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Arora M, Pozzato I, McBain C, Tran Y, Sandalic D, Myles D, Middleton JW, Craig A. Cognitive Reserve and Its Association with Cognitive and Mental Health Status following an Acute Spinal Cord Injury. J Clin Med 2023; 12:4258. [PMID: 37445291 DOI: 10.3390/jcm12134258] [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: 04/18/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a common secondary condition associated with spinal cord injury (SCI). Cognitive reserve (CR) is believed to protect against cognitive decline and can be assessed by premorbid intelligence (pmIQ). Despite the potential utility of pmIQ as a complementary metric in the evaluation of MCI in SCI, this approach has been infrequently employed. The purpose of this study was to examine the association between MCI and pmIQ in adults with SCI with the aim of exploring the potential value of pmIQ as a marker of CR in this population. METHODS Cognitive function was assessed on three occasions in adults with SCI over a 12-month period post-injury, and pmIQ was assessed once at baseline. Demographic and mental health measures were also collected, and logistic regression was conducted to determine the strength of association between pmIQ and MCI while adjusting for factors such as mental health and age. RESULTS The regression analysis revealed that at the time of admission to SCI rehabilitation, the MCI assessed by a valid neurocognitive screen was strongly associated with pmIQ. That is, if a person has MCI, there was 5.4 greater odds (p < 0.01) that they will have poor pmIQ compared to a person without MCI after adjustment for age and mental health. CONCLUSIONS The assessment of CR is an important area that should be considered to improve the process of diagnosing MCI in adults with an acute SCI and potentially facilitate earlier intervention to slow or prevent cognitive decline.
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Affiliation(s)
- Mohit Arora
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Ilaria Pozzato
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Candice McBain
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2113, Australia
| | - Danielle Sandalic
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Daniel Myles
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - James Walter Middleton
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Ashley Craig
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
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Sandalic D, Tran Y, Arora M, Middleton J, McBain C, Myles D, Pozzato I, Craig A. Improving Assessment of Cognitive Impairment after Spinal Cord Injury: Methods to Reduce the Risk of Reporting False Positives. J Clin Med 2022; 12:jcm12010068. [PMID: 36614869 PMCID: PMC9820950 DOI: 10.3390/jcm12010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Adults with spinal cord injury (SCI) are reported to have heightened risk of cognitive impairment, notably mild cognitive impairment (MCI). Reports of increased risk of MCI are almost exclusively based on cross-sectional assessments of cognitive function using norm-referenced scores. Norm-referenced single-point assessments do not reflect cognitive decline at the individual level but rather represent between group differences in cognitive function. The practice of relying solely on norm-referenced assessment to study MCI after SCI is therefore problematic as it lends to potential misclassification of MCI. Premorbid intelligence estimates permit comparison of people's actual versus expected cognitive function and thereby can be used to validate the presence of genuine cognitive decline. These are not utilized in the assessment of MCI after SCI. This study simulated data for 500,000 adults with SCI to compare norm-referenced and premorbid-intelligence methods of screening for MCI to examine the potential extent of MCI misclassification after SCI resulting from the overreliance on norm-referenced methods and exclusion of premorbid intelligence methods. One in five to one in 13 simulated adults with SCI were potentially misclassified as having MCI showing that measures of premorbid cognitive function must be included in assessment of cognitive function after SCI.
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Affiliation(s)
- Danielle Sandalic
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- SCI Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Correspondence:
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Sydney, NSW 2113, Australia
| | - Mohit Arora
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - James Middleton
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Spinal Outreach Service, Royal Rehab, Ryde, Sydney, NSW 2112, Australia
| | - Candice McBain
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Daniel Myles
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ashley Craig
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
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Sandalic D, Craig A, Tran Y, Arora M, Pozzato I, McBain C, Tonkin H, Simpson G, Gopinath B, Kaur J, Shetty S, Weber G, Middleton J. Cognitive Impairment in Individuals With Spinal Cord Injury: Findings of a Systematic Review With Robust Variance and Network Meta-analyses. Neurology 2022; 99:e1779-e1790. [PMID: 35985827 DOI: 10.1212/wnl.0000000000200957] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Estimates of the prevalence (10%-60%) of cognitive impairment in individuals with spinal cord injury (SCI) are too broad, and which domains of cognition are most affected is unclear. We performed a meta-analysis to investigate impairments across domains of cognitive functioning to provide a nuanced picture of research conducted to date into cognitive impairment after SCI. METHODS Results of peer-reviewed studies published in English between 1980 and 2021 comparing ≥20 participants with SCI with able-bodied controls were synthesized using meta-analysis. The primary outcomes were neurocognitive test scores categorized into 5 cognitive domains as listed in the Diagnostic and Statistical Manual of Mental Disorders: Complex Attention, Executive Functioning, Learning and Memory, Language, and Perceptual Motor Function. Two researchers independently assessed and verified extracted data to comply with meta-analytic reporting guidelines. Robust variance estimation meta-analysis was conducted to determine an overall pooled effect size across all cognitive domains using data extracted from studies. Using network meta-analysis, we synthesized eligible studies and made comparisons with the 5 domains of cognitive functioning serving as the outcomes and SCI as the condition. RESULTS Of 4,783 potential studies, 13 met final inclusion criteria. Studies met 6 of 8 quality assessment criteria generally. Results suggested that adults with SCI experience reduced cognitive functioning (effect size: -0.84; 95% CI -1.24 to -0.44, p < 0.001) compared with able-bodied individuals, with deficits mostly in attention (g = -0.64; 95% CI -0.92 to -0.38) and executive functioning (g = -0.61, 95% CI -0.89 to -0.04). Publication bias and high heterogeneity (I2: 86%) qualify these findings and highlight the need to improve research methods in this area. DISCUSSION Adults with SCI seem more likely than adults who are able-bodied to display cognitive impairments mostly in areas of attention and executive functioning. Research practices must become consistent to reduce heterogeneity so that the validity and reliability of the results of future studies into cognitive impairment after SCI improves.
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Affiliation(s)
- Danielle Sandalic
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia.
| | - Ashley Craig
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Yvonne Tran
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Mohit Arora
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Ilaria Pozzato
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Candice McBain
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Helen Tonkin
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Grahame Simpson
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Bamini Gopinath
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Jasbeer Kaur
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Sachin Shetty
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - Gerard Weber
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
| | - James Middleton
- From the John Walsh Centre for Rehabilitation Research (D.S., A.C., M.A., I.P., C.M., G.S., J.M.), The Kolling Institute, Royal North Shore Hospital, St Leonards; Northern Clinical School (DST, A.C., M.A., I.P., C.M., G.S., J.M.), Faculty of Medicine and Health, The University of Sydney; Royal North Shore Hospital (D.S., H.T., J.K.), St Leonards; Australian Institute of Health Innovation (Y.T., B.G.), Macquarie University, North Ryde; Prince of Wales Hospital (S.S.), Randwick; and Royal Rehab (G.W.), Ryde, NSW, Australia
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Sandalic D, Arora M, Pozzato I, Simpson G, Middleton J, Craig A. A Narrative Review of Research on Adjustment to Spinal Cord Injury and Mental Health: Gaps, Future Directions, and Practice Recommendations. Psychol Res Behav Manag 2022; 15:1997-2010. [PMID: 35957761 PMCID: PMC9363004 DOI: 10.2147/prbm.s259712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
Abstract
Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into "positive" or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with "outcomes" to better inform management of mental health after SCI.
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Affiliation(s)
- Danielle Sandalic
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mohit Arora
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ilaria Pozzato
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Grahame Simpson
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - James Middleton
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ashley Craig
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Investigating Dynamics of the Spinal Cord Injury Adjustment Model: Mediation Model Analysis. J Clin Med 2022; 11:jcm11154557. [PMID: 35956172 PMCID: PMC9369731 DOI: 10.3390/jcm11154557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is a severe neurological injury that results in damage to multiple bodily systems. SCI rehabilitation requires a significant focus on improving adjustment to the injury. This paper presents a detailed description of the Spinal Cord Injury Adjustment Model (SCIAM), which clarifies how individuals adjust to SCI and contends that adjustment to SCI is a multifactorial process involving non-linear dynamic adaptation over time. Evidence supporting SCIAM is also discussed. Mediation analyses were conducted to test the mediator dynamics proposed by the model. The analyses tested the relationship between two moderators (self-care and secondary health conditions), mediators (two self-efficacy items and appraisal of quality of life or QoL), and positive versus negative vitality/mental health as outcomes. Results showed that higher self-efficacy and perceived QoL was related to greater independence in self-care and reduced negative impacts of secondary health conditions. This study supported the mediation role of self-efficacy and other appraisals such as perceived QoL in enhancing self-care and buffering the negative impact of health challenges. In conclusion, it is important to employ a holistic model such as SCIAM to conceptualise and increase understanding of the process of adjustment following a severe neurological injury such as SCI.
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Kalkhoran AK, Alipour MR, Jafarzadehgharehziaaddin M, Zangbar HS, Shahabi P. Intersection of hippocampus and spinal cord: a focus on the hippocampal alpha-synuclein accumulation, dopaminergic receptors, neurogenesis, and cognitive function following spinal cord injury in male rats. BMC Neurosci 2022; 23:44. [PMID: 35820831 PMCID: PMC9277791 DOI: 10.1186/s12868-022-00729-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background Following Spinal Cord Injury (SCI), innumerable inflammatory and degenerative fluctuations appear in the injured site, and even remotely in manifold areas of the brain. Howbeit, inflammatory, degenerative, and oscillatory changes of motor cortices have been demonstrated to be due to SCI, according to recent studies confirming the involvement of cognitive areas of the brain, such as hippocampus and prefrontal cortex. Therefore, addressing SCI induced cognitive complications via different sights can be contributory in the treatment approaches. Results Herein, we used 16 male Wistar rats (Sham = 8, SCI = 8). Immunohistochemical results revealed that spinal cord contusion significantly increases the accumulation of alpha-synuclein and decreases the expression of Doublecortin (DCX) in the hippocampal regions like Cornu Ammonis1 (CA1) and Dentate Gyrus (DG). Theses degenerative manifestations were parallel with a low expression of Achaete-Scute Family BHLH Transcription Factor 1 (ASCL1), SRY (sex determining region Y)-box 2 (SOX2), and dopaminergic receptors (D1 and D5). Additionally, based on the TUNEL assay analysis, SCI significantly increased the number of apoptotic cells in the CA1 and DG regions. Cognitive function of the animals was assessed, using the O-X maze and Novel Object Recognition (NORT); the obtained findings indicted that after SCI, hippocampal neurodegeneration significantly coincides with the impairment of learning, memory and recognition capability of the injured animals. Conclusions Based on the obtained findings, herein SCI reduces neurogenesis, decreases the expression of D1 and D5, and increases apoptosis in the hippocampus, which are all associated with cognitive function deficits. Graphical Abstract ![]()
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Affiliation(s)
- Ahad Karimzadeh Kalkhoran
- Drug Applied Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 51666-14766, East Azarbayjan, Iran
| | - Mohammad Reza Alipour
- Drug Applied Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 51666-14766, East Azarbayjan, Iran
| | | | - Hamid Soltani Zangbar
- Department of Neuroscience and Cognition, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azarbayjan, Iran.
| | - Parviz Shahabi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 51666-14766, East Azarbayjan, Iran.
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Sandalic D, Tran Y, Craig A, Arora M, Pozzato I, Simpson G, Gopinath B, Kaur J, Shetty S, Weber G, Benad L, Middleton JW. The Need for a Specialized Neurocognitive Screen and Consistent Cognitive Impairment Criteria in Spinal Cord Injury: Analysis of the Suitability of the Neuropsychiatry Unit Cognitive Assessment Tool. J Clin Med 2022; 11:jcm11123344. [PMID: 35743411 PMCID: PMC9225056 DOI: 10.3390/jcm11123344] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
The assessment of mild cognitive impairment (MCI) following spinal cord injury (SCI) is vital. However, there are no neurocognitive screens which have been developed specifically to meet the unique requirements for SCI, nor are there consistent MCI criteria applied to determine the rates of MCI. The aim of this study was to determine the suitability of a neurocognitive screen for assessing MCI in adults with SCI. A total of 127 participants were recruited. Socio-demographic and injury related variables were assessed. All participants completed the screen. Descriptive statistics are provided for total/domain screen scores and all items, and the screen’s ability to distinguish MCI was examined. Congeneric confirmatory factor analyses (CFA) were employed to investigate structural validity. The screen total score was sensitive to differences in neurocognitive capacity, as well as for time since the injury occurred (p < 0.01). The MCI rate ranged between 17−36%. CFA revealed attention and visuoconstruction domains had an adequate model fit and executive function had poor fit, while CFA models for memory and language did not fit the data (did not converge), hence could not be determined. While the screen differentiated between those with MCI and those without, and MCI as a function of time since injury, limitations of its suitability for assessing MCI after SCI exist, demonstrating the need for a specialized neurocognitive screen for adults with SCI.
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Affiliation(s)
- Danielle Sandalic
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (D.S.); (M.A.); (I.P.); (G.S.); (J.W.M.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- SCI Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (J.K.); (L.B.)
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2113, Australia; (Y.T.); (B.G.)
| | - Ashley Craig
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (D.S.); (M.A.); (I.P.); (G.S.); (J.W.M.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Correspondence:
| | - Mohit Arora
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (D.S.); (M.A.); (I.P.); (G.S.); (J.W.M.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (D.S.); (M.A.); (I.P.); (G.S.); (J.W.M.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Grahame Simpson
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (D.S.); (M.A.); (I.P.); (G.S.); (J.W.M.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Bamini Gopinath
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2113, Australia; (Y.T.); (B.G.)
| | - Jasbeer Kaur
- SCI Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (J.K.); (L.B.)
| | - Sachin Shetty
- SCI Unit, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
| | - Gerard Weber
- SCI Unit, Royal Rehab, Ryde, NSW 2112, Australia;
| | - Lisa Benad
- SCI Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (J.K.); (L.B.)
| | - James W. Middleton
- John Walsh Centre Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (D.S.); (M.A.); (I.P.); (G.S.); (J.W.M.)
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Spinal Outreach Service, Royal Rehab, Ryde, NSW 2112, Australia
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8
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Köhli P, Otto E, Jahn D, Reisener MJ, Appelt J, Rahmani A, Taheri N, Keller J, Pumberger M, Tsitsilonis S. Future Perspectives in Spinal Cord Repair: Brain as Saviour? TSCI with Concurrent TBI: Pathophysiological Interaction and Impact on MSC Treatment. Cells 2021; 10:2955. [PMID: 34831179 PMCID: PMC8616497 DOI: 10.3390/cells10112955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022] Open
Abstract
Traumatic spinal cord injury (TSCI), commonly caused by high energy trauma in young active patients, is frequently accompanied by traumatic brain injury (TBI). Although combined trauma results in inferior clinical outcomes and a higher mortality rate, the understanding of the pathophysiological interaction of co-occurring TSCI and TBI remains limited. This review provides a detailed overview of the local and systemic alterations due to TSCI and TBI, which severely affect the autonomic and sensory nervous system, immune response, the blood-brain and spinal cord barrier, local perfusion, endocrine homeostasis, posttraumatic metabolism, and circadian rhythm. Because currently developed mesenchymal stem cell (MSC)-based therapeutic strategies for TSCI provide only mild benefit, this review raises awareness of the impact of TSCI-TBI interaction on TSCI pathophysiology and MSC treatment. Therefore, we propose that unravelling the underlying pathophysiology of TSCI with concomitant TBI will reveal promising pharmacological targets and therapeutic strategies for regenerative therapies, further improving MSC therapy.
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Affiliation(s)
- Paul Köhli
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ellen Otto
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Denise Jahn
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marie-Jacqueline Reisener
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
| | - Jessika Appelt
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Adibeh Rahmani
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nima Taheri
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
| | - Johannes Keller
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
- University Hospital Hamburg-Eppendorf, Department of Trauma Surgery and Orthopaedics, Martinistraße 52, 20246 Hamburg, Germany
| | - Matthias Pumberger
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
| | - Serafeim Tsitsilonis
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
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9
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Craig A, Pozzato I, Arora M, Middleton J, Rodrigues D, McBain C, Tran Y, Davis GM, Gopinath B, Kifley A, Krassioukov A, Braithwaite J, Mitchell R, Gustin SM, Schoffl J, Cameron ID. A neuro-cardiac self-regulation therapy to improve autonomic and neural function after SCI: a randomized controlled trial protocol. BMC Neurol 2021; 21:329. [PMID: 34445983 PMCID: PMC8387669 DOI: 10.1186/s12883-021-02355-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is associated with autonomic imbalance and significant secondary conditions, including cardiac and brain dysfunction that adversely impact health and wellbeing. This study will investigate the effectiveness (intention-to-treat) of a neuro-cardiac self-regulation therapy to improve autonomic and neural/brain activity in adults with SCI living in the community. METHODS A two-arm parallel, randomised controlled trial in which adults with SCI living in the community post-rehabilitation will be randomly assigned to a treatment or control group. The treatment group (N = 60) aged 18-70 years with a chronic traumatic or non-traumatic SCI, will receive intervention sessions once per week for 10 weeks, designed to regulate autonomic activity using computer-based feedback of heart rate variability and controlled breathing (called HRV-F). Comprehensive neurophysiological and psychological assessment will occur at baseline, immediate post-treatment, and 6 and 12-months post-treatment. Primary outcome measures include electrocardiography/heart rate variability (to assess autonomic nervous system function) and transcranial doppler sonography (to assess cerebral blood circulation in basal cerebral arteries). Secondary outcomes measures include continuous blood pressure, electroencephalography, functional near-infrared spectroscopy, respiration/breath rate, electrooculography, cognitive capacity, psychological status, pain, fatigue, sleep and quality of life. Controls (N = 60) will receive usual community care, reading material and a brief telephone call once per week for 10 weeks and be similarly assessed over the same time period as the HRV-F group. Linear mixed model analysis with repeated measures will determine effectiveness of HRV-F and latent class mixture modelling used to determine trajectories for primary and selected secondary outcomes of interest. DISCUSSION Treatments for improving autonomic function after SCI are limited. It is therefore important to establish whether a neuro-cardiac self-regulation therapy can result in improved autonomic functioning post-SCI, as well as whether HRV-F is associated with better outcomes for secondary conditions such as cardiovascular health, cognitive capacity and mental health. TRIAL REGISTRATION The study has been prospectively registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12621000870853 .aspx). Date of Registration: 6th July 2021. Trial Sponsor: The University of Sydney, NSW 2006. Protocol version: 22/07/2021.
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Affiliation(s)
- Ashley Craig
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia.
| | - Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Mohit Arora
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - James Middleton
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Dianah Rodrigues
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Candice McBain
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Yvonne Tran
- Macquarie University Hearing (MU Hearing), Macquarie University, North Ryde, NSW, 2113, Australia
| | - Glen M Davis
- Exercise and Sports Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bamini Gopinath
- Macquarie University Hearing (MU Hearing), Macquarie University, North Ryde, NSW, 2113, Australia
| | - Annette Kifley
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Andrei Krassioukov
- ICORD, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Health Systems Research, Macquarie University, North Ryde, NSW, 2113, Australia
| | - Rebecca Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Health Systems Research, Macquarie University, North Ryde, NSW, 2113, Australia
| | - Sylvia M Gustin
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia
| | - Jacob Schoffl
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Ian D Cameron
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
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