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Anderson JFI, Oehr LE, Chen J, Maller JJ, Seal ML, Yang JYM. The relationship between cognition and white matter tract damage after mild traumatic brain injury in a premorbidly healthy, hospitalised adult cohort during the post-acute period. Front Neurol 2023; 14:1278908. [PMID: 37936919 PMCID: PMC10626495 DOI: 10.3389/fneur.2023.1278908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Recent developments in neuroimaging techniques enable increasingly sensitive consideration of the cognitive impact of damage to white matter tract (WMT) microstructural organisation after mild traumatic brain injury (mTBI). Objective This study investigated the relationship between WMT microstructural properties and cognitive performance. Participants setting and design Using an observational design, a group of 26 premorbidly healthy adults with mTBI and a group of 20 premorbidly healthy trauma control (TC) participants who were well-matched on age, sex, premorbid functioning and a range of physical, psychological and trauma-related variables, were recruited following hospital admission for traumatic injury. Main measures All participants underwent comprehensive unblinded neuropsychological examination and structural neuroimaging as outpatients 6-10 weeks after injury. Neuropsychological examination included measures of speed of processing, attention, memory, executive function, affective state, pain, fatigue and self-reported outcome. The WMT microstructural properties were estimated using both diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) modelling techniques. Tract properties were compared between the corpus callosum, inferior longitudinal fasciculus, uncinate fasciculus, anterior corona radiata and three segmented sections of the superior longitudinal fasciculus. Results For the TC group, in all investigated tracts, with the exception of the uncinate fasciculus, two DTI metrics (fractional anisotropy and apparent diffusion coefficient) and one NODDI metric (intra-cellular volume fraction) revealed expected predictive linear relationships between extent of WMT microstructural organisation and processing speed, memory and executive function. The mTBI group showed a strikingly different pattern relative to the TC group, with no relationships evident between WMT microstructural organisation and cognition on most tracts. Conclusion These findings indicate that the predictive relationship that normally exists in adults between WMT microstructural organisation and cognition, is significantly disrupted 6-10 weeks after mTBI and suggests that WMT microstructural organisation and cognitive function have disparate recovery trajectories.
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Affiliation(s)
- Jacqueline F. I. Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Lucy E. Oehr
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Jian Chen
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Jerome J. Maller
- General Electric Healthcare, Melbourne, VIC, Australia
- Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Marc L. Seal
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), The Royal Children's Hospital, Melbourne, VIC, Australia
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2
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Jones C, Ramsey K, Beydoun HA, Johnstone B. Neuropsychological deficit profiles for service members with mild traumatic brain injury. Brain Inj 2023:1-10. [PMID: 37183388 DOI: 10.1080/02699052.2023.2209739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Neuropsychological deficits are generally assessed in terms of absolute level of functioning, e.g. high average, average, low average, although there is increased interest in calculating indices of relative degree of decline, e.g. mild, moderate, severe. OBJECTIVE To examine differences in demographic, psychiatric, and military-specific characteristics for relative degree of decline in neuropsychological profiles attributed to traumatic brain injuries (TBIs) among service members (SMs). METHODS Data were drawn from an existing clinical database of 269 SMs who received neuropsychological evaluations for TBI (Wechsler Test of Adult Reading, Wechsler Adult Intelligence Scale, California Verbal Learning Test, Delis-Kaplan Executive Function System) at a military treatment facility between 2013 and 2018. Independent sample t-tests and one-way ANOVA tests with pairwise comparisons were performed. RESULTS Memory and problem-solving abilities were the most and least affected domains, respectively. Greater relative decline was observed among male and White SMs and those with post-traumatic stress disorder (PTSD). By contrast, there were no differences in relative decline according to military rank or work status. CONCLUSION Relative degree of decline after TBI among SMs is differentially impacted according to neuropsychological domain, with greater impairment among male and White SMs as well as those with PTSD.
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Affiliation(s)
- Caitlin Jones
- Fort Belvoir Intrepid Spirit Center, Fort Belvoir, VA, USA
- The Geneva Foundation, Tacoma, WA, USA
| | - Kathryn Ramsey
- Fort Belvoir Intrepid Spirit Center, Fort Belvoir, VA, USA
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center, Fort Belvoir, VA, USA
| | | | - Brick Johnstone
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
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3
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Campbell A, Gustafsson L, Gullo H, Summers M, Rosbergen I, Grimley R. Uncharted territory: The feasibility of serial computerised cognitive assessment the first week post-stroke. J Stroke Cerebrovasc Dis 2022; 31:106614. [PMID: 35858514 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cognitive impairment is common and problematic post-stroke, yet vital information to understand early cognitive recovery is lacking. To examine early cognitive recovery, it is first necessary to establish the feasibility of repeat cognitive assessment during the acute post-stroke phase. OBJECTIVE To determine if serial computerised testing is feasible for cognitive assessment in an acute post-stroke phase, measured by assessment completion rates. METHOD An observational cohort study recruited consecutive stroke patients admitted to an acute stroke unit within 48 hours of onset. Daily assessment with the Cambridge Neuropsychological Test Automated Battery (CANTAB) was performed for seven days, and single Montreal Cognitive Assessment (MoCA). RESULTS Seventy-one participants were recruited, mean age 74 years, with 67 completing daily testing. Participants had predominantly mild (85%; NIHSS ≤6), ischemic (90%) stroke, 32% demonstrated clinical delirium. The first day of testing, 76% of participants completed CANTAB batteries. Eighty-seven percent of participants completed MoCA a mean of 3.4 days post-stroke. The proportion of CANTAB batteries completed improved significantly from day 2 to day 3 post-stroke with test completion rates stabilizing ≥ 92% by day 4. Participants with incomplete CANTAB were older, with persisting delirium, and longer stay in acute care. CONCLUSION Serial computerised cognitive assessments are feasible the first week post-stroke and provide a novel approach to measuring cognitive change for both clinical and research purposes. Maximum completion rates by day four have clinical implications for optimal timing of cognitive testing.
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Affiliation(s)
- Alana Campbell
- Brisbane, Queensland, Australia; and Queensland Health (Sunshine Coast Hospital and Health Service), The University of Queensland (School of Health and Rehabilitation Sciences), Sunshine Coast, QLD, Australia.
| | - Louise Gustafsson
- Griffith University (School of Health Sciences and Social Work), Brisbane, QLD, Australia
| | - Hannah Gullo
- The University of Queensland (School of Health and Rehabilitation Sciences), Brisbane, QLD, Australia
| | - Mathew Summers
- University of the Sunshine Coast (School of Health and Behavioural Sciences), Sunshine Coast, QLD, Australia
| | - Ingrid Rosbergen
- Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, QLD, Australia
| | - Rohan Grimley
- Griffith University and Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
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4
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Anderson JFI, Cockle E. Investigating the Effect of Fatigue and Psychological Distress on Information Processing Speed in the Postacute Period After Mild Traumatic Brain Injury in Premorbidly Healthy Adults. Arch Clin Neuropsychol 2021; 36:918-920. [PMID: 33388744 DOI: 10.1093/arclin/acaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 11/14/2022] Open
Abstract
Impairments in processing speed under conditions of increasing cognitive load have been reported in individuals with mild traumatic brain injury (mTBI). In other conditions that are also associated with white matter disruption, both psychological distress and fatigue have been shown to underlie this impairment. OBJECTIVE the current study aimed to investigate whether slowing of processing abilities under conditions of greater cognitive load is independent of fatigue and psychological status in premorbidly healthy individuals with subacute mTBI. METHOD using a prospective observational design, we examined 84 individuals with mTBI approximately 8 weeks after injury and 47 healthy control (HC) participants. They were assessed with the Symbol Digit Modality Test, an n-back task and a rate of gain of information choice reaction time task that conforms to Hick's law. Participants were also assessed with measures of fatigue and psychological status. RESULTS as expected, findings revealed no group differences on simple reaction time tasks, but as task complexity increased, the mTBI group performed more slowly than the HC group. This group difference occurred independently of fatigue and psychological distress levels and was associated with a moderate effect size. CONCLUSIONS during the subacute period after mTBI, premorbidly healthy individuals demonstrate impairment in their ability to rapidly process information as the cognitive load of the task increases beyond simple reaction time requirements. Examination of whether these changes affect resumption of premorbid roles is warranted.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria 3010, Australia.,Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, Victoria, 3181, Australia
| | - Emily Cockle
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria 3010, Australia
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5
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Joseph ALC, Lippa SM, McNally SM, Garcia KM, Leary JB, Dsurney J, Chan L. Estimating premorbid intelligence in persons with traumatic brain injury: an examination of the Test of Premorbid Functioning. APPLIED NEUROPSYCHOLOGY. ADULT 2021; 28:535-543. [PMID: 31519111 PMCID: PMC7067634 DOI: 10.1080/23279095.2019.1661247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Knowledge of intelligence is essential for interpreting cognitive performance following traumatic brain injury (TBI). The Test of Premorbid Functioning (ToPF), a word reading test co-normed with the Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV), was examined as a tool for estimating premorbid intelligence in persons with a history of TBI. Fifty-two participants with mild, moderate, or severe TBI were administered the ToPF and WAIS-IV between two weeks and 19 months post-injury. The independent ability of the ToPF/demographic score and the Verbal Comprehension Index (VCI) to predict WAIS-IV Full Scale IQ (FSIQ) was examined, as were discrepancies between ToPF and WAIS-IV scores within and between participants. The ToPF/demographic predicted FSIQ accounted for a significant proportion of variability in actual FSIQ, above and beyond that accounted for by education or time since injury. ToPF and WAIS-IV scores did not differ by injury severity. In our sample, the ToPF/demographic predicted FSIQ underestimated intelligence in a substantial portion of our participants (31%), particularly in those with high average to superior intelligence. Finally, VCI scores were more predictive of actual FSIQ than the ToPF/demographic predicted FSIQ. The ToPF frequently underestimated post-injury intelligence and is therefore not accurately measuring premorbid intelligence in our sample, particularly in those with above average to superior intelligence. Clinicians are encouraged to administer the entire WAIS-IV, or at minimum the VCI subtests, for a more accurate measure of intelligence in those with above average intelligence and history of TBI.
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Affiliation(s)
- Annie-Lori C. Joseph
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - S. M. Lippa
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - S. M. McNally
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - K. M. Garcia
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - J. B. Leary
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - J. Dsurney
- Tampa Psychological Associates, Tampa, FL, USA
| | - L. Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD
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6
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Anderson JFI. Cognitive complaint and objective cognition during the post-acute period after mild traumatic brain injury in pre-morbidly healthy adults. Brain Inj 2021; 35:103-113. [PMID: 33459065 DOI: 10.1080/02699052.2020.1859613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary Objective:The most widely used proxies of cognitive complaint after mTBI are post-concussion syndrome (PCS) symptom checklists, which do not have a clear relationship with cognition. This study investigated whether an mTBI-specific cognitive complaint measure would have clearer associations with objective cognition than a widely used PCS symptom checklist.Research Design:An observational design was used. A sample of 109 participants (52 mTBI and 57 healthy controls) completed a PCS symptom checklist, a cognitive complaint measure, and measures of information processing speed, attention, memory, executive function, depression and anxiety.Main Outcomes and Results:In the healthy control group, cognitive complaint was significantly associated with objective cognitive performance and was not associated with psychological status. In contrast, PCS endorsement was unrelated to objective cognition but was associated with psychological status. For the mTBI group, neither PCS endorsement nor cognitive complaint was associated with cognitive performance, but both measures were associated with psychological status.Conclusions:This study indicates that neither cognitive nor PCS symptom measures are reliable indicators of underlying cognitive function in the post-acute period after mTBI. Further, suffering an mTBI may affect the linear relationship that exists between cognitive symptom endorsement and cognitive function in healthy adults.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Psychology Department, The Alfred Hospital, Melbourne, Australia
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7
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Marx BP, Thompson-Hollands J, Lee DJ, Resick PA, Sloan DM. Estimated Intelligence Moderates Cognitive Processing Therapy Outcome for Posttraumatic Stress Symptoms. Behav Ther 2021; 52:162-169. [PMID: 33483114 PMCID: PMC8439555 DOI: 10.1016/j.beth.2020.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022]
Abstract
Although patient intelligence may be an important determinant of the degree to which individuals may comprehend, comply with, and ultimately benefit from trauma-focused treatment, no prior studies have examined the impact of patient intelligence on benefit from psychotherapies for PTSD. We investigated the degree to which educational achievement, often used as a proxy for intelligence, and estimated full scale intelligence quotient (FSIQ) scores themselves moderated treatment outcomes for two effective psychotherapies for PTSD: Cognitive Processing Therapy (CPT) and Written Exposure Therapy (WET). Participants, 126 treatment-seeking adults with PTSD (52% male; mean age = 43.9, SD = 14.6), were equally randomized to CPT and WET; PTSD symptom severity was measured at baseline and 6-, 12-, 24-, 36-, and 60-weeks following the first treatment session. Multilevel models revealed that participants with higher FSIQ scores experienced significantly greater PTSD symptom reduction through the 24-week assessment in CPT but not WET; this effect did not persist through the 60-week assessment. Educational achievement did not moderate symptom change through either 24- or 60-weeks. Individuals with higher FSIQ who are treated with CPT may experience greater symptom improvement in the early stages of recovery.
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Affiliation(s)
| | | | | | | | - Denise M Sloan
- National Center for PTSD at VA Boston Healthcare System; Boston University School of Medicine
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8
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Garba AE, Grossberg GT, Enard KR, Jano FJ, Roberts EN, Marx CA, Buchanan PM. Testing the Cognitive Reserve Index Questionnaire in an Alzheimer's Disease Population. J Alzheimers Dis Rep 2020; 4:513-524. [PMID: 33532699 PMCID: PMC7835984 DOI: 10.3233/adr-200244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Alzheimer's disease (AD) is the 6th leading cause of death in the United States and has no cure or progression prevention. The Cognitive Reserve (CR) theory poses that constant brain activity earlier in life later helps to deter pathological changes in the brain, delaying the onset of disease symptoms. Objective To determine the reliability and validity of the Cognitive Reserve Index questionnaire (CRIq) in AD patients. Methods Primary data collection was done using the CRIq to quantify CR in 90 participants. Correlations and multivariable linear regressions were used to assess reliability and validity. Results Reliability was tested in 34 participants. A Pearson correlation coefficient of 0.89 (p < 0.001) indicated a strong positive correlation. Validity was tested in 33 participants. A Pearson correlation coefficient of 0.30 (p = 0.10) indicated an insignificant weak positive correlation. Conclusion The CRIq was found reliable. Gaining a better understanding of how CR tools can be used in various cognitive populations will help with the establishment of a research tool that is universally accepted as a true CR measure.
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Affiliation(s)
- Asabe E Garba
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | | | - Kimberly R Enard
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Fabian J Jano
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Emma N Roberts
- Saint Louis University School of Medicine, St. Louis, MO, USA
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9
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Hurtubise J, Baher T, Messa I, Cutler L, Shahein A, Hastings M, Carignan-Querqui M, Erdodi LA. Verbal fluency and digit span variables as performance validity indicators in experimentally induced malingering and real world patients with TBI. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 9:337-354. [DOI: 10.1080/21622965.2020.1719409] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Tabarak Baher
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Isabelle Messa
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Laura Cutler
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Ayman Shahein
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | | | | | - Laszlo A. Erdodi
- Department of Psychology, University of Windsor, Windsor, Canada
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10
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Steward KA, Kennedy R, Novack TA, Crowe M, Marson DC, Triebel KL. The Role of Cognitive Reserve in Recovery From Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:E18-E27. [PMID: 28520675 PMCID: PMC5693786 DOI: 10.1097/htr.0000000000000325] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether cognitive reserve (CR) attenuates the initial impact of traumatic brain injury (TBI) on cognitive performance (neural reserve) and results in faster cognitive recovery rates in the first year postinjury (neural compensation), and whether the advantage of CR differs on the basis of the severity of TBI. SETTING Inpatient/outpatient clinics at an academic medical center. PARTICIPANTS Adults with mild TBI (mTBI; n = 28), complicated mild TBI (cmTBI; n = 24), and moderate to severe TBI (msevTBI; n = 57), and demographically matched controls (n = 66). DESIGN Retrospective, longitudinal cohort assessed at 1, 6, and 12 months postinjury. MAIN MEASURES Outcomes were 3 cognitive domains: processing speed/executive function, verbal fluency, and memory. Premorbid IQ, estimated with the Wechsler Test of Adult Reading, served as CR proxy. RESULTS Higher premorbid IQ was associated with better performance on cognitive domains at 1 month postinjury, and the effect of IQ was similarly beneficial for all groups. Cognitive recovery rate was moderated only by TBI severity; those with more severe TBI had faster recovery in the first year. CONCLUSION Results support only the neural reserve theory of CR within a TBI population and indicate that CR is neuroprotective, regardless of the degree of TBI. Higher premorbid CR does not allow for more rapid adaptation and recovery from injury.
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Affiliation(s)
- Kayla A. Steward
- Department of Psychology, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Richard Kennedy
- Department of Medicine, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Thomas A. Novack
- Department of Physical Medicine and Rehabilitation, University of
Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Daniel C. Marson
- Department of Neurology, University of Alabama at Birmingham,
Birmingham, AL, USA
| | - Kristen L. Triebel
- Department of Neurology, University of Alabama at Birmingham,
Birmingham, AL, USA
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11
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Undurti A, Colasurdo EA, Sikkema CL, Schultz JS, Peskind ER, Pagulayan KF, Wilkinson CW. Chronic Hypopituitarism Associated with Increased Postconcussive Symptoms Is Prevalent after Blast-Induced Mild Traumatic Brain Injury. Front Neurol 2018. [PMID: 29515515 PMCID: PMC5825904 DOI: 10.3389/fneur.2018.00072] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The most frequent injury sustained by US service members deployed to Iraq or Afghanistan is mild traumatic brain injuries (mTBI), or concussion, by far most often caused by blast waves from improvised explosive devices or other explosive ordnance. TBI from all causes gives rise to chronic neuroendocrine disorders with an estimated prevalence of 25-50%. The current study expands upon our earlier finding that chronic pituitary gland dysfunction occurs with a similarly high frequency after blast-related concussions. We measured circulating hormone levels and accessed demographic and testing data from two groups of male veterans with hazardous duty experience in Iraq or Afghanistan. Veterans in the mTBI group had experienced one or more blast-related concussion. Members of the deployment control (DC) group encountered similar deployment conditions but had no history of blast-related mTBI. 12 of 39 (31%) of the mTBI participants and 3 of 20 (15%) veterans in the DC group screened positive for one or more neuroendocrine disorders. Positive screens for growth hormone deficiency occurred most often. Analysis of responses on self-report questionnaires revealed main effects of both mTBI and hypopituitarism on postconcussive and posttraumatic stress disorder (PTSD) symptoms. Symptoms associated with pituitary dysfunction overlap considerably with those of PTSD. They include cognitive deficiencies, mood and anxiety disorders, sleep problems, diminished quality of life, deleterious changes in metabolism and body composition, and increased cardiovascular mortality. When such symptoms are due to hypopituitarism, they may be alleviated by hormone replacement. These findings suggest consideration of routine post-deployment neuroendocrine screening of service members and veterans who have experienced blast-related mTBI and are reporting postconcussive symptoms.
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Affiliation(s)
- Arundhati Undurti
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Elizabeth A Colasurdo
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, WA, United States
| | - Carl L Sikkema
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, WA, United States
| | - Jaclyn S Schultz
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, WA, United States
| | - Elaine R Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, WA, United States
| | - Kathleen F Pagulayan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VISN 20 Northwest Network Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, WA, United States
| | - Charles W Wilkinson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, WA, United States
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