1
|
Abbott CC, Miller J, Farrar D, Argyelan M, Lloyd M, Squillaci T, Kimbrell B, Ryman S, Jones TR, Upston J, Quinn DK, Peterchev AV, Erhardt E, Datta A, McClintock SM, Deng ZD. Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes. Neuropsychopharmacology 2024; 49:640-648. [PMID: 38212442 PMCID: PMC10876627 DOI: 10.1038/s41386-023-01780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated that increased E-field strength improves ECT's antidepressant effect but worsens cognitive outcomes. Amplitude-determined seizure titration may reduce the E-field variability relative to fixed amplitude ECT. In this investigation, we assessed the relationships among amplitude-determined seizure-threshold (STa), E-field magnitude, and clinical outcomes in older adults (age range 50 to 80 years) with depression. Subjects received brain imaging, depression assessment, and neuropsychological assessment pre-, mid-, and post-ECT. STa was determined during the first treatment with a Soterix Medical 4×1 High Definition ECT Multi-channel Stimulation Interface (Investigation Device Exemption: G200123). Subsequent treatments were completed with right unilateral electrode placement (RUL) and 800 mA. We calculated Ebrain defined as the 90th percentile of E-field magnitude in the whole brain for RUL electrode placement. Twenty-nine subjects were included in the final analyses. Ebrain per unit electrode current, Ebrain/I, was associated with STa. STa was associated with antidepressant outcomes at the mid-ECT assessment and bitemporal electrode placement switch. Ebrain/I was associated with changes in category fluency with a large effect size. The relationship between STa and Ebrain/I extends work from preclinical models and provides a validation step for ECT E-field modeling. ECT with individualized amplitude based on E-field modeling or STa has the potential to enhance neuroscience-based ECT parameter selection and improve clinical outcomes.
Collapse
Affiliation(s)
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Danielle Farrar
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Miklos Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Taylor Squillaci
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Brian Kimbrell
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Sephira Ryman
- Mind Research Network, Albuquerque, NM, USA
- Department of Neurology, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Angel V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | | | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Zhi-De Deng
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
2
|
Robertson-Benta CR, Pabbathi Reddy S, Stephenson DD, Sicard V, Hergert DC, Dodd AB, Campbell RA, Phillips JP, Meier TB, Quinn DK, Mayer AR. Cognition and post-concussive symptom status after pediatric mild traumatic brain injury. Child Neuropsychol 2024; 30:203-220. [PMID: 36825526 PMCID: PMC10447629 DOI: 10.1080/09297049.2023.2181946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
Cognitive impairment and post-concussive symptoms (PCS) represent hallmark sequelae of pediatric mild traumatic brain injury (pmTBI). Few studies have directly compared cognition as a function of PCS status longitudinally. Cognitive outcomes were therefore compared for asymptomatic pmTBI, symptomatic pmTBI, and healthy controls (HC) during sub-acute (SA; 1-11 days) and early chronic (EC; approximately 4 months) post-injury phases. We predicted worse cognitive performance for both pmTBI groups relative to HC at the SA visit. At the EC visit, we predicted continued impairment from the symptomatic group, but no difference between asymptomatic pmTBI and HCs. A battery of clinical (semi-structured interviews and self-report questionnaires) and neuropsychological measures were administered to 203 pmTBI and 139 HC participants, with greater than 80% retention at the EC visit. A standardized change method classified pmTBI into binary categories of asymptomatic or symptomatic based on PCS scores. Symptomatic pmTBI performed significantly worse than HCs on processing speed, attention, and verbal memory at SA visit, whereas lower performance was only present for verbal memory for asymptomatic pmTBI. Lower performance in verbal memory persisted for both pmTBI groups at the EC visit. Surprisingly, a minority (16%) of pmTBI switched from asymptomatic to symptomatic status at the EC visit. Current findings suggest that PCS and cognition are more closely coupled during the first week of injury but become decoupled several months post-injury. Evidence of lower performance in verbal memory for both asymptomatic and symptomatic pmTBI suggests that cognitive recovery may be a process separate from the resolution of subjective symptomology.
Collapse
Affiliation(s)
- Cidney R Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Sharvani Pabbathi Reddy
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - David D Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Veronik Sicard
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Danielle C Hergert
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Richard A Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - John P Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Departments of Psychology and Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
- Departments of Psychology and Neurology, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
3
|
Mayer AR, McQuaid JR, Wick TV, Dodd AB, Robertson-Benta CR, Stephenson DD, van der Horn HJ, Quinn DK, Davis WA, Hittson AK, Sapien RE, Phillips JP, Campbell RA. Sex- and Age-Related Differences in Post-Concussive Symptom Reporting Among Children and Their Parents. J Neurotrauma 2024; 41:209-221. [PMID: 37725586 DOI: 10.1089/neu.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Pediatric mild traumatic brain injury (pmTBI) has received increased public attention over the past decade, especially for children who experience persistent post-concussive symptoms (PCS). Common methods for obtaining pediatric PCS rely on both self- and parental report, exhibit moderate test-retest reliability, and variable child-parent agreement, and may yield high false positives. The current study investigated the impact of age and biological sex on PCS reporting (Post-Concussion Symptom Inventory) in patients with pmTBI (n = 286) at retrospective, 1 week, 4 months, and 1 year post-injury time points, as well as reported symptoms in healthy controls (HC; n = 218) at equivalent assessment times. HC and their parents reported higher PCS for their retrospective rating relative to the other three other study visits. Child-parent agreement was highest for female adolescents, but only approached acceptable ranges (≥ 0.75) immediately post-injury. Poor-to-fair child/parental agreement was observed for most other study visits for pmTBI and at all visits for HC. Parents rated female adolescents as being more symptomatic than their male counterparts in spite of small (pmTBI) or no (HC) sex-related differences in self-reported ratings, suggestive of a potential cultural bias in parental ratings. Test-retest reliability for self-report was typically below acceptable ranges for both pmTBI and HC groups, with reliability decreasing for HC and increasing for pmTBI as a function of time between visits. Parental test-retest reliability was higher for females. Although continued research is needed, current results support the use of child self-report over parental ratings for estimating PCS burden. Results also highlight the perils of relying on symptom self-report for diagnostic and prognostic purposes.
Collapse
Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jessica R McQuaid
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Tracey V Wick
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Cidney R Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - David D Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Harm J van der Horn
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - William A Davis
- Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico, USA
| | - Anne K Hittson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Robert E Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - John P Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard A Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
4
|
Erickson JM, Quinn DK, Kalra I, Roy D. The Neuropsychiatry Special Interest Group: a Model for Organizing and Optimizing Member Engagement in a National Organization. Acad Psychiatry 2023; 47:700-701. [PMID: 37704878 DOI: 10.1007/s40596-023-01854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Affiliation(s)
| | - Davin K Quinn
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Inder Kalra
- Einstein Jefferson Healthcare Network, Philadelphia, PA, USA
| | - Durga Roy
- John Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Plummer AM, Matos YL, Lin HC, Ryman SG, Birg A, Quinn DK, Parada AN, Vakhtin AA. Gut-brain pathogenesis of post-acute COVID-19 neurocognitive symptoms. Front Neurosci 2023; 17:1232480. [PMID: 37841680 PMCID: PMC10568482 DOI: 10.3389/fnins.2023.1232480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Approximately one third of non-hospitalized coronavirus disease of 2019 (COVID-19) patients report chronic symptoms after recovering from the acute stage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Some of the most persistent and common complaints of this post-acute COVID-19 syndrome (PACS) are cognitive in nature, described subjectively as "brain fog" and also objectively measured as deficits in executive function, working memory, attention, and processing speed. The mechanisms of these chronic cognitive sequelae are currently not understood. SARS-CoV-2 inflicts damage to cerebral blood vessels and the intestinal wall by binding to angiotensin-converting enzyme 2 (ACE2) receptors and also by evoking production of high levels of systemic cytokines, compromising the brain's neurovascular unit, degrading the intestinal barrier, and potentially increasing the permeability of both to harmful substances. Such substances are hypothesized to be produced in the gut by pathogenic microbiota that, given the profound effects COVID-19 has on the gastrointestinal system, may fourish as a result of intestinal post-COVID-19 dysbiosis. COVID-19 may therefore create a scenario in which neurotoxic and neuroinflammatory substances readily proliferate from the gut lumen and encounter a weakened neurovascular unit, gaining access to the brain and subsequently producing cognitive deficits. Here, we review this proposed PACS pathogenesis along the gut-brain axis, while also identifying specific methodologies that are currently available to experimentally measure each individual component of the model.
Collapse
Affiliation(s)
- Allison M. Plummer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Yvette L. Matos
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
| | - Henry C. Lin
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Sephira G. Ryman
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Aleksandr Birg
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Alisha N. Parada
- Division of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Andrei A. Vakhtin
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
| |
Collapse
|
6
|
Quinn DK, Upston J, Jones TR, Gibson BC, Olmstead TA, Yang J, Price AM, Bowers-Wu DH, Durham E, Hazlewood S, Farrar DC, Miller J, Lloyd MO, Garcia CA, Ojeda CJ, Hager BW, Vakhtin AA, Abbott CC. Electric field distribution predicts efficacy of accelerated intermittent theta burst stimulation for late-life depression. Front Psychiatry 2023; 14:1215093. [PMID: 37593449 PMCID: PMC10427506 DOI: 10.3389/fpsyt.2023.1215093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for late-life depression (LLD) but may have lower rates of response and remission owing to age-related brain changes. In particular, rTMS induced electric field strength may be attenuated by cortical atrophy in the prefrontal cortex. To identify clinical characteristics and treatment parameters associated with response, we undertook a pilot study of accelerated fMRI-guided intermittent theta burst stimulation (iTBS) to the right dorsolateral prefrontal cortex in 25 adults aged 50 or greater diagnosed with LLD and qualifying to receive clinical rTMS. Methods Participants underwent baseline behavioral assessment, cognitive testing, and structural and functional MRI to generate individualized targets and perform electric field modeling. Forty-five sessions of iTBS were delivered over 9 days (1800 pulses per session, 50-min inter-session interval). Assessments and testing were repeated after 15 sessions (Visit 2) and 45 sessions (Visit 3). Primary outcome measure was the change in depressive symptoms on the Inventory of Depressive Symptomatology-30-Clinician (IDS-C-30) from Visit 1 to Visit 3. Results Overall there was a significant improvement in IDS score with the treatment (Visit 1: 38.6; Visit 2: 31.0; Visit 3: 21.3; mean improvement 45.5%) with 13/25 (52%) achieving response and 5/25 (20%) achieving remission (IDS-C-30 < 12). Electric field strength and antidepressant effect were positively correlated in a subregion of the ventrolateral prefrontal cortex (VLPFC) (Brodmann area 47) and negatively correlated in the posterior dorsolateral prefrontal cortex (DLPFC). Conclusion Response and remission rates were lower than in recently published trials of accelerated fMRI-guided iTBS to the left DLPFC. These results suggest that sufficient electric field strength in VLPFC may be a contributor to effective rTMS, and that modeling to optimize electric field strength in this area may improve response and remission rates. Further studies are needed to clarify the relationship of induced electric field strength with antidepressant effects of rTMS for LLD.
Collapse
Affiliation(s)
- Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Thomas R. Jones
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Benjamin C. Gibson
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Tessa A. Olmstead
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Justine Yang
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | | | - Dorothy H. Bowers-Wu
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Erick Durham
- Department of Psychiatry, Texas Tech University, El Paso, TX, United States
| | - Shawn Hazlewood
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Danielle C. Farrar
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Jeremy Miller
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Megan O. Lloyd
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Crystal A. Garcia
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Cesar J. Ojeda
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | - Brant W. Hager
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| | | | - Christopher C. Abbott
- Department of Psychiatry and Behavioral Sciences, UNM, Albuquerque, NM, United States
| |
Collapse
|
7
|
Horwitz LI, Thaweethai T, Brosnahan SB, Cicek MS, Fitzgerald ML, Goldman JD, Hess R, Hodder SL, Jacoby VL, Jordan MR, Krishnan JA, Laiyemo AO, Metz TD, Nichols L, Patzer RE, Sekar A, Singer NG, Stiles LE, Taylor BS, Ahmed S, Algren HA, Anglin K, Aponte-Soto L, Ashktorab H, Bassett IV, Bedi B, Bhadelia N, Bime C, Bind MAC, Black LJ, Blomkalns AL, Brim H, Castro M, Chan J, Charney AW, Chen BK, Chen LQ, Chen P, Chestek D, Chibnik LB, Chow DC, Chu HY, Clifton RG, Collins S, Costantine MM, Cribbs SK, Deeks SG, Dickinson JD, Donohue SE, Durstenfeld MS, Emery IF, Erlandson KM, Facelli JC, Farah-Abraham R, Finn AV, Fischer MS, Flaherman VJ, Fleurimont J, Fonseca V, Gallagher EJ, Gander JC, Gennaro ML, Gibson KS, Go M, Goodman SN, Granger JP, Greenway FL, Hafner JW, Han JE, Harkins MS, Hauser KSP, Heath JR, Hernandez CR, Ho O, Hoffman MK, Hoover SE, Horowitz CR, Hsu H, Hsue PY, Hughes BL, Jagannathan P, James JA, John J, Jolley S, Judd SE, Juskowich JJ, Kanjilal DG, Karlson EW, Katz SD, Kelly JD, Kelly SW, Kim AY, Kirwan JP, Knox KS, Kumar A, Lamendola-Essel MF, Lanca M, Lee-lannotti JK, Lefebvre RC, Levy BD, Lin JY, Logarbo BP, Logue JK, Longo MT, Luciano CA, Lutrick K, Malakooti SK, Mallett G, Maranga G, Marathe JG, Marconi VC, Marshall GD, Martin CF, Martin JN, May HT, McComsey GA, McDonald D, Mendez-Figueroa H, Miele L, Mittleman MA, Mohandas S, Mouchati C, Mullington JM, Nadkarni GN, Nahin ER, Neuman RB, Newman LT, Nguyen A, Nikolich JZ, Ofotokun I, Ogbogu PU, Palatnik A, Palomares KTS, Parimon T, Parry S, Parthasarathy S, Patterson TF, Pearman A, Peluso MJ, Pemu P, Pettker CM, Plunkett BA, Pogreba-Brown K, Poppas A, Porterfield JZ, Quigley JG, Quinn DK, Raissy H, Rebello CJ, Reddy UM, Reece R, Reeder HT, Rischard FP, Rosas JM, Rosen CJ, Rouphael NG, Rouse DJ, Ruff AM, Saint Jean C, Sandoval GJ, Santana JL, Schlater SM, Sciurba FC, Selvaggi C, Seshadri S, Sesso HD, Shah DP, Shemesh E, Sherif ZA, Shinnick DJ, Simhan HN, Singh U, Sowles A, Subbian V, Sun J, Suthar MS, Teunis LJ, Thorp JM, Ticotsky A, Tita ATN, Tragus R, Tuttle KR, Urdaneta AE, Utz PJ, VanWagoner TM, Vasey A, Vernon SD, Vidal C, Walker T, Ward HD, Warren DE, Weeks RM, Weiner SJ, Weyer JC, Wheeler JL, Whiteheart SW, Wiley Z, Williams NJ, Wisnivesky JP, Wood JC, Yee LM, Young NM, Zisis SN, Foulkes AS. Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design. PLoS One 2023; 18:e0286297. [PMID: 37352211 PMCID: PMC10289397 DOI: 10.1371/journal.pone.0286297] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/12/2023] [Indexed: 06/25/2023] Open
Abstract
IMPORTANCE SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options. REGISTRATION NCT05172024.
Collapse
Affiliation(s)
- Leora I. Horwitz
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Shari B. Brosnahan
- Division of Pulmonary Critical Care and Sleep Medicine, NYU Langone Health, New York, New York, United States of America
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Megan L. Fitzgerald
- Patient Led Research Collaboration on COVID-19, Washington, DC, United States of America
| | - Jason D. Goldman
- Division of Infectious Diseases, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Rachel Hess
- Department of Population Health Sciences and Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - S. L. Hodder
- Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Michael R. Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Medford, Massachusetts, United States of America
| | - Jerry A. Krishnan
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Adeyinka O. Laiyemo
- Department of Medicine, Howard University, Washington, DC, United States of America
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Lauren Nichols
- Body Politic COVID-19 Support Group, Boston, Massachusetts, United States of America
| | - Rachel E. Patzer
- Department of Medicine and Surgery, Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Anisha Sekar
- Patient Led Research Collaboration on COVID-19, Washington, DC, United States of America
| | - Nora G. Singer
- Department of Medicine and Rheumatology, The MetroHealth Medical Center, Cleveland, Ohio, United States of America
| | - Lauren E. Stiles
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States of America
| | - Barbara S. Taylor
- Department of Medicine, Division of Infectious Diseases and Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Heather A. Algren
- Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Khamal Anglin
- Department of Epidemiology and Biostatistics, University of California at San Francisco Institute of Global Health Sciences, San Francisco, San Francisco, California, United States of America
| | - Lisa Aponte-Soto
- College of Science and Health, Department of Health Sciences, DePaul University, Chicago, Illinois, United States of America
| | - Hassan Ashktorab
- Department of Medicine, Howard University, Washington, DC, United States of America
| | - Ingrid V. Bassett
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brahmchetna Bedi
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Nahid Bhadelia
- Center for Emerging Infectious Diseases Policy and Research, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Christian Bime
- Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lora J. Black
- Department of Clinical Research, Sanford Research, Sioux Falls, South Dakota, United States of America
| | - Andra L. Blomkalns
- Department of Emergency Medicine, Stanford University, Stanford, California, United States of America
| | - Hassan Brim
- Department of Pathology, Howard University, Washington, DC, United States of America
| | - Mario Castro
- Division of Pulmonary and Critical Care, University of Kansas Medical Center, Kansas City, Kansas City, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Alexander W. Charney
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Benjamin K. Chen
- Division of Infectious Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Li Qing Chen
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Peter Chen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - David Chestek
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Lori B. Chibnik
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Dominic C. Chow
- Department of Medicine, University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Helen Y. Chu
- Department of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Rebecca G. Clifton
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Shelby Collins
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Hospital, Columbus, Ohio, United States of America
| | - Sushma K. Cribbs
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Steven G. Deeks
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - John D. Dickinson
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sarah E. Donohue
- Department of Research Services, University of Illinois College of Medicine, Peoria, Illinois, United States of America
| | - Matthew S. Durstenfeld
- Department of Medicine, Division of Cardiology at Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California, United States of America
| | - Ivette F. Emery
- MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, United States of America
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Julio C. Facelli
- Department of Biomedical Informatics and Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, United States of America
| | - Rachael Farah-Abraham
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Aloke V. Finn
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland, United States of America
| | - Melinda S. Fischer
- Department of Medicine, Division of Infectious Diseases and Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Judes Fleurimont
- Mile Square Health Center, University of Illinois Chicago, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Emily J. Gallagher
- Department of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente of Georgia, Atlanta, Georgia, United States of America
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Kelly S. Gibson
- Department of Obstetrics and Gynecology, MetroHealth System, Cleveland, Ohio, United States of America
| | - Minjoung Go
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Steven N. Goodman
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Joey P. Granger
- Department of Physiology & Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Frank L. Greenway
- Clinical Trials, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - John W. Hafner
- Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, United States of America
| | - Jenny E. Han
- Department of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Michelle S. Harkins
- Department of Internal Medicine University of New Mexico, Health Science Center, Albuquerque, New Mexico, United States of America
| | - Kristine S. P. Hauser
- Clinical Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - James R. Heath
- Department of Bioengineering, Institute for Systems Biology, Seattle, Washington, United States of America
| | - Carla R. Hernandez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
| | - On Ho
- Seattle Children’s Therapeutics, Seattle, Washington, United States of America
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware, United States of America
| | - Susan E. Hoover
- Department of Clinical Research, Sanford Research, Sioux Falls, South Dakota, United States of America
| | - Carol R. Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Harvey Hsu
- Department of Internal Medicine, University of Arizona, Phoenix, Arizona, United States of America
| | - Priscilla Y. Hsue
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Judith A. James
- Department of Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America
| | - Janice John
- Department of Family Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
| | - Sarah Jolley
- Department of Pulmonary and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - S. E. Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Joy J. Juskowich
- Department of Medicine, Division of Infectious Diseases, West Virginia School of Medicine, Morgantown, West Virginia, United States of America
| | - Diane G. Kanjilal
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Elizabeth W. Karlson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart D. Katz
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - J. Daniel Kelly
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Sara W. Kelly
- Department of Pediatrics & Department of Research Services, University of Illinois College of Medicine, Peoria, Illinois, United States of America
| | - Arthur Y. Kim
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John P. Kirwan
- Department Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Kenneth S. Knox
- Department of Internal Medicine, University of Arizona, Phoenix, Arizona, United States of America
| | - Andre Kumar
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | | | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joyce K. Lee-lannotti
- Department of Internal Medicine and Neurology, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, United States of America
| | - R. Craig Lefebvre
- Communications Practice Area, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Bruce D. Levy
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Janet Y. Lin
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Brian P. Logarbo
- Tulane Center for Clinical Research, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Jennifer K. Logue
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michele T. Longo
- Tulane Center for Clinical Neurosciences, Tulane School of Medicine, New Orleans, Louisiana, United States of America
| | - Carlos A. Luciano
- Department of Neurology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, United States of America
| | - Karen Lutrick
- Department of Family & Community Medicine, University of Arizona, College of Medicine – Tucson, Tucson, Arizona, United States of America
| | - Shahdi K. Malakooti
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Gail Mallett
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
| | - Gabrielle Maranga
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Jai G. Marathe
- Department of Medicine, Section of Infectious Diseases, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Vincent C. Marconi
- Department of Medicine, Infectious Diseases and Department of Global Health, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Gailen D. Marshall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Christopher F. Martin
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Heidi T. May
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, Utah, United States of America
| | - Grace A. McComsey
- Department of Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Dylan McDonald
- Department of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Lucio Miele
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Murray A. Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, United States of America
| | - Christian Mouchati
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Janet M. Mullington
- Department of Neurology and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Girish N. Nadkarni
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Erica R. Nahin
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Robert B. Neuman
- Division of Cardiology, Kaiser Permanente of Georgia, Atlanta, Georgia, United States of America
| | - Lisa T. Newman
- Department of Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Amber Nguyen
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Janko Z. Nikolich
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Princess U. Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, United States of America
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Kristy T. S. Palomares
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, United States of America
| | - Tanyalak Parimon
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sairam Parthasarathy
- Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Thomas F. Patterson
- Department of Medicine, Department of Infectious Disease, University of Texas Health, San Antonio, Texas, United States of America
| | - Ann Pearman
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Michael J. Peluso
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, California, United States of America
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Christian M. Pettker
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Beth A. Plunkett
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, Illinois, United States of America
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, United States of America
| | - Athena Poppas
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - J. Zachary Porterfield
- Department of Internal Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky, United States of America
| | - John G. Quigley
- Department of Medicine, Division of Hematology/Oncology, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Candida J. Rebello
- Department of Nutrition and Chronic Disease, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Uma M. Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America
| | - Rebecca Reece
- Department of Medicine, Division of Infectious Diseases, West Virginia School of Medicine, Morgantown, West Virginia, United States of America
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Franz P. Rischard
- Department of Pulmonary and Critical Care, University of Arizona, Tucson, Arizona, United States of America
| | - Johana M. Rosas
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Clifford J. Rosen
- MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, United States of America
| | - Nadine G. Rouphael
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, United States of America
| | - Adam M. Ruff
- Division of Pulmonary and Critical Care, University of Kansas Medical Center, Kansas City, Kansas City, United States of America
| | - Christina Saint Jean
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Grecio J. Sandoval
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Jorge L. Santana
- Department of Medicine, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Shannon M. Schlater
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Caitlin Selvaggi
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center San Antonio, San Antonio, Texas, United States of America
| | - Howard D. Sesso
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Dimpy P. Shah
- Department of Population Health Sciences, Mays Cancer Center, University of Texas Health, San Antonio, Texas, United States of America
| | - Eyal Shemesh
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Zaki A. Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, United States of America
| | - Daniel J. Shinnick
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Upinder Singh
- Department of Internal Medicine, Stanford University, Stanford, California, United States of America
| | - Amber Sowles
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Vignesh Subbian
- Department of Biomedical Engineering, Department of Systems and Industrial Engineering, University of Arizona College of Engineering, Tucson, Arizona, United States of America
| | - Jun Sun
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Mehul S. Suthar
- Department of Pediatrics, Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America
| | - Larissa J. Teunis
- Health Services Research Center, Emory University, Atlanta, Georgia, United States of America
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Amberly Ticotsky
- Department of Family Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology and Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Robin Tragus
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Katherine R. Tuttle
- Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Spokane, Washington, United States of America
| | - Alfredo E. Urdaneta
- Department of Emergency Medicine, Stanford University, Stanford, California, United States of America
| | - P. J. Utz
- Department of Internal Medicine, Stanford University, Stanford, California, United States of America
| | - Timothy M. VanWagoner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Andrew Vasey
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Suzanne D. Vernon
- Department of Research, Bateman Horne Center, Salt Lake City, Utah, United States of America
| | - Crystal Vidal
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Tiffany Walker
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Honorine D. Ward
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - David E. Warren
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Ryan M. Weeks
- Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Steven J. Weiner
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jennifer L. Wheeler
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sidney W. Whiteheart
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky, United States of America
| | - Zanthia Wiley
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Natasha J. Williams
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital of Los Angeles, Los Angeles, California, United States of America
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Natalie M. Young
- Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Sokratis N. Zisis
- Department of Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
8
|
Mertens N, Cavanagh J, Brandt E, Fratzke V, Story-Remer J, Rieger R, Wilson JK, Gill D, Campbell R, Quinn DK. Effects of anodal tDCS on electroencephalography correlates of cognitive control in mild-to-moderate traumatic brain injury. NeuroRehabilitation 2023; 53:209-220. [PMID: 37638454 DOI: 10.3233/nre-230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) may provide a potential therapy for cognitive deficits caused by traumatic brain injury (TBI), yet its efficacy and mechanisms of action are still uncertain. OBJECTIVE We hypothesized that anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) would boost the influence of a cognitive training regimen in a mild-to-moderate TBI (mmTBI) sample. Cognitive enhancement was measured by examining event-related potentials (ERPs) during cognitive control tasks from pre- to post-treatment. METHODS Thirty-four participants with mmTBI underwent ten sessions of cognitive training with active (n = 17) or sham (n = 17) anodal tDCS to the left DLPFC. ERPs were assessed during performance of an auditory oddball (3AOB), N-back, and dot pattern expectancy (DPX) task before and after treatment. RESULTS P3b amplitudes significantly decreased from baseline to post-treatment testing, regardless of tDCS condition, in the N-back task. The active tDCS group demonstrated a significantly increased P3a amplitude in the DPX task. No statistically significant stimulation effects were seen during the 3AOB and N-back tasks. CONCLUSION Active anodal tDCS paired with cognitive training led to increases in P3a amplitudes in the DPX, inferring increased cognitive control. P3b decreased in the N-back task demonstrating the effects of cognitive training. These dissociated P3 findings suggest separate mechanisms invoked by different neuroplasticity-inducing paradigms (stimulation versus training) in brain networks that support executive functioning.
Collapse
Affiliation(s)
- Nickolas Mertens
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, USA
| | - James Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Emma Brandt
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, USA
| | - Violet Fratzke
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, USA
| | | | - Rebecca Rieger
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, USA
| | - J Kevin Wilson
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, USA
| | - Darbi Gill
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, USA
| | - Richard Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
9
|
Peters ME, Gurin LJ, Quinn DK, Roy D. Neurorehabilitation through a Neuropsychiatric Lens. NeuroRehabilitation 2023; 53:173-176. [PMID: 37638458 DOI: 10.3233/nre-236003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lindsey J Gurin
- Departments of Neurology, Psychiatry, and Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
Mayer AR, Quinn DK. Neuroimaging Biomarkers of New-Onset Psychiatric Disorders Following Traumatic Brain Injury. Biol Psychiatry 2022; 91:459-469. [PMID: 34334188 PMCID: PMC8665933 DOI: 10.1016/j.biopsych.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 02/07/2023]
Abstract
Traumatic brain injury (TBI) has traditionally been associated with cognitive and behavioral changes during both the acute and chronic phases of injury. Because of its noninvasive nature, neuroimaging has the potential to provide unique information on underlying macroscopic and microscopic biological mechanisms that may serve as causative agents for these neuropsychiatric sequelae. This broad scoping review identifies at least 4 common macroscopic pathways that exist between TBI and new-onset psychiatric disorders, as well as several examples of how neuroimaging is currently being utilized in clinical research. The review then critically examines the strengths and limitations of neuroimaging for elucidating TBI-related microscopic pathology, such as microstructural changes, neuroinflammation, proteinopathies, blood-brain barrier damage, and disruptions in cellular signaling. A summary is then provided for how neuroimaging is currently being used to investigate TBI-related pathology in new-onset neurocognitive disorders, depression, and posttraumatic stress disorder. Identified gaps in the literature include a lack of prospective studies to definitively associate imaging findings with the development of new-onset psychiatric disorders, as well as antemortem imaging studies subsequently confirmed with postmortem correlates in the same study cohort. Although the spatial resolution and specificity of imaging biomarkers has greatly improved over the last 2 decades, we conclude that neuroimaging biomarkers do not yet exist for the definitive in vivo diagnosis of cellular pathology. This represents a necessary next step for further elucidating causal relationships between TBI and new-onset psychiatric disorders.
Collapse
Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM 87106,Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131,Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131,Department of Psychology, University of New Mexico, Albuquerque, NM 87131,Corresponding author: Andrew Mayer, Ph.D., The Mind Research Network, Pete & Nancy Domenici Hall, 1101 Yale Blvd. NE, Albuquerque, NM 87106 USA; Tel: 505-272-0769; Fax: 505-272-8002;
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131
| |
Collapse
|
11
|
Deng ZD, Argyelan M, Miller J, Quinn DK, Lloyd M, Jones TR, Upston J, Erhardt E, McClintock SM, Abbott CC. Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes. Mol Psychiatry 2022; 27:1676-1682. [PMID: 34853404 PMCID: PMC9095458 DOI: 10.1038/s41380-021-01380-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023]
Abstract
Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes, but the underlying mechanisms for antidepressant response and procedure-induced cognitive side effects have yet to be elucidated. Such mechanisms may be complex and involve certain ECT parameters and brain regions. Regarding parameters, the electrode placement (right unilateral or bitemporal) determines the geometric shape of the electric field (E-field), and amplitude determines the E-field magnitude in select brain regions (e.g., hippocampus). Here, we aim to determine the relationships between hippocampal E-field strength, hippocampal neuroplasticity, and antidepressant and cognitive outcomes. We used hippocampal E-fields and volumes generated from a randomized clinical trial that compared right unilateral electrode placement with different pulse amplitudes (600, 700, and 800 mA). Hippocampal E-field strength was variable but increased with each amplitude arm. We demonstrated a linear relationship between right hippocampal E-field and right hippocampal neuroplasticity. Right hippocampal neuroplasticity mediated right hippocampal E-field and antidepressant outcomes. In contrast, right hippocampal E-field was directly related to cognitive outcomes as measured by phonemic fluency. We used receiver operating characteristic curves to determine that the maximal right hippocampal E-field associated with cognitive safety was 112.5 V/m. Right hippocampal E-field strength was related to the whole-brain ratio of E-field strength per unit of stimulation current, but this whole-brain ratio was unrelated to antidepressant or cognitive outcomes. We discuss the implications of optimal hippocampal E-field dosing to maximize antidepressant outcomes and cognitive safety with individualized amplitudes.
Collapse
Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA
| | - Jeremy Miller
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Megan Lloyd
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Thomas R Jones
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Joel Upston
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Shawn M McClintock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | | |
Collapse
|
12
|
Abstract
Anxiety is common in patients with chronic kidney disease, but in its extreme expressions, anxiety can also be a complicating comorbid psychiatric illness. There is only a small literature base on anxiety disorders in patients with renal disease, and many of the studies are not sufficiently specific about which anxiety disorders are being studied. Larger epidemiological studies are required to delineate the incidence, prevalence, and outcomes associated with the varied anxiety disorders. In addition, the impact of the co-occurrence of anxiety with other chronic psychiatric or medical problems, needs further study. Anxiety is a clinical condition that warrants treatment, primarily due to its association with mortality in end-stage renal disease patients, and its negative impact on perceived quality of life. Therapeutic options for patients with anxiety and kidney disease include both pharmacologic and nonpharmacologic approaches. Current treatment strategies for anxiety specific to patients with renal disease are provided.
Collapse
Affiliation(s)
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Paul L Kimmel
- Department of Medicine, George Washington University, Washington, DC
| |
Collapse
|
13
|
Quinn DK, Story-Remer J, Brandt E, Fratzke V, Rieger R, Wilson JK, Gill D, Mertens N, Hunter M, Upston J, Jones TR, Richardson JD, Myers O, Arciniegas DB, Campbell R, Clark VP, Yeo RA, Shuttleworth CW, Mayer AR. Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury. Front Hum Neurosci 2022; 16:1026639. [PMID: 36310843 PMCID: PMC9608772 DOI: 10.3389/fnhum.2022.1026639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Persistent posttraumatic symptoms (PPS) may manifest after a mild-moderate traumatic brain injury (mmTBI) even when standard brain imaging appears normal. Transcranial direct current stimulation (tDCS) represents a promising treatment that may ameliorate pathophysiological processes contributing to PPS. Objective/Hypothesis: We hypothesized that in a mmTBI population, active tDCS combined with training would result in greater improvement in executive functions and post-TBI cognitive symptoms and increased resting state connectivity of the stimulated region, i.e., left dorsolateral prefrontal cortex (DLPFC) compared to control tDCS. Methods: Thirty-four subjects with mmTBI underwent baseline assessments of demographics, symptoms, and cognitive function as well as resting state functional magnetic resonance imaging (rsfMRI) in a subset of patients (n = 24). Primary outcome measures included NIH EXAMINER composite scores, and the Neurobehavioral Symptom Inventory (NSI). All participants received 10 daily sessions of 30 min of executive function training coupled with active or control tDCS (2 mA, anode F3, cathode right deltoid). Imaging and assessments were re-obtained after the final training session, and assessments were repeated after 1 month. Mixed-models linear regression and repeated measures analyses of variance were calculated for main effects and interactions. Results: Both active and control groups demonstrated improvements in executive function (EXAMINER composite: p < 0.001) and posttraumatic symptoms (NSI cognitive: p = 0.01) from baseline to 1 month. Active anodal tDCS was associated with greater improvements in working memory reaction time compared to control (p = 0.007). Reaction time improvement correlated significantly with the degree of connectivity change between the right DLPFC and the left anterior insula (p = 0.02). Conclusion: Anodal tDCS improved reaction time on an online working memory task in a mmTBI population, and decreased connectivity between executive network and salience network nodes. These findings generate important hypotheses for the mechanism of recovery from PPS after mild-moderate TBI.
Collapse
Affiliation(s)
- Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jacqueline Story-Remer
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Emma Brandt
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Violet Fratzke
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Rebecca Rieger
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - John Kevin Wilson
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Darbi Gill
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Nickolas Mertens
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Michael Hunter
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Thomas R Jones
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - David B Arciniegas
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Richard Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States.,Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States.,Mind Research Network, Albuquerque, NM, United States
| | - Ronald A Yeo
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - C William Shuttleworth
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | | |
Collapse
|
14
|
Quinn DK. Letter to Editor: Book Review. J Acad Consult Liaison Psychiatry 2021. [DOI: 10.1016/j.jaclp.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
15
|
Hogeveen J, Aragon DF, Rogge-Obando K, Campbell RA, Shuttleworth CW, Avila-Rieger RE, Yeo RA, Wilson JK, Fratzke V, Brandt E, Story-Remer J, Gill D, Mayer AR, Cavanagh JF, Quinn DK. Ventromedial Prefrontal-Anterior Cingulate Hyperconnectivity and Resilience to Apathy in Traumatic Brain Injury. J Neurotrauma 2021; 38:2264-2274. [PMID: 33787328 PMCID: PMC8328044 DOI: 10.1089/neu.2020.7363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Apathy is a common and impairing sequela of traumatic brain injury (TBI). Yet, little is known about the neural mechanisms determining in which patients apathy does or does not develop post-TBI. We aimed to elucidate the impact of TBI on motivational neural circuits and how this shapes apathy over the course of TBI recovery. Resting-state functional magnetic resonance imaging data were collected in patients with subacute mild TBI (n = 44), chronic mild-to-moderate TBI (n = 26), and nonbrain-injured control participants (CTRL; n = 28). We measured ventromedial prefrontal cortex (vmPFC) functional connectivity (FC) as a function of apathy, using an a priori vmPFC seed adopted from a motivated decision-making study in an independent TBI study cohort. Patients reported apathy using a well-validated tool for assaying apathy in TBI. The vmPFC-to-wholebrain FC was contrasted between groups, and we fit regression models with apathy predicting vmPFC FC. Subacute and chronic TBI caused increased apathy relative to CTRL, replicating previous work suggesting that apathy has an enduring impact in TBI. The vmPFC was functionally connected to the canonical default network, and this architecture did not differ between subacute TBI, chronic TBI, and CTRL groups. Critically, in TBI, increased apathy scores predicted decreased vmPFC-dorsal anterior cingulate cortex (dACC) FC. Last, we subdivided the TBI group based on patients above versus below the threshold for "clinically significant apathy," finding that TBI patients with clinically significant apathy demonstrated comparable vmPFC-dACC FC to CTRLs, whereas TBI patients with subthreshold apathy scores demonstrated vmPFC-dACC hyperconnectivity relative to both CTRLs and patients with clinically significant apathy. Post-TBI vmPFC-dACC hyperconnectivity may represent an adaptive compensatory response, helping to maintain motivation and enabling resilience to the development of apathy after neurotrauma. Given the role of vmPFC-dACC circuits in value-based decision making, rehabilitation strategies designed to improve this ability may help to reduce apathy and improve functional outcomes in TBI.
Collapse
Affiliation(s)
- Jeremy Hogeveen
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Denicia F. Aragon
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kimberly Rogge-Obando
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard A. Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - C. William Shuttleworth
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca E. Avila-Rieger
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
- Montefiore Medical Center, Bronx, New York, USA
| | - Ronald A. Yeo
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - J. Kevin Wilson
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Violet Fratzke
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- College of Education, Clemson University, Clemson, South Carolina, USA
| | - Emma Brandt
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jacqueline Story-Remer
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois, USA
| | - Darbi Gill
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew R. Mayer
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- The Mind Research Network/LBERI, Albuquerque, New Mexico, USA
| | - James F. Cavanagh
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| |
Collapse
|
16
|
Erickson JM, Quinn DK. Moria of Jastrowitz After Bilateral Hippocampal Lesions. J Acad Consult Liaison Psychiatry 2021; 62:357-362. [PMID: 34102132 DOI: 10.1016/j.jaclp.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer M Erickson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM
| |
Collapse
|
17
|
Hergert DC, Robertson-Benta C, Sicard V, Schwotzer D, Hutchison K, Covey DP, Quinn DK, Sadek JR, McDonald J, Mayer AR. Use of Medical Cannabis to Treat Traumatic Brain Injury. J Neurotrauma 2021; 38:1904-1917. [PMID: 33256496 DOI: 10.1089/neu.2020.7148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is not a single pharmacological agent with demonstrated therapeutic efficacy for traumatic brain injury (TBI). With recent legalization efforts and the growing popularity of medical cannabis, patients with TBI will inevitably consider medical cannabis as a treatment option. Pre-clinical TBI research suggests that cannabinoids have neuroprotective and psychotherapeutic properties. In contrast, recreational cannabis use has consistently shown to have detrimental effects. Our review identified a paucity of high-quality studies examining the beneficial and adverse effects of medical cannabis on TBI, with only a single phase III randomized control trial. However, observational studies demonstrate that TBI patients are using medical and recreational cannabis to treat their symptoms, highlighting inconsistencies between public policy, perception of potential efficacy, and the dearth of empirical evidence. We conclude that randomized controlled trials and prospective studies with appropriate control groups are necessary to fully understand the efficacy and potential adverse effects of medical cannabis for TBI.
Collapse
Affiliation(s)
- Danielle C Hergert
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Cidney Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Veronik Sicard
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Daniela Schwotzer
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Kent Hutchison
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| | - Dan P Covey
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Davin K Quinn
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Joseph R Sadek
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,New Mexico VA Health Care System, Albuquerque, New Mexico, USA
| | - Jacob McDonald
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA.,Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Psychology Department, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
18
|
Quinn DK, Jones TR, Upston J, Huff M, Ryman SG, Vakhtin AA, Abbott CC. Right prefrontal intermittent theta-burst stimulation for major depressive disorder: A case series. Brain Stimul 2020; 14:97-99. [PMID: 33242610 DOI: 10.1016/j.brs.2020.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA.
| | - Thomas R Jones
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Michael Huff
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Sephira G Ryman
- Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Andrei A Vakhtin
- Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM, 87106, USA
| | - Christopher C Abbott
- Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, University of New Mexico, Albuquerque, NM, 87106, USA
| |
Collapse
|
19
|
Quinn DK, Upston J, Jones T, Brandt E, Story-Remer J, Fratzke V, Wilson JK, Rieger R, Hunter MA, Gill D, Richardson JD, Campbell R, Clark VP, Yeo RA, Shuttleworth CW, Mayer AR. Cerebral Perfusion Effects of Cognitive Training and Transcranial Direct Current Stimulation in Mild-Moderate TBI. Front Neurol 2020; 11:545174. [PMID: 33117255 PMCID: PMC7575722 DOI: 10.3389/fneur.2020.545174] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Persistent post-traumatic symptoms (PPS) after traumatic brain injury (TBI) can lead to significant chronic functional impairment. Pseudocontinuous arterial spin labeling (pCASL) has been used in multiple studies to explore changes in cerebral blood flow (CBF) that may result in acute and chronic TBI, and is a promising neuroimaging modality for assessing response to therapies. Methods: Twenty-four subjects with chronic mild-moderate TBI (mmTBI) were enrolled in a pilot study of 10 days of computerized executive function training combined with active or sham anodal transcranial direct current stimulation (tDCS) for treatment of cognitive PPS. Behavioral surveys, neuropsychological testing, and magnetic resonance imaging (MRI) with pCASL sequences to assess global and regional CBF were obtained before and after the training protocol. Results: Robust improvements in depression, anxiety, complex attention, and executive function were seen in both active and sham groups between the baseline and post-treatment visits. Global CBF decreased over time, with differences in regional CBF noted in the right inferior frontal gyrus (IFG). Active stimulation was associated with static or increased CBF in the right IFG, whereas sham was associated with reduced CBF. Neuropsychological performance and behavioral symptoms were not associated with changes in CBF. Discussion: The current study suggests a complex picture between mmTBI, cerebral perfusion, and recovery. Changes in CBF may result from physiologic effect of the intervention, compensatory neural mechanisms, or confounding factors. Limitations include a small sample size and heterogenous injury sample, but these findings suggest promising directions for future studies of cognitive training paradigms in mmTBI.
Collapse
Affiliation(s)
- Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Thomas Jones
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Emma Brandt
- Department of Neuroscience, University of New Mexico, Albuquerque, NM, United States
| | | | - Violet Fratzke
- Department of Neuroscience, University of New Mexico, Albuquerque, NM, United States.,Chicago Medical School, Chicago, IL, United States
| | - J Kevin Wilson
- Department of Neuroscience, University of New Mexico, Albuquerque, NM, United States
| | - Rebecca Rieger
- Department of Neuroscience, University of New Mexico, Albuquerque, NM, United States
| | | | - Darbi Gill
- Department of Neuroscience, University of New Mexico, Albuquerque, NM, United States
| | - Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Richard Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States.,Department of Neuroscience, University of New Mexico, Albuquerque, NM, United States
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States.,Mind Research Network, Albuquerque, NM, United States
| | - Ronald A Yeo
- Department of Neuroscience, University of New Mexico, Albuquerque, NM, United States.,Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | | | | |
Collapse
|
20
|
Luo A, Muraida S, Pinchotti D, Richardson E, Ye E, Hollingsworth B, Win A, Myers O, Langsjoen J, Valles E, Zolyomi A, Quinn DK. Bispectral Index Monitoring With Density Spectral Array for Delirium Detection. J Acad Consult Liaison Psychiatry 2020; 62:318-329. [PMID: 33223218 DOI: 10.1016/j.psym.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Delirium in hospitalized patients often goes undetected. Cerebral state monitors, which measure limited-channel electroencephalography, have shown potential for improving delirium detection. OBJECTIVE The aim of this study was to compare an FDA-approved cerebral state monitor, bispectral index monitoring with density spectral array (DSA), for delirium identification with clinical screening methods. METHODS Hospitalized patients receiving psychiatric consultation were assessed for delirium using the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and underwent bispectral index monitor + DSA monitoring. Visual inspection of frequency band power of the DSA was performed by 2 trained independent raters. Average hue values were calculated for each frequency band using image analysis software as the device did not allow for extraction of raw electroencephalography data. Delirious versus nondelirious group averages, sensitivity, specificity, and area under the curve were calculated for significant DSA variables and the 3D-CAM. RESULTS In an initial cohort of 43 patients, visual ratings of the DSA were not associated with delirium (P > 0.1). In a larger cohort of 123 subjects, multiple band hue ratios were associated with delirium, although none survived correction for multiple comparisons. In a subgroup of 74 non-neurological patients, low theta/low delta ratio was significantly associated with delirium (P = 0.001) (sensitivity/specificity/area under the curve: 83%/70%/0.757; 3D-CAM: 67%/77%/0.717; paired-sample area under the curve difference: -0.040, P = 0.68). In 21 patients with dementia, low theta power demonstrated significantly greater sensitivity/specificity/area under the curve of 83%/78%/0.824, whereas 3D-CAM achieved 50%/78%/0.639 (P = 0.04). CONCLUSION Bispectral index monitor + DSA was similar to 3D-CAM for detecting delirium in hospitalized patients with and without neurological disorders, and was significantly more accurate in patients with dementia. More studies are needed to validate the use of cerebral state monitors for quantitative delirium detection.
Collapse
Affiliation(s)
- Alice Luo
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131.
| | - Susan Muraida
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131
| | - Dana Pinchotti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | - Elizabeth Richardson
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | - Enstin Ye
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | | | - Alexander Win
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131
| | - Jens Langsjoen
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, 87106
| | - Emiliano Valles
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| | - Arpad Zolyomi
- Department of Anesthesiology, University of New Mexico, Albuquerque, NM, 87106
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, 87131
| |
Collapse
|
21
|
Tonarelli SB, Quinn DK. Comment: Biomarkers for mild traumatic brain injury: Role of the exosomes. Neurology 2020; 94:1017. [PMID: 32461280 DOI: 10.1212/wnl.0000000000009574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Silvina B Tonarelli
- From the Psychiatry Department (S.B.T.), Texas Tech University Health Science Center, El Paso; and UNM Department of Psychiatry and Behavioral Sciences (D.K.Q.), Albuquerque, NM
| | - Davin K Quinn
- From the Psychiatry Department (S.B.T.), Texas Tech University Health Science Center, El Paso; and UNM Department of Psychiatry and Behavioral Sciences (D.K.Q.), Albuquerque, NM
| |
Collapse
|
22
|
Mayer AR, Hanlon FM, Shaff NA, Stephenson DD, Ling JM, Dodd AB, Hogeveen J, Quinn DK, Ryman SG, Pirio-Richardson S. Evidence for asymmetric inhibitory activity during motor planning phases of sensorimotor synchronization. Cortex 2020; 129:314-328. [PMID: 32554227 DOI: 10.1016/j.cortex.2020.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/15/2020] [Accepted: 04/19/2020] [Indexed: 01/11/2023]
Abstract
Sensorimotor synchronization (SMS) is frequently dependent on coordination of excitatory and inhibitory activity across hemispheres, as well as the cognitive control over environmental distractors. However, the timing (motor planning versus execution) and cortical regions involved in these processes remain actively debated. Functional magnetic resonance imaging data were therefore analyzed from 34 strongly right-handed healthy adults performing a cued (to initiate motor planning) SMS task with either their right or left hand (motor execution phase) based on spatially congruent or incongruent visual stimuli. Behavioral effects of incongruent stimuli were limited to the first stimulus. Functionally, greater activation was observed in left sensorimotor cortex (SMC) and right cerebellar Lobule V for congruent versus incongruent stimuli. A negative blood-oxygen level dependent response, a putative marker of neural inhibition, was present in bilateral SMC, right supplemental motor area (SMA) and bilateral cerebellar Lobule V during the motor planning, but not execution phase. The magnitude of the inhibitory response was greater in right cortical regions and cerebellar Lobule V. Homologue connectivity was associated with inhibitory activity in the right SMA, suggesting that individual differences in intrinsic connectivity may mediate transcallosal inhibition. In summary, results suggest increased inhibition (i.e., greater negative BOLD response) within the right relative to left hemisphere, which was released once motor programs were executed. Both task and intrinsic functional connectivity results highlight a critical role of the left SMA in interhemispheric inhibition and motor planning.
Collapse
Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/LBERI, Albuquerque, NM, USA; Departments of Psychology, University of New Mexico, Albuquerque, NM, USA; Department of Neurology, University of New Mexico, Albuquerque, NM, USA; Departments of Psychiatry, University of New Mexico, Albuquerque, NM, USA.
| | | | | | | | - Josef M Ling
- The Mind Research Network/LBERI, Albuquerque, NM, USA
| | - Andrew B Dodd
- The Mind Research Network/LBERI, Albuquerque, NM, USA
| | - Jeremy Hogeveen
- Departments of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Davin K Quinn
- Departments of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | | | | |
Collapse
|
23
|
Mayer AR, Stephenson DD, Dodd AB, Robertson-Benta CR, Pabbathi Reddy S, Shaff NA, Yeates KO, van der Horn HJ, Wertz CJ, Park G, Oglesbee SJ, Bedrick EJ, Campbell RA, Phillips JP, Quinn DK. Comparison of Methods for Classifying Persistent Post-Concussive Symptoms in Children. J Neurotrauma 2020; 37:1504-1511. [PMID: 31964232 DOI: 10.1089/neu.2019.6805] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pediatric mild traumatic brain injury (pmTBI) has received increased public scrutiny over the past decade, especially regarding children who experience persistent post-concussive symptoms (PPCS). However, several methods for defining PPCS exist in clinical and scientific literature, and even healthy children frequently exhibit non-specific, concussive-like symptoms. Inter-method agreement (six PPCS methods), observed misclassification rates, and other psychometric properties were examined in large cohorts of consecutively recruited adolescent patients with pmTBI (n = 162) 1 week and 4 months post-injury and in age/sex-matched healthy controls (HC; n = 117) at equivalent time intervals. Six published PPCS methods were stratified into Simple Change (e.g., International Statistical Classification of Diseases and Related Health Problems, 10th revision [ICD-10]) and Standardized Change (e.g., reliable change indices) algorithms. Among HC, test-retest reliability was fair to good across the 4-month assessment window, with evidence of bias (i.e., higher symptom ratings) during retrospective relative to other assessments. Misclassification rates among HC were higher (>30%) for Simple Change algorithms, with poor inter-rater reliability of symptom burden across HC and their parents. A 49% spread existed in terms of the proportion of pmTBI patients "diagnosed" with PPCS at 4 months, with superior inter-method agreement among standardized change algorithms. In conclusion, the self-reporting of symptom burden is only modestly reliable in typically developing adolescents over a 4-month period, with additional evidence for systematic bias in both adolescent and parental ratings. Significant variation existed for identifying pmTBI patients who had "recovered" (i.e., those who did not meet individual criteria for PPCS) from concussion across the six definitions, representing a considerable challenge for estimating the true incidence rate of PPCS in published literature. Although relatively straightforward to obtain, current findings question the utility of the most commonly used Simple Change scores for diagnosis of PPCS in clinical settings.
Collapse
Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - David D Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Cidney R Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Sharvani Pabbathi Reddy
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Harm J van der Horn
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA.,Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Grace Park
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Scott J Oglesbee
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Richard A Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - John P Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
24
|
Hergert DC, Mayer AR, Hutchinson K, Sadek JR, Quinn DK. Medical Cannabis Reduced Agitation in Acquired Brain Injury: A Case Study. Psychosomatics 2020; 61:819-824. [PMID: 32111375 DOI: 10.1016/j.psym.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Danielle C Hergert
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, NM.
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, NM; Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM; Psychology Department, University of New Mexico, Albuquerque, NM
| | - Kent Hutchinson
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO
| | - Joseph R Sadek
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM; Behavioral Health Care Line, New Mexico VA Health Care System, Albuquerque, NM
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM
| |
Collapse
|
25
|
Mayer AR, Stephenson DD, Wertz CJ, Dodd AB, Shaff NA, Ling JM, Park G, Oglesbee SJ, Wasserott BC, Meier TB, Witkiewitz K, Campbell RA, Yeo RA, Phillips JP, Quinn DK, Pottenger A. Proactive inhibition deficits with normal perfusion after pediatric mild traumatic brain injury. Hum Brain Mapp 2019; 40:5370-5381. [PMID: 31456319 PMCID: PMC6864901 DOI: 10.1002/hbm.24778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/11/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022] Open
Abstract
Although much attention has been generated in popular media regarding the deleterious effects of pediatric mild traumatic brain injury (pmTBI), a paucity of empirical evidence exists regarding the natural course of biological recovery. Fifty pmTBI patients (12–18 years old) were consecutively recruited from Emergency Departments and seen approximately 1 week and 4 months post‐injury in this prospective cohort study. Data from 53 sex‐ and age‐matched healthy controls (HC) were also collected. Functional magnetic resonance imaging was obtained during proactive response inhibition and at rest, in conjunction with independent measures of resting cerebral blood flow. High temporal resolution imaging enabled separate modeling of neural responses for preparation and execution of proactive response inhibition. A priori predictions of failed inhibitory responses (i.e., hyperactivation) were observed in motor circuitry (pmTBI>HC) and sensory areas sub‐acutely and at 4 months post‐injury. Paradoxically, pmTBI demonstrated hypoactivation (HC>pmTBI) during target processing, along with decreased activation within prefrontal cognitive control areas. Functional connectivity within motor circuitry at rest suggested that deficits were limited to engagement during the inhibitory task, whereas normal resting cerebral perfusion ruled out deficits in basal perfusion. In conclusion, current results suggest blood oxygen‐level dependent deficits during inhibitory control may exceed commonly held beliefs about physiological recovery following pmTBI, potentially lasting up to 4 months post‐injury.
Collapse
Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/LBERI, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico.,Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | | | | | - Andrew B Dodd
- The Mind Research Network/LBERI, Albuquerque, New Mexico
| | | | - Josef M Ling
- The Mind Research Network/LBERI, Albuquerque, New Mexico
| | - Grace Park
- Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Scott J Oglesbee
- Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | | | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Richard A Campbell
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | - Ronald A Yeo
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - John P Phillips
- The Mind Research Network/LBERI, Albuquerque, New Mexico.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | - Amy Pottenger
- Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
26
|
Broadway JM, Rieger RE, Campbell RA, Quinn DK, Mayer AR, Yeo RA, Wilson JK, Gill D, Fratzke V, Cavanagh JF. Executive function predictors of delayed memory deficits after mild traumatic brain injury. Cortex 2019; 120:240-248. [PMID: 31344589 DOI: 10.1016/j.cortex.2019.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/23/2019] [Accepted: 06/20/2019] [Indexed: 12/14/2022]
Abstract
Delayed memory deficits are common for patients with mild traumatic brain injury (mTBI), according to a recent systematic review of meta-analyses (Karr et al., 2014). However, there has been little work to identify different cognitive processes that may be underpinning these delayed memory deficits for mTBI. Frontal cortex is important for delayed memory, and is implicated in the pathophysiology of mTBI; moreover, frontal lobes are typically considered the locus of executive abilities. To further explore these relationships, we sought to partly explain delayed memory deficits after mTBI by examining behavioral indicators of executive function. Results showed that sub-acute as well as chronic mTBI patients performed worse than controls on the delayed memory trial of the Hopkins Verbal Learning Test-Revised (Brandt & Benedict, 2001), recalling approximately 18% and 15% fewer words, respectively. Furthermore, worse delayed memory performance was associated with less use of the cognitive strategy of semantic clustering, and with lower scores for the executive function composite from a standardized neuropsychological battery (NIH EXAMINER; Kramer et al., 2014). In contrast, serial clustering, a memory organizational strategy thought to be less dependent on executive function, did not show strong relationships to clinical status or delayed memory performance. This exploratory work suggests novel hypotheses to be tested in future, confirmatory studies, including that general executive functions and/or semantic clustering will mediate delayed memory deficits following mTBI.
Collapse
Affiliation(s)
- James M Broadway
- University of New Mexico Health Sciences Center, Department of Neurosciences, USA
| | | | - Richard A Campbell
- University of New Mexico Health Sciences Center, Department of Psychiatry and Behavioral Sciences, USA
| | - Davin K Quinn
- University of New Mexico Health Sciences Center, Department of Psychiatry and Behavioral Sciences, USA
| | | | - Ronald A Yeo
- University of New Mexico, Department of Psychology, USA
| | | | - Darbi Gill
- University of New Mexico Health Sciences Center, Department of Neurosciences, USA
| | | | | |
Collapse
|
27
|
Cavanagh JF, Wilson JK, Rieger RE, Gill D, Broadway JM, Story Remer JH, Fratzke V, Mayer AR, Quinn DK. ERPs predict symptomatic distress and recovery in sub-acute mild traumatic brain injury. Neuropsychologia 2019; 132:107125. [PMID: 31228481 DOI: 10.1016/j.neuropsychologia.2019.107125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/02/2019] [Accepted: 06/14/2019] [Indexed: 01/07/2023]
Abstract
Mild traumatic brain injury (mTBI) can affect high-level executive functioning long after somatic symptoms resolve. We tested if simple EEG responses within an oddball paradigm could capture variance relevant to this clinical problem. The P3a and P3b components reflect bottom-up and top-down processes driving engagement with exogenous stimuli. Since these features are related to primitive decision abilities, abnormal amplitudes following mTBI may account for problems in the ability to exert executive control. Sub-acute (<2 weeks) mTBI participants (N = 38) and healthy controls (N = 24) were assessed at an initial session as well as a two-month follow-up (sessions 1 and 2). We contrasted the initial assessment to a comparison group of participants with chronic symptomatology following brain injury (N = 23). There were no group differences in P3a or P3b amplitudes. Yet in the sub-acute mTBI group, higher symptomatology on the Frontal Systems Behavior scale (FrSBe), a questionnaire validated as measuring symptomatic distress related to frontal lobe injury, correlated with lower P3a in session 1. This relationship was replicated in session 2. These findings were distinct from chronic TBI participants, who instead expressed a relationship between increased FrSBe symptoms and a lower P3b component. In the sub-acute group, P3b amplitudes in the first session correlated with the degree of symptom change between sessions 1 and 2, above and beyond demographic predictors. Controls did not show any relationship between FrSBe symptoms and P3a or P3b. These findings identify symptom-specific alterations in neural systems that vary along the time course of post-concussive symptomatology.
Collapse
Affiliation(s)
- James F Cavanagh
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA.
| | - J Kevin Wilson
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA
| | - Rebecca E Rieger
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA
| | - Darbi Gill
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - James M Broadway
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - Jacqueline Hope Story Remer
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - Violet Fratzke
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - Andrew R Mayer
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA; University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA; Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM, 87106, USA
| | - Davin K Quinn
- University of New Mexico Health Sciences Center, Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, Albuquerque, NM, 87106, USA
| |
Collapse
|
28
|
Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, Dember LM, Diaz-Linhart Y, Dubovsky A, Greene T, Grote N, Kutner N, Trivedi MH, Quinn DK, Ver Halen N, Weisbord SD, Young BA, Kimmel PL, Hedayati SS. Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial. Ann Intern Med 2019; 170:369-379. [PMID: 30802897 DOI: 10.7326/m18-2229] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited. OBJECTIVE To determine the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for treating depression in patients receiving hemodialysis. DESIGN Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343). SETTING 41 dialysis facilities in 3 U.S. metropolitan areas. PARTICIPANTS Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2. INTERVENTION Engagement interview versus control visit (phase 1) and 12 weeks of CBT delivered in the dialysis facility versus sertraline treatment (phase 2). MEASUREMENTS The primary outcome for phase 1 was the proportion of participants who started depression treatment within 28 days. For phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms-Clinician-Rated (QIDS-C) at 12 weeks. RESULTS The proportion of participants who initiated treatment after the engagement or control visit did not differ (66% vs. 64%, respectively; P = 0.77; estimated risk difference, 2.1 [95% CI, -12.1 to 16.4]). Compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, -1.84 [CI, -3.54 to -0.13]; P = 0.035). Adverse events were more frequent in the sertraline than the CBT group. LIMITATION No randomized comparison was made with no treatment, and persistence of treatment effect was not assessed. CONCLUSION An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute, Dialysis Clinic, Kidney Research Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.
Collapse
Affiliation(s)
- Rajnish Mehrotra
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Daniel Cukor
- State University of New York Downstate Medical Center, Brooklyn, New York (D.C., N.V.)
| | - Mark Unruh
- University of New Mexico, Albuquerque, New Mexico (M.U., D.K.Q.)
| | - Tessa Rue
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Patrick Heagerty
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Scott D Cohen
- George Washington University, Washington, DC (S.D.C.)
| | - Laura M Dember
- University of Pennsylvania, Philadelphia, Pennsylvania (L.M.D.)
| | | | - Amelia Dubovsky
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Tom Greene
- University of Utah, Salt Lake City, Utah (T.G.)
| | - Nancy Grote
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | | | | | - Davin K Quinn
- University of New Mexico, Albuquerque, New Mexico (M.U., D.K.Q.)
| | - Nisha Ver Halen
- State University of New York Downstate Medical Center, Brooklyn, New York (D.C., N.V.)
| | - Steven D Weisbord
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania (S.D.W.)
| | - Bessie A Young
- Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington (B.A.Y.)
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland (P.L.K.)
| | - S Susan Hedayati
- University of Texas Southwestern, Dallas, Texas (M.H.T., S.S.H.)
| |
Collapse
|
29
|
Affiliation(s)
- Davin K Quinn
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
| | - Andrew R Mayer
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
| | - Christina L Master
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
| | - Jesse R Fann
- From the Department of Psychiatry and Behavioral Sciences, the MIND Research Network, and the Department of Psychology, University of New Mexico, Albuquerque; the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and the Division of Orthopedics and Sports Medicine, Children's Hospital of Philadelphia, Philadelphia; and the Departments of Psychiatry and Behavioral Sciences and of Physical Medicine and Rehabilitation, University of Washington, Seattle
| |
Collapse
|
30
|
Pinchotti DM, Abbott C, Quinn DK. Targeted Electroconvulsive Therapy for Super Refractory Status Epilepticus: A Case Report and Literature Review. Psychosomatics 2017; 59:302-305. [PMID: 29150213 DOI: 10.1016/j.psym.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Dana M Pinchotti
- Department of Psychiatry, University of New Mexico, Albuquerque, NM.
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, NM; R01: ECT current amplitude and medial temporal lobe engagement, 1R01MH111826 MRN COBRE II Project 5: Multimodal Imaging of Neuropsychiatric Disorders (MIND): Mechanisms & Biomarkers (COBRE II), 5P20GM103472, Albuquerque, NM
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM; 2P20-GM109089-O1A1, The UNM Center for Brain Recovery and Repair, Albuquerque, NM
| |
Collapse
|
31
|
Abstract
OBJECTIVE This review provides an in-depth overview of diagnostic schema and risk factors influencing recovery during the acute, subacute (operationally defined as up to 3 months postinjury), and chronic injury phases across the full spectrum of individuals (e.g., athletes to neurosurgery patients) with mild traumatic brain injury (mTBI). Particular emphasis is placed on the complex differential diagnoses for patients with prolonged postconcussive symptoms. METHODS Select literature review and synthesis. RESULTS In spite of an increase in public awareness surrounding the acute and potential long-term effects of mTBI, the medical field remains fragmented both in terms of the diagnostic (different criteria proffered by multiple medical organizations) and prognostic factors that influence patient care. CONCLUSIONS Given the lack of objective biomarkers and the spectrum of different disorders that likely encompass mTBI, clinicians are encouraged to adopt a probabilistic, rather than definitive, diagnostic and prognostic framework. The relevance of accurately diagnosing and managing the different manifestations of mTBI becomes clear when one considers the overall incidence of the disorder (42 million people each year worldwide), and the different treatment implications for patients with a true neurodegenerative disorder (e.g., chronic traumatic encephalopathy; rare) vs potentially treatable conditions (e.g., depression or posttraumatic headache; frequent).
Collapse
Affiliation(s)
- Andrew R Mayer
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M.); Departments of Neurology (A.R.M.), Psychiatry (A.R.M., D.K.Q.), and Psychology (A.R.M.), University of New Mexico School of Medicine, Albuquerque; Departments of Pediatrics and Surgery (C.L.M.), The Children's Hospital of Philadelphia; and Perelman School of Medicine at the University of Pennsylvania (C.L.M.), Philadelphia.
| | - Davin K Quinn
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M.); Departments of Neurology (A.R.M.), Psychiatry (A.R.M., D.K.Q.), and Psychology (A.R.M.), University of New Mexico School of Medicine, Albuquerque; Departments of Pediatrics and Surgery (C.L.M.), The Children's Hospital of Philadelphia; and Perelman School of Medicine at the University of Pennsylvania (C.L.M.), Philadelphia
| | - Christina L Master
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M.); Departments of Neurology (A.R.M.), Psychiatry (A.R.M., D.K.Q.), and Psychology (A.R.M.), University of New Mexico School of Medicine, Albuquerque; Departments of Pediatrics and Surgery (C.L.M.), The Children's Hospital of Philadelphia; and Perelman School of Medicine at the University of Pennsylvania (C.L.M.), Philadelphia
| |
Collapse
|
32
|
Moguel-Cobos G, Maroney Z, Erickson JM, Tröster AI, Quinn DK. Psychogenic Movement Disorders and Dopamine Transporter Scans: Still a Clinical Diagnosis? Psychosomatics 2016; 58:83-89. [PMID: 27889083 DOI: 10.1016/j.psym.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Guillermo Moguel-Cobos
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
| | - Zane Maroney
- University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ; Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico Psychiatric Center, Albuquerque, NM
| |
Collapse
|
33
|
Affiliation(s)
- Jennifer M. Erickson
- Division of Consultation Liaison Psychiatry & Psychosomatic Medicine, Icahn School of Medicine, Mount Sinai Beth Israel, New York
| | - Davin K. Quinn
- Psychiatric Consultation Service, University of New Mexico School of Medicine, Albuquerque
| | - Edward Shorter
- Faculty of Medicine, University of Toronto, Toronto, Ont., Canada
| |
Collapse
|
34
|
Repchak AT, Quinn DK. Epileptic Catatonia: A Case Series and Systematic Review. Psychosomatics 2015; 57:217-25. [PMID: 26892327 DOI: 10.1016/j.psym.2015.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 12/14/2022]
Affiliation(s)
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| |
Collapse
|
35
|
Merideth FL, Quinn DK. "Walking the Walk": Decisional Capacity Deficits After Right Hemisphere Subdural Hematoma. Psychosomatics 2015; 57:102-6. [PMID: 26481960 DOI: 10.1016/j.psym.2015.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/26/2015] [Accepted: 07/06/2015] [Indexed: 11/18/2022]
Affiliation(s)
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico.
| |
Collapse
|
36
|
Apodaca K, Baker J, Bin-Bilal H, Raskin Y, Quinn DK. Ertapenem-Induced Delirium: A Case Report and Literature Review. Psychosomatics 2015; 56:561-6. [DOI: 10.1016/j.psym.2015.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 12/01/2022]
|
37
|
Affiliation(s)
- Rachel F. Eyler
- School of Pharmacy; University of Connecticut; Storrs Connecticut
| | - Mark L. Unruh
- School of Medicine; University of New Mexico; Albuquerque New Mexico
| | - Davin K. Quinn
- School of Medicine; University of New Mexico; Albuquerque New Mexico
| | - Aloun Mary Vilay
- College of Pharmacy; University of New Mexico; Albuquerque New Mexico
| |
Collapse
|
38
|
Gonzales N, Quinn DK, Rayburn W. Perinatal Catatonia: A Case Report and Literature Review. Psychosomatics 2014; 55:708-14. [DOI: 10.1016/j.psym.2014.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/25/2022]
|
39
|
Quinn DK, Abbott CC. Catatonia after cerebral hypoxia: do the usual treatments apply? Psychosomatics 2014; 55:525-35. [PMID: 25262046 PMCID: PMC4182149 DOI: 10.1016/j.psym.2014.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurologic deterioration occurring days to weeks after a cerebral hypoxic event accompanied by diffuse white matter demyelination is called delayed posthypoxic leukoencephalopathy (DPHL). Manifestations of DPHL are diverse and include dementia, gait disturbance, incontinence, pyramidal tract signs, parkinsonism, chorea, mood and thought disorders, akinetic mutism, and rarely catatonia. METHODS We report a case of malignant catatonia in a patient diagnosed with DPHL that was refractory to electroconvulsive therapy (ECT) and review the literature on catatonia in DPHL. RESULTS The patient was a 56-year-old woman with schizoaffective disorder who was admitted with catatonia 2 weeks after hospitalization for drug overdose and respiratory failure. Her catatonic symptoms did not respond to treatment of lorazepam, amantadine, methylphenidate, or 10 sessions of bilateral ECT at maximum energy. Repeat magnetic resonance imaging revealed extensive periventricular white matter lesions not present on admission scans, and she was diagnosed with DPHL. DISCUSSION No treatment for DPHL has been proven to be widely effective. Hyperbaric oxygen treatments may reduce the rate of development, and symptom improvement has been reported with stimulants and other psychotropic agents. Review of literature reveals rare success with GABAergic agents for catatonia after cerebral hypoxia and no cases successfully treated with ECT. There are 7 case reports of neurologic decompensation during ECT treatment after a cerebral hypoxic event. CONCLUSION Caution is advised when considering ECT for catatonia when delayed sequelae of cerebral hypoxia are on the differential diagnosis, as there is a dearth of evidence to support this treatment approach.
Collapse
Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM..
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM
| |
Collapse
|
40
|
Abstract
Electroconvulsive therapy (ECT) is the most effective treatment for a depressive episode but the mechanism of action and neural correlates of response are poorly understood. Different theories have suggested that anticonvulsant properties or neurotrophic effects are related to the unique mechanism of action of ECT. This review assessed longitudinal imaging investigations (both structural and functional) associated with ECT response published from 2002 to August 2013. We identified 26 investigations that used a variety of different imaging modalities and data analysis methods. Despite these methodological differences, we summarized the major findings of each investigation and identified common patterns that exist across multiple investigations. The ECT response is associated with decreased frontal perfusion, metabolism, and functional connectivity and increased volume and neuronal chemical metabolites. The general collective of longitudinal neuroimaging investigations support both the anticonvulsant and the neurotrophic effects of ECT. We propose a conceptual framework that integrates these seemingly contradictory hypotheses.
Collapse
Affiliation(s)
- Christopher C. Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Patrick Gallegos
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nathan Rediske
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nicholas T. Lemke
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Davin K. Quinn
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| |
Collapse
|
41
|
Quinn DK, Deligtisch A, Rees C, Brodsky A, Evans D, Khafaja M, Abbott CC. Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders. Neuromodulation 2014; 17:629-36; discussion 636. [PMID: 24512146 DOI: 10.1111/ner.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms. MATERIALS AND METHODS The authors review the literature on psychiatric complications in DBS for movement disorders and propose a heuristic for categorizing symptoms according to their temporal relationship with the DBS implantation process. RESULTS Psychiatric symptoms after DBS can be categorized as preimplantation, intra-operative/perioperative, stimulation related, device malfunction, medication related, and chronic stimulation related/long term. Once determined, the specific etiology of a symptom guides the practitioner in treatment. CONCLUSIONS A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
Collapse
Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Quinn DK, Hunt J, Diaz S, Fricchione GL. Abulia and post-tap agitation in normal-pressure hydrocephalus. J Neuropsychiatry Clin Neurosci 2013; 25:E54-6. [PMID: 23487236 DOI: 10.1176/appi.neuropsych.12030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Yarns BC, Quinn DK. Telephone effect in akinetic mutism from traumatic brain injury. Psychosomatics 2013; 54:609-10. [PMID: 23932533 DOI: 10.1016/j.psym.2013.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM
| | | |
Collapse
|
44
|
Washinsky M, Quinn DK. Delirious mania associated with Bardet-Biedl syndrome, an inherited ciliopathy. Psychosomatics 2013; 54:484-7. [PMID: 23352051 DOI: 10.1016/j.psym.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/07/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Michael Washinsky
- Department of Psychiatry, the University of New Mexico, Albuquerque, NM
| | | |
Collapse
|
45
|
Abramson DW, Quinn DK, Stern TA. Methadone-Associated QTc Prolongation: A Case Report and Review of the Literature. Prim Care Companion J Clin Psychiatry 2012; 10:470-6. [PMID: 19287558 DOI: 10.4088/pcc.v10n0609] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
46
|
|
47
|
Quinn DK, McGahee SM, Politte LC, Duncan GN, Cusin C, Hopwood CJ, Stern TA. Complications of carbon monoxide poisoning: a case discussion and review of the literature. Prim Care Companion J Clin Psychiatry 2012; 11:74-9. [PMID: 19617936 DOI: 10.4088/pcc.08r00651] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 08/25/2008] [Indexed: 10/20/2022]
|
48
|
Zahajszky J, Quinn DK, Smith FA, Stern TA. Cognitive and perceptual disturbances in a young man. Prim Care Companion J Clin Psychiatry 2011; 9:59-63. [PMID: 17599171 PMCID: PMC1894835 DOI: 10.4088/pcc.v09n0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
49
|
Quinn DK, Flaherty AW, Herman JB, Kleinschmidt TL. Over the rainbow: a case of traumatic brain injury. Harv Rev Psychiatry 2010; 18:56-66. [PMID: 20047461 DOI: 10.3109/10673220903523953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Davin K Quinn
- University of New Mexico Psychiatric Center, Albuquerque, NM, USA.
| | | | | | | |
Collapse
|
50
|
Caplan JP, Epstein LA, Quinn DK, Stevens JR, Stern TA. Neuropsychiatric Effects of Prescription Drug Abuse. Neuropsychol Rev 2007; 17:363-80. [PMID: 17701457 DOI: 10.1007/s11065-007-9037-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 06/29/2007] [Indexed: 11/27/2022]
Abstract
Prescription drugs have become a major category of abused substances, and there is evidence that the prevalence of prescription drug abuse may soon overtake that of illicit drugs. Study of prescription drugs has been hampered by vague terminology, since prescription drugs are only separated from other drugs of abuse by social and legal constructs. Reviewed herein is published literature on the abuse of four major categories of abused prescription drugs: sedative-hypnotics, stimulants, anabolic steroids, and anticholinergics. The review emphasizes evidence regarding the effects of these drugs on neural systems. Other abused prescription drugs that fall outside of the major categories are also briefly addressed.
Collapse
Affiliation(s)
- Jason P Caplan
- Behavioral Health Services, UPH Hospital - Kino Campus, 5th Floor, 2800 E. Ajo Way, Tucson, AZ, USA.
| | | | | | | | | |
Collapse
|