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Donahue EK, Foreman RP, Duran JJ, Jakowec MW, O'Neill J, Petkus AJ, Holschneider DP, Choupan J, Van Horn JD, Venkadesh S, Bayram E, Litvan I, Schiehser DM, Petzinger GM. Increased perivascular space volume in white matter and basal ganglia is associated with cognition in Parkinson's Disease. Brain Imaging Behav 2024; 18:57-65. [PMID: 37855955 PMCID: PMC10844402 DOI: 10.1007/s11682-023-00811-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
Perivascular spaces (PVS), fluid-filled compartments surrounding brain vasculature, are an essential component of the glymphatic system responsible for transport of waste and nutrients. Glymphatic system impairment may underlie cognitive deficits in Parkinson's disease (PD). Studies have focused on the role of basal ganglia PVS with cognition in PD, but the role of white matter PVS is unknown. This study examined the relationship of white matter and basal ganglia PVS with domain-specific and global cognition in individuals with PD. Fifty individuals with PD underwent 3T T1w magnetic resonance imaging (MRI) to determine PVS volume fraction, defined as PVS volume normalized to total regional volume, within (i) centrum semiovale, (ii) prefrontal white matter (medial orbitofrontal, rostral middle frontal, superior frontal), and (iii) basal ganglia. A neuropsychological battery included assessment of global cognitive function (Montreal Cognitive Assessment, and global cognitive composite score), and cognitive-specific domains (executive function, memory, visuospatial function, attention, and language). Higher white matter rostral middle frontal PVS was associated with lower scores in both global cognitive and visuospatial function. In the basal ganglia higher PVS was associated with lower scores for memory with a trend towards lower global cognitive composite score. While previous reports have shown that greater amount of PVS in the basal ganglia is associated with decline in global cognition in PD, our findings suggest that increased white matter PVS volume may also underlie changes in cognition.
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Affiliation(s)
- Erin Kaye Donahue
- Department of Neurology, Keck School of Medicine, University of Southern California, 1333 San Pablo St, MCA-243, Los Angeles, CA, 90033, USA
| | - Ryan Patrick Foreman
- Department of Neurology, Keck School of Medicine, University of Southern California, 1333 San Pablo St, MCA-243, Los Angeles, CA, 90033, USA
| | - Jared Joshua Duran
- Department of Neurology, Keck School of Medicine, University of Southern California, 1333 San Pablo St, MCA-243, Los Angeles, CA, 90033, USA
| | - Michael Walter Jakowec
- Department of Neurology, Keck School of Medicine, University of Southern California, 1333 San Pablo St, MCA-243, Los Angeles, CA, 90033, USA
| | - Joseph O'Neill
- Division of Child Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, 90024, USA
| | - Andrew J Petkus
- Department of Neurology, Keck School of Medicine, University of Southern California, 1333 San Pablo St, MCA-243, Los Angeles, CA, 90033, USA
| | - Daniel P Holschneider
- Department of Neurology, Keck School of Medicine, University of Southern California, 1333 San Pablo St, MCA-243, Los Angeles, CA, 90033, USA
- Department of Psychiatry & the Behavioral Sciences, University of Southern California, Los Angeles, CA, 90033, USA
| | - Jeiran Choupan
- Laboratory of NeuroImaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, Charlottesville, VA, 22904, USA
- School of Data Science, University of Virginia, Charlottesville, VA, 22904, USA
| | - Siva Venkadesh
- Department of Psychology, University of Virginia, Charlottesville, VA, 22904, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorder Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Irene Litvan
- Parkinson and Other Movement Disorder Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Dawn M Schiehser
- Veterans Administration San Diego Healthcare System (VASDHS), San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego, CA, 92093, USA
| | - Giselle Maria Petzinger
- Department of Neurology, Keck School of Medicine, University of Southern California, 1333 San Pablo St, MCA-243, Los Angeles, CA, 90033, USA.
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Nakhla MZ, Bangen KJ, Schiehser DM, Roesch S, Zlatar ZZ. Greater subjective cognitive decline severity is associated with worse memory performance and lower entorhinal cerebral blood flow in healthy older adults. J Int Neuropsychol Soc 2024; 30:1-10. [PMID: 36781410 PMCID: PMC10423746 DOI: 10.1017/s1355617723000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Subjective cognitive decline (SCD) is a potential early risk marker for Alzheimer's disease (AD), but its utility may vary across individuals. We investigated the relationship of SCD severity with memory function and cerebral blood flow (CBF) in areas of the middle temporal lobe (MTL) in a cognitively normal and overall healthy sample of older adults. Exploratory analyses examined if the association of SCD severity with memory and MTL CBF was different in those with lower and higher cardiovascular disease (CVD) risk status. METHODS Fifty-two community-dwelling older adults underwent magnetic resonance imaging, neuropsychological testing, and were administered the Everyday Cognition Scale (ECog) to measure SCD. Regression models investigated whether ECog scores were associated with memory performance and MTL CBF, followed by similar exploratory regressions stratified by CVD risk status (i.e., lower vs higher stroke risk). RESULTS Higher ECog scores were associated with lower objective memory performance and lower entorhinal cortex CBF after adjusting for demographics and mood. In exploratory stratified analyses, these associations remained significant in the higher stroke risk group only. CONCLUSIONS Our preliminary findings suggest that SCD severity is associated with cognition and brain markers of preclinical AD in otherwise healthy older adults with overall low CVD burden and that this relationship may be stronger for individuals with higher stroke risk, although larger studies with more diverse samples are needed to confirm these findings. Our results shed light on individual characteristics that may increase the utility of SCD as an early risk marker of cognitive decline.
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Affiliation(s)
- Marina Z. Nakhla
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Katherine J. Bangen
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Dawn M. Schiehser
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Scott Roesch
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, 92182
| | - Zvinka Z. Zlatar
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
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Caudle MM, Spadoni AD, Schiehser DM, Simmons AN, Bomyea J. Neural activity and network analysis for understanding reasoning using the matrix reasoning task. Cogn Process 2023; 24:585-594. [PMID: 37597116 PMCID: PMC10533635 DOI: 10.1007/s10339-023-01152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
Reasoning requires the ability to manipulate mental representations and understand relationships between objects. There is a paucity of research regarding the functional connections between multiple brain areas that may interact during commonly used reasoning tasks. The present study aimed to examine functional activation and connectivity of frontoparietal regions during a Matrix Decision Making Task, completed by twenty-one right-handed healthy participants while undergoing fMRI. Voxel-wise whole brain analysis of neural response to the task revealed activation spanning dorsal and lateral prefrontal, occipital, and parietal regions. Utilizing Group Iterative Multiple Model Estimation, a data-driven approach that estimates the presence and direction of connectivity between specific ROIs, connectivity between prefrontal and sensory processing regions were revealed. Moreover, the magnitude of connectivity strength between the left precentral gyrus and left dorsal cingulate (dACC) was positively correlated with MR behavioral performance. Taken together, results are consistent with earlier work demonstrating involvement of regions comprising the central executive network in relational reasoning. These data expand existing knowledge regarding communication of key brain regions during the task and demonstrate that understanding how key brain regions are interconnected can effectively predict the quality of behavioral output.
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Affiliation(s)
- M M Caudle
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California San Diego, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - A D Spadoni
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - D M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - A N Simmons
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - J Bomyea
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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Donahue EK, Venkadesh S, Bui V, Tuazon AC, Wang RK, Haase D, Foreman RP, Duran JJ, Petkus A, Wing D, Higgins M, Holschneider DP, Bayram E, Litvan I, Jakowec MW, Van Horn JD, Schiehser DM, Petzinger GM. Physical activity intensity is associated with cognition and functional connectivity in Parkinson's disease. Parkinsonism Relat Disord 2022; 104:7-14. [PMID: 36191358 DOI: 10.1016/j.parkreldis.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cognitive impairment is common in Parkinson's disease (PD) and often leads to dementia, with no effective treatment. Aging studies suggest that physical activity (PA) intensity has a positive impact on cognition and enhanced functional connectivity may underlie these benefits. However, less is known in PD. This cross-sectional study examined the relationship between PA intensity, cognitive performance, and resting state functional connectivity in PD and whether PA intensity influences the relationship between functional connectivity and cognitive performance. METHODS 96 individuals with mild-moderate PD completed a comprehensive neuropsychological battery. Intensity of PA was objectively captured over a seven-day period using a wearable device (ActiGraph). Time spent in light and moderate intensity PA was determined based on standardized actigraphy cut points. Resting-state fMRI was assessed in a subset of 50 individuals to examine brain-wide functional connectivity. RESULTS Moderate intensity PA (MIPA), but not light PA, was associated with better global cognition, visuospatial function, memory, and executive function. Individuals who met the WHO recommendation of ≥150 min/week of MIPA demonstrated better global cognition, executive function, and visuospatial function. Resting-state functional connectivity associated with MIPA included a combination of brainstem, hippocampus, and regions in the frontal, cingulate, and parietal cortices, which showed higher connectivity across the brain in those achieving the WHO MIPA recommendation. Meeting this recommendation positively moderated the associations between identified functional connectivity and global cognition, visuospatial function, and language. CONCLUSION Encouraging MIPA, particularly the WHO recommendation of ≥150 min of MIPA/week, may represent an important prescription for PD cognition.
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Affiliation(s)
- Erin K Donahue
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Siva Venkadesh
- Department of Psychology, University of Virginia, Charlottesville, VA, 22904, USA
| | - Vy Bui
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Angelie Cabrera Tuazon
- Veterans Administration San Diego Healthcare System (VASDHS), San Diego, CA, 92161, USA; Department of Psychiatry, University of California, San Diego, CA, 92093, USA
| | - Ryan K Wang
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Danielle Haase
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ryan P Foreman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Jared J Duran
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Andrew Petkus
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - David Wing
- Veterans Administration San Diego Healthcare System (VASDHS), San Diego, CA, 92161, USA; Herbert Wertheim School of Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, USA
| | - Michael Higgins
- Veterans Administration San Diego Healthcare System (VASDHS), San Diego, CA, 92161, USA; Herbert Wertheim School of Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, USA
| | - Daniel P Holschneider
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA; Department of Psychiatry & the Behavioral Sciences, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorder Center, Department of Neurosciences, University of California San Diego, California, 92092-0886, USA
| | - Irene Litvan
- Parkinson and Other Movement Disorder Center, Department of Neurosciences, University of California San Diego, California, 92092-0886, USA
| | - Michael W Jakowec
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, Charlottesville, VA, 22904, USA; School of Data Science, University of Virginia, Charlottesville, VA, 22904, USA
| | - Dawn M Schiehser
- Veterans Administration San Diego Healthcare System (VASDHS), San Diego, CA, 92161, USA; Department of Psychiatry, University of California, San Diego, CA, 92093, USA
| | - Giselle M Petzinger
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
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Whiteley N, Pluim CF, Split M, Cabrera Tuazon A, Moore RC, Irene Litvan, Lessig S, Filoteo JV, Schiehser DM. Prospective predictors of care partner burden and depression in Parkinson's disease. Int J Geriatr Psychiatry 2022; 37. [PMID: 35996353 DOI: 10.1002/gps.5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Care partners who provide informal care to individuals with Parkinson's disease (PD) report higher levels of burden and depression; however, longitudinal research on these symptoms is scarce. The current study assessed changes in care partner burden and depression, and patient and care partner predictors of these symptoms over time. Such knowledge may provide important information for assessment and treatment of depression and burden in care partners of individuals with PD. RESEARCH DESIGN AND METHODS Participants were 88 PD patients without dementia and their self-identified care partner (n = 88). Care partners completed the Geriatric Depression Scale and Zarit Burden Interview. PD participants completed mood questionnaires and a motor exam at baseline and 2 year follow-up. Relationships among care partner burden and depression over time with patient and care partner predictors (i.e., demographic, mood, and disease characteristics) were assessed using correlations and regression analyses. RESULTS Care partner burden and depression significantly increased over an approximate 2 year period. Greater baseline disease severity predicted worsening of care partner burden (p = 0.028), while baseline patient depression predicted worsening of care partner depression (p = 0.002). CONCLUSIONS Results highlight differential impacts of specific PD symptoms on worsening care partner burden compared to depression; increased PD disease severity predicts increased burden, while patient mood predicts worsening of depression over time. Targeting PD disease severity and mood symptoms may prevent the progression of care partner burden and depression.
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Affiliation(s)
- Nicole Whiteley
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Celina F Pluim
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Molly Split
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - Stephanie Lessig
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - J Vincent Filoteo
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, California, USA
| | - Dawn M Schiehser
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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Jurick SM, Crocker LD, Merritt VC, Sanderson-Cimino ME, Keller AV, Glassman LH, Twamley EW, Rodgers CS, Schiehser DM, Aupperle RL, Jak AJ. Independent and Synergistic Associations Between TBI Characteristics and PTSD Symptom Clusters on Cognitive Performance and Postconcussive Symptoms in Iraq and Afghanistan Veterans. J Neuropsychiatry Clin Neurosci 2022; 33:98-108. [PMID: 33441014 DOI: 10.1176/appi.neuropsych.20050128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators sought to evaluate the independent and interactive associations between mild traumatic brain injury (mTBI) characteristics and posttraumatic stress disorder (PTSD) symptoms with regard to postconcussive symptoms and cognition among treatment-seeking veterans of the U.S. conflicts in Iraq and Afghanistan. METHODS Sixty-seven Iraq and Afghanistan veterans who had a history of mTBI and comorbid PTSD were grouped based on injury mechanism (blast versus nonblast) and number of lifetime mTBIs (one to two versus three or more). Independent associations between mTBI characteristics and PTSD symptom clusters were evaluated with regard to cognition and postconcussive symptoms. Follow-up analyses were conducted to determine any interactive associations between TBI characteristics and PTSD symptom clusters. RESULTS Higher PTSD symptoms, particularly hyperarousal, were associated with poorer executive functioning and higher postconcussive symptoms. No direct relationships were observed between PTSD symptom clusters and memory or processing speed. The relationship between hyperarousal and processing speed was moderated by lifetime mTBIs, such that those with a history of at least three mTBIs demonstrated a negative association between hyperarousal and processing speed. Blast-related mTBI history was associated with reduced processing speed, compared with non-blast-related mTBI. However, an interaction was observed such that among those with blast-related mTBI history, higher re-experiencing symptoms were associated with poorer processing speed, whereas veterans without history of blast-related mTBI did not demonstrate an association between processing speed and re-experiencing symptoms. CONCLUSIONS Higher hyperarousal and re-experiencing symptoms were associated with reduced processing speed among veterans with repetitive and blast-related mTBI history, respectively. PTSD symptoms, specifically hyperarousal, were associated with poorer executive functioning and higher postconcussive symptoms. Limited associations were found between injury characteristics and cognition chronically following mTBI. However, these results support synergistic effects of specific PTSD symptom clusters and TBI characteristics.
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Affiliation(s)
- Sarah M Jurick
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Laura D Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Victoria C Merritt
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Mark E Sanderson-Cimino
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Amber V Keller
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Lisa H Glassman
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Carie S Rodgers
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Robin L Aupperle
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
| | - Amy J Jak
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego (Jurick, Crocker, Twamley, Schiehser, Jak); Department of Psychiatry, University of California San Diego (Jurick, Merritt, Glassman, Twamley, Schiehser, Jak); VA San Diego Healthcare System, San Diego (Jurick, Crocker, Merritt, Glassman, Twamley, Schiehser, Jak); San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Sanderson-Cimino, Keller); PsychArmor Institute, San Diego (Rodgers); and the Laureate Institute for Brain Research, University of Tulsa, Oklahoma (Aupperle)
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Pluim CF, Nakhla MZ, Split M, Filoteo JV, Litvan I, Moore RC, Lessig S, Schiehser DM. Changes in Self- and Informant-Reported Frontal Behaviors in Parkinson's Disease: A Longitudinal Study. J Geriatr Psychiatry Neurol 2022; 35:89-101. [PMID: 33030110 DOI: 10.1177/0891988720964257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Frontal behaviors (i.e., executive dysfunction, disinhibition, apathy) are common in Parkinson's disease (PD). However, it is unclear if patient and informant reports of patient frontal behaviors are in agreement over time. METHOD Sixty-two PD patients without dementia and their informants (87% spouses/partners) completed the self- and informant-versions of the Frontal Systems Behavior Scale at baseline and 2-year follow-up. Dyad ratings were compared and predictors of behavior ratings were examined. RESULTS Patient and informant reports at baseline and follow-up were in agreement, with significant increases in overall frontal behaviors, executive dysfunction, and apathy. Higher levels of baseline patient depression and caregiver burden predicted decrements in patient-reported executive function; worse patient cognition at baseline predicted worsening apathy as rated by informants. CONCLUSIONS PD patients and their informants are concordant in their ratings of worsening frontal behaviors over time. Targeting patient depression, cognition, and caregiver burden may improve decrements in frontal behaviors (executive dysfunction and apathy) in PD.
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Affiliation(s)
- Celina F Pluim
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA
| | - Marina Z Nakhla
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,464916SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Molly Split
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA
| | - J Vincent Filoteo
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, 8784University of California San Diego, La Jolla, CA, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, 8784University of California San Diego, La Jolla, CA, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, 8784University of California San Diego, La Jolla, CA, USA
| | - Raeanne C Moore
- Department of Psychiatry, 8784University of California San Diego, La Jolla, CA, USA
| | - Stephanie Lessig
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, 8784University of California San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, 8784University of California San Diego, La Jolla, CA, USA
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8
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Merritt VC, Sakamoto MS, Sorg SF, Clark AL, Bondi MW, Schiehser DM, Delano-Wood L. Elevated Neuropsychological Intraindividual Variability Predicts Poorer Health-Related Quality of Life in Veterans with a History of Mild Traumatic Brain Injury. J Neurotrauma 2022; 39:238-242. [PMID: 33599168 PMCID: PMC8785717 DOI: 10.1089/neu.2020.7516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We examined the association between cognitive functioning and health-related quality of life (HR-QOL) in military veterans with a history of mild traumatic brain injury (mTBI) using two methods to assess cognition: mean performance on cognitive composite scores and across-test intraindividual variability (IIV). The sample included 73 veterans (84.9% male; age, mean = 32.47 years) who completed neuropsychological testing and self-report questionnaires ∼7 years post-injury. Three cognitive composite scores representing mean performance were computed, including memory, attention/processing speed (A/PS), and executive functioning (EF). Three IIV indices were also calculated reflecting degree of dispersion across the same cognitive domains: memory-IIV, A/PS-IIV, and EF-IIV. The Posttraumatic Stress Disorder (PTSD) Checklist-Military Version (PCL-M) was used to assess current PTSD symptoms, and the World Health Organization Quality of Life Short Version Physical Health domain was used to assess HR-QOL. Hierarchical linear regressions adjusting for PTSD symptoms demonstrated that IIV indices, but not mean cognitive composite scores, significantly predicted HR-QOL. Specifically, memory-IIV, A/PS-IIV, and EF-IIV, when taken together, made an independent and significant contribution to the prediction of HR-QOL. Examination of the standardized coefficients showed that the A/PS-IIV index was uniquely associated with HR-QOL, such that higher A/PS-IIV scores significantly predicted poorer HR-QOL. Our results are the first to show that, in veterans with remote mTBI histories, greater fluctuations in cognitive performance significantly contribute to poorer HR-QOL, even after accounting for PTSD symptom severity. Moreover, findings suggest that, compared to traditional mean cognitive performance scores, measures of IIV may represent more sensitive indicators of clinical outcome and better align with subjective experiences of distress.
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Affiliation(s)
- Victoria C. Merritt
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - McKenna S. Sakamoto
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
| | - Scott F. Sorg
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alexandra L. Clark
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Mark W. Bondi
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Dawn M. Schiehser
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
| | - Lisa Delano-Wood
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, California, USA
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9
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Jarrahi B, McEwen SC, Holschneider DP, Schiehser DM, Petkus AJ, Gomez ME, Van Horn JD, Filoteo V, Jakowec MW, Petzinger GM. The Effects of Cardiorespiratory and Motor Skill Fitness on Intrinsic Functional Connectivity of Neural Networks in Individuals with Parkinson's Disease. Brain Plast 2021; 7:77-95. [PMID: 34868875 PMCID: PMC8609487 DOI: 10.3233/bpl-200115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Studies in aging older adults have shown the positive association between cognition and exercise related fitness, particularly cardiorespiratory fitness. These reports have also demonstrated the association of high cardiorespiratory fitness, as well as other types of fitness, on the reversal of age-related decline in neural network connectivity, highlighting the potential role of fitness on age- and disease-related brain changes. While the clinical benefits of exercise are well-documented in Parkinson’s disease (PD), the extent to which cardiorespiratory fitness (assessed by estimated VO2max testing) or motor skill fitness (assessed by the Physical Performance Test (PPT)) affects neural network connectivity in PD remains to be investigated. The purpose of this study was to explore the hypothesis that higher fitness level is associated with an increase in the intrinsic network connectivity of cognitive networks commonly affected in PD. Methods: In this cross-sectional resting state fMRI, we used a multivariate statistical approach based on high-dimensional independent component analysis (ICA) to investigate the association between two independent fitness metrics (estimated VO2max and PPT) and resting state network connectivity. Results: We found that increased estimated VO2max was associated with increased within network connectivity in cognitive networks known to be impaired in PD, including those sub-serving memory and executive function. There was a similar trend for high levels of PPT to be associated with increased within network connectivity in distinct resting state networks. The between functional network connectivity analysis revealed that cardiorespiratory fitness was associated with increased functional connectivity between somatosensory motor network and several cognitive networks sub-serving memory, attention, and executive function. Conclusion: This study provides important empirical data supporting the potential association between two forms of fitness and multiple resting state networks impacting PD cognition. Linking fitness to circuit specific modulation of resting state network connectivity will help establish a neural basis for the positive effects of fitness and specific exercise modalities and provide a foundation to identify underlying mechanisms to promote repair.
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Affiliation(s)
- Behnaz Jarrahi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sarah C McEwen
- Pacific Brain Health Center, Pacific Neuroscience Institute, Santa Monica, CA, USA.,Department of Translational Neurosciences and Neurotherapeutics, Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | - Daniel P Holschneider
- Department of Neurology, University of Southern California, Los Angeles, CA, USA.,Department of Psychiatry and the Behavioral Sciences, University of Southern California, San Pablo St., Los Angeles, CA, USA
| | - Dawn M Schiehser
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andrew J Petkus
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Megan E Gomez
- Department of Psychology, Tibor Rubin Veterans Administration Medical Center, Long Beach, CA, USA
| | - Jack D Van Horn
- Department of Psychology and School of Data Science, University of Virginia, Charlottesville, VA, USA
| | - Vincent Filoteo
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Michael W Jakowec
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Giselle M Petzinger
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
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10
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Sakamoto MS, Delano-Wood L, Schiehser DM, Merritt VC. Predicting veteran health-related quality of life following mild traumatic brain injury. Rehabil Psychol 2021; 66:461-469. [PMID: 34871025 DOI: 10.1037/rep0000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE To examine health-related quality of life (HR-QOL) in Veterans with and without a history of mild traumatic brain injury (mTBI) and investigate correlates and predictors of HR-QOL within the mTBI sample. Research Method/Design: Participants (N = 144) included 81 Veterans with a history of mTBI and 63 Veteran controls (VCs) without a history of mTBI. Primary outcomes of interest were the 8 subscales of the 36-Item Short Form Survey (SF-36). Participants also completed questionnaires measuring combat exposure, depressive and posttraumatic stress disorder (PTSD) symptoms, and neurobehavioral symptoms. RESULTS ANCOVAs adjusting for age found that, relative to VCs, the mTBI group demonstrated poorer HR-QOL across all SF-36 subscales (p's = ≤.001-.006; ηp² = .05-.21). After adjusting for age, combat exposure, and depressive and PTSD symptoms, the mTBI group endorsed poorer HR-QOL on the Physical Role Functioning, General Health, and Social Functioning subscales (p's = .011-.032; ηp² = .03-.05). Within the mTBI sample, employment status, lifetime number of mTBIs, depression, PTSD, and neurobehavioral symptoms collectively predicted all 8 SF-36 subscales (p's < .001), accounting for 29-65% of the total variance. Although depression and neurobehavioral symptoms tended to be the strongest predictors of HR-QOL, lifetime number of mTBIs and employment status were also important predictors of specific HR-QOL domains. CONCLUSIONS Results suggest that, above and beyond depression, PTSD, and combat exposure, history of remote mTBI contributes to aspects of HR-QOL-particularly in perceptions of physical health and social functioning. Furthermore, different combinations of predictor variables are associated with different HR-QOL domains, highlighting the need for multimodal treatments within this vulnerable population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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11
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Sorg SF, Werhane ML, Merritt VC, Clark AL, Holiday KA, Hanson KL, Jak AJ, Schiehser DM, Delano-Wood L. Research Letter: PTSD Symptom Severity and Multiple Traumatic Brain Injuries Are Associated With Elevated Memory Complaints in Veterans With Histories of Mild TBI. J Head Trauma Rehabil 2021; 36:418-423. [PMID: 33656481 PMCID: PMC8969182 DOI: 10.1097/htr.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The evaluation of memory complaints in mild traumatic brain injury (mTBI) remains an important clinical consideration, especially in the context of comorbid psychiatric symptoms such as posttraumatic stress disorder (PTSD). We compared subjective memory complaints in veterans with and without a history of mTBI, examined ratings between those with single versus multiple mTBIs, and investigated associations between memory complaints and PTSD symptom severity. METHODS 117 outpatient veterans (mTBI: n = 79 [single mTBI: n = 22, multiple mTBI: n = 57], military controls [MCs]: n = 38) completed a TBI history assessment, the Prospective-Retrospective Memory Questionnaire (PRMQ), and the PTSD Checklist-Military Version (PCL-M). RESULTS Hierarchical multiple regression showed that greater PCL-M scores significantly predicted elevated PRMQ-Total scores, accounting for 38% of the variance explained (P < .001). mTBI status predicted an additional 5% of variance in memory complaints (P < .01). The multiple-mTBI group endorsed more memory complaints than either MCs (P < .01) or the single-mTBI group (P < .05), who did not differ from MCs (P > .50). CONCLUSIONS Comorbid PTSD symptoms are an important factor when considering memory complaints in veterans with a reported history of mTBI. However, independent of comorbid PTSD symptoms, mTBI status-particularly in the context of repetitive neurotrauma-uniquely contributes to memory complaints. Findings suggest that veterans with a history of multiple mTBIs may be a particularly vulnerable group in need of specialized interventions and/or psychoeducation.
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Affiliation(s)
- Scott F Sorg
- Research and Psychology Services (Drs Sorg, Merritt, Clark, Hanson, Jak, Schiehser, and Delano-Wood) and Center of Excellence for Stress and Mental Health (Drs Jak, Schiehser, and Delano-Wood), VA San Diego Healthcare System, San Diego, California; SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California (Ms Holiday); Department of Psychiatry, University of California San Diego (Drs Sorg, Merritt, Clark, Hanson, Jak, Schiehser, and Delano-Wood); and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dr Werhane)
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12
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Sakamoto MS, Delano-Wood L, Sorg SF, Schiehser DM, Merritt VC. Unemployment Status Is Associated With Greater Cognitive Intraindividual Variability in Veterans With a History of Remote Mild TBI. J Head Trauma Rehabil 2021; 36:E391-E396. [PMID: 34145154 DOI: 10.1097/htr.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between employment status and neuropsychological functioning in veterans with a history of remote mild traumatic brain injury (mTBI) using 2 approaches to assess cognitive performance: (a) standard, traditional mean cognitive performance; and (b) across-test intraindividual variability (IIV). SETTING Outpatient Veterans Affairs (VA) hospital. PARTICIPANTS Eligibility criteria included veterans with a history of mTBI who performed adequately on performance validity tests. Participants (N = 75; 37 employed, 38 unemployed) were evaluated, on average, about 5.5 years after their most recent mTBI. DESIGN Observational cohort study; all participants completed a clinical interview and a comprehensive neuropsychological assessment. MAIN MEASURES Primary outcomes of interest included mean cognitive composite test scores and IIV scores on tasks of memory, attention/processing speed, and executive functioning. RESULTS Logistic regression models showed that mean cognitive performance was not predictive of employment status; however, IIV indices were ( = 7.88, P = .048) and accounted for 13% of the variance. Greater memory-IIV was significantly associated with being unemployed (β = -.16, SE = .07, P = .020, Exp(B) = 0.85; 95% CI, 0.74-0.98). CONCLUSION These findings build upon prior work showing that IIV, or cognitive dispersion, is associated with important functional outcomes following mTBI, including employment status. Future studies are needed to verify these findings, but the present study suggests that IIV indices offer a clinically meaningful marker of cognitive functioning and should be considered when evaluating functional outcomes following head trauma.
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Affiliation(s)
- McKenna S Sakamoto
- Research & Psychology Services (Ms Sakamoto and Drs Delano-Wood, Sorg, Schiehser, and Merritt) and Center of Excellence for Stress and Mental Health (Drs Delano-Wood, Schiehser, and Merritt), VA San Diego Healthcare System (VASDHS), San Diego, California; and Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla (Drs Delano-Wood, Sorg, Schiehser, and Merritt)
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13
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Chung YC, Fisher BE, Finley JM, Kim A, Petkus AJ, Schiehser DM, Jakowec MW, Petzinger GM. Cognition and motor learning in a Parkinson's disease cohort: importance of recall in episodic memory. Neuroreport 2021; 32:1153-1160. [PMID: 34334776 DOI: 10.1097/wnr.0000000000001707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Impaired motor learning in individuals with Parkinson's disease is often attributed to deficits in executive function, which serves as an important cognitive process supporting motor learning. However, less is known about the role of other cognitive domains and its association with motor learning in Parkinson's disease. The objective of this study was to investigate the associations between motor learning and multiple domains of cognitive performance in individuals with Parkinson's disease. Twenty-nine participants with Parkinson's disease received comprehensive neuropsychological testing, followed by practice of a bimanual finger sequence task. A retention test of the finger sequence task was completed 24 h later. Hierarchical linear regressions were used to examine the associations between motor learning (acquisition rate and retention) and cognitive performance in five specific cognitive domains, while controlling for age, sex, and years of Parkinson's disease diagnosis. We found that a higher acquisition rate was associated with better episodic memory, specifically better recall in visual episodic memory, in individuals with Parkinson's disease. No significant associations were observed between retention and cognitive performance in any domains. The association between motor acquisition and episodic memory indicates an increased dependency on episodic memory as a potential compensatory cognitive strategy used by individuals with Parkinson's disease during motor learning.
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Affiliation(s)
| | | | | | - Aram Kim
- Division of Biokinesiology and Physical Therapy
| | - Andrew J Petkus
- Department of Neurology, University of Southern California, Los Angeles
| | - Dawn M Schiehser
- Psychology and Research Services, Veterans Administration San Diego Healthcare System (VASDHS), San Diego, California, USA
| | - Michael W Jakowec
- Department of Neurology, University of Southern California, Los Angeles
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14
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Nakhla MZ, Cohen L, Salmon DP, Smirnov DS, Marquine MJ, Moore AA, Schiehser DM, Zlatar ZZ. Self-reported subjective cognitive decline is associated with global cognition in a community sample of Latinos/as/x living in the United States. J Clin Exp Neuropsychol 2021; 43:663-676. [PMID: 34709141 PMCID: PMC8720066 DOI: 10.1080/13803395.2021.1989381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although subjective cognitive decline (SCD) may be an early risk marker of Alzheimer's Disease (AD), research on SCD among Hispanics/Latinos/as/x (henceforth Latinos/as) living in the U.S. is lacking. We investigated if the cross-sectional relationship of self-reported SCD with objective cognition varies as a function of ethnic background (Latinos/as versus Non-Hispanic Whites [NHWs]). Secondary analyses conducted solely within the Latino/a group investigated if informant reported SCD is associated with objective cognition and whether self-reported SCD is related to markers of brain health in a sub-sample of Latinos/as with available MRI data. METHODS Eighty-three participants (≥60 years of age) without dementia (35 Latinos/as; 48 NHWs) completed the Mattis Dementia Rating Scale (MDRS) and the Subjective Cognitive Decline-Questionnaire (SCD-Q). Additionally, 22 Latino/a informants completed the informant-version of the SCD-Q. Hierarchical regression models investigated if ethnicity moderates the association of MDRS and SCD-Q scores after adjusting for demographics and depressive symptoms. Correlational analyses within the Latino/a group investigated self- and informant-reported associations of SCD-Q scores with objective cognition, and associations of self-reported SCD-Q scores with medial temporal lobe volume and thickness. RESULTS Latinos/as had lower education and MDRS scores than NHWs. Higher SCD-Q scores were associated with lower MDRS scores only in Latinos/as. Within the Latino/a group, self, but not informant reported SCD was related to objective cognition. Medium to large effect sizes were found whereby higher self-reported SCD was associated with lower entorhinal cortex thickness and left hippocampal volume in Latinos/as. CONCLUSIONS The association of SCD and concurrent objectively measured global cognition varied by ethnic background and was only significant in Latinos/as. Self-reported SCD may be an indicator of cognitive and brain health in Latinos/as without dementia, prompting clinicians to monitor cognition. Future studies should explore if SCD predicts objective cognitive decline in diverse groups of Latinos/as living in the U.S.
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Affiliation(s)
- Marina Z. Nakhla
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Lynn Cohen
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
| | - David P. Salmon
- Department of Neurosciences; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
| | - Denis S. Smirnov
- Department of Neurosciences; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
| | - María J. Marquine
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
| | - Alison A. Moore
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
| | - Dawn M. Schiehser
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Zvinka Z. Zlatar
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
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15
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Sullan MJ, Crocker LD, Thomas KR, Orff HJ, Davey DK, Jurick SM, Twamley EW, Norman SB, Schiehser DM, Aupperle R, Jak AJ. Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment. Behav Res Ther 2021; 143:103892. [PMID: 34091276 DOI: 10.1016/j.brat.2021.103892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
Poor sleep quality is common among Veterans with posttraumatic stress disorder (PTSD) and history of traumatic brain injury (TBI). However, the relationship between sleep quality and treatment outcomes following trauma-focused interventions is less well-understood in this population. We sought to better understand whether 1) sleep quality changed as a result of trauma-focused treatment and 2) if baseline sleep quality moderated psychological and neurobehavioral treatment outcomes. Our sample consisted of 100 Iraq/Afghanistan era Veterans with PTSD and history of mild to moderate TBI who were randomized to one of two trauma-focused treatments: 1) Cognitive Processing Therapy (CPT) or 2) combined CPT and Cognitive Symptom Management and Rehabilitation Therapy (SMART-CPT). Self-reported sleep quality, psychiatric symptoms (PTSD and depression), and neurobehavioral concerns were assessed at multiple timepoints throughout the study. Multilevel modeling showed sleep quality did not improve, regardless of treatment condition. However, worse baseline sleep quality was associated with less improvement in PTSD symptoms and cognitive complaints. There was no effect of baseline sleep quality on change in depression symptoms. These findings suggest that more targeted treatments to address sleep quality either prior to or in conjunction with trauma-focused therapy may help to improve treatment outcomes for Veterans with comorbid PTSD and TBI history.
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Affiliation(s)
- Molly J Sullan
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Laura D Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Henry J Orff
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Delaney K Davey
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA
| | - Sarah M Jurick
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Sonya B Norman
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA; National Center for PTSD, White River Junction, VT, USA
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA
| | - Robin Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA; School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Amy J Jak
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA.
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16
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Van Patten R, Mahmood Z, Pickell D, Maye JE, Roesch S, Twamley EW, Filoteo JV, Schiehser DM. REM Sleep Behavior Disorder in Parkinson's Disease: Change in Cognitive, Psychiatric, and Functional Outcomes from Baseline to 16-47-Month Follow-Up. Arch Clin Neuropsychol 2021; 37:1-11. [PMID: 34037689 DOI: 10.1093/arclin/acab037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Rapid Eye Movement Sleep Behavior Disorder (RBD) is common in Parkinson's Disease (PD) and is associated with cognitive impairment; however, the majority of the evidence on the impact of RBD on multidomain cognitive batteries in PD is cross-sectional. This study evaluated the longitudinal impact of probable RBD (pRBD) on cognitive, psychiatric, and functional outcomes in people with PD. METHOD Case-control study. A total of 65 people with PD completed the study protocol at baseline and 16-to-47-month follow-up. Participants were classified as pRBD+ (n = 25) or pRBD- (n = 40) based on an established cutoff of 6 on the RBD Sleep Questionnaire (RBDSQ). Participants also completed a) comprehensive cognitive testing, b) self-report measures of depression, anxiety, and apathy, and c) performance-based and other-report forms of instrumental activities of daily living. RESULTS Baseline mean age was 67.8 (SD = 8.1; range = 45-86) and baseline mean years of education was 16.4 (SD = 2.1; range = 12-20). The two groups did not differ on measured demographic characteristics. Baseline mean T-scores for cognitive tests were in the average range (46-55). Hierarchical linear models tested group differences in cognitive and functional decline from baseline to follow-up, controlling for appropriate demographic and psychiatric variables. Compared to the pRBD- group, pRBD+ participants showed greater decline in attention/working memory (r = -0.31; p = 0.01) and UPSA financial skills (r = -0.31; p = 0.01). No other group differences approached significance. CONCLUSIONS RBD may differentially affect attention/working memory and financial abilities in PD. Results underscore the importance of regular RBD screening in older adults with PD in order to triage symptomatic patients to appropriate cognitive and medical interventions.
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Affiliation(s)
- Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Zanjbeel Mahmood
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Delaney Pickell
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jacqueline E Maye
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Scott Roesch
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - J Vincent Filoteo
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Neuroscience, University of California San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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17
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Petkus AJ, Jarrahi B, Holschneider DP, Gomez ME, Filoteo JV, Schiehser DM, Fisher BE, Van Horn JD, Jakowec MW, McEwen SC, Petzinger G. Thalamic volume mediates associations between cardiorespiratory fitness (VO 2max) and cognition in Parkinson's disease. Parkinsonism Relat Disord 2021; 86:19-26. [PMID: 33819900 DOI: 10.1016/j.parkreldis.2021.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Cognitive deficits occur in Parkinson's disease (PD). Cardiorespiratory fitness (CRF) is associated with better cognitive performance in aging especially in executive function (EF) and memory. The association between CRF and cognitive performance is understudied in people with PD. Brain structures underlying associations also remains unknown. This cross-sectional study examined the associations between CRF and cognitive performance in PD. We also examined associations between CRF and brain structures impacted in PD. Mediation analysis were conducted to examine whether brain structures impacted in PD mediate putative associations between CRF and cognitive performance. METHODS Individuals with PD (N = 33) underwent magnetic resonance imaging (MRI), CRF evaluation (estimated VO2max), and neuropsychological assessment. Composite cognitive scores of episodic memory, EF, attention, language, and visuospatial functioning were generated. Structural equation models were constructed to examine whether MRI volume estimates (thalamus and pallidum) mediated associations between CRF and cognitive performance (adjusting for age, education, PD disease duration, sex, MDS-UPDRS motor score, and total intracranial volume). RESULTS Higher CRF was associated with better episodic memory (Standardized β = 0.391; p = 0.008), EF (Standardized β = 0.324; p = 0.025), and visuospatial performance (Standardized β = 0.570; p = 0.005). Higher CRF was associated with larger thalamic (Standardized β = 0.722; p = 0.004) and pallidum (Standardized β = 0.635; p = 0.004) volumes. Thalamic volume mediated the association between higher CRF and better EF (Indirect effect = 0.309) and episodic memory (Indirect effect = 0.209) performance (p < 0.05). The pallidum did not significantly mediate associations between CRF and cognitive outcomes. CONCLUSION The thalamus plays an important role in the association between CRF and both EF and episodic memory in PD.
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Affiliation(s)
- Andrew J Petkus
- Department of Neurology, University of Southern California, 1520 San Pablo St., HCC-2, Suite 3000, Los Angeles, CA, 90033, USA.
| | - Behnaz Jarrahi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, 94305, USA
| | - Daniel P Holschneider
- Department of Neurology, University of Southern California, 1520 San Pablo St., HCC-2, Suite 3000, Los Angeles, CA, 90033, USA; Department of Psychiatry and the Behavioral Sciences, University of Southern California, 1333 San Pablo St., Los Angeles, CA, 90033, USA
| | - Megan E Gomez
- Department of Psychology, Tibor Rubin Veterans Administration Medical Center, Long Beach, CA, 90822, USA
| | - J Vincent Filoteo
- Psychology and Research Services, Veterans Administration San Diego Health Care System, San Diego, CA, 92161, USA; Departments of Psychiatry and Neurosciences, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - Dawn M Schiehser
- Psychology and Research Services, Veterans Administration San Diego Health Care System, San Diego, CA, 92161, USA; Departments of Psychiatry and Neurosciences, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90033, USA
| | - John D Van Horn
- Department of Psychology and School of Data Science, University of Virginia, Charlottesville, VA, 22904, USA
| | - Michael W Jakowec
- Department of Neurology, University of Southern California, 1520 San Pablo St., HCC-2, Suite 3000, Los Angeles, CA, 90033, USA
| | - Sarah C McEwen
- Department of Translational Neurosciences and Neurotherapeutics, Saint John's Cancer Institute, Santa Monica, CA, 90404, USA
| | - Giselle Petzinger
- Department of Neurology, University of Southern California, 1520 San Pablo St., HCC-2, Suite 3000, Los Angeles, CA, 90033, USA
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18
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Sumida CA, Lopez FV, Van Etten EJ, Whiteley N, Moore RC, Litvan I, Lessig S, Gilbert PE, Schmitter-Edgecombe M, Filoteo JV, Schiehser DM. Medication Management Performance in Parkinson’s Disease: Examination of Process Errors. Arch Clin Neuropsychol 2021; 36:1307-1315. [DOI: 10.1093/arclin/acab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Individuals with Parkinson’s disease (PD) are at risk for increased medication mismanagement, which can lead to worse clinical outcomes. However, the nature of the errors (i.e., undertaking or overtaking medications) contributing to mismanagement and their relationship to cognition in PD is unknown. Therefore, this study sought to examine errors committed on the Medication Management Ability Assessment (MMAA) between PD participants with normal cognition (PD-NC) or mild cognitive impairment (PD-MCI) relative to healthy adults (HA).
Method
HA (n = 74), PD-NC (n = 102), and PD-MCI (n = 45) participants were administered the MMAA to assess undertaking, overtaking, and overall errors as well as overall performance (total score). Additionally, participants were administered a comprehensive neuropsychological battery from which cognitive composites of Attention, Learning, Memory, Language, Visuospatial, and Executive Functioning were derived.
Results
Separate negative binomial regression analyses indicated the PD-MCI group performed significantly worse overall on the MMAA (total score) and committed more undertaking and overall errors relative to HA and PD-NC. In the PD-MCI group, poorer MMAA performance was associated with worse delayed memory performance, whereas cognitive performance was not related to MMAA in HA or PC-NC.
Conclusion
Compared to PD and healthy adults with normal cognition, PD-MCI patients exhibited greater difficulty with medication management, particularly with undertaking medications. Poorer medication management in PD-MCI was associated with worse delayed recall. Thus, PD-MCI patients experiencing memory problems may require additional assistance with their medications. Findings have clinical relevance suggesting that objective measures of medication errors may assist clinicians in identifying PD patients needing adherence strategies.
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Affiliation(s)
- Catherine A Sumida
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - Francesca V Lopez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA
| | - Emily J Van Etten
- Department of Psychology, University of Arizona, Tucson, AZ, 85721, USA
| | - Nicole Whiteley
- Research Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Stephanie Lessig
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
- Neurology Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Paul E Gilbert
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, Department of Psychology, San Diego State University, San Diego, CA 92182-4611, USA
| | | | - J Vincent Filoteo
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
- Psychology Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Dawn M Schiehser
- Research Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
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19
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Eglit GM, Lopez F, Schiehser DM, Pirogovsky‐Turk E, Litvan I, Lessig S, Filoteo JV. Delineation of Apathy Subgroups in Parkinson's Disease: Differences in Clinical Presentation, Functional Ability, Health-related Quality of Life, and Caregiver Burden. Mov Disord Clin Pract 2021; 8:92-99. [PMID: 33426163 PMCID: PMC7780962 DOI: 10.1002/mdc3.13127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Apathy is a prevalent, multidimensional neuropsychiatric condition in Parkinson's disease (PD). Several authors have proposed apathy subtypes in PD, but no study has examined the classification of PD patients into distinct apathy subtypes, nor has any study examined the clinical utility of doing so. OBJECTIVES The current study used a data-driven approach to explore the existence and associated clinical characteristics of apathy subtypes in PD. METHOD The Apathy Scale (AS) was administered to 157 non-demented individuals with PD. Participants were classified into apathy subgroups through cluster analysis. Differences among apathy subtypes on external clinical indicators were explored across apathy subgroups. RESULTS Individuals with PD were classified into three subgroups: a Non-Apathetic group with low levels of apathy symptoms, a Low Interest/Energy group, characterized by elevated symptoms of low interest/energy and minimal low initiation/emotional indifference symptoms, and a Low Initiation group, characterized by an absence of low interest/energy symptoms and elevated levels of low initiation/emotional indifference symptoms. Both Low Interest/Energy and Low Initiation groups exhibited worse depression, fatigue, anxiety, health-related quality of life, and caregiver burden than the Non-Apathetic subgroup. The Low Initiation group exhibited worse overall cognition, emotional well-being, state anxiety, communicative ability, and functional ability than the Low Interest/Energy group. Importantly, disease-related characteristics did not differ across apathy symptom subgroups. CONCLUSIONS Non-demented PD patients can be separated into distinct apathy symptom subgroups, which are differentially associated with important clinical variables. Apathy subgroup membership may reflect disruption to different neural systems independent of disease progression.
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Affiliation(s)
- Graham M.L. Eglit
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Sam and Rose Stein Institute for Research on AgingUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Francesca Lopez
- Psychology and Research ServicesVeterans Administration San Diego Health Care SystemSan DiegoCaliforniaUSA
| | - Dawn M. Schiehser
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Psychology and Research ServicesVeterans Administration San Diego Health Care SystemSan DiegoCaliforniaUSA
| | - Eva Pirogovsky‐Turk
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Irene Litvan
- Department of Neurosciences, Movement Disorder CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Stephanie Lessig
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of Neurosciences, Movement Disorder CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - J. Vincent Filoteo
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Psychology and Research ServicesVeterans Administration San Diego Health Care SystemSan DiegoCaliforniaUSA
- Department of Neurosciences, Movement Disorder CenterUniversity of California San DiegoLa JollaCaliforniaUSA
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20
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Flowers M, Leung A, Schiehser DM, Metzger-Smith V, Delano-Wood L, Sorg S, Kunnel A, Wong A, Vaninetti M, Golshan S, Lee R. Severities in persistent mild traumatic brain injury related headache is associated with changes in supraspinal pain modulatory functions. Mol Pain 2021; 17:17448069211037881. [PMID: 34365850 PMCID: PMC8358489 DOI: 10.1177/17448069211037881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Emerging evidence suggests mild traumatic brain injury related headache (MTBI-HA) is a form of neuropathic pain state. Previous supraspinal mechanistic studies indicate patients with MTBI-HA demonstrate a dissociative state with diminished levels of supraspinal prefrontal pain modulatory functions and enhanced supraspinal sensory response to pain in comparison to healthy controls. However, the relationship between supraspinal pain modulatory functional deficit and severity of MTBI-HA is largely unknown. Understanding this relationship may provide enhanced levels of insight about MTBI-HA and facilitate the development of treatments. This study assessed pain related supraspinal resting states among MTBI-HA patients with various headache intensity phenotypes with comparisons to controls via functional magnetic resonance imaging (fMRI). Resting state fMRI data was analyzed with self-organizing-group-independent-component-analysis in three MTBI-HA intensity groups (mild, moderate, and severe) and one control group (n = 16 per group) within a pre-defined supraspinal pain network based on prior studies. In the mild-headache group, significant increases in supraspinal function were observed in the right premotor cortex (T = 3.53, p < 0.001) and the left premotor cortex (T = 3.99, p < 0.0001) when compared to the control group. In the moderate-headache group, a significant (T = -3.05, p < 0.01) decrease in resting state activity was observed in the left superior parietal cortex when compared to the mild-headache group. In the severe-headache group, significant decreases in resting state supraspinal activities in the right insula (T = -3.46, p < 0.001), right premotor cortex (T = -3.30, p < 0.01), left premotor cortex (T = -3.84, p < 0.001), and left parietal cortex (T = -3.94, p < 0.0001), and an increase in activity in the right secondary somatosensory cortex (T = 4.05, p < 0.0001) were observed when compared to the moderate-headache group. The results of the study suggest that the increase in MTBI-HA severity may be associated with an imbalance in the supraspinal pain network with decline in supraspinal pain modulatory function and enhancement of sensory/pain decoding.
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Affiliation(s)
- Matthew Flowers
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Albert Leung
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Valerie Metzger-Smith
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Scott Sorg
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, The University of California, San Diego, La Jolla, CA, USA
| | - Alphonsa Kunnel
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Angeline Wong
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael Vaninetti
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Anesthesiology, The University of California, San Diego, La Jolla, CA, USA
| | - Shahrokh Golshan
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Roland Lee
- Department of Radiology, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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21
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Shahidi B, Bursch RW, Carmel JS, Carranza AC, Cooper KM, Lee JV, O'Connor CN, Sorg SF, Maluf KS, Schiehser DM. Greater Severity and Functional Impact of Post-traumatic Headache in Veterans With Comorbid Neck Pain Following Traumatic Brain Injury. Mil Med 2020; 186:1207-1214. [PMID: 33306100 DOI: 10.1093/milmed/usaa532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Post-traumatic headache (PTH) is a commonly experienced symptom after mild traumatic brain injury (mTBI). Blast injury- or blunt injury-related mechanisms for mTBI in veterans can also affect musculoskeletal structures in the neck, resulting in comorbid neck pain (NP). However, it is unknown whether the presence of comorbid NP may be associated with a different pattern of headache symptoms, physical functioning, or emotional functioning compared to those without comorbid NP. The purpose of this study is to examine the role of comorbid NP in veterans with mTBI and PTH. DESIGN AND METHODS This was a cross-sectional investigation of an existing dataset that included 33 veterans who met inclusion criteria for PTH after mTBI. Standardized measures of headache severity and frequency, insomnia, fatigue, mood disorders, and physical and emotional role function were compared between groups with and without comorbid NP. RESULTS The majority of participants with PTH reported comorbid NP (n = 22/33, 67%). Those with comorbid NP experienced more headache symptoms that were severe or incapacitating, as compared to mild or moderate for those without NP (φ = 0.343, P = .049); however, no differences in headache frequency (φ = 0.231, P = .231) or duration (φ = 0.129, P = .712) were observed. Participants with comorbid NP also reported greater insomnia (d = 1.16, P = .003) and fatigue (d = 0.868, P = .040) as well as lower physical functioning (d = 0.802, P = .036) and greater bodily pain (d = 0.762, P = .012). There were no differences in anxiety, depression, mental health, emotional role limitations, vitality, or social functioning between those with and without comorbid NP (d ≤ 0.656, P ≥ .079). CONCLUSIONS A majority of veterans with mTBI and PTH in our sample reported comorbid NP that was associated with greater headache symptom severity and physical limitations, but not with mood or emotional limitations. Preliminary findings from this small convenience sample indicate that routine assessment of comorbid NP and associated physical limitations should be considered in veterans with mTBI and PTH.
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Affiliation(s)
- Bahar Shahidi
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA 92037, USA
| | - Robyn W Bursch
- Department of Physical Therapy, San Diego State University, School of Exercise and Nutritional Sciences, San Diego, CA 92182, USA
| | - Jennifer S Carmel
- Department of Physical Therapy, San Diego State University, School of Exercise and Nutritional Sciences, San Diego, CA 92182, USA
| | - Ashleigh C Carranza
- Department of Physical Therapy, San Diego State University, School of Exercise and Nutritional Sciences, San Diego, CA 92182, USA
| | - Kelsey M Cooper
- Department of Physical Therapy, San Diego State University, School of Exercise and Nutritional Sciences, San Diego, CA 92182, USA
| | - Jayme V Lee
- Department of Physical Therapy, San Diego State University, School of Exercise and Nutritional Sciences, San Diego, CA 92182, USA
| | - Colleen N O'Connor
- Department of Physical Therapy, San Diego State University, School of Exercise and Nutritional Sciences, San Diego, CA 92182, USA
| | - Scott F Sorg
- Veterans Association San Diego Healthcare System, Research Service, San Diego, CA 92161, USA.,Veterans Association San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Katrina S Maluf
- Department of Physical Therapy, San Diego State University, School of Exercise and Nutritional Sciences, San Diego, CA 92182, USA
| | - Dawn M Schiehser
- Veterans Association San Diego Healthcare System, Research Service, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92037, USA
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22
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Mahmood Z, Van Patten R, Nakhla MZ, Twamley EW, Filoteo JV, Schiehser DM. REM Sleep Behavior Disorder in Parkinson's Disease: Effects on Cognitive, Psychiatric, and Functional outcomes. J Int Neuropsychol Soc 2020; 26:894-905. [PMID: 32375913 PMCID: PMC7554050 DOI: 10.1017/s1355617720000430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rapid eye movement sleep behavior disorder (RBD) affects 33-46% of patients with Parkinson's disease (PD) and may be a risk factor for neuropsychological and functional deficits. However, the role of RBD on neuropsychological functioning in PD has yet to be fully determined. We, therefore, examined differences in neurocognitive performance, functional capacity, and psychiatric symptoms among nondemented PD patients with probable RBD (PD/pRBD+) and without (PD/pRBD-), and healthy comparison participants (HC). METHODS Totally, 172 participants (58 PD/pRBD+; 65 PD/pRBD-; 49 HC) completed an RBD sleep questionnaire, psychiatric/clinical questionnaires, performance-based and self-reported functional capacity measures, and underwent a comprehensive neuropsychological battery assessing attention/working memory, language, visuospatial function, verbal and visual learning and memory, and executive function. RESULTS Controlling for psychiatric symptom severity, the PD/pRBD+ group had poorer executive functioning and learning performance than the PD/pRBD- group and poorer neuropsychological functioning across all individual cognitive domains than the HCs. In contrast, PD/pRBD- patients had significantly lower scores than HCs only in the language domain. Moreover, PD/pRBD+ patients demonstrated significantly poorer medication management skills compared to HCs. Both PD groups reported greater depressive and anxiety severity compared to HCs; PD/pRBD+ group also endorsed greater severity of apathy compared to HCs. CONCLUSIONS The presence of pRBD is associated with poorer neuropsychological functioning in PD such that PD patients with pRBD have poorer cognitive, functional, and emotional outcomes compared to HC participants and/or PD patients without pRBD. Our findings underscore the importance of RBD assessment for improved detection and treatment of neuropsychological deficits (e.g., targeted cognitive interventions).
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Affiliation(s)
- Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
| | - Ryan Van Patten
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA
| | - Marina Z Nakhla
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
| | - J Vincent Filoteo
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA
- Department of Neurosciences, Movement Disorders Center, University of California, San Diego, CA, USA
| | - Dawn M Schiehser
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
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23
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Holiday KA, Clark AL, Merritt VC, Nakhla MZ, Sorg S, Delano-Wood L, Schiehser DM. Response inhibition in Veterans with a history of mild traumatic brain injury: The role of self-reported complaints in objective performance. J Clin Exp Neuropsychol 2020; 42:556-568. [PMID: 32657255 DOI: 10.1080/13803395.2020.1776847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although objective deficits in response inhibition (RI) have been detected in civilians with mild traumatic brain injury (mTBI), it remains unclear whether objective RI is worse in military Veterans with mTBI despite the prevalence of self-reported disinhibition. Assessing RI in Veterans is critical due to their unique characteristics, including combat and blast exposure, in addition to the prevalence of psychiatric comorbidity. Therefore, the aims of this study were to (1) examine RI performance in Veterans with mTBI compared to non-mTBI Veterans and (2) compare RI performance in well-defined subgroups of mTBI Veterans with and without self-reported complaints of disinhibition to non-mTBI Veterans. METHOD 53 mTBI Veterans and 37 non-mTBI Veterans completed a Go/No-Go RI task and measures of self-reported disinhibition (Frontal Systems Behavior Scale) and psychiatric symptoms. ANCOVAs covarying for mood and demographics compared RI performances of the non-mTBI Veterans to (1) the total sample of mTBI Veterans (n= 53) and to (2) mTBI Veterans with elevated (t-score ≥ 60; mTBI-SubjDis; n= 23) and low (t-score < 60; mTBI-NoSubjDis; n= 30) levels of self-reported disinhibition. RESULTS There were no significant differences in RI between the mTBI group as a whole and the non-mTBI Veterans group. However, when Veterans with mTBI were divided into groups by clinically-significant concern about their disinhibition, the mTBI-SubjDis group demonstrated significantly worse RI than the mTBI-NoSubjDis and non-mTBI Veteran groups. No significant differences in RI performance were observed between the mTBI-NoSubjDis and non-mTBI Veteran groups. CONCLUSIONS Results indicate that mTBI Veterans with elevated levels of self-reported disinhibition show diminished performance on objective measures of RI, independent of mood. Findings highlight the unique contribution of subjective complaints on executive functioning in mTBI, and they underscore the importance of assessing cognitive complaints in order to identify those most at risk for poor-long term outcomes.
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Affiliation(s)
- Kelsey A Holiday
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA.,Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Alexandra L Clark
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Victoria C Merritt
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Marina Z Nakhla
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology , San Diego, CA, USA.,Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Scott Sorg
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA.,Department of Psychiatry, University of California , San Diego, CA, USA
| | - Lisa Delano-Wood
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA.,Department of Psychiatry, University of California , San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
| | - Dawn M Schiehser
- Psychology and Research Services, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA.,Department of Psychiatry, University of California , San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS) , San Diego, CA, USA
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Merritt VC, Lapira KM, Clark AL, Sorg SF, Werhane ML, Jak AJ, Bondi MW, Schiehser DM, Delano-Wood L. APOE-ε4 Genotype is Associated with Elevated Post-Concussion Symptoms in Military Veterans with a Remote History of Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2020; 34:706-712. [PMID: 30521018 DOI: 10.1093/arclin/acy082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/28/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We evaluated the influence of the APOE-ε4 allele on post-concussive symptoms in military Veterans with a remote history of mild traumatic brain injury (mTBI). METHOD Participants (N = 77) were administered neuropsychiatric measures, on average, approximately 5 years following their most recent mTBI and provided a DNA sample for APOE genotyping. Veterans were divided into two groups based on their ε4 status (n = 14 ε4+, n = 63 ε4-). The Neurobehavioral Symptom Inventory (NSI) was the primary outcome measure, from which a total score was derived, as well as three symptom clusters (somatic, cognitive, and affective). RESULTS ANCOVAs showed a significant main effect of ε4 genotype on the NSI total score and somatic symptom cluster after adjusting for posttraumatic stress symptoms and mTBI history (p = .019-.028, ηp2 = .064-.073), such that ε4+ Veterans endorsed significantly greater symptoms than ε4- Veterans. CONCLUSIONS Our findings suggest that genetic risk may help to explain the poorer long-term outcomes often observed in this population.
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Affiliation(s)
| | | | - Alexandra L Clark
- VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.,San Diego State University/University of California San Diego (SDSU/UCSD), Joint Doctoral Program in Clinical Psychology; San Diego, CA, USA
| | - Scott F Sorg
- VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.,UCSD, School of Medicine, Department of Psychiatry; La Jolla, CA, USA
| | - Madeleine L Werhane
- VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.,San Diego State University/University of California San Diego (SDSU/UCSD), Joint Doctoral Program in Clinical Psychology; San Diego, CA, USA
| | - Amy J Jak
- VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.,UCSD, School of Medicine, Department of Psychiatry; La Jolla, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS; San Diego, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.,UCSD, School of Medicine, Department of Psychiatry; La Jolla, CA, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.,UCSD, School of Medicine, Department of Psychiatry; La Jolla, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS; San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS); San Diego, CA, USA.,UCSD, School of Medicine, Department of Psychiatry; La Jolla, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS; San Diego, CA, USA
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25
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Petkus AJ, Filoteo JV, Schiehser DM, Gomez ME, Hui JS, Jarrahi B, McEwen S, Jakowec MW, Petzinger GM. Mild cognitive impairment, psychiatric symptoms, and executive functioning in patients with Parkinson's disease. Int J Geriatr Psychiatry 2020; 35:396-404. [PMID: 31894601 DOI: 10.1002/gps.5255] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/21/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) and psychiatric symptoms (anxiety, depression, and apathy) are common in Parkinson's disease (PD). While studies have supported the association between psychiatric symptoms and cognitive performance in PD, it is unclear if the magnitude of link between psychiatric symptoms and cognitive health is stronger by MCI status. The purpose of this study was to examine the association between cognitive performance and psychiatric symptoms in PD and whether MCI status moderates this association. METHODS/DESIGN Participants (N = 187) completed a comprehensive neuropsychological assessment that included measures of attention, language, executive function (EF), visuospatial ability, episodic memory, and psychiatric symptoms. Participants were classified as PD-MCI (N = 73) or PD-normal cognition (NC; N = 114). Linear regression analyses were conducted to examine the association between psychiatric symptoms and cognitive performance and the moderating effect of PD-MCI status. RESULTS There were no differences in mean psychiatric symptoms between PD-MCI and PD-NC. Psychiatric symptoms were predominantly associated with worse EF. The magnitude of the association between anxiety and worse EF was larger in participants with PD-MCI compared with PD-NC. A multivariable regression analysis examining the independent contributions of each symptom demonstrated the most robust association between EF and anxiety. CONCLUSIONS Symptoms of anxiety, depression, and apathy are associated with worse executive functioning in individuals with PD. PD-MCI may be important in moderating the association between cognitive performance, specifically anxiety, and EF. Factors that promote cognitive resilience may serve as key therapeutic modalities in managing neuropsychiatric symptoms in PD.
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Affiliation(s)
- Andrew J Petkus
- Department of Neurology, University of Southern California, Los Angeles, California
| | - J Vincent Filoteo
- Psychology Service, Veterans Administration San Diego Healthcare System (VA/SDHS), San Diego, California.,Department of Psychiatry, University of California, San Diego, California.,Department of Neuroscience, University of California, San Diego, California
| | - Dawn M Schiehser
- Psychology Service, Veterans Administration San Diego Healthcare System (VA/SDHS), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Megan E Gomez
- Veterans Administration Long Beach Healthcare System (VA/LBHS), Long Beach, California
| | - Jennifer S Hui
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Behnaz Jarrahi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California
| | - Sarah McEwen
- Pacific Neuroscience Institute, Santa Monica, California
| | - Michael W Jakowec
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Giselle M Petzinger
- Department of Neurology, University of Southern California, Los Angeles, California
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26
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Merritt VC, Clark AL, Evangelista ND, Sorg SF, Schiehser DM, Delano-Wood L. Dissociation of BDNF Val66Met polymorphism on neurocognitive functioning in military veterans with and without a history of remote mild traumatic brain injury. Clin Neuropsychol 2020; 34:1226-1247. [PMID: 32204647 DOI: 10.1080/13854046.2020.1740324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Since neurocognitive functioning following mild traumatic brain injury (mTBI) may be influenced by genetic factors that mediate synaptic survival and repair, we examined the influence of a common brain-derived neurotrophic factor (BDNF) polymorphism (Val66Met) on cognition using a well-defined sample of military Veterans with and without a history of mTBI. METHOD Participants included 138 Veterans (mTBI = 75; military controls [MCs] = 63) who underwent neuropsychological testing, including completion of self-report measures assessing psychiatric distress, and BDNF genotyping. The mTBI group was tested roughly 66.7 months following their most recent mTBI. Veterans were divided into two groups-Met+ (Met/Met and Met/Val; n = 49) and Met- (Val/Val; n = 89) and compared on domain-specific cognitive composite scores representing memory, executive functioning, and visuospatial speed. RESULTS ANCOVAs adjusting for psychiatric distress, sex, years of education, and ethnicity/race revealed a significant group (mTBI vs. MC) by BDNF genotype (Met + vs. Met-) interaction for the memory (p = .024; ηp 2 = .039) and executive functioning (p = .010; ηp 2 = .050) composites, such that Met+ mTBI Veterans demonstrated better performance than Met- mTBI Veterans on the cognitive measures, whereas Met+ MCs demonstrated worse performance relative to Met- MCs on the cognitive measures. No significant interaction was observed for the visuospatial speed composite (p = .938; ηp 2 < .001). CONCLUSIONS These findings offer preliminary evidence to suggest that the Met allele may be protective in the context of remote mTBI. Findings need to be replicated using larger samples, and future studies are necessary to elucidate the precise mechanisms and neural underpinnings of this interaction.
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Affiliation(s)
- Victoria C Merritt
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA
| | - Alexandra L Clark
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA
| | - Nicole D Evangelista
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Scott F Sorg
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA
| | - Dawn M Schiehser
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Lisa Delano-Wood
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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27
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Clark AL, Sorg SF, Holiday K, Bigler ED, Bangen KJ, Evangelista ND, Bondi MW, Schiehser DM, Delano-Wood L. Fatigue Is Associated With Global and Regional Thalamic Morphometry in Veterans With a History of Mild Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:382-392. [PMID: 29385016 PMCID: PMC6066453 DOI: 10.1097/htr.0000000000000377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Fatigue is a complex, multidimensional phenomenon that commonly occurs following traumatic brain injury (TBI). The thalamus-a structure vulnerable to both primary and secondary injuries in TBI-is thought to play a pivotal role in the manifestation of fatigue. We explored how neuroimaging markers of local and global thalamic morphometry relate to the subjective experience of fatigue post-TBI. METHODS Sixty-three Veterans with a history of mild TBI underwent structural magnetic resonance imaging and completed questionnaires related to fatigue and psychiatric symptoms. FMRIB's Software (FSL) was utilized to obtain whole brain and thalamic volume estimates, as well as to perform regional thalamic morphometry analyses. RESULTS Independent of age, sex, intracranial volume, posttraumatic stress disorder, and depressive symptoms, greater levels of self-reported fatigue were significantly associated with decreased right (P = .026) and left (P = .046) thalamic volumes. Regional morphometry analyses revealed that fatigue was significantly associated with reductions in the anterior and dorsomedial aspects of the right thalamic body (P < .05). Similar trends were observed for the left thalamic body (P < .10). CONCLUSIONS Both global and regional thalamic morphometric changes are associated with the subjective experience of fatigue in Veterans with a history of mild TBI. These findings support a theory in which disruption of thalamocorticostriatal circuitry may result in the manifestation of fatigue in individuals with a history of neurotrauma.
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Affiliation(s)
- Alexandra L. Clark
- San Diego State University/University of California, San Diego
(SDSU/UCSD) Joint Doctoral Program in Clinical Psychology
- VA San Diego Healthcare System (VASDHS)
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS)
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | - Kelsey Holiday
- San Diego State University/University of California, San Diego
(SDSU/UCSD) Joint Doctoral Program in Clinical Psychology
- VA San Diego Healthcare System (VASDHS)
| | - Erin D. Bigler
- Department of Psychology and the Neuroscience Center, Brigham and
Young University
| | - Katherine J. Bangen
- VA San Diego Healthcare System (VASDHS)
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | | | - Mark W. Bondi
- VA San Diego Healthcare System (VASDHS)
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS)
- Center of Excellence for Stress and Mental Health, VASDHS
- University of California San Diego, School of Medicine, Department
of Psychiatry
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS)
- Center of Excellence for Stress and Mental Health, VASDHS
- University of California San Diego, School of Medicine, Department
of Psychiatry
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28
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Lopez FV, Eglit GML, Schiehser DM, Pirogovsky-Turk E, Litvan I, Lessig S, Filoteo JV. Factor Analysis of the Apathy Scale in Parkinson's Disease. Mov Disord Clin Pract 2019; 6:379-386. [PMID: 31286007 DOI: 10.1002/mdc3.12767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 12/29/2022] Open
Abstract
Background The Apathy Scale (AS), a popular measure of apathy in Parkinson's disease (PD), has been somewhat limited for failing to characterize dimensions of apathy, such as those involving cognitive, behavioral, and emotional apathy symptoms. This study sought to determine whether factors consistent with these apathy dimensions in PD could be identified on the AS, examine the associations between these factors and disease-related characteristics, and compare PD patients and healthy control (HCs) on identified factors. Methods Confirmatory (CFA) and exploratory factor analysis (EFA) were conducted on AS scores of 157 nondemented PD patients to identify AS factors. These factors were then correlated with important disease-related characteristics, and PD and HC participants were compared across these factors. Results Previously proposed AS models failed to achieve an adequate fit in CFA. A subsequent EFA revealed two factors on the AS reflecting joint cognitive-behavioral aspects of apathy (Motivation-Interest-Energy) and emotional apathy symptoms (Indifference). Both factors were associated with anxiety, depression, health-related quality of life, and independent activities of daily living, with Indifference associated more with the latter. In addition, only the Indifference factor was associated with cognitive functioning. PD patients reported higher levels of symptoms than HCs on both factors, with the group difference slightly larger on the Motivation-Interest-Energy factor. Conclusion The AS can be decomposed into two factors reflecting Motivation-Interest-Energy and Indifference symptoms. These factors are differentially associated with clinical variables, including cognition and independent activities of daily living, indicating the importance of evaluating apathy from a multidimensional perspective.
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Affiliation(s)
- Francesca V Lopez
- Veterans Administration San Diego Healthcare System San Diego California USA
| | - Graham M L Eglit
- Department of Psychiatry University of California San Diego La Jolla California USA.,Sam and Rose Stein Institute for Research on Aging University of California San Diego La Jolla California USA
| | - Dawn M Schiehser
- Veterans Administration San Diego Healthcare System San Diego California USA.,Department of Psychiatry University of California San Diego La Jolla California USA
| | - Eva Pirogovsky-Turk
- Department of Psychiatry University of California San Diego La Jolla California USA
| | - Irene Litvan
- Department of Neurosciences University of California San Diego La Jolla California USA
| | - Stephanie Lessig
- Veterans Administration San Diego Healthcare System San Diego California USA.,Department of Neurosciences University of California San Diego La Jolla California USA
| | - J Vincent Filoteo
- Veterans Administration San Diego Healthcare System San Diego California USA.,Department of Psychiatry University of California San Diego La Jolla California USA.,Department of Neurosciences University of California San Diego La Jolla California USA
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Jak AJ, Jurick S, Crocker LD, Sanderson-Cimino M, Aupperle R, Rodgers CS, Thomas KR, Boyd B, Norman SB, Lang AJ, Keller AV, Schiehser DM, Twamley EW. SMART-CPT for veterans with comorbid post-traumatic stress disorder and history of traumatic brain injury: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2019; 90:333-341. [PMID: 30554135 DOI: 10.1136/jnnp-2018-319315] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/19/2018] [Accepted: 11/18/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To better concurrently address emotional and neuropsychological symptoms common in veterans with comorbid post-traumatic stress disorder (PTSD) and history of traumatic brain injury (TBI), we integrated components of compensatory cognitive training from the Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) programme into cognitive processing therapy (CPT) for PTSD to create a hybrid treatment, SMART-CPT (CogSMART+CPT). This study compared the efficacy of standard CPT with SMART-CPT for treatment of veterans with comorbid PTSD and history of TBI reporting cognitive symptoms. METHODS One hundred veterans with PTSD, a history of mild to moderate TBI and current cognitive complaints were randomised and received individually delivered CPT or SMART-CPT for 12 weeks. Participants underwent psychological, neurobehavioural and neuropsychological assessments at baseline, on completion of treatment and 3 months after treatment. RESULTS Both CPT and SMART-CPT resulted in clinically significant reductions in PTSD and postconcussive symptomatology and improvements in quality of life. SMART-CPT resulted in additional improvements in the neuropsychological domains of attention/working memory, verbal learning/memory and novel problem solving. CONCLUSION SMART-CPT, a mental health intervention for PTSD, combined with compensatory cognitive training strategies, reduces PTSD and neurobehavioural symptoms and also provides added value by improving cognitive functioning.
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Affiliation(s)
- Amy J Jak
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA .,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Sarah Jurick
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Laura D Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | | | - Robin Aupperle
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, USA
| | | | - Kelsey R Thomas
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Briana Boyd
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Sonya B Norman
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,National Center for PTSD, White River Junction, Vermont, USA
| | - Ariel J Lang
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Amber V Keller
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
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30
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Kaufmann CN, Orff HJ, Moore RC, Delano-Wood L, Depp CA, Schiehser DM. Psychometric Characteristics of the Insomnia Severity Index in Veterans With History of Traumatic Brain Injury. Behav Sleep Med 2019; 17:12-18. [PMID: 28098495 PMCID: PMC5740012 DOI: 10.1080/15402002.2016.1266490] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/BACKGROUND The Insomnia Severity Index (ISI) is a widely used self-report measure of insomnia symptoms. However, to date this measure has not been validated or well-characterized in veterans who have experienced traumatic brain injury (TBI). This study assessed the psychometric properties and convergent, divergent, construct, and discriminate validity of the ISI in veterans with a history of TBI. PARTICIPANTS Eighty-three veterans with history of TBI were seen in the VA San Diego Healthcare System as part of a research protocol. METHODS Measures included the ISI, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Neurobehavioral Symptom Inventory, Beck Depression Inventory-II, Beck Anxiety Inventory, and PTSD Checklist-Military Version. RESULTS The ISI demonstrated moderate to strong or excellent convergent and divergent validity. A principal component analysis indicated a single construct with excellent internal consistency (Cronbach's alpha = 0.92). In exploratory analyses, the ISI discriminated well between those with (73%) and without (27%) sleep disturbance based on the PSQI. CONCLUSIONS Results from this study indicate validity of the ISI in assessing insomnia in veterans with history of TBI and suggest a cutoff score not dissimilar from non-TBI populations. Findings from this study can help inform clinical applicability of the ISI, as well as future studies of insomnia in TBI.
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Affiliation(s)
- Christopher N. Kaufmann
- Veterans Administration San Diego Healthcare System, La Jolla, CA,Department of Psychiatry, UC San Diego, La Jolla, CA,Stein Research Institute for Healthy Aging, UC San Diego, La Jolla, CA
| | - Henry J. Orff
- Veterans Administration San Diego Healthcare System, La Jolla, CA,Center of Excellence for Stress and Mental Health, VASDHS
| | - Raeanne C. Moore
- Veterans Administration San Diego Healthcare System, La Jolla, CA,Department of Psychiatry, UC San Diego, La Jolla, CA,Stein Research Institute for Healthy Aging, UC San Diego, La Jolla, CA
| | - Lisa Delano-Wood
- Veterans Administration San Diego Healthcare System, La Jolla, CA,Department of Psychiatry, UC San Diego, La Jolla, CA,Center of Excellence for Stress and Mental Health, VASDHS
| | - Colin A. Depp
- Veterans Administration San Diego Healthcare System, La Jolla, CA,Department of Psychiatry, UC San Diego, La Jolla, CA,Stein Research Institute for Healthy Aging, UC San Diego, La Jolla, CA
| | - Dawn M. Schiehser
- Veterans Administration San Diego Healthcare System, La Jolla, CA,Department of Psychiatry, UC San Diego, La Jolla, CA,Center of Excellence for Stress and Mental Health, VASDHS
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31
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Lopez FV, Split M, Filoteo JV, Litvan I, Moore RC, Pirogovsky-Turk E, Liu L, Lessig S, Schiehser DM. Does the Geriatric Depression Scale measure depression in Parkinson's disease? Int J Geriatr Psychiatry 2018; 33:1662-1670. [PMID: 30251374 DOI: 10.1002/gps.4970] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/06/2018] [Indexed: 11/11/2022]
Abstract
UNLABELLED The Geriatric Depression Scale (GDS) is recommended for screening depression in individuals with Parkinson's disease (PD). Empirical evidence, however, is limited regarding its validity and factor structure in PD. Thus, the current study sought to evaluate the convergent and divergent validity of the GDS, as well as the structure and validity of the derived factors. METHOD Nondemented individuals with PD (n = 158) completed the GDS-30, and items were subjected to a principle component analysis. Geriatric Depression Scale total and factor scores were correlated with depression items from the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRSd) and Hamilton Rating Scale for Depression (HAMDd), as well as with the Apathy Scale (AS), State-Trait Anxiety Inventory (STAI), Modified Fatigue Impact Scale (MFIS), Parkinson's disease Sleep Scale, and a Subjective Cognitive Function composite score. RESULTS The GDS total score was strongly correlated with divergent neuropsychiatric measures (AS, r = 0.57; STAI, r = 0.66; MFIS, r = 0.60), while only moderately correlated with convergent measures (MDS-UPDRSd, r = 0.36; HAMDd, r = 0.32; Ps < 0.05). Linear regression analyses revealed standardized measures of anxiety, apathy, and fatigue independently predicted the GDS total score, while depression items (MDS-UPDRSd and HAMDd) failed to reach significance. Three independent factors were identified: Anxiety, Apathy, and Fatigue. These factors were significantly predicted by their respective convergent measures. CONCLUSIONS Taken together, our findings suggest that the GDS and its subscales appear to primarily measure anxiety, apathy, and fatigue in PD, or alternatively, these symptom dimensions may be predominant in PD-depression. Future research with clinically diagnosed samples is needed to confirm these initial findings.
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Affiliation(s)
- Francesca V Lopez
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Molly Split
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - J Vincent Filoteo
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California San Diego, La Jolla, California.,Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Raeanne C Moore
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Eva Pirogovsky-Turk
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Lin Liu
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Stephanie Lessig
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Dawn M Schiehser
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California San Diego, La Jolla, California
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Clark AL, Merritt VC, Bigler ED, Bangen KJ, Werhane M, Sorg SF, Bondi MW, Schiehser DM, Delano-Wood L. Blast-Exposed Veterans With Mild Traumatic Brain Injury Show Greater Frontal Cortical Thinning and Poorer Executive Functioning. Front Neurol 2018; 9:873. [PMID: 30473678 PMCID: PMC6237912 DOI: 10.3389/fneur.2018.00873] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Blast exposure (BE) and mild traumatic brain injury (mTBI) have been independently linked to pathological brain changes. However, the combined effects of BE and mTBI on brain structure have yet to be characterized. Therefore, we investigated whether regional differences in cortical thickness exist between mTBI Veterans with and without BE while on deployment. We also examined whether cortical thickness (CT) and cognitive performance differed among mTBI Veterans with low vs. high levels of cumulative BE. Methods: 80 Veterans with mTBI underwent neuroimaging and completed neuropsychological testing and self-report symptom rating scales. Analyses of covariance (ANCOVA) were used to compare blast-exposed Veterans (mTBI+BE, n = 51) to those without BE (mTBI-BE, n = 29) on CT of frontal and temporal a priori regions of interest (ROIs). Next, multiple regression analyses were used to examine whether CT and performance on an executive functions composite differed among mTBI Veterans with low (mTBI+BE Low, n = 22) vs. high (mTBI+BE High, n = 26) levels of cumulative BE. Results: Adjusting for age, numer of TBIs, and PTSD symptoms, the mTBI+BE group showed significant cortical thinning in frontal regions (i.e., left orbitofrontal cortex [p = 0.045], left middle frontal gyrus [p = 0.023], and right inferior frontal gyrus [p = 0.034]) compared to the mTBI-BE group. No significant group differences in CT were observed for temporal regions (p's > 0.05). Multiple regression analyses revealed a significant cumulative BE × CT interaction for the left orbitofrontal cortex (p = 0.001) and left middle frontal gyrus (p = 0.020); reduced CT was associated with worse cognitive performance in the mTBI+BE High group but not the mTBI+BE Low group. Conclusions: Findings show that Veterans with mTBI and BE may be at risk for cortical thinning post-deployment. Moreover, our results demonstrate that reductions in CT are associated with worse executive functioning among Veterans with high levels of cumulative BE. Future longitudinal studies are needed to determine whether BE exacerbates mTBI-related cortical thinning or independently negatively influences gray matter structure.
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Affiliation(s)
- Alexandra L. Clark
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | | | - Erin D. Bigler
- Department of Psychology and the Neuroscience Center, Brigham and Young University, San Diego, CA, United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Madeleine Werhane
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Scott F. Sorg
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Dawn M. Schiehser
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
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Petkus AJ, Filoteo JV, Schiehser DM, Gomez ME, Petzinger G. Worse cognitive performance predicts increased anxiety and depressive symptoms in patients with Parkinson's disease: A bidirectional analysis. Neuropsychology 2018; 33:35-46. [PMID: 30335414 DOI: 10.1037/neu0000498] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Symptoms of anxiety, depression commonly co-occur with cognitive decline in patients with Parkinson's disease (PD). The directionality of this association is unclear, however, in that poor cognitive performance may lead to increased symptoms of anxiety and depression or higher anxiety and depressive symptoms may lead to cognitive decline. The purpose of this study was to elucidate the directionality of the association between symptoms of anxiety and depression with cognitive performance in newly diagnosed patients with PD. METHOD Longitudinal data from 362 nondemented participants from the Parkinson's Progression Markers Initiative (PPMI) were examined. Participants completed as many as five assessments of anxiety symptoms, depressive symptoms, and cognitive performance over a 4-year period. Bivariate dual change score models were fit to examine the dynamic association between level and change of anxiety and depressive symptoms with level and change in cognitive performance. RESULTS Across all cognitive domains, worse performance was associated with subsequently higher state anxiety, trait anxiety, and depressive symptoms. The reverse direction was not significant as higher state anxiety, trait anxiety, and depressive symptoms were not associated with subsequent declines in cognitive performance. CONCLUSIONS Poorer cognitive performance, across all cognitive domains, was a risk factor for increased symptoms of anxiety and depression a year later. No support was present for the alternative hypothesis that anxiety and depression are associated with subsequent cognitive decline. Clinical implications include the importance of psychoeducation, as well as assessing and monitoring anxiety and depression in patients with PD with poor cognitive performance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Merritt VC, Clark AL, Crocker LD, Sorg SF, Werhane ML, Bondi MW, Schiehser DM, Delano-Wood L. Repetitive mild traumatic brain injury in military veterans is associated with increased neuropsychological intra-individual variability. Neuropsychologia 2018; 119:340-348. [DOI: 10.1016/j.neuropsychologia.2018.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
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Merritt VC, Clark AL, Sorg SF, Evangelista ND, Werhane ML, Bondi MW, Schiehser DM, Delano-Wood L. Apolipoprotein E (APOE) ε4 genotype is associated with reduced neuropsychological performance in military veterans with a history of mild traumatic brain injury. J Clin Exp Neuropsychol 2018; 40:1050-1061. [DOI: 10.1080/13803395.2018.1508555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Alexandra L. Clark
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Madeleine L. Werhane
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
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Clark AL, Delano-Wood L, Sorg SF, Werhane ML, Hanson KL, Schiehser DM. Cognitive fatigue is associated with reduced anterior internal capsule integrity in veterans with history of mild to moderate traumatic brain injury. Brain Imaging Behav 2018; 11:1548-1554. [PMID: 27738990 DOI: 10.1007/s11682-016-9594-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
No known studies have directly examined white matter microstructural correlates of cognitive fatigue post-TBI in a Veteran sample. We therefore investigated the relationship between cognitive fatigue and white matter integrity in Veterans with history of mild to moderate TBI (mmTBI). 59 Veterans (TBI = 34, Veteran Controls [VCs] = 25]) with and without history of mmTBI underwent structural 3T DTI scans and completed questionnaires related to cognitive fatigue and psychiatric symptoms. Tractography was employed on six regions of interest, including the anterior and posterior limbs of the internal capsule; genu; body and splenium of the corpus callosum; and cingulum bundle. Group analyses revealed that those with history of mmTBI displayed significantly greater levels of cognitive fatigue relative to those with no history of head injury (p = .02). Within the mmTBI group, independent of psychiatric symptoms, decreased white matter microstructural integrity of the left anterior internal capsule was associated with greater levels of cognitive fatigue (p = .01). Results show that the subjective experience of cognitive fatigue following neurotrauma may be linked to the disruption of striato-thalamo-cortical tracts that are important in mediating arousal and higher-order cognitive processes. These findings build upon those from existing functional neuroimaging studies in those with history of TBI, providing further evidence for the neural basis of cognitive fatigue in head injured adults.
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Affiliation(s)
- Alexandra L Clark
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego (SDSU/UCSD), San Diego, CA, USA.,VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Scott F Sorg
- VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Madeleine L Werhane
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego (SDSU/UCSD), San Diego, CA, USA.,VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Karen L Hanson
- VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. .,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA. .,School of Medicine, Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
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Merritt VC, Clark AL, Sorg SF, Evangelista ND, Werhane M, Bondi MW, Schiehser DM, Delano-Wood L. Apolipoprotein E ε4 Genotype Is Associated with Elevated Psychiatric Distress in Veterans with a History of Mild to Moderate Traumatic Brain Injury. J Neurotrauma 2018; 35:2272-2282. [PMID: 29463164 DOI: 10.1089/neu.2017.5372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
As few studies have examined the relationship between the apolipoprotein E (APOE) gene and clinical outcomes after military-related traumatic brain injury (TBI), we aimed to determine whether the ε4 allele of the APOE gene influences neuropsychiatric symptoms in veterans with a history of mild-to-moderate TBI. Participants included 133 veterans (TBI = 79; military controls [MC] = 54) who underwent APOE genotyping and were divided into ε4+ (TBI = 18; MC = 15) and ε4- (TBI = 61; MC = 39) groups. All participants underwent evaluation of psychological distress using the Beck Depression Inventory-II, Beck Anxiety Inventory, and PTSD Checklist-Military Version. Two-way analyses of variance were conducted to examine the effect of group (TBI vs. MC) and APOE-ε4 status (ε4+ vs. ε4-) across symptom measures. There was a significant main effect of group across all symptom measures (TBI > MC; all p values <0.001), no main effect of ε4 genotype (p = 0.152-0.222), and a significant interaction of group by ε4 genotype across all measures (p = 0.027-0.047). Specifically, for TBI participants, ε4+ veterans demonstrated significantly higher symptom scores across all measures when compared to ε4- veterans (p = 0.007-0.015). For MC participants, ε4 status had no effect on the severity of psychiatric symptom scores (p = 0.585-0.708). Our results demonstrate that, in our well-characterized sample of veterans with history of neurotrauma, possession of the ε4 allele conveys risk for increased symptomatology (i.e., depression, anxiety, and post-traumatic stress disorder), even well outside of the acute phase of injury. Findings suggest a meaningful relationship between APOE genotype and psychiatric distress post-TBI, and they suggest that there is a brain basis for the complex neuropsychiatric presentation often observed in this vulnerable population. Future longitudinal studies are needed in order to further our understanding of how genetic factors influence response to TBI.
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Affiliation(s)
| | - Alexandra L Clark
- 2 San Diego State University/University of California , San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Scott F Sorg
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California
| | | | - Madeleine Werhane
- 2 San Diego State University/University of California , San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Mark W Bondi
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California
| | - Dawn M Schiehser
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California.,4 Center of Excellence for Stress and Mental Health , VASDHS, San Diego, California
| | - Lisa Delano-Wood
- 1 VA San Diego Healthcare System (VASDHS) , San Diego, California.,3 Department of Psychiatry, School of Medicine , UCSD, San Diego, California.,4 Center of Excellence for Stress and Mental Health , VASDHS, San Diego, California
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Orff HJ, Sorg SF, Holiday KA, Clark AL, Delano-Wood L, Schiehser DM. 0300 Comparison of Sleep Disturbance and Quantitative Volumetric MRI Measures in Veterans With and Without History of Mild Traumatic Brain Injury (mTBI). Sleep 2018. [DOI: 10.1093/sleep/zsy061.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H J Orff
- VA San Diego, Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA
- UCSD Department of Psychiatry, San Diego, CA
| | - S F Sorg
- UCSD Department of Psychiatry, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | - K A Holiday
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | - A L Clark
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | - L Delano-Wood
- VA San Diego, Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA
- UCSD Department of Psychiatry, San Diego, CA
| | - D M Schiehser
- VA San Diego, Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA
- UCSD Department of Psychiatry, San Diego, CA
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Jurick SM, Weissberger GH, Clark LR, Wierenga CE, Chang YL, Schiehser DM, Han SD, Jak AJ, Dev SI, Bondi MW. Faulty Adaptation to Repeated Face-Name Associative Pairs in Mild Cognitive Impairment is Predictive of Cognitive Decline. Arch Clin Neuropsychol 2018; 33:168-183. [PMID: 28655152 PMCID: PMC6093342 DOI: 10.1093/arclin/acx056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/24/2017] [Accepted: 06/09/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We examined BOLD (Blood-Oxygen-Level Dependent) activity reduction upon stimuli repetition of face-name pairs in older adults with amnestic (aMCI) and non-amnestic (naMCI) mild cognitive impairment diagnosed using a comprehensive actuarial method, and relationships between activity reduction and behavioral indices. METHOD Twenty-nine cognitively healthy older adults (CHs) and 20 with MCI (n = 12 aMCI; n = 8 naMCI) underwent functional MRI event-related imaging, a comprehensive neuropsychological battery, and 1-year follow-up exam. During scanning, participants were shown face-name pairs 1-3 times and administered a post-scan recognition task. RESULTS The MCI group demonstrated less activity reduction upon repetition of face-name pairs within the MTL and other regions compared to CHs. Less activity reduction was associated with poorer Time 1 neuropsychological performance for the CH group and poorer post-scan recognition performance for the MCI group. Less activity reduction was related to poorer neuropsychological performance at Time 2 in the MCI group. Within MCIs, those with aMCI demonstrated less activity reduction upon repetition of face-name pairs than those with naMCI. CONCLUSIONS Distinct patterns of brain activity were identified in the MCI group compared to CHs, and aMCI compared to naMCI. Activated regions were not restricted to traditional memory circuitry, implicating a wider network of regions involved in the encoding of associative tasks. Findings add support to the hypothesis that lack of reduced BOLD activity reflects "faulty adaptation" to repeated stimuli and that reduction in activity represents successful encoding processes. They also provide further support for use of the face-name paradigm as a marker of prodromal Alzheimer's disease, and method to distinguish between MCI subtypes.
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Affiliation(s)
- Sarah M Jurick
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Gali H Weissberger
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lindsay R Clark
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Christina E Wierenga
- VA San Diego Healthcare System, Research Service, San Diego, CA, USA
- University of California, San Diego Department of Psychiatry, La Jolla, CA, USA
| | - Yu-Ling Chang
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Dawn M Schiehser
- VA San Diego Healthcare System, Research Service, San Diego, CA, USA
- University of California, San Diego Department of Psychiatry, La Jolla, CA, USA
| | - S Duke Han
- VA San Diego Healthcare System, Research Service, San Diego, CA, USA
- University of California, San Diego Department of Psychiatry, La Jolla, CA, USA
| | - Amy J Jak
- VA San Diego Healthcare System, Research Service, San Diego, CA, USA
- University of California, San Diego Department of Psychiatry, La Jolla, CA, USA
| | - Sheena I Dev
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System, Research Service, San Diego, CA, USA
- University of California, San Diego Department of Psychiatry, La Jolla, CA, USA
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Colvonen PJ, Glassman LH, Crocker LD, Buttner MM, Orff H, Schiehser DM, Norman SB, Afari N. Corrigendum to “Pretreatment biomarkers predicting PTSD psychotherapy outcomes: A systematic review” [Neurosci. Biobehav. Rev. 75 (2017) 140–156]. Neurosci Biobehav Rev 2018; 84:495. [DOI: 10.1016/j.neubiorev.2017.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Holiday KA, Pirogovsky‐Turk E, Malcarne VL, Filoteo JV, Litvan I, Lessig SL, Song D, Schiehser DM. Psychometric Properties and Characteristics of the North-East Visual Hallucinations Interview in Parkinson's Disease. Mov Disord Clin Pract 2017; 4:717-723. [PMID: 28435846 PMCID: PMC5396180 DOI: 10.1002/mdc3.12479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/31/2016] [Accepted: 01/29/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Visual Hallucinations (VH) are a common symptom experienced by individuals with Parkinson's disease (PD); however, a validated measure of VH has yet to be established for this population. The North-East Visual Hallucinations Interview (NEVHI), a promising VH measure, has not been well validated in PD. The aim of this study was to evaluate the convergent and discriminant validity of the NEVHI as well as the proportional identification and characteristics of VH in PD. METHODS One hundred seventeen individuals with PD completed the NEVHI as well as evaluations of psychological, cognitive, motor, and visual functioning as measures of convergent and divergent validity. The hallucination items from the Neuropsychiatric Inventory (NPI) and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Scale (MDS-UPDRS) were used to assess convergent validity. RESULTS The NEVHI identified 20.5% of PD patients with VH, which consisted of all individuals detected by the MDS-UPDRS and NPI and nine additional individuals not detected by the other measures. The NEVHI was strongly correlated with the MDS-UPDRS hallucinations item, and weakly correlated with the NPI VH item. Weak to non-significant correlations were found between the NEVHI and measures of psychological, cognitive, motor, visual, and demographic characteristics. DISCUSSION The NEVHI identified a greater number of individuals with VH than either the MDS-UPDRS or NPI. Results demonstrated good convergent validity between the NEVHI and a clinician-administered-to-patient-report measure of VH and excellent divergent validity, supporting the NEVHI as a valid and preferable measure for assessing the presence of VH in PD.
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Affiliation(s)
- Kelsey A. Holiday
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
| | - Eva Pirogovsky‐Turk
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
| | - Vanessa L. Malcarne
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia
- Universisty of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - J. Vincent Filoteo
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
| | - Irene Litvan
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCalifornia
| | - Stephanie L. Lessig
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCalifornia
- Neurology ServiceVA San Diego Healthcare SystemSan DiegoCalifornia
| | - David Song
- Department of NeuroscienceUniversity of CaliforniaRiversideCalifornia
| | - Dawn M. Schiehser
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
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Werhane ML, Evangelista ND, Clark AL, Sorg SF, Bangen KJ, Tran M, Schiehser DM, Delano-Wood L. Pathological vascular and inflammatory biomarkers of acute- and chronic-phase traumatic brain injury. Concussion 2017; 2:CNC30. [PMID: 30202571 PMCID: PMC6094091 DOI: 10.2217/cnc-2016-0022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/19/2016] [Indexed: 12/24/2022] Open
Abstract
Given the demand for developing objective methods for characterizing traumatic brain injury (TBI), research dedicated to evaluating putative biomarkers has burgeoned over the past decade. Since it is critical to elucidate the underlying pathological processes that underlie the higher diverse outcomes that follow neurotrauma, considerable efforts have been aimed at identifying biomarkers of both the acute- and chronic-phase TBI. Such information is not only critical for helping to elucidate the pathological changes that lead to poor long-term outcomes following TBI but it may also assist in the identification of possible prevention and interventions for individuals who sustain head trauma. In the current review, we discuss the potential role of vascular dysfunction and chronic inflammation in both acute- and chronic-phase TBI, and we also highlight existing studies that have investigated inflammation biomarkers associated with poorer injury outcome.
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Affiliation(s)
- Madeleine L Werhane
- San Diego State University/University of California, San Diego (SDSU/UC San Diego) Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Alexandra L Clark
- San Diego State University/University of California, San Diego (SDSU/UC San Diego) Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Scott F Sorg
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - My Tran
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- San Diego State University (SDSU), San Diego, CA 92182, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
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Moore RC, Marquine MJ, Straus E, Depp CA, Moore DJ, Schiehser DM, Richtand NM, Jeste DV, Eyler LT. Predictors and Barriers to Mental Health Treatment Utilization Among Older Veterans Living With HIV. Prim Care Companion CNS Disord 2017; 19. [PMID: 28157277 DOI: 10.4088/pcc.16m02059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022] Open
Abstract
Objective To identify key mood, social, and functional correlates of current participation in mental health treatment and barriers to participation in mental health treatment among older HIV infected (HIV+) veterans. Methods HIV+ veterans (N = 150) aged ≥ 50 years receiving HIV-related medical care at the VA San Diego Healthcare System, San Diego, California, anonymously completed a survey assessing current self-reported mood, social support, daily functioning problems, mental health service utilization, and barriers to participating in mental health services. Veterans also completed the 2-item Patient Health Questionnaire (PHQ-2), a validated depression screening instrument frequently used in primary care settings. Data were collected from February 2014 to May 2014. Results Overall, 44% of participants screened positive for depressive symptomatology on the PHQ-2; 55% of those who screened positive were participating in mental health treatment. Of the 45% of veterans who screened positive on the PHQ-2 and were not in treatment, two-thirds (66%) stated they had been offered services; however, they were not engaging in or accepting the services. Regardless of PHQ-2 status, current self-reported depressive symptoms emerged as an independent, significant positive predictor of participation in mental health treatment (odds ratio = 5.98; 95% CI, 1.16-30.72; P = .03), whereas anxiety, HIV-related stigma, sufficiency of social support, and daily functioning problems were not associated with mental health treatment utilization. Primary reported barriers to mental health treatment included scheduling/availability, travel time and transportation, and discomfort with group settings. Conclusions Results of this study suggest there may be a need to better engage older HIV+ veterans in depression-related treatment. The use of telehealth technology, such as teletherapy, electronic devices, and cell phone-based programs, may be beneficial in helping older HIV+ veterans overcome many barriers that restrict their participation in mental health treatment.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA 92103-8231. .,VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Elizabeth Straus
- California School of Professional Psychology, Alliant International University, San Diego, California, USA
| | - Colin A Depp
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Neil M Richtand
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Lisa T Eyler
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
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Clark AL, Bangen KJ, Sorg SF, Schiehser DM, Evangelista ND, McKenna B, Liu TT, Delano-Wood L. Dynamic association between perfusion and white matter integrity across time since injury in Veterans with history of TBI. Neuroimage Clin 2016; 14:308-315. [PMID: 28210542 PMCID: PMC5299206 DOI: 10.1016/j.nicl.2016.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Cerebral blood flow (CBF) plays a critical role in the maintenance of neuronal integrity, and CBF alterations have been linked to deleterious white matter changes. Although both CBF and white matter microstructural alterations have been observed within the context of traumatic brain injury (TBI), the degree to which these pathological changes relate to one another and whether this association is altered by time since injury have not been examined. The current study therefore sought to clarify associations between resting CBF and white matter microstructure post-TBI. METHODS 37 veterans with history of mild or moderate TBI (mmTBI) underwent neuroimaging and completed health and psychiatric symptom questionnaires. Resting CBF was measured with multiphase pseudocontinuous arterial spin labeling (MPPCASL), and white matter microstructural integrity was measured with diffusion tensor imaging (DTI). The cingulate cortex and cingulum bundle were selected as a priori regions of interest for the ASL and DTI data, respectively, given the known vulnerability of these regions to TBI. RESULTS Regression analyses controlling for age, sex, and posttraumatic stress disorder (PTSD) symptoms revealed a significant time since injury × resting CBF interaction for the left cingulum (p < 0.005). Decreased CBF was significantly associated with reduced cingulum fractional anisotropy (FA) in the chronic phase; however, no such association was observed for participants with less remote TBI. CONCLUSIONS Our results showed that reduced CBF was associated with poorer white matter integrity in those who were further removed from their brain injury. Findings provide preliminary evidence of a possible dynamic association between CBF and white matter microstructure that warrants additional consideration within the context of the negative long-term clinical outcomes frequently observed in those with history of TBI. Additional cross-disciplinary studies integrating multiple imaging modalities (e.g., DTI, ASL) and refined neuropsychiatric assessment are needed to better understand the nature, temporal course, and dynamic association between brain changes and clinical outcomes post-injury.
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Affiliation(s)
- Alexandra L. Clark
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, United States
- VA San Diego Healthcare System (VASDHS), United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), United States
- Center of Excellence for Stress and Mental Health, VASDHS, United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Nicole D. Evangelista
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Benjamin McKenna
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Thomas T. Liu
- University of California San Diego, Department of Radiology, Keck Center for Functional MRI, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), United States
- Center of Excellence for Stress and Mental Health, VASDHS, United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
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Dozier ME, Wetherell JL, Twamley EW, Schiehser DM, Ayers CR. The relationship between age and neurocognitive and daily functioning in adults with hoarding disorder. Int J Geriatr Psychiatry 2016; 31:1329-1336. [PMID: 26876803 PMCID: PMC5612662 DOI: 10.1002/gps.4438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/05/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Given the increase in hoarding symptoms with age, there is a pressing need for understanding the clinical features as they relate to potential interventions for older adults with hoarding disorder (HD). The aim of the current investigation was to explore age-related differences in the level of functional and cognitive impairment in individuals with HD. METHODS The current study utilized the baseline assessments of 122 adults with HD. Age-related differences in the raw scores of psychiatric, cognitive, and daily functioning were analyzed using a series of multiple regression models controlling for the possible age-related differences in premorbid IQ. RESULTS Our results suggested that older adults with HD may experience increased levels of impairment in skills related to executive functioning and everyday functioning when compared with younger adults with HD. CONCLUSIONS Given these difficulties with neurocognitive functioning, older HD patients may require interventions that focus more on behavioral and functional skills, rather than focusing on changing thought processes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mary E. Dozier
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
| | - Julie L. Wetherell
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
| | - Elizabeth W. Twamley
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
| | - Dawn M. Schiehser
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
| | - Catherine R. Ayers
- San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA,University of California, San Diego School of Medicine, CA, USA
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Sorg SF, Schiehser DM, Bondi MW, Luc N, Clark AL, Jacobson MW, Frank LR, Delano-Wood L. White Matter Microstructural Compromise Is Associated With Cognition But Not Posttraumatic Stress Disorder Symptoms in Military Veterans With Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:297-308. [PMID: 26360008 PMCID: PMC5997182 DOI: 10.1097/htr.0000000000000189] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate white matter microstructure compromise in Veterans with a history of traumatic brain injury (TBI) and its possible contribution to posttraumatic stress disorder (PTSD) symptomatology and neuropsychological functioning via diffusion tensor imaging. PARTICIPANTS AND METHODS Thirty-eight Veterans with mild (n = 33) and moderate (n = 5) TBI and 17 military control participants without TBI completed neuropsychological testing and psychiatric screening and underwent magnetic resonance imaging an average of 4 years following their TBI event(s). Fractional anisotropy (FA) and diffusivity measures were extracted from 9 white matter tracts. RESULTS Compared with military control participants, TBI participants reported higher levels of PTSD symptoms and performed worse on measures of memory and psychomotor-processing speed. Traumatic brain injury was associated with lower FA in the genu of the corpus callosum and left cingulum bundle. Fractional anisotropy negatively correlated with processing speed and/or executive functions in 7 of the 8 tracts. Regional FA did not correlate with memory or PTSD symptom ratings. CONCLUSION Results suggest that current PTSD symptoms are independent of TBI-related white matter alterations, as measured by diffusion tensor imaging. In addition, white matter microstructural compromise may contribute to reduced processing speed in our sample of participants with history of neurotrauma. Findings of the current study add insight into the factors associated with complicated recovery from mild to moderate TBI.
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Affiliation(s)
- Scott F. Sorg
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Dawn M. Schiehser
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Mark W. Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Norman Luc
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Alexandra L. Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego CA, 92120
| | - Mark W. Jacobson
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lawrence R. Frank
- Dept. of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
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Schiehser DM, Delano-Wood L, Jak AJ, Hanson KL, Sorg SF, Orff H, Clark AL. Predictors of cognitive and physical fatigue in post-acute mild-moderate traumatic brain injury. Neuropsychol Rehabil 2016; 27:1031-1046. [PMID: 27535726 DOI: 10.1080/09602011.2016.1215999] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Post-traumatic fatigue (PTF) is a common, disabling, and often chronic symptom following traumatic brain injury (TBI). Yet, the impact of chronic cognitive and physical fatigue and their associations with psychiatric, sleep, cognitive, and psychosocial sequelae in mild-moderate TBI remain poorly understood. Sixty Veterans with a history of mild-moderate TBI and 40 Veteran controls (VC) were administered the Modified Fatigue Impact Scale, a validated measure of TBI-related cognitive and physical fatigue as well as measures of neuropsychiatric, psychosocial, sleep, and objective cognitive functioning. Compared to VC, TBI Veterans endorsed significantly greater levels of cognitive and physical fatigue. In TBI, psychiatric symptoms, sleep disturbance, and post-traumatic amnesia (PTA) were associated with both cognitive and physical fatigue, while loss of consciousness (LOC) and poor attention/processing speed were related to elevations in cognitive fatigue only. In regression analyses, anxiety, sleep disturbance, and LOC significantly predicted cognitive fatigue, while only post-traumatic stress symptoms and PTA contributed to physical fatigue. Cognitive and physical fatigue are problematic symptoms following mild-moderate TBI that are differentially associated with specific injury and psychiatric sequelae. Findings provide potential symptom targets for interventions aimed at ameliorating fatigue, and further underscore the importance of assessing and treating fatigue as a multi-dimensional symptom following TBI.
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Affiliation(s)
- Dawn M Schiehser
- a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA
| | - Lisa Delano-Wood
- a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA
| | - Amy J Jak
- a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA
| | - Karen L Hanson
- a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA
| | - Scott F Sorg
- a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA
| | - Henry Orff
- a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA
| | - Alexandra L Clark
- d San Diego State University Joint Doctoral Program in Clinical Psychology , University of California San Diego , San Diego , CA , USA
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Hanson KL, Schiehser DM, Clark AL, Sorg SF, Kim RT, Jacobson MW, Werhane ML, Jak AJ, Twamley EW, Delano-Wood L. Problem alcohol use in veterans with mild traumatic brain injury: Associations with cognitive performance and psychiatric symptoms. J Clin Exp Neuropsychol 2016; 38:1115-30. [PMID: 27430280 DOI: 10.1080/13803395.2016.1198468] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Given that little is known about the associations between alcohol use, cognition, and psychiatric symptoms among veterans with a history of mild traumatic brain injury (mTBI), we aimed to (a) characterize how they differ from veteran controls on a measure of problem drinking; (b) investigate whether problem drinking is associated with demographic or mTBI characteristics; and (c) examine the associations between alcohol use, mTBI history, psychiatric functioning, and cognition. METHOD We assessed 59 veterans (n = 32 with mTBI history; n = 27 military controls) for problem alcohol use (Alcohol Use Disorders Identification Test: AUDIT), psychiatric symptoms, and neuropsychological functioning. RESULTS Compared to controls, veterans with mTBI history were more likely to score above the AUDIT cutoff score of 8 (p = .016), suggesting a higher rate of problem drinking. Participants with mTBI history also showed elevated psychiatric symptoms (ps < .001) and lower cognitive scores (ps < .05 to < .001). Veterans with higher AUDIT scores were younger (p = .05) and had less education (p < .01) and more psychiatric symptoms (ps < .01), but mTBI characteristics did not differ. After controlling for combat and mTBI history (R(2) = .04, ns) and posttraumatic stress disorder (PTSD) symptoms (ΔR(2) = .08, p = .05), we found that higher AUDIT scores were associated with poorer attention/processing speed, F(9, 37) = 2.55, p = .022; ΔR(2) = .26, p = .03. CONCLUSIONS This preliminary study suggested that veterans with mTBI history may be at increased risk for problem drinking. Problem alcohol use was primarily associated with more severe PTSD symptoms and poorer attention/processing speed, though not with combat or mTBI characteristics per se. Importantly, findings emphasize the importance of assessing for and treating problematic alcohol use and comorbid psychiatric symptoms among veterans, including those with a history of neurotrauma.
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Affiliation(s)
- Karen L Hanson
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Dawn M Schiehser
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Alexandra L Clark
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,e San Diego State University Joint Doctoral Program in Clinical Psychology , University of California San Diego , San Diego , CA , USA
| | - Scott F Sorg
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA
| | - Russell T Kim
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA
| | - Mark W Jacobson
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Madeleine L Werhane
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,e San Diego State University Joint Doctoral Program in Clinical Psychology , University of California San Diego , San Diego , CA , USA
| | - Amy J Jak
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Elizabeth W Twamley
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
| | - Lisa Delano-Wood
- a VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.,b Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.,c Veterans Medical Research Foundation , San Diego , CA , USA.,d Department of Psychiatry, School of Medicine , University of California San Diego , San Diego , CA , USA
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Ayers CR, Dozier ME, Wetherell JL, Twamley EW, Schiehser DM. Executive Functioning in Participants Over Age of 50 with Hoarding Disorder. Am J Geriatr Psychiatry 2016; 24:342-9. [PMID: 26809603 PMCID: PMC5612623 DOI: 10.1016/j.jagp.2015.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/28/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The current investigation utilized mid-life and late-life participants diagnosed with hoarding disorder (HD) to explore the relationship between executive functioning and hoarding severity. DESIGN Correlational analyses were used to investigate the associations between executive functioning and hoarding severity in nondemented participants. Multiple regression was used to determine if executive functioning had a unique association with HD severity when accounting for depressive symptoms. SETTING Participants were recruited from the San Diego area for HD intervention studies. PARTICIPANTS Participants were 113 nondemented adults aged 50-86 years who met DSM-5 criteria for HD. The mean age of the sample utilized in the analyses was 63.76 years (SD, 7.2; range, 51-85 years). The sample was mostly female (72%), Caucasian (81.4%), and unmarried (78%). MEASUREMENTS Hoarding severity was assessed using the Saving Inventory-Revised and the Clutter Image Rating and depression was assessed using the Hospital Anxiety and Depression Scale. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST-128) and the Trail Making and Verbal Fluency subtests of the Delis-Kaplan Executive Function System. RESULTS Executive function (operationalized as perseveration on the WCST-128) was significantly associated with Clutter Image Ratings. In a multivariate context, executive function and depressive symptom severity were both significant predictors of variance in Clutter Image Rating. CONCLUSIONS Our results suggest that executive function is related to severity of HD symptoms and should be considered as part of the conceptualization of HD.
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Affiliation(s)
- Catherine R Ayers
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Mary E Dozier
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Julie Loebach Wetherell
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Dawn M Schiehser
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
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Clark AL, Sorg SF, Schiehser DM, Luc N, Bondi MW, Sanderson M, Werhane ML, Delano-Wood L. Deep white matter hyperintensities affect verbal memory independent of PTSD symptoms in veterans with mild traumatic brain injury. Brain Inj 2016; 30:864-71. [DOI: 10.3109/02699052.2016.1144894] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alexandra L. Clark
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Norman Luc
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Mark Sanderson
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Madeleine L. Werhane
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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