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Tsyben A, Guilfoyle MR, Laing RJC, Timofeev I, Anwar F, Trivedi RA, Kirollos RW, Turner C, Allanson J, Mee H, Outtrim JG, Menon DK, Hutchinson PJA, Helmy A. Comparison of health-related quality of life in patients with traumatic brain injury, subarachnoid haemorrhage and cervical spine disease. Br J Neurosurg 2022:1-7. [PMID: 36495241 DOI: 10.1080/02688697.2022.2152777] [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] [Received: 08/03/2021] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The degree of disability that is acceptable to patients following traumatic brain injury (TBI) continues to be debated. While the dichotomization of outcome on the Glasgow Outcome Score (GOSE) into 'favourable' and 'unfavourable' continues to guide clinical decisions, this may not reflect an individual's subjective experience. The aim of this study is to assess how patients' self-reported quality of life (QoL) relates to objective outcome assessments and how it compares to other debilitating neurosurgical pathologies, including subarachnoid haemorrhage (SAH) and cervical myelopathy. METHOD A retrospective analysis of over 1300 patients seen in Addenbrooke's Hospital, Cambridge, UK with TBI, SAH and patients pre- and post- cervical surgery was performed. QoL was assessed using the SF-36 questionnaire. Kruskal-Wallis test was used to analyse the difference in SF-36 domain scores between the four unpaired patient groups. To determine how the point of dichotomization of GOSE into 'favourable' and 'unfavourable' outcome affected QOL, SF-36 scores were compared between GOSE and mRS. RESULTS There was a statistically significant difference in the median Physical Component Score (PCS) and Mental Component Score (MCS) of SF-36 between the three neurosurgical pathologies. Patients with TBI and SAH scored higher on most SF-36 domains when compared with cervical myelopathy patients in the severe category. While patients with Upper Severe Disability on GOSE showed significantly higher PC and MC scores compared to GOSE 3, there was a significant degree of variability in individual responses across the groups. CONCLUSION A significant number of patients following TBI and SAH have better self-reported QOL than cervical spine patients and patients' subjective perception and expectations following injury do not always correspond to objective disability. These results can guide discussion of treatment and outcomes with patients and families.
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Affiliation(s)
- Anastasia Tsyben
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Mathew R Guilfoyle
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Rodney J C Laing
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Fahim Anwar
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Rikin A Trivedi
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | | | - Carole Turner
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Judith Allanson
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Harry Mee
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Joanne G Outtrim
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - David K Menon
- Neurocritical Care Unit & University Department of Anaesthesia, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Peter J A Hutchinson
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Adel Helmy
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland
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2
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Needham EJ, Ren AL, Digby RJ, Norton EJ, Ebrahimi S, Outtrim JG, Chatfield DA, Manktelow AE, Leibowitz MM, Newcombe VFJ, Doffinger R, Barcenas-Morales G, Fonseca C, Taussig MJ, Burnstein RM, Samanta RJ, Dunai C, Sithole N, Ashton NJ, Zetterberg H, Gisslén M, Edén A, Marklund E, Openshaw PJM, Dunning J, Griffiths MJ, Cavanagh J, Breen G, Irani SR, Elmer A, Kingston N, Summers C, Bradley JR, Taams LS, Michael BD, Bullmore ET, Smith KGC, Lyons PA, Coles AJ, Menon DK. Brain injury in COVID-19 is associated with dysregulated innate and adaptive immune responses. Brain 2022; 145:4097-4107. [PMID: 36065116 PMCID: PMC9494359 DOI: 10.1093/brain/awac321] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022] Open
Abstract
COVID-19 is associated with neurological complications including stroke, delirium and encephalitis. Furthermore, a post-viral syndrome dominated by neuropsychiatric symptoms is common, and is seemingly unrelated to COVID-19 severity. The true frequency and underlying mechanisms of neurological injury are unknown, but exaggerated host inflammatory responses appear to be a key driver of COVID-19 severity. We investigated the dynamics of, and relationship between, serum markers of brain injury [neurofilament light (NfL), glial fibrillary acidic protein (GFAP) and total tau] and markers of dysregulated host response (autoantibody production and cytokine profiles) in 175 patients admitted with COVID-19 and 45 patients with influenza. During hospitalization, sera from patients with COVID-19 demonstrated elevations of NfL and GFAP in a severity-dependent manner, with evidence of ongoing active brain injury at follow-up 4 months later. These biomarkers were associated with elevations of pro-inflammatory cytokines and the presence of autoantibodies to a large number of different antigens. Autoantibodies were commonly seen against lung surfactant proteins but also brain proteins such as myelin associated glycoprotein. Commensurate findings were seen in the influenza cohort. A distinct process characterized by elevation of serum total tau was seen in patients at follow-up, which appeared to be independent of initial disease severity and was not associated with dysregulated immune responses unlike NfL and GFAP. These results demonstrate that brain injury is a common consequence of both COVID-19 and influenza, and is therefore likely to be a feature of severe viral infection more broadly. The brain injury occurs in the context of dysregulation of both innate and adaptive immune responses, with no single pathogenic mechanism clearly responsible.
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Affiliation(s)
- Edward J Needham
- Correspondence to: Edward Needham Department of Clinical Neurosciences University of Cambridge, Cambridge, UK E-mail:
| | - Alexander L Ren
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Richard J Digby
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Emma J Norton
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Soraya Ebrahimi
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Joanne G Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Doris A Chatfield
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Anne E Manktelow
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Maya M Leibowitz
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | | | - Rainer Doffinger
- Department of Clinical Biochemistry and Immunology, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Claudia Fonseca
- Cambridge Protein Arrays Ltd, Babraham Research Campus, Cambridge, UK
| | - Michael J Taussig
- Cambridge Protein Arrays Ltd, Babraham Research Campus, Cambridge, UK
| | - Rowan M Burnstein
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Romit J Samanta
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Cordelia Dunai
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
| | - Nyarie Sithole
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation Trust, Cambridge, UK
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Jeffrey Cheah Biomedical Centre, Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arden Edén
- Department of Infectious Diseases, Institute of Biomedicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emelie Marklund
- Department of Infectious Diseases, Institute of Biomedicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Jake Dunning
- Nuffield Department of Medicine, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Michael J Griffiths
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Jonathan Cavanagh
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gerome Breen
- Department of Social Genetic and Developmental Psychiatry, King’s College London, London, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anne Elmer
- Cambridge Clinical Research Centre, NIHR Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
- Department of Haematology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Charlotte Summers
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - John R Bradley
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology (CIBCI) and Department Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, Guy's Campus, London, UK
| | - Benedict D Michael
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
| | - Edward T Bullmore
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge Biomedical Campus, Cambridge, UK
| | - Kenneth G C Smith
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Jeffrey Cheah Biomedical Centre, Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Paul A Lyons
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Jeffrey Cheah Biomedical Centre, Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
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3
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Hampshire A, Chatfield DA, MPhil AM, Jolly A, Trender W, Hellyer PJ, Giovane MD, Newcombe VF, Outtrim JG, Warne B, Bhatti J, Pointon L, Elmer A, Sithole N, Bradley J, Kingston N, Sawcer SJ, Bullmore ET, Rowe JB, Menon DK. Multivariate profile and acute-phase correlates of cognitive deficits in a COVID-19 hospitalised cohort. EClinicalMedicine 2022; 47:101417. [PMID: 35505938 PMCID: PMC9048584 DOI: 10.1016/j.eclinm.2022.101417] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 02/02/2023] Open
Abstract
Background Preliminary evidence has highlighted a possible association between severe COVID-19 and persistent cognitive deficits. Further research is required to confirm this association, determine whether cognitive deficits relate to clinical features from the acute phase or to mental health status at the point of assessment, and quantify rate of recovery. Methods 46 individuals who received critical care for COVID-19 at Addenbrooke's hospital between 10th March 2020 and 31st July 2020 (16 mechanically ventilated) underwent detailed computerised cognitive assessment alongside scales measuring anxiety, depression and post-traumatic stress disorder under supervised conditions at a mean follow up of 6.0 (± 2.1) months following acute illness. Patient and matched control (N = 460) performances were transformed into standard deviation from expected scores, accounting for age and demographic factors using N = 66,008 normative datasets. Global accuracy and response time composites were calculated (G_SScore & G_RT). Linear modelling predicted composite score deficits from acute severity, mental-health status at assessment, and time from hospital admission. The pattern of deficits across tasks was qualitatively compared with normal age-related decline, and early-stage dementia. Findings COVID-19 survivors were less accurate (G_SScore=-0.53SDs) and slower (G_RT=+0.89SDs) in their responses than expected compared to their matched controls. Acute illness, but not chronic mental health, significantly predicted cognitive deviation from expected scores (G_SScore (p=0.0037) and G_RT (p = 0.0366)). The most prominent task associations with COVID-19 were for higher cognition and processing speed, which was qualitatively distinct from the profiles of normal ageing and dementia and similar in magnitude to the effects of ageing between 50 and 70 years of age. A trend towards reduced deficits with time from illness (r∼=0.15) did not reach statistical significance. Interpretation Cognitive deficits after severe COVID-19 relate most strongly to acute illness severity, persist long into the chronic phase, and recover slowly if at all, with a characteristic profile highlighting higher cognitive functions and processing speed. Funding This work was funded by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre (BRC), NIHR Cambridge Clinical Research Facility (BRC-1215-20014), the Addenbrooke's Charities Trust and NIHR COVID-19 BioResource RG9402. AH is funded by the UK Dementia Research Institute Care Research and Technology Centre and Imperial College London Biomedical Research Centre. ETB and DKM are supported by NIHR Senior Investigator awards. JBR is supported by the Wellcome Trust (220258) and Medical Research Council (SUAG/051 G101400). VFJN is funded by an Academy of Medical Sciences/ The Health Foundation Clinician Scientist Fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Adam Hampshire
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Doris A. Chatfield
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Anne Manktelow MPhil
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Amy Jolly
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - William Trender
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Peter J. Hellyer
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Martina Del Giovane
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | | | - Joanne G. Outtrim
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Ben Warne
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Junaid Bhatti
- Department of Psychiatry, University of Cambridge, United Kingdom
| | - Linda Pointon
- Department of Psychiatry, University of Cambridge, United Kingdom
| | - Anne Elmer
- National Institute for Health Research Cambridge Clinical Research Facility, Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Nyarie Sithole
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Division of Infectious Diseases, Department of Medicine, University of Cambridge, United Kingdom
| | - John Bradley
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Department of Medicine, University of Cambridge, United Kingdom
- National Institute for Health Research Cambridge BioResource, United Kingdom
| | - Nathalie Kingston
- National Institute for Health Research COVID-19 BioResource, United Kingdom
| | - Stephen J. Sawcer
- Department of Clinical Neurosciences, and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Edward T. Bullmore
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, United Kingdom
| | - James B. Rowe
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, United Kingdom
- Department of Clinical Neurosciences, and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - David K. Menon
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Division of Anaesthesia, Department of Medicine, University of Cambridge
| | - the Cambridge NeuroCOVID Group, the NIHR COVID-19 BioResource, and Cambridge NIHR Clinical Research Facility
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, United Kingdom
- National Institute for Health Research Cambridge Clinical Research Facility, Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Division of Infectious Diseases, Department of Medicine, University of Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, United Kingdom
- National Institute for Health Research Cambridge BioResource, United Kingdom
- Department of Clinical Neurosciences, and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, United Kingdom
- Division of Anaesthesia, Department of Medicine, University of Cambridge
- National Institute for Health Research COVID-19 BioResource, United Kingdom
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4
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Tsvetanov KA, Spindler LRB, Stamatakis EA, Newcombe VFJ, Lupson VC, Chatfield DA, Manktelow AE, Outtrim JG, Elmer A, Kingston N, Bradley JR, Bullmore ET, Rowe JB, Menon DK. Hospitalisation for COVID-19 predicts long lasting cerebrovascular impairment: A prospective observational cohort study. Neuroimage Clin 2022; 36:103253. [PMID: 36451358 PMCID: PMC9639388 DOI: 10.1016/j.nicl.2022.103253] [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: 07/19/2022] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Human coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has multiple neurological consequences, but its long-term effect on brain health is still uncertain. The cerebrovascular consequences of COVID-19 may also affect brain health. We studied the chronic effect of COVID-19 on cerebrovascular health, in relation to acute severity, adverse clinical outcomes and in contrast to control group data. Here we assess cerebrovascular health in 45 patients six months after hospitalisation for acute COVID-19 using the resting state fluctuation amplitudes (RSFA) from functional magnetic resonance imaging, in relation to disease severity and in contrast with 42 controls. Acute COVID-19 severity was indexed by COVID-19 WHO Progression Scale, inflammatory and coagulatory biomarkers. Chronic widespread changes in frontoparietal RSFA were related to the severity of the acute COVID-19 episode. This relationship was not explained by chronic cardiorespiratory dysfunction, age, or sex. The level of cerebrovascular dysfunction was associated with cognitive, mental, and physical health at follow-up. The principal findings were consistent across univariate and multivariate approaches. The results indicate chronic cerebrovascular impairment following severe acute COVID-19, with the potential for long-term consequences on cognitive function and mental wellbeing.
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Affiliation(s)
- Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
| | - Lennart R B Spindler
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Emmanuel A Stamatakis
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Virginia F J Newcombe
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Victoria C Lupson
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Doris A Chatfield
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Anne E Manktelow
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Joanne G Outtrim
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Anne Elmer
- Cambridge Clinical Research Centre, NIHR Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, United Kingdom; Department of Haematology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Edward T Bullmore
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, Cambridge, United Kingdom
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom; Cambridge Clinical Research Centre, NIHR Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
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5
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Needham EJ, Stoevesandt O, Thelin EP, Zetterberg H, Zanier ER, Al Nimer F, Ashton NJ, Outtrim JG, Newcombe VFJ, Mousa HS, Simrén J, Blennow K, Yang Z, Hutchinson PJ, Piehl F, Helmy AE, Taussig MJ, Wang KKW, Jones JL, Menon DK, Coles AJ. Complex Autoantibody Responses Occur following Moderate to Severe Traumatic Brain Injury. J Immunol 2021; 207:90-100. [PMID: 34145056 DOI: 10.4049/jimmunol.2001309] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/26/2021] [Indexed: 02/02/2023]
Abstract
Most of the variation in outcome following severe traumatic brain injury (TBI) remains unexplained by currently recognized prognostic factors. Neuroinflammation may account for some of this difference. We hypothesized that TBI generated variable autoantibody responses between individuals that would contribute to outcome. We developed a custom protein microarray to detect autoantibodies to both CNS and systemic Ags in serum from the acute-phase (the first 7 d), late (6-12 mo), and long-term (6-13 y) intervals after TBI in human patients. We identified two distinct patterns of immune response to TBI. The first was a broad response to the majority of Ags tested, predominantly IgM mediated in the acute phase, then IgG dominant at late and long-term time points. The second was responses to specific Ags, most frequently myelin-associated glycopeptide (MAG), which persisted for several months post-TBI but then subsequently resolved. Exploratory analyses suggested that patients with a greater acute IgM response experienced worse outcomes than predicted from current known risk factors, suggesting a direct or indirect role in worsening outcome. Furthermore, late persistence of anti-MAG IgM autoantibodies correlated with raised serum neurofilament light concentrations at these time points, suggesting an association with ongoing neurodegeneration over the first year postinjury. Our results show that autoantibody production occurs in some individuals following TBI, can persist for many years, and is associated with worse patient outcome. The complexity of responses means that conventional approaches based on measuring responses to single antigenic targets may be misleading.
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Affiliation(s)
- Edward J Needham
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom; .,Division of Anaesthesia, Department of Medicine, University of Cambridge, United Kingdom
| | | | - Eric P Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurovascular Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Academic Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom.,United Kingdom Dementia Research Institute at University College London, London, United Kingdom
| | - Elisa R Zanier
- Dipartimento di Ricerca Neuroscienze, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Faiez Al Nimer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Joanne G Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, United Kingdom
| | - Virginia F J Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, University of Cambridge, United Kingdom; and
| | - Hani S Mousa
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute
| | - Peter J Hutchinson
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adel E Helmy
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mike J Taussig
- Cambridge Protein Arrays Ltd., Cambridge, United Kingdom
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute
| | - Joanne L Jones
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, University of Cambridge, United Kingdom; and
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
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6
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Tas J, Beqiri E, van Kaam CR, Ercole A, Bellen G, Bruyninckx D, Cabeleira M, Czosnyka M, Depreitere B, Donnelly J, Fedriga M, Hutchinson PJ, Menon D, Meyfroidt G, Liberti A, Outtrim JG, Robba C, Hoedemaekers CWE, Smielewski P, Aries MJ. An Update on the COGiTATE Phase II Study: Feasibility and Safety of Targeting an Optimal Cerebral Perfusion Pressure as a Patient-Tailored Therapy in Severe Traumatic Brain Injury. Acta Neurochir Suppl 2021; 131:143-147. [PMID: 33839835 DOI: 10.1007/978-3-030-59436-7_29] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Monitoring of cerebral autoregulation (CA) in patients with a traumatic brain injury (TBI) can provide an individual 'optimal' cerebral perfusion pressure (CPP) target (CPPopt) at which CA is best preserved. This potentially offers an individualized precision medicine approach. Retrospective data suggest that deviation of CPP from CPPopt is associated with poor outcomes. We are prospectively assessing the feasibility and safety of this approach in the COGiTATE [CPPopt Guided Therapy: Assessment of Target Effectiveness] study. Its primary objective is to demonstrate the feasibility of individualizing CPP at CPPopt in TBI patients. The secondary objectives are to investigate the safety and physiological effects of this strategy. METHODS The COGiTATE study has included patients in four European hospitals in Cambridge, Leuven, Nijmegen, and Maastricht (coordinating centre). Patients with severe TBI requiring intracranial pressure (ICP)-directed therapy are allocated into one of two groups. In the intervention group, CPPopt is calculated using a published (modified) algorithm. In the control group, the CPP target recommended in the Brain Trauma Foundation guidelines (CPP 60-70 mmHg) is used. RESULTS Patient recruitment started in February 2018 and will continue until 60 patients have been studied. Fifty-one patients (85% of the intended total) have been recruited in October 2019. The first results are expected early 2021. CONCLUSION This prospective evaluation of the feasibility, safety and physiological implications of autoregulation-guided CPP management is providing evidence that will be useful in the design of a future phase III study in severe TBI patients.
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Affiliation(s)
- Jeanette Tas
- Department of Intensive Care Medicine, University of Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Physiology and Transplantation, University of Milan, Milan, Italy
| | - C R van Kaam
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ari Ercole
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Gert Bellen
- Department of Neurosciences, Catholic University Leuven, University Hospital Leuven, Leuven, Belgium
| | - D Bruyninckx
- Department of Neurosciences, Catholic University Leuven, University Hospital Leuven, Leuven, Belgium
| | - Manuel Cabeleira
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Bart Depreitere
- Department of Neurosciences, Catholic University Leuven, University Hospital Leuven, Leuven, Belgium
| | - Joseph Donnelly
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marta Fedriga
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Peter J Hutchinson
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - D Menon
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Geert Meyfroidt
- Department of Cellular and Molecular Medicine, Catholic University Leuven, University Hospital, Leuven, Belgium
| | - Annalisa Liberti
- Department of Intensive Care Medicine, University of Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J G Outtrim
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - C Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - C W E Hoedemaekers
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marcel J Aries
- Department of Intensive Care Medicine, University of Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Carroll EL, Outtrim JG, Forsyth F, Manktelow AE, Hutchinson PJA, Tenovuo O, Posti JP, Wilson L, Sahakian BJ, Menon DK, Newcombe VFJ. Mild traumatic brain injury recovery: a growth curve modelling analysis over 2 years. J Neurol 2020; 267:3223-3234. [PMID: 32535683 PMCID: PMC7578150 DOI: 10.1007/s00415-020-09979-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 02/29/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND An improved understanding of the trajectory of recovery after mild traumatic brain injury is important to be able to understand individual patient outcomes, for longitudinal patient care and to aid the design of clinical trials. OBJECTIVE To explore changes in health, well-being and cognition over the 2 years following mTBI using latent growth curve (LGC) modelling. METHODS Sixty-one adults with mTBI presenting to a UK Major Trauma Centre completed comprehensive longitudinal assessment at up to five time points after injury: 2 weeks, 3 months, 6 months, 1 year and 2 years. RESULTS Persisting problems were seen with neurological symptoms, cognitive issues and poor quality of life measures including 28% reporting incomplete recovery on the Glasgow Outcome Score Extended at 2 years. Harmful drinking, depression, psychological distress, disability, episodic memory and working memory did not improve significantly over the 2 years following injury. For other measures, including the Rivermead Post-Concussion Symptoms and Quality of Life after Brain Injury (QOLIBRI), LGC analysis revealed significant improvement over time with recovery tending to plateau at 3-6 months. INTERPRETATION Significant impairment may persist as late as 2 years after mTBI despite some recovery over time. Longitudinal analyses which make use of all available data indicate that recovery from mTBI occurs over a longer timescale than is commonly believed. These findings point to the need for long-term management of mTBI targeting individuals with persisting impairment.
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Affiliation(s)
- Ellen L Carroll
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Joanne G Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Faye Forsyth
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Anne E Manktelow
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter J A Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Olli Tenovuo
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Jussi P Posti
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Barbara J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Virginia F J Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK.
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Abstract
OBJECTIVES To use wrist-worn accelerometers (Axivity AX3) to establish normative physical activity (PA) and acceptability data for the high-risk elderly preoperative population, to assess whether PA could be modified by a prehabilitation intervention as part of routine care, to assess any correlation between accelerometer-measured PA and self-reported PA and to assess the acceptability of wearing wrist-worn accelerometers in this population. STUDY DESIGN Prospective, observational, pilot study. SETTING Single National Health Service Hospital. PARTICIPANTS Frail patients≥65 years awaiting major surgery referred to a multidisciplinary preoperative clinic at which they received a routine intervention aimed at improving their PA. 35 patients were recruited. Average age 79.9 years (SD=5.6). PRIMARY OUTCOMES Normative PA data measured as a mean daily Euclidean norm minus one (ENMO) in milli-gravitational units (mg). SECONDARY OUTCOMES Measure PA levels (mg) following a routine preoperative intervention. Determine correlation between patient-reported PA (measured using the Physical Activity Scale for the Elderly) and accelerometer-measured PA (mg). Assess acceptability of wearing a wrist-worn accelerometer measured using Visual Analogue Scale (VAS) questionnaire and device wear time (hours). RESULTS Median baseline daily PA was 14.3 mg (IQR 9.75-22.04) with an improvement in PA detected following the intervention (median ENMO post intervention 20.91 mg (IQR 14.83-27.53), p=0.022). There was no significant correlation between accelerometer-measured and self-reported PA (baseline ρ=0.162 (p=0.4), post intervention ρ=-0.144 (p=0.5)). We found high acceptability ratings (median score of 10/10 on VAS, IQR 8-10) and wear-time compliance (163.2 hours (IQR 150-167.5) preintervention and 166.1 hours (IQR 162.5-167) post intervention). CONCLUSIONS Accelerometery is acceptable to this population and increases in PA levels measured following an unoptimised routine clinical intervention which indicates that health behavioural change interventions may be successful during the preoperative period. Accelerometers may therefore be a useful tool to design and validate interventions for improving PA in this setting. TRIAL REGISTRATION NUMBER NCT03737903.
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Affiliation(s)
- Lisa Grimes
- University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joanne G Outtrim
- University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, University of Cambridge Institute of Public Health, Cambridge, UK
| | - Ari Ercole
- University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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9
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Beqiri E, Smielewski P, Robba C, Czosnyka M, Cabeleira MT, Tas J, Donnelly J, Outtrim JG, Hutchinson P, Menon D, Meyfroidt G, Depreitere B, Aries MJ, Ercole A. Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: the COGiTATE phase II study protocol. BMJ Open 2019; 9:e030727. [PMID: 31542757 PMCID: PMC6756360 DOI: 10.1136/bmjopen-2019-030727] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Individualising therapy is an important challenge for intensive care of patients with severe traumatic brain injury (TBI). Targeting a cerebral perfusion pressure (CPP) tailored to optimise cerebrovascular autoregulation has been suggested as an attractive strategy on the basis of a large body of retrospective observational data. The objective of this study is to prospectively assess the feasibility and safety of such a strategy compared with fixed thresholds which is the current standard of care from international consensus guidelines. METHODS AND ANALYSIS CPPOpt Guided Therapy: Assessment of Target Effectiveness (COGiTATE) is a prospective, multicentre, non-blinded randomised, controlled trial coordinated from Maastricht University Medical Center, Maastricht (The Netherlands). The other original participating centres are Cambridge University NHS Foundation Trust, Cambridge (UK), and University Hospitals Leuven, Leuven (Belgium). Adult severe TBI patients requiring intracranial pressure monitoring are randomised within the first 24 hours of admission in neurocritical care unit. For the control arm, the CPP target is the Brain Trauma Foundation guidelines target (60-70 mm Hg); for the intervention group an automated CPP target is provided as the CPP at which the patient's cerebrovascular reactivity is best preserved (CPPopt). For a maximum of 5 days, attending clinicians review the CPP target 4-hourly. The main hypothesis of COGiTATE are: (1) in the intervention group the percentage of the monitored time with measured CPP within a range of 5 mm Hg above or below CPPopt will reach 36%; (2) the difference in between groups in daily therapy intensity level score will be lower or equal to 3. ETHICS AND DISSEMINATION Ethical approval has been obtained for each participating centre. The results will be presented at international scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02982122.
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Affiliation(s)
- Erta Beqiri
- Clinical Neuroscience, University of Cambridge, Cambridge, UK
- Physiology and Transplantation, University of Milan, Milano, Italy
| | | | - Chiara Robba
- Anaesthesia and Intensive Care,Policlinico San Martino, IRCCS for Oncology and Neuroscience, University of Genoa, Genova, Italy
| | - Marek Czosnyka
- Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | | | - Jeanette Tas
- Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Joseph Donnelly
- Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | | | | | - David Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Intensieve geneeskunde, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Bart Depreitere
- Intensieve geneeskunde, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marcel J Aries
- Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
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10
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Veenith TV, Carter EL, Grossac J, Newcombe VFJ, Outtrim JG, Nallapareddy S, Lupson V, Correia MM, Mada MM, Williams GB, Menon DK, Coles JP. Normobaric hyperoxia does not improve derangements in diffusion tensor imaging found distant from visible contusions following acute traumatic brain injury. Sci Rep 2017; 7:12419. [PMID: 28963497 PMCID: PMC5622132 DOI: 10.1038/s41598-017-12590-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/01/2017] [Indexed: 11/09/2022] Open
Abstract
We have previously shown that normobaric hyperoxia may benefit peri-lesional brain and white matter following traumatic brain injury (TBI). This study examined the impact of brief exposure to hyperoxia using diffusion tensor imaging (DTI) to identify axonal injury distant from contusions. Fourteen patients with acute moderate/severe TBI underwent baseline DTI and following one hour of 80% oxygen. Thirty-two controls underwent DTI, with 6 undergoing imaging following graded exposure to oxygen. Visible lesions were excluded and data compared with controls. We used the 99% prediction interval (PI) for zero change from historical control reproducibility measurements to demonstrate significant change following hyperoxia. Following hyperoxia DTI was unchanged in controls. In patients following hyperoxia, mean diffusivity (MD) was unchanged despite baseline values lower than controls (p < 0.05), and fractional anisotropy (FA) was lower within the left uncinate fasciculus, right caudate and occipital regions (p < 0.05). 16% of white and 14% of mixed cortical and grey matter patient regions showed FA decreases greater than the 99% PI for zero change. The mechanistic basis for some findings are unclear, but suggest that a short period of normobaric hyperoxia is not beneficial in this context. Confirmation following a longer period of hyperoxia is required.
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Affiliation(s)
- Tonny V Veenith
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
- Department of Critical Care Medicine, University Hospital of Birmingham NHS Trust, Queen Elizabeth Medical Centre, Birmingham, B15 2TH, UK
| | - Eleanor L Carter
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Julia Grossac
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
- Anesthesiology and Critical Care Department, University Hospital of Toulouse, 31000, Toulouse, France
| | - Virginia F J Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Joanne G Outtrim
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Sri Nallapareddy
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Victoria Lupson
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Marta M Correia
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Marius M Mada
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Guy B Williams
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Jonathan P Coles
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK.
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11
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Lauer J, Moreno-López L, Manktelow A, Carroll EL, Outtrim JG, Coles JP, Newcombe VF, Sahakian BJ, Menon DK, Stamatakis EA. Neural correlates of visual memory in patients with diffuse axonal injury. Brain Inj 2017; 31:1513-1520. [PMID: 28707953 DOI: 10.1080/02699052.2017.1341998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PRIMARY OBJECTIVE To investigate the neural substrates of visual memory in a sample of patients with traumatic brain injury (TBI). We hypothesized that patients with decreased grey and white matter volume in frontal and parietal cortices as well as medial temporal and occipital lobes would perform poorly on the tests of visual memory analysed. METHODS AND PROCEDURES 39 patients and 53 controls were assessed on tests of visual memory and learning from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Patients with TBI were scanned with magnetic resonance imaging (MRI). Partial correlations and multiple regression analyses were used to examine relationships between cognitive variables and MRI volumetric findings. This study complements and extends previous studies by performing volumetric comparisons on a variety of resolution levels, from whole brain to voxel-based level analysis. MAIN OUTCOMES AND RESULTS Patients with TBI performed significantly worse than controls in all the tasks assessed. Performance was associated with wide-spread reductions in grey and white matter volume of several cortical and subcortical structures as well as with cerebrospinal fluid space enlargement in accordance with previous studies of memory in patients with TBI and cognitive models suggesting that memory problems involve the alteration of multiple systems. CONCLUSIONS Our results propose that compromised visual memory in patients with TBI is related to a distributed pattern of volume loss in regions mediating memory and attentional processing.
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Affiliation(s)
- Juliane Lauer
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK
| | | | - Anne Manktelow
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK
| | - Ellen L Carroll
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK
| | - Joanne G Outtrim
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK
| | - Jonathan P Coles
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK
| | - Virginia F Newcombe
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK.,c Department of Clinical Neurosciences, Wolfson Brain Imaging Centre , University of Cambridge , Cambridge Biomedical Campus, Cambridge , UK
| | - Barbara J Sahakian
- b Department of Psychiatry and MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute , University of Cambridge , Cambridge , UK.,c Department of Clinical Neurosciences, Wolfson Brain Imaging Centre , University of Cambridge , Cambridge Biomedical Campus, Cambridge , UK
| | - David K Menon
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK.,c Department of Clinical Neurosciences, Wolfson Brain Imaging Centre , University of Cambridge , Cambridge Biomedical Campus, Cambridge , UK
| | - Emmanuel A Stamatakis
- a Division of Anaesthesia , University of Cambridge , Cambridge , UK.,c Department of Clinical Neurosciences, Wolfson Brain Imaging Centre , University of Cambridge , Cambridge Biomedical Campus, Cambridge , UK
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12
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Newcombe VFJ, Correia MM, Ledig C, Abate MG, Outtrim JG, Chatfield D, Geeraerts T, Manktelow AE, Garyfallidis E, Pickard JD, Sahakian BJ, Hutchinson PJA, Rueckert D, Coles JP, Williams GB, Menon DK. Dynamic Changes in White Matter Abnormalities Correlate With Late Improvement and Deterioration Following TBI: A Diffusion Tensor Imaging Study. Neurorehabil Neural Repair 2016; 30:49-62. [PMID: 25921349 DOI: 10.1177/1545968315584004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is not a single insult with monophasic resolution, but a chronic disease, with dynamic processes that remain active for years. We aimed to assess patient trajectories over the entire disease narrative, from ictus to late outcome. METHODS Twelve patients with moderate-to-severe TBI underwent magnetic resonance imaging in the acute phase (within 1 week of injury) and twice in the chronic phase of injury (median 7 and 21 months), with some undergoing imaging at up to 2 additional time points. Longitudinal imaging changes were assessed using structural volumetry, deterministic tractography, voxel-based diffusion tensor analysis, and region of interest analyses (including corpus callosum, parasagittal white matter, and thalamus). Imaging changes were related to behavior. RESULTS Changes in structural volumes, fractional anisotropy, and mean diffusivity continued for months to years postictus. Changes in diffusion tensor imaging were driven by increases in both axial and radial diffusivity except for the earliest time point, and were associated with changes in reaction time and performance in a visual memory and learning task (paired associates learning). Dynamic structural changes after TBI can be detected using diffusion tensor imaging and could explain changes in behavior. CONCLUSIONS These data can provide further insight into early and late pathophysiology, and begin to provide a framework that allows magnetic resonance imaging to be used as an imaging biomarker of therapy response. Knowledge of the temporal pattern of changes in TBI patient populations also provides a contextual framework for assessing imaging changes in individuals at any given time point.
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Affiliation(s)
| | | | | | - Maria G Abate
- University of Cambridge, Cambridge, UK Gerardo Hospital, Monza, Milan, Italy
| | | | | | - Thomas Geeraerts
- University of Cambridge, Cambridge, UK University Hospital of Toulouse, Toulouse, France
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13
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Veenith TV, Carter EL, Grossac J, Newcombe VF, Outtrim JG, Nallapareddy S, Lupson V, Correia MM, Mada MM, Williams GB, Menon DK, Coles JP. Use of diffusion tensor imaging to assess the impact of normobaric hyperoxia within at-risk pericontusional tissue after traumatic brain injury. J Cereb Blood Flow Metab 2014; 34:1622-7. [PMID: 25005875 PMCID: PMC4269721 DOI: 10.1038/jcbfm.2014.123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/15/2014] [Accepted: 06/09/2014] [Indexed: 12/31/2022]
Abstract
Ischemia and metabolic dysfunction remain important causes of neuronal loss after head injury, and we have shown that normobaric hyperoxia may rescue such metabolic compromise. This study examines the impact of hyperoxia within injured brain using diffusion tensor imaging (DTI). Fourteen patients underwent DTI at baseline and after 1 hour of 80% oxygen. Using the apparent diffusion coefficient (ADC) we assessed the impact of hyperoxia within contusions and a 1 cm border zone of normal appearing pericontusion, and within a rim of perilesional reduced ADC consistent with cytotoxic edema and metabolic compromise. Seven healthy volunteers underwent imaging at 21%, 60%, and 100% oxygen. In volunteers there was no ADC change with hyperoxia, and contusion and pericontusion ADC values were higher than volunteers (P<0.01). There was no ADC change after hyperoxia within contusion, but an increase within pericontusion (P<0.05). We identified a rim of perilesional cytotoxic edema in 13 patients, and hyperoxia resulted in an ADC increase towards normal (P=0.02). We demonstrate that hyperoxia may result in benefit within the perilesional rim of cytotoxic edema. Future studies should address whether a longer period of hyperoxia has a favorable impact on the evolution of tissue injury.
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Affiliation(s)
- Tonny V Veenith
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Eleanor L Carter
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Julia Grossac
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Virginia F Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Joanne G Outtrim
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Sridhar Nallapareddy
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Victoria Lupson
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Marta M Correia
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Marius M Mada
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Guy B Williams
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Jonathan P Coles
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
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14
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Abstract
Background The purpose of this study was to assess the accuracy of ovulation detection by the DuoFertility® monitor compared with transvaginal ultrasound in infertile women with regular menstrual cycles. Methods Eight infertile patients, aged 27–40 years, with a body mass index of 19–29, regular menses, normal ovaries on pelvic ultrasound scan, and normal early follicular luteinizing hormone (LH), follicle-stimulating hormone, and prolactin were recruited from infertility clinics in primary and secondary care for this pilot, prospective, observational study. The patients were asked to use the DuoFertility monitor for the whole cycle, with investigators and patients blind to DuoFertility data. Daily urine LH monitoring commenced on cycle day 8, with daily transvaginal ultrasound following the first positive LH until ovulation was observed. Ovulation was further confirmed by serum progesterone. The main outcome measure was detection of ovulation by the DuoFertility monitor, and correlation between day of ovulation assessed by DuoFertility and ultrasound. Results DuoFertility identified ovulation as having occurred within one day of that determined via ultrasound in all cycles. The sensitivity of ovulation detection was 100% (95% confidence interval 82–100). The specificity could not be concluded from the data. Conclusion In infertile women with regular cycles, the DuoFertility monitor appears to accurately identify ovulatory cycles and the day of ovulation.
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Affiliation(s)
- Jennie Cb Rollason
- Cambridge IVF, Addenbrooke's NHS Trust, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Joanne G Outtrim
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Raj S Mathur
- Cambridge IVF, Addenbrooke's NHS Trust, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Hong YT, Veenith T, Dewar D, Outtrim JG, Mani V, Williams C, Pimlott S, Hutchinson PJA, Tavares A, Canales R, Mathis CA, Klunk WE, Aigbirhio FI, Coles JP, Baron JC, Pickard JD, Fryer TD, Stewart W, Menon DK. Amyloid imaging with carbon 11-labeled Pittsburgh compound B for traumatic brain injury. JAMA Neurol 2014; 71:23-31. [PMID: 24217171 PMCID: PMC4084932 DOI: 10.1001/jamaneurol.2013.4847] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To image amyloid deposition in patients with traumatic brain injury (TBI) using carbon 11-labeled Pittsburgh Compound B ([11C]PiB) positron emission tomography (PET) and to validate these findings using tritium-labeled PiB ([3H]PiB) autoradiography and immunocytochemistry in autopsy-acquired tissue. DESIGN, SETTING, AND PARTICIPANTS In vivo PET at tertiary neuroscience referral center and ex vivo immunocytochemistry of autopsy-acquired brain tissue from a neuropathology archive. [11C]PiB PET was used to image amyloid deposition in 11 controls (median [range] age, 35 [24-60] years) and in 15 patients (median [range] age, 33 [21-50] years) between 1 and 361 days after a TBI. [3H]PiB autoradiography and immunocytochemistry for β-amyloid (Aβ) and β-amyloid precursor protein in brain tissue were obtained from separate cohorts of 16 patients (median [range] age, 46 [21-70] years) who died between 3 hours and 56 days after a TBI and 7 controls (median [range] age, 61 [29-71] years) who died of other causes. MAIN OUTCOMES AND MEASURES We quantified the [11C]PiB distribution volume ratio and standardized uptake value ratio in PET images. The distribution volume ratio and the standardized uptake value ratio were measured in cortical gray matter, white matter, and multiple cortical and white matter regions of interest, as well as in striatal and thalamic regions of interest. We examined [3H]PiB binding and Aβ and β-amyloid precursor protein immunocytochemistry in autopsy-acquired brain tissue. RESULTS Compared with the controls, the patients with TBI showed significantly increased [11C]PiB distribution volume ratios in cortical gray matter and the striatum (corrected P < .05 for both), but not in the thalamus or white matter. Increases in [11C]PiB distribution volume ratios in patients with TBI were seen across most cortical subregions, were replicated using comparisons of standardized uptake value ratios, and could not be accounted for by methodological confounders. Autoradiography revealed [3H]PiB binding in neocortical gray matter, in regions where amyloid deposition was demonstrated by immunocytochemistry; white matter showed Aβ and β-amyloid precursor protein by immunocytochemistry, but no [3H]PiB binding. No plaque-associated amyloid immunoreactivity or [3H]PiB binding was seen in cerebellar gray matter in autopsy-acquired tissue from either controls or patients with TBI, although 1 sample of cerebellar tissue from a patient with TBI showed amyloid angiopathy in meningeal vessels. CONCLUSIONS AND RELEVANCE [11C]PiB shows increased binding following TBI. The specificity of this binding is supported by neocortical [3H]PiB binding in regions of amyloid deposition in the postmortem tissue of patients with TBI. [11C]PiB PET could be valuable in imaging amyloid deposition following TBI.
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Affiliation(s)
- Young T. Hong
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, England5Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
| | - Tonny Veenith
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, England
| | - Deborah Dewar
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland
| | - Joanne G. Outtrim
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, England
| | - Vaithianadan Mani
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, England
| | - Claire Williams
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, England
| | - Sally Pimlott
- University of Glasgow and Southern General Hospital, Glasgow, Scotland
| | | | - Adriana Tavares
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland
| | - Roberto Canales
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, England5Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
| | - Chester A. Mathis
- Departments of Radiology and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E. Klunk
- Departments of Psychiatry and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Franklin I. Aigbirhio
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, England5Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
| | - Jonathan P. Coles
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, England
| | - Jean-Claude Baron
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, England5Department of Clinical Neurosciences, University of Cambridge, Cambridge, England8INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - John D. Pickard
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, England5Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
| | - Tim D. Fryer
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, England5Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
| | - William Stewart
- University of Glasgow and Southern General Hospital, Glasgow, Scotland
| | - David K. Menon
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, England2Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, England
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Veenith TV, Carter E, Grossac J, Newcombe VFJ, Outtrim JG, Lupson V, Williams GB, Menon DK, Coles JP. Inter subject variability and reproducibility of diffusion tensor imaging within and between different imaging sessions. PLoS One 2013; 8:e65941. [PMID: 23840380 PMCID: PMC3696006 DOI: 10.1371/journal.pone.0065941] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/30/2013] [Indexed: 02/02/2023] Open
Abstract
The aim of these studies was to provide reference data on intersubject variability and reproducibility of diffusion tensor imaging. Healthy volunteers underwent imaging on two occasions using the same 3T Siemens Verio magnetic resonance scanner. At each session two identical diffusion tensor sequences were obtained along with standard structural imaging. Fractional anisotropy, apparent diffusion coefficient, axial and radial diffusivity maps were created and regions of interest applied in normalised space. The baseline data from all 26 volunteers were used to calculate the intersubject variability, while within session and between session reproducibility were calculated from all the available data. The reproducibility of measurements were used to calculate the overall and within session 95% prediction interval for zero change. The within and between session reproducibility data were lower than the values for intersubject variability, and were different across the brain. The regional mean (range) coefficient of variation figures for within session reproducibility were 2.1 (0.9-5.5%), 1.2 (0.4-3.9%), 1.2 (0.4-3.8%) and 1.8 (0.4-4.3%) for fractional anisotropy, apparent diffusion coefficient, axial and radial diffusivity, and were lower than between session reproducibility measurements (2.4 (1.1-5.9%), 1.9 (0.7-5.7%), 1.7 (0.7-4.7%) and 2.4 (0.9-5.8%); p<0.001). The calculated overall and within session 95% prediction intervals for zero change were similar. This study provides additional reference data concerning intersubject variability and reproducibility of diffusion tensor imaging conducted within the same imaging session and different imaging sessions. These data can be utilised in interventional studies to quantify change within a single imaging session, or to assess the significance of change in longitudinal studies of brain injury and disease.
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Affiliation(s)
- Tonny V. Veenith
- Division of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Eleanor Carter
- Division of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Julia Grossac
- Division of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | | | - Joanne G. Outtrim
- Division of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Victoria Lupson
- Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom
| | - Guy B. Williams
- Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom
| | - David K. Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Jonathan P. Coles
- Division of Anaesthesia, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
- * E-mail:
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Kasahara M, Menon DK, Salmond CH, Outtrim JG, Tavares JVT, Carpenter TA, Pickard JD, Sahakian BJ, Stamatakis EA. Traumatic brain injury alters the functional brain network mediating working memory. Brain Inj 2011; 25:1170-87. [DOI: 10.3109/02699052.2011.608210] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Newcombe VFJ, Outtrim JG, Chatfield DA, Manktelow A, Hutchinson PJ, Coles JP, Williams GB, Sahakian BJ, Menon DK. Parcellating the neuroanatomical basis of impaired decision-making in traumatic brain injury. Brain 2011; 134:759-68. [PMID: 21310727 PMCID: PMC3044832 DOI: 10.1093/brain/awq388] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Cognitive dysfunction is a devastating consequence of traumatic brain injury that affects the majority of those who survive with moderate-to-severe injury, and many patients with mild head injury. Disruption of key monoaminergic neurotransmitter systems, such as the dopaminergic system, may play a key role in the widespread cognitive dysfunction seen after traumatic axonal injury. Manifestations of injury to this system may include impaired decision-making and impulsivity. We used the Cambridge Gambling Task to characterize decision-making and risk-taking behaviour, outside of a learning context, in a cohort of 44 patients at least six months post-traumatic brain injury. These patients were found to have broadly intact processing of risk adjustment and probability judgement, and to bet similar amounts to controls. However, a patient preference for consistently early bets indicated a higher level of impulsiveness. These behavioural measures were compared with imaging findings on diffusion tensor magnetic resonance imaging. Performance in specific domains of the Cambridge Gambling Task correlated inversely and specifically with the severity of diffusion tensor imaging abnormalities in regions that have been implicated in these cognitive processes. Thus, impulsivity was associated with increased apparent diffusion coefficient bilaterally in the orbitofrontal gyrus, insula and caudate; abnormal risk adjustment with increased apparent diffusion coefficient in the right thalamus and dorsal striatum and left caudate; and impaired performance on rational choice with increased apparent diffusion coefficient in the bilateral dorsolateral prefrontal cortices, and the superior frontal gyri, right ventrolateral prefrontal cortex, the dorsal and ventral striatum, and left hippocampus. Importantly, performance in specific cognitive domains of the task did not correlate with diffusion tensor imaging abnormalities in areas not implicated in their performance. The ability to dissociate the location and extent of damage with performance on the various task components using diffusion tensor imaging allows important insights into the neuroanatomical basis of impulsivity following traumatic brain injury. The ability to detect such damage in vivo may have important implications for patient management, patient selection for trials, and to help understand complex neurocognitive pathways.
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Affiliation(s)
- Virginia F. J. Newcombe
- 1 Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK,2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK
| | - Joanne G. Outtrim
- 1 Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK,2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK
| | - Doris A. Chatfield
- 1 Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK,2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK
| | - Anne Manktelow
- 1 Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK,2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK
| | - Peter J. Hutchinson
- 2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK,3 Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK
| | - Jonathan P. Coles
- 1 Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK,2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK
| | - Guy B. Williams
- 1 Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Barbara J. Sahakian
- 4 Department of Psychiatry, School of Clinical Medicine, University of Cambridge, CB2 2QQ UK,5 MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EB, UK
| | - David K. Menon
- 1 Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK,2 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, CB2 2QQ, UK
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Kasahara M, Menon DK, Salmond CH, Outtrim JG, Taylor Tavares JV, Carpenter TA, Pickard JD, Sahakian BJ, Stamatakis EA. Altered functional connectivity in the motor network after traumatic brain injury. Neurology 2010; 75:168-76. [PMID: 20625170 DOI: 10.1212/wnl.0b013e3181e7ca58] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A large proportion of survivors of traumatic brain injury (TBI) have persistent cognitive impairments, the profile of which does not always correspond to the size and location of injuries. One possible explanation could be that TBI-induced damage extends beyond obvious lesion sites to affect remote brain networks. We explored this hypothesis in the context of a simple and well-characterized network, the motor network. The aim of this cross-sectional study was to establish the residual integrity of the motor network as an important proof of principle of abnormal connectivity in TBI. METHODS fMRI data were obtained from 12 right-handed patients and 9 healthy controls while they performed the finger-thumb opposition task with the right hand. We used both conventional and psychophysiologic interaction (PPI) analyses to examine the integrity of functional connections from brain regions we found to be activated in the paradigm we used. RESULTS As expected, the analysis showed significant activations of the left primary motor cortex (M1), right cerebellum (Ce), and bilateral supplementary motor area (SMA) in controls. However, only the activation of M1 survived robust statistical thresholding in patients. In controls, the PPI analysis revealed that left M1, SMA, and right Ce positively interacted with the left frontal cortex and negatively interacted with the right supramarginal gyrus. In patients, we observed no negative interaction and reduced interhemispheric interactions from these seed regions. CONCLUSIONS These observations suggest that patients display compromised activation and connectivity patterns during the finger-thumb opposition task, which may imply functional reorganization of motor networks following TBI.
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Affiliation(s)
- M Kasahara
- Division of Anaesthesia, University Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
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Kasahara M, Menon DK, Salmond CH, Outtrim JG, Tavares JVT, Carpenter TA, Sahakian BJ, Stamatakis EA. Restructuring of functional connectivity in motor network after traumatic brain injury (TBI). Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70395-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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