Predictors of postconcussive symptoms 3 months after mild traumatic brain injury.
ABSTRACT There is continuing controversy regarding predictors of poor outcome following mild traumatic brain injury (mTBI). This study aimed to prospectively examine the influence of preinjury factors, injury-related factors, and postinjury factors on outcome following mTBI.
Participants were 123 patients with mTBI and 100 trauma patient controls recruited and assessed in the emergency department and followed up 1 week and 3 months postinjury. Outcome was measured in terms of reported postconcussional symptoms. Measures included the ImPACT Post-Concussional Symptom Scale and cognitive concussion battery, including Attention, Verbal and Visual memory, Processing Speed and Reaction Time modules, pre- and postinjury SF-36 and MINI Psychiatric status ratings, VAS Pain Inventory, Hospital Anxiety and Depression Scale, PTSD Checklist-Specific, and Revised Social Readjustment Scale.
Presence of mTBI predicted postconcussional symptoms 1 week postinjury, along with being female and premorbid psychiatric history, with elevated HADS anxiety a concurrent indicator. However, at 3 months, preinjury physical or psychiatric problems but not mTBI most strongly predicted continuing symptoms, with concurrent indicators including HADS anxiety, PTSD symptoms, other life stressors and pain. HADS anxiety and age predicted 3-month PCS in the mTBI group, whereas PTSD symptoms and other life stressors were most significant for the controls. Cognitive measures were not predictive of PCS at 1 week or 3 months.
Given the evident influence of both premorbid and concurrent psychiatric problems, especially anxiety, on postinjury symptoms, managing the anxiety response in vulnerable individuals with mTBI may be important to minimize ongoing sequelae.
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ABSTRACT: Post-traumatic amnesia (PTA) is an acute characteristic of traumatic brain injury (TBI) and the duration of PTA is commonly used to estimate the severity of brain injury. In the context of mild traumatic brain injury (MTBI), PTA is an essential part of the routine clinical assessment. Macroscopic lesions in temporal lobes, especially hippocampal regions, are thought to be connected to the memory loss. However, conventional neuroimaging has failed to reveal neuropathological correlates of PTA in MTBI. Texture analysis (TA) is an image analysis technique that quantifies the minor MRI signal changes among image pixels and thus the variations in intensity patterns within the image. The objective of this work was to apply the TA technique to MR images of MTBI patients and control subjects and to assess the microstructural damage in medial temporal lobes of patients with MTBI with definite PTA. TA was performed for Flair images of 50 MTBI patients and 50 age- and gender-matched controls in the regions of amygdala, hippocampus, and thalamus. It was hypothesized that (i) there would be statistically significant differences in TA parameters between patients with MTBIs and controls, and (ii) the duration of PTA would be related to TA parameters in patients with MTBI. No significant textural differences were observed between patients and controls in the regions of interest (p > 0.01). No textural features were observed to correlate with the duration of PTA. Subgroup analyses were conducted on patients with PTA of over one hour (n=33) and compared the four TA parameters to the age- and gender-matched controls (n=33). The findings were similar. This study did not reveal significant textural changes in medial temporal structures that could be related to the duration of PTA.Journal of neurotrauma 03/2014; · 4.25 Impact Factor
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ABSTRACT: The Sports Concussion Assessment Tool-2 (SCAT2) is a posttrauma evaluative screener for concussion. Although a revised version (SCAT3) recently was released, the SCAT2 continues in use. Moreover, there have been no reports of normative values with college athletes with the SCAT2 or SCAT3. Similar to the SCAT3, the SCAT2 includes a 22-item self-report symptom scale, the Standardized Assessment of Concussion (SAC), and a hard surface-only version of the Balance Error Scoring System (BESS). The SCAT3 does not employ a total score and adds an optional gait component. The purpose of this study was to develop normative values for collegiate athletes on the SCAT2 and its subparts with respect to sex, collision risk by sport, and concussion history. In preseason, 477 college athletes (332 male, 145 female) completed the SCAT2. The average total score was 91.08 (SD = 5.60). The average number of symptoms endorsed was 1.75. Average SAC and BESS scores were 27.17 (SD = 2.01) and 25.64 (SD = 4.07), respectively. Little or no difference was found in total and component scores due to sex, sport type, or concussion history. When baseline measurement is lacking, these data provide a good benchmark for interpreting SCAT2 and SCAT3 performance.Applied Neuropsychology: Adult 08/2014; · 1.32 Impact Factor
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ABSTRACT: Abstract Objectives: To evaluate exaggerated reaction to novelty as a behavioural marker of sub-clinical cognitive dysfunction in individuals with a history of mild traumatic brain injury (mTBI). Background and hypothesis: A sub-set of individuals who sustain mTBIs report persistent cognitive difficulties despite normal performance on traditional neuropsychological measures. Evidence of subtle neuroimaging abnormalities following mTBI lends support to such subjective complaints. However, behavioural evidence is limited. This study examined whether behavioural response to task novelty ('novelty effect' or NE) is exaggerated in mTBI (NE has previously successfully identified pre-clinical cognitive decline among older adults). It was hypothesized that individuals with a history of mTBI would exhibit increased NE relative to controls, despite normal performance on traditional neuropsychological measures. Methods: Thirty-eight male criminal offenders completed semi-structured interviews of their mTBI and other history, conventional neuropsychological testing and a computerized motor planning task that quantified NE. Results: As expected, participants with a history of mTBI exhibited significantly greater NE, despite no group differences in traditional neuropsychological test performance. A greater number of injuries was positively related to NE magnitude and unrelated to traditional measures. Conclusions: Increased NE indexes sub-clinical sequelae of mTBI and may represent a general marker of mild neurological dysfunction.Brain Injury 03/2014; · 1.51 Impact Factor