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Ganesh A, Al-Shamli S, Mahadevan S, Chan MF, Burke DT, Al Rasadi K, Al Saadoon M, Al–Adawi S. The Frequency of Neuropsychiatric Sequelae After Traumatic Brain Injury in the Global South: A systematic review and meta-analysis. Sultan Qaboos Univ Med J 2024; 24:161-176. [PMID: 38828247 PMCID: PMC11139369 DOI: 10.18295/squmj.12.2023.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 06/05/2024] Open
Abstract
This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post-TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.
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Affiliation(s)
- Aishwarya Ganesh
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - David T. Burke
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Khalid Al Rasadi
- Medical Research Center, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Muna Al Saadoon
- Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Samir Al–Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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2
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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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3
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Uiterwijk D, Stargatt R, Crowe SF. Objective Cognitive Outcomes and Subjective Emotional Sequelae in Litigating Adults with a Traumatic Brain Injury: The Impact of Performance and Symptom Validity Measures. Arch Clin Neuropsychol 2022; 37:1662-1687. [PMID: 35704852 DOI: 10.1093/arclin/acac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examined the relative contribution of performance and symptom validity in litigating adults with traumatic brain injury (TBI), as a function of TBI severity, and examined the relationship between self-reported emotional symptoms and cognitive tests scores while controlling for validity test performance. METHOD Participants underwent neuropsychological assessment between January 2012 and June 2021 in the context of compensation-seeking claims related to a TBI. All participants completed a cognitive test battery, the Personality Assessment Inventory (including symptom validity tests; SVTs), and multiple performance validity tests (PVTs). Data analyses included independent t-tests, one-way ANOVAs, correlation analyses, and hierarchical multiple regression. RESULTS A total of 370 participants were included. Atypical PVT and SVT performance were associated with poorer cognitive test performance and higher emotional symptom report, irrespective of TBI severity. PVTs and SVTs had an additive effect on cognitive test performance for uncomplicated mTBI, but less so for more severe TBI. The relationship between emotional symptoms and cognitive test performance diminished substantially when validity test performance was controlled, and validity test performance had a substantially larger impact than emotional symptoms on cognitive test performance. CONCLUSION Validity test performance has a significant impact on the neuropsychological profiles of people with TBI, irrespective of TBI severity, and plays a significant role in the relationship between emotional symptoms and cognitive test performance. Adequate validity testing should be incorporated into every neuropsychological assessment, and associations between emotional symptoms and cognitive outcomes that do not consider validity testing should be interpreted with extreme caution.
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Affiliation(s)
- Daniel Uiterwijk
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Robyn Stargatt
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Simon F Crowe
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
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4
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The Relationship Between Cognitive Functioning and Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder in Adults with a Traumatic Brain Injury: a Meta-Analysis. Neuropsychol Rev 2021; 32:758-806. [PMID: 34694543 DOI: 10.1007/s11065-021-09524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.
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5
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Relations Among Performance and Symptom Validity, Mild Traumatic Brain Injury, and Posttraumatic Stress Disorder Symptom Burden in Postdeployment Veterans. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09415-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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6
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EMDR Treatment for Persistent Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Case Study. JOURNAL OF EMDR PRACTICE AND RESEARCH 2021. [DOI: 10.1891/emdr-d-21-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The majority of people who experience mild traumatic brain injury (mTBI) have a healthy recovery, where initial somatic, cognitive, psychological, and behavioral mTBI-related symptoms resolve naturally within hours or days. Unfortunately, a significant minority of people develop persistent post-concussion symptoms, sometimes referred to as persistent post-concussion syndrome (pPCS), often causing severe long-term reduction in well-being and daily function. Psychological and neuropsychological treatments are typically limited to antidepressants, psychoeducation on mTBI and pPCS, basic neurorehabilitative cognitive compensatory strategies, traditional cognitive behavioral therapy, or no treatment at all. This paper discusses a single case study which demonstrates how eye movement desensitization and reprocessing (EMDR) therapy might provide psychological improvement in clients who sustain mTBI and develop pPCS. The case example describes a 57-year-old man who sustained a mTBI from a serious road traffic collision as a pedestrian and who developed pPCS. Treatment included nine 1.5-hour EMDR sessions across a 5-month period (the first being an assessment). Measures of psychological symptom change and client feedback were taken at pretreatment, midtreatment, posttreatment, and aftertreatment had ceased to gauge long-term status. Measures were taken at 18-month follow-up and 4-year review (which followed litigation settlement). The novel viability for the application of EMDR for this client group isdiscussed.
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7
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Panayiotou A, Crowe S, Jackson M. An Analogue Study of the Psychological and Psychosocial Processes Associated With Post‐concussion Symptoms. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2010.00018.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Simon Crowe
- School of Psychological Science, La Trobe University
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8
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MacMullin P, Hodgson N, Damar U, Lee HHC, Hameed MQ, Dhamne SC, Hyde D, Conley GM, Morriss N, Qiu J, Mannix R, Hensch TK, Rotenberg A. Increase in Seizure Susceptibility After Repetitive Concussion Results from Oxidative Stress, Parvalbumin-Positive Interneuron Dysfunction and Biphasic Increases in Glutamate/GABA Ratio. Cereb Cortex 2020; 30:6108-6120. [PMID: 32676666 DOI: 10.1093/cercor/bhaa157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic symptoms indicating excess cortical excitability follow mild traumatic brain injury, particularly repetitive mild traumatic brain injury (rmTBI). Yet mechanisms underlying post-traumatic excitation/inhibition (E/I) ratio abnormalities may differ between the early and late post-traumatic phases. We therefore measured seizure threshold and cortical gamma-aminobutyric acid (GABA) and glutamate (Glu) concentrations, 1 and 6 weeks after rmTBI in mice. We also analyzed the structure of parvalbumin-positive interneurons (PVIs), their perineuronal nets (PNNs), and their electroencephalography (EEG) signature (gamma frequency band power). For mechanistic insight, we measured cortical oxidative stress, reflected in the reduced/oxidized glutathione (GSH/GSSG) ratio. We found that seizure susceptibility increased both early and late after rmTBI. However, whereas increased Glu dominated the E/I 1 week after rmTBI, Glu concentration normalized and the E/I was instead characterized by depressed GABA, reduced per-PVI parvalbumin expression, and reduced gamma EEG power at the 6-week post-rmTBI time point. Oxidative stress was increased early after rmTBI, where transient PNN degradation was noted, and progressed throughout the monitoring period. We conclude that GSH depletion, perhaps triggered by early Glu-mediated excitotoxicity, leads to late post-rmTBI loss of PVI-dependent cortical inhibitory tone. We thus propose dampening of Glu signaling, maintenance of redox state, and preservation of PVI inhibitory capacity as therapeutic targets for post-rmTBI treatment.
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Affiliation(s)
| | | | - Ugur Damar
- F.M. Kirby Neurobiology Center, Department of Neurology
| | | | - Mustafa Q Hameed
- F.M. Kirby Neurobiology Center, Department of Neurology.,Department of Neurosurgery
| | | | - Damon Hyde
- F.M. Kirby Neurobiology Center, Department of Neurology
| | - Grace M Conley
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nicholas Morriss
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jianhua Qiu
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Rebekah Mannix
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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9
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Calvillo M, Irimia A. Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury. Front Psychol 2020; 11:1423. [PMID: 32733322 PMCID: PMC7358255 DOI: 10.3389/fpsyg.2020.01423] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) can be serious partly due to the challenges of assessing and treating its neurocognitive and affective sequelae. The effects of a single TBI may persist for years and can limit patients’ activities due to somatic complaints (headaches, vertigo, sleep disturbances, nausea, light or sound sensitivity), affective sequelae (post-traumatic depressive symptoms, anxiety, irritability, emotional instability) and mild cognitive impairment (MCI, including social cognition disturbances, attention deficits, information processing speed decreases, memory degradation and executive dysfunction). Despite a growing amount of research, study comparison and knowledge synthesis in this field are problematic due to TBI heterogeneity and factors like injury mechanism, age at or time since injury. The relative lack of standardization in neuropsychological assessment strategies for quantifying sequelae adds to these challenges, and the proper administration of neuropsychological testing relative to the relationship between TBI, MCI and neuroimaging has not been reviewed satisfactorily. Social cognition impairments after TBI (e.g., disturbed emotion recognition, theory of mind impairment, altered self-awareness) and their neuroimaging correlates have not been explored thoroughly. This review consolidates recent findings on the cognitive and affective consequences of TBI in relation to neuropsychological testing strategies, to neurobiological and neuroimaging correlates, and to patient age at and assessment time after injury. All cognitive domains recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are reviewed, including social cognition, complex attention, learning and memory, executive function, language and perceptual-motor function. Affect and effort are additionally discussed owing to their relationships to cognition and to their potentially confounding effects. Our findings highlight non-negligible cognitive and affective impairments following TBI, their gravity often increasing with injury severity. Future research should study (A) language, executive and perceptual-motor function (whose evolution post-TBI remains under-explored), (B) the effects of age at and time since injury, and (C) cognitive impairment severity as a function of injury severity. Such efforts should aim to develop and standardize batteries for cognitive subdomains—rather than only domains—with high ecological validity. Additionally, they should utilize multivariate techniques like factor analysis and related methods to clarify which cognitive subdomains or components are indeed measured by standardized tests.
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Affiliation(s)
- Maria Calvillo
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States.,Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
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10
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Nelson NW, Disner SG, Anderson CR, Doane BM, McGuire K, Lamberty GJ, Hoelzle J, Sponheim SR. Blast concussion and posttraumatic stress as predictors of postcombat neuropsychological functioning in OEF/OIF/OND veterans. Neuropsychology 2020; 34:116-126. [PMID: 31545626 PMCID: PMC6940504 DOI: 10.1037/neu0000594] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Many combat veterans exhibit cognitive limitations of uncertain origin. In this study, we examined factors that predict cognitive functioning by considering effects of blast-related concussion (BRC), non-blast-related concussion (NBRC), and posttraumatic stress disorder (PTSD) symptoms. Analyses specifically tested whether (a) BRC and NBRC were distinct in their prediction of cognitive performance; (b) a dose-response relationship existed between recurrent concussion (BRC and NBRC) and cognitive impairment; and (c) PTSD symptoms mediated the relationship between BRC and cognitive performance. METHOD Two hundred eighty veterans with combat zone deployment histories completed semistructured clinical interviews to define BRC and NBRC histories, current and past mental health disorders, and dimensional ratings of PTSD symptomatology. Participants were also administered a number of neuropsychological measures to appraise cognitive functioning. RESULTS A structural equation model (SEM) suggested that BRC and NBRC were not distinct in their prediction of cognitive performance, and there was no evidence that recurrent concussion (blast or nonblast) was directly associated with cognitive performance. BRC was significantly associated with PTSD symptoms (r = .24), PTSD symptoms were significantly associated with cognitive performance in the SEM (r = -.27), and PTSD symptoms significantly mediated the link between BRC and cognitive performance (p = .03). CONCLUSIONS These results suggest that concussion history fails to directly contribute to cognitive performance, regardless of mechanism (blast or nonblast) and recurrence. BRC is nonetheless unique in its contribution to PTSD and PTSD-related cognitive deficits. Results support interventions specific to PTSD management in the interest of promoting neuropsychological functioning among war veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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11
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Tsatsakis A, Tsoukalas D, Fragkiadaki P, Vakonaki E, Tzatzarakis M, Sarandi E, Nikitovic D, Tsilimidos G, Alegakis AK. Developing BIOTEL: A Semi-Automated Spreadsheet for Estimating Telomere Length and Biological Age. Front Genet 2019; 10:84. [PMID: 30838025 PMCID: PMC6389611 DOI: 10.3389/fgene.2019.00084] [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] [Received: 10/22/2018] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telomere length (TL) is causally related to aging and several age-related diseases. Specifically, the abundance of short telomeres and the rate of telomere shortening are strong determinants of cell homeostasis. Thus, tools for analyzing and manipulating TL data can vastly improve research focused on aging. Aim: In this study, we developed a semi-automated worksheet, BIOTEL, to generate individual and group TL statistics and provide a crude estimation of biological age. Results: Data from the Telomere Length Database Project (TLDP) were implemented to the spreadsheet to produce TL statistics. 150 participants were included, and their age was from 21 to 82 years, and the sex distribution ratio was 52.3%: 47.7% (male: female). Initially, we analyzed the fluorescence intensities of telomeres that were measured on metaphase spread leukocytes using three-dimensional (3D) quantitative-fluorescent in situ hybridization (Q-FISH) procedures (3D DNA FISH) with a (C3TA2)3 peptide nucleic acid (PNA) probe. Raw data of fluorescence intensities, demographic data and medical records from the participants were imported into the worksheet. Basic statistical analyses of TL data were provided through BIOTEL, including TL percentiles, specialized charts for TL distribution including the percentage of critically short telomeres (< 3,000 kilobases), individual telomere profiles, and graphs of biological age vs. chronological age. Conclusion: BIOTEL ver. 2.4 is a functional semi-automated worksheet that calculates a wide range of TL statistics, thus a useful tool with applications in research of telomeres and biological age estimation.
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Affiliation(s)
- Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, Heraklion, Greece
| | - Dimitrios Tsoukalas
- Laboratory of Toxicology, Medical School, University of Crete, Heraklion, Greece.,Metabolomic Medicine, Health Clinics for Autoimmune and Chronic Diseases, Athens, Greece
| | | | - Elena Vakonaki
- Laboratory of Toxicology, Medical School, University of Crete, Heraklion, Greece
| | - Manolis Tzatzarakis
- Laboratory of Toxicology, Medical School, University of Crete, Heraklion, Greece
| | - Evangelia Sarandi
- Laboratory of Toxicology, Medical School, University of Crete, Heraklion, Greece.,Metabolomic Medicine, Health Clinics for Autoimmune and Chronic Diseases, Athens, Greece
| | - Dragana Nikitovic
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, Heraklion, Greece
| | - Gerasimos Tsilimidos
- Metabolomic Medicine, Health Clinics for Autoimmune and Chronic Diseases, Athens, Greece
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12
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Grandhi R, Tavakoli S, Ortega C, Simmonds MJ. A Review of Chronic Pain and Cognitive, Mood, and Motor Dysfunction Following Mild Traumatic Brain Injury: Complex, Comorbid, and/or Overlapping Conditions? Brain Sci 2017; 7:brainsci7120160. [PMID: 29211026 PMCID: PMC5742763 DOI: 10.3390/brainsci7120160] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/25/2017] [Accepted: 12/02/2017] [Indexed: 11/29/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is commonly encountered in clinical practice. While the cognitive ramifications of mTBI are frequently described in the literature, the impact of mTBI on emotional, sensory, and motor function is not as commonly discussed. Chronic pain is a phenomenon more prevalent among patients with mTBI compared to those with moderate or severe traumatic brain injury. Chronic pain can become a primary disorder of the central nervous system (CNS) expressed as widespread pain, and cognitive, mood, and movement dysfunction. Shared mechanisms across chronic pain conditions can account for how pain is generated and maintained in the CNS, irrespective of the underlying structural pathology. Herein, we review the impact of mTBI on cognitive, emotional, sensory, and motor domains, and the role of pain as an important confounding variable in patient recovery and dysfunction following mTBI.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurosurgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX 78229-3900, USA.
| | - Samon Tavakoli
- Department of Neurosurgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX 78229-3900, USA.
| | - Catherine Ortega
- Department of Physical Therapy, University of Texas Health San Antonio, San Antonio, TX 78229, USA.
| | - Maureen J Simmonds
- Department of Physical Therapy, University of Texas Health San Antonio, San Antonio, TX 78229, USA.
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13
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Elliott TR, Hsiao YY, Kimbrel NA, Meyer E, DeBeer BB, Gulliver SB, Kwok OM, Morissette SB. Resilience and Traumatic Brain Injury Among Iraq/Afghanistan War Veterans: Differential Patterns of Adjustment and Quality of Life. J Clin Psychol 2016; 73:1160-1178. [PMID: 27922725 DOI: 10.1002/jclp.22414] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/28/2016] [Accepted: 10/05/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined the degree to which a resilient personality prototype predicted adjustment among war Veterans with and without a traumatic brain injury (TBI) while covarying the level of combat exposure. METHOD A total of 127 war Veterans (107 men, 20 women; average age = 37 years) participated. Personality prototypes were derived from the Multidimensional Personality Questionnaire (Patrick, Curtain, & Tellegen, 2002). Measures were administered at baseline, and a subset was administered at 4- and 8-month follow-ups. RESULTS Veterans with resilient personalities reported less sleep disturbance, more health-promoting behaviors, psychological flexibility, and emotional distress tolerance than Veterans with undercontrolled or overcontrolled prototypes. Path models revealed that resilience significantly predicted posttraumatic stress disorder (PTSD), depression, quality of life, and social support over time. TBI had unique and consistent effects only on PTSD. CONCLUSION Personality characteristics influence distress and quality of life among war Veterans with and without TBI. Implications for assessment, interventions, and research are discussed.
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Affiliation(s)
| | | | - Nathan A Kimbrel
- Durham Veterans Affairs Medical Center.,VA Mid-Atlantic Mental Illness Research, Education Clinical Center.,Duke University Medical Center
| | - Eric Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System.,Texas A&M University Health Science Center
| | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System.,Texas A&M University Health Science Center
| | - Suzy Bird Gulliver
- Texas A&M University Health Science Center.,Warrior Research Institute at Baylor Scott & White Health
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14
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Zaninotto AL, Vicentini JE, Fregni F, Rodrigues PA, Botelho C, de Lucia MCS, Paiva WS. Updates and Current Perspectives of Psychiatric Assessments after Traumatic Brain Injury: A Systematic Review. Front Psychiatry 2016; 7:95. [PMID: 27378949 PMCID: PMC4906018 DOI: 10.3389/fpsyt.2016.00095] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/19/2016] [Indexed: 01/06/2023] Open
Abstract
Neuropsychological and psychiatric disorders represent a major concern and cause of disabilities after the trauma, contributing to worse recovery after traumatic brain injury (TBI). However, the lack of well-defined parameters to evaluate patient's psychiatric disorders leads to a wide range of diagnoses and symptoms. The aim of this study was to perform a review of literature in order to gather data of the most common scales and inventories used to assess and diagnose depression, anxiety, and posttraumatic stress disorder (PTSD) after TBI. We conducted a literature search via MEDLINE, PubMed, and Web of Science. We included reviews, systematic reviews, and meta-analysis studies, and we used the following keywords: "traumatic brain injury OR TBI," "depression OR depressive disorder," "anxiety," and "posttraumatic stress disorder OR PTSD." From 610 titles, a total of 68 systematic reviews or meta-analysis were included in the section "Results" of this review: depression (n = 32), anxiety (n = 9), and PTSD (n = 27). Depression after TBI is a more established condition, with more homogeneous studies. Anxiety and PTSD disorders have been studied in a heterogeneous way, usually as comorbidity with other psychiatric disorders. Some scales and inventories designed for the general community may not be appropriate for patients with TBI.
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Affiliation(s)
- Ana Luiza Zaninotto
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | - Jessica Elias Vicentini
- Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
| | | | - Cibele Botelho
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | | | - Wellingson Silva Paiva
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
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Chiang CC, Guo SE, Huang KC, Lee BO, Fan JY. Trajectories and associated factors of quality of life, global outcome, and post-concussion symptoms in the first year following mild traumatic brain injury. Qual Life Res 2015; 25:2009-19. [PMID: 26706751 DOI: 10.1007/s11136-015-1215-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI). METHODS This was a prospective longitudinal study of 100 participants with mTBI from neurosurgical outpatient departments in Chiayi County District Hospitals in Taiwan. The checklist of post-concussion syndromes (CPCS) was used to assess PCS at enrollment and at 1, 3, and 12 months after mTBI; the glasgow outcome scale extended (GOSE), the quality of life after brain injured (QOLIBRI), Chinese version, and the Short Form 36 Health Survey (SF-36), Taiwan version, were used to assess mTBI global outcome and QoL at 1, 3, and 12 months after mTBI. RESULTS Latent class growth models (LCGMs) indicated the change trajectories of QOLIBRI, PCS SF-36, MCS SF-36, GOSE, and PCS. Classes of trajectory were associated with age ≥40 years, unemployment at 1 month after injury, and educational level ≤12 years. Univariate analysis revealed that employment status at 1 month post-injury was correlated with the trajectories of QOLIBRI, PCS SF-36, MCS SF-36, and GOSE, but not PCS. CONCLUSIONS Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI.
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Affiliation(s)
- Chia-Chen Chiang
- Department of Nursing, Ministry of Health and Welfare Sinying Hospital, Tainan, Taiwan
| | - Su-Er Guo
- Department of Nursing and Graduate Institute of Nursing, Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Kuo-Chang Huang
- Section of Neurosurgery, Department of Surgery, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Bih-O Lee
- Department of Nursing and Graduate Institute of Nursing, Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Jun-Yu Fan
- Department of Nursing and Graduate Institute of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Road, Kwei-Shan, Taoyuan, 333-03, Taiwan.
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A Meta-Analytic Review of Minnesota Multiphasic Personality Inventory—2nd Edition (MMPI-2) Profile Elevations Following Traumatic Brain Injury. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9236-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Preinjury coping, emotional functioning, and quality of life following uncomplicated and complicated mild traumatic brain injury. J Head Trauma Rehabil 2015; 29:407-17. [PMID: 23535388 DOI: 10.1097/htr.0b013e31828654b4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify preinjury coping profiles among adults with uncomplicated mild traumatic brain injury (mTBI) and complicated mTBI and to determine whether preinjury coping profiles contribute to the prediction of emotional functioning and quality of life (QOL) 3 months post-mTBI. PARTICIPANTS One hundred eighty-seven persons with medically documented mTBI (uncomplicated mTBI, n = 89; complicated mTBI, n = 98) were recruited from the emergency center of a level I trauma center and followed in community 3 months post-mTBI. MEASURES The Ways of Coping Questionnaire was administered within 2 weeks of injury. Cluster analysis was used to group participants on basis of their preinjury use of problem-focused and avoidant coping strategies. The Brief Symptom Inventory and the 36-item Short-Form Health Survey were administered 3 months postinjury. RESULTS Cluster analysis distinguished 3 distinct preinjury coping profiles that were differentially associated with outcomes. Participants who used avoidant coping showed the worse emotional functioning and QOL outcomes, although this cluster also reported high usage of problem-focused strategies. Preinjury coping profiles explained a significant proportion of the variance in depression, anxiety, and mental health QOL at 3 months postinjury beyond that accounted for by demographic characteristics and mTBI severity. CONCLUSIONS Cluster analysis holds practical value in illustrating the pattern of coping strategies used by person with uncomplicated and complicated mTBI. It appears worthwhile to address coping in future trials of interventions that are aimed at improving emotional functioning after mTBI.
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Miskey HM, Shura RD, Yoash-Gantz RE, Rowland JA. Personality Assessment Inventory profiles of veterans: Differential effects of mild traumatic brain injury and psychopathology. Brain Imaging Behav 2015; 9:461-71. [PMID: 25913646 DOI: 10.1007/s11682-015-9391-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neuropsychiatric complaints often accompany mild traumatic brain injury (mTBI), a common condition in post-deployed Veterans. Self-report, multi-scale personality inventories may elucidate the pattern of psychiatric distress in this cohort. This study investigated valid Personality Assessment Inventory (PAI) profiles in post-deployed Veterans. METHOD Measures of psychopathology and mTBI were examined in a sample of 144 post-deployed Veterans divided into groups: healthy controls (n = 40), mTBI only (n = 31), any mental health diagnosis only (MH; n = 25), comorbid mTBI and Posttraumatic Stress Disorder (mTBI/PTSD; n = 23), and comorbid mTBI, PTSD, and other psychological diagnoses (mTBI/PTSD/MDD+; n = 25). RESULTS There were no significant differences between the mTBI and the control group on mean PAI subscale elevation, or number of subscale elevations above 60T or 70T. The other three groups had significantly higher overall mean scores, and more elevations above 60 and 70T compared to both controls and mTBI only. The mTBI/PTSD/MDD+ group showed the highest and most elevations. After entering demographics, PTSD, and number of other psychological diagnoses into hierarchical regressions using the entire sample, mTBI history did not predict mean PAI subscale score or number of elevations above 60T or 70T. PTSD was the only significant predictor. There were no interaction effects between mTBI and presence of PTSD, or between mTBI and total number of diagnoses. CONCLUSIONS This study suggests that mTBI alone is not uniquely related to psychiatric distress in Veterans, but that PTSD accounts for self-reported symptom distress.
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Affiliation(s)
- Holly M Miskey
- Mental Health & Behavioral Sciences Service Line, W.G. (Bill) Hefner Veteran's Affairs Medical Center, 11-M2/MH&BS, 1601 Brenner Ave, Salisbury, NC, 28144, USA.
- Mid-Atlantic Mental Illness Research Education and Clinical Centers (MIRECC), Durham, NC, USA.
| | - Robert D Shura
- Mental Health & Behavioral Sciences Service Line, W.G. (Bill) Hefner Veteran's Affairs Medical Center, 11-M2/MH&BS, 1601 Brenner Ave, Salisbury, NC, 28144, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Centers (MIRECC), Durham, NC, USA
| | - Ruth E Yoash-Gantz
- Mental Health & Behavioral Sciences Service Line, W.G. (Bill) Hefner Veteran's Affairs Medical Center, 11-M2/MH&BS, 1601 Brenner Ave, Salisbury, NC, 28144, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Centers (MIRECC), Durham, NC, USA
| | - Jared A Rowland
- Mid-Atlantic Mental Illness Research Education and Clinical Centers (MIRECC), Durham, NC, USA
- Research and Education Service Line, W. G. (Bill) Hefner VA Medical Center, Salisbury, NC, USA
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Nelson NW, Anderson CR, Thuras P, Kehle-Forbes SM, Arbisi PA, Erbes CR, Polusny MA. Factors associated with inconsistency in self-reported mild traumatic brain injury over time among military personnel in Iraq. Br J Psychiatry 2015; 206:237-44. [PMID: 25614533 DOI: 10.1192/bjp.bp.114.149096] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Estimates of the prevalence of mild traumatic brain injury (mTBI) among military personnel and combat veterans rely almost exclusively on retrospective self-reports; however, reliability of these reports has received little attention. AIMS To examine the consistency of reporting of mTBI over time and identify factors associated with inconsistent reporting. METHOD A longitudinal cohort of 948 US National Guard Soldiers deployed to Iraq completed self-report questionnaire screening for mTBI and psychological symptoms while in-theatre 1 month before returning home (time 1, T1) and 1 year later (time 2, T2). RESULTS Most respondents (n = 811, 85.5%) were consistent in their reporting of mTBI across time. Among those who were inconsistent in their reports (n = 137, 14.5%), the majority denied mTBI at T1 and affirmed mTBI at T2 (n = 123, 89.8%). Respondents rarely endorsed mTBI in-theatre and later denied mTBI (n = 14, 10.2% of those with inconsistent reports). Post-deployment post-traumatic stress symptoms and non-specific physical complaints were significantly associated with inconsistent report of mTBI. CONCLUSIONS Military service members' self-reports of mTBI are generally consistent over time; however, inconsistency in retrospective self-reporting of mTBI status is associated with current post-traumatic stress symptoms and non-specific physical health complaints.
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Affiliation(s)
- Nathaniel W Nelson
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Carolyn R Anderson
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Paul Thuras
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Shannon M Kehle-Forbes
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Paul A Arbisi
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Christopher R Erbes
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
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Snell DL, Surgenor LJ, Hay-Smith EJC, Williman J, Siegert RJ. The contribution of psychological factors to recovery after mild traumatic brain injury: Is cluster analysis a useful approach? Brain Inj 2014; 29:291-9. [DOI: 10.3109/02699052.2014.976594] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PRIMARY OBJECTIVES This study examined the potential emotional sequelae following self-reported mild head injury (MHI; e.g. 'altered state of consciousness' [ASC]) in university students with a particular focus on arousal status and responsivity to experimental manipulation of arousal. RESEARCH DESIGN A quasi-experimental design (n = 91) was used to examine arousal status (self-reported and physiological indices) and response to manipulated arousal (i.e. induced psychosocial stress/activation; reduced activation/relaxation) between persons who acknowledged prior MHI and persons with no-MHI. MAIN OUTCOME AND RESULTS University students who self-reported MHI were physiologically under-aroused and less responsive to stressors (both laboratory and environmental) compared to their no-MHI cohort. Those with reported loss of consciousness demonstrated the most attenuated emotional arousal responses (i.e. flattened electrodermal responsivity) relative to those with only a reported ASC, followed by those with no-MHI. CONCLUSIONS The under-arousal in traumatic brain injury has been hypothesized to be associated with ventromedial prefrontal cortex disruption. This under-arousal may be mirrored in persons who self-report experiencing subtle head trauma. Students who reported MHI may be less able to physiologically respond and/or cognitively appraise stressful experiences as compared to their no-MHI cohort; and experience subtle persistent consequences despite the subtle nature of the reported head trauma.
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Affiliation(s)
- Julie M Baker
- Neuropsychology Cognitive Research Laboratory, Department of Psychology and
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22
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Affiliation(s)
- Emilie Godwin
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University
Richmond, VAUSA
| | - Brittney Chappell
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University
Richmond, VAUSA
| | - Jeffrey Kreutzer
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University
Richmond, VAUSA
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Athletes' age, sex, and years of education moderate the acute neuropsychological impact of sports-related concussion: a meta-analysis. J Int Neuropsychol Soc 2014; 20:64-80. [PMID: 23375058 DOI: 10.1017/s1355617712001464] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The objective of this study is to determine which pre-existing athlete characteristics, if any, are associated with greater deficits in functioning following sports-related concussion, after controlling for factors previously shown to moderate this effect (e.g., time since injury). Ninety-one independent samples of concussion were included in a fixed+systematic effects meta-analysis (n = 3,801 concussed athletes; 5,631 controls). Moderating variables were assessed using analogue-to-ANOVA and meta-regression analyses. Post-injury assessments first conducted 1-10 days following sports-related concussion revealed significant neuropsychological dysfunction, postural instability and post-concussion symptom reporting (d = -0.54, -1.10, and -1.14, respectively). During this interval, females (d = -0.87), adolescent athletes competing in high school competitions (d = -0.60), and those with 10 years of education (d = -1.32) demonstrated larger post-concussion neuropsychological deficits than males (d = -0.42), adults (d = -0.25), athletes competing at other levels of competition (d = -0.43 to -0.41), or those with 16 years of education (d = -0.15), respectively. However, these sub-groups' differential impairment/recovery beyond 10 days could not be reliably quantified from available literature. Pre-existing athlete characteristics, particularly age, sex and education, were demonstrated to be significant modifiers of neuropsychological outcomes within 10 days of a sports-related concussion. Implications for return-to-play decision-making and future research directions are discussed.
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Gfeller JD, Roskos PT. A comparison of insufficient effort rates, neuropsychological functioning, and neuropsychiatric symptom reporting in military veterans and civilians with chronic traumatic brain injury. BEHAVIORAL SCIENCES & THE LAW 2013; 31:833-849. [PMID: 24123226 DOI: 10.1002/bsl.2084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Abstract
Neuropsychological evaluation of persons with chronic traumatic brain injury (TBI) symptoms is complicated by multiple factors. The authors explored the impact of mechanism of injury, effort testing performance, and neuropsychiatric status in a sample of military veterans (V-TBI) and civilians (C-TBI) with chronic TBI. V-TBI (n = 74), C-TBI (n = 67), and healthy civilian control (C-HC) participants (n = 66), completed a battery of neuropsychological, effort, and self-report neuropsychiatric measures. Results indicated that C-HC and C-TBI participants exhibited comparably low failure rates on effort tests (6% and 3%, respectively). V-TBI participants exhibited significantly higher rates of failure (18%). Subgroups (n = 20) of effort-screened participants matched for demographics and disability level were compared regarding neuropsychological performance and neuropsychiatric self-report. Both TBI groups exhibited limited neuropsychological impairment, relative to the C-HC participants. The V-TBI group exhibited pronounced neuropsychiatric symptomology compared with the other participant groups. The implications of these findings are discussed for evaluation in the context of disability and litigation.
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Affiliation(s)
- Jeffrey D Gfeller
- Department of Psychology and Department of Neurosurgery, Saint Louis University
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25
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Sweet JJ, Goldman DJ, Guidotti Breting LM. Traumatic brain injury: guidance in a forensic context from outcome, dose-response, and response bias research. BEHAVIORAL SCIENCES & THE LAW 2013; 31:756-778. [PMID: 24019125 DOI: 10.1002/bsl.2088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/26/2013] [Accepted: 07/31/2013] [Indexed: 06/02/2023]
Abstract
Traumatic brain injury (TBI) occurs at a high incidence, involving millions of individuals in the U.S. alone. Related to this, there are large numbers of litigants and claimants who are referred annually for forensic evaluation. In formulating opinions regarding claimed injuries, the present review advises experts to rely on two sets of information: TBI outcome and neuropsychological dose-response studies of non-litigants and non-claimants, and response bias literature that has demonstrated the relatively high risk of invalid responding among examinees referred within a secondary gain context, which in turn has resulted in the development of specific assessment methods. Regarding prospective methods for detecting possible response bias, both symptom validity tests, for measuring over-reporting of symptoms on inventories and questionnaires, and performance validity tests, for measuring insufficient effort on ability tests, are considered essential.
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Affiliation(s)
- Jerry J Sweet
- University of Chicago, Pritzker School of Medicine, Chicago, IL; NorthShore University HealthSystem, Evanston, IL
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26
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Larrabee GJ, Rohling ML. Neuropsychological differential diagnosis of mild traumatic brain injury. BEHAVIORAL SCIENCES & THE LAW 2013; 31:686-701. [PMID: 24105915 DOI: 10.1002/bsl.2087] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Abstract
The diagnosis and evaluation of mild traumatic brain injury (mTBI) is reviewed from the perspective of meta-analyses of neuropsychological outcome, showing full recovery from a single, uncomplicated mTBI by 90 days post-trauma. Persons with history of complicated mTBI characterized by day-of-injury computed tomography or magnetic resonance imaging abnormalities, and those who have suffered prior mTBIs may or may not show evidence of complete recovery similar to that experienced by persons suffering a single, uncomplicated mTBI. Persistent post-concussion syndrome (PCS) is considered as a somatoform presentation, influenced by the non-specificity of PCS symptoms which commonly occur in non-TBI samples and co-vary as a function of general life stress, and psychological factors including symptom expectation, depression and anxiety. A model is presented for forensic evaluation of the individual mTBI case, which involves open-ended interview, followed by structured interview, record review, and detailed neuropsychological testing. Differential diagnosis includes consideration of other neurologic and psychiatric disorders, symptom expectation, diagnosis threat, developmental disorders, and malingering.
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Affiliation(s)
- Glenn J Larrabee
- Independent Practice, 2650 Bahia Vista Street, Suite 308, Sarasota, FL, 34239, U.S.A
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27
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Snell DL, Hay-Smith EJC, Surgenor LJ, Siegert RJ. Examination of outcome after mild traumatic brain injury: The contribution of injury beliefs and Leventhal's Common Sense Model. Neuropsychol Rehabil 2013; 23:333-62. [DOI: 10.1080/09658211.2012.758419] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Larrabee GJ, Binder LM, Rohling ML, Ploetz DM. Meta-analytic methods and the importance of non-TBI factors related to outcome in mild traumatic brain injury: response to Bigler et al. (2013). Clin Neuropsychol 2013; 27:215-37. [PMID: 23414416 DOI: 10.1080/13854046.2013.769634] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bigler et al. (2013, The Clinical Neuropsychologist) contend that weak methodology and poor quality of the studies comprising our recent meta-analysis led us to miss detecting a subgroup of mild traumatic brain injury (mTBI) characterized by persisting symptomatic complaint and positive biomarkers for neurological damage. Our computation of non-significant Q, tau(2), and I(2) statistics contradicts the existence of a subgroup of mTBI with poor outcome, or variation in effect size as a function of quality of research design. Consistent with this conclusion, the largest single contributor to our meta-analysis, Dikmen, Machamer, Winn, and Temkin (1995, Neuropsychology, 9, 80) yielded an effect size, -0.02, that was smaller than our overall effect size of -0.07 despite using the most liberal definition of mTBI: loss of consciousness less than 1 hour, with no exclusion of subjects who had positive CT scans. The evidence is weak for biomarkers of mTBI, such as diffusion tensor imaging and for demonstrable neuropathology in uncomplicated mTBI. Postconcussive symptoms, and reduced neuropsychological test scores are not specific to mTBI but can result from pre-existing psychosocial and psychiatric problems, expectancy effects and diagnosis threat. Moreover, neuropsychological impairment is seen in a variety of primary psychiatric disorders, which themselves are predictive of persistent complaints following mTBI. We urge use of prospective studies with orthopedic trauma controls in future investigations of mTBI to control for these confounding factors.
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Daneshvar DH, Riley DO, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Long-term consequences: effects on normal development profile after concussion. Phys Med Rehabil Clin N Am 2011; 22:683-700, ix. [PMID: 22050943 DOI: 10.1016/j.pmr.2011.08.009] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Each year in the United States, approximately 1.7 million people are diagnosed with a traumatic brain injury (TBI), about 75% of which are classified as mild TBIs or concussions. Although symptoms typically resolve in a matter of weeks, both children and adults may suffer from postconcussion syndrome for months or longer. A progressive tauopathy, chronic traumatic encephalopathy, is believed to stem from repeated brain trauma. Alzheimer-like dementia, Parkinsonism, and motor neuron disease are also associated with repetitive brain trauma. Effective diagnoses, treatments, and education plans are required to reduce the future burden and incidence of long-term effects of head injuries.
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Affiliation(s)
- Daniel H Daneshvar
- Department of Neurology, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston 02118, MA, USA.
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30
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Current world literature. Curr Opin Anaesthesiol 2011; 24:224-33. [PMID: 21386670 DOI: 10.1097/aco.0b013e32834585d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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