Post-traumatic Headache and Mild Traumatic Brain Injury: Brain Networks and Connectivity.

PURPOSE OF REVIEW: Post-traumatic headache (PTH) consequent to mild traumatic brain injury (mTBI) is a complex, multidimensional, chronic neurological disorder. The purpose of this review is to evaluate the current neuroimaging studies on mTBI and PTH with a specific focus on brain networks and connectivity patterns. RECENT FINDINGS: We present findings on PTH incidence and prevalence, as well as the latest neuroimaging research findings on mTBI and PTH. Additionally, we propose a new strategy in studying PTH following mTBI. The diversity and heterogeneity of pathophysiological mechanisms underlying mild traumatic brain injury pose unique challenges on how we interpret neuroimaging findings in PTH. Evaluating alterations in the intrinsic brain network connectivity patterns using novel imaging and analytical techniques may provide additional insights into PTH disease state and therefore inform effective treatment strategies.

Central adiposity is negatively associated with hippocampal-dependent relational memory among overweight and obese children.

OBJECTIVE: To assess associations between adiposity and hippocampal-dependent and hippocampal-independent memory forms among prepubertal children. STUDY DESIGN: Prepubertal children (age 7-9 years; n = 126), classified as non-overweight (<85th percentile body mass index [BMI]-for-age [n = 73]) or overweight/obese (≥85th percentile BMI-for-age [n = 53]), completed relational (hippocampal-dependent) and item (hippocampal-independent) memory tasks. Performance was assessed with both direct (behavioral accuracy) and indirect (preferential disproportionate viewing [PDV]) measures. Adiposity (ie, percent whole-body fat mass, subcutaneous abdominal adipose tissue, visceral adipose tissue, and total abdominal adipose tissue) was assessed by dual-energy X-ray absorptiometry. Backward regression identified significant (P < .05) predictive models of memory performance. Covariates included age, sex, pubertal timing, socioeconomic status (SES), IQ, oxygen consumption, and BMI z-score. RESULTS: Among overweight/obese children, total abdominal adipose tissue was a significant negative predictor of relational memory behavioral accuracy, and pubertal timing together with SES jointly predicted the PDV measure of relational memory. In contrast, among non-overweight children, male sex predicted item memory behavioral accuracy, and a model consisting of SES and BMI z-score jointly predicted the PDV measure of relational memory. CONCLUSION: Regional, but not whole-body, fat deposition was selectively and negatively associated with hippocampal-dependent relational memory among overweight/obese prepubertal children.

Neurodevelopmental Disorders and Risk of Concussion: Findings from the National Collegiate Athletic Association Department of Defense Grand Alliance Concussion Assessment, Research, and Education (NCAA-DOD CARE) Consortium (2014-2017).

Evidence suggests neurodevelopmental disorders (NDs) may be associated with an increased incidence of concussion, but no studies have cross-sectionally and longitudinally assessed the associations of NDs and sex with concussion in collegiate athletes. We sought to assess the odds and relative risk (RR) of concussion in athletes self-reporting a diagnosis of attention deficit/hyperactivity disorder (ADHD), learning disability (LD), and ADHD+LD. Data from the Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) were used to evaluate the likelihood of concussion for male and female athletes with ADHD, LD, and ADHD+LD, relative to controls. Odds ratios (ORs) of concussion history prior to enrollment and relative risk ratios for incurring a concussion following enrollment, with and without concussion history were calculated for all groups. Athletes with self-reported diagnosis of ADHD, LD, and ADHD+LD were more likely to report a single concussion (OR range = 1.528 to 1.828) and multiple concussions (OR range = 1.849 to 2.365) prior to enrollment in the CARE Consortium, irrespective of sex compared with control athletes. While enrolled in CARE, male athletes with ADHD, LD, and ADHD+LD had greater risk of incurring a concussion (RR range = 1.369 to 2.243) than controls, irrespective of concussion history. Male athletes with ADHD+LD with concussion history (RR = 2.221) and without concussion history (RR = 1.835) had greater risk of incurring a concussion than controls. These results suggest NDs may be associated with increased odds of single and multiple concussions, irrespective of sex. However, when we accounted for concussion history, it appears only male athletes with ADHD+LD had greater risk than respective controls. There were no significant differences between females and males with ADHD, LD, or ADHD+LD for either odds of concussion history or risk for incurring concussion.

QEEG correlates of cognitive processing speed in children and adolescents with traumatic brain injuries.

Both quantitative electroencephalography (qEEG) and cognitive measures have been used to understand the underlying brain changes that occur in individuals after experiencing a traumatic brain injury, however, research exploring the relationship between qEEG patterns and cognitive test performance is scarcely studied in school-aged populations. The purpose of the present study was to explore first, the neuropsychological and academic deficits in young individuals with TBI; and second, the underlying relationship between qEEG patterns and cognitive test performance. Analyses included 21 school-aged participants whom have experienced a recent TBI and 15 school-aged participants whom have never experienced a TBI. Mean subtest and composite scores were compared and regression analyses were used to determine whether alpha band and beta band qEEG coherence values predicted processing speed measures. Results suggest that young individuals who experienced a recent TBI exhibit general deficits in cognition and academic skills beyond what would be expected in the general population. Further, beta band coherence with the frontal brain regions significantly predicted processing speed scores, providing evidence of a relationship between qEEG patterns and processing speed. This outlines a relatively inexpensive method for utilizing neural connectivity to verify cognitive deficits for school-aged individuals with a recent TBI.

The long-term outcomes of sport-related concussion in pediatric populations.

Although the field of concussion research is rapidly growing, the majority of research has focused on injured adults, with children being an often-neglected population. Traumatic brain injury is a leading cause of death and disability in children, with over 1.5 million cases being treated in North America annually. Approximately 75% of these injuries are classified as a concussion. Further, children are disproportionately affected by sports-related injuries, with 65% of all pediatric concussions occurring during sport and recreation. Therefore, understanding the outcomes of pediatric sportrelated concussion is of great importance, particularly given the vulnerability of the developing brain. The purpose of this review is to provide an up-to-date understanding of the outcomes of pediatric sport-related concussion from a data-driven perspective, focusing heavily on experimental studies.

Sensitivity to sounds in sport-related concussed athletes: a new clinical presentation of hyperacusis.

Sensitivity to sounds is one frequent symptom of a sport-related concussion, but its assessment rarely goes beyond a single question. Here we examined sensitivity to sounds using psychoacoustic and psychometric outcomes in athletes beyond the acute phase of injury. Fifty-eight college athletes with normal hearing who either had incurred one or more sport-related concussions (N = 28) or who had never suffered head injury (N = 30) participated. Results indicated that the Concussed group scored higher on the Hyperacusis questionnaire and displayed greater sensitivity to sounds in psychoacoustic tasks compared to the Control group. However, further analyses that separated the Concussed group in subgroups with Sound sensitivity symptom (N = 14) and Without sound sensitivity symptom (N = 14) revealed that athletes with the sound complaint were the ones responsible for the effect: Concussed athletes with self-reported sound sensitivity had lower Loudness Discomfort Thresholds (LDLs), higher Depression and Hyperacusis scores, and shifted loudness growth functions compared to the other subgroup. A simple mediation model disclosed that LDLs exert their influence both directly on Hyperacusis scores as well as indirectly via depressive symptoms. We thus report a new clinical presentation of hyperacusis and discuss possible mechanisms by which it could arise from concussion.

Effects of the FITKids physical activity randomized controlled trial on conflict monitoring in youth.

The present study investigated the effect of a 9-month physical activity (PA) intervention on children's cardiorespiratory fitness levels and neuroelectric indices of conflict monitoring (i.e., error-related negativity, ERN). Four hundred twenty-eight preadolescent children (8-9 years old) were randomized into a PA intervention or wait-list control group, and completed a fitness and cognitive control assessment (i.e., modified flanker task) at pre- and posttest. Following exclusion criterion, 308 children were included in the analyses (PA intervention: n = 139; wait-list control: n = 169). Children in the intervention displayed greater improvements in fitness and response accuracy, which were accompanied by stability of ERN amplitude from pre- to posttest. In contrast, the control group revealed increased ERN amplitude at posttest compared to pretest, despite no change in fitness or task performance. These findings demonstrate the efficacy of daily PA for promoting children's fitness and underlying neural processes associated with effective conflict monitoring. Such findings have significant implications for promoting organized PA programs intended to foster overall physical and brain health in school age children.

The independent influence of concussive and sub-concussive impacts on soccer players' neurophysiological and neuropsychological function.

Accumulating research demonstrates that repetitive sub-concussive impacts can alter the structure, function and connectivity of the brain. However, the functional significance of these alterations as well as the independent contribution of concussive and sub-concussive impacts to neurophysiological and neuropsychological health are unclear. Accordingly, we compared the neurophysiological and neuropsychological function of contact athletes with (concussion group) and without (sub-concussion group) a history of concussion, to non-contact athletes. We evaluated event-related brain potentials (ERPs) elicited during an oddball task and performance on a targeted battery of neuropsychological tasks. Athletes in the sub-concussion and concussion groups exhibited similar amplitude reductions in the ERP indices of attentional resource allocation (P3b) and attentional orienting (P3a) relative to non-contact athletes. However, only athletes in the concussion group exhibited reduced amplitude in the ERP index of perceptual attention (N1). Athletes in the sub-concussion and concussion groups also exhibited deficits in memory recall relative to non-contact athletes, but athletes in the concussion group also exhibited significantly more recall errors than athletes in the sub-concussion group. Additionally, only athletes in the concussion group exhibited response delays during the oddball task. The current findings suggest that sub-concussive impacts are associated with alterations in the neurophysiological and neuropsychological indices of essential cognitive functions, albeit to a lesser degree than the combination of sub-concussive and concussive impacts.

The influence of cardiorespiratory fitness on strategic, behavioral, and electrophysiological indices of arithmetic cognition in preadolescent children.

The current study investigated the influence of cardiorespiratory fitness on arithmetic cognition in forty 9-10 year old children. Measures included a standardized mathematics achievement test to assess conceptual and computational knowledge, self-reported strategy selection, and an experimental arithmetic verification task (including small and large addition problems), which afforded the measurement of event-related brain potentials (ERPs). No differences in math achievement were observed as a function of fitness level, but all children performed better on math concepts relative to math computation. Higher fit children reported using retrieval more often to solve large arithmetic problems, relative to lower fit children. During the arithmetic verification task, higher fit children exhibited superior performance for large problems, as evidenced by greater d' scores, while all children exhibited decreased accuracy and longer reaction time for large relative to small problems, and incorrect relative to correct solutions. On the electrophysiological level, modulations of early (P1, N170) and late ERP components (P3, N400) were observed as a function of problem size and solution correctness. Higher fit children exhibited selective modulations for N170, P3, and N400 amplitude relative to lower fit children, suggesting that fitness influences symbolic encoding, attentional resource allocation and semantic processing during arithmetic tasks. The current study contributes to the fitness-cognition literature by demonstrating that the benefits of cardiorespiratory fitness extend to arithmetic cognition, which has important implications for the educational environment and the context of learning.

Acute exercise facilitates brain function and cognition in children who need it most: an ERP study of individual differences in inhibitory control capacity.

The present study examined the effects of moderate-intensity aerobic exercise on aspects of cognitive control in two groups of children categorized by higher- and lower-task performance. Event-related brain potentials (ERPs) were collected in 40 preadolescent children during a modified flanker task following 20 min of treadmill walking and seated rest on separate occasions. Participants were bifurcated into two groups based on task performance following the resting session. Findings revealed that following exercise, higher-performers maintained accuracy and exhibited no change in P3 amplitude compared to seated rest. Lower-performers demonstrated a differential effect, such that accuracy measures improved, and P3 amplitude increased following exercise. Lastly, both groups displayed smaller N2 amplitude and shorter P3 latency following exercise, suggesting an overall facilitation in response conflict and the speed of stimulus classification. The current findings replicate prior research reporting the beneficial influence of acute aerobic exercise on cognitive performance in children. However, children with lower inhibitory control capacity may benefit the most from single bouts of exercise. These data are among the first to demonstrate the differential effect of physical activity on individuals who vary in inhibitory control, and further support the role of aerobic exercise for brain health during development.

Dietary lipids are differentially associated with hippocampal-dependent relational memory in prepubescent children.

BACKGROUND: Studies in rodents and older humans have shown that the hippocampus-a brain structure critical to relational/associative memory-has remarkable plasticity as a result of lifestyle factors (eg, exercise). However, the effect of dietary intake on hippocampal-dependent memory during childhood has remained unexamined. OBJECTIVE: We investigated the cross-sectional relation of dietary components characteristic of the Western diet, including saturated fatty acids (SFAs), omega-3 (n-3) fatty acids, and refined sugar, with hippocampal-dependent relational memory in prepubescent children. DESIGN: Participants aged 7-9 y (n = 52) reported their dietary intake by using the Youth-Adolescent Food-Frequency Questionnaire and completed memory tasks designed to assess relational (hippocampal-dependent) and item (hippocampal-independent) memory. Performance on the memory tasks was assessed with both direct (accuracy) and indirect (eye movement) measures. RESULTS: Partial correlations adjusted for body mass index showed a positive relation between relational memory accuracy and intake of omega-3 fatty acids and a negative relation of both relational and item memory accuracy with intake of SFAs. Potential confounding factors of age, sex, intelligence quotient, socioeconomic status, pubertal timing, and aerobic fitness (maximal oxygen volume) were not significantly related to any of the dietary intake measures. Eye movement measures of relational memory (preferential viewing to the target stimulus) showed a negative relation with intake of added sugar. CONCLUSIONS: SFA intake was negatively associated with both forms of memory, whereas omega-3 fatty acid intake was selectively positively associated with hippocampal-dependent relational memory. These findings are among the first to show a link between habitual dietary intake and cognitive health as pertaining to hippocampal function in childhood. The Fitness Improves Thinking Kids (FITKids) and FITKids2 trials were registered at www.clinicaltrials.gov as NCT01334359 and NCT01619826, respectively.

White matter microstructure is associated with cognitive control in children.

Cognitive control, which involves the ability to pay attention and suppress interference, is important for learning and achievement during childhood. The white matter tracts related to control during childhood are not well known. We examined the relationship between white matter microstructure and cognitive control in 61 children aged 7-9 years using diffusion tensor imaging (DTI). This technique enables an in vivo characterization of microstructural properties of white matter based on properties of diffusion. Such properties include fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity, measures thought to reflect specific biological properties of white matter integrity. Our results suggest that children with higher estimates of white matter integrity in the corona radiata, superior longitudinal fasciculus, posterior thalamic radiation, and cerebral peduncle were more accurate during incongruent (> > < > >, < < > < <) and neutral (-->-, --<--) trials of a task of cognitive control. Importantly, less interference during the task (i.e., incongruent and neutral difference scores) was associated with greater white matter microstructure in the posterior thalamic radiation and cerebral peduncle. Fiber tracts in a frontal-parietal-striatal-motor circuit seem to play a role in cognitive control in children.