Brain injury最新文献

Objectives: 1) Describe clinically significant symptoms over 4 years following hospitalization after mild traumatic brain injury (mTBI); 2) examine quality of life (QoL), social participation, and healthcare service use in relation to symptom burden.

Methods: Longitudinal cohort study in which 142 adults (ages 18-65) hospitalized following mTBI were assessed 4, 8, 12, 24, 36, and 48 months post-injury. Questionnaires and interviews evaluated fatigue, insomnia, cognitive complaints, anxiety, depression, headaches, dizziness, QoL, social participation, and healthcare service use for mTBI symptoms. The number of clinically significant symptoms (based on validated cutoff scores) was totaled for each participant; QoL, social participation, and healthcare services were examined in relation to the number of symptoms.

Results: At each timepoint, ≥45% of the participants experienced 3+ symptoms and ≥15% experienced 5+. The mean number of symptoms was similar over time (2.48-2.79; p = 0.32). The presence of 3+ symptoms was associated with poor QoL and social participation, including lower rates of return-to-work. Healthcare service use was not universal, even among individuals with 5+ symptoms.

Conclusions: Clinicians should be alert to the long-term presence of multiple symptoms following hospitalization after mTBI, as these affect a significant proportion of individuals and are associated with poorer outcomes.

Objective: To examine differences in health-related quality of life (HRQoL) and concussion symptoms among Black/African American adolescent football athletes with and without a history of concussion.

Methods: Athletes' pre-season health questionnaires were analyzed. HRQoL consisted of the Patient-Reported Outcome Measurement Information System (PROMIS®) Life Satisfaction and Psychological Stress Experienced. Total number and severity of concussion symptoms were evaluated using the 21-item Post-Concussion Symptoms Scale. Concussion history was self-reported. Differences in HRQoL and concussion symptom measures were evaluated between those with and without a history of concussion using Mann-Whitney U tests. Statistical significance was set at p < 0.05.

Results: The sample consisted of 239 Black/African American adolescents (age 15.66 ± 1.22), of which 45 (18.83%) reported a history and 194 (81.17%) reported no history of concussion. Significant differences were found in psychological stress (p = 0.027), total number of symptoms (p = 0.006), and symptom severity (p = 0.003), where those with a history of concussion reported higher scores. No significant difference was found for life satisfaction.

Conclusion: Black/African American adolescent athletes with a history of concussion endorsed higher concussion symptoms, higher symptom severity, and more psychological stress. This underscores the importance of incorporating HRQoL measures post-injury and the inclusion of underrepresented populations to promote a more holistic understanding of concussions.

Background: It has been hypothesized that the gut microbiome affects ischemic stroke occurrence. However, the relationship between stroke and gastrointestinal (GI) disorders is not well understood. We aimed to determine whether GI syndromes are associated with an increased risk of ischemic stroke.

Methods: We conducted case-control and cohort studies using the TriNetX US Collaborative Network database (2018-2022). In the case-control study, patients with ischemic stroke were compared to propensity-score-matched controls with at least 3 years of prior data. The cohort study assessed the risk of stroke in patients with specific GI syndromes over 5 years compared to matched controls.

Results: For the case-control study, 551,738 patients with ischemic stroke were matched with 19,419,979 negative controls, resulting in 548,179 pairs after matching. Compared to matched negative controls, all GI syndromes, appendectomy, and GI medications were significantly associated with ischemic stroke (all p < 0.001). In the cohort study, all GI syndromes were significantly associated with ischemic stroke (all risk ratio (RR) > 1, p < 0.001), but appendectomy was not [RR 1.28, 95% Confidence Interval (CI): 0.89-1.82].

Conclusion: Several GI disorders were associated with an increased risk of future ischemic stroke, providing more evidence on the gut-brain axis. Further research is warranted to confirm these findings and investigate underlying mechanisms.

Background: Nurses are at the forefront of managing agitation after moderate-to-severe traumatic brain injury (msTBI), but little is known about their experiences. This study aimed to explore how nurses understand, experience, and manage agitation after msTBI in an inpatient rehabilitation setting.

Methods: A qualitative descriptive study using semi-structured interviews was used to understand the experiences of agitation after msTBI for 15 nurses (aged 20-61 years, 80% female) on an inpatient brain injury rehabilitation unit. Reflexive thematic analysis was completed on interview transcripts.

Results: Nursing experiences were characterized into four key themes relating to: 1) what nurses considered to be core features and causes of agitation; 2) factors they considered important in shaping agitation; 3) strategies they used to manage agitation; and 4) the challenges and rewards of working with patients at an early stage of recovery after TBI.

Conclusions: Nurses had a detailed understanding of agitation after msTBI and its management. Managing agitation and PTA more broadly was experienced as physically, cognitively, and emotionally draining, yet it was seen as vital for supporting recovery and was personally meaningful for nurses. A lack of formal training and organizational support was a barrier to feeling competent and confident in the role.

Background: A growing concern in neuropsychology is whether neuropsychological test measures (NTMs) can predict functional outcome (i.e. ecological validity). The relationship between neuropsychological tests and return to work (RTW) outcomes following mild traumatic brain injury (mTBI) found that the majority of tests were either weakly or completely unrelated. As such, many have opined that clinical neuropsychology should adopt new tests that relate test performance to real-world functioning, such as the Behavioural Assessment of Dysexecutive Syndrome (BADS). Further investigation into the BADS sensitivity to employment status in a mTBI sample is needed.

Present study: We aimed to investigate if the BADS is better at differentiating between employment status compared to traditional pen-and-paper neuropsychological test measures in a sample of patients in the post-acute period of recovery after mTBI.

Results: Following correction of family-wise error, neither the BADS nor traditional tests could differentiate employment status in patients with mTBI who were in the post-acute period of recovery.

Conclusions: The lack of significant findings in the majority of the tests highlights the importance of other facets of a complete neuropsychological assessment. Furthermore, researchers may benefit from investigating other forms of assessment that could prove to be more ecologically valid.

Objectives: To compare interoceptive sensibility in participants with and without traumatic brain injury (TBI+ and TBI-, respectively); and explore the relations of interoceptive sensibility domains with alexithymia, psychological distress, and post-traumatic stress outcomes, as well as whether relations were stronger in TBI+ versus TBI- group.

Method: Cross-sectional survey study conducted in adults with TBI+ and TBI-. The Multidimensional Assessment of Interoceptive Awareness (MAIA-2) evaluated eight dimensions of interoceptive sensibility, and validated scales assessed alexithymia, psychological distress.

Results: Relative to TBI-, participants with TBI scored lower on three MAIA subscales - Not Distracting, Self-Regulation, and Body Listening. Facets of interoceptive sensibility were associated with alexithymia, psychological distress, and posttraumatic stress symptoms. For two subscales (Attention Regulation, Not Worrying), lower interoceptive sensibility was related to higher psychological symptoms (alexithymia and posttraumatic stress symptoms, respectively) in the TBI+ group relative to the TBI- group.

Conclusion: Individuals with TBI demonstrated lower interoceptive sensibility across multiple domains compared to those without TBI. Lower Attention Regulation and Not Worrying were more strongly associated with alexithymia and posttraumatic stress symptoms, respectively, in those with TBI. Interventions targeting interoceptive sensibility - such as mindfulness-based or somatic-focused therapies - may be beneficial for individuals with TBI to improve psychological well-being.

Primary objective: This is Part I of a four-part review that examines traditional neuropsychological assessment methods and techniques in mild traumatic brain injury (mTBI). Absence of neuropsychological findings has been used to argue no residual neuropathological effects from mTBI. However, given the current potential that advanced multimodality and quantitative neuroimaging can now demonstrate about underlying neurobiology of brain-behavior relations, this review shows that traditional neuropsychological test as standalone findings cannot directly address the underlying complexities of detecting mTBI neuropathology.

Research design: This is a review.

Methods and procedures: Traditional neuropsychological tests, their development, methods and conclusions over the past 50+ years are the centerpiece of this review juxtaposed with 21^st century advanced neuroimaging and improved understanding of the neurobiology and potential neuropathology of mTBI.

Main outcome and results: Traditional neuropsychological methods were never developed for detecting subtle changes in neurocognitive or neurobehavioral functioning as a standalone procedure and likewise, never designed to address the multifaceted issues related to symptom burden from having sustained a mTBI, especially after three-months post-injury. Advanced neuroimaging methods have the potential to inform the clinician and researcher about potential neurobiological factors to best understand relevant neuropsychological outcome factors associated with mTBI outcome. A model is presented that helps explain how adaptation and accommodation may occur after mTBI within the context of 'normal' traditional neuropsychological test findings.

Conclusions: The limitations of traditional neuropsychological testing in mTBI outlined within the context of how advanced neuroimaging improves our understanding of mTBI outcome.

Background: Memantine is thought to function as a neuroprotective agent because of its impact on the progression of various neurodegenerative diseases. This study examines memantine's neuroprotective effects in reducing complications resulting from brain injuries.

Methods: The keywords were searched in the PubMed, Scopus, and Web of Science databases. Human studies were excluded. SYRCLE's RoB was utilized to assess the quality of the studies.

Results: Of 1543 articles reviewed up to November 20, 2024, 51 met the established inclusion and exclusion criteria. The results indicated a strong association between memantine administration and: 1) decreased infarct size, reduced number of apoptotic cells, less brain edema, lower oxidative stress index, and diminished inflammatory responses, alongside improved neurobehavioral outcomes in ischemic stroke models; 2) less hematoma expansion, reduced brain edema and damage, decreased inflammation, and notable enhancement in neurobehavioral function and survival in hemorrhagic stroke models, coupled with the prevention of delayed cerebral vasospasm in subarachnoid hemorrhage cases; and 3) diminished brain injury, reduced infarct volume, less oxidative stress, and marked improvement in neurofunctional recovery in traumatic brain injury models.

Conclusions: Memantine's potential neuroprotective properties could improve neurofunctional outcomes for patients with acute brain injuries.

Objective: This study assessed the relationship between insulin-like growth factor 1 (IGF-1) level and symptom severity in adolescents with traumatic brain injury (TBI), focusing on correlation with post-injury symptom severity, depression, and anxiety.

Design: This retrospective observational study included adolescents aged 13-17 years (n = 52) with mild TBI (mTBI, n = 30) or moderate/severe TBI (msTBI, n = 22), based on best Glasgow Coma Scale score recorded in the first 24 h post-injury. Participants were 3-12 months post-TBI with available IGF-1 values and complete Rivermead Post Concussion Symptoms Questionnaire (RPQ-13), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) responses. Outcome measures were correlated with IGF-1 z-scores with Kendall's Tau analysis.

Results: RPQ-13 and GAD-7 scores were significantly higher in msTBI (p = 0.0472 and p = 0.0085, respectively). IGF-1 z-scores negatively correlated with RPQ-13 scores in mTBI (tau = -0.65, p < 0.0001) and msTBI (tau = -0.85, p < 0.0001), and with GAD-7 scores in mTBI (tau = -0.30, p = 0.0302) and msTBI (tau = -0.39, p = 0.0144). Only msTBI demonstrated a significant negative correlation between IGF-1 z-score and PHQ-9 scores (tau = -0.82, p < 0.0001).

Conclusions: Adolescents with msTBI experienced greater post-injury symptom severity and anxiety than those with mTBI. Low IGF-1 levels correlated with greater post-injury symptom severity, anxiety, and depression (msTBI only), supporting IGF-1 as a potential biomarker in adolescent TBI.