The impact of mild head injury on neuropsychological capacity in chronic alcoholics.

OBJECTIVE: To evaluate a history of remote head injury as a risk factor for subsequent dementia due to Alzheimer's disease. METHODS: 271 participants of a community based longitudinal study of...

Traumatic brain injury has been associated with short-term olfactory dysfunction, but the association of number of prior head injuries and head injury severity with both subjective and objective long-term olfactory function is less clear. To investigate the associations of prior head injury, number of prior head injuries, and head injury severity with subjective and psychophysical (objective) olfactory function in older adults and to examine concordance between subjective and objective olfactory function among individuals with and without head injury. This prospective cohort study included 5951 participants who attended Atherosclerosis Risk in Communities (ARIC) Study visit 5 (2011 through 2013). Data analysis was performed between November 2021 and May 2022. Head injury was defined by self-report and International Classification of Diseases codes. Self-reported subjective olfactory dysfunction was assessed by the question, "Do you suffer from smell loss or a significantly decreased sense of smell?" Objective olfactory performance was assessed using the 12-item Sniffin' Sticks odor identification test. Overall, the 5951 participants were a mean (SD) age of 75.6 (5.2) years, 3501 (58.8%) were female, 1356 (22.8%) were of Black race, and 1666 (28.0%) had a history of head injury. Participants with prior head injury were more likely than individuals without prior head injury to report subjective olfactory dysfunction (24% vs 20%; difference, 4%; 95% CI, 1% to 6%) and have objective anosmia (15% vs 13%; difference, 2%; 95% CI, 0.1% to 4%) but had lower concordance between subjective and objective assessment (72% vs 77%; difference, -5%; 95% CI, -8% to -3%). In logistic regression models adjusted for sociodemographics and medical comorbidities including cognitive status, participants with a history of prior head injury, particularly individuals with 2 or more prior head injuries and more severe head injuries, were more likely to self-report subjective olfactory dysfunction and were more likely to be found to have objective anosmia compared with participants with no history of head injury. Findings of this cohort study provide evidence supporting the association between head injury and olfactory dysfunction, particularly among individuals who experienced multiple prior head injuries and among individuals with more severe head injury. The findings also suggest that individuals with prior head injury were more likely to both under-self-report and over-self-report deficits compared with objective olfactory testing; therefore, it may be important to consider objective olfactory testing in this patient population.

BackgroundNeuropsychiatric conditions occur more frequently among elderly. With rising proportion of elderly in India, the burden due to neuropsychiatric disorders is bound to escalate. Many of these disorders have been associated with dementia, though the relationship is complex.MethodPrevalence of neuropsychiatric conditions, such as stroke, head injury, depression and early‐life stress were assessed in two parallel, longitudinal, aging cohorts, from rural and urban India, namely, the Srinivaspura Aging Neurosenescence and COGnition (SANSCOG) study and Tata Longitudinal Study of Aging (TLSA), respectively. As part of their baseline clinical assessments, subjects from both cohorts were screened for depression using the self‐rated, Geriatric Depression Scale (GDS) and the clinician‐rated, Hamilton’s Depression Rating Scale (HDRS). Past history of depression and history of early life stressors, such as parental death and parental divorce in childhood were obtained. Self‐reported history of stroke, head injury and risk for vascular dementia using Hatchinski’s Ischemic Index (HIS) were also assessed.ResultProportion of subjects diagnosed with depression using GDS was 9.77% in the rural and 9.66% in the urban cohort, whereas corresponding numbers using HDRS were 6.55% and 3.82%, with female preponderance in both cohorts. Proportion of subjects with past history of depression was 4.82% and 5.07% in the rural and urban cohorts, respectively. Early life parental death was more in the rural 10.91%) as compared with the urban cohort (3.66%). History of stroke was reported in 1.25% and 2.31% of the rural and urban cohorts, respectively. There was no significant difference in proportion of subjects with history of head injury between the rural (4.16%) and urban (4.77%) cohorts. In the rural cohort, 0.23% scored above the threshold for vascular dementia on HIS, whereas none of the subjects scored above the threshold in the urban cohort.ConclusionGDS is a more sensitive tool than HDRS at screening for depression in elderly. Neuropsychiatric conditions such as history of stroke, head injury and risk for vascular dementia did not show any consistent trend of variation between both the cohorts. Further longitudinal assessments of these neuropsychiatric conditions along with parallel monitoring of cognitive changes will help in identifying their causal relationship with dementia.

The authors aim to delineate cognitive dysfunction associated with posttraumatic stress disorder (PTSD) by evaluating a well-defined cohort of former World War II prisoners of war (POWs) with documented trauma and minimal comorbidities. The authors studied a cross-sectional assessment of neuropsychological performance in former POWs with PTSD, PTSD with other psychiatric comorbidities, and those with no PTSD or psychiatric diagnoses. Participants who developed PTSD had average IQ, while those who did not develop PTSD after similar traumatic experiences had higher IQs than average (approximately 116). Those with PTSD performed significantly less well in tests of selective frontal lobe functions and psychomotor speed. In addition, PTSD patients with co-occurring psychiatric conditions experienced impairment in recognition memory for faces. Higher IQ appears to protect individuals who undergo a traumatic experience from developing long-term PTSD, while cognitive dysfunctions appear to develop with or subsequent to PTSD. These distinctions were supported by the negative and positive correlations of these cognitive dysfunctions with quantitative markers of trauma, respectively. There is a suggestion that some cognitive decrements occur in PTSD patients only when they have comorbid psychiatric diagnoses.

Limited information about school outcomes among children (especially early childhood) with lifetime history of head injury, including traumatic brain injury (TBI), may inhibit efforts to support their academics and physical and mental health. Baseline data (2016-2018) from the Adolescent Brain Cognitive Development (ABCD) study were analyzed to describe associations between parent-proxy reported lifetime history of head injury or TBI before age 9 and school outcomes and behavioral challenges among 9- and 10-year-old children. Having a lifetime history of head injury before age 9 was associated with increased odds of parent-perceived poor school performance (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.14-1.81), a drop in grades (AOR = 1.28, 95%CI = 1.06-1.54), recent receipt of detentions or suspensions (AOR = 1.29, 95%CI = 1.02-1.65), and receipt of special educational services (AOR = 1.23, 95%CI = 1.08-1.41). Of those with a lifetime history of head injury, males displayed poorer school outcomes and greater behavioral challenges than females. Similar associations were observed between lifetime history of TBI before age 9 and worse school outcomes, with males continuing to demonstrate stronger associations. These findings underscore the importance of screening for history of head injury and TBI and providing training for school professionals to help ensure students with a history of head or traumatic brain injury have appropriate supports in place.

Primary objectives : To identify the incidence of head injury (HI) amongst mentally disordered offenders (MDOs) in UK medium secure units (MSUs) and test the hypothesis that patients with a history of HI are more difficult to discharge than patients without HI. Design, methods and procedures : One hundred and thirteen MDOs being discharged to community settings from five MSUs in England were recruited consecutively between 1 April 1999 and 31 December 2000. Data on previous HI, offending history and discharge planning were collected from clinical casenotes, structured questionnaires and interviews with clinical staff. Main outcomes and results : More patients with HI (57.4%) than patients without HI (47%) had a violent index offence. Risk assessments carried out prior to discharge showed patients with HI to be at greater risk of violence to others and of self-harm than patients without HI ( p h 0.05). All but two patients in the HI group were difficult to discharge (43, 95.6%), compared to 52 (82.5%) in the non-HI group. Conclusions : Information on previous HI should be collected on admission to MSUs and considered when planning for discharge.

ABSTRACTBackground: Prior studies suggest a link between head injuries and substance use but do not routinely capture mechanisms connecting the two. Objectives: The goal of the study was to explore whether past head injuries predicted current substance use among young adults, taking factors such as stress, self-esteem, temper, and risk-taking into consideration. Methods: Data were drawn from a web-based survey conducted in 2014 and 2015 at a public university in the United States (n = 897). Questions were asked about history of head injuries as well as past 12-month binge drinking, marijuana use, and prescription drug misuse. To evaluate the association between head injury and substance use, two logistic regression models were performed for each substance. Head injury was first regressed on the outcome, then related risk factors were entered into the models to determine whether they explained any association between injury and outcome. Results: A history of multiple head injuries was associated with increased odds of bingeing, marijuana, and prescription drug use. Prior delinquency and risk-taking accounted for the associations with bingeing and marijuana use. Taking all variables into consideration, multiple head injuries were associated with greater odds for prescription drug misuse. Conclusions: Results suggest the need to give consideration to a range of concomitant variables when considering behavioral outcomes associated with head injury. Head injuries may be a marker of a constellation of risk-taking behaviors that contributes to substance use. For those with multiple injuries, misuse of prescription drugs may be an attempt to cope with lingering side effects.

BackgroundConcussions are gaining attention as a risk factor for Alzheimer's disease (AD). Previous reports suggest concussion, also called head injury (HI), may be associated with changes to AD biomarkers, including amyloid and tau. However, there has been little characterization of biofluid biomarkers in older adults with remote history of HI.ObjectiveWe investigated whether aging participants at risk for AD with self-reported HI history would demonstrate alterations to cerebrospinal fluid (CSF) and blood plasma biomarkers of AD.MethodsUsing two-way ANCOVAs and linear mixed effects models, we examined both baseline cross-sectional and longitudinal associations between HI history, cognition, and AD biofluid biomarkers in 100 participants with HI history compared to 2411 without HI history from the ADNI dataset.ResultsOn baseline analysis, participants with HI history had higher CSF Aβ42/40 ratios than non-HI participants. There were no other baseline differences in biomarkers between HI and non-HI participants, nor were there any main effects of HI upon longitudinal analysis. We observed consistent main effects of age and cognitive impairment that suggested a pattern of worsened AD biomarker signatures in impaired participants with increasing age.ConclusionsOur findings do not support an association between self-reported HI history and AD fluid biomarkers in older adults from the ADNI dataset. Further characterization of fluid biomarker trajectories both in the acute post-HI period and in participants with remote HI is needed to understand the temporal dynamics of fluid biomarkers after HI and the implications of HI for AD risk.

Associations between significant head injury and persisting disability and violent crime in women in prison in Scotland, UK: a cross-sectional study

The Ruff Figural Fluency Test: heightened right frontal lobe delta activity as a function of performance

A patient with a history of severe head injury 10 years ago regained ability to walk after years of being bound to a wheelchair. During the last psychiatric hospitalization, quetiapine was increased to therapeutic dose using a normal titration. As a result the patient developed dystonia of multiple muscle groups requiring 4 days of hospitalization for remittance of symptoms. In this paper, we take a close look at the literature concerning extrapiramidal symptoms (EPS) in this context, and we suggest that in patients with a history of head injury, it is warranted to consider a slower titration of antipsychotic medications, including ones that are considered having a lower risk of EPS such as quetiapine.

Head injury is highly prevalent among intimate partner violence (IPV) offenders. This study investigates responsiveness to cognitive behavioral therapy (CBT) for partnerviolent men with and without a history of head injury using archival data on 310 males seeking IPV counseling at a community domestic violence agency. Participants reported on their history of head injury, age at injury, and length of time unconscious in a structured interview at program intake. Criminal justice outcomes were assessed for the 2-year period after scheduled completion of treatment using a publicly available state database. A significantly greater percentage of men with a history of head injury (N = 84) than those without (N = 226) had criminal involvement for incidents of partner abuse during the follow-up period. In addition, men with a history of moderate-to-severe head injury (n = 25) had more criminal involvement for general violence than those with no history of head injury. The findings highlight the need to screen partner-violent men for head injury and to develop and investigate intervention enhancements for those individuals.

Introduction Head injuries are becoming much more prevalent and may be secondary to sports injuries, motor vehicle accidents, falls, domestic violence, assault, and military blast explosions. Sleepiness may occur acutely and/or chronically after a head injury. Chronic hypersomnia may be overlooked or under-reported in those with a history of head injury, and the association may not be made. Hypersomnia can occur in those with mild, moderate, and severe head injuries, with or without loss of consciousness. The pathophysiology/neuropathology of sleep-wake disturbances after Traumatic Brain Injury was discussed by Lim and Baumann 2020 in their Up To Date review entitled “Sleep-wake disorders in patients with traumatic brain injury”. They reported possible abnormalities in orexin/hypocretin, decreased histaminergic neurons, melatonin abnormalities, decreased serotonergic neurons, decreased noradrenergic neurons, and structural brain changes that can play a role. It is also possible that a head injury occurs in someone predisposed to the development of narcolepsy or that the sleepiness of undiagnosed narcolepsy leads to increased injuries. Methods A retrospective review of charts from 2013 to 2020 revealed 176 patients diagnosed with narcolepsy in our psychiatric/sleep outpatient practice. Information on head injuries was obtained by questionnaires completed by the patient and/or interview with staff. Narcolepsy was diagnosed by PSG/MSLT and/or DSM-V criteria of narcolepsy. Results Of the 176 patients diagnosed with narcolepsy, 125 were female (71%) and 51 were male (29%). The age range was 11 to 75 years, with an average age of 39 years old. Cataplexy was present in 117 patients (66.8%). A history of a head injury was reported at intake by 50 patients (28.4%). Of the patients with a history of a head injury, 34 (68%) were female, 16 (32%) were male, and 36 (72 %) had a history of cataplexy. Conclusion This study revealed 28.4% of patients diagnosed with narcolepsy reported a history of a head injury of varying degrees of severity. While direct causation cannot be declared, the association of a head injury and continued hypersomnia suggests further evaluation of narcolepsy may be beneficial. Support (if any) **No support for this study was given.

Neurobehavioral symptoms are not uncommon after a traumatic brain injury. However, psychiatric syndromes per se have rarely been studied in patients with such an injury. The purpose of this study was to evaluate the type and extent of psychiatric syndromes in patients with traumatic brain injury. One hundred ninety-six hospitalized adults were studied 1 year after a traumatic brain injury with the use of a two-stage psychiatric diagnostic procedure. Psychiatric diagnoses were made according to ICD-10 criteria on the basis of data from the Schedules for Clinical Assessment in Neuropsychiatry interview. Of 164 patients interviewed, 30 (18.3%) had an ICD-10 diagnosis of a psychiatric illness. Among the 120 patients who were 18-64 years old, 21.7% had a psychiatric illness, compared with 16.4% in a study of the general population. A depressive illness was present in 13.9% of the traumatic brain injury patients, compared with 2.1% of the general population, and panic disorder was present in 9.0%, compared with 0.8% of the general population. In comparison with the general population, a higher proportion of adult patients had developed psychiatric illnesses 1 year after a traumatic brain injury; the rates of depressive episode and panic disorder were significantly higher in the study group. A history of psychiatric illness, an unfavorable global outcome according to the Glasgow Outcome Scale, a lower score on the Mini-Mental State examination, and fewer years of formal education seemed to be important risk factors in the development of a psychiatric illness. Compensation claims, however, were not associated with the rate of psychiatric illness.

To provide nationally representative prevalence estimates of disability associated with prior head injury with loss of consciousness in the United States and to examine associations between prior head injury and disability. This was a cross-sectional analysis of 7,390 participants ≥40 years of age in the 2011-2014 National Health and Nutrition Examination Surveys (NHANES). Head injury with loss of consciousness was assessed by self-report. Domains of disability were assessed with a standardized structured questionnaire and measured grip strength. Logistic and linear regression models adjusted for demographic, socioeconomic/behavioral, and medical comorbidity variables were used. Multiple imputation was used to account for missing covariate data. Mean age of participants was 58 years; 53% were female; 71% were non-Hispanic White; and 16% had a history of head injury with loss of consciousness. Overall, participants with a history of head injury had higher prevalence of disability in at least 1 domain of functioning compared to individuals without head injury (47.4% vs 38.6%, p < 0.001), with the highest prevalence of disability in the domains of mobility and work productivity. In fully adjusted models, head injury was significantly positively associated with disability in all domains assessed on the standardized questionnaire (all p < 0.05). Participants with head injury had greater grip strength (all p < 0.05). We found that 47.4% of individuals ≥40 years of age in the United States with a history of head injury are living with disability in at least 1 domain of functioning, corresponding to 11.4 million affected individuals. This significant burden of disability suggests that efforts are needed to improve functioning among individuals with head injury.