Cognitive-communication performance following mild traumatic brain injury: Influence of sex, age, education, site of lesion and bilingualism

Narrative Discourse Performance in Traumatic Brain Injury: Does Story Comprehension Predict Story Retelling?

PURPOSE

Little is known about the relationship between discourse comprehension and production in traumatic brain injury (TBI), especially for spoken language. This study examined to what extent narrative discourse comprehension accounts for narrative discourse production outcomes (story grammar, story completeness). A secondary aim was to provisionally test an assumption of a discourse model, the structure building framework (SBF), that discourse comprehension and production share cognitive processes by investigating the strength of the relationship between them.

METHOD

Twenty-one individuals with TBI completed story comprehension and story retelling tasks. Discourse measures included the Discourse Comprehension Test, a picture story comprehension task, story grammar, and story completeness. Correlational and multiple regression analyses were performed using comprehension measures as predictors for production measures.

RESULTS

There were significant moderate-to-large correlations between all comprehension and production measures. Comprehension measures approached but did not reach significance for predicting story grammar performance but strongly predicted story completeness outcomes.

CONCLUSIONS

The story comprehension measures likely tapped content aspects of discourse more so than organization. Results provided support for a link between content-focused discourse comprehension measures and discourse production outcomes, which may have clinical implications for approaches to discourse intervention. Findings were interpreted as providing preliminary support for the SBF's claim that discourse production deploys the same processes involved in discourse comprehension.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26338045.

Longitudinal changes in sodium concentration and in clinical outcome in mild traumatic brain injury

Ionic imbalances and sodium channel dysfunction, well-known sequelae of traumatic brain injury (TBI), promote functional impairment in affected subjects. Therefore, non-invasive measurement of sodium concentrations using 23Na MRI has the potential to detect clinically relevant injury and predict persistent symptoms. Recently, we reported diffusely lower apparent total sodium concentrations (aTSC) in mild TBI patients compared to controls, as well as correlations between lower aTSC and worse clinical outcomes. The main goal of this study was to determine whether these aTSC findings, and their changes over time, predict outcomes at 3- and 12-month from injury. Twenty-seven patients previously studied with 23Na MRI and outcome measures at 22 ± 10 days (average ± standard deviation) after injury (visit-1, v1) were contacted at 3- (visit-2, v2) and 12-month after injury (visit-3, v3) to complete the Rivermead post-concussion symptoms questionnaire (RPQ), the extended Glasgow outcome scale (GOSE), and the brief test of adult cognition by telephone (BTACT). Follow-up 1H and 23Na MRI were additionally scheduled at v2. Linear regression was used to calculate aTSC in global grey and white matters. Six hypotheses were tested in relation to the serial changes in outcome measures and in aTSC, and in relation to the cross-sectional and serial relationships between aTSC and outcome. Twenty patients contributed data at v2 and fifteen at v3. Total RPQ and composite BTACT z-scores differed significantly for v2 and v3 in comparison to v1 (each P < 0.01), reflecting longitudinally reduced symptomatology and improved performance on cognitive testing. No associations between aTSC and outcome were observed at v2. Previously lower grey and white matter aTSC normalized at v2 in comparison to controls, in line with a statistically detectable longitudinal increase in grey matter aTSC between v1 and v2 (P = 0.0004). aTSC values at v1 predicted a subset of future BTACT subtest scores, but not future RPQ scores nor GOSE-defined recovery status. Similarly, aTSC rates of change correlated with BTACT rates of change, but not with those of RPQ. Tissue aTSC, previously shown to be diffusely decreased compared to controls at v1, was no longer reduced by v2, suggesting normalization of the sodium ionic equilibrium. These changes were accompanied by marked improvement in outcome. The results support the notion that early aTSC from 23Na MRI predicts future BTACT, but not RPQ scores, nor future GOSE status.

Contribution of Working Memory and Inferencing to Narrative Discourse Comprehension and Production in Traumatic Brain Injury

PURPOSE

The goal of this study was to identify some potential key cognitive and communicative processes underlying narrative discourse ability following traumatic brain injury (TBI). Specifically, this study (a) investigated the contribution of working memory (WM) and inferencing to narrative discourse comprehension and production; (b) tested key assumptions posited by the Structure Building Framework (SBF), a discourse model; and (c) evaluated the potential for inferencing to contribute to discourse ability beyond a shared variance with WM.

METHOD

Twenty-one individuals with TBI completed six tasks yielding seven measures: verbal and nonverbal WM updating (WMU-V and WMU-NV, respectively), predictive inferencing, the Discourse Comprehension Test (DCT), a picture story comprehension (PSC) task, and story retelling (story grammar and story completeness). Regression analyses were performed using WM and inferencing as predictors for narrative performance.

RESULTS

WM measures were significant predictors of DCT performance and approached significance as predictors of PSC. Inferencing approached significance as a unique predictor for the DCT and story completeness. WMU-V and WMU-NV were highly collinear, and neither WM measure predicted discourse outcomes over and above the other's contribution.

CONCLUSIONS

WM was more strongly associated with comprehension processes, whereas inferencing may be associated with both comprehension and production outcomes. Findings were interpreted as supporting SBF assumptions of domain generality of cognitive processes and mechanisms involved in discourse while also challenging assumptions that the same cognitive substrates are marshaled for comprehension and production processes.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23148647.

Brain dynamics in triple-network interactions and its relation to multiple cognitive impairments in mild traumatic brain injury

Traumatic brain injury (TBI) disrupt the coordinated activity of triple-network and produce impairments across several cognitive domains. The triple-network model posits a key role of the salience network (SN) that regulates interactions with the central executive network (CEN) and default mode network (DMN). However, the aberrant dynamic interactions among triple-network and associations with neurobehavioral symptoms in mild TBI was still unclear. In present study, we used brain network interaction index (NII) and dynamic functional connectivity to examine the time-varying cross-network interactions among the triple-network in 109 acute patients, 41 chronic patients, and 65 healthy controls. Dynamic cross-network interactions were significantly increased and more variable in mild TBI compared to controls. Crucially, mild TBI exhibited an increased NII as enhanced integrations between the SN and CEN while reduced coupling of the SN with DMN. The increased NII also implied much severer and multiple domains of cognitive impairments at both acute and chronic mild TBI. Abnormities in time-varying engagement of triple-network is a clinically relevant neurobiological signature of psychopathology in mild TBI. The findings provided align with and advance an emerging perspective on the importance of aberrant brain dynamics associated with highly disparate cognitive and behavioral outcomes in trauma.

Functional Connectome Dynamics After Mild Traumatic Brain Injury According to Age and Sex

Neural and cognitive deficits after mild traumatic brain injury (mTBI) are paralleled by changes in resting state functional correlation (FC) networks that mirror post-traumatic pathophysiology effects on functional outcomes. Using functional magnetic resonance images acquired both acutely and chronically after injury (∼1 week and ∼6 months post-injury, respectively), we map post-traumatic FC changes across 136 participants aged 19-79 (52 females), both within and between the brain's seven canonical FC networks: default mode, dorsal attention, frontoparietal, limbic, somatomotor, ventral attention, and visual. Significant sex-dependent FC changes are identified between (A) visual and limbic, and between (B) default mode and somatomotor networks. These changes are significantly associated with specific functional recovery patterns across all cognitive domains (p < 0.05, corrected). Changes in FC between default mode, somatomotor, and ventral attention networks, on the one hand, and both temporal and occipital regions, on the other hand, differ significantly by age group (p < 0.05, corrected), and are paralleled by significant sex differences in cognitive recovery independently of age at injury (p < 0.05, corrected). Whereas females' networks typically feature both significant (p < 0.036, corrected) and insignificant FC changes, males more often exhibit significant FC decreases between networks (e.g., between dorsal attention and limbic, visual and limbic, default-mode and somatomotor networks, p < 0.0001, corrected), all such changes being accompanied by significantly weaker recovery of cognitive function in males, particularly older ones (p < 0.05, corrected). No significant FC changes were found across 35 healthy controls aged 66-92 (20 females). Thus, male sex and older age at injury are risk factors for significant FC alterations whose patterns underlie post-traumatic cognitive deficits. This is the first study to map, systematically, how mTBI impacts FC between major human functional networks.

Cognitive-Communication Complaints and Referrals for Speech-Language Pathology Services Following Concussion

PURPOSE

Speech-language pathologists are increasingly being recognized as key members of concussion management teams. This study investigates whether self-report of communication problems postconcussion may be useful in identifying clients who could benefit from speech-language pathology services.

METHOD

Participants included 41 adolescents and adults from an outpatient specialty concussion clinic. All completed the La Trobe Communication Questionnaire (LCQ) at admission, and 23 repeated this measure at discharge. Participants were prospectively enrolled, with chart reviews providing demographic, injury, and medical factors. The analysis considered (a) communication complaints and resolution over time, including comparison to two previously published LCQ studies of typical adults and adults with and without traumatic brain injury (TBI); (b) the relationship between communication complaints, participant factors, and common concussion assessments; and (c) factors related to speech-language pathology service referral for rehabilitation.

RESULTS

At first visit, 12 of 41 participants (29%) reported communication problems, although 19 (46%) reported difficulty with greater than half of LCQ items. At a group level, compared to published reference data of both people with chronic mixed severity TBI and controls, participants in this study reported more problems at first visit with communication overall, as well as greater difficulty with the LCQ Initiation/Conversation Flow subscale. Partner Sensitivity subscale scores at first visit were also greater than published control data. LCQ subscale scores of Initiation/Conversation Flow and Partner Sensitivity decreased from first visit to last visit, demonstrating resolution over time. Only concussion symptom scales and not demographic, injury, or cognitive screenings were related to LCQ scores. The same two LCQ subscales, Initiation/Conversation Flow and Partner Sensitivity, predicted referral for speech-language pathology services, along with symptom scales and being injured due to motor vehicle crash.

DISCUSSION

A subset of people recovering from concussion report experiencing communication problems. Reporting of particular communication problems was related to referral for speech-language pathology rehabilitation services and may be useful in directing care after concussion.

[Features of the patient management with traumatic brain injury]

The aim of our study was to consider features of pathogenesis, diagnosis and therapy of traumatic brain injury (TBI) from the viewpoint of neurologist. The mechanisms of emerging injury of the central nervous system, including neuro-inflammation and oxidative stress in patients with TBI, and correlations between clinical manifestations and severity of TBI are discussed. Special attention is paid to the description of certain TBI consequences, e.g. structural drug-resistant epilepsy and post-traumatic stress disorder. We provide evidence for difficulties and lesser availability of rehabilitation programs to patients with TBI during COVID-19 pandemics. One should mention a need for administration of Mexidol as the antioxidant/antihypoxant drug into complex therapy of TBI in such patients. In the period of COVID-19 pandemics, the role of neurologist in management of TBI patients still increases, especially, at the outpatient treatment stage, and when carrying out therapy and medical rehabilitation programs.