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So I, Meusel LAC, Sharma B, Monette GA, Colella B, Wheeler AL, Rabin JS, Mikulis DJ, Green REA. Longitudinal Patterns of Functional Connectivity in Moderate-to-Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:665-682. [PMID: 36367163 DOI: 10.1089/neu.2022.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Longitudinal neuroimaging studies aid our understanding of recovery mechanisms in moderate-to-severe traumatic brain injury (TBI); however, there is a dearth of longitudinal functional connectivity research. Our aim was to characterize longitudinal functional connectivity patterns in two clinically important brain networks, the frontoparietal network (FPN) and the default mode network (DMN), in moderate-to-severe TBI. This inception cohort study of prospectively collected longitudinal data used resting-state functional magnetic resonance imaging (fMRI) to characterize functional connectivity patterns in the FPN and DMN. Forty adults with moderate-to-severe TBI (mean ± standard deviation [SD]; age = 39.53 ± 16.49 years, education = 13.92 ± 3.20 years, lowest Glasgow Coma Scale score = 6.63 ± 3.24, sex = 70% male) were scanned at approximately 0.5, 1-1.5, and 3+ years post-injury. Seventeen healthy, uninjured participants (mean ± SD; age = 38.91 ± 15.57 years, education = 15.11 ± 2.71 years, sex = 29% male) were scanned at baseline and approximately 11 months afterwards. Group independent component analyses and linear mixed-effects modeling with linear splines that contained a knot at 1.5 years post-injury were employed to investigate longitudinal network changes, and associations with covariates, including age, sex, and injury severity. In patients with TBI, functional connectivity in the right FPN increased from approximately 0.5 to 1.5 years post-injury (unstandardized estimate = 0.19, standard error [SE] = 0.07, p = 0.009), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.21, SE = 0.11, p = 0.009), and marginally declined afterwards (estimate = -0.10, SE = 0.06, p = 0.079). Functional connectivity in the DMN increased from approximately 0.5 to 1.5 years (estimate = 0.15, SE = 0.05, p = 0.006), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.19, SE = 0.08, p = 0.021), and was estimated to decline from 1.5 to 3+ years (estimate = -0.04, SE = 0.04, p = 0.303). Similarly, the left FPN increased in functional connectivity from approximately 0.5 to 1.5 years post-injury (estimate = 0.15, SE = 0.05, p = 0.002), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.18, SE = 0.07, p = 0.008), and was estimated to decline thereafter (estimate = -0.04, SE = 0.03, p = 0.254). At approximately 0.5 years post-injury, patients showed hypoconnectivity compared with healthy, uninjured participants at baseline. Covariates were not significantly associated in any of the models. Findings of early improvement but a tapering and possible decline in connectivity thereafter suggest that compensatory effects are time-limited. These later reductions in connectivity mirror growing evidence of behavioral and structural decline in chronic moderate-to-severe TBI. Targeting such declines represents a novel avenue of research and offers potential for improving clinical outcomes.
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Affiliation(s)
- Isis So
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Liesel-Ann C Meusel
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Bhanu Sharma
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Medical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Georges A Monette
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Brenda Colella
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada
| | - Robin E A Green
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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2
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Ramanathan P, Liu R, Chen MH, Kennedy MRT. Memory and Executive Functions Subserving Judgments of Learning: Cognitive Reorganization After Traumatic Brain Injury. Neuropsychol Rehabil 2022; 32:2203-2226. [PMID: 34006181 DOI: 10.1080/09602011.2021.1929345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We investigated relationships between psychometric measures of memory, executive functions (EFs), and task-based measures of Judgments of Learning (JOLs) in individuals with and without Traumatic Brain Injury (TBI), to study functional reorganization after TBI. We hypothesized that, in controls, accuracy of immediate JOLs would be associated with short-term memory and EFs (but not long-term memory, LTM), while accuracy of delayed JOLs would be associated primarily with LTM. We hypothesized that those with good recovery from TBI would demonstrate functional reorganization of the relationships between memory, EFs, and JOLs. Eighteen individuals with TBI and 18 matched controls completed eight neuropsychological tests of memory and EFs. They studied word-pairs, made immediate and delayed JOLs, and took a cued-recall test for the studied word-pairs. Stepwise regression and Lasso analyses generated a predictive model of JOL accuracy for each group. Accuracy of immediate JOLs in controls was predicted by short-term memory, inhibition, switching, and cognitive fluency, while accuracy of delayed JOLs was predicted by verbal recall. In individuals with TBI, inhibition predicted immediate JOL accuracy and switching predicted delayed JOL accuracy. Cognitive reorganization in those with good long-term recovery from TBI may account for the ability to make JOLs with accuracy similar to controls.
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Affiliation(s)
- Pradeep Ramanathan
- Department of Speech, Language, and Hearing Sciences, California State University, Hayward, CA, USA
| | - Ran Liu
- Statistics, Takeda Pharmaceutical Co. Limited, Cambridge, MA, USA
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Mary R T Kennedy
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA, USA
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3
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Fortin J, Grondin S, Blanchet S. Level of processing's effect on episodic retrieval following traumatic brain injury in the elderly: An event-related potential study. Brain Cogn 2021; 154:105805. [PMID: 34638050 DOI: 10.1016/j.bandc.2021.105805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
Individuals who have sustained a traumatic brain injury (TBI) can suffer from episodic memory impairments. Until now, the neural correlates underlying episodic retrieval in individuals with TBI remained scarce, particularly in older adults. We aimed to fill this gap by recording event-related potentials during an old/new episodic recognition task in 26 older adults, 13 healthy and 13 with TBI. The task manipulated the level of processing in encoding with the use of semantic organizational strategies (deep guided, deep self-guided, and shallow encoding). For all encoding conditions, behavioral data analyses on the discrimination rate indicated that older adults with TBI were globally impaired compared with healthy older adults. The electrophysiological results indicated that the left-parietal effect was larger in the deep guided condition than in the shallow condition. In addition, the results show that the mid-frontal and left-parietal positive old/new effects were absent in both groups. The main findings are the observation, in the control group only, of an early frontal old/new effect (P200; 150-300 ms) and of a late frontal old/new effect on the left hemisphere, only in the Spontaneous condition. Together, results suggest an impairment of the allocation of attentional resources and working memory necessary for retrieving and monitoring items in the elderly with TBI.
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Affiliation(s)
- J Fortin
- École de psychologie, Université Laval, Quebec city, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, CIRRIS, Quebec City (QC), Canada.
| | - S Grondin
- École de psychologie, Université Laval, Quebec city, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, CIRRIS, Quebec City (QC), Canada.
| | - S Blanchet
- École de psychologie, Université Laval, Quebec city, Quebec, Canada; Laboratoire Mémoire, Cerveau et Cognition (LMC(2)), Institut de Psychologie, Université de Paris, Paris, France.
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4
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Liebrand M, Solbakk AK, Funderud I, Buades-Rotger M, Knight RT, Krämer UM. Intact Proactive Motor Inhibition after Unilateral Prefrontal Cortex or Basal Ganglia Lesions. J Cogn Neurosci 2021; 33:1862-1879. [PMID: 34375417 DOI: 10.1162/jocn_a_01691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Previous research provided evidence for the critical importance of the PFC and BG for reactive motor inhibition, that is, when actions are cancelled in response to external signals. Less is known about the role of the PFC and BG in proactive motor inhibition, referring to preparation for an upcoming stop signal. In this study, patients with unilateral lesions to the BG or lateral PFC performed in a cued go/no-go task, whereas their EEG was recorded. The paradigm called for cue-based preparation for upcoming, lateralized no-go signals. Based on previous findings, we focused on EEG indices of cognitive control (prefrontal beta), motor preparation (sensorimotor mu/beta, contingent negative variation [CNV]), and preparatory attention (occipital alpha, CNV). On a behavioral level, no differences between patients and controls were found, suggesting an intact ability to proactively prepare for motor inhibition. Patients showed an altered preparatory CNV effect, but no other differences in electrophysiological activity related to proactive and reactive motor inhibition. Our results suggest a context-dependent role of BG and PFC structures in motor inhibition, being critical in reactive, unpredictable contexts, but less so in situations where one can prepare for stopping on a short timescale.
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Affiliation(s)
| | - Anne-Kristin Solbakk
- University of Oslo, Norway.,Oslo University Hospital, Norway.,Helgeland Hospital, Mosjøen, Norway
| | - Ingrid Funderud
- University of Oslo, Norway.,Helgeland Hospital, Mosjøen, Norway
| | - Macià Buades-Rotger
- University of Lübeck, Germany.,Radboud University, Nijmegen, The Netherlands
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5
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Quantitative multimodal imaging in traumatic brain injuries producing impaired cognition. Curr Opin Neurol 2021; 33:691-698. [PMID: 33027143 DOI: 10.1097/wco.0000000000000872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cognitive impairments are a devastating long-term consequence following traumatic brain injury (TBI). This review provides an update on the quantitative mutimodal neuroimaging studies that attempt to elucidate the mechanism(s) underlying cognitive impairments and their recovery following TBI. RECENT FINDINGS Recent studies have linked individual specific behavioural impairments and their changes over time to physiological activity and structural changes using EEG, PET and MRI. Multimodal studies that combine measures of physiological activity with knowledge of neuroanatomical and connectivity damage have also illuminated the multifactorial function-structure relationships that underlie impairment and recovery following TBI. SUMMARY The combined use of multiple neuroimaging modalities, with focus on individual longitudinal studies, has the potential to accurately classify impairments, enhance sensitivity of prognoses, inform targets for interventions and precisely track spontaneous and intervention-driven recovery.
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6
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Fortin J, Grondin S, Blanchet S. Event-related potentials of episodic encoding after traumatic brain injury in older adults. Brain Res 2021; 1766:147504. [PMID: 33910039 DOI: 10.1016/j.brainres.2021.147504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/16/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022]
Abstract
Episodic memory and attention impairments are frequently observed following a traumatic brain injury (TBI). Older adults are more affected than young adults after a TBI, partly because of the age-related neural and memory changes. Neural mechanisms underlying episodic memory deficits in older adults with chronic TBI remain to be investigated. The current study aimed to investigate the impact of TBI in older adults on the neural mechanisms of episodic encoding. Event-related potentials were recorded while 13 participants with mild-to-severe TBI and 14 matched controls were performing an episodic memory task in which the level of organizational strategy was manipulated through three encoding conditions. Participants were explicitly instructed to memorize words without any semantic relationship (Unrelated condition), words semantically related without any given strategies (Spontaneous condition) and words semantically related with provided category labels and organizational strategy (Guided condition). Behavioral performances indicated that older individuals with a TBI were impaired compared to matched controls whatever the condition. The electrophysiological findings showed a reduction of the P200 and LPC components amplitude in the TBI group relative to control group. Moreover, control participants without any neurological history showed a right frontal sustained activity only in the Spontaneous condition, whereas a right frontal asymmetry was observed in participants with chronic TBI whatever the encoding conditions. This was mainly the result of negative left frontal activity. These findings evidence neural dysfunctions underlying attentional and associative processes involved in memory strategies after a TBI sustained at an older age that are consistent with executive functions impairments.
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Affiliation(s)
- Julie Fortin
- École de psychologie, Université Laval, Quebec City (Qc), Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City (Qc), Canada.
| | - Simon Grondin
- École de psychologie, Université Laval, Quebec City (Qc), Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City (Qc), Canada.
| | - Sophie Blanchet
- École de psychologie, Université Laval, Quebec City (Qc), Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City (Qc), Canada; Laboratoire Mémoire, Cerveau et Cognition (LMC(2)), Institut de Psychologie, Université Paris Descartes, Université de Paris, Paris, France.
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7
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Spadoni AD, Huang M, Simmons AN. Emerging Approaches to Neurocircuits in PTSD and TBI: Imaging the Interplay of Neural and Emotional Trauma. Curr Top Behav Neurosci 2019; 38:163-192. [PMID: 29285732 PMCID: PMC8896198 DOI: 10.1007/7854_2017_35] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) commonly co-occur in general and military populations and have a number of overlapping symptoms. While research suggests that TBI is risk factor for PTSD and that PTSD may mediate TBI-related outcomes, the mechanisms of these relationships are not well understood. Neuroimaging may help elucidate patterns of neurocircuitry both specific and common to PTSD and TBI and thus help define the nature of their interaction, refine diagnostic classification, and may potentially yield opportunities for targeted treatments. In this review, we provide a summary of some of the most common and the most innovative neuroimaging approaches used to characterize the neural circuits associated with PTSD, TBI, and their comorbidity. We summarize the state of the science for each disorder and describe the few studies that have explicitly attempted to characterize the neural substrates of their shared and dissociable influence. While some promising targets in the medial frontal lobes exist, there is not currently a comprehensive understanding of the neurocircuitry mediating the interaction of PTSD and TBI. Future studies should exploit innovative neuroimaging approaches and longitudinal designs to specifically target the neural mechanisms driving PTSD-TBI-related outcomes.
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Affiliation(s)
- Andrea D Spadoni
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Mingxiong Huang
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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8
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Kullberg-Turtiainen M, Vuorela K, Huttula L, Turtiainen P, Koskinen S. Individualized goal directed dance rehabilitation in chronic state of severe traumatic brain injury: A case study. Heliyon 2019; 5:e01184. [PMID: 30805564 PMCID: PMC6374582 DOI: 10.1016/j.heliyon.2019.e01184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/13/2018] [Accepted: 01/25/2019] [Indexed: 12/31/2022] Open
Abstract
Few long-term studies report late outcomes after severe traumatic brain injury. New rehabilitation techniques are needed for this heterogenous patient group. We present a dance intervention six and half years after an extreme severe TBI including excessive diffuse axonal injury, which disconnects the brain networks. Given the fact, that efficient brain function depends on the integrated operation of large-scale brain networks like default mode network (DMN), we created an intervention with multisensory and multimodal approach and goal-directed behavior. The intervention lasted four months including weekly one-hour dance lessons with the help of a physiotherapist and dance teacher. The measures included functional independence measure (FIM), repeated electroencephalogram (EEG) analysis of three subnets of DMN and clinical evaluations and observations. The results showed clear improvement after the intervention, and FIM stayed in elevated level during several years after the intervention. We present suggestion for further studies using larger patient groups.
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Affiliation(s)
| | | | | | | | - Sanna Koskinen
- University of Helsinki, Department of Psychology and Logopedics, Faculty of Medicine, Finland
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9
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Abstract
Over 1.4 million people in the United States experience traumatic brain injury (TBI) each year and approximately 52,000 people die annually due to complications related to TBI. Traditionally, TBI has been viewed as a static injury with significant consequences for frontal lobe functioning that plateaus after some window of recovery, remaining relatively stable thereafter. However, over the past decade there has been growing consensus that the consequences of TBI are dynamic, with unique characteristics expressed at the individual level and over the life span. This chapter first discusses the pathophysiology of TBI in order to understand its dynamic process and then describes the behavioral changes that are the result of injury with focus on frontal lobe functions. It integrates a historical perspective on structural and functional brain-imaging approaches used to understand how TBI impacts the frontal lobes, as well as more recent approaches to examine large-scale network changes after TBI. The factors most useful for outcome prediction are surveyed, along with how the theoretical frameworks used to predict recovery have developed over time. In this chapter, the authors argue for the need to understand outcome after TBI as a dynamic process with individual trajectories, taking a network theory perspective to understand the consequences of disrupting frontal systems in TBI. Within this framework, understanding frontal lobe dysfunction within a larger coordinated neural network to study TBI may provide a novel perspective in outcome prediction and in developing individualized treatments.
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Affiliation(s)
- Rachel A Bernier
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States.
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10
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Abiko K, Shiga T, Katoh C, Hirata K, Kuge Y, Kobayashi K, Ikeda S, Ikoma K. Relationship between intelligence quotient (IQ) and cerebral metabolic rate of oxygen in patients with neurobehavioural disability after traumatic brain injury. Brain Inj 2018; 32:1367-1372. [DOI: 10.1080/02699052.2018.1496478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kagari Abiko
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Rehabilitation Medicine, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Hokkaido University School of medicine, Sapporo, Japan
| | - Chietsugu Katoh
- Department of Nuclear Medicine, Hokkaido University School of medicine, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University School of medicine, Sapporo, Japan
| | - Yuji Kuge
- Department of Tracer kinetics, Hokkaido University, Sapporo, Japan
| | - Kentaro Kobayashi
- Department of Nuclear Medicine, Hokkaido University School of medicine, Sapporo, Japan
| | - Satoshi Ikeda
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Katsunori Ikoma
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
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11
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Manivannan S, Makwana M, Ahmed AI, Zaben M. Profiling biomarkers of traumatic axonal injury: From mouse to man. Clin Neurol Neurosurg 2018; 171:6-20. [PMID: 29803093 DOI: 10.1016/j.clineuro.2018.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
Traumatic brain injury (TBI) poses a major public health problem on a global scale. Its burden results from high mortality and significant morbidity in survivors. This stems, in part, from an ongoing inadequacy in diagnostic and prognostic indicators despite significant technological advances. Traumatic axonal injury (TAI) is a key driver of the ongoing pathological process following TBI, causing chronic neurological deficits and disability. The science underpinning biomarkers of TAI has been a subject of many reviews in recent literature. However, in this review we provide a comprehensive account of biomarkers from animal models to clinical studies, bridging the gap between experimental science and clinical medicine. We have discussed pathogenesis, temporal kinetics, relationships to neuro-imaging, and, most importantly, clinical applicability in order to provide a holistic perspective of how this could improve TBI diagnosis and predict clinical outcome in a real-life setting. We conclude that early and reliable identification of axonal injury post-TBI with the help of body fluid biomarkers could enhance current care of TBI patients by (i) increasing speed and accuracy of diagnosis, (ii) providing invaluable prognostic information, (iii) allow efficient allocation of rehabilitation services, and (iv) provide potential therapeutic targets. The optimal model for assessing TAI is likely to involve multiple components, including several blood biomarkers and neuro-imaging modalities, at different time points.
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Affiliation(s)
- Susruta Manivannan
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom
| | - Milan Makwana
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom
| | - Aminul Islam Ahmed
- Clinical Neurosciences, University of Southampton, Southampton, SO16 6YD, United Kingdom; Wessex Neurological Centre, University Hospitals Southampton, Southampton, SO16 6YD, United Kingdom
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom; Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom.
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12
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Brown J, Hux K. Ecologically Valid Assessment of Prospective Memory for Task Planning and Execution by Adults With Acquired Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:819-831. [PMID: 28672375 DOI: 10.1044/2017_ajslp-16-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/29/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Individuals with acquired brain injury (ABI) often struggle due to inadequate planning and execution skills for completing nonroutine tasks. This study's purpose was to pilot ecologically valid procedures to assess planning for and execution of prospective daily activities. METHOD Participants included 9 adults with histories of severe ABI and 9 controls. Data collection included both prospective task planning and execution. First, participants created a plan for later execution of daily tasks in accordance with preestablished rules. Over the subsequent 10 days, participants independently attempted task completion. Differences within and between participant groups regarding planning and task performance were evaluated statistically and through examiner observation. RESULTS Participants with ABI implemented minimal planning strategies. They demonstrated highly variable performance and displayed substantially greater difficulty initiating and successfully executing tasks in adherence to rules than participants without ABI. CONCLUSIONS Evaluating planning strategies and execution of novel prospective tasks is a crucial but often neglected aspect of assessment following ABI. Implementing ecologically valid procedures to evaluate this aspect of functioning can reveal individual strengths and challenges and provide guidance for developing effective intervention programs. Examining potential roles played by planning and strategy execution provides critical assessment information relating to independent living.
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Affiliation(s)
- Jessica Brown
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis
| | - Karen Hux
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
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13
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Mannino C, Glenn TC, Hovda DA, Vespa PM, McArthur DL, Van Horn JD, Wright MJ. Acute glucose and lactate metabolism are associated with cognitive recovery following traumatic brain injury. J Neurosci Res 2017; 96:696-701. [PMID: 28609544 DOI: 10.1002/jnr.24097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/08/2022]
Abstract
Traumatic brain injury (TBI) is associated with acute cerebral metabolic crisis (ACMC). ACMC-related atrophy appears to be prominent in frontal and temporal lobes following moderate-to-severe TBI. This atrophy is correlated with poorer cognitive outcomes in TBI. The current study investigated ability of acute glucose and lactate metabolism to predict long-term recovery of frontal-temporal cognitive function in participants with moderate-to-severe TBI. Cerebral metabolic rate of glucose and lactate were measured by the Kety-Schmidt method on days 0-7 post-injury. Indices of frontal-temporal cognitive processing were calculated for six months post-injury; 12 months post-injury; and recovery (the difference between the six- and 12-month scores). Glucose and lactate metabolism were included in separate regression models, as they were highly intercorrelated. Also, glucose and lactate values were centered and averaged and included in a final regression model. Models for the prediction frontal-temporal cognition at six and 12 months post-injury were not significant. However, average glucose and lactate metabolism predicted recovery of frontal-temporal cognition, accounting for 23% and 22% of the variance, respectively. Also, maximum glucose metabolism, but not maximum lactate metabolism, was an inverse predictor in the recovery of frontal-temporal cognition, accounting for 23% of the variance. Finally, the average of glucose and lactate metabolism predicted frontal-temporal cognitive recovery, accounting for 22% of the variance. These data indicate that acute glucose and lactate metabolism both support cognitive recovery from TBI. Also, our data suggest that control of endogenous fuels and/or supplementation with exogenous fuels may have therapeutic potential for cognitive recovery from TBI.
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Affiliation(s)
| | - Thomas C Glenn
- University of California, Los Angeles, Department of Neurosurgery
| | - David A Hovda
- University of California, Los Angeles, Department of Neurosurgery
| | - Paul M Vespa
- University of California, Los Angeles, Department of Neurosurgery.,University of California, Los Angeles, Department of Neurology
| | - David L McArthur
- University of California, Los Angeles, Department of Neurosurgery
| | - John D Van Horn
- University of Southern California, Laboratory of Neuro Imaging, Institute for Neuroimaging Informatics, Department of Neurology
| | - Matthew J Wright
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences.,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
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14
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Does time heal all wounds? Experimental diffuse traumatic brain injury results in persisting histopathology in the thalamus. Behav Brain Res 2016; 340:137-146. [PMID: 28042008 DOI: 10.1016/j.bbr.2016.12.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/30/2016] [Accepted: 12/28/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Thalamic dysfunction has been implicated in overall chronic neurological dysfunction after traumatic brain injury (TBI), however little is known about the underlying histopathology. In experimental diffuse TBI (dTBI), we hypothesize that persisting histopathological changes in the ventral posteromedial (VPM) nucleus of the thalamus is indicative of progressive circuit reorganization. Since circuit reorganization in the VPM impacts the whisker sensory system, the histopathology could explain the development of hypersensitivity to whisker stimulation by 28days post-injury; similar to light and sound hypersensitivity in human TBI survivors. METHODS Adult, male Sprague-Dawley rats underwent craniotomy and midline fluid percussion injury (FPI) (moderate severity; 1.8-2.0atm) or sham surgery. At 1d, 7d, and 28days post-FPI (d FPI) separate experiments confirmed the cytoarchitecture (Giemsa stain) and evaluated neuropathology (silver stain), activated astrocytes (GFAP), neuron morphology (Golgi stain) and microglial morphology (Iba-1) in the VPM. RESULTS Cytoarchitecture was unchanged throughout the time course, similar to previously published data; however, neuropathology and astrocyte activation were significantly increased at 7d and 28d and activated microglia were present at all time points. Neuron morphology was dynamic over the time course with decreased dendritic complexity (fewer branch points; decreased length of processes) at 7d FPI and return to sham values by 28d FPI. CONCLUSIONS These data indicate that dTBI results in persisting thalamic histopathology out to a chronic time point. While these changes can be indicative of either adaptive (recovery) or maladaptive (neurological dysfunction) circuit reorganization, they also provide a potential mechanism by which maladaptive circuit reorganization could contribute to the development of chronic neurological dysfunction. Understanding the processes that mediate circuit reorganization is critical to the development of future therapies for TBI patients.
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15
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Abstract
There is a paucity of accurate and reliable biomarkers to detect traumatic brain injury, grade its severity, and model post-traumatic brain injury (TBI) recovery. This gap could be addressed via advances in brain mapping which define injury signatures and enable tracking of post-injury trajectories at the individual level. Mapping of molecular and anatomical changes and of modifications in functional activation supports the conceptual paradigm of TBI as a disorder of large-scale neural connectivity. Imaging approaches with particular relevance are magnetic resonance techniques (diffusion weighted imaging, diffusion tensor imaging, susceptibility weighted imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, and positron emission tomographic methods including molecular neuroimaging). Inferences from mapping represent unique endophenotypes which have the potential to transform classification and treatment of patients with TBI. Limitations of these methods, as well as future research directions, are highlighted.
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16
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Antonakakis M, Dimitriadis SI, Zervakis M, Micheloyannis S, Rezaie R, Babajani-Feremi A, Zouridakis G, Papanicolaou AC. Altered cross-frequency coupling in resting-state MEG after mild traumatic brain injury. Int J Psychophysiol 2016; 102:1-11. [PMID: 26910049 DOI: 10.1016/j.ijpsycho.2016.02.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/23/2016] [Accepted: 02/16/2016] [Indexed: 01/21/2023]
Abstract
Cross-frequency coupling (CFC) is thought to represent a basic mechanism of functional integration of neural networks across distant brain regions. In this study, we analyzed CFC profiles from resting state Magnetoencephalographic (MEG) recordings obtained from 30 mild traumatic brain injury (mTBI) patients and 50 controls. We used mutual information (MI) to quantify the phase-to-amplitude coupling (PAC) of activity among the recording sensors in six nonoverlapping frequency bands. After forming the CFC-based functional connectivity graphs, we employed a tensor representation and tensor subspace analysis to identify the optimal set of features for subject classification as mTBI or control. Our results showed that controls formed a dense network of stronger local and global connections indicating higher functional integration compared to mTBI patients. Furthermore, mTBI patients could be separated from controls with more than 90% classification accuracy. These findings indicate that analysis of brain networks computed from resting-state MEG with PAC and tensorial representation of connectivity profiles may provide a valuable biomarker for the diagnosis of mTBI.
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Affiliation(s)
- Marios Antonakakis
- Digital Image and Signal Processing Laboratory, School of Electronic and Computer Engineering, Technical University of Crete, Chania 73100, Greece.
| | - Stavros I Dimitriadis
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom; Artificial Intelligence and Information Analysis Laboratory, Department of Informatics, Aristotle University, Thessaloniki 54124, Greece; Neuroinformatics Group, Department of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece. http://www.neuroinformatics.gr
| | - Michalis Zervakis
- Digital Image and Signal Processing Laboratory, School of Electronic and Computer Engineering, Technical University of Crete, Chania 73100, Greece
| | | | - Roozbeh Rezaie
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Abbas Babajani-Feremi
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - George Zouridakis
- Basque Center on Cognition, Brain and Language (BCBL), Paseo Mikeletegi 69, 20009 Donostia-San Sebastián, Spain; Biomedical Imaging Lab, Departments of Engineering Technology, Computer Science, Biomedical Engineering, and Electrical and Computer Engineering, University of Houston, Houston, TX 77204, USA
| | - Andrew C Papanicolaou
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
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17
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Compensation through Functional Hyperconnectivity: A Longitudinal Connectome Assessment of Mild Traumatic Brain Injury. Neural Plast 2015; 2016:4072402. [PMID: 26819765 PMCID: PMC4706919 DOI: 10.1155/2016/4072402] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a major public health concern. Functional MRI has reported alterations in several brain networks following mTBI. However, the connectome-scale brain network changes are still unknown. In this study, sixteen mTBI patients were prospectively recruited from an emergency department and followed up at 4-6 weeks after injury. Twenty-four healthy controls were also scanned twice with the same time interval. Three hundred fifty-eight brain landmarks that preserve structural and functional correspondence of brain networks across individuals were used to investigate longitudinal brain connectivity. Network-based statistic (NBS) analysis did not find significant difference in the group-by-time interaction and time effects. However, 258 functional pairs show group differences in which mTBI patients have higher functional connectivity. Meta-analysis showed that "Action" and "Cognition" are the most affected functional domains. Categorization of connectomic signatures using multiview group-wise cluster analysis identified two patterns of functional hyperconnectivity among mTBI patients: (I) between the posterior cingulate cortex and the association areas of the brain and (II) between the occipital and the frontal lobes of the brain. Our results demonstrate that brain concussion renders connectome-scale brain network connectivity changes, and the brain tends to be hyperactivated to compensate the pathophysiological disturbances.
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18
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Amyot F, Arciniegas DB, Brazaitis MP, Curley KC, Diaz-Arrastia R, Gandjbakhche A, Herscovitch P, Hinds SR, Manley GT, Pacifico A, Razumovsky A, Riley J, Salzer W, Shih R, Smirniotopoulos JG, Stocker D. A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. J Neurotrauma 2015; 32:1693-721. [PMID: 26176603 PMCID: PMC4651019 DOI: 10.1089/neu.2013.3306] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.
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Affiliation(s)
- Franck Amyot
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David B. Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, Texas
- Brain Injury Research, TIRR Memorial Hermann, Houston, Texas
| | | | - Kenneth C. Curley
- Combat Casualty Care Directorate (RAD2), U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Amir Gandjbakhche
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Peter Herscovitch
- Positron Emission Tomography Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sidney R. Hinds
- Defense and Veterans Brain Injury Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Silver Spring, Maryland
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Anthony Pacifico
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | | | - Jason Riley
- Queens University, Kingston, Ontario, Canada
- ArcheOptix Inc., Picton, Ontario, Canada
| | - Wanda Salzer
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | - Robert Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James G. Smirniotopoulos
- Department of Radiology, Neurology, and Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Derek Stocker
- Walter Reed National Military Medical Center, Bethesda, Maryland
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19
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Buchsbaum MS, Simmons AN, DeCastro A, Farid N, Matthews SC. Clusters of Low (18)F-Fluorodeoxyglucose Uptake Voxels in Combat Veterans with Traumatic Brain Injury and Post-Traumatic Stress Disorder. J Neurotrauma 2015; 32:1736-50. [PMID: 25915799 DOI: 10.1089/neu.2014.3660] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Individuals with mild traumatic brain injury (TBI) show diminished metabolic activity when studied with positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG). Since blast injury may not be localized in the same specific anatomical areas in every patient or may be diffuse, significance probability mapping may be vulnerable to false-negative detection of abnormalities. To address this problem, we used an anatomically independent measure to assess PET scans: increased numbers of contiguous voxels that are 2 standard deviations below values found in an uninjured control group. We examined this in three age-matched groups of male patients: 16 veterans with a history of mild TBI, 17 veterans with both mild TBI and post-traumatic stress disorder (PTSD), and 15 veterans without either condition. After FDG administration, subjects performed a modified version of the California Verbal Learning Task. Clusters of low uptake voxels were identified by computing the mean and standard deviation for each voxel in the healthy combat veteran group and then determining the voxel-based z-score for the patient groups. Abnormal clusters were defined as those that contained contiguous voxels with a z-score <-2. Patients with mild TBI alone and patients with TBI+PTSD had larger clusters of low uptake voxels, and cluster size significantly differentiated the mild TBI groups from combat controls. Clusters were more irregular in shape in patients, and patients also had a larger number of low-activity voxels throughout the brain. In mild TBI and TBI+PTSD patients, but not healthy subjects, cluster volume was significantly correlated with verbal learning during FDG uptake.
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Affiliation(s)
- Monte S Buchsbaum
- 1 Department of Psychiatry, University of California , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Alan N Simmons
- 1 Department of Psychiatry, University of California , San Diego, California.,3 Center of Excellence in Stress and Mental Health , Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Alex DeCastro
- 1 Department of Psychiatry, University of California , San Diego, California
| | - Nikdokht Farid
- 2 Department of Radiology, University of California , San Diego, California
| | - Scott C Matthews
- 1 Department of Psychiatry, University of California , San Diego, California.,3 Center of Excellence in Stress and Mental Health , Veterans Affairs San Diego Healthcare System, San Diego, California.,4 ASPIRE Center , Veterans Affairs San Diego Healthcare System, San Diego, California
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20
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Abstract
Traumatic brain injury (TBI) is a major cause of death and disability, and therefore an important health and socioeconomic problem for our society. Individuals surviving from a moderate to severe TBI frequently suffer from long-lasting cognitive deficits. Such deficits include different aspects of cognition such as memory, attention, executive functions, and awareness of their deficits. This chapter presents a review of the main neuropsychological and neuroimaging studies of patients with TBI. These studies found that patients evolve differently according to the severity of the injury, the mechanism causing the injury, and the lesion location. Further research is necessary to develop rehabilitation methods that enhance brain plasticity and recovery after TBI. In this chapter, we summarize current knowledge and controversies, focusing on cognitive sequelae after TBI. Recommendations from the Common Data Elements are provided, with an emphasis on diagnosis, outcome measures, and studies organization to make data more comparable across studies. Final considerations on neuroimaging advances, rehabilitation approaches, and genetics are described in the final section of the chapter.
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Affiliation(s)
- Irene Cristofori
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
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21
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Lepping RJ, Brooks WM, Kirchhoff BA, Martin LE, Kurylo M, Ladesich L, Lierman JA, Varghese G, Savage CR. Effectiveness of Semantic Encoding Strategy Training after Traumatic Brain Injury is Correlated with Frontal Brain Activation Change. INTERNATIONAL JOURNAL OF PHYSICAL MEDICINE & REHABILITATION 2015; 3. [PMID: 32832578 PMCID: PMC7440179 DOI: 10.4172/2329-9096.1000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Traumatic Brain Injury (TBI) is frequently associated with chronic, treatment-resistant memory problems, and is one of the leading causes of disability in otherwise healthy adults. Cognitive rehabilitation therapies are used with the goal of improving memory functioning; however, not all patients benefit. Prefrontal cortex (PFC) is critical for employing effective memory strategies. We hypothesized that memory improvement after a brief cognitive intervention would be associated with increases in PFC activation during a memory task. Methods The current study used behavioral analyses and functional magnetic resonance imaging (fMRI) to examine the effects of two days of intensive semantic encoding strategy training on memory performance and brain activation patterns in patients in the post-acute stage of TBI. fMRI data were collected before and after training while participants learned word lists. Results Post-training vs. pre-training changes in total recall and semantic clustering during recall were positively correlated with post-training vs. pre-training changes in neural activation in PFC. Conclusions These results suggest that variability in treatment response to cognitive training after TBI may be due in part to variability in PFC function, and that some survivors of TBIs may benefit from treatments specifically targeting the PFC.
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Affiliation(s)
- Rebecca J Lepping
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas city, USA
| | - William M Brooks
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas city, USA.,Department of Neurology, University of Kansas Medical Center, Kansas city, USA
| | | | - Laura E Martin
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas city, USA.,Department of Preventive Medicine, University of Kansas Medical Center, Kansas city, USA
| | - Monica Kurylo
- Department of Psychiatry, University of Kansas Medical Center, Kansas city, USA.,Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas city, USA
| | - Linda Ladesich
- Meadowbrook Rehabilitation Hospital, Gardner, Kansas city, USA
| | - Jo Ann Lierman
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas city, USA
| | - George Varghese
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas city, USA
| | - Cary R Savage
- Department of Psychiatry, University of Kansas Medical Center, Kansas city, USA.,Center for Health Behavior Neuroscience, University of Kansas Medical Center, Kansas city, USA
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22
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Mansour A, Lajiness-O’Neill R. Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI). ACTA ACUST UNITED AC 2015. [DOI: 10.4236/psych.2015.64033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Van Der Naalt J. Resting functional imaging tools (MRS, SPECT, PET and PCT). HANDBOOK OF CLINICAL NEUROLOGY 2015; 127:295-308. [PMID: 25702224 DOI: 10.1016/b978-0-444-52892-6.00019-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Functional imaging includes imaging techniques that provide information about the metabolic and hemodynamic status of the brain. Most commonly applied functional imaging techniques in patients with traumatic brain injury (TBI) include magnetic resonance spectroscopy (MRS), single photon emission computed tomography (SPECT), positron emission tomography (PET) and perfusion CT (PCT). These imaging modalities are used to determine the extent of injury, to provide information for the prediction of outcome, and to assess evidence of cerebral ischemia. In TBI, secondary brain damage mainly comprises ischemia and is present in more than 80% of fatal cases with traumatic brain injury (Graham et al., 1989; Bouma et al., 1991; Coles et al., 2004). In particular, while SPECT measures cerebral perfusion and MRS determines metabolism, PET is able to assess both perfusion and cerebral metabolism. This chapter will describe the application of these techniques in traumatic brain injury separately for the major groups of severity comprising the mild and moderate to severe group. The application in TBI and potential difficulties of each technique is described. The use of imaging techniques in children will be separately outlined.
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Affiliation(s)
- J Van Der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands.
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24
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Arvind Pala P, N'Kaoua B, Mazaux JM, Simion A, Lozes S, Sorita E, Sauzéon H. Everyday-like memory and its cognitive correlates in healthy older adults and in young patients with traumatic brain injury: a pilot study based on virtual reality. Disabil Rehabil Assist Technol 2014; 9:463-73. [PMID: 25030298 DOI: 10.3109/17483107.2014.941952] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED PURPOSE STATE: A pilot-study with a comparison approach between aging and traumatic brain injury (TBI) is proposed to investigate everyday object memory patterns using a virtual HOMES test. METHODS Sixteen young controls, 15 older adults and 15 TBI patients underwent the HOMES test and traditional tests. RESULTS Older adults and TBI patients exhibited similar HOMES performances: poor recall, a greater recognition benefit, high false recognitions, but intact clustering and proactive interference effects. The age-related differences for HOMES measures were mainly mediated by executive functioning, while the HOMES performances in the TBI group were correlated with memory measures. CONCLUSION The differential cognitive mediating effects for a similar everyday-like memory pattern are discussed by highlighting the need for more cautious interpretations of cognitive mechanisms behind similar behavioral patterns in different populations especially in clinical and rehabilitation settings.
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Affiliation(s)
- P Arvind Pala
- EA4136-Laboratoire, Handicap et Système Nerveux, Université de Bordeaux , Bordeaux , France
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25
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Early metabolic crisis-related brain atrophy and cognition in traumatic brain injury. Brain Imaging Behav 2014; 7:307-15. [PMID: 23636971 DOI: 10.1007/s11682-013-9231-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Traumatic brain injury often results in acute metabolic crisis. We recently demonstrated that this is associated with chronic brain atrophy, which is most prominent in the frontal and temporal lobes. Interestingly, the neuropsychological profile of traumatic brain injury is often characterized as 'frontal-temporal' in nature, suggesting a possible link between acute metabolic crisis-related brain atrophy and neurocognitive impairment in this population. While focal lesions and diffuse axonal injury have a well-established role in the neuropsychological deficits observed following traumatic brain injury, no studies to date have examined the possible contribution of acute metabolic crisis-related atrophy in the neuropsychological sequelae of traumatic brain injury. In the current study we employed positron emission tomography, magnetic resonance imaging, and neuropsychological assessments to ascertain the relationship between acute metabolic crisis-related brain atrophy and neurocognitive outcome in a sample of 14 right-handed traumatic brain injury survivors. We found that acute metabolic crisis-related atrophy in the frontal and temporal lobes was associated with poorer attention, executive functioning, and psychomotor abilities at 12 months post-injury. Furthermore, participants with gross frontal and/or temporal lobe atrophy exhibited numerous clinically significant neuropsychological deficits in contrast to participants with other patterns of brain atrophy. Our findings suggest that interventions that reduce acute metabolic crisis may lead to improved functional outcomes for traumatic brain injury survivors.
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26
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Krause MO, Kennedy MRT, Nelson PB. Masking release, processing speed and listening effort in adults with traumatic brain injury. Brain Inj 2014; 28:1473-84. [DOI: 10.3109/02699052.2014.920520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Abstract
Diffuse axonal injury after traumatic brain injury (TBI) produces neurological impairment by disconnecting brain networks. This structural damage can be mapped using diffusion MRI, and its functional effects can be investigated in large-scale intrinsic connectivity networks (ICNs). Here, we review evidence that TBI substantially disrupts ICN function, and that this disruption predicts cognitive impairment. We focus on two ICNs--the salience network and the default mode network. The activity of these ICNs is normally tightly coupled, which is important for attentional control. Damage to the structural connectivity of these networks produces predictable abnormalities of network function and cognitive control. For example, the brain normally shows a 'small-world architecture' that is optimized for information processing, but TBI shifts network function away from this organization. The effects of TBI on network function are likely to be complex, and we discuss how advanced approaches to modelling brain dynamics can provide insights into the network dysfunction. We highlight how structural network damage caused by axonal injury might interact with neuroinflammation and neurodegeneration in the pathogenesis of Alzheimer disease and chronic traumatic encephalopathy, which are late complications of TBI. Finally, we discuss how network-level diagnostics could inform diagnosis, prognosis and treatment development following TBI.
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28
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Lengenfelder J, Arjunan A, Chiaravalloti N, Smith A, DeLuca J. Assessing Frontal Behavioral Syndromes and Cognitive Functions in Traumatic Brain Injury. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 22:7-15. [PMID: 25529586 DOI: 10.1080/23279095.2013.816703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeannie Lengenfelder
- a Kessler Foundation Research Center , West Orange
- b Department of Physical Medicine and Rehabilitation , Rutgers University-New Jersey Medical School , Newark , New Jersey
| | - Aparna Arjunan
- c Kessler Foundation Research Center , West Orange , New Jersey
| | - Nancy Chiaravalloti
- a Kessler Foundation Research Center , West Orange
- b Department of Physical Medicine and Rehabilitation , Rutgers University-New Jersey Medical School , Newark , New Jersey
| | - Angela Smith
- c Kessler Foundation Research Center , West Orange , New Jersey
| | - John DeLuca
- a Kessler Foundation Research Center , West Orange
- b Department of Physical Medicine and Rehabilitation , Rutgers University-New Jersey Medical School , Newark , New Jersey
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Fox WC, Park MS, Belverud S, Klugh A, Rivet D, Tomlin JM. Contemporary imaging of mild TBI: the journey toward diffusion tensor imaging to assess neuronal damage. Neurol Res 2013; 35:223-32. [PMID: 23485049 DOI: 10.1179/1743132813y.0000000162] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To follow the progression of neuroimaging as a means of non-invasive evaluation of mild traumatic brain injury (mTBI) in order to provide recommendations based on reproducible, defined imaging findings. METHODS A comprehensive literature review and analysis of contemporary published articles was performed to study the progression of neuroimaging findings as a non-invasive 'biomarker' for mTBI. RESULTS Multiple imaging modalities exist to support the evaluation of patients with mTBI, including ultrasound (US), computed tomography (CT), single photon emission computed tomography (SPECT), positron emission tomography (PET), and magnetic resonance imaging (MRI). These techniques continue to evolve with the development of fractional anisotropy (FA), fiber tractography (FT), and diffusion tensor imaging (DTI). DISCUSSION Modern imaging techniques, when applied in the appropriate clinical setting, may serve as a valuable tool for diagnosis and management of patients with mTBI. An understanding of modern neuroanatomical imaging will enhance our ability to analyse injury and recognize the manifestations of mTBI.
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Affiliation(s)
- W Christopher Fox
- Department of Neurosurgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
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30
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Ford JH, Giovanello KS, Guskiewicz KM. Episodic memory in former professional football players with a history of concussion: an event-related functional neuroimaging study. J Neurotrauma 2013; 30:1683-701. [PMID: 23679098 DOI: 10.1089/neu.2012.2535] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous research has demonstrated that sport-related concussions can have short-term effects on cognitive processes, but the long-term consequences are less understood and warrant more research. This study was the first to use event-related functional magnetic resonance imaging (fMRI) to examine long-term differences in neural activity during memory tasks in former athletes who have sustained multiple sport-related concussions. In an event-related fMRI study, former football players reporting multiple sport-related concussions (i.e., three or more) were compared with players who reported fewer than three concussions during a memory paradigm examining item memory (i.e., memory for the particular elements of an event) and relational memory (i.e., memory for the relationships between elements). Behaviorally, we observed that concussion history did not significantly affect behavioral performance, because persons in the low and high concussion groups had equivalent performance on both memory tasks, and in addition, that concussion history was not associated with any behavioral memory measures. Despite demonstrating equivalent behavioral performance, the two groups of former players demonstrated different neural recruitment patterns during relational memory retrieval, suggesting that multiple concussions may be associated with functional inefficiencies in the relational memory network. In addition, the number of previous concussions significantly correlated with functional activity in a number of brain regions, including the medial temporal lobe and inferior parietal lobe. Our results provide important insights in understanding the long-term functional consequences of sustaining multiple sports-related concussions.
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Affiliation(s)
- Jaclyn H Ford
- 1 Department of Psychology, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina
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Sperduti M, Martinelli P, Kalenzaga S, Devauchelle AD, Lion S, Malherbe C, Gallarda T, Amado I, Krebs MO, Oppenheim C, Piolino P. Don't be Too Strict with Yourself! Rigid Negative Self-Representation in Healthy Subjects Mimics the Neurocognitive Profile of Depression for Autobiographical Memory. Front Behav Neurosci 2013; 7:41. [PMID: 23734107 PMCID: PMC3659304 DOI: 10.3389/fnbeh.2013.00041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/22/2013] [Indexed: 01/27/2023] Open
Abstract
Autobiographical memory (AM) comprises representation of both specific (episodic) and generic (semantic) personal information. Depression is characterized by a shift from episodic to semantic AM retrieval. According to theoretical models, this process ("overgeneralization"), would be linked to reduced executive resources. Moreover, "overgeneral" memories, accompanied by a negativity bias in depression, lead to a pervasive negative self-representation. As executive functions and AM specificity are also closely intricate among "non-clinical" populations, "overgeneral" memories could result in depressive emotional responses. Consequently, our hypothesis was that the neurocognitive profile of healthy subjects showing a rigid negative self-image would mimic that of patients. Executive functions and self-image were measured and brain activity was recorded, by means of fMRI, during episodic AMs retrieval in young healthy subjects. The results show an inverse correlation, that is, a more rigid and negative self-image produces lower performances in both executive and specific memories. Moreover, higher negative self-image is associated with decreased activity in the left ventro-lateral prefrontal and in the anterior cingulate cortex, repeatedly shown to exhibit altered functioning in depression. Activity in these regions, on the contrary, positively correlates with executive and memory performances, in line with their role in executive functions and AM retrieval. These findings suggest that rigid negative self-image could represent a marker or a vulnerability trait of depression by being linked to reduced executive function efficiency and episodic AM decline. These results are encouraging for psychotherapeutic approaches aimed at cognitive flexibility in depression and other psychiatric disorders.
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Affiliation(s)
- Marco Sperduti
- Laboratoire Mémoire et Cognition, Institut de Psychologie, Université Paris DescartesBoulogne-Billancourt, France
- INSERM U894, Centre de Psychiatrie et Neurosciences, Université Paris DescartesParis, France
| | - Pénélope Martinelli
- Laboratoire Mémoire et Cognition, Institut de Psychologie, Université Paris DescartesBoulogne-Billancourt, France
- INSERM U894, Centre de Psychiatrie et Neurosciences, Université Paris DescartesParis, France
| | - Sandrine Kalenzaga
- Laboratoire Mémoire et Cognition, Institut de Psychologie, Université Paris DescartesBoulogne-Billancourt, France
- INSERM U894, Centre de Psychiatrie et Neurosciences, Université Paris DescartesParis, France
| | | | - Stéphanie Lion
- INSERM U894, Service d’Imagerie, Université Paris Descartes Sorbonne Paris CitéParis, France
| | - Caroline Malherbe
- INSERM U894, Service d’Imagerie, Université Paris Descartes Sorbonne Paris CitéParis, France
| | - Thierry Gallarda
- INSERM U894, Centre de Psychiatrie et Neurosciences, Université Paris DescartesParis, France
- Faculté de Médecine, Centre Hospitalier Sainte-Anne, Service Hospitalier Universitaire, Université Paris DescartesParis, France
| | - Isabelle Amado
- INSERM U894, Centre de Psychiatrie et Neurosciences, Université Paris DescartesParis, France
- Faculté de Médecine, Centre Hospitalier Sainte-Anne, Service Hospitalier Universitaire, Université Paris DescartesParis, France
| | - Marie-Odile Krebs
- INSERM U894, Centre de Psychiatrie et Neurosciences, Université Paris DescartesParis, France
- Faculté de Médecine, Centre Hospitalier Sainte-Anne, Service Hospitalier Universitaire, Université Paris DescartesParis, France
| | - Catherine Oppenheim
- INSERM U894, Service d’Imagerie, Université Paris Descartes Sorbonne Paris CitéParis, France
| | - Pascale Piolino
- Laboratoire Mémoire et Cognition, Institut de Psychologie, Université Paris DescartesBoulogne-Billancourt, France
- INSERM U894, Centre de Psychiatrie et Neurosciences, Université Paris DescartesParis, France
- Institut Universitaire de FranceParis, France
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Terry DP, Faraco CC, Smith D, Diddams MJ, Puente AN, Miller LS. Lack of long-term fMRI differences after multiple sports-related concussions. Brain Inj 2013; 26:1684-96. [PMID: 23163249 DOI: 10.3109/02699052.2012.722259] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) or concussion has been acutely associated with several cognitive symptoms, including deficits in response inhibition, working memory and motor performance. The pervasiveness of these cognitive symptoms has been more controversial. The effects of multiple concussions on neuropsychological functioning and brain activation following at least 6-months post-mTBI were examined. METHODS Twenty right-handed male athletes with a history of at least two concussions and 20 age/pre-morbid IQ/athletic-experience matched controls underwent neuropsychological assessment and fMRI scanning where they performed versions of a colour-word Stroop interference task, an operation-span working memory task and a finger-tapping task. RESULTS The Attention index score on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was lower for the concussion group, but only at liberal statistical threshold. Total RBANS score approached statistical significance. Reaction time during neurobehavioural tasks was similar across groups, but accuracy was reduced in the concussed group on the working memory task. Despite expected activation patterns within each group, there were no group differences in neural activation on any functional tasks using either whole-brain or ROI-specific analyses at liberal statistical thresholds. CONCLUSION There were minimal differences between the two closely matched groups. Results point to the relative plasticity of younger adults' cognitive abilities following concussion.
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Affiliation(s)
- Douglas P Terry
- Psychology Department, University of Georgia, Athens, GA, USA
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Mohanty M, Gupta SK. Home based neuropsychological rehabilitation in severe traumatic brain injury: a case report. Ann Neurosci 2013; 20:31-5. [PMID: 25206008 PMCID: PMC4117091 DOI: 10.5214/ans.0972.7531.200111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Traumatic Brain Injury (TBI) is the most common cause of death and disability in young people. The patients with TBI often suffer impairments in psycho motor speed, memory, attention, speed of information processing, executive functioning, fluid intelligence, language and visuo-spatial skills. These impairments need to be addressed as these have a significant impact on their social and occupational functioning. Neuropsychological rehabilitation has been found to be useful in improving cognitive and day to day functioning. It focuses on the improvement of basic abilities which in turn enhance cognitive functioning. The aim of the present study was to develop a home based neuropsychological rehabilitation programme and examine its usefulness in severe TBI. A single case study method was adopted. A detailed assessment was done at 1½ months (pre-assessment) and 9 months (post-intervention) to evaluate the changes. Post-intervention improvement was observed in her cognitive functions and day to day functioning. She had resumed her previous job also. Home based neuropsychological rehabilitation emerged to be useful in brain damaged patients.
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Ham TE, Sharp DJ. How can investigation of network function inform rehabilitation after traumatic brain injury? Curr Opin Neurol 2012; 25:662-9. [DOI: 10.1097/wco.0b013e328359488f] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim J, Whyte J, Patel S, Europa E, Slattery J, Coslett HB, Detre JA. A perfusion fMRI study of the neural correlates of sustained-attention and working-memory deficits in chronic traumatic brain injury. Neurorehabil Neural Repair 2012; 26:870-80. [PMID: 22357634 PMCID: PMC5650500 DOI: 10.1177/1545968311434553] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Given that traumatic brain injury (TBI) results in chronic alteration of baseline cerebral perfusion, a perfusion functional MRI (fMRI) method that dissociates resting- and task-related cerebral blood flow (CBF) changes can be useful in noninvasively investigating the neural correlates of cognitive dysfunction and recovery in TBI. OBJECTIVE The authors used continuous arterial spin-labeled (ASL) perfusion fMRI to characterize CBF at rest and during sustained-attention and working-memory tasks. METHODS A total of 18 to 21 individuals with moderate to severe TBI and 14 to 18 demographically matched healthy controls completed 3 continuous 6-minute perfusion fMRI scans (resting, visual sustained attention, and 2-back working memory). RESULTS For both tasks, TBI participants showed worse behavioral performance than controls. Voxelwise neuroimaging analysis of the 2-back task found that group differences in task-induced CBF changes were localized to bilateral superior occipital cortices and the left superior temporal cortex. Whereas controls deactivated these areas during task performance, TBI participants tended to activate these same areas. These regions were among those found to be disproportionately hypoperfused at rest after TBI. For both tasks, the control and TBI groups showed different patterns of correlation between performance and task-related CBF changes. CONCLUSIONS ASL perfusion fMRI demonstrated differences between individuals with TBI and healthy controls in resting perfusion and in task-evoked CBF changes as well as different patterns of performance-activation correlation. These results are consistent with the notion that sensory/attentional modulation deficits contribute to higher cognitive dysfunction in TBI.
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Affiliation(s)
- Junghoon Kim
- Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Elkins Park, PA 19027, USA.
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Arenth PM, Russell KC, Scanlon JM, Kessler LJ, Ricker JH. Encoding and recognition after traumatic brain injury: neuropsychological and functional magnetic resonance imaging findings. J Clin Exp Neuropsychol 2012; 34:333-44. [PMID: 22360275 PMCID: PMC3311702 DOI: 10.1080/13803395.2011.633896] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although impairment of episodic memory is common after traumatic brain injury (TBI), the complex nature of human memory suggests the need to study more than recall alone. For this reason, we are presenting an extension with additional analyses of persons reported in a previous publication ( Russell, Arenth, Scanlon, Kessler, & Ricker, 2011 ). We examined both the encoding and recognition components of an episodic memory paradigm containing both word and letter string blocks using functional magnetic resonance imaging (fMRI) and neuropsychological testing. This paradigm was completed by 12 persons with complicated mild, moderate, or severe TBI and 12 matched uninjured controls. Comparisons were made between groups and stimulus types. While task behavioral performance was not significantly different between groups, imaging results showed greater activation for the TBI group during the encoding portion of the task, while the control group exhibited more activation on the recognition portion. Observed areas of activation suggest that the TBI group may have used a less effective, but more automatic verbal strategy for encoding the nonpronounceable letter strings, while controls may have opted for more of a recognition-focused strategy. Group differences in California Verbal Learning Test-Second Edition (CVLT-II) performance supported these ideas, and further neuropsychological testing also suggested limitations in executive functioning in the TBI group that may have influenced performance. Implications for intervention are discussed.
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Affiliation(s)
- Patricia M. Arenth
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
- University of Pittsburgh Center for the Neural Basis of Cognition
| | - Kathryn C. Russell
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
- University of Pittsburgh Center for the Neural Basis of Cognition
| | - Joelle M. Scanlon
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
| | - Lauren J. Kessler
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
| | - Joseph H. Ricker
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
- University of Pittsburgh Center for the Neural Basis of Cognition
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Lifshitz J, Lisembee AM. Neurodegeneration in the somatosensory cortex after experimental diffuse brain injury. Brain Struct Funct 2012; 217:49-61. [PMID: 21597967 PMCID: PMC3536493 DOI: 10.1007/s00429-011-0323-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
Abstract
Disruption and consequent reorganization of central nervous system circuits following traumatic brain injury may manifest as functional deficits and behavioral morbidities. We previously reported axotomy and neuronal atrophy in the ventral basal (VB) complex of the thalamus, without gross degeneration after experimental diffuse brain injury in adult rats. Pathology in VB coincided with the development of late-onset aberrant behavioral responses to whisker stimulation, which lead to the current hypothesis that neurodegeneration after experimental diffuse brain injury includes the primary somatosensory barrel cortex (S1BF), which receives projection of VB neurons and mediates whisker somatosensation. Over 28 days after midline fluid percussion brain injury, argyrophilic reaction product within superficial layers and layer IV barrels at 1 day progresses into the cortex to subcortical white matter by 7 days, and selective inter-barrel septa and subcortical white matter labeling at 28 days. Cellular consequences were determined by stereological estimates of neuronal nuclear volumes and number. In all cortical layers, neuronal nuclear volumes significantly atrophied by 42-49% at 7 days compared to sham, which marginally attenuated by 28 days. Concomitantly, the number of healthy neurons was reduced by 34-45% at 7 days compared to sham, returning to control levels by 28 days. Progressive neurodegeneration, including argyrophilic reaction product and neuronal nuclear atrophy, indicates injury-induced damage and reorganization of the reciprocal thalamocortical projections that mediate whisker somatosensation. The rodent whisker barrel circuit may serve as a discrete model to evaluate the causes and consequences of circuit reorganization after diffuse brain injury.
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Affiliation(s)
- Jonathan Lifshitz
- Spinal Cord and Brain Injury Research Center, University of Kentucky Chandler Medical Center, Office B463, Biomedical and Biological Sciences Research Building, 741 S. Limestone St, Lexington, KY 40536-0509, USA.
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Raja Beharelle A, Tisserand D, Stuss DT, McIntosh AR, Levine B. Brain activity patterns uniquely supporting visual feature integration after traumatic brain injury. Front Hum Neurosci 2011; 5:164. [PMID: 22180740 PMCID: PMC3238543 DOI: 10.3389/fnhum.2011.00164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 11/22/2011] [Indexed: 11/17/2022] Open
Abstract
Traumatic brain injury (TBI) patients typically respond more slowly and with more variability than controls during tasks of attention requiring speeded reaction time. These behavioral changes are attributable, at least in part, to diffuse axonal injury (DAI), which affects integrated processing in distributed systems. Here we use a multivariate method sensitive to distributed neural activity to compare brain activity patterns of patients with chronic phase moderate to-severe TBI to those of controls during performance on a visual feature integration task assessing complex attentional processes that has previously shown sensitivity to TBI. The TBI patients were carefully screened to be free of large focal lesions that can affect performance and brain activation independently of DAI. The task required subjects to hold either one or three features of a Target in mind while suppressing responses to distracting information. In controls, the multi-feature condition activated a distributed network including limbic, prefrontal, and medial temporal structures. TBI patients engaged this same network in the single-feature and baseline conditions. In multi-feature presentations, TBI patients alone activated additional frontal, parietal, and occipital regions. These results are consistent with neuroimaging studies using tasks assessing different cognitive domains, where increased spread of brain activity changes was associated with TBI. Our results also extend previous findings that brain activity for relatively moderate task demands in TBI patients is similar to that associated with of high task demands in controls.
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Affiliation(s)
- Anjali Raja Beharelle
- Rotman Research Institute of Baycrest Centre, University of Toronto Toronto, ON, Canada
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Russell KC, Arenth PM, Scanlon JM, Kessler LJ, Ricker JH. A functional magnetic resonance imaging investigation of episodic memory after traumatic brain injury. J Clin Exp Neuropsychol 2011; 33:538-47. [PMID: 21294021 PMCID: PMC3109130 DOI: 10.1080/13803395.2010.537253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Traumatic brain injury often negatively impacts episodic memory; however, studies of the neural substrates of this impairment have been limited. In this study, both encoding and recognition of visually presented stimuli were examined with functional magnetic resonance imaging. Twelve adults with chronic complicated mild, moderate, and severe injuries were compared with a matched group of 12 controls. Behavioral task performance did not differentiate the groups. During neuroimaging, however, the group of individuals with traumatic brain injury exhibited increased activation, as well as increased bilaterality and dispersion as compared to controls. Findings are discussed in terms of increased resource recruitment.
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Affiliation(s)
- Kathryn C. Russell
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
- University of Pittsburgh Center for the Neural Basis of Cognition
| | - Patricia M. Arenth
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
- University of Pittsburgh Center for the Neural Basis of Cognition
| | - Joelle M. Scanlon
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
| | - Lauren J. Kessler
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
| | - Joseph H. Ricker
- University of Pittsburgh Department of Physical Medicine and Rehabilitation
- University of Pittsburgh Center for the Neural Basis of Cognition
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40
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Hillary FG, Medaglia JD, Gates K, Molenaar PC, Slocomb J, Peechatka A, Good DC. Examining working memory task acquisition in a disrupted neural network. ACTA ACUST UNITED AC 2011; 134:1555-70. [PMID: 21571783 DOI: 10.1093/brain/awr043] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is mounting literature that examines brain activation during tasks of working memory in individuals with neurological disorders such as traumatic brain injury. These studies represent a foundation for understanding the functional brain changes that occur after moderate and severe traumatic brain injury, but the focus on topographical brain-'activation' differences ignores potential alterations in how nodes communicate within a distributed neural network. The present study makes use of the most recently developed connectivity modelling (extended-unified structural equation model) to examine performance during a well-established working-memory task (the n-back) in individuals sustaining moderate and severe traumatic brain injury. The goal is to use the findings observed in topographical activation analysis as the basis for second-level effective connectivity modelling. Findings reveal important between-group differences in within-hemisphere connectivity during task acquisition, with the control sample demonstrating rapid within-left hemisphere connectivity increases and the traumatic brain injury sample demonstrating consistently elevated within-right hemisphere connectivity. These findings also point to important maturational effects from 'early' to 'late' during task performance, including diminished right prefrontal cortex involvement and an anterior to posterior shift in connectivity with increased task exposure. We anticipate that this approach to functional imaging data analysis represents an important future direction for understanding how neural plasticity is expressed in brain disorders.
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Affiliation(s)
- Frank G Hillary
- Department of Psychology, Pennsylvania State University, 223 Bruce V. Moore Building, University Park, PA 16802, USA.
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41
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Decreased prefrontal cortex activity in mild traumatic brain injury during performance of an auditory oddball task. Brain Imaging Behav 2011; 4:232-47. [PMID: 20703959 DOI: 10.1007/s11682-010-9102-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Up to one-third of patients with mild traumatic brain injury (TBI) demonstrate persistent cognitive deficits in the 'executive' function domain. Mild TBI patients have shown prefrontal cortex activity deficits during the performance of executive tasks requiring active information maintenance and manipulation. However, it is unclear whether these deficits are related to the executive processes themselves, or to the degree of mental effort. To determine whether prefrontal deficits also would be found during less effortful forms of executive ability, fMRI images were obtained on 31 mild TBI patients and 31 control participants during three-stimulus auditory oddball task performance. Although patients and controls had similar topographical patterns of brain activity, region-of-interest analysis revealed significantly decreased activity in right dorsolateral prefrontal cortex for mild TBI patients during target stimulus detection. Between-group analyses found evidence for potential compensatory brain activity during target detection and default-mode network dysfunction only during the detection of novel stimuli.
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42
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Hinzman JM, Thomas TC, Burmeister JJ, Quintero JE, Huettl P, Pomerleau F, Gerhardt GA, Lifshitz J. Diffuse brain injury elevates tonic glutamate levels and potassium-evoked glutamate release in discrete brain regions at two days post-injury: an enzyme-based microelectrode array study. J Neurotrauma 2010; 27:889-99. [PMID: 20233041 DOI: 10.1089/neu.2009.1238] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) survivors often suffer from a wide range of post-traumatic deficits, including impairments in behavioral, cognitive, and motor function. Regulation of glutamate signaling is vital for proper neuronal excitation in the central nervous system. Without proper regulation, increases in extracellular glutamate can contribute to the pathophysiology and neurological dysfunction seen in TBI. In the present studies, enzyme-based microelectrode arrays (MEAs) that selectively measure extracellular glutamate at 2 Hz enabled the examination of tonic glutamate levels and potassium chloride (KCl)-evoked glutamate release in the prefrontal cortex, dentate gyrus, and striatum of adult male rats 2 days after mild or moderate midline fluid percussion brain injury. Moderate brain injury significantly increased tonic extracellular glutamate levels by 256% in the dentate gyrus and 178% in the dorsal striatum. In the dorsal striatum, mild brain injury significantly increased tonic glutamate levels by 200%. Tonic glutamate levels were significantly correlated with injury severity in the dentate gyrus and striatum. The amplitudes of KCl-evoked glutamate release were increased significantly only in the striatum after moderate injury, with a 249% increase seen in the dorsal striatum. Thus, with the MEAs, we measured discrete regional changes in both tonic and KCl-evoked glutamate signaling, which were dependent on injury severity. Future studies may reveal the specific mechanisms responsible for glutamate dysregulation in the post-traumatic period, and may provide novel therapeutic means to improve outcomes after TBI.
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Affiliation(s)
- Jason M Hinzman
- Department of Anatomy and Neurobiology, University of Kentucky Chandler Medical Center, Lexington, Kentucky 40536-0509, USA
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Fornander L, Nyman T, Hansson T, Ragnehed M, Brismar T. Age- and time-dependent effects on functional outcome and cortical activation pattern in patients with median nerve injury: a functional magnetic resonance imaging study. J Neurosurg 2010; 113:122-8. [DOI: 10.3171/2009.10.jns09698] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors conducted a study to determine age- and time-dependent effects on the functional outcome after median nerve injury and repair and how such effects are related to changes in the pattern of cortical activation in response to tactile stimulation of the injured hand.
Methods
The authors studied 11 patients with complete unilateral median nerve injury at the wrist repaired with epineural suture. In addition, 8 patients who were reported on in a previous study were included in the statistical analysis. In the entire study cohort, the mean age at injury was 23.3 ± 13.4 years (range 7–57 years) and the time after injury ranged from 1 to 11 years. Sensory perception was measured with the static 2-point discrimination test and monofilaments. Functional MR imaging was conducted during tactile stimulation (brush strokes) of Digits II–III and IV–V of both hands, respectively.
Results
Tactile sensation was diminished in the median territory in all patients. The strongest predictor of 2-point discrimination was age at injury (p < 0.0048), and when this was accounted for in the regression analysis, the other age- and time-dependent predictors had no effect. The activation ratios (injured/healthy hand) for Digit II–III and Digit IV–V stimulation were positively correlated (rho 0.59, p < 0.011). The activation ratio for Digit II–III stimulation correlated weakly with time after injury (p < 0.041). The activation ratio of Digits IV–V correlated weakly with both age at injury (p < 0.048) and time after injury (p < 0.033), but no predictor reached significance in the regression model. The mean ratio of ipsi- and contralateral hemisphere activation after stimulation of the injured hand was 0.55, which was not significantly different from the corresponding ratio of the healthy hand (0.66).
Conclusions
Following a median nerve injury (1–11 years after injury) there may be an initial increase in the volume of the cortical representation, which subsequently declines during the restoration phase. These dynamic changes may involve both median and ulnar nerve cortical representation, because both showed negative correlation with time after injury. These findings are in agreement with animal studies showing that cortical plasticity is an important mechanism for functional recovery after peripheral nerve injury and repair.
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Affiliation(s)
- Lotta Fornander
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm
- 2Department of Orthopaedics, Vrinnevi Hospital, Norrköping
- 3Departments of Plastic Surgery, Hand Surgery and Burns, and
| | - Torbjörn Nyman
- 5Anaesthesiology, University Hospital, Linköping, Sweden
| | - Thomas Hansson
- 3Departments of Plastic Surgery, Hand Surgery and Burns, and
| | - Mattias Ragnehed
- 4Division of Radiological Sciences, IMH, Linköping University; and
| | - Tom Brismar
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm
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Zhang J, Mitsis EM, Chu K, Newmark RE, Hazlett EA, Buchsbaum MS. Statistical parametric mapping and cluster counting analysis of [18F] FDG-PET imaging in traumatic brain injury. J Neurotrauma 2010; 27:35-49. [PMID: 19715400 DOI: 10.1089/neu.2009.1049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this study we investigated regional cerebral glucose metabolism abnormalities of [(18)F] fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in traumatic brain injury (TBI). PET images of 81 TBI patients and 68 normal controls were acquired and a word list learning task was administered during the uptake period. The TBI group included 35 patients with positive structural imaging (CT or MRI) findings soon after injury, 40 patients with negative findings, and 6 cases without structural imaging. Statistical parametric mapping (SPM) analysis was applied with several levels of spatial smoothing. Cluster counting analysis was performed for each subject to identify abnormal clusters with contiguous voxel values that deviated by two standard deviations or more from the mean of the normal controls, and to count the number of clusters in 10 size categories. SPM maps demonstrated that the 81 patients had significantly lower FDG uptake than normal controls, widely across the cortex (including bilateral frontal and temporal regions), and in the thalamus. Cluster counting results indicated that TBI patients had a higher proportion of larger clusters than controls. These large low-FDG-uptake clusters of the TBI patients were closer to the brain edge than those of controls. These results suggest that deficits of cerebral metabolism in TBI are spread over multiple brain areas, that they are closer to the cortical surface than clusters in controls, and that group spatial patterns of abnormal cerebral metabolism may be similar in TBI patients with cognitive deficits with and without obvious acute abnormalities identified on structural imaging.
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Affiliation(s)
- Jing Zhang
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA
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45
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Wright MJ, Schmitter-Edgecombe M, Woo E. Verbal memory impairment in severe closed head injury: the role of encoding and consolidation. J Clin Exp Neuropsychol 2010; 32:728-36. [PMID: 20175012 DOI: 10.1080/13803390903512652] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We applied the item-specific deficit approach (ISDA) to California Verbal Learning Test data obtained from 56 severe, acceleration-deceleration closed head injury (CHI) participants and 62 controls. The CHI group demonstrated deficits on all ISDA indices in comparison to controls. Regression analyses indicated that encoding deficits, followed by consolidation deficits, accounted for most of the variance in delayed recall. Additionally, level of acquisition played a partial role in CHI-associated consolidation difficulties. Finally, CHI encoding deficits were largely driven by low semantic clustering during list learning. These results suggest that encoding (primary) and consolidation (secondary) deficits account for CHI-associated verbal memory impairment.
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Affiliation(s)
- Matthew J Wright
- Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
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46
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Hall KD, Lifshitz J. Diffuse traumatic brain injury initially attenuates and later expands activation of the rat somatosensory whisker circuit concomitant with neuroplastic responses. Brain Res 2010; 1323:161-73. [PMID: 20122903 DOI: 10.1016/j.brainres.2010.01.067] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/22/2010] [Accepted: 01/23/2010] [Indexed: 01/27/2023]
Abstract
Traumatic brain injury can initiate an array of chronic neurological deficits, effecting executive function, language and sensorimotor integration. Mechanical forces produce the diffuse pathology that disrupts neural circuit activation across vulnerable brain regions. The present manuscript explores the hypothesis that the extent of functional activation of brain-injured circuits is a consequence of initial disruption and consequent reorganization. In the rat, enduring sensory sensitivity to whisker stimulation directs regional analysis to the whisker barrel circuit. Adult, male rats were subjected to midline fluid percussion brain or sham injury and evaluated between 1day and 42days post-injury. Whisker somatosensory regions of the cortex and thalamus maintained cellular composition as visualized by Nissl stain. Within the first week post-injury, quantitatively less cFos activation was elicited by whisker stimulation, potentially due to axotomy within and surrounding the whisker circuit as visualized by amyloid precursor protein immunohistochemistry. Over six weeks post-injury, cFos activation after whisker stimulation showed a significant linear correlation with time in the cortex (r(2)=0.545; p=0.015), non-significant correlation in the thalamus (r(2)=0.326) and U-shaped correlation in the dentate gyrus (r(2)=0.831), all eventually exceeding sham levels. Ongoing neuroplastic responses in the cortex are evidenced by accumulating growth associated protein and synaptophysin gene expression. In the thalamus, the delayed restoration of plasticity markers may explain the broad distribution of neuronal activation extending into the striatum and hippocampus with whisker stimulation. The sprouting of diffuse-injured circuits into diffuse-injured tissue likely establishes maladaptive circuits responsible for behavioral morbidity. Therapeutic interventions to promote adaptive circuit restructuring may mitigate post-traumatic morbidity.
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Affiliation(s)
- Kelley D Hall
- Spinal Cord and Brain Injury Research Center, Chandler Medical Center, University of Kentucky, USA
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Nakamura T, Hillary FG, Biswal BB. Resting network plasticity following brain injury. PLoS One 2009; 4:e8220. [PMID: 20011533 PMCID: PMC2788622 DOI: 10.1371/journal.pone.0008220] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 11/06/2009] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to examine neural network properties at separate time-points during recovery from traumatic brain injury (TBI) using graph theory. Whole-brain analyses of the topological properties of the fMRI signal were conducted in 6 participants at 3 months and 6 months following severe TBI. Results revealed alterations of network properties including a change in the degree distribution, reduced overall strength in connectivity, and increased "small-worldness" from 3 months to 6 months post injury. The findings here indicate that, during recovery from injury, the strength but not the number of network connections diminishes, so that over the course of recovery, the network begins to approximate what is observed in healthy adults. These are the first data examining functional connectivity in a disrupted neural system during recovery.
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Affiliation(s)
- Toru Nakamura
- Department of Radiology, University of Medicine and Dentistry of New Jersey – New Jersey Medical School, Newark, New Jersey, United States of America
| | - Frank G. Hillary
- Department of Psychology, Penn State University, University Park, Pennsylvania, United States of America
- * E-mail: (FGH); (BBB)
| | - Bharat B. Biswal
- Department of Radiology, University of Medicine and Dentistry of New Jersey – New Jersey Medical School, Newark, New Jersey, United States of America
- * E-mail: (FGH); (BBB)
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Smits M, Dippel DWJ, Houston GC, Wielopolski PA, Koudstaal PJ, Hunink MGM, van der Lugt A. Postconcussion syndrome after minor head injury: brain activation of working memory and attention. Hum Brain Mapp 2009; 30:2789-803. [PMID: 19117278 DOI: 10.1002/hbm.20709] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
After minor head injury (MHI) postconcussive symptoms (PCS) such as memory and attention deficits frequently occur. It has been hypothesised that PCS are caused by microstructural damage to the brain due to shearing injury, which is not detectable with conventional imaging, and may be responsible for a functional deficit. The purpose of this study was to correlate functional magnetic resonance imaging brain activation of working memory and selective attention with PCS. 21 MHI patients and 12 healthy controls were scanned at 3T. Stimulation paradigms were the n-back and Counting Stroop tasks to engage working memory and selective attention, respectively. Functional data analysis consisted of random effects group analyses, correlating brain activation patterns with the severity of PCS as evaluated with the Rivermead postconcussion symptoms questionnaire. At minimal working memory load, activation was seen in patients with greater severity of PCS in the working memory network. With an increase of working memory load, increase of activation was more pronounced in patients with greater severity of PCS. At high and increased working memory load, activation associated with the severity of PCS was seen in the posterior parietal area, parahippocampal gyrus, and posterior cingulate gyrus. Activation related to selective attention processing was increased with greater severity of PCS. The increased activity in relation to working memory and attention, and the recruitment of brain areas outside the working memory network at high working memory load, may be considered a reflection of the brain's compensatory response to microstructural injury in patients with PCS.
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Affiliation(s)
- Marion Smits
- Department of Radiology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Ueno H, Maruishi M, Miyatani M, Muranaka H, Kondo K, Ohshita T, Matsumoto M. Brain activations in errorless and errorful learning in patients with diffuse axonal injury: A functional MRI study. Brain Inj 2009; 23:291-8. [PMID: 19330592 DOI: 10.1080/02699050902794855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cazalis F, Feydy A, Valabrègue R, Pélégrini-Issac M, Pierot L, Azouvi P. fMRI study of problem-solving after severe traumatic brain injury. Brain Inj 2009; 20:1019-28. [PMID: 17060134 DOI: 10.1080/02699050600664384] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the cerebral correlates of the dysexecutive syndrome after diffuse severe traumatic brain injury (TBI). METHODS Ten patients with sub-acute/chronic severe TBI without detectable focal cortical contusion and 11 matched healthy subjects were included in a parametric fMRI study using a planning task, the Tower of London. RESULTS Brain activation in the left Dorsolateral Pre-frontal Cortex (DLPFC) and the Anterior Cingulate Cortex (ACC) was closely related to performance. Patients with TBI who performed the task efficiently showed, like healthy controls who obtained a similar pattern of performance, a large activation in the left DLPFC and a small activation in the ACC. In contrast, poor performance was associated with a reduced activation in these both regions. CONCLUSION Problem-solving deficits after severe diffuse TBI could be related to an impaired activation of the DLPFC and of the ACC.
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