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Fox AJ, Matthews N, Qiu Z, Filmer HL, Dux PE. On the lasting impact of mild traumatic brain injury on working memory: Behavioural and electrophysiological evidence. Neuropsychologia 2024; 204:109005. [PMID: 39313130 DOI: 10.1016/j.neuropsychologia.2024.109005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 08/06/2024] [Accepted: 09/20/2024] [Indexed: 09/25/2024]
Abstract
Despite increasing recognition of the significance of mild traumatic brain injury (mTBI), the long-term cognitive consequences of the injury remain unclear. More sensitive measures that can detect subtle cognitive changes and consideration of individual variability are needed to properly characterise cognitive outcomes following mTBI. Here, we used complex behavioural tasks, individual differences approaches, and electrophysiology to investigate the long-term cognitive effects of a history of mTBI. In Experiment 1, participants with self-reported mTBI history (n=82) showed poorer verbal working memory performance on the operation span task compared to control participants (n=88), but there were no group differences in visual working memory, multitasking, cognitive flexibility, attentional control, visuospatial ability, or information processing speed. Individual differences analyses revealed that time since injury and presence of memory loss predicted visual working memory capacity and visuospatial ability, respectively, in those with mTBI history. In Experiment 2, participants with mTBI history (n=20) again demonstrated poorer verbal working memory on the operation span task compared to control participants (n=38), but no group differences were revealed on a visuospatial complex span task or simpler visual working memory measures. We also explored the electrophysiological indices of visual working memory using EEG during a change detection task. No differences were observed in early sensory event-related potentials (P1, N1) or the later negative slow wave associated with visual working memory capacity. Together, these findings suggest that mTBI history may be associated with a lasting, isolated disruption in the subsystem underlying verbal working memory storage. The results emphasise the importance of sensitive cognitive measures and accounting for individual variability in injury characteristics when assessing mTBI outcomes.
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Affiliation(s)
- Amaya J Fox
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia.
| | - Natasha Matthews
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Zeguo Qiu
- Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - Hannah L Filmer
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Paul E Dux
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
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2
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Fu Z, Liu M, Wang S, Zhang H, Sun Y, Zhou Y, Li X, Ming P, Song J, Xu G. Impairment of inhibitory control due to repetitive subconcussions from indirect brain impacts: Evidence from event-related potentials and resting-state EEG complexity in parachuters. Brain Res Bull 2024; 216:111053. [PMID: 39173778 DOI: 10.1016/j.brainresbull.2024.111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/27/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024]
Abstract
The present study aims to investigate the unknown relationship between inhibitory control and repetitive subconcussion induced by the indirect brain impacts. We enrolled 28 parachuters exposed to repetitive subconcussion (SC) and 27 matched health controls (HC). Parachuters who have completed at least 70 actual parachuting (71-112 times) and at least 1500 simulated platform jumps (1500-4500 times) were included in the SC group. The SC group had a reduced accuracy rate in both the Stroop congruent and incongruent conditions. Larger N2 and N450 amplitudes were elicited in the frontal regions of the SC group, which indicate compensatory adaptations to the deficit in conflict monitoring. The reduced frontal resting-state EEG complexity in full-band (1-40 Hz) may demonstrate the frontal structural damage following the indirect brain impacts of repetitive subconcussion. Pearson correlation analysis showed that in the SC group, the frontal beta-band sample entropy values are positively correlated with the accuracy rate of the Stroop incongruent condition, suggesting the frontal beta-band sample entropy values may serve as potential electrophysiological markers of impaired inhibitory control after indirectly repetitive brain impacts. This study provides the robust evidence that repetitive subconcussion resulting from indirect brain impacts may lead to impairment of inhibitory control.
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Affiliation(s)
- Zhenghao Fu
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China
| | - Min Liu
- Airborne Troop Hospital, Wuhan, China
| | - Shuochen Wang
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China
| | - Haoran Zhang
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China; Medical College, Wuhan University of Science and Technology, 947 Heping Avenue, Wuhan 430081, China
| | - Yuanyi Sun
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China
| | - Yang Zhou
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China; Hubei University of Medicine, 16 Shanghai Road, Shiyan, Hubei Province 442000, China
| | - Xiang Li
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China; Hubei University of Medicine, 16 Shanghai Road, Shiyan, Hubei Province 442000, China
| | | | - Jian Song
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China.
| | - Guozheng Xu
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China.
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Gard A, Kornaropoulos EN, Portonova Wernersson M, Rorsman I, Blennow K, Zetterberg H, Tegner Y, De Maio A, Markenroth Bloch K, Björkman-Burtscher I, Pessah-Rasmussen H, Nilsson M, Marklund N. Widespread White Matter Abnormalities in Concussed Athletes Detected by 7T Diffusion Magnetic Resonance Imaging. J Neurotrauma 2024; 41:1533-1549. [PMID: 38481124 PMCID: PMC11564857 DOI: 10.1089/neu.2023.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Sports-related concussions may cause white matter injuries and persistent post-concussive symptoms (PPCS). We hypothesized that athletes with PPCS would have neurocognitive impairments and white matter abnormalities that could be revealed by advanced neuroimaging using ultra-high field strength diffusion tensor (DTI) and diffusion kurtosis (DKI) imaging metrics and cerebrospinal fluid (CSF) biomarkers. A cohort of athletes with PPCS severity limiting the ability to work/study and participate in sport school and/or social activities for ≥6 months completed 7T magnetic resonance imaging (MRI) (morphological T1-weighed volumetry, DTI and DKI), extensive neuropsychological testing, symptom rating, and CSF biomarker sampling. Twenty-two athletes with PPCS and 22 controls were included. Concussed athletes performed below norms and significantly lower than controls on all but one of the psychometric neuropsychology tests. Supratentorial white and gray matter, as well as hippocampal volumes did not differ between concussed athletes and controls. However, of the 72 examined white matter tracts, 16% of DTI and 35% of DKI metrics (in total 28%) were significantly different between concussed athletes and controls. DKI fractional anisotropy and axial kurtosis were increased, and DKI radial diffusivity and radial kurtosis decreased in concussed athletes when compared with controls. CSF neurofilament light (NfL; an axonal injury marker), although not glial fibrillary acidic protein, correlated with several diffusion metrics. In this first 7T DTI and DKI study investigating PPCS, widespread microstructural alterations were observed in the white matter, correlating with CSF markers of axonal injury. More white matter changes were observed using DKI than using DTI. These white matter alterations may indicate persistent pathophysiological processes following concussion in sport.
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Affiliation(s)
- Anna Gard
- Department of Clinical Sciences Lund, Neurosurgery, Neurology, Lund University, Lund, Sweden
| | - Evgenios N. Kornaropoulos
- Department of Clinical Sciences Lund, Diagnostic Radiology, Neurology, Lund University, Lund, Sweden
| | - Maria Portonova Wernersson
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Neurology, Lund University, Lund, Sweden
| | - Ia Rorsman
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, 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, Clear Water Bay, Hong Kong, China
| | - Yelverton Tegner
- Department of Health, Education and Technology, Division of Health and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Alessandro De Maio
- Department of Radiological, Oncological and Pathological Sciences. Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Karin Markenroth Bloch
- Department of Clinical Sciences Lund, Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Isabella Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Neurology, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Markus Nilsson
- Department of Clinical Sciences Lund, Diagnostic Radiology, Neurology, Lund University, Lund, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, and Skåne University Hospital, Lund, Sweden
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Vintimilla A, Hooper T, James CR, Lu HC, Natesan K, Kapila J, Sizer P. The Effect of Exercise-Induced Central Fatigue on Cervical Spine Joint Position Error, Strength, and Endurance. Int J Sports Phys Ther 2024; 19:290-300. [PMID: 38439782 PMCID: PMC10909308 DOI: 10.26603/001c.92703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/06/2024] [Indexed: 03/06/2024] Open
Abstract
Background Fatigue is common in sports, impairing performance and increasing injury risk, yet little is known regarding fatigue and concussion. Impaired neck neuromuscular function may contribute to concussion at baseline, where central fatigue may further impair neck function resulting in increased concussion risk. These effects may be magnified in athletes with a history of concussion. Purpose To determine the effect of exercise induced central fatigue on neck joint position error, strength, and endurance in healthy subjects and those with a history of concussion. The investigators hypothesized that EICF would have a negative effect on all variables. Study Design Healthy subjects were examined using a single factor, within-subjects repeated measures design. Concussion history subjects were examined using a single-subject design. Methods Nineteen healthy subjects and five subjects with a history of concussion were recruited for the study. Cervical joint position error, muscle strength, and neck flexor endurance were tested before and after exercise induced fatigue. Results There was a significant increase in constant (p = 0.0027) and absolute joint position error (JPE) (p < 0.001); decrease in neck flexor endurance (p < 0.001); and decrease neck strength into cervical flexion (p = 0.01) in healthy subjects following fatigue. Among concussion history subjects, five demonstrated a significant increase in absolute and constant JPE (p < 0.05); four demonstrated a significant decrease in neck flexor endurance (p < 0.05); one in neck flexion muscle strength (p < 0.05); and three in neck extension and rotation muscle strength (p < 0.05) following fatigue. Conclusions Cervical neuromuscular function deteriorated following fatigue in healthy subjects. Resulting impairments may affect force alterations in cervical control, potentially increasing concussion risk. Concussion history subjects descriptively demonstrated similar results, however further research should examine formal comparisons involving subjects with and without concussion history. Level of Evidence 3b.
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Affiliation(s)
| | - Troy Hooper
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - C Roger James
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Ho Cheng Lu
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Karthick Natesan
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Jeegisha Kapila
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Phil Sizer
- Rehabilitation Sciences Texas Tech University Health Sciences Center
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Fox AJ, Filmer HL, Dux PE. The influence of self-reported history of mild traumatic brain injury on cognitive performance. Sci Rep 2022; 12:16999. [PMID: 36220885 PMCID: PMC9554181 DOI: 10.1038/s41598-022-21067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/22/2022] [Indexed: 12/29/2022] Open
Abstract
The long-term cognitive consequences of mild traumatic brain injury (mTBI) are poorly understood. Studies investigating cognitive performance in the chronic stage of injury in both hospital-based and population-based samples have revealed inconsistent findings. Importantly, population-based mTBI samples remain under-studied in the literature. This study investigated cognitive performance among individuals with a history of self-reported mTBI using a battery of cognitively demanding behavioural tasks. Importantly, more than half of the mTBI participants had experienced multiple mild head injuries. Compared to control participants (n = 49), participants with a history of mTBI (n = 30) did not demonstrate deficits in working memory, multitasking ability, cognitive flexibility, visuospatial ability, response inhibition, information processing speed or social cognition. There was moderate evidence that the mTBI group performed better than control participants on the visual working memory measure. Overall, these findings suggest that even multiple instances of mTBI do not necessarily lead to long-term cognitive impairment at the group level. Thus, we provide important evidence of the impact of chronic mTBI across a number of cognitive processes in a population-based sample. Further studies are necessary to determine the impact that individual differences in injury-related variables have on cognitive performance in the chronic stage of injury.
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Affiliation(s)
- Amaya J. Fox
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Hannah L. Filmer
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
| | - Paul E. Dux
- grid.1003.20000 0000 9320 7537School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, QLD 4072 Australia
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Phillips B, Adkins JC, Jones BD, Dalecki M. Prolonged eye-hand decoupling deficits in young adults with a history of concussion from adolescence. Eur J Sport Sci 2022; 23:1036-1046. [PMID: 35722908 DOI: 10.1080/17461391.2022.2085186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Previous studies reported that adolescents with a sport-related concussion history showed prolonged visuomotor deficits during an eye-hand decoupling task until around 1.5-2 years post-event. The present study expands this work, examining whether such deficits do or do not emerge when testing individuals in young adulthood, i.e. later post-event. Twenty-one non-athlete college students with sport-related concussion history from adolescence (CH; M = 21 yrs.; M = 46 months post-concussion, range 10-90 months) and twenty controls with no history of concussion (NoH; M = 21 yrs.) performed two touchscreen-based visuomotor tasks. It included a coupled task where eyes and hand moved in similar directions, and decoupled-task with eyes and hand going to different directions. Movement planning (e.g. reaction time, initial direction error) and execution (e.g. movement time, path length) related variables were analyzed in both groups and conditions. Movement execution measures were similar for both groups and conditions (all p > 0.05). However, movement planning was impaired in the CH participants in the eye-hand decoupling condition (p < 0.05). CH's initial direction error was larger (i.e. worse spatial movement planning) than in the NoH group. Although movement execution deficits shown in earlier work in youth were not present in young adults, the present results suggest that a sport-related concussion sustained in adolescence can lead to prolonged deficits with spatial movement planning processes while performing eye-hand decoupling tasks about four years post-injury. Further research should investigate whether these deficits continue into adulthood and expand control on time since concussion and number of concussion metrics.Highlights Young adult college students with a history of a sport-related concussion from adolescence, tested about four years post-incident, showed spatial movement preparation deficits during an eye-hand decoupling visuomotor task.Eye-hand reversal decoupling errors also correlated with time since concussion in those with concussion history.These prolonged eye-hand decoupling deficits may emerge with ongoing time post-event, as comparable deficits were absent in previous work where youth were tested sooner post-injury.Our current findings point towards long-lasting performance impairments in young adult non-athletes after a sport-related concussion from adolescence.
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Affiliation(s)
- Brandon Phillips
- School of Kinesiology, Louisiana State University, Baton Rouge, LA
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY
| | - Jaxon C. Adkins
- School of Kinesiology, Louisiana State University, Baton Rouge, LA
| | - Briasha D. Jones
- School of Kinesiology, Louisiana State University, Baton Rouge, LA
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Marc Dalecki
- School of Kinesiology, Louisiana State University, Baton Rouge, LA
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Veillon-Bradshaw M, Phillips B, Jones BD, Dalecki M. Eye-Hand Decoupling Deficits in Young Adults with Concussion History from Adolescence: Issues with Task Novelty or Task Demand? Neurosci Lett 2022; 781:136668. [DOI: 10.1016/j.neulet.2022.136668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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