THE IMPACT OF SEX ON NEUROPSYCHIATRIC SYMPTOMS IN OLDER ADULTS POST TRAUMATIC BRAIN INJURY

One of the more hotly debated issues in the field of post-traumatic stress disorder (PTSD) is the role of traumatic brain injury (TBI), and particularly mild traumatic brain injury (mTBI). This topic became increasingly the focus of attention in the context of recent wars in Iraq and Afghanistan, where many troops suffered PTSD and mTBIs. Over three-quarters of injuries sustained in these conflicts arose from encounters with explosive devices, and accordingly it was often claimed that the “signature injuries” of the wars in Iraq and Afghanistan were both PTSD and mTBI. Clinicians and researchers have thus given renewed attention to the interplay of these two conditions. This chapter reviews definitional issues of PTSD and mTBI, how PTSD can develop after mTBI, the impact mTBI may have on stress responses, the distinctive role of postconcussive syndrome, and how to manage PTSD following mTBI.

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In-Hospital Mortality Following Traumatic Brain Injury Among Older Medicare Beneficiaries, Comparing Statin Users With Nonusers

Journal of Pharmacy Technology ◽

10.1177/8755122517735656 ◽

2017 ◽

Vol 33 (6) ◽

pp. 225-236 ◽

Cited By ~ 2

Author(s):

Bilal Khokhar ◽

Linda Simoni-Wastila ◽

Julia F. Slejko ◽

Eleanor Perfetto ◽

Min Zhan ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Health Concern ◽

Future Research ◽

Small Scale ◽

Medicare Beneficiaries ◽

The Impact ◽

Statin Use

Background: Traumatic brain injury (TBI) is a significant public health concern for older adults. Small-scale human studies have suggested pre-TBI statin use is associated with decreased in-hospital mortality following TBI, highlighting the need for large-scale translational research. Objective: To investigate the relationship between pre-TBI statin use and in-hospital mortality following TBI. Methods: A retrospective study of Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 was conducted to assess the impact of pre-TBI statin use on in-hospital mortality following TBI. Exposure of interest included atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Beneficiaries were classified as current, recent, past, and nonusers of statins prior to TBI. The outcome of interest was in-hospital mortality. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) comparing current, recent, and prior statin use to nonuse. Results: Most statin users were classified as current users (90%). Current atorvastatin (OR = 0.88; 95% = CI 0.82, 0.96), simvastatin (OR = 0.84; 95% CI = 0.79, 0.91), and rosuvastatin (OR = 0.79; 95% CI = 0.67, 0.94) use were associated with a significant decrease in the risk of in-hospital mortality following TBI. Conclusions: In addition to being the most used statins, current use of atorvastatin, rosuvastatin, and simvastatin was associated with a significant decrease in in-hospital mortality following TBI among older adults. Future research must include clinical trials to help exclude the possibility of a healthy user effect in order to better understand the impact of statin use on in-hospital mortality following TBI.

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Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury

Journal of Pharmacy Technology ◽

10.1177/8755122517710671 ◽

2017 ◽

Vol 33 (4) ◽

pp. 156-166

Author(s):

Bilal Khokhar ◽

Linda Simoni-Wastila ◽

Julia F. Slejko ◽

Eleanor Perfetto ◽

Min Zhan ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

National Sample ◽

Pharmacological Therapy ◽

Medicare Beneficiaries ◽

Future Studies ◽

Factors Associated ◽

The Impact ◽

Statin Use

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins’ potential to reduce mortality, there is limited research regarding statin use among older adults. Objective: To characterize and investigate factors associated with statin use among older adults with TBI. Methods: A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Results: Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). Conclusions: This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

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Misdiagnosis of post-traumatic stress disorder following severe traumatic brain injury

The British Journal of Psychiatry ◽

10.1192/bjp.186.5.423 ◽

2005 ◽

Vol 186 (5) ◽

pp. 423-426 ◽

Cited By ~ 37

Author(s):

Ruth E. Sumpter ◽

Tom M. McMillan

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Structured Interview ◽

Self Report ◽

Post Traumatic Stress ◽

Post Traumatic ◽

The Impact

BackgroundThe incidence of post-traumatic stress disorder (PTSD) after traumatic brain injury is unclear. One issue involves the validity of diagnosis using self-report questionnaires.AimsTo compare PTSD ‘caseness' arising from questionnaire self-report and structured interview.MethodParticipants (n=34) with traumatic brain injury were recruited. Screening measures and self-report questionnaires were administered, followed by the structured interview.ResultsUsing questionnaires, 59% fulfilled criteria for PTSD on the Post-traumatic Diagnostic Scale and 44% on the Impact of Events Scale, whereas using structured interview (Clinician-Administered PTSD Scale) only 3% were ‘cases'. This discrepancy may arise from confusions between effects of PTSD and traumatic brain injury.ConclusionsAfter traumatic brain injury, PTSD self-report measures might be used for screening but not diagnosis.

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Poster 11: The Impact of Time Since Injury and Number of Injuries in Older Adults With Traumatic Brain Injury and Implications for Brain Plasticity

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2008.08.038 ◽

2008 ◽

Vol 89 (10) ◽

pp. e11

Author(s):

Amanda Sacks ◽

Angela Yi ◽

Joshua Cantor ◽

Lisa Speilman ◽

Christaan Greer

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Brain Plasticity ◽

The Impact ◽

Time Since Injury

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Brain Volume, Connectivity, and Neuropsychological Performance in Mild Traumatic Brain Injury: The Impact of Post-Traumatic Stress Disorder Symptoms

Journal of Neurotrauma ◽

10.1089/neu.2015.4323 ◽

2017 ◽

Vol 34 (1) ◽

pp. 16-22 ◽

Cited By ~ 13

Author(s):

Katherine C. Lopez ◽

Jacob B. Leary ◽

Dzung L. Pham ◽

Yi-Yu Chou ◽

John Dsurney ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Brain Volume ◽

Neuropsychological Performance ◽

Post Traumatic Stress ◽

Post Traumatic ◽

The Impact

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Greater Severity and Functional Impact of Post-Traumatic Headache in Veterans with Comorbid Neck Pain following Traumatic Brain Injury

10.1101/2020.05.12.20099390 ◽

2020 ◽

Author(s):

Bahar Shahidi ◽

Robyn W Bursch ◽

Jennifer S Carmel ◽

Ashleigh C Carranza ◽

Kelsey M Cooper ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Neck Pain ◽

Psychosocial Functioning ◽

Bodily Pain ◽

Functional Impact ◽

Role Function ◽

Emotional Role ◽

Post Traumatic ◽

The Impact

Purpose/Hypothesis: Traumatic brain injury (TBI) affects 1.7 million people in the U.S. annually, the majority being mild in severity (mTBI). Post-traumatic headache (PTH) is one of the most common symptoms experienced after mTBI caused by head or neck trauma and is often refractory to treatment. Although military Veterans commonly experience mTBI after blast or blunt injuries that likely affect musculoskeletal structures in the neck, the prevalence of cervical symptoms in Veterans with PTH following mTBI have not been well characterized. Similarly, the impact of comorbid neck pain on physical and psychosocial functioning in this population is unknown. This study aims to assess the prevalence of neck pain in Veterans with PTH following mTBI, and to compare the severity and functional impact of PTH between those with and without comorbid neck pain. Number of Subjects: 33 Veterans with PTH after a military-related mTBI were identified from a secondary analysis of data from a prior study. Materials and Methods: Participants were determined to have PTH if they responded to questions on the Patient Headache History Questionnaire (PHHQ), attributed PTH to an accident or injury, and reported PTH in the TBI history. Individuals with both PTH and comorbid neck pain (PTH+NP) were identified based on an affirmative response to one or more questions on the PHHQ indicating that HA episodes were either preceded or accompanied by neck pain. Standardized measures of HA severity and frequency, insomnia, fatigue, mood disorders (Depression, Anxiety, and Posttraumatic Stress Disorder), and physical and emotional role function (SF-36) were compared between groups with and without comorbid neck pain. Results: Of the 33 participants with PTH, 22 (67%) also had neck pain. There were no differences in demographic or TBI-specific characteristics between groups (p>0.069). Sixty-three percent of the PTH+NP group reported severe or incapacitating HA, compared to 27% of those with PTH alone (P=0.049). Insomnia severity and fatigue were significantly greater in the PTH+NP group (P<0.040), and physical function due to bodily pain and physical role function was significantly lower in the PTH+NP group (P<0.036). There were no significant differences between groups for any of the mood or emotional-role functioning scales (P>0.326). Conclusions: The majority of Veterans with mTBI and PTH reported comorbid neck pain. Veterans with PTH and NP reported increased severity of HA, insomnia, fatigue, and a greater physical, but not emotional functional limitations compared to those without NP.

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