1
|
O'Connor V, Shura R, Armistead-Jehle P, Cooper DB. Neuropsychological Evaluation in Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:593-605. [PMID: 38945653 DOI: 10.1016/j.pmr.2024.02.010] [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] [Indexed: 07/02/2024]
Abstract
Neuropsychological evaluations can be helpful in the aftermath of traumatic brain injury. Cognitive functioning is assessed using standardized assessment tools and by comparing an individual's scores on testing to normative data. These evaluations examine objective cognitive functioning as well as other factors that have been shown to influence performance on cognitive tests (eg, psychiatric conditions, sleep) in an attempt to answer a specific question from referring providers. Referral questions may focus on the extent of impairment, the trajectory of recovery, or ability to return to work, sport, or the other previous activity.
Collapse
Affiliation(s)
- Victoria O'Connor
- Department of Veterans Affairs, W. G. (Bill) Hefner VA Healthcare System, 1601 Brenner Avenue (11M), Salisbury, NC 28144, USA; Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Robert Shura
- Department of Veterans Affairs, W. G. (Bill) Hefner VA Healthcare System, 1601 Brenner Avenue (11M), Salisbury, NC 28144, USA; Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA; Via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - Patrick Armistead-Jehle
- Department of Veterans Affairs, Concussion Clinic, Munson Army Health Center, 550 Pope Avenue, Fort Leavenworth, KS 66027, USA
| | - Douglas B Cooper
- Department of Psychiatry, University of Texas Health Science Center (UT-Health), South Texas VA Healthcare System, San Antonio Polytrauma Rehabilitation Center, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA; Department of Rehabilitation Medicine, University of Texas Health Science Center (UT-Health), South Texas VA Healthcare System, San Antonio Polytrauma Rehabilitation Center, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA
| |
Collapse
|
2
|
Kelly JP, Priemer DS, Perl DP, Filley CM. Sports Concussion and Chronic Traumatic Encephalopathy: Finding a Path Forward. Ann Neurol 2023; 93:222-225. [PMID: 36504163 PMCID: PMC10108279 DOI: 10.1002/ana.26566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
Sports concussion has recently assumed special importance because of the widely publicized entity of chronic traumatic encephalopathy (CTE). Identified primarily in former contact sports athletes with repeated mild traumatic brain injury (mTBI), CTE is a distinct tauopathy that can only be diagnosed postmortem and for which no specific treatment is available. Although the hazards of repeated mTBI are generally acknowledged, a spirited controversy has developed because a firm link between sports concussion and CTE has been questioned. We briefly review the history of CTE, discuss areas of uncertainty, and offer suggestions to assist neurologists confronting these issues and advance understanding of this vexing problem. ANN NEUROL 2023;93:222-225.
Collapse
Affiliation(s)
- James P Kelly
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Marcus Institute for Brain Health, Anschutz Medical Campus, Aurora, CO, USA
| | - David S Priemer
- Department of Defense/Uniformed Services University Brain Tissue Repository, Bethesda, MD, USA.,Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Daniel P Perl
- Department of Defense/Uniformed Services University Brain Tissue Repository, Bethesda, MD, USA.,Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Christopher M Filley
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Marcus Institute for Brain Health, Anschutz Medical Campus, Aurora, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
3
|
Filley CM. White matter dementia then… and now. Front Neurol 2022; 13:1043583. [PMID: 36479053 PMCID: PMC9721363 DOI: 10.3389/fneur.2022.1043583] [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] [Received: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 03/27/2024] Open
Abstract
White matter dementia (WMD) is a concept introduced in 1988 to highlight the importance of white matter pathology in producing cognitive dysfunction and dementia. Whereas gray matter, particularly the cerebral cortex, has been primarily investigated in the dementias, subcortical pathology has long been correlated with cognitive loss, and a corticocentric perspective cannot account for the full range of neurobehavioral disorders. Within the subcortical regions, white matter is prominent, accounting for about half the volume of the adult brain, and many white matter diseases, injuries, and intoxications can produce cognitive dysfunction so severe as to justify the term dementia. Recognition of this novel syndrome relied heavily on the introduction of magnetic resonance imaging (MRI) that permitted in vivo visualization of white matter lesions. Neuropsychological studies clarified the clinical presentation of WMD by identifying a profile dominated by cognitive slowing and executive dysfunction, and a precursor syndrome of mild cognitive dysfunction was proposed to identify early cognitive impairment that may later evolve to WMD. As knowledge advanced, the role of white matter in structural connectivity within distributed neural networks was elucidated. In addition, highlighting the frequent commingling of gray and white matter involvement, white matter pathology was associated with neurodegenerative diseases such as Alzheimer's disease and chronic traumatic encephalopathy, with potentially transformative clinical implications. In particular, preventive measures and treatments exploiting white matter restoration and plasticity are gaining much attention. Today, WMD has matured into a concept that not only integrates knowledge from across the spectrum of clinical neuroscience, but also informs new investigations into many perplexing disorders and enables a more complete understanding of brain-behavior relationships.
Collapse
Affiliation(s)
- Christopher M. Filley
- Behavioral Neurology Section, Department of Neurology and Psychiatry, University of Colorado School of Medicine, Marcus Institute for Brain Health, Aurora, CO, United States
| |
Collapse
|
4
|
Iqubal A, Bansal P, Iqubal MK, Pottoo FH, Haque SE. An Overview and Therapeutic Promise of Nutraceuticals against Sports-Related Brain Injury. Curr Mol Pharmacol 2021; 15:3-22. [PMID: 33538684 DOI: 10.2174/1874467214666210203211914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
Sports-related traumatic brain injury (TBI) is one of the common neurological maladies experienced by athletes. Earlier the term 'punch drunk syndrome' was used in the case TBI of boxers and now this term is replaced by chronic traumatic encephalopathy (CTE). Sports-related brain injury can either be short term or long term. A common instance of brain injury encompasses subdural hematoma, concussion, cognitive dysfunction, amnesia, headache, vision issue, axonopathy, or even death if remain undiagnosed or untreated. Further, chronic TBI may lead to pathogenesis of neuroinflammation and neurodegeneration via tauopathy, formation of neurofibrillary tangles, and damage to the blood-brain barrier, microglial, and astrocyte activation. Thus, altered pathological, neurochemical, and neurometabolic attributes lead to the modulation of multiple signaling pathways and cause neurological dysfunction. Available pharmaceutical interventions are based on one drug one target hypothesis and thereby unable to cover altered multiple signaling pathways. However, in recent time's pharmacological intervention of nutrients and nutraceuticals have been explored as they exert a multifactorial mode of action and maintain over homeostasis of the body. There are various reports available showing the positive therapeutic effect of nutraceuticals in sport-related brain injury. Therefore, in the current article we have discussed the pathology, neurological consequence, sequelae, and perpetuation of sports-related brain injury. Further, we have discussed various nutraceutical supplements as well as available animal models to explore the neuroprotective effect/ upshots of these nutraceuticals in sports-related brain injury.
Collapse
Affiliation(s)
- Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Pratichi Bansal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Faheem Hyder Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal, University, P.O.BOX 1982, Damman, 31441, . Saudi Arabia
| | - Syed Ehtaishamul Haque
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| |
Collapse
|