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Dams-O'Connor K, Bulas A, Haag H(L, Spielman LA, Fernandez A, Frederick-Hawley L, Hoffman JM, Goldin Frazier Y. Screening for Brain Injury Sustained in the Context of Intimate Partner Violence (IPV): Measure Development and Preliminary Utility of the Brain Injury Screening Questionnaire IPV Module. J Neurotrauma 2023; 40:2087-2099. [PMID: 36879469 PMCID: PMC10623077 DOI: 10.1089/neu.2022.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract Intimate partner violence (IPV) is associated with risk for multi-etiology brain injury (BI), including repetitive head impacts, isolated traumatic brain injuries (TBI), and anoxic/hypoxic injury secondary to nonfatal strangulation (NFS). IPV-related injuries are often unreported, but evidence suggests that survivors are more likely to report when asked directly. There are currently no validated tools for screening of brain injury related to IPV that meet World Health Organization guidelines for this population. Here, we describe measure development methods and preliminary utility of the Brain Injury Screening Questionnaire IPV (BISQ-IPV) module. We culled items from existing IPV and TBI screening tools and sought two rounds of stakeholder feedback regarding content coverage, terminology, and safety of administration. The resulting stakeholder-informed BISQ-IPV module is a seven-item self-report measure that uses contextual cues (e.g., being shoved, shaken, strangled) to query lifetime history of IPV-related head/neck injury. We introduced the BISQ-IPV module into the Late Effects of TBI (LETBI) study to investigate rates of violent and IPV-specific head/neck injury reporting in a TBI sample. Among those who completed the BISQ-IPV module (n = 142), 8% of the sample (and 20% of women) reported IPV-related TBI, and 15% of the sample (34% of women) reported IPV-related head or neck injury events that did not result in loss or alteration of consciousness. No men reported NFS; one woman reported inferred BI secondary to NFS, and 6% of women reported NFS events. Those who endorsed IPV-BI were all women, many were highly educated, and many reported low incomes. We then compared reporting of violent TBIs and head/neck injury events among individuals who completed the core BISQ wherein IPV is not specifically queried (administered from 2015-2018; n = 156) to that of individuals who completed the core BISQ preceded by the BISQ-IPV module (BISQ+IPV, administered from 2019-2021; n = 142). We found that 9% of those who completed the core BISQ reported violent TBI (e.g., abuse, assault), whereas 19% of those who completed the BISQ+IPV immediately preceding the core BISQ reported non-IPV-related violent TBI on the core BISQ. These findings suggest that standard TBI screening tools are inadequate for identifying IPV-BI and structured cueing of IPV-related contexts yields greater reporting of both IPV- and non-IPV-related violent BI. When not queried directly, IPV-BI remains a hidden variable in TBI research studies.
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Affiliation(s)
- Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashlyn Bulas
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Halina (Lin) Haag
- Department of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa A. Spielman
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angela Fernandez
- Department of OBGYN and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lynn Frederick-Hawley
- Department of OBGYN and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yelena Goldin Frazier
- Yelena Goldin Frazier Curect Neuropsychology of New York, East Rockaway, New York, USA
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Hanrahan JG, Burford C, Nagappan P, Adegboyega G, Rajkumar S, Kolias A, Helmy A, Hutchinson PJ. Is dementia more likely following traumatic brain injury? A systematic review. J Neurol 2023; 270:3022-3051. [PMID: 36810827 DOI: 10.1007/s00415-023-11614-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The association between traumatic brain injury (TBI) and dementia is controversial, and of growing importance considering the ageing demography of TBI. OBJECTIVE To review the scope and quality of the existing literature investigating the relationship between TBI and dementia. METHODS We conducted a systematic review following PRISMA guidelines. Studies that compared TBI exposure and dementia risk were included. Studies were formally assessed for quality with a validated quality-assessment tool. RESULTS 44 studies were included in the final analysis. 75% (n = 33) were cohort studies and data collection was predominantly retrospective (n = 30, 66.7%). 25 studies (56.8%) found a positive relationship between TBI and dementia. Clearly defined and valid measures of assessing TBI history were lacking (case-control studies-88.9%, cohort studies-52.9%). Most studies failed to justify a sample size (case-control studies-77.8%, cohort studies-91.2%), blind assessors to exposure (case-control-66.7%) or blind assessors to exposure status (cohort-3.00%). Studies that identified a relationship between TBI and dementia had a longer median follow-up time (120 months vs 48 months, p = 0.022) and were more likely to use validated TBI definitions (p = 0.01). Studies which clearly defined TBI exposure (p = 0.013) and accounted for TBI severity (p = 0.036) were also more likely to identify an association between TBI and dementia. There was no consensus method by which studies diagnosed dementia and neuropathological confirmation was only available in 15.5% of studies. CONCLUSIONS Our review suggests a relationship between TBI and dementia, but we are unable to predict the risk of dementia for an individual following TBI. Our conclusions are limited by heterogeneity in both exposure and outcome reporting and by poor study quality. Future studies should; (a) use validated methods to define TBI, accounting for TBI severity; (b) follow consensus agreement on criteria for dementia diagnosis; and (c) undertake follow-up that is both longitudinal, to determine if there is a progressive neurodegenerative change or static post-traumatic deficit, and of sufficient duration.
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Affiliation(s)
- John Gerrard Hanrahan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Charlotte Burford
- Department of General Surgery, East Kent University Hospitals NHS Foundation Trust, Ashford, UK.
| | - Palani Nagappan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Gideon Adegboyega
- Bart's and the London Medical School, Queen Mary University of London, London, UK
| | - Shivani Rajkumar
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Adel Helmy
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Peter John Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Jiang Y, Hu H, He X, Li X, Zhang Y, Lou J, Wu Y, Fang J, Shao X, Fang J. Specificity for the correlation between the body surface and viscera in the pathological state of COPD: A prospective, controlled, and assessor-blinded trial. Front Physiol 2023; 14:1051190. [PMID: 37153229 PMCID: PMC10159081 DOI: 10.3389/fphys.2023.1051190] [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: 09/23/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Background: The association between the body surface and viscera remains obscure, but a better understanding of the body surface-viscera correlation will maximize its diagnostic and therapeutic values in clinical practice. Therefore, this study aimed to investigate the specificity of body surface-viscera correlation in the pathological state. Methods: The study subjects included 40 participants with chronic obstructive pulmonary disease (COPD) in the COPD group and 40 age-matched healthy participants in the healthy control group. Laser Doppler flowmetry, infrared thermography, and functional near-infrared spectroscopy were respectively adopted to measure 1) the perfusion unit (PU), 2) temperature, and 3) regional oxygen saturation (rSO2) of four specific sites distributed in the heart and lung meridians. These three outcome measures reflected the microcirculatory, thermal, and metabolic characteristics, respectively. Results: Regarding the microcirculatory and thermal characteristics of the body surface, the PU and temperature of specific sites on the body surface [i.e., Taiyuan (LU9) and Chize (LU5) in the lung meridian] in the COPD group were significantly increased compared with healthy controls (p < 0.05), whereas PU and temperature of other sites in the heart meridian [i.e., Shenmen (HT7) and Shaohai (HT3)] did not change significantly (p > 0.05). Regarding the metabolic characteristics, rSO2 of specific sites in the lung meridian [i.e., Taiyuan (LU9) and Chize (LU5)] and Shaohai (HT3) of the heart meridian in the COPD group was significantly decreased compared with healthy controls (p < 0.01), whereas rSO2 of Shenmen (HT7) in the heart meridian did not change significantly (p > 0.05). Conclusion: In the disease state of COPD, the microcirculatory, thermal, and metabolic characteristics of specific sites on the body surface in the lung meridian generally manifest more significant changes than those in the heart meridian, thereby supporting relative specificity for the body surface-viscera correlation in the pathological state.
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Affiliation(s)
- Yongliang Jiang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hantong Hu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaofen He
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoyu Li
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yajun Zhang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiali Lou
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuanyuan Wu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Junfan Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaomei Shao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianqiao Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Jianqiao Fang,
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Dennis EL, Baron D, Bartnik‐Olson B, Caeyenberghs K, Esopenko C, Hillary FG, Kenney K, Koerte IK, Lin AP, Mayer AR, Mondello S, Olsen A, Thompson PM, Tate DF, Wilde EA. ENIGMA brain injury: Framework, challenges, and opportunities. Hum Brain Mapp 2022; 43:149-166. [PMID: 32476212 PMCID: PMC8675432 DOI: 10.1002/hbm.25046] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of disability worldwide, but the heterogeneous nature of TBI with respect to injury severity and health comorbidities make patient outcome difficult to predict. Injury severity accounts for only some of this variance, and a wide range of preinjury, injury-related, and postinjury factors may influence outcome, such as sex, socioeconomic status, injury mechanism, and social support. Neuroimaging research in this area has generally been limited by insufficient sample sizes. Additionally, development of reliable biomarkers of mild TBI or repeated subconcussive impacts has been slow, likely due, in part, to subtle effects of injury and the aforementioned variability. The ENIGMA Consortium has established a framework for global collaboration that has resulted in the largest-ever neuroimaging studies of multiple psychiatric and neurological disorders. Here we describe the organization, recent progress, and future goals of the Brain Injury working group.
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Affiliation(s)
- Emily L. Dennis
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - David Baron
- Western University of Health SciencesPomonaCaliforniaUSA
| | - Brenda Bartnik‐Olson
- Department of RadiologyLoma Linda University Medical CenterLoma LindaCaliforniaUSA
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of PsychologyDeakin UniversityBurwoodVictoriaAustralia
| | - Carrie Esopenko
- Department of Rehabilitation and Movement SciencesRutgers Biomedical Health SciencesNewarkNew JerseyUSA
| | - Frank G. Hillary
- Department of PsychologyPennsylvania State UniversityUniversity ParkPennsylvaniaUSA
- Social Life and Engineering Sciences Imaging CenterUniversity ParkPennsylvaniaUSA
| | - Kimbra Kenney
- Department of NeurologyUniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of ExcellenceWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Alexander P. Lin
- Center for Clinical SpectroscopyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Andrew R. Mayer
- Mind Research NetworkAlbuquerqueNew MexicoUSA
- Department of Neurology and PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Alexander Olsen
- Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
- Department of Physical Medicine and RehabilitationSt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Paul M. Thompson
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
- Department of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and OphthalmologyUniversity of Southern California (USC)Los AngelesCaliforniaUSA
| | - David F. Tate
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Elisabeth A. Wilde
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
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5
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Dams-O'Connor K, Bellgowan PSF, Corriveau R, Pugh MJ, Smith DH, Schneider JA, Whittaker K, Zetterberg H. Alzheimer's Disease-Related Dementias Summit 2019: National research priorities for the investigation of traumatic brain injury as a risk factor for Alzheimer's Disease and Related Dementias. J Neurotrauma 2021; 38:3186-3194. [PMID: 34714152 DOI: 10.1089/neu.2021.0216] [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] [Indexed: 12/18/2022] Open
Abstract
TBI is a risk factor for later life dementia. Clinical and preclinical studies have elucidated multiple mechanisms through which TBI may influence or exacerbate multiple pathological processes underlying Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD). The National Institutes of Health hosts triennial ADRD Summits to inform a national research agenda, and the 2019 ADRD Summit was the first to highlight 'TBI and AD/ADRD Risk' as an emerging topic in the field. A multidisciplinary committee of TBI researchers with relevant expertise reviewed extant literature, identified research gaps and opportunities, and proposed draft research recommendations at the 2019 ADRD Summit. These research recommendations, further refined after broad stakeholder input at the Summit, cover four overall areas: (1) Encourage crosstalk and interdisciplinary collaboration between TBI and dementia researchers, (2) Establish infrastructure to study TBI as a risk factor for AD/ADRD, (3) Promote basic and clinical research examining the development and progression of TBI AD/ADRD neuropathologies and associated clinical symptoms, and (4) Characterize the clinical phenotype of progressive dementia associated with TBI and develop non-invasive diagnostic approaches. These recommendations recognize a need to strengthen communication and build frameworks to connect the complexity of TBI with rapidly evolving AD/ADRD research. Recommendations acknowledge TBI as a clinically and pathologically heterogeneous disease whose associations with AD/ADRDs remain incompletely understood. The recommendations highlight the scientific advantage of investigating AD/ADRD in the context of a known TBI exposure, the study of which can directly inform on disease mechanisms and treatment targets for AD/ADRDs with shared common pathways.
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Affiliation(s)
- Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Department of Rehabilitation and Human Performance, New York, New York, United States.,Icahn School of Medicine at Mount Sinai, 5925, Department of Neurology, New York, New York, United States; kristen.dams-o'
| | - Patrick S F Bellgowan
- National Institute of Neurological Disorders and Stroke, 35046, Bethesda, Maryland, United States;
| | - Roderick Corriveau
- National Institute of Neurological Disorders and Stroke, 35046, Bethesda, Maryland, United States;
| | - Mary Jo Pugh
- The University of Utah School of Medicine, 12348, Department of Medicine, Division of Epidemiology, Salt Lake City, Utah, United States.,VA Salt Lake City Health Care System, 20122, Salt Lake City, Utah, United States;
| | - Douglas H Smith
- University of Pennsylvania, Department of Neurosurgery, Philadelphia, Pennsylvania, United States;
| | - Julie A Schneider
- Rush University Medical Center, Department of Pathology, Chicago, Illinois, United States;
| | - Keith Whittaker
- National Institute of Neurological Disorders and Stroke, 35046, Bethesda, Maryland, United States;
| | - Henrik Zetterberg
- Sahlgrenska Academy at the University of Gothenburg, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, S-431 80 Mölndal, Sweden.,Sahlgrenska University Hospital, Clinical Neurochemistry Laboratory, S-431 80 Mölndal, Sweden.,UCL Institute of Neurology, Department of Neurodegenerative Disease, Queen Square, London, WC1E 6BT, United Kingdom of Great Britain and Northern Ireland.,UK Dementia Research Institute at UCL, London, WC1E 6BT, United Kingdom of Great Britain and Northern Ireland;
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Dell KC, Grossner EC, Staph J, Schatz P, Hillary FG. A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury. Neurotrauma Rep 2021; 2:255-269. [PMID: 34223556 PMCID: PMC8244518 DOI: 10.1089/neur.2020.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health factors impacting both the occurrence of, and recovery from traumatic brain injury (TBI) vary in complexity, and present genuine challenges to researchers and healthcare professionals seeking to characterize injury consequences and determine prognosis. However, attempts to clarify causal links between injury characteristics and clinical outcomes (including mortality) often compel researchers to exclude pre-existing health conditions (PECs) in their samples, including psychiatric history, medication usage, and other comorbid conditions. In this pre-registered population-based study (total starting n = 939,123 patients), we examined trends in PEC incidence over 22 years in the state of Pennsylvania (1997-2019) in individuals sustaining TBI (n = 169,452) and individuals with orthopedic injury (n = 87,637). The goal was to determine how PECs interact with age and injury severity to influence short-term outcomes. A further goal was to determine whether number of PECs, or specific PEC clusters contributed to worse outcomes within the TBI cohort, compared with orthopedic injury alone. Primary findings indicate that PECs significantly influenced mortality within the TBI cohort; patients having four or more PECs were associated with approximately a two times greater likelihood of dying in acute care (odds ratio [OR] 1.9). Additionally, cluster analyses revealed four distinct PEC clusters that are age and TBI severity dependent. Overall, the likelihood of zero PECs hovers at ∼25%, which is critical to consider in TBI outcomes work and could potentially contribute to the challenges facing intervention science with regard to reproducibility of findings.
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Affiliation(s)
- Kristine C Dell
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA.,Social and Life and Engineering Sciences Imaging Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Emily C Grossner
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA.,Social and Life and Engineering Sciences Imaging Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jason Staph
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA
| | - Frank G Hillary
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA.,Social and Life and Engineering Sciences Imaging Center, The Pennsylvania State University, University Park, Pennsylvania, USA.,Department of Neurology, Hershey Medical Center, Hershey, Pennsylvania, USA
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7
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Rao VA, Bechtold KT, Arciniegas DB, Samus QM, Albrecht J, Pugh BT, Jacoby A, Buenaver L. Establishment of a Patient-Centered Outcomes Research Network for Individuals with TBI and Neuropsychiatric Symptoms. Brain Inj 2020; 34:548-555. [PMID: 32050805 DOI: 10.1080/02699052.2020.1725980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: The overarching goal of this project was to establish a group comprised of a variety of TBI stakeholders for the purpose of: (1) determining facilitators and barriers in management of neuropsychiatric symptoms after TBI; (2) identifying strategies for maintaining a TBI PCOR network; (3) enumerating research topics related to TBI neuropsychiatry; and (4) highlighting policy changes related to TBI neuropsychiatry.Methods: Twenty-nine TBI stakeholders participated in focus group discussions. Qualitative analyses were conducted both manually and using Dedoose software.Results: Participant-identified barriers included stigma associated with experiencing neuropsychiatric symptoms and poor insurance coverage. Facilitators included treatment focused on education of neuropsychiatric symptoms after TBI and having a comprehensive caregiver plan. Best strategies for maintaining TBI PCOR network included having a well-defined project, continued regular meetings, and on-going education of network members. Pertinent research topics included TBI and aging, factors influencing outcomes after TBI, substance use disorders related to TBI, and effectiveness of telemental health services. Needed policy changes included making TBI neuropsychiatry education accessible to stakeholders and improving accessibility of TBI neuropsychiatric care.Conclusion: TBI stakeholders identified several facilitators of care for neuropsychiatric symptoms after TBI and suggested research topics and best practices for conducting PCOR in this area.
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Affiliation(s)
- Vani A Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kathleen T Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - David B Arciniegas
- Marcus Institute for Brain Health, University of Colorado School of Medicine, Baltimore, USA
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jennifer Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Bryan T Pugh
- Brain Injury Association of Maryland, Baltimore, USA
| | - Aaron Jacoby
- VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, USA
| | - Luis Buenaver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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8
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Barr WB. POINT/COUNTER-POINT-Links between traumatic brain injury and dementia remain poorly defined. Arch Clin Neuropsychol 2020; 35:128-132. [PMID: 32008038 DOI: 10.1093/arclin/acz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
There has been considerable public interest in the topic of traumatic brain injury (TBI) as a risk factor for development of late-life dementia. A review was performed on empirical studies examining the relationship between these two conditions. Although results from a number of studies clearly demonstrate that TBI is a positive risk factor for developing dementia, there are an equivalent number of studies that obtain inconclusive or negative findings. Inconsistencies across studies are often the result of methodological findings including the nature of the investigational design, choice of comparison groups, and criteria used to define cases. In many studies, the diagnosis of TBI is obtained retrospectively in a manner that is subject to bias. Accurate identification of dementia cases is often compromised by the use of inappropriately brief follow-up periods and variations in diagnostic methods. There remains no universally accepted neurobiological mechanism to explain the transition from acute TBI to the chronic effects of dementia. Studies of specialty populations, including athletes and military personnel are beset by secular and cohort effects, raising questions about the applicability of findings to the general population. No existing studies have been able to exclude the possible effects of confounding medical or lifestyle factors in facilitating the onset of dementia following TBI. Although the research findings suggest a general association between TBI and dementia, the specifics of the relationship remain poorly defined.
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Affiliation(s)
- William B Barr
- Departments of Neurology & Psychiatry, NYU School of Medicine, Ney York, NY, USA
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9
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Gardner RC, Rivera E, O’Grady M, Doherty C, Yaffe K, Corrigan JD, Bogner J, Kramer J, Wilson F. Screening for Lifetime History of Traumatic Brain Injury Among Older American and Irish Adults at Risk for Dementia: Development and Validation of a Web-Based Survey. J Alzheimers Dis 2020; 74:699-711. [PMID: 32065793 PMCID: PMC7849628 DOI: 10.3233/jad-191138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is an established risk factor for dementia but mechanisms are uncertain. Accurate TBI exposure classification is critical for cognitive aging research studies seeking to discover mechanisms and treatments of post-TBI dementia. Brief TBI screens, commonly used in epidemiological studies of cognitive aging, are insensitive, leading to exposure mis-classification. Comprehensive TBI interviews, while more sensitive, may be impractical. OBJECTIVE We aimed to develop and validate a scalable, self-administered, comprehensive, web-based, TBI exposure survey for use in international cognitive aging research. METHODS We adapted a gold-standard comprehensive TBI interview (the Ohio State University TBI Identification Method; OSU TBI-ID) into a self-administered web-based survey for older adults (Older Adult modification of the OSU TBI-ID; OA OSU TBI-ID). We assessed reliability of our web-based survey versus the gold-standard interview among 97 older adults with normal cognition and mild cognitive impairment (MCI). In addition, we assessed sensitivity of the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) brief TBI screen versus the interview among 70 older adults with normal cognition. RESULTS Our OA OSU TBI-ID web-based survey had good to excellent reliability versus the interview (κ 0.66-0.73; ICCs 0.68-0.81) even among the sub-set with MCI (κ 0.74-0.88; ICCs 0.76-0.85), except for several age-at-injury variables. The NACC UDS brief TBI screen missed 50% of TBI exposures identified using the OSU TBI-ID interview. CONCLUSION The OSU TBI-ID interview and web-based survey may facilitate more accurate TBI exposure classification in cognitive aging research thereby accelerating discovery of targetable mechanisms of post-TBI dementia.
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Affiliation(s)
- Raquel C. Gardner
- Memory and Aging Center, Department of Neurology, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Global Brain Health Institute, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
| | - Ernesto Rivera
- Memory and Aging Center, Department of Neurology, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
| | - Megan O’Grady
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Colin Doherty
- Trinity Institute of Neurosciences (TCIN), School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Kristine Yaffe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Global Brain Health Institute, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
- Departments of Psychiatry and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - John D. Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Jennifer Bogner
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Joel Kramer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
- Global Brain Health Institute, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
| | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Abstract
Over 1.4 million people in the United States experience traumatic brain injury (TBI) each year and approximately 52,000 people die annually due to complications related to TBI. Traditionally, TBI has been viewed as a static injury with significant consequences for frontal lobe functioning that plateaus after some window of recovery, remaining relatively stable thereafter. However, over the past decade there has been growing consensus that the consequences of TBI are dynamic, with unique characteristics expressed at the individual level and over the life span. This chapter first discusses the pathophysiology of TBI in order to understand its dynamic process and then describes the behavioral changes that are the result of injury with focus on frontal lobe functions. It integrates a historical perspective on structural and functional brain-imaging approaches used to understand how TBI impacts the frontal lobes, as well as more recent approaches to examine large-scale network changes after TBI. The factors most useful for outcome prediction are surveyed, along with how the theoretical frameworks used to predict recovery have developed over time. In this chapter, the authors argue for the need to understand outcome after TBI as a dynamic process with individual trajectories, taking a network theory perspective to understand the consequences of disrupting frontal systems in TBI. Within this framework, understanding frontal lobe dysfunction within a larger coordinated neural network to study TBI may provide a novel perspective in outcome prediction and in developing individualized treatments.
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Affiliation(s)
- Rachel A Bernier
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States.
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11
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Kenney K, Iacono D, Edlow BL, Katz DI, Diaz-Arrastia R, Dams-O'Connor K, Daneshvar DH, Stevens A, Moreau AL, Tirrell LS, Varjabedian A, Yendiki A, van der Kouwe A, Mareyam A, McNab JA, Gordon WA, Fischl B, McKee AC, Perl DP. Dementia After Moderate-Severe Traumatic Brain Injury: Coexistence of Multiple Proteinopathies. J Neuropathol Exp Neurol 2018; 77:50-63. [PMID: 29155947 DOI: 10.1093/jnen/nlx101] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/24/2017] [Indexed: 12/14/2022] Open
Abstract
We report the clinical, neuroimaging, and neuropathologic characteristics of 2 patients who developed early onset dementia after a moderate-severe traumatic brain injury (TBI). Neuropathological evaluation revealed abundant β-amyloid neuritic and cored plaques, diffuse β-amyloid plaques, and frequent hyperphosphorylated-tau neurofibrillary tangles (NFT) involving much of the cortex, including insula and mammillary bodies in both cases. Case 1 additionally showed NFTs in both the superficial and deep cortical layers, occasional perivascular and depth-of-sulci NFTs, and parietal white matter rarefaction, which corresponded with decreased parietal fiber tracts observed on ex vivo MRI. Case 2 additionally showed NFT predominance in the superficial layers of the cortex, hypothalamus and brainstem, diffuse Lewy bodies in the cortex, amygdala and brainstem, and intraneuronal TDP-43 inclusions. The neuropathologic diagnoses were atypical Alzheimer disease (AD) with features of chronic traumatic encephalopathy and white matter loss (Case 1), and atypical AD, dementia with Lewy bodies and coexistent TDP-43 pathology (Case 2). These findings support an epidemiological association between TBI and dementia and further characterize the variety of misfolded proteins that may accumulate after TBI. Analyses with comprehensive clinical, imaging, genetic, and neuropathological data are required to characterize the full clinicopathological spectrum associated with dementias occurring after moderate-severe TBI.
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Affiliation(s)
- Kimbra Kenney
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Diego Iacono
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Brian L Edlow
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Douglas I Katz
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Ramon Diaz-Arrastia
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Kristen Dams-O'Connor
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Allison Stevens
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Allison L Moreau
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Lee S Tirrell
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Ani Varjabedian
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Anastasia Yendiki
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Andre van der Kouwe
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Azma Mareyam
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Jennifer A McNab
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Wayne A Gordon
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Bruce Fischl
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Ann C McKee
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
| | - Daniel P Perl
- Department of Neurology; Department of Pathology, F. Edward Hébert School of Medicine; Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Research (HJF); Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Neurology; Alzheimer's Disease Center and CTE Program, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;Department of Rehabilitation Medicine; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts; and Department of Pathology, Boston University School of Medicine, Boston, Massachusetts
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12
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The chronic and evolving neurological consequences of traumatic brain injury. Lancet Neurol 2017; 16:813-825. [PMID: 28920887 DOI: 10.1016/s1474-4422(17)30279-x] [Citation(s) in RCA: 312] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) can have lifelong and dynamic effects on health and wellbeing. Research on the long-term consequences emphasises that, for many patients, TBI should be conceptualised as a chronic health condition. Evidence suggests that functional outcomes after TBI can show improvement or deterioration up to two decades after injury, and rates of all-cause mortality remain elevated for many years. Furthermore, TBI represents a risk factor for a variety of neurological illnesses, including epilepsy, stroke, and neurodegenerative disease. With respect to neurodegeneration after TBI, post-mortem studies on the long-term neuropathology after injury have identified complex persisting and evolving abnormalities best described as polypathology, which includes chronic traumatic encephalopathy. Despite growing awareness of the lifelong consequences of TBI, substantial gaps in research exist. Improvements are therefore needed in understanding chronic pathologies and their implications for survivors of TBI, which could inform long-term health management in this sizeable patient population.
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Julien J, Joubert S, Ferland MC, Frenette L, Boudreau-Duhaime M, Malo-Véronneau L, de Guise E. Association of traumatic brain injury and Alzheimer disease onset: A systematic review. Ann Phys Rehabil Med 2017; 60:347-356. [DOI: 10.1016/j.rehab.2017.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/13/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
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14
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Abstract
There is a long history linking traumatic brain injury (TBI) with the development of dementia. Despite significant reservations, such as recall bias or concluding causality for TBI, a summary of recent research points to several conclusions on the TBI-dementia relationship. 1) Increasing severity of a single moderate-to-severe TBI increases the risk of subsequent Alzheimer's disease (AD), the most common type of dementia. 2) Repetitive, often subconcussive, mild TBIs increases the risk for chronic traumatic encephalopathy (CTE), a degenerative neuropathology. 3) TBI may be a risk factor for other neurodegenerative disorders that can be associated with dementia. 4) TBI appears to lower the age of onset of TBI-related neurocognitive syndromes, potentially adding "TBI cognitive-behavioral features". The literature further indicates several specific risk factors for TBI-associated dementia: 5) any blast or blunt physical force to the head as long as there is violent head displacement; 6) decreased cognitive and/or neuronal reserve and the related variable of older age at TBI; and 7) the presence of apolipoprotein E ɛ4 alleles, a genetic risk factor for AD. Finally, there are neuropathological features relating TBI with neurocognitive syndromes: 8) acute TBI results in amyloid pathology and other neurodegenerative proteinopathies; 9) CTE shares features with neurodegenerative dementias; and 10) TBI results in white matter tract and neural network disruptions. Although further research is needed, these ten findings suggest that dose-dependent effects of violent head displacement in vulnerable brains predispose to dementia; among several potential mechanisms is the propagation of abnormal proteins along damaged white matter networks.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Gardner RC, Langa KM, Yaffe K. Subjective and objective cognitive function among older adults with a history of traumatic brain injury: A population-based cohort study. PLoS Med 2017; 14:e1002246. [PMID: 28267747 PMCID: PMC5340352 DOI: 10.1371/journal.pmed.1002246] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is extremely common across the lifespan and is an established risk factor for dementia. The cognitive profile of the large and growing population of older adults with prior TBI who do not have a diagnosis of dementia, however, has not been well described. Our aim was to describe the cognitive profile associated with prior TBI exposure among community-dwelling older adults without dementia-an understudied but potentially vulnerable population. METHODS AND FINDINGS In this population-based cohort study, we studied 984 community-dwelling older adults (age 51 y and older and their spouses) without dementia who had been randomly selected from respondents to the 2014 wave of the Health and Retirement Study to participate in a comprehensive TBI survey and who either reported no prior TBI (n = 737) or prior symptomatic TBI resulting in treatment in a hospital (n = 247). Mean time since first TBI was 38 ± 19 y. Outcomes assessed included measures of global cognitive function, verbal episodic memory, semantic fluency, and calculation as well as a measure of subjective memory ("How would you rate your memory at the present time?"). We compared outcomes between the two TBI groups using regression models adjusting for demographics, medical comorbidities, and depression. Sensitivity analyses were performed stratified by TBI severity (no TBI, TBI without loss of consciousness [LOC], and TBI with LOC). Respondents with TBI were younger (mean age 64 ± 10 y versus 68 ± 11 y), were less likely to be female, and had higher prevalence of medical comorbidities and depression than respondents without TBI. Respondents with TBI did not perform significantly differently from respondents without TBI on any measure of objective cognitive function in either raw or adjusted models (fully adjusted: global cognitive function score 15.4 versus 15.2, p = 0.68; verbal episodic memory score 4.4 versus 4.3, p = 0.79; semantic fluency score 15.7 versus 14.0, p = 0.21; calculation impairment 22% versus 26%, risk ratio [RR] [95% CI] = 0.86 [0.67-1.11], p = 0.24). Sensitivity analyses stratified by TBI severity produced similar results. TBI was associated with significantly increased risk for subjective memory impairment in models adjusted for demographics and medical comorbidities (29% versus 24%; RR [95% CI]: 1.26 [1.02-1.57], p = 0.036). After further adjustment for active depression, however, risk for subjective memory impairment was no longer significant (RR [95% CI]: 1.18 [0.95-1.47], p = 0.13). Sensitivity analyses revealed that risk of subjective memory impairment was increased only among respondents with TBI with LOC and not among those with TBI without LOC. Furthermore, the risk of subjective memory impairment was significantly greater among those with TBI with LOC versus those without TBI even after adjustment for depression (RR [95% CI]: partially adjusted, 1.38 [1.09-1.74], p = 0.008; fully adjusted, 1.28 [1.01-1.61], p = 0.039). CONCLUSIONS In this population-based study of community-dwelling older adults without dementia, those with prior TBI with LOC were more likely to report subjective memory impairment compared to those without TBI even after adjustment for demographics, medical comorbidities, and active depression. Lack of greater objective cognitive impairment among those with versus without TBI may be due to poor sensitivity of the cognitive battery or survival bias, or may suggest that post-TBI cognitive impairment primarily affects executive function and processing speed, which were not rigorously assessed in this study. Our findings show that among community-dwelling non-demented older adults, history of TBI is common but may not preferentially impact cognitive domains of episodic memory, attention, working memory, verbal semantic fluency, or calculation.
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Affiliation(s)
- Raquel C. Gardner
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
- * E-mail:
| | - Kenneth M. Langa
- Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States of America
- Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan, United States of America
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kristine Yaffe
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
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Abstract
OBJECTIVES The aim of this study was to characterize the neuropsychological profile of lifetime traumatic brain injury (TBI) in older Veterans. METHODS Participants were 169 older Veterans [mean age=79.1 years (range, 51-97 years), 89% male, 92% Caucasian], 88 with lifetime TBI and 81 without TBI, living in Veterans' retirement homes in independent residence. TBI history was ascertained with the Ohio State TBI Identification Method structured interview. Cognition was assessed with neuropsychological tests: Raw scores were converted to Z-scores compared to age-corrected normative data and combined into five domain composite Z-scores (attention/working memory, learning/memory, language, processing speed, executive functioning). We investigated the association between TBI and performance in each cognitive domain in linear mixed effects models, with and without adjustment for demographics, medical comorbidities, and psychiatric variables. RESULTS Compared to those without TBI, older Veterans with TBI had greater deficits in processing speed (estimate=-.52; p=.01; f 2=.08 in fully adjusted model) and executive functioning (estimate=-.41; p=.02; f 2=.06 in fully adjusted model) but performed similarly in the attention/working memory, learning/memory, and language domains (all p>.05). TBI-associated deficits were most prominent among individuals with multiple mild TBIs and those with any moderate-to-severe TBI, but were not clearly present among those with single mild TBI. CONCLUSIONS The neuropsychological profile of lifetime TBI in older Veterans is characterized by slowed processing speed and executive dysfunction, especially among those with greater injury burden. This pattern may reflect long-standing deficits or a TBI-associated cognitive decline process distinct from Alzheimer's disease. (JINS, 2017, 23, 56-64).
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Dams-O'Connor K, Guetta G, Hahn-Ketter AE, Fedor A. Traumatic brain injury as a risk factor for Alzheimer's disease: current knowledge and future directions. Neurodegener Dis Manag 2016; 6:417-29. [PMID: 27599555 DOI: 10.2217/nmt-2016-0017] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
There is growing concern about the late effects of traumatic brain injury (TBI). This scoping review summarizes clinical research from the past 10 years that evaluates the relationship between TBI and Alzheimer's disease. This review identified five studies that found increased risk for dementia after TBI, two studies that found no increased risk and four studies that found a relationship only under certain conditions or in specified subsamples. Methodological differences across studies preclude direct comparison of results, and discrepant findings elucidate the complex course of post-TBI neurodegeneration. We discuss the factors that influence the strength and direction of the relationship between TBI and Alzheimer's disease, and the implications of this body of research for patient care and future research.
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Affiliation(s)
- Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gabrielle Guetta
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Amanda E Hahn-Ketter
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Andrew Fedor
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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18
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Mendez MF, Paholpak P, Lin A, Zhang JY, Teng E. Prevalence of Traumatic Brain Injury in Early Versus Late-Onset Alzheimer's Disease. J Alzheimers Dis 2016; 47:985-93. [PMID: 26401777 DOI: 10.3233/jad-143207] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is the most established environmental risk factor for Alzheimer's disease (AD), but it is unclear if TBI is specifically associated with early-onset AD (EOAD). OBJECTIVE To evaluate the relationship between TBI and EOAD (<65 years). METHODS We identified 1,449 EOAD, 4,337 late-onset AD (LOAD), and corresponding EOAD-matched and LOAD-matched normal controls (NC) in the National Alzheimer's Coordinating Center Uniform (NACC) database and compared the prevalence of any history of TBI as well as measures of cognition, function, behavior, and neuropathology. For validation, we determined TBI prevalence among 115 well-characterized clinic patients with EOAD. RESULTS Part A: The prevalence of any TBI in the NACC-database EOAD participants (13.3%) was comparable to that observed in the clinic EOAD patients (13.9%) but significantly higher than in the NACC-database LOAD participants (7.7% ; p < 0.0001) and trended to higher compared to EOAD-matched NC (11.1% ; logistic regression p = 0.053). Part B: When we compared EOAD patients with documented non-acute and non-residually impairing TBI to EOAD without a documented history of prior TBI, those with TBI had significantly more disinhibition. Part C: Autopsies did not reveal differences in AD neuropathology based on a history of TBI. CONCLUSIONS These findings suggest, but do not establish, that TBI is a specific risk factor for EOAD and may lead to disinhibition, a feature that often results from the frontal effects of head injury. This study recommends further research on the effects of TBI in EOAD in larger numbers of participants.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Pongsatorn Paholpak
- Department of Neurology, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Andrew Lin
- Department of Neurology, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jeannie Y Zhang
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Edmond Teng
- Department of Neurology, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Hay J, Johnson VE, Smith DH, Stewart W. Chronic Traumatic Encephalopathy: The Neuropathological Legacy of Traumatic Brain Injury. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2016; 11:21-45. [PMID: 26772317 DOI: 10.1146/annurev-pathol-012615-044116] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Almost a century ago, the first clinical account of the punch-drunk syndrome emerged, describing chronic neurological and neuropsychiatric sequelae occurring in former boxers. Thereafter, throughout the twentieth century, further reports added to our understanding of the neuropathological consequences of a career in boxing, leading to descriptions of a distinct neurodegenerative pathology, termed dementia pugilistica. During the past decade, growing recognition of this pathology in autopsy studies of nonboxers who were exposed to repetitive, mild traumatic brain injury, or to a single, moderate or severe traumatic brain injury, has led to an awareness that it is exposure to traumatic brain injury that carries with it a risk of this neurodegenerative disease, not the sport or the circumstance in which the injury is sustained. Furthermore, the neuropathology of the neurodegeneration that occurs after traumatic brain injury, now termed chronic traumatic encephalopathy, is acknowledged as being a complex, mixed, but distinctive pathology, the detail of which is reviewed in this article.
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Affiliation(s)
- Jennifer Hay
- School of Medicine and.,Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Victoria E Johnson
- Penn Center for Brain Injury and Repair, and Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Douglas H Smith
- Penn Center for Brain Injury and Repair, and Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - William Stewart
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow G12 8QQ, United Kingdom; .,Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
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Portbury SD, Adlard PA. Traumatic Brain Injury, Chronic Traumatic Encephalopathy, and Alzheimer’s Disease: Common Pathologies Potentiated by Altered Zinc Homeostasis. J Alzheimers Dis 2015; 46:297-311. [DOI: 10.3233/jad-143048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Deutsch MB, Mendez MF, Teng E. Interactions between traumatic brain injury and frontotemporal degeneration. Dement Geriatr Cogn Disord 2015; 39:143-53. [PMID: 25531628 PMCID: PMC4427348 DOI: 10.1159/000369787] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Prior work in smaller cohorts suggests that traumatic brain injury (TBI) may be a risk factor for frontotemporal degeneration (FTD). We sought to confirm and extend these results using the National Alzheimer's Coordinating Center Uniform Data Set. METHODS We compared the TBI prevalence between FTD subjects and matched normal controls. Indices of cognitive, behavioral, functional, and global dementia severity were compared between FTD subjects with and without prior TBI. RESULTS Remote TBI with extended loss of consciousness (TBI-ext) was more common in individuals with FTD than in controls (OR: 1.67; 95% CI: 1.004-2.778). With TBI-ext, less functional and global impairment was seen in the behavioral variant of FTD, but more behavioral pathology was seen in the semantic variant. CONCLUSION TBI may increase the FTD risk and influence clinical symptomatology and severity in FTD subtypes.
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Affiliation(s)
- Mariel B. Deutsch
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Edmond Teng
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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