Brain Injury Screening Questionnaire Research Articles

Sports-related concussion not associated with long-term cognitive or behavioural deficits: the PROTECT-TBI study

BackgroundThe cognitive effects of sports-related concussion (SRC) have been the subject of vigorous debate but there has been little research into long-term outcomes in non-athlete populations.MethodsThis cohort study of UK...

Neuroimaging and Clinical Findings in Healthy Middle-Aged Adults With Mild Traumatic Brain Injury in the PREVENT Dementia Study

Traumatic brain injuries (TBI) represent an important, potentially modifiable risk factor for dementia. Despite frequently observed vascular imaging changes in individuals with TBI, the relationships between TBI-associated changes in brain imaging and clinical outcomes have largely been overlooked in community cases of TBI. To assess whether TBI are associated with and interact with midlife changes in neuroimaging and clinical features in otherwise healthy individuals. This cross-sectional analysis used baseline data from the PREVENT Dementia program collected across 5 sites in the UK and Ireland between 2014 and 2020. Eligible participants were cognitively healthy midlife adults aged between 40 and 59 years. Data were analyzed between January 2023 and April 2024. Lifetime TBI history was assessed using the Brain Injury Screening Questionnaire. Cerebral microbleeds and other markers of cerebral small vessel disease (white matter hyperintensities [WMH], lacunes, perivascular spaces) were assessed on 3T magnetic resonance imaging. Clinical measures were cognition, sleep, depression, gait, and cardiovascular disease (CVD) risk, assessed using Computerized Assessment of Information Processing (COGNITO), Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies Depression Scale, clinical interviews, and the Framingham Risk Score, respectively. Of 617 participants (median [IQR] age, 52 [47-56] years; 380 female [61.6%]), 223 (36.1%) had a history of TBI. TBI was associated with higher microbleed count (β = 0.10; 95% CI, 0.01-0.18; P = .03), with a dose-response association observed with increasing number of TBI events (β = 0.05; 95% CI, 0.01-0.09; P = .03). Conversely, TBI was not associated with other measures of small vessel disease, including WMH. Furthermore, TBI moderated microbleed associations with vascular risk factors and clinical outcomes, such that associations were present only in the absence of TBI. Importantly, observations held when analyses were restricted to individuals reporting only mild TBI. In this cross-sectional study of healthy middle-aged adults, detectable changes in brain imaging and clinical features were associated with remote, even mild, TBI in the general population. The potential contribution of vascular injury to TBI-related neurodegeneration presents promising avenues to identify potential targets, with findings highlighting the need to reduce TBI through early intervention and prevention in both clinical care and policymaking.

Is lifetime traumatic brain injury a risk factor for mild cognitive impairment in veterans compared to non-veterans?

ABSTRACT Background: Traumatic brain injury (TBI) is prevalent in veterans and may occur at any stages of their life (before, during, or after military service). This is of particular concern, as previous evidence in the general population has identified TBI as a strong risk factor for mild cognitive impairment (MCI), a known precursor of dementia. Objectives: This study aimed to investigate whether exposure to at least one TBI across the lifetime was a risk factor for MCI in ageing UK veterans compared to non-veterans. Method: This cross-sectional study comprised of data from PROTECT, a cohort study comprising UK veterans and non-veterans aged ≥ 50 years at baseline. Veteran and TBI status were self-reported using the Military Service History Questionnaire (MSHQ) and the Brain Injury Screening Questionnaire (BISQ), respectively. MCI was the outcome of interest, and was defined as subjective cognitive impairment and objective cognitive impairment. Results: The sample population comprised of veterans (n = 701) and non-veterans (n = 12,389). TBI was a significant risk factor for MCI in the overall sample (OR = 1.21, 95% CI 1.11–1.31) compared to individuals without TBI. The prevalence of TBI was significantly higher in veterans compared to non-veterans (69.9% vs 59.5%, p < .001). There was no significant difference in the risk of MCI between veterans with TBI and non-veterans with TBI (OR = 1.19, 95% CI 0.98–1.45). Conclusion: TBI remains an important risk factor for MCI, irrespective of veteran status. The clinical implications indicate the need for early intervention for MCI prevention after TBI.

Cerebral microbleeds in traumatic brain injury associated with differential risk factors and clinical outcomes: the PREVENT‐Dementia study

AbstractBackgroundCerebral microbleeds (CMB) are predictive of increased risk of dementia and stroke. Although commonly regarded as vascular markers, CMB can also stem from non‐vascular aetiologies like head injuries or traumatic brain injury (TBI), although these are often overlooked. Therefore, this study examines CMB in relation to TBI, and their differential causes (i.e., risk factors) and consequences (i.e., clinical outcomes).MethodIn 605 healthy middle‐aged adults (aged 40‐59), CMB were rated on 3T susceptibility weighted imaging (SWI) MRI. TBI was assessed using the Brain Injury Screening Questionnaire (BISQ). TBI+ was defined as at least one blow to the head resulting in loss of consciousness (36.0%; n = 217). Memory was assessed using the COGNITO battery. Interaction analyses examined TBI*CMB interactions on hypertension, gait, and memory. Dominance analysis examined the relative contribution of TBI and vascular risk factors on predicting gait disturbances and memory. All models adjusted for sex, age, education, and study site.ResultTBI was related to higher CMB count (t = 2.06, p = .039), and were more common in males (48.3%) than females (28.0%) (Χ2 = 28.91, p&lt;.001). Number of TBI events related to poorer memory (t = ‐2.62, p = .009) and gait disturbances (t = 3.54, p&lt;.001). Interaction analyses demonstrated that hypertension (t = ‐2.26, p = .024), memory (t = 2.70, p = .007) and gait (t = ‐2.29, p = .023) were less closely related to CMB in individuals with greater number of TBI events, relative to those with fewer TBIs. Regionally, these interactions were significant for lobar CMB, but not deep subcortical CMB. Within the TBI+ group, dominance analysis demonstrated that number of TBI events outperformed vascular risk factors in predicting gait disturbances (Contribution to R2: TBI = 52.9%, vascular risk = 32.6%) and memory (TBI = 28.7%, vascular risk = 1.2%).ConclusionCMB appeared to differ aetiologically and clinically in those with and without TBI. In individuals with TBI, TBI itself was the dominant driver of clinical deficits. When compared to CMB of presumed vascular origins cross‐sectionally, TBI‐related CMB may appear to be less detrimental. However, longitudinal analysis is required to determine how TBI‐related CMB differ in clinical trajectory and downstream pathologies. This study highlights the importance of differentiating between CMB of vascular origins vs. TBI in both research and clinically to aid prognosis and treatment decisions.

What influence does self‐reported history of single or repeated mild TBI have on cognitive performance and brain volume at mid‐life?

AbstractBackgroundThe long‐term consequences of mild traumatic brain injury (mTBI) are poorly understood. Prior studies have shown that a history of mTBI is associated with a 2 fold increase of dementia diagnosis. However, the precise mechanisms for increased dementia risk which could start in mid‐life remain unclear. TBI can cause varying degrees of damage to different regions of the brain, and as a result, may affect distinct subdomains of cognitive function in distinct ways. This study investigated cognitive performance and brain volume among individuals at risk of Alzheimer’s Disease (AD) in mid‐life with a history of self‐reported mTBI.Method578 participants (118 no head injury, 116 single mTBI &amp; 344 repeated mTBI) aged 40‐60 years participating in the PREVENT study, a large cohort study examining the risk of AD in mid‐life, underwent structural 3T MRI and neuropsychometric evaluation (ACE‐III and COGNITO) at baseline. Self‐reported, cross‐sectional data on head injury were collected through the Brain Injury Screening Questionnaire (BISQ). FSL (version 6.0.1) was used to calculate brain volume (correcting for head size). Comparisons between participants with no history of head injury and single or repeated mTBI were done using a one‐way ANOVA.ResultThere was no statistically significant difference in total brain volume between participants with or without a history of mTBI (F(2,576) = 1.24, p = 0.29). There was also no significant difference between self‐reported mTBI and ACE‐III total scores F(2,579) = 0.0112, p = 0.99) or performance on memory (p = 0.87), language (p = 0.24), visuospatial abilities (p = 0.61) and attention (p = 0.14) in the COGNITO battery.ConclusionWe found no evidence that a history of mTBI (single or repeated) is associated with cognitive impairment in this cohort. Future longitudinal studies are necessary to further evaluate self‐reported mTBI and how the aging process might interact with cognitive outcome post‐injury. Future analysis of covariates such as lower socioeconomic status, gender, physical health and history of alcohol/drug use, that are known to impact cognitive performance and are related to greater rates of TBI, will be studied to determine the influence of a history of mTBI on dementia risk.

Cerebral microbleeds in traumatic brain injury associated with differential risk factors and clinical outcomes: the PREVENT‐Dementia study

AbstractBackgroundCerebral microbleeds (CMB) are predictive of increased risk of dementia and stroke. Although commonly regarded as vascular markers, CMB can also stem from non‐vascular aetiologies like head injuries or traumatic brain injury (TBI), although these are often overlooked. Therefore, this study examines CMB in relation to TBI, and their differential causes (i.e., risk factors) and consequences (i.e., clinical outcomes).MethodIn 605 healthy middle‐aged adults (aged 40‐59), CMB were rated on 3T susceptibility weighted imaging (SWI) MRI. TBI was assessed using the Brain Injury Screening Questionnaire (BISQ). TBI+ was defined as at least one blow to the head resulting in loss of consciousness (36.0%; n = 217). Memory was assessed using the COGNITO battery. Interaction analyses examined TBI*CMB interactions on hypertension, gait, and memory. Dominance analysis examined the relative contribution of TBI and vascular risk factors on predicting gait disturbances and memory. All models adjusted for sex, age, education, and study site.ResultTBI was related to higher CMB count (t = 2.06, p = .039), and were more common in males (48.3%) than females (28.0%) (Χ2 = 28.91, p&lt;.001). Number of TBI events related to poorer memory (t = ‐2.62, p = .009) and gait disturbances (t = 3.54, p&lt;.001). Interaction analyses demonstrated that hypertension (t = ‐2.26, p = .024), memory (t = 2.70, p = .007) and gait (t = ‐2.29, p = .023) were less closely related to CMB in individuals with greater number of TBI events, relative to those with fewer TBIs. Regionally, these interactions were significant for lobar CMB, but not deep subcortical CMB. Within the TBI+ group, dominance analysis demonstrated that number of TBI events outperformed vascular risk factors in predicting gait disturbances (Contribution to R2: TBI = 52.9%, vascular risk = 32.6%) and memory (TBI = 28.7%, vascular risk = 1.2%).ConclusionCMB appeared to differ aetiologically and clinically in those with and without TBI. In individuals with TBI, TBI itself was the dominant driver of clinical deficits. When compared to CMB of presumed vascular origins cross‐sectionally, TBI‐related CMB may appear to be less detrimental. However, longitudinal analysis is required to determine how TBI‐related CMB differ in clinical trajectory and downstream pathologies. This study highlights the importance of differentiating between CMB of vascular origins vs. TBI in both research and clinically to aid prognosis and treatment decisions.

Screening for Brain Injury Sustained in the Context of Intimate Partner Violence (IPV): Measure Development and Preliminary Utility of the Brain Injury Screening Questionnaire IPV Module.

Abstract Intimate partner violence (IPV) is associated with risk for multi-etiology brain injury (BI), including repetitive head impacts, isolated traumatic brain injuries (TBI), and anoxic/hypoxic injury secondary to nonfatal strangulation (NFS). IPV-related injuries are often unreported, but evidence suggests that survivors are more likely to report when asked directly. There are currently no validated tools for screening of brain injury related to IPV that meet World Health Organization guidelines for this population. Here, we describe measure development methods and preliminary utility of the Brain Injury Screening Questionnaire IPV (BISQ-IPV) module. We culled items from existing IPV and TBI screening tools and sought two rounds of stakeholder feedback regarding content coverage, terminology, and safety of administration. The resulting stakeholder-informed BISQ-IPV module is a seven-item self-report measure that uses contextual cues (e.g., being shoved, shaken, strangled) to query lifetime history of IPV-related head/neck injury. We introduced the BISQ-IPV module into the Late Effects of TBI (LETBI) study to investigate rates of violent and IPV-specific head/neck injury reporting in a TBI sample. Among those who completed the BISQ-IPV module (n = 142), 8% of the sample (and 20% of women) reported IPV-related TBI, and 15% of the sample (34% of women) reported IPV-related head or neck injury events that did not result in loss or alteration of consciousness. No men reported NFS; one woman reported inferred BI secondary to NFS, and 6% of women reported NFS events. Those who endorsed IPV-BI were all women, many were highly educated, and many reported low incomes. We then compared reporting of violent TBIs and head/neck injury events among individuals who completed the core BISQ wherein IPV is not specifically queried (administered from 2015-2018; n = 156) to that of individuals who completed the core BISQ preceded by the BISQ-IPV module (BISQ+IPV, administered from 2019-2021; n = 142). We found that 9% of those who completed the core BISQ reported violent TBI (e.g., abuse, assault), whereas 19% of those who completed the BISQ+IPV immediately preceding the core BISQ reported non-IPV-related violent TBI on the core BISQ. These findings suggest that standard TBI screening tools are inadequate for identifying IPV-BI and structured cueing of IPV-related contexts yields greater reporting of both IPV- and non-IPV-related violent BI. When not queried directly, IPV-BI remains a hidden variable in TBI research studies.

Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study.

Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = -0.163, p < 0.001), executive scores (B = -0.151, p = 0.004), and processing speed (B = -0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = -0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = -0.149, p = 0.025) and attention scores (B = -0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = -0.135, p < 0.001), processing speed (B = -0.072, p = 0.009), and working memory (B = -0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.

Traumatic Brain Injury History Among Individuals Using Mental Health and Addictions Services: A Scoping Review.

Traumatic brain injury (TBI) has been increasingly linked in population research to psychiatric problems as well as substance use and related harms, suggesting that individuals with TBI may also present more frequently to mental health and addictions (MHA) services. Little is known, however, about TBI history among MHA service users. The objectives of this review were to understand (i) the prevalence of TBI history among MHA service users; (ii) how TBI history is identified in MHA service settings; and (iii) predictors or outcomes of TBI that have been reported in MHA service users. A scoping review was conducted in accordance with PRISMA Scoping Review Extension guidelines. A search for relevant literature was conducted in MEDLINE, PsycINFO, SPORTDiscus, CINAHL, and Embase as well as various gray literature sources. Twenty-eight relevant studies were identified. TBI was defined and operationalized heterogeneously between studies, and TBI history prevalence rates ranged considerably among the study samples. The included studies used varied methods to identify TBI history in MHA settings, such as clinical chart audits, single-item questions, or structured questionnaires (eg, Brain Injury Screening Questionnaire or Ohio State University TBI Identification Method). TBI history was most consistently associated with indicators of more severe substance use problems and mental health symptoms as well as increased aggression or risk to others. Studies reported less consistent findings regarding the relationship of TBI to physical health, cognitive impairment, functioning, risk to self, and type of psychiatric diagnosis. Screening for TBI history in MHA settings may contribute important information for risk assessment and care planning. However, to be clinically useful, assessment of TBI history will require consistent operationalization of TBI as well as use of validated screening methods.

Repeated concussions associated with worsened working memory, attention and processing speed, but preserved delayed memory: A PROTECT study

AbstractBackgroundApproximately 5% of all dementia diagnoses may be attributable to traumatic brain injuries (TBI), but the precise pathway and required thresholds for increased dementia risk remain unclear. TBI can cause disparate degrees of damage to parts of the brain and thus may affect different subdomains of cognitive function differently. This study examined the strength of associations between traumatic brain injuries and cognitive subdomains in a healthy cohort of older adults.MethodCognitive and demographic data was collected from individuals aged 50 ‐ 93 (n = 12,041) participating in the PROTECT study, a large online cohort study. Self reported, cross sectional data on head injury were collected through the Brain Injury Screening Questionnaire (BISQ). Cognitive tests were standardised and grouped into four domain scores using the FLAME composite (Working Memory, Delayed Memory, Processing Speed and Attention) based on a principle components analysis (KMO test = 0.724). Regression analyses were performed, examining the association between numbers of head injuries, episodes of loss of consciousness and the cognitive domain scores.Result62.8% of participants reported a previous head injury and 33% of those had at least one episode of subsequent loss of consciousness (21% overall). There was a significant association between the self‐reported historical number of head injuries and poorer working memory, attention and processing speed (B = ‐0.005, ‐0.007, ‐0.014 and p=0.004, &lt;0.001, &lt;0.001 respectively). Self‐reported historical episodes of head injuries followed by loss of consciousness (LOC) demonstrated similar, albeit stronger, associations with working memory, attention and processing speed (B = ‐0.019, ‐0.024, ‐0.024 and p = 0.002, &lt;0.001, &lt;0.001). Neither numbers of head injuries or LOC were associated with poorer delayed memory performance.ConclusionThe PROTECT study is one of the largest, healthy older adult cohorts to examine the link between TBI and cognitive outcomes. Although it is cross sectional the increasing effect sizes seen for increasing severity of head injury indicates a dose‐response relationship suggestive of causation. Our results suggest that TBI may differentially impact particular brain areas and functions and that cognitive impairment in those with a history of TBI has a distinct pathological and clinical phenotype.

Prior Concussion History and Baseline Symptoms Outweigh Sex Differences for Risk Factors of New Concussion in a Sample of Colligate Athletes

<h3>Research Objectives</h3> To test the hypothesis that a history of concussion prior to the collegiate pre-season is associated with risk for re-injury. We also investigate sex differences in cognitive functioning and self-reported concussion symptoms and their associations with new concussion risk. <h3>Design</h3> Longitudinal cohort study with two consecutive pre-season (P) baseline evaluations (P1 and P2). <h3>Setting</h3> Urban NCAA Division I University. <h3>Participants</h3> 212 collegiate athletes (46% female) ≥18 years of age who participated in soccer, baseball/softball, lacrosse, basketball, volleyball, track & field, and/or cheerleading. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) includes self-reported history of diagnosed concussions, computerized cognitive assessment, and Post-Concussion Symptom Scale (PCSS). The Brain Injury Screening Questionnaire (BISQ) characterizes lifetime history of brain injury/concussion. <h3>Results</h3> Twenty-six percent (n=56) of athletes reported ≥ 1 prior concussion at P1. There were 40 new concussions recorded between P1 and P2, 21 (53%) of which were among athletes who reported a lifetime history of concussion at P1. New concussions occurred in 24% of female athletes (n=23) and 15% of male athletes (n=17). Prior history of concussion and sex were significant predictors of new concussion between P1 and P2; however, in adjusted models, inclusion of P1 poor impulse control and PCSS total symptom scores attenuated the effect of sex on risk for new injury. <h3>Conclusions</h3> Collegiate athletes with a lifetime history of concussion had a significantly higher risk of sustaining a new concussion. Pre-season symptomology and impulse control may play a role in observed sex differences related to risk of injury. Screening for lifetime history of concussion (including those sustained outside of sports participation) may inform risk tolerance, monitoring, and return-to-play decision-making. <h3>Author(s) Disclosures</h3> NIH, NIDILRR, DoD, PCORI

Author Response: Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players.

We completely share Dr. Dams-O’Connor's hope for replication studies and increasingly complete and accurate data.1 In our cohort of 35 former elite athletes, we did not think it surprising to have uncovered no history of moderate-severe traumatic brain injury (TBI)—as commonly defined2—nor did we find it to be in stark contrast to population-based studies. Indeed, our reading of the study cited to suggest a high (>20%) prevalence in the general population of more severe TBI is that only 192/6,998 respondents (2.7%) recollected a TBI with loss of consciousness >30 minutes—the definition used in that study for moderate-severe TBI.3 At that rate (about 1/37), it would not be unexpected to find 0% prevalence in a cohort of 35 individuals. Moreover, from the data cited on intercollegiate athletes using the Brain Injury Screening Questionnaire, showing that 12/90 recollected a TBI with loss of consciousness lasting several minutes to an hour, interpreted as clinically significant TBI, it cannot be ascertained whether any of those individuals had a moderate, as opposed to a mild, TBI.4 In our common quest for scientific rigor, it is important that the value of a structured TBI screening tool be neither understated nor overstated.

Effects of head trauma and sport participation in young-onset Parkinson\u2019s disease

Head trauma (HT) is emerging as an event anticipating onset of neurodegenerative disorders. However, the potential contribution of HT in young-onset cases (YOPD, age at onset < 50) of Parkinson’s disease (PD) has not been examined yet. Here, we systematically assessed HT history in PD patients to estimate the risk associated, especially in terms of age of onset, and define the correlations with the clinical-biochemical profile. The Brain Injury Screening Questionnaire (BISQ) was administered to 94 PD patients (31 with YOPD, known monogenic forms excluded) and 70 controls. HT history was correlated with motor and non-motor scores in all patients, and to CSF biomarkers of neurodegeneration (α-synuclein, amyloid-β42, total and phosporiled-181 tau, lactate, CSF/serum albumin) into a subgroup. HT increased the risk for both PD and YOPD. In PD patients, but not in those with YOPD, the number of HTs directly correlated with CSF total-tau levels. No other correlations resulted between HT and clinical parameters. Sport-related HT was a specific risk factor for YOPD; conversely, the prolonged sporting life represented a protective factor. HTs can favor PD onset, even as YOPD. Sport-related HT resulted a risk factor for YOPD, although the longer sporting practice delayed PD onset, protecting from YOPD. Tauopathy may underlie the overall association between HT and PD. Additional mechanisms could be instead implicated in HT contribution to YOPD onset.

Characterizing Traumatic Brain Injury and Its Association with Losing Stable Housing in a Community-based Sample.

Traumatic brain injury (TBI) is increasingly recognized as a common and impactful health determinant in homeless and precariously housed populations. We sought to describe the history of TBI in a precariously housed sample and evaluate how TBI was associated with the initial loss and lifetime duration of homelessness and precarious housing. We characterized the prevalence, mechanisms, and sex difference of lifetime TBI in a precariously housed sample. We also examined the impact of TBI severity and timing on becoming and staying homeless or precariously housed; 285 precariously housed participants completed the Brain Injury Screening Questionnaire in addition to other health assessments. A history of TBI was reported in 82.1% of the sample, with 64.6% reporting > 1 TBI, and 21.4% reporting a moderate or severe TBI. Assault was the most common mechanism of injury overall, and females reported significantly more traumatic brain injuries due to physical abuse than males (adjusted OR = 1.26, 95% CI = 1.14 to 1.39, P < 0.0001). The first moderate or severe TBI was significantly closer to the first experience of homelessness (b = 2.79, P = 0.003) and precarious housing (b = 2.69, P < 0.0001) than was the first mild TBI. In participants who received their first TBI prior to becoming homeless or precariously housed, traumatic brain injuries more proximal to the initial loss of stable housing were associated with a longer lifetime duration of homelessness (RR = 1.04, 95% CI = 1.02 to 1.06, P < 0.0001) and precarious housing (RR = 1.03, 95% CI = 1.01 to 1.04, P < 0.0001). These findings demonstrate the high prevalence of TBI in this vulnerable population, and that aspects of TBI severity and timing are associated with the loss and lifetime duration of stable housing.

Impact of mild head injury on diffusion MRI brain characteristics in midlife: Data from the PREVENT Dementia Study

AbstractBackgroundTraumatic brain injury (TBI) has been associated with an increased risk of dementia, but the link between mild TBI across the life‐course remains unclear. The PREVENT Dementia study is recruiting healthy volunteers in middle age (aged 40 – 59) to identify factors that may increase their risk of dementia. This analysis assessed white matter integrity and its association with the incidence, frequency and severity of TBIs.Methods140 subjects (mean age=51.9 years) from the PREVENT Dementia study West London site underwent a 3T MRI scan, including diffusion‐weighted (DW) imaging, and completed the self‐report Brain Injury Screening Questionnaire (BISQ). DW images were processed using FSL tools (EDDY, DTIFIT, TBSS) and resulting fractional anisotropy (FA) and mean diffusivity (MD) spatial maps were fed into voxelwise cross‐subject analysis (FWE‐corrected at p&lt;0.05). BISQ summary scores were used as regressors in cross‐subject analyses to test the effect on WM integrity of a) no TBI (N=29) vs. any TBI (N=107), b) number of TBIs, and c) severity of TBIs. Gender, years of education, NART score, presence of psychiatric diagnoses and substance abuse were included as covariates. One participant with severe TBI (BISQ severity=6) and three participants with moderate TBI (BISQ severity=4) were excluded from analyses.ResultsHigher FA was observed in bilateral body of the corpus callosum, superior corona radiata and forceps minor in those that reported at least one TBI compared to those that had none. There was no effect of this on MD. There was no significant association of the number of TBIs with either FA or MD. However, increased severity of TBI was significantly associated with higher FA in similar regions showing an effect of any vs. no TBI. Increased severity of TBI was also significantly associated with lower MD in the same regions.ConclusionsIt is unclear if higher FA reflects a mechanism of recovery post‐TBI or the injury itself. We plan to analyse a larger sample, as this sub‐group may not be representative, and include other possible confounders, such as cognition and age of and time since injury, to explore what these results may infer about mild TBI and dementia risk.

The Risk for Traumatic Brain Injury and Persisting Symptomatology in Elementary, Secondary, and University-Level Students

Purpose: This study is part of the first systematic program in the Republic of Cyprus examining the prevalence of traumatic brain injury (TBI) in children, teenagers, and university students. The study incorporated the Greek Version of the Brain Injury Screening Questionnaire (BISQ-G) as the primary tool to identify students with TBI. Methods: The BISQ-G was sent out to 2,800 families of children (aged 6–18 years) attending rural and urban elementary and secondary schools from varied socioeconomic backgrounds. Nine hundred forty-four questionnaires (33.8%) were returned. In addition to school-aged children, 322 university students (aged 17–25 years) were recruited from 3 universities and completed the BISQ-G. Results: Analyses indicated that 5.8% elementary, 9.7% secondary, and 22.7% university students had symptoms consistent with TBI. Several participants reported more than 1 TBI. Etiology of TBI was similar in all 3 groups and included sports, biking, and falls. Factor analyses yielded a 7-factor structure for the BISQ-G. Discussion/Conclusions: The BISQ-G is a valid tool for the identification of individuals with a prior history of TBI. Causes and symptoms of TBI were similar to those reported in the international literature. The article concludes with suggestions for TBI management in the schools.

Association of Visual Tracking Metrics With Post-concussion Symptomatology.

Attention impairment may provide a cohesive neurobiological explanation for clusters of clinical symptoms that occur after a concussion; therefore, objective quantification of attention is needed. Visually tracking a moving target is an attention-dependent sensorimotor function, and eye movement can be recorded easily and objectively to quantify performance. Our previous work suggested the utility of gaze-target synchronization metrics of a predictive visual tracking task in concussion screening and recovery monitoring. Another objectively quantifiable performance measure frequently suggested for concussion screening is simple visuo-manual reaction time (simple reaction time, SRT). Here, we used visual tracking and SRT tasks to assess changes between pre- and within-2-week post-concussion performances and explore their relationships to post-concussion symptomatology. Athletes participating in organized competitive sports were recruited. Visual tracking and SRT records were collected from the recruited athlete pool as baseline measures over a 4-year period. When athletes experienced a concussion, they were re-assessed within 2 weeks of their injury. We present the data from a total of 29 concussed athletes. Post-concussion symptom burden was assessed with the Rivermead Post-Concussion Symptoms Questionnaire and subscales of the Brain Injury Screening Questionnaire. Post-concussion changes in visual tracking and SRT performance were examined using a paired t-test. Correlations of changes in visual tracking and SRT performance to symptom burden were examined using Pearson's coefficients. Post-concussion changes in visual tracking performance were not consistent among the athletes. However, changes in several visual tracking metrics had moderate to strong correlations to symptom scales (r up to 0.68). On the other hand, while post-concussion SRT performance was reduced (p < 0.01), the changes in the performance metrics were not meaningfully correlated to symptomatology (r ≤ 0.33). Results suggest that visual tracking performance metrics reflect clinical symptoms when assessed within 2 weeks of concussion. Evaluation of concussion requires assessments in multiple domains because the clinical profiles are heterogeneous. While most individuals show recovery within a week of injury, others experience prolonged recovery periods. Visual tracking performance metrics may serve as a biomarker of debilitating symptoms of concussion implicating attention as a root cause of such pathologies.

The Relationship Between Traumatic Brain Injury and Criminality in Juvenile Offenders.

To examine the relationship between traumatic brain injury (TBI) and criminal behavior in youth who are incarcerated or on probation in Texas. Seven juvenile justice facilities. Juvenile offenders in state or county correctional facilities or on probation. Screening for TBI was conducted among adolescents at 7 juvenile justice centers. Participants were administered the Brain Injury Screening Questionnaire, and results were linked to participants' offense history and psychiatric diagnoses. One in 4 juvenile offenders met criteria for TBI, and the majority of injuries occurred prior to the adolescents' criminal offenses. A history of TBI was related to more violent crimes, as well as more mental health diagnoses and symptoms. The high rates of TBI and levels of distress found in juvenile offenders suggest a need for preventive actions, interventions to compensate for challenges related to TBI, and programs to assist individuals' transitions into the community.

Screening for traumatic brain injury: findings and public health implications.

To provide an overview of a series of projects that used a structured self-report screening tool in diverse settings and samples to screen for lifetime history of traumatic brain injury (TBI). Diverse community settings. Homeless persons (n = 111), individuals with HIV seeking vocational rehabilitation (n = 173), youth in the juvenile justice system (n = 271), public schoolchildren (n = 174), substance users (n = 845), intercollegiate athletes (n = 90), and other community-based samples (n = 396). Cross-sectional. Brain Injury Screening Questionnaire. Screening using the Brain Injury Screening Questionnaire finds that 27% to 54% of those in high-risk populations report a history of TBI with chronic symptoms. Associations between TBI and social, academic, or other problems are evident in several studies. In non-high-risk community samples, 9% to 12% of individuals report TBI with chronic symptoms. Systematic TBI screening can be implemented efficiently and inexpensively in a variety of settings. Lifetime TBI history data gathered using a structured self-report instrument can augment existing estimates of the prevalence of TBI, both as an acute event and as a chronic condition. Identification of individuals with TBI can facilitate primary prevention efforts, such as reducing risk for reinjury in high-risk groups, and provide access to appropriate interventions that can reduce the personal and societal costs of TBI (tertiary prevention).

The Relationship between Sleep Architecture and Symptoms of Sleep Disturbance in Individuals with Traumatic Brain Injury

Objective: To measure sleep architecture in individuals with TBI and determine its relationship with self-reported sleep quality, fatigue, and daytime sleepiness. Design: Participants: completed self-report measures and underwent two nights of in-laboratory nocturnal polysomnography. Setting: General community. Participants: 46 individuals with mild to severe TBI. Inclusion criteria included age between 18 years to 65 years and a documented TBI as a result of a blow to the head with a loss of consciousness or period of being dazed and confused (e.g., EMS report, hospital record, physician record, or a positive screen on the Brain Injury Screening Questionnaire). Participants: were required to be at least one year post injury (SD Z 13.33 years, range 1.17 years e 56.33 years), English-speaking, and have at least a sixth-grade reading level. No use of Modafinil, amphetamines or soporific medications (e.g., zolpidem, zolpidem MR, eszopiclone, zaleplon, sedating antidepressants, melatonin, valerian root, Benedryl, Ramelteon or chloral hydrate) was allowed 72 hours prior to polysomnography. Use of medications known to cause hypersomnolence (e.g. barbiturates, benzodiazepines, opiates) was not allowed for seven days prior to study. Exclusion criteria included active hepatic or renal failure (which may lead to hypersomnia), active substance abuse disorder, prior or current psychotic disorder, pre-existing neurological disorder or a brain injury with an etiology other than trauma, untreated hypothyroidism and any medical condition or reason that, in the investigator’s opinion, might make the participant unsuitable to participate. All participants were recruited through flyer postings in the Mount Sinai Medical Center and through healthcare provider referrals. The study was approved by the institutional review board of Icahn School of Medicine at Mount Sinai. Informed consent was obtained prior to screening to determine whether or not they met inclusion/exclusion criteria. Interventions: Not applicable. Main Outcome Measure(s): The measures included self-report measures of sleep quality (Pittsburgh Sleep Quality Index; PSQI), fatigue (Multidimensional Assessment of Fatigue; MAF), daytime sleepiness (Epworth Sleepiness Scale; ESS), and nocturnal polysomnography (NPSG) from which sleep efficiency, sleep onset latency, REM latency, wake time after sleep onset, and percentage of stage 1, 2, 3, and REM 4 sleep were extracted. Results: Pearson product-moment correlation coefficients were used to analyze the association between responses on self-report questionnaires. Hierarchical linear regression was used to analyze the association between NPSG sleep parameters and self-report questionnaires, adjusting for age, sex, body mass index, sleep apnea, and TBI severity. Poor sleep quality as measured by the PSQI was associated with fatigue as measured by the MAF. Poor sleep quality was associated with poor sleep efficiency, short duration of stage 2 sleep, and long duration of rapid eye movement sleep. There was a weak association between high levels of fatigue and poor sleep efficiency. Daytime sleepiness as assessed was not associated with any NPSG sleep parameters. Conclusions: In this sample of TBI survivors, those who reported poor sleep quality evidenced shorter time spent in stage 2 sleep compared to those who reported better sleep quality. These findings suggest that disruptions in stage 2 sleep might underlie the symptoms of sleep disturbance experienced following TBI.