1
|
Thorne J, Hellewell SC, Cowen G, Ring A, Jefferson A, Chih H, Gozt AK, Buhagiar F, Thomas E, Papini M, Bynevelt M, Celenza A, Xu D, Honeybul S, Pestell CF, Fatovich D, Fitzgerald M. Symptoms Associated With Exercise Intolerance and Resting Heart Rate Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00129. [PMID: 38453632 DOI: 10.1097/htr.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVES People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterized. This study sought to investigate the association between symptoms, resting heart rate (HR), and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery. METHODS Prospective observational study of adults aged 18 to 65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest, and exercise tolerance was assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR. RESULTS Data from 32 participants were assessed (mean age 36.5 ± 12.6 years, 41% female, 5.7 ± 1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (P = .002 and P = .025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (P = .001 and P = .014, respectively), with individuals who were exercise intolerant having a higher mean number of symptoms in each profile than those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with a higher resting HR (>80 bpm) (P = .048 and P = .028, respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sports- or non-sports-related), having a higher mood-related clinical profile was associated with persisting symptoms at 3 months postinjury (adjusted odds ratio = 2.08; 95% CI, 1.11-3.90; P = .013). CONCLUSION Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI.
Collapse
Affiliation(s)
- Jacinta Thorne
- Author Affiliations: School of Allied Health (Ms Thorne and Mr Ring) and Curtin Medical School (Drs Cowen, Jefferson, and Xu), Faculty of Health Sciences, Curtin Health Innovation Research Institute (Mss Thorne and Papini and Drs Hellewell, Cowen, Gozt, Pestell, and Fitzgerald), and School of Population Health (Drs Chih, Thomas, and Xu), Curtin University, Bentley, Western Australia; Perron Institute for Neurological and Translational Science, Nedlands, Western Australia (Mss Thorne and Papini and Drs Hellewell, Gozt, and Fitzgerald); Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia (Mr Ring); School of Psychological Science (Drs Buhagiar and Pestell) and Divisions of Surgery (Dr Thomas) and Emergency Medicine (Dr Celenza), School of Medicine, The University of Western Australia, Nedlands, Western Australia; Neurological Intervention & Imaging Service of Western Australia (Dr Bynevelt) and Emergency Department (Dr Celenza), Sir Charles Gairdner Hospital, Nedlands, Western Australia; The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Dr Xu); Sir Charles Gairdner, Royal Perth and Fiona Stanley Hospitals, Perth, Western Australia (Dr Honeybul); Emergency Medicine, Royal Perth Hospital, University of Western Australia (Dr Fatovich); and Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Western Australia (Dr Fatovich)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Imms P, Chowdhury NF, Chaudhari NN, Amgalan A, Poudel G, Caeyenberghs K, Irimia A. Prediction of cognitive outcome after mild traumatic brain injury from acute measures of communication within brain networks. Cortex 2024; 171:397-412. [PMID: 38103453 PMCID: PMC10922490 DOI: 10.1016/j.cortex.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/04/2023] [Accepted: 10/20/2023] [Indexed: 12/19/2023]
Abstract
A considerable but ill-defined proportion of patients with mild traumatic brain injury (mTBI) experience persistent cognitive sequelae; the ability to identify such individuals early can help their neurorehabilitation. Here we tested the hypothesis that acute measures of efficient communication within brain networks are associated with patients' risk for unfavorable cognitive outcome six months after mTBI. Diffusion and T1-weighted magnetic resonance imaging, alongside cognitive measures, were obtained to map connectomes both one week and six months post injury in 113 adult patients with mTBI (71 males). For task-related brain networks, communication measures (characteristic path length, global efficiency, navigation efficiency) were moderately correlated with changes in cognition. Taking into account the covariance of age and sex, more unfavorable communication within networks were associated with worse outcomes within cognitive domains frequently impacted by mTBI (episodic and working memory, verbal fluency, inductive reasoning, and processing speed). Individuals with more unfavorable outcomes had significantly longer and less efficient pathways within networks supporting verbal fluency (all t > 2.786, p < .006), highlighting the vulnerability of language to mTBI. Participants in whom a task-related network was relatively inefficient one week post injury were up to eight times more likely to have unfavorable cognitive outcome pertaining to that task. Our findings suggest that communication measures within task-related networks identify mTBI patients who are unlikely to develop persistent cognitive deficits after mTBI. Our approach and findings can help to stratify mTBI patients according to their expected need for follow-up and/or neurorehabilitation.
Collapse
Affiliation(s)
- Phoebe Imms
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA.
| | - Nahian F Chowdhury
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA.
| | - Nikhil N Chaudhari
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA; Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA USA.
| | - Anar Amgalan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA.
| | - Govinda Poudel
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne Burwood Campus, Burwood, VIC, Australia.
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA; Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA USA; Department of Quantitative & Computational Biology, Dana and David Dornsife College of Arts & Sciences, University of Southern California, Los Angeles, CA USA.
| |
Collapse
|
3
|
Kopczynski A, Carteri RB, Rodolphi MS, Oses JP, Portela LO, Geller CA, de Oliveira VG, De Bastiani MA, Strogulski NR, Smith DH, Portela LV. Lower and higher volumes of physical exercise build up brain reserves against memory deficits triggered by a head injury in mice. Exp Neurol 2023; 363:114352. [PMID: 36813223 PMCID: PMC10103909 DOI: 10.1016/j.expneurol.2023.114352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Decreasing neurotrophic support and impaired mitochondrial bioenergetics are key mechanisms for long-term neurodegeneration and cognitive decline after traumatic brain injury (TBI). We hypothesize that preconditioning with lower and higher volumes of physical exercise upregulates the CREB-BDNF axis and bioenergetic capability, which might serve as neural reserves against cognitive impairment after severe TBI. Using a running wheel mounted in the home cage, mice were engaged in lower (LV, 48 h free access, and 48 h locked) and higher (HV, daily free access) exercise volumes for thirty days. Subsequently, LV and HV mice remained for additional thirty days in the home cage with the running wheel locked and were euthanized. The sedentary group had the running wheel always locked. For the same type of exercise stimulus in a given time, daily workout presents higher volume than alternate days workout. The total distance ran in the wheel was the reference parameter to confirm distinct exercise volumes. On average, LV exercise ran 27.522 m and HV exercise ran 52.076 m. Primarily, we investigate whether LV and HV protocols increase neurotrophic and bioenergetic support in the hippocampus thirty days after exercise ceased. Regardless of volume, exercise increased hippocampal pCREBSer133-CREB-proBDNF-BDNF signaling and mitochondrial coupling efficiency, excess capacity, and leak control, that may compose the neurobiological basis for neural reserves. Further, we challenge these neural reserves against secondary memory deficits triggered by a severe TBI. After thirty days of exercise LV and HV, and sedentary (SED) mice were submitted to the CCI model. Mice remained for additional thirty days in the home cage with the running wheel locked. The mortality after severe TBI was approximately 20% in LV and HV, while in the SED was 40%. Also, LV and HV exercise sustained hippocampal pCREBSer133-CREB-proBDNF-BDNF signaling, mitochondrial coupling efficiency, excess capacity, and leak control for thirty days after severe TBI. Corroborating these benefits, the mitochondrial H2O2 production linked to complexes I and II was attenuated by exercise regardless of the volume. These adaptations attenuated spatial learning and memory deficits caused by TBI. In summary, preconditioning with LV and HV exercise builds up long-lasting CREB-BDNF and bioenergetic neural reserves that preserve memory fitness after severe TBI.
Collapse
Affiliation(s)
- Afonso Kopczynski
- Laboratório de Neurotrauma e Biomarcadores, Departamento de Bioquímica, Programa de Pós-Graduação em Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | - Randhall B Carteri
- Laboratório de Neurotrauma e Biomarcadores, Departamento de Bioquímica, Programa de Pós-Graduação em Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil; Centro Universitário Metodista, Departamento de Nutrição, Instituto Porto Alegre, IPA, Porto Alegre, Brazil; CESUCA Centro Universitário, Departamento de Nutrição, Cachoeirinha, RS, Brazil
| | - Marcelo S Rodolphi
- Laboratório de Neurotrauma e Biomarcadores, Departamento de Bioquímica, Programa de Pós-Graduação em Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | - Jean P Oses
- Programa de Pós-Graduação em Ciências Fisiológicas, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Luiz O Portela
- Laboratório de Performance em Ambiente Simulado (LAPAS), Centro de Educação Física, Universidade Federal de Santa Maria - UFSM, Santa Maria, RS, Brazil
| | - Cesar A Geller
- Laboratório de Performance em Ambiente Simulado (LAPAS), Centro de Educação Física, Universidade Federal de Santa Maria - UFSM, Santa Maria, RS, Brazil
| | - Vitória G de Oliveira
- Laboratório de Neurotrauma e Biomarcadores, Departamento de Bioquímica, Programa de Pós-Graduação em Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | - Marco Antonio De Bastiani
- Zimmer Neuroimaging Lab, Departamento de Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Nathan R Strogulski
- Laboratório de Neurotrauma e Biomarcadores, Departamento de Bioquímica, Programa de Pós-Graduação em Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil; School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - Douglas H Smith
- Penn Center for Brain Injury and Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Luis V Portela
- Laboratório de Neurotrauma e Biomarcadores, Departamento de Bioquímica, Programa de Pós-Graduação em Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil.
| |
Collapse
|
4
|
Choi Y, Park JH, Hong KJ, Ro YS, Song KJ, Shin SD. Development and validation of a prehospital-stage prediction tool for traumatic brain injury: a multicentre retrospective cohort study in Korea. BMJ Open 2022; 12:e055918. [PMID: 35022177 PMCID: PMC8756263 DOI: 10.1136/bmjopen-2021-055918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Predicting diagnosis and prognosis of traumatic brain injury (TBI) at the prehospital stage is challenging; however, using comprehensive prehospital information and machine learning may improve the performance of the predictive model. We developed and tested predictive models for TBI that use machine learning algorithms using information that can be obtained in the prehospital stage. DESIGN This was a multicentre retrospective study. SETTING AND PARTICIPANTS This study was conducted at three tertiary academic emergency departments (EDs) located in an urban area of South Korea. The data from adult patients with severe trauma who were assessed by emergency medical service providers and transported to three participating hospitals between 2014 to 2018 were analysed. RESULTS We developed and tested five machine learning algorithms-logistic regression analyses, extreme gradient boosting, support vector machine, random forest and elastic net (EN)-to predict TBI, TBI with intracranial haemorrhage or injury (TBI-I), TBI with ED or admission result of admission or transferred (TBI with non-discharge (TBI-ND)) and TBI with ED or admission result of death (TBI-D). A total of 1169 patients were included in the final analysis, and the proportions of TBI, TBI-I, TBI-ND and TBI-D were 24.0%, 21.5%, 21.3% and 3.7%, respectively. The EN model yielded an area under receiver-operator curve of 0.799 for TBI, 0.844 for TBI-I, 0.811 for TBI-ND and 0.871 for TBI-D. The EN model also yielded the highest specificity and significant reclassification improvement. Variables related to loss of consciousness, Glasgow Coma Scale and light reflex were the three most important variables to predict all outcomes. CONCLUSION Our results inform the diagnosis and prognosis of TBI. Machine learning models resulted in significant performance improvement over that with logistic regression analyses, and the best performing model was EN.
Collapse
Affiliation(s)
- Yeongho Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|