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Howe EI, Andelic N, Brunborg C, Zeldovich M, Helseth E, Skandsen T, Olsen A, Fure SCR, Theadom A, Rauen K, Madsen BÅ, Jacobs B, van der Naalt J, Tartaglia MC, Einarsen CE, Storvig G, Tronvik E, Tverdal C, von Steinbüchel N, Røe C, Hellstrøm T. Frequency and predictors of headache in the first 12 months after traumatic brain injury: results from CENTER-TBI. J Headache Pain 2024; 25:44. [PMID: 38528477 DOI: 10.1186/s10194-024-01751-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury. METHODS A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors. RESULTS A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury. CONCLUSIONS Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache. TRIAL REGISTRATION ClinicalTrials.gov NCT02210221.
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Affiliation(s)
- Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Marina Zeldovich
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
| | - Alexander Olsen
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silje C R Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Alice Theadom
- TBI Network, Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Katrin Rauen
- Neurological Rehabilitation Center Godeshöhe, Bonn, Germany
- Department of Traumatology & Department of Psychiatry, Psychotherapy, and Psychosomatics, Neuroscience Center Zurich, University of Zurich, University Hospital Zurich, Zürich, Switzerland
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Benedikte Å Madsen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- Canadian Concussion Centre, Krembil Brain Institute, Toronto, ON, Canada
- Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Cathrine Elisabeth Einarsen
- Department of Neuromedicine and Movement Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gøril Storvig
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Tronvik
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neurology, St. Olav University Hospital, Trondheim, Norway
| | - Cathrine Tverdal
- Department of Neurosurgery, Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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Theadom A, Jones K, Starkey N, Barker-Collo S, Ameratunga S, Faulkner J, Ao BT, Feigin V. Symptoms and Engagement in Anti-social Behavior 10 Years After Mild Traumatic Brain Injury Within a Community Civilian Sample: A Prospective Cohort Study With Age-Sex Matched Control Group. Arch Phys Med Rehabil 2024; 105:295-302. [PMID: 37558153 DOI: 10.1016/j.apmr.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To determine if there are longer-term effects on symptoms, health status, mood, and behavior 10 years after a mild traumatic brain injury (mTBI). DESIGN Prospective cohort study. SETTING Community-based, civilian sample. PARTICIPANTS Adults aged ≥16 years at follow-up who experienced an mTBI 10 years ago, and an age and sex-matched non-injured control group. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES mTBI cases and controls were asked to complete self-report assessments of functioning (WHO Disability Assessment Schedule Version 2), symptoms (Rivermead Post-Concussion Symptom Questionnaire), health status (100-point scale), alcohol (Alcohol Use Disorders Identification Test) and substance use (Alcohol, Smoking and Substance Involvement Screening Test), and whether they had engaged in any anti-social behaviors over the past 12 months. RESULTS Data were analyzed for 368 participants (184 mTBI cases and 184 age-sex matched controls). Just over a third of mTBI cases (64, 34.8%) reported that they were still affected by their index mTBI 10 years later. After adjusting for education and ethnicity, the mTBI group had statistically higher overall symptom burden (F=22.32, P<.001, ηp2=0.07) compared with controls. This difference remained after excluding those who experienced a recurrent TBI. The mTBI group were more than 3 times as likely to have engaged in anti-social behavior during the previous 12 months (F=5.89, P=.02). There were no group differences in health status, functioning, or problematic alcohol or substance use 10 years post-injury. CONCLUSIONS This study provides evidence of potential longer-term associations between mTBI, post-concussion symptoms, and anti-social behavior which warrants further evaluation. Future research should also examine if longer-term effects may be preventable with access to early rehabilitation post-injury.
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Affiliation(s)
- Alice Theadom
- Traumatic Brain Injury Network, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand.
| | - Kelly Jones
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Starkey
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | | | - Shanthi Ameratunga
- Department of Epidemiology and Biostatistics, University of Auckland and Te Whatu Ora, Auckland, New Zealand
| | - Josh Faulkner
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Braden Te Ao
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
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Picon EL, Wardell V, Palombo DJ, Todd RM, Aziz B, Bedi S, Silverberg ND. Factors perpetuating functional cognitive symptoms after mild traumatic brain injury. J Clin Exp Neuropsychol 2023; 45:988-1002. [PMID: 37602857 DOI: 10.1080/13803395.2023.2247601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI. METHODS A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group. RESULTS Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group. CONCLUSIONS This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca M Todd
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bilal Aziz
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sanjana Bedi
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Cherup NP, Robayo LE, Vastano R, Fleming L, Levin BE, Widerström-Noga E. Neuropsychological Function in Traumatic Brain Injury and the Influence of Chronic Pain. Percept Mot Skills 2023; 130:1495-1523. [PMID: 37219529 DOI: 10.1177/00315125231174082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cognitive dysfunction, pain, and psychological morbidity all present unique challenges to those living with traumatic brain injury (TBI). In this study we examined (a) the impact of pain across domains of attention, memory, and executive function, and (b) the relationships between pain and depression, anxiety, and post-traumatic stress disorder (PTSD) in persons with chronic TBI. Our sample included 86 participants with a TBI and chronic pain (n = 26), patients with TBI and no chronic pain (n = 23), and a pain-free control group without TBI (n = 37). Participants visited the laboratory and completed a comprehensive battery of neuropsychological tests as part of a structured interview. Multivariate analysis of covariance using education as a covariate, failed to detect a significant group difference for neuropsychological composite scores of attention, memory, and executive function (p = .165). A follow-up analysis using multiple one-way analysis of variance (ANOVA) was conducted for individual measures of executive function. Post-hoc testing indicated that those in both TBI groups preformed significantly worse on measures of semantic fluency when compared to controls (p < 0.001, ηρ2 = .16). Additionally, multiple ANOVAs indicated that those with TBI and pain scored significantly worse across all psychological assessments (p < .001). We also found significant associations between measures of pain and most psychological symptoms. A follow-up stepwise linear regression among those in the TBI pain group indicated that post concussive complaints, pain severity, and neuropathic pain symptoms differentially contributed to symptoms of depression, anxiety, and PTSD. These findings suggest deficits in verbal fluency among those living with chronic TBI, with results also reinforcing the multidimensional nature of pain and its psychological significance in this population.
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Affiliation(s)
- Nicholas P Cherup
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Linda E Robayo
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Roberta Vastano
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Loriann Fleming
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Bonnie E Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva Widerström-Noga
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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Faulkner JW, Theadom A, Snell DL, Williams MN. Network analysis applied to post-concussion symptoms in two mild traumatic brain injury samples. Front Neurol 2023; 14:1226367. [PMID: 37545717 PMCID: PMC10398392 DOI: 10.3389/fneur.2023.1226367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Objective A latent disease explanation cannot exclusively explain post-concussion symptoms after mild traumatic brain injury (mTBI). Network analysis offers an alternative form of explanation for relationships between symptoms. The study aimed to apply network analysis to post-concussion symptoms in two different mTBI cohorts; an acute treatment-seeking sample and a sample 10 years post-mTBI. Method The treatment-seeking sample (n = 258) were on average 6 weeks post-injury; the 10 year post mTBI sample (n = 193) was derived from a population-based incidence and outcomes study (BIONIC). Network analysis was completed on post-concussion symptoms measured using the Rivermead Post-Concussion Questionnaire. Results In the treatment-seeking sample, frustration, blurred vision, and concentration difficulties were central to the network. These symptoms remained central in the 10 year post mTBI sample. A Network Comparison Test revealed evidence of a difference in network structure across the two samples (p = 0.045). However, the only symptoms that showed significant differences in strength centrality across samples were irritability and restlessness. Conclusion The current findings suggest that frustration, blurred vision and concentration difficulties may have an influential role in the experience and maintenance of post-concussion symptoms. The impact of these symptoms may remain stable over time. Targeting and prioritising the management of these symptoms may be beneficial for mTBI rehabilitation.
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Affiliation(s)
- Josh W. Faulkner
- Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
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Bødker RL, Marcussen M. Pilot study protocol of a randomized controlled trial for the potential effects of creatine monohydrate on persistent post-concussive symptoms. Front Neurol 2023; 14:1209548. [PMID: 37475743 PMCID: PMC10354866 DOI: 10.3389/fneur.2023.1209548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Mild traumatic brain injury or concussion is a global public concern, with an estimated annual incidence between 48 million and 96 million worldwide. It is a socioeconomical problem, and almost one-third of individuals with concussion suffer from severe persistent post-concussive symptoms (PPCS), with an increased risk of unemployment or terminating their studies. To date, no single treatment is available with guaranteed success. Creatine monohydrate (CrM) has shown potential as a treatment for post-concussive symptoms, having a positive impact on cognitive function, chronic fatigue, depression, and anxiety. The aim of this study is to examine the effect of CrM on PPCS assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Methods The study is designed as a double-blinded randomised controlled trial. Study participants are found through neurological outpatient clinics in Denmark or through social media. They will be between 25 and 35 years of age, will have suffered from PPCS for 6-12 months prior to inclusion, and will have no comorbidities. The participants will be randomly allocated to either an intervention group (INT), placebo group (PLA), or control group (CG). Baseline data will be collected immediately after inclusion, and the study period will be 7 weeks. Follow-up data will be collected 1 week after the end of the study period. The primary outcome of the study is changes in RPQ score. Changes in weight and training status will be adjusted for as potential confounders. Ethics and dissemination This protocol is approved by the National Committee on Health Research (97508) and by the Danish Data Protection Agency 11.651. The investigators intend to submit their study findings for publication in peer-reviewed journals and disseminate the findings via presentation at academic meetings/conferences.Clinical Trial registration: NCT05562232, registered September 30, 2022.
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Affiliation(s)
- Ronni Lykke Bødker
- Commotio Denmark, Køge, Denmark
- Department of Public Health, University of Southern, Odense, Denmark
| | - Michael Marcussen
- Department of Public Health, University of Southern, Odense, Denmark
- Research unit of Psychiatry, Region Zealand, Slagelse, Denmark
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Snell DL, Faulkner JW, Williman JA, Silverberg ND, Theadom A, Surgenor LJ, Hackney J, Siegert RJ. Fear avoidance and return to work after mild traumatic brain injury. Brain Inj 2023; 37:541-550. [PMID: 36856140 DOI: 10.1080/02699052.2023.2180663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Fear avoidance is associated with symptom persistence after mild traumatic brain injury (mTBI). In this study, we investigated whether fear avoidance was associated with other outcomes such as return to work-related activity (RTW). MATERIALS AND METHODS We analyzed associations between fear avoidance and RTW 6-9 months after mTBI, in two merged prospective mTBI cohorts. Adult participants aged 16 or over (n=175), presenting to outpatient services in New Zealand within 3 months of their injury, who were engaged in work-related activity at the time of injury, were included. Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury (FAB-TBI) questionnaire at enrollment and 6 months later. Associations between FAB-TBI scores and RTW outcome were analyzed using multivariate approaches. RESULTS Overall, 53% of participants had RTW by 6-9 months after mTBI. While early fear avoidance was weakly associated with RTW, persistent high fear avoidance between study assessments or increasing avoidance with time were associated with greater odds of still being off work 6-9 months after injury. CONCLUSIONS Pervasive and increasing avoidance of symptom triggers after mTBI were associated with lower rates of RTW 6-9 months after mTBI. Further research is needed to better understand transition points along the recovery trajectory where fear avoidance behaviors fade or increase after mTBI.
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Affiliation(s)
- Deborah L Snell
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Josh W Faulkner
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | | | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Alice Theadom
- TBI Network, Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lois J Surgenor
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Richard J Siegert
- TBI Network, Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Brooks KJL, Sullivan KA. Factor structure of the modified Rivermead Post-concussion Symptoms Questionnaire (mRPQ): an exploratory analysis with healthy adult simulators. Brain Inj 2023; 37:87-94. [PMID: 36653341 DOI: 10.1080/02699052.2023.2165150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Persistent postconcussion symptoms (PPCS) are challenging to diagnose. An improved diagnostic process could consider typical and atypical postconcussion symptoms. This study examined the structure of a modified Rivermead Post-concussion Symptoms Questionnaire (mRPQ) with both symptom types. METHOD 298 adult volunteers were randomized into groups: honest responders, mild traumatic brain injury (mTBI) simulators (MS), and biased mTBI simulators (BMS). Both mTBI simulating groups were coached about mTBI and primed about the simulation context (compensation evaluation). The BMS group was also encouraged to bias (exaggerate) symptoms. The participants completed an online battery of tests, including the mRPQ. RESULTS An exploratory factor analysis of the mRPQ (full sample) revealed a three-factor solution, including a separate dimension for atypical symptoms (all item loadings >0.45, ~4% of explained variance). The overall and group analyses of the standard RPQ items (typical symptoms) found a one- or two-factor solution, as did the analyses of atypical symptoms. CONCLUSIONS Consistent with prior RPQ research, a unidimensional or bifactor structure was measurable from standard RPQ symptoms. Whilst this study did not find support for domain-level symptom scores for either typical or atypical symptoms, the findings support the use of an overall atypical symptoms score.
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Affiliation(s)
- Kelly Jack Lee Brooks
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Karen A Sullivan
- School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Abstract
OBJECTIVE Response distortions in the reporting of postconcussion symptoms can occur for many reasons. The Rivermead Post-concussion Symptoms Questionnaire (RPQ) was recently modified to include an embedded symptom validity indicator to test for atypical symptoms. The present study used a simulation design to investigate the psychometric properties of the modified RPQ (mRPQ). METHOD 298 adult volunteers were randomised into three groups: honest responding (Controls, C) who reported actual, current symptoms; mild traumatic brain injury (mTBI) simulators (MS) who role played being injured, and; biased mTBI simulators (BMS) who role played being injured and were asked to bias (exaggerate) their response. The MS and BMS participants received instructions to support the simulation. All participants completed the mRPQ and a modified Neurobehavioral Symptom Inventory (mNSI). RESULTS A 2 × 3 mixed ANOVA with one within-group variable (Symptom type: Standard or Atypical) and one between-group variable (Instruction type: C, MS, BMS) found a significant two-way interaction (p < .05, ηp2 = .08). CONCLUSIONS The BMS group had score elevations for both standard and atypical postconcussion symptoms; therefore, both symptom types should be considered when evaluating for biased responding. The mRPQ has promising psychometric properties and should be further developed.
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Affiliation(s)
- Kelly Jack Lee Brooks
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen A Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Langevin P, Frémont P, Fait P, Roy JS. Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthop J Sports Med 2022; 10:23259671221127049. [PMID: 36250029 PMCID: PMC9561659 DOI: 10.1177/23259671221127049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity of symptoms after a concussion/mild traumatic brain injury. However, its responsiveness to monitor clinical recovery has yet to be determined. Purpose To evaluate the responsiveness of the PCSS to change and longitudinal validity in patients with persistent postconcussive symptoms as well as to explore the responsiveness of other clinical outcome measures to monitor recovery of physical symptoms in patients with persistent postconcussive symptoms. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Patients with persistent symptoms after a concussion (N = 109) were evaluated using self-reported questionnaires at baseline and after a 6-week rehabilitation program. The program consisted of an individualized symptom-limited aerobic exercise program combined with education. Questionnaires included the PCSS, Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), and Numeric Pain Rating Scale (NPRS) related to 1) neck pain and 2) headache. Internal responsiveness was evaluated using the effect size (ES) and standardized response mean (SRM), and external responsiveness was determined with the minimal clinically important difference (MCID) calculated using a receiver operating characteristic curve. The global rating of change was used as the external criterion. Pearson correlations were used to determine the longitudinal validity. Results The PCSS was highly responsive (ES and SRM, >1.3) and had an MCID of 26.5 points (of 132) for the total score and 5.5 (of 22) for the number of symptoms. For longitudinal validity, low to moderate correlations were found between changes in PCSS and changes in NDI, HDI, and DHI. The NDI, HDI, DHI, and NPRS were also highly responsive (ES and SRM, >0.8). Conclusion All questionnaires including the PCSS were highly responsive and can be used with confidence by clinicians and researchers to evaluate change over time in a concussion population with persistent symptoms.
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Affiliation(s)
- Pierre Langevin
- Clinique Cortex and Physio Interactive, Quebec City, Québec,
Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval,
Quebec City, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social
Integration (CIRRIS), Québec Rehabilitation Institute, Quebec City, Québec,
Canada
| | - Pierre Frémont
- Department of Rehabilitation, Faculty of Medicine, Université Laval,
Quebec City, Québec, Canada
| | - Philippe Fait
- Clinique Cortex and Physio Interactive, Quebec City, Québec,
Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social
Integration (CIRRIS), Québec Rehabilitation Institute, Quebec City, Québec,
Canada.,Department of Human Kinetics, Université du Québec à Trois-Rivières,
Quebec City, Québec, Canada.,Research Center in Neuropsychology and Cognition (CERNEC), Montréal,
Québec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval,
Quebec City, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social
Integration (CIRRIS), Québec Rehabilitation Institute, Quebec City, Québec,
Canada.,Jean-Sébastien Roy, PT, PhD, Centre for Interdisciplinary
Research in Rehabilitation and Social Integration, Québec Rehabilitation
Institute, 525, Boulevard Wilfrid Hamel, Quebec City, Québec, Canada, G1M 2S8
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11
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Le Sage N, Chauny JM, Berthelot S, Archambault P, Neveu X, Moore L, Boucher V, Frenette J, De Guise É, Ouellet MC, Lee J, McRae AD, Lang E, Émond M, Mercier É, Tardif PA, Swaine B, Cameron P, Perry JJ. Post-Concussion Symptoms Rule: Derivation and Validation of a Clinical Decision Rule for Early Prediction of Persistent Symptoms after a Mild Traumatic Brain Injury. J Neurotrauma 2022; 39:1349-1362. [PMID: 35765917 PMCID: PMC9529302 DOI: 10.1089/neu.2022.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common problem. Depending on diagnostic criteria, 13 to 62% of those patients develop persistent post-concussion symptoms (PPCS). The main objective of this prospective multi-center study is to derive and validate a clinical decision rule (CDR) for the early prediction of PPCS. Patients aged ≥14 years were included if they presented to one of our seven participating emergency departments (EDs) within 24 h of an mTBI. Clinical data were collected in the ED, and symptom evolution was assessed at 7, 30 and 90 days post-injury using the Rivermead Post-Concussion Questionnaire (RPQ). The primary outcome was PPCS at 90 days after mTBI. A predictive model called the Post-Concussion Symptoms Rule (PoCS Rule) was developed using the methodological standards for CDR. Of the 1083 analyzed patients (471 and 612 for the derivation and validation cohorts, respectively), 15.6% had PPCS. The final model included the following factors assessed in the ED: age, sex, history of prior TBI or mental health disorder, headache in ED, cervical sprain and hemorrhage on computed tomography. The 7-day follow-up identified additional risk factors: headaches, sleep disturbance, fatigue, sensitivity to light, and RPQ ≥21. The PoCS Rule had a sensitivity of 91.4% and 89.6%, a specificity of 53.8% and 44.7% and a negative predictive value of 97.2% and 95.8% in the derivation and validation cohorts, respectively. The PoCS Rule will help emergency physicians quickly stratify the risk of PPCS in mTBI patients and better plan post-discharge resources.
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Affiliation(s)
- Natalie Le Sage
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
- VITAM-Centre de recherche en santé durable, Université Laval, Québec, Canada
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Université de Montréal, Quebec, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Patrick Archambault
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Xavier Neveu
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Valérie Boucher
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Jérôme Frenette
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Élaine De Guise
- Department of Emergency Medicine, McGill University, Québec, Canada
| | | | - Jacques Lee
- Department of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Andrew D. McRae
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Marcel Émond
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Éric Mercier
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | | | - Bonnie Swaine
- Department of Emergency Medicine, Université de Montréal, Quebec, Canada
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Victoria, Australia
| | - Jeffrey J. Perry
- Department of Emergency Medicine, Ottawa Hospital Research Institute, Ontario, Canada
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12
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Nguyen JVK, McKay A, Ponsford J, Davies K, Makdissi M, Drummond SPA, Reyes J, Willmott C. Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOveR): protocol of an investigator-blinded, randomised, case series with multiple baseline design to evaluate the feasibility and preliminary efficacy of a 12-week treatment for persistent post-concussion symptoms. Pilot Feasibility Stud 2022; 8:198. [PMID: 36064489 PMCID: PMC9441831 DOI: 10.1186/s40814-022-01153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Up to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored. METHODS Fifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews. DISCUSSION Results from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes. TRIAL REGISTRATION ANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118.
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Affiliation(s)
- Jack V K Nguyen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia
| | - Adam McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Katie Davies
- Neurological Rehabilitation Group, Melbourne, Australia
| | - Michael Makdissi
- Olympic Park Sports Medicine Centre, Melbourne, Australia.,Australian Football League, AFL House, 140 Harbour Esplanade, Docklands, Melbourne, VIC, 3008, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia
| | - Jonathan Reyes
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia.,Australian Football League, AFL House, 140 Harbour Esplanade, Docklands, Melbourne, VIC, 3008, Australia
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, GPO Box 1449, Melbourne, VIC, 3001, Australia. .,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia. .,Australian Football League, AFL House, 140 Harbour Esplanade, Docklands, Melbourne, VIC, 3008, Australia.
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Mitra B, Reyes J, O'Brien WT, Surendran N, Carter A, Bain J, McEntaggart L, Sorich E, Shultz SR, O'Brien TJ, Willmott C, Rosenfeld JV, McDonald SJ. Micro-RNA levels and symptom profile after mild traumatic brain injury: A longitudinal cohort study. J Clin Neurosci 2021; 95:81-87. [PMID: 34929656 DOI: 10.1016/j.jocn.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/06/2021] [Accepted: 11/21/2021] [Indexed: 12/21/2022]
Abstract
Micro riboneucleic acids (miRNAs) may be transcribed after brain injury and be detectable in plasma. This study aimed to assess the discriminative ability of seven miRNAs in plasma to differentiate between patients with mild traumatic brain injury (mTBI) and healthy controls. Changes in miRNA levels over 28 days were compared to changes in self-reported symptom profile. This was a prospective cohort study with longitudinal measurements of miRNA levels and symptom self-report. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) was used to determine symptom severity. Mean normalised expression ratios (NER) of miRNAs at day 0 between mTBI and healthy controls were compared. An analysis of response profiles compared the response over time of miRNA species with RPQ symptom severity. miRNA levels of subjects who were defined to have "recovered" on Day 7 and 28 were compared to "non-recovered" subjects. There were 28 mTBI patients and 30 healthy controls included for analysis. Symptom severity was significantly higher on the day of injury among mTBI subjects (p < 0.001), and miRNA 32-5p levels were also higher (p = 0.009). Change of miRNA levels were similar to RPQ change at Day 7, but significantly different at Day 28. Differences were observed among miRNA levels of recovered subjects. This study demonstrated differences in miRNA levels among mTBI subjects compared to healthy controls and different miRNA levels among those who had recovered compared to those reporting symptoms. The change in profiles of miRNAs was different to symptom severity, suggesting that the two measures reflect different aspects of brain injury and recovery.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
| | - Jonathan Reyes
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Nanda Surendran
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Annie Carter
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Jesse Bain
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Laura McEntaggart
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | | | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Jeffrey V Rosenfeld
- Department Neurosurgery, Alfred Hospital, Melbourne, Australia; Department Surgery, Monash University, Melbourne, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Australia
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15
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Thomas BP, Tarumi T, Wang C, Zhu DC, Tomoto T, Munro Cullum C, Dieppa M, Diaz-Arrastia R, Bell K, Madden C, Zhang R, Ding K. Hippocampal and rostral anterior cingulate blood flow is associated with affective symptoms in chronic traumatic brain injury. Brain Res 2021; 1771:147631. [PMID: 34464600 DOI: 10.1016/j.brainres.2021.147631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/02/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to assess cerebral blood flow (CBF) and its association with self-reported symptoms in chronic traumatic brain injury (TBI). PARTICIPANTS Sixteen participants with mild to severe TBI and persistent self-reported neurological symptoms, 6 to 72 months post-injury were included. For comparison, 16 age- and gender-matched healthy normal control participants were also included. MAIN MEASURES Regional CBF and brain volume were assessed using pseudo-continuous Arterial Spin Labeling (PCASL) and T1-weighted data respectively. Cognitive function and self-reported symptoms were assessed in TBI participants using the national institutes of health (NIH) Toolbox Cognition Battery and Patient-Reported Outcome Measurement Information System respectively. Associations between CBF and cognitive function, symptoms were assessed. RESULTS Global CBF and regional brain volumes were similar between groups, but region of interest (ROI) analysis revealed lower CBF bilaterally in the thalamus, hippocampus, left caudate, and left amygdala in the TBI group. Voxel-wise analysis revealed that CBF in the hippocampus, parahippocampus, rostral anterior cingulate, inferior frontal gyrus, and other temporal regions were negatively associated with self-reported anger, anxiety, and depression symptoms. Furthermore, region of interest (ROI) analysis revealed that hippocampal and rostral anterior cingulate CBF were negatively associated with symptoms of fatigue, anxiety, depression, and sleep issues. CONCLUSION Regional CBF deficit was observed in the group with chronic TBI compared to the normal control (NC) group despite similar volume of cerebral structures. The observed negative correlation between regional CBF and affective symptoms suggests that CBF-targeted intervention may potentially improve affective symptoms and quality of life after TBI, which needs to be assessed in future studies.
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Affiliation(s)
- Binu P Thomas
- Advanced Imaging Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA; Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA; Department of Bioengineering, University of Texas at Arlington, 500 UTA Blvd., Arlington, TX 76010, USA.
| | - Takashi Tarumi
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA.
| | - Ciwen Wang
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, 86 Service Road, East Lansing, MI 48824, USA
| | - Tsubasa Tomoto
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA
| | - C Munro Cullum
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA; Department of Radiology and Cognitive Imaging Research Center, Michigan State University, 86 Service Road, East Lansing, MI 48824, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA; Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA
| | - Marisara Dieppa
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 51 North 39(th) St, Philadelphia, PA 19104, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA
| | - Christopher Madden
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, 86 Service Road, East Lansing, MI 48824, USA
| | - Rong Zhang
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390, USA
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