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Cai LT, Brett BL, Palacios EM, Yuh EL, Bourla I, Wren-Jarvis J, Wang Y, Mac Donald C, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Levin HS, Robertson CS, Temkin N, Markowitz AJ, Manley GT, Stein MB, McCrea MA, Zafonte RD, Nelson LD, Mukherjee P. Emotional Resilience Predicts Preserved White Matter Microstructure Following Mild Traumatic Brain Injury. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:164-175. [PMID: 36152948 PMCID: PMC10065831 DOI: 10.1016/j.bpsc.2022.08.015] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adult patients with mild traumatic brain injury (mTBI) exhibit distinct phenotypes of emotional and cognitive functioning identified by latent profile analysis of clinical neuropsychological assessments. When discerned early after injury, these latent clinical profiles have been found to improve prediction of long-term outcomes from mTBI. The present study hypothesized that white matter (WM) microstructure is better preserved in an emotionally resilient mTBI phenotype compared with a neuropsychiatrically distressed mTBI phenotype. METHODS The present study used diffusion magnetic resonance imaging to investigate and compare WM microstructure in major association, projection, and commissural tracts between the two phenotypes and over time. Diffusion magnetic resonance images from 172 patients with mTBI were analyzed to compute individual diffusion tensor imaging maps at 2 weeks and 6 months after injury. RESULTS By comparing the diffusion tensor imaging parameters between the two phenotypes at global, regional, and voxel levels, emotionally resilient patients were shown to have higher axial diffusivity compared with neuropsychiatrically distressed patients early after mTBI. Longitudinal analysis revealed greater compromise of WM microstructure in neuropsychiatrically distressed patients, with greater decrease of global axial diffusivity and more widespread decrease of regional axial diffusivity during the first 6 months after injury compared with emotionally resilient patients. CONCLUSIONS These results provide neuroimaging evidence of WM microstructural differences underpinning mTBI phenotypes identified from neuropsychological assessments and show differing longitudinal trajectories of these biological effects. These findings suggest that diffusion magnetic resonance imaging can provide short- and long-term imaging biomarkers of resilience.
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Affiliation(s)
- Lanya T Cai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eva M Palacios
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christine Mac Donald
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Ramon Diaz-Arrastia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Harvey S Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Amy J Markowitz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Geoffrey T Manley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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Dennis EL, Newsome MR, Lindsey HM, Adamson M, Austin TA, Disner SG, Eapen BC, Esopenko C, Franz CE, Geuze E, Haswell C, Hinds SR, Hodges CB, Irimia A, Kenney K, Koerte IK, Kremen WS, Levin HS, Morey RA, Ollinger J, Rowland JA, Scheibel RS, Shenton ME, Sullivan DR, Talbert LD, Thomopoulos SI, Troyanskaya M, Walker WC, Wang X, Ware AL, Werner JK, Williams W, Thompson PM, Tate DF, Wilde EA. Altered lateralization of the cingulum in deployment-related traumatic brain injury: An ENIGMA military-relevant brain injury study. Hum Brain Mapp 2023; 44:1888-1900. [PMID: 36583562 PMCID: PMC9980891 DOI: 10.1002/hbm.26179] [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: 08/05/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/31/2022] Open
Abstract
Traumatic brain injury (TBI) in military populations can cause disruptions in brain structure and function, along with cognitive and psychological dysfunction. Diffusion magnetic resonance imaging (dMRI) can detect alterations in white matter (WM) microstructure, but few studies have examined brain asymmetry. Examining asymmetry in large samples may increase sensitivity to detect heterogeneous areas of WM alteration in mild TBI. Through the Enhancing Neuroimaging Genetics Through Meta-Analysis Military-Relevant Brain Injury working group, we conducted a mega-analysis of neuroimaging and clinical data from 16 cohorts of Active Duty Service Members and Veterans (n = 2598). dMRI data were processed together along with harmonized demographic, injury, psychiatric, and cognitive measures. Fractional anisotropy in the cingulum showed greater asymmetry in individuals with deployment-related TBI, driven by greater left lateralization in TBI. Results remained significant after accounting for potentially confounding variables including posttraumatic stress disorder, depression, and handedness, and were driven primarily by individuals whose worst TBI occurred before age 40. Alterations in the cingulum were also associated with slower processing speed and poorer set shifting. The results indicate an enhancement of the natural left laterality of the cingulum, possibly due to vulnerability of the nondominant hemisphere or compensatory mechanisms in the dominant hemisphere. The cingulum is one of the last WM tracts to mature, reaching peak FA around 42 years old. This effect was primarily detected in individuals whose worst injury occurred before age 40, suggesting that the protracted development of the cingulum may lead to increased vulnerability to insults, such as TBI.
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Affiliation(s)
- Emily L. Dennis
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare SystemSalt Lake CityUtahUSA
| | - Mary R. Newsome
- Michael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
- H. Ben Taub Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonTexasUSA
| | - Hannah M. Lindsey
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare SystemSalt Lake CityUtahUSA
| | - Maheen Adamson
- Rehabilitation DepartmentVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- NeurosurgeryStanford School of MedicineStanfordCaliforniaUSA
- Operational Military Exposure Network (WOMEN), VA Palo Alto Healthcare SystemCaliforniaPalo Alto94304USA
| | - Tara A. Austin
- The VA Center of Excellence for Research on Returning War VeteransWacoTexasUSA
| | - Seth G. Disner
- Minneapolis VA Health Care SystemMinneapolisMinnesottaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of Minnesota Medical SchoolMinneapolisMinnesottaUSA
| | - Blessen C. Eapen
- Department of Physical Medicine and RehabilitationVA Greater Los Angeles Health Care SystemLos AngelesCaliforniaUSA
- Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Carrie Esopenko
- Department of Rehabilitation and Human PerformanceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Carol E. Franz
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Elbert Geuze
- University Medical Center UtrechtUtrechtThe Netherlands
- Brain Research and Innovation CentreMinistry of DefenceUtrechtThe Netherlands
| | - Courtney Haswell
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
| | - Sidney R. Hinds
- Department of NeurologyUniformed Services UniversityBethesdaMarylandUSA
| | - Cooper B. Hodges
- Department of Physical Medicine and RehabilitationVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Biomedical EngineeringViterbi School of Engineering, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kimbra Kenney
- Department of NeurologyUniformed Services UniversityBethesdaMarylandUSA
- National Intrepid Center of ExcellenceWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyLudwig‐Maximilians‐UniversitätMunichGermany
| | - William S. Kremen
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoLa JollaCaliforniaUSA
- Center of Excellence for Stress and Mental HealthVA San Diego Healthcare SystemLa JollaCaliforniaUSA
| | - Harvey S. Levin
- Michael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
- H. Ben Taub Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonTexasUSA
| | - Rajendra A. Morey
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke‐UNC Brain Imaging and Analysis CenterDuke UniversityDurhamNorth CarolinaUSA
- VA Mid‐Atlantic Mental Illness Research Education and Clinical Center (MA‐MIRECC)DurhamNorth CarolinaUSA
| | - John Ollinger
- National Intrepid Center of ExcellenceWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Jared A. Rowland
- VA Mid‐Atlantic Mental Illness Research Education and Clinical Center (MA‐MIRECC)DurhamNorth CarolinaUSA
- W.G. (Bill) Hefner VA Medical CenterSalisburyNorth CarolinaUSA
- Department of Neurobiology & AnatomyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Randall S. Scheibel
- Michael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
- H. Ben Taub Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonTexasUSA
| | - Martha E. Shenton
- Psychiatry Neuroimaging LaboratoryBrigham and Women's HospitalBostonMassachusettsUSA
- VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Danielle R. Sullivan
- National Center for PTSDVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Leah D. Talbert
- Department of PsychologyBrigham Young UniversityProvoUtahUSA
| | - Sophia I. Thomopoulos
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
- H. Ben Taub Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonTexasUSA
| | - William C. Walker
- Department of Physical Medicine and RehabilitationVirginia Commonwealth UniversityRichmondVirginiaUSA
- Hunter Holmes McGuire Veterans Affairs Medical CenterRichmondVirginiaUSA
| | - Xin Wang
- Department of PsychiatryUniversity of ToledoToledoOhioUSA
| | - Ashley L. Ware
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- Department of PsychologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - John Kent Werner
- Department of NeurologyUniformed Services UniversityBethesdaMarylandUSA
| | - Wright Williams
- Michael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - Paul M. Thompson
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and OphthalmologyUSCLos AngelesCaliforniaUSA
| | - David F. Tate
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare SystemSalt Lake CityUtahUSA
| | - Elisabeth A. Wilde
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare SystemSalt Lake CityUtahUSA
- H. Ben Taub Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonTexasUSA
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Palacios EM, Yuh EL, Mac Donald CL, Bourla I, Wren-Jarvis J, Sun X, Vassar MJ, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Robertson CS, Stein MB, Temkin N, McCrea MA, Levin HS, Markowitz AJ, Jain S, Manley GT, Mukherjee P. Diffusion Tensor Imaging Reveals Elevated Diffusivity of White Matter Microstructure that Is Independently Associated with Long-Term Outcome after Mild Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2022; 39:1318-1328. [PMID: 35579949 PMCID: PMC9529303 DOI: 10.1089/neu.2021.0408] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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] [Indexed: 02/01/2023] Open
Abstract
Diffusion tensor imaging (DTI) literature on single-center studies contains conflicting results regarding acute effects of mild traumatic brain injury (mTBI) on white matter (WM) microstructure and the prognostic significance. This larger-scale multi-center DTI study aimed to determine how acute mTBI affects WM microstructure over time and how early WM changes affect long-term outcome. From Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a cohort study at 11 United States level 1 trauma centers, a total of 391 patients with acute mTBI ages 17 to 60 years were included and studied at two weeks and six months post-injury. Demographically matched friends or family of the participants were the control group (n = 148). Axial diffusivity (AD), fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) were the measures of WM microstructure. The primary outcome was the Glasgow Outcome Scale Extended (GOSE) score of injury-related functional limitations across broad life domains at six months post-injury. The AD, MD, and RD were higher and FA was lower in mTBI versus friend control (FC) at both two weeks and six months post-injury throughout most major WM tracts of the cerebral hemispheres. In the mTBI group, AD and, to a lesser extent, MD decreased in WM from two weeks to six months post-injury. At two weeks post-injury, global WM AD and MD were both independently associated with six-month incomplete recovery (GOSE <8 vs = 8) even after accounting for demographic, clinical, and other imaging factors. DTI provides reliable imaging biomarkers of dynamic WM microstructural changes after mTBI that have utility for patient selection and treatment response in clinical trials. Continued technological advances in the sensitivity, specificity, and precision of diffusion magnetic resonance imaging hold promise for routine clinical application in mTBI.
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Affiliation(s)
- Eva M. Palacios
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Esther L. Yuh
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | | | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Mary J. Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Neurological Surgery, UCSF, San Francisco, California, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Murray B. Stein
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael A. McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Harvey S. Levin
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Amy J. Markowitz
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, California, USA
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Max JE, Drake I, Vaida F, Hesselink JR, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Levin HS. Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 35:141-150. [PMID: 35989573 PMCID: PMC10317586 DOI: 10.1176/appi.neuropsych.21120301] [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: 11/30/2022]
Abstract
OBJECTIVE To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence of a novel psychiatric disorder, was assessed 6 months after the injury. RESULTS The recruited sample numbered 177 children, and 141 children (80%) returned for the six-month assessment. Of the 141 children, 58 (41%) developed a novel psychiatric disorder. In univariable analyses, novel psychiatric disorder was significantly associated with lower SES, higher psychosocial adversity, and lesions in frontal lobe locations, such as frontal white matter, superior frontal gyrus, inferior frontal gyrus, and orbital gyrus. Multivariable analyses found that novel psychiatric disorder was independently and significantly associated with frontal-lobe white matter, superior frontal gyrus, and orbital gyrus lesions. CONCLUSION The results demonstrate that occurrence of novel psychiatric disorders following pediatric TBI requiring hospitalization is common and has identifiable psychosocial and specific biological predictors. However, only the lesion predictors were independently related to this adverse psychiatric outcome.
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Affiliation(s)
- Jeffrey E. Max
- University of California, San Diego, Department of Psychiatry
- Rady Children’s Hospital, San Diego
| | | | - Florin Vaida
- University of California, San Diego, Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics
| | | | | | | | | | - Erin D. Bigler
- Brigham Young University, Department of Psychology
- University of Utah, TBI and Concussion Center, Department of Neurology
| | - Elisabeth A. Wilde
- University of Utah, TBI and Concussion Center, Department of Neurology
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation
| | | | - Tony T. Yang
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences
| | - Olga Tymofiyeva
- University of California, San Francisco, Department of Radiology and Biomedical Imaging
| | - Harvey S. Levin
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation
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5
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Fino PC, Dibble LE, Wilde EA, Fino NF, Johnson P, Cortez MM, Hansen CR, van der Veen SM, Skop KM, Werner JK, Tate DF, Levin HS, Pugh MJV, Walker WC. Sensory Phenotypes for Balance Dysfunction After Mild Traumatic Brain Injury. Neurology 2022; 99:e521-e535. [PMID: 35577572 PMCID: PMC9421603 DOI: 10.1212/wnl.0000000000200602] [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] [Received: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent team-based models of care use symptom subtypes to guide treatments of individuals with chronic effects of mild traumatic brain injury (mTBI). However, these subtypes, or phenotypes, may be too broad, particularly for balance (e.g., vestibular subtype). To gain insight into mTBI-related imbalance, we (1) explored whether a dominant sensory phenotype (e.g., vestibular impaired) exists in the chronic mTBI population, (2) determined the clinical characteristics, symptomatic clusters, functional measures, and injury mechanisms that associate with sensory phenotypes for balance control in this population, and (3) compared the presentations of sensory phenotypes between individuals with and without previous mTBI. METHODS A secondary analysis was conducted on the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium. Sensory ratios were calculated from the sensory organization test, and individuals were categorized into 1 of the 8 possible sensory phenotypes. Demographic, clinical, and injury characteristics were compared across phenotypes. Symptoms, cognition, and physical function were compared across phenotypes, groups, and their interaction. RESULTS Data from 758 Service Members and Veterans with mTBI and 172 individuals with no lifetime history of mTBI were included. Abnormal visual, vestibular, and proprioception ratios were observed in 29%, 36%, and 38% of people with mTBI, respectively, with 32% exhibiting more than 1 abnormal sensory ratio. Within the mTBI group, global outcomes (p < 0.001), self-reported symptom severity (p < 0.027), and nearly all physical and cognitive functioning tests (p < 0.027) differed across sensory phenotypes. Individuals with mTBI generally reported worse symptoms than their non-mTBI counterparts within the same phenotype (p = 0.026), but participants with mTBI in the vestibular-deficient phenotype reported lower symptom burdens than their non-mTBI counterparts (e.g., mean [SD] Dizziness Handicap Inventory = 4.9 [8.1] for mTBI vs 12.8 [12.4] for non-mTBI, group × phenotype interaction p < 0.001). Physical and cognitive functioning did not differ between the groups after accounting for phenotype. DISCUSSION Individuals with mTBI exhibit a variety of chronic balance deficits involving heterogeneous sensory integration problems. While imbalance when relying on vestibular information is common, it is inaccurate to label all mTBI-related balance dysfunction under the vestibular umbrella. Future work should consider specific classification of balance deficits, including specific sensory phenotypes for balance control.
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Affiliation(s)
- Peter C Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Leland E Dibble
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Elisabeth A Wilde
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Nora F Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Paula Johnson
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Melissa M Cortez
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Colby R Hansen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Susanne M van der Veen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Karen M Skop
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - J Kent Werner
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - David F Tate
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Harvey S Levin
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Mary Jo V Pugh
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - William C Walker
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
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Lowet DS, Vaida F, Hesselink JR, Levin HS, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Max JE. Novel Oppositional Defiant Disorder 12 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 34:149-157. [PMID: 35040660 DOI: 10.1176/appi.neuropsych.21060149] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators examined the factors predictive of novel oppositional defiant disorder in the 6-12 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years old who experienced a TBI were recruited from consecutive admissions to five hospitals. Participants were evaluated soon after injury (baseline) for preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, and injury severity, to develop a biopsychosocial predictive model for development of novel oppositional defiant disorder. MRI analyses were conducted to examine potential brain lesions. Psychiatric outcome, including that of novel oppositional defiant disorder, was assessed 12 months after injury. RESULTS Although 177 children were recruited for the study, 120 children without preinjury oppositional defiant disorder, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 12-month assessment. Of these 120 children, seven (5.8%) exhibited novel oppositional defiant disorder, and none developed conduct disorder or DBD NOS in the 6-12 months postinjury. Novel oppositional defiant disorder was significantly associated with lower socioeconomic status, higher psychosocial adversity, and lower preinjury adaptive functioning. CONCLUSIONS These results demonstrate that novel oppositional defiant disorder following TBI selectively and negatively affects an identifiable group of children. Both proximal (preinjury adaptive function) and distal (socioeconomic status and psychosocial adversity) psychosocial variables significantly increase risk for this outcome.
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Affiliation(s)
- Daniel S Lowet
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - John R Hesselink
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Harvey S Levin
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Linda Ewing-Cobbs
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Russell J Schachar
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Sandra B Chapman
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Erin D Bigler
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Elisabeth A Wilde
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Ann E Saunders
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Tony T Yang
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Olga Tymofiyeva
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego (Lowet, Max), Herbert Wertheim School of Public Health, Division of Biostatistics and Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Department of Pediatrics, University of Texas Health Science Center, Houston (Ewing-Cobbs); Department of Psychiatry, University of Texas Health Science Center, Houston (Saunders); The Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
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Lowet DS, Kolan A, Vaida F, Hesselink JR, Levin HS, Ewing-Cobbs L, Schachar RJ, Chapman SB, Bigler ED, Wilde EA, Saunders AE, Yang TT, Tymofiyeva O, Arif H, Max JE. Novel Oppositional Defiant Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents. J Neuropsychiatry Clin Neurosci 2022; 34:68-76. [PMID: 34763527 PMCID: PMC10362978 DOI: 10.1176/appi.neuropsych.21020052] [Citation(s) in RCA: 5] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The investigators aimed to assess predictive factors of novel oppositional defiant disorder (ODD) among children and adolescents in the first 6 months following traumatic brain injury (TBI). METHODS Children ages 5-14 years who experienced a TBI were recruited from consecutive admissions to five hospitals. Testing of a biopsychosocial model that may elucidate the development of novel ODD included assessment soon after injury (baseline) of preinjury characteristics, including psychiatric disorders, adaptive function, family function, psychosocial adversity, family psychiatric history, socioeconomic status, injury severity, and postinjury processing speed (which may be a proxy for brain injury). MRI analyses were also conducted to examine potential brain lesions. Psychiatric outcome, including that of novel ODD, was assessed 6 months after the injury. RESULTS A total of 177 children and adolescents were recruited for the study, and 134 who were without preinjury ODD, conduct disorder, or disruptive behavior disorder not otherwise specified (DBD NOS) returned for the 6-month assessment. Of those who returned 6 months postinjury, 11 (8.2%) developed novel ODD, and none developed novel conduct disorder or DBD NOS. Novel ODD was significantly associated with socioeconomic status, preinjury family functioning, psychosocial adversity, and processing speed. CONCLUSIONS These findings show that an important minority of children with TBI developed ODD. Psychosocial and injury-related variables, including socioeconomic status, lower family function, psychosocial adversity, and processing speed, significantly increase risk for this outcome.
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Affiliation(s)
- Daniel S Lowet
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Anish Kolan
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - John R Hesselink
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Harvey S Levin
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Linda Ewing-Cobbs
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Russell J Schachar
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Sandra B Chapman
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Erin D Bigler
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Elisabeth A Wilde
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Ann E Saunders
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Tony T Yang
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Olga Tymofiyeva
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Hattan Arif
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego (Lowet, Arif, Max); Quinnipiac University, Hamden, Conn. (Kolan); Herbert Wertheim School of Public Health, Division of Biostatistics & Bioinformatics, University of California, San Diego (Vaida); Department of Radiology, University of California, San Diego (Hesselink); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (Levin); Departments of Pediatrics (Ewing-Cobbs) and Psychiatry (Saunders), University of Texas Health Science Center, Houston; the Hospital for Sick Children, University of Toronto (Schachar); Center for BrainHealth, University of Texas, Dallas (Chapman); Department of Psychology, Brigham Young University, Provo, Utah (Bigler); Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City (Bigler, Wilde); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Yang); Department of Radiology and Biomedical Imaging, University of California, San Francisco (Tymofiyeva); and Rady Children's Hospital, San Diego (Max)
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Wilde EA, Hyseni I, Lindsey HM, Faber J, McHenry JM, Bigler ED, Biekman BD, Hollowell LL, McCauley SR, Hunter JV, Ewing-Cobbs L, Aitken ME, MacLeod M, Chu ZD, Noble-Haeusslein LJ, Levin HS. A Preliminary DTI Tractography Study of Developmental Neuroplasticity 5-15 Years After Early Childhood Traumatic Brain Injury. Front Neurol 2022; 12:734055. [PMID: 35002913 PMCID: PMC8732947 DOI: 10.3389/fneur.2021.734055] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
Plasticity is often implicated as a reparative mechanism when addressing structural and functional brain development in young children following traumatic brain injury (TBI); however, conventional imaging methods may not capture the complexities of post-trauma development. The present study examined the cingulum bundles and perforant pathways using diffusion tensor imaging (DTI) in 21 children and adolescents (ages 10–18 years) 5–15 years after sustaining early childhood TBI in comparison with 19 demographically-matched typically-developing children. Verbal memory and executive functioning were also evaluated and analyzed in relation to DTI metrics. Beyond the expected direction of quantitative DTI metrics in the TBI group, we also found qualitative differences in the streamline density of both pathways generated from DTI tractography in over half of those with early TBI. These children exhibited hypertrophic cingulum bundles relative to the comparison group, and the number of tract streamlines negatively correlated with age at injury, particularly in the late-developing anterior regions of the cingulum; however, streamline density did not relate to executive functioning. Although streamline density of the perforant pathway was not related to age at injury, streamline density of the left perforant pathway was significantly and positively related to verbal memory scores in those with TBI, and a moderate effect size was found in the right hemisphere. DTI tractography may provide insight into developmental plasticity in children post-injury. While traditional DTI metrics demonstrate expected relations to cognitive performance in group-based analyses, altered growth is reflected in the white matter structures themselves in some children several years post-injury. Whether this plasticity is adaptive or maladaptive, and whether the alterations are structure-specific, warrants further investigation.
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Affiliation(s)
- Elisabeth A Wilde
- Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology, Baylor College of Medicine, Houston, TX, United States.,Department of Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Ilirjana Hyseni
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Hannah M Lindsey
- Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States.,Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Jessica Faber
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - James M McHenry
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Erin D Bigler
- Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States.,Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Brian D Biekman
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Laura L Hollowell
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Stephen R McCauley
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology, Baylor College of Medicine, Houston, TX, United States.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Jill V Hunter
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States.,Department of Radiology, Baylor College of Medicine, Houston, TX, United States.,Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, United States
| | - Linda Ewing-Cobbs
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mary E Aitken
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Marianne MacLeod
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Zili D Chu
- Department of Radiology, Baylor College of Medicine, Houston, TX, United States.,Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, United States
| | - Linda J Noble-Haeusslein
- Departments of Psychology and Neurology, University of Texas at Austin, Austin, TX, United States
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology, Baylor College of Medicine, Houston, TX, United States.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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Schmidt AT, Lindsey HM, Dennis E, Wilde EA, Biekman BD, Chu ZD, Hanten GR, Formon DL, Spruiell MS, Hunter JV, Levin HS. Diffusion Tensor Imaging Correlates of Resilience Following Adolescent Traumatic Brain Injury. Cogn Behav Neurol 2021; 34:259-274. [PMID: 34851864 PMCID: PMC8647770 DOI: 10.1097/wnn.0000000000000283] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is associated with considerable mortality and morbidity in adolescents, but positive outcomes are possible. Resilience is the concept that some individuals flourish despite significant adversity. OBJECTIVE To determine if there is a relationship between resilience-promoting factors that are known to promote resilience and white matter (WM) microstructure 1 year after complicated mild TBI or moderate or severe TBI that is sustained by adolescents. METHOD We examined the relationship between performance on a self-report measure of resilience-promoting factors and WM integrity assessed by diffusion tensor imaging in a group of adolescents who had sustained either a TBI (n = 38) or an orthopedic injury (OI) (n = 23). RESULTS Immediately following injury, the individuals with TBI and the OI controls had comparable levels of resilience-promoting factors; however, at 1 year post injury, the TBI group endorsed fewer resilience-promoting factors and exhibited WM disruption compared with the OI controls. The individuals with TBI who had more resilience-promoting factors at 1 year post injury exhibited increased WM integrity, but the OI controls did not. Findings were particularly strong for the following structures: anterior corona radiata, anterior limb of the internal capsule, and genu of the corpus callosum-structures that are implicated in social cognition and are frequently disrupted after TBI. Relationships were notable for caregiver and community-level resilience-promoting factors. CONCLUSION The current findings are some of the first to indicate neurobiological evidence of previously noted buffering effects of resilience-promoting factors in individuals with TBI.
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Affiliation(s)
- Adam T. Schmidt
- Department of Psychological Sciences, Texas Tech University Campus, Lubbock, Texas
| | | | - Emily Dennis
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | | | - Brian D. Biekman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Zili D. Chu
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gerri R. Hanten
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Dana L. Formon
- Colorado Department of Human Services, Office of Behavioral Health, Court Services Division, Denver, Colorado
| | - Matthew S. Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, Texas
- Department of Pediatric Radiology, Texas Children’s Hospital, Houston, Texas
| | - Harvey S. Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
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Burke J, Gugger J, Ding K, Kim JA, Foreman B, Yue JK, Puccio AM, Yuh EL, Sun X, Rabinowitz M, Vassar MJ, Taylor SR, Winkler EA, Deng H, McCrea M, Stein MB, Robertson CS, Levin HS, Dikmen S, Temkin NR, Barber J, Giacino JT, Mukherjee P, Wang KKW, Okonkwo DO, Markowitz AJ, Jain S, Lowenstein D, Manley GT, Diaz-Arrastia R. Association of Posttraumatic Epilepsy With 1-Year Outcomes After Traumatic Brain Injury. JAMA Netw Open 2021; 4:e2140191. [PMID: 34964854 PMCID: PMC8717106 DOI: 10.1001/jamanetworkopen.2021.40191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Posttraumatic epilepsy (PTE) is a recognized sequela of traumatic brain injury (TBI), but the long-term outcomes associated with PTE independent of injury severity are not precisely known. OBJECTIVE To determine the incidence, risk factors, and association with functional outcomes and self-reported somatic, cognitive, and psychological concerns of self-reported PTE in a large, prospectively collected TBI cohort. DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective cohort study was conducted as part of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study and identified patients presenting with TBI to 1 of 18 participating level 1 US trauma centers from February 2014 to July 2018. Patients with TBI, extracranial orthopedic injuries (orthopedic controls), and individuals without reported injuries (eg, friends and family of participants; hereafter friend controls) were prospectively followed for 12 months. Data were analyzed from January 2020 to April 2021. EXPOSURE Demographic, imaging, and clinical information was collected according to TBI Common Data Elements. Incidence of self-reported PTE was assessed using the National Institute of Neurological Disorders and Stroke Epilepsy Screening Questionnaire (NINDS-ESQ). MAIN OUTCOMES AND MEASURES Primary outcomes included Glasgow Outcome Scale Extended, Rivermead Cognitive Metric (RCM; derived from the Rivermead Post Concussion Symptoms Questionnaire), and the Brief Symptom Inventory-18 (BSI). RESULTS Of 3296 participants identified as part of the study, 3044 met inclusion criteria, and 1885 participants (mean [SD] age, 41.3 [17.1] years; 1241 [65.8%] men and 644 [34.2%] women) had follow-up information at 12 months, including 1493 patients with TBI; 182 orthopedic controls, 210 uninjured friend controls; 41 patients with TBI (2.8%) and no controls had positive screening results for PTE. Compared with a negative screening result for PTE, having a positive screening result for PTE was associated with presenting Glasgow Coma Scale score (8.1 [4.8] vs.13.5 [3.3]; P < .001) as well as with anomalous acute head imaging findings (risk ratio, 6.42 [95% CI, 2.71-15.22]). After controlling for age, initial Glasgow Coma Scale score, and imaging findings, compared with patients with TBI and without PTE, patients with TBI and with positive PTE screening results had significantly lower Glasgow Outcome Scale Extended scores (mean [SD], 6.1 [1.7] vs 4.7 [1.5]; P < .001), higher BSI scores (mean [SD], 50.2 [10.7] vs 58.6 [10.8]; P = .02), and higher RCM scores (mean [SD], 3.1 [2.6] vs 5.3 [1.9]; P = .002) at 12 months. CONCLUSIONS AND RELEVANCE In this cohort study, the incidence of self-reported PTE after TBI was found to be 2.8% and was independently associated with unfavorable outcomes. These findings highlight the need for effective antiepileptogenic therapies after TBI.
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Affiliation(s)
- John Burke
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - James Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas
| | - Jennifer A. Kim
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - John K. Yue
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Ava M. Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Esther L. Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Radiology, University of California. San Francisco
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Miri Rabinowitz
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary J. Vassar
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sabrina R. Taylor
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Ethan A. Winkler
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Murray B. Stein
- Department of Psychiatry and Public Health, University of California, San Diego
| | - Claudia S. Robertson
- Departments of Neurosurgery and Critical Care, Baylor College of Medicine, Houston, Texas
| | - Harvey S. Levin
- Departments of Neurosurgery and Neurology, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Nancy R. Temkin
- Department of Neurosurgery, University of Washington, Seattle
- Departments of Biostatistics, University of Washington, Seattle
| | - Jason Barber
- Departments of Biostatistics, University of Washington, Seattle
| | - Joseph T. Giacino
- Rehabilitation Neuropsychology, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Radiology, University of California. San Francisco
| | - Kevin K. W. Wang
- Department of Psychiatry and Neurosciences, McKnight Brain Institute, University of Florida, Gainesville
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amy J. Markowitz
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego
| | | | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
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11
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Troyanskaya M, Pastorek NJ, Wilde EA, Tombridge KA, Day AM, Levin HS, Scheibel RS. Risk factors for decline in cognitive performance following deployment-related mild traumatic brain injury: A preliminary report. Neurocase 2021; 27:457-461. [PMID: 34783300 DOI: 10.1080/13554794.2021.2002912] [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] [Indexed: 10/19/2022]
Abstract
Thorough identification of risk factors for delayed decline in cognitive performance following combat-related mild traumatic brain injury (mTBI) is important for guiding comprehensive post-deployment rehabilitation. In a sample of veterans who reported at least one deployment-related mTBI, preliminary results indicate that factors including a history of loss of consciousness over 1 min, current obesity and hypertension, and Black race were more prevalent in those with decreased scores on a measure of memory function. These factors should be considered by clinicians and researchers working with current and former military personnel.
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Affiliation(s)
- Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA
| | - Nicholas J Pastorek
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA
| | - Elisabeth A Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA.,Department of Neurology, University of Utah School of Medicine. Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Medical Center. Salt Lake City, Ut, USA
| | | | - Alyssa M Day
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,Department of Psychology. Houston, University of Houston, TX, USA
| | - Harvey S Levin
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA.,Department of Neurology, Baylor College of Medicine. Houston, Tx, USA.,Department of Neurosurgery, Baylor College of Medicine. Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine. Houston, Tx, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Houston, TX, USA
| | - Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine. Houston, Tx, USA
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12
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Kreitzer N, Jain S, Young JS, Sun X, Stein MB, McCrea MA, Levin HS, Giacino JT, Markowitz AJ, Manley GT, Nelson LD. Comparing the Quality of Life after Brain Injury-Overall Scale and Satisfaction with Life Scale as Outcome Measures for Traumatic Brain Injury Research. J Neurotrauma 2021; 38:3352-3363. [PMID: 34435894 DOI: 10.1089/neu.2020.7546] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
It is important to measure quality of life (QoL) after traumatic brain injury (TBI), yet limited studies have compared QoL inventories. In 2579 TBI patients, orthopedic trauma controls, and healthy friend control participants, we compared the Quality of Life After Brain Injury-Overall Scale (QOLIBRI-OS), developed for TBI patients, to the Satisfaction with Life Scale (SWLS), an index of generic life satisfaction. We tested the hypothesis that group differences (TBI and orthopedic trauma vs. healthy friend controls) would be larger for the QOLIBRI-OS than the SWLS and that the QOLIBRI-OS would manifest more substantial changes over time in the injured groups, demonstrating more relevance of the QOLIBRI-OS to traumatic injury recovery. (1) We compared the group differences (TBI vs. orthopedic trauma control vs. friend control) in QoL as indexed by the SWLS versus the QOLIBRI-OS and (2) characterized changes across time in these two inventories across 1 year in these three groups. Our secondary objective was to characterize the relationship between TBI severity and QoL. As compared with healthy friend controls, the QOLIBRI reflected greater reductions in QoL than the SWLS for both the TBI group (all time points) and the orthopedic trauma control group (2 weeks and 3 months). The QOLIBRI-OS better captured expected improvements in QoL during the injury recovery course in injured groups than the SWLS, which demonstrated smaller changes over time. TBI severity was not consistently or robustly associated with self-reported QoL. The findings imply that, as compared with the SWLS, the QOLIBRI-OS appears to identify QoL issues more specifically relevant to traumatically injured patients and may be a more appropriate primary QoL outcome measure for research focused on the sequelae of traumatic injuries.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California, San Diego, San Diego, California, USA
| | - Michael A McCrea
- Departments of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Amy J Markowitz
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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13
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Troyanskaya M, Pastorek NJ, Walder A, Wilde EA, Kennedy JE, Levin HS, Scheibel RS. Role of deployment-related mTBI and resilience in perceived participation limitations among Veterans. Military Psychology 2021. [DOI: 10.1080/08995605.2021.1962191] [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: 10/20/2022]
Affiliation(s)
- Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Nicholas J. Pastorek
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Annette Walder
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Elisabeth A. Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Jan E. Kennedy
- DefenseTX And Veterans Brain Injury Center, Brooke Army Medical Center Ft Sam Houston, San Antonio, Texas, USA
- General Dynamics Information Technology Falls Church, Falls Church, Virginia, USA
| | - Harvey S. Levin
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurology, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Randall S. Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
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14
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Rincon SP, Mukherjee P, Levin HS, Temkin NR, Mac Donald CL, Krainak DM, Sun X, Jain S, Taylor SR, Markowitz AJ, Kumar A, Manley GT, Yuh EL. Interrater Reliability of National Institutes of Health Traumatic Brain Injury Imaging Common Data Elements for Brain Magnetic Resonance Imaging in Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2831-2840. [PMID: 34275326 PMCID: PMC9836673 DOI: 10.1089/neu.2021.0138] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH-NINDS) Traumatic Brain Injury (TBI) Imaging Common Data Elements (CDEs) are standardized definitions for pathological intracranial lesions based on their appearance on neuroimaging studies. The NIH-NINDS TBI Imaging CDEs were designed to be as consistent as possible with the U.S. Food and Drug Administration (FDA) definition of biomarkers as "an indicator of normal biological processes, pathogenic processes, or biological responses to an exposure or intervention." However, the FDA qualification process for biomarkers requires proof of reliable biomarker test measurements. We determined the interrater reliability of TBI Imaging CDEs on subacute brain magnetic resonance imaging (MRI) performed on 517 mild TBI patients presenting to 11 U.S. level 1 trauma centers. Three U.S. board-certified neuroradiologists independently evaluated brain MRI performed 2 weeks post-injury for the following CDEs: traumatic axonal injury (TAI), diffuse axonal injury (DAI), and brain contusion. We found very high interrater agreement for brain contusion, with prevalence- and bias-adjusted kappa (PABAK) values for pairs of readers from 0.92 [95% confidence interval, 0.88-0.95] to 0.94 [0.90-0.96]. We found intermediate agreement for TAI and DAI, with PABAK values of 0.74-0.78 [0.70-0.82]. The near-perfect agreement for subacute brain contusion is likely attributable to the high conspicuity and distinctive appearance of these lesions on T1-weighted images. Interrater agreement for TAI and DAI was lower, because signal void in small vascular structures, and artifactual foci of signal void, can be difficult to distinguish from the punctate round or linear areas of slight hemorrhage that are a common hallmark of TAI/DAI on MRI.
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Affiliation(s)
- Sandra P. Rincon
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Harvey S. Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Daniel M. Krainak
- U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Sabrina R. Taylor
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Amy J. Markowitz
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | | | - Geoffrey T. Manley
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Esther L. Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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15
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McCrea MA, Giacino JT, Barber J, Temkin NR, Nelson LD, Levin HS, Dikmen S, Stein M, Bodien YG, Boase K, Taylor SR, Vassar M, Mukherjee P, Robertson C, Diaz-Arrastia R, Okonkwo DO, Markowitz AJ, Manley GT, Adeoye O, Badjatia N, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson AR, Foreman B, Gardner R, Gaudette E, Goldman D, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Keene CD, Korley FK, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Ngwenya LB, Noel F, Nolan A, Palacios E, Perl D, Puccio A, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Toga A, Valadka A, Wang K, Yue JK, Yuh E, Zafonte R. Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study. JAMA Neurol 2021; 78:982-992. [PMID: 34228047 DOI: 10.1001/jamaneurol.2021.2043] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the US and worldwide. Few studies have enabled prospective, longitudinal outcome data collection from the acute to chronic phases of recovery after msTBI. Objective To prospectively assess outcomes in major areas of life function at 2 weeks and 3, 6, and 12 months after msTBI. Design, Setting, and Participants This cohort study, as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, was conducted at 18 level 1 trauma centers in the US from February 2014 to August 2018 and prospectively assessed longitudinal outcomes, with follow-up to 12 months postinjury. Participants were patients with msTBI (Glasgow Coma Scale scores 3-12) extracted from a larger group of patients with mild, moderate, or severe TBI who were enrolled in TRACK-TBI. Data analysis took place from October 2019 to April 2021. Exposures Moderate or severe TBI. Main Outcomes and Measures The Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale (DRS) were used to assess global functional status 2 weeks and 3, 6, and 12 months postinjury. Scores on the GOSE were dichotomized to determine favorable (scores 4-8) vs unfavorable (scores 1-3) outcomes. Neurocognitive testing and patient reported outcomes at 12 months postinjury were analyzed. Results A total of 484 eligible patients were included from the 2679 individuals in the TRACK-TBI study. Participants with severe TBI (n = 362; 283 men [78.2%]; median [interquartile range] age, 35.5 [25-53] years) and moderate TBI (n = 122; 98 men [80.3%]; median [interquartile range] age, 38 [25-53] years) were comparable on demographic and premorbid variables. At 2 weeks postinjury, 36 of 290 participants with severe TBI (12.4%) and 38 of 93 participants with moderate TBI (41%) had favorable outcomes (GOSE scores 4-8); 301 of 322 in the severe TBI group (93.5%) and 81 of 103 in the moderate TBI group (78.6%) had moderate disability or worse on the DRS (total score ≥4). By 12 months postinjury, 142 of 271 with severe TBI (52.4%) and 54 of 72 with moderate TBI (75%) achieved favorable outcomes. Nearly 1 in 5 participants with severe TBI (52 of 270 [19.3%]) and 1 in 3 with moderate TBI (23 of 71 [32%]) reported no disability (DRS score 0) at 12 months. Among participants in a vegetative state at 2 weeks, 62 of 79 (78%) regained consciousness and 14 of 56 with available data (25%) regained orientation by 12 months. Conclusions and Relevance In this study, patients with msTBI frequently demonstrated major functional gains, including recovery of independence, between 2 weeks and 12 months postinjury. Severe impairment in the short term did not portend poor outcomes in a substantial minority of patients with msTBI. When discussing prognosis during the first 2 weeks after injury, clinicians should be particularly cautious about making early, definitive prognostic statements suggesting poor outcomes and withdrawal of life-sustaining treatment in patients with msTBI.
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Affiliation(s)
- Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Harvey S Levin
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Neurological Surgery, University of Washington, Seattle
| | - Murray Stein
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle
| | - Sabrina R Taylor
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Mary Vassar
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Pratik Mukherjee
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Claudia Robertson
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - David O Okonkwo
- Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amy J Markowitz
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Geoffrey T Manley
- Neurological Surgery, University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sonia Jain
- University of California, San Diego, La Jolla
| | | | | | - Joel Kramer
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | - Amber Nolan
- University of California, San Francisco, San Francisco
| | - Eva Palacios
- University of California, San Francisco, San Francisco
| | - Daniel Perl
- Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | - Arthur Toga
- University of Southern California, Los Angeles
| | | | | | - John K Yue
- University of California, San Francisco, San Francisco
| | - Esther Yuh
- University of California, San Francisco, San Francisco
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16
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Dennis EL, Caeyenberghs K, Hoskinson KR, Merkley TL, Suskauer SJ, Asarnow RF, Babikian T, Bartnik-Olson B, Bickart K, Bigler ED, Ewing-Cobbs L, Figaji A, Giza CC, Goodrich-Hunsaker NJ, Hodges CB, Hovenden ES, Irimia A, Königs M, Levin HS, Lindsey HM, Max JE, Newsome MR, Olsen A, Ryan NP, Schmidt AT, Spruiell MS, Wade BSC, Ware AL, Watson CG, Wheeler AL, Yeates KO, Zielinski BA, Kochunov P, Jahanshad N, Thompson PM, Tate DF, Wilde EA. White Matter Disruption in Pediatric Traumatic Brain Injury: Results From ENIGMA Pediatric Moderate to Severe Traumatic Brain Injury. Neurology 2021; 97:e298-e309. [PMID: 34050006 PMCID: PMC8302152 DOI: 10.1212/wnl.0000000000012222] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Our study addressed aims (1) to test the hypothesis that moderate-severe traumatic brain injury (TBI) in pediatric patients is associated with widespread white matter (WM) disruption, (2) to test the hypothesis that age and sex affect WM organization after injury, and (3) to examine associations between WM organization and neurobehavioral outcomes. METHODS Data from 10 previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the Enhancing NeuroImaging Genetics Through Meta-Analysis (ENIGMA) Pediatric Moderate/Severe TBI (msTBI) working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline. RESULTS Five hundred seven children and adolescents (244 with complicated msTBI and 263 controls) were included. Patients were clustered into 3 postinjury intervals: acute/subacute, <2 months; postacute, 2 to 6 months; and chronic, ≥6 months. Outcomes were dMRI metrics and postinjury behavioral problems as indexed by the Child Behavior Checklist. Our analyses revealed altered WM diffusion metrics across multiple tracts and all postinjury intervals (effect sizes range d = -0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time after injury. We observed a sex-by-group interaction: female patients with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (β = 0.043), which coincided with more parent-reported behavioral problems (β = -0.0027). CONCLUSIONS WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically meaningful patient subtypes.
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Affiliation(s)
- Emily L Dennis
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Karen Caeyenberghs
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Kristen R Hoskinson
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Tricia L Merkley
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Stacy J Suskauer
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Robert F Asarnow
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Talin Babikian
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Brenda Bartnik-Olson
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Kevin Bickart
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Erin D Bigler
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Linda Ewing-Cobbs
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Anthony Figaji
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Christopher C Giza
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Naomi J Goodrich-Hunsaker
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Cooper B Hodges
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Elizabeth S Hovenden
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Andrei Irimia
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Marsh Königs
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Harvey S Levin
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Hannah M Lindsey
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Jeffrey E Max
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Mary R Newsome
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Alexander Olsen
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Nicholas P Ryan
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Adam T Schmidt
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Matthew S Spruiell
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Benjamin S C Wade
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Ashley L Ware
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Christopher G Watson
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Anne L Wheeler
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Keith Owen Yeates
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Brandon A Zielinski
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Peter Kochunov
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Neda Jahanshad
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Paul M Thompson
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - David F Tate
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
| | - Elisabeth A Wilde
- From the Department of Neurology (E.L.D., T.L.M., E.D.B., N.J.G.-H., E.S.H., H.M.L., B.S.C.W., B.A.Z., D.F.T., E.A.W.), University of Utah School of Medicine; George E. Wahlen Veterans Affairs Medical Center (E.L.D., N.J.G.-H., H.M.L., D.F.T., E.A.W.), Salt Lake City, UT; Cognitive Neuroscience Unit (K.C., N.P.R.), School of Psychology, Deakin University, Geelong, Australia; Center for Biobehavioral Health (K.R.H.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (K.R.H.), The Ohio State University College of Medicine, Columbus; Department of Psychology (T.L.M., E.D.B., N.J.G.-H., C.B.H., H.M.L.) and Neuroscience Center (T.L.M., E.D.B.), Brigham Young University, Provo, UT; Kennedy Krieger Institute (S.J.S.); Departments of Physical Medicine & Rehabilitation and Pediatrics (S.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Biobehavioral Sciences (R.F.A., T.B.), Semel Institute for Neuroscience and Human Behavior, Brain Research Institute (R.F.A.), and Department of Psychology (R.F.A.), UCLA; UCLA Steve Tisch BrainSPORT Program (T.B., K.B., C.C.G.), Los Angeles; Department of Radiology (B.B.-O.), Loma Linda University Medical Center; Departments of Neurology (K.B.) and Neurosurgery (C.C.G.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Pediatrics (L.E.-C., C.G.W.), Children's Learning Institute, University of Texas Health Science Center at Houston; Division of Neurosurgery (A.F.) and Neuroscience Institute (A.F.), University of Cape Town, South Africa; Department of Pediatrics (C.C.G.), Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA; Department of Physical Medicine and Rehabilitation (C.B.H.), Virginia Commonwealth University, Richmond; Ethel Percy Andrus Gerontology Center (A.I.), Leonard Davis School of Gerontology, and Department of Biomedical Engineering (A.I.), Viterbi School of Engineering, University of Southern California, Los Angeles; Emma Children's Hospital (M.K.), Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, the Netherlands; H. Ben Taub Department of Physical Medicine and Rehabilitation (H.S.L., M.R.N., M.S.S., E.A.W.), Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Center (H.S.L., M.R.N.), Houston, TX; Department of Psychiatry (J.E.M.), University of California, San Diego, La Jolla; Department of Psychiatry (J.E.M.), Rady Children's Hospital, San Diego, CA; Department of Psychology (A.O.), Norwegian University of Science and Technology, Trondheim; Department of Physical Medicine and Rehabilitation (A.O.), St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Clinical Sciences (N.P.R.), Murdoch Children's Research Institute; Department of Paediatrics (N.P.R.), University of Melbourne, Australia; Department of Psychological Sciences (A.T.S.), Texas Tech University, Lubbock; Ahmanson-Lovelace Brain Mapping Center (B.S.C.W.), Department of Neurology, University of California, Los Angeles; Department of Psychology (A.L. Ware, K.O.Y.), University of Calgary, Alberta; Hospital for Sick Children (A.L. Wheeler), Neuroscience and Mental Health Program; Physiology Department (A.L. Wheeler), University of Toronto, Ontario; Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute (K.O.Y.) and Departments of Pediatrics and Clinical Neurosciences (K.O.Y.), University of Calgary, Alberta, Canada; Department of Pediatrics (B.A.Z.), University of Utah School of Medicine, Salt Lake City; Maryland Psychiatric Research Center (P.K.), University of Maryland School of Medicine, Baltimore; Imaging Genetics Center (N.J., P.M.T.), Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina Del Rey; and Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology (P.M.T.), USC, Los Angeles, CA
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Yuh EL, Jain S, Sun X, Pisica D, Harris MH, Taylor SR, Markowitz AJ, Mukherjee P, Verheyden J, Giacino JT, Levin HS, McCrea M, Stein MB, Temkin NR, Diaz-Arrastia R, Robertson CS, Lingsma HF, Okonkwo DO, Maas AIR, Manley GT, Adeoye O, Badjatia N, Boase K, Bodien Y, Corrigan JD, Crawford K, Dikmen S, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson AR, Foreman B, Gardner R, Gaudette E, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Keene CD, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Nelson L, Ngwenya LB, Noel F, Nolan A, Palacios E, Perl D, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Toga A, Valadka A, Vassar M, Zafonte R. Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury: A TRACK-TBI Study With External Validation in CENTER-TBI. JAMA Neurol 2021; 78:1137-1148. [PMID: 34279565 PMCID: PMC8290344 DOI: 10.1001/jamaneurol.2021.2120] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Question Are different patterns of intracranial injury on head computed tomography associated with prognosis after mild traumatic brain injury (mTBI)? Findings In this cohort study, subarachnoid hemorrhage, subdural hematoma, and contusion often co-occurred and were associated with both incomplete recovery and more severe impairment out to 12 months after injury, while intraventricular and/or petechial hemorrhage co-occurred and were associated with more severe impairment up to 12 months after injury; epidural hematoma was associated with incomplete recovery at some points but not with more severe impairment. Some intracranial hemorrhage patterns were more strongly associated with outcomes than previously validated demographic and clinical variables. Meaning In this study, different pathological features on head computed tomography carried different implications for mild traumatic brain injury prognosis to 1 year. Importance A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. Objective To identify pathological CT features associated with adverse outcomes after mTBI. Design, Setting, and Participants The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale–Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. Exposures Acute nonpenetrating head trauma. Main Outcomes and Measures Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs ≥5) at 2 weeks and 3, 6, and 12 months. Results In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in TRACK-TBI: 3.47 [95% CI, 1.66-7.26]). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI .98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). Findings were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. Conclusions and Relevance In this study, pathological CT features carried different prognostic implications after mTBI to 1 year postinjury. Some patterns of injury were associated with worse outcomes than others. These results support that patients with mTBI and these CT features need TBI-specific education and systematic follow-up.
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Affiliation(s)
- Esther L Yuh
- Brain and Spinal Injury Center, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Dana Pisica
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mark H Harris
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | - Sabrina R Taylor
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | - Amy J Markowitz
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | - Jan Verheyden
- Research and Development, Icometrix, Leuven, Belgium
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla.,Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle
| | | | | | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joel Kramer
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | | | - Amber Nolan
- University of California, San Francisco, San Francisco
| | - Eva Palacios
- University of California, San Francisco, San Francisco
| | - Daniel Perl
- Uniformed Services University, Bethesda, Maryland
| | | | | | | | | | | | | | - Arthur Toga
- University of Southern California, Los Angeles
| | | | - Mary Vassar
- University of California, San Francisco, San Francisco
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18
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Nelson LD, Kramer MD, Joyner KJ, Patrick CJ, Stein MB, Temkin N, Levin HS, Whyte J, Markowitz AJ, Giacino J, Manley GT. Relationship between transdiagnostic dimensions of psychopathology and traumatic brain injury (TBI): A TRACK-TBI study. J Abnorm Psychol 2021; 130:423-434. [PMID: 34110838 DOI: 10.1037/abn0000672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neuropsychiatric symptoms are common, comorbid, and often disabling for patients with traumatic brain injury (TBI). Identifying transdiagnostic symptom dimensions post-TBI may help overcome limitations of traditional psychiatric diagnoses and advance treatment development. We characterized the dimensional structure of neuropsychiatric symptoms at 2-weeks postinjury in n = 1,732 TBI patients and n = 238 orthopedic-injured trauma controls (OTC) from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Symptoms were reported on the Brief Symptom Inventory-18, Patient Health Questionnaire-9 Depression checklist, PTSD Checklist for DSM-5, PROMIS Pain Intensity scale, and Insomnia Severity Index. We established a novel factor model of neuropsychiatric symptoms and evaluated how 3 TBI severity strata and OTC patients differed in symptom severity. The final factor model had 6 first-order factors subsumed by 2 second-order factors: Internalizing (encompassing Depression, Anxiety, and Fear) and Somatic symptoms (Sleep, Physical, Pain). Somatic symptoms fit better as a correlated factor of (vs. a lower-order factor within) Internalizing. All symptom dimensions except for Pain were more severe in 1 or more TBI subgroups, as compared to the OTC group. Milder brain injury was generally associated with more severe symptoms, whereas more general injury severity (higher level of care, e.g., emergency department, intensive care unit) was associated with more pain. The findings indicate a broad factor resembling the internalizing factor of general psychopathology in traumatically injured patients, alongside a distinct somatic symptom factor. Brain injury, especially milder brain injury, may exacerbate liabilities toward these symptoms. These neuropsychiatric dimensions may help advance more precision medicine research for TBI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Nancy Temkin
- Departments of Neurological Surgery and Biostatistics
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19
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Bigler ED, Skiles M, Wade BSC, Abildskov TJ, Tustison NJ, Scheibel RS, Newsome MR, Mayer AR, Stone JR, Taylor BA, Tate DF, Walker WC, Levin HS, Wilde EA. FreeSurfer 5.3 versus 6.0: are volumes comparable? A Chronic Effects of Neurotrauma Consortium study. Brain Imaging Behav 2021; 14:1318-1327. [PMID: 30511116 DOI: 10.1007/s11682-018-9994-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/27/2022]
Abstract
Automated neuroimaging methods like FreeSurfer ( https://surfer.nmr.mgh.harvard.edu/ ) have revolutionized quantitative neuroimaging analyses. Such analyses provide a variety of metrics used for image quantification, including magnetic resonance imaging (MRI) volumetrics. With the release of FreeSurfer version 6.0, it is important to assess its comparability to the widely-used previous version 5.3. The current study used data from the initial 249 participants in the ongoing Chronic Effects of Neurotrauma Consortium (CENC) multicenter observational study to compare the volumetric output of versions 5.3 and 6.0 across various regions of interest (ROI). In the current investigation, the following ROIs were examined: total intracranial volume, total white matter volume, total ventricular volume, total gray matter volume, and right and left volumes for the thalamus, pallidum, putamen, caudate, amygdala and hippocampus. Absolute ROI volumes derived from FreeSurfer 6.0 differed significantly from those obtained using version 5.3. We also employed a clinically-based evaluation strategy to compare both versions in their prediction of age-mediated volume reductions (or ventricular increase) in the aforementioned structures. Statistical comparison involved both general linear modeling (GLM) and random forest (RF) methods, where cross-validation error was significantly higher using segmentations from FreeSurfer version 5.3 versus version 6.0 (GLM: t = 4.97, df = 99, p value = 2.706e-06; RF: t = 4.85, df = 99, p value = 4.424e-06). Additionally, the relative importance of ROIs used to predict age using RFs differed between FreeSurfer versions, indicating substantial differences in the two versions. However, from the perspective of correlational analyses, fitted regression lines and their slopes were similar between the two versions, regardless of version used. While absolute volumes are not interchangeable between version 5.3 and 6.0, ROI correlational analyses appear to yield similar results, suggesting the interchangeability of ROI volume for correlational studies.
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Affiliation(s)
- Erin D Bigler
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA.
| | - Marc Skiles
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA
| | - Benjamin S C Wade
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA.,Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA.,Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, CA, USA
| | - Tracy J Abildskov
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA
| | - Nick J Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Randall S Scheibel
- Michael DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Mary R Newsome
- Michael DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | | | - James R Stone
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | | | - David F Tate
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | | | - Harvey S Levin
- Michael DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Elisabeth A Wilde
- Michael DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.,University of Utah, Salt Lake City, UT, USA
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20
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Koerte IK, Esopenko C, Hinds SR, Shenton ME, Bonke EM, Bazarian JJ, Bickart KC, Bigler ED, Bouix S, Buckley TA, Choe MC, Echlin PS, Gill J, Giza CC, Hayes J, Hodges CB, Irimia A, Johnson PK, Kenney K, Levin HS, Lin AP, Lindsey HM, Lipton ML, Max JE, Mayer AR, Meier TB, Merchant-Borna K, Merkley TL, Mills BD, Newsome MR, Porfido T, Stephens JA, Tartaglia MC, Ware AL, Zafonte RD, Zeineh MM, Thompson PM, Tate DF, Dennis EL, Wilde EA, Baron D. The ENIGMA sports injury working group:- an international collaboration to further our understanding of sport-related brain injury. Brain Imaging Behav 2021; 15:576-584. [PMID: 32720179 PMCID: PMC7855299 DOI: 10.1007/s11682-020-00370-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sport-related brain injury is very common, and the potential long-term effects include a wide range of neurological and psychiatric symptoms, and potentially neurodegeneration. Around the globe, researchers are conducting neuroimaging studies on primarily homogenous samples of athletes. However, neuroimaging studies are expensive and time consuming, and thus current findings from studies of sport-related brain injury are often limited by small sample sizes. Further, current studies apply a variety of neuroimaging techniques and analysis tools which limit comparability among studies. The ENIGMA Sports Injury working group aims to provide a platform for data sharing and collaborative data analysis thereby leveraging existing data and expertise. By harmonizing data from a large number of studies from around the globe, we will work towards reproducibility of previously published findings and towards addressing important research questions with regard to diagnosis, prognosis, and efficacy of treatment for sport-related brain injury. Moreover, the ENIGMA Sports Injury working group is committed to providing recommendations for future prospective data acquisition to enhance data quality and scientific rigor.
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Affiliation(s)
- Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität München, Waltherstr. 23, 80337, Munich, Germany.
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Science, Rutgers Biomedical Health Sciences, Newark, NJ, USA
- School of Graduate Studies, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Sidney R Hinds
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Elena M Bonke
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität München, Waltherstr. 23, 80337, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - Jeffrey J Bazarian
- Departments of Emergency Medicine & Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Kevin C Bickart
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Neurology and Neuropsychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Meeryo C Choe
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, ON, Canada
| | - Jessica Gill
- Department of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jasmeet Hayes
- Psychology Department, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Paula K Johnson
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Michael L Lipton
- Departments of Radiology, Psychiatry and Behavioral Sciences and The Dominick P. Purpura Department of Neuroscience, The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Radiology, Montefiore Medicine, Bronx, NY, USA
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, Rady Children's Hospital, San Diego, CA, USA
| | - Andrew R Mayer
- Mind Research Network, Albuquerque, NM, USA
- Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kian Merchant-Borna
- Departments of Emergency Medicine & Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Tricia L Merkley
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Brian D Mills
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Tara Porfido
- School of Graduate Studies, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Jaclyn A Stephens
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Maria Carmela Tartaglia
- Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - David Baron
- Western University of Health Sciences, Pomona, CA, USA
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21
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Xu LB, Yue JK, Korley F, Puccio AM, Yuh EL, Sun X, Rabinowitz M, Vassar MJ, Taylor SR, Winkler EA, Puffer RC, Deng H, McCrea M, Stein MB, Robertson CS, Levin HS, Dikmen S, Temkin NR, Giacino JT, Mukherjee P, Wang KK, Okonkwo DO, Markowitz AJ, Jain S, Manley GT, Diaz-Arrastia R. High-Sensitivity C-Reactive Protein is a Prognostic Biomarker of Six-Month Disability after Traumatic Brain Injury: Results from the TRACK-TBI Study. J Neurotrauma 2021; 38:918-927. [PMID: 33161875 PMCID: PMC7987360 DOI: 10.1089/neu.2020.7177] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Indexed: 12/26/2022] Open
Abstract
Systemic inflammation impacts outcome after traumatic brain injury (TBI), but most TBI biomarker studies have focused on brain-specific proteins. C-reactive protein (CRP) is a widely used biomarker of inflammation with potential as a prognostic biomarker after TBI. The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study prospectively enrolled TBI patients within 24 h of injury, as well as orthopedic injury and uninjured controls; biospecimens were collected at enrollment. A subset of hospitalized participants had blood collected on day 3, day 5, and 2 weeks. High-sensitivity CRP (hsCRP) and glial fibrillary acidic protein (GFAP) were measured. Receiver operating characteristic analysis was used to evaluate the prognostic ability of hsCRP for 6-month outcome, using the Glasgow Outcome Scale-Extended (GOSE). We included 1206 TBI subjects, 122 orthopedic trauma controls (OTCs), and 209 healthy controls (HCs). Longitudinal biomarker sampling was performed in 254 hospitalized TBI subjects and 19 OTCs. hsCRP rose between days 1 and 5 for TBI and OTC subjects, and fell by 2 weeks, but remained elevated compared with HCs (p < 0.001). Longitudinally, hsCRP was significantly higher in the first 2 weeks for subjects with death/severe disability (GOSE <5) compared with those with moderate disability/good recovery (GOSE ≥5); AUC was highest at 2 weeks (AUC = 0.892). Combining hsCRP and GFAP at 2 weeks produced AUC = 0.939 for prediction of disability. Serum hsCRP measured within 2 weeks of TBI is a prognostic biomarker for disability 6 months later. hsCRP may have utility as a biomarker of target engagement for anti-inflammatory therapies.
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Affiliation(s)
- Linda B. Xu
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John K. Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ava M. Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Esther L. Yuh
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Miri Rabinowitz
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mary J. Vassar
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Sabrina R. Taylor
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ethan A. Winkler
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ross C. Puffer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Murray B. Stein
- Department of Psychiatry and Family Medicine, University of California San Diego, San Diego, California, USA
| | - Claudia S. Robertson
- Department of Neurosurgery and Critical Care, Baylor College of Medicine, Houston, Texas, USA
| | - Harvey S. Levin
- Department of Neurosurgery and Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy R. Temkin
- Department of Neurosurgery and Biostatistics, University of Washington, Seattle, Washington, USA
| | - Joseph T. Giacino
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pratik Mukherjee
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Kevin K.W. Wang
- Department of Psychiatry and Neurosciences, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amy J. Markowitz
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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Tate DF, Dennis EL, Adams JT, Adamson MM, Belanger HG, Bigler ED, Bouchard HC, Clark AL, Delano-Wood LM, Disner SG, Eapen BC, Franz CE, Geuze E, Goodrich-Hunsaker NJ, Han K, Hayes JP, Hinds SR, Hodges CB, Hovenden ES, Irimia A, Kenney K, Koerte IK, Kremen WS, Levin HS, Lindsey HM, Morey RA, Newsome MR, Ollinger J, Pugh MJ, Scheibel RS, Shenton ME, Sullivan DR, Taylor BA, Troyanskaya M, Velez C, Wade BS, Wang X, Ware AL, Zafonte R, Thompson PM, Wilde EA. Coordinating Global Multi-Site Studies of Military-Relevant Traumatic Brain Injury: Opportunities, Challenges, and Harmonization Guidelines. Brain Imaging Behav 2021; 15:585-613. [PMID: 33409819 PMCID: PMC8035292 DOI: 10.1007/s11682-020-00423-2] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Traumatic brain injury (TBI) is common among military personnel and the civilian population and is often followed by a heterogeneous array of clinical, cognitive, behavioral, mood, and neuroimaging changes. Unlike many neurological disorders that have a characteristic abnormal central neurologic area(s) of abnormality pathognomonic to the disorder, a sufficient head impact may cause focal, multifocal, diffuse or combination of injury to the brain. This inconsistent presentation makes it difficult to establish or validate biological and imaging markers that could help improve diagnostic and prognostic accuracy in this patient population. The purpose of this manuscript is to describe both the challenges and opportunities when conducting military-relevant TBI research and introduce the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Military Brain Injury working group. ENIGMA is a worldwide consortium focused on improving replicability and analytical power through data sharing and collaboration. In this paper, we discuss challenges affecting efforts to aggregate data in this patient group. In addition, we highlight how "big data" approaches might be used to understand better the role that each of these variables might play in the imaging and functional phenotypes of TBI in Service member and Veteran populations, and how data may be used to examine important military specific issues such as return to duty, the late effects of combat-related injury, and alteration of the natural aging processes.
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Affiliation(s)
- David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
| | - John T Adams
- Western University of Health Sciences, Pomona, CA, USA
| | - Maheen M Adamson
- Defense and Veterans Brain Injury Center, VA Palo Alto, Palo Alto, CA, USA
- Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Heather G Belanger
- United States Special Operations Command (USSOCOM), Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- St Michaels Inc, Tampa, FL, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Heather C Bouchard
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Alexandra L Clark
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa M Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Seth G Disner
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol E Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Elbert Geuze
- University Medical Center Utrecht, Utrecht, Netherlands
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands
| | - Naomi J Goodrich-Hunsaker
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Kihwan Han
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jasmeet P Hayes
- Psychology Department, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Sidney R Hinds
- Department of Defense/United States Army Medical Research and Materiel Command, Fort Detrick, Frederick, MD, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Elizabeth S Hovenden
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - William S Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mary Jo Pugh
- Information Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, UT, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Randall S Scheibel
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Brockton Division, VA Boston Healthcare System, Brockton, MA, USA
| | - Danielle R Sullivan
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Brian A Taylor
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Carmen Velez
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Benjamin Sc Wade
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital/Brigham & Women's Hospital, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Department of Neurology, USC, Los Angeles, CA, USA
- Department of Pediatrics, USC, Los Angeles, CA, USA
- Department of Psychiatry, USC, Los Angeles, CA, USA
- Department of Radiology, USC, Los Angeles, CA, USA
- Department of Engineering, USC, Los Angeles, CA, USA
- Department of Ophthalmology, USC, Los Angeles, CA, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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23
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Levin HS, Temkin NR, Barber J, Nelson LD, Robertson C, Brennan J, Stein MB, Yue JK, Giacino JT, McCrea MA, Diaz-Arrastia R, Mukherjee P, Okonkwo DO, Boase K, Markowitz AJ, Bodien Y, Taylor S, Vassar MJ, Manley GT. Association of Sex and Age With Mild Traumatic Brain Injury-Related Symptoms: A TRACK-TBI Study. JAMA Netw Open 2021; 4:e213046. [PMID: 33822070 PMCID: PMC8025125 DOI: 10.1001/jamanetworkopen.2021.3046] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Knowledge of differences in mild traumatic brain injury (mTBI) recovery by sex and age may inform individualized treatment of these patients. OBJECTIVE To identify sex-related differences in symptom recovery from mTBI; secondarily, to explore age differences within women, who demonstrate poorer outcomes after TBI. DESIGN, SETTING, AND PARTICIPANTS The prospective cohort study Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) recruited 2000 patients with mTBI from February 26, 2014, to July 3, 2018, and 299 patients with orthopedic trauma (who served as controls) from January 26, 2016, to July 27, 2018. Patients were recruited from 18 level I trauma centers and followed up for 12 months. Data were analyzed from August 19, 2020, to March 3, 2021. EXPOSURES Patients with mTBI (defined by a Glasgow Coma Scale score of 13-15) triaged to head computed tomography in 24 hours or less; patients with orthopedic trauma served as controls. MAIN OUTCOMES AND MEASURES Measured outcomes included (1) the Rivermead Post Concussion Symptoms Questionnaire (RPQ), a 16-item self-report scale that assesses postconcussion symptom severity over the past 7 days relative to preinjury; (2) the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), a 20-item test that measures the severity of posttraumatic stress disorder symptoms; (3) the Patient Health Questionnaire-9 (PHQ-9), a 9-item scale that measures depression based on symptom frequency over the past 2 weeks; and (4) the Brief Symptom Inventory-18 (BSI-18), an 18-item scale of psychological distress (split into Depression and Anxiety subscales). RESULTS A total of 2000 patients with mTBI (1331 men [67%; mean (SD) age, 41.0 (17.3) years; 1026 White (78%)] and 669 women [33%; mean (SD) age, 43.0 (18.5) years; 505 (76%) White]). After adjustment of multiple comparisons, significant TBI × sex interactions were observed for cognitive symptoms (B = 0.76; 5% false discovery rate-corrected P = .02) and somatic RPQ symptoms (B = 0.80; 5% false discovery rate-corrected P = .02), with worse symptoms in women with mTBI than men, but no sex difference in symptoms in control patients with orthopedic trauma. Within the female patients evaluated, there was a significant TBI × age interaction for somatic RPQ symptoms, which were worse in female patients with mTBI aged 35 to 49 years compared with those aged 17 to 34 years (B = 1.65; P = .02) or older than 50 years (B = 1.66; P = .02). CONCLUSIONS AND RELEVANCE This study found that women were more vulnerable than men to persistent mTBI-related cognitive and somatic symptoms, whereas no sex difference in symptom burden was seen after orthopedic injury. Postconcussion symptoms were also worse in women aged 35 to 49 years than in younger and older women, but further investigation is needed to corroborate these findings and to identify the mechanisms involved. Results suggest that individualized clinical management of mTBI should consider sex and age, as some women are especially predisposed to chronic postconcussion symptoms even 12 months after injury.
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Affiliation(s)
- Harvey S. Levin
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | | | | | | | | | - Joseph T. Giacino
- Spaulding Rehabilitation Center, Boston, Massachusetts
- Massachusetts General Hospital, Boston
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | | | | | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle
| | | | - Yelena Bodien
- Spaulding Rehabilitation Center, Boston, Massachusetts
- Massachusetts General Hospital, Boston
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24
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Dennis EL, Caeyenberghs K, Asarnow RF, Babikian T, Bartnik-Olson B, Bigler ED, Figaji A, Giza CC, Goodrich-Hunsaker NJ, Hodges CB, Hoskinson KR, Königs M, Levin HS, Lindsey HM, Livny A, Max JE, Merkley TL, Newsome MR, Olsen A, Ryan NP, Spruiell MS, Suskauer SJ, Thomopoulos SI, Ware AL, Watson CG, Wheeler AL, Yeates KO, Zielinski BA, Thompson PM, Tate DF, Wilde EA. Challenges and opportunities for neuroimaging in young patients with traumatic brain injury: a coordinated effort towards advancing discovery from the ENIGMA pediatric moderate/severe TBI group. Brain Imaging Behav 2021; 15:555-575. [PMID: 32734437 PMCID: PMC7855317 DOI: 10.1007/s11682-020-00363-x] [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] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability in children in both developed and developing nations. Children and adolescents suffer from TBI at a higher rate than the general population, and specific developmental issues require a unique context since findings from adult research do not necessarily directly translate to children. Findings in pediatric cohorts tend to lag behind those in adult samples. This may be due, in part, both to the smaller number of investigators engaged in research with this population and may also be related to changes in safety laws and clinical practice that have altered length of hospital stays, treatment, and access to this population. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric Moderate/Severe TBI (msTBI) group aims to advance research in this area through global collaborative meta-analysis of neuroimaging data. In this paper, we discuss important challenges in pediatric TBI research and opportunities that we believe the ENIGMA Pediatric msTBI group can provide to address them. With the paucity of research studies examining neuroimaging biomarkers in pediatric patients with TBI and the challenges of recruiting large numbers of participants, collaborating to improve statistical power and to address technical challenges like lesions will significantly advance the field. We conclude with recommendations for future research in this field of study.
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Affiliation(s)
- Emily L Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA.
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Boston, MA, USA.
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Robert F Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
- Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Brenda Bartnik-Olson
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Erin D Bigler
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Anthony Figaji
- Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Naomi J Goodrich-Hunsaker
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Cooper B Hodges
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marsh Königs
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, Amsterdam, The Netherlands
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hannah M Lindsey
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Abigail Livny
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Tel-Hashomer, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Tel-Hashomer, Israel
| | - Jeffrey E Max
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Department of Psychiatry, Rady Children's Hospital, San Diego, CA, USA
| | - Tricia L Merkley
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nicholas P Ryan
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Matthew S Spruiell
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, MD, USA
- Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher G Watson
- Department of Pediatrics, Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anne L Wheeler
- Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, Canada
- Physiology Department, University of Toronto, Toronto, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Brandon A Zielinski
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - David F Tate
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
- Missouri Institute of Mental Health and University of Missouri, St Louis, MO, USA
| | - Elisabeth A Wilde
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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25
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Nelson LD, Barber JK, Temkin NR, Dams-O'Connor K, Dikmen S, Giacino JT, Kramer MD, Levin HS, McCrea MA, Whyte J, Bodien YG, Yue JK, Manley GT. Validity of the Brief Test of Adult Cognition by Telephone in Level 1 Trauma Center Patients Six Months Post-Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2020; 38:1048-1059. [PMID: 33107388 DOI: 10.1089/neu.2020.7295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Our objective was to examine the construct validity of the Brief Test of Adult Cognition by Telephone (BTACT) and its relationship to traumatic brain injury (TBI) of differing severities. Data were analyzed on 1422 patients with TBI and 170 orthopedic trauma controls (OTC) from the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Participants were assessed at 6 months post-injury with the BTACT and an in-person neuropsychological battery. We examined the BTACT's factor structure, factorial group invariance, convergent and discriminant validity, and relationship to TBI and TBI severity. Confirmatory factor analysis supported both a 1-factor model and a 2-factor model comprising correlated Episodic Memory and Executive Function (EF) factors. Both models demonstrated strict invariance across TBI severity and OTC groups. Correlations between BTACT and criterion measures suggested that the BTACT memory indices predominantly reflect verbal episodic memory, whereas the BTACT EF factor correlated with a diverse range of cognitive tests. Although the EF factor and other BTACT indices showed significant relationships with TBI and TBI severity, some group effect sizes were larger for more comprehensive in-person cognitive tests than the BTACT. The BTACT is a promising, brief, phone-based cognitive screening tool for patients with TBI. Although the BTACT's memory items appear to index verbal Episodic Memory, items that purport to assess EFs may reflect a broader array of cognitive domains. The sensitivity of the BTACT to TBI severity is lower than domain-specific neuropsychological measures, suggesting it should not be used as a substitute for comprehensive, in-person cognitive testing at 6 months post-TBI.
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Affiliation(s)
- Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Nancy R Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington, USA
| | - Kristen Dams-O'Connor
- Departments of Rehabilitation and Human Performance, Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | | | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
| | - Yelena G Bodien
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston Massachusetts, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston Massachusetts, USA
| | - John K Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
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26
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Wilde EA, Merkley TL, Lindsey HM, Bigler ED, Hunter JV, Ewing-Cobbs L, Aitken ME, MacLeod MC, Hanten G, Chu ZD, Abildskov TJ, Noble-Haeusslein LJ, Levin HS. Developmental Alterations in Cortical Organization and Socialization in Adolescents Who Sustained a Traumatic Brain Injury in Early Childhood. J Neurotrauma 2020; 38:133-143. [PMID: 32503385 DOI: 10.1089/neu.2019.6698] [Citation(s) in RCA: 4] [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] [Indexed: 11/13/2022] Open
Abstract
This study investigated patterns of cortical organization in adolescents who had sustained a traumatic brain injury (TBI) during early childhood to determine ways in which early head injury may alter typical brain development. Increased gyrification in other patient populations is associated with polymicrogyria and aberrant development, but this has not been investigated in TBI. Seventeen adolescents (mean age = 14.1 ± 2.4) who sustained a TBI between 1-8 years of age, and 17 demographically-matched typically developing children (TDC) underwent a high-resolution, T1-weighted 3-Tesla magnetic resonance imaging (MRI) at 6-15 years post-injury. Cortical white matter volume and organization was measured using FreeSurfer's Local Gyrification Index (LGI). Despite a lack of significant difference in white matter volume, participants with TBI demonstrated significantly increased LGI in several cortical regions that are among those latest to mature in normal development, including left parietal association areas, bilateral dorsolateral and medial frontal areas, and the right posterior temporal gyrus, relative to the TDC group. Additionally, there was no evidence of increased surface area in the regions that demonstrated increased LGI. Higher Vineland-II Socialization scores were associated with decreased LGI in right frontal and temporal regions. The present results suggest an altered pattern of expected development in cortical gyrification in the TBI group, with changes in late-developing frontal and parietal association areas. Such changes in brain structure may underlie cognitive and behavioral deficits associated with pediatric TBI. Alternatively, increased gyrification following TBI may represent a compensatory mechanism that allows for typical development of cortical surface area, despite reduced brain volume.
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Affiliation(s)
- Elisabeth A Wilde
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.,Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.,Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Tricia L Merkley
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA.,Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, Arizona, USA.,Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA.,Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Jill V Hunter
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.,Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Linda Ewing-Cobbs
- Department of Pediatrics, Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mary E Aitken
- Arkansas Children's Research Institute and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arizona, USA
| | - Marianne C MacLeod
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Gerri Hanten
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Zili D Chu
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Tracy J Abildskov
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Linda J Noble-Haeusslein
- Departments of Neurology and Psychology and the Institute of Neuroscience, University of Texas at Austin, Austin, Texas, USA
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.,Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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Wilde EA, Goodrich-Hunsaker NJ, Ware AL, Taylor BA, Biekman BD, Hunter JV, Newman-Norlund R, Scarneo S, Casa DJ, Levin HS. Diffusion Tensor Imaging Indicators of White Matter Injury Are Correlated with a Multimodal Electroencephalography-Based Biomarker in Slow Recovering, Concussed Collegiate Athletes. J Neurotrauma 2020; 37:2093-2101. [DOI: 10.1089/neu.2018.6365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Elisabeth A. Wilde
- George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Naomi J. Goodrich-Hunsaker
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Ashley L. Ware
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, Texas, USA
| | - Brian A. Taylor
- Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brian D. Biekman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, Texas, USA
| | - Jill V. Hunter
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
- E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Roger Newman-Norlund
- Department of Psychology, University of South Carolina School of Arts and Sciences, Columbia, South Carolina, USA
| | - Samantha Scarneo
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Harvey S. Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Vedantam A, Brennan J, Levin HS, McCarthy JJ, Dash PK, Redell JB, Yamal JM, Robertson CS. Early versus Late Profiles of Inflammatory Cytokines after Mild Traumatic Brain Injury and Their Association with Neuropsychological Outcomes. J Neurotrauma 2020; 38:53-62. [PMID: 32600167 DOI: 10.1089/neu.2019.6979] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 12/12/2022] Open
Abstract
Despite pre-clinical evidence for the role of inflammation in traumatic brain injury (TBI), there is limited data on inflammatory biomarkers in mild TBI (mTBI). In this study, we describe the profile of plasma inflammatory cytokines and explore associations between these cytokines and neuropsychological outcomes after mTBI. Patients with mTBI with negative computed tomography and orthopedic injury (OI) controls without mTBI were prospectively recruited from emergency rooms at three trauma centers. Plasma inflammatory cytokine levels were measured from venous whole-blood samples that were collected at enrollment (within 24 h of injury) and at 6 months after injury. Neuropsychological tests were performed at 1 week, 1 month, 3 months, and 6 months after the injury. Multivariate regression analysis was performed to identify associations between inflammatory cytokines and neuropsychological outcomes. A total of 53 mTBI and 24 OI controls were included in this study. The majority of patients were male (62.3%), and injured in motor vehicle accidents (37.7%). Plasma interleukin (IL)-2 (p = 0.01) and IL-6 (p = 0.01) within 24 h post-injury were significantly higher for mTBI patients compared with OI controls. Elevated plasma IL-2 at 24 h was associated with more severe 1-week post-concussive symptoms (p = 0.001). At 6 months, elevated plasma IL-10 was associated with greater depression scores (p = 0.004) and more severe post-traumatic stress disorder (PTSD) symptoms (p = 0.001). Plasma cytokine levels (within 24 h and at 6 months post-injury) were significantly associated with early and late post-concussive symptoms, PTSD, and depression scores after mTBI. These results highlight the potential role of inflammation in the pathophysiology of post-traumatic symptoms after mTBI.
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Affiliation(s)
- Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey Brennan
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - James J McCarthy
- Department of Emergency Medicine, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Pramod K Dash
- Department of Neurobiology and Anatomy, University of Texas Health Sciences Center, Houston, Texas, USA
| | - John B Redell
- Department of Neurobiology and Anatomy, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
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Affiliation(s)
- Lindsay D Nelson
- Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Harvey S Levin
- Departments of Physical Medicine, Neurology, Neurosurgery and Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michael A McCrea
- Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
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Nelson LD, Temkin NR, Dikmen S, Barber J, Giacino JT, Yuh E, Levin HS, McCrea MA, Stein MB, Mukherjee P, Okonkwo DO, Robertson CS, Diaz-Arrastia R, Manley GT, Adeoye O, Badjatia N, Boase K, Bodien Y, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson A, Foreman B, Gardner R, Gaudette E, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Korley F, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Noel F, Palacios E, Perl D, Puccio A, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Taylor S, Toga A, Valadka A, Vassar MJ, Vespa P, Wang K, Yue JK, Zafonte R. Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. JAMA Neurol 2019; 76:1049-1059. [PMID: 31157856 DOI: 10.1001/jamaneurol.2019.1313] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear. Objectives To characterize the natural history of recovery of daily function following mTBI vs peripheral orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes. Design, Setting, and Participants TRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018, and followed up for 12 months. A total of 1453 patients at 11 level I trauma center emergency departments or inpatient units met inclusion criteria (ie, mTBI [n = 1154] or peripheral orthopedic traumatic injury [n = 299]) and were enrolled within 24 hours of injury; mTBI participants had admission GCS scores of 13 to 15 and clinical head CT scans. Patients with peripheral orthopedic trauma injury served as the control (OTC) group. Exposures Participants with mTBI or OTC. Main Outcomes and Measures The Glasgow Outcome Scale Extended (GOSE) scale score, reflecting injury-related functional limitations across broad life domains at 2 weeks and 3, 6, and 12 months postinjury was the primary outcome. The possible score range of the GOSE score is 1 (dead) to 8 (upper good recovery), with a score less than 8 indicating some degree of functional impairment. Results Of the 1453 participants, 953 (65.6%) were men; mean (SD) age was 40.9 (17.1) years in the mTBI group and 40.9 (15.4) years in the OTC group. Most participants (mTBI, 87%; OTC, 93%) reported functional limitations (GOSE <8) at 2 weeks postinjury. At 12 months, the percentage of mTBI participants reporting functional limitations was 53% (95% CI, 49%-56%) vs 38% (95% CI, 30%-45%) for OTCs. A higher percentage of CT+ patients reported impairment (61%) compared with the mTBI CT- group (49%; relative risk [RR], 1.24; 95% CI, 1.08-1.43) and a higher percentage in the mTBI CT-group compared with the OTC group (RR, 1.28; 95% CI, 1.02-1.60). Conclusions and Relevance Most patients with mTBI presenting to US level I trauma centers report persistent, injury-related life difficulties at 1 year postinjury, suggesting the need for more systematic follow-up of patients with mTBI to provide treatments and reduce the risk of chronic problems after mTBI.
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Affiliation(s)
| | | | | | | | - Joseph T Giacino
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston
| | | | | | | | - Murray B Stein
- University of California, San Diego, La Jolla.,Veterans Affairs San Diego Healthcare System, San Diego, California
| | | | | | - Claudia S Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | | | | | | | | | - Kim Boase
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - Randall Chesnut
- Department of Neurological Surgery, University of Washington, Seattle
| | | | | | | | | | - V Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond
| | - Adam Ferguson
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Raquel Gardner
- Department of Neurology, University of California, San Francisco
| | | | | | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Sonia Jain
- University of California, San Diego, La Jolla
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Joel Kramer
- Department of Neurology, University of California, San Francisco
| | | | - Chris Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joan Machamer
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Christopher Madden
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Alastair Martin
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Randall Merchant
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond
| | - Florence Noel
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Eva Palacios
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Miri Rabinowitz
- Department of Neurology, University of Pennsylvania, Philadelphia
| | | | - Angelle Sander
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gabriela Satris
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - David Schnyer
- Department of Psychology, University of Texas at Austin, Austin
| | | | | | - Sabrina Taylor
- Department of Neurological Surgery, University of California, San Francisco
| | - Arthur Toga
- University of Southern California, Los Angeles
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond
| | - Mary J Vassar
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Paul Vespa
- Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles
| | - Kevin Wang
- Department of Psychiatry, University of Florida, Gainesville
| | - John K Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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Maloney KA, Schmidt AT, Hanten GR, Levin HS. [Formula: see text] Executive dysfunction in children and adolescents with behavior disorders and traumatic brain injury. Child Neuropsychol 2019; 26:69-82. [PMID: 31311419 DOI: 10.1080/09297049.2019.1640868] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Traumatic brain injury (TBI) is known to contribute to deficits in executive functioning (EF). Executive functioning abilities are disrupted in adolescents with either conduct disorder or oppositional defiant disorder, collectively known as disruptive behavior disorders (DBDs). There is little research on the relationship between executive dysfunction and DBDs in a group with a confirmed history of TBI. The current study endeavored to examine EF abilities, as measured by parent report on the Behavior Rating Inventory of Executive Function (BRIEF), in four groups: (1) adolescents with a TBI history and co-occurring DBDs history, (2) adolescents with a TBI history and no DBDs history, (3) adolescents with an orthopedic injury (OI) history and co-occurring DBDs history, and (4) adolescents with an OI history and no DBDs history. Groups were matched on the basis of age at injury and estimated socioeconomic status. Participants were evaluated at five time-points throughout the study, within 1 month of injury (initial assessment), 3, 12, 18, and 24 months post-injury. Results indicated the TBI and DBDs group was not significantly different from the OI and DBDs group, and both DBDs groups suffered higher levels of executive dysfunction than the TBI only and OI only groups, which were not significantly different from each other. Results also showed across the four groups, EF deficits were significantly lower at 1 month and 24 months post-injury, suggesting a positive trajectory in EF skill development. Results are discussed in terms of the prognostic importance of EF deficits in children with DBDs.
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Affiliation(s)
- Kelsey A Maloney
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Adam T Schmidt
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Gerri R Hanten
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Harvey S Levin
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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Yue JK, Levin HS, Suen CG, Morrissey MR, Runyon SJ, Winkler EA, Puffer RC, Deng H, Robinson CK, Rick JW, Phelps RRL, Sharma S, Taylor SR, Vassar MJ, Cnossen MC, Lingsma HF, Gardner RC, Temkin NR, Barber J, Dikmen SS, Yuh EL, Mukherjee P, Stein MB, Cage TA, Valadka AB, Okonkwo DO, Manley GT. Age and sex-mediated differences in six-month outcomes after mild traumatic brain injury in young adults: a TRACK-TBI study. Neurol Res 2019; 41:609-623. [PMID: 31007155 DOI: 10.1080/01616412.2019.1602312] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Risk factors for young adults with mTBI are not well understood. Improved understanding of age and sex as risk factors for impaired six-month outcomes in young adults is needed. Methods: Young adult mTBI subjects aged 18-39 years (18-29y; 30-39y) with six-month outcomes were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Multivariable regressions were performed for outcomes with age, sex, and the interaction factor age-group*sex as variables of interest, controlling for demographic and injury variables. Mean-differences (B) and 95% CIs are reported. Results: One hundred mTBI subjects (18-29y, 70%; 30-39y, 30%; male, 71%; female, 29%) met inclusion criteria. On multivariable analysis, age-group*sex was associated with six-month post-traumatic stress disorder (PTSD; PTSD Checklist-Civilian version); compared with female 30-39y, female 18-29y (B= -19.55 [-26.54, -4.45]), male 18-29y (B= -19.70 [-30.07, -9.33]), and male 30-39y (B= -15.49 [-26.54, -4.45]) were associated with decreased PTSD symptomatology. Female sex was associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended (GOSE): B= -0.6 [1.0, -0.1]). Comparatively, 30-39y scored higher on six-month nonverbal processing speed (Wechsler Adult Intelligence Scale-Processing Speed Index (WAIS-PSI); B= 11.88, 95% CI [1.66, 22.09]). Conclusions: Following mTBI, young adults aged 18-29y and 30-39y may have different risks for impairment. Sex may interact with age for PTSD symptomatology, with females 30-39y at highest risk. These results may be attributable to cortical maturation, biological response, social modifiers, and/or differential self-report. Confirmation in larger samples is needed; however, prevention and rehabilitation/counseling strategies after mTBI should likely be tailored for age and sex.
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Affiliation(s)
- John K Yue
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Harvey S Levin
- c Departments of Neurology and Neurosurgery , Baylor College of Medicine , Houston , TX , USA
| | - Catherine G Suen
- d Department of Neurology , University of Utah , Salt Lake City , UT , USA
| | - Molly Rose Morrissey
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sarah J Runyon
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ethan A Winkler
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ross C Puffer
- e Department of Neurological Surgery , Mayo Clinic , Rochester , MN , USA.,f Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Hansen Deng
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Caitlin K Robinson
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Jonathan W Rick
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ryan R L Phelps
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sourabh Sharma
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sabrina R Taylor
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Mary J Vassar
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Maryse C Cnossen
- g Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Hester F Lingsma
- g Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Raquel C Gardner
- h Department of Neurology , University of California San Francisco , San Francisco , CA , USA.,i Department of Neurology , Veterans Affairs Medical Center , San Francisco , CA , USA
| | - Nancy R Temkin
- j Departments of Neurological Surgery and Biostatistics , University of Washington , Seattle , WA , USA
| | - Jason Barber
- j Departments of Neurological Surgery and Biostatistics , University of Washington , Seattle , WA , USA
| | - Sureyya S Dikmen
- k Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Esther L Yuh
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,l Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Pratik Mukherjee
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,l Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Murray B Stein
- m Departments of Psychiatry and Family Medicine , University of California San Diego , San Diego , CA , USA
| | - Tene A Cage
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Alex B Valadka
- n Department of Neurological Surgery , Virginia Commonwealth University , Richmond , VA , USA
| | - David O Okonkwo
- f Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Geoffrey T Manley
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
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- o TRACK-TBI Investigators are listed below in alphabetical order by last name
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Wu T, Merkley TL, Wilde EA, Barnes A, Li X, Chu ZD, McCauley SR, Hunter JV, Levin HS. A preliminary report of cerebral white matter microstructural changes associated with adolescent sports concussion acutely and subacutely using diffusion tensor imaging. Brain Imaging Behav 2019; 12:962-973. [PMID: 28812290 DOI: 10.1007/s11682-017-9752-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diffusion tensor imaging (DTI) has demonstrated its utility in detecting microscopic post-concussion cerebral white matter structural changes, which are not routinely evident on conventional neuroimaging modalities. In this study, we compared 10 adolescents with sports concussion (SC) to 12 orthopedically-injured (OI) individuals within 96 h and three months post injury to 12 typically-developing (TD) participants using DTI and volumetric analyses. In terms of volume, no group differences were noted between SC, OI and TD groups at both 96 h and three months post concussion. Results did not show significant differences between SC, OI, and TD groups for both fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in all regions of interest within 96 h post concussion. However, at three months post-injury, the SC group exhibited significantly lower FA than the TD group in various regions of interest. In terms of ADC, significant group differences between SC and TD groups were found in some regions, with SC group having higher ADC than TD. No group differences for FA and ADC were noted between SC and OI groups at three months post-injury. However, several moderate effect sizes on between-group analyses were noted such that FA was lower and ADC was higher in SC relative to OI. Longitudinally, the SC group demonstrated decreased FA and increased ADC in some areas. The findings highlight the fact that the brain continues to change during the post-injury recovery period, and raises the possibility that adverse changes may result from the neurometabolic cascade that purportedly ensues following SC. DTI may potentially be used to characterize the nature of brain changes that occur following sports-related concussions.
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Affiliation(s)
- Trevor Wu
- Mercy Health St. Mary's, Michigan State University, 220 Cherry St SE, Grand Rapids, MI, 49503, USA
| | - Tricia L Merkley
- Barrow Neurological Institute, 222 W. Thomas Road, Suite 315, Phoenix, AZ, 85013, USA
| | - Elisabeth A Wilde
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA.
| | - Amanda Barnes
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1440, Miami, FL, 33136, USA
| | - Xiaoqi Li
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Zili David Chu
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Stephen R McCauley
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Jill V Hunter
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Harvey S Levin
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
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Wilde EA, Ware AL, Li X, Wu TC, McCauley SR, Barnes A, Newsome MR, Biekman BD, Hunter JV, Chu ZD, Levin HS. Orthopedic Injured versus Uninjured Comparison Groups for Neuroimaging Research in Mild Traumatic Brain Injury. J Neurotrauma 2018; 36:239-249. [PMID: 29786476 DOI: 10.1089/neu.2017.5513] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 12/20/2022] Open
Abstract
To address controversy surrounding the most appropriate comparison group for mild traumatic brain injury (mTBI) research, mTBI patients 12-30 years of age were compared with an extracranial orthopedic injury (OI) patient group and an uninjured, typically developing (TD) participant group with comparable demographic backgrounds. Injured participants underwent subacute (within 96 h) and late (3 months) diffusion tensor imaging (DTI); TD controls underwent DTI once. Group differences in fractional anisotropy (FA) and mean diffusivity (MD) of commonly studied white matter tracts were assessed. For FA, subacute group differences occurred in the bilateral inferior frontal occipital fasciculus (IFOF) and right inferior longitudinal fasciculus (ILF), and for MD, differences were found in the total corpus callosum, right uncinate fasciculus, IFOF, ILF, and bilateral cingulum bundle (CB). In these analyses, differences (lower FA and higher MD) were generally observed between the mTBI and TD groups but not between the mTBI and OI groups. After a 3 month interval, groups significantly differed in left IFOF FA and in right IFOF and CB MD; the TD group had significantly higher FA and lower MD than both injury groups, which did not differ. There was one exception to this pattern, in which the OI group demonstrated significantly lower FA in the left ILF than the TD group, although neither group differed from the mTBI group. The mTBI and OI groups had generally similar longitudinal results. Findings suggest that different conclusions about group-level DTI analyses could be drawn, depending on the selected comparison group, highlighting the need for additional research in this area. Where possible, mTBI studies may benefit from the inclusion of both OI and TD controls.
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Affiliation(s)
- Elisabeth A Wilde
- 1 Michael E. DeBakey VA Medical Center, Houston, Texas.,2 George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,4 Department of Neurology, Baylor College of Medicine, Houston, Texas.,5 Department of Radiology, and Baylor College of Medicine, Houston, Texas.,7 Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Ashley L Ware
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,8 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston, Houston, Texas
| | - Xiaoqi Li
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Trevor C Wu
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,9 Hauenstein Neurosciences, Mercy Health St. Mary's, Grand Rapids, Michigan
| | - Stephen R McCauley
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,4 Department of Neurology, Baylor College of Medicine, Houston, Texas.,6 Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Amanda Barnes
- 10 Department of Obstetrics and Gynecology, University of Southern California Medical Center, Los Angeles, California
| | - Mary R Newsome
- 1 Michael E. DeBakey VA Medical Center, Houston, Texas.,3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Brian D Biekman
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,8 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston, Houston, Texas
| | - Jill V Hunter
- 3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,5 Department of Radiology, and Baylor College of Medicine, Houston, Texas.,11 Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas
| | - Zili D Chu
- 5 Department of Radiology, and Baylor College of Medicine, Houston, Texas.,11 Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas
| | - Harvey S Levin
- 1 Michael E. DeBakey VA Medical Center, Houston, Texas.,3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.,4 Department of Neurology, Baylor College of Medicine, Houston, Texas.,6 Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Ware AL, Biekman B, Hachey R, MacLeod M, Bird W, Pathak S, Clarke E, Borrasso A, Puccio AM, Glavin K, Pomiecko K, Moretti P, Beers SR, Levin HS, Schneider W, Okonkwo DO, Wilde EA. A Preliminary High-Definition Fiber Tracking Study of the Executive Control Network in Blast-Induced Traumatic Brain Injury. J Neurotrauma 2018; 36:686-701. [PMID: 30070176 DOI: 10.1089/neu.2018.5725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Blast-induced traumatic brain injury (bTBI) is common in veterans of the Iraq- and Afghanistan-era conflicts. However, the typical subtlety of neural alterations and absence of definitive biomarkers impede clinical detection on conventional imaging. This preliminary study examined the structure and functional correlates of executive control network (ECN) white matter in veterans to investigate the clinical utility of using high-definition fiber tracking (HDFT) to detect chronic bTBI. Demographically similar male veterans (N = 38) with and without bTBI (ages 24 to 50 years) completed standardized neuropsychological testing and magnetic resonance imaging. Quantitative HDFT metrics of subcortical-dorsolateral prefrontal cortex (DLPFC) tracts were derived. Moderate-to-large group effects were observed on HDFT metrics. Relative to comparisons, bTBI demonstrated elevated quantitative anisotropy (QA) and reduced right hemisphere volume of all examined tracts, and reduced fiber count and increased generalized fractional anisotropy in the right DLPFC-putamen tract and DLPFC-thalamus, respectively. The Group × Age interaction effect on DLPFC-caudate tract volume was large; age negatively related to volume in the bTBI group, but not comparison group. Groups performed similarly on the response inhibition measure. Performance (reaction time and commission errors) robustly correlated with HDFT tract metrics (QA and tract volume) in the comparison group, but not bTBI group. Results support anomalous density and integrity of ECN connectivity, particularly of the right DLPFC-putamen pathway, in bTBI. Results also support exacerbated aging in veterans with bTBI. Similar ECN function despite anomalous microstructure could reflect functional compensation in bTBI, although alternate interpretations are explored.
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Affiliation(s)
- Ashley L Ware
- 1 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston , Houston, Texas.,2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - Brian Biekman
- 1 Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics (TIMES), University of Houston , Houston, Texas.,2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - Rebecca Hachey
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Marianne MacLeod
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - William Bird
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Sudhir Pathak
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Emily Clarke
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Allison Borrasso
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Ava M Puccio
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kelly Glavin
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Kristopher Pomiecko
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Paolo Moretti
- 5 Department of Neurology, Baylor College of Medicine , Houston, Texas.,6 Neurology Service, Michael E. DeBakey VA Medical Center , Houston, Texas.,7 Department of Neurology, University of Utah School of Health Sciences , Salt Lake City, Utah.,8 Department of Human and Molecular Genetics, University of Utah School of Health Sciences , Salt Lake City, Utah.,9 Neurology Service, George E. Wahlen VA Medical Center , Salt Lake City, Utah
| | - Sue R Beers
- 10 Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, PA
| | - Harvey S Levin
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,11 Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Walter Schneider
- 3 Learning Research and Development Center, University of Pittsburgh , Pittsburgh, Pennsylvania.,12 Department of Psychology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - David O Okonkwo
- 4 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Elisabeth A Wilde
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,5 Department of Neurology, Baylor College of Medicine , Houston, Texas.,6 Neurology Service, Michael E. DeBakey VA Medical Center , Houston, Texas.,7 Department of Neurology, University of Utah School of Health Sciences , Salt Lake City, Utah.,9 Neurology Service, George E. Wahlen VA Medical Center , Salt Lake City, Utah.,13 Department of Radiology, Baylor College of Medicine , Houston, Texas
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Newsome MR, Wilde EA, Bigler ED, Liu Q, Mayer AR, Taylor BA, Steinberg JL, Tate DF, Abildskov TJ, Scheibel RS, Walker WC, Levin HS. Functional brain connectivity and cortical thickness in relation to chronic pain in post-911 veterans and service members with mTBI. Brain Inj 2018; 32:1236-1244. [PMID: 30047797 DOI: 10.1080/02699052.2018.1494853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/28/2022]
Abstract
OBJECTIVES Investigate the relation of chronic pain interference to functional connectivity (FC) of brain regions and to cortical thickness in post-911 Veterans and Service Members (SMs) who sustained a mild traumatic brain injury (mTBI). METHODS This is an observational study with cross-sectional analyses. A sample of 65 enrollees completing initial evaluation at a single site of the Chronic Effects of Neurotrauma Consortium (CENC) reported pain interference ratings on the TBI QOL. Functional connectivity and cortical thickness were measured. RESULTS Severity of pain interference was negatively related to FC of the default mode network (DMN), i.e., participants who reported more severe pain interference had less FC between mesial prefrontal cortex and posterior regions of the DMN including posterior cingulate cortex and precuneus. Cortical thickness of specific regions was positively related to severity of pain interference. CONCLUSION The more that pain was perceived to interfere with daily life, the less the FC between regions in a network associated with self-referential thought and mind wandering. Although cortical thickness in specific brain regions was positively related to severity of pain interference, follow-up longitudinal data, control group data, and study of individual differences in this cohort will expand this initial report and replicate these findings.
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Affiliation(s)
- Mary R Newsome
- a Michael DeBakey VA Medical Center and H. Ben Taub , Department of Physical Medicine & Rehabilitation, Baylor College of Medicine , Houston , TX , USA
| | - Elisabeth A Wilde
- a Michael DeBakey VA Medical Center and H. Ben Taub , Department of Physical Medicine & Rehabilitation, Baylor College of Medicine , Houston , TX , USA.,b Department of Neurology, University of Utah , Salt Lake City , UT , USA
| | - Erin D Bigler
- c Department of Psychology, Brigham Young University , Provo , UT , USA
| | - Qisheng Liu
- a Michael DeBakey VA Medical Center and H. Ben Taub , Department of Physical Medicine & Rehabilitation, Baylor College of Medicine , Houston , TX , USA
| | - Andrew R Mayer
- d The Mind Research Network, Department of Psychology, University of New Mexico , Albuquerque , NM , USA
| | - Brian A Taylor
- e College of Engineering, Virginia Commonwealth University , Richmond , VA , USA
| | - Joel L Steinberg
- f Department of Psychiatry, Virginia Commonwealth University , Richmond , VA , USA
| | - David F Tate
- g Missouri Institute of Mental Health, University of Missouri-St. Louis , St. Louis , MO , USA
| | - Tracy J Abildskov
- c Department of Psychology, Brigham Young University , Provo , UT , USA
| | - Randall S Scheibel
- a Michael DeBakey VA Medical Center and H. Ben Taub , Department of Physical Medicine & Rehabilitation, Baylor College of Medicine , Houston , TX , USA
| | - William C Walker
- h Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University , Richmond , VA , USA
| | - Harvey S Levin
- a Michael DeBakey VA Medical Center and H. Ben Taub , Department of Physical Medicine & Rehabilitation, Baylor College of Medicine , Houston , TX , USA
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Kenney K, Qu BX, Lai C, Devoto C, Motamedi V, Walker WC, Levin HS, Nolen T, Wilde EA, Diaz-Arrastia R, Gill J. Higher exosomal phosphorylated tau and total tau among veterans with combat-related repetitive chronic mild traumatic brain injury. Brain Inj 2018; 32:1276-1284. [PMID: 29889559 DOI: 10.1080/02699052.2018.1483530] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 01/20/2023]
Abstract
OBJECTIVE The objective of the study is to measure plasma and exosomal levels of tau, phosphorylated tau (p-tau), and amyloid beta (Aβ) in Veterans with historical mild traumatic brain injury (mTBI) and chronic neuropsychological symptoms. METHODS Tau, p-tau, Aβ40, and Aβ42 were measured by ultrasensitive immunoassay in plasma and exosomes from 195 Veterans enrolled in the Chronic Effects of Neurotrauma Consortium Multicenter Observational Study. Protein biomarkers were compared among groups with and without mTBI with loss of consciousness (LOC) or post-traumatic amnesia (PTA), and also in those with and without repetitive (≥3) mTBI (rTBI) compared to those with 0 (TBI-neg) and 1-2 mTBI. RESULTS There were no differences in measures of plasma and exosomal protein levels among mTBI with LOC or PTA, mTBI with alteration of consciousness only or TBI-neg. Exosomal tau and exosomal p-tau were elevated in rTBI compared to those with 2 or fewer mTBIs and TBI-neg (p < 0.05). Elevations of exosomal tau and p-tau significantly correlated with post-traumatic and post-concussive symptoms, with exosomal tau also relating specifically to cognitive, affective, and somatic post-concussive symptoms (p < 0.05). CONCLUSION rTBI is associated with elevations of exosomal p-tau and exosomal tau, suggesting that blood-based exosomes may provide a peripheral source of informative, centrally derived biomarkers in remote mTBI and that rTBI may contribute to chronic neuropsychological symptoms.
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Affiliation(s)
- Kimbra Kenney
- a Department of Neurology , Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,b National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA
| | - Bao-Xi Qu
- a Department of Neurology , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Chen Lai
- c National Institutes of Health , National Institute of Nursing Research , Bethesda , MD , USA
| | - Christina Devoto
- c National Institutes of Health , National Institute of Nursing Research , Bethesda , MD , USA
| | - Vida Motamedi
- c National Institutes of Health , National Institute of Nursing Research , Bethesda , MD , USA
| | - William C Walker
- d Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA
| | - Harvey S Levin
- e Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,f VA Rehabilitation Research Center of Excellence , Michael E DeBakey VA Medical Center , Houston , TX , USA
| | - Tracy Nolen
- g RTI International , Research Triangle Park NC , USA
| | - Elisabeth A Wilde
- e Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,f VA Rehabilitation Research Center of Excellence , Michael E DeBakey VA Medical Center , Houston , TX , USA.,h Department of Neurology , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Ramon Diaz-Arrastia
- i Department of Neurology , University of Pennsylvania , Philadelphia , PA , USA
| | - Jessica Gill
- c National Institutes of Health , National Institute of Nursing Research , Bethesda , MD , USA.,j Center for Neuroscience and Regenerative Medicine, Biomarker Core , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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Hoot MR, Levin HS, Smith AN, Goldberg G, Wilde EA, Walker WC, Eapen BC, Nolen T, Pugh NL. Pain and chronic mild traumatic brain injury in the US military population: a Chronic Effects of Neurotrauma Consortium study. Brain Inj 2018; 32:1169-1177. [PMID: 29883191 DOI: 10.1080/02699052.2018.1482427] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PRIMARY OBJECTIVES To describe the association between mild traumatic brain injury (mTBI) and pain intensity and pain interference outcomes while accounting for potential confounders and mediators including environmental factors and comorbidities in a cohort of US Veterans of the Iraq and Afghanistan wars. RESEARCH DESIGN Cross-sectional snapshot of baseline data from a prospective, longitudinal study. METHODS Effects of mTBI on pain intensity and pain interference were compared between participants with or without mTBI exposure. Data were analysed using covariate-adjusted regression analyses as well as structural equation modelling (SEM) methods to assess the robustness of findings across different modelling assumptions. As results of the two approaches were consistent with respect to the overall association between mTBI exposure and pain, the results focus primarily on the SEM findings. RESULTS The mTBI exposed group reported significantly greater indices of post-traumatic stress disorder (PTSD), depression, anxiety and sleep disturbance. After accounting for other factors, mTBI exposure was significantly, but indirectly associated with the pain interference and pain intensity outcomes. CONCLUSIONS mTBI is strongly associated with pain intensity and pain interference in this sample. However, the effect appears to be mediated by other common mTBI comorbidities: PTSD, depression, anxiety and sleep disturbance.
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Affiliation(s)
- Michelle R Hoot
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,b Defense and Veterans Brain Injury Center , Richmond , VA , USA
| | - Harvey S Levin
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - Austin N Smith
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,b Defense and Veterans Brain Injury Center , Richmond , VA , USA
| | - Gary Goldberg
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA
| | - Elisabeth A Wilde
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - William C Walker
- a Department of Physical Medicine and Rehabilitation , Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA.,b Defense and Veterans Brain Injury Center , Richmond , VA , USA.,e Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA
| | - Blessen C Eapen
- f Physical Medicine and Rehabilitation Services, South Texas Veterans Health Care System , San Antonio , TX , USA
| | - T Nolen
- g Biostatistics and Epidemiology Division, RTI International, Research Triangle Park , NC , USA
| | - N L Pugh
- g Biostatistics and Epidemiology Division, RTI International, Research Triangle Park , NC , USA
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Walker WC, Hirsch S, Carne W, Nolen T, Cifu DX, Wilde EA, Levin HS, Brearly TW, Eapen BC, Williams R. Chronic Effects of Neurotrauma Consortium (CENC) multicentre study interim analysis: Differences between participants with positive versus negative mild TBI histories. Brain Inj 2018; 32:1079-1089. [PMID: 29851515 DOI: 10.1080/02699052.2018.1479041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Compare characteristics and outcomes of combat-exposed military personnel with positive versus negative mild traumatic brain injury (mTBI) histories. SETTING Recruitment was from registration lists and ambulatory clinics at four veterans administration hospitals. PARTICIPANTS Consented veterans and service members completing initial evaluation by September 2016 (n = 492). DESIGN Observational with cross-sectional analyses. MAIN MEASURES Multimodal assessments including structured interviews, record review, questionnaires, neuroendocrine labs and neurocognitive and sensorimotor performance. RESULTS In unadjusted comparisons to those absent lifetime mTBI, the mTBI positive group (84%) had greater combat exposure, more potential concussive events, less social support and more comorbidities, including asthma, sleeping problems and post-traumatic stress disorder. They also fared worse on all sensory and pain symptom scores and self-reported functional and global outcomes. They had poorer scores on Wechsler Adult Intelligence Scale-IV coding (processing speed), TMT-B (visual-motor integration and executive function) and two posturography subtests, but were otherwise equal to TBI negative participants on neurocognitive and sensorimotor testing and neuroendocrine levels. CONCLUSIONS Although differences in characteristics exist which were not adjusted for, participants with historical mTBI have greater symptomatology and life functioning difficulties compared with non-TBI. Performance measures were less dissimilar between groups. These findings will guide further research within this accruing cohort.
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Affiliation(s)
- William C Walker
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA.,b Hunter Holmes McGuire VA Medical Center , Richmond , VA , USA
| | | | - William Carne
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA.,b Hunter Holmes McGuire VA Medical Center , Richmond , VA , USA
| | - Tracy Nolen
- c RTI International, RTP , Durham , NC , USA
| | - David X Cifu
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA.,b Hunter Holmes McGuire VA Medical Center , Richmond , VA , USA
| | - Elisabeth A Wilde
- d Michael E. DeBakey VA Medical Center , Houston , TX , USA.,e Baylor College of Medicine , Houston , TX , USA
| | - Harvey S Levin
- d Michael E. DeBakey VA Medical Center , Houston , TX , USA.,e Baylor College of Medicine , Houston , TX , USA
| | | | - Blessen C Eapen
- g Polytrauma Rehabilitation Center, South Texas Veterans Health Care System , San Antonio , TX , USA.,h Department of Rehabilitation Medicine , UT Health San Antonio , TX , USA
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Dennis EL, Wilde EA, Newsome MR, Scheibel RS, Troyanskaya M, Velez C, Wade BSC, Drennon AM, York GE, Bigler ED, Abildskov TJ, Taylor BA, Jaramillo CA, Eapen B, Belanger H, Gupta V, Morey R, Haswell C, Levin HS, Hinds SR, Walker WC, Thompson PM, Tate DF. ENIGMA MILITARY BRAIN INJURY: A COORDINATED META-ANALYSIS OF DIFFUSION MRI FROM MULTIPLE COHORTS. Proc IEEE Int Symp Biomed Imaging 2018; 2018:1386-1389. [PMID: 30034577 PMCID: PMC6049824 DOI: 10.1109/isbi.2018.8363830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Traumatic brain injury (TBI) is a significant cause of morbidity in military Veterans and Service Members. While most individuals recover fully from mild injuries within weeks, some continue to experience symptoms including headaches, disrupted sleep, and other cognitive, behavioral or physical symptoms. Diffusion magnetic resonance imaging (dMRI) shows promise in identifying areas of structural disruption and predicting outcomes. Although some studies suggest widespread structural disruption after brain injury, dMRI studies of military brain injury have yielded mixed results so far, perhaps due to the subtlety of mild injury, individual differences in injury location, severity and mechanism, and comorbidity with other disorders such as post-traumatic stress disorder (PTSD), depression, and substance abuse. We present preliminary dMRI results from the ENIGMA (Enhancing Neuroimaging Genetics through Meta-Analysis) military brain injury working group. We found higher fractional anisotropy (FA) in participants with a history of TBI. Understanding the injury and recovery process, along with factors that influence these, will lead to improved diagnosis and treatment.
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Affiliation(s)
- Emily L Dennis
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Elisabeth A Wilde
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Mary R Newsome
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Carmen Velez
- University of Missouri-St. Louis, St. Louis, MO, USA
| | - Benjamin S C Wade
- University of Missouri-St. Louis, St. Louis, MO, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, CA, USA
| | | | | | - Erin D Bigler
- Department of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Tracy J Abildskov
- Department of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Brian A Taylor
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX
| | - Blessen Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX
| | - Heather Belanger
- James A. Haley Veterans Hospital, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
| | - Vikash Gupta
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | | | | | - Harvey S Levin
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Sidney R Hinds
- Department of Defense/United States Army Medical Research and Materiel Command
| | - William C Walker
- Defense and Veterans Brain Injury Center, San Antonio, TX, USA
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond VA
- Hunter Holmes McGuire VAMC, Richmond VA
| | - Paul M Thompson
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA
| | - David F Tate
- University of Missouri-St. Louis, St. Louis, MO, USA
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Laurent-Vannier A, Rambaud C, Levin HS. Letter to the Editor. Subdural collections in infants: trauma or not trauma? J Neurosurg Pediatr 2017; 20:302-303. [PMID: 28598264 DOI: 10.3171/2017.3.peds17109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anne Laurent-Vannier
- France SBS, Saint-Maurice Hospitals, Saint Maurice, France.,APHP, CHU Raymond Poincaré, Service d'Anatomie Pathologique et Médecine Legale, Garches, France.,Université Versailles-St Quentin, Faculté de Médecine, Versailles, France; and.,Baylor College of Medicine, Houston, TX
| | - Caroline Rambaud
- France SBS, Saint-Maurice Hospitals, Saint Maurice, France.,APHP, CHU Raymond Poincaré, Service d'Anatomie Pathologique et Médecine Legale, Garches, France.,Université Versailles-St Quentin, Faculté de Médecine, Versailles, France; and.,Baylor College of Medicine, Houston, TX
| | - Harvey S Levin
- France SBS, Saint-Maurice Hospitals, Saint Maurice, France.,APHP, CHU Raymond Poincaré, Service d'Anatomie Pathologique et Médecine Legale, Garches, France.,Université Versailles-St Quentin, Faculté de Médecine, Versailles, France; and.,Baylor College of Medicine, Houston, TX
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Levin HS. Comments on “Outcome Trends after US Military Concussive Injury”. J Neurotrauma 2017; 34:2204-2205. [DOI: 10.1089/neu.2017.5108] [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)
- Harvey S. Levin
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
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Christidi F, Karavasilis E, Zalonis I, Ferentinos P, Giavri Z, Wilde EA, Xirou S, Rentzos M, Zouvelou V, Velonakis G, Toulas P, Efstathopoulos E, Poulou L, Argyropoulos G, Athanasakos A, Zambelis T, Levin HS, Karandreas N, Kelekis N, Evdokimidis I. Memory-related white matter tract integrity in amyotrophic lateral sclerosis: an advanced neuroimaging and neuropsychological study. Neurobiol Aging 2017; 49:69-78. [DOI: 10.1016/j.neurobiolaging.2016.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/05/2016] [Accepted: 09/21/2016] [Indexed: 11/16/2022]
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Wilde EA, Bigler ED, Huff T, Wang H, Black GM, Christensen ZP, Goodrich-Hunsaker N, Petrie JA, Abildskov T, Taylor BA, Stone JR, Tustison NJ, Newsome MR, Levin HS, Chu ZD, York GE, Tate DF. Quantitative structural neuroimaging of mild traumatic brain injury in the Chronic Effects of Neurotrauma Consortium (CENC): Comparison of volumetric data within and across scanners. Brain Inj 2016; 30:1442-1451. [DOI: 10.1080/02699052.2016.1219063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Faber J, Wilde EA, Hanten G, Ewing-Cobbs L, Aitken ME, Yallampalli R, MacLeod MC, Mullins SH, Chu ZD, Li X, Hunter JV, Noble-Haeusslein L, Levin HS. Ten-year outcome of early childhood traumatic brain injury: Diffusion tensor imaging of the ventral striatum in relation to executive functioning. Brain Inj 2016; 30:1635-1641. [PMID: 27680309 DOI: 10.1080/02699052.2016.1199910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The long-term effects of TBI on verbal fluency and related structures, as well as the relation between cognition and structural integrity, were evaluated. It was hypothesized that the group with TBI would evidence poorer performance on cognitive measures and a decrease in structural integrity. RESEARCH DESIGN Between a paediatric group with TBI and a group of typically-developing children, the long-term effects of traumatic brain injury were investigated in relation to both structural integrity and cognition. Common metrics for diffusion tensor imaging (DTI) were used as indicators of white matter integrity. METHODS AND PROCEDURES Using DTI, this study examined ventral striatum (VS) integrity in 21 patients aged 10-18 years sustaining moderate-to-severe traumatic brain injury (TBI) 5-15 years earlier and 16 demographically comparable subjects. All participants completed Delis-Kaplan Executive Functioning System (D-KEFS) sub-tests. MAIN OUTCOMES AND RESULTS The group with TBI exhibited lower fractional anisotropy (FA) and executive functioning performance and higher apparent diffusion coefficient (ADC). DTI metrics correlated with D-KEFS performance (right VS FA with Inhibition errors, right VS ADC with Letter Fluency, left VS FA and ADC with Category Switching). CONCLUSIONS TBI affects VS integrity, even in a chronic phase, and may contribute to executive functioning deficits.
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Affiliation(s)
- J Faber
- a Rice University , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation
| | - E A Wilde
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - G Hanten
- b Department of Physical Medicine and Rehabilitation
| | - L Ewing-Cobbs
- f Children's Learning Institute and Department of Pediatrics , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - M E Aitken
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - R Yallampalli
- b Department of Physical Medicine and Rehabilitation.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - M C MacLeod
- b Department of Physical Medicine and Rehabilitation
| | - S H Mullins
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Z D Chu
- d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - X Li
- b Department of Physical Medicine and Rehabilitation
| | - J V Hunter
- b Department of Physical Medicine and Rehabilitation.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - L Noble-Haeusslein
- i Departments of Neurosurgical Surgery and Physical Therapy and Rehabilitation Science , University of California , San Francisco , CA , USA
| | - H S Levin
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
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Scheibel RS, Newsome MR, Steinberg JL, Pearson DA, Rauch RA, Mao H, Troyanskaya M, Sharma RG, Levin HS. Altered Brain Activation During Cognitive Control in Patients With Moderate to Severe Traumatic Brain Injury. Neurorehabil Neural Repair 2016; 21:36-45. [PMID: 17172552 DOI: 10.1177/1545968306294730] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 11/17/2022]
Abstract
Background. Persistent deficits in cognitive control have been documented following traumatic brain injury (TBI) but are inconsistently related to the presence and location of focal lesions. Objective. Functional magnetic resonance imaging (fMRI) was used to examine brain activation during a cognitive control task in patients with moderate to severe TBI or orthopedic injury (OI). Methods. Fourteen TBI patients and 10 OI patients underwent fMRI at 3 months postinjury using a stimulus-response compatibility task in which response accuracy and reaction time were measured. Performance between the groups was equated by individually adjusting the amount of training. Groups did not differ in age, gender, or education. Results. Brain activation during stimulus-response incompatibility was greater in TBI patients than in OI patients within the cingulate, medial frontal, middle frontal, and superior frontal gyri. However, the positive regression of activation with response accuracy during stimulus-response incompatibility indicated a stronger relationship for OI patients than the TBI group within the anterior cingulate gyrus, medial frontal, and parietal regions, as well as deep brain structures (eg, brainstem). The number of focal lesions within either the whole brain or within prefrontal areas was not related to brain activation, but there was a relationship between activation and TBI severity. Conclusions. These findings suggest that neural networks mediating cognitive control are altered after moderate to severe TBI, possibly as a result of diffuse axonal injury, and that the typical relationship of brain activation to performance is disrupted.
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Affiliation(s)
- Randall S Scheibel
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
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Newsome MR, Li X, Lin X, Wilde EA, Ott S, Biekman B, Hunter JV, Dash PK, Taylor BA, Levin HS. Functional Connectivity Is Altered in Concussed Adolescent Athletes Despite Medical Clearance to Return to Play: A Preliminary Report. Front Neurol 2016; 7:116. [PMID: 27504104 PMCID: PMC4958621 DOI: 10.3389/fneur.2016.00116] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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] [Received: 04/22/2016] [Accepted: 07/06/2016] [Indexed: 01/24/2023] Open
Abstract
Recovery following sports-related concussion (SRC) is slower and often more complicated in young adolescent athletes than in collegiate players. Further, the clinical decision to return to play is currently based on symptoms and cognitive performance without direct knowledge of brain function. We tested the hypothesis that brain functional connectivity (FC) would be aberrant in recently concussed, asymptomatic athletes who had been cleared to return to play. A seed-based FC analysis measured the FC of the default mode network (DMN) (seeds = anterior cingulate cortex, posterior cingulate cortex (PCC), right lateral parietal cortex, and left lateral parietal cortex) 30 days after SRC in asymptomatic high school athletes cleared to return to play (n = 13) and was compared to the FC of high school athletes with orthopedic injury (OI) (n = 13). The SRC group demonstrated greater FC than the OI group between the PCC and the ventral lateral prefrontal cortex, as well as between the right lateral parietal cortex and lateral temporal cortex (with regions both outside of and within the DMN). Additionally, the OI group demonstrated greater FC than the SRC group between right lateral parietal cortex and supramarginal gyrus. When relating the FC results to verbal memory performance approximately 1 week and 1 month after injury, significantly different between-group relations were found for the posterior cingulate and right lateral parietal cortex seeds. However, the groups did not differ in verbal memory at 1 month. We suggest that changes in FC are apparent 1-month post-SRC despite resolution of post-concussion symptoms and recovery of cognitive performance in adolescent athletes cleared to return to play.
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Affiliation(s)
- Mary R Newsome
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, TX , USA
| | - Xiaoqi Li
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, TX , USA
| | - Xiaodi Lin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, TX , USA
| | - Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Summer Ott
- Department of Orthopedic Surgery, UTHealth McGovern Medical School , Houston, TX , USA
| | - Brian Biekman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, TX , USA
| | - Jill V Hunter
- Department of Radiology, Texas Children's Hospital , Houston, TX , USA
| | - Pramod K Dash
- Department of Neurobiology and Anatomy, UTHealth McGovern Medical School , Houston, TX , USA
| | - Brian A Taylor
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Troyanskaya M, Pastorek NJ, Scheibel RS, Petersen NJ, Walder A, Henson HK, Levin HS. Choosing appropriate comparison group participants in studies of veterans: Characteristics of orthopedically injured and uninjured Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans. J Clin Exp Neuropsychol 2016; 38:811-9. [PMID: 27171190 DOI: 10.1080/13803395.2016.1167172] [Citation(s) in RCA: 4] [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: 10/21/2022]
Abstract
INTRODUCTION Research addressing deployment-related traumatic brain injury (TBI) is fairly complex due to a high prevalence of comorbid conditions, multiple exposures, and the lack of acute medical records. Therefore, there is a need for a well-defined, matching comparison group. This study compared deployment-related characteristics, everyday functioning, and cognitive performance in recently deployed veterans who had not sustained any injuries with those who had orthopedic injuries during deployment, but who were without a history of TBI. METHOD Participants included 45 individuals who had been deployed and who were without injuries and a group of 27 individuals who reported at least one orthopedic injury during deployment. The Mayo-Portland Adaptability Inventory-4, Community Integration Questionnaire, Veterans RAND 36 Item Health Survey, Brief Pain Inventory, Barratt Impulsiveness Scale-11, and posttraumatic stress disorder (PTSD) Checklist-Civilian (PCL-C) were used to assess daily functioning. Cognitive performance was measured using the Controlled Oral Word Association Test, Trail Making Test, Color-Word Interference Test, and Verbal Selective Reminding Test. The two groups were compared using t tests based on equal variances. The effect size was calculated. RESULTS There were no between-group differences, with all variables having p-values >.1 and small to medium effect sizes. DISCUSSION Orthopedic injuries sustained during deployment that did not require evacuation or hospitalization did not have any lasting effect on participants' health, cognition, and daily functioning relative to other deployed individuals with no history of injury. These results indicate the two groups are comparable and that their data could be potentially combined to create a single comparison group. Due to the small sample available for this study, the current results are considered preliminary, and further investigation is needed.
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Affiliation(s)
- Maya Troyanskaya
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA
| | - Nicholas J Pastorek
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA
| | - Randall S Scheibel
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA
| | - Nancy J Petersen
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Department of Medicine , Baylor College of Medicine , Houston , TX , USA
| | - Annette Walder
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Department of Medicine , Baylor College of Medicine , Houston , TX , USA
| | - Helene K Henson
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA
| | - Harvey S Levin
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA.,e Department of Neurosurgery , Baylor College of Medicine , Houston , TX , USA.,f Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
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Goldstein FC, Caveney AF, Hertzberg VS, Silbergleit R, Yeatts SD, Palesch YY, Levin HS, Wright DW. Very Early Administration of Progesterone Does Not Improve Neuropsychological Outcomes in Subjects with Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2016; 34:115-120. [PMID: 26973025 DOI: 10.1089/neu.2015.4313] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A Phase III, double-blind, placebo-controlled trial (ProTECT III) found that administration of progesterone did not reduce mortality or improve functional outcome as measured by the Glasgow Outcome Scale Extended (GOSE) in subjects with moderate to severe traumatic brain injury. We conducted a secondary analysis of neuropsychological outcomes to evaluate whether progesterone is associated with improved recovery of cognitive and motor functioning. ProTECT III was conducted at 49 level I trauma centers in the United States. Adults with moderate to severe TBI were randomized to receive intravenous progesterone or placebo within 4 h of injury for a total of 4 days. At 6 months, subjects underwent evaluation of memory, attention, executive functioning, language, and fine motor coordination/dexterity. Chi-square analysis revealed no significant difference in the proportion of subjects (263/280 progesterone, 283/295 placebo) with Galveston Orientation and Amnesia Test scores ≥75. Analyses of covariance did not reveal significant treatment effects for memory (Buschke immediate recall, p = 0.53; delayed recall, p = 0.94), attention (Trails A speed, p = 0.81 and errors, p = 0.22; Digit Span Forward length, p = 0.66), executive functioning (Trails B speed, p = 0.97 and errors, p = 0.93; Digit Span Backward length, p = 0.60), language (timed phonemic fluency, p = 0.05), and fine motor coordination/dexterity (Grooved Pegboard dominant hand time, p = 0.75 and peg drops, p = 0.59; nondominant hand time, p = 0.74 and peg drops, p = 0.61). Pearson Product Moment Correlations demonstrated significant (p < 0.001) associations between better neuropsychological performance and higher GOSE scores. Similar to the ProTECT III trial's results of the primary outcome, the secondary outcomes do not provide evidence of a neuroprotective effect of progesterone.
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Affiliation(s)
- Felicia C Goldstein
- 1 Department of Neurology, Emory University School of Medicine , Atlanta, Georgia
| | - Angela F Caveney
- 2 Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
| | - Vicki S Hertzberg
- 3 School of Nursing, Emory University School of Medicine , Atlanta, Georgia
| | - Robert Silbergleit
- 4 Department of Emergency Medicine, University of Michigan Medical School , Ann Arbor, Michigan
| | - Sharon D Yeatts
- 5 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Yuko Y Palesch
- 5 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Harvey S Levin
- 6 Department of Physical Medicine & Rehabilitation, Baylor College of Medicine , Houston, Texas
| | - David W Wright
- 7 Department of Emergency Medicine, Emory University School of Medicine , Atlanta, Georgia
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Govindarajan KA, Narayana PA, Hasan KM, Wilde EA, Levin HS, Hunter JV, Miller ER, Patel VKS, Robertson CS, McCarthy JJ. Cortical Thickness in Mild Traumatic Brain Injury. J Neurotrauma 2016; 33:1809-1817. [PMID: 26959810 DOI: 10.1089/neu.2015.4253] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 10/22/2022] Open
Abstract
Magnetic resonance imaging data were acquired at ∼24 h and ∼3 months post-injury on mild traumatic brain injury (mTBI; n = 75) and orthopedic injury (n = 60) cohorts. The mTBI subjects were randomly assigned to a treatment group with atorvastatin or a non-treatment mTBI group. The treatment group was further divided into drug and placebo subgroups. FreeSurfer software package was used to compute cortical thickness based on the three dimensional T1-weighted images at both time-points. Cross-sectional analysis was carried out to compare cortical thickness between the mTBI and control groups. Longitudinal unbiased templates were generated for all subjects and cortical thickness measurements were compared between baseline and follow-up scans in the mTBI group. At baseline, significant reduction in cortical thickness was observed in the left middle temporal and the right superior parietal regions in the mTBI group, relative to the control group (p = 0.01). At follow-up, significant cortical thinning was again observed in the left middle temporal cortex in the mTBI group. Further analysis revealed significant cortical thinning only in the non-treatment group relative to the control group. In the follow-up, small regions with significant but subtle cortical thinning and thickening were seen in the frontal, temporal, and parietal lobes in the left hemisphere in the non-treatment group only. Our results indicate that cortical thickness could serve as a useful measure in identifying subtle changes in mTBI patients.
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Affiliation(s)
- Koushik A Govindarajan
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | - Ponnada A Narayana
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | - Khader M Hasan
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | - Elisabeth A Wilde
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,3 Department of Radiology, Baylor College of Medicine , Houston, Texas
| | - Harvey S Levin
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,4 Michael E. DeBakey Veterans Affairs Medical Center , Houston, Texas
| | - Jill V Hunter
- 3 Department of Radiology, Baylor College of Medicine , Houston, Texas
| | - Emmy R Miller
- 5 Department of Neurosurgery, Virginia Commonwealth University , Richmond, Virginia
| | - Vipul Kumar S Patel
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | | | - James J McCarthy
- 7 Department of Emergency Medicine, University of Texas Health Science Center at Houston , Houston, Texas
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