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Vaibhav K, Gulhane M, Ahluwalia P, Kumar M, Ahluwalia M, Rafiq AM, Amble V, Zabala MG, Miller JB, Goldman L, Mondal AK, Deak F, Kolhe R, Arbab AS, Vale FL. Single episode of moderate to severe traumatic brain injury leads to chronic neurological deficits and Alzheimer's-like pathological dementia. GeroScience 2024:10.1007/s11357-024-01183-3. [PMID: 38733547 DOI: 10.1007/s11357-024-01183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic brain injury (TBI) is one of the foremost causes of disability and mortality globally. While the scientific and medical emphasis is to save lives and avoid disability during acute period of injury, a severe health problem can manifest years after injury. For instance, TBI increases the risk of cognitive impairment in the elderly. Remote TBI history was reported to be a cause of the accelerated clinical trajectory of Alzheimer's disease-related dementia (ADRD) resulting in earlier onset of cognitive impairment and increased AD-associated pathological markers like greater amyloid deposition and cortical thinning. It is not well understood whether a single TBI event may increase the risk of dementia. Moreover, the cellular signaling pathways remain elusive for the chronic effects of TBI on cognition. We have hypothesized that a single TBI induces sustained neuroinflammation and disrupts cellular communication in a way that results later in ADRD pathology. To test this, we induced TBI in young adult CD1 mice and assessed the behavioral outcomes after 11 months followed by pathological, histological, transcriptomic, and MRI assessment. On MRI scans, these mice showed significant loss of tissue, reduced CBF, and higher white matter injury compared to sham mice. We found these brains showed progressive atrophy, markers of ADRD, sustained astrogliosis, loss of neuronal plasticity, and growth factors even after 1-year post-TBI. Because of progressive neurodegeneration, these mice had motor deficits, showed cognitive impairments, and wandered randomly in open field. We, therefore, conclude that progressive pathology after adulthood TBI leads to neurodegenerative conditions such as ADRD and impairs neuronal functions.
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Affiliation(s)
- Kumar Vaibhav
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.
- Transdisciplinary Research Initiative in Inflammaging and Brain Aging (TRIBA), Augusta University, Augusta, GA, USA.
| | - Mayuri Gulhane
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Pankaj Ahluwalia
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Manish Kumar
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meenakshi Ahluwalia
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ashiq M Rafiq
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Vibha Amble
- Center for Undergraduate Research Studies, Augusta University, Augusta, GA, USA
| | - Manuela G Zabala
- Center for Undergraduate Research Studies, Augusta University, Augusta, GA, USA
| | - Jacob B Miller
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- The Graduate School, Augusta University, Augusta, GA, USA
| | - Liam Goldman
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Ashis K Mondal
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ferenc Deak
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ravindra Kolhe
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ali S Arbab
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Fernando L Vale
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
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Boyko M, Gruenbaum BF, Oleshko A, Merzlikin I, Zlotnik A. Diet's Impact on Post-Traumatic Brain Injury Depression: Exploring Neurodegeneration, Chronic Blood-Brain Barrier Destruction, and Glutamate Neurotoxicity Mechanisms. Nutrients 2023; 15:4681. [PMID: 37960334 PMCID: PMC10649677 DOI: 10.3390/nu15214681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Traumatic brain injury (TBI) has a profound impact on cognitive and mental functioning, leading to lifelong impairment and significantly diminishing the quality of life for affected individuals. A healthy blood-brain barrier (BBB) plays a crucial role in guarding the brain against elevated levels of blood glutamate, making its permeability a vital aspect of glutamate regulation within the brain. Studies have shown the efficacy of reducing excess glutamate in the brain as a treatment for post-TBI depression, anxiety, and aggression. The purpose of this article is to evaluate the involvement of dietary glutamate in the development of depression after TBI. We performed a literature search to examine the effects of diets abundant in glutamate, which are common in Asian populations, when compared to diets low in glutamate, which are prevalent in Europe and America. We specifically explored these effects in the context of chronic BBB damage after TBI, which may initiate neurodegeneration and subsequently have an impact on depression through the mechanism of chronic glutamate neurotoxicity. A glutamate-rich diet leads to increased blood glutamate levels when contrasted with a glutamate-poor diet. Within the context of chronic BBB disruption, elevated blood glutamate levels translate to heightened brain glutamate concentrations, thereby intensifying neurodegeneration due to glutamate neurotoxicity.
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Affiliation(s)
- Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna Oleshko
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Igor Merzlikin
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
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Schaffert J, Chiang HS, Fatima H, LoBue C, Hart J, Cullum CM. History of traumatic brain injury does not alter course of neurocognitive decline in older adults with and without cognitive impairment. Neuropsychology 2023; 37:923-932. [PMID: 37023289 PMCID: PMC10556197 DOI: 10.1037/neu0000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE Traumatic brain injury (TBI) history is associated with dementia risk, but it is unclear whether TBI history significantly hastens neurocognitive decline in older adults. METHOD Data were derived from the National Alzheimer's Coordinating Center (NACC) data set. Participants with a history of TBI (TBI +; n = 1,467) were matched to individuals without a history of TBI (TBI-; n = 1,467) based on age (50-97, M = 71.61, SD = 8.40), sex, education, race, ethnicity, cognitive diagnosis, functional decline, number of Apolipoprotein ε4 (APOE ε4) alleles, and number of annual visits (3-6). Mixed linear models were used to assess longitudinal neuropsychological test composite scores of executive functioning/attention/speed, language, and memory in TBI + and TBI- participants. Interactions between TBI and demographics, APOE ε4 status, and cognitive diagnosis were also examined. RESULTS Longitudinal neuropsychological functioning did not differ between TBI groups (p's > .001). There was a significant three-way interaction (age, TBI history, time) in language (F[20, 5750.1] = 3.133, p < .001) and memory performance (F[20, 6580.8] = 3.386, p < .001), but post hoc analyses revealed TBI history was not driving this relationship (all p's > .096). No significant interactions were observed between TBI history and sex, education, race/ethnicity, number of APOE ε4 alleles, or cognitive diagnosis (p's > .001). CONCLUSIONS Findings suggest TBI history, regardless of demographic factors, APOE ε4 status, or cognitive diagnosis, does not alter the course of neurocognitive functioning later-in-life in older adults with or without cognitive impairment. Future clinicopathological longitudinal studies that well-characterize head injuries and the associated clinical course are needed to help clarify the mechanism in which TBI may increase dementia risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, U.S
| | - Hsueh-Sheng Chiang
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, U.S
- Callier Center, School of Behavioral and Brain Sciences, UT Dallas, Dallas, TX, U.S
| | - Hudaisa Fatima
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, U.S
| | - Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, U.S
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, U.S
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, U.S
- Callier Center, School of Behavioral and Brain Sciences, UT Dallas, Dallas, TX, U.S
| | - C. Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, U.S
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, U.S
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S
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Bjorklund GR, Wong J, Brafman D, Bowser R, Stabenfeldt SE. Traumatic brain injury induces TDP-43 mislocalization and neurodegenerative effects in tissue distal to the primary injury site in a non-transgenic mouse. Acta Neuropathol Commun 2023; 11:137. [PMID: 37608352 PMCID: PMC10463884 DOI: 10.1186/s40478-023-01625-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 08/24/2023] Open
Abstract
Traumatic brain injury (TBI) initiates tissue and cellular damage to the brain that is immediately followed by secondary injury sequalae with delayed and continual damage. This secondary damage includes pathological processes that may contribute to chronic neurodegeneration and permanent functional and cognitive deficits. TBI is also associated with an increased risk of developing neurodegenerative diseases such as Alzheimer's disease (AD), frontotemporal dementia (FTD), and amyotrophic lateral sclerosis (ALS) as indicated by shared pathological features. For example, abnormalities in the TAR DNA-binding Protein 43 (TDP-43) that includes cytoplasmic mislocalization, cytosolic aggregation, and an increase in phosphorylation and ubiquitination are seen in up to 50% of FTD cases, up to 70% of AD cases, and is considered a hallmark pathology of ALS occurring in > 97% of cases. Yet the prevalence of TDP-43 pathology post-TBI has yet to be fully characterized. Here, we employed a non-transgenic murine controlled cortical injury model of TBI and observed injury-induced hallmark TDP-43 pathologies in brain and spinal cord tissue distal to the primary injury site and did not include the focally damaged tissue within the primary cortical injury site. Analysis revealed a temporal-dependent and significant increase in neuronal TDP-43 mislocalization in the cortical forebrain rostral to and distant from the primary injury site up to 180 days post injury (DPI). TDP-43 mislocalization was also detected in neurons located in the ventral horns of the cervical spinal cord following a TBI. Moreover, a cortical layer-dependent affect was identified, increasing from superficial to deeper cortical layers over time from 7 DPI up to 180 DPI. Lastly, RNAseq analysis confirmed an injury-induced misregulation of several key biological processes implicated in neurons that increased over time. Collectively, this study demonstrates a connection between a single moderate TBI event and chronic neurodegenerative processes that are not limited to the primary injury site and broadly distributed throughout the cortex and corticospinal tract.
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Affiliation(s)
- George R Bjorklund
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Jennifer Wong
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - David Brafman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Robert Bowser
- Department of Translational Neuroscience, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Sarah E Stabenfeldt
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA.
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Peters ME, Lyketsos CG. The glymphatic system's role in traumatic brain injury-related neurodegeneration. Mol Psychiatry 2023; 28:2707-2715. [PMID: 37185960 DOI: 10.1038/s41380-023-02070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
In at least some individuals who suffer a traumatic brain injury (TBI), there exists a risk of future neurodegenerative illness. This review focuses on the association between the brain-based paravascular drainage pathway known as the "glymphatic system" and TBI-related neurodegeneration. The glymphatic system is composed of cerebrospinal fluid (CSF) flowing into the brain parenchyma along paravascular spaces surrounding penetrating arterioles where it mixes with interstitial fluid (ISF) before being cleared along paravenous drainage pathways. Aquaporin-4 (AQP4) water channels on astrocytic end-feet appear essential for the functioning of this system. The current literature linking glymphatic system disruption and TBI-related neurodegeneration is largely based on murine models with existing human research focused on the need for biomarkers of glymphatic system function (e.g., neuroimaging modalities). Key findings from the existing literature include evidence of glymphatic system flow disruption following TBI, mechanisms of this decreased flow (i.e., AQP4 depolarization), and evidence of protein accumulation and deposition (e.g., amyloid β, tau). The same studies suggest that glymphatic dysfunction leads to subsequent neurodegeneration, cognitive decline, and/or behavioral change although replication in humans is needed. Identified emerging topics from the literature are as follows: link between TBI, sleep, and glymphatic system dysfunction; influence of glymphatic system disruption on TBI biomarkers; and development of novel treatments for glymphatic system disruption following TBI. Although a burgeoning field, more research is needed to elucidate the role of glymphatic system disruption in TBI-related neurodegeneration.
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Affiliation(s)
- Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Velmurugan GV, Hubbard WB, Prajapati P, Vekaria HJ, Patel SP, Rabchevsky AG, Sullivan PG. LRP1 Deficiency Promotes Mitostasis in Response to Oxidative Stress: Implications for Mitochondrial Targeting after Traumatic Brain Injury. Cells 2023; 12:1445. [PMID: 37408279 PMCID: PMC10217498 DOI: 10.3390/cells12101445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 07/07/2023] Open
Abstract
The brain undergoes oxidative stress and mitochondrial dysfunction following physiological insults such as Traumatic brain injury (TBI), ischemia-reperfusion, and stroke. Pharmacotherapeutics targeting mitochondria (mitoceuticals) against oxidative stress include antioxidants, mild uncouplers, and enhancers of mitochondrial biogenesis, which have been shown to improve pathophysiological outcomes after TBI. However, to date, there is no effective treatment for TBI. Studies have suggested that the deletion of LDL receptor-related protein 1 (LRP1) in adult neurons or glial cells could be beneficial and promote neuronal health. In this study, we used WT and LRP1 knockout (LKO) mouse embryonic fibroblast cells to examine mitochondrial outcomes following exogenous oxidative stress. Furthermore, we developed a novel technique to measure mitochondrial morphometric dynamics using transgenic mitochondrial reporter mice mtD2g (mitochondrial-specific Dendra2 green) in a TBI model. We found that oxidative stress increased the quantity of fragmented and spherical-shaped mitochondria in the injury core of the ipsilateral cortex following TBI, whereas rod-like elongated mitochondria were seen in the corresponding contralateral cortex. Critically, LRP1 deficiency significantly decreased mitochondrial fragmentation, preserving mitochondrial function and cell growth following exogenous oxidative stress. Collectively, our results show that targeting LRP1 to improve mitochondrial function is a potential pharmacotherapeutic strategy against oxidative damage in TBI and other neurodegenerative diseases.
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Affiliation(s)
- Gopal V. Velmurugan
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 405036, USA; (G.V.V.); (W.B.H.); (P.P.); (H.J.V.); (S.P.P.); (A.G.R.)
- Department of Neuroscience, University of Kentucky, Lexington, KY 40536, USA
| | - W. Brad Hubbard
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 405036, USA; (G.V.V.); (W.B.H.); (P.P.); (H.J.V.); (S.P.P.); (A.G.R.)
- Lexington Veterans’ Affairs Healthcare System, Lexington, KY 40502, USA
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
| | - Paresh Prajapati
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 405036, USA; (G.V.V.); (W.B.H.); (P.P.); (H.J.V.); (S.P.P.); (A.G.R.)
- Department of Neuroscience, University of Kentucky, Lexington, KY 40536, USA
- Lexington Veterans’ Affairs Healthcare System, Lexington, KY 40502, USA
| | - Hemendra J. Vekaria
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 405036, USA; (G.V.V.); (W.B.H.); (P.P.); (H.J.V.); (S.P.P.); (A.G.R.)
- Department of Neuroscience, University of Kentucky, Lexington, KY 40536, USA
- Lexington Veterans’ Affairs Healthcare System, Lexington, KY 40502, USA
| | - Samir P. Patel
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 405036, USA; (G.V.V.); (W.B.H.); (P.P.); (H.J.V.); (S.P.P.); (A.G.R.)
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
| | - Alexander G. Rabchevsky
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 405036, USA; (G.V.V.); (W.B.H.); (P.P.); (H.J.V.); (S.P.P.); (A.G.R.)
- Department of Physiology, University of Kentucky, Lexington, KY 40536, USA
| | - Patrick G. Sullivan
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 405036, USA; (G.V.V.); (W.B.H.); (P.P.); (H.J.V.); (S.P.P.); (A.G.R.)
- Department of Neuroscience, University of Kentucky, Lexington, KY 40536, USA
- Lexington Veterans’ Affairs Healthcare System, Lexington, KY 40502, USA
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Grasset L, Power MC, Crivello F, Tzourio C, Chêne G, Dufouil C. How Traumatic Brain Injury History Relates to Brain Health MRI Markers and Dementia Risk: Findings from the 3C Dijon Cohort. J Alzheimers Dis 2023; 92:183-193. [PMID: 36710672 PMCID: PMC10041415 DOI: 10.3233/jad-220658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The long-term effects of traumatic brain injury (TBI) with loss of consciousness (LOC) on magnetic resonance imaging (MRI) markers of brain health and on dementia risk are still debated. OBJECTIVE To investigate the associations of history of TBI with LOC with incident dementia and neuroimaging markers of brain structure and small vessel disease lesions. METHODS The analytical sample consisted in 4,144 participants aged 65 and older who were dementia-free at baseline from the Three City -Dijon study. History of TBI with LOC was self-reported at baseline. Clinical Dementia was assessed every two to three years, up to 12 years of follow-up. A subsample of 1,675 participants <80 years old underwent a brain MRI at baseline. We investigated the associations between history of TBI with LOC and 1) incident all cause and Alzheimer's disease (AD) dementia using illness-death models, and 2) neuroimaging markers at baseline. RESULTS At baseline, 8.3% of the participants reported a history of TBI with LOC. In fully-adjusted models, participants with a history of TBI with LOC had no statistically significant differences in dementia risk (HR = 0.90, 95% CI = 0.60-1.36) or AD risk (HR = 1.03, 95% CI = 0.69-1.52), compared to participants without TBI history. History of TBI with LOC was associated with lower white matter volume (β= -4.58, p = 0.048), but not with other brain volumes, white matter hyperintensities volume, nor covert brain infarct. CONCLUSION This study did not find evidence of an association between history of TBI with LOC and dementia or AD dementia risks over 12-year follow-up, brain atrophy, or markers of small vessel disease.
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Affiliation(s)
- Leslie Grasset
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; CIC1401-EC, Bordeaux, France
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Christophe Tzourio
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Bordeaux, France
| | - Geneviève Chêne
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; CIC1401-EC, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Carole Dufouil
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; CIC1401-EC, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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Carlisle TC, Birlea M, Restrepo D, Filley CM. Headache-Associated Phantosmia as a Harbinger of Lewy Body Dementia. J Neuropsychiatry Clin Neurosci 2022; 35:92-97. [PMID: 35989571 PMCID: PMC11022529 DOI: 10.1176/appi.neuropsych.21110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Olfactory hallucinations, or phantosmias, can occur in many neurological, psychiatric, and medical conditions, but no widely used standardized approach exists to comprehensively assess qualitative olfactory dysfunction in the clinical setting. Additionally, medical professionals, patients, and their family members may not recognize phantosmia as a potentially neurological problem. Given the many possible etiologies for symptomatic phantosmia, it is important to recognize this unusual presentation and elicit a meaningful history to explore the potential underlying cause. We describe a 77-year-old gentleman with a two-year history of headaches accompanied by smelling a foul odor and discuss the differential diagnosis for new onset and persistent phantosmia. This unusual case ultimately manifested features consistent with Lewy body dementia, highlighting the varied clinical presentations that are possible with this neurodegenerative disorder. We discuss the possible pathophysiology of phantosmia in Lewy body disorders, including a proposed mechanism for olfactory hallucinations arising prior to the typical well-formed hallucinations in Lewy body dementia.
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Affiliation(s)
- Tara C Carlisle
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Marius Birlea
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Diego Restrepo
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Christopher M Filley
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
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Latent Neuropsychological Profiles to Discriminate Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Active-Duty Service Members. J Head Trauma Rehabil 2022; 37:E438-E448. [PMID: 35452025 PMCID: PMC9585096 DOI: 10.1097/htr.0000000000000779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether cognitive and psychological symptom profiles differentiate clinical diagnostic classifications (eg, history of mild traumatic brain injury [mTBI] and posttraumatic stress disorder [PTSD]) in military personnel. METHODS US Active-Duty Service Members (N = 209, 89% male) with a history of mTBI (n = 56), current PTSD (n = 23), combined mTBI + PTSD (n = 70), or orthopedic injury controls (n = 60) completed a neuropsychological battery assessing cognitive and psychological functioning. Latent profile analysis was performed to determine how neuropsychological outcomes of individuals clustered together. Diagnostic classifications (ie, mTBI, PTSD, mTBI + PTSD, and orthopedic injury controls) within each symptom profile were examined. RESULTS A 5-profile model had the best fit. The profiles differentiated subgroups with high (34.0%) or normal (21.5%) cognitive and psychological functioning, cognitive symptoms (19.1%), psychological symptoms (15.3%), and combined cognitive and psychological symptoms (10.0%). The symptom profiles differentiated participants as would generally be expected. Participants with PTSD were mainly represented in the psychological symptom subgroup, while orthopedic injury controls were mainly represented in the high-functioning subgroup. Further, approximately 79% of participants with comorbid mTBI and PTSD were represented in a symptomatic group (∼24% = cognitive symptoms, ∼29% = psychological symptoms, and 26% = combined cognitive/psychological symptoms). Our results also showed that approximately 70% of military personnel with a history of mTBI were represented in the high- and normal-functioning groups. CONCLUSIONS These results demonstrate both overlapping and heterogeneous symptom and performance profiles in military personnel with a history of mTBI, PTSD, and/or mTBI + PTSD. The overlapping profiles may underscore why these diagnoses are often difficult to diagnose and treat, but suggest that advanced statistical models may aid in identifying profiles representing symptom and cognitive performance impairments within patient groups and enable identification of more effective treatment targets.
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Adamson MM, Main K, Harris OA, Kang X. Sex differences in cortical thickness and diffusion properties in patients with traumatic brain injury: a pilot study. Brain Inj 2022; 36:488-502. [PMID: 35113752 DOI: 10.1080/02699052.2022.2034046] [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: 11/02/2022]
Abstract
OBJECTIVE Cortical thickness and diffusion properties are important measures of gray and white matter integrity in those with traumatic brain injury (TBI). Many studies show that healthy adult females have greater cortical thickness than males across numerous brain sites. In this study, we explored this sex difference in patients with TBI. METHOD Participants consisted of 32 patients with TBI and 21 neurologically healthy controls. All were scanned by magnetic resonance imaging (MRI). Differences in cortical thickness and diffusion properties were examined between groups (i.e., TBI/control, male/female). RESULTS Patients with TBI had more cortical thinning (both hemispheres) compared to controls. They also showed decreased fractional anisotropy (FA) for several major white matter tracts. Healthy females had significantly greater cortical thickness compared to healthy males. However, this difference was smaller among the patients with TBI. We found no sex differences in diffusion properties. There were moderate correlations between cortical thickness, diffusion properties, and cognitive performance, as measured by the Trail Making Test B. CONCLUSION These findings contribute to a growing discussion on sex differences in cortical thickness and diffusion properties. Sexual dimorphism could necessitate different clinical profiles, targets, and rehabilitation strategies in patients with TBI.
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Affiliation(s)
- Maheen M Adamson
- Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Keith Main
- Research Division, Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Odette A Harris
- Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Xiaojian Kang
- Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA
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11
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LoBue C, Kelley BJ, Hart J, Helphrey J, Schaffert J, Cullum CM, Peters ME, Douglas PM. Mild Traumatic Brain Injury Is Related to Elevated Cerebrospinal Fluid Tau in Alzheimer's Disease Dementia. J Alzheimers Dis 2022; 87:1491-1496. [PMID: 35491792 PMCID: PMC9241585 DOI: 10.3233/jad-220112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Few studies have examined an association between mild traumatic brain injury (mTBI) and Alzheimer's disease (AD). For this reason, we compared an AD dementia group with an mTBI history (n = 10) to a matched AD control group (n = 20) on measures of cognitive function, cerebral glucose metabolism, and markers of amyloid and tau deposition. Only a trend and medium-to-large effect size for higher phosphorylated and total tau was identified for the mTBI group. A history of mTBI may be associated with greater tau in AD, indicating a potential pathway for increasing risk for AD, though further evaluation with larger samples is needed.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brendan J. Kelley
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
| | - Jessica Helphrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - C. Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter M. Douglas
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX
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12
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Omalu B, Hammers J. In Reply: Recommendation to Create New Neuropathologic Guidelines for the Postmortem Diagnosis of Chronic Traumatic Encephalopathy. Neurosurgery 2022; 90:e21-e23. [PMID: 34982893 DOI: 10.1227/neu.0000000000001768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bennet Omalu
- Department of Medical Pathology and Laboratory Medicine , University of California, Davis, Davis , California , USA
| | - Jennifer Hammers
- Forensic Science and Law Program , Bayer School of Natural and Environmental Sciences , Duquesne University, Pittsburgh , Pennsylvania , USA
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13
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Omalu B, Hammers J. Letter: Traumatic Encephalopathy Syndrome [TES] Is Not Chronic Traumatic Encephalopathy [CTE]: CTE Is Only a Subtype of TES. Neurosurgery 2021; 89:E205-E206. [PMID: 34271585 DOI: 10.1093/neuros/nyab231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bennet Omalu
- Department of Medical Pathology and Laboratory Medicine University of California, Davis Davis, California, USA
| | - Jennifer Hammers
- Forensic Science and Law Program Bayer School of Natural and Environmental Sciences Duquesne University Pittsburgh, Pennsylvania, USA
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14
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Poluyi E, Morgan E, Poluyi C, Ikwuegbuenyi C, Imaguezegie G. Examining the Relationship between Concussion and Neurodegenerative Disorders: A Review on Amyotrophic Lateral Sclerosis (ALS) and Alzheimer’s Disease (AD). INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0041-1725571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background Current epidemiological studies have examined the associations between moderate and severe traumatic brain injury (TBI) and their risks of developing neurodegenerative diseases. Concussion, also known as mild TBI (mTBI), is however quite distinct from moderate or severe TBIs. Only few studies in this burgeoning area have examined concussion—especially repetitive episodes—and neurodegenerative diseases. Thus, no definite relationship has been established between them.
Objectives This review will discuss the available literatures linking concussion and amyotrophic lateral sclerosis (ALS) and Alzheimer’s disease (AD).
Materials and Methods Given the complexity of this subject, a realist review methodology was selected which includes clarifying the scope and developing a theoretical framework, developing a search strategy, selection and appraisal, data extraction, and synthesis. A detailed literature matrix was set out in order to get relevant and recent findings on this topic.
Results Presently, there is no objective clinical test for the diagnosis of concussion because the features are less obvious on physical examination. Absence of an objective test in diagnosing concussion sometimes leads to skepticism when confirming the presence or absence of concussion. Intriguingly, several possible explanations have been proposed in the pathological mechanisms that lead to the development of some neurodegenerative disorders (such as ALS and AD) and concussion but the two major events are deposition of tau proteins (abnormal microtubule proteins) and neuroinflammation, which ranges from glutamate excitotoxicity pathways and inflammatory pathways (which leads to a rise in the metabolic demands of microglia cells and neurons), to mitochondrial function via the oxidative pathways.
Conclusion mTBI constitutes majority of brain injuries. However, studies have focused mostly on moderate-to-severe TBI as highlighted above with inconclusive and paucity of studies linking concussion and neurodegenerative disorders. Although, it is highly probable that repetitive concussion (mTBI) and subconcussive head injuries may be risk factors for ALS) and AD from this review. It will be imperative therefore to conduct more research with a focus on mTBI and its association with ALS and AD.
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Affiliation(s)
- Edward Poluyi
- Department of Clinical Neuroscience, University of Roehampton, London, United Kingdom
| | - Eghosa Morgan
- Department of Neurosurgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Charles Poluyi
- MPH Program, University of Buffalo, New York, United States
| | | | - Grace Imaguezegie
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
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15
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Raymont V, Thayanandan T. What do we know about the risks of developing dementia after traumatic brain injury? Minerva Med 2020; 112:288-297. [PMID: 33164474 DOI: 10.23736/s0026-4806.20.07084-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traumatic brain injury (TBI) is a risk factor for the later development of dementia, but although the evidence dates back to the early 20th century, the nature of any association and its mechanistic pathways remain unclear. There has been greater focus on this subject over recent years, in part because of increasing reports around sports related TBIs, especially in the USA. Differences in research methods and clinical sampling remain the primary reason for the variable findings, although there is clearly increased prevalence of neurodegenerative disorders in general. Duration of follow up, definition of both TBI and dementia, and differences in the extent to which other dementia risk factors are controlled, as well as concerns about medical record accuracy are all issues yet to be resolved in TBI research, as is an absence pathological evidence. In addition, TBI has been reported to initiate a cascade of pathological processes related to several neurodegenerative disorders, and as such, it is likely that the risks vary between individuals. Given the evidence that dementia risk may increase with injury severity and frequency, a detailed account of age and type of injury, as well as lifetime TBI exposure is essential to document in future studies, and further longitudinal research with biomarker assessments are needed.
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Affiliation(s)
- Vanessa Raymont
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK -
| | - Tony Thayanandan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
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16
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Chiasseu M, Fesharaki-Zadeh A, Saito T, Saido TC, Strittmatter SM. Gene-environment interaction promotes Alzheimer's risk as revealed by synergy of repeated mild traumatic brain injury and mouse App knock-in. Neurobiol Dis 2020; 145:105059. [PMID: 32858147 PMCID: PMC7572902 DOI: 10.1016/j.nbd.2020.105059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/17/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
There is a strong unmet need for translational progress towards Alzheimer's disease (AD) modifying therapy. Unfortunately, preclinical modeling of the disease has been disappointing, relying primarily on transgenic mouse overexpression of rare dominant mutations. Clinical manifestation of AD symptoms is known to reflect interaction between environmental and genetic risks. Mild traumatic brain injury (mTBI) is an environmental risk for dementia, including Alzheimer's, but there has been limited mechanistic analysis of mTBI contribution to AD. Here, we investigate the interplay between mTBI and Aβ precursor protein gene mutation in AD pathogenesis. We employed a knock-in (KI) model of AD that expresses the Aß-containing exons from human APP bearing the Swedish and Iberian mutations, namely AppNL-F/NL-F mice. Without environmental risk, this genetic variation yields minimal mouse symptomatology. Anesthetized 4-month-old KI mice and their age-matched wild type (WT) controls were subjected to repeated mild closed head injury (rmCHI), once daily for 14 days. Anesthetized, uninjured genotype- and age-matched mice were used as sham controls. At 3- and 8-months post-injury, amyloid-β, phospho-tau and Iba1 expression in the injured KI cortices were assessed. Our data reveal that rmCHI enhances accumulation of amyloid-β and hyperphosphorylated tau inclusions, as well as neuroinflammation in AppNL-F/NL-F mice. Furthermore, novel object recognition and Morris water maze tests demonstrated that rmCHI greatly exacerbates persistent cognitive deficits in APPNL-F/NL-F mice. Therefore, study of gene-environment interaction demonstrates that combining risk factors provides a more robust model for AD, and that repeated mTBI substantially accelerates AD pathology in a genetically susceptible situation.
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Affiliation(s)
- Marius Chiasseu
- Cellular Neuroscience, Neurodegeneration and Repair Program, Yale University School of Medicine, New Haven, CT, USA; Departments of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Arman Fesharaki-Zadeh
- Cellular Neuroscience, Neurodegeneration and Repair Program, Yale University School of Medicine, New Haven, CT, USA; Departments of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Takashi Saito
- Laboratory for Proteolytic Neuroscience, RIKEN Center for Brain Science, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan; Department of Neurocognitive Science, Institute of Brain Science, Nagoya City University Graduate School of Medical Science, 1 Kawasumi, Mizuho-ku, Mizuho-cho, Nagoya, Aichi 467-8601, Japan
| | - Takaomi C Saido
- Laboratory for Proteolytic Neuroscience, RIKEN Center for Brain Science, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - Stephen M Strittmatter
- Cellular Neuroscience, Neurodegeneration and Repair Program, Yale University School of Medicine, New Haven, CT, USA; Departments of Neurology, Yale University School of Medicine, New Haven, CT, USA; Departments of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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17
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Fields L, Didehbani N, Hart J, Cullum CM. No Linear Association Between Number of Concussions or Years Played and Cognitive Outcomes in Retired NFL Players. Arch Clin Neuropsychol 2020; 35:233-239. [PMID: 30844072 DOI: 10.1093/arclin/acz008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/17/2018] [Accepted: 02/05/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of the current study is to examine whether concussion history and years played are linearly associated with cognitive outcomes in retired National Football League (NFL) players. METHOD Thirty-five retired NFL players over the age of 50 who had sustained at least one concussion completed a clinical interview and brief neuropsychological battery. Correlational analyses were conducted between exposure variables [number of total concussions, concussions with loss of consciousness (LOC), and years played] and cognitive performance as characterized by cognitive composite scores based on performance on neuropsychological measures (attention/processing speed, language, memory, and overall composite scores). RESULTS Correlational analyses corrected for multiple comparisons did not reveal any statistically significant correlations between exposure variables and cognitive outcomes. CONCLUSIONS We did not find a significant linear association between cognitive outcomes and either number of total concussions, concussions with LOC, or years played in the NFL. These findings do not support a dose-response relationship between sports-related exposure to head impacts and cognitive outcomes later in life. Rather, the findings suggest that cognitive difficulties experienced by some retired players later in life are not directly linearly associated with quantified exposure to head impacts sustained throughout a football career, but related to factors or combinations of factors that have yet to be elucidated.
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Affiliation(s)
- Lindy Fields
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,University of Texas at Dallas, Dallas, TX, USA
| | - C Munro Cullum
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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18
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Takahata K, Kimura Y, Sahara N, Koga S, Shimada H, Ichise M, Saito F, Moriguchi S, Kitamura S, Kubota M, Umeda S, Niwa F, Mizushima J, Morimoto Y, Funayama M, Tabuchi H, Bieniek KF, Kawamura K, Zhang MR, Dickson DW, Mimura M, Kato M, Suhara T, Higuchi M. PET-detectable tau pathology correlates with long-term neuropsychiatric outcomes in patients with traumatic brain injury. Brain 2020; 142:3265-3279. [PMID: 31504227 DOI: 10.1093/brain/awz238] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022] Open
Abstract
Tau deposits is a core feature of neurodegenerative disorder following traumatic brain injury (TBI). Despite ample evidence from post-mortem studies demonstrating exposure to both mild-repetitive and severe TBIs are linked to tau depositions, associations of topology of tau lesions with late-onset psychiatric symptoms due to TBI have not been explored. To address this issue, we assessed tau deposits in long-term survivors of TBI by PET with 11C-PBB3, and evaluated those associations with late-life neuropsychiatric outcomes. PET data were acquired from 27 subjects in the chronic stage following mild-repetitive or severe TBI and 15 healthy control subjects. Among the TBI patients, 14 were diagnosed as having late-onset symptoms based on the criteria of traumatic encephalopathy syndrome. For quantification of tau burden in TBI brains, we calculated 11C-PBB3 binding capacity (cm3), which is a summed voxel value of binding potentials (BP*ND) multiplied by voxel volume. Main outcomes of the present study were differences in 11C-PBB3 binding capacity between groups, and the association of regional 11C-PBB3 binding capacity with neuropsychiatric symptoms. To confirm 11C-PBB3 binding to tau deposits in TBI brains, we conducted in vitro PBB3 fluorescence and phospho-tau antibody immunofluorescence labelling of brain sections of chronic traumatic encephalopathy obtained from the Brain Bank. Our results showed that patients with TBI had higher 11C-PBB3 binding capacities in the neocortical grey and white matter segments than healthy control subjects. Furthermore, TBI patients with traumatic encephalopathy syndrome showed higher 11C-PBB3 binding capacity in the white matter segment than those without traumatic encephalopathy syndrome, and regional assessments revealed that subgroup difference was also significant in the frontal white matter. 11C-PBB3 binding capacity in the white matter segment correlated with the severity of psychosis. In vitro assays demonstrated PBB3-positive tau inclusions at the depth of neocortical sulci, confirming 11C-PBB3 binding to tau lesions. In conclusion, increased 11C-PBB3 binding capacity is associated with late-onset neuropsychiatric symptoms following TBI, and a close correlation was found between psychosis and 11C-PBB3 binding capacity in the white matter.
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Affiliation(s)
- Keisuke Takahata
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Kimura
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Naruhiko Sahara
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, USA
| | - Hitoshi Shimada
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Masanori Ichise
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Fumie Saito
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sho Moriguchi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Soichiro Kitamura
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Department of Psychiatry, Nara Medical University, Nara, Japan
| | - Manabu Kubota
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Satoshi Umeda
- Department of Psychology, Keio University, Tokyo, Japan
| | - Fumitoshi Niwa
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Jin Mizushima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Morimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michitaka Funayama
- Department of Psychiatry, Japanese Red Cross Ashikaga Hospital, Ashikaga, Tochigi, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Ming-Rong Zhang
- Department of Radiopharmaceuticals Development, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | | | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Motoichiro Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Suhara
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Makoto Higuchi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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19
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Grasset L, Glymour MM, Yaffe K, Swift SL, Gianattasio KZ, Power MC, Zeki Al Hazzouri A. Association of traumatic brain injury with dementia and memory decline in older adults in the United States. Alzheimers Dement 2020; 16:853-861. [PMID: 32323483 DOI: 10.1002/alz.12080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/18/2019] [Accepted: 02/07/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION To examine associations of history of traumatic brain injuries (TBIs) with loss of consciousness (LOC) with dementia incidence and memory decline. METHODS We studied 2718 participants from the 1992 enrollment cohort of the Health and Retirement Study (HRS) aged 65 years or older in 2000. History of TBI with LOC was self-reported in 1992. Dementia was assessed using four algorithms established in HRS. Participants were followed from 2000 to 2014 with repeated measures of dementia and memory performance. Cox models and linear mixed-effects models were used. RESULTS In 1992, 11.9% of the participants reported a history of TBI with LOC. In fully adjusted models for all four algorithms, participants with a history of TBI with LOC had no statistically significant difference in dementia incidence nor in memory decline, compared to participants without TBI history. DISCUSSION Our study did not find evidence of a long-term association between history of TBI with LOC (of unknown frequency and severity) and dementia incidence or memory decline.
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Affiliation(s)
- Leslie Grasset
- Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,Inserm, CIC1401-EC, Bordeaux, France
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Neurology, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Samuel L Swift
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Kan Z Gianattasio
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Heath, George Washington University, Washington, DC, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Heath, George Washington University, Washington, DC, USA
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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20
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Kempuraj D, Ahmed ME, Selvakumar GP, Thangavel R, Dhaliwal AS, Dubova I, Mentor S, Premkumar K, Saeed D, Zahoor H, Raikwar SP, Zaheer S, Iyer SS, Zaheer A. Brain Injury-Mediated Neuroinflammatory Response and Alzheimer's Disease. Neuroscientist 2020; 26:134-155. [PMID: 31092147 PMCID: PMC7274851 DOI: 10.1177/1073858419848293] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Traumatic brain injury (TBI) is a major health problem in the United States, which affects about 1.7 million people each year. Glial cells, T-cells, and mast cells perform specific protective functions in different regions of the brain for the recovery of cognitive and motor functions after central nervous system (CNS) injuries including TBI. Chronic neuroinflammatory responses resulting in neuronal death and the accompanying stress following brain injury predisposes or accelerates the onset and progression of Alzheimer's disease (AD) in high-risk individuals. About 5.7 million Americans are currently living with AD. Immediately following brain injury, mast cells respond by releasing prestored and preactivated mediators and recruit immune cells to the CNS. Blood-brain barrier (BBB), tight junction and adherens junction proteins, neurovascular and gliovascular microstructural rearrangements, and dysfunction associated with increased trafficking of inflammatory mediators and inflammatory cells from the periphery across the BBB leads to increase in the chronic neuroinflammatory reactions following brain injury. In this review, we advance the hypothesis that neuroinflammatory responses resulting from mast cell activation along with the accompanying risk factors such as age, gender, food habits, emotional status, stress, allergic tendency, chronic inflammatory diseases, and certain drugs can accelerate brain injury-associated neuroinflammation, neurodegeneration, and AD pathogenesis.
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Affiliation(s)
- Duraisamy Kempuraj
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Mohammad Ejaz Ahmed
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Govindhasamy Pushpavathi Selvakumar
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Ramasamy Thangavel
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Arshdeep S. Dhaliwal
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Iuliia Dubova
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Shireen Mentor
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Keerthivaas Premkumar
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Daniyal Saeed
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Haris Zahoor
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Sudhanshu P. Raikwar
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Smita Zaheer
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Shankar S. Iyer
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Asgar Zaheer
- Harry S. Truman Memorial Veterans Hospital, U.S. Department of Veterans Affairs’, Columbia, MO 65201, USA
- Department of Neurology, and the Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO 65212, USA
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21
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Filley CM, Arciniegas DB, Brenner LA, Anderson CA, Kelly JP. Chronic Traumatic Encephalopathy: A Clinical Perspective. J Neuropsychiatry Clin Neurosci 2019; 31:170-172. [PMID: 31012827 DOI: 10.1176/appi.neuropsych.18100223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher M Filley
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - David B Arciniegas
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - Lisa A Brenner
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - C Alan Anderson
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - James P Kelly
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
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22
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Schwab N, Grenier K, Hazrati LN. DNA repair deficiency and senescence in concussed professional athletes involved in contact sports. Acta Neuropathol Commun 2019; 7:182. [PMID: 31727161 PMCID: PMC6857343 DOI: 10.1186/s40478-019-0822-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022] Open
Abstract
Mild traumatic brain injury (mTBI) leads to diverse symptoms including mood disorders, cognitive decline, and behavioral changes. In some individuals, these symptoms become chronic and persist in the long-term and can confer an increased risk of neurodegenerative disease and dementia diagnosis later in life. Despite the severity of its consequences, the pathophysiological mechanism of mTBI remains unknown. In this post-mortem case series, we assessed DNA damage-induced cellular senescence pathways in 38 professional athletes with a history of repeated mTBI and ten controls with no mTBI history. We assessed clinical presentation, neuropathological changes, load of DNA damage, morphological markers of cellular senescence, and expression of genes involved in DNA damage signaling, DNA repair, and cellular senescence including the senescence-associated secretory phenotype (SASP). Twenty-eight brains with past history of repeated mTBI history had DNA damage within ependymal cells, astrocytes, and oligodendrocytes. DNA damage burden was increased in brains with proteinopathy compared to those without. Cases also showed hallmark features of cellular senescence in glial cells including astrocytic swelling, beading of glial cell processes, loss of H3K27Me3 (trimethylation at lysine 27 of histone H3) and lamin B1 expression, and increased expression of cellular senescence and SASP pathways. Neurons showed a spectrum of changes including loss of emerin nuclear membrane expression, loss of Brahma-related gene-1 (BRG1 or SMARCA4) expression, loss of myelin basic protein (MBP) axonal expression, and translocation of intranuclear tau to the cytoplasm. Expression of DNA repair proteins was decreased in mTBI brains. mTBI brains showed substantial evidence of DNA damage and cellular senescence. Decreased expression of DNA repair genes suggests inefficient DNA repair pathways in this cohort, conferring susceptibly to cellular senescence and subsequent brain dysfunction after mTBI. We therefore suggest that brains of contact-sports athletes are characterized by deficient DNA repair and DNA damage-induced cellular senescence and propose that this may affect neurons and be the driver of brain dysfunction in mTBI, predisposing the progression to neurodegenerative diseases. This study provides novel targets for diagnostic and prognostic biomarkers, and represents viable targets for future treatments.
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Affiliation(s)
- Nicole Schwab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
- The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada
| | - Karl Grenier
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
- The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Lili-Naz Hazrati
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.
- The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, ON, Canada.
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23
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Bailey KC, Burmaster SA, Schaffert J, LoBue C, Vela D, Rossetti H, Cullum CM. Associations of Race-Ethnicity and History of Traumatic Brain Injury With Age at Onset of Alzheimer's Disease. J Neuropsychiatry Clin Neurosci 2019; 32:280-285. [PMID: 31619118 PMCID: PMC7162699 DOI: 10.1176/appi.neuropsych.19010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether a history of traumatic brain injury (TBI) is associated with age at onset of Alzheimer's disease (AD) in three racial-ethnic groups. METHODS Data from 7,577 non-Hispanic Caucasian, 792 African American, and 870 Hispanic participants with clinically diagnosed AD were obtained from the National Alzheimer's Coordinating Center. Participants were categorized by the presence or absence of self-reported remote history of TBI (>1 year before diagnosis of AD) with loss of consciousness (LOC) (TBI+) or no history of TBI with LOC (TBI-). Any group differences in education; sex; APOE ε4 alleles; family history of dementia; or history of depression, stroke, hypertension, hypercholesterolemia, and diabetes were included in analyses of covariance comparing clinician-estimated age at AD symptom onset for the TBI+ and TBI- groups. RESULTS AD onset occurred 2.3 years earlier for non-Hispanic Caucasians (F=30.49, df=1, 7,572, p<0.001) and 3.4 years earlier for African Americans (F=5.17, df=1, 772, p=0.023) in the TBI+ group. In the Hispanic cohort, females in the TBI+ group had AD onset 5.6 years earlier, compared with females in the TBI- group (F=6.96, df=1, 865, p=0.008); little difference in age at AD onset was observed for Hispanic males with and without a TBI history. CONCLUSIONS A history of TBI with LOC was associated with AD onset 2-3 years earlier in non-Hispanic Caucasians and African Americans and an onset nearly 6 years earlier in Hispanic females; no association was observed in Hispanic males. Further work in underserved populations is needed to understand possible underlying mechanisms for these differences.
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Affiliation(s)
- K Chase Bailey
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Bailey, Burmaster, Schaffert, LoBue, Vela, Rossetti, Cullum); and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (LoBue, Cullum)
| | - Sandra A Burmaster
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Bailey, Burmaster, Schaffert, LoBue, Vela, Rossetti, Cullum); and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (LoBue, Cullum)
| | - Jeff Schaffert
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Bailey, Burmaster, Schaffert, LoBue, Vela, Rossetti, Cullum); and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (LoBue, Cullum)
| | - Christian LoBue
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Bailey, Burmaster, Schaffert, LoBue, Vela, Rossetti, Cullum); and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (LoBue, Cullum)
| | - Daniela Vela
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Bailey, Burmaster, Schaffert, LoBue, Vela, Rossetti, Cullum); and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (LoBue, Cullum)
| | - Heidi Rossetti
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Bailey, Burmaster, Schaffert, LoBue, Vela, Rossetti, Cullum); and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (LoBue, Cullum)
| | - C Munro Cullum
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Bailey, Burmaster, Schaffert, LoBue, Vela, Rossetti, Cullum); and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (LoBue, Cullum)
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24
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Pavlovic D, Pekic S, Stojanovic M, Popovic V. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary 2019; 22:270-282. [PMID: 30929221 DOI: 10.1007/s11102-019-00957-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traumatic brain injury (TBI) causes substantial neurological disabilities and mental distress. Annual TBI incidence is in magnitude of millions, making it a global health challenge. Categorization of TBI into severe, moderate and mild by scores on the Glasgow coma scale (GCS) is based on clinical grounds and standard brain imaging (CT). Recent research focused on repeated mild TBI (sport and non-sport concussions) suggests that a considerable number of patients have long-term disabling neurocognitive and neurobehavioral sequelae. These relate to subtle neuronal injury (diffuse axonal injury) visible only by using advanced neuroimaging distinguishing microstructural tissue damage. With advanced MRI protocols better characterization of TBI is achievable. Diffusion tensor imaging (DTI) visualizes white matter pathology, susceptibility weight imaging (SWI) detects microscopic bleeding while functional magnetic resonance imaging (fMRI) provides closer understanding of cognitive disorders etc. However, advanced imaging is still not integrated in the clinical care of patients with TBI. Patients with chronic TBI may experience many somatic disorders, cognitive disturbances and mental complaints. The underlying pathophysiological mechanisms occurring in TBI are complex, brain injuries are highly heterogeneous and include neuroendocrine dysfunctions. Post-traumatic neuroendocrine dysfunctions received attention since the year 2000. Occurrence of TBI-related hypopituitarism does not correlate to severity of the GCS scores. Complete or partial hypopituitarism (isolated growth hormone (GH) deficiency as most frequent) may occur after mild TBI equally as after moderate-to-severe TBI. Many symptoms of hypopituitarism overlap with symptoms occurring in patients with chronic TBI, i.e. they have lower scores on neuropsychological examinations (cognitive disability) and have more symptoms of mental distress (depression and fatigue). The great challenges for the endocrinologist are: (1) detection of hypopituitarism in patients with TBI prospectively (in the acute phase and months to years after TBI), (2) assessment of the extent of cognitive impairment at baseline, and (3) monitoring of treatment effects (alteration of cognitive functioning and mental distress with hormone replacement therapy). Only few studies recently suggest that with growth hormone (rhGH) replacement in patients with chronic TBI and with abnormal GH secretion, cognitive performance may not change while symptoms related to depression and fatigue improve. Stagnation in post-TBI rehabilitation progress is recommended as a signal for clinical suspicion of neuroendocrine dysfunction. This remains a challenging area for more research.
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Affiliation(s)
- Dragan Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, Belgrade, 11 000, Serbia
| | - Sandra Pekic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Marko Stojanovic
- Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Vera Popovic
- Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
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25
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Psychometric Evaluation of Anxiety, Depression, and Sleep Quality after a Mild Traumatic Brain Injury: A Longitudinal Study. Behav Neurol 2019; 2019:4364592. [PMID: 31110595 PMCID: PMC6487154 DOI: 10.1155/2019/4364592] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/22/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction. Over 1 million mild traumatic brain injury (mTBI) cases are reported annually worldwide and may result in cognitive, physical, and emotional deterioration; depression; anxiety; and sleep problems. However, studies on long-term mTBI effects are limited. This study included 440 patients, and regular follow-ups of psychological assessments were performed for 2 years. Four questionnaires, including the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), Beck's anxiety inventory (BAI), and Beck's depression inventory (BDI), were used to evaluate sleep problems, daytime sleepiness, anxiety, and depression, respectively. Results show that BAI and BDI scores considerably improved at the 6th-week, 1st-year, and 2nd-year follow-ups compared to baseline, yet these remained significantly different. In addition, anxiety and depression were prominent symptoms in a select subgroup of patients with poor initial evaluations, which improved over the 2 years. However, the ESS and PSQI scores fluctuated only mildly over the same time span. In conclusion, the mTBI patients showed a gradual improvement of anxiety and depression over the 2 years following injury. While anxiety and depression levels for mTBI patients in general did not return to premorbid status, improvements were observed. Sleep disorders persisted and were consistent with initial levels of distress.
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26
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King D, Hume PA, Hardaker N, Pearce A, Cummins C, Clark T. Traumatic brain injuries in New Zealand: National Insurance (Accident Compensation Corporation) claims from 2012 to 2016. J Neurol Sci 2019; 399:61-68. [PMID: 30776729 DOI: 10.1016/j.jns.2019.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 11/25/2022]
Abstract
AIM To provide epidemiological data and related costs to the national health insurance scheme for traumatic brain injury (TBI) in New Zealand. METHOD A retrospective analytical review utilising detailed descriptive minor and moderate-to-severe epidemiological TBI data obtained from the Accident Compensation Corporation (ACC) for 2012-2016. Injuries were analysed by three levels of increasing severity: moderate, moderate-to-serious (MSC) and severe claims categories. RESULTS Over the January 2012 to December 2016 period there were 97,955 claims for TBI costing ACC $1,450,643,667 [equivalent to £$743,417,120]. Falls accounted for nearly half (41.7%, 8262), and over a quarter (39.9%; $67,626,000 [£34,662,176]) of the moderate claims for TBI. Motor vehicle accidents recorded the highest percentage (36.5%), total costs ($610,978,229 [£313,170,000]) and highest mean cost per-moderate claim per-year ($47,372 ± $2401 [£24,282 ± £1231]) for MSC TBI claims. This was similar for severe claims where motor vehicles accidents accounted for 56% of the total serious claims, 65.1% of the costs with a mean cost per-serious claim of $64,913 ± 4331 [£32,759 ± £2186] per-year. CONCLUSION There were 97,955 TBI injury claims lodged over the duration of the study with 36% (n = 35,304) classified as MSC. The incidence of total TBI in New Zealand was 432 per 100,000 population, and 155 per 100,000 for MSC TBI claims. Despite the growing number of studies reporting on the effects of sports-related TBI, there is a paucity of studies reporting on the longitudinal effects of TBI in falls, assaults and motor vehicle accidents. Further research is warranted into the assessment and management of intimate partner violence and child abuse victims for TBI's.
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Affiliation(s)
- Doug King
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand; School of Science and Technology, University of New England, Armidale, NSW, Australia.
| | - Patria A Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand; National Institute of Stroke and Applied Neuroscience (NISAN), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Hardaker
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand; Accident Compensation Corporation, Wellington, New Zealand
| | - Alan Pearce
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Cloe Cummins
- School of Science and Technology, University of New England, Armidale, NSW, Australia; Institute for Sport Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - Trevor Clark
- Australian College of Physical Education, Department of Sport Performance, Sydney Olympic Park NSW, Australia
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27
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Al-Dahhak R, Khoury R, Qazi E, Grossberg GT. Traumatic Brain Injury, Chronic Traumatic Encephalopathy, and Alzheimer Disease. Clin Geriatr Med 2018; 34:617-635. [PMID: 30336991 DOI: 10.1016/j.cger.2018.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is a major health and economic burden. With increasing aging population, this issue is expected to continue to rise. Neurodegenerative disorders are more common with aging population in general regardless of history of TBI. Recent evidence continues to support a relation between a TBI and neurocognitive decline later in life (such as in athletes and military). This article summarizes the pathologic and clinical effects of TBI (regardless of severity) on the later development of dementia in individuals 65 years or older.
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Affiliation(s)
- Roula Al-Dahhak
- Department of Neurology, Saint Louis University, 1438 South Grand Boulevard, Suite 105, St Louis, MO 63104, USA.
| | - Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
| | - Erum Qazi
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
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28
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Therapeutic potential of vitamin E and its derivatives in traumatic brain injury-associated dementia. Neurol Sci 2018; 39:989-998. [DOI: 10.1007/s10072-018-3398-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 03/28/2018] [Indexed: 01/01/2023]
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29
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Schaffert J, LoBue C, White CL, Chiang HS, Didehbani N, Lacritz L, Rossetti H, Dieppa M, Hart J, Cullum CM. Traumatic brain injury history is associated with an earlier age of dementia onset in autopsy-confirmed Alzheimer's disease. Neuropsychology 2018; 32:410-416. [PMID: 29389151 DOI: 10.1037/neu0000423] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate whether a history of traumatic brain injury (TBI) with reported loss of consciousness (LOC) is a risk factor for earlier onset of Alzheimer's disease (AD) in an autopsy-confirmed sample. METHOD Data from 2,133 participants with autopsy-confirmed AD (i.e., at least Braak neurofibrillary tangle stages III to VI and CERAD neuritic plaque score moderate to frequent) were obtained from the National Alzheimer's Coordinating Center (NACC). Participants were categorized by presence/absence of self-reported remote (i.e., >1 year prior to their first Alzheimer's Disease Center visit) history of TBI with LOC (TBI+ vs. TBI-). Analyses of Covariance (ANCOVA) controlling for sex, education, and race compared groups on clinician-estimated age of symptom onset and age of diagnosis. RESULTS Average age of onset was 2.34 years earlier (p = .01) for the TBI+ group (n = 194) versus the TBI- group (n = 1900). Dementia was diagnosed on average 2.83 years earlier (p = .002) in the TBI+ group (n = 197) versus the TBI- group (n = 1936). Using more stringent neuropathological criteria (i.e., Braak stages V-VI and CERAD frequent), both age of AD onset and diagnosis were 3.6 years earlier in the TBI+ group (both p's < .001). CONCLUSIONS History of TBI with reported LOC appears to be a risk factor for earlier AD onset. This is the first study to use autopsy-confirmed cases, supporting previous investigations that used clinical criteria for the diagnosis of AD. Further investigation as to possible underlying mechanisms of association is needed. (PsycINFO Database Record
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