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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.
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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
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2
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Jacquens A, Csaba Z, Soleimanzad H, Bokobza C, Delmotte PR, Userovici C, Boussemart P, Chhor V, Bouvier D, van de Looij Y, Faivre V, Diao S, Lemoine S, Blugeon C, Schwendimann L, Young-Ten P, Naffaa V, Laprevote O, Tanter M, Dournaud P, Van Steenwinckel J, Degos V, Gressens P. Deleterious effect of sustained neuroinflammation in pediatric traumatic brain injury. Brain Behav Immun 2024; 120:99-116. [PMID: 38705494 DOI: 10.1016/j.bbi.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Despite improved management of traumatic brain injury (TBI), it still leads to lifelong sequelae and disability, particularly in children. Chronic neuroinflammation (the so-called tertiary phase), in particular, microglia/macrophage and astrocyte reactivity, is among the main mechanisms suspected of playing a role in the generation of lesions associated with TBI. The role of acute neuroinflammation is now well understood, but its persistent effect and impact on the brain, particularly during development, are not. Here, we investigated the long-term effects of pediatric TBI on the brain in a mouse model. METHODS Pediatric TBI was induced in mice on postnatal day (P) 7 by weight-drop trauma. The time course of neuroinflammation and myelination was examined in the TBI mice. They were also assessed by magnetic resonance, functional ultrasound, and behavioral tests at P45. RESULTS TBI induced robust neuroinflammation, characterized by acute microglia/macrophage and astrocyte reactivity. The long-term consequences of pediatric TBI studied on P45 involved localized scarring astrogliosis, persistent microgliosis associated with a specific transcriptomic signature, and a long-lasting myelination defect consisting of the loss of myelinated axons, a decreased level of myelin binding protein, and severe thinning of the corpus callosum. These results were confirmed by reduced fractional anisotropy, measured by diffusion tensor imaging, and altered inter- and intra-hemispheric connectivity, measured by functional ultrasound imaging. In addition, adolescent mice with pediatric TBI showed persistent social interaction deficits and signs of anxiety and depressive behaviors. CONCLUSIONS We show that pediatric TBI induces tertiary neuroinflammatory processes associated with white matter lesions and altered behavior. These results support our model as a model for preclinical studies for tertiary lesions following TBI.
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Affiliation(s)
- Alice Jacquens
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Zsolt Csaba
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | - Haleh Soleimanzad
- Physics for Medicine Paris, Inserm, ESPCI Paris, PSL Research University, CNRS, 75005 Paris, France
| | - Cindy Bokobza
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | | | | | | | - Vibol Chhor
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | - Damien Bouvier
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | - Yohan van de Looij
- Université de Genève, Service Développement et Croissance, Département de Pédiatrie, Faculté de Médecine, 1211 Genève, Suisse; Centre d'Imagerie Biomédicale, Section Technologie d'Imagerie Animale, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Suisse
| | - Valérie Faivre
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | - Siaho Diao
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | - Sophie Lemoine
- Genomics Core Facility, Département de Biologie, École Normale Supérieure, Institut de Biologie de l'ENS (IBENS), CNRS, INSERM, Université PSL, Paris, France
| | - Corinne Blugeon
- Genomics Core Facility, Département de Biologie, École Normale Supérieure, Institut de Biologie de l'ENS (IBENS), CNRS, INSERM, Université PSL, Paris, France
| | | | | | - Vanessa Naffaa
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | - Olivier Laprevote
- Université de Paris, CNRS, CiTCoM, 75006 Paris, France; Hôpital Européen Georges Pompidou, AP-HP, Service de Biochimie, 75015 Paris, France
| | - Mickael Tanter
- Physics for Medicine Paris, Inserm, ESPCI Paris, PSL Research University, CNRS, 75005 Paris, France
| | - Pascal Dournaud
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
| | | | - Vincent Degos
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Gressens
- Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France
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Amico F, Koberda JL. Quantitative Electroencephalography Objectivity and Reliability in the Diagnosis and Management of Traumatic Brain Injury: A Systematic Review. Clin EEG Neurosci 2023:15500594231202265. [PMID: 37792559 DOI: 10.1177/15500594231202265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background. Persons with a history of traumatic brain injury (TBI) may exhibit short- and long-term cognitive deficits as well as psychiatric symptoms. These symptoms often reflect functional anomalies in the brain that are not detected by standard neuroimaging. In this context, quantitative electroencephalography (qEEG) is more suitable to evaluate non-normative activity in a wide range of clinical settings. Method. We searched the literature using the "Medline" and "Web of Science" online databases. The search was concluded on February 23, 2023, and revised on July 12, 2023. It returned 134 results from Medline and 4 from Web of Science. We then applied the PRISMA method, which led to the selection of 31 articles, the most recent one published in March 2023. Results. The qEEG method can detect functional anomalies in the brain occurring immediately after and even years after injury, revealing in most cases abnormal power variability and increases in slow (delta and theta) versus decreases in fast (alpha, beta, and gamma) frequency activity. Moreover, other findings show that reduced beta coherence between frontoparietal regions is associated with slower processing speed in patients with recent mild TBI (mTBI). More recently, machine learning (ML) research has developed highly reliable models and algorithms for the detection of TBI, some of which are already integrated into commercial qEEG equipment. Conclusion. Accumulating evidence indicates that the qEEG method may improve the diagnosis and management of TBI, in many cases revealing long-term functional anomalies in the brain or even neuroanatomical insults that are not revealed by standard neuroimaging. While FDA clearance has been obtained only for some of the commercially available equipment, the qEEG method allows for systematic, cost-effective, non-invasive, and reliable investigations at emergency departments. Importantly, the automated implementation of intelligent algorithms based on multimodally acquired, clinically relevant measures may play a key role in increasing diagnosis reliability.
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Affiliation(s)
- Francesco Amico
- Neotherapy, Weston, FL, USA
- Texas Center for Lifestyle Medicine, Houston, TX, USA
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4
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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Kim JH, Taylor AJ, Himmelbach M, Hagberg GE, Scheffler K, Ress D. Characterization of the blood oxygen level dependent hemodynamic response function in human subcortical regions with high spatiotemporal resolution. Front Neurosci 2022; 16:1009295. [PMID: 36303946 PMCID: PMC9592726 DOI: 10.3389/fnins.2022.1009295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022] Open
Abstract
Subcortical brain regions are absolutely essential for normal human function. These phylogenetically early brain regions play critical roles in human behaviors such as the orientation of attention, arousal, and the modulation of sensory signals to cerebral cortex. Despite the critical health importance of subcortical brain regions, there has been a dearth of research on their neurovascular responses. Blood oxygen level dependent (BOLD) functional MRI (fMRI) experiments can help fill this gap in our understanding. The BOLD hemodynamic response function (HRF) evoked by brief (<4 s) neural activation is crucial for the interpretation of fMRI results because linear analysis between neural activity and the BOLD response relies on the HRF. Moreover, the HRF is a consequence of underlying local blood flow and oxygen metabolism, so characterization of the HRF enables understanding of neurovascular and neurometabolic coupling. We measured the subcortical HRF at 9.4T and 3T with high spatiotemporal resolution using protocols that enabled reliable delineation of HRFs in individual subjects. These results were compared with the HRF in visual cortex. The HRF was faster in subcortical regions than cortical regions at both field strengths. There was no significant undershoot in subcortical areas while there was a significant post-stimulus undershoot that was tightly coupled with its peak amplitude in cortex. The different BOLD temporal dynamics indicate different vascular dynamics and neurometabolic responses between cortex and subcortical nuclei.
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Affiliation(s)
- Jung Hwan Kim
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Amanda J. Taylor
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Marc Himmelbach
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Gisela E. Hagberg
- High Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Biomedical Magnetic Resonance, Eberhard Karl’s University of Tübingen and University Hospital, Tübingen, Germany
| | - Klaus Scheffler
- High Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Biomedical Magnetic Resonance, Eberhard Karl’s University of Tübingen and University Hospital, Tübingen, Germany
| | - David Ress
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
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Lopez DA, Christensen ZP, Foxe JJ, Ziemer LR, Nicklas PR, Freedman EG. Association between mild traumatic brain injury, brain structure, and mental health outcomes in the Adolescent Brain Cognitive Development Study. Neuroimage 2022; 263:119626. [PMID: 36103956 DOI: 10.1016/j.neuroimage.2022.119626] [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: 06/01/2022] [Revised: 07/20/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Children that experience a mild traumatic brain injury (mTBI) are at an increased risk of neural alterations that can deteriorate mental health. We test the hypothesis that mTBI is associated with psychopathology and that structural brain metrics (e.g., volume, area) meaningfully mediate the relation in an adolescent population. METHODS We analyzed behavioral and brain MRI data from 11,876 children who participated in the Adolescent Brain Cognitive Development (ABCD) Study. Mixed-effects models were used to examine the longitudinal association between mTBI and mental health outcomes. Bayesian methods were used to investigate brain regions that are intermediate between mTBI and symptoms of poor mental health. RESULTS There were 199 children with mTBI and 527 with possible mTBI across the three ABCD Study visits. There was a 7% (IRR = 1.07, 95% CI: 1.01, 1.13) and 15% (IRR = 1.16, 95% CI: 1.05, 1.26) increased risk of emotional or behavioral problems in children that experienced possible mTBI or mTBI, respectively. Possible mTBI was associated with a 17% (IRR: 1.17, 95% CI: 0.99, 1.40) increased risk of experiencing distress following a psychotic-like experience. We did not find any brain regions that meaningfully mediated the relationship between mTBI and mental health outcomes. Analysis of volumetric measures found that approximately 2% to 5% of the total effect of mTBI on mental health outcomes operated through total cortical volume. Image intensity measure analyses determined that approximately 2% to 5% of the total effect was mediated through the left-hemisphere of the dorsolateral prefrontal cortex. CONCLUSION Results indicate an increased risk of emotional and behavioral problems in children that experienced possible mTBI or mTBI. Mediation analyses did not elucidate the mechanisms underlying the association between mTBI and mental health outcomes.
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Affiliation(s)
- Daniel A Lopez
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Zachary P Christensen
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - John J Foxe
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Laura R Ziemer
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Paige R Nicklas
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Edward G Freedman
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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7
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Osmanlıoğlu Y, Parker D, Alappatt JA, Gugger JJ, Diaz-Arrastia RR, Whyte J, Kim JJ, Verma R. Connectomic assessment of injury burden and longitudinal structural network alterations in moderate-to-severe traumatic brain injury. Hum Brain Mapp 2022; 43:3944-3957. [PMID: 35486024 PMCID: PMC9374876 DOI: 10.1002/hbm.25894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/14/2022] Open
Abstract
Traumatic brain injury (TBI) is a major public health problem. Caused by external mechanical forces, a major characteristic of TBI is the shearing of axons across the white matter, which causes structural connectivity disruptions between brain regions. This diffuse injury leads to cognitive deficits, frequently requiring rehabilitation. Heterogeneity is another characteristic of TBI as severity and cognitive sequelae of the disease have a wide variation across patients, posing a big challenge for treatment. Thus, measures assessing network-wide structural connectivity disruptions in TBI are necessary to quantify injury burden of individuals, which would help in achieving personalized treatment, patient monitoring, and rehabilitation planning. Despite TBI being a disconnectivity syndrome, connectomic assessment of structural disconnectivity has been relatively limited. In this study, we propose a novel connectomic measure that we call network normality score (NNS) to capture the integrity of structural connectivity in TBI patients by leveraging two major characteristics of the disease: diffuseness of axonal injury and heterogeneity of the disease. Over a longitudinal cohort of moderate-to-severe TBI patients, we demonstrate that structural network topology of patients is more heterogeneous and significantly different than that of healthy controls at 3 months postinjury, where dissimilarity further increases up to 12 months. We also show that NNS captures injury burden as quantified by posttraumatic amnesia and that alterations in the structural brain network is not related to cognitive recovery. Finally, we compare NNS to major graph theory measures used in TBI literature and demonstrate the superiority of NNS in characterizing the disease.
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Affiliation(s)
- Yusuf Osmanlıoğlu
- Department of Computer Science, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Drew Parker
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob A Alappatt
- Speech and hearing, bioscience and technology program, Harvard Medical School, Harvard University, Boston, MA, USA
| | - James J Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramon R Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, TBI Rehabilitation Research LaboratoryEinstein Medical Center, Elkins Park, Pennsylvania, USA
| | - Junghoon J Kim
- Department of Molecular, Cellular, and Biomedical Sciences, CUNY School of Medicine, The City College of New York, New York, New York, USA
| | - Ragini Verma
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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8
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McDonald MA, Tayebi M, McGeown JP, Kwon EE, Holdsworth SJ, Danesh-Meyer HV. A window into eye movement dysfunction following mTBI: A scoping review of magnetic resonance imaging and eye tracking findings. Brain Behav 2022; 12:e2714. [PMID: 35861623 PMCID: PMC9392543 DOI: 10.1002/brb3.2714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Mild traumatic brain injury (mTBI), commonly known as concussion, is a complex neurobehavioral phenomenon affecting six in 1000 people globally each year. Symptoms last between days and years as microstructural damage to axons and neurometabolic changes result in brain network disruption. There is no clinically available objective biomarker to diagnose the severity of injury or monitor recovery. However, emerging evidence suggests eye movement dysfunction (e.g., saccades and smooth pursuits) in patients with mTBI. Patients with a higher symptom burden and prolonged recovery time following injury may show higher degrees of eye movement dysfunction. Likewise, recent advances in magnetic resonance imaging (MRI) have revealed both white matter tract damage and functional network alterations in mTBI patients, which involve areas responsible for the ocular motor control. This scoping review is presented in three sections: Section 1 explores the anatomical control of eye movements to aid the reader with interpreting the discussion in subsequent sections. Section 2 examines the relationship between abnormal MRI findings and eye tracking after mTBI based on the available evidence. Finally, Section 3 communicates gaps in our knowledge about MRI and eye tracking, which should be addressed in order to substantiate this emerging field.
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Affiliation(s)
- Matthew A McDonald
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand
| | - Maryam Tayebi
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joshua P McGeown
- Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland University of Technology Traumatic Brain Injury Network, Auckland, New Zealand
| | - Eryn E Kwon
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Institute, Gisborne, New Zealand.,Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Eye Institute, Auckland, New Zealand
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9
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Lee J, Kim S, Kim YH, Park U, Lee J, McKee AC, Kim KH, Ryu H, Lee J. Non-Targeted Metabolomics Approach Revealed Significant Changes in Metabolic Pathways in Patients with Chronic Traumatic Encephalopathy. Biomedicines 2022; 10:1718. [PMID: 35885023 PMCID: PMC9313062 DOI: 10.3390/biomedicines10071718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 12/20/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is frequently found in athletes and those who have experienced repetitive head traumas. CTE is associated with a variety of neuropathologies, which cause cognitive and behavioral impairments in CTE patients. However, currently, CTE can only be diagnosed after death via brain autopsy, and it is challenging to distinguish it from other neurodegenerative diseases with similar clinical features. To better understand this multifaceted disease and identify metabolic differences in the postmortem brain tissues of CTE patients and control subjects, we performed ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS)-based non-targeted metabolomics. Through multivariate and pathway analysis, we found that the brains of CTE patients had significant changes in the metabolites involved in astrocyte activation, phenylalanine, and tyrosine metabolism. The unique metabolic characteristics of CTE identified in this study were associated with cognitive dysfunction, amyloid-beta deposition, and neuroinflammation. Altogether, this study provided new insights into the pathogenesis of CTE and suggested appealing targets for both diagnosis and treatment for the disease.
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Affiliation(s)
- Jinkyung Lee
- Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea; (J.L.); (Y.H.K.)
- Department of Biotechnology, Graduate School, Korea University, Seoul 02841, Korea;
| | - Suhyun Kim
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea; (S.K.); (U.P.)
| | - Yoon Hwan Kim
- Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea; (J.L.); (Y.H.K.)
- Department of Biotechnology, Graduate School, Korea University, Seoul 02841, Korea;
| | - Uiyeol Park
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea; (S.K.); (U.P.)
| | - Junghee Lee
- Boston University Alzheimer’s Disease Research Center (BUADRC), Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (J.L.); (A.C.M.)
| | - Ann C. McKee
- Boston University Alzheimer’s Disease Research Center (BUADRC), Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (J.L.); (A.C.M.)
| | - Kyoung Heon Kim
- Department of Biotechnology, Graduate School, Korea University, Seoul 02841, Korea;
| | - Hoon Ryu
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea; (S.K.); (U.P.)
| | - Jeongae Lee
- Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea; (J.L.); (Y.H.K.)
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10
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Braga MFM, Juranek J, Eiden LE, Li Z, Figueiredo TH, de Araujo Furtado M, Marini AM. GABAergic circuits of the basolateral amygdala and generation of anxiety after traumatic brain injury. Amino Acids 2022; 54:1229-1249. [PMID: 35798984 DOI: 10.1007/s00726-022-03184-y] [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: 04/19/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury (TBI) has reached epidemic proportions around the world and is a major public health concern in the United States. Approximately 2.8 million individuals sustain a traumatic brain injury and are treated in an Emergency Department yearly in the U.S., and about 50,000 of them die. Persistent symptoms develop in 10-15% of the cases including neuropsychiatric disorders. Anxiety is the second most common neuropsychiatric disorder that develops in those with persistent neuropsychiatric symptoms after TBI. Abnormalities or atrophy in the temporal lobe has been shown in the overwhelming number of TBI cases. The basolateral amygdala (BLA), a temporal lobe structure that consolidates, stores and generates fear and anxiety-based behavioral outputs, is a critical brain region in the anxiety circuitry. In this review, we sought to capture studies that characterized the relationship between human post-traumatic anxiety and structural/functional alterations in the amygdala. We compared the human findings with results obtained with a reproducible mild TBI animal model that demonstrated a direct relationship between the alterations in the BLA and an anxiety-like phenotype. From this analysis, both preliminary insights, and gaps in knowledge, have emerged which may open new directions for the development of rational and more efficacious treatments.
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Affiliation(s)
- Maria F M Braga
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Jenifer Juranek
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77030, USA
| | - Lee E Eiden
- Section On Molecular Neuroscience, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Zheng Li
- Section On Synapse Development and Plasticity, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Taiza H Figueiredo
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Marcio de Araujo Furtado
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Ann M Marini
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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11
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Haidar MA, Shakkour Z, Barsa C, Tabet M, Mekhjian S, Darwish H, Goli M, Shear D, Pandya JD, Mechref Y, El Khoury R, Wang K, Kobeissy F. Mitoquinone Helps Combat the Neurological, Cognitive, and Molecular Consequences of Open Head Traumatic Brain Injury at Chronic Time Point. Biomedicines 2022; 10:biomedicines10020250. [PMID: 35203460 PMCID: PMC8869514 DOI: 10.3390/biomedicines10020250] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) is a heterogeneous disease in its origin, neuropathology, and prognosis, with no FDA-approved treatments. The pathology of TBI is complicated and not sufficiently understood, which is the reason why more than 30 clinical trials in the past three decades turned out unsuccessful in phase III. The multifaceted pathophysiology of TBI involves a cascade of metabolic and molecular events including inflammation, oxidative stress, excitotoxicity, and mitochondrial dysfunction. In this study, an open head TBI mouse model, induced by controlled cortical impact (CCI), was used to investigate the chronic protective effects of mitoquinone (MitoQ) administration 30 days post-injury. Neurological functions were assessed with the Garcia neuroscore, pole climbing, grip strength, and adhesive removal tests, whereas cognitive and behavioral functions were assessed using the object recognition, Morris water maze, and forced swim tests. As for molecular effects, immunofluorescence staining was conducted to investigate microgliosis, astrocytosis, neuronal cell count, and axonal integrity. The results show that MitoQ enhanced neurological and cognitive functions 30 days post-injury. MitoQ also decreased the activation of astrocytes and microglia, which was accompanied by improved axonal integrity and neuronal cell count in the cortex. Therefore, we conclude that MitoQ has neuroprotective effects in a moderate open head CCI mouse model by decreasing oxidative stress, neuroinflammation, and axonal injury.
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Affiliation(s)
- Muhammad Ali Haidar
- Faculty of Biochemistry and Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon; (M.A.H.); (C.B.); (S.M.); (H.D.)
| | - Zaynab Shakkour
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA;
| | - Chloe Barsa
- Faculty of Biochemistry and Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon; (M.A.H.); (C.B.); (S.M.); (H.D.)
| | - Maha Tabet
- Centre de Biologie Integrative (CBI), Molecular, Cellular, and Developmental Biology Department (MCD), University of Toulouse, Centre National de la Recherche Scientifique (CNRS), Université Paul Sabatier (UPS), 31062 Toulouse, France;
| | - Sarin Mekhjian
- Faculty of Biochemistry and Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon; (M.A.H.); (C.B.); (S.M.); (H.D.)
| | - Hala Darwish
- Faculty of Biochemistry and Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon; (M.A.H.); (C.B.); (S.M.); (H.D.)
| | - Mona Goli
- Chemistry and Bioehcmistry Department, Texas Tech University, Lubbock, TX 79409, USA; (M.G.); (Y.M.)
| | - Deborah Shear
- Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (D.S.); (J.D.P.)
| | - Jignesh D. Pandya
- Brain Trauma Neuroprotection (BTN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (D.S.); (J.D.P.)
| | - Yehia Mechref
- Chemistry and Bioehcmistry Department, Texas Tech University, Lubbock, TX 79409, USA; (M.G.); (Y.M.)
| | - Riyad El Khoury
- Neuromuscular Diagnostic Laboratory, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
- Correspondence: (R.E.K.); (K.W.); (F.K.)
| | - Kevin Wang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry, University of Florida, Gainesville, FL 32611, USA
- Correspondence: (R.E.K.); (K.W.); (F.K.)
| | - Firas Kobeissy
- Faculty of Biochemistry and Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon; (M.A.H.); (C.B.); (S.M.); (H.D.)
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry, University of Florida, Gainesville, FL 32611, USA
- Correspondence: (R.E.K.); (K.W.); (F.K.)
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12
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Mitoquinone supplementation alleviates oxidative stress and pathologic outcomes following repetitive mild traumatic brain injury at a chronic time point. Exp Neurol 2022; 351:113987. [DOI: 10.1016/j.expneurol.2022.113987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/23/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
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13
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Sandry J, Dobryakova E. Global hippocampal and selective thalamic nuclei atrophy differentiate chronic TBI from Non-TBI. Cortex 2021; 145:37-56. [PMID: 34689031 DOI: 10.1016/j.cortex.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/04/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
Traumatic brain injury (TBI) may increase susceptibility to neurodegenerative diseases later in life. One neurobiological parallel between chronic TBI and neurodegeneration may be accelerated aging and the nature of atrophy across subcortical gray matter structures. The main aim of the present investigation is to evaluate and rank the degree that subcortical gray matter atrophy differentiates chronic moderate-severe TBI from non-TBI participants by evaluating morphometric differences between groups. Forty individuals with moderate-severe chronic TBI (9.23 yrs from injury) and 33 healthy controls (HC) underwent high resolution 3D T1-weighted structural magnetic resonance imaging. Whole brain volume was classified into white matter, cortical and subcortical gray matter structures with hippocampi and thalami further segmented into subfields and nuclei, respectively. Extensive atrophy was observed across nearly all brain regions for chronic TBI participants. A series of multivariate logistic regression models identified subcortical gray matter structures of the hippocampus and thalamus as the most sensitive to differentiating chronic TBI from non-TBI participants (McFadden R2 = .36, p < .001). Further analyses revealed the pattern of hippocampal atrophy to be global, occurring across nearly all subfields. The pattern of thalamic atrophy appeared to be much more selective and non-uniform, with largest between-group differences evident for nuclei bordering the ventricles. Subcortical gray matter was negatively correlated with time since injury (r = -.31, p = .054), while white matter and cortical gray matter were not. Cognitive ability was lower in the chronic TBI group (Cohen's d = .97, p = .003) and correlated with subcortical structures including the pallidum (r2 = .23, p = .038), thalamus (r2 = .36, p = .007) and ventral diencephalon (r2 = .23, p = .036). These data may support an accelerated aging hypothesis in chronic moderate-severe TBI that coincides with a similar neuropathological profile found in neurodegenerative diseases.
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Affiliation(s)
- Joshua Sandry
- Psychology Department, Montclair State University, Montclair, NJ, USA.
| | - Ekaterina Dobryakova
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School Newark, NJ, USA
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14
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Brain Volume in Veterans: Relationship to Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E330-E341. [PMID: 32108709 DOI: 10.1097/htr.0000000000000559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Clarify associations between diagnosis of posttraumatic stress disorder (PTSD) and deployment traumatic brain injury (TBI) on salient regional brain volumes in returning combat veterans. PARTICIPANTS Iraq and Afghanistan era combat veterans, N = 163, 86.5% male. MAIN MEASURES Clinician-administered PTSD Scale (CAPS-5), Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), magnetic resonance imaging. METHODS Hierarchical regression analyses evaluated associations and interactions between current and lifetime PTSD diagnosis, deployment TBI, and bilateral volume of hippocampus, anterior cingulate cortex, amygdala, orbitofrontal cortex, precuneus, and insula. RESULTS Deployment TBI was associated with lower bilateral hippocampal volume (P = .007-.032) and right medial orbitofrontal cortex volume (P = .006). Neither current nor lifetime PTSD diagnosis was associated with volumetric outcomes beyond covariates and deployment TBI. CONCLUSION History of deployment TBI is independently associated with lower volumes in hippocampus and medial orbitofrontal cortex. These results support TBI as a potential contributing factor to consider in reduced cortical volume in PTSD.
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15
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Bajaj S, Raikes AC, Razi A, Miller MA, Killgore WDS. Blue-Light Therapy Strengthens Resting-State Effective Connectivity within Default-Mode Network after Mild TBI. J Cent Nerv Syst Dis 2021; 13:11795735211015076. [PMID: 34104033 PMCID: PMC8145607 DOI: 10.1177/11795735211015076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Emerging evidence suggests that post concussive symptoms, including mood changes, may be improved through morning blue-wavelength light therapy (BLT). However, the neurobiological mechanisms underlying these effects remain unknown. We hypothesize that BLT may influence the effective brain connectivity (EC) patterns within the default-mode network (DMN), particularly involving the medial prefrontal cortex (MPFC), which may contribute to improvements in mood. Methods: Resting-state functional MRI data were collected from 41 healthy-controls (HCs) and 28 individuals with mild traumatic brain injury (mTBI). Individuals with mTBI also underwent a diffusion-weighted imaging scan and were randomly assigned to complete either 6 weeks of daily morning BLT (N = 14) or amber light therapy (ALT; N = 14). Advanced spectral dynamic causal modeling (sDCM) and diffusion MRI connectometry were used to estimate EC patterns and structural connectivity strength within the DMN, respectively. Results: The sDCM analysis showed dominant connectivity pattern following mTBI (pre-treatment) within the hemisphere contralateral to the one observed for HCs. BLT, but not ALT, resulted in improved directional information flow (ie, EC) from the left lateral parietal cortex (LLPC) to MPFC within the DMN. The improvement in EC from LLPC to MPFC was accompanied by stronger structural connectivity between the 2 areas. For the BLT group, the observed improvements in function and structure were correlated (at a trend level) with changes in self-reported happiness. Conclusions: The current preliminary findings provide empirical evidence that morning short-wavelength light therapy could be used as a novel alternative rehabilitation technique for mTBI. Trial registry: The research protocols were registered in the ClinicalTrials.gov database (CT Identifiers NCT01747811 and NCT01721356).
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience (SCAN) Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
- Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
- Sahil Bajaj, Multimodal Clinical Neuroimaging Laboratory, Center for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE 68010, USA.
| | - Adam C Raikes
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, USA
| | - Adeel Razi
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging at Monash University, Clayton, VIC, Australia
- The Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Department of Electronic Engineering, NED University of Engineering and Technology, Karachi, Pakistan
| | - Michael A Miller
- Social, Cognitive and Affective Neuroscience (SCAN) Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - William DS Killgore
- Social, Cognitive and Affective Neuroscience (SCAN) Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
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16
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Zhuo J, Jiang L, Rhodes CS, Roys S, Shanmuganathan K, Chen H, Prince JL, Badjatia N, Gullapalli RP. Early Stage Longitudinal Subcortical Volumetric Changes following Mild Traumatic Brain Injury. Brain Inj 2021; 35:725-733. [PMID: 33822686 PMCID: PMC8207827 DOI: 10.1080/02699052.2021.1906445] [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: 09/15/2020] [Revised: 02/15/2021] [Accepted: 03/17/2021] [Indexed: 01/07/2023]
Abstract
Objective: To investigate early brain volumetric changes from acute to 6 months following mild traumatic brain injury (mTBI) in deep gray matter regions and their association with patient 6-month outcome.Methods: Fifty-six patients with mTBI underwent MRI and behavioral evaluation at acute (<10 days) and approximately 1 and 6 months post injury. Regional volume changes were investigated in key gray matter regions: thalamus, hippocampus, putamen, caudate, pallidum, and amygdala, and compared with volumes from 34 healthy control subjects. In patients with mTBI, we further assessed associations between longitudinal regional volume changes with patient outcome measures at 6 months including post-concussive symptoms, cognitive performance, and overall satisfaction with life.Results: Reduction in thalamic and hippocampal volumes was observed at 1 month among patients with mTBI. Such volume reduction persisted in the thalamus until 6 months. Changes in thalamic volumes also correlated with multiple symptom and functional outcome measures in patients at 6 months.Conclusion: Our results indicate that the thalamus may be differentially affected among patients with mTBI, resulting in both structural and functional deficits with subsequent post-concussive sequelae and may serve as a biomarker for the assessment of efficacy of novel therapeutic interventions.
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Affiliation(s)
- Jiachen Zhuo
- Center for Advanced Imaging Research, Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Li Jiang
- Center for Advanced Imaging Research, Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Chandler Sours Rhodes
- Center for Advanced Imaging Research, Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Steven Roys
- Center for Advanced Imaging Research, Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Karthikamanthan Shanmuganathan
- Center for Advanced Imaging Research, Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Hegang Chen
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Jerry L. Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD
| | - Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Rao P. Gullapalli
- Center for Advanced Imaging Research, Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
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17
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Latchoumane CFV, Betancur MI, Simchick GA, Sun MK, Forghani R, Lenear CE, Ahmed A, Mohankumar R, Balaji N, Mason HD, Archer-Hartmann SA, Azadi P, Holmes PV, Zhao Q, Bellamkonda RV, Karumbaiah L. Engineered glycomaterial implants orchestrate large-scale functional repair of brain tissue chronically after severe traumatic brain injury. SCIENCE ADVANCES 2021; 7:7/10/eabe0207. [PMID: 33674306 PMCID: PMC7935369 DOI: 10.1126/sciadv.abe0207] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/21/2021] [Indexed: 05/14/2023]
Abstract
Severe traumatic brain injury (sTBI) survivors experience permanent functional disabilities due to significant volume loss and the brain's poor capacity to regenerate. Chondroitin sulfate glycosaminoglycans (CS-GAGs) are key regulators of growth factor signaling and neural stem cell homeostasis in the brain. However, the efficacy of engineered CS (eCS) matrices in mediating structural and functional recovery chronically after sTBI has not been investigated. We report that neurotrophic factor functionalized acellular eCS matrices implanted into the rat M1 region acutely after sTBI significantly enhanced cellular repair and gross motor function recovery when compared to controls 20 weeks after sTBI. Animals subjected to M2 region injuries followed by eCS matrix implantations demonstrated the significant recovery of "reach-to-grasp" function. This was attributed to enhanced volumetric vascularization, activity-regulated cytoskeleton (Arc) protein expression, and perilesional sensorimotor connectivity. These findings indicate that eCS matrices implanted acutely after sTBI can support complex cellular, vascular, and neuronal circuit repair chronically after sTBI.
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Affiliation(s)
- Charles-Francois V Latchoumane
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
- Edgar L. Rhodes Center for ADS, College of Agriculture and Environmental Sciences, University of Georgia, Athens, GA 30602, USA
| | - Martha I Betancur
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, 101 Science Drive, Durham, NC 27705, USA
| | - Gregory A Simchick
- Department of Physics and Astronomy, University of Georgia, Athens, GA 30602, USA
- Bio-Imaging Research Center, University of Georgia, Athens, GA 30602, USA
| | - Min Kyoung Sun
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
- Division of Neuroscience, Biomedical & Health Sciences Institute, University of Georgia, Athens, GA 30602, USA
| | - Rameen Forghani
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
| | - Christopher E Lenear
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
- Edgar L. Rhodes Center for ADS, College of Agriculture and Environmental Sciences, University of Georgia, Athens, GA 30602, USA
| | - Aws Ahmed
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
- Edgar L. Rhodes Center for ADS, College of Agriculture and Environmental Sciences, University of Georgia, Athens, GA 30602, USA
| | - Ramya Mohankumar
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
| | - Nivedha Balaji
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
| | - Hannah D Mason
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
| | | | - Parastoo Azadi
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602, USA
| | - Philip V Holmes
- Division of Neuroscience, Biomedical & Health Sciences Institute, University of Georgia, Athens, GA 30602, USA
- Psychology Department, University of Georgia, Athens, GA 30602, USA
| | - Qun Zhao
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA
- Department of Physics and Astronomy, University of Georgia, Athens, GA 30602, USA
- Bio-Imaging Research Center, University of Georgia, Athens, GA 30602, USA
| | - Ravi V Bellamkonda
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, 101 Science Drive, Durham, NC 27705, USA
| | - Lohitash Karumbaiah
- Regenerative Bioscience Center, University of Georgia, Athens, GA 30602, USA.
- Edgar L. Rhodes Center for ADS, College of Agriculture and Environmental Sciences, University of Georgia, Athens, GA 30602, USA
- Division of Neuroscience, Biomedical & Health Sciences Institute, University of Georgia, Athens, GA 30602, USA
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18
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Biegon A. Considering Biological Sex in Traumatic Brain Injury. Front Neurol 2021; 12:576366. [PMID: 33643182 PMCID: PMC7902907 DOI: 10.3389/fneur.2021.576366] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
Published epidemiological studies of traumatic brain injury (TBI) of all severities consistently report higher incidence in men. Recent increases in the participation of women in sports and active military service as well as increasing awareness of the very large number of women who sustain but do not report TBI as a result of intimate partner violence (IPV) suggest that the number of women with TBI is significantly larger than previously believed. Women are also grossly under-represented in clinical and natural history studies of TBI, most of which include relatively small numbers of women, ignore the role of sex- and age-related gonadal hormone levels, and report conflicting results. The emerging picture from recent studies powered to detect effects of biological sex as well as age (as a surrogate of hormonal status) suggest young (i.e., premenopausal) women are more likely to die from TBI relative to men of the same age group, but this is reversed in the 6th and 7th decades of life, coinciding with postmenopausal status in women. New data from concussion studies in young male and female athletes extend this finding to mild TBI, since female athletes who sustained mild TBI are significantly more likely to report more symptoms than males. Studies including information on gonadal hormone status at the time of injury are still too scarce and small to draw reliable conclusions, so there is an urgent need to include biological sex and gonadal hormone status in the design and analysis of future studies of TBI.
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Affiliation(s)
- Anat Biegon
- Department of Radiology and Neurology, Stony Brook University School of Medicine, Stony Brook, NY, United States
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19
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Debarle C, Perlbarg V, Jacquens A, Pélégrini-Issac M, Bisch M, Prigent A, Lesimple B, Caron E, Lefort M, Bayen E, Galanaud D, Pradat-Diehl P, Puybasset L, Degos V. Global mean diffusivity: A radiomarker discriminating good outcome long term after traumatic brain injury. Ann Phys Rehabil Med 2021; 64:101433. [PMID: 32992024 DOI: 10.1016/j.rehab.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a chronic pathology responsible for cognitive disorders impacting outcome. Global clinical outcome several years after TBI may be associated with anatomical sequelae. Anatomical lesions are not well described because characterizing diffuse axonal injury and brain atrophy require using specific MRI sequences with quantitative measures. The best radiologic parameter to describe the lesions long term after TBI is not known. OBJECTIVE We aimed to first, assess the global volumetric and diffusion parameters related to long-term outcome after TBI and second, define the most discriminating parameter. METHODS In this observational study, we included 96 patients with severe TBI and 22 healthy volunteers. The mean delay after TBI was 63.2 months [range 31-119]. The Glasgow Outcome Scale Extended (GOS-E) was used to assess the global long-term clinical outcome. All patients underwent multimodal MRI with measures of brain volume, ventricle volume, global fractional anisotropy (FA) and global mean diffusivity (MD). RESULTS All 96 participants had significant impairment in global FA, global MD, brain volume and ventricle volume as compared with the 22 controls (P<0.01). Only global MD significantly differed between the "good recovery" group (GOS-E score 7-8) and the other two groups: GOS-E scores 3-4 and 5-6. Brain volume significantly differed between the GOS-E 7-8 and 3-4 groups. Global MD was the most discriminating radiological parameter for the "good recovery" group versus other patients, long term after TBI. FA appeared less relevant at this time. Global atrophy was higher in patients than controls but lacked reliability to discriminate groups of patients. CONCLUSION Global mean diffusivity seems a more promising radiomarker than global FA for discriminating good outcome long term after TBI. Further work is needed to understand the evolution of these long-term radiological parameters after TBI.
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Affiliation(s)
- Clara Debarle
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France.
| | - Vincent Perlbarg
- BRAINTALE SAS, Paris, France; Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Alice Jacquens
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France; Sorbonne Université, Groupe de Recherche Clinique Biosfast, Paris, France
| | | | - Marion Bisch
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Amélie Prigent
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Blandine Lesimple
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Elsa Caron
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France
| | - Muriel Lefort
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Eléonore Bayen
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France
| | - Damien Galanaud
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France; AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neuroradiological Department, Paris, France
| | - Pascale Pradat-Diehl
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France; Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Louis Puybasset
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France; AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Vincent Degos
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France; Sorbonne Université, Groupe de Recherche Clinique Biosfast, Paris, France
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20
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Lin X, Zhang X, Liu Q, Zhao P, Zhang H, Wang H, Yi Z. Theory of mind in adults with traumatic brain injury: A meta-analysis. Neurosci Biobehav Rev 2020; 121:106-118. [PMID: 33359093 DOI: 10.1016/j.neubiorev.2020.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/27/2020] [Accepted: 12/08/2020] [Indexed: 01/11/2023]
Abstract
Studies of abnormal theory of mind (ToM) performance in adult patients with traumatic brain injury (TBI) have reported inconsistent results. Therefore, we conducted a meta-analysis to characterize ToM performance in adult patients with TBI. Random-effects models were employed to estimate the overall effect size and the differential effect sizes across different ToM aspects. Based on a sample of 28 studies (1031 patients and 865 healthy controls), the meta-analytic findings revealed that ToM was significantly impaired in adult patients with TBI compared to healthy controls (g = -1.13). Besides, patients with TBI showed significant impairments in individual ToM tasks, as well as for different stimulus modes and contents involved in these ToM tasks. A meta-regression indicated a positive association between ToM performance and Glasgow Coma Scale score. The results of the current meta-analysis suggest that the performance in ToM tasks may be a good predictor of functional outcomes in adults with TBI, which is important for the identification of targets for cognitive interventions and the development of useful training intervention programs.
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Affiliation(s)
- XiaoGuang Lin
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, PR China
| | - XueLing Zhang
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, PR China
| | - QinQin Liu
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, PR China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Hui Zhang
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - HongSheng Wang
- Department of Neurosurgery, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China.
| | - ZhongQuan Yi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China.
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21
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de Souza NL, Parker R, Gonzalez CS, Ryan JD, Esopenko C. Effect of age at time of injury on long-term changes in intrinsic functional connectivity in traumatic brain injury. Brain Inj 2020; 34:1646-1654. [PMID: 33090913 DOI: 10.1080/02699052.2020.1832257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alterations in resting-state functional connectivity (rsFC) occur in the acute and chronic phases following traumatic brain injury (TBI); however, few studies have assessed long-term (>1 year) changes in rsFC. METHODS Resting-state functional magnetic resonance imaging (rsfMRI) scans were obtained from the Federal Interagency Traumatic Brain Injury Research Informatics Systems. Patients with primarily mild TBI (n = 39) completed rsfMRI scans at the sub-acute (~10 days) and long-term (~18 months) phases. We examined changes in voxel-based rsFC from anterior medial prefrontal cortex (aMPFC) and posterior cingulate cortex (PCC) seeds in the default mode network (DMN) between both phases. The effect of age at the time of injury on long-term rsFC was also examined. RESULTS Increased rsFC from the aMPFC and the PCC to frontal and temporal regions was shown at ~18-months post-injury. Widespread increases in rsFC from the aMPFC and between the PCC and frontal regions were shown for younger patients at time of injury, but limited increases of rsFC were noted at ~18 months in older patients. CONCLUSION Long-term increases in rsFC were found following TBI, but age at the time of injury was associated with distinct rsFC profiles suggesting that younger patients show greater increases in rsFC over time.
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Affiliation(s)
- Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences , Newark, New Jersey, USA
| | - Rachel Parker
- Rotman Research Institute at Baycrest , Toronto, Ontario, Canada
| | - Christie S Gonzalez
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences , Newark, New Jersey, USA
| | - Jennifer D Ryan
- Rotman Research Institute at Baycrest , Toronto, Ontario, Canada.,Department of Psychology, University of Toronto , Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences , Newark, New Jersey, USA
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22
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Sharma B, Changoor A, Monteiro L, Colella B, Green R. Prognostic-factors for neurodegeneration in chronic moderate-to-severe traumatic brain injury: a systematic review protocol. Syst Rev 2020; 9:23. [PMID: 32014038 PMCID: PMC6998211 DOI: 10.1186/s13643-020-1281-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/15/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability. Recently, a paradigm shift in our understanding of moderate-to-severe TBI has led to its reconceptualization as a progressive neurodegenerative disorder. Widespread progressive atrophy is observed in the months and years post-injury, long after the acute effects of the injury have resolved. Some studies have begun to examine prognostic demographic, injury-related, and post-injury risk factors that contribute to these declines. A synthesis of this information, and in particular, an increased understanding of post-injury factors that may be modifiable, would improve our ability to design interventions to reduce neurodegeneration in moderate-to-severe TBI. This systematic review aims to identify prognostic factors for neural deterioration in moderate-to-severe TBI, and thereby inform future intervention research in this population. METHODS This review protocol was informed by and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. Search strategies (designed to identify literature on prognostic factors of neurodegeneration in adults with moderate-to-severe TBI) optimized for MEDLINE, EMBASE PsychINFO, CINAHL, SportDiscus, and Cochrane Central Register of Controlled Trials will be developed with the assistance of a health sciences librarian. Retrieved studies will be screened by two team members. Studies must report on longitudinal neuroimaging (i.e., two or more scans in the same cohort) or neuroimaging in a cross-sectional study and potential prognostic factors for neurodegeneration, such as demographics (e.g., gender, age, education), injury (e.g., severity, etiology), or post-injury characteristics (e.g., type and length of therapy, activity level, mood). DISCUSSION By identifying prognostic factors for neurodegeneration, this systematic review can help inform injury management, as well as intervention research designed to offset the effects of modifiable prognostic factors, such as low levels of cognitive or physical activity. In turn, this systematic review can increase our understanding of how to improve outcome following moderate-to-severe TBI. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019122389.
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Affiliation(s)
- Bhanu Sharma
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G2A2 Canada
- Department of Medical Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 L8 Canada
| | - Alana Changoor
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G2A2 Canada
| | - Leanne Monteiro
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G2A2 Canada
| | - Brenda Colella
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G2A2 Canada
| | - Robin Green
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G2A2 Canada
- Department of Psychiatry, University of Toronto, 550 University Avenue, Toronto, ON M5G2A2 Canada
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23
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Sarmiento K, Gioia GA, Kirkwood MW, Wade SL, Yeates KO. A commentary for neuropsychologists on CDC's guideline on the diagnosis and management of mild traumatic brain injury among children. Clin Neuropsychol 2020; 34:259-277. [PMID: 31530221 PMCID: PMC7039321 DOI: 10.1080/13854046.2019.1660806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/28/2019] [Accepted: 08/18/2019] [Indexed: 12/27/2022]
Abstract
Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline.Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline.Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices.Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.
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Affiliation(s)
- Kelly Sarmiento
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerard A. Gioia
- Division of Pediatric Neuropsychology, Children’s National Health System, George Washington University School of Medicine, Washington, DC, USA
| | - Michael W. Kirkwood
- Department of Physical Medicine and Rehabilitation, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Keith O. Yeates
- Departments of Psychology and Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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24
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Wang Y, Nencka AS, Meier TB, Guskiewicz K, Mihalik JP, Alison Brooks M, Saykin AJ, Koch KM, Wu YC, Nelson LD, McAllister TW, Broglio SP, McCrea MA. Cerebral blood flow in acute concussion: preliminary ASL findings from the NCAA-DoD CARE consortium. Brain Imaging Behav 2020; 13:1375-1385. [PMID: 30159767 DOI: 10.1007/s11682-018-9946-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sport-related concussion (SRC) has become a major health problem, affecting millions of athletes each year. Despite the increasing occurrence and prevalence of SRC, its underlying mechanism and recovery course have yet to be fully elucidated. The National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium is a large-scale, multisite study of the natural history of concussion across multiple sports. The Advanced Research Core (ARC) of CARE is focused on the advanced biomarker assessment of a reduced subject cohort. This paper reports findings from two ARC sites to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared relative CBF maps assessed in 24 concussed contact sport athletes obtained at 24-48 h after injury to those of a control group of 24 matched contact sport players. Significantly less CBF was detected in several brain regions in concussed athletes, while clinical assessments also indicated clinical symptom and performance impairments in SRC patients. Correlations were found between decreased CBF in acute SRC and clinical assessments, including Balance Error Scoring System total score and Immediate Post-Concussion Assessment and Cognitive Test memory composite and impulse control composite scores, as well as days from injury to asymptomatic. Although using different ASL MRI sequences, our preliminary results from two sites are consistent with previous reports and suggest that advanced ASL MRI methods might be useful for detecting acute neurobiological changes in acute SRC.
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Affiliation(s)
- Yang Wang
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Kevin Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, 250 East Franklin Street, Chapel Hill, NC, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina, 250 East Franklin Street, Chapel Hill, NC, USA
| | - M Alison Brooks
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Kevin M Koch
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Steven P Broglio
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
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25
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Hilz MJ, Wang R, Liu M, Muresanu D, Flanagan S, Winder K, Hösl K, Hummel T. Emotional and Autonomic Processing of Olfactory Stimuli Is Compromised in Patients with a History of Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:125-138. [PMID: 31298614 DOI: 10.1089/neu.2018.6215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with a history of mild traumatic brain injury (post-mTBI patients) may have enduring cardiovascular-autonomic dysregulation and emotional problems. Olfactory stimulation (OS) triggers emotional and cardiovascular-autonomic responses that might be compromised in post-mTBI patients. We therefore evaluated these responses to OS in post-mTBI patients. In 17 post-mTBI patients (interval since mTBI: 32.4 ± 6.8 months) and 17 age- and sex-matched controls, we recorded respiration, electrocardiographic RR intervals, and systolic and diastolic blood pressures (BPsys, BPdia) before and during pleasant vanilla stimulation and unpleasant hydrogen sulphide (H2S) stimulation. Participants rated OS-related pleasantness, arousal, intensity, and familiarity on 9-point Likert scales. Analyses of variance (ANOVAs) with post hoc analyses compared parameters within each group before and during OS. To assess associations between pleasantness, arousal, intensity, and familiarity, we correlated OS scores within groups (significance: p < 0.05). Baseline parameters were similar between groups. Only in controls, vanilla stimulation significantly lowered BPsys and BPdia, whereas H2S stimulation lowered RR intervals. Vanilla-related pleasantness scores were lower, intensity scores were higher in patients than controls. During vanilla stimulation, pleasantness scores correlated negatively with arousal scores in controls, whereas familiarity scores correlated positively with intensity scores in patients. During H2S stimulation, familiarity scores correlated negatively with pleasantness scores in controls, whereas pleasantness scores correlated negatively with arousal scores in mTBI patients. Post-mTBI patients could not change BP or RR intervals during OS but perceived vanilla stimuli as less pleasant and more intense than did controls. Associations between pleasantness, arousal, intensity, and familiarity differed between groups suggesting different activation of the olfactory network and the central autonomic network upon OS. Subtle lesions within these networks might cause persistent changes in emotional and cognitive odor perception and cardiovascular responses.
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Affiliation(s)
- Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mao Liu
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dafin Muresanu
- Department of Clinical Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Steven Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York
| | - Klemens Winder
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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26
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Harris TC, de Rooij R, Kuhl E. The Shrinking Brain: Cerebral Atrophy Following Traumatic Brain Injury. Ann Biomed Eng 2019; 47:1941-1959. [PMID: 30341741 PMCID: PMC6757025 DOI: 10.1007/s10439-018-02148-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
Cerebral atrophy in response to traumatic brain injury is a well-documented phenomenon in both primary investigations and review articles. Recent atrophy studies focus on exploring the region-specific patterns of cerebral atrophy; yet, there is no study that analyzes and synthesizes the emerging atrophy patterns in a single comprehensive review. Here we attempt to fill this gap in our current knowledge by integrating the current literature into a cohesive theory of preferential brain tissue loss and by identifying common risk factors for accelerated atrophy progression. Our review reveals that observations for mild traumatic brain injury remain inconclusive, whereas observations for moderate-to-severe traumatic brain injury converge towards robust patterns: brain tissue loss is on the order of 5% per year, and occurs in the form of generalized atrophy, across the entire brain, or focal atrophy, in specific brain regions. The most common regions of focal atrophy are the thalamus, hippocampus, and cerebellum in gray matter and the corpus callosum, corona radiata, and brainstem in white matter. We illustrate the differences of generalized and focal gray and white matter atrophy on emerging deformation and stress profiles across the whole brain using computational simulation. The characteristic features of our atrophy simulations-a widening of the cortical sulci, a gradual enlargement of the ventricles, and a pronounced cortical thinning-agree well with clinical observations. Understanding region-specific atrophy patterns in response to traumatic brain injury has significant implications in modeling, simulating, and predicting injury outcomes. Computational modeling of brain atrophy could open new strategies for physicians to make informed decisions for whom, how, and when to administer pharmaceutical treatment to manage the chronic loss of brain structure and function.
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27
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Anxiety Disorders in Adults With Childhood Traumatic Brain Injury: Evidence of Difficulties More Than 10 Years Postinjury. J Head Trauma Rehabil 2019; 33:191-199. [PMID: 28520662 DOI: 10.1097/htr.0000000000000312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore long-term psychiatric outcomes in individuals with a history of childhood traumatic brain injury (TBI) or orthopedic injury (OI). SETTING Hospital emergency department, medical admission records and outpatient settings. PARTICIPANTS There were 95 males (M = 22.78 years, SD = 3.44 years) and 74 females (M = 22.27 years, SD = 3.09 years), 65 with mild TBI (M = 23.25 years, SD = 3.58 years), 61 with moderate-severe TBI (M = 22.34 years, SD = 2.79 years), and 43 with OI (M = 21.81 years, SD = 3.36 years). DESIGN Longitudinal, between-subjects, cross-sectional design using retrospective and current data. MAIN MEASURES Semistructured interview to obtain psychiatric diagnoses and background information, and medical records for identification of TBI. RESULTS Group with moderate-severe TBI presented with significantly higher rates of any anxiety disorder (χ2 = 6.81, P = .03) and comorbid anxiety disorder (χ2 = 6.12, P < .05). Group with overall TBI presented with significantly higher rates of any anxiety disorder (χ1 = 5.36, P = .02), panic attacks (χ1 = 4.43, P = .04), specific phobias (χ1 = 4.17, P = .04), and depression (χ1 = 3.98, P < .05). Prediction analysis revealed a statistically significant model (χ7 = 41.84, P < .001) explaining 23% to 37% of the variance in having any anxiety disorder, with significant predictors being group (TBI) and gender (female). CONCLUSIONS Children who have sustained a TBI may be vulnerable to persistent anxiety, panic attacks, specific phobias, and depression, even 13 years after the injury event.
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28
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Santhanam P, Wilson SH, Mulatya C, Oakes TR, Weaver LK. Age-Accelerated Reduction in Cortical Surface Area in United States Service Members and Veterans with Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder. J Neurotrauma 2019; 36:2922-2929. [PMID: 31094282 DOI: 10.1089/neu.2018.6242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite the prevalence of combat-related mild traumatic brain injury (mTBI) and relatively high incidence of concurrent post-traumatic stress disorder (PTSD), the joint effect of these conditions on the brain is not well understood. Further, few studies in the mTBI or PTSD populations focus on cortical surface area measures, despite known disruptions to cytoarchitecture of the cortex. This study examines the effects of comorbid mTBI and PTSD on age-related surface area changes across the cortex, as compared with a group with mTBI only. While a direct comparison of PTSD versus non-PTSD groups showed little difference on surface area measures, several regions showed a decline in surface area, with increasing age and a significant PTSD-by-age interaction effect, indicating an age-dependent decrease in surface area in those with both mTBI and PTSD. The findings suggest an apparent age-accelerated shrinking of the cortical surface area in some regions when mTBI and PTSD are present, a pattern that was not consistently found in those with mTBI only. Among the several cortical regions with significant age-by-group interactions were bilateral posterior cingulate cortex (left: p = 0.03; right: p = 0.02), isthmus of the cingulate (left: p = 0.016; right: p = 0.001), and lateral orbitofrontal cortex (left: p = 0.038; right: p = 0.02). It is possible that these findings are related to a larger pattern of premature neurodegeneration and age-acceleration noted in those with long-term PTSD.
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Affiliation(s)
- Priya Santhanam
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| | | | | | - Terrence R Oakes
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lindell K Weaver
- Division of Hyperbaric, Medicine Intermountain Medical Center, Murray, UT and Intermountain LDS Hospital, Salt Lake City, Utah.,Department of Medicine, University of Utah, Salt Lake City, Utah
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29
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Johnson BD, O'Leary MC, McBryde M, Sackett JR, Schlader ZJ, Leddy JJ. Face cooling exposes cardiac parasympathetic and sympathetic dysfunction in recently concussed college athletes. Physiol Rep 2019; 6:e13694. [PMID: 29741235 PMCID: PMC5941219 DOI: 10.14814/phy2.13694] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 12/24/2022] Open
Abstract
We tested the hypothesis that concussed college athletes (CA) have attenuated parasympathetic and sympathetic responses to face cooling (FC). Eleven symptomatic CA (age: 20 ± 2 years, 5 women) who were within 10 days of concussion diagnosis and 10 healthy controls (HC; age: 24 ± 4 years, 5 women) participated. During FC, a plastic bag filled with ice water (~0°C) was placed on the forehead, eyes, and cheeks for 3 min. Heart rate (ECG) and blood pressure (photoplethysmography) were averaged at baseline and every 60 sec during FC. High‐frequency (HF) power was obtained from spectral analysis of the R‐R interval. Data are presented as a change from baseline. Baseline heart rate (HC: 61 ± 12, CA: 57 ± 12 bpm; P = 0.69), mean arterial pressure (MAP) (HC: 94 ± 10, CA: 96 ± 13 mmHg; P = 0.74), and HF (HC: 2294 ± 2314, CA: 2459 ± 2058 msec2; P = 0.86) were not different between groups. Heart rate in HC decreased at 2 min (−7 ± 11 bpm; P = 0.02) but did not change in CA (P > 0.43). MAP increased at 1 min (HC: 12 ± 6, CA: 6 ± 6 mmHg), 2 min (HC: 21 ± 7, CA: 11 ± 7 mmHg), and 3 min (HC: 20 ± 6, CA: 13 ± 7 mmHg) in both groups (P < 0.01 for all) but the increase was greater at each interval in HC (P < 0.02). HF increased at 1 min (12354 ± 11489 msec2; P < 0.01) and 2 min (5832 ± 8002 msec2; P = 0.02) in HC but did not change in CA (P > 0.58). The increase in HF at 1 min was greater in HC versus CA (P < 0.01). These data indicate that symptomatic concussed patients have impaired cardiac parasympathetic and sympathetic activation.
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Affiliation(s)
- Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Morgan C O'Leary
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Muhamed McBryde
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - James R Sackett
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - John J Leddy
- UBMD, Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, New York
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30
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Thau-Zuchman O, Gomes RN, Dyall SC, Davies M, Priestley JV, Groenendijk M, De Wilde MC, Tremoleda JL, Michael-Titus AT. Brain Phospholipid Precursors Administered Post-Injury Reduce Tissue Damage and Improve Neurological Outcome in Experimental Traumatic Brain Injury. J Neurotrauma 2018; 36:25-42. [PMID: 29768974 PMCID: PMC6306688 DOI: 10.1089/neu.2017.5579] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Traumatic brain injury (TBI) leads to cellular loss, destabilization of membranes, disruption of synapses and altered brain connectivity, and increased risk of neurodegenerative disease. A significant and long-lasting decrease in phospholipids (PLs), essential membrane constituents, has recently been reported in plasma and brain tissue, in human and experimental TBI. We hypothesized that supporting PL synthesis post-injury could improve outcome post-TBI. We tested this hypothesis using a multi-nutrient combination designed to support the biosynthesis of PLs and available for clinical use. The multi-nutrient, Fortasyn® Connect (FC), contains polyunsaturated omega-3 fatty acids, choline, uridine, vitamins, cofactors required for PL biosynthesis, and has been shown to have significant beneficial effects in early Alzheimer's disease. Male C57BL/6 mice received a controlled cortical impact injury and then were fed a control diet or a diet enriched with FC for 70 days. FC led to a significantly improved sensorimotor outcome and cognition, reduced lesion size and oligodendrocyte loss, and it restored myelin. It reversed the loss of the synaptic protein synaptophysin and decreased levels of the axon growth inhibitor, Nogo-A, thus creating a permissive environment. It decreased microglia activation and the rise in ß-amyloid precursor protein and restored the depressed neurogenesis. The effects of this medical multi-nutrient suggest that support of PL biosynthesis post-TBI, a new treatment paradigm, has significant therapeutic potential in this neurological condition for which there is no satisfactory treatment. The multi-nutrient tested has been used in dementia patients and is safe and well tolerated, which would enable rapid clinical exploration in TBI.
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Affiliation(s)
- Orli Thau-Zuchman
- 1 Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Rita N Gomes
- 1 Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Simon C Dyall
- 3 Bournemouth University, Royal London House, Bournemouth, United Kingdom
| | - Meirion Davies
- 1 Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - John V Priestley
- 1 Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Martine Groenendijk
- 2 Nutricia Research-Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Martijn C De Wilde
- 2 Nutricia Research-Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Jordi L Tremoleda
- 1 Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Adina T Michael-Titus
- 1 Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Misquitta K, Dadar M, Tarazi A, Hussain MW, Alatwi MK, Ebraheem A, Multani N, Khodadadi M, Goswami R, Wennberg R, Tator C, Green R, Colella B, Davis KD, Mikulis D, Grinberg M, Sato C, Rogaeva E, Louis Collins D, Tartaglia MC. The relationship between brain atrophy and cognitive-behavioural symptoms in retired Canadian football players with multiple concussions. Neuroimage Clin 2018; 19:551-558. [PMID: 29984163 PMCID: PMC6029563 DOI: 10.1016/j.nicl.2018.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 10/31/2022]
Abstract
Multiple concussions, particularly in contact sports, have been associated with cognitive deficits, psychiatric impairment and neurodegenerative diseases like chronic traumatic encephalopathy. We used volumetric and deformation-based morphometric analyses to test the hypothesis that repeated concussions may be associated with smaller regional brain volumes, poorer cognitive performance and behavioural symptoms among former professional football players compared to healthy controls. This study included fifty-three retired Canadian Football League players, 25 age- and education-matched healthy controls, and controls from the Cambridge Centre for Aging and Neuroscience database for validation. Volumetric analyses revealed greater hippocampal atrophy than expected for age in former athletes with multiple concussions than controls and smaller left hippocampal volume was associated with poorer verbal memory performance in the former athletes. Deformation-based morphometry confirmed smaller bilateral hippocampal volume that was associated with poorer verbal memory performance in athletes. Repeated concussions may lead to greater regional atrophy than expected for age.
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Affiliation(s)
- Karen Misquitta
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Mahsa Dadar
- McConnell Brain Imaging Centre, Montreal Neurological Institute, 3801 Rue Universite, Montreal, QC H3A 2B4, Canada
| | - Apameh Tarazi
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Mohammed W Hussain
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Mohammed K Alatwi
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Ahmed Ebraheem
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Namita Multani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada; Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Ruma Goswami
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Richard Wennberg
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Charles Tator
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Department of Surgery, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Robin Green
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON M5G 2A2, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Brenda Colella
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, ON M5G 2A2, Canada
| | - Karen Deborah Davis
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - David Mikulis
- Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Department of Medical Imaging, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Mark Grinberg
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, Montreal Neurological Institute, 3801 Rue Universite, Montreal, QC H3A 2B4, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada; Canadian Concussion Center, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst St., Toronto, ON M5T 2S8, Canada; Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada.
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32
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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33
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Ruet A, Joyeux F, Segobin S, Jokic C, Desgranges B, Eustache F, Pitel AL. Severe Traumatic Brain Injury Patients without Focal Lesion but with Behavioral Disorders: Shrinkage of Gray Matter Nuclei and Thalamus Revealed in a Pilot Voxel-Based MRI Study. J Neurotrauma 2018; 35:1552-1556. [PMID: 29648977 DOI: 10.1089/neu.2017.5242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
After a traumatic brain injury (TBI), behavioral disorders can occur without major focal brain lesion, and in these situations, their pathophysiology remains unclear. The aim of this study is to examine whether TBI patients with behavioral disorders but without any focal damage, as observed from an initial clinical CT scan, present subtle volumetric alterations that could be measured voxel-by-voxel in the whole brain with MRI. Eight male adults with severe TBI who had behavioral sequela but not major focal cerebral lesion and 17 age-matched controls underwent a volumetric T1-weighted 1.5T MRI. A two step analysis was performed. First, gray matter (GM) and white matter (WM) volumes were compared between groups using voxel-based morphometry. Second, we examined brain regions systematically damaged using the sum of the individual binary maps obtained from z-maps thresholded at -1.75 for significant GM and WM atrophy. TBI patients had lower GM volume than controls (p < 0.001, uncorrected) in the right parahippocampal gyrus; left and right superior, middle, and inferior temporal gyri; left superior frontal gyrus; right middle frontal gyrus; thalami; mammillary bodies; caudate nuclei; insulae; cerebellar cortex; and vermis. WM volume was lower (p < 0.001, uncorrected) in the TBI group than in controls in the periventricular area and around the basal nuclei. We found shrinkage in the dorsomedial thalami in each of the TBI patients, and in the posterior part of the right putamen and caudate nuclei in seven TBI patients. Shrinkage in the dorsomedial thalami and in the posterior part of the right putamen and caudate nuclei may be a common effect of the disseminated microscopic lesions, and be associated with behavioral issues in severe TBI patients without major focal lesions.
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Affiliation(s)
- Alexis Ruet
- 1 CHU de Caen, Service de Médecine Physique et de Réadaptation, Caen, France .,2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France .,3 CH Aunay Bayeux, Service de Médecine Physique et de Réadaptation, Aunay/Odon, France
| | - Françoise Joyeux
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France .,3 CH Aunay Bayeux, Service de Médecine Physique et de Réadaptation, Aunay/Odon, France
| | - Shailendra Segobin
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
| | - Corine Jokic
- 3 CH Aunay Bayeux, Service de Médecine Physique et de Réadaptation, Aunay/Odon, France
| | - Béatrice Desgranges
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
| | - Francis Eustache
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
| | - Anne-Lise Pitel
- 2 INSERM; EPHE, Neuropsychologie et Imagerie de la Mémoire Humaine, UNICAEN, PSL Research University , Normandie Université, Caen, France
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34
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Apathy following traumatic brain injury: A review. Neuropsychologia 2018; 118:40-47. [PMID: 29660377 DOI: 10.1016/j.neuropsychologia.2018.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/27/2018] [Accepted: 04/09/2018] [Indexed: 01/19/2023]
Abstract
Apathy is a common problem after traumatic brain injury (TBI) and can have a major impact on cognitive function, psychosocial outcome and engagement in rehabilitation. For scientists and clinicians it remains one of the least understood aspects of brain-behaviour relationships encompassing disturbances of cognition, motivation, emotion and action, and is variously an indication of organic brain disease or psychiatric disorder. Apathy can be both sign and symptom and has been proposed as a diagnosis in its own right as well as a secondary feature of other conditions. This review considers previous approaches to apathy in terms of relevant psychological constructs and those neural counterparts most likely to be implicated after TBI. Neurobehavioural disorders of apathy are characterised chiefly by dysfunction of executive control of goal-oriented behaviour or the neural substrates of reward-based and emotional learning. We argue that it is possible to distinguish a primary disorder of apathy as an organic neurobehavioural state from secondary presentations due to an impoverished environment or psychological disturbance which has implications for treatment.
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35
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Wang R, Hösl KM, Ammon F, Markus J, Koehn J, Roy S, Liu M, de Rojas Leal C, Muresanu D, Flanagan SR, Hilz MJ. Eyeball pressure stimulation induces subtle sympathetic activation in patients with a history of moderate or severe traumatic brain injury. Clin Neurophysiol 2018; 129:1161-1169. [PMID: 29635100 DOI: 10.1016/j.clinph.2018.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/23/2018] [Accepted: 03/07/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE After traumatic brain injury (TBI), there may be persistent central-autonomic-network (CAN) dysfunction causing cardiovascular-autonomic dysregulation. Eyeball-pressure-stimulation (EPS) normally induces cardiovagal activation. In patients with a history of moderate or severe TBI (post-moderate-severe-TBI), we determined whether EPS unveils cardiovascular-autonomic dysregulation. METHODS In 51 post-moderate-severe-TBI patients (32.7 ± 10.5 years old, 43.1 ± 33.4 months post-injury), and 30 controls (29.1 ± 9.8 years), we recorded respiration, RR-intervals (RRI), systolic and diastolic blood-pressure (BPsys, BPdia), before and during EPS (120 sec; 30 mmHg), using an ocular-pressure-device (Okulopressor®). We calculated spectral-powers of mainly sympathetic low (LF: 0.04-0.15 Hz) and parasympathetic high (HF: 0.15-0.5 Hz) frequency RRI-fluctuations, sympathetically mediated LF-powers of BPsys, and calculated normalized (nu) LF- and HF-powers of RRI. We compared parameters between groups before and during EPS by repeated-measurement-analysis-of-variance with post-hoc analysis (significance: p < 0.05). RESULTS At rest, sympathetically mediated LF-BPsys-powers were significantly lower in the patients than the controls. During EPS, only controls significantly increased RRIs and parasympathetically mediated HFnu-RRI-powers, but decreased LF-RRI-powers, LFnu-RRI-powers, and LF-BPsys-powers; in contrast, the patients slightly though significantly increased BPsys upon EPS, without changing any other parameter. CONCLUSIONS In post-moderate-severe-TBI patients, autonomic BP-modulation was already compromised at rest. During EPS, our patients failed to activate cardiovagal modulation but slightly increased BPsys, indicating persistent CAN dysregulation. SIGNIFICANCE Our findings unveil persistence of subtle cardiovascular-autonomic dysregulation even years after TBI.
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Affiliation(s)
- Ruihao Wang
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina M Hösl
- Dept. of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Fabian Ammon
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jörg Markus
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Julia Koehn
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sankanika Roy
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mao Liu
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carmen de Rojas Leal
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Dafin Muresanu
- Dept. of Clinical Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Steven R Flanagan
- Dept. of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Max J Hilz
- Dept. of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Dept of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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36
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Yang A, Xiao XH, Liu ZH, Wan ZL, Wang ZY. A Multimodal Magnetic Resonance Imaging Study of Recovery of Consciousness in Severe Traumatic Brain Injury: Preliminary Results. J Neurotrauma 2018; 35:308-313. [PMID: 29141511 DOI: 10.1089/neu.2017.5335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ang Yang
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Xue Hong Xiao
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Zhong Hua Liu
- Department of Neurology and Neurological Rehabilitation, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Zhi Long Wan
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
| | - Ze Yan Wang
- Department of MR, Affiliated Zhongshan City Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhonshan, China
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37
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Scheibel RS. Functional Magnetic Resonance Imaging of Cognitive Control following Traumatic Brain Injury. Front Neurol 2017; 8:352. [PMID: 28824524 PMCID: PMC5543081 DOI: 10.3389/fneur.2017.00352] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/05/2017] [Indexed: 11/13/2022] Open
Abstract
Novel and non-routine tasks often require information processing and behavior to adapt from moment to moment depending on task requirements and current performance. This ability to adapt is an executive function that is referred to as cognitive control. Patients with moderate-to-severe traumatic brain injury (TBI) have been reported to exhibit impairments in cognitive control and functional magnetic resonance imaging (fMRI) has provided evidence for TBI-related alterations in brain activation using various fMRI cognitive control paradigms. There is some support for greater and more extensive cognitive control-related brain activation in patients with moderate-to-severe TBI, relative to comparison subjects without TBI. In addition, some studies have reported a correlation between these activation increases and measures of injury severity. Explanations that have been proposed for increased activation within structures that are thought to be directly involved in cognitive control, as well as the extension of this over-activation into other brain structures, have included compensatory mechanisms, increased demand upon normal processes required to maintain adequate performance, less efficient utilization of neural resources, and greater vulnerability to cognitive fatigue. Recent findings are also consistent with the possibility that activation increases within some structures, such as the posterior cingulate gyrus, may reflect a failure to deactivate components of the default mode network (DMN) and that some cognitive control impairment may result from ineffective coordination between the DMN and components of the salience network. Functional neuroimaging studies examining cognitive control-related activation following mild TBI (mTBI) have yielded more variable results, with reports of increases, decreases, and no significant change. These discrepancies may reflect differences among the various mTBI samples under study, recovery of function in some patients, different task characteristics, and the presence of comorbid conditions such as depression and posttraumatic stress disorder that also alter brain activation. There may be mTBI populations with activation changes that overlap with those found following more severe injuries, including symptomatic mTBI patients and those with acute injuries, but future research to address such dysfunction will require well-defined samples with adequate controls for injury characteristics, comorbid disorders, and severity of post-concussive symptoms.
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Affiliation(s)
- Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
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38
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Hilz MJ, Wang R, Markus J, Ammon F, Hösl KM, Flanagan SR, Winder K, Koehn J. Severity of traumatic brain injury correlates with long-term cardiovascular autonomic dysfunction. J Neurol 2017; 264:1956-1967. [PMID: 28770375 PMCID: PMC5587629 DOI: 10.1007/s00415-017-8581-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/21/2017] [Accepted: 07/25/2017] [Indexed: 01/22/2023]
Abstract
After traumatic brain injury (TBI), central autonomic dysfunction might contribute to long-term increased mortality rates. Central autonomic dysfunction might depend on initial trauma severity. This study was performed to evaluate differences in autonomic modulation at rest and upon standing between patients with a history of mild TBI (post-mild-TBI patients), moderate or severe TBI (post-moderate–severe-TBI patients), and healthy controls. In 20 post-mild-TBI patients (6–78 months after TBI), age-matched 20 post-moderate–severe-TBI patients (6–94 months after TBI) and 20 controls, we monitored respiration, RR intervals (RRI) and systolic blood pressure (BPsys) at supine rest and upon standing. We determined mainly sympathetic low (LF) and parasympathetic high (HF) frequency powers of RRI fluctuations, sympathetically mediated LF-BPsys powers, LF/HF-RRI ratios, normalized (nu) LF-RRI and HF-RRI powers, and compared data between groups, at rest and upon standing (ANOVA with post hoc testing). We correlated autonomic parameters with initial Glasgow Coma Scale (GCS) scores (Spearman test; significance: p < 0.05). Supine BPsys and LFnu-RRI powers were higher while HFnu-RRI powers were lower in post-moderate–severe-TBI patients than post-mild-TBI patients and controls. LFnu-RRI powers were higher and HFnu-RRI powers were lower in post-mild-TBI patients than controls. Upon standing, only post-mild-TBI patients and controls increased LF-BPsys powers and BPsys and decreased HF-RRI powers. GCS scores correlated positively with LFnu-RRI powers, LF/HF-RRI ratios, and inversely with HFnu-RRI powers, at standing position. More than 6 months after TBI, there is autonomic dysfunction at rest and upon standing which is more pronounced after moderate–severe than mild TBI and in part correlates with initial trauma severity.
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Affiliation(s)
- Max J Hilz
- Clinical Department of Autonomic Neurology, University College London, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. .,Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. .,Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA.
| | - Ruihao Wang
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jörg Markus
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Fabian Ammon
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Steven R Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Klemens Winder
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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39
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Drijkoningen D, Chalavi S, Sunaert S, Duysens J, Swinnen SP, Caeyenberghs K. Regional Gray Matter Volume Loss Is Associated with Gait Impairments in Young Brain-Injured Individuals. J Neurotrauma 2017; 34:1022-1034. [DOI: 10.1089/neu.2016.4500] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Drijkoningen
- University Medical Center Utrecht, Utrecht, the Netherlands
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospital, Leuven, Belgium
| | - Jacques Duysens
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
| | - Stephan P. Swinnen
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
- Leuven Research Institute for Neuroscience and Disease, Leuven, Belgium
| | - Karen Caeyenberghs
- Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Leuven, Belgium
- Australian Catholic University, Melbourne, Australia
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Perrine K, Helcer J, Tsiouris AJ, Pisapia DJ, Stieg P. The Current Status of Research on Chronic Traumatic Encephalopathy. World Neurosurg 2017; 102:533-544. [PMID: 28254594 DOI: 10.1016/j.wneu.2017.02.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) evolved from the term dementia pugilistica describing the dementia found in many boxers to its current use in describing the dementia and depression sometimes found in athletes subjected to multiple concussions or subconcussive blows to the head. Concurrently, the neuropathology evolved to specify a unique type of tauopathy found in perivascular spaces at the depth of sulci and other features not typically seen in neurodegenerative tauopathies. Four stages of CTE have been proposed, with 4 corresponding clinical syndromes of traumatic encephalopathy syndrome. However, it remains unclear whether this is a syndrome unique to repetitive head trauma, especially in contact sports, because the epidemiology has been difficult to establish. In particular, research to date has had a denominator problem in not establishing the total number of potential cases at risk for developing CTE. The current review examines the evidence to date for these syndromes and contributing or complicating factors affecting the neuropathology, neuroimaging, and clinical presentations associated with them.
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Affiliation(s)
- Kenneth Perrine
- Department of Neurological Surgery, Weill Cornell Medical College, New York, USA.
| | - Jacqueline Helcer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - David J Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Philip Stieg
- Department of Neurological Surgery, Weill Cornell Medical College, New York, USA
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Churchill N, Hutchison M, Richards D, Leung G, Graham S, Schweizer TA. Brain Structure and Function Associated with a History of Sport Concussion: A Multi-Modal Magnetic Resonance Imaging Study. J Neurotrauma 2017; 34:765-771. [DOI: 10.1089/neu.2016.4531] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Nathan Churchill
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Doug Richards
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - General Leung
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Simon Graham
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Tom A. Schweizer
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterals and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Esopenko C, Levine B. Autobiographical memory and structural brain changes in chronic phase TBI. Cortex 2017; 89:1-10. [PMID: 28189664 DOI: 10.1016/j.cortex.2017.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 11/26/2016] [Accepted: 01/01/2017] [Indexed: 12/27/2022]
Abstract
Traumatic brain injury (TBI) is associated with a range of neuropsychological deficits, including attention, memory, and executive functioning attributable to diffuse axonal injury (DAI) with accompanying focal frontal and temporal damage. Although the memory deficit of TBI has been well characterized with laboratory tests, comparatively little research has examined retrograde autobiographical memory (AM) at the chronic phase of TBI, with no prior studies of unselected patients drawn directly from hospital admissions for trauma. Moreover, little is known about the effects of TBI on canonical episodic and non-episodic (e.g., semantic) AM processes. In the present study, we assessed the effects of chronic-phase TBI on AM in patients with focal and DAI spanning the range of TBI severity. Patients and socioeconomic- and age-matched controls were administered the Autobiographical Interview (AI) (Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002) a widely used method for dissociating episodic and semantic elements of AM, along with tests of neuropsychological and functional outcome. Measures of episodic and non-episodic AM were compared with regional brain volumes derived from high-resolution structural magnetic resonance imaging (MRI). Severe TBI (but not mild or moderate TBI) was associated with reduced recall of episodic autobiographical details and increased recall of non-episodic details relative to healthy comparison participants. There were no significant associations between AM performance and neuropsychological or functional outcome measures. Within the full TBI sample, autobiographical episodic memory was associated with reduced volume distributed across temporal, parietal, and prefrontal regions considered to be part of the brain's AM network. These results suggest that TBI-related distributed volume loss affects episodic autobiographical recollection.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, USA
| | - Brian Levine
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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Yan H, Feng Y, Wang Q. Altered Effective Connectivity of Hippocampus-Dependent Episodic Memory Network in mTBI Survivors. Neural Plast 2016; 2016:6353845. [PMID: 28074162 PMCID: PMC5198188 DOI: 10.1155/2016/6353845] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/14/2016] [Indexed: 11/29/2022] Open
Abstract
Traumatic brain injuries (TBIs) are generally recognized to affect episodic memory. However, less is known regarding how external force altered the way functionally connected brain structures of the episodic memory system interact. To address this issue, we adopted an effective connectivity based analysis, namely, multivariate Granger causality approach, to explore causal interactions within the brain network of interest. Results presented that TBI induced increased bilateral and decreased ipsilateral effective connectivity in the episodic memory network in comparison with that of normal controls. Moreover, the left anterior superior temporal gyrus (aSTG, the concept forming hub), left hippocampus (the personal experience binding hub), and left parahippocampal gyrus (the contextual association hub) were no longer network hubs in TBI survivors, who compensated for hippocampal deficits by relying more on the right hippocampus (underlying perceptual memory) and the right medial frontal gyrus (MeFG) in the anterior prefrontal cortex (PFC). We postulated that the overrecruitment of the right anterior PFC caused dysfunction of the strategic component of episodic memory, which caused deteriorating episodic memory in mTBI survivors. Our findings also suggested that the pattern of brain network changes in TBI survivors presented similar functional consequences to normal aging.
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Affiliation(s)
- Hao Yan
- Neuroimaging Laboratory, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen 518060, China
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
- Departments of Linguistics and Psychology, Xidian University, Xi'an 710071, China
| | - Yanqin Feng
- Departments of Linguistics and Psychology, Xidian University, Xi'an 710071, China
| | - Qian Wang
- School of Foreign Languages, Northwestern Polytechnical University, Xi'an 710029, China
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Wilde EA, Bigler ED, Huff T, Wang H, Black GM, Christensen ZP, Goodrich-Hunsaker N, Petrie JA, Abildskov T, Taylor BA, Stone JR, Tustison NJ, Newsome MR, Levin HS, Chu ZD, York GE, Tate DF. Quantitative structural neuroimaging of mild traumatic brain injury in the Chronic Effects of Neurotrauma Consortium (CENC): Comparison of volumetric data within and across scanners. Brain Inj 2016; 30:1442-1451. [DOI: 10.1080/02699052.2016.1219063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Tate DF, Wade BSC, Velez CS, Drennon AM, Bolzenius J, Gutman BA, Thompson PM, Lewis JD, Wilde EA, Bigler ED, Shenton ME, Ritter JL, York GE. Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury. J Neurol 2016; 263:2065-79. [PMID: 27435967 PMCID: PMC5564450 DOI: 10.1007/s00415-016-8236-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
Mild traumatic brain injury (mTBI) is a significant health concern. The majority who sustain mTBI recover, although ~20 % continue to experience symptoms that can interfere with quality of life. Accordingly, there is a critical need to improve diagnosis, prognostic accuracy, and monitoring (recovery trajectory over time) of mTBI. Volumetric magnetic resonance imaging (MRI) has been successfully utilized to examine TBI. One promising improvement over standard volumetric approaches is to analyze high-dimensional shape characteristics of brain structures. In this study, subcortical shape and volume in 76 Service Members with mTBI was compared to 59 Service Members with orthopedic injury (OI) and 17 with post-traumatic stress disorder (PTSD) only. FreeSurfer was used to quantify structures from T1-weighted 3 T MRI data. Radial distance (RD) and Jacobian determinant (JD) were defined vertex-wise on parametric mesh-representations of subcortical structures. Linear regression was used to model associations between morphometry (volume and shape), TBI status, and time since injury (TSI) correcting for age, sex, intracranial volume, and level of education. Volumetric data was not significantly different between the groups. JD was significantly increased in the accumbens and caudate and significantly reduced in the thalamus of mTBI participants. Additional significant associations were noted between RD of the amygdala and TSI. Positive trend-level associations between TSI and the amygdala and accumbens were observed, while a negative association was observed for third ventricle. Our findings may aid in the initial diagnosis of mTBI, provide biological targets for functional examination, and elucidate regions that may continue remodeling after injury.
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Affiliation(s)
- David F Tate
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA.
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
| | - Benjamin S C Wade
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Carmen S Velez
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA
| | - Ann Marie Drennon
- Defense and Veterans Brain Injury Centers, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA
| | - Boris A Gutman
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Jeffrey D Lewis
- Department of Neurology, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Erin D Bigler
- Departments of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Brockton Division, VA Boston Healthcare System, Brockton, MA, USA
| | - John L Ritter
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Gerald E York
- Alaska Radiology Associates, TBI Imaging and Research, Anchorage, AK, USA
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Sorg SF, Schiehser DM, Bondi MW, Luc N, Clark AL, Jacobson MW, Frank LR, Delano-Wood L. White Matter Microstructural Compromise Is Associated With Cognition But Not Posttraumatic Stress Disorder Symptoms in Military Veterans With Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:297-308. [PMID: 26360008 PMCID: PMC5997182 DOI: 10.1097/htr.0000000000000189] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate white matter microstructure compromise in Veterans with a history of traumatic brain injury (TBI) and its possible contribution to posttraumatic stress disorder (PTSD) symptomatology and neuropsychological functioning via diffusion tensor imaging. PARTICIPANTS AND METHODS Thirty-eight Veterans with mild (n = 33) and moderate (n = 5) TBI and 17 military control participants without TBI completed neuropsychological testing and psychiatric screening and underwent magnetic resonance imaging an average of 4 years following their TBI event(s). Fractional anisotropy (FA) and diffusivity measures were extracted from 9 white matter tracts. RESULTS Compared with military control participants, TBI participants reported higher levels of PTSD symptoms and performed worse on measures of memory and psychomotor-processing speed. Traumatic brain injury was associated with lower FA in the genu of the corpus callosum and left cingulum bundle. Fractional anisotropy negatively correlated with processing speed and/or executive functions in 7 of the 8 tracts. Regional FA did not correlate with memory or PTSD symptom ratings. CONCLUSION Results suggest that current PTSD symptoms are independent of TBI-related white matter alterations, as measured by diffusion tensor imaging. In addition, white matter microstructural compromise may contribute to reduced processing speed in our sample of participants with history of neurotrauma. Findings of the current study add insight into the factors associated with complicated recovery from mild to moderate TBI.
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Affiliation(s)
- Scott F. Sorg
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Dawn M. Schiehser
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Mark W. Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Norman Luc
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Alexandra L. Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego CA, 92120
| | - Mark W. Jacobson
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lawrence R. Frank
- Dept. of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
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47
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Lifshitz J, Rowe RK, Griffiths DR, Evilsizor MN, Thomas TC, Adelson PD, McIntosh TK. Clinical relevance of midline fluid percussion brain injury: Acute deficits, chronic morbidities and the utility of biomarkers. Brain Inj 2016; 30:1293-1301. [PMID: 27712117 DOI: 10.1080/02699052.2016.1193628] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND After 30 years of characterisation and implementation, fluid percussion injury (FPI) is firmly recognised as one of the best-characterised reproducible and clinically relevant models of TBI, encompassing concussion through diffuse axonal injury (DAI). Depending on the specific injury parameters (e.g. injury site, mechanical force), FPI can model diffuse TBI with or without a focal component and may be designated as mild-to-severe according to the chosen mechanical forces and resulting acute neurological responses. Among FPI models, midline FPI may best represent clinical diffuse TBI, because of the acute behavioural deficits, the transition to late-onset behavioural morbidities and the absence of gross histopathology. REVIEW The goal here was to review acute and chronic physiological and behavioural deficits and morbidities associated with diffuse TBI induced by midline FPI. In the absence of neurodegenerative sequelae associated with focal injury, there is a need for biomarkers in the diagnostic, prognostic, predictive and therapeutic approaches to evaluate outcomes from TBI. CONCLUSIONS The current literature suggests that midline FPI offers a clinically-relevant, validated model of diffuse TBI to investigators wishing to evaluate novel therapeutic strategies in the treatment of TBI and the utility of biomarkers in the delivery of healthcare to patients with brain injury.
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Affiliation(s)
- Jonathan Lifshitz
- a Translational Neurotrauma Research Program , BARROW Neurological Institute at Phoenix Children's Hospital , Phoenix , AZ , USA.,b Department of Child Health , University of Arizona, College of Medicine - Phoenix , Phoenix , AZ , USA.,c Phoenix VA Healthcare System , Phoenix , AZ , USA.,d Neuroscience Graduate Program , Arizona State University , Tempe , AZ , USA
| | - Rachel K Rowe
- a Translational Neurotrauma Research Program , BARROW Neurological Institute at Phoenix Children's Hospital , Phoenix , AZ , USA.,b Department of Child Health , University of Arizona, College of Medicine - Phoenix , Phoenix , AZ , USA.,c Phoenix VA Healthcare System , Phoenix , AZ , USA
| | - Daniel R Griffiths
- a Translational Neurotrauma Research Program , BARROW Neurological Institute at Phoenix Children's Hospital , Phoenix , AZ , USA.,b Department of Child Health , University of Arizona, College of Medicine - Phoenix , Phoenix , AZ , USA
| | - Megan N Evilsizor
- a Translational Neurotrauma Research Program , BARROW Neurological Institute at Phoenix Children's Hospital , Phoenix , AZ , USA.,b Department of Child Health , University of Arizona, College of Medicine - Phoenix , Phoenix , AZ , USA
| | - Theresa C Thomas
- a Translational Neurotrauma Research Program , BARROW Neurological Institute at Phoenix Children's Hospital , Phoenix , AZ , USA.,b Department of Child Health , University of Arizona, College of Medicine - Phoenix , Phoenix , AZ , USA.,c Phoenix VA Healthcare System , Phoenix , AZ , USA.,d Neuroscience Graduate Program , Arizona State University , Tempe , AZ , USA
| | - P David Adelson
- a Translational Neurotrauma Research Program , BARROW Neurological Institute at Phoenix Children's Hospital , Phoenix , AZ , USA.,b Department of Child Health , University of Arizona, College of Medicine - Phoenix , Phoenix , AZ , USA.,d Neuroscience Graduate Program , Arizona State University , Tempe , AZ , USA
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48
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Brain Magnetic Resonance Imaging for Traumatic Brain Injury: Why, When, and How? Top Magn Reson Imaging 2016; 24:225-39. [PMID: 26502305 DOI: 10.1097/rmr.0000000000000061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Conventional magnetic resonance imaging (MRI) and angiography (MRA) provide invaluable information in the evaluation of patients with all stages and grades of traumatic brain injury (TBI). The information obtained with MRI provides a more complete assessment of the patient's brain injury and possible long-term sequelae.
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Lopez KC, Leary JB, Pham DL, Chou YY, Dsurney J, Chan L. Brain Volume, Connectivity, and Neuropsychological Performance in Mild Traumatic Brain Injury: The Impact of Post-Traumatic Stress Disorder Symptoms. J Neurotrauma 2016; 34:16-22. [PMID: 26942337 DOI: 10.1089/neu.2015.4323] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is commonly associated with mild traumatic brain injury (mTBI). To better understand their relationship, we examined neuroanatomical structures and neuropsychological performance in a sample of individuals with mTBI, with and without PTSD symptoms. Thirty-nine subjects with mTBI were dichotomized into those with (n = 12) and without (n = 27) significant PTSD symptoms based on scores on the PTSD Checklist. Using a region-of-interest approach, fronto-temporal volumes, fiber bundles obtained by diffusion tensor imaging, and neuropsychological scores were compared between the two groups. After controlling for total intracranial volume and age, subjects with mTBI and PTSD symptoms exhibited volumetric differences in the entorhinal cortex, an area associated with memory networks, relative to mTBI-only patients (F = 4.28; p = 0.046). Additionally, subjects with PTSD symptoms showed reduced white matter integrity in the right cingulum bundle (axial diffusivity, F = 6.04; p = 0.020). Accompanying these structural alterations, mTBI and PTSD subjects also showed impaired performance in encoding (F = 5.98; p = 0.019) and retrieval (F = 7.32; p = 0.010) phases of list learning and in tests of processing speed (Wechsler Adult Intelligence Scale Processing Speed Index, F = 12.23; p = 0.001; Trail Making Test A, F = 5.56; p = 0.024). Increased volume and white matter disruptions in these areas, commonly associated with memory functions, may be related to functional disturbances during cognitively demanding tasks. Differences in brain volume and white matter integrity between mTBI subjects and those with mTBI and co-morbid PTSD symptoms point to neuroanatomical differences that may underlie poorer recovery of mTBI subjects who experience PTSD symptoms. These findings support theoretical models of PTSD and its relationship to learning deficits.
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Affiliation(s)
- Katherine C Lopez
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - Jacob B Leary
- 2 Rehabilitation Medicine Department, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Dzung L Pham
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - Yi-Yu Chou
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - John Dsurney
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - Leighton Chan
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland.,2 Rehabilitation Medicine Department, Clinical Center, National Institutes of Health , Bethesda, Maryland
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50
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Hilz MJ, Liu M, Koehn J, Wang R, Ammon F, Flanagan SR, Hösl KM. Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury. BMC Neurol 2016; 16:61. [PMID: 27146718 PMCID: PMC4857428 DOI: 10.1186/s12883-016-0584-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 04/29/2016] [Indexed: 02/04/2023] Open
Abstract
Background Patients with a history of mild TBI (post-mTBI-patients) have an unexplained increase in long-term mortality which might be related to central autonomic dysregulation (CAD). We investigated whether standardized baroreflex-loading, induced by a Valsalva maneuver (VM), unveils CAD in otherwise healthy post-mTBI-patients. Methods In 29 healthy persons (31.3 ± 12.2 years; 9 women) and 25 post-mTBI-patients (35.0 ± 13.2 years, 7 women, 4–98 months post-injury), we monitored respiration (RESP), RR-intervals (RRI) and systolic blood pressure (BP) at rest and during three VMs. At rest, we calculated parameters of total autonomic modulation [RRI-coefficient-of-variation (CV), RRI-standard-deviation (RRI-SD), RRI-total-powers], of sympathetic [RRI-low-frequency-powers (LF), BP-LF-powers] and parasympathetic modulation [square-root-of-mean-squared-differences-of-successive-RRIs (RMSSD), RRI-high-frequency-powers (HF)], the index of sympatho-vagal balance (RRI LF/HF-ratios), and baroreflex sensitivity (BRS). We calculated Valsalva-ratios (VR) and times from lowest to highest RRIs after strain (VR-time) as indices of parasympathetic activation, intervals from highest systolic BP-values after strain-release to the time when systolic BP had fallen by 90 % of the differences between peak-phase-IV-BP and baseline-BP (90 %-BP-normalization-times), and velocities of BP-normalization (90 %-BP-normalization-velocities) as indices of sympathetic withdrawal. We compared patient- and control-parameters before and during VM (Mann-Whitney-U-tests or t-tests; significance: P < 0.05). Results At rest, RRI-CVs, RRI-SDs, RRI-total-powers, RRI-LF-powers, BP-LF-powers, RRI-RMSSDs, RRI-HF-powers, and BRS were lower in patients than controls. During VMs, 90 %-BP-normalization-times were longer, and 90 %-BP-normalization-velocities were lower in patients than controls (P < 0.05). Conclusions Reduced autonomic modulation at rest and delayed BP-decrease after VM-induced baroreflex-loading indicate subtle CAD with altered baroreflex adjustment to challenge. More severe autonomic challenge might trigger more prominent cardiovascular dysregulation and thus contribute to increased mortality risk in post-mTBI-patients.
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Affiliation(s)
- Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany.
| | - Mao Liu
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Fabian Ammon
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Steven R Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Prof.-Ernst-Nathan-Strasse 1, 90419, Nuremberg, Germany
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