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McDonald AM, Murdaugh DL, Heinzman KA, Cardan RA, Jacob J, Fiveash JB, Nabors LB, Cooper CA, Hoyle JM, Milner D, Cardenas CE. Longitudinal brain volumetrics in glioma survivors. J Neurosurg 2024:1-8. [PMID: 38669700 DOI: 10.3171/2024.1.jns231980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/26/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE Radiation therapy (RT) is used selectively for patients with low-grade glioma (LGG) given the concerns for potential cognitive effects in survivors, but prior cognitive outcome studies among LGG survivors have had inconsistent findings. Translational studies that characterize changes in brain anatomy and physiology after treatment of LGG may help to both contextualize cognitive findings and improve the overall understanding of radiation effects in normal brain tissue. This study aimed to investigate the hypothesis that patients with LGG who are treated with RT will experience greater brain volume loss than those who do not receive RT. METHODS This retrospective longitudinal study included all patients with WHO grade 2 glioma who received posttreatment surveillance MRI at the University of Alabama at Birmingham. Volumetric analysis of contralateral cortical white matter (WM), cortical gray matter (GM), and hippocampus was performed on all posttreatment T1-weighted MRI sequences using the SynthSeg script. The effect of clinical and treatment variables on brain volumes was assessed using two-level hierarchical linear models. RESULTS The final study cohort consisted of 105 patients with 1974 time points analyzed. The median length of imaging follow-up was 4.6 years (range 0.36-18.9 years), and the median number of time points analyzed per patient was 12 (range 2-40). Resection was performed in 79 (75.2%) patients, RT was administered to 61 (58.1%) patients, and chemotherapy was administered to 66 (62.9%) patients. Age at diagnosis (β = -0.06, p < 0.001) and use of RT (β = -1.12, p = 0.002) were associated with the slope of the contralateral cortical GM volume model (i.e., change in GM over time). Age at diagnosis (β = -0.08, p < 0.001), midline involvement (β = 1.31, p = 0.006), and use of RT (β = -1.45, p = 0.001) were associated with slope of the contralateral cortical WM volume model. Age (β = -0.0027, p = 0.001), tumor resection (β = -0.069, p < 0.001), use of chemotherapy (β = -0.0597, p = 0.003), and use of RT (β = -0.0589, p < 0.001) were associated with the slope of the contralateral hippocampus volume model. CONCLUSIONS This study demonstrated volume loss in contralateral brain structures among LGG survivors, and patients who received RT experienced greater volume loss than those who did not. The results of this study may help to provide context for cognitive outcome research in LGG survivors and inform the design of future strategies to preserve cognition.
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Affiliation(s)
- Andrew M McDonald
- Departments of1Radiation Oncology
- 2Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham; and
| | - Donna L Murdaugh
- 2Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham; and
- 3Pediatrics
| | - Katherine A Heinzman
- Departments of1Radiation Oncology
- 2Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham; and
| | | | | | | | | | - Courtney A Cooper
- Departments of1Radiation Oncology
- 2Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham; and
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King KP, Humiston T, Gowey MA, Murdaugh DL, Dutton GR, Lansing AH. A biobehavioural and social-structural model of inflammation and executive function in pediatric chronic health conditions. Health Psychol Rev 2024; 18:24-40. [PMID: 36581801 PMCID: PMC10307927 DOI: 10.1080/17437199.2022.2162430] [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: 05/20/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Evidence indicates that pediatric chronic health conditions (CHCs) often impair executive functioning (EF) and impaired EF undermines pediatric CHC management. This bidirectional relationship likely occurs due to biobehavioural and social-structural factors that serve to maintain this feedback loop. Specifically, biobehavioural research suggests that inflammation may sustain a feedback loop that links together increased CHC severity, challenges with EF, and lower engagement in health promoting behaviours. Experiencing social and environmental inequity also maintains pressure on this feedback loop as experiencing inequities is associated with greater inflammation, increased CHC severity, as well as challenges with EF and engagement in health promoting behaviours. Amidst this growing body of research, a model of biobehavioural and social-structural factors that centres inflammation and EF is warranted to better identify individual and structural targets to ameliorate the effects of CHCs on children, families, and society at large. This paper proposes this model, reviews relevant literature, and delineates actionable research and clinical implications.
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Affiliation(s)
| | - Tori Humiston
- University of Vermont, Department of Psychological Sciences
| | - Marissa A. Gowey
- University of Alabama-Birmingham School of Medicine, Department of Pediatrics
| | - Donna L. Murdaugh
- University of Alabama-Birmingham School of Medicine, Department of Pediatrics
| | - Gareth R. Dutton
- University of Alabama-Birmingham School of Medicine, Department of Preventive Medicine
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Murdaugh DL, Milner D, Cardenas CE, Heinzman KA, Cooper CA, Tabb JN, Bhatia S, McDonald AM. Volumetric brain assessment of long-term head and neck cancer survivors. Radiother Oncol 2024; 191:110068. [PMID: 38142935 PMCID: PMC10922648 DOI: 10.1016/j.radonc.2023.110068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Radiation therapy (RT) for locally advanced head and neck cancer (HNC) often exposes subcortical brain structures to radiation. We performed this study to assess region-specific brain volumetrics in a population of long term HNC survivors. METHODS AND MATERIALS Forty HNC survivors were enrolled at a mean of 6.4 years from completion of RT. Patients underwent a research MRI protocol that included a 3D T1- weighted whole-brain scan on a 3 Tesla MRI scanner. Voxel based morphometry was performed using the Computational Anatomy Toolbox with the Neuromorphometrics atlas. Healthy controls from the Human Connectome Project were used as a comparison cohort. Study participants also completed a comprehensive neurocognitive assessment. RESULTS The final study cohort consisted of 38 participants after excluding 2 participants due to image quality. HNC survivors displayed widespread reduction in gray matter (GM) brain region volumes that included bilateral medial frontal cortex, temporal lobe, hippocampus, supplemental motor area, and cerebellum. Greater radiation exposure was associated with reduced GM volume in the left ventral diencephalon (r = -0.512, p = 0.003). Associations between cognition and regional GM volumes were identified for motor coordination and bilateral cerebellum (left, r = 0.444, p = 0.009; right, r = 0.372, p = 0.030), confrontation naming and left amygdala (r = 0.382, p = 0.026), verbal memory and bilateral thalamus (left, r = 0.435, p = 0.010; right, r = 0.424, p = 0.012), right amygdala (r = 0.339, p = 0.050), and right putamen (r = 0.364, p = 0.034). CONCLUSIONS Reductions in GM were observed within this cohort of primarily non-nasopharyngeal HNC survivors as compared to a control sample. GM volumes were associated with performance in multiple cognitive domains. Results of this exploratory study support the need for investigation of anatomic brain changes as an important translational corollary to cognitive problems among HNC survivors.
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Affiliation(s)
- Donna L Murdaugh
- University of Alabama at Birmingham, Department of Radiation Oncology, United States; University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship, United States; University of Alabama at Birmingham, Department of Pediatrics, United States
| | - Desmin Milner
- University of Alabama at Birmingham, Department of Radiology, United States
| | - Carlos E Cardenas
- University of Alabama at Birmingham, Department of Radiation Oncology, United States
| | - Katherine A Heinzman
- University of Alabama at Birmingham, Department of Radiation Oncology, United States; University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship, United States
| | - Courtney A Cooper
- University of Alabama at Birmingham, Department of Radiation Oncology, United States; University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship, United States
| | - Jazmyne N Tabb
- Brookwood Baptist Medical Center, Birmingham, AL, United States
| | - Smita Bhatia
- University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship, United States; University of Alabama at Birmingham, Department of Pediatrics, United States
| | - Andrew M McDonald
- University of Alabama at Birmingham, Department of Radiation Oncology, United States; University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship, United States.
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Seghatol-Eslami VC, Cook EW, Sharafeldin N, Wolfson J, Murdaugh DL. Adaptive functioning and academic achievement in pediatric survivors of acute lymphoblastic leukemia: Associations with executive functioning, socioeconomic status, and academic support. Eur J Haematol 2024; 112:266-275. [PMID: 37798080 DOI: 10.1111/ejh.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES This study examines associations of functional outcomes (adaptive functioning and academic achievement) with executive functioning (EF), socioeconomic status (SES), and academic support in pediatric acute lymphoblastic leukemia (ALL) survivors. METHODS Fifty survivors of B-lineage ALL treated with chemotherapy-only (42% female, 76% NHW, ages 6-19) were evaluated on performance-based EF and academic achievement, and parent-rated EF and adaptive functioning. Area deprivation and child opportunity (i.e., SES) were extracted using census blocks and tracts. Academic support data were extracted from chart review. RESULTS Compared to population norms, pediatric ALL survivors demonstrated significantly lower overall adaptive skills and performance in word reading and math calculation (all p ≤ .011). Frequencies of impairment were significantly elevated on all adaptive scales and in math calculation compared to the population (all p ≤ .002). Parent-rated EF significantly predicted overall adaptive skills (p < .001), while performance-based EF significantly predicted word reading and math calculation (all p < .05). Adaptive functioning was not associated with neighborhood-specific variables or academic support. However, academic support predicted word reading (p < .001), while area deprivation and academic support predicted performance-based EF (all p ≤ .02). CONCLUSIONS Screening of functional outcomes, targeted intervention, and neuropsychological monitoring are necessary to support pediatric ALL survivors' neurocognitive and psychosocial development.
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Affiliation(s)
- Victoria C Seghatol-Eslami
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edwin W Cook
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donna L Murdaugh
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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King KP, Keller CV, Evans CT, Murdaugh DL, Gower BA, Gowey MA. Inflammation, Executive Function, and Adiposity in Children With or at Risk for Obesity: A Pilot Study. J Pediatr Psychol 2023; 48:134-143. [PMID: 36111823 PMCID: PMC10167924 DOI: 10.1093/jpepsy/jsac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Obesity is associated with executive function (EF) deficits across the lifespan. Higher body mass index (BMI), obesity severity, and poorer adherence and weight outcomes in obesity treatment have all been associated with EF deficits. Adult literature has begun to emphasize neuroinflammation in obesity as a possible pathway to later cognitive impairment in EF. However, pediatric obesity literature has yet to establish associations between peripheral inflammation and EF. Thus, the present study examined associations and variability in inflammation, EF, and adiposity in children with or at risk for obesity. Additionally, inflammation was examined as a mediator of the relationship between adiposity and EF. METHODS Children (N = 39) aged 8-12 years with BMI ≥ 50th percentile were recruited. The NIH Toolbox Cognitive Battery was used to assess performance-based EF. Peripheral inflammation was assessed in fasted sera. Dual-energy X-ray absorptiometry scans were conducted to assess body composition. Linear regression and Hayes' PROCESS Model 4 (Hayes, 2017) were used to evaluate associations between adiposity and inflammation, inflammation and EF, and whether adiposity effects EF through its effect on inflammation. RESULTS Positive associations were identified between adiposity and inflammation, and negative to null associations were identified between inflammation and EF. Medium indirect effects of adiposity on EF through inflammation were detected. CONCLUSION Pilot evidence suggests greater adiposity is linked with greater inflammation, which in turn is associated with less EF in some domains. Directionality and causality cannot yet be established, but with replication, findings may inform efforts to target EF in pediatric obesity.
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Affiliation(s)
- Kathryn P King
- Department of Psychology, University of Alabama at Birmingham, USA
| | | | - Corinne T Evans
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Donna L Murdaugh
- Department of Pediatrics, University of Alabama at Birmingham, USA
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - Marissa A Gowey
- Department of Pediatrics, University of Alabama at Birmingham, USA
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Trapani JA, Murdaugh DL. Processing efficiency in pediatric cancer survivors: A review and operationalization for outcomes research and clinical utility. Brain Behav 2022; 12:e2809. [PMID: 36330565 PMCID: PMC9759139 DOI: 10.1002/brb3.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Childhood cancer and cancer-related treatments disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Given that assessment tools vary widely across researchers and clinicians, it has been daunting to identify distinct patterns in outcomes across diverse cancer types and to implement systematic neurocognitive screening tools. This review aims to operationalize processing efficiency skill impairment-or inefficient neural processing as measured by working memory and processing speed abilities-as a worthwhile avenue for continued study within the context of childhood cancer. METHODS A comprehensive literature review was conducted to examine the existing research on cognitive late effects and biopsychosocial risk factors in order to conceptualize processing efficiency skill trends in childhood cancer survivors. RESULTS While a frequently reported pattern of neurobiological (white matter) and cognitive (working memory and processing speed) disruption is consistent with processing efficiency skill impairment, these weaknesses have not yet been fully operationalized in this population. We offer a theoretical model that highlights the impacts of a host of biological and environmental factors on the underlying neurobiological substrates of cancer survivors that precede and may even predict long-term cognitive outcomes and functional abilities following treatment. CONCLUSION The unified construct of processing efficiency may be useful in assessing and communicating neurocognitive skills in both outcomes research and clinical practice. Deficits in processing efficiency may serve as a possible indicator of cognitive late effects and functional outcomes due to the unique relationship between processing efficiency skills and neurobiological disruption following cancer treatment. Continued research along these lines is crucial for advancing childhood cancer outcomes research and improving quality of life for survivors.
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Affiliation(s)
- Julie A Trapani
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donna L Murdaugh
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Murdaugh DL, Bosworth A, Patel SK, Sharafeldin N, Chen Y, Francisco L, Forman SJ, Wong FL, Bhatia S. Self-endorsed cognitive problems versus objectively assessed cognitive impairment in blood or bone marrow transplantation recipients: A longitudinal study. Cancer 2020; 126:2174-2182. [PMID: 32097508 DOI: 10.1002/cncr.32773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/08/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cognitive impairment in survivors of blood or bone marrow transplantation (BMT) is well documented. However, to the authors' knowledge, the clinical relevance of self-endorsed cognitive problems and their relation to objectively assessed cognitive impairment is not known. METHODS The authors assessed cognitive impairment in 378 BMT recipients (median age, 52.2 years, 40% of whom were female and 68% of whom were non-Hispanic white) and 98 healthy controls at 5 predetermined time points: at baseline (before BMT) and at 6 months, 1 year, 2 years, and 3 years after BMT. Self-endorsed cognitive problems were evaluated using the Neuropsychological Impairment Scale (NIS) and correlated with a standardized 2-hour battery of objective cognitive testing at each time point. The authors examined the magnitude of difference in self-endorsed cognitive problems between BMT recipients and healthy controls, and the rate of change in scores over time. Multivariable analyses were used to identify clinical and/or demographic variables associated with self-endorsed cognitive problems. The authors also examined the association between cognitive impairment and returning to work after BMT. RESULTS Compared with healthy controls, BMT recipients endorsed more cognitive problems (P < .001) at all time points, and the rate of change in NIS scores was found to be significantly greater in BMT recipients. Fatigue was associated with greater endorsement of cognitive problems at 1 year after BMT (odds ratio, 4.23; 95% CI, 2.1-8.3 [P < .001]). Overall, there was a statistically significant, modest correlation noted between self-endorsed cognitive problems and objective cognitive impairment (range, 0.401-0.445 [P ≤ .01]). Higher self-endorsed cognitive problems were associated with a 3.7-fold (P = .02) higher odds of not returning to work at 3 years after BMT. CONCLUSIONS The results of the current study demonstrated that self-endorsed cognitive problems can help to identify vulnerable patient subpopulations for detailed cognitive assessment and possible cognitive remediation.
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Affiliation(s)
- Donna L Murdaugh
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alysia Bosworth
- Department of Population Sciences, City of Hope, Duarte, California
| | - Sunita K Patel
- Department of Population Sciences, City of Hope, Duarte, California
| | - Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yanjun Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, California
| | - Smita Bhatia
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
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McDonald AM, Murdaugh DL, Milner D, Cardan RA, Bhatia S. Brain dosimetry from locally advanced head and neck cancer radiotherapy: implications for neurocognitive outcomes research. Acta Oncol 2018; 57:1589-1592. [PMID: 30141706 DOI: 10.1080/0284186x.2018.1497295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Andrew M. McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna L. Murdaugh
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desmin Milner
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rex A. Cardan
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Murdaugh DL, Ono KE, Morris SO, Burns TG. Effects of Developmental Age on Symptom Reporting and Neurocognitive Performance in Youth After Sports-Related Concussion Compared to Control Athletes. J Child Neurol 2018; 33:474-481. [PMID: 29667530 DOI: 10.1177/0883073818766815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/16/2022]
Abstract
There is increased necessity to focus research on school-aged athletes with sports-related concussion (SRC). This study assessed differences in symptom reporting and neurocognitive performance in youth athletes who sustained a sports-related concussion. A total of 1345 concussed and 3529 nonconcussed athletes (ages 8-21) completed the Immediate Post-concussive Assessment and Cognitive Testing (ImPACT). Analyses of covariance were conducted in order to assess differences in neurocognitive performance and symptom reporting between the sports-related concussion and control groups across age ranges. Longitudinal hierarchical linear modeling was employed to examine age and its relationship with rates of sports-related concussion recovery in neurocognitive performance. Results revealed athletes aged 13 to 15 had significantly lower neurocognitive performance scores compared to same-aged athletes without a history of sports-related concussion. With respect to the hierarchical linear modeling results, age was identified as a unique predictor of symptom recovery, particularly for ages 8 to 12. Results provide a better understanding of typical symptom reporting and neurocognitive outcomes for younger athletes across different ages.
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Affiliation(s)
| | - Kim E Ono
- 1 Children's Healthcare of Atlanta, Atlanta, GA, USA
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Thye MD, Murdaugh DL, Kana RK. Brain Mechanisms Underlying Reading the Mind from Eyes, Voice, and Actions. Neuroscience 2018; 374:172-186. [DOI: 10.1016/j.neuroscience.2018.01.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/17/2018] [Accepted: 01/21/2018] [Indexed: 01/06/2023]
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Murdaugh DL, Ono KE, Reisner A, Burns TG. Assessment of Sleep Quantity and Sleep Disturbances During Recovery From Sports-Related Concussion in Youth Athletes. Arch Phys Med Rehabil 2018; 99:960-966. [PMID: 29425698 DOI: 10.1016/j.apmr.2018.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the relation between sleep quantity and sleep disturbances on symptoms and neurocognitive ability during the acute phase (<7d) and after sports-related concussion (SRC; >21d). DESIGN Prospective inception cohort study. SETTING General community setting of regional middle and high schools. PARTICIPANTS A sample (N=971) including youth athletes with SRC (n=528) and controls (n=443) (age, 10-18y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Athletes completed the Immediate Post-Concussion Assessment and Cognitive Testing battery. Partial correlation analyses and independent t tests were conducted to assess sleep quantity the night before testing. Multivariate analysis of covariance was used to assess sleep disturbances and their interaction with age. RESULTS Less sleep quantity was correlated with greater report of cognitive (P=.001) and neuropsychological (P=.024) symptoms specific to prolonged recovery from SRC. Sleep disturbances significantly affect each migraine, cognitive, and neuropsychological symptoms (P<.001). A significant interaction was found between sleep disturbances and age (P=.04) at >21 days post-SRC. CONCLUSIONS Findings emphasize that the continued presence of low sleep quantity and sleep disturbances in youth athletes with SRC should be a specific indicator to health professionals that these athletes are at an increased risk of protracted recovery. Further research should identify additional factors that may interact with sleep to increase the risk of protracted recovery.
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Affiliation(s)
| | - Kim E Ono
- Children's Healthcare of Atlanta, Atlanta, GA
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Maximo JO, Murdaugh DL, O'Kelley S, Kana RK. Changes in intrinsic local connectivity after reading intervention in children with autism. Brain Lang 2017; 175:11-17. [PMID: 28869842 DOI: 10.1016/j.bandl.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/30/2017] [Accepted: 08/27/2017] [Indexed: 06/07/2023]
Abstract
Most of the existing behavioral and cognitive intervention programs in autism spectrum disorders (ASD) have not been tested at the neurobiological level, thus falling short of finding quantifiable neurobiological changes underlying behavioral improvement. The current study takes a translational neuroimaging approach to test the impact of a structured visual imagery-based reading intervention on improving reading comprehension and assessing its underlying local neural circuitry. Behavioral and resting state functional MRI (rs-fMRI) data were collected from children with ASD who were randomly assigned to an Experimental group (ASD-EXP; n=14) and a Wait-list control group (ASD-WLC; n=14). Participants went through an established reading intervention training program (Visualizing and Verbalizing for language comprehension and thinking or V/V; 4-h per day, 10-weeks, 200h of face-to-face instruction). Local functional connectivity was examined using a connection density approach from graph theory focusing on brain areas considered part of the Reading Network. The main results are as follows: (I) the ASD-EXP group showed significant improvement, compared to the ASD-WLC group, in their reading comprehension ability evidenced from change in comprehension scores; (II) the ASD-EXP group showed increased local brain connectivity in Reading Network regions compared to the ASD-WLC group post-intervention; (III) intervention-related changes in local brain connectivity were observed in the ASD-EXP from pre to post-intervention; and (IV) improvement in language comprehension significantly predicted changes in local connectivity. The findings of this study provide novel insights into brain plasticity in children with developmental disorders using targeted intervention programs.
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Affiliation(s)
- Jose O Maximo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna L Murdaugh
- University of Alabama at Birmingham, Birmingham, AL, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sarah O'Kelley
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajesh K Kana
- University of Alabama at Birmingham, Birmingham, AL, USA.
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Murdaugh DL, King TZ, O’toole K. The efficacy of a pilot pediatric cognitive remediation summer program to prepare for transition of care. Child Neuropsychol 2017; 25:131-151. [DOI: 10.1080/09297049.2017.1391949] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Donna L. Murdaugh
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Tricia Z. King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Kathleen O’toole
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Murdaugh DL, Maximo JO, Cordes CE, O'Kelley SE, Kana RK. From word reading to multisentence comprehension: Improvements in brain activity in children with autism after reading intervention. Neuroimage Clin 2017; 16:303-312. [PMID: 28856093 PMCID: PMC5565787 DOI: 10.1016/j.nicl.2017.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 06/13/2017] [Accepted: 08/12/2017] [Indexed: 12/22/2022]
Abstract
Background Children with ASD show a unique reading profile characterized by decoding abilities equivalent to verbal abilities, but with lower comprehension skills. Neuroimaging studies have found recruitment of regions primarily associated with visual processing (e.g., fusiform gyrus and medial parietal cortex), but reduced activation in frontal and temporal regions, when reading in adults with ASD. The purpose of this study was to assess neural changes associated with an intense reading intervention program in children with ASD using three fMRI tasks of reading. Methods 25 children with ASD were randomly assigned to a treatment (ASD-EXP) or waitlist group (ASD-WLC). Children participated in a reading intervention program (4-hour sessions per day, 5 days a week for 10 weeks). We utilized three tasks: word, sentence, and multisentence processing, each with differential demands of reading comprehension. fMRI data were acquired at each of two scanning sessions 10-weeks apart. Results Across tasks, post-intervention results revealed that the ASD-EXP group showed greater activation in bilateral precentral gyrus and the postcentral gyrus, visual processing regions (e.g., occipital cortex, fusiform gyrus), and frontal regions. In the word task, left thalamus and the right angular gyrus (AG) activation was unique to the ASD-EXP group post-intervention. Sentence tasks showed differential activation of core language areas (e.g., IFG, IPL) post-intervention. Conclusions Our results provide evidence for differential recruitment of brain regions based on task demands in children with ASD, and support the potential of targeted interventions to alter brain activation in response to positive gains in treatment. Children with ASD have a different reading profile from other reading disorders that needs to be specifically targeted in interventions.
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Key Words
- ADI, Autism Diagnostic Interview-Revised
- ADOS, Autism Diagnostic Observation Schedule
- ASD, autism spectrum disorder
- ASD-EXP, children with ASD in the treatment group
- ASD-WLC, children with ASD in the waitlist control group
- Children with ASD
- GORT-4, Gray Oral Reading Test – Fourth Edition
- Intervention
- LFFG, left fusiform gyrus
- LIFG, left inferior frontal gyrus
- LIOG, left inferior occipital gyrus
- LMFG, left middle frontal gyrus
- LPCG, left precentral gyrus
- LSMA, left supplementary motor area
- LSPL, left superior parietal lobule
- LSTG, left superior temporal gyrus
- LTHAL, left thalamus
- Reading comprehension
- SORT-R, Slosson Oral Reading Test - Revised
- V/V, Visualizing and Verbalizing
- WASI, Wechsler Abbreviated Scale of Intelligence
- fMRI
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Donna L. Murdaugh
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jose O. Maximo
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Claire E. Cordes
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah E. O'Kelley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajesh K. Kana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Corresponding author at: Department of Psychology, University of Alabama, Birmingham, CIRC 235G, 1719 6th Ave South, Birmingham, AL 35294-0021, USA.
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Bednarz HM, Maximo JO, Murdaugh DL, O'Kelley S, Kana RK. "Decoding versus comprehension": Brain responses underlying reading comprehension in children with autism. Brain Lang 2017; 169:39-47. [PMID: 28242518 DOI: 10.1016/j.bandl.2017.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 06/06/2023]
Abstract
Despite intact decoding ability, deficits in reading comprehension are relatively common in children with autism spectrum disorders (ASD). However, few neuroimaging studies have tested the neural bases of this specific profile of reading deficit in ASD. This fMRI study examined activation and synchronization of the brain's reading network in children with ASD with specific reading comprehension deficits during a word similarities task. Thirteen typically developing children and 18 children with ASD performed the task in the MRI scanner. No statistically significant group differences in functional activation were observed; however, children with ASD showed decreased functional connectivity between the left inferior frontal gyrus (LIFG) and the left inferior occipital gyrus (LIOG). In addition, reading comprehension ability significantly positively predicted functional connectivity between the LIFG and left thalamus (LTHAL) among all subjects. The results of this study provide evidence for altered recruitment of reading-related neural resources in ASD children and suggest specific weaknesses in top-down modulation of semantic processing.
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Affiliation(s)
- Haley M Bednarz
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose O Maximo
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna L Murdaugh
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah O'Kelley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajesh K Kana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Murdaugh DL, Maximo JO, Kana RK. Changes in intrinsic connectivity of the brain's reading network following intervention in children with autism. Hum Brain Mapp 2015; 36:2965-79. [PMID: 26058572 DOI: 10.1002/hbm.22821] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 03/30/2015] [Accepted: 04/06/2015] [Indexed: 01/14/2023] Open
Abstract
While task-based neuroimaging studies have identified alterations in neural circuitry underlying language processing in children with autism spectrum disorders [ASD], resting state functional magnetic resonance imaging [rsfMRI] is a promising alternative to the constraints posed by task-based fMRI. This study used rsfMRI, in a longitudinal design, to study the impact of a reading intervention on connectivity of the brain regions involved in reading comprehension in children with ASD. Functional connectivity was examined using group independent component analysis (GICA) and seed-based correlation analysis of Broca's and Wernicke's areas, in three groups of participants: an experimental group of ASD children (ASD-EXP), a wait list control group of ASD children (ASD-WLC), and a group of typically developing (TD) control children. Both GICA and seed-based analyses revealed stronger functional connectivity of Broca's and Wernicke's areas in the ASD-EXP group postintervention. Additionally, improvement in reading comprehension in the ASD-EXP group was correlated with greater connectivity in both Broca's and Wernicke's area in the GICA identified reading network component. In addition, increased connectivity between the Broca's area and right postcentral and right STG, and the Wernicke's area and LIFG, were also correlated with greater improvement in reading comprehension. Overall, this study revealed widespread changes in functional connectivity of the brain's reading network as a result of intervention in children with ASD. These novel findings provide valuable insights into the neuroplasticity of brain areas underlying reading and the impact of intensive intervention in modifying them in children with ASD.
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Affiliation(s)
- Donna L Murdaugh
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Jose O Maximo
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Rajesh K Kana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
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Murdaugh DL, Deshpande HD, Kana RK. The Impact of Reading Intervention on Brain Responses Underlying Language in Children With Autism. Autism Res 2015; 9:141-54. [DOI: 10.1002/aur.1503] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/02/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Donna L. Murdaugh
- Department of Psychology; University of Alabama at Birmingham; Birmingham Alabama
| | | | - Rajesh K. Kana
- Department of Psychology; University of Alabama at Birmingham; Birmingham Alabama
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Murdaugh DL, Nadendla KD, Kana RK. Differential role of temporoparietal junction and medial prefrontal cortex in causal inference in autism: An independent component analysis. Neurosci Lett 2014; 568:50-5. [PMID: 24695086 DOI: 10.1016/j.neulet.2014.03.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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Murdaugh DL, Shinkareva SV, Deshpande HR, Wang J, Pennick MR, Kana RK. Differential deactivation during mentalizing and classification of autism based on default mode network connectivity. PLoS One 2012. [PMID: 23185536 PMCID: PMC3501481 DOI: 10.1371/journal.pone.0050064] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The default mode network (DMN) is a collection of brain areas found to be consistently deactivated during task performance. Previous neuroimaging studies of resting state have revealed reduced task-related deactivation of this network in autism. We investigated the DMN in 13 high-functioning adults with autism spectrum disorders (ASD) and 14 typically developing control participants during three fMRI studies (two language tasks and a Theory-of-Mind (ToM) task). Each study had separate blocks of fixation/resting baseline. The data from the task blocks and fixation blocks were collated to examine deactivation and functional connectivity. Deficits in the deactivation of the DMN in individuals with ASD were specific only to the ToM task, with no group differences in deactivation during the language tasks or a combined language and self-other discrimination task. During rest blocks following the ToM task, the ASD group showed less deactivation than the control group in a number of DMN regions, including medial prefrontal cortex (MPFC), anterior cingulate cortex, and posterior cingulate gyrus/precuneus. In addition, we found weaker functional connectivity of the MPFC in individuals with ASD compared to controls. Furthermore, we were able to reliably classify participants into ASD or typically developing control groups based on both the whole-brain and seed-based connectivity patterns with accuracy up to 96.3%. These findings indicate that deactivation and connectivity of the DMN were altered in individuals with ASD. In addition, these findings suggest that the deficits in DMN connectivity could be a neural signature that can be used for classifying an individual as belonging to the ASD group.
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Affiliation(s)
- Donna L. Murdaugh
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Svetlana V. Shinkareva
- Department of Psychology, University of South Carolina, Columbia, South Carolina, United States of America
| | - Hrishikesh R. Deshpande
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jing Wang
- Department of Psychology, University of South Carolina, Columbia, South Carolina, United States of America
| | - Mark R. Pennick
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rajesh K. Kana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Kishinevsky FI, Cox JE, Murdaugh DL, Stoeckel LE, Cook EW, Weller RE. fMRI reactivity on a delay discounting task predicts weight gain in obese women. Appetite 2012; 58:582-92. [DOI: 10.1016/j.appet.2011.11.029] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 01/03/2023]
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Abstract
Behavioral studies have suggested that food cues have stronger motivating effects in obese than in normal-weight individuals, which may be a risk factor underlying obesity. Previous cross-sectional neuroimaging studies have suggested that this difference is mediated by increased reactivity to food cues in parts of the reward system in obese individuals. To date, however, only a few prospective neuroimaging studies have been conducted to examine whether individual differences in brain activation elicited by food cues can predict differences in weight change. We used functional magnetic resonance imaging (fMRI) to investigate activation in reward-system as well as other brain regions in response to viewing high-calorie food vs. control pictures in 25 obese individuals before and after a 12-week psychosocial weight-loss treatment and at 9-mo follow-up. In those obese individuals who were least successful in losing weight during the treatment, we found greater pre-treatment activation to high-calorie food vs. control pictures in brain regions implicated in reward-system processes, such as the nucleus accumbens, anterior cingulate, and insula. We found similar correlations with weight loss in brain regions implicated by other studies in vision and attention, such as superior occipital cortex, inferior and superior parietal lobule, and prefrontal cortex. Furthermore, less successful weight maintenance at 9-mo follow-up was predicted by greater post-treatment activation in such brain regions as insula, ventral tegmental area, putamen, and fusiform gyrus. In summary, we found that greater activation in brain regions mediating motivational and attentional salience of food cues in obese individuals at the start of a weight-loss program was predictive of less success in the program and that such activation following the program predicted poorer weight control over a 9-mo follow-up period.
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Affiliation(s)
- Donna L Murdaugh
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294-1170, USA.
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Kana RK, Murdaugh DL, Libero LE, Pennick MR, Wadsworth HM, Deshpande R, Hu CP. Probing the brain in autism using FMRI and diffusion tensor imaging. J Vis Exp 2011:3178. [PMID: 21931296 DOI: 10.3791/3178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Newly emerging theories suggest that the brain does not function as a cohesive unit in autism, and this discordance is reflected in the behavioral symptoms displayed by individuals with autism. While structural neuroimaging findings have provided some insights into brain abnormalities in autism, the consistency of such findings is questionable. Functional neuroimaging, on the other hand, has been more fruitful in this regard because autism is a disorder of dynamic processing and allows examination of communication between cortical networks, which appears to be where the underlying problem occurs in autism. Functional connectivity is defined as the temporal correlation of spatially separate neurological events. Findings from a number of recent fMRI studies have supported the idea that there is weaker coordination between different parts of the brain that should be working together to accomplish complex social or language problems. One of the mysteries of autism is the coexistence of deficits in several domains along with relatively intact, sometimes enhanced, abilities. Such complex manifestation of autism calls for a global and comprehensive examination of the disorder at the neural level. A compelling recent account of the brain functioning in autism, the cortical underconnectivity theory, provides an integrating framework for the neurobiological bases of autism. The cortical underconnectivity theory of autism suggests that any language, social, or psychological function that is dependent on the integration of multiple brain regions is susceptible to disruption as the processing demand increases. In autism, the underfunctioning of integrative circuitry in the brain may cause widespread underconnectivity. In other words, people with autism may interpret information in a piecemeal fashion at the expense of the whole. Since cortical underconnectivity among brain regions, especially the frontal cortex and more posterior areas, has now been relatively well established, we can begin to further understand brain connectivity as a critical component of autism symptomatology. A logical next step in this direction is to examine the anatomical connections that may mediate the functional connections mentioned above. Diffusion Tensor Imaging (DTI) is a relatively novel neuroimaging technique that helps probe the diffusion of water in the brain to infer the integrity of white matter fibers. In this technique, water diffusion in the brain is examined in several directions using diffusion gradients. While functional connectivity provides information about the synchronization of brain activation across different brain areas during a task or during rest, DTI helps in understanding the underlying axonal organization which may facilitate the cross-talk among brain areas. This paper will describe these techniques as valuable tools in understanding the brain in autism and the challenges involved in this line of research.
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Affiliation(s)
- Rajesh K Kana
- Department of Psychology, University of Alabama at Birmingham, USA.
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Abstract
OBJECTIVE Binge eating involves an abnormal motivation for highly palatable food in that these foods are repeatedly consumed despite their binge-triggering effects and life-affecting consequences associated with binge eating. We determined if rats identified as binge-eating prone (BEP) similarly display abnormal motivation for palatable food. METHOD Food-sated BEP and binge-eating resistant (BER) rats were given voluntary access to palatable food paired with increasing intensity of footshock. Later, they were exposed to a period of cyclic caloric restriction-refeeding. RESULTS BEPs consumed significantly more and tolerated higher levels of footshock for palatable food than BERs. Cyclic restriction-refeeding increased BERs' tolerance of shock for palatable food. DISCUSSION Previously observed parallels of the rat BEP model to human binge eating can now be extended to include an abnormal motivation for palatable food. This model should prove useful in identifying specific genes that interact with the nutritional environment to mediate binge eating and may point to novel physiological targets to treat compulsive overeating.
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Affiliation(s)
- Kimberly D. Oswald
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
| | - Donna L. Murdaugh
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
| | - Vinetra L. King
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
| | - Mary M. Boggiano
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, 35294-1170, USA
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