The Impact of Neurocognitive Functioning on the Course of Posttraumatic Stress Symptoms following Civilian Traumatic Brain Injury

Background: One out of seven individuals who have suffered a traumatic brain injury (TBI) develops a posttraumatic stress disorder (PTSD), which is often associated with neurocognitive impairment. The present study explores the impact of neurocognitive functioning after mild, moderate, and severe TBI on the course of PTSD symptoms. Methods: The data of 671 adults admitted to hospital for a TBI was drawn from the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. After six- and 12-months post-injury, participants completed the PTSD Checklist-5 (PCL-5), from which change scores were calculated. At six months, participants also completed a neurocognitive assessment including the Rey Auditory Verbal Learning Test, the Trail Making Test, and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Linear regressions were performed to identify associations between cognitive functioning and PCL-5 change scores. Results: Overall, mean PCL-5 change scores showed no clear change (−0.20 ± 9.88), but 87 improved and 80 deteriorated by a change score of 10 or more. CANTAB Rapid Visual Information Processing scores were significantly associated with PCL-5 change scores. Conclusions: Strong sustained attention was associated with improvement in PTSD symptoms. Assessing cognitive performance may help identify individuals at risk of developing (persisting) PTSD post-TBI and offer opportunities for informing treatment strategies.

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Examining the Prospective Relationship between Family Affective Responsiveness and Theory of Mind in Chronic Paediatric Traumatic Brain Injury

Brain Impairment ◽

10.1017/brimp.2016.20 ◽

2016 ◽

Vol 18 (1) ◽

pp. 88-101 ◽

Cited By ~ 5

Author(s):

Nicholas P. Ryan ◽

Kim Mihaljevic ◽

Miriam H. Beauchamp ◽

Cathy Catroppa ◽

Louise Crossley ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Theory Of Mind ◽

Childhood And Adolescence ◽

Post Injury ◽

Related Factors ◽

Lesion Location ◽

Severe Tbi ◽

The Impact ◽

Affective Responsiveness

Childhood and adolescence coincide with rapid structural and functional maturation of brain networks implicated in Theory of Mind (ToM); however, the impact of paediatric traumatic brain injury (TBI) on the development of these higher order skills is not well understood. ToM can be partitioned intoconative ToM, defined as the ability to understand how indirect speech acts involving irony and empathy are used to influence the mental or affective state of the listener; andaffective ToM, concerned with understanding that facial expressions are often used for social purposes to convey emotions that we want people to think we feel. In a sample of 84 children with mild-severe TBI and 40 typically developing controls, this study examined the effect of paediatric TBI on affective and conative ToM; and evaluated the respective contributions of injury-related factors (injury severity/lesion location) and non-injury-related environmental variables (socio-economic status (SES)/family functioning) to long-term ToM outcomes. Results showed that the poorest ToM outcomes were documented in association with mild-complicated and moderate TBI, rather than severe TBI. Lesion location and SES did not significantly contribute to conative or affective ToM. Post-injury family affective responsiveness was the strongest and most significant predictor of conative ToM. Results suggest that clinicians should exercise caution when prognosticating based on early clinical indicators, and that group and individual-level outcome prediction should incorporate assessment of a range of injury- and non-injury-related factors. Moreover, the affective quality of post-injury family interactions represents a potentially modifiable risk factor, and might be a useful target for family-centred interventions designed to optimise social cognitive outcomes after paediatric TBI.

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Performance discrepancies on the California Verbal Learning Test–Children's Version (CVLT–C) in children with traumatic brain injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617704104025 ◽

2004 ◽

Vol 10 (4) ◽

pp. 482-488 ◽

Cited By ~ 27

Author(s):

JACOBUS DONDERS ◽

MICHAEL T. MINNEMA

Keyword(s):

Traumatic Brain Injury ◽

Information Processing ◽

Brain Injury ◽

Verbal Learning ◽

California Verbal Learning Test ◽

Cerebral Lesions ◽

Speed Of Information Processing ◽

Learning Test ◽

Pediatric Tbi ◽

The Impact

One hundred sixty-seven children with traumatic brain injury (TBI), selected from an 8-year series of consecutive referrals to a Midwestern rehabilitation hospital, completed the California Verbal Learning Test–Children's Version (CVLT–C) and the Wechsler Intelligence Scale for Children–Third Edition (WISC–III) within 1 year after injury. A large proactive interference (PI) effect, defined as performance on the second list that was at least 1.5 standard deviations below that on the 1st one, was statistically significantly more common in this clinical sample (21%) than in the CVLT–C standardization sample (11%). Other performance discrepancies, including retroactive interference, rapid forgetting, and retrieval problems, occurred at approximately the same rate in the clinical and standardization samples. Children with anterior cerebral lesions were about 3 times less likely to have a large PI effect than children without such lesions, but the former group performed worse on the first CVLT–C list. The impact of pediatric TBI on a wide range of CVLT–C quantitative variables was mediated by speed of information processing, as assessed by the WISC–III Processing Speed factor index. It is concluded that failure to release from PI is somewhat common, although certainly not universal, in children with TBI. Unlike with adults, anterior cerebral lesions are not associated selectively with an increased risk for PI after pediatric TBI but rather with a reduced efficiency of allocation of cognitive resources. Deficits in speed of information processing appear to be primarily responsible for the learning deficits on the CVLT–C after pediatric TBI. (JINS, 2004, 10, 482–488.)

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A Review of the Co-Occurrence of Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

Advances in Neurology and Neuroscience ◽

10.33140/an.04.03.05 ◽

2021 ◽

Vol 4 (3) ◽

Keyword(s):

Traumatic Brain Injury ◽

Posttraumatic Stress Disorder ◽

Brain Injury ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Symptomatic Relief ◽

Pharmacologic Treatment ◽

Treatment Interventions ◽

The Impact

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) often co-occur. This review describes the overlap between PTSD and TBI with special emphasis on mild TBI (mTBI) by defining these two conditions and their differential diagnosis. The impact of mTBI on PTSD is outlined and vice versa. The various psychotherapeutic and pharmacologic treatment interventions that could provide a symptomatic relief for both conditions are summarized with the hope that by implementing these interventions, individuals afflicted by these potentially very disabling conditions will experience improved functioning and quality of life.

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A-125 The Impact of Bilingualism on Symbol Digit Modalities Test Performance Following Traumatic Brain Injury

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.143 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1175-1175

Author(s):

Raelynn Munoz ◽

Daniel W Lopez-Hernandez ◽

Rachel A Rugh-Fraser ◽

Jasman Sidhu ◽

Pavel Y Litvin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Deficits ◽

Test Performance ◽

Oral Performance ◽

Neurocognitive Performance ◽

Post Injury ◽

Cognitive Speed ◽

The Impact ◽

Larger Sample

Abstract Objective Traumatic brain injury (TBI) survivors exhibit cognitive deficits. Research suggests that multilingualism can influence neurocognitive performance. We examined the effects of TBI and bilingualism/monolingualism on a test of attention and cognitive speed (i.e., Symbol Digit Modalities Test; SDMT). Method The sample consisted of 55 healthy comparison (27 Spanish-English bilinguals; 28 English-monolinguals), 34 acute TBI (14 Spanish-English bilinguals; 23 English-monolinguals), and 27 chronic TBI (13 Spanish-English bilinguals; 12 English-monolinguals) participants. Acute TBI participants were tested 6 months post-injury; chronic TBI participants were tested 12 months or more post-injury. A series of 3X2 ANOVAs were conducted to determine the effect of TBI and language on SDMT written and oral performance. Results ANOVAs revealed the healthy comparison group outperformed both TBI groups on SDMT written, p = 0.000, ηp2 = 0.21. Also, the healthy comparison and chronic TBI groups outperformed the acute TBI group on SDMT oral, p = 0.000, ηp2 = 0.13. Interaction effects emerged between TBI and bilingualism/monolingualism. On SDMT written and oral, acute TBI English-monolinguals outperformed acute TBI Spanish-English bilinguals; meanwhile, chronic TBI Spanish-English bilinguals outperformed chronic TBI English-monolinguals, p < 0.05, ηp2 = 0.09–0.10. Conclusion The acute TBI group performed worse than healthy comparison adults on both SDMT tasks. Furthermore, the chronic TBI group demonstrated better SDMT oral abilities compared to the acute TBI group. Relative to monolinguals with TBI, our findings suggest better cognitive recovery of attention and cognitive speed in bilingual TBI participants. Future studies with larger sample sizes should examine if learning English first or second impacts Spanish-English bilingual TBI survivors’ SDMT performance compared to English-monolingual TBI survivors.

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Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis

Neurocritical Care ◽

10.1007/s12028-020-01151-7 ◽

2020 ◽

Author(s):

Julia K. Böhm ◽

◽

Helge Güting ◽

Sophie Thorn ◽

Nadine Schäfer ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Antiplatelet Therapy ◽

Post Injury ◽

Coagulation Profile ◽

Trauma Induced Coagulopathy ◽

Increased Risk ◽

Independent Risk Factors ◽

The Impact ◽

Admission Glasgow Coma Scale

Abstract Background Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. Methods This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. Results Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to − 6, hypothermia and hypotension increased risk significantly. Conclusion Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.

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Enhanced Acquisition and Retention of Conditioned Eyeblink Responses in Veterans Expressing PTSD Symptoms: Modulation by Lifetime History of Mild Traumatic Brain Injury

Frontiers in Behavioral Neuroscience ◽

10.3389/fnbeh.2020.595007 ◽

2020 ◽

Vol 14 ◽

Author(s):

Justin D. Handy ◽

W. Geoffrey Wright ◽

Amanda Haskell ◽

Labeeby Servatius ◽

Richard J. Servatius

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Eyeblink Conditioning ◽

Unconditional Stimulus ◽

Ptsd Symptoms ◽

Conditioned Eyeblink ◽

Enhanced Sensitivity ◽

Conditioned Responses ◽

The Impact

Enhanced acquisition of eyeblink conditioning is observed in active duty military and veterans expressing PTSD symptoms (PTSD+) and those expressing temperamental vulnerabilities to develop PTSD after traumatic experiences, such as behaviorally inhibited temperament. There is a growing literature showing persistent cerebellar abnormalities in those experiencing mild traumatic brain injury (mTBI+) as well as linkages between mTBI and PTSD. With the dependency of eyeblink conditioning on cerebellar processes, the impact of mTBI on eyeblink conditioning in veterans expressing PTSD is unknown. The present study assessed eyeblink conditioning in veterans during two sessions separated by 1 week. With a focus on the accelerated learning of veterans expressing PTSD, training utilized a protocol which degrades learning through interspersing conditioned stimulus (CS) exposures amongst delay-type trials of CS and unconditional stimulus (US) co-terminating trials. Faster acquisition of the eyeblink conditioned responses (CR) was observed in PTSD during Week 1. The Week 2 assessment revealed an interaction of mTBI and PTSD, such that asymptotic performance of PTSD+ was greater than PTSD− among mTBI− veterans, whereas these groups did not differ in mTBI+ veterans. To further examine the relationship between enhanced sensitivity to acquire eyeblink conditioning and PTSD, cluster analysis was performed based on performance across training sessions. Those with enhanced sensitivity to acquire eyeblink conditioned responses expressed more PTSD symptoms, which were specific to Cluster C symptoms of avoidance, in addition to greater behavioral inhibition. These results support the continued investigation of the conditioned eyeblink response as a behavioral indicator of stress-related psychopathology.

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The impact of deployment and traumatic brain injury on the health and behavior of children of US military service members and veterans

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104517740405 ◽

2017 ◽

Vol 23 (3) ◽

pp. 425-441

Author(s):

Tracey A Brickell ◽

Louis M French ◽

Sara M Lippa ◽

Rael T Lange

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Emotional Health ◽

Post Injury ◽

Number Of Children ◽

Us Military ◽

Combat Deployment ◽

And Behavior ◽

The Impact

This study examined the impact of service member/veteran (SMV) combat deployment and traumatic brain injury (TBI) on the health and behavior of his or her children. Participants were 104 female spouse caregivers of US SMVs who had sustained a mild, severe, or penetrating TBI. Participants completed the Children’s Health and Behavior Questionnaire (CHBQ; r = .758 to .881) that evaluates school grades, behavior, medical health, emotional health, and social participation: (a) prior to the first combat deployment, (b) in the month prior to the TBI, (c) within 2 years after the TBI, and (d) 2 or more years after the TBI. A substantial number of children experienced a decline in health and behavior following the TBI (41.7%–79.1%). Of those who declined (a) 68.8%–75.5% declined within the first 2 years post-injury, followed by improvement or stabilization; (b) 6.7%–15.6% declined only after 2 or more years post-injury; (c) 15.6%–25.0% declined within the first 2 years post-injury and then again 2 or more years post-injury; and (d) 16.9%–26.5% experienced a decline as a result of deployment, followed by an additional decline after the SMV’s TBI. Services are required for children of SMVs following TBI and deployment, particularly children at risk for poor outcome.

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PTSD Modifies Performance on a Task of Affective Executive Control among Deployed OEF/OIF Veterans with Mild Traumatic Brain Injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617713000544 ◽

2013 ◽

Vol 19 (7) ◽

pp. 792-801 ◽

Cited By ~ 18

Author(s):

Melissa M. Amick ◽

Alexandra Clark ◽

Catherine B. Fortier ◽

Michael Esterman ◽

Ann M. Rasmusson ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Executive Control ◽

Reaction Times ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Decision Bias ◽

Affective Stimuli ◽

The Impact

AbstractIndividuals with post-traumatic stress disorder (PTSD) show a cognitive bias for threatening information, reflecting dysregulated executive control for affective stimuli. This study examined whether comorbid mild Traumatic Brain Injury (mTBI) with PTSD exacerbates this bias. A computer-administered Affective Go/No-Go task measured reaction times (RTs) and errors of omission and commission to words with a non–combat-related positive or negative valence in 72 deployed United States service members from the wars in Iraq and Afghanistan. Incidents of military-related mTBI were measured with the Boston Assessment of Traumatic Brain Injury-Lifetime. PTSD symptoms were measured with the Clinician-Administered PTSD Scale. Participants were divided into those with (mTBI+, n = 34) and without a history of military-related mTBI (mTBI−, n = 38). Valence of the target stimuli differentially impacted errors of commission and decision bias (criterion) in the mTBI+ and mTBI− groups. Specifically, within the mTBI+ group, increasing severity of PTSD symptoms was associated with an increasingly liberal response pattern (defined as more commission errors to negative distractors and greater hit rate for positive stimuli) in the positive compared to the negative blocks. This association was not observed in the mTBI− group. This study underscores the importance of considering the impact of a military-related mTBI and PTSD severity upon affective executive control. (JINS, 2013, 19, 1–10)

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Beta blocker use in traumatic brain injury based on the high-sensitive troponin status (BBTBBT): methodology and protocol implementation of a double-blind randomized controlled clinical trial

Trials ◽

10.1186/s13063-021-05872-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ayman El-Menyar ◽

Mohammad Asim ◽

Ahmed Abdel-Aziz Bahey ◽

Talat Chughtai ◽

Abdulnasser Alyafai ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Calcium Binding ◽

Troponin T ◽

Controlled Clinical Trial ◽

Post Injury ◽

Double Blind ◽

Severity Of Injury ◽

The Impact ◽

High Sensitive Troponin

Abstract Background Beta-adrenergic receptor blockers (BB) play an important role in the protection of organs that are susceptible for secondary injury due to stress-induced adrenergic surge. However, the use of BB in traumatic brain injury (TBI) patients is not yet the standard of care which necessitates clear scientific evidence to be used. The BBTBBT study aims to determine whether early administration of propranolol based on the high-sensitive troponin T(HsTnT) status will improve the outcome of TBI patients. We hypothesized that early propranolol use is effective in reducing 10- and 30-day mortality in TBI patients. Secondary outcomes will include correlation between serum biomarkers (troponin, epinephrine, cytokines, enolase, S100 calcium binding protein B) and the severity of injury and the impact of BB use on the duration of hospital stay and functional status at a 3-month period. Methods The BBTBBT study is a prospective, randomized, double-blinded, placebo-controlled three-arm trial of BB use in mild-to-severe TBI patients based on the HsTnT status. All enrolled patients will be tested for HsTnT at the first 4 and 6 h post-injury. Patients with positive HsTnT will receive BB if there is no contraindication (group 1). Patients with negative HsTnT will be randomized to receive either propranolol (group 2) or placebo (group 3). The time widow for receiving the study treatment is the first 24 h post-injury. Discussion Early BB use may reduce the catecholamine storm and subsequently the cascade of immune and inflammatory changes associated with TBI. HsTnT could be a useful fast diagnostic and prognostic tool in TBI patients. This study will be of great clinical interest to improve survival and functional outcomes of TBI patients. Trial registration ClinicalTrials.gov NCT04508244. Registered on 7 August 2020. Recruitment started on 29 December 2020 and is ongoing.

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A-15 PTSD Symptoms Are Related to Cognition Following Complicated Mild and Moderate TBI, but Not Severe and Penetrating TBI

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.16 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1037-1037

Author(s):

Sara M Lippa ◽

Tracey A Brickell ◽

Louis M French ◽

Rael T Lange

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Performance ◽

Military Service ◽

Neuropsychological Performance ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Injury ◽

History Of ◽

Severe Tbi

Abstract Objective Despite the strong evidence suggesting post-traumatic stress disorder (PTSD) symptoms negatively impact cognition following mild traumatic brain injury (TBI), little is known about this relationship in more severe TBI. This study investigates the relationship between PTSD symptoms and cognitive performance following complicated mild, moderate, severe, and penetrating TBI. Methods Participants were 137 U.S. military service members and veterans (SMVs) with a history of complicated mild or more severe TBI prospectively enrolled in the Defense and Veterans Brain Injury Center (DVBIC)/Traumatic Brain Injury Center of Excellence (TBICoE) 15-Year Longitudinal TBI Study. Participants were divided into two groups: complicated mild/moderate TBI (n = 64) and severe/penetrating TBI (n = 73). Participants completed a neuropsychological assessment, including the PTSD Checklist-Civilian Version one year or more post-injury. Six neuropsychological composite scores and an overall test battery mean (OTBM) were considered. Participants who failed symptom validity tests were excluded. Hierarchical linear regressions were conducted evaluating neuropsychological performance. Results TBI severity (βs:-0.163 to −0.253, ps < 0.04) and PTSD symptoms (βs:-0.189 to −0.212), ps < 0.03) were related to neuropsychological performance in the overall sample. Within the severe/penetrating TBI group, PTSD symptoms were unrelated to cognitive performance. Within the complicated mild/moderate TBI group, PTSD symptoms were significantly related to processing speed (R2Δ = 0.080, β = −0.284, p = 0.016), immediate memory (R2Δ = 0.204, β = −0.453, p < 0.001), delayed memory (R2Δ = 0.180, β = −0.426, p < 0.001), executive functioning (R2Δ = 0.102, β = −0.319, p = 0.007), and the OTBM (R2Δ = 0.170, β = −0.413, p < 0.001). Discussion PTSD symptom severity was significantly related to neuropsychological performance in SMVs with complicated mild/moderate TBI. PTSD symptoms should be considered when evaluating patients with a history of complicated mild to moderate TBI.

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