Traumatic Brain Injury In Chronic Phase Research Articles

Pathological vascular and inflammatory biomarkers of acute- and chronic-phase traumatic brain injury.

Given the demand for developing objective methods for characterizing traumatic brain injury (TBI), research dedicated to evaluating putative biomarkers has burgeoned over the past decade. Since it is critical to elucidate the underlying pathological processes that underlie the higher diverse outcomes that follow neurotrauma, considerable efforts have been aimed at identifying biomarkers of both the acute- and chronic-phase TBI. Such information is not only critical for helping to elucidate the pathological changes that lead to poor long-term outcomes following TBI but it may also assist in the identification of possible prevention and interventions for individuals who sustain head trauma. In the current review, we discuss the potential role of vascular dysfunction and chronic inflammation in both acute- and chronic-phase TBI, and we also highlight existing studies that have investigated inflammation biomarkers associated with poorer injury outcome.

Autobiographical memory and structural brain changes in chronic phase TBI

Traumatic brain injury (TBI) is associated with a range of neuropsychological deficits, including attention, memory, and executive functioning attributable to diffuse axonal injury (DAI) with accompanying focal frontal and temporal damage. Although the memory deficit of TBI has been well characterized with laboratory tests, comparatively little research has examined retrograde autobiographical memory (AM) at the chronic phase of TBI, with no prior studies of unselected patients drawn directly from hospital admissions for trauma. Moreover, little is known about the effects of TBI on canonical episodic and non-episodic (e.g., semantic) AM processes. In the present study, we assessed the effects of chronic-phase TBI on AM in patients with focal and DAI spanning the range of TBI severity. Patients and socioeconomic- and age-matched controls were administered the Autobiographical Interview (AI) (Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002) a widely used method for dissociating episodic and semantic elements of AM, along with tests of neuropsychological and functional outcome. Measures of episodic and non-episodic AM were compared with regional brain volumes derived from high-resolution structural magnetic resonance imaging (MRI). Severe TBI (but not mild or moderate TBI) was associated with reduced recall of episodic autobiographical details and increased recall of non-episodic details relative to healthy comparison participants. There were no significant associations between AM performance and neuropsychological or functional outcome measures. Within the full TBI sample, autobiographical episodic memory was associated with reduced volume distributed across temporal, parietal, and prefrontal regions considered to be part of the brain's AM network. These results suggest that TBI-related distributed volume loss affects episodic autobiographical recollection.

Quantified MRI and cognition in TBI with diffuse and focal damage

In patients with chronic-phase traumatic brain injury (TBI), structural MRI is readily attainable and provides rich anatomical information, yet the relationship between whole-brain structural MRI measures and neurocognitive outcome is relatively unexplored and can be complicated by the presence of combined focal and diffuse injury. In this study, sixty-three patients spanning the full range of TBI severity received high-resolution structural MRI concurrent with neuropsychological testing. Multivariate statistical analysis assessed covariance patterns between volumes of grey matter, white matter, and sulcal/subdural and ventricular CSF across 38 brain regions and neuropsychological test performance. Patients with diffuse and diffuse + focal injury were analyzed both separately and together. Tests of speeded attention, working memory, and verbal learning and memory robustly covaried with a distributed pattern of volume loss over temporal, ventromedial prefrontal, right parietal regions, and cingulate regions. This pattern was modulated by the presence of large focal lesions, but held even when analyses were restricted to those with diffuse injury. Effects were most consistently observed within grey matter. Relative to regional brain volumetric data, clinically defined injury severity (depth of coma at time of injury) showed only weak relation to neuropsychological outcome. The results showed that neuropsychological test performance in patients with TBI is related to a distributed pattern of volume loss in regions mediating mnemonic and attentional processing. This relationship holds for patients with and without focal lesions, indicating that diffuse injury alone is sufficient to cause significant neuropsychological disability in relation to regional volume loss. Quantified structural brain imaging data provides a highly sensitive index of brain integrity that is related to cognitive functioning in chronic phase TBI.

Psychopathological evaluation of traumatic brain injury patients with the Neuropsychiatric Inventory

IntroductionThe Neuropsychiatric Inventory (NPI) is a scale that assesses psychiatric symptoms in patients with neurological disorders, principally dementia. Despite its advantages, there are few published studies in traumatic brain injury (TBI) patients. With the NPI information we are going to describe the psychopathologic disorders in a group of TBI chronic patients and look for the possible association with psychiatric history and outcome measures. MethodThe NPI was applied to caregivers of 53 patients with severe TBI in chronic phase. We also collected functional and community integration scales. Results92.5% of patients had some neuropsychiatric symptoms, according to NPI. The most frequent were irritability/lability, apathy and depression/dysphoria. Those patients with drugs abuse history had more psychiatric symptoms. Presence of agitation/aggression, apathy and disinhibition were correlated with more disabilities. ConclusionsPsychiatric disorders are common among patients with TBI. The NPI is a scale that systematically assesses the behavioural and emotional disorders more common in these patients. Some of the symptoms negatively influence the degree of disability.

Day Care Group Training for Patients with Chronic-phase Traumatic Brain Injury

外傷性脳損傷 (TBI) 者の社会的孤立を防ぐために，集団で行う心理療法が注目され，さまざまな形態でのグループ訓練が試みられてきた．本報告ではTBI者に対して，デイケアの形態で行うグループ訓練の有効性を認知面と心理行動面に分けて検証した．過去3 年間にデイケアに参加したTBI 20 例を対象とし，訓練6 カ月後に家族に対して行った質問票の結果で，心理面 (抑うつ気分・興奮) と，行動面 (他者情動の理解・身だしなみ) に有意な改善がみられた．これは，我々のとったグループ訓練の体制によりTBI者の発動性やコミュニケーション能力が改善したためであると考察された．TBI者の心理行動面の改善に，デイケアの形態をとったグループ訓練は有効であった．

Cortical gray matter volume deficit is present in first episode schizophrenics

In patients with chronic-phase traumatic brain injury (TBI), structural MRI is readily attainable and provides rich anatomical information, yet the relationship between whole-brain structural MRI measures and neurocognitive outcome is relatively unexplored and can be complicated by the presence of combined focal and diffuse injury. In this study, sixty-three patients spanning the full range of TBI severity received high-resolution structural MRI concurrent with neuropsychological testing. Multivariate statistical analysis assessed covariance patterns between volumes of grey matter, white matter, and sulcal/subdural and ventricular CSF across 38 brain regions and neuropsychological test performance. Patients with diffuse and diffuse + focal injury were analyzed both separately and together. Tests of speeded attention, working memory, and verbal learning and memory robustly covaried with a distributed pattern of volume loss over temporal, ventromedial prefrontal, right parietal regions, and cingulate regions. This pattern was modulated by the presence of large focal lesions, but held even when analyses were restricted to those with diffuse injury. Effects were most consistently observed within grey matter. Relative to regional brain volumetric data, clinically defined injury severity (depth of coma at time of injury) showed only weak relation to neuropsychological outcome. The results showed that neuropsychological test performance in patients with TBI is related to a distributed pattern of volume loss in regions mediating mnemonic and attentional processing. This relationship holds for patients with and without focal lesions, indicating that diffuse injury alone is sufficient to cause significant neuropsychological disability in relation to regional volume loss. Quantified structural brain imaging data provides a highly sensitive index of brain integrity that is related to cognitive functioning in chronic phase TBI.