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Roh H, Kim W, Hwang SY, Lee MS, Kim JH. Altered pattern of theta and gamma oscillation to visual stimuli in patients with postconcussion syndrome. J Neurophysiol 2024; 131:1240-1249. [PMID: 38691013 DOI: 10.1152/jn.00253.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/18/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024] Open
Abstract
Although many patients with mild traumatic brain injury (mTBI) suffer from postconcussional syndrome (PCS) including abnormal emotional responses, most conventional imaging studies fail to detect any causative brain lesion. We hypothesized that event-related electroencephalography (EEG) recordings with time-frequency analysis would show a distinguishable pattern in patients with mTBI with PCS compared with normal healthy controls. EEG signals were collected from a total of 18 subjects: eight patients with mTBI with PCS and 10 healthy control subjects. The signals were recorded while the subjects were presented with affective visual stimuli, including neutral, pleasant, and unpleasant emotional cues. Event-related spectral perturbation analysis was performed to calculate frontal midline theta activity and posterior midline gamma activity, followed by statistical analysis to identify whether patients with mTBI with PCS have distinct patterns of theta or gamma oscillations in response to affective stimuli. Compared with the healthy control group, patients with mTBI with PCS did not show a significant increase in the power of frontal theta activity in response to the pleasant stimuli, indicating less susceptibility toward pleasant cues. Moreover, the patient group showed attenuated gamma oscillatory activity, with no clear alteration in gamma oscillations in response to either pleasant or unpleasant cues. This study demonstrates that patients with mTBI with PCS exhibited altered patterns of oscillatory activities in the theta and gamma bands in response to affective visual stimuli compared with the normal control group. The current finding implicates that these distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.NEW & NOTEWORTHY Patients with mild traumatic brain injury (mTBI) with postconcussional syndrome (PCS) exhibited altered patterns of changes in oscillatory activities in the theta and gamma bands in response to visual affective stimuli. Distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.
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Affiliation(s)
- Haewon Roh
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Won Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Soon-Young Hwang
- The Department of Biostatistics, Korea University of Medicine, Seoul, Korea
| | - Moon Soo Lee
- The Department of Psychiatry, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
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Fry L, Logemann A, Waldron E, Holker E, Porter J, Eskridge C, Naini S, Basso MR, Taylor SE, Melnik T, Whiteside DM. Emotional functioning in long COVID: Comparison to post-concussion syndrome using the Personality Assessment Inventory. Clin Neuropsychol 2024; 38:963-983. [PMID: 37838973 DOI: 10.1080/13854046.2023.2264546] [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: 04/11/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
Objective: Recent studies on Long COVID found that patients report prominent emotional distress and significant correlations between distress and cognitive performance have been identified, raising the question of how to manage or treat these issues. To understand psychological functioning in Long COVID further, this study examined personality responses on the Personality Assessment Inventory (PAI) to compare psychological functioning in a Long COVID group with a post-concussion syndrome (PCS) group, a syndrome with a significant psychological component. Participants and methods: Participants included 201 consecutive Long COVID outpatients (Mean age = 48.87 years, mean education = 14.82, 71.6% Female, 82.6% White) and a comparison group of 102 consecutively referred PCS outpatients (Mean age = 46.08, mean education = 14.17, 63.7% Female, 88.2% White). Effect sizes and t-tests were calculated using the PAI validity, clinical, interpersonal, and treatment consideration scales as well as clinical subscales. Results: The results replicated earlier findings on the PAI in Long COVID by demonstrating that both Long COVID and PCS groups had the highest mean elevations on SOM and DEP scales but no statistically significant between group differences in mean scale elevations. Results support similarities in psychological functioning between Long COVID and PCS patients emphasizing the importance of evaluating psychological functioning in neuropsychological evaluations for these populations. Further, results suggest that psychological treatment strategies for PCS patients may be helpful for Long COVID patients, but more research is needed.
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Affiliation(s)
- Laura Fry
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Allison Logemann
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Eric Waldron
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Erin Holker
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jim Porter
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Courtney Eskridge
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Savana Naini
- Graduate School of Professional Psychology, University of St Thomas, Saint Paul, MN, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, NY, USA
| | - Sarah E Taylor
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tanya Melnik
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Douglas M Whiteside
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
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Pinyopornpanish K, Buawangpong N, Soontornpun A, Thaikla K, Pateekhum C, Nantsupawat N, Wiwatkunupakarn N, Jiraporncharoen W, Angkurawaranon C. A household survey of the prevalence of subjective cognitive decline and mild cognitive impairment among urban community-dwelling adults aged 30 to 65. Sci Rep 2024; 14:7783. [PMID: 38565884 PMCID: PMC10987517 DOI: 10.1038/s41598-024-58150-3] [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: 09/22/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
While it is possible to detect cognitive decline before the age of 60, and there is a report indicating that certain cognitive abilities peak in one's 30s, the evidence regarding cognitive problems in populations younger than 65 years is scarce. This study aims to (1) determine the proportion of community-dwelling adults with different cognitive status, and (2) determine the prevalence of neuropsychiatric behaviors. A population-based survey was conducted in Chiang Mai, Thailand. Individuals aged 30 to 65 were recruited and assessed for demographic data, memory complaints, cognitive performance, and neuropsychiatric symptoms using self-reported questionnaires. In a total of 539 participants, 33.95% had mild cognitive impairment (MCI), 7.05% had subjective cognitive decline (SCD), and 52.50% had neuropsychiatric symptoms. The risk of MCI increased with age, and neuropsychiatric symptoms were significantly higher in those with MCI or SCD than in those without (p < 0.001). The most common complaints were sleep problems, anxiety, and irritability. Screening for MCI in adults aged < 65 years might be useful. However, further investigation on the appropriate age to screen and the program's cost-effectiveness is suggested.
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Affiliation(s)
- Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Atiwat Soontornpun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kanittha Thaikla
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chanapat Pateekhum
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nopakoon Nantsupawat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand.
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Thompson K, Lo AHY, McGlashan HL, Ownsworth T, Haslam C, Pegna A, Reutens DC. Measures of Subjective Memory for People with Epilepsy: A Systematic Review of Measurement Properties. Neuropsychol Rev 2024; 34:67-97. [PMID: 36633798 DOI: 10.1007/s11065-022-09568-x] [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: 09/30/2021] [Accepted: 10/21/2022] [Indexed: 01/13/2023]
Abstract
People with epilepsy frequently express concern about the burden of memory problems in their everyday lives. Self-report memory questionnaires may provide valuable insight into individuals' perceptions of their everyday memory performance and changes over time. Yet, despite their potential utility, the measurement properties of self-report memory questionnaires have not been evaluated in epilepsy. This systematic review aimed to provide a critical appraisal of the measurement properties of self-report memory questionnaires for adults with epilepsy. Following protocol registration (PROSPERO CRD42020210967), a systematic search of PubMed, EMBASE, Web of Science, CINAHL, and PsychInfo from database inception until 27 May 2021 was conducted. Eligible studies were published in English-language peer-reviewed journals, recruited adults with epilepsy, and reported on the development or evaluation of the measurement properties of a self-report memory questionnaire. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology was used to evaluate each study of a measurement property, and results were qualitatively synthesised. In total, 80 articles and one test manual were located containing 153 studies of measurement properties pertinent to 23 self-report memory questionnaires. Overall, no scale could be recommended outright for the evaluation of subjective memory symptoms in adults with epilepsy. This was due to the near absence of dedicated content validation studies relevant to this population and shortcomings in the methodology and scientific reporting of available studies of structural validity. Recommendations to support the advancement and psychometric validation of self-report memory questionnaires for people with epilepsy are provided.
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Affiliation(s)
- Kate Thompson
- Centre for Advanced Imaging, the University of Queensland, Brisbane, QLD, Australia.
- Psychology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia.
| | - Ada H Y Lo
- Psychology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - Hannah L McGlashan
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
- Surgical Treatment and Rehabilitation Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Catherine Haslam
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - Alan Pegna
- School of Psychology, the University of Queensland, Brisbane, QLD, Australia
| | - David C Reutens
- Centre for Advanced Imaging, the University of Queensland, Brisbane, QLD, Australia
- Neurology Department, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
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Levy AM, Saling MM, Anderson JFI. Frequency and extent of cognitive complaint following adult civilian mild traumatic brain injury: a systematic review and meta-analysis. BRAIN IMPAIR 2023; 24:309-332. [PMID: 38167200 DOI: 10.1017/brimp.2022.19] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cognitive symptoms are associated with return to work, healthcare use and quality of life after mild traumatic brain injury (mTBI). Additionally, while overall 'post-concussion' symptoms are often present at similar levels in mTBI and control groups, cognitive complaints may be specifically elevated in mTBI. A systematic review and meta-analysis was conducted to investigate the frequency and extent of cognitive complaints following adult civilian mTBI, and compare it to the frequency and extent of complaints in control populations (PROSPERO: CRD42020151284). METHOD This review included studies published up to March 2022. Thirteen studies were included in the systematic review, and six were included in the meta-analysis. Data extraction and quality assessment were conducted by two independent reviewers. RESULTS Cognitive complaints are common after mTBI, although reported rates differed greatly across studies. Results suggested that mTBI groups report cognitive complaints to a significantly greater extent than control groups (Hedges' g = 0.85, 95% CI 0.31-1.40, p = .0102). Heterogeneity between studies was high (τ2 = 0.20, 95% CI 0.04-1.58; I2 = 75.0%, 95% CI 43.4%-89.0%). Between-group differences in symptom reporting were most often found when healthy rather than injured controls were employed. CONCLUSIONS Cognitive complaints are consistently reported after mTBI, and are present at greater levels in mTBI patients than in controls. Despite the importance of these complaints, including in regards to return to work, healthcare use and quality of life, there has been limited research in this area, and heterogeneity in research methodology is common.
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Affiliation(s)
- Arielle M Levy
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
- Psychology Department, The Alfred Hospital, Melbourne, VIC3004, Australia
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Levy AM, Saling MM, Anderson JFI. Psychological distress and gender predict cognitive complaint after adult civilian mild traumatic brain injury in pre-morbidly healthy adults. Neuropsychol Rehabil 2023:1-21. [PMID: 37493086 DOI: 10.1080/09602011.2023.2236348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/24/2023] [Indexed: 07/27/2023]
Abstract
Subjective cognitive symptoms are common after mild traumatic brain injury (mTBI), and are associated with important outcome factors including return to work. This study examined self-reported cognitive symptoms in mTBI and trauma controls (TCs), and explored psychological distress and gender as predictors of these symptoms. Pre-morbidly healthy adults with mTBI (n = 68) and general trauma (n = 40) were prospectively recruited from inpatient hospital wards and assessed 6-10 weeks post-injury. Primary measures included self-reported cognitive symptoms, post-concussion symptoms, and psychological distress. Groups were matched on all background variables, including objective cognitive performance. Within this context, subjective cognitive symptoms were significantly elevated after mTBI relative to TCs (t = 3.396, p = .001). In contrast, there was no difference in post-concussion symptoms between groups (t = 1.275, p = .206). Psychological distress (β = .536, p < .001) and gender (β = .253, p = .012) predicted subjective cognitive symptoms in mTBI, with females and those with higher distress reporting greater symptoms. Unlike general post-concussion symptoms, subjective cognitive symptoms were elevated after mTBI relative to TCs, suggesting that mTBI-specific factors underly this elevation. Females and individuals with high psychological distress are important subgroups to consider for potential intervention following mTBI.
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Affiliation(s)
- Arielle M Levy
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Psychology Department, The Alfred Hospital, Melbourne, Australia
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de Neeling M, Liessens D, Depreitere B. Relationship between psychosocial and psychiatric risk factors and poor long-term outcome following mild traumatic brain injury: A systematic review. Eur J Neurol 2023; 30:1540-1550. [PMID: 36708085 DOI: 10.1111/ene.15713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Mild traumatic brain injury (mTBI) has an estimated worldwide incidence of >60 million per year, and long-term persistent postconcussion symptoms (PPCS) are increasingly recognized as being predicted by psychosocial variables. Patients at risk for PPCS may be amenable to closer follow-up to treat modifiable symptoms and prevent chronicity. In this regard, similarities seem to exist with psychosocial risk factors for chronicity in other health-related conditions. However, as opposed to other conditions, no screening instruments exist for mTBI. METHODS A systematic search of the literature on psychological and psychiatric predictors of long-term symptoms in mTBI was performed by two independent reviewers using PubMed, Embase, and Web of Science. RESULTS Fifty papers were included in the systematic analysis. Anxiety, depressive symptoms, and emotional distress early after injury predict PPCS burden and functional outcome up to 1 year after injury. In addition, coping styles and preinjury psychiatric disorders and mental health also correlate with PPCS burden and functional outcome. Associations between PPCS and personality and beliefs were reported, but either these effects were small or evidence was limited. CONCLUSIONS Early psychological and psychiatric factors may negatively interact with recovery potential to increase the risk of chronicity of PPCS burden after mTBI. This opens opportunities for research on screening tools and early intervention in patients at risk.
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Affiliation(s)
| | - Dirk Liessens
- Saint Camillus Psychiatric Center, Bierbeek, Belgium
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Anderson JFI, Jordan AS. Sex predicts post-concussion symptom reporting, independently of fatigue and subjective sleep disturbance, in premorbidly healthy adults after mild traumatic brain injury. Neuropsychol Rehabil 2023; 33:173-188. [PMID: 34724887 DOI: 10.1080/09602011.2021.1993274] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relationship between sex and post-concussion symptom (PCS) reporting after mild traumatic brain injury (mTBI) is not well understood. Subjective sleep disturbance and fatigue impact PCS reporting after mTBI and show sex differences in the normal population. This study investigated whether sex had a relationship with PCS reporting after mTBI, independently of self-reported sleep disturbance and fatigue. Ninety-two premorbidly healthy adults in the post-acute period after mTBI completed the Rivermead Post-Concussion Symptoms Questionnaire, the Pittsburgh Sleep Quality Index, the Multidimensional Fatigue Inventory and measures of depression, anxiety and post-traumatic stress symptomatology. Females (n = 23) demonstrated higher levels of fatigue (p = .019) and greater psychological distress (p = .001) than males (n = 69), but equivalent levels of sleep disturbance (p = .946). Bootstrapping analyses were undertaken because PCS responses were not normally distributed. Female sex predicted greater PCS reporting (p = .001), independently of subjective sleep disturbance, fatigue, psychological distress and litigation status. The current findings support and extend previous work showing premorbidly healthy females are at higher risk of experiencing elevated PCS after mTBI than males in the post-acute period after mTBI. It may be beneficial for clinicians to be particularly sensitive to increased symptom reporting after mTBI in females, irrespective of sleep quality, fatigue or psychological status.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Psychology Department, The Alfred Hospital, Prahran, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
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Brown J, Kaelin D, Mattingly E, Mello C, Miller ES, Mitchell G, Picon LM, Waldron-Perine B, Wolf TJ, Frymark T, Bowen R. American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2455-2526. [PMID: 36373898 DOI: 10.1044/2022_ajslp-21-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. PURPOSE The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. METHOD A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. RECOMMENDATIONS This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.
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Affiliation(s)
| | | | | | | | - E Sam Miller
- Maryland State Department of Education, Baltimore
| | | | | | | | | | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
| | - Rebecca Bowen
- American Speech-Language-Hearing Association, Rockville, MD
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Pertz M, Kowalski T, Jetschke K, Schmieder K, Schlegel U, Miller D. Pre- and postoperative self-reported and objectively assessed neurocognitive functioning in lower grade glioma patients. J Clin Neurosci 2022; 106:185-193. [DOI: 10.1016/j.jocn.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
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van Gils P, van Heugten C, Sep S, Moulaert V, Hofmeijer J, Verbunt J. A change of perspective? An explorative study on why patients may not subjectively report cognitive impairments after a cardiac arrest. Resuscitation 2022; 180:59-63. [PMID: 36185035 DOI: 10.1016/j.resuscitation.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022]
Abstract
AIM Cardiac arrest survivors are at risk of long-term cognitive impairment. Patients with cognitive impairments do not always have cognitive complaints and vice versa. Not reporting cognitive complaints could be caused by a lack of awareness. We hypothesized that caregivers report more cognitive failures than patients, indicating patients' lack of insight into cognitive functioning. METHODS This is a secondary analysis of the Activity and Life After Survival of Cardiac Arrest study on survivors of cardiac arrest and their caregivers. They were assessed at two weeks, three months, and one year after cardiac arrest. At each time point, the patient and the caregiver filled out the cognitive failure questionnaire (CFQ) regarding the patient. We analysed the correlation, intraclass correlation, and self-proxy discrepancy between patients and caregivers on the CFQ over time. RESULTS One-hundred-and-nineteen cardiac arrest survivors (mean age = 60, 85 % male) and their caregivers were included. The CFQ scores of the patients and caregivers were equally low. The correlation (T1 r = 0.31; T2 r = 0.40; T3 r = 0.55) and intraclass correlation (T1 r = 0.48; T2 r = 0.56; T3 r = 0.71) between patient and caregiver increased over time. CONCLUSION This study does not support a lack of awareness of cognitive impairments by long-term cardiac arrest survivors. Future research may focus on alternative explanations for why patients have less cognitive complaints than expected based on the frequency of cognitive impairments. Possible explanations include a response shift.
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Affiliation(s)
- Pauline van Gils
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands.
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Simone Sep
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherland; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Véronique Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jeanine Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherland; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Parrington L, Brumbach BH, Peterka RJ, King LA. Do sensorimotor control properties mediate sway in people with chronic balance complaints following mTBI? Gait Posture 2022; 96:173-178. [PMID: 35667229 DOI: 10.1016/j.gaitpost.2022.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Up to 40% of mild traumatic brain injuries (mTBI) can result in chronic unresolved symptoms, such as balance impairment, that persist beyond three months. Sensorimotor control, the collective coordination and regulation of both sensory and motor components of the postural control system, may underlie balance deficits in chronic mTBI. The aim of this study was to determine if the relationship between severity of impairment in chronic (> 3 months) mTBI and poorer balance performance was mediated by sensorimotor integration measures. METHODS Data were collected from 61 healthy controls and 58 mTBI participants suffering persistent balance problems. Participants completed questionnaires (Dizziness Handicap Inventory (DHI), Neurobehavioral Symptom Inventory (NSI), and Sports Concussion Assessment Tool Symptom Questionnaire (SCAT2)) and performed instrumented postural sway assessments and a test of Central Sensory Motor Integration (CSMI). Exploratory Factor Analysis was used to reduce the variables used within the mediation models to constructs of impairment (Impairment Severity - based on questionnaires), balance (Sway Dispersion - based on instrumented postural sway measures), and sensorimotor control (Sensory Weighting, Motor Activation and Time Delay - based on parameters from CSMI tests). Mediation analyses used path analysis to estimate the direct effect (between impairment and balance) and indirect (mediating) effects (from sensorimotor control). RESULTS Two out of three sensorimotor integration factors (Motor Activation and Time Delay) mediated the relationship between Impairment Severity and Sway Dispersion, however, there was no mediating effect of Sensory Weighting. SIGNIFICANCE These findings have clinical implications since rehabilitation of balance commonly focuses on sensory cues. Our findings indicate the importance of Motor Activation and Time Delay, and thus a focus on strategies to improve factors related to these constructs throughout the rehabilitative process (i.e., level of muscular contractions to control joint torques; response time to stimuli/perturbations) may improve a patient's balance control.
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Affiliation(s)
- Lucy Parrington
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA; Department of Dietetics, Human Nutrition and Sport, School of Sport and Exercise Science, La Trobe University, Melbourne, Australia
| | - Barbara H Brumbach
- Biostatistics & Design Program, Oregon Health & Science University, Portland, USA
| | - Robert J Peterka
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA
| | - Laurie A King
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA.
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13
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Rioux M, Wardell V, Palombo DJ, Picon EL, Le ML, Silverberg ND. Memory for forgetting in adults with persistent symptoms following concussion. J Clin Exp Neuropsychol 2022; 44:19-30. [PMID: 35536243 DOI: 10.1080/13803395.2022.2067326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Persistent memory complaints following concussion often do not coincide with evidence of objective memory impairment. To the extent this clinical presentation represents Functional Cognitive Disorder (FCD), we would expect preservation or even enhancement of memory for instances of forgetting, based on two lines of prior evidence. First, emotional arousal enhances autobiographical memory. People who experience memory lapses as worrisome may better remember them. Second, individuals with FCD can paradoxically provide detailed accounts of memory lapses compared to patients with neurodegenerative disease, who tend to provide vague examples. The current study aimed to better characterize the recall of forgetting events in people with subjective memory problems following concussion. METHODS The study sample consisted of adults with chronic post-concussion symptoms (N = 37, M = 42.7 years old; 70.27% women; M = 24.9 months post-injury) and normal-range performance on conventional neuropsychological tests. Participants completed a measure of memory complaint severity and the Autobiographical Interview (AI). The AI was used to quantify the richness of narrative recollections of recent instances when they forgot something and (control) personal events that did not involve forgetting. Linear regression modeling assessed the relationship between memory complaint severity and AI variables, including narrative details, valence, arousal, and rehearsal of memories. RESULTS There was no association between memory complaint severity and memory for forgetting vs. control events. We further found no association between memory complaint severity and AI performance overall (collapsing across forgetting and control events). Participants with greater memory complaints experienced past memory lapses as more negative than control memories, but did not consistently differ on other AI phenomenological variables. CONCLUSION Autobiographical recall of memory lapses appears preserved but not selectively heightened in people who report experiencing severe memory problems long after concussion. This inconsistency supports conceptualization of persistent memory complaints after concussion as FCD.
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Affiliation(s)
- Mathilde Rioux
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - M Lindy Le
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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14
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Mollica A, Dey A, Cairncross M, Silverberg N, Burke MJ. Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches. Semin Neurol 2022; 42:168-181. [PMID: 35114694 DOI: 10.1055/s-0041-1742143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postconcussive symptoms following mild traumatic brain injury (mTBI)/concussion are common, disabling, and challenging to manage. Patients can experience a range of symptoms (e.g., mood disturbance, headaches, insomnia, vestibular symptoms, and cognitive dysfunction), and neuropsychiatric management relies heavily on nonpharmacological and multidisciplinary approaches. This article presents an overview of current nonpharmacological strategies for postconcussive symptoms including psychoeducation; psychotherapy; vestibular, visual, and physical therapies; cognitive rehabilitation; as well as more novel approaches, such as neuromodulation. Ultimately, treatment and management of mTBI should begin early with appropriate psychoeducation/counseling, and be tailored based on core symptoms and individual goals.
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Affiliation(s)
- Adriano Mollica
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ayan Dey
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Noah Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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15
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Picon EL, Todorova EV, Palombo DJ, Perez DL, Howard AK, Silverberg ND. OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1177-1184. [PMID: 35443277 PMCID: PMC9396453 DOI: 10.1093/arclin/acac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The etiology of persistent memory complaints after concussion is poorly understood. Memory perfectionism (highly valuing memory ability and intolerance of minor memory lapses) may help explain why some people report persistent subjective memory problems in the absence of corresponding objective memory impairment. This study investigated the relationship between memory perfectionism and persistent memory complaints after concussion. METHODS Secondary analysis of baseline data from a randomized controlled trial. Adults (N = 77; 61% women) with persistent symptoms following concussion were recruited from outpatient specialty clinics. Participants completed the National Institutes of Health Toolbox Cognition Battery, Test of Memory Malingering-Trial 1, and questionnaires measuring memory perfectionism (Metamemory in Adulthood-Achievement subscale), forgetfulness and other postconcussion symptoms (Rivermead Postconcussion Symptoms Questionnaire; RPQ), and depression (Patient Health Questionnaire-2) at M = 17.8 weeks postinjury. Patients with versus without severe memory complaints (based on the RPQ) were compared. RESULTS Memory perfectionism was associated cross-sectionally with severe memory complaint, after controlling for objective memory ability, overall cognitive ability, and depression (95% confidence interval for odds ratio = 1.11-1.40). Sensitivity analyses showed that this relationship did not depend on use of specific objective memory tests nor on inclusion of participants who failed performance validity testing. In a control comparison to test the specificity of identified relationships, memory perfectionism was not associated with severe fatigue (95% confidence interval for odds ratio = 0.91-1.07). CONCLUSIONS Memory perfectionism may be a risk factor for persistent memory symptoms after concussion, with potential relevance to the spectrum of functional cognitive disorders more broadly.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evgenia V Todorova
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, British Columbia Neuropsychiatry Program Vancouver, British Columbia, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David L Perez
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew K Howard
- Department of Psychiatry, British Columbia Neuropsychiatry Program Vancouver, British Columbia, Canada
- British Columbia Neuropsychiatry Program Vancouver, British Columbia, Canada
| | - Noah D Silverberg
- Corresponding author at: Department of Psychology, University of British Columbia, 3505-2136 West Mall, Vancouver, British Columbia V6T 1Z4, Canada. Tel.: 604-734-1313 ext. 2316; Fax: 604-714-4168E-mail address: (N.D. Silverberg)
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16
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Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 103:1222-1232. [PMID: 34516996 DOI: 10.1016/j.apmr.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where "psychoeducation" was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation-the Rehabilitation Treatment Specification System-can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.
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17
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Johansson B. Mental Fatigue after Mild Traumatic Brain Injury in Relation to Cognitive Tests and Brain Imaging Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115955. [PMID: 34199339 PMCID: PMC8199529 DOI: 10.3390/ijerph18115955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 01/09/2023]
Abstract
Most people recover within months after a mild traumatic brain injury (TBI) or concussion, but some will suffer from long-term fatigue with a reduced quality of life and the inability to maintain their employment status or education. For many people, mental fatigue is one of the most distressing and long-lasting symptoms following an mTBI. No efficient treatment options can be offered. The best method for measuring fatigue today is with fatigue self-assessment scales, there being no objective clinical tests available for mental fatigue. The aim here is to provide a narrative review and identify fatigue in relation to cognitive tests and brain imaging methods. Suggestions for future research are presented.
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Affiliation(s)
- Birgitta Johansson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 413 45 Göteborg, Sweden
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18
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19
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Hromas GA, Houck ZM, Asken BM, Svingos AM, Greif SM, Heaton SC, Jaffee MS, Bauer RM. Making a Difference: Affective Distress Explains Discrepancy Between Objective and Subjective Cognitive Functioning After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:186-195. [PMID: 32898033 DOI: 10.1097/htr.0000000000000618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the relationship between subjective cognitive symptoms and objective cognitive test scores in patients after concussion. We additionally examined factors associated with subjective and objective cognitive dysfunction, as well as their discrepancy. PARTICIPANTS Eighty-six individuals (65.1% female; 74.4% adult) from an interdisciplinary concussion clinic. METHODS Subjective and objective cognitive functioning was measured via the SCAT-Symptom Evaluation and the CNS Vital Signs Neurocognition Index (NCI), respectively. Cognitive discrepancy scores were derived by calculating standardized residuals (via linear regression) using subjective symptoms as the outcome and NCI score as the predictor. Hierarchical regression assessed predictors (age, education, time postinjury, attention-deficit/hyperactivity disorder, affective distress, and sleep disturbance) of cognitive discrepancy scores. Nonparametric analyses evaluated relationships between predictor variables, subjective symptoms, and NCI. RESULTS More severe affective and sleep symptoms (large and medium effects), less time postinjury (small effect), and older age (small effect) were associated with higher subjective cognitive symptoms. Higher levels of affective distress and less time since injury were associated with higher cognitive discrepancy scores (β = .723, P < .001; β = -.204, P < .05, respectively). CONCLUSION Clinical interpretation of subjective cognitive dysfunction should consider these additional variables. Evaluation of affective distress is warranted in the context of higher subjective cognitive complaints than objective test performance.
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Affiliation(s)
- Gabrielle A Hromas
- Departments of Clinical and Health Psychology (Mss Hromas, Svingos, and Greif, Mr Houck, and Drs Heaton and Bauer), Neurology (Dr Jaffee), and Neuroscience (Dr Jaffee), University of Florida, Gainesville; Department of Neurology, Memory and Aging Center, University of California, San Francisco (Dr Asken); and North Florida/South Georgia Brain Rehabilitation Research Center, Gainesville, Florida (Dr Bauer)
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20
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Apolipoprotein E ( APOE) ε4 Status Moderates the Relationship Between Close-Range Blast Exposure and Cognitive Functioning. J Int Neuropsychol Soc 2021; 27:315-328. [PMID: 33138883 DOI: 10.1017/s1355617720001034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Recent studies suggest that close-range blast exposure (CBE), regardless of acute concussive symptoms, may have negative long-term effects on brain health and cognition; however, these effects are highly variable across individuals. One potential genetic risk factor that may impact recovery and explain the heterogeneity of blast injury's long-term cognitive outcomes is the inheritance of an apolipoprotein (APOE) ε4 allele, a well-known genetic risk factor for Alzheimer's disease. We hypothesized that APOE ε4 carrier status would moderate the impact of CBE on long-term cognitive outcomes. METHODS To test this hypothesis, we examined 488 post-9/11 veterans who completed assessments of neuropsychological functioning, psychiatric diagnoses, history of blast exposure, military and non-military mild traumatic brain injuries (mTBIs), and available APOE genotypes. We separately examined the effects of CBE on attention, memory, and executive functioning in individuals with and without the APOE ε4 allele. RESULTS As predicted, we observed a differential impact of CBE status on cognition as a function of APOE ε4 status, in which CBE ε4 carriers displayed significantly worse neuropsychological performance, specifically in the domain of memory. These results persisted after adjusting for clinical, demographic, and genetic factors and were not observed when examining other neurotrauma variables (i.e., lifetime or military mTBI, distant blast exposure), though these variables displayed similar trends. CONCLUSIONS These results suggest APOE ε4 carriers are more vulnerable to the impact of CBE on cognition and highlight the importance of considering genetic risk when studying cognitive effects of neurotrauma.
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21
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van der Kuil MNA, Visser-Meily JMA, Evers AWM, van der Ham IJM. Navigation ability in patients with acquired brain injury: A population-wide online study. Neuropsychol Rehabil 2021; 32:1405-1428. [PMID: 33715586 DOI: 10.1080/09602011.2021.1893192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The ability to travel independently is a vital part of an autonomous life. It is important to investigate to what degree people with acquired brain injuries (ABI) suffer from navigation impairments. The aim of this study was to investigate the prevalence and characteristics of objective and subjective navigation impairments in the population of ABI patients. A large-scale online navigation study was conducted with 435 ABI patients and 7474 healthy controls. Participants studied a route through a virtual environment and completed 5 navigation tasks that assessed distinct functional components of navigation ability. Subjective navigation abilities were assessed using the Wayfinding questionnaire. Patients were matched to controls using propensity score matching. Overall, performance on objective navigation tasks was significantly lower in the ABI population compared to the healthy controls. The landmark recognition, route continuation and allocentric location knowledge tasks were most vulnerable to brain injury. The prevalence of subjective navigation impairments was higher in the ABI population compared to the healthy controls. In conclusion, a substantial proportion (39.1%) of the ABI population reports navigation impairments. We advocate the evaluation of objective and subjective navigation ability in neuropsychological assessments of ABI patients.
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Affiliation(s)
- M N A van der Kuil
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A W M Evers
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands.,Medical Delta, Leiden University, TU Delft and Erasmus University, Leiden, the Netherlands
| | - I J M van der Ham
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
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22
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Use of Repetitive Transcranial Magnetic Stimulation in the Treatment of Neuropsychiatric and Neurocognitive Symptoms Associated With Concussion in Military Populations. J Head Trauma Rehabil 2020; 35:388-400. [PMID: 33165152 DOI: 10.1097/htr.0000000000000628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the year 2000, over 342 000 military service members have experienced a concussion, often associated with chronic neuropsychiatric and neurocognitive symptoms. Repetitive transcranial magnetic stimulation (rTMS) protocols have been developed for many of these symptoms in the general population. OBJECTIVE To conduct a scoping review of the literature on rTMS for neuropsychological and neurocognitive symptoms following concussion. METHODS PubMed and Google Scholar search engines identified 9 articles, written in English, corresponding to the search terms TBI or concussion; and TMS or rTMS; and depression, PTSD, or cognition. Studies that were not therapeutic trials or case reports, did not have neuropsychiatric or neurocognitive primary outcome measures, or described samples where 80% or more of the cohort did not have a TBI were excluded. RESULTS There were no reports of seizures nor difference in the frequency or quality of other adverse events as compared with the broader rTMS literature, supporting the safety of rTMS in this population. Support for the efficacy of rTMS for the treatment of neuropsychiatric and neurocognitive symptoms, in this population, is limited. CONCLUSIONS Large-scale, innovative, neuroscience-informed protocols are recommended to elucidate the potential utility of rTMS for the complex neuropsychiatric and neurocognitive symptoms associated with military concussions.
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23
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Rinaldi A, Stewart-Willis JJ, Scarisbrick D, Proctor-Weber Z. Clinical utility of the TOMMe10 scoring criteria for detecting suboptimal effort in an mTBI veteran sample. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:670-676. [PMID: 32780587 DOI: 10.1080/23279095.2020.1803870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the context of diminishing reimbursement and patient access demands, researchers continually refine performance validity measures (PVMs) to maximize efficiency while maintaining confidence in obtained data. This is particularly true for high PVM failure populations (e.g., mTBI patients). The TOMMe10 (number of errors on first 10 TOMM items) is one method this study utilized for classifying PVM performance as pass/fail (fail defined as failure on 2 of 6 PVM scores, pass defined as 0/1 failures). The present study hypothesized that the TOMMe10 would have equitable sensitivity/specificity for identifying non-credible cognitive performance among veterans with mTBI compared to previous research findings and commonly used performance validity measures (e.g., TOMM or WMT). Data were analyzed from 54 veterans assigned to a pass and fail group based on their performance across six recognized PVMs. Results revealed pass/fail groups were not significantly different regarding age, educational, or racial background. ROC analyses found the TOMMe10 demonstrated excellent discriminability (AUC = .803 ±.128), indicating that the TOMMe10 could have clinical utility within an mTBI veteran sample, particularly in conjunction with a second PVM. Specific population limitations are discussed. Additional research should elucidate this measure's performance with additional populations, including non-veteran mTBI, dementia, moderate-severe TBI, and inpatient populations.
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Affiliation(s)
- Anthony Rinaldi
- Department of Psychology, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | | | - David Scarisbrick
- WVU Department of Behavioral Medicine and Psychiatry, WVU Department of Neuroscience, West Virginia School of Medicine, Morgantown, VA, USA
| | - Zoe Proctor-Weber
- Department of Psychology, C.W. Bill Young Bay Pines VAHCS, Bay Pines, FL, USA
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24
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Acute Respiratory Failure Survivors' Physical, Cognitive, and Mental Health Outcomes: Quantitative Measures versus Semistructured Interviews. Ann Am Thorac Soc 2020; 16:731-737. [PMID: 30844293 DOI: 10.1513/annalsats.201812-851oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Rationale: Increasingly, patients are surviving acute respiratory failure (ARF), prompting the need to better understand standardized outcome measures commonly used during ARF follow-up studies. Objectives: Investigate standardized outcome measures (patient-reported physical and mental health measures, and cognitive testing) compared with findings from semistructured, qualitative interviews. Methods: As part of two ARF multicenter follow-up studies, standardized outcome measures were obtained, followed by qualitative evaluation via an in-depth, semistructured interview conducted and coded by two independent researchers. Qualitative interviews revealed the following post-ARF survivorship themes: physical impairment; anxiety, depression, and post-traumatic stress disorder symptoms; and cognitive impairment. Scores from standardized measures related to these themes were compared for ARF survivors reporting versus not reporting these themes in their qualitative interviews. Results: Of 59 invited ARF survivors, 48 (81%) completed both standardized outcome measures and qualitative interviews. Participants' median (interquartile range) age was 53 (43-64) years; 54% were female, and 88% were living independently before hospitalization. The two independent reviewers classifying the presence or absence of themes from the qualitative interviews had excellent agreement (κ = 0.80). There were significantly worse scores on standardized outcome measures for survivors reporting (vs. not reporting) physical and mental health impairments in their qualitative interviews. However, standardized cognitive test scores did not differ between patients reporting versus not reporting cognitive impairments in their qualitative interviews. Conclusions: These findings support the use of recommended, commonly used standardized outcome measures for physical and mental health impairments in ARF survivorship research. However, caution is needed in interpreting self-reported cognitive function compared with standardized cognitive testing.
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25
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Vasterling JJ, Aslan M, Proctor SP, Ko J, Leviyah X, Concato J. Long-term negative emotional outcomes of warzone TBI. Clin Neuropsychol 2020; 34:1088-1104. [PMID: 32301397 DOI: 10.1080/13854046.2020.1749935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Many veterans of the Iraq and Afghanistan Wars have experienced traumatic brain injury (TBI). Although prior work has examined associations between TBI and development of psychiatric syndromes, less is known about associations between TBI and component emotions constituting these syndromes, especially in the long term. The purpose of this study was to examine the long-term emotional consequences of deployment-related TBI. METHODS As part of VA Cooperative Studies Program #566, we assessed a sample of n = 456 US Army soldiers prior to an index deployment to Iraq, and again an average of 8.3 years (SD = 2.4 years) after their deployment for a long-term follow-up assessment. In this report, we used adjusted regression analyses to examine the relationship of deployment TBI to depression, anxiety, and stress symptom severity measured at the long-term follow-up assessment. A structured interview was used to determine TBI history; the Depression, Anxiety, and Stress Scale, 21-item version (DASS-21) was used to determine emotional status at the follow-up evaluation. RESULTS Warzone TBI events, particularly when greater than mild in severity, were independently associated with depression, anxiety, and stress severity at long-term follow-up, even after taking into account variance attributable to pre-deployment emotional distress and war-zone stress. Post-hoc analyses did not detect independent associations of either number of events or injury mechanism with outcomes. CONCLUSIONS These findings highlight the potentially enduring and multi-faceted emotional effects of deployment TBI, underscoring the need for early assessment of negative affectivity in warzone veterans reporting TBI.
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Affiliation(s)
- Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA.,Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Susan P Proctor
- U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA.,Research Service, VA Boston Healthcare System, Boston, MA, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA
| | - Xenia Leviyah
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - John Concato
- Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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26
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The Discrepancy Between Cognitive Complaints and Neuropsychological Test Findings in Persons With Traumatic Brain Injury. J Head Trauma Rehabil 2020; 35:E382-E392. [PMID: 32108707 DOI: 10.1097/htr.0000000000000557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To better identify variables related to discrepancies between subjective cognitive complaints and objective neuropsychological findings in persons with traumatic brain injury (TBI). SETTING Three rehabilitation centers in the United States. PARTICIPANTS In total, 504 community-dwelling adult survivors of TBI following discharge from inpatient rehabilitation. DESIGN Prospective cohort observation study. MAIN MEASURES Wechsler Adult Intelligence Scale, Fourth Edition, Digit Span; Rey Auditory Verbal Learning Test; Trail Making Test, Part B; Word Memory Test; Patient Health Questionnaire-9; Neurobehavioral Symptom Inventory; TBI-Quality of Life item bank. RESULTS Statistical analyses revealed multiple factors associated with subjective-objective discrepancies in attention, memory, and executive functions. Depression was consistently associated with underestimation of cognitive abilities. However, subjective-objective discrepancies varied by cognitive domains in regard to other factors related to underestimation and overestimation of abilities. CONCLUSIONS Reconciling and interpreting subjective-objective discrepancies regarding cognitive functions following TBI are important tasks for case conceptualization and treatment planning. Depression is an important patient characteristic to consider when discrepancy patterns indicate underestimation of cognitive abilities. This study highlights the importance of assessing mood, a modifiable patient characteristic, with self-report symptom inventories. Future studies are needed to connect these findings with TBI outcomes.
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Abstract
The purpose of this study was to experimentally investigate the relationship between positive affect elicitation (using a short video clip) prior to exercise and affect during acute aerobic exercise. A counterbalanced, within-subject experimental design was used. We conducted three related experiments. In Experiment 1, 30 adults aged 18–40 years participated in a positive affect-elicitation condition (“affective priming”) and a control condition. Participation involved watching a five-minute video clip, as well as walking on a treadmill at a (self-selected) brisk pace for ten minutes. We compared affective ratings at baseline and intra-exercise for both conditions using a 2 (condition; priming versus no priming) × 2 (time; pre- versus mid-exercise) repeated measures ANOVA. In the follow-up experiments, we re-examined the relationship between affective priming and intra-exercise affect, addressing some limitations noted with Experiment 1. In Experiment 2, we compared the affect-elicitation properties of self-selected and imposed video clips. In Experiment 3, we re-investigated the potential affective benefits of priming, while including a neutral (neither positive nor negative) video during the control condition to attenuate potential demand characteristics, and a positive video-only condition to investigate possible carryover effects. Self-selected and imposed film clips showed similar affect-elicitation properties. Comparing the priming and control conditions, there were notable differences in the mean intra-exercise affective valence ratings (p = 0.07 Experiment 1, p = 0.01 Experiment 3). The mean affective activation ratings were not significantly different (p = 0.07 Experiment 1, p = 0.86 Experiment 3). Priming the affective state prior to exercise may be beneficial for enhancing intra-exercise affect.
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van Lonkhuizen PJ, Rijnen SJ, van der Linden SD, Rutten GM, Gehring K, Sitskoorn MM. Subjective cognitive functioning in patients with a meningioma: Its course and association with objective cognitive functioning and psychological symptoms. Psychooncology 2019; 28:1654-1662. [PMID: 31141624 PMCID: PMC6772142 DOI: 10.1002/pon.5136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Although meningioma patients show deficits in objective cognitive functioning (OCF) measured with neuropsychological tests, subjective cognitive functioning (SCF) has received little attention. We investigate SCF from pre- to postsurgery and its associations with OCF, psychological, sociodemographic, and clinical characteristics. METHODS SCF was measured using the Cognitive Failures Questionnaire (CFQ) 1 day before (T0) and 3 (T3) and 12 months (T12) after surgery. Patients' scores were compared with normative data and changes over time were assessed. The neuropsychological battery CNS Vital Signs and the Hospital Anxiety and Depression Scale were administered. Correlations of SCF with OCF, psychological, sociodemographic, and clinical characteristics were explored. RESULTS Patients reported significantly better SCF as compared with controls at T0 (N = 54) and T3 (N = 242), but not at T12 (N = 50). A significant decrease in group level SCF was observed from T0 to T12 (n = 24, P < .001). SCF was associated with anxiety at all time points (rs = -0.543 to -0.352) and with depression at T3 and T12 (r = -0.338 and -0.574), but not with OCF, sociodemographic, or clinical characteristics (rs = -0.202 to 0.288). CONCLUSIONS Meningioma patients experienced better SCF as compared with controls before and 3 months after surgery, which might be the result of phenomena related to disease and recovery. As the findings suggest that cognitive symptoms might increase later on, future studies should further investigate the course of SCF in meningioma patients. In clinical practice, measurements of SCF should be combined with those of OCF and psychological distress in order to determine whether and which interventions are needed.
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Affiliation(s)
- Pearl J.C. van Lonkhuizen
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Sophie J.M. Rijnen
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Sophie D. van der Linden
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Geert‐Jan M. Rutten
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - Karin Gehring
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgthe Netherlands
- Department of NeurosurgeryElisabeth‐TweeSteden HospitalTilburgthe Netherlands
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van der Linden SD, Gehring K, Rutten GJM, Kop WJ, Sitskoorn MM. Prevalence and correlates of fatigue in patients with meningioma before and after surgery. Neurooncol Pract 2019; 7:77-85. [PMID: 32257286 PMCID: PMC7104880 DOI: 10.1093/nop/npz023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Fatigue is a common symptom in patients with brain tumors, but comprehensive studies on fatigue in patients with meningioma specifically are lacking. This study examined the prevalence and correlates of fatigue in meningioma patients. Methods Patients with grade I meningioma completed the Multidimensional Fatigue Inventory (MFI-20) before and 1 year after neurosurgery. The MFI consists of 5 subscales: General Fatigue, Physical Fatigue, Mental Fatigue, Reduced Motivation, and Reduced Activity. Patients’ scores were compared with normative data. Preoperative fatigue was compared with postoperative fatigue. Correlations with sex, age, education, tumor hemisphere, preoperative tumor volume, antiepileptic drugs (AEDs), symptoms of anxiety/depression, and self-reported cognitive complaints were explored. Results Questionnaires were completed by 65 patients preoperatively, and 53 patients postoperatively. Of 34 patients, data from both time points were available. Patients had significantly higher fatigue levels on all subscales compared to normative values at both time points. Mean scores on General Fatigue, Physical Fatigue, and Mental Fatigue remained stable over time and improvements were observed on Reduced Motivation and Reduced Activity. Preoperatively, the prevalence of high fatigue (Z-score ≥ 1.3) varied between 34% for Reduced Motivation and 43% for General Fatigue/Mental Fatigue. The postoperative prevalence ranged from 19% for Reduced Activity to 49% on Mental Fatigue. Fatigue was associated with cognitive complaints, anxiety and depression, but not with education, tumor lateralization, tumor volume, or AEDs. Conclusion Fatigue is a common and persistent symptom in patients with meningioma undergoing neurosurgery. Findings emphasize the need for more research and appropriate care targeting fatigue for meningioma patients.
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Affiliation(s)
- Sophie D van der Linden
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, The Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, The Netherlands
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, The Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, The Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, The Netherlands
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Tilburg University, Center of Research on Psychology in Somatic diseases (CoRPS), The Netherlands
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Iverson GL. Network Analysis and Precision Rehabilitation for the Post-concussion Syndrome. Front Neurol 2019; 10:489. [PMID: 31191426 PMCID: PMC6548833 DOI: 10.3389/fneur.2019.00489] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/23/2019] [Indexed: 01/25/2023] Open
Abstract
Some people experience persistent symptoms following a mild traumatic brain injury (MTBI), and the etiology of those symptoms has been debated for generations. Post-concussion-like symptoms are caused by many factors both before and after MTBI, and this non-specificity is the bedrock of the conundrum regarding the existence of the post-concussion syndrome. A latent model or common cause theory for the syndrome is inconsistent with the prevailing biopsychosocial conceptualization. It is the thesis of this paper that adopting a network perspective for persistent symptoms following MTBI, including the post-concussion syndrome, could lead to new insights and targeted treatment and rehabilitation strategies. The network perspective posits that symptoms co-occur because they are strongly inter-related, activating, amplifying, and mutually reinforcing, not because they arise from a common latent disease entity. This approach requires a conceptual shift away from thinking that symptoms reflect an underlying disease or disorder toward viewing inter-related symptoms as constituting the syndrome or disorder. The symptoms do not arise from an underlying syndrome—the symptoms are the syndrome. A network analysis approach allows us to embrace heterogeneity and comorbidity, and it might lead to the identification of new approaches to sequenced care. The promise of precision rehabilitation requires us to better understand the interconnections among symptoms and problems so that we can produce more individualized and effective treatment and rehabilitation.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,MassGeneral Hospital for Children Sport Concussion Program, Boston, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
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31
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Jang SH, Kim SH, Lee HD. Traumatic axonal injury of the cingulum in patients with mild traumatic brain injury: a diffusion tensor tractography study. Neural Regen Res 2019; 14:1556-1561. [PMID: 31089054 PMCID: PMC6557111 DOI: 10.4103/1673-5374.255977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The cingulum, connecting the orbitofrontal cortex to the medial temporal lobe, involves in diverse cognition functions including attention, memory, and motivation. To investigate the relationship between the cingulum injury and cognitive impairment in patients with chronic mild traumatic brain injury, we evaluated the integrity between the anterior cingulum and the basal forebrain using diffusion tensor tractography in 73 patients with chronic mild traumatic brain injury (39 males, 34 females, age 43.29 ± 11.42 years) and 40 healthy controls (22 males, 18 females, age 40.11 ± 16.81 years). The patients were divided into three subgroups based on the integrity between the anterior cingulum and the basal forebrain on diffusion tensor tractography: subgroup A (n = 19 patients) - both sides of the anterior cingulum were intact; subgroup B (n = 36 patients) - either side of the anterior cingulum was intact; and subgroup C (18 patients) - both sides of the anterior cingulum were discontinued. There were significant differences in total Memory Assessment Scale score between subgroups A and B and between subgroups A and C. There were no significant differences in diffusion tensor tractography parameters (fractional anisotropy, apparent diffusion coefficient, and fiber volume) between patients and controls. These findings suggest that the integrity between the anterior cingulum and the basal forebrain, but not diffusion tensor tractography parameter, can be used to predict the cognitive function of patients with chronic mild traumatic brain injury. This study was approved by Yeungnam University Hospital Institutional Review Board (approval No. YUMC-2014-01-425-010) on August 16, 2017.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
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32
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Balakrishnan B, Rus RM, Chan KH, Martin AG, Awang MS. Prevalence of Postconcussion Syndrome after Mild Traumatic Brain Injury in Young Adults from a Single Neurosurgical Center in East Coast of Malaysia. Asian J Neurosurg 2019; 14:201-205. [PMID: 30937035 PMCID: PMC6417307 DOI: 10.4103/ajns.ajns_49_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Context: Postconcussion syndrome (PCS) is a set of symptoms occurred after a mild traumatic brain injury (MTBI). Aims: This study aims to determine the prevalence of PCS in a young adult population from a single Neurological Centre in Malaysia's East Coast and to evaluate the factors associated with PCS in MTBI patients. Settings and Design: This was a cross-sectional study conducted in a Neurological Centre at Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia, from January 2016 to December 2016. Subjects and Methods: A total of 209 patients; 133 males and 76 females, in the age range of 16–84 years, were randomly recruited for this study. All the selected patients were subjected to the checklist for diagnosis of PCS as per International Statistical Classification of Diseases and Related Health Problems 10th edition classification at a 2-week interval. Statistical Analysis Used: Descriptive statistic and Multivariable Logistic Regression Model were used for frequency and percentage analyses of categorical variables, using SPSS version 23.0. Results: Only 20 patients were identified with PCS. There were more female (70%) patients with PCS than the male (30%) patients. The prevalence of PCS for 2 weeks, 3 and 6 months since injuries were 9.6%, 8.1%, and 8.1% respectively. Majority (80%) of the patients were found to have PCS due to road traffic accidents, while the remaining were attributed to assault (15%), and falls (5%). Among the sample population, 25% were smokers, while 10% of them had either skull fracture or premorbidity. Conclusion: Less than 10% of patients with MTBI had PCS after 6 months’ following trauma. None of the variables tested were significant factors for the development of PCS symptoms.
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Affiliation(s)
- Buveinthiran Balakrishnan
- Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Razman Mohd Rus
- Department of Community Medicine, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Kin Hup Chan
- Department of Neurosurgery, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Arvind Gerard Martin
- Department of Neurosurgery, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Mohamed Saufi Awang
- Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia.,Department of Neurosurgery, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
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Anderson JFI, Fitzgerald P. Associations between coping style, illness perceptions and self-reported symptoms after mild traumatic brain injury in prospectively studied pre-morbidly healthy individuals. Neuropsychol Rehabil 2018; 30:1115-1128. [PMID: 30560733 DOI: 10.1080/09602011.2018.1556706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigated whether coping style and/or illness perceptions are related to the severity of self-reported post-concussion syndrome (PCS) symptoms in the post-acute period after mild traumatic brain injury (mTBI). We hypothesised that reporting of early and late enduring-type PCS symptomatology (self-reported symptoms) would be significantly and negatively associated with: (a) an active "approach" coping style and (b) the belief that the injury would have negative consequences on the respondent's life. Using a prospective observational design we assessed 61 pre-morbidly healthy individuals who were admitted to hospital after an mTBI. Participants were assessed with measures of coping style and illness perception as well as PCS, depressive, anxiety and post-traumatic stress symptomatology. After controlling for current psychological distress, approach coping style significantly and independently predicted the severity of self-reported symptoms for early-type PCS symptomatology, but not late enduring-type PCS symptoms. The extent to which the respondent believed their symptoms were due to the mTBI significantly and independently predicted both early and late enduring-type PCS symptoms. This study indicates that different patterns of coping and illness perceptions are associated with early vs. late enduring types of PCS symptoms; this may have implications for the treatment of post-injury self-reported symptoms.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Psychology Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, Victoria, Australia.,Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Melbourne, Victoria, Australia
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Xu X, Jiang S, Xu E, Wu X, Zhao R. Inhibition of CB1 receptor ameliorates spatial learning and memory impairment in mice with traumatic brain injury. Neurosci Lett 2018; 696:127-131. [PMID: 30576711 DOI: 10.1016/j.neulet.2018.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/21/2022]
Abstract
Traumatic brain injury (TBI) is an increasingly prevalent condition affecting people of all ages and genders. The impairment of spatial learning and memory is one of the most common effects of TBI. Unfortunately, it currently lacks effective therapeutic interventions. The endocannabinoid (EC) system regulates a diverse array of physiological processes. Here, we found a 6.7-fold increase of 2-AG levels at 1 d post-TBI, declining thereafter. After 5 d, the levels were still 3.3-fold higher than in the controls. AM281, a CB1 receptor antagonist, reversed the TBI-reduced NMDA receptor subunits NR2B in the hippocampus and ameliorate the spatial learning and memory impairment at 7 d post-TBI, suggesting CB1 receptor is involved in the TBI-induced hippocampal-dependent spatial learning and memory impairment.
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Affiliation(s)
- Xiaoming Xu
- Department of Forensic Clinical Medicine, School of Forensic Medicine, China Medical University, Shenyang, PR China.
| | - Shukun Jiang
- Department of Forensic Clinical Medicine, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Enyu Xu
- Department of Forensic Toxicological Analysis, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Xu Wu
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
| | - Rui Zhao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, PR China
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35
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The Role of Pain Catastrophizing in Cognitive Functioning Among Veterans With a History of Mild Traumatic Brain Injury. J Head Trauma Rehabil 2018; 34:E61-E66. [PMID: 30499934 DOI: 10.1097/htr.0000000000000453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the role of pain catastrophizing (PC) in neuropsychological functioning in veterans with a history of mild traumatic brain injury (TBI). PARTICIPANTS Thirty-nine Iraq and Afghanistan combat veterans evaluated in the post-acute phase following mild TBI. METHODS Participants underwent psychiatric and TBI clinical interviews, neuropsychological tests, and self-report assessments of PC, pain intensity, depression, and posttraumatic stress disorder symptoms. Cognitive functioning composite scores of executive functioning, processing speed, and learning and memory were created. Composites were entered as dependent variables into separate linear regressions to examine relations with PC. RESULTS Greater PC was associated with worse executive functioning and processing speed even when controlling for confounding variables. CONCLUSIONS One's interpretation of pain, in addition to pain intensity, has implications for cognitive functioning. Future research is encouraged to determine whether adaptive pain coping mechanisms improve cognitive functioning or, alternatively, whether cognitive rehabilitation strategies reduce PC.
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36
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Stewart-Willis JJ, Heyanka D, Proctor-Weber Z, England H, Bruhns M. Premorbid IQ Predicts Postconcussive Symptoms in OEF/OIF/OND Veterans with mTBI. Arch Clin Neuropsychol 2018; 33:206-215. [PMID: 28595276 DOI: 10.1093/arclin/acx053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/31/2017] [Indexed: 12/20/2022] Open
Abstract
Objective Extant literature has demonstrated that symptoms of postconcussive syndrome (PCS) persist well beyond the expected 3-month post-injury recovery period in a minority of individuals with mild traumatic brain injury (mTBI). Suboptimal performance on validity measures and pre- and post-injury psychosocial stressors - rather than actual mTBI or current cognitive functioning - have been identified as predictors of chronic PCS. Whether premorbid IQ has any influence on chronic PCS has been understudied, in the context of established psychogenic etiologies. Method The sample included 31 veterans, who underwent mTBI neuropsychological evaluations six or more months post-injury in a VA outpatient neuropsychology clinic. A two-step multiple linear regression was conducted to examine the effects on the outcome variable, PCS (Neurobehavioral Symptom Inventory), of the following predictors: cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status; Attention, Immediate Memory, and Delayed Memory Indices), performance validity, depression (Beck Depression Inventory-Second Edition), posttraumatic stress disorder (PTSD Checklist, Civilian Version), quality of sleep (Pittsburgh Sleep Quality Index), pain (Brief Pain Inventory), education, and Premorbid IQ (Wechsler Test of Adult Reading). Results The overall regression model containing all nine predictor variables was statistically significant. Depression (p < .05) and premorbid IQ (p < .05) were the most salient predictors of chronic PCS; in that lower premorbid IQ and greater endorsed symptoms of depression were associated with higher PCS scores. In Step 2 of the multiple linear regression, the WTAR explained an additional 6.7% of the variance in PCS after controlling for psychosocial stressors and current cognitive ability. Conclusion The findings support premorbid IQ as a unique and relevant predictor of chronic PCS, with significance variance accounted for beyond education, cognitive functioning, and psychosocial variables. Given the predictive relationship between premorbid IQ and PCS, adapting postconcussive interventions to meet the specific needs of individuals with varying levels of intellect may be important in minimizing ongoing symptomatology.
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Affiliation(s)
- Jada J Stewart-Willis
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Daniel Heyanka
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Zoe Proctor-Weber
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Heather England
- Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA
| | - Maya Bruhns
- Rehabilitation Service, JFK/Johnson Rehabilitation Institute, Center for Head Injuries Edison, NJ 08820, USA
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37
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Lunter CM, Carroll EL, Housden C, Outtrim J, Forsyth F, Rivera A, Maimaris C, Boyle A, Sahakian BJ, Menon DK, Newcombe VF. Neurocognitive testing in the emergency department: A potential assessment tool for mild traumatic brain injury. Emerg Med Australas 2018; 31:355-361. [PMID: 30175893 DOI: 10.1111/1742-6723.13163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/02/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite mild traumatic brain injury (mTBI) accounting for 80% of head injury diagnoses, recognition of individuals at risk of cognitive dysfunction remains a challenge in the acute setting. The objective of this study was to evaluate the feasibility and potential role for computerised cognitive testing as part of a complete ED head injury assessment. METHODS mTBI patients (n = 36) who incurred a head injury within 24 h of presentation to the ED were compared to trauma controls (n = 20) and healthy controls (n = 20) on tests assessing reaction time, speed and attention, episodic memory, working memory and executive functioning. Testing occurred during their visit to the ED at a mean of 12 h post-injury for mTBI and 9.4 h for trauma controls. These tasks were part of the Cambridge Neuropsychological Test Automated Battery iPad application. Healthy controls were tested in both a quiet environment and the ED to investigate the potential effects of noise and distraction on neurocognitive function. RESULTS Reaction time was significantly slower in the mTBI group compared to trauma patients (P = 0.015) and healthy controls (P = 0.011), and deficits were also seen in working memory compared to healthy controls (P ≤ 0.001) and in executive functioning (P = 0.021 and P < 0.001) compared to trauma and healthy controls. Performances in the control group did not differ between testing environments. CONCLUSION Computerised neurocognitive testing in the ED is feasible and can be utilised to detect deficits in cognitive performance in the mTBI population as part of a routine head injury assessment.
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Affiliation(s)
- Catherine M Lunter
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Ellen L Carroll
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | | | - Joanne Outtrim
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Faye Forsyth
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Annie Rivera
- National Institute of Health Research/Wellcome Trust Clinical Research Facility, Cambridge, UK
| | - Chris Maimaris
- Department of Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Adrian Boyle
- Department of Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK
| | | | - David K Menon
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
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Brands IM, Verlinden I, Ribbers GM. A study of the influence of cognitive complaints, cognitive performance and symptoms of anxiety and depression on self-efficacy in patients with acquired brain injury. Clin Rehabil 2018; 33:327-334. [PMID: 30168362 DOI: 10.1177/0269215518795249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: To examine the relationship between self-efficacy for managing brain injury-specific symptoms and cognitive performance, subjective cognitive complaints and anxiety and depression symptoms in patients with acquired brain injury (ABI). DESIGN: Clinical cohort study. SETTING: General hospitals, rehabilitation centres. SUBJECTS: A total of 122 patients with newly ABI (mean age = 54.4 years (SD, 12.2)) were assessed at discharge home from inpatient neurorehabilitation or at start of outpatient neurorehabilitation after discharge home from acute hospital. Mean time since injury was 14.1 weeks (SD, 8.6). MAIN MEASURES: Self-efficacy was measured using the Traumatic Brain Injury (TBI) Self-Efficacy Questionnaire (SEsx), mean score = 82.9 (SD, 21.8). Objective cognitive performance was measured with the Symbol Digit Modalities Test (SDMT), mean z-score = -1.36 (SD, 1.31). Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale (HADS), cognitive complaints with the self-rating form of the Dysexecutive Questionnaire (DEX-P). RESULTS: Higher levels of subjective cognitive complaints and higher levels of anxiety and depression symptoms were significantly associated with lower self-efficacy (β = -0.35; P = .001 and β =-0.43; P < .001, respectively). Objective cognitive performance was not significantly associated with self-efficacy (β = 0.04, P = .53). DEX-P scores accounted for 42% and HADS scores for 7% of the total 57% variance explained. Objective cognitive performance did not correlate significantly with subjective cognitive complaints (r = -.13, P = .16). CONCLUSION: Control over interfering emotions and mastery over brain injury-associated symptoms seems important in the development of self-efficacy for managing brain injury-specific symptoms.
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Affiliation(s)
- Ingrid Mh Brands
- 1 Department of Neurorehabilitation, Libra Rehabilitation & Audiology, Eindhoven, The Netherlands
| | - Inge Verlinden
- 1 Department of Neurorehabilitation, Libra Rehabilitation & Audiology, Eindhoven, The Netherlands
| | - Gerard M Ribbers
- 2 Department of Rehabilitation, Erasmus MC, Rotterdam, The Netherlands.,3 Department of Neurorehabilitation, Rijndam Rehabilitation Centre, Rotterdam, The Netherlands
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39
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Bodapati AS, Combs HL, Pastorek NJ, Miller B, Troyanskaya M, Romesser J, Sim A, Linck J. Detection of symptom over-reporting on the Neurobehavioral Symptom Inventory in OEF/OIF/OND veterans with history of mild TBI. Clin Neuropsychol 2018; 33:539-556. [DOI: 10.1080/13854046.2018.1482003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Anjuli S. Bodapati
- Michael E DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | | | - Nicholas J. Pastorek
- Michael E DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Brian Miller
- Michael E DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | | | | | - Anita Sim
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - John Linck
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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40
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Ngwenya LB, Gardner RC, Yue JK, Burke JF, Ferguson AR, Huang MC, Winkler EA, Pirracchio R, Satris GG, Yuh EL, Mukherjee P, Valadka AB, Okonkwo DO, Manley GT. Concordance of common data elements for assessment of subjective cognitive complaints after mild-traumatic brain injury: a TRACK-TBI Pilot Study. Brain Inj 2018; 32:1071-1078. [DOI: 10.1080/02699052.2018.1481527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Laura B. Ngwenya
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Raquel C. Gardner
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, San Francisco Veterans Administration Medical Center, San Francisco, CA, USA
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - John F. Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Michael C. Huang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A. Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Gabriela G. Satris
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Esther L. Yuh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Alex B. Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
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41
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van der Horn HJ, Scheenen ME, de Koning ME, Liemburg EJ, Spikman JM, van der Naalt J. The Default Mode Network as a Biomarker of Persistent Complaints after Mild Traumatic Brain Injury: A Longitudinal Functional Magnetic Resonance Imaging Study. J Neurotrauma 2017; 34:3262-3269. [DOI: 10.1089/neu.2017.5185] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Harm J. van der Horn
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Myrthe E. Scheenen
- Department of Neuropsychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Myrthe E. de Koning
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edith J. Liemburg
- NeuroImaging Center of the Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba M. Spikman
- Department of Neuropsychology, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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42
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Næss-Schmidt ET, Blicher JU, Tietze A, Rask CU, Svendsen SW, Schröder A, Thastum MM, Tuborgh AH, Frederiksen OV, Østergaard L, Eskildsen SF, Hansen B, Jespersen S, Nielsen JF. Diffusion MRI findings in patients with extensive and minimal post-concussion symptoms after mTBI and healthy controls: a cross sectional study. Brain Inj 2017; 32:91-98. [PMID: 29095055 DOI: 10.1080/02699052.2017.1377352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PRIMARY OBJECTIVES We hypothesized that the microstructure of the corpus callosum, thalamus and hippocampus, as measured with diffusion and Mean of the Kurtosis Tensor (MKT) MRI, differs between healthy subjects and patients with extensive and minimal post-concussion symptoms (PCS) and that MKT measures correlate with PCS severity and self-reported cognitive symptoms. RESEARCH DESIGN A cross-sectional study comparing patients with extensive PCS and patients with minimal PCS 2-5 months after mild traumatic brain injury (mTBI) with each other and with an external healthy control group. METHODS AND PROCEDURES Diffusion MRI was obtained in 25 patients with extensive PCS and in 25 patients with minimal PCS as measured by the Rivermead Post-concussion Symptoms Questionnaire. The patients were matched on age, sex and time since accident. Data from an external healthy control group (n = 27) was included. MAIN OUTCOME AND RESULTS There was no difference in MKT between the two groups with mTBI and no correlation between MKT and PCS. There was no difference between the three groups in other diffusion measures. CONCLUSIONS Our results did not point to microstructural changes in the corpus callosum, thalamus and hippocampus in relation to PCS after mTBI.
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Affiliation(s)
| | - Jakob Udby Blicher
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Anna Tietze
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,c Dept of Neuroradiology , Aarhus University Hospital , Aarhus , Denmark
| | - Charlotte Ulrikka Rask
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark.,e Regional Centre for Child and Adolescent Psychiatry, Risskov , Aarhus University Hospital , Aarhus , Denmark
| | - Susanne Wulff Svendsen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
| | - Andreas Schröder
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Mille Møller Thastum
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Astrid Høeg Tuborgh
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Oana-Veronica Frederiksen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
| | - Leif Østergaard
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,c Dept of Neuroradiology , Aarhus University Hospital , Aarhus , Denmark
| | - Simon Fristed Eskildsen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Brian Hansen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Sune Jespersen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,f Dept of Physics and Astronomy , Aarhus University , Aarhus , Denmark
| | - Jørgen Feldbæk Nielsen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
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43
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Cognitive impairments and subjective cognitive complaints after survival of cardiac arrest: A prospective longitudinal cohort study. Resuscitation 2017; 120:132-137. [DOI: 10.1016/j.resuscitation.2017.08.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/16/2017] [Accepted: 08/05/2017] [Indexed: 11/19/2022]
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44
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Byrne C, Coetzer R, Addy K. Investigating the discrepancy between subjective and objective cognitive impairment following acquired brain injury: The role of psychological affect. NeuroRehabilitation 2017; 41:501-512. [DOI: 10.3233/nre-162015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christopher Byrne
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
| | - Rudi Coetzer
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, NHS Wales, UK
- School of Psychology, Bangor University, Bangor, UK
| | - Karen Addy
- North Wales Neuropsychology Services, Bangor, UK
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45
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Scheenen ME, Visser-Keizer AC, de Koning ME, van der Horn HJ, van de Sande P, van Kessel M, van der Naalt J, Spikman JM. Cognitive Behavioral Intervention Compared to Telephone Counseling Early after Mild Traumatic Brain Injury: A Randomized Trial. J Neurotrauma 2017; 34:2713-2720. [DOI: 10.1089/neu.2016.4885] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Myrthe E. Scheenen
- Department of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemarie C. Visser-Keizer
- Department of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Myrthe E. de Koning
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harm J. van der Horn
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter van de Sande
- Department of Medical Psychology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Marlies van Kessel
- Department of Medical Psychology, Medical Spectrum Twente Enschede, Enschede, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba M. Spikman
- Department of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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46
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Abstract
Education to improve symptom management is an agreed-upon strategy to reduce the impact of symptoms on the quality of life for persons with mild traumatic brain injury. The purpose of this study was to investigate whether current discharge education practices are deemed adequate by persons treated and released from the emergency department with concussion. A review of current literature identified a need for patient education improvements in emergency departments. Strategies for improving information retention in the mild traumatic brain injury patient population for effective symptom management are identified. A concussion symptom management booklet was created using current scientific information. The concussion education booklet along with standardized postconcussion education was provided to patients with mild traumatic brain injuries who were discharged from a level I trauma center emergency department. A prospective small-scale study was performed to establish the ease of use and usefulness of the newly created concussion education booklet and determine whether patients preferred the booklet of information over the standard discharge instructions.
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47
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Cnossen MC, Winkler EA, Yue JK, Okonkwo DO, Valadka AB, Steyerberg EW, Lingsma HF, Manley GT. Development of a Prediction Model for Post-Concussive Symptoms following Mild Traumatic Brain Injury: A TRACK-TBI Pilot Study. J Neurotrauma 2017; 34:2396-2409. [PMID: 28343409 DOI: 10.1089/neu.2016.4819] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-concussive symptoms occur frequently after mild traumatic brain injury (mTBI) and may be categorized as cognitive, somatic, or emotional. We aimed to: 1) assess whether patient demographics and clinical variables predict development of each of these three symptom categories, and 2) develop a prediction model for 6-month post-concussive symptoms. Patients with mTBI (Glasgow Coma Scale score 13-15) from the prospective multi-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study (2010-2012) who completed the Rivermead Post Concussion Symptoms Questionnaire (RPQ) at 6 months post-injury were included. Linear regression was utilized to determine the predictive value of candidate predictors for cognitive, somatic, and emotional subscales individually, as well as the overall RPQ. The final prediction model was developed using least absolute shrinkage and selection operator shrinkage and bootstrap validation. We included 277 mTBI patients (70% male; median age 42 years). No major differences in the predictive value of our set of predictors existed for the cognitive, somatic, and emotional subscales, and therefore one prediction model for the RPQ total scale was developed. Years of education, pre-injury psychiatric disorders, and prior TBI were the strongest predictors of 6-month post-concussive symptoms. The total set of predictors explained 21% of the variance, which decreased to 14% after bootstrap validation. Demographic and clinical variables at baseline are predictive of 6-month post-concussive symptoms following mTBI; however, these variables explain less than one-fifth of the total variance in outcome. Model refinement with larger datasets, more granular variables, and objective biomarkers are needed before implementation in clinical practice.
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Affiliation(s)
- Maryse C Cnossen
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Ewout W Steyerberg
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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48
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Reyes Gavilan PA, Matallana DL, Santiago G, Filizzola C, Morillo A, Velasco S, Bermúdez S. DEVELOPING A SOCIAL COGNITION TASK FOR fMRI IN PATIENTS WITH MILD TRAUMATIC BRAIN INJURY. UNIVERSITAS PSYCHOLOGICA 2017. [DOI: 10.11144/javeriana.upsy15-5.dsct] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Hellstrøm T, Kaufmann T, Andelic N, Soberg HL, Sigurdardottir S, Helseth E, Andreassen OA, Westlye LT. Predicting Outcome 12 Months after Mild Traumatic Brain Injury in Patients Admitted to a Neurosurgery Service. Front Neurol 2017; 8:125. [PMID: 28443058 PMCID: PMC5385465 DOI: 10.3389/fneur.2017.00125] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/16/2017] [Indexed: 01/16/2023] Open
Abstract
Objective Accurate outcome prediction models for patients with mild traumatic brain injury (MTBI) are key for prognostic assessment and clinical decision-making. Using multivariate machine learning, we tested the unique and added predictive value of (1) magnetic resonance imaging (MRI)-based brain morphometric and volumetric characterization at 4-week postinjury and (2) demographic, preinjury, injury-related, and postinjury variables on 12-month outcomes, including global functioning level, postconcussion symptoms, and mental health in patients with MTBI. Methods A prospective, cohort study of patients (n = 147) aged 16–65 years with a 12-month follow-up. T1-weighted 3 T MRI data were processed in FreeSurfer, yielding accurate cortical reconstructions for surface-based analyses of cortical thickness, area, and volume, and brain segmentation for subcortical and global brain volumes. The 12-month outcome was defined as a composite score using a principal component analysis including the Glasgow Outcome Scale Extended, Rivermead Postconcussion Questionnaire, and Patient Health Questionnaire-9. Using leave-one-out cross-validation and permutation testing, we tested and compared three prediction models: (1) MRI model, (2) clinical model, and (3) MRI and clinical combined. Results We found a strong correlation between observed and predicted outcomes for the clinical model (r = 0.55, p < 0.001). The MRI model performed at the chance level (r = 0.03, p = 0.80) and the combined model (r = 0.45, p < 0.002) were slightly weaker than the clinical model. Univariate correlation analyses revealed the strongest association with outcome for postinjury factors of posttraumatic stress (Posttraumatic Symptom Scale-10, r = 0.61), psychological distress (Hospital Anxiety and Depression Scale, r = 0.52), and widespread pain (r = 0.43) assessed at 8 weeks. Conclusion We found no added predictive value of MRI-based measures of brain cortical morphometry and subcortical volumes over and above demographic and clinical features.
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Affiliation(s)
- Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tobias Kaufmann
- KG Jebsen Centre for Psychosis Research/Norwegian Centre for Mental Disorder Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, CHARM Research Centre for Habilitation and Rehabilitation Models & Services, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helene L Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Eirik Helseth
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- KG Jebsen Centre for Psychosis Research/Norwegian Centre for Mental Disorder Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Lars T Westlye
- KG Jebsen Centre for Psychosis Research/Norwegian Centre for Mental Disorder Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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50
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Câmara-Costa H, Bull KS, Kennedy C, Wiener A, Calaminus G, Resch A, Kieffer V, Lalande C, Poggi G, von Hoff K, Grill J, Doz F, Rutkowski S, Massimino M, Kortmann RD, Lannering B, Dellatolas G, Chevignard M. Quality of survival and cognitive performance in children treated for medulloblastoma in the PNET 4 randomized controlled trial. Neurooncol Pract 2017; 4:161-170. [PMID: 31385949 DOI: 10.1093/nop/npw028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The relationship between direct assessments of cognitive performance and questionnaires assessing quality of survival (QoS) is reported to be weak-to-nonexistent. Conversely, the associations between questionnaires evaluating distinct domains of QoS tend to be strong. This pattern remains understudied. Methods In the HIT-SIOP PNET4 randomized controlled trial, cognitive assessments, including Full Scale, Verbal and Performance IQ, Working Memory, and Processing Speed, were undertaken in 137 survivors of standard-risk medulloblastoma from 4 European countries. QoS questionnaires, including self-reports and/or parent reports of the Behavior Rating Inventory of Executive Function (BRIEF), the Health Utilities Index, the Strengths and Difficulties Questionnaire, and the Pediatric Quality of Life Inventory, were completed for 151 survivors. Correlations among direct cognitive assessments, QoS questionnaires, and clinical data were examined in participants with both assessments available (n = 86). Results Correlations between direct measures of cognitive performance and QoS questionnaires were weak, except for moderate correlations between the BRIEF Metacognition Index (parent report) and working memory (r = .32) and between health status (self-report) and cognitive outcomes (r = .35-.44). Correlations among QoS questionnaires were moderate to strong both for parent and self-report (r = .39-.76). Principal Component Analysis demonstrated that questionnaires and cognitive assessments loaded on 2 separate factors. Conclusions We hypothesize that the strong correlations among QoS questionnaires is partially attributable to the positive/negative polarity of all questions on the questionnaires, coupled with the relative absence of disease-specific questions. These factors may be influenced by respondents' personality and emotional characteristics, unlike direct assessments of cognitive functioning, and should be taken into account in clinical trials.
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Affiliation(s)
- Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France (H.C.C., G.D.)
| | - Kim S Bull
- University of Southampton, Faculty of Medicine, Southampton, SO16 6YD, UK (K.S.B., C.K.)
| | - Colin Kennedy
- University of Southampton, Faculty of Medicine, Southampton, SO16 6YD, UK (K.S.B., C.K.)
| | - Andreas Wiener
- University of Bonn, Paediatric Oncology, Bonn and University Hospital Muenster, Paediatric Oncology, Münster, Germany (A.W., G.C.)
| | - Gabriele Calaminus
- University of Bonn, Paediatric Oncology, Bonn and University Hospital Muenster, Paediatric Oncology, Münster, Germany (A.W., G.C.)
| | - Anika Resch
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.R., K.V.H., S.R.)
| | - Virginie Kieffer
- Hôpitaux de Saint Maurice, Saint Maurice; Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, France (V.K.)
| | | | - Geraldina Poggi
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy (G.P.)
| | - Katja von Hoff
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.R., K.V.H., S.R.)
| | - Jacques Grill
- Gustave Roussy, Villejuif 94805, France (C.L., J.G.).,Université Paris Saclay, Villejuif 94805, France (J.G.)
| | - François Doz
- Institut Curie and University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.D.)
| | - Stefan Rutkowski
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.R., K.V.H., S.R.)
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (M.M.)
| | - Rolf-Dieter Kortmann
- University of Leipzig, Department of Radiation Therapy, Leipzig, Germany (R.D.K.)
| | - Birgitta Lannering
- University of Gothenburg, Department of Paediatric Oncology, Gothenburg, Sweden (B.L.)
| | - Georges Dellatolas
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France (H.C.C., G.D.)
| | - Mathilde Chevignard
- Saint Maurice Hospitals, Rehabilitation Department for children with acquired neurological injury; F-94410 Saint Maurice, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, CNRS, LIB, F-7013 Paris, France (M.C.)
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