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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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Troyanskaya M, Pastorek NJ, Jamal F, Jackson GR, Sarwar AI, Wilde EA, Scheibel RS. A pilot study of olfactory function in veterans with a history of deployment-related mild traumatic brain injury. Neurocase 2022; 28:459-466. [PMID: 36576237 DOI: 10.1080/13554794.2022.2159444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Olfactory impairment in military populations is highly prevalent and often attributed to the long-term effects of mild traumatic brain injury (mTBI) and chronic psychiatric disorders. The main goal of this investigation was to examine olfactory function in a cohort of combat veterans using a quantitative smell test.Participants underwent a neurological examination, completed performance validity testing (PVT), provided deployment history, and their medical records were reviewed.Participants were 38 veterans with a deployment-related mTBI who passed the PVT and did not have ongoing substance misuse issues. Olfactory examination revealed normosmia in 20 participants and various degrees of deficit in 18. The groups did not differ in demographics, post-injury interval, or current clinical (non-psychiatric) conditions. Participants with hyposmia frequently reported being exposed to a higher number of blasts and being positioned closer to the nearest primary blast, and more often endorsed a period of loss of consciousness after the most serious mTBI. In addition, they more often reported tympanic membrane perforation, extracranial injuries, and histories of both blast and blunt force mTBI. Comorbid diagnoses of posttraumatic stress disorder, depression, chronic headaches, and pain were more common among them as well.Several blast exposure and injury-related characteristics increase the likelihood of long-term olfactory impartments, comorbid psychiatric conditions, and chronic pain among veterans with history of deployment-related mTBI. Notably, none of the participants with hyposmia had a clinical diagnosis of olfactory dysfunction or were receiving service-connected disability for loss of sense of smell at the time of their assessment.
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Affiliation(s)
- Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Nicholas J Pastorek
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Fariha Jamal
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, TX, USA.,Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - George R Jackson
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, TX, USA.,Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Aliya I Sarwar
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, TX, USA.,Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Elisabeth A Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.,Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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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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Rao RK, McConnell DD, Litofsky NS. The impact of cigarette smoking and nicotine on traumatic brain injury: a review. Brain Inj 2022; 36:1-20. [PMID: 35138210 DOI: 10.1080/02699052.2022.2034186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/28/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Traumatic Brain Injury (TBI) and tobacco smoking are both serious public health problems. Many people with TBI also smoke. Nicotine, a component of tobacco smoke, has been identified as a premorbid neuroprotectant in other neurological disorders. This study aims to provide better understanding of relationships between tobacco smoking and nicotine use and effect on outcome/recovery from TBI. METHODS PubMed database, SCOPUS, and PTSDpub were searched for relevant English-language papers. RESULTS Twenty-nine human clinical studies and nine animal studies were included. No nicotine-replacement product use in human TBI clinical studies were identified. While smoking tobacco prior to injury can be harmful primarily due to systemic effects that can compromise brain function, animal studies suggest that nicotine as a pharmacological agent may augment recovery of cognitive deficits caused by TBI. CONCLUSIONS While tobacco smoking before or after TBI has been associated with potential harms, many clinical studies downplay correlations for most expected domains. On the other hand, nicotine could provide potential treatment for cognitive deficits following TBI by reversing impaired signaling pathways in the brain including those involving nAChRs, TH, and dopamine. Future studies regarding the impact of cigarette smoking and vaping on patients with TBI are needed .
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Affiliation(s)
- Rohan K Rao
- Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Diane D McConnell
- Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - N Scott Litofsky
- Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
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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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Ma HP, Ou JC, Chen KY, Liao KH, Kang SJ, Wang JY, Chiang YH, Wu JCC. Screening for Poor Self-Reported Sleep Quality at 12 Weeks in Post-Mild Traumatic Brain Injury Patients Using the HF-Age-Gender (HAG) Index. Brain Sci 2021; 11:1369. [PMID: 34827369 PMCID: PMC8615360 DOI: 10.3390/brainsci11111369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022] Open
Abstract
To identify a screening tool for poor self-reported sleep quality at 12 weeks according to non-invasive measurements and patients' characteristics in the first week after mild traumatic brain injury (mTBI), data from 473 mTBI participants were collected and follow-ups were performed at 12 weeks. Patients with previous poor self-reported sleep quality prior to the injury were excluded. Patients were then divided into two groups at 12 weeks according to the Pittsburgh Sleep Quality Index based on whether or not they experienced poor sleep quality. The analysis was performed on personal profiles and heart rate variability (HRV) for 1 week. After analyzing the non-invasive measurements and characteristics of mTBI patients who did not complain of poor sleep quality, several factors were found to be relevant to the delayed onset of poor sleep quality, including age, gender, and HRV measurements. The HRV-age-gender (HAG) index was proposed and found to have 100% sensitivity (cut-off, 7; specificity, 0.537) to predicting whether the patient will experience poor sleep quality after mTBI at the 12-week follow-up. The HAG index helps us to identify patients with mTBI who have no sleep quality complaints but are prone to developing poor self-reported sleep quality. Additional interventions to improve sleep quality would be important for these particular patients in the future.
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Affiliation(s)
- Hon-Ping Ma
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
| | - Ju-Chi Ou
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
- Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Kai-Yun Chen
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
- Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
| | - Kuo-Hsing Liao
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Shuo-Jhen Kang
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
- Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jia-Yi Wang
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
- Division of Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Yung-Hsiao Chiang
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
- Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Division of Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - John Chung-Che Wu
- Neuroscience Research Center, Taipei Medical University, Taipei 110, Taiwan; (J.-C.O.); (K.-Y.C.); (K.-H.L.); (S.-J.K.); (J.-Y.W.); (Y.-H.C.)
- Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Division of Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei 110, Taiwan
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Lieb DA, Raiciulescu S, DeGraba T, Sours Rhodes C. Investigation of the Relationship Between Frequency of Blast Exposure, mTBI History, and Post-traumatic Stress Symptoms. Mil Med 2021; 187:e702-e710. [PMID: 34114019 DOI: 10.1093/milmed/usab205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/08/2021] [Accepted: 05/14/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are common conditions among military personnel that frequently co-occur. This study investigated relationships between self-reported blast exposure, mTBI history, and current post-traumatic stress (PTS) symptoms in a population of active duty service members (n = 202) from the Intensive Outpatient Program at the National Intrepid Center of Excellence. MATERIALS AND METHODS Participants were divided into four mTBI groups (0, 1, 2, and 3+) and four blast exposure groups (0-10, 11-100, 101-1,000, and 1,000+). Self-reported lifetime mTBI and blast history were obtained via the Ohio State University TBI Identification Method. PTSS severity was obtained via the PTSD Checklist-Civilian version (PCL-C). Several secondary measures of depression, anxiety, chronic mTBI symptoms, and sleep were also assessed. RESULTS The total PCL-C scores differed significantly between mTBI groups, with significant differences detected between the 0/1 mTBI groups and the 3+ mTBI groups. Similar group differences were noted across the three PCL-C subgroup scores (avoidance, re-experiencing, and hyperarousal); however, when comparing the proportion of group participants meeting DSM-IV criteria for each symptom cluster, significant differences between mTBI groups were only noted for avoidance (P = .002). No group differences were noted in PTS symptom severity or distribution between blast groups. CONCLUSIONS This study demonstrates an association between lifetime mTBI history and PTS symptom severity and distribution but failed to identify the significant group in self-reported symptoms between the blast exposure groups. Results suggest that additional research is needed to understand the neurobiological mechanism behind these associations and the need for the development of precise assessment tools that are able to more accurately quantify significant lifetime sub-concussive and blast exposures experienced by service members in training and combat operations.
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Affiliation(s)
- David A Lieb
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Thomas DeGraba
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889-5649, USA
| | - Chandler Sours Rhodes
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889-5649, USA.,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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8
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Robinson-Freeman KE, Collins KL, Garber B, Terblanche R, Risling M, Vermetten E, Besemann M, Mistlin A, Tsao JW. A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI. Front Neurol 2020; 11:836. [PMID: 32982907 PMCID: PMC7477387 DOI: 10.3389/fneur.2020.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.
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Affiliation(s)
| | - Kassondra L Collins
- Department of Physical Therapy, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bryan Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Ronel Terblanche
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Marten Risling
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Eric Vermetten
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Markus Besemann
- Physical Medicine and Rehabilitation, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Alan Mistlin
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, Children's Foundation Research Institute, Memphis, TN, United States
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9
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Lecca D, Bader M, Tweedie D, Hoffman AF, Jung YJ, Hsueh SC, Hoffer BJ, Becker RE, Pick CG, Lupica CR, Greig NH. (-)-Phenserine and the prevention of pre-programmed cell death and neuroinflammation in mild traumatic brain injury and Alzheimer's disease challenged mice. Neurobiol Dis 2019; 130:104528. [PMID: 31295555 PMCID: PMC6716152 DOI: 10.1016/j.nbd.2019.104528] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/05/2019] [Accepted: 07/06/2019] [Indexed: 01/12/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a risk factor for neurodegenerative disorders, such as Alzheimer's disease (AD) and Parkinson's disease (PD). TBI-derived neuropathologies are promoted by inflammatory processes: chronic microgliosis and release of pro-inflammatory cytokines that further promote neuronal dysfunction and loss. Herein, we evaluated the effect on pre-programmed cell death/neuroinflammation/synaptic integrity and function of (-)-Phenserine tartrate (Phen), an agent originally developed for AD. This was studied at two clinically translatable doses (2.5 and 5.0 mg/kg, BID), in a weight drop (concussive) mTBI model in wild type (WT) and AD APP/PSEN1 transgenic mice. Phen mitigated mTBI-induced cognitive impairment, assessed by Novel Object Recognition and Y-maze behavioral paradigms, in WT mice. Phen fully abated mTBI-induced neurodegeneration, evaluated by counting Fluoro-Jade C-positive (FJC+) cells, in hippocampus and cortex of WT mice. In APP/PSEN1 mice, degenerating cell counts were consistently greater across all experimental groups vs. WT mice. mTBI elevated FJC+ cell counts vs. the APP/PSEN1 control (sham) group, and Phen similarly mitigated this. Anti-inflammatory effects on microglial activation (IBA1-immunoreactivity (IR)) and the pro-inflammatory cytokine TNF-α were evaluated. mTBI increased IBA1-IR and TNF-α/IBA1 colocalization vs. sham, both in WT and APP/PSEN1 mice. Phen decreased IBA1-IR throughout hippocampi and cortices of WT mice, and in cortices of AD mice. Phen, likewise, reduced levels of IBA1/TNF-α-IR colocalization volume across all areas in WT animals, with a similar trend in APP/PSEN1 mice. Actions on astrocyte activation by mTBI were followed by evaluating GFAP, and were similarly mitigated by Phen. Synaptic density was evaluated by quantifying PSD-95+ dendritic spines and Synaptophysin (Syn)-IR. Both were significantly reduced in mTBI vs. sham in both WT and APP/PSEN1 mice. Phen fully reversed the PSD-95+ spine loss in WT and Syn-IR decrease in both WT and APP/PSEN1 mice. To associate immunohistochemical changes in synaptic markers with function, hippocampal long term potentiation (LTP) was induced in WT mice. LTP was impaired by mTBI, and this impairment was mitigated by Phen. In synopsis, clinically translatable doses of Phen ameliorated mTBI-mediated pre-programmed cell death/neuroinflammation/synaptic dysfunction in WT mice, consistent with fully mitigating mTBI-induced cognitive impairments. Phen additionally demonstrated positive actions in the more pathologic brain microenvironment of AD mice, further supporting consideration of its repurposing as a treatment for mTBI.
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Affiliation(s)
- Daniela Lecca
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Miaad Bader
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - David Tweedie
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Alexander F Hoffman
- Electrophysiology Research Section, Cellular Neurobiology Research Branch, Intramural Research Program, National Institute on Drug Abuse, NIH, 21224 Baltimore, MD, USA
| | - Yoo Jin Jung
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Shin-Chang Hsueh
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Barry J Hoffer
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Robert E Becker
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA; Aristea Translational Medicine Corporation, Park City, UT 84098, USA
| | - Chaim G Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel; Center for the Biology of Addictive Diseases, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Carl R Lupica
- Electrophysiology Research Section, Cellular Neurobiology Research Branch, Intramural Research Program, National Institute on Drug Abuse, NIH, 21224 Baltimore, MD, USA
| | - Nigel H Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD 21224, USA.
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10
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Kenney K, Diaz-Arrastia R. Risk of Dementia Outcomes Associated With Traumatic Brain Injury During Military Service. JAMA Neurol 2019; 75:1043-1044. [PMID: 29800966 DOI: 10.1001/jamaneurol.2018.0347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Services, Bethesda, Maryland.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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11
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12
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Schwedt TJ. Structural and Functional Brain Alterations in Post-traumatic Headache Attributed to Mild Traumatic Brain Injury: A Narrative Review. Front Neurol 2019; 10:615. [PMID: 31258507 PMCID: PMC6587675 DOI: 10.3389/fneur.2019.00615] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/24/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction: By definition, post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) is not associated with brain structural abnormalities that are seen on routine clinical inspection of brain images. However, subtle brain structural abnormalities, as well as functional abnormalities, detected via research imaging techniques yield insights into the pathophysiology of PTH. The objective of this manuscript is to summarize published findings regarding research imaging of the brain in PTH attributed to mTBI. Methods:For this narrative review, PubMed was searched using the terms “post-traumatic headache” or “post-concussion headache” and “imaging” or “magnetic resonance imaging” or “research imaging” or “positron emission tomography”. Articles were chosen for inclusion based on their relevance to the topic. Results: Ten articles were ultimately included within this review. The studies investigated white matter tract integrity and functional connectivity in acute PTH, structural measures, white matter tract integrity, cerebral blood flow, and functional connectivity in persistent PTH (PPTH), and proton spectroscopy in both acute and persistent PTH. The articles demonstrate that acute and persistent PTH are associated with abnormalities in brain structure, that acute and persistent PTH are also associated with abnormalities in brain function, that it might be possible to predict the persistence of PTH using brain imaging findings, and that there are differences in imaging findings when comparing PTH to healthy controls and when comparing PTH to migraine. Although it is not entirely clear if the imaging findings are directly attributable to PTH as opposed to the underlying TBI or other post-TBI symptoms, correlations between the imaging findings with headache frequency and headache resolution suggest a true relationship between the imaging findings and PTH. Conclusions: PTH attributed to mTBI is associated with abnormalities in brain structure and function that can be detected via research imaging. Additional studies are needed to determine the specificity of the findings for PTH, to differentiate findings attributed to PTH from those attributed to the underlying TBI and coexistent post-TBI symptoms, and to determine the accuracy of imaging findings for predicting the development of PPTH.
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Affiliation(s)
- Todd J Schwedt
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
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13
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Hsueh SC, Lecca D, Greig NH, Wang JY, Selman W, Hoffer BJ, Miller JP, Chiang YH. (-)-Phenserine Ameliorates Contusion Volume, Neuroinflammation, and Behavioral Impairments Induced by Traumatic Brain Injury in Mice. Cell Transplant 2019; 28:1183-1196. [PMID: 31177840 PMCID: PMC6767878 DOI: 10.1177/0963689719854693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Traumatic brain injury (TBI), a major cause of mortality and morbidity, affects 10 million people worldwide, with limited treatment options. We have previously shown that (-)-phenserine (Phen), an acetylcholinesterase inhibitor originally designed and tested in clinical phase III trials for Alzheimer's disease, can reduce neurodegeneration after TBI and reduce cognitive impairments induced by mild TBI. In this study, we used a mouse model of moderate to severe TBI by controlled cortical impact to assess the effects of Phen on post-trauma histochemical and behavioral changes. Animals were treated with Phen (2.5 mg/kg, IP, BID) for 5 days started on the day of injury and the effects were evaluated by behavioral and histological examinations at 1 and 2 weeks after injury. Phen significantly attenuated TBI-induced contusion volume, enlargement of the lateral ventricle, and behavioral impairments in motor asymmetry, sensorimotor functions, motor coordination, and balance functions. The morphology of microglia was shifted to an active from a resting form after TBI, and Phen dramatically reduced the ratio of activated to resting microglia, suggesting that Phen also mitigates neuroinflammation after TBI. While Phen has potent anti-acetylcholinesterase activity, its (+) isomer Posiphen shares many neuroprotective properties but is almost completely devoid of anti-acetylcholinesterase activity. We evaluated Posiphen at a similar dose to Phen and found similar mitigation in lateral ventricular size increase, motor asymmetry, motor coordination, and balance function, suggesting the improvement of these histological and behavioral tests by Phen treatment occur via pathways other than anti-acetylcholinesterase inhibition. However, the reduction of lesion size and improvement of sensorimotor function by Posiphen were much smaller than with equivalent doses of Phen. Taken together, these results show that post-injury treatment with Phen over 5 days significantly ameliorates severity of TBI. These data suggest a potential development of this compound for clinical use in TBI therapy.
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Affiliation(s)
- Shih-Chang Hsueh
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daniela Lecca
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Nigel H Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Jia-Yi Wang
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei
| | - Warren Selman
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Barry J Hoffer
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yung-Hsiao Chiang
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei.,Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei.,Department of Neurosurgery, Taipei Medical University Hospital, Taipei.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei
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14
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Wadhawan A, Stiller JW, Potocki E, Okusaga O, Dagdag A, Lowry CA, Benros ME, Postolache TT. Traumatic Brain Injury and Suicidal Behavior: A Review. J Alzheimers Dis 2019; 68:1339-1370. [DOI: 10.3233/jad-181055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Abhishek Wadhawan
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, USA
| | - John W. Stiller
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Neurology Consultation Service, Washington, DC, USA
- Maryland State Athletic Commission, Baltimore, MD, USA
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Olaoluwa Okusaga
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Aline Dagdag
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA
| | - Christopher A. Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodor T. Postolache
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA
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15
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Bader M, Li Y, Lecca D, Rubovitch V, Tweedie D, Glotfelty E, Rachmany L, Kim HK, Choi HI, Hoffer BJ, Pick CG, Greig NH, Kim DS. Pharmacokinetics and efficacy of PT302, a sustained-release Exenatide formulation, in a murine model of mild traumatic brain injury. Neurobiol Dis 2019; 124:439-453. [PMID: 30471415 PMCID: PMC6710831 DOI: 10.1016/j.nbd.2018.11.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/29/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022] Open
Abstract
Traumatic brain injury (TBI) is a neurodegenerative disorder for which no effective pharmacological treatment is available. Glucagon-like peptide 1 (GLP-1) analogues such as Exenatide have previously demonstrated neurotrophic and neuroprotective effects in cellular and animal models of TBI. However, chronic or repeated administration was needed for efficacy. In this study, the pharmacokinetics and efficacy of PT302, a clinically available sustained-release Exenatide formulation (SR-Exenatide) were evaluated in a concussive mild (m)TBI mouse model. A single subcutaneous (s.c.) injection of PT302 (0.6, 0.12, and 0.024 mg/kg) was administered and plasma Exenatide concentrations were time-dependently measured over 3 weeks. An initial rapid regulated release of Exenatide in plasma was followed by a secondary phase of sustained-release in a dose-dependent manner. Short- and longer-term (7 and 30 day) cognitive impairments (visual and spatial deficits) induced by weight drop mTBI were mitigated by a single post-injury treatment with Exenatide delivered by s.c. injection of PT302 in clinically translatable doses. Immunohistochemical evaluation of neuronal cell death and inflammatory markers, likewise, cross-validated the neurotrophic and neuroprotective effects of SR-Exenatide in this mouse mTBI model. Exenatide central nervous system concentrations were 1.5% to 2.0% of concomitant plasma levels under steady-state conditions. These data demonstrate a positive beneficial action of PT302 in mTBI. This convenient single, sustained-release dosing regimen also has application for other neurological disorders, such as Alzheimer's disease, Parkinson's disease, multiple system atrophy and multiple sclerosis where prior preclinical studies, likewise, have demonstrated positive Exenatide actions.
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Affiliation(s)
- Miaad Bader
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Yazhou Li
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institutes of Health, National Institute on Aging, Baltimore, MD, USA
| | - Daniela Lecca
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institutes of Health, National Institute on Aging, Baltimore, MD, USA
| | - Vardit Rubovitch
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - David Tweedie
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institutes of Health, National Institute on Aging, Baltimore, MD, USA
| | - Elliot Glotfelty
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institutes of Health, National Institute on Aging, Baltimore, MD, USA; Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lital Rachmany
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Hee Kyung Kim
- Peptron Inc., Yuseong-gu, Daejeon, Republic of Korea
| | - Ho-Il Choi
- Peptron Inc., Yuseong-gu, Daejeon, Republic of Korea
| | - Barry J Hoffer
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chaim G Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel; Center for the Biology of Addictive Diseases, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Nigel H Greig
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institutes of Health, National Institute on Aging, Baltimore, MD, USA.
| | - Dong Seok Kim
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institutes of Health, National Institute on Aging, Baltimore, MD, USA; Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
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16
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Using Next-Generation Sequencing Transcriptomics To Determine Markers of Post-traumatic Symptoms: Preliminary Findings from a Post-deployment Cohort of Soldiers. G3-GENES GENOMES GENETICS 2019; 9:463-471. [PMID: 30622122 PMCID: PMC6385974 DOI: 10.1534/g3.118.200516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Post-traumatic stress disorder is a concerning psychobehavioral disorder thought to emerge from the complex interaction between genetic and environmental factors. For soldiers exposed to combat, the risk of developing this disorder is twofold and diagnosis is often late, when much sequela has set in. To be able to identify and diagnose in advance those at “risk” of developing post-traumatic stress disorder, would greatly taper the gap between late sequelae and treatment. Therefore, this study sought to determine whether the transcriptome can be used to track the development of post-traumatic stress disorder in this unique and susceptible cohort of individuals. Gene expression levels in peripheral blood samples from 85 Canadian infantry soldiers (n = 58 participants negative for symptoms of post-traumatic stress disorder and n = 27 participants with symptoms of post-traumatic stress disorder) following return from deployment to Afghanistan were determined using RNA sequencing technology. Count-based gene expression quantification, normalization and differential analysis (with thorough correction for confounders) revealed genes associated to PTSD; LRP8 and GOLM1. These preliminary results provide a proof-of-principle for the diagnostic utility of blood-based gene expression profiles for tracking symptoms of post-traumatic stress disorder in soldiers returning from tour. It is also the first to report transcriptome-wide expression profiles alongside a post-traumatic symptom checklist.
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17
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Sleep assessment in a randomized trial of hyperbaric oxygen in U.S. service members with post concussive mild traumatic brain injury compared to normal controls. Sleep Med 2018; 51:66-79. [DOI: 10.1016/j.sleep.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/20/2022]
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18
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Karnati HK, Garcia JH, Tweedie D, Becker RE, Kapogiannis D, Greig NH. Neuronal Enriched Extracellular Vesicle Proteins as Biomarkers for Traumatic Brain Injury. J Neurotrauma 2018; 36:975-987. [PMID: 30039737 DOI: 10.1089/neu.2018.5898] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of injury-related death throughout the world and lacks effective treatment. Surviving TBI patients often develop neuropsychiatric symptoms, and the molecular mechanisms underlying the neuronal damage and recovery following TBI are not well understood. Extracellular vesicles (EVs) are membranous nanoparticles that are divided into exosomes (originating in the endosomal/multi-vesicular body [MVB] system) and microvesicles (larger EVs produced through budding of the plasma membrane). Both types of EVs are generated by all cells and are secreted into the extracellular environment, and participate in cell-to-cell communication and protein and RNA delivery. EVs enriched for neuronal origin can be harvested from peripheral blood samples and their contents quantitatively examined as a window to follow potential changes occurring in brain. Recent studies suggest that the levels of exosomal proteins and microRNAs (miRNAs) may represent novel biomarkers to support the clinical diagnosis and potential response to treatment for neurological disorders. In this review, we focus on the biogenesis of EVs, their molecular composition, and recent advances in research of their contents as potential diagnostic tools for TBI.
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Affiliation(s)
- Hanuma Kumar Karnati
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Joseph H Garcia
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - David Tweedie
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Robert E Becker
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.,2 Aristea Translational Medicine Corporation, Park City, Utah
| | - Dimitrios Kapogiannis
- 3 Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Nigel H Greig
- 1 Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Stewart-Willis JJ, Heyanka D, Proctor-Weber Z, England H, Bruhns M. Premorbid IQ Predicts Postconcussive Symptoms in OEF/OIF/OND Veterans with mTBI. Arch Clin Neuropsychol 2018; 33:206-215. [PMID: 28595276 DOI: 10.1093/arclin/acx053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/31/2017] [Indexed: 12/20/2022] Open
Abstract
Objective Extant literature has demonstrated that symptoms of postconcussive syndrome (PCS) persist well beyond the expected 3-month post-injury recovery period in a minority of individuals with mild traumatic brain injury (mTBI). Suboptimal performance on validity measures and pre- and post-injury psychosocial stressors - rather than actual mTBI or current cognitive functioning - have been identified as predictors of chronic PCS. Whether premorbid IQ has any influence on chronic PCS has been understudied, in the context of established psychogenic etiologies. Method The sample included 31 veterans, who underwent mTBI neuropsychological evaluations six or more months post-injury in a VA outpatient neuropsychology clinic. A two-step multiple linear regression was conducted to examine the effects on the outcome variable, PCS (Neurobehavioral Symptom Inventory), of the following predictors: cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status; Attention, Immediate Memory, and Delayed Memory Indices), performance validity, depression (Beck Depression Inventory-Second Edition), posttraumatic stress disorder (PTSD Checklist, Civilian Version), quality of sleep (Pittsburgh Sleep Quality Index), pain (Brief Pain Inventory), education, and Premorbid IQ (Wechsler Test of Adult Reading). Results The overall regression model containing all nine predictor variables was statistically significant. Depression (p < .05) and premorbid IQ (p < .05) were the most salient predictors of chronic PCS; in that lower premorbid IQ and greater endorsed symptoms of depression were associated with higher PCS scores. In Step 2 of the multiple linear regression, the WTAR explained an additional 6.7% of the variance in PCS after controlling for psychosocial stressors and current cognitive ability. Conclusion The findings support premorbid IQ as a unique and relevant predictor of chronic PCS, with significance variance accounted for beyond education, cognitive functioning, and psychosocial variables. Given the predictive relationship between premorbid IQ and PCS, adapting postconcussive interventions to meet the specific needs of individuals with varying levels of intellect may be important in minimizing ongoing symptomatology.
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Affiliation(s)
- Jada J Stewart-Willis
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Daniel Heyanka
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Zoe Proctor-Weber
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Heather England
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Maya Bruhns
- Rehabilitation Service, JFK/Johnson Rehabilitation Institute, Center for Head Injuries Edison, NJ 08820, USA
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Interactive effects of Traumatic Brain Injury and Anxiety Sensitivity Cognitive Concerns on Post-traumatic Stress among Active Duty Soldiers. COGNITIVE THERAPY AND RESEARCH 2018; 41:902-910. [PMID: 30220753 DOI: 10.1007/s10608-017-9863-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Albanese BJ, Macatee RJ, Boffa JW, Bryan CJ, Zvolensky MJ, Schmidt NB. Interactive effects of traumatic brain injury and anxiety sensitivity on PTSD symptoms: A replication and extension in two clinical samples. COGNITIVE THERAPY AND RESEARCH 2018; 42:510-523. [PMID: 29881128 PMCID: PMC5986097 DOI: 10.1007/s10608-017-9883-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Brian J Albanese
- Department of Psychology, Florida State University, Tallahasssee, FL, USA
| | - Richard J Macatee
- Department of Psychology, Florida State University, Tallahasssee, FL, USA
| | - Joseph W Boffa
- Department of Psychology, Florida State University, Tallahasssee, FL, USA
| | - Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA
- Department of Psychology, University of Utah, UT, USA
| | | | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahasssee, FL, USA
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Albanese BJ, Macatee RJ, Stentz LA, Schmidt NB, Bryan CJ. Interactive effects of cumulative lifetime traumatic brain injuries and combat exposure on posttraumatic stress among deployed military personnel. Cogn Behav Ther 2018; 48:77-88. [PMID: 29932812 DOI: 10.1080/16506073.2018.1478446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual's lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist - Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.
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Affiliation(s)
- Brian J Albanese
- a Department of Psychology , Florida State University , Tallahasssee , FL , USA
| | - Richard J Macatee
- a Department of Psychology , Florida State University , Tallahasssee , FL , USA
| | - Lauren A Stentz
- a Department of Psychology , Florida State University , Tallahasssee , FL , USA
| | - Norman B Schmidt
- a Department of Psychology , Florida State University , Tallahasssee , FL , USA
| | - Craig J Bryan
- b National Center for Veterans Studies , Salt Lake City , UT , USA.,c Department of Psychology , University of Utah , Salt Lake City , UT , USA
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23
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DePalma RG, Hoffman SW. Combat blast related traumatic brain injury (TBI): Decade of recognition; promise of progress. Behav Brain Res 2018; 340:102-105. [DOI: 10.1016/j.bbr.2016.08.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 12/22/2022]
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24
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Song H, Cui J, Simonyi A, Johnson CE, Hubler GK, DePalma RG, Gu Z. Linking blast physics to biological outcomes in mild traumatic brain injury: Narrative review and preliminary report of an open-field blast model. Behav Brain Res 2018; 340:147-158. [DOI: 10.1016/j.bbr.2016.08.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/13/2016] [Accepted: 08/19/2016] [Indexed: 12/14/2022]
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Neurobehavioral Characteristics of Older Veterans With Remote Traumatic Brain Injury. J Head Trauma Rehabil 2018; 32:E8-E15. [PMID: 27323220 DOI: 10.1097/htr.0000000000000245] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE While traumatic brain injury (TBI) is common across the life span, the detailed neurobehavioral characteristics of older adults with prior TBI remain unclear. Our goal was to compare the clinical profile of older independently living veterans with and without prior TBI. SETTING Two veterans' retirement communities. PARTICIPANTS Seventy-five participants with TBI and 71 without (mean age = 78 years). DESIGN Cross-sectional. MAIN MEASURES TBI history was determined by the Ohio State University TBI Questionnaire. We assessed psychiatric and medical history via interviews and chart review and conducted measures assessing functional/lifestyle, psychiatric, and cognitive outcomes. Regression analyses (adjusted for demographics, diabetes, prior depression, substance abuse, and site) were performed to compare between TBI and non-TBI participants. RESULTS Compared with veterans without TBI, those with TBI had greater functional impairment (adjusted P = .05), endorsed more current depressive (adjusted P = .04) and posttraumatic stress disorder symptoms (adjusted P = .01), and had higher rates of prior depression and substance abuse (both adjusted Ps < .01). While composite memory and language scores did not differ between groups, participants with TBI performed worse on tests of executive functioning/processing speed (adjusted P = .01). CONCLUSIONS Our results suggest that TBI may have adverse long-term neurobehavioral consequences and that TBI-exposed adults may require careful screening and follow-up.
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Bethune A, da Costa L, van Niftrik CHB, Feinstein A. Suicidal Ideation After Mild Traumatic Brain Injury: A Consecutive Canadian Sample. Arch Suicide Res 2017; 21:392-402. [PMID: 27310250 DOI: 10.1080/13811118.2016.1199990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to elucidate psychosocial and injury features contributing to SI following concussion or mild traumatic brain injury (mTBI) and the time course for its development. Between 1998 and 2012, a sample of 871 patients referred to a follow-up clinic after concussion treatment in an urban tertiary care ED were consecutively offered enrollment at 3 months post injury. Data from psychiatric and social-demographic assessments were consecutively collected at 2 visits (3 and 6 months after injury) respectively. Chi-square and t-tests were performed to identify associations between variables related with SI. Logistic regression analysis was performed to identify factors independently associated. During the enrolment period, 2,296 patients with mTBI presented to the ED. 871 adults completed psychiatric and social demographic clinic assessments at 3 months, and 500 returned at 6 months. Suicidal ideation was expressed by 6.3% at 3 months and 8.2% at 6 months. Regression models showed SI independently associated with: speaking English as a second language (ESL) and injury mechanism (MVC passenger) at 3 and 6 months; and history of depression and marital status at 3 months only. SI is common 3 months after mTBI, and appears more at 6 month follow up. These findings suggest earlier screening for predisposing factors and closer monitoring of those at risk for suicidality.
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Nagappan PG, Subramaniam S, Wang DY. Olfaction as a soldier-- a review of the physiology and its present and future use in the military. Mil Med Res 2017; 4:9. [PMID: 28344819 PMCID: PMC5359863 DOI: 10.1186/s40779-017-0119-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
Olfaction is one of our 5 main qualitative sensory abilities. In this review, we have examined the physiology of olfaction from the olfactory receptor to the brain. Through analyzing the physiology of olfaction, we have found that the biochemistry of olfactory nerve stimulation is unique from that of other similar pathways. Upon receiving large amounts of input from the olfactory nerve, the olfactory bulb, followed by several layers of centrifugal and centripetal processing in the brain, has to sort the information from the input as well as integrate it with other inputs from the brain to develop a coherent understanding of the input. We then examined the implications of olfaction in the military, the practical applications of electronic noses and problems associated with injury to olfaction that could affect compensation and combat worthiness of a soldier following injury. In the military, olfaction can allow the army to perform at its best through 4 main methods, namely ensuring olfaction is consistent with other dimensions of perception (ensuring optimal olfaction ability in all soldiers in combat), understanding the impact of different common combat environments on the sense of smell, utilizing odor as a defense mechanism and using olfactory aids when necessary. Electronic noses are olfactory aids that have a large potential in the military ranging from saving lives through the detection of explosives to potential methods for improving combustion efficiency. There are several problems associated with injury to olfaction that should be considered when deciding on compensation and combat worthiness of the soldier following an injury.
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Affiliation(s)
| | | | - De-Yun Wang
- Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore.,Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228 Singapore
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Abstract
This article reviews possible ways that traumatic brain injury (TBI) can induce migraine-type post-traumatic headaches (PTHs) in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD), are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.
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Abstract
Chronic pain, especially headache, is an exceedingly common complication of traumatic brain injury (TBI). In fact, paradoxically, the milder the TBI, the more likely one is to develop headaches. The environment of injury and the associated comorbidities can have a significant impact on the frequency and severity of headaches and commonly serve to direct management of the headaches. Trauma likely contributes to the development of headaches via alterations in neuronal signaling, inflammation, and musculoskeletal changes. The clinical picture of the patient with post-traumatic headaches is often that of a mixed headache disorder with features of tension-type headaches as well as migrainous headaches. Treatment of these headaches is thus often guided by the predominant characteristics of the headaches and can include pharmacologic and nonpharmacologic strategies. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, primarily impaired sleep. Nonpharmacologic interventions for post-traumatic headaches include thermal and physical modalities as well as cognitive behavioral approaches. As with many postconcussive symptoms, headaches can lessen with time but in up to 25% of patients, chronic headaches are long-term residua.
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30
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Alosco ML, Jarnagin J, Tripodis Y, Platt M, Martin B, Chaisson CE, Baugh CM, Fritts NG, Cantu RC, Stern RA. Olfactory Function and Associated Clinical Correlates in Former National Football League Players. J Neurotrauma 2016; 34:772-780. [PMID: 27430424 DOI: 10.1089/neu.2016.4536] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Professional American football players incur thousands of repetitive head impacts (RHIs) throughout their lifetime. The long-term consequences of RHI are not well characterized, but may include olfactory dysfunction. RHI has been associated with changes to brain regions involved in olfaction, and olfactory impairment is common after traumatic brain injury. Olfactory dysfunction is a frequent early sequelae of neurodegenerative diseases (e.g., Alzheimer's disease), and RHI is associated with the neurodegenerative disease, chronic traumatic encephalopathy (CTE). We examined olfaction, and its association with clinical measures, in former National Football League (NFL) players. Ninety-five former NFL players (ages 40-69) and 28 same-age controls completed a neuropsychological and neuropsychiatric evaluation as part of a National Institutes of Health-funded study. The Brief Smell Identification Test (B-SIT) assessed olfaction. Principal component analysis generated a four-factor structure of the clinical measures: behavioral/mood, psychomotor speed/executive function, and verbal and visual memory. Former NFL players had worse B-SIT scores relative to controls (p = 0.0096). A B-SIT cutoff of 11 had the greatest accuracy (c-statistic = 0.61) and specificity (79%) for discriminating former NFL players from controls. In the former NFL players, lower B-SIT scores correlated with greater behavioral/mood impairment (p = 0.0254) and worse psychomotor speed/executive functioning (p = 0.0464) after controlling for age and education. Former NFL players exhibited lower olfactory test scores relative to controls, and poorer olfactory test performance was associated with worse neuropsychological and neuropsychiatric functioning. Future work that uses more-comprehensive tests of olfaction and structural and functioning neuroimaging may improve understanding on the association between RHI and olfaction.
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Affiliation(s)
- Michael L Alosco
- 1 Department of Neurology, Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Johnny Jarnagin
- 2 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Yorghos Tripodis
- 3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Michael Platt
- 4 Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine , Boston, Massachusetts
| | - Brett Martin
- 2 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Christine E Chaisson
- 2 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,6 Department of Biostatistics, Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Christine M Baugh
- 1 Department of Neurology, Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,7 Interfaculty Initiative in Health Policy , Cambridge, Massachusetts
| | - Nathan G Fritts
- 2 Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Robert C Cantu
- 8 Department of Neurology and Neurosurgery, Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Robert A Stern
- 1 Department of Neurology, Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,8 Department of Neurology and Neurosurgery, Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston, Massachusetts.,9 Department of Anatomy & Neurobiology, Boston University School of Medicine , Boston, Massachusetts
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31
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Shively SB, Horkayne-Szakaly I, Jones RV, Kelly JP, Armstrong RC, Perl DP. Characterisation of interface astroglial scarring in the human brain after blast exposure: a post-mortem case series. Lancet Neurol 2016; 15:944-953. [DOI: 10.1016/s1474-4422(16)30057-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/07/2016] [Accepted: 04/18/2016] [Indexed: 01/23/2023]
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Abstract
OBJECTIVES Recent advances in neuroimaging methodologies sensitive to axonal injury have made it possible to assess in vivo the extent of traumatic brain injury (TBI) -related disruption in neural structures and their connections. The objective of this paper is to review studies examining connectivity in TBI with an emphasis on structural and functional MRI methods that have proven to be valuable in uncovering neural abnormalities associated with this condition. METHODS We review studies that have examined white matter integrity in TBI of varying etiology and levels of severity, and consider how findings at different times post-injury may inform underlying mechanisms of post-injury progression and recovery. Moreover, in light of recent advances in neuroimaging methods to study the functional connectivity among brain regions that form integrated networks, we review TBI studies that use resting-state functional connectivity MRI methodology to examine neural networks disrupted by putative axonal injury. RESULTS The findings suggest that TBI is associated with altered structural and functional connectivity, characterized by decreased integrity of white matter pathways and imbalance and inefficiency of functional networks. These structural and functional alterations are often associated with neurocognitive dysfunction and poor functional outcomes. CONCLUSIONS TBI has a negative impact on distributed brain networks that lead to behavioral disturbance.
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Xydakis MS, Mulligan LP, Smith AB, Olsen CH, Lyon DM, Belluscio L. Olfactory impairment and traumatic brain injury in blast-injured combat troops: a cohort study. Neurology 2015; 84:1559-67. [PMID: 25788559 PMCID: PMC4408285 DOI: 10.1212/wnl.0000000000001475] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/05/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine whether a structured and quantitative assessment of differential olfactory performance-recognized between a blast-injured traumatic brain injury (TBI) group and a demographically comparable blast-injured control group-can serve as a reliable antecedent marker for preclinical detection of intracranial neurotrauma. METHODS We prospectively and consecutively enrolled 231 polytrauma inpatients, acutely injured from explosions during combat operations in either Afghanistan or Iraq and requiring immediate stateside evacuation and sequential admission to our tertiary care medical center over a 2½-year period. This study correlates olfactometric scores with both contemporaneous neuroimaging findings as well as the clinical diagnosis of TBI, tabulates population-specific incidence data, and investigates return of olfactory function. RESULTS Olfactometric score predicted abnormal neuroimaging significantly better than chance alone (area under the curve = 0.78, 95% confidence interval [CI] 0.70-0.87). Normosmia was present in all troops with mild TBI (i.e., concussion) and all control subjects. Troops with radiographic evidence of frontal lobe injuries were 3 times more likely to have olfactory impairment than troops with injuries to other brain regions (relative risk 3.0, 95% CI 0.98-9.14). Normalization of scores occurred in all anosmic troops available for follow-up testing. CONCLUSION Quantitative identification olfactometry has limited sensitivity but high specificity as a marker for detecting acute structural neuropathology from trauma. When considering whether to order advanced neuroimaging, a functional disturbance with central olfactory impairment should be regarded as an important tool to inform the decision process. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that central olfactory dysfunction identifies patients with TBI who have intracranial radiographic abnormalities with a sensitivity of 35% (95% CI 20.6%-51.7%) and specificity of 100% (95% CI 97.7%-100.0%).
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Affiliation(s)
- Michael S Xydakis
- From Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.), Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), Neuroradiology (A.B.S.), Preventive Medicine & Biostatistics (C.H.O.), Uniformed Services University (M.S.X., L.P.M., A.B.S., D.M.L.), Bethesda; and Neurological Disorders and Stroke (L.B.), National Institutes of Health, Bethesda, MD.
| | - Lisa P Mulligan
- From Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.), Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), Neuroradiology (A.B.S.), Preventive Medicine & Biostatistics (C.H.O.), Uniformed Services University (M.S.X., L.P.M., A.B.S., D.M.L.), Bethesda; and Neurological Disorders and Stroke (L.B.), National Institutes of Health, Bethesda, MD
| | - Alice B Smith
- From Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.), Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), Neuroradiology (A.B.S.), Preventive Medicine & Biostatistics (C.H.O.), Uniformed Services University (M.S.X., L.P.M., A.B.S., D.M.L.), Bethesda; and Neurological Disorders and Stroke (L.B.), National Institutes of Health, Bethesda, MD
| | - Cara H Olsen
- From Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.), Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), Neuroradiology (A.B.S.), Preventive Medicine & Biostatistics (C.H.O.), Uniformed Services University (M.S.X., L.P.M., A.B.S., D.M.L.), Bethesda; and Neurological Disorders and Stroke (L.B.), National Institutes of Health, Bethesda, MD
| | - Dina M Lyon
- From Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.), Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), Neuroradiology (A.B.S.), Preventive Medicine & Biostatistics (C.H.O.), Uniformed Services University (M.S.X., L.P.M., A.B.S., D.M.L.), Bethesda; and Neurological Disorders and Stroke (L.B.), National Institutes of Health, Bethesda, MD
| | - Leonardo Belluscio
- From Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.), Otorhinolaryngology/Head & Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), Neuroradiology (A.B.S.), Preventive Medicine & Biostatistics (C.H.O.), Uniformed Services University (M.S.X., L.P.M., A.B.S., D.M.L.), Bethesda; and Neurological Disorders and Stroke (L.B.), National Institutes of Health, Bethesda, MD
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Mac Donald CL, Adam OR, Johnson AM, Nelson EC, Werner NJ, Rivet DJ, Brody DL. Acute post-traumatic stress symptoms and age predict outcome in military blast concussion. Brain 2015; 138:1314-26. [PMID: 25740219 DOI: 10.1093/brain/awv038] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/16/2014] [Indexed: 11/13/2022] Open
Abstract
High rates of adverse outcomes have been reported following blast-related concussive traumatic brain injury in US military personnel, but the extent to which such adverse outcomes can be predicted acutely after injury is unknown. We performed a prospective, observational study of US military personnel with blast-related concussive traumatic brain injury (n = 38) and controls (n = 34) enrolled between March and September 2012. Importantly all subjects returned to duty and did not require evacuation. Subjects were evaluated acutely 0-7 days after injury at two sites in Afghanistan and again 6-12 months later in the United States. Acute assessments revealed heightened post-concussive, post-traumatic stress, and depressive symptoms along with worse cognitive performance in subjects with traumatic brain injury. At 6-12 months follow-up, 63% of subjects with traumatic brain injury and 20% of controls had moderate overall disability. Subjects with traumatic brain injury showed more severe neurobehavioural, post-traumatic stress and depression symptoms along with more frequent cognitive performance deficits and more substantial headache impairment than control subjects. Logistic regression modelling using only acute measures identified that a diagnosis of traumatic brain injury, older age, and more severe post-traumatic stress symptoms provided a good prediction of later adverse global outcomes (area under the receiver-operating characteristic curve = 0.84). Thus, US military personnel with concussive blast-related traumatic brain injury in Afghanistan who returned to duty still fared quite poorly on many clinical outcome measures 6-12 months after injury. Poor global outcome seems to be largely driven by psychological health measures, age, and traumatic brain injury status. The effects of early interventions and longer term implications of these findings are unknown.
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Affiliation(s)
- Christine L Mac Donald
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Octavian R Adam
- 2 Naval Medical Centre Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708 USA
| | - Ann M Johnson
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Elliot C Nelson
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Nicole J Werner
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Dennis J Rivet
- 2 Naval Medical Centre Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708 USA
| | - David L Brody
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
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Fonda JR, Hunt PR, McGlinchey RE, Rudolph JL, Milberg WP, Reynolds MW, Yonan C. Identification of pseudobulbar affect symptoms in Veterans with possible traumatic brain injury. ACTA ACUST UNITED AC 2015; 52:839-49. [DOI: 10.1682/jrrd.2014.08.0191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 05/29/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Jennifer R. Fonda
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, Boston, MA
| | | | - Regina E. McGlinchey
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, Boston, MA
| | - James L. Rudolph
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, Boston, MA;Medicine, Harvard Medical School, Boston, MA
| | - William P. Milberg
- Translational Research Center for Traumatic Brain Injury and Stress Disorders, and Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, Boston, MA
| | | | - Charles Yonan
- Health Economics and Outcomes Research, Avanir Pharmaceuticals Inc, Aliso Viejo, CA
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Elder GA, Stone JR, Ahlers ST. Effects of low-level blast exposure on the nervous system: is there really a controversy? Front Neurol 2014; 5:269. [PMID: 25566175 PMCID: PMC4271615 DOI: 10.3389/fneur.2014.00269] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/29/2014] [Indexed: 12/20/2022] Open
Abstract
High-pressure blast waves can cause extensive CNS injury in human beings. However, in combat settings, such as Iraq and Afghanistan, lower level exposures associated with mild traumatic brain injury (mTBI) or subclinical exposure have been much more common. Yet controversy exists concerning what traits can be attributed to low-level blast, in large part due to the difficulty of distinguishing blast-related mTBI from post-traumatic stress disorder (PTSD). We describe how TBI is defined in human beings and the problems posed in using current definitions to recognize blast-related mTBI. We next consider the problem of applying definitions of human mTBI to animal models, in particular that TBI severity in human beings is defined in relation to alteration of consciousness at the time of injury, which typically cannot be assessed in animals. However, based on outcome assessments, a condition of "low-level" blast exposure can be defined in animals that likely approximates human mTBI or subclinical exposure. We review blast injury modeling in animals noting that inconsistencies in experimental approach have contributed to uncertainty over the effects of low-level blast. Yet, animal studies show that low-level blast pressure waves are transmitted to the brain. In brain, low-level blast exposures cause behavioral, biochemical, pathological, and physiological effects on the nervous system including the induction of PTSD-related behavioral traits in the absence of a psychological stressor. We review the relationship of blast exposure to chronic neurodegenerative diseases noting the paradoxical lowering of Abeta by blast, which along with other observations suggest that blast-related TBI is pathophysiologically distinct from non-blast TBI. Human neuroimaging studies show that blast-related mTBI is associated with a variety of chronic effects that are unlikely to be explained by co-morbid PTSD. We conclude that abundant evidence supports low-level blast as having long-term effects on the nervous system.
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Affiliation(s)
- Gregory A. Elder
- Neurology Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James R. Stone
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Stephen T. Ahlers
- Department of Neurotrauma, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
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Theeler B, Lucas S, Riechers RG, Ruff RL. Post-traumatic headaches in civilians and military personnel: a comparative, clinical review. Headache 2014; 53:881-900. [PMID: 23721236 DOI: 10.1111/head.12123] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2013] [Indexed: 12/14/2022]
Abstract
Post-traumatic headache (PTH) is the most frequent symptom after traumatic brain injury (TBI). We review the epidemiology and characterization of PTH in military and civilian settings. PTH appears to be more likely to develop following mild TBI (concussion) compared with moderate or severe TBI. PTH often clinically resembles primary headache disorders, usually migraine. For migraine-like PTH, individuals who had the most severe headache pain had the highest headache frequencies. Based on studies to date in both civilian and military settings, we recommend changes to the current definition of PTH. Anxiety disorders such as post-traumatic stress disorder (PTSD) are frequently associated with TBI, especially in military populations and in combat settings. PTSD can complicate treatment of PTH as a comorbid condition of post-concussion syndrome. PTH should not be treated as an isolated condition. Comorbid conditions such as PTSD and sleep disturbances also need to be treated. Double-blind placebo-controlled trials in PTH population are necessary to see whether similar phenotypes in the primary headache disorders and PTH will respond similarly to treatment. Until blinded treatment trials are completed, we suggest that, when possible, PTH be treated as one would treat the primary headache disorder(s) that the PTH most closely resembles.
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Affiliation(s)
- Brett Theeler
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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MacDonald CL, Johnson AM, Nelson EC, Werner NJ, Fang R, Flaherty SF, Brody DL. Functional status after blast-plus-impact complex concussive traumatic brain injury in evacuated United States military personnel. J Neurotrauma 2014; 31:889-98. [PMID: 24367929 DOI: 10.1089/neu.2013.3173] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fundamental questions remain unanswered about the longitudinal impact of blast-plus-impact complex traumatic brain injuries (TBI) from wars in Iraq and Afghanistan. This prospective, observational study investigated measures of clinical outcome in US military personnel evacuated to Landstuhl Regional Medical Center (LRMC) in Germany after such "blast-plus" concussive TBIs. Glasgow Outcome Scale-Extended assessments completed 6-12 months after injury indicated a moderate overall disability in 41/47 (87%) blast-plus TBI subjects and a substantial but smaller number (11/18, 61%, p=0.018) of demographically similar US military controls without TBI evacuated for other medical reasons. Cognitive function assessed with a neuropsychological test battery was not different between blast-plus TBI subjects and controls; performance of both groups was generally in the normal range. No subject was found to have focal neurological deficits. However, 29/47 (57%) of blast-plus subjects with TBI met all criteria for post-traumatic stress disorder (PTSD) versus 5/18 (28%) of controls (p=0.014). PTSD was highly associated with overall disability; 31/34 patients with PTSD versus 19/31 patients who did not meet full PTSD criteria had moderate to severe disability (p=0.0003). Symptoms of depression were also more severe in the TBI group (p=0.05), and highly correlated with PTSD severity (r=0.86, p<0.0001). Thus, in summary, high rates of PTSD and depression but not cognitive impairment or focal neurological deficits were observed 6-12 months after concussive blast-plus-impact complex TBI. Overall disability was substantially greater than typically reported in civilian non-blast concussive ("mild") patients with TBI, even with polytrauma. The relationship between these clinical outcomes and specific blast-related aspects of brain injuries versus other combat-related factors remains unknown.
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O'Neil ME, Carlson KF, Storzbach D, Brenner LA, Freeman M, Quiñones AR, Motu'apuaka M, Kansagara D. Factors Associated with Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review. J Int Neuropsychol Soc 2014; 20:1-13. [PMID: 24499707 DOI: 10.1017/s135561771300146x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A history of mild traumatic brain injury (mTBI) is common among military members who served in Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). We completed a systematic review to describe the cognitive, mental health, physical health, functional, social, and cost consequences of mTBI in Veteran and military personnel. Of 2668 reviewed abstracts, the 31 included studies provided very low strength evidence for the questions of interest. Cognitive, physical, and mental health symptoms were commonly reported by Veterans/military members with a history of mTBI. On average, these symptoms were not significantly more common in those with a history of mTBI than in those without, although a lack of significant mean differences does not preclude the possibility that some individuals could experience substantial effects related to mTBI history. Evidence of potential risk or protective factors moderating mTBI outcomes was unclear. Although the overall strength of evidence is very low due to methodological limitations of included studies, our findings are consistent with civilian studies. Appropriate re-integration services are needed to address common comorbid conditions, such as treatment for post-traumatic stress disorder, substance use disorders, headaches, and other difficulties that Veterans and members of the military may experience after deployment regardless of mTBI history. (JINS, 2014, 20, 1-13).
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Affiliation(s)
| | | | | | - Lisa A Brenner
- 5 Denver VA Medical Center, VISN 19 MIRECC, Denver, Colorado
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41
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Ommaya AK, Adams KM, Allman RM, Collins EG, Cooper RA, Dixon CE, Fishman PS, Henry JA, Kardon R, Kerns RD, Kupersmith J, Lo A, Macko R, McArdle R, McGlinchey RE, McNeil MR, O'Toole TP, Peckham PH, Tuszynski MH, Waxman SG, Wittenberg GF. Guest editorial: Opportunities in rehabilitation research. ACTA ACUST UNITED AC 2013; 50:vii-xxxii. [PMID: 24203548 DOI: 10.1682/jrrd.2012.09.0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Baxter D, Sharp DJ, Feeney C, Papadopoulou D, Ham TE, Jilka S, Hellyer PJ, Patel MC, Bennett AN, Mistlin A, McGilloway E, Midwinter M, Goldstone AP. Pituitary dysfunction after blast traumatic brain injury: The UK BIOSAP study. Ann Neurol 2013; 74:527-36. [PMID: 23794460 PMCID: PMC4223931 DOI: 10.1002/ana.23958] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/08/2013] [Accepted: 05/24/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pituitary dysfunction is a recognized consequence of traumatic brain injury (TBI) that causes cognitive, psychological, and metabolic impairment. Hormone replacement offers a therapeutic opportunity. Blast TBI (bTBI) from improvised explosive devices is commonly seen in soldiers returning from recent conflicts. We investigated: (1) the prevalence and consequences of pituitary dysfunction following moderate to severe bTBI and (2) whether it is associated with particular patterns of brain injury. METHODS Nineteen male soldiers with moderate to severe bTBI (median age = 28.3 years) and 39 male controls with moderate to severe nonblast TBI (nbTBI; median age = 32.3 years) underwent full dynamic endocrine assessment between 2 and 48 months after injury. In addition, soldiers had structural brain magnetic resonance imaging, including diffusion tensor imaging (DTI), and cognitive assessment. RESULTS Six of 19 (32.0%) soldiers with bTBI, but only 1 of 39 (2.6%) nbTBI controls, had anterior pituitary dysfunction (p = 0.004). Two soldiers had hyperprolactinemia, 2 had growth hormone (GH) deficiency, 1 had adrenocorticotropic hormone (ACTH) deficiency, and 1 had combined GH/ACTH/gonadotrophin deficiency. DTI measures of white matter structure showed greater traumatic axonal injury in the cerebellum and corpus callosum in those soldiers with pituitary dysfunction than in those without. Soldiers with pituitary dysfunction after bTBI also had a higher prevalence of skull/facial fractures and worse cognitive function. Four soldiers (21.1%) commenced hormone replacement(s) for hypopituitarism. INTERPRETATION We reveal a high prevalence of anterior pituitary dysfunction in soldiers suffering moderate to severe bTBI, which was more frequent than in a matched group of civilian moderate to severe nbTBI subjects. We recommend that all patients with moderate to severe bTBI should routinely have comprehensive assessment of endocrine function.
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Affiliation(s)
- David Baxter
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London; Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham
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Crum-Cianflone NF, Jacobson I. Gender differences of postdeployment post-traumatic stress disorder among service members and veterans of the Iraq and Afghanistan conflicts. Epidemiol Rev 2013; 36:5-18. [PMID: 23988441 DOI: 10.1093/epirev/mxt005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite the marked expansion of roles for women in the US military over the last decade, whether differences by gender exist in regard to the development of mental health conditions postdeployment is unclear. This comprehensive review of the literature (2001-2012) examined whether US servicewomen were more likely than men to experience post-traumatic stress disorder (PTSD) after returning from deployments to the Iraq and Afghanistan conflicts. Findings from 18 studies from 8 unique study populations were reviewed. Seven studies found that women had a higher risk for screening positive for PTSD compared with men, including prospectively designed studies that evaluated new-onset PTSD among members from all service branches. Although results from studies with Veterans Affairs samples found women at decreased risk in 4 analyses, these studies used the same source databases, were conducted in treatment-seeking populations, and were mostly unable to account for combat experience. Seven studies detected no differences by gender. In summary, women appeared to have a moderately higher risk for postdeployment PTSD, although there was a lack of consensus among the studies, and even those with the most rigorous methods were not designed specifically to evaluate potential gender differences. Given the limitations of the published literature, further research should use longitudinal study designs and comprehensive evaluations of deployment experiences while adjusting for predeployment factors to confirm that gender differences exist with regard to postdeployment PTSD.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; MST, military-related sexual trauma; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; PCL-C, PTSD Checklist Civilian Version; PTSD, post-traumatic stress disorder; VA, Veterans Administration
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DeKosky ST, Blennow K, Ikonomovic MD, Gandy S. Acute and chronic traumatic encephalopathies: pathogenesis and biomarkers. Nat Rev Neurol 2013; 9:192-200. [PMID: 23558985 PMCID: PMC4006940 DOI: 10.1038/nrneurol.2013.36] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over the past decade, public awareness of the long-term pathological consequences of traumatic brain injury (TBI) has increased. Such awareness has been stimulated mainly by reports of progressive neurological dysfunction in athletes exposed to repetitive concussions in high-impact sports such as boxing and American football, and by the rising number of TBIs in war veterans who are now more likely to survive explosive blasts owing to improved treatment. Moreover, the entity of chronic traumatic encephalopathy (CTE)--which is marked by prominent neuropsychiatric features including dementia, parkinsonism, depression, agitation, psychosis, and aggression--has become increasingly recognized as a potential late outcome of repetitive TBI. Annually, about 1% of the population in developed countries experiences a clinically relevant TBI. The goal of this Review is to provide an overview of the latest understanding of CTE pathophysiology, and to delineate the key issues that are challenging clinical and research communities, such as accurate quantification of the risk of CTE, and development of reliable biomarkers for single-incident TBI and CTE.
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Affiliation(s)
- Steven T DeKosky
- Office of the Dean and Department of Neurology, University of Virginia School of Medicine, P. O. Box 800793, Charlottesville, VA 22908, USA.
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45
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Park E, Eisen R, Kinio A, Baker AJ. Electrophysiological white matter dysfunction and association with neurobehavioral deficits following low-level primary blast trauma. Neurobiol Dis 2013; 52:150-9. [PMID: 23238347 DOI: 10.1016/j.nbd.2012.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/02/2012] [Accepted: 12/03/2012] [Indexed: 01/31/2023] Open
Affiliation(s)
- Eugene Park
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada.
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46
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Peskind ER, Brody D, Cernak I, McKee A, Ruff RL. Military- and sports-related mild traumatic brain injury: clinical presentation, management, and long-term consequences. J Clin Psychiatry 2013; 74:180-8; quiz 188. [PMID: 23473351 PMCID: PMC5904388 DOI: 10.4088/jcp.12011co1c] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CME Background Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results. Participants may receive credit by reading the article, correctly answering at least 70% of the questions in the Posttest, and completing the Evaluation. The Posttest and Evaluation are now available online only at PSYCHIATRIST.COM (Keyword: February). CME Objective After studying the Commentary by Peskind et al, you should be able to: Accreditation Statement The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit Designation The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Note The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit ™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1 hour of Category I credit for completing this program. Date of Original Release/Review This educational activity is eligible for AMA PRA Category 1 Credit ™ through February 29, 2016. The latest review of this material was January 2013.
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Affiliation(s)
- Elaine R Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Stroupe KT, Smith BM, Hogan TP, St. Andre JR, Pape T, Steiner ML, Proescher E, Huo Z, Evans CT. Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury. ACTA ACUST UNITED AC 2013; 50:1047-68. [DOI: 10.1682/jrrd.2012.06.0107] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 01/31/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Kevin T. Stroupe
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL
| | - Bridget M. Smith
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL
| | - Timothy P. Hogan
- Center for Health Quality, Outcomes and Economic Research & eHealth QUERI, National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; and Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA
| | | | - Theresa Pape
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL;Physical Medicine and Rehabilitation, Edward Hines Jr. VA Hospital, Hines, IL
| | - Monica L. Steiner
- Physical Medicine and Rehabilitation, Edward Hines Jr. VA Hospital, Hines, IL
| | | | - Zhiping Huo
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL
| | - Charlesnika T. Evans
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL;Spinal Cord Injury Quality Enhancement Research Initiative (QUERI), Edward Hines Jr. VA Hospital, Hines, IL;Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
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