy Memorial VA Hospital, San Antonio, Tex. (Cooper)
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21
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Braun D, Schöniger C, Pyrc J, Petrowski K. Traumatic brain injury as vulnerability factor for the development of psychological disorders in a prospective single-event trauma traffic accident sample. Brain Inj 2021; 35:604-608. [PMID: 33719837 DOI: 10.1080/02699052.2021.1894480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Primary Objective: Traumatic brain injuries (TBIs) present a relevant problem among individuals involved in traffic accidents. The aim of this study was to investigate the impact of TBI on the development of psychological symptoms after a traffic accident.Research Design: This cohort study investigates, whether individuals involved in traffic accidents with TBI are more likely to develop psychological illness than those without TBI.Measures and Procedures: 59 men (patients: n= 19, controls: n= 40) and 64 women (patients: n= 21, controls n= 43) participated in the study (Mean age: M= 40.23; SD = 13.19; Injury severity score ISS: M= 6.48, SD = 5.99). The psychological distress was compared between the two groups using t-tests. The impact of ISS, number and duration of surgeries were regarded using regression analyses.Main Outcomes and Results: No indications for a heightened risk of psychological disorders in patients with TBI were found. The treatment at the hospital had no measurable influence on the development of psychological disorders. Nevertheless, in the Dexamethasone-suppression-test there was an increased stress load of patients with TBI caused by injury severity and operations.Conclusions: TBIs do not seem to cause psychological illness directly but the number of surgeries and the injury severity can influence the stress load which is associated with psychological symptoms.
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Affiliation(s)
- Désirée Braun
- Department of Psychology and Psychotherapy, University Witten, Herdecke, Germany.,Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine, Mainz, Germany
| | - Christian Schöniger
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine, Mainz, Germany
| | - Jaroslaw Pyrc
- Clinic for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine, Mainz, Germany.,Dresden University of Technology, Department of Internal Medicine III, Dresden, Germany
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22
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Moriarty H, Robinson KM, Winter L. The additional burden of PTSD on functioning and depression in veterans with traumatic brain injury. Nurs Outlook 2021; 69:167-181. [PMID: 33608113 DOI: 10.1016/j.outlook.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many United States veterans and active military with a history of traumatic brain injury (TBI) also experience challenges from comorbid posttraumatic stress disorder (PTSD), yet the additional burden of PTSD is not clear. PURPOSE To address this knowledge gap, this study examined the relationship of PTSD to cognitive, social, and physical functioning and depressive symptoms in veterans recently diagnosed with TBI. METHODS Veterans were recruited from a VA rehabilitation clinic. The Patient Competency Rating Scale and Center for Epidemiologic Studies Depression Scale measured functioning and depression, respectively. Chart review captured PTSD diagnosis. FINDINGS In the sample of 83 veterans, 65% had a current PTSD diagnosis. After controlling for sociodemographic variables and TBI severity, PTSD was a significant predictor of lower cognitive, social, and physical functioning and higher depressive symptomatology. DISCUSSION Clinicians should incorporate PTSD assessment in their work with veterans with TBI. Integrated behavioral health and rehabilitation interventions that provide strategies for veterans to manage TBI symptoms and PTSD are critical.
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Affiliation(s)
- Helene Moriarty
- Villanova University, M. Louise Fitzpatrick College of Nursing, Villanova, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Nursing Service, Philadelphia, PA.
| | - Keith M Robinson
- University of Pennsylvania, Perelman School of Medicine, Department of Physical Medicine and Rehabilitation, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Rehabilitation Medicine Service, Philadelphia, PA
| | - Laraine Winter
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Nursing Service, Philadelphia, PA
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23
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Clark AL, Weigand AJ, Bangen KJ, Merritt VC, Bondi MW, Delano-Wood L. Repetitive mTBI is associated with age-related reductions in cerebral blood flow but not cortical thickness. J Cereb Blood Flow Metab 2021; 41:431-444. [PMID: 32248731 PMCID: PMC8369996 DOI: 10.1177/0271678x19897443] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mild traumatic brain injury (mTBI) is a risk factor for Alzheimer's disease (AD), and evidence suggests cerebrovascular dysregulation initiates deleterious neurodegenerative cascades. We examined whether mTBI history alters cerebral blood flow (CBF) and cortical thickness in regions vulnerable to early AD-related changes. Seventy-four young to middle-aged Veterans (mean age = 34, range = 23-48) underwent brain scans. Participants were divided into: (1) Veteran Controls (n = 27), (2) 1-2 mTBIs (n = 26), and (2) 3+ mTBIs (n = 21) groups. Resting CBF was measured using MP-PCASL. T1 structural scans were processed with FreeSurfer. CBF and cortical thickness estimates were extracted from nine AD-vulnerable regions. Regression analyses examined whether mTBI moderated the association between age, CBF, and cortical thickness. Regressions adjusting for sex and posttraumatic stress revealed mTBI moderated the association between age and CBF of the precuneus as well as superior and inferior parietal cortices (p's < .05); increasing age was associated with lower CBF in the 3+ mTBIs group, but not in the VCs or 1-2 mTBIs groups. mTBI did not moderate associations between age and cortical thickness (p's >.05). Repetitive mTBI is associated with cerebrovascular dysfunction in AD-vulnerable regions and may accelerate pathological aging trajectories.
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Affiliation(s)
- Alexandra L Clark
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Victoria C Merritt
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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24
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Sharma A, Muresanu DF, Castellani RJ, Nozari A, Lafuente JV, Sahib S, Tian ZR, Buzoianu AD, Patnaik R, Wiklund L, Sharma HS. Mild traumatic brain injury exacerbates Parkinson's disease induced hemeoxygenase-2 expression and brain pathology: Neuroprotective effects of co-administration of TiO 2 nanowired mesenchymal stem cells and cerebrolysin. PROGRESS IN BRAIN RESEARCH 2020; 258:157-231. [PMID: 33223035 DOI: 10.1016/bs.pbr.2020.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mild traumatic brain injury (mTBI) is one of the leading predisposing factors in the development of Parkinson's disease (PD). Mild or moderate TBI induces rapid production of tau protein and alpha synuclein (ASNC) in the cerebrospinal fluid (CSF) and in several brain areas. Enhanced tau-phosphorylation and ASNC alters the molecular machinery of the brain leading to PD pathology. Recent evidences show upregulation of constitutive isoform of hemeoxygenase (HO-2) in PD patients that correlates well with the brain pathology. mTBI alone induces profound upregulation of HO-2 immunoreactivity. Thus, it would be interesting to explore whether mTBI exacerbates PD pathology in relation to tau, ASNC and HO-2 expression. In addition, whether neurotrophic factors and stem cells known to reduce brain pathology in TBI could induce neuroprotection in PD following mTBI. In this review role of mesenchymal stem cells (MSCs) and cerebrolysin (CBL), a well-balanced composition of several neurotrophic factors and active peptide fragments using nanowired delivery in PD following mTBI is discussed based on our own investigation. Our results show that mTBI induces concussion exacerbates PD pathology and nanowired delivery of MSCs and CBL induces superior neuroprotection. This could be due to reduction in tau, ASNC and HO-2 expression in PD following mTBI, not reported earlier. The functional significance of our findings in relation to clinical strategies is discussed.
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Affiliation(s)
- Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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25
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Boscarino JJ, Figley CR, Adams RE, Urosevich TG, Kirchner HL, Boscarino JA. Mental health status in veterans residing in rural versus non-rural areas: results from the veterans' health study. Mil Med Res 2020; 7:44. [PMID: 32951600 PMCID: PMC7504679 DOI: 10.1186/s40779-020-00272-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. METHODS Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. RESULTS A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). CONCLUSIONS Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.
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Affiliation(s)
- Joseph J Boscarino
- Clinical Psychology Department, William James College, Newton, MA, 02459, USA
| | - Charles R Figley
- School of Social Work, Tulane University, New Orleans, LA, 70112, USA
| | - Richard E Adams
- Department of Sociology, Kent State University, Kent, OH, 44242, USA
| | | | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA.
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26
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Pryweller JR, Baughman BC, Frasier SD, O'Conor EC, Pandhi A, Wang J, Morrison AA, Tsao JW. Performance on the DANA Brief Cognitive Test Correlates With MACE Cognitive Score and May Be a New Tool to Diagnose Concussion. Front Neurol 2020; 11:839. [PMID: 32982908 PMCID: PMC7492197 DOI: 10.3389/fneur.2020.00839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/06/2020] [Indexed: 12/02/2022] Open
Abstract
Nearly 380,000 U.S. service members between 2000 and 2017 were, and at least 300,000 athletes annually are, diagnosed with concussion. It is imperative to establish a gold-standard diagnostic test to quickly and accurately diagnose concussion. In this non-randomized, prospective study, we examined the reliability and validity of a novel neurocognitive assessment tool, the Defense Automated Neurobehavioral Assessment (DANA), designed to be a more sensitive, yet efficient, measure of concussion symptomatology. In this study, the DANA Brief version was compared to an established measure of concussion screening, the Military Acute Concussion Evaluation (MACE), in a group of non-concussed service members. DANA Brief subtests demonstrated low to moderate reliability, as measured by intra-class correlation coefficient (ICC; values range: 0.28–0.58), which is comparable to other computerized neurocognitive tests that are widely-implemented to diagnose concussion. Statistically significant associations were found between learning and memory components of the DANA Brief and the diagnostic MACE cognitive test score (DANA Brief subtests: CDD: R2 = 0.05, p = 0.023; CDS: R2 = 0.10, p = 0.010). However, a more robust relationship was found between DANA Brief components involving attention and working memory, including immediate memory, and the MACE cognitive test score (DANA Brief subtests: GNG: R2 = 0.08, p = 0.003; PRO: R2 = 0.08, p = 0.002). These results provide evidence that the DANA Rapid version, a 5-min assessment self-administered on a hand-held portable device, based on the DANA Brief version, may serve as a clinically useful and improved neurocognitive concussion screen to minimize the time between injury and diagnosis in settings where professional medical evaluation may be unavailable or delayed. The DANA's portability, durability, shorter test time and lack of need for a medical professional to diagnose concussion overcome these critical limitations of the MACE.
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Affiliation(s)
- Jennifer R Pryweller
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Brandon C Baughman
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.,Semmes Murphey Clinic, Memphis, TN, United States
| | - Samuel D Frasier
- Department of Otolaryngology - Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, United States
| | - Ellen C O'Conor
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Abhi Pandhi
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jiajing Wang
- Division of Biostatistics, Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Aimee A Morrison
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Jack W Tsao
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.,Memphis Veterans Affairs Medical Center, Memphis, TN, United States.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
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27
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Merritt VC, Jurick SM, Crocker LD, Sullan MJ, Sakamoto MS, Davey DK, Hoffman SN, Keller AV, Jak AJ. Associations Between Multiple Remote Mild TBIs and Objective Neuropsychological Functioning and Subjective Symptoms in Combat-Exposed Veterans. Arch Clin Neuropsychol 2020; 35:491-505. [PMID: 32128559 DOI: 10.1093/arclin/acaa006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate relationships between multiple mild traumatic brain injuries (mTBIs) and objective and subjective clinical outcomes in a sample of combat-exposed Veterans, adjusting for psychiatric distress and combat exposure. METHOD In this cross-sectional study, 73 combat-exposed Iraq/Afghanistan Veterans were divided into three groups based on mTBI history: 0 mTBIs (n = 31), 1-2 mTBIs (n = 21), and 3+ mTBIs (n = 21). Veterans with mTBI were assessed, on average, 7.78 years following their most recent mTBI. Participants underwent neuropsychological testing and completed self-report measures assessing neurobehavioral, sleep, and pain symptoms. RESULTS MANCOVAs adjusting for psychiatric distress and combat exposure showed no group differences on objective measures of attention/working memory, executive functioning, memory, and processing speed (all p's > .05; ηp2 = .00-.06). In contrast, there were significant group differences on neurobehavioral symptoms (p's = < .001-.036; ηp2 = .09-.43), sleep difficulties (p = .037; ηp2 = .09), and pain symptoms (p < .001; ηp2 = .21). Pairwise comparisons generally showed that the 3+ mTBI group self-reported the most severe symptoms, followed by comparable symptom reporting between the 0 and 1-2 mTBI groups. CONCLUSIONS History of multiple, remote mTBIs is associated with elevated subjective symptoms but not objective neuropsychological functioning in combat-exposed Veterans. These results advance understanding of the long-term consequences of repetitive mTBI in this population and suggest that Veterans with 3+ mTBIs may especially benefit from tailored treatments aimed at ameliorating specific neurobehavioral, sleep, and pain symptoms.
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Affiliation(s)
- Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Sarah M Jurick
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Laura D Crocker
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Molly J Sullan
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Delaney K Davey
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Samantha N Hoffman
- San Diego Joint Doctoral Program in Clinical Psychology, State University/University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Amber V Keller
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Amy J Jak
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
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28
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Frueh BC, Madan A, Fowler JC, Stomberg S, Bradshaw M, Kelly K, Weinstein B, Luttrell M, Danner SG, Beidel DC. "Operator syndrome": A unique constellation of medical and behavioral health-care needs of military special operation forces. Int J Psychiatry Med 2020; 55:281-295. [PMID: 32052666 DOI: 10.1177/0091217420906659] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE U.S. military special operation forces represent the most elite units of the U.S. Armed Forces. Their selection is highly competitive, and over the course of their service careers, they experience intensive operational training and combat deployment cycles. Yet, little is known about the health-care needs of this unique population. METHOD Professional consultations with over 50 special operation forces operators (and many spouses or girlfriends) over the past 6 years created a naturalistic, observational base of knowledge that allowed our team to identify a unique pattern of interrelated medical and behavioral health-care needs. RESULTS We identified a consistent pattern of health-care difficulties within the special operation forces community that we and other special operation forces health-care providers have termed "Operator Syndrome." This includes interrelated health and functional impairments including traumatic brain injury effects; endocrine dysfunction; sleep disturbance; obstructive sleep apnea; chronic joint/back pain, orthopedic problems, and headaches; substance abuse; depression and suicide; anger; worry, rumination, and stress reactivity; marital, family, and community dysfunction; problems with sexual health and intimacy; being "on guard" or hypervigilant; memory, concentration, and cognitive impairments; vestibular and vision impairments; challenges of the transition from military to civilian life; and common existential issues. CONCLUSIONS "Operator Syndrome" may be understood as the natural consequences of an extraordinarily high allostatic load; the accumulation of physiological, neural, and neuroendocrine responses resulting from the prolonged chronic stress; and physical demands of a career with the military special forces. Clinical research and comprehensive, intensive immersion programs are needed to meet the unique needs of this community.
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Affiliation(s)
- B Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, USA.,Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Alok Madan
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - J Christopher Fowler
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Sasha Stomberg
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Major Bradshaw
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Karen Kelly
- Department of Warfighter Performance, Naval Health Research Center, San Diego, CA, USA
| | - Benjamin Weinstein
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Morgan Luttrell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - Summer G Danner
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - Deborah C Beidel
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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29
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Hellewell SC, Beaton CS, Welton T, Grieve SM. Characterizing the Risk of Depression Following Mild Traumatic Brain Injury: A Meta-Analysis of the Literature Comparing Chronic mTBI to Non-mTBI Populations. Front Neurol 2020; 11:350. [PMID: 32508733 PMCID: PMC7248359 DOI: 10.3389/fneur.2020.00350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Mild traumatic brain injury (mTBI) is associated with depressed mood acutely post-injury, but there is little evidence regarding long-term depression. The aim of this study was to determine the odds ratio (OR) of depression chronically following mTBI. Methods: We searched Medline (PubMed), ProQuest, and Web of Science from date of database creation to January 23, 2019, for eligible studies examining depression at least 6 months post-injury in adult subjects with mTBI of any etiology, including civilians and military. Three authors independently reviewed titles and abstracts for study eligibility. Data were extracted and collated by two investigators. Risk of bias was assessed with the SIGN methodology. Study data were pooled using random-effects meta-analysis. The primary exposure was mTBI, and the primary outcome was depression. Secondary exploratory variables were time of assessment, age at injury, age at assessment, sex, and etiology. Results: We included 47 cross-sectional studies (n = 25,103 mTBI and 29,982 control), 26 cohort studies (n = 70,119 mTBI, 262,034 control), four prospective observational studies (n = 1,058 mTBI and 733 control), two prospective longitudinal studies (n = 119 mTBI, 81 control), two case-control studies (n = 56 mTBI, 56 control), and one randomized controlled trial (n = 252 mTBI, 3,214 control). mTBI was associated with a 3.29-fold increased risk of depression (OR 3.29, 95% CI 2.68–4.03, I2 = 96%). The OR for depression did not change when subjects were assessed at 6–12 months (OR 2.43, 1.45–4.07), years 1–2 (OR 4.12, 2.10–8.07); 2–10 (OR 3.28, 2.42–4.46), or 10+ (OR 3.42, 1.51–7.77). Similar risk of depression was sustained across different age at injury (<25: OR 2.26, 1.82–2.81; 25–35: OR 4.67, 3.06–7.14; >35: OR 2.69, 1.42–5.10) and different age at assessment (<40 years: OR 3.14, 2.48–3.99; >40 years: OR 4.57, 2.54–8.24). Female sex had a non-significant increase in OR (OR 19.97, 2.39–166.93) compared to male (OR 3.0, 2.33–3.86). mTBI etiology had no impact on depression. Conclusions: Those experiencing mTBI are more than three times more likely to experience depression compared to those without a history of mTBI, and this risk remains decades beyond the mTBI event. Future longitudinal studies are needed to identify and mitigate this risk.
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Affiliation(s)
- Sarah C Hellewell
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Caerwen S Beaton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Welton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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30
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Iljazi A, Ashina H, Al-Khazali HM, Lipton RB, Ashina M, Schytz HW, Ashina S. Post-Traumatic Stress Disorder After Traumatic Brain Injury-A Systematic Review and Meta-Analysis. Neurol Sci 2020; 41:2737-2746. [PMID: 32415640 DOI: 10.1007/s10072-020-04458-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the relative frequency and relative risk of post-traumatic stress disorder (PTSD) attributed to traumatic brain injury (TBI). DATA SOURCES PubMed and Embase were searched from database inception until January 26, 2019. STUDY SELECTION Two independent investigators screened titles, abstracts, and full texts. We selected studies that included subjects presenting with TBI, and where the number of subjects with TBI and PTSD could be extrapolated. There were no restrictions on study design. DATA EXTRACTION AND SYNTHESIS Data were extracted by two independent investigators and results were pooled using random-effects meta-analysis. RESULTS In civilian populations, relative frequency of PTSD following TBI was 12.2% after 3 months (CI-95 (7.6 to 16.8%) I2 = 83.1%), 16.3% after 6 months (CI-95 (10.2 to 22.4%), I2 = 88.4%), 18.6% after 12 months (CI-95 (10.2 to 26.9%), I2 = 91.5%), and 11.0% after 24 months (CI-95 (0.0 to 25.8%), I2 = 92.0%). Relative risk was 1.67 after 3 months (CI-95 (1.17 to 2.38), P = 0.011, I2 = 49%), 1.36 after 6 months (CI-95 (0.81 to 2.30), P = 0.189, I2 = 34%), and 1.70 after 12 months (CI-95 (1.16-2.50), P = 0.014, I2 = 89%). In military populations, the relative frequency of associated PTSD was 48.2% (CI-95 (44.3 to 52.1%), I2 = 100%) with a relative risk of 2.33 (CI-95 (2.00 to 2.72), P < 0.0001, I2 = 99.9%). CONCLUSIONS AND RELEVANCE TBI is a risk factor for PTSD in clinic-based civilian populations. There are insufficient data to assess the relative frequency or relative risk of PTSD in moderate to severe TBI. Due to significant between-study heterogeneity, the findings of our study should be interpreted with caution.
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Affiliation(s)
- Afrim Iljazi
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- BIDMC Comprehensive Headache Center, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Haidar Muhsen Al-Khazali
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard B Lipton
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sait Ashina
- BIDMC Comprehensive Headache Center, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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31
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Ciarlone SL, Statz JK, Goodrich JA, Norris JN, Goforth CW, Ahlers ST, Tschiffely AE. Neuroendocrine function and associated mental health outcomes following mild traumatic brain injury in OEF‐deployed service members. J Neurosci Res 2020; 98:1174-1187. [DOI: 10.1002/jnr.24604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Stephanie L. Ciarlone
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- The Henry M. Jackson Foundation Inc. Bethesda MD USA
| | - Jonathan K. Statz
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- The Henry M. Jackson Foundation Inc. Bethesda MD USA
| | - Jessica A. Goodrich
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- The Henry M. Jackson Foundation Inc. Bethesda MD USA
| | - Jacob N. Norris
- Cyber, Science, & Technology Department Space and Naval Warfare Systems Center Pacific San Diego CA USA
| | - Carl W. Goforth
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- Department of Surgery Uniformed Services University of the Health Sciences Bethesda MD USA
| | - Stephen T. Ahlers
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
| | - Anna E. Tschiffely
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
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32
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Gray M, Adamson MM, Thompson RC, Kapphahn KI, Han S, Chung JS, Harris OA. Sex differences in symptom presentation and functional outcomes: a pilot study in a matched sample of veterans with mild TBI. Brain Inj 2020; 34:535-547. [DOI: 10.1080/02699052.2020.1725979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Max Gray
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Maheen M. Adamson
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Ryan C. Thompson
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | | | - Summer Han
- Department of Neurosurgery, Stanford School of Medicine, Palo Alto, CA, USA
| | - Joyce S. Chung
- Department of Polytrauma, VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Odette A. Harris
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
- Department of Neurosurgery, Stanford School of Medicine, Palo Alto, CA, USA
- Department of Polytrauma, VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
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33
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Stubbs JL, Green KE, Silverberg ND, Howard A, Dhariwal AK, Brubacher JR, Garraway N, Heran MKS, Sekhon MS, Aquino A, Purcell V, Hutchison JS, Torres IJ, Panenka WJ. Atypical Somatic Symptoms in Adults With Prolonged Recovery From Mild Traumatic Brain Injury. Front Neurol 2020; 11:43. [PMID: 32117012 PMCID: PMC7010927 DOI: 10.3389/fneur.2020.00043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
Somatization may contribute to persistent symptoms after mild traumatic brain injury (mTBI). In two independently-recruited study samples, we characterized the extent to which symptoms atypical of mTBI but typical for patients suffering from somatization (e.g., gastrointestinal upset, musculoskeletal, and cardiorespiratory complaints) were present in adult patients with prolonged recovery following mTBI. The first sample was cross-sectional and consisted of mTBI patients recruited from the community who reported ongoing symptoms attributable to a previous mTBI (n = 16) along with a healthy control group (n = 15). The second sample consisted of patients with mTBI prospectively recruited from a Level 1 trauma center who had either good recovery (GOSE = 8; n = 32) or poor recovery (GOSE < 8; n = 29). In all participants, we evaluated atypical somatic symptoms using the Patient Health Questionnaire-15 and typical post-concussion symptoms with the Rivermead Post-Concussion Symptom Questionnaire. Participants with poor recovery from mTBI had significantly higher "atypical" somatic symptoms as compared to the healthy control group in Sample 1 (b = 4.308, p < 0.001) and to mTBI patients with good recovery in Sample 2 (b = 3.169, p < 0.001). As would be expected, participants with poor outcome in Sample 2 had a higher burden of typical rather than atypical symptoms [t (28) = 4.750, p < 0.001, d = 0.88]. However, participants with poor recovery still reported atypical somatic symptoms that were significantly higher (1.4 standard deviations, on average) than those with good recovery. Our results suggest that although "typical" post-concussion symptoms predominate after mTBI, a broad range of somatic symptoms also frequently accompanies mTBI, and that somatization may represent an important, modifiable factor in mTBI recovery.
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Affiliation(s)
- Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Katherine E Green
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Noah D Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andrew Howard
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada
| | - Amrit K Dhariwal
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Naisan Garraway
- Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Mypinder S Sekhon
- Division of Critical Care, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Angela Aquino
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Purcell
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - James S Hutchison
- Department of Critical Care, The Hospital for Sick Children, Toronto, ON, Canada.,Neuroscience and Mental Health Research Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
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34
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A Systematic Review and Meta-analysis on PTSD Following TBI Among Military/Veteran and Civilian Populations. J Head Trauma Rehabil 2020; 35:E21-E35. [DOI: 10.1097/htr.0000000000000514] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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35
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Prevalence and Severity of Psychiatric Disorders and Suicidal Behavior in Service Members and Veterans With and Without Traumatic Brain Injury: Systematic Review. J Head Trauma Rehabil 2020; 35:1-13. [DOI: 10.1097/htr.0000000000000478] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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36
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Sacramento CB, Sondhi D, Rosenberg JB, Chen A, Giordano S, Pey E, Lee V, Stiles KM, Havlicek DF, Leopold PL, Kaminsky SM, Crystal RG. Anti-Phospho-Tau Gene Therapy for Chronic Traumatic Encephalopathy. Hum Gene Ther 2019; 31:57-69. [PMID: 31608704 DOI: 10.1089/hum.2019.174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder caused by repetitive trauma to the central nervous system (CNS) suffered by soldiers, contact sport athletes, and civilians following accident-related trauma. CTE is a CNS tauopathy, with trauma-induced inflammation leading to accumulation of hyperphosphorylated forms of the microtubule-binding protein Tau (pTau), resulting in neurofibrillary tangles and progressive loss of neurons. At present, there are no therapies to treat CTE. We hypothesized that direct CNS administration of an adeno-associated virus (AAV) vector coding for an anti-pTau antibody would generate sufficient levels of anti-pTau in the CNS to suppress pTau accumulation thus interrupting the pathogenic process. Using a serotype AAVrh.10 gene transfer vector coding for a monoclonal antibody directed against pTau, we demonstrate the feasibility of this strategy in a murine CTE model in which pTau accumulation was elicited by repeated traumatic brain injury (TBI) using a closed cortical impact procedure over 5 days. Direct delivery of AAVrh.10 expression vectors coding for either of the two different anti-pTau antibodies to the hippocampus of these TBI mice significantly reduced pTau levels across the CNS. Using doses that can be safely scaled to humans, the data demonstrate that CNS administration of AAVrh.10anti-pTau is effective, providing a new strategy to interrupt the CTE consequences of TBI.
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Affiliation(s)
| | - Dolan Sondhi
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Jonathan B Rosenberg
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Alvin Chen
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Stephanie Giordano
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Eduard Pey
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Vladlena Lee
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Katie M Stiles
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - David F Havlicek
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Philip L Leopold
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Stephen M Kaminsky
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
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Desai A, Chen H, Kim HY. Multiple Mild Traumatic Brain Injuries Lead to Visual Dysfunction in a Mouse Model. J Neurotrauma 2019; 37:286-294. [PMID: 31530220 DOI: 10.1089/neu.2019.6602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Visual dysfunction is a common occurrence after traumatic brain injury (TBI). We investigated in this study effects of single or multiple mild TBI on visual function in mice using a closed head injury model that permits unconstrained head movement after impact. Adult mice were briefly anesthetized with isoflurane and given one or three mild TBI with the closed head injury by mechanically engineered rotational acceleration (CHIMERA) device with an interinjury interval of 24 h. Mice were then tested in the Morris water maze, visual cliff, and open field tests from day 19 to day 32 and for visual evoked potential at 5 weeks after the last injury and euthanized. Mice with multiple TBI showed impaired performance in the visible platform water maze test and had increased errors in the visual cliff test. Further, there was a graded difference in visual evoked potential, with the single injury mice showing modest reduction in N1 amplitude whereas the multiple injuries produced significant reduction compared to sham and single injury groups. The optic tract of the injured mice showed increases in glial cell immunostaining. The increase in glial fibrillary acid protein immunostaining reached statistical significance for both injured groups whereas the ionized calcium binding adaptor molecule 1 immunostaining was only significantly increased in the optic tract of repeatedly injured mice. These results indicate that multiple injuries using CHIMERA may result in visual deficits, which can affect certain behavioral performances. The change in vision may be a useful marker when monitoring repeated TBI outcome and screening for protective agents from TBI.
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Affiliation(s)
- Abhishek Desai
- Laboratory of Molecular Signaling, NIAAA, NIH, Rockville, Maryland
| | - Huazhen Chen
- Laboratory of Molecular Signaling, NIAAA, NIH, Rockville, Maryland.,Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Hee-Yong Kim
- Laboratory of Molecular Signaling, NIAAA, NIH, Rockville, Maryland
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Cutting to the Pathophysiology Chase: Translating Cutting-Edge Neuroscience to Rehabilitation Practice in Sports-Related Concussion Management. J Orthop Sports Phys Ther 2019; 49:811-818. [PMID: 31154951 DOI: 10.2519/jospt.2019.8884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mild traumatic brain injury, or concussion, is a common sports injury. Concussion involves physical injury to brain tissue and vascular and axonal damage that manifests as transient and often nonspecific clinical symptoms. Concussion diagnosis is challenging, and the relationship between brain injury and clinical symptoms is unclear. The purpose of this commentary was to translate cutting-edge neuroscience to rehabilitation practice. We (1) highlight potential biomarkers that may improve our understanding of concussion and its recovery, (2) explain why researchers must address the paucity of concussion research in female athletes, and (3) present female-specific factors that should be accounted for in future studies. Integrating objective, quantitative measures of concussion pathophysiology with concussion history, genetics, and genomics will help caregivers identify concussed athletes, tailor recovery protocols, and protect athletes from potential long-term effects of cumulative head impact. J Orthop Sports Phys Ther 2019;49(11):811-818. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8884.
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Bugay V, Bozdemir E, Vigil FA, Chun SH, Holstein DM, Elliott WR, Sprague CJ, Cavazos JE, Zamora DO, Rule G, Shapiro MS, Lechleiter JD, Brenner R. A Mouse Model of Repetitive Blast Traumatic Brain Injury Reveals Post-Trauma Seizures and Increased Neuronal Excitability. J Neurotrauma 2019; 37:248-261. [PMID: 31025597 DOI: 10.1089/neu.2018.6333] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Repetitive blast traumatic brain injury (TBI) affects numerous soldiers on the battlefield. Mild TBI has been shown to have long-lasting effects with repeated injury. We have investigated effects on neuronal excitability after repetitive, mild TBI in a mouse model of blast-induced brain injury. We exposed mice to mild blast trauma of an average peak overpressure of 14.6 psi, repeated across three consecutive days. While a single exposure did not reveal trauma as indicated by the glial fibrillary acidic protein indicator, three repetitive blasts did show significant increases. As well, mice had an increased indicator of inflammation (Iba-1) and increased tau, tau phosphorylation, and altered cytokine levels in the spleen. Video-electroencephalographic monitoring 48 h after the final blast exposure demonstrated seizures in 50% (12/24) of the mice, most of which were non-convulsive seizures. Long-term monitoring revealed that spontaneous seizures developed in at least 46% (6/13) of the mice. Patch clamp recording of dentate gyrus hippocampus neurons 48 h post-blast TBI demonstrated a shortened latency to the first spike and hyperpolarization of action potential threshold. We also found that evoked excitatory postsynaptic current amplitudes were significantly increased. These findings indicate that mild, repetitive blast exposures cause increases in neuronal excitability and seizures and eventual epilepsy development in some animals. The non-convulsive nature of the seizures suggests that subclinical seizures may occur in individuals experiencing even mild blast events, if repeated.
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Affiliation(s)
- Vladislav Bugay
- Cell and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas
| | - Eda Bozdemir
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas
| | - Fabio A Vigil
- Cell and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas
| | - Sang H Chun
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas
| | - Deborah M Holstein
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas
| | - William R Elliott
- Sensory Trauma, United States Army Institute of Surgical Research, Fort Sam Houston San Antonio, Texas
| | - Cassie J Sprague
- Sensory Trauma, United States Army Institute of Surgical Research, Fort Sam Houston San Antonio, Texas
| | - Jose E Cavazos
- Cell and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas.,Department of Neurology, University of Texas Health San Antonio, San Antonio, Texas
| | - David O Zamora
- Sensory Trauma, United States Army Institute of Surgical Research, Fort Sam Houston San Antonio, Texas
| | | | - Mark S Shapiro
- Cell and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas
| | - James D Lechleiter
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio, San Antonio, Texas
| | - Robert Brenner
- Cell and Integrative Physiology, University of Texas Health San Antonio, San Antonio, Texas
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Barnes DE, Byers AL, Gardner RC, Seal KH, Boscardin WJ, Yaffe K. Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans. JAMA Neurol 2019; 75:1055-1061. [PMID: 29801145 DOI: 10.1001/jamaneurol.2018.0815] [Citation(s) in RCA: 246] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Traumatic brain injury (TBI) is common in both veteran and civilian populations. Prior studies have linked moderate and severe TBI with increased dementia risk, but the association between dementia and mild TBI, particularly mild TBI without loss of consciousness (LOC), remains unclear. Objective To examine the association between TBI severity, LOC, and dementia diagnosis in veterans. Design, Setting, and Participants This cohort study of all patients diagnosed with a TBI in the Veterans Health Administration health care system from October 1, 2001, to September 30, 2014, and a propensity-matched comparison group. Patients with dementia at baseline were excluded. Researchers identified TBIs through the Comprehensive TBI Evaluation database, which is restricted to Iraq and Afghanistan veterans, and the National Patient Care Database, which includes veterans of all eras. The severity of each TBI was based on the most severe injury recorded and classified as mild without LOC, mild with LOC, mild with LOC status unknown, or moderate or severe using Department of Defense or Defense and Veterans Brain Injury Center criteria. International Classification of Diseases, Ninth Revision codes were used to identify dementia diagnoses during follow-up and medical and psychiatric comorbidities in the 2 years prior to the index date. Main Outcomes and Measures Dementia diagnosis in veterans who had experienced TBI with or without LOC and control participants without TBI exposure. Results The study included 178 779 patients diagnosed with a TBI in the Veterans Health Administration health care system and 178 779 patients in a propensity-matched comparison group. Veterans had a mean (SD) age of nearly 49.5 (18.2) years at baseline; 33 250 (9.3%) were women, and 259 136 (72.5%) were non-Hispanic white individuals. Differences between veterans with and without TBI were small. A total of 4698 veterans (2.6%) without TBI developed dementia compared with 10 835 (6.1%) of those with TBI. After adjustment for demographics and medical and psychiatric comobidities, adjusted hazard ratios for dementia were 2.36 (95% CI, 2.10-2.66) for mild TBI without LOC, 2.51 (95% CI, 2.29-2.76) for mild TBI with LOC, 3.19 (95% CI, 3.05-3.33) for mild TBI with LOC status unknown, and 3.77 (95% CI, 3.63-3.91) for moderate to severe TBI. Conclusions and Relevance In this cohort study of more than 350 000 veterans, even mild TBI without LOC was associated with more than a 2-fold increase in the risk of dementia diagnosis. Studies of strategies to determine mechanisms, prevention, and treatment of TBI-related dementia in veterans are urgently needed.
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Affiliation(s)
- Deborah E Barnes
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Amy L Byers
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Raquel C Gardner
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Neurology, University of California, San Francisco
| | - Karen H Seal
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco.,Department of Medicine, University of California, San Francisco
| | - W John Boscardin
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Medicine, University of California, San Francisco
| | - Kristine Yaffe
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco.,Department of Neurology, University of California, San Francisco
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Putnam LJ, Willes AM, Kalata BE, Disher ND, Brusich DJ. Expansion of a fly TBI model to four levels of injury severity reveals synergistic effects of repetitive injury for moderate injury conditions. Fly (Austin) 2019; 13:1-11. [PMID: 31524048 DOI: 10.1080/19336934.2019.1664363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Several million traumatic brain injury (TBI) events are reported in the United States annually. However, mild TBI events often go unreported, and mild and repetitive mild TBI conditions are challenging to model. Fruit flies (Drosophila melanogaster) have gained traction for the study of TBI. The best-characterized fly TBI model is the high-impact trauma (HIT) method. We replicated the HIT method and confirmed several previous findings at the standard level of injury severity. We then expanded upon the HIT model by characterizing mortality across three reduced levels of injury severity. Importantly, we found reduced mortality with reduced injury severity and synergistic effects on mortality in response to repetitive TBI by our moderate injury conditions. Last, we compared moderate, repetitive TBI to a single severe TBI via assessment of the pattern of mortality and geotaxis performance in the 24 h following TBI. We found the number and severity of injuries could result in different patterns of death, while all TBI conditions led to impaired geotaxis compared to uninjured flies at 0.5 h and 6 h post-TBI. Thus, we have extended a well-characterized model of TBI in flies, and shown the utility of this model for making unique insights into TBI across various severities, injury numbers, and time-points post-injury.
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Affiliation(s)
- Lauren J Putnam
- Human Biology, College of Science, Engineering, and Technology, University of Wisconsin - Green Bay, Green Bay, WI, USA
| | - Ashley M Willes
- Human Biology, College of Science, Engineering, and Technology, University of Wisconsin - Green Bay, Green Bay, WI, USA
| | - Brooke E Kalata
- Human Biology, College of Science, Engineering, and Technology, University of Wisconsin - Green Bay, Green Bay, WI, USA
| | - Nathaniel D Disher
- Human Biology, College of Science, Engineering, and Technology, University of Wisconsin - Green Bay, Green Bay, WI, USA
| | - Douglas J Brusich
- Human Biology, College of Science, Engineering, and Technology, University of Wisconsin - Green Bay, Green Bay, WI, USA
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Wooten NR, Brittingham JA, Hossain A, Hopkins LA, Sumi NS, Jeffery DD, Tavakoli AS, Chakraborty H, Levkoff SE, Larson MJ. Army Warrior Care Project (AWCP): Rationale and methods for a longitudinal study of behavioral health care in Army Warrior Transition Units using Military Health System data, FY2008-2015. Int J Methods Psychiatr Res 2019; 28:e1788. [PMID: 31373125 PMCID: PMC6791723 DOI: 10.1002/mpr.1788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/28/2019] [Accepted: 04/24/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Warrior Transition Units (WTUs) are specialized military units co-located with major military treatment facilities providing a Triad of Care involving primary care physicians, case managers, and military leadership to soldiers needing comprehensive medical care. We describe the rationale and methods for studying behavioral health care in WTUs and characterize soldiers assigned to WTUs. METHODS The Army Warrior Care Project (AWCP) analyzes U.S. Department of Defense Military Health System data to examine behavioral health problems and service utilization among Army soldiers who were assigned to WTUs after returning from Afghanistan and Iraq deployments, FY2008-2015. RESULTS WTU members (N = 31,094) comprised 3.5% of the AWCP cohort (N = 883,091). Almost all (96.5%) had one WTU assignment for a median of 327 days; 77.3% were assigned before deployment ended, ≤30 or >365 days post-deployment; 59.4% had deployment-related behavioral health diagnoses. CONCLUSIONS An overwhelming majority of soldiers had one WTU assignment for almost a year. A substantial proportion of WTU soldiers had psychological impairment, which limited performance of their military duties. The AWCP is the first longitudinal study of redeployed soldiers assigned to WTUs and provides a unique opportunity to advance our understanding of behavioral health among soldiers needing comprehensive medical care after combat deployments.
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Affiliation(s)
- Nikki R. Wooten
- College of Social Work, Hamilton CollegeUniversity of South CarolinaColumbiaSouth Carolina
| | - Jordan A. Brittingham
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth Carolina
| | - Akhtar Hossain
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth Carolina
| | | | - Nahid S. Sumi
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth Carolina
| | - Diana D. Jeffery
- Clinical Services Division, Defense Health AgencyU. S. Department of DefenseFalls ChurchVirginia
| | - Abbas S. Tavakoli
- College of NursingUniversity of South CarolinaColumbiaSouth Carolina
| | - Hrishikesh Chakraborty
- Duke Clinical Research Center and Center for AIDS ResearchDuke UniversityDurhamNorth Carolina
| | - Sue E. Levkoff
- College of Social Work, Hamilton CollegeUniversity of South CarolinaColumbiaSouth Carolina
| | - Mary Jo Larson
- Institute of Behavioral Health, Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusetts
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Kinney AR, Eakman AM, Lassell R, Wood W. Equine-assisted interventions for veterans with service-related health conditions: a systematic mapping review. Mil Med Res 2019; 6:28. [PMID: 31462305 PMCID: PMC6714435 DOI: 10.1186/s40779-019-0217-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans. Equine-assisted interventions are emerging as an additional treatment modality, but little is known regarding the safe and effective delivery of these interventions. This study aimed to describe the following features of the body of literature concerning equine-assisted interventions among veterans: 1) veterans who have participated in equine-assisted interventions; 2) specific characteristics of equine-assisted interventions in veterans; and 3) the specific characteristics of research on equine-assisted interventions in veterans. METHODS We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017. Searches of nine databases yielded 3336 unique records, six of which met the inclusion criteria and were reviewed. Data relevant to the study aims were extracted and analyzed. RESULTS Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results. The detailed methods of EAI varied in the reported studies, ranging from communicating with the horse to mounted exercises. There was also great diversity in outcome measurement. The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped. Studies provided insufficient detail with respect to the description of the intervention, reasons for attrition, and the dose-response relationship. CONCLUSIONS Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy. Targeted outcomes should be expanded, including outcomes more closely aligned with the nature of polytraumatic injuries. Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants, components of the intervention, factors contributing to attrition, and optimal dose-response relationships.
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Affiliation(s)
- Adam R. Kinney
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80523 USA
| | - Aaron M. Eakman
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80523 USA
| | - Rebecca Lassell
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80523 USA
- Temple Grandin Equine Center, Department of Animal Sciences, Colorado State University, Fort Collins, CO 80523 USA
| | - Wendy Wood
- Temple Grandin Equine Center, Department of Animal Sciences, Colorado State University, Fort Collins, CO 80523 USA
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Herrold AA, Smith B, Aaronson AL, Coleman J, Pape TLB. Relationships and Evidence-Based Theoretical Perspectives on Persisting Symptoms and Functional Impairment Among Mild Traumatic Brain Injury and Behavioral Health Conditions. Mil Med 2019; 184:138-147. [PMID: 30901443 DOI: 10.1093/milmed/usy306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/15/2018] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study is to characterize and describe the relationships between symptoms and functional impairment following mild traumatic brain injury (mTBI) and behavioral health conditions (BHCs) in order to inform evidence-based theories on why symptoms and functional impairments persist in some individuals but not others. This is a retrospective, multi-site, cross-sectional study utilizing data collected from a total of 289 Operation Iraqi Freedom/Operation Enduring Freedom Veterans who were classified into diagnostic groups using the symptom attribution and classification algorithm and the VA clinical reminder and comprehensive traumatic brain injury evaluation. The Neurobehavioral Symptom Inventory was used to assess mTBI symptom number and severity. The World Health Organization Disability Assessment Schedule 2.0 was used to assess functional impairment. Symptom profiles differed between diagnostic groups irrespective of symptom attribution method used. Veterans with both mTBI and BHCs and those with BHCs alone had consistently greater number of symptoms and more severe symptoms relative to no symptom and symptoms resolved groups. Symptom number and severity were significantly associated with functional impairment. Both symptom number and functional impairment were significantly associated with the number of mTBI exposures. Together, these results informed evidence-based theories on understanding why symptoms and functional impairment persist among some OEF/OIF Veterans.
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Affiliation(s)
- Amy A Herrold
- Research Service & Center for Innovation and Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, 5000 S 5th Ave, MC 151 H, Hines, IL.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, 710 N Lakeshore Dr., Chicago, IL
| | - Bridget Smith
- Research Service & Center for Innovation and Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, 5000 S 5th Ave, MC 151 H, Hines, IL.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, 310 E. Superior St., Morton 4-685, Chicago, IL
| | - Alexandra L Aaronson
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, 710 N Lakeshore Dr., Chicago, IL.,Mental Health Service Line, Edward Hines Jr., VA Hospital, 5000 S. 5th Ave, Hines, IL
| | - John Coleman
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX
| | - Theresa L-B Pape
- Research Service & Center for Innovation and Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, 5000 S 5th Ave, MC 151 H, Hines, IL.,Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, 710 N Lakeshore Dr., Chicago, IL
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Vonder Haar C, Martens KM, Bashir A, McInnes KA, Cheng WH, Cheung H, Stukas S, Barron C, Ladner T, Welch KA, Cripton PA, Winstanley CA, Wellington CL. Repetitive closed-head impact model of engineered rotational acceleration (CHIMERA) injury in rats increases impulsivity, decreases dopaminergic innervation in the olfactory tubercle and generates white matter inflammation, tau phosphorylation and degeneration. Exp Neurol 2019; 317:87-99. [DOI: 10.1016/j.expneurol.2019.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 01/20/2023]
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Mooney SR, Stafford J, Seats E. Medical Evaluation Board Involvement, Non-Credible Cognitive Testing, and Emotional Response Bias in Concussed Service Members. Mil Med 2019; 183:e546-e554. [PMID: 29590406 DOI: 10.1093/milmed/usy038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Military Service Members (SMs) with post-concussive symptoms are commonly referred for further evaluation and possible treatment to Department of Defense Traumatic Brain Injury Clinics where neuropsychological screening/evaluations are being conducted. Understudied to date, the base rates of noncredible task engagement/performance validity testing (PVT) during cognitive screening/evaluations in military settings appears to be high. The current study objectives are to: (1) examine the base rates of noncredible PVTs of SMs undergoing routine clinical or Medical Evaluation Board (MEB) related workups using multiple objective performance-based indicators; (2) determine whether involvement in MEB is associated with PVT or symptom exaggeration/symptom validity testing (SVT) results; (3) elucidate which psychiatric symptoms are associated with noncredible PVT performances; and (4) determine whether MEB participation moderates the relationship between psychological symptom exaggeration and whether or not SM goes on to demonstrate PVTs failures - or vice versa. Materials and Methods Retrospective study of 71 consecutive military concussion cases drawn from a DoD TBI Clinic neuropsychology clinic database. As part of neuropsychological evaluations, patients completed several objective performance-based PVTs and SVT. Results Mean (SD) age of SMs was 36.0 (9.5), ranging from 19-59, and 93% of the sample was male. The self-identified ethnicity resulted in the following percentages: 62% Non-Hispanic White, 22.5% African American, and 15.5% Hispanic or Latino. The majority of the sample (97%) was Active Duty Army and 51% were involved in the MEB at the time of evaluation. About one-third (35.9%) of routine clinical patients demonstrated failure on one or more PVT indicators (12.8% failed 2) while PVT failure rates amongst MEB patients ranged from 15.6% to 37.5% (i.e., failed 2 or 1 PVTs, respectively). Base rates of failures on one or more PVT did not differ between routine clinical versus MEB patients (p = 0.94). MEB involvement was not associated with increased emotional symptom response bias as compared to routine clinical patients. PVT failures were positively correlated with somatization, anxiety, depressive symptoms, suspicious and hostility, atypical perceptions/alienation/subjective cognitive difficulties, borderline personality traits/features, and penchant for aggression in addition to symptom over-endorsement/exaggeration. No differences between routine clinical and MEB patients across other SVT indicators were found. MEB status did not moderate the relationship between any of the SVTs. Conclusion Study results are broadly consistent with the prior published studies that documented low to moderately high base rates of noncredible task engagement during neuropsychological evaluations in military and veteran settings. Results are in contrast to prior studies that have suggested involvement in MEB is associated with increased likelihood of poor PVT performances. This is the first to show that MEB involvement did not enhance/strengthen the association between PVT performances and evidence of SVTs. Consistent with prior studies, these results do highlight that the same SMs who fail PVTs also tend to be the ones who go on to endorse a myriad of psychiatric symptoms and proclivities. Implications of variable or poor task engagement during routine clinical and MEB neuropsychological evaluation in military settings on treatment and disposition planning cannot be overstated.
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Affiliation(s)
- Scott R Mooney
- Dwight D. Eisenhower Army Medical Center - TBI Clinic, Neuroscience & Rehabilitation Center, 300 E. Hospital Road, Fort Gordon, GA
| | - Jane Stafford
- University of South Carolina-Aiken, 471 University Parkway, Aiken, SC
| | - Elizabeth Seats
- University of South Carolina-Aiken, 471 University Parkway, Aiken, SC
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Goetzl EJ, Ledreux A, Granholm AC, Elahi FM, Goetzl L, Hiramoto J, Kapogiannis D. Neuron-Derived Exosome Proteins May Contribute to Progression From Repetitive Mild Traumatic Brain Injuries to Chronic Traumatic Encephalopathy. Front Neurosci 2019; 13:452. [PMID: 31133789 PMCID: PMC6517542 DOI: 10.3389/fnins.2019.00452] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/23/2019] [Indexed: 12/22/2022] Open
Abstract
The recent recognition that Alzheimer disease-like pathology may be found in chronic traumatic encephalopathy (CTE) even after acute mild traumatic brain injury (mTBI) has increased the urgency of elucidating mechanisms, identifying biomarkers predictive of high risk of development of CTE, and establishing biomarker profiles indicative of impactful effects of treatments. Of the many proteins that are loaded into neuron-derived exosomes (NDEs) from damaged neurons after acute TBI, the levels of prion cellular protein (PRPc), coagulation factor XIII (XIIIa), synaptogyrin-3, IL-6, and aquaporins remain elevated for months. Prolonged heightened expression of aquaporins and IL-6 may account for the persistent central nervous system edema and inflammation of CTE. PRPc, XIIIa and synaptogyrin-3 bind and concentrate neurotoxic forms of oligomeric amyloid β peptides or P-tau for delivery into neurons at or distant from the site of trauma. Our progression factor hypothesis of CTE asserts that physiological neuronal proteins, such as PRPc, XIIIa, synaptogyrin-3, IL-6 and aquaporins, that increase in concentration in neurons and NDEs for months after acute TBI, are etiological contributors to CTE by either direct actions or by recruiting neurotoxic forms of Aβ peptides or P-tau. Such progression factors also may be useful new targets for development of drugs to prevent CTE.
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Affiliation(s)
- Edward J Goetzl
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | | | - Fanny M Elahi
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Laura Goetzl
- Department of Obstetrics, Gynecology and Reproductive Sciences, Health Sciences Center at Houston, University of Texas, Houston, TX, United States
| | - Jade Hiramoto
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Dimitrios Kapogiannis
- Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
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Differences in Posttraumatic Stress Disorder, Depression, and Attribution of Symptoms in Service Members With Combat Versus Noncombat Mild Traumatic Brain Injury. J Head Trauma Rehabil 2019; 35:37-45. [PMID: 31033746 DOI: 10.1097/htr.0000000000000486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compares combat-related mild traumatic brain injury (mTBI) to non-combat-related mTBI in rates of posttraumatic stress disorder (PTSD) and depression after injury, severity of postconcussive symptoms (PCSs), and attribution of those symptoms to mTBI versus PTSD. PARTICIPANTS A total of 371 active duty service members (SMs) with documented history of mTBI, divided into combat and non-combat-related cohorts. DESIGN Retrospective cohort study. MAIN MEASURES Diagnoses of PTSD and depression based on medical record review and self-report. PCSs measured using Neurobehavioral Symptom Index. Attribution of symptoms based on a rating scale asking how much mTBI, PTSD, depression, deployment, or readjustment stress contributed to current symptoms. RESULTS Prevalence of PTSD was significantly higher after a combat-related mTBI, compared with a noncombat mTBI (P = .001). Prevalence of depression did not differ between the 2 groups. PCSs were high in both combat and noncombat mTBIs, with no statistical difference between groups. SMs with PTSD reported higher PCS, regardless of combat status. SMs without PTSD attributed symptoms mainly to mTBI, whereas SMs with PTSD, regardless of combat status, were much more likely to attribute symptoms to PTSD, depression, and deployment/readjustment stress. CONCLUSIONS This research contributes to our understanding of the complex interplay between mTBI and PTSD in both combat and noncombat injuries within the military population and the importance of addressing both simultaneously.
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Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, Vassar MJ, Okonkwo DO, Diaz-Arrastia R, Robertson CS, Mukherjee P, McCrea M, Mac Donald CL, Yue JK, Yuh E, Sun X, Campbell-Sills L, Temkin N, Manley GT, Adeoye O, Badjatia N, Boase K, Bodien Y, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Diaz-Arrastia R, Dikmen S, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson A, Foreman B, Gardner R, Gaudette E, Giacino JT, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Korley F, Kramer J, Kreitzer N, Levin H, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, McCrea M, Merchant R, Mukherjee P, Nelson LD, Noel F, Okonkwo DO, Palacios E, Perl D, Puccio A, Rabinowitz M, Robertson CS, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Stein MB, Taylor S, Toga A, Temkin N, Valadka A, Vassar MJ, Vespa P, Wang K, Yue JK, Yuh E, Zafonte R. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. JAMA Psychiatry 2019; 76:249-258. [PMID: 30698636 PMCID: PMC6439818 DOI: 10.1001/jamapsychiatry.2018.4288] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. OBJECTIVE To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. MAIN OUTCOMES AND MEASURES Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. RESULTS Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. CONCLUSIONS AND RELEVANCE After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.
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Affiliation(s)
- Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla,Department of Family Medicine & Public Health, University of California San Diego, La Jolla,VA San Diego Healthcare System, San Diego, California
| | - Sonia Jain
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Lindsay D. Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Mary J. Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Neurological Surgery, University of California, San Francisco
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Claudia S. Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Pratik Mukherjee
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Radiology & Biomedical Imaging, University of California, San Francisco,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | | | - John K. Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Esther Yuh
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Radiology & Biomedical Imaging, University of California, San Francisco,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Xiaoying Sun
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | | | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle,Department of Biostatistics, University of Washington, Seattle
| | - Geoffrey T. Manley
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Neurological Surgery, University of California, San Francisco
| | | | | | | | - Kim Boase
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - Randall Chesnut
- Department of Neurological Surgery, University of Washington, Seattle
| | | | | | | | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - V Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond
| | - Adam Ferguson
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Raquel Gardner
- Department of Neurology, University of California, San Francisco
| | | | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Sonia Jain
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Joel Kramer
- Department of Neurology, University of California, San Francisco
| | | | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Chris Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joan Machamer
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Christopher Madden
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Alastair Martin
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Randall Merchant
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond
| | - Pratik Mukherjee
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Radiology & Biomedical Imaging, University of California, San Francisco.,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Florence Noel
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eva Palacios
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Miri Rabinowitz
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Claudia S Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - Angelle Sander
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gabriela Satris
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - David Schnyer
- Department of Psychology, University of Texas at Austin, Austin
| | | | | | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla.,Department of Family Medicine & Public Health, University of California San Diego, La Jolla.,VA San Diego Healthcare System, San Diego, California
| | - Sabrina Taylor
- Department of Neurological Surgery, University of California, San Francisco
| | - Arthur Toga
- University of Southern California, Los Angeles
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle.,Department of Biostatistics, University of Washington, Seattle
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond
| | - Mary J Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco
| | - Paul Vespa
- Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles
| | - Kevin Wang
- Department of Psychiatry, University of Florida, Gainesville
| | - John K Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Esther Yuh
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Radiology & Biomedical Imaging, University of California, San Francisco.,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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Mac Donald CL, Barber J, Patterson J, Johnson AM, Dikmen S, Fann JR, Temkin N. Association Between 5-Year Clinical Outcome in Patients With Nonmedically Evacuated Mild Blast Traumatic Brain Injury and Clinical Measures Collected Within 7 Days Postinjury in Combat. JAMA Netw Open 2019; 2:e186676. [PMID: 30646193 PMCID: PMC6324322 DOI: 10.1001/jamanetworkopen.2018.6676] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although previous work has examined clinical outcomes in combat-deployed veterans, questions remain regarding how symptoms evolve or resolve following mild blast traumatic brain injury (TBI) treated in theater and their association with long-term outcomes. OBJECTIVE To characterize 5-year outcome in patients with nonmedically evacuated blast concussion compared with combat-deployed controls and understand what clinical measures collected acutely in theater are associated with 5-year outcome. DESIGN, SETTING, AND PARTICIPANTS A prospective, longitudinal cohort study including 45 service members with mild blast TBI within 7 days of injury (mean 4 days) and 45 combat deployed nonconcussed controls was carried out. Enrollment occurred in Afghanistan at the point of injury with evaluation of 5-year outcome in the United States. The enrollment occurred from March to September 2012 with 5-year follow up completed from April 2017 to May 2018. Data analysis was completed from June to July 2018. EXPOSURES Concussive blast TBI. All patients were treated in theater, and none required medical evacuation. MAIN OUTCOMES AND MEASURES Clinical measures collected in theater included measures for concussion symptoms, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, balance performance, combat exposure intensity, cognitive performance, and demographics. Five-year outcome evaluation included measures for global disability, neurobehavioral impairment, PTSD symptoms, depression symptoms, and 10 domains of cognitive function. Forward selection multivariate regression was used to determine predictors of 5-year outcome for global disability, neurobehavior impairment, PTSD, and cognitive function. RESULTS Nonmedically evacuated patients with concussive blast injury (n = 45; 44 men, mean [SD] age, 31 [5] years) fared poorly at 5-year follow-up compared with combat-deployed controls (n = 45; 35 men; mean [SD] age, 34 [7] years) on global disability, neurobehavioral impairment, and psychiatric symptoms, whereas cognitive changes were unremarkable. Acute predictors of 5-year outcome consistently identified TBI diagnosis with contribution from acute concussion and mental health symptoms and select measures of cognitive performance depending on the model for 5-year global disability (area under the curve following bootstrap validation [AUCBV] = 0.79), neurobehavioral impairment (correlation following bootstrap validation [RBV] = 0.60), PTSD severity (RBV = 0.36), or cognitive performance (RBV = 0.34). CONCLUSIONS AND RELEVANCE Service members with concussive blast injuries fared poorly at 5-year outcome. The results support a more focused acute screening of mental health following TBI diagnosis as strong indicators of poor long-term outcome. This extends prior work examining outcome in patients with concussive blast injury to the larger nonmedically evacuated population.
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Affiliation(s)
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Jana Patterson
- Department of Neurological Surgery, University of Washington, Seattle
| | - Ann M. Johnson
- Center for Clinical Studies, Washington University, Saint Louis Missouri
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Jesse R. Fann
- Department of Psychiatry, University of Washington, Seattle
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
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