History Of Brain Injury Research Articles

FRI352 Diabetes Insipidus With Hypokalemia In A 30 Week Pregnant Female

Abstract Disclosure: C.B. Stanfield: None. In this case, we will discuss a 29 year old G4P0121 African American female at 30 weeks gestation presented to women’s urgent care for nausea, vomiting and diarrhea after starting magnesium supplementation for incidentally diagnosed hypokalemia around 4 weeks prior. Vitals were significant for a BP of 133/60 and HR 110. Laboratory studies were significant for potassium of 3 mmol/L, sodium 155 mmol/L, magnesium 2.2mmol/L, AST 104, ALT 62 and UA with 2+ proteinuria. Patient admitted to the OBGYN service for preeclampsia with severe features. Patient was noted to have over 16L UOP over the first 24 hours of admission; 4.5L intake. Further labs obtained showed hemoglobin A1C of 4.9, serum osmolality of 308 mOsm/kg, urine osmolality 77 mOsm/kg and urine specific gravity 1.002. DDAVP was given with urine osmolality increasing from 77 to 137 mmol/L. Working differential diagnoses included gestational diabetes insipidus (DI), central DI or nephrogenic DI due to hypokalemia. Co-peptin assay was drawn; is a send out at our institution. Of note, the patient had no known history of brain injury, surgery, radiation or Sheehan Syndrome. However her previous pregnancies had been complicated by hypokalemia, hypertension and pre-eclampsia with emergent cesarean-section. She subsequently underwent emergency cesarean-section on hospital day 2 for non-reassuring fetal activity with delivery of viable 1230g male. After delivery, the patients hypokalemia resolved. Post-op, DDAVP for 3 days was continued per hospital DI protocol with appropriate response. Co-peptin resulted at 22.3, excluding central DI as a diagnosis. On time of discharge, patient had gone without DDAVP for >48 hours with intact thirst mechanism. Given improvement/resolution of DI and persistently low urine osmolality even after DDAVP administration prior to delivery, the DI was believed to be gestational with a component of nephrogenic DI as well due to hypokalemia. Gestational DI occurs due to increased placental vasopressinase which degrades the antidiuretic hormone (ADH). It is associated with pre-eclampsia, acute fatty liver of pregnancy and HELLP syndrome. DDAVP is a modified synthetic analog of endogenous ADH and is resistant to breakdown by placental vasopressinase and can be used to treat gestational DI. Definitive management is achieved with delivery of the fetus and can last up to six weeks after delivery. Presentation: Friday, June 16, 2023

Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study.

Headache (HA) is a common persistent complaint following mild traumatic brain injury (mTBI), but the association with remote mTBI is not well established, and risk factors are understudied. Determine the relationship of mTBI history and other factors with HA prevalence and impact among combat-exposed current and former service members (SMs). Secondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. We examined the association of lifetime mTBI history, demographic, military, medical and psychosocial factors with (1) HA prevalence ("lately, have you experienced headaches?") using logistic regression and (2) HA burden via the Headache Impact Test-6 (HIT-6) using linear regression. Each lifetime mTBI was categorized by mechanism (blast-related or not) and setting (combat deployed or not). Participants with non-credible symptom reporting were excluded, leaving N = 1,685 of whom 81% had positive mTBI histories. At a median 10 years since last mTBI, mTBI positive participants had higher HA prevalence (69% overall, 78% if 3 or more mTBIs) and greater HA burden (67% substantial/severe impact) than non-TBI controls (46% prevalence, 54% substantial/severe impact). In covariate-adjusted analysis, HA prevalence was higher with greater number of blast-related mTBIs (OR 1.81; 95% CI 1.48, 2.23), non-blast mTBIs while deployed (OR 1.42; 95% CI 1.14, 1.79), or non-blast mTBIs when not deployed (OR 1.23; 95% CI 1.02, 1.49). HA impact was only higher with blast-related mTBIs. Female identity, younger age, PTSD symptoms, and subjective sleep quality showed effects in both prevalence and impact models, with the largest mean HIT-6 elevation for PTSD symptoms. Additionally, combat deployment duration and depression symptoms were factors for HA prevalence, and Black race and Hispanic/Latino ethnicity were factors for HA impact. In sensitivity analyses, time since last mTBI and early HA onset were both non-significant. The prevalence of HA symptoms among formerly combat-deployed veterans and SMs is higher with more lifetime mTBIs regardless of how remote. Blast-related mTBI raises the risk the most and is uniquely associated with elevated HA burden. Other demographic and potentially modifiable risk factors were identified that may inform clinical care.

Research Letter: TBI Severity Moderates the Association Between Subjective and Objective Attention in Older Veterans.

This study examined the moderating effect of traumatic brain injury (TBI) history on subjective and objective cognition across multiple cognitive domains. Participants included 242 Vietnam-era veterans with a history of no TBI (n = 86), mild TBI (n = 74), or moderate-to-severe TBI (n = 82) from the observational Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study. Objective cognition was the outcome and was measured using neuropsychological measures in the domains of memory, attention/executive functioning, and language. Subjective cognition was measured using the memory, divided attention, and language subscales from the Everyday Cognition (ECog) measure. TBI severity status was the moderating variable. Veterans with a history of moderate-to-severe TBI had a stronger negative association between subjective and objective attention relative to participants without a TBI ( P = .002). Although this association did not differ between mild TBI and no TBI history groups ( P = .100), the association between subjective and objective attention for the mild TBI group was intermediate to the no TBI and moderate-to-severe TBI history groups. TBI status did not moderate associations between subjective and objective memory or language. Results highlight the importance of assessing subjective and objective cognition in older veterans and the relevance of attention in the context of TBI history. More work is needed to better understand the intersection of TBI and aging and how these factors may be used to guide individualized assessment and treatment approaches for older veterans.

Exploring Interactions Between Traumatic Brain Injury History and Gender on Medical Comorbidities in Military Veterans: An Epidemiological Analysis in the VA Million Veteran Program.

Epidemiological studies of medical comorbidities and possible gender differences associated with traumatic brain injury (TBI) are limited, especially among military veterans. The purpose of this study was to examine relationships between TBI history and a wide range of medical conditions in a large, national sample of veterans, and to explore interactions with gender. Participants of this cross-sectional epidemiological study included 491,604 veterans (9.9% TBI cases; 8.3% women) who enrolled in the VA Million Veteran Program (MVP). Outcomes of interest were medical comorbidities (i.e., neurological, mental health, circulatory, and other medical conditions) assessed using the MVP Baseline Survey, a self-report questionnaire. Logistic regression models adjusting for age and gender showed that veterans with TBI history consistently had significantly higher rates of medical comorbidities than controls, with the greatest differences observed across mental health (odds ratios [ORs] = 2.10-3.61) and neurological (ORs = 1.57-6.08) conditions. Similar patterns were found when evaluating men and women separately. Additionally, significant TBI-by-gender interactions were observed, particularly for mental health and neurological comorbidities, such that men with a history of TBI had greater odds of having several of these conditions than women with a history of TBI. These findings highlight the array of medical comorbidities experienced by veterans with a history of TBI, and illustrate that clinical outcomes differ for men and women with TBI history. Although these results are clinically informative, more research is needed to better understand the role of gender on health conditions in the context of TBI and how gender interacts with other social and cultural factors to influence clinical trajectories following TBI. Ultimately, understanding the biological, psychological, and social mechanisms underlying these comorbidities may help with tailoring TBI treatment by gender and improve quality of life for veterans with TBI history.

Repeatability of quantitative T1rho magnetic resonance imaging in normal brain tissues at 3.0T

PurposeT1rho imaging is a promising MRI technique for imaging of brain disease. This study aimed to assess the repeatability of quantitative T1rho imaging in the normal brain grey and white matter. MethodsThe study prospectively recruited 30 healthy volunteers without a history of neurological diseases or brain injury, and T1rho was performed and quantified from three imaging sessions. Repeat measures analysis of variance (ANOVA) and within-subject coefficients of variation (wCoV) was used to detect differences in T1rho values between the three scans. ResultsThe results showed low wCoVs of less than 4.3% (range 0.92–4.27%) across all the brain structures. No significant differences were observed in T1rho measurement between the three scans (p > 0.05). The amygdala and hippocampus showed the highest T1rho values of 91.79 ± 2.55 msec and 91.07 ± 2.11 msec respectively, and the palladium and putamen had the lowest values of 67.60 ± 1.84 msec and 71.83 ± 1.85 msec respectively. ConclusionT1rho shows high test–retest repeatability for whole brain imaging in serial imaging sessions, indicating it to be a reliable sequence for quantitative brain imaging.

Mild traumatic brain injury history is associated with lower brain network resilience in soldiers.

Special Operations Forces combat soldiers sustain frequent blast and blunt neurotrauma, most often classified as mild traumatic brain injuries. Exposure to repetitive mild traumatic brain injuries is associated with persistent behavioural, cognitive, emotional and neurological symptoms later in life. Identifying neurophysiological changes associated with mild traumatic brain injury exposure, in the absence of present-day symptoms, is necessary for detecting future neurological risk. Advancements in graph theory and functional MRI have offered novel ways to analyse complex whole-brain network connectivity. Our purpose was to determine how mild traumatic brain injury history, lifetime incidence and recency affected whole-brain graph theoretical outcome measures. Healthy male Special Operations Forces combat soldiers (age = 33.2 ± 4.3 years) underwent multimodal neuroimaging at a biomedical research imaging centre using 3T Siemens Prisma or Biograph MRI scanners in this cross-sectional study. Anatomical and functional scans were preprocessed. The blood-oxygen-level-dependent signal was extracted from each functional MRI time series using the Big Brain 300 atlas. Correlations between atlas regions were calculated and Fisher z-transformed to generate subject-level correlation matrices. The Brain Connectivity Toolbox was used to obtain functional network measures for global efficiency (the average inverse shortest path length), local efficiency (the average global efficiency of each node and its neighbours), and assortativity coefficient (the correlation coefficient between the degrees of all nodes on two opposite ends of a link). General linear models were fit to compare mild traumatic brain injury lifetime incidence and recency. Nonparametric ANOVAs were used for tests on non-normally distributed data. Soldiers with a history of mild traumatic brain injury had significantly lower assortativity than those who did not self-report mild traumatic brain injury (t148 = 2.44, P = 0.016). The assortativity coefficient was significantly predicted by continuous mild traumatic brain injury lifetime incidence [F1,144 = 6.51, P = 0.012]. No differences were observed between recency groups, and no global or local efficiency differences were observed between mild traumatic brain injury history and lifetime incidence groups. Brain networks with greater assortativity have more resilient, interconnected hubs, while those with lower assortativity indicate widely distributed, vulnerable hubs. Greater lifetime mild traumatic brain injury incidence predicted lower assortativity in our study sample. Less resilient brain networks may represent a lack of physiological recovery in mild traumatic brain injury patients, who otherwise demonstrate clinical recovery, more vulnerability to future brain injury and increased risk for accelerated age-related neurodegenerative changes. Future longitudinal studies should investigate whether decreased brain network resilience may be a predictor for long-term neurological dysfunction.

A-03 Preliminary Evidence for Motor Vehicle Accidents and Associated Concussion Response Severity in Older Adults

Abstract Purpose To determine if mechanism of injury is associated with differences in initial response to concussion in older adults. Methods Fifty older adults (54% female) aged 50-84 (59.14±6.54) were recruited from a sports medicine concussion clinic at initial appointment. Inclusion criteria included age (50+) and injury date within the last year. Exclusion criteria included prior diagnosis of a neurological disorder and/or brain malformation, psychiatric diagnosis other than anxiety/depression, prior history of moderate or severe brain injury, and/or ongoing litigation. Mechanism of injury in the sample included 22 falls/accidents (44%), 20 MVAs (40%), 2 sport/recreation (4%), 1 assault (2%), and 5 other (10%). Participants were assigned to two independent groups, MVA and Non-MVA. Outcome measures included Vestibular/Ocular-Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), and Concussion Clinical Profile Screening (CP Screen). Response severity was operationalized by VOMS Total and CP Screen Total. Two-tailed independent t-tests (alpha<.05) examined differences between groups at initial visit. Results There were no significant differences between groups in terms of demographics or other common risk factors. There were no differences between groups for response severity. The MVA group reported more severe vestibular complaints t(41) =2.07, p=.044, more severe cognitive complaints, t(44)=3.68, p<.001, and demonstrated worse scores on domains of visual memory, t(43)=-2.16, p=.037, reaction time, t(43)=3.07, p=.004, and visual motor speed, t(43)=-2.85, p=.007. Conclusions MVA-related concussions may result in more focal disruption of vestibular and cognitive performance in older adults. Future research is warranted to confirm the findings of this study, to explore potential explanations for these findings, and to further explore how concussion presents in older adults.

An Integrated Behavioral-Neuropsychiatric Treatment Plan Reduces Severe Challenging Behavior in an Adolescent With Neurobehavioral Complications of Neonatal Brain Injury

We present the case of a 15-year-old adolescent boy with a neurobehavioral disorder who experienced a brain injury during the first month of life. The forms of challenging behaviors were severe and included aggression, property destruction, volitional incontinence, and suicidal statements, and had resulted in two psychiatric hospitalizations and multiple emergency evaluations prior to intervention. The intervention was preceded by a functional behavior assessment suggesting that a differential reinforcement intervention could be designed to minimize reinforcement of challenging behaviors while maximizing reinforcement of adaptive, positive behaviors. The intervention was introduced following the baseline phase and there was an immediate decrease in the rate of challenging behaviors and in the utilization of emergency psychiatric services. Improvements continued for 6 weeks, after which a medication was added to promote sleep onset (to decrease sleep onset latency) along with behavioral guidelines, which led to further improvements for an additional 12 weeks. A follow-up phase of 3 months showed sustained results. The study illustrates the value of an integrated approach utilizing applied behavior analysis and sequenced neuropsychiatry, and a neurobehavioral formulation where components of the participant’s brain injury history are integrated with an operant formulation as circumstances that explain the problem behavior while effectively suggesting strategies for behavioral treatment. Because the intervention was implemented by support staff in a group home, it illustrates the ability of support staff to work therapeutically with severe behavior presentations using structured behavioral interventions.

Effects of Mobile Phone Use on Gait and Balance Control in Young Adults: A Hip–Ankle Strategy

Background: This study aimed to derive the effects of walking while using a mobile phone on balance perturbation and joint movement among young adults. Methods: Sixteen healthy college students with no history of brain injury were tested. The participants were asked to walk under four different conditions: (1) walking, (2) browsing, (3) dialing, and (4) texting. Indicators related to balance control and lower limb kinematic/kinetic parameters were analyzed using the continuous relative phase and statistical nonparametric mapping methods. Results: Walking while using a mobile phone slowed participants’ gait speed and reduced the cadence, stride length, and step length. The posterior tilt angle (0–14%, 57–99%), torque of the hip flexion (0–15%, 30–35%, 75–100%), and angle of the hip flexion (0–28%, 44–100%) decreased significantly. The activation of biceps femoris and gastrocnemius, hip stiffness, and ankle stiffness increased significantly. This impact on gait significantly differed among three dual tasks: texting > browsing > dialing. Conclusion: Che overlap of walking and mobile phone use affects the gait significantly. The “hip–ankle strategy” may result in a “smooth” but slower gait, while this strategy was deliberate and tense. In addition, this adjustment also increases the stiffness of the hip and ankle, increasing the risk of fatigue. Findings regarding this effect may prove that even for young healthy adults, walking with mobile phone use induces measurable adjustment of the motor pattern. These results suggest the importance of simplifying the control of the movement.

If Midlife Brain Injury Is a Risk Factor for Alzheimer's Disease and Related Dementias, What Is the Neuropathologic Mechanism?

While we know that brain injuries related to sport and military activities sometimes lead to cognitive impairment or early onset dementia, it is unclear if and how they might influence the development of Alzheimer's Disease and Related Dementias (ADRD). Published analytic conclusions have been mixed. Two reports in the Journal of Alzheimer's Disease reach the same answer: a history of brain injury appears to be a risk factor for generalized brain atrophy, which would likely increase vulnerability to the subsequent development of any variety of ADRD, or to dementia directly attributable to reduced brain mass.

Early Brain Amyloid Accumulation at PET in Military Instructors Exposed to Subconcussive Blast Injuries.

Background Traumatic brain injury (TBI) is the leading cause of disability in young adults. Recurrent TBI is associated with a range of neurologic sequelae, but the contributing factors behind the development of such chronic encephalopathy are poorly understood. Purpose To quantify early amyloid β deposition in the brain of otherwise healthy adult men exposed to repeated subconcussive blast injury using amyloid PET. Materials and Methods In this prospective study from January 2020 to December 2021, military instructors who were routinely exposed to repeated blast events were evaluated at two different points: baseline (before blast exposure from breacher or grenade) and approximately 5 months after baseline (after blast exposure). Age-matched healthy control participants not exposed to blasts and without a history of brain injury were evaluated at similar two points. Neurocognitive evaluation was performed with standard neuropsychologic testing in both groups. Analysis of PET data consisted of standardized uptake value measurements in six relevant brain regions and a whole-brain voxel-based statistical approach. Results Participants were men (nine control participants [median age, 33 years; IQR, 32-36 years] and nine blast-exposed participants [median age, 33 years; IQR, 30-34 years]; P = .82). In the blast-exposed participants, four brain regions showed significantly increased amyloid deposition after blast exposure: inferomedial frontal lobe (P = .004), precuneus (P = .02), anterior cingulum (P = .002), and superior parietal lobule (P = .003). No amyloid deposition was observed in the control participants. Discriminant analysis on the basis of regional changes of amyloid accumulation correctly classified the nine healthy control participants as healthy control participants (100%), and seven of the nine blast-exposed participants (78%) were correctly classified as blast exposed. Based on the voxel-based analysis, whole-brain parametric maps of early abnormal early amyloid uptake were obtained. Conclusion Early brain amyloid accumulation was identified and quantified at PET in otherwise healthy adult men exposed to repetitive subconcussive traumatic events. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Haller in this issue.

Association Between TBI Exposure and Multiple Sclerosis Among Post-9/11 Era Veterans (P1-5.027)

<h3>Objective:</h3> Identify associations of traumatic brain injury (TBI) history and subsequent diagnosis of multiple sclerosis (MS). <h3>Background:</h3> MS prevalence has increased since 2013 and has been linked to environmental factors (e.g., smoking history, obesity, Epstein-Barr Virus). More limited data suggest a link between MS and multiple concussions and TBI. This study examined the association of TBI and MS in Post-9/11 era veterans. <h3>Design/Methods:</h3> Our retrospective cohort study included Veterans who received Department of Defense (DoD) care in at least three years FY2000–2019. We identified MS using ICD9 (340) or ICD10 codes (G35). We identified TBI exposure using a hierarchical approach prioritizing data from the DoD Trauma Registry, self-reported loss/alteration of consciousness, or post-traumatic amnesia, and then ICD-9/10 diagnosis. TBI was classified as no TBI, mild TBI, moderate/severe TBI, and penetrating TBI. Index dates were the first date of TBI diagnosis or were simulated by drawing from the distribution of true index dates within age brackets for those without TBI. Other covariates included age, sex, race/ethnicity, health behaviors (e.g., smoking, substance use disorders, overdose, obesity) and comorbid health conditions associated with MS (e.g., depression, anxiety, hypertension, hypercholesterolemia, and chronic lung disease). We conducted competing event (Fine-Gray) analyses examining time from TBI/index day to MS diagnosis. <h3>Results:</h3> Of the 2,291,789 Veterans who met inclusion criteria (mean age=33; SD=11) 16.6% had TBI exposure. Time to MS was fastest for women (HR 2.4; 95%CI 2.2–2.6) and veterans with the following clinical characteristics before index date: stroke (HR 2.1; 95%CI 1.8–2.5), other neurological conditions (HR 2.2; 95%CI 1.8–2.6) and TBI severity (penetrating [HR 1.96; 95%CI 1.5–2.6]; moderate/severe [HR 1.5; 95%CI 1.2–1.8]; mild [HR 1.5; 95%CI 1.3–1.6]). <h3>Conclusions:</h3> Our study found that neurological conditions including TBI were the strongest clinical predictors of MS emergence in this younger Veteran cohort, which should be considered in caring for Post-9/11 Veterans with neurological conditions. <b>Disclosure:</b> The institution of Dr. Pugh has received research support from Department of Defense, Epilepsy Research Program. The institution of Dr. Pugh has received research support from VA Health Services Research and Development Service. The institution of Dr. Pugh has received research support from VA Rehabilitation Research and Development Service. The institution of Dr. Pugh has received research support from Congressionally Directed Research Programs. The institution of Dr. Pugh has received research support from Sanofi. Megan Amuan has nothing to disclose. Dr. Ocier has nothing to disclose. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Romaguera Law Group. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Lewis Brisbois. The institution of Dr. Graham has received research support from Department of Veterans Affairs. Dr. Graham has received personal compensation in the range of $10,000-$49,999 for serving as a Speaker with MER (non-profit CME provider). Dr. Graham has received personal compensation in the range of $500,000-$999,999 for serving as a Employee with Department of Veterans Affairs. An immediate family member of Dr. Graham has received personal compensation in the range of $100,000-$499,999 for serving as a Exployee with Department of Veterans Affairs. Dr. Adamson has nothing to disclose.

Traumatic brain injury history and baseline symptoms outweigh sex differences for risk of concussion in a sample of collegiate athletes

ABSTRACT Objective To test the hypothesis that a history of traumatic brain injury (TBI) prior to the collegiate pre-season is associated with risk for re-injury. We also investigate sex differences, cognitive functioning, and self-reported concussion symptoms and their associations with concussion risk. Methods A longitudinal cohort study consisting of collegiate athletes (n = 212) who completed consecutive preseason evaluations (P1 and P2) between 2012 and 2015, averaging 12.9 (SD = 4.2) months apart. Results There were 40 new concussions recorded between P1 and P2, 21 (53%) of which were among athletes who reported a lifetime history of mild TBI/concussion at P1. New P1-P2 concussions occurred in 24% of female athletes (n = 23) and 15% of male athletes (n = 17). History of TBI and female sex were significant predictors of new concussion between P1 and P2; however, in adjusted models, the inclusion of Impulse Control and PCSS Total symptom scores attenuated the effect of sex on the risk for new injury. Conclusion Collegiate athletes with a lifetime history of TBI had a significantly higher risk of sustaining a subsequent concussion. Pre-season emotional and somatic symptomology may contribute to incident concussion risk. The findings highlight the importance of considering lifetime head injury exposure and baseline symptomatology when interpreting sex differences and evaluating concussion risk.

Cricoid chondronecrosis: a serious complication of prolonged endotracheal intubation

Chondronecrosis is a rare life-threatening complication of endotracheal intubation. This case is a patient with a history of severe brain injury, who developed a cricoid chondronecrosis after prolonged intubation. The complication was suspected when decannulation led to upper airway obstruction and was confirmed by laryngoscopy and computed tomography. We discuss the diagnosis of the condition, the causative factors, treatment through a literature review.

Long-term changes in cognitive status of patients with type 2 diabetes mellitus after coronary artery bypass graft surgery

Aim. To study long-term changes (5 to 7 years after coronary artery bypass graft (CABG) surgery) in cognitive status of patients with type 2 diabetes.Materials and Methods. The study included 47 male patients admitted to the Research Institute for Complex Issues of Cardiovascular Diseases for the CABG surgery. Criteria of inclusion were signed informed consent, age from 40 to 75 years, male gender, planned on-pump CABG surgery, and right-handedness. Criteria of exclusion were brain pathology at multislice computed tomography, chronic cerebral ischemia grade II-IV, Beck Depression Inventory score &gt; 16 points, the Mini-Mental State Examination (MMSE) score &lt; 24 points and the Frontal Assessment Battery score &lt; 11 points, arrhythmia, class IIB-IV chronic heart failure stage IIB, chronic obstructive pulmonary disease, cancer, and past medical history of brain injury or stroke. Pre-operative examination of patients classified them into two groups: with (n = 21) and without (n = 26) type 2 diabetes mellitus (DM).Results. 5-7 years after CABG surgery, patients with type 2 DM had a cognitive decline according to MMSE scale as compared to the preoperative level (28,0 [27,0; 29,0] and 27,0 [26,0; 28,0], p = 0.04). In keeping with these findings, odds ratio (OR) of mild cognitive impairment (MCI) in patients with type 2 DM was 1.92 (95% CI = 1.09- 3.37, p = 0.02). Psychomotor and executive functions were reduced in patients with type 2 DM both at baseline and in particular 5-7 years after CABG (p ≤ 0.05). The correlation between glycated hemoglobin (HbA1c) and cognitive parameters were found only in patients with type 2 DM. Higher HbA1c level was also associated with deteriorated executive functions and short-term memory.Conclusion. 5−7 years after CABG surgery, patients with type 2 DM suffer from a cognitive decline and reduced psychomotor and executive functions.

How Traumatic Brain Injury History Relates to Brain Health MRI Markers and Dementia Risk: Findings from the 3C Dijon Cohort.

The long-term effects of traumatic brain injury (TBI) with loss of consciousness (LOC) on magnetic resonance imaging (MRI) markers of brain health and on dementia risk are still debated. To investigate the associations of history of TBI with LOC with incident dementia and neuroimaging markers of brain structure and small vessel disease lesions. The analytical sample consisted in 4,144 participants aged 65 and older who were dementia-free at baseline from the Three City -Dijon study. History of TBI with LOC was self-reported at baseline. Clinical Dementia was assessed every two to three years, up to 12 years of follow-up. A subsample of 1,675 participants <80 years old underwent a brain MRI at baseline. We investigated the associations between history of TBI with LOC and 1) incident all cause and Alzheimer's disease (AD) dementia using illness-death models, and 2) neuroimaging markers at baseline. At baseline, 8.3% of the participants reported a history of TBI with LOC. In fully-adjusted models, participants with a history of TBI with LOC had no statistically significant differences in dementia risk (HR = 0.90, 95% CI = 0.60-1.36) or AD risk (HR = 1.03, 95% CI = 0.69-1.52), compared to participants without TBI history. History of TBI with LOC was associated with lower white matter volume (β= -4.58, p = 0.048), but not with other brain volumes, white matter hyperintensities volume, nor covert brain infarct. This study did not find evidence of an association between history of TBI with LOC and dementia or AD dementia risks over 12-year follow-up, brain atrophy, or markers of small vessel disease.

Experience of a cognitive behavioural therapy and mindfulness intervention for men with a history of traumatic brain injury in prison: a thematic analysis

ABSTRACT Interventions to improve awareness of brain injury and support the development of coping strategies may help reduce potential longer-term impacts. A 10 session, group-based, cognitive behavioural therapy (CBT) and mindfulness intervention was conducted in prison, with adult men reporting a history of brain injury. Following completion of the intervention, 17/36 (47.2%) participants were interviewed about their experiences of TBI and the intervention. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Four themes were identified: the journey into jail, learning from others, new understandings and developing new ways of coping. The results revealed that the intervention improved self-understanding, enabling them to be more accepting of their difficulties and experiencing hope through learning new ways of responding to life situations. Increased breaks, a focus on wider TBI implications and a follow-up session were suggested improvements.

Exploring and Mapping Screening Tools for Cognitive Impairment and Traumatic Brain Injury in the Homelessness Context: A Scoping Review.

Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.

Supported Employment for Veterans with Traumatic Brain Injury History: Is it Working?

<h3>Research Objectives</h3> To examine characteristics and employment outcomes among Veterans with traumatic brain injury (TBI) history enrolled in Supported Employment. This program provides intense, individualized supported for individuals whose disabilities interfere with finding and maintaining employment. Supported Employment providers work closely with the Veteran's clinical treatment team, Veterans, and employers to ensure clinical and vocational supports are provided to facilitate workplace success. <h3>Design</h3> Review of Department of Veterans Affairs (VA) administrative and electronic medical record data collected between 2020-2022. <h3>Setting</h3> 12 VA medical centers. <h3>Participants</h3> Veterans with TBI history. <h3>Interventions</h3> Supported Employment. <h3>Main Outcome Measures</h3> Employment status. <h3>Results</h3> 92 Veterans with TBI history were referred to a VA Supported Employment program. They were primarily male (96%), White (74%), non-Hispanic (85%), Post-9/11 Veterans (59%) with an average age of 41 ± 10.4 years. The majority (83%) received VA service-connected disability compensation for up to 29 health conditions, and 30% were 100% service-connected. The majority were referred by the Polytrauma/TBI clinic (53%). At enrollment, they had been unemployed for 5 months (median). To date, half (51%) obtained at least 1 job within approximately 3 months (median = 97 days) of Supported Employment program entry. Incarceration history, current homelessness, and level of service-connected disability rating did not differ among Veterans who did or did not obtain employment (all ps > .05). <h3>Conclusions</h3> The majority of Veterans with TBI history and co-occurring military-related health conditions have demonstrated success in obtaining employment within a relatively short amount of time following enrollment in a Supported Employment program. Health and psychosocial factors that may be barriers to employment were not associated with obtaining a job, underscoring the effectiveness of Supported Employment services for Veterans with TBI history who may otherwise have employment challenges. <h3>Author(s) Disclosures</h3> The authors have no conflicts to declare.

18F‐MK‐6240 Tau PET as a Biomarker for Chronic Traumatic Encephalopathy: Case Series of 10 Symptomatic Former National Football League Players

AbstractBackgroundThe pathognomonic lesion of chronic traumatic encephalopathy (CTE) is the perivascular deposition of neuronal phosphorylated tau (p‐tau). Patchy p‐tau deposits initially accumulate in frontotemporal cortices. Medial temporal lobes (MTL) become involved in late stage. Validated in vivo biomarkers for CTE p‐tau do not exist. 18F‐MK‐6240 is a second‐generation tau PET ligand with improved imaging properties compared with first‐generation ligands, but its utility in CTE is unknown. We report initial results from an ongoing proof‐of‐concept study investigating MK‐6240 in people at risk for CTE.MethodTen older adult male symptomatic former National Football League (NFL) players completed tau (MK‐6240) and amyloid (florbetapir) PET imaging and neuropsychological testing. MK‐6240 data were acquired from 36 cognitively unimpaired males without traumatic brain injury history (but unknown contact sport history) from the Wisconsin Registry for Alzheimer’s Prevention (mean age=66.3, SD=6.3; mean MMSE=29.6, SD=0.5). Using cerebellar gray matter reference, 70‐90 min MK‐6240 SUVR images were created. W‐score (age‐adjusted z‐scores) maps were generated using the control data and thresholded at w&gt;1.65 to visualize high binding voxels. Images and scatter plots of uptake in NFL players and controls were qualitatively assessed due to the small sample size.ResultsSample characteristics are in Table 1 (age range:51‐72, 5/10 Black). All NFL players had a negative florbetapir PET. 9/10 were cognitively impaired, particularly in memory and executive functions (Table 2). One former NFL player (case 4) had MTL MK‐6240 uptake greater than all controls, along with focal low intensity uptake in the superior frontal cortex (Figure 1). Two NFL players (cases 6 and 9) had mildly elevated MTL MK‐6240 uptake, particularly in entorhinal cortex and parahippocampus, though similar binding was seen in some controls (Figure 2). There was minimal MTL uptake in the remaining NFL players. Cortical uptake was complicated by contamination from off‐target meningeal binding.ConclusionsExisting data suggests current radioligands (e.g., flortaucipir) developed for Alzheimer’s disease might have restricted utility to late stage CTE. This might be true for MK‐6240 and off‐target meningeal binding complicates detection of cortical p‐tau. Data collection is ongoing and the larger data set will inform on MK‐6240 as a biomarker for CTE.