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Kagialis A, Simos N, Manolitsi K, Vakis A, Simos P, Papadaki E. Functional connectivity-hemodynamic (un)coupling changes in chronic mild brain injury are associated with mental health and neurocognitive indices: a resting state fMRI study. Neuroradiology 2024; 66:985-998. [PMID: 38605104 PMCID: PMC11133187 DOI: 10.1007/s00234-024-03352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To examine hemodynamic and functional connectivity alterations and their association with neurocognitive and mental health indices in patients with chronic mild traumatic brain injury (mTBI). METHODS Resting-state functional MRI (rs-fMRI) and neuropsychological assessment of 37 patients with chronic mTBI were performed. Intrinsic connectivity contrast (ICC) and time-shift analysis (TSA) of the rs-fMRI data allowed the assessment of regional hemodynamic and functional connectivity disturbances and their coupling (or uncoupling). Thirty-nine healthy age- and gender-matched participants were also examined. RESULTS Patients with chronic mTBI displayed hypoconnectivity in bilateral hippocampi and parahippocampal gyri and increased connectivity in parietal areas (right angular gyrus and left superior parietal lobule (SPL)). Slower perfusion (hemodynamic lag) in the left anterior hippocampus was associated with higher self-reported symptoms of depression (r = - 0.53, p = .0006) and anxiety (r = - 0.484, p = .002), while faster perfusion (hemodynamic lead) in the left SPL was associated with lower semantic fluency (r = - 0.474, p = .002). Finally, functional coupling (high connectivity and hemodynamic lead) in the right anterior cingulate cortex (ACC)) was associated with lower performance on attention and visuomotor coordination (r = - 0.50, p = .001), while dysfunctional coupling (low connectivity and hemodynamic lag) in the left ventral posterior cingulate cortex (PCC) and right SPL was associated with lower scores on immediate passage memory (r = - 0.52, p = .001; r = - 0.53, p = .0006, respectively). Uncoupling in the right extrastriate visual cortex and posterior middle temporal gyrus was negatively associated with cognitive flexibility (r = - 0.50, p = .001). CONCLUSION Hemodynamic and functional connectivity differences, indicating neurovascular (un)coupling, may be linked to mental health and neurocognitive indices in patients with chronic mTBI.
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Affiliation(s)
- Antonios Kagialis
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece
| | - Nicholas Simos
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Katina Manolitsi
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Antonios Vakis
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Efrosini Papadaki
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece.
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece.
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Sachdeva T, Ganpule SG. Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge. Neurotrauma Rep 2024; 5:243-253. [PMID: 38515548 PMCID: PMC10956535 DOI: 10.1089/neur.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Blast-induced neurotrauma (BINT) is an important injury paradigm of neurotrauma research. This short communication summarizes the current knowledge of BINT. We divide the BINT research into several broad categories-blast wave generation in laboratory, biomechanics, pathology, behavioral outcomes, repetitive blast in animal models, and clinical and neuroimaging investigations in humans. Publications from 2000 to 2023 in each subdomain were considered. The analysis of the literature has brought out salient aspects. Primary blast waves can be simulated reasonably in a laboratory using carefully designed shock tubes. Various biomechanics-based theories of BINT have been proposed; each of these theories may contribute to BINT by generating a unique biomechanical signature. The injury thresholds for BINT are in the nascent stages. Thresholds for rodents are reasonably established, but such thresholds (guided by primary blast data) are unavailable in humans. Single blast exposure animal studies suggest dose-dependent neuronal pathologies predominantly initiated by blood-brain barrier permeability and oxidative stress. The pathologies were typically reversible, with dose-dependent recovery times. Behavioral changes in animals include anxiety, auditory and recognition memory deficits, and fear conditioning. The repetitive blast exposure manifests similar pathologies in animals, however, at lower blast overpressures. White matter irregularities and cortical volume and thickness alterations have been observed in neuroimaging investigations of military personnel exposed to blast. Behavioral changes in human cohorts include sleep disorders, poor motor skills, cognitive dysfunction, depression, and anxiety. Overall, this article provides a concise synopsis of current understanding, consensus, controversies, and potential future directions.
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Affiliation(s)
- Tarun Sachdeva
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Shailesh G. Ganpule
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
- Department of Design, Indian Institute of Technology Roorkee, Roorkee, India
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Tang S, Xu S, Wilder D, Medina AE, Li X, Fiskum GM, Jiang L, Kakulavarapu VR, Long JB, Gullapalli RP, Sajja VS. Longitudinal Biochemical and Behavioral Alterations in a Gyrencephalic Model of Blast-Related Mild Traumatic Brain Injury. Neurotrauma Rep 2024; 5:254-266. [PMID: 38515547 PMCID: PMC10956534 DOI: 10.1089/neur.2024.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Blast-related traumatic brain injury (bTBI) is a major cause of neurological disorders in the U.S. military that can adversely impact some civilian populations as well and can lead to lifelong deficits and diminished quality of life. Among these types of injuries, the long-term sequelae are poorly understood because of variability in intensity and number of the blast exposure, as well as the range of subsequent symptoms that can overlap with those resulting from other traumatic events (e.g., post-traumatic stress disorder). Despite the valuable insights that rodent models have provided, there is a growing interest in using injury models using species with neuroanatomical features that more closely resemble the human brain. With this purpose, we established a gyrencephalic model of blast injury in ferrets, which underwent blast exposure applying conditions that closely mimic those associated with primary blast injuries to warfighters. In this study, we evaluated brain biochemical, microstructural, and behavioral profiles after blast exposure using in vivo longitudinal magnetic resonance imaging, histology, and behavioral assessments. In ferrets subjected to blast, the following alterations were found: 1) heightened impulsivity in decision making associated with pre-frontal cortex/amygdalar axis dysfunction; 2) transiently increased glutamate levels that are consistent with earlier findings during subacute stages post-TBI and may be involved in concomitant behavioral deficits; 3) abnormally high brain N-acetylaspartate levels that potentially reveal disrupted lipid synthesis and/or energy metabolism; and 4) dysfunction of pre-frontal cortex/auditory cortex signaling cascades that may reflect similar perturbations underlying secondary psychiatric disorders observed in warfighters after blast exposure.
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Affiliation(s)
- Shiyu Tang
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Su Xu
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Donna Wilder
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Alexandre E. Medina
- Department of Pediatrics, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xin Li
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gary M. Fiskum
- Department of Anesthesiology, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Shock, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Li Jiang
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Venkata R. Kakulavarapu
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Joseph B. Long
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Rao P. Gullapalli
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Kryza-Lacombe M, Santiago R, Hwang A, Raptentsetsang S, Maruyama BA, Chen J, Cassar M, Abrams G, Novakovic-Agopian T, Mukherjee P. Resting-State Connectivity Changes After Goal-Oriented Attentional Self-Regulation Training in Veterans With Mild Traumatic Brain Injury: Preliminary Findings from a Randomized Controlled Trial. Neurotrauma Rep 2023; 4:420-432. [PMID: 37405257 PMCID: PMC10316036 DOI: 10.1089/neur.2022.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Mild traumatic brain injury (mTBI) can have lasting consequences on cognitive functioning and well-being. Goal-Oriented Attentional Self-Regulation (GOALS) training has been shown to improve attention and executive functioning, as well as emotional functioning, in veterans with chronic TBI. An ongoing clinical trial (NCT02920788) is further evaluating GOALS training, including underlying neural mechanisms of change. The present study aimed to examine training-induced neuroplasticity by resting-state functional connectivity (rsFC) changes in GOALS versus active control. Veterans with a history of mTBI ≥6 months post-injury (N = 33) were randomly assigned to GOALS (n = 19) or an intensity-matched active control group (Brain Health Education [BHE] training; n = 14). GOALS consists of attention regulation and problem solving applied to individually defined, relevant goals through a combination of group, individual, and home practice sessions. Participants underwent multi-band resting-state functional magnetic resonance imaging at baseline and post-intervention. Exploratory 2 × 2 mixed analyses of variance identified pre-to-post changes in seed-based connectivity for GOALS versus BHE in five significant clusters. GOALS versus BHE demonstrated a significant increase in right lateral pre-frontal cortex connectivity with the right frontal pole and right middle temporal gyrus, as well as increased posterior cingulate connectivity with the pre-central gyrus. Rostral pre-frontal cortex connectivity with the right precuneus and the right frontal pole decreased in GOALS versus BHE. These GOALS-related changes in rsFC point to potential neural mechanisms underlying the intervention. This training-induced neuroplasticity may play a role in improved cognitive and emotional functioning post-GOALS.
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Affiliation(s)
- Maria Kryza-Lacombe
- Mental Illness Research Education and Clinical Centers, Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Rachel Santiago
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
| | - Anna Hwang
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Sky Raptentsetsang
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Brian A. Maruyama
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
| | - Jerry Chen
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
| | | | - Gary Abrams
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Tatjana Novakovic-Agopian
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Pratik Mukherjee
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
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Terpsma R, Carlsen RW, Szalkowski R, Malave S, Fawzi AL, Franck C, Hovey C. Head Impact Modeling to Support a Rotational Combat Helmet Drop Test. Mil Med 2023; 188:e745-e752. [PMID: 34508268 DOI: 10.1093/milmed/usab374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/23/2021] [Accepted: 08/30/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The Advanced Combat Helmet (ACH) military specification (mil-spec) provides blunt impact acceleration criteria that must be met before use by the U.S. warfighter. The specification, which requires a helmeted magnesium Department of Transportation (DOT) headform to be dropped onto a steel hemispherical target, results in a translational headform impact response. Relative to translations, rotations of the head generate higher brain tissue strains. Excessive strain has been implicated as a mechanical stimulus leading to traumatic brain injury (TBI). We hypothesized that the linear constrained drop test method of the ACH specification underreports the potential for TBI. MATERIALS AND METHODS To establish a baseline of translational acceleration time histories, we conducted linear constrained drop tests based on the ACH specification and then performed simulations of the same to verify agreement between experiment and simulation. We then produced a high-fidelity human head digital twin and verified that biological tissue responses matched experimental results. Next, we altered the ACH experimental configuration to use a helmeted Hybrid III headform, a freefall cradle, and an inclined anvil target. This new, modified configuration allowed both a translational and a rotational headform response. We applied this experimental rotation response to the skull of our human digital twin and compared brain deformation relative to the translational baseline. RESULTS The modified configuration produced brain strains that were 4.3 times the brain strains from the linear constrained configuration. CONCLUSIONS We provide a scientific basis to motivate revision of the ACH mil-spec to include a rotational component, which would enhance the test's relevance to TBI arising from severe head impacts.
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Affiliation(s)
- Ryan Terpsma
- Terminal Ballistics Technology Department 5421, Sandia National Laboratories, Albuquerque, NM 87185, USA
| | - Rika Wright Carlsen
- Department of Engineering, Robert Morris University, Moon Township, PA 15108, USA
| | | | | | - Alice Lux Fawzi
- School of Engineering, Brown University, Providence, RI 02912, USA
| | - Christian Franck
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Chad Hovey
- Terminal Ballistics Technology Department 5421, Sandia National Laboratories, Albuquerque, NM 87185, USA
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Vedaei F, Mashhadi N, Zabrecky G, Monti D, Navarreto E, Hriso C, Wintering N, Newberg AB, Mohamed FB. Identification of chronic mild traumatic brain injury using resting state functional MRI and machine learning techniques. Front Neurosci 2023; 16:1099560. [PMID: 36699521 PMCID: PMC9869678 DOI: 10.3389/fnins.2022.1099560] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a major public health concern that can result in a broad spectrum of short-term and long-term symptoms. Recently, machine learning (ML) algorithms have been used in neuroscience research for diagnostics and prognostic assessment of brain disorders. The present study aimed to develop an automatic classifier to distinguish patients suffering from chronic mTBI from healthy controls (HCs) utilizing multilevel metrics of resting-state functional magnetic resonance imaging (rs-fMRI). Sixty mTBI patients and forty HCs were enrolled and allocated to training and testing datasets with a ratio of 80:20. Several rs-fMRI metrics including fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), degree centrality (DC), voxel-mirrored homotopic connectivity (VMHC), functional connectivity strength (FCS), and seed-based FC were generated from two main analytical categories: local measures and network measures. Statistical two-sample t-test was employed comparing between mTBI and HCs groups. Then, for each rs-fMRI metric the features were selected extracting the mean values from the clusters showing significant differences. Finally, the support vector machine (SVM) models based on separate and multilevel metrics were built and the performance of the classifiers were assessed using five-fold cross-validation and via the area under the receiver operating characteristic curve (AUC). Feature importance was estimated using Shapley additive explanation (SHAP) values. Among local measures, the range of AUC was 86.67-100% and the optimal SVM model was obtained based on combined multilevel rs-fMRI metrics and DC as a separate model with AUC of 100%. Among network measures, the range of AUC was 80.42-93.33% and the optimal SVM model was obtained based on the combined multilevel seed-based FC metrics. The SHAP analysis revealed the DC value in the left postcentral and seed-based FC value between the motor ventral network and right superior temporal as the most important local and network features with the greatest contribution to the classification models. Our findings demonstrated that different rs-fMRI metrics can provide complementary information for classifying patients suffering from chronic mTBI. Moreover, we showed that ML approach is a promising tool for detecting patients with mTBI and might serve as potential imaging biomarker to identify patients at individual level. Clinical trial registration [clinicaltrials.gov], identifier [NCT03241732].
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Affiliation(s)
- Faezeh Vedaei
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Najmeh Mashhadi
- Department of Computer Science and Engineering, University of California Santa Cruz, Santa Cruz, CA, United States
| | - George Zabrecky
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniel Monti
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Emily Navarreto
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chloe Hriso
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy Wintering
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Andrew B. Newberg
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B. Mohamed
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
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Cramer SW, Haley SP, Popa LS, Carter RE, Scott E, Flaherty EB, Dominguez J, Aronson JD, Sabal L, Surinach D, Chen CC, Kodandaramaiah SB, Ebner TJ. Wide-field calcium imaging reveals widespread changes in cortical functional connectivity following mild traumatic brain injury in the mouse. Neurobiol Dis 2023; 176:105943. [PMID: 36476979 PMCID: PMC9972226 DOI: 10.1016/j.nbd.2022.105943] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
>2.5 million individuals in the United States suffer mild traumatic brain injuries (mTBI) annually. Mild TBI is characterized by a brief period of altered consciousness, without objective findings of anatomic injury on clinical imaging or physical deficit on examination. Nevertheless, a subset of mTBI patients experience persistent subjective symptoms and repeated mTBI can lead to quantifiable neurological deficits, suggesting that each mTBI alters neurophysiology in a deleterious manner not detected using current clinical methods. To better understand these effects, we performed mesoscopic Ca2+ imaging in mice to evaluate how mTBI alters patterns of neuronal interactions across the dorsal cerebral cortex. Spatial Independent Component Analysis (sICA) and Localized semi-Nonnegative Matrix Factorization (LocaNMF) were used to quantify changes in cerebral functional connectivity (FC). Repetitive, mild, controlled cortical impacts induce temporary neuroinflammatory responses, characterized by increased density of microglia exhibiting de-ramified morphology. These temporary neuro-inflammatory changes were not associated with compromised cognitive performance in the Barnes maze or motor function as assessed by rotarod. However, long-term alterations in functional connectivity (FC) were observed. Widespread, bilateral changes in FC occurred immediately following impact and persisted for up to 7 weeks, the duration of the experiment. Network alterations include decreases in global efficiency, clustering coefficient, and nodal strength, thereby disrupting functional interactions and information flow throughout the dorsal cerebral cortex. A subnetwork analysis shows the largest disruptions in FC were concentrated near the impact site. Therefore, mTBI induces a transient neuroinflammation, without alterations in cognitive or motor behavior, and a reorganized cortical network evidenced by the widespread, chronic alterations in cortical FC.
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Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Samuel P Haley
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Laurentiu S Popa
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Russell E Carter
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Earl Scott
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Evelyn B Flaherty
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Judith Dominguez
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Justin D Aronson
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Luke Sabal
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Daniel Surinach
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Timothy J Ebner
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
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Klimova A, Breukelaar IA, Bryant RA, Korgaonkar MS. A comparison of the functional connectome in mild traumatic brain injury and post-traumatic stress disorder. Hum Brain Mapp 2022; 44:813-824. [PMID: 36206284 PMCID: PMC9842915 DOI: 10.1002/hbm.26101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) often co-occur in the context of threat to one's life. These conditions also have an overlapping symptomatology and include symptoms of anxiety, poor concentration and memory problems. A major challenge has been articulating the underlying neurobiology of these overlapping conditions. The primary aim of this study was to compare intrinsic functional connectivity between mTBI (without PTSD) and PTSD (without mTBI). The study included functional MRI data from 176 participants: 42 participants with mTBI, 67 with PTSD and a comparison group of 66 age and sex-matched healthy controls. We used network-based statistical analyses for connectome-wide comparisons of intrinsic functional connectivity between mTBI relative to PTSD and controls. Our results showed no connectivity differences between mTBI and PTSD groups. However, we did find that mTBI had significantly reduced connectivity relative to healthy controls within an extensive network of regions including default mode, executive control, visual and auditory networks. The mTBI group also displayed hyperconnectivity between dorsal and ventral attention networks and perceptual regions. The PTSD group also demonstrated abnormal connectivity within these networks relative to controls. Connectivity alterations were not associated with severity of PTSD or post-concussive symptoms in either clinical group. Taken together, the similar profiles of intrinsic connectivity alterations in these two conditions provide neural evidence that can explain, in part, the overlapping symptomatology between mTBI and PTSD.
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Affiliation(s)
- Aleksandra Klimova
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia
| | - Isabella A. Breukelaar
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia,School of PsychologyUniversity of New South WalesSydneyAustralia
| | - Richard A. Bryant
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia,School of PsychologyUniversity of New South WalesSydneyAustralia
| | - Mayuresh S. Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical ResearchThe University of SydneyWestmeadAustralia,Department of Psychiatry, Faculty of Medicine and HealthUniversity of SydneyWestmeadAustralia
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Comparing resting-state connectivity of working memory networks in U.S. Service members with mild traumatic brain injury and posttraumatic stress disorder. Brain Res 2022; 1796:148099. [PMID: 36162495 DOI: 10.1016/j.brainres.2022.148099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022]
Abstract
Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are prevalent among military populations, and both have been associated with working memory (WM) impairments. Previous resting-state functional connectivity (rsFC) research conducted separately in PTSD and mTBI populations suggests that there may be similar and distinct abnormalities in WM-related networks. However, no studies have compared rsFC of WM brain regions in participants with mTBI versus PTSD. We used resting-state fMRI to investigate rsFC of WM networks in U.S. Service Members (n = 127; ages 18-59) with mTBI only (n = 46), PTSD only (n = 24), and an orthopedically injured (OI) control group (n = 57). We conducted voxelwise rsFC analyses with WM brain regions to test for differences in WM network connectivity in mTBI versus PTSD. Results revealed reduced rsFC between ventrolateral prefrontal cortex (vlPFC), lateral premotor cortex, and dorsolateral prefrontal cortex (dlPFC) WM regions and brain regions in the dorsal attention and somatomotor networks in both mTBI and PTSD groups versus controls. When compared to those with mTBI, individuals with PTSD had lower rsFC between both the lateral premotor WM seed region and middle occipital gyrus as well as between the dlPFC WM seed region and paracentral lobule. Interestingly, only vlPFC connectivity was significantly associated with WM performance across the samples. In conclusion, we found primarily overlapping patterns of reduced rsFC in WM brain regions in both mTBI and PTSD groups. Our finding of decreased vlPFC connectivity associated with WM is consistent with previous clinical and neuroimaging studies. Overall, these results provide support for shared neural substrates of WM in individuals with either mTBI or PTSD.
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10
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Amgalan A, Maher AS, Imms P, Ha MY, Fanelle TA, Irimia A. Functional Connectome Dynamics After Mild Traumatic Brain Injury According to Age and Sex. Front Aging Neurosci 2022; 14:852990. [PMID: 35663576 PMCID: PMC9158471 DOI: 10.3389/fnagi.2022.852990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Neural and cognitive deficits after mild traumatic brain injury (mTBI) are paralleled by changes in resting state functional correlation (FC) networks that mirror post-traumatic pathophysiology effects on functional outcomes. Using functional magnetic resonance images acquired both acutely and chronically after injury (∼1 week and ∼6 months post-injury, respectively), we map post-traumatic FC changes across 136 participants aged 19-79 (52 females), both within and between the brain's seven canonical FC networks: default mode, dorsal attention, frontoparietal, limbic, somatomotor, ventral attention, and visual. Significant sex-dependent FC changes are identified between (A) visual and limbic, and between (B) default mode and somatomotor networks. These changes are significantly associated with specific functional recovery patterns across all cognitive domains (p < 0.05, corrected). Changes in FC between default mode, somatomotor, and ventral attention networks, on the one hand, and both temporal and occipital regions, on the other hand, differ significantly by age group (p < 0.05, corrected), and are paralleled by significant sex differences in cognitive recovery independently of age at injury (p < 0.05, corrected). Whereas females' networks typically feature both significant (p < 0.036, corrected) and insignificant FC changes, males more often exhibit significant FC decreases between networks (e.g., between dorsal attention and limbic, visual and limbic, default-mode and somatomotor networks, p < 0.0001, corrected), all such changes being accompanied by significantly weaker recovery of cognitive function in males, particularly older ones (p < 0.05, corrected). No significant FC changes were found across 35 healthy controls aged 66-92 (20 females). Thus, male sex and older age at injury are risk factors for significant FC alterations whose patterns underlie post-traumatic cognitive deficits. This is the first study to map, systematically, how mTBI impacts FC between major human functional networks.
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Affiliation(s)
- Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Alexander S. Maher
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Michelle Y. Ha
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Timothy A. Fanelle
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
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11
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Colamaria A, Blagia M, Carbone F, Fochi NP. Blast-related traumatic brain injury: Report of a severe case and review of the literature. Surg Neurol Int 2022; 13:151. [PMID: 35509563 PMCID: PMC9062926 DOI: 10.25259/sni_1134_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Traumatic brain injury (TBI) is a well-known brain dysfunction commonly encountered in activities such as military combat or collision sports. The etiopathology can vary depending on the context and bomb explosions are becoming increasingly common in war zones, urban terrorist attacks, and civilian criminal feuds. Blast-related TBI may cause the full severity range of neurotrauma, from a mild concussion to severe, penetrating injury. Recent classifications of the pathophysiological mechanisms comprise five factors that reflect the gravity of the experienced trauma and suggest to the clinician different pathways of injury and consequent pathology caused by the explosion. Case Description: In the present report, the authors describe a case of 26 years old presenting with blast-related severe TBI caused by the detonation of an explosive in an amusement arcade. Surgical decompression to control intracranial pressure and systemic antibiotic treatment to manage and prevent wound infections were the main options available in a civilian hospital. Conclusion: While numerous studies examined the burden of blast-related brain injuries on service members, few papers have tackled this problem in a civilian setting, where hospitals are not sufficiently equipped, and physicians lack the necessary training. The present case demonstrates the urgent need for evidence-based diagnostic and therapeutic protocols in civilian hospitals that would improve the outcome of such patients.
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Affiliation(s)
| | - Maria Blagia
- Department of Neurosurgery, Giovanni XXIII Hospital, Bari,
| | - Francesco Carbone
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
| | - Nicola Pio Fochi
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
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12
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Zhang D, Zhu P, Yin B, Zhao P, Wang S, Ye L, Bai L, Yan Z, Bai G. Frontal White Matter Hyperintensities Effect on Default Mode Network Connectivity in Acute Mild Traumatic Brain Injury. Front Aging Neurosci 2022; 13:793491. [PMID: 35250532 PMCID: PMC8890121 DOI: 10.3389/fnagi.2021.793491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
The functional connectivity of the brain depends not only on the structural integrity of the cortex but also on the white matter pathways between cortical areas. White matter hyperintensities (WMH), caused by chronic hypoperfusion in the white matter, play a role in the outcome of traumatic brain injury (TBI) and other neurodegenerative disorders. Herein, we investigate how the location and volume of WMH affect the default-mode network (DMN) connectivity in acute mild TBI (mTBI) patients. Forty-six patients with acute mTBI and 46 matched healthy controls were enrolled in the study. All participants underwent T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging (MRI), resting-state functional MRI (fMRI),and neuropsychological assessments. The volume and location of WMH were recorded. The relationships between the WMH volume and clinical assessments were evaluated using Spearman’s correlation. Patients with higher frontal lobe WMH volume had more severe post-concussion symptoms and poorer information processing speed. Moreover, these patients had significantly lower functional connectivity in the right middle temporal gyrus, left middle frontal gyrus, right superior frontal gyrus, and left anterior cingulate cortex, compared with patients with low frontal lobe WMH volume. Compared to the controls, the patients with high frontal WMH volume exhibited significantly lower functional connectivity in the right inferior temporal gyrus, left anterior cingulate cortex, and right superior frontal gyrus. These findings suggest that frontal lobe WMH volume may modulate the functional connectivity within the DMN. Therefore, the WMH volume in specific regions of the brain, particularly the frontal and parietal lobes, may accelerate the process of aging and cognitive impairment may be a useful biomarker for the diagnosis and prognosis of acute mTBI.
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Affiliation(s)
- Danbin Zhang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pingyi Zhu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pinghui Zhao
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Limei Ye
- Department of Radiology, Jinhua Municipal Central Hospital and Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Zhihan Yan,
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Basic Science and Translational Research of Radiation Oncology, Wenzhou, China
- Guanghui Bai,
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Fan L, Xu H, Su J, Qin J, Gao K, Ou M, Peng S, Shen H, Li N. Discriminating mild traumatic brain injury using sparse dictionary learning of functional network dynamics. Brain Behav 2021; 11:e2414. [PMID: 34775693 PMCID: PMC8671791 DOI: 10.1002/brb3.2414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 09/23/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is usually caused by a bump, blow, or jolt to the head or penetrating head injury, and carries the risk of inducing cognitive disorders. However, identifying the biomarkers for the diagnosis of mTBI is challenging as evident abnormalities in brain anatomy are rarely found in patients with mTBI. In this study, we tested whether the alteration of functional network dynamics could be used as potential biomarkers to better diagnose mTBI. We propose a sparse dictionary learning framework to delineate spontaneous fluctuation of functional connectivity into the subject-specific time-varying evolution of a set of overlapping group-level sparse connectivity components (SCCs) based on the resting-state functional magnetic resonance imaging (fMRI) data from 31 mTBI patients in the early acute phase (<3 days postinjury) and 31 healthy controls (HCs). The identified SCCs were consistently distributed in the cohort of subjects without significant inter-group differences in connectivity patterns. Nevertheless, subject-specific temporal expression of these SCCs could be used to discriminate patients with mTBI from HCs with a classification accuracy of 74.2% (specificity 64.5% and sensitivity 83.9%) using leave-one-out cross-validation. Taken together, our findings indicate neuroimaging biomarkers for mTBI individual diagnosis based on the temporal expression of SCCs underlying time-resolved functional connectivity.
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Affiliation(s)
- Liangwei Fan
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China
| | - Huaze Xu
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China
| | - Jianpo Su
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China
| | - Jian Qin
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China
| | - Kai Gao
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China
| | - Min Ou
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China
| | - Song Peng
- Radiology Department, Xiangya 3rd Hospital, Central South University, Changsha, China
| | - Hui Shen
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China
| | - Na Li
- Radiology Department, Xiangya 3rd Hospital, Central South University, Changsha, China
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14
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Machine Learning Classification of Mild Traumatic Brain Injury Using Whole-Brain Functional Activity: A Radiomics Analysis. DISEASE MARKERS 2021; 2021:3015238. [PMID: 34840627 PMCID: PMC8616658 DOI: 10.1155/2021/3015238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022]
Abstract
Objectives To investigate the classification performance of support vector machine in mild traumatic brain injury (mTBI) from normal controls. Methods Twenty-four mTBI patients (15 males and 9 females; mean age, 38.88 ± 13.33 years) and 24 age and sex-matched normal controls (13 males and 11 females; mean age, 40.46 ± 11.4 years) underwent resting-state functional MRI examination. Seven imaging parameters, including amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), degree centrality (DC), voxel-mirrored homotopic connectivity (VMHC), long-range functional connectivity density (FCD), and short-range FCD, were entered into the classification model to distinguish the mTBI from normal controls. Results The ability for any single imaging parameters to distinguish the two groups is lower than multiparameter combinations. The combination of ALFF, fALFF, DC, VMHC, and short-range FCD showed the best classification performance for distinguishing the two groups with optimal AUC value of 0.778, accuracy rate of 81.11%, sensitivity of 88%, and specificity of 75%. The brain regions with the highest contributions to this classification mainly include bilateral cerebellum, left orbitofrontal cortex, left cuneus, left temporal pole, right inferior occipital cortex, bilateral parietal lobe, and left supplementary motor area. Conclusions Multiparameter combinations could improve the classification performance of mTBI from normal controls by using the brain regions associated with emotion and cognition.
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15
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Morelli N, Johnson NF, Kaiser K, Andreatta RD, Heebner NR, Hoch MC. Resting state functional connectivity responses post-mild traumatic brain injury: a systematic review. Brain Inj 2021; 35:1326-1337. [PMID: 34487458 DOI: 10.1080/02699052.2021.1972339] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mild traumatic brain injuries (mTBI) are associated with functional network connectivity alterations throughout recovery. Yet, little is known about the adaptive or maladaptive nature of post-mTBI connectivity and which networks are predisposed to altered function and adaptation. The objective of this review was to determine functional connectivity changes post-mTBI and to determine the adaptive or maladaptive nature of connectivity through direct comparisons of connectivity and behavioral data. Literature was systematically searched and appraised for methodological quality. A total of 16 articles were included for review. There was conflicting evidence of post-mTBI connectivity responses as decreased connectivity was noted in 4 articles, 6 articles reported increased connectivity, 5 reported a mixture of increased and decreased connectivity, while 1 found no differences in connectivity. Supporting evidence for adaptive post-mTBI increases in connectivity were found, particularly in the frontoparietal, cerebellar, and default mode networks. Although initial results are promising, continued longitudinal research that systematically controls for confounding variables and that standardizes methodologies is warranted to adequately understand the neurophysiological recovery trajectory of mTBI.
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Affiliation(s)
- Nathan Morelli
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Nathan F Johnson
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Kimberly Kaiser
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Richard D Andreatta
- Rehabilitation Sciences Doctoral Program, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington, Kentucky, USA
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16
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Aberrant Static and Dynamic Functional Network Connectivity in Acute Mild Traumatic Brain Injury with Cognitive Impairment. Clin Neuroradiol 2021; 32:205-214. [PMID: 34463779 DOI: 10.1007/s00062-021-01082-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to investigate differences in static and dynamic functional network connectivity (FNC) and explore their association with neurocognitive performance in acute mild traumatic brain injury (mTBI). METHODS A total of 76 patients with acute mTBI and 70 age-matched and sex-matched healthy controls were enrolled (age 43.79 ± 10.22 years vs. 45.63 ± 9.49 years; male/female: 34/42 vs. 38/32; all p > 0.05) and underwent resting-state functional magnetic resonance imaging (fMRI) scan (repetition time/echo time = 2000/30 ms, 230 volumes). Independent component analysis was conducted to evaluate static and dynamic FNC patterns on the basis of nine resting-state networks, namely, auditory network (AUDN), dorsal attention network (dAN), ventral attention network (vAN), default mode network (DMN), left frontoparietal network (LFPN), right frontoparietal network (RFPN), somatomotor network (SMN), visual network (VN), and salience network (SN). Spearman's correlation among aberrances in FNC values, and Montreal cognitive assessment (MoCA) scores was further measured in mTBI. RESULTS Compared with controls, patients with mTBI showed wide aberrances of static FNC, such as reduced FNC in DMN-vAN and VN-vAN pairs. The mTBI patients exhibited aberrant dynamic FNC in state 2, involving reduced FNC aberrance in the vAN with AUDN, VN with DMN and dAN, and SN with SMN and vAN. Reduced dFNC in the SN-vAN pair was negatively correlated with the MoCA score. CONCLUSION Our findings suggest that aberrant static and dynamic FNC at the acute stage may contribute to cognitive symptoms, which not only may expand knowledge regarding FNC cognition relations from the static perspective but also from the dynamic perspective.
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17
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Vakhtin AA, Zhang Y, Wintermark M, Ashford JW, Furst AJ. Distant histories of mild traumatic brain injury exacerbate age-related differences in white matter properties. Neurobiol Aging 2021; 107:30-41. [PMID: 34371285 DOI: 10.1016/j.neurobiolaging.2021.07.002] [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: 03/02/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
We examined associations of distant histories of mild traumatic brain injury (mTBI) with non-linear and linear trajectories of white matter (WM) properties across a wide age range (23-77). Diffusion tensor imaging (DTI) data obtained from 171 Veterans with histories of clinically diagnosed mTBIs and 115 controls were subjected to tractography, isolating 20 major WM tracts. Non-linear and linear effects of age on each tract's diffusion properties were examined in terms of their interactions with group (mTBI and control). The non-linear model revealed 7 tracts in which the mTBI group's DTI metrics rapidly deviated from control trajectories in middle and late adulthoods, despite the injuries having occurred in the late 20s, on average. In contrast, no interactions between prior injuries and age were detected when examining linear trajectories. Distant mTBIs may thus accelerate normal age-related trajectories of WM degeneration much later in life. As such, life-long histories of head trauma should be assessed in all patients in their mid-to-late adulthoods, whether neurologically healthy or presenting with seemingly unrelated neuropathology.
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Affiliation(s)
- Andrei A Vakhtin
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA.
| | - Yu Zhang
- War Related Illness and Injury Study Center (WRIISC), Palo Alto Veterans Affairs Hospital, Palo Alto, CA, USA
| | - Max Wintermark
- Neuroradiology, Stanford University School of Medicine, Stanford, CA, USA
| | - John W Ashford
- War Related Illness and Injury Study Center (WRIISC), Palo Alto Veterans Affairs Hospital, Palo Alto, CA, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ansgar J Furst
- War Related Illness and Injury Study Center (WRIISC), Palo Alto Veterans Affairs Hospital, Palo Alto, CA, USA; Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Polytrauma System of Care, Palo Alto Veterans Affairs Hospital, Palo Alto, CA, USA
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18
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Lu L, Li F, Chen H, Wang P, Zhang H, Chen YC, Yin X. Functional connectivity dysfunction of insular subdivisions in cognitive impairment after acute mild traumatic brain injury. Brain Imaging Behav 2021; 14:941-948. [PMID: 32304021 PMCID: PMC7275020 DOI: 10.1007/s11682-020-00288-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose This study aimed to investigate the early functional connectivity alterations between insula subdivisions and other cortical regions in patients with acute mild traumatic brain injury (mTBI) and subsequently to explore the relationship between functional connectivity changes of insula subdivisions with other cortical regions and cognitive function. Methods Fifty-three mTBI patients and 37 age-, gender- and education level- matched healthy controls were included in this study. All participants obtained resting state functional magnetic resonance imaging (rs-fMRI) and clinical and neuropsychological evaluations (Montreal cognitive assessment, MoCA) at the acute stage. Functional connectivity alterations of insula subdivisions and correlations with MoCA were further explored by seed-voxel functional connectivity. Results Compared with healthy controls, patients with acute mTBI showed significantly decreased functional connectivity between the L-vAI and the left middle temporal gyrus and right superior frontal gyrus and significantly decreased functional connectivity between the R-vAI and the right middle frontal gyrus and right hippocampus. While significantly decreased functional connectivity were observed between the L-dAI and the right superior frontal gyrus. In addition, significantly increased functional connectivity was observed between the R-PI and the left inferior frontal gyrus. Furthermore, the mTBI group demonstrated positive correlations between performances in orientation and insula and middle temporal gyrus and superior frontal gyrus and middle frontal gyrus functional connectivities. Abstraction scores for mTBI patients positively correlated with functional connectivity between insula and middle frontal gyrus. Conclusions The present study demonstrated functional connectivity dysfunction of insula subdivisions and correlations between these alterations and cognitive performance, which provide a novel insight into the neurophysiological mechanism of cognitive impairment in patients with mTBI at the acute stage.
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Affiliation(s)
- Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, China
| | - Fengfang Li
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, China.
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, China.
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19
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Philippi CL, Velez CS, Wade BSC, Drennon AM, Cooper DB, Kennedy JE, Bowles AO, Lewis JD, Reid MW, York GE, Newsome MR, Wilde EA, Tate DF. Distinct patterns of resting-state connectivity in U.S. service members with mild traumatic brain injury versus posttraumatic stress disorder. Brain Imaging Behav 2021; 15:2616-2626. [PMID: 33759113 DOI: 10.1007/s11682-021-00464-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/27/2022]
Abstract
Mild traumatic brain injury (mTBI) is highly prevalent in military populations, with many service members suffering from long-term symptoms. Posttraumatic stress disorder (PTSD) often co-occurs with mTBI and predicts worse clinical outcomes. Functional neuroimaging research suggests there are both overlapping and distinct patterns of resting-state functional connectivity (rsFC) in mTBI versus PTSD. However, few studies have directly compared rsFC of cortical networks in military service members with these two conditions. In the present study, U.S. service members (n = 137; ages 19-59; 120 male) underwent resting-state fMRI scans. Participants were divided into three study groups: mTBI only, PTSD only, and orthopedically injured (OI) controls. Analyses investigated group differences in rsFC for cortical networks: default mode (DMN), frontoparietal (FPN), salience, somatosensory, motor, auditory, and visual. Analyses were family-wise error (FWE) cluster-corrected and Bonferroni-corrected for number of network seeds regions at the whole brain level (pFWE < 0.002). Both mTBI and PTSD groups had reduced rsFC for DMN and FPN regions compared with OI controls. These group differences were largely driven by diminished connectivity in the PTSD group. rsFC with the middle frontal gyrus of the FPN was increased in mTBI, but decreased in PTSD. Overall, these results suggest that PTSD symptoms may have a more consistent signal than mTBI. Our novel findings of opposite patterns of connectivity with lateral prefrontal cortex highlight a potential biomarker that could be used to differentiate between these conditions.
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Affiliation(s)
- Carissa L Philippi
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
| | - Carmen S Velez
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.,University of Utah, Salt Lake City, UT, USA
| | - Benjamin S C Wade
- University of Utah, Salt Lake City, UT, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, CA, USA
| | - Ann Marie Drennon
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jan E Kennedy
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | - Amy O Bowles
- Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Jeffrey D Lewis
- Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Matthew W Reid
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | | | - Mary R Newsome
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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Resting-State Network Plasticity Induced by Music Therapy after Traumatic Brain Injury. Neural Plast 2021; 2021:6682471. [PMID: 33763126 PMCID: PMC7964116 DOI: 10.1155/2021/6682471] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/22/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
Traumatic brain injury (TBI) is characterized by a complex pattern of abnormalities in resting-state functional connectivity (rsFC) and network dysfunction, which can potentially be ameliorated by rehabilitation. In our previous randomized controlled trial, we found that a 3-month neurological music therapy intervention enhanced executive function (EF) and increased grey matter volume in the right inferior frontal gyrus (IFG) in patients with moderate-to-severe TBI (N = 40). Extending this study, we performed longitudinal rsFC analyses of resting-state fMRI data using a ROI-to-ROI approach assessing within-network and between-network rsFC in the frontoparietal (FPN), dorsal attention (DAN), default mode (DMN), and salience (SAL) networks, which all have been associated with cognitive impairment after TBI. We also performed a seed-based connectivity analysis between the right IFG and whole-brain rsFC. The results showed that neurological music therapy increased the coupling between the FPN and DAN as well as between these networks and primary sensory networks. By contrast, the DMN was less connected with sensory networks after the intervention. Similarly, there was a shift towards a less connected state within the FPN and SAL networks, which are typically hyperconnected following TBI. Improvements in EF were correlated with rsFC within the FPN and between the DMN and sensorimotor networks. Finally, in the seed-based connectivity analysis, the right IFG showed increased rsFC with the right inferior parietal and left frontoparietal (Rolandic operculum) regions. Together, these results indicate that the rehabilitative effects of neurological music therapy after TBI are underpinned by a pattern of within- and between-network connectivity changes in cognitive networks as well as increased connectivity between frontal and parietal regions associated with music processing.
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21
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Perez Garcia G, De Gasperi R, Gama Sosa MA, Perez GM, Otero-Pagan A, Pryor D, Abutarboush R, Kawoos U, Hof PR, Dickstein DL, Cook DG, Gandy S, Ahlers ST, Elder GA. Laterality and region-specific tau phosphorylation correlate with PTSD-related behavioral traits in rats exposed to repetitive low-level blast. Acta Neuropathol Commun 2021; 9:33. [PMID: 33648608 PMCID: PMC7923605 DOI: 10.1186/s40478-021-01128-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022] Open
Abstract
Military veterans who experience blast-related traumatic brain injuries often suffer from chronic cognitive and neurobehavioral syndromes. Reports of abnormal tau processing following blast injury have raised concerns that some cases may have a neurodegenerative basis. Rats exposed to repetitive low-level blast exhibit chronic neurobehavioral traits and accumulate tau phosphorylated at threonine 181 (Thr181). Using data previously reported in separate studies we tested the hypothesis that region-specific patterns of Thr181 phosphorylation correlate with behavioral measures also previously determined and reported in the same animals. Elevated p-tau Thr181 in anterior neocortical regions and right hippocampus correlated with anxiety as well as fear learning and novel object localization. There were no correlations with levels in amygdala or posterior neocortical regions. Particularly striking were asymmetrical effects on the right and left hippocampus. No systematic variation in head orientation toward the blast wave seems to explain the laterality. Levels did not correlate with behavioral measures of hyperarousal. Results were specific to Thr181 in that no correlations were observed for three other phospho-acceptor sites (threonine 231, serine 396, and serine 404). No consistent correlations were linked with total tau. These correlations are significant in suggesting that p-tau accumulation in anterior neocortical regions and the hippocampus may lead to disinhibited amygdala function without p-tau elevation in the amygdala itself. They also suggest an association linking blast injury with tauopathy, which has implications for understanding the relationship of chronic blast-related neurobehavioral syndromes in humans to neurodegenerative diseases.
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22
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Zhuang X, Mishra V, Nandy R, Yang Z, Sreenivasan K, Bennett L, Bernick C, Cordes D. Resting-State Static and Dynamic Functional Abnormalities in Active Professional Fighters With Repetitive Head Trauma and With Neuropsychological Impairments. Front Neurol 2020; 11:602586. [PMID: 33362704 PMCID: PMC7758536 DOI: 10.3389/fneur.2020.602586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Previous neuroimaging studies have identified structural brain abnormalities in active professional fighters with repetitive head trauma and correlated these changes with fighters' neuropsychological impairments. However, functional brain changes in these fighters derived using neuroimaging techniques remain unclear. In this study, both static and dynamic functional connectivity alterations were investigated (1) between healthy normal control subjects (NC) and fighters and (2) between non-impaired and impaired fighters. Resting-state fMRI data were collected on 35 NC and 133 active professional fighters, including 68 impaired fighters and 65 non-impaired fighters, from the Professional Fighters Brain Health Study at our center. Impaired fighters performed worse on processing speed (PSS) tasks with visual-attention and working-memory demands. The static functional connectivity (sFC) matrix was estimated for every pair of regions of interest (ROI) using a subject-specific parcellation. The dynamic functional connectivity (dFC) was estimated using a sliding-window method, where the variability of each ROI pair across all windows represented the temporal dynamics. A linear regression model was fitted for all 168 subjects, and different t-contrast vectors were used for between-group comparisons. An association analysis was further conducted to evaluate FC changes associated with PSS task performances without creating artificial impairment group-divisions in fighters. Following corrections for multiple comparisons using network-based statistics, our study identified significantly reduced long-range frontal-temporal, frontal-occipital, temporal-occipital, and parietal-occipital sFC strengths in fighters than in NCs, corroborating with previously observed structural damages in corresponding white matter tracts in subjects experiencing repetitive head trauma. In impaired fighters, significantly decreased sFC strengths were found among key regions involved in visual-attention, executive and cognitive process, as compared to non-impaired fighters. Association analysis further reveals similar sFC deficits to worse PSS task performances in all 133 fighters. With our choice of dFC indices, we were not able to observe any significant dFC changes beyond a trend-level increased temporal variability among similar regions with weaker sFC strengths in impaired fighters. Collectively, our functional brain findings supplement previously reported structural brain abnormalities in fighters and are important to comprehensively understand brain changes in fighters with repetitive head trauma.
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Affiliation(s)
- Xiaowei Zhuang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States
| | - Virendra Mishra
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Rajesh Nandy
- School of Public Health, University of North Texas, Fort Worth, TX, United States
| | - Zhengshi Yang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States
| | - Karthik Sreenivasan
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States
| | - Lauren Bennett
- Pickup Family Neuroscience Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, United States
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,UW Medicine, Seattle, WA, United States
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,Department of Brain Health, University of Nevada, Las Vegas, NV, United States.,Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, United States
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23
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Phipps H, Mondello S, Wilson A, Dittmer T, Rohde NN, Schroeder PJ, Nichols J, McGirt C, Hoffman J, Tanksley K, Chohan M, Heiderman A, Abou Abbass H, Kobeissy F, Hinds S. Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review. Front Neurol 2020; 11:559318. [PMID: 33224086 PMCID: PMC7667277 DOI: 10.3389/fneur.2020.559318] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022] Open
Abstract
As a result of armed conflict, head trauma from exposure to blasts is an increasing critical health issue, particularly among military service members. Whilst numerous studies examined the burden of blast-related brain injuries on service members', few systematic reviews have been published. This work provides a comprehensive summary of the evidence on blast-related mild traumatic brain injury (mTBI) burden in active U.S. military service members and inactive Veterans, describing characteristics and outcomes. Records published up to April 2017 were identified through a search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and Cochrane Library. Records-based and original research reporting on U.S. military service members and Veterans with mild blast TBI were included. Data on subject characteristics, exposure, diagnostic criterion, and outcomes were extracted from included studies using a standardized extraction form and were presented narratively. Of the 2,290 references identified by the search, 106 studies with a total of 37,515 participants met inclusion criteria for blast-related mTBI. All but nine studies were based out of military or Veteran medical facilities. Unsurprisingly, men were over-represented (75–100%). The criteria used to define blast-related mTBI were consistent; however, the methodology used to ascertain whether individuals met those criteria for diagnosis were inconsistent. The diagnosis, most prevalent among the Army, heavily relied on self-reported histories. Commonly reported adverse outcomes included hearing disturbances and headaches. The most frequently associated comorbidities were post-traumatic stress disorder, depression, anxiety, sleep disorders, attention disorders, and cognitive disorders. The primary objective of this review was to provide a summary of descriptive data on blast-related mTBI in a U.S. military population. Low standardization of the methods for reaching diagnosis and problems in the study reporting emphasize the importance to collect high-quality data to fill knowledge gaps pertaining to blast-related mTBI.
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Affiliation(s)
- Helen Phipps
- Booz Allen Hamilton, San Antonio, TX, United States
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | | | | | | | | | | | | | | | | | | | | | - Hussein Abou Abbass
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Psychiatry, Center for Neuroproteomics and Biomarkers Research, University of Florida, Gainesville, FL, United States
| | - Sidney Hinds
- Medical Research and Development Command, Ft Detrick, MD, United States
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24
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Cassoudesalle H, Petit A, Chanraud S, Petit H, Badaut J, Sibon I, Dehail P. Changes in resting-state functional brain connectivity associated with head impacts over one men's semi-professional soccer season. J Neurosci Res 2020; 99:446-454. [PMID: 33089563 DOI: 10.1002/jnr.24742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
Soccer, as a contact sport, exposes players to repetitive head impacts, especially through heading the ball. The question of a long-term brain cumulative effect remains. Our objective was to determine whether exposure to head impacts over one soccer season was associated with changes in functional brain connectivity at rest, using magnetic resonance imaging (MRI). In this prospective cohort study, 10 semi-professional men soccer players, aged 18-25 years, and 20 age-matched men athletes without a concussion history and who do not practice any contact sport were recruited in Bordeaux (France). Exposure to head impacts per soccer player during competitive games over one season was measured using video analysis. Resting-state functional magnetic resonance imaging data were acquired for both groups at two times, before and after the season. With a seed-based analysis, resting-state networks that have been intimately associated with aspects of cognitive functioning were investigated. The results showed a mean head impacts of 42 (±33) per soccer player over the season, mainly intentional head-to-ball impacts and no concussion. No head impact was found among the other athletes. The number of head impacts between the two MRI acquisitions before and after the season was associated with increased connectivity within the default mode network and the cortico-cerebellar network. In conclusion, our findings suggest that the brain functioning changes over one soccer season in association with exposure to repetitive head impacts.
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Affiliation(s)
- Hélène Cassoudesalle
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France.,"Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
| | - Adrien Petit
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Sandra Chanraud
- Neuroimaging and Human Cognition Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Hervé Petit
- "Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
| | - Jérôme Badaut
- Brain Molecular Imaging Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Igor Sibon
- Neuroimaging and Human Cognition Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Patrick Dehail
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France.,"Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
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25
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Sheth C, Rogowska J, Legarreta M, McGlade E, Yurgelun-Todd D. Functional connectivity of the anterior cingulate cortex in Veterans with mild traumatic brain injury. Behav Brain Res 2020; 396:112882. [PMID: 32853657 DOI: 10.1016/j.bbr.2020.112882] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is one of the most prevalent injuries in the military with mild traumatic brain injury (mTBI) accounting for approximately 70-80 % of all TBI. TBI has been associated with diffuse and focal brain changes to structures and networks underlying cognitive-emotional processing. Although the anterior cingulate cortex (ACC) plays a critical role in emotion regulation and executive function and is susceptible to mTBI, studies focusing on ACC resting state functional connectivity (rs-fc) in Veterans are limited. METHODS Veterans with mTBI (n = 49) and with no history of TBI (n = 25), ages 20-54 completed clinical assessments and an 8-minute resting state functional magnetic resonance imaging (rs-fMRI) on a 3 T Siemens scanner. Imaging results were analyzed with left and right ACC as seed regions using SPM8. Regression analyses were performed with time since injury. RESULTS Seed-based analysis showed increased connectivity of the left and right ACC with brain regions including middle and posterior cingulate regions, preceneus, and occipital regions in the mTBI compared to the non-TBI group. CONCLUSIONS The rs-fMRI results indicate hyperconnectivity in Veterans with mTBI. These results are consistent with previous studies of recently concussed athletes showing ACC hyperconnectivity. Enhanced top-down control of attention networks necessary to compensate for the microstructural damage following mTBI may explain ACC hyperconnectivity post-mTBI.
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Affiliation(s)
- Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA.
| | - Jadwiga Rogowska
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Margaret Legarreta
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA.
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA.
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA.
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26
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Abstract
OBJECTIVES Mild traumatic brain injury (mTBI) is a major public health concern that has generated considerable scientific interest as a complex brain disorder that is associated with long-term neural consequences. This article reviews the literature on cerebrovascular dysfunction in chronic mTBI, with a focus on the long-term neural implications of such dysfunction. METHODS AND RESULTS Evidence is presented from human neuroimaging studies to support cerebrovascular involvement in long-term mTBI pathology. In addition, a pathway between mTBI and neurodegeneration via cerebrovascular dysfunction is explored. CONCLUSIONS Future work focused on identifying the neurobiological mechanisms underlying the neural consequences of mTBI will be important to guide therapeutic interventions and long-term care for patients with mTBI.
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27
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Park M, Chung J, Kim JK, Jeong Y, Moon WJ. Altered Functional Brain Networks in Patients with Traumatic Anosmia: Resting-State Functional MRI Based on Graph Theoretical Analysis. Korean J Radiol 2020; 20:1536-1545. [PMID: 31606958 PMCID: PMC6791817 DOI: 10.3348/kjr.2019.0104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Traumatic anosmia is a common disorder following head injury; however, little is known regarding its neural basis and influence on the functional networks. Therefore, we aimed to investigate the functional connectivity changes in patients with traumatic anosmia compared to healthy controls using resting-state functional magnetic resonance imaging (rs-fMRI). MATERIALS AND METHODS Sixteen patients with traumatic anosmia and 12 healthy controls underwent rs-fMRI. Differences in the connectivity of the olfactory and whole brain networks were compared between the two groups. Graph theoretical parameters, such as modularity and global efficiency of the whole brain or olfactory networks, were calculated and compared. Correlation analyses were performed between the parameters and disease severity. RESULTS Patients with traumatic anosmia showed decreased intra-network connectivity in the olfactory network (false discovery rate [FDR]-corrected p < 0.05) compared with that in healthy controls. Furthermore, the inter-network connectivity was increased in both the olfactory (FDR-corrected p < 0.05) and whole brain networks (degree-based statistic-corrected p < 0.05) in the anosmia group. The whole brain networks showed decreased modularity (p < 0.001) and increased global efficiency (p = 0.019) in patients with traumatic anosmia. The modularity and global efficiency were correlated with disease severity in patients with anosmia (p < 0.001 and p = 0.002, respectively). CONCLUSION Traumatic anosmia increased the inter-network connectivity observed with rs-fMRI in the olfactory and global brain functional networks. rs-fMRI parameters may serve as potential biomarkers for traumatic anosmia by revealing a more widespread functional damage than previously expected.
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Affiliation(s)
- Mina Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.,Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jinyong Chung
- Laboratory for Cognitive Neuroscience and NeuroImaging, Department of Bio and Brain Engineering, and KI for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Jin Kook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Jeong
- Laboratory for Cognitive Neuroscience and NeuroImaging, Department of Bio and Brain Engineering, and KI for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea.
| | - Won Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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28
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Monroe DC, Cecchi NJ, Gerges P, Phreaner J, Hicks JW, Small SL. A Dose Relationship Between Brain Functional Connectivity and Cumulative Head Impact Exposure in Collegiate Water Polo Players. Front Neurol 2020; 11:218. [PMID: 32300329 PMCID: PMC7145392 DOI: 10.3389/fneur.2020.00218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
A growing body of evidence suggests that chronic, sport-related head impact exposure can impair brain functional integration and brain structure and function. Evidence of a robust inverse relationship between the frequency and magnitude of repeated head impacts and disturbed brain network function is needed to strengthen an argument for causality. In pursuing such a relationship, we used cap-worn inertial sensors to measure the frequency and magnitude of head impacts sustained by eighteen intercollegiate water polo athletes monitored over a single season of play. Participants were evaluated before and after the season using computerized cognitive tests of inhibitory control and resting electroencephalography. Greater head impact exposure was associated with increased phase synchrony [r(16) > 0.626, p < 0.03 corrected], global efficiency [r(16) > 0.601, p < 0.04 corrected], and mean clustering coefficient [r(16) > 0.625, p < 0.03 corrected] in the functional networks formed by slow-wave (delta, theta) oscillations. Head impact exposure was not associated with changes in performance on the inhibitory control tasks. However, those with the greatest impact exposure showed an association between changes in resting-state connectivity and a dissociation between performance on the tasks after the season [r(16) = 0.481, p = 0.043] that could also be attributed to increased slow-wave synchrony [F(4, 135) = 113.546, p < 0.001]. Collectively, our results suggest that athletes sustaining the greatest head impact exposure exhibited changes in whole-brain functional connectivity that were associated with altered information processing and inhibitory control.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Paul Gerges
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Jenna Phreaner
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Steven L Small
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
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29
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Gordon EM, May GJ, Nelson SM. MRI-based measures of intracortical myelin are sensitive to a history of TBI and are associated with functional connectivity. Neuroimage 2019; 200:199-209. [PMID: 31203023 PMCID: PMC6703948 DOI: 10.1016/j.neuroimage.2019.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 06/12/2019] [Indexed: 01/31/2023] Open
Abstract
Traumatic brain injuries (TBIs) induce persistent behavioral and cognitive deficits via diffuse axonal injury. Axonal injuries are often examined in vivo using diffusion MRI, which identifies damaged and demyelinated regions in deep white matter. However, TBI patients can exhibit impairment in the absence of diffusion-measured abnormalities, suggesting that axonal injury and demyelination may occur outside the deep white matter. Importantly, myelinated axons are also present within the cortex. Cortical myelination cannot be measured using diffusion imaging, but can be mapped in-vivo using the T1-w/T2-w ratio method. Here, we conducted the first work examining effects of TBI on intracortical myelin in living humans by applying myelin mapping to 46 US Military Veterans with a history of TBI. We observed that myelin maps could be created in TBI patients that matched known distributions of cortical myelin. After controlling for age and presence of blast injury, the number of lifetime TBIs was associated with reductions in the T1-w/T2-w ratio across the cortex, most significantly in a highly-myelinated lateral occipital region corresponding with the human MT+ complex. Further, the T1-w/T2-w ratio in this MT+ region predicted resting-state functional connectivity of that region. By contrast, a history of blast TBI did not affect the T1-w/T2-w ratio in either a diffuse or focal pattern. These findings suggest that intracortical myelin, as measured using the T1-w/T2-w ratio, may be a TBI biomarker that is anatomically complementary to diffusion MRI. Thus, myelin mapping could potentially be combined with diffusion imaging to improve MRI-based diagnostic tools for TBI.
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Affiliation(s)
- Evan M Gordon
- VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr, 151-C, Waco, TX, 76711, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1600 Viceroy Dr #800, Dallas, TX, 75235, USA; Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building Suite B.309, Waco, TX, 76706, USA.
| | - Geoffrey J May
- VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr, 151-C, Waco, TX, 76711, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1600 Viceroy Dr #800, Dallas, TX, 75235, USA; Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building Suite B.309, Waco, TX, 76706, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, 8441 Riverside Parkway, Bryan, TX, 77807, USA
| | - Steven M Nelson
- VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr, 151-C, Waco, TX, 76711, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1600 Viceroy Dr #800, Dallas, TX, 75235, USA; Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building Suite B.309, Waco, TX, 76706, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, 8441 Riverside Parkway, Bryan, TX, 77807, USA
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30
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Chong CD, Wang L, Wang K, Traub S, Li J. Homotopic region connectivity during concussion recovery: A longitudinal fMRI study. PLoS One 2019; 14:e0221892. [PMID: 31577811 PMCID: PMC6774501 DOI: 10.1371/journal.pone.0221892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/16/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To (i) investigate alterations in homotopic functional connectivity (hfc) in concussed patients relative to healthy controls (HC) and to (ii) interrogate whether hfc in concussed patients normalized during the recovery process. The relationship between symptom recovery and change in hfc was assessed using post-hoc analyses. METHODS This study included 15 concussed patients (mean age = 39.1, SD = 10.1; sex: 13 females, 2 males) and 15 HC (mean age = 39.1, SD = 11.7; sex: 13 females, 2 males). Hfc patterns were interrogated using resting-state magnetic resonance imaging (rs-MRI) for 29 a priori selected pain-processing regions. Concussed patients underwent imaging at two time-points; at 1-month post-concussion (mean time following concussion: 28 days, SD = 9.5) and again at 5-months post-concussion (mean time following concussion: 121 days, SD = 13). At both time-points, symptoms associated with concussion were assessed using the Sports Concussion Assessment Tool (SCAT-3). RESULTS Concussed patients had significantly weaker hfc in the following six regions 1-month post-concussion compared to HC: middle cingulate, posterior insula, middle occipital, spinal trigeminal nucleus, precentral and the pulvinar. There were no regions of significantly stronger hfc in concussed patients relative to HC. Longitudinally, patients showed significant symptom recovery 5-months post-concussion and had significant strengthening of hfc patterns in seven homotopic ROIs: middle cingulate, posterior insula, middle occipital, secondary somatosensory area, spinal trigeminal nucleus, precentral, and the pulvinar. Post-hoc analyses indicated a significant negative correlation between somatosensory functional connectivity strengthening and symptom severity. CONCLUSION At 1-month post-concussion, patients had significantly weaker hfc in a number of pain-processing regions relative to HC. However, over a period of 5-months, region-pair connectivity showed significant recovery and normalization. Those patients with more successful symptom recovery at 5-months post-concussion had more functional somatosensory strengthening, suggesting an association between functional strengthening and post-concussion symptom recovery.
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Affiliation(s)
| | - Lujia Wang
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Kun Wang
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Stephen Traub
- Mayo Clinic Arizona, Phoenix, AZ, United States of America
| | - Jing Li
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
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31
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Mufti O, Mathew S, Harris A, Siesky B, Burgett KM, Verticchio Vercellin AC. Ocular changes in traumatic brain injury: A review. Eur J Ophthalmol 2019; 30:867-873. [PMID: 31378077 DOI: 10.1177/1120672119866974] [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: 12/14/2022]
Abstract
Traumatic brain injury is represented by a penetrating or non-penetrating head injury, which causes disruption in the normal functioning of the brain. Traumatic brain injury has been an ardently debated topic of discussion due to its prevalence in media centric persons such as military personnel and athletes. Current assessments for traumatic brain injury have looked at vestibulo-ocular and vascular parameters to aid in diagnosis. Innovations in non-invasive ophthalmic imaging have allowed for the visualization of specific tissue structure/function relationships in a variety of ophthalmic and neurodegenerative diseases. As the eye and brain share significant embryological and physiological pathways, ocular imaging modalities may provide a novel and impactful tool in advancing assessment of traumatic brain injury. Herein, we examined the available literature and data on visual fields, mean retinal nerve fiber layer thickness, retinal ganglion cell layer thickness, and cerebral blood flow following traumatic brain injury. This review of published individual and population-based studies was performed in order to explore the feasibility and importance of considering ocular imaging biomarkers following traumatic brain injury.
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Affiliation(s)
- Osama Mufti
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunu Mathew
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent Siesky
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kendall M Burgett
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
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Wooten DW, Ortiz-Terán L, Zubcevik N, Zhang X, Huang C, Sepulcre J, Atassi N, Johnson KA, Zafonte RD, El Fakhri G. Multi-Modal Signatures of Tau Pathology, Neuronal Fiber Integrity, and Functional Connectivity in Traumatic Brain Injury. J Neurotrauma 2019; 36:3233-3243. [PMID: 31210098 DOI: 10.1089/neu.2018.6178] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
[18F]AV-1451 (aka 18F-Flortaucipir, [18F]T807) was developed for positron-emission tomography (PET) imaging of paired helical filaments of hyperphosphorylated tau, which are of interest in a range of neuropathologies, including traumatic brain injury (TBI). Magnetic resonance imaging (MRI) techniques like diffusion tensor imaging (DTI) and resting state functional connectivity assess structural and functional characteristics of the brain, complementing the molecular information that can be obtained by PET. The goal herein was to explore the utility of such multi-modal imaging in a case series based on a population of TBI subjects. This study probes the interrelationship between tau deposition, white matter integrity, and gray matter functional connectivity across the spectrum of TBI. Nineteen subjects (11 controls, five former contact sports athletes, one automotive accident, and two with military-related injury) underwent [18F]AV-1451 PET and magnetic resonance scanning procedures. [18F]AV-1451 distribution volume ratio (DVR) was estimated using the Logan method and the cerebellum as a reference region. Diffusion tractography images and fractional anisotropy (FA) images were generated using diffusion toolkit and FSL. Resting-state functional MRI (fMRI) analysis was based on a graph theory metric, namely weighted degree centrality. TBI subjects showed greater heterogeneity in [18F]AV-1451 DVR when compared with control subjects. In a subset of TBI subjects, areas with high [18F]AV-1451 binding corresponded with increased FA and diminished white matter tract density in DTI. Functional MRI results exhibited an increase in functional connectivity, particularly among local connections, in the areas where tau aggregates were more prevalent. In a case series of a diverse group of TBI subjects, brain regions with elevated tau burden exhibited increased functional connectivity as well as decreased white matter integrity. These findings portray molecular, microstructural, and functional corollaries of TBI that spatially coincide and can be measured in the living human brain using noninvasive neuroimaging techniques.
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Affiliation(s)
- Dustin W Wooten
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura Ortiz-Terán
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nevena Zubcevik
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital Harvard Medical School, Charlestown, Massachusetts
| | - Xiaomeng Zhang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chuan Huang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nazem Atassi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keith A Johnson
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital Harvard Medical School, Charlestown, Massachusetts
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Karr JE, Rau HK, Shofer JB, Hendrickson RC, Peskind ER, Pagulayan KF. Variables associated with subjective cognitive change among Iraq and Afghanistan war Veterans with blast-related mild traumatic brain injury. J Clin Exp Neuropsychol 2019; 41:680-693. [DOI: 10.1080/13803395.2019.1611740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Justin E. Karr
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
| | - Holly K. Rau
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
| | - Jane B. Shofer
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Rebecca C. Hendrickson
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Elaine R. Peskind
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathleen F. Pagulayan
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Neuroanatomical and functional alterations of insula in mild traumatic brain injury patients at the acute stage. Brain Imaging Behav 2019; 14:907-916. [PMID: 30734204 DOI: 10.1007/s11682-019-00053-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cognitive impairment is a major cause of disability and decline in quality of life in mild traumatic brain injury (mTBI) survivors, but the underlying pathophysiology is still poorly understood. The insula has extensive connections to other cortex and is believed to responsible for integrating external and internal processes and controlling cognitive functions. To explore this hypothesis, we investigated early alterations in the gray matter volume (GMV) and brain functional connectivity (FC) of insula in mTBI patients within 7 days after injury and any possible correlations with cognitive function. A total of 58 mTBI patients at the acute stage and 32 matched healthy controls were recruited and underwentT1-weighted magnetic resonance imaging (MRI)andresting-state functional MRI scans within 7 days of injury. FC was characterized using seed-based region of interest analysis method. The patients' cognitive function was evaluated with Montreal Cognitive Assessment (MoCA) score. The resulting of GMV and FC of insula were correlated with cognitive alterations. We found that the GMV was significantly reduced only in the right insula in mTBI patients and no significant GMV increase was observed in either hemisphere. mTBI patients demonstrated decreased FC in the right parahippocampal gyrus and increased FC in the right supramargianl gyrus. In addition, compared to the healthy controls, the mTBI patients in the acute stage presented a decline in the visuospatial/executive (p = 0.013) and attention (p = 0.038) subcategories. In the mTBI group, the changes in GMV in the right insula were positively correlated with poor attention performance (r = 0.316, p = 0.016). Our data demonstrated alterations of the GMV and resting-stateFC of the right insula in mTBI patients at the acute stage. These early changes in GMV and resting-state FC perhaps serve as a potential biomarker for improving the understanding of cognitive decline for mTBI in the acute setting.
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Ware AL, Biekman B, Hachey R, MacLeod M, Bird W, Pathak S, Clarke E, Borrasso A, Puccio AM, Glavin K, Pomiecko K, Moretti P, Beers SR, Levin HS, Schneider W, Okonkwo DO, Wilde EA. A Preliminary High-Definition Fiber Tracking Study of the Executive Control Network in Blast-Induced Traumatic Brain Injury. J Neurotrauma 2018; 36:686-701. [PMID: 30070176 DOI: 10.1089/neu.2018.5725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Blast-induced traumatic brain injury (bTBI) is common in veterans of the Iraq- and Afghanistan-era conflicts. However, the typical subtlety of neural alterations and absence of definitive biomarkers impede clinical detection on conventional imaging. This preliminary study examined the structure and functional correlates of executive control network (ECN) white matter in veterans to investigate the clinical utility of using high-definition fiber tracking (HDFT) to detect chronic bTBI. Demographically similar male veterans (N = 38) with and without bTBI (ages 24 to 50 years) completed standardized neuropsychological testing and magnetic resonance imaging. Quantitative HDFT metrics of subcortical-dorsolateral prefrontal cortex (DLPFC) tracts were derived. Moderate-to-large group effects were observed on HDFT metrics. Relative to comparisons, bTBI demonstrated elevated quantitative anisotropy (QA) and reduced right hemisphere volume of all examined tracts, and reduced fiber count and increased generalized fractional anisotropy in the right DLPFC-putamen tract and DLPFC-thalamus, respectively. The Group × Age interaction effect on DLPFC-caudate tract volume was large; age negatively related to volume in the bTBI group, but not comparison group. Groups performed similarly on the response inhibition measure. Performance (reaction time and commission errors) robustly correlated with HDFT tract metrics (QA and tract volume) in the comparison group, but not bTBI group. Results support anomalous density and integrity of ECN connectivity, particularly of the right DLPFC-putamen pathway, in bTBI. Results also support exacerbated aging in veterans with bTBI. Similar ECN function despite anomalous microstructure could reflect functional compensation in bTBI, although alternate interpretations are explored.
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Affiliation(s)
- Ashley L Ware
- 1 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston , Houston, Texas.,2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - Brian Biekman
- 1 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston , Houston, Texas.,2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - Rebecca Hachey
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Marianne MacLeod
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - William Bird
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Sudhir Pathak
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Emily Clarke
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Allison Borrasso
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Ava M Puccio
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kelly Glavin
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kristopher Pomiecko
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Paolo Moretti
- 5 Department of Neurology, Baylor College of Medicine , Houston, Texas.,6 Neurology Service, Michael E. DeBakey VA Medical Center , Houston, Texas.,7 Department of Neurology, University of Utah School of Health Sciences , Salt Lake City, Utah.,8 Department of Human and Molecular Genetics, University of Utah School of Health Sciences , Salt Lake City, Utah.,9 Neurology Service, George E. Wahlen VA Medical Center , Salt Lake City, Utah
| | - Sue R Beers
- 10 Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, PA
| | - Harvey S Levin
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,11 Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Walter Schneider
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania.,12 Department of Psychology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - David O Okonkwo
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Elisabeth A Wilde
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,5 Department of Neurology, Baylor College of Medicine , Houston, Texas.,6 Neurology Service, Michael E. DeBakey VA Medical Center , Houston, Texas.,7 Department of Neurology, University of Utah School of Health Sciences , Salt Lake City, Utah.,9 Neurology Service, George E. Wahlen VA Medical Center , Salt Lake City, Utah.,13 Department of Radiology, Baylor College of Medicine , Houston, Texas
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Yuan W, Barber Foss KD, Dudley J, Thomas S, Galloway R, DiCesare C, Leach J, Scheifele P, Farina M, Valencia G, Smith D, Altaye M, Rhea CK, Talavage T, Myer GD. Impact of Low-Level Blast Exposure on Brain Function after a One-Day Tactile Training and the Ameliorating Effect of a Jugular Vein Compression Neck Collar Device. J Neurotrauma 2018; 36:721-734. [PMID: 30136637 DOI: 10.1089/neu.2018.5737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Special Weapons and Tactics (SWAT) personnel who conduct breacher exercises are at risk for blast-related head trauma. We aimed to investigate the potential impact of low-level blast exposure during breacher training on the neural functioning of working memory and auditory network connectivity. We also aimed to evaluate the effects of a jugular vein compression collar, designed to internally mitigate slosh energy absorption, preserving neural functioning and connectivity, following blast exposure. A total of 23 SWAT personnel were recruited and randomly assigned to a non-collar (n = 11) and collar group (n = 12). All participants completed a 1-day breacher training with multiple blast exposure. Prior to and following training, 18 participants (non-collar, n = 8; collar, n = 10) completed functional magnetic resonance imaging (fMRI) of working memory using N-Back task; 20 participants (non-collar, n = 10; collar, n = 12) completed resting-state fMRI. Key findings from the working memory analysis include significantly increased fMRI brain activation in the right insular, right superior temporal pole, right inferior frontal gyrus, and pars orbitalis post-training for the non-collar group (p < 0.05, threshold-free cluster enhancement corrected), but no changes were noted for the collar group. The elevation in fMRI activation in the non-collar group was found to correlate significantly (n = 7, r = 0.943, p = 0.001) with average peak impulse amplitude experienced during the training. In the resting-state fMRI analysis, significant pre- to post-training increase in connectivity between the auditory network and two discrete regions (left middle frontal gyrus and left superior lateral occipital/angular gyri) was found in the non-collar group, while no change was observed in the collar group. These data provided initial evidence of the impact of low-level blast on working memory and auditory network connectivity as well as the protective effect of collar on brain function following blast exposure, and is congruent with previous collar findings in sport-related traumatic brain injury.
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Affiliation(s)
- Weihong Yuan
- 1 Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,10 University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Kim D Barber Foss
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Jonathan Dudley
- 1 Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Staci Thomas
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Ryan Galloway
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Christopher DiCesare
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - James Leach
- 3 Division of Radiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,10 University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Pete Scheifele
- 4 Department of Communication Sciences and Disorders, University of Cincinnati , Ohio
| | - Megan Farina
- 4 Department of Communication Sciences and Disorders, University of Cincinnati , Ohio
| | - Gloria Valencia
- 4 Department of Communication Sciences and Disorders, University of Cincinnati , Ohio
| | - David Smith
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Mekibib Altaye
- 5 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Christopher K Rhea
- 6 Department of Kinesiology, University of North Carolina at Greensboro , Greensboro, North Carolina
| | - Thomas Talavage
- 7 School of Electrical and Computer Engineering, Purdue University , West Lafayette, Indiana
| | - Gregory D Myer
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,8 Departments of Pediatrics and Orthopedic Surgery, University of Cincinnati , Ohio.,9 The Micheli Center for Sports Injury Prevention , Waltham, Massachusetts
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37
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Rosenthal S, Gray M, Fatima H, Sair HI, Whitlow CT. Functional MR Imaging: Blood Oxygen Level-Dependent and Resting State Techniques in Mild Traumatic Brain Injury. Neuroimaging Clin N Am 2018; 28:107-115. [PMID: 29157847 DOI: 10.1016/j.nic.2017.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This article discusses mild traumatic brain injury (mTBI)-associated effects on brain functional connectivity assessed via resting-state functional MR (fMR) imaging. Several studies have reported acute post-injury default mode network hyperconnectivity, followed by a period of decreased connectivity before later connectivity normalization in some patients. Other studies have reported mTBI associated effects on connectivity that remain evident for up to 5-years or more. Discordance in the published literature regarding the direction of network connectivity changes (eg, increased versus decreased connectivity) may reflect differences in timing of data collection post-injury, as well as the need to standardize MR imaging acquisition protocols and processing methods.
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Affiliation(s)
- Scott Rosenthal
- Radiology Informatics and Image Processing Laboratory (RIIPL), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Division of Neuroradiology, Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Matthew Gray
- Radiology Informatics and Image Processing Laboratory (RIIPL), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Division of Neuroradiology, Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Hudaisa Fatima
- Radiology Informatics and Image Processing Laboratory (RIIPL), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Division of Neuroradiology, Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Haris I Sair
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21205, USA
| | - Christopher T Whitlow
- Radiology Informatics and Image Processing Laboratory (RIIPL), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Division of Neuroradiology, Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Department of Biomedical Engineering, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Clinical Translational Sciences Institute (CTSI), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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38
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Bonnette S, Diekfuss JA, Kiefer AW, Riley MA, Barber Foss KD, Thomas S, DiCesare CA, Yuan W, Dudley J, Reches A, Myer GD. A jugular vein compression collar prevents alterations of endogenous electrocortical dynamics following blast exposure during special weapons and tactical (SWAT) breacher training. Exp Brain Res 2018; 236:2691-2701. [PMID: 29987537 DOI: 10.1007/s00221-018-5328-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Abstract
Exposure to explosive blasts places one at risk for traumatic brain injury, especially for special weapons and tactics (SWAT) and military personnel, who may be repeatedly exposed to blasts. In the current study, the effectiveness of a jugular vein compression collar to prevent alterations in resting-state electrocortical activity following a single-SWAT breacher training session was investigated. SWAT team personnel were randomly assigned to wear a compression collar during breacher training and resting state electroencephalography (EEG) was measured within 2 days prior to and two after breacher training. It was hypothesized that significant changes in brain dynamics-indicative of possible underlying neurodegenerative processes-would follow blast exposure for those who did not wear the collar, with ameliorated changes for the collar-wearing group. Using recurrence quantification analysis (RQA) it was found that participants who did not wear the collar displayed longer periods of laminar electrocortical behavior (as indexed by RQA's vertical max line measure) after breacher training. It is proposed that the blast wave exposure for the no-collar group may have reduced the number of pathways, via axonal disruption-for electrical transmission-resulting in the EEG signals becoming trapped in laminar states for longer periods of time. Longer laminar states have been associated with other electrocortical pathologies, such as seizure, and may be important for understanding head trauma and recovery.
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Affiliation(s)
- Scott Bonnette
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Jed A Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam W Kiefer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Center for Cognition, Action, and Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Michael A Riley
- Center for Cognition, Action, and Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Kim D Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Staci Thomas
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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39
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Vergara VM, Mayer AR, Kiehl KA, Calhoun VD. Dynamic functional network connectivity discriminates mild traumatic brain injury through machine learning. NEUROIMAGE-CLINICAL 2018; 19:30-37. [PMID: 30034999 PMCID: PMC6051314 DOI: 10.1016/j.nicl.2018.03.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/22/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022]
Abstract
Mild traumatic brain injury (mTBI) can result in symptoms that affect a person's cognitive and social abilities. Improvements in diagnostic methodologies are necessary given that current clinical techniques have limited accuracy and are solely based on self-reports. Recently, resting state functional network connectivity (FNC) has shown potential as an important imaging modality for the development of mTBI biomarkers. The present work explores the use of dynamic functional network connectivity (dFNC) for mTBI detection. Forty eight mTBI patients (24 males) and age-gender matched healthy controls were recruited. We identified a set of dFNC states and looked at the possibility of using each state to classify subjects in mTBI patients and healthy controls. A linear support vector machine was used for classification and validated using leave-one-out cross validation. One of the dFNC states achieved a high classification performance of 92% using the area under the curve method. A series of t-test analysis revealed significant dFNC increases between cerebellum and sensorimotor networks. This significant increase was detected in the same dFNC state useful for classification. Results suggest that dFNC can be used to identify optimal dFNC states for classification excluding those that does not contain useful features. Dynamic functional connectivity and support vector machine classified traumatic brain injury patients and healthy controls. Out of 4 dynamic brain states, we identified 1 state useful for classification. Classification performance of the dynamic state of interest achieved a performance of 92% area under the curve method.
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Affiliation(s)
- Victor M Vergara
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States.
| | - Andrew R Mayer
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States; Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States; Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States.
| | - Kent A Kiehl
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States.
| | - Vince D Calhoun
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM 87106, United States; Dept of ECE, University of New Mexico, Albuquerque, NM 87131, United States.
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40
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Gordon EM, Scheibel RS, Zambrano-Vazquez L, Jia-Richards M, May GJ, Meyer EC, Nelson SM. High-Fidelity Measures of Whole-Brain Functional Connectivity and White Matter Integrity Mediate Relationships between Traumatic Brain Injury and Post-Traumatic Stress Disorder Symptoms. J Neurotrauma 2018; 35:767-779. [PMID: 29179667 PMCID: PMC8117405 DOI: 10.1089/neu.2017.5428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Traumatic brain injury (TBI) disrupts brain communication and increases risk for post-traumatic stress disorder (PTSD). However, mechanisms by which TBI-related disruption of brain communication confers PTSD risk have not been successfully elucidated in humans. This may be in part because functional MRI (fMRI), the most common technique for measuring functional brain communication, is unreliable for characterizing individual patients. However, this unreliability can be overcome with sufficient within-individual data. Here, we examined whether relationships could be observed among TBI, structural and functional brain connectivity, and PTSD severity by collecting ∼3.5 hours of resting-state fMRI and diffusion tensor imaging (DTI) data in each of 26 United States military veterans. We observed that a TBI history was associated with decreased whole-brain resting-state functional connectivity (RSFC), while the number of lifetime TBIs was associated with reduced whole-brain fractional anisotropy (FA). Both RSFC and FA explained independent variance in PTSD severity, with RSFC mediating the TBI-PTSD relationship. Finally, we showed that large amounts of per-individual data produced highly reliable RSFC measures, and that relationships among TBI, RSFC/FA, and PTSD could not be observed with typical data quantities. These results demonstrate links among TBI, brain connectivity, and PTSD severity, and illustrate the need for precise characterization of individual patients using high-data fMRI scanning.
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Affiliation(s)
- Evan M. Gordon
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
| | - Randall S. Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
| | | | | | - Geoffrey J. May
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
- Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, College Station, TX
| | - Eric C. Meyer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, College Station, TX
| | - Steven M. Nelson
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
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Vergara VM, Mayer AR, Damaraju E, Calhoun VD. The effect of preprocessing in dynamic functional network connectivity used to classify mild traumatic brain injury. Brain Behav 2017; 7:e00809. [PMID: 29075569 PMCID: PMC5651393 DOI: 10.1002/brb3.809] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/19/2017] [Accepted: 07/20/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Dynamic functional network connectivity (dFNC), derived from magnetic resonance imaging (fMRI), is an important technique in the search for biomarkers of brain diseases such as mild traumatic brain injury (mTBI). At the individual level, mTBI can affect cognitive functions and change personality traits. Previous research aimed at detecting significant changes in the dFNC of mTBI subjects. However, one of the main concerns in dFNC analysis is the appropriateness of methods used to correct for subject movement. In this work, we focus on the effect that rearranging movement correction at different points of the processing pipeline has in dFNC analysis utilizing mTBI data. METHODS The sample cohort consists of 50 mTBI patients and matched healthy controls. A 5-min resting-state run was completed by each participant. Data were preprocessed using different pipeline alternatives varying with the place where motion-related variance was removed. In all pipelines, group-independent component analysis (gICA) followed by dFNC analysis was performed. Additional tests were performed varying the detection of temporal spikes, the number of gICA components, and the sliding-window size. A linear support vector machine was used to test how each pipeline affects classification accuracy. RESULTS Results suggest that correction for motion variance before spatial smoothing, but leaving correction for spiky time courses after gICA produced the best mean classification performance. The number of gICA components and the sliding-window size were also important in determining classification performance. Variance in spikes correction affected some pipelines more than others with fewer significant differences than the other parameters. CONCLUSION The sequence of preprocessing steps motion regression, smoothing, gICA, and despiking produced data most suitable for differentiating mTBI from healthy subjects. However, the selection of optimal preprocessing parameters strongly affected the final results.
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Affiliation(s)
| | - Andrew R Mayer
- The Mind Research Network Albuquerque NM USA.,Departments of Neurology and Psychiatry University of New Mexico Albuquerque NM USA
| | | | - Vince D Calhoun
- The Mind Research Network Albuquerque NM USA.,Department of Electrical and Computer Engineering University of New Mexico Albuquerque NM USA
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Miller DR, Logue MW, Wolf EJ, Maniates H, Robinson ME, Hayes JP, Stone A, Schichman S, McGlinchey RE, Milberg WP, Miller MW. Posttraumatic stress disorder symptom severity is associated with reduced default mode network connectivity in individuals with elevated genetic risk for psychopathology. Depress Anxiety 2017; 34:632-640. [PMID: 28494120 PMCID: PMC5523965 DOI: 10.1002/da.22633] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Accumulating evidence suggests that posttraumatic stress disorder (PTSD) is associated with disrupted default mode network (DMN) connectivity, but findings across studies have not been uniform. Individual differences in relevant genes may account for some of the reported variability in the relationship between DMN connectivity and PTSD. In this study, we investigated this possibility using genome-wide association study (GWAS) derived polygenic risk scores (PRSs) for relevant psychiatric traits. We hypothesized that the association between PTSD and DMN connectivity would be moderated by genetic risk for one or more psychiatric traits such that individuals with elevated polygenic risk for psychopathology and severe PTSD would exhibit disrupted DMN connectivity. METHODS Participants were 156 white, non-Hispanic veterans of the wars in Iraq and Afghanistan who were genotyped and underwent resting state functional magnetic resonance imaging and clinical assessment. PRSs for neuroticism, anxiety, major depressive disorder, and cross-disorder risk (based on five psychiatric disorders) were calculated using summary statistics from published large-scale consortia-based GWASs. RESULTS Cross-disorder polygenic risk influenced the relationship between DMN connectivity and PTSD symptom severity such that individuals at greater genetic risk showed a significant negative association between PTSD symptom severity and connectivity between the posterior cingulate cortex and right middle temporal gyrus. Polygenic risk for neuroticism, anxiety, and major depressive disorder did not influence DMN connectivity directly or through an interaction with PTSD. CONCLUSIONS Findings illustrate the potential power of genome-wide PRSs to advance understanding of the relationship between PTSD and DMN connectivity, a putative neural endophenotype of the disorder.
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Affiliation(s)
- Danielle R. Miller
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Mark W. Logue
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Biomedical Genetics, Boston University School of Medicine, Boston, MA, USA,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Erika J. Wolf
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Hannah Maniates
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Meghan E. Robinson
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Geriatric Research, Educational and Clinical Center and Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System, Boston, MA, USA
| | - Jasmeet P. Hayes
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA USA
| | - Annjanette Stone
- Pharmacogenomics Analysis Laboratory, Research Service, Central Arkansas Veterans Healthcare System
| | - Steven Schichman
- Pharmacogenomics Analysis Laboratory, Research Service, Central Arkansas Veterans Healthcare System
| | - Regina E. McGlinchey
- Geriatric Research, Educational and Clinical Center and Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - William P. Milberg
- Geriatric Research, Educational and Clinical Center and Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark W. Miller
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Vergara VM, Mayer AR, Damaraju E, Hutchison K, Calhoun VD. The effect of preprocessing pipelines in subject classification and detection of abnormal resting state functional network connectivity using group ICA. Neuroimage 2017; 145:365-376. [PMID: 27033684 PMCID: PMC5035165 DOI: 10.1016/j.neuroimage.2016.03.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022] Open
Abstract
Resting state functional network connectivity (rsFNC) derived from functional magnetic resonance (fMRI) imaging is emerging as a possible biomarker to identify several brain disorders. Recently it has been pointed out that methods used to preprocess head motion variance might not fully remove all unwanted effects in the data. Proposed processing pipelines locate the treatment of head motion effects either close to the beginning or as one of the final steps. In this work, we assess several preprocessing pipelines applied in group independent component analysis (gICA) methods to study the rsFNC of the brain. The evaluation method utilizes patient/control classification performance based on linear support vector machines and leave-one-out cross validation. In addition, we explored group tests and correlation with severity measures in the patient population. We also tested the effect of removing high frequencies via filtering. Two real data cohorts were used: one consisting of 48 mTBI and one composed of 21 smokers, both with their corresponding matched controls. A simulation procedure was designed to test the classification power of each pipeline. Results show that data preprocessing can change the classification performance. In real data, regressing motion variance before gICA produced clearer group differences and stronger correlation with nicotine dependence.
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Affiliation(s)
- Victor M Vergara
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA.
| | - Andrew R Mayer
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA; Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Eswar Damaraju
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM 87106, USA
| | - Kent Hutchison
- Departments of Psychology and Neuroscience, University of Colorado, Boulder, CO 80302, USA
| | - Vince D Calhoun
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM 87106, USA
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Salat DH, Robinson ME, Miller DR, Clark DC, McGlinchey RE. Neuroimaging of deployment-associated traumatic brain injury (TBI) with a focus on mild TBI (mTBI) since 2009. Brain Inj 2017; 31:1204-1219. [PMID: 28981347 PMCID: PMC9206728 DOI: 10.1080/02699052.2017.1327672] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES A substantial body of recent research has aimed to better understand the clinical sequelae of military trauma through the application of advanced brain imaging procedures in Veteran populations. The primary objective of this review was to highlight a portion of these recent studies to demonstrate how imaging tools can be used to understand military-associated brain injury. METHODS We focus here on the phenomenon of mild traumatic brain injury (mTBI) given its high prevalence in the Veteran population and current recognition of the need to better understand the clinical implications of this trauma. This is intended to provide readers with an initial exposure to the field of neuroimaging of mTBI with a brief introduction to the concept of traumatic brain injury, followed by a summary of the major imaging techniques that have been applied to the study of mTBI. RESULTS Taken together, the collection of studies reviewed demonstrates a clear role for neuroimaging towards understanding the various neural consequences of mTBI as well as the clinical complications of such brain changes. CONCLUSIONS This information must be considered in the larger context of research into mTBI, including the potentially unique nature of blast exposure and the long-term consequences of mTBI.
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Affiliation(s)
- David H. Salat
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Department of Radiology, Charlestown, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - Meghan E. Robinson
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Danielle R. Miller
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Dustin C. Clark
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Geriatric Research, Education and Clinical Center (GRECC), Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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46
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Wu X, Kirov II, Gonen O, Ge Y, Grossman RI, Lui YW. MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update. Radiology 2016; 279:693-707. [PMID: 27183405 DOI: 10.1148/radiol.16142535] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mild traumatic brain injury (mTBI), also commonly referred to as concussion, affects millions of Americans annually. Although computed tomography is the first-line imaging technique for all traumatic brain injury, it is incapable of providing long-term prognostic information in mTBI. In the past decade, the amount of research related to magnetic resonance (MR) imaging of mTBI has grown exponentially, partly due to development of novel analytical methods, which are applied to a variety of MR techniques. Here, evidence of subtle brain changes in mTBI as revealed by these techniques, which are not demonstrable by conventional imaging, will be reviewed. These changes can be considered in three main categories of brain structure, function, and metabolism. Macrostructural and microstructural changes have been revealed with three-dimensional MR imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and higher order diffusion imaging. Functional abnormalities have been described with both task-mediated and resting-state blood oxygen level-dependent functional MR imaging. Metabolic changes suggesting neuronal injury have been demonstrated with MR spectroscopy. These findings improve understanding of the true impact of mTBI and its pathogenesis. Further investigation may eventually lead to improved diagnosis, prognosis, and management of this common and costly condition. (©) RSNA, 2016.
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Affiliation(s)
- Xin Wu
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Ivan I Kirov
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Oded Gonen
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Yulin Ge
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Robert I Grossman
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Yvonne W Lui
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
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Huang MX, Harrington DL, Robb Swan A, Angeles Quinto A, Nichols S, Drake A, Song T, Diwakar M, Huang CW, Risbrough VB, Dale A, Bartsch H, Matthews S, Huang JW, Lee RR, Baker DG. Resting-State Magnetoencephalography Reveals Different Patterns of Aberrant Functional Connectivity in Combat-Related Mild Traumatic Brain Injury. J Neurotrauma 2016; 34:1412-1426. [PMID: 27762653 DOI: 10.1089/neu.2016.4581] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Blast mild traumatic brain injury (mTBI) is a leading cause of sustained impairment in military service members and veterans. However, the mechanism of persistent disability is not fully understood. The present study investigated disturbances in brain functioning in mTBI participants using a source-imaging-based approach to analyze functional connectivity (FC) from resting-state magnetoencephalography (rs-MEG). Study participants included 26 active-duty service members or veterans who had blast mTBI with persistent post-concussive symptoms, and 22 healthy control active-duty service members or veterans. The source time courses from regions of interest (ROIs) were used to compute ROI to whole-brain (ROI-global) FC for different frequency bands using two different measures: 1) time-lagged cross-correlation and 2) phase-lock synchrony. Compared with the controls, blast mTBI participants showed increased ROI-global FC in beta, gamma, and low-frequency bands, but not in the alpha band. Sources of abnormally increased FC included the: 1) prefrontal cortex (right ventromedial prefrontal cortex [vmPFC], right rostral anterior cingulate cortex [rACC]), and left ventrolateral and dorsolateral prefrontal cortex; 2) medial temporal lobe (bilateral parahippocampus, hippocampus, and amygdala); and 3) right putamen and cerebellum. In contrast, the blast mTBI group also showed decreased FC of the right frontal pole. Group differences were highly consistent across the two different FC measures. FC of the left ventrolateral prefrontal cortex correlated with executive functioning and processing speed in mTBI participants. Altogether, our findings of increased and decreased regionalpatterns of FC suggest that disturbances in intrinsic brain connectivity may be the result of multiple mechanisms, and are associated with cognitive sequelae of the injury.
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Affiliation(s)
- Ming-Xiong Huang
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Deborah L Harrington
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Ashley Robb Swan
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Annemarie Angeles Quinto
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Sharon Nichols
- 3 Department of Neuroscience, University of California , San Diego, California
| | | | - Tao Song
- 2 Department of Radiology, University of California , San Diego, California
| | - Mithun Diwakar
- 2 Department of Radiology, University of California , San Diego, California
| | - Charles W Huang
- 5 Department of Bioengineering, University of California , San Diego, California
| | - Victoria B Risbrough
- 6 Department of Psychiatry, University of California , San Diego, California.,7 VA Center of Excellence for Stress and Mental Health , San Diego, California
| | - Anders Dale
- 2 Department of Radiology, University of California , San Diego, California
| | - Hauke Bartsch
- 2 Department of Radiology, University of California , San Diego, California
| | - Scott Matthews
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,6 Department of Psychiatry, University of California , San Diego, California.,8 Aspire Center , VASDHS Residential Rehabilitation Treatment Program, San Diego, California
| | | | - Roland R Lee
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Dewleen G Baker
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,6 Department of Psychiatry, University of California , San Diego, California.,7 VA Center of Excellence for Stress and Mental Health , San Diego, California
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Vergara VM, Mayer AR, Damaraju E, Kiehl KA, Calhoun V. Detection of Mild Traumatic Brain Injury by Machine Learning Classification Using Resting State Functional Network Connectivity and Fractional Anisotropy. J Neurotrauma 2016; 34:1045-1053. [PMID: 27676221 DOI: 10.1089/neu.2016.4526] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) may adversely affect a person's thinking, memory, personality, and behavior. While mild TBI (mTBI) diagnosis is challenging, there is a risk for long-term psychiatric, neurologic, and psychosocial problems in some patients that motivates the search for new and better biomarkers. Recently, diffusion magnetic resonance imaging (dMRI) has shown promise in detecting mTBI, but its validity is still being investigated. Resting state functional network connectivity (rsFNC) is another approach that is emerging as a promising option for the diagnosis of mTBI. The present work investigated the use of rsFNC for mTBI detection compared with dMRI results on the same cohort. Fifty patients with mTBI (25 males) and age-sex matched healthy controls were recruited. Features from dMRI were obtained using all voxels, the enhanced Z-score microstructural assessment for pathology, and the distribution corrected Z-score. Features based on rsFNC were obtained through group independent component analysis and correlation between pairs of resting state networks. A linear support vector machine was used for classification and validated using leave-one-out cross validation. Classification achieved a maximum accuracy of 84.1% for rsFNC and 75.5% for dMRI and 74.5% for both combined. A t test analysis revealed significant increase in rsFNC between cerebellum versus sensorimotor networks and between left angular gyrus versus precuneus in subjects with mTBI. These outcomes suggest that inclusion of both common and unique information is important for classification of mTBI. Results also suggest that rsFNC can yield viable biomarkers that might outperform dMRI and points to connectivity to the cerebellum as an important region for the detection of mTBI.
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Affiliation(s)
- Victor M Vergara
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Andrew R Mayer
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,2 Department of Neurology, University of New Mexico School of Medicine , Albuquerque, New Mexico
| | - Eswar Damaraju
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,3 Department of ECE, University of New Mexico , Albuquerque, New Mexico
| | - Kent A Kiehl
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,4 Department of Psychology, University of New Mexico , Albuquerque, New Mexico
| | - Vince Calhoun
- 1 The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,3 Department of ECE, University of New Mexico , Albuquerque, New Mexico
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Abstract
OBJECTIVES Blast explosions are the most frequent mechanism of traumatic brain injury (TBI) in recent wars, but little is known about their long-term effects. METHODS Functional connectivity (FC) was measured in 17 veterans an average of 5.46 years after their most serious blast related TBI, and in 15 demographically similar veterans without TBI or blast exposure. Subcortical FC was measured in bilateral caudate, putamen, and globus pallidus. The default mode and fronto-parietal networks were also investigated. RESULTS In subcortical regions, between-groups t tests revealed altered FC from the right putamen and right globus pallidus. However, following analysis of covariance (ANCOVA) with age, depression (Center for Epidemiologic Studies Depression Scale), and posttraumatic stress disorder symptom (PTSD Checklist - Civilian version) measures, significant findings remained only for the right globus pallidus with anticorrelation in bilateral temporal occipital fusiform cortex, occipital fusiform gyrus, lingual gyrus, and cerebellum, as well as the right occipital pole. No group differences were found for the default mode network. Although reduced FC was found in the fronto-parietal network in the TBI group, between-group differences were nonsignificant after the ANCOVA. CONCLUSIONS FC of the globus pallidus is altered years after exposure to blast related TBI. Future studies are necessary to explore the trajectory of changes in FC in subcortical regions after blast TBI, the effects of isolated versus repetitive blast-related TBI, and the relation to long-term outcomes in veterans. (JINS, 2016, 22, 631-642).
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Advanced neuroimaging applied to veterans and service personnel with traumatic brain injury: state of the art and potential benefits. Brain Imaging Behav 2016; 9:367-402. [PMID: 26350144 DOI: 10.1007/s11682-015-9444-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Traumatic brain injury (TBI) remains one of the most prevalent forms of morbidity among Veterans and Service Members, particularly for those engaged in the conflicts in Iraq and Afghanistan. Neuroimaging has been considered a potentially useful diagnostic and prognostic tool across the spectrum of TBI generally, but may have particular importance in military populations where the diagnosis of mild TBI is particularly challenging, given the frequent lack of documentation on the nature of the injuries and mixed etiologies, and highly comorbid with other disorders such as post-traumatic stress disorder, depression, and substance misuse. Imaging has also been employed in attempts to understand better the potential late effects of trauma and to evaluate the effects of promising therapeutic interventions. This review surveys the use of structural and functional neuroimaging techniques utilized in military studies published to date, including the utilization of quantitative fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), volumetric analysis, diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), positron emission tomography (PET), magnetoencephalography (MEG), task-based and resting state functional MRI (fMRI), arterial spin labeling (ASL), and magnetic resonance spectroscopy (MRS). The importance of quality assurance testing in current and future research is also highlighted. Current challenges and limitations of each technique are outlined, and future directions are discussed.
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