Brain injury最新文献

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.

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.

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 study investigates the effect and underlying mechanisms of IL-18 binding protein (IL-18BP) on anxiety-like behaviors in rats following traumatic brain injury (TBI).

Methods and procedures: Thirty-six Sprague-Dawley rats were divided into three groups: sham, TBI, and TBI+IL-18BP. Anxiety-like behaviors were evaluated using the open field and elevated plus maze tests. Immunofluorescence staining was performed to assess the number of neurons, activated astrocytes, and the proportion of astrocytes positive for NLRP3 and IL-18. IL-18 levels in serum and cerebrospinal fluid (CSF) were quantified via ELISA. Western blot analysis was conducted to measure the expression of NLRP3, cleaved caspase-1 (cl-caspase-1), and N-GSDMD in the amygdala.

Main outcomes and results: Thirty days post-TBI, both the TBI and TBI+IL-18BP groups exhibited increased anxiety-like behaviors, elevated IL-18 levels in serum and CSF, greater activation of astrocytes in the amygdala, a higher percentage of NLRP3 and IL-18-positive astrocytes, and upregulated expression of pyroptosis-related proteins compared to the sham group (p < 0.05). However, the TBI+IL-18BP group showed significant reductions in these parameters compared to the TBI group (p < 0.05).

Conclusions: IL-18BP appears to mitigate anxiety-like behaviors in TBI rats, likely through a mechanism that involves reducing astrocyte apoptosis.

Objective: The primary objective was to investigate the association between and the predictive value of hippocampal volume on verbal episodic memory (VEM), in participants with chronic moderate-to-severe TBI (MS-TBI).

Method: Nighty-one individuals with MS-TBI (males = 82, females = 9) were included (mean age = 33.57 years; mean educational level = 12.20 years; mean time since injury = 5.16 years). To assess VEM the Immediate Recall 1st Try, AVLT Total, Short and Long Delay Recall and Recognition trials of the Auditory Verbal Learning Test (AVLT) Greek Version, and the Immediate and Delayed Recall tasks from the Logical Memory subtest (Wechsler Memory Scale-III) were implemented. T1-weighted magnetic resonance images were used to extract global volumes and unilateral and bilateral hippocampal volume.

Results: Bilateral hippocampal volume was positively associated with the AVLT Long Delay Recall scores. Also, the left hippocampal volume was positively correlated with the AVLT Long Delay Recall and the LM Delayed Recall scores. Finally, the left hippocampal volume predicted performance on the LM Delayed and the AVLT Long Delay Recall tasks.

Conclusion: These findings suggest a potential role of the hippocampus in VEM performance in chronic MS-TBI and highlight the need for further research to clarify these associations and guide the development of targeted memory interventions.

Objectives: To summarize patient perspectives after participating in a behavioral intervention designed to improve adherence to positive airway pressure therapy in Veterans with traumatic brain injury (TBI) and obstructive sleep apnea. The four-module adherence intervention was based on Motivational Interviewing and Cognitive Behavior Therapy principles and was adapted for persons with cognitive impairments.

Methods: Post-intervention semi-structured interviews were conducted with 13 patients with moderate-to-severe TBI. This qualitative study used a pragmatic and deductive approach with the Health Belief Model as the overarching framework. Two qualitative researchers coded and analyzed data with saturation reached after six interviews.

Results: The sample mean age was 51.4 years (SD = 10.8), who were on average 9.4 years post-TBI (SD = 10.1) and 6.8 years (SD = 5.1) post-OSA diagnosis. Patient feedback was organized into four themes that aligned with the Health Belief Model and two themes pertaining to logistics.

Conclusions: Participation in this adherence intervention was associated with increased awareness of OSA severity, its impact on them, and treatment benefits. Future research should examine the effectiveness of the intervention in real world clinical settings and obtain consumer input from treating clinicians to optimize the program and patient health and functioning.

Background: Acute neck pain following a concussion has been identified as a symptom associated with a delay in symptom resolution and persistent post-concussion symptoms (PPCS), but little is known about the relationship between the presence of acute neck pain and other known risk factors of delayed return to play (RTP) such as sex, sport contact level, and race.

Methods: This study reports the findings of a secondary data analysis of a prospective cohort study sample from the Concussion Assessment, Research, and Education (CARE) Consortium. We examined the possible mediating effects of neck pain severity on known factors of delayed RTP (sex, sport contact level, and race) following a suspected concussion.

Results: While neck pain was identified as significant predictor of delayed RTP (b = .046, S.E.  = .021, Wald χ²(1) = 4.745, p = 0.029), no interaction effect was observed between neck pain and the explored mediating factors of sex, sport contact level, and race.

Conclusions: These results suggest that independent of an individual's sex, sport contact level, and/or race, the presence of neck pain following a suspected concussion should be further evaluated and differentially diagnosed to rule out comorbid pathologies that may be contributing to PPCS following a suspected concussion.