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OBJECTIVE: Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adult's access to and engagement with mental health care). These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older adults who have experienced significant stress events, particularly elder mistreatment, within a larger trauma specialty clinic. Leveraging home-based telemedicine, the clinic provides evidence-based psychotherapy tailored to older adults' needs. METHODS: From 2021 through 2023, the authors retrospectively examined treatment initiation, engagement, completion, and clinical outcomes among 231 older adults age 60+ who reported trauma that met DSM-5 criterion A criteria for Post-traumatic Stress Disorder (PTSD), depression and other mental health comorbid conditions related to their traumatic event. The clinic uses an automated measurement-based care approach that facilitates Quality Improvement projects, allowing us to track treatment initiation, engagement, completion, and clinical outcomes for all patients. RESULTS: The results indicated high treatment completion, high engagement with telemedicine-delivered interventions, and, most importantly, significant changes in clinical outcomes. CONCLUSION: These findings highlight the importance of expanding telemedicine-based mental health services for older adults, challenging ageist norms, and prioritizing older adults' mental health needs by providing tailored services to this patient population.
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Deficits in verbal learning and memory are a prominent feature of neurocognitive function in HIV-infected women, and are associated with high levels of perceived stress. To understand the neurobiological factors contributing to this stress-related memory impairment, we examined the association between stress, verbal memory, and brain volumes in HIV-infected women. Participants included 38 HIV-infected women (Mean age=43.9years) from the Chicago Consortium of the Women's Interagency HIV Study (WIHS). Participants underwent structural magnetic resonance imaging (MRI) and completed standardized measures of verbal learning and memory and stress (Perceived Stress Scale-10; PSS-10). Brain volumes were evaluated in a priori regions of interest, including the medial temporal lobe (MTL) and prefrontal cortex (PFC). Compared to HIV-infected women with lower stress (PSS-10 scores in lower two tertiles), HIV-infected women with higher stress (scores in the top tertile), performed worse on measures of verbal learning and memory and showed smaller volumes bilaterally in the parahippocampal gyrus, superior frontal gyrus, middle frontal gyrus, and inferior frontal gyrus (p's<0.05). Reduced volumes in the inferior frontal gyrus, middle frontal gyrus, and superior frontal gyrus (all right hemisphere) were negatively associated with verbal learning and memory performance. Prefrontal cortical atrophy is associated with stress-related deficits in verbal learning and memory in HIV-infected women. The time course of these volume losses in relation to memory deficits has yet to be elucidated, but the magnitude of the volumetric differences between women with higher versus lower stress suggests a prolonged vulnerability due to chronic stress and/or early life trauma.
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Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/psicología , Discapacidades para el Aprendizaje/diagnóstico por imagen , Trastornos de la Memoria/diagnóstico por imagen , Corteza Prefrontal/diagnóstico por imagen , Estrés Psicológico/diagnóstico por imagen , Adulto , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Discapacidades para el Aprendizaje/etiología , Modelos Lineales , Estudios Longitudinales , Imagen por Resonancia Magnética , Trastornos de la Memoria/etiología , Persona de Mediana Edad , Análisis Multivariante , Pruebas Neuropsicológicas , Tamaño de los Órganos , Percepción del Habla , Estrés Psicológico/complicaciones , Lóbulo Temporal/diagnóstico por imagenRESUMEN
HIV-infected women may be particularly vulnerable to verbal learning and memory deficits. One factor contributing to these deficits is high perceived stress, which is associated with prefrontal cortical (PFC) atrophy and memory outcomes sensitive to PFC function, including retrieval and semantic clustering. We examined the association between stress and PFC activation during a verbal memory task in 36 HIV-infected women from the Chicago Consortium of the Women's Interagency HIV Study (WIHS) to better understand the role of the PFC in this stress-related impairment. Participants completed standardized measures of verbal learning and memory and stress (perceived stress scale-10). We used functional magnetic resonance imaging to assess brain function while participants completed encoding and recognition phases of a verbal memory task. HIV-infected women with higher stress (scores in top tertile) performed worse on all verbal memory outcomes including strategic encoding (p < 0.05) compared to HIV-infected women with lower stress (scores in lower two tertiles). Patterns of brain activation during recognition (but not encoding) differed between women with higher vs. lower stress. During recognition, women with higher stress demonstrated greater deactivation in medial PFC and posterior cingulate cortex compared to women with lower stress (p < 0.05). Greater deactivation in medial PFC marginally related to less efficient strategic retrieval (p = 0.06). Similar results were found in analyses focusing on PTSD symptoms. Results suggest that stress might alter the function of the medial PFC in HIV-infected women resulting in less efficient strategic retrieval and deficits in verbal memory.
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Giro del Cíngulo/diagnóstico por imagen , Infecciones por VIH/complicaciones , Corteza Prefrontal/diagnóstico por imagen , Estrés Psicológico/complicaciones , Adulto , Mapeo Encefálico , Femenino , Giro del Cíngulo/fisiopatología , Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/fisiopatología , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Recuerdo Mental/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Corteza Prefrontal/fisiopatología , Índice de Severidad de la Enfermedad , Estrés Psicológico/diagnóstico por imagen , Estrés Psicológico/fisiopatología , Aprendizaje Verbal/fisiologíaRESUMEN
Traumatic brain injury (TBI) is a leading cause of death and disability in every developed country in the world and is believed to be a risk factor in the later development of depression, anxiety disorders and neurodegenerative diseases including chronic traumatic encephalopathy (CTE), Alzheimer's Disease (AD), Parkinson's Disease (PD), and amyotrophic lateral sclerosis (ALS). One challenge faced by those who conduct research into TBI is the lack of a verified and validated biomarker that can be used to diagnose TBI or for use as a prognostic variable which can identify those at risk for poor recovery following injury or at risk for neurodegeneration later in life. Neuroimaging continues to hold promise as a TBI biomarker but is limited by a lack of clear relationship between the neuropathology of injury/recovery and the quantitative and image based data that is obtained. Specifically lacking is the data on biochemical and biologic changes that lead to alterations in neuroimaging markers. There are multiple routes towards developing the knowledge required to more definitively link pathology to imaging but the most efficient approach is expanded leveraging of in vivo human blood, serum, and imaging biomarkers with both in vivo and ex vivo animal findings. This review describes the current use and limitations of imaging in TBI including a discussion of currently used animal injury models and the available animal imaging data and extracted markers that hold the greatest promise for helping translate alterations in imaging back to injury pathology. Further, it reviews both the human and animal TBI literature supporting current standards, identifies the remaining voids in the literature, and briefly highlights recent advances in molecular imaging. This article is part of a Special Issue entitled 'Traumatic Brain Injury'.
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Biomarcadores/sangre , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/patología , Enfermedades Neurodegenerativas/diagnóstico , Enfermedades Neurodegenerativas/patología , Neuroimagen , Animales , Encéfalo/metabolismo , Encéfalo/patología , Humanos , Factores de RiesgoRESUMEN
The Val158Met (rs4680) single-nucleotide polymorphism (SNP) of the catechol-O-methyltransferase gene (COMT) influences executive function and prefrontal function through its effect on dopamine (DA) metabolism. Both HIV and the Val allele of the Val158Met SNP are associated with compromised executive function and inefficient prefrontal function. The present study used behavioral and neuroimaging techniques to determine independent and interactive associations between HIV serostatus and COMT genotype on working memory and prefrontal function in women. For the behavioral study, 54 HIV-infected and 33 HIV-uninfected women completed the 0-, 1-, and 2-back conditions of the verbal N-back, a working memory test. For the imaging study, 36 women (23 HIV-infected, 13 HIV-uninfected) underwent functional magnetic resonance imaging (fMRI) assessments while completing the N-back task. HIV-infected women demonstrated significantly worse N-back performance compared with HIV-uninfected women (p < 0.05). A significant serostatus by genotype interaction (p < 0.01) revealed that, among Val/Val, but not Met allele carriers, HIV-infected women performed significantly worse than HIV-uninfected controls across N-back conditions (p < 0.01). Analogous to behavioral findings, a serostatus by genotype interaction revealed that HIV-infected Val/Val carriers showed significantly greater prefrontal activation compared with HIV-uninfected Val/Val carriers (p < 0.01). Conversely, HIV-uninfected Met allele carriers demonstrated significantly greater prefrontal activation compared with HIV-infected Met allele carriers. Findings suggest that the combination of HIV infection and the Val/Val COMT genotype leads to working memory deficits and altered prefrontal function in HIV-infected individuals.
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Catecol O-Metiltransferasa/genética , Infecciones por VIH/genética , Infecciones por VIH/psicología , Memoria a Corto Plazo , Polimorfismo de Nucleótido Simple , Corteza Prefrontal/fisiopatología , Adulto , Alelos , Estudios de Casos y Controles , Función Ejecutiva , Femenino , Expresión Génica , Genotipo , Infecciones por VIH/fisiopatología , Infecciones por VIH/virología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Pruebas Neuropsicológicas , Corteza Prefrontal/virología , SerotipificaciónRESUMEN
Crack cocaine use is associated with impaired verbal memory in HIV-infected women more than uninfected women. To understand the neural basis for this impairment, this study examined the effects of crack cocaine use on activation of the prefrontal cortex (PFC) and strategic encoding during a verbal memory task in HIV-infected women. Three groups of HIV-infected women from the Chicago Consortium of the Women's Interagency HIV Study were compared: current users of crack cocaine (n = 10), former users of cocaine (n = 11), and women who had never used cocaine (n = 9). Participants underwent functional magnetic resonance imaging during a verbal memory task and completed a neuropsychological test of verbal memory. On the neuropsychological test, current crack users performed significantly worse than other groups on semantic clustering, a measure of strategic encoding, p < 0.05. During encoding, activation in left anterior cingulate cortex (ACC) was lower in current and former cocaine users compared to never users. During recognition, activation in bilateral PFC, specifically left dorsal medial PFC and bilateral dorsolateral PFC, was lower in current and former users compared to women who had never used cocaine. Lower activation in left dorsolateral PFC was correlated with worse performance on the recognition task, p < 0.05. The verbal learning and memory deficits associated with cocaine use in women with HIV may be partially accounted for by alterations in ACC and PFC function.
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Cocaína Crack/efectos adversos , Giro del Cíngulo/efectos de los fármacos , Infecciones por VIH/complicaciones , Corteza Prefrontal/efectos de los fármacos , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
Population-based studies have supported the hypothesis that a positive history of traumatic brain injury (TBI) is associated with an increased incidence of neurological disease and psychiatric comorbidities, including chronic traumatic encephalopathy, Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. These epidemiologic studies, however, do not offer a clear definition of that risk, and leave unanswered the bounding criteria for greater lifetime risk of neurodegeneration. Key factors that likely mediate the degree of risk of neurodegeneration include genetic factors, significant premorbid and comorbid medical history (e.g. depression, multiple head injuries and repetitive subconcussive impact to the brain, occupational risk, age at injury, and severity of brain injury). However, given the often-described concerns in self-report accuracy as it relates to history of multiple TBIs, low frequency of patient presentation to a physician in the case of mild brain injuries, and challenges with creating clear distinctions between injury severities, disentangling the true risk for neurodegeneration based solely on population-based studies will likely remain elusive. Given this reality, multiple modalities and approaches must be combined to characterize who are at risk so that appropriate interventions to alter progression of neurodegeneration can be evaluated. This article presents data from a study that highlights uses of neuroimaging and areas of needed research in the link between TBI and neurodegenerative disease.
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Lesiones Encefálicas/patología , Encéfalo/patología , Enfermedades Neurodegenerativas/epidemiología , Adulto , Lesiones Encefálicas/epidemiología , Enfermedad Crónica , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are signature injuries of the wars in Iraq and Afghanistan and have been linked to an increased risk of Alzheimer's disease (AD) and other dementias. A meeting hosted by the Alzheimer's Association and the Veterans' Health Research Institute (NCIRE) in May 2012 brought together experts from the U.S. military and academic medical centers around the world to discuss current evidence and hypotheses regarding the pathophysiological mechanisms linking TBI, PTSD, and AD. Studies underway in civilian and military populations were highlighted, along with new research initiatives such as a study to extend the Alzheimer's Disease Neuroimaging Initiative (ADNI) to a population of veterans exposed to TBI and PTSD. Greater collaboration and data sharing among diverse research groups is needed to advance an understanding and appropriate interventions in this continuum of military injuries and neurodegenerative disease in the aging veteran.
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Enfermedad de Alzheimer/epidemiología , Personal Militar , Salud de los Veteranos , Campaña Afgana 2001- , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/etiología , Enfermedad de Alzheimer/metabolismo , Biomarcadores , Traumatismos por Explosión/epidemiología , Traumatismos por Explosión/psicología , Daño Encefálico Crónico/epidemiología , Daño Encefálico Crónico/etiología , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/psicología , Bases de Datos Factuales/estadística & datos numéricos , Diagnóstico Precoz , Programas de Gobierno/métodos , Programas de Gobierno/organización & administración , Humanos , Guerra de Irak 2003-2011 , Medicina Militar/organización & administración , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Estudios Multicéntricos como Asunto/estadística & datos numéricos , National Institute of Neurological Disorders and Stroke (U.S.) , Neuroimagen , Factores de Riesgo , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Estados Unidos , United States Department of Defense/organización & administración , United States Department of Veterans Affairs/organización & administración , Salud de los Veteranos/estadística & datos numéricosRESUMEN
PURPOSE: Collecting validated surveys that describe symptom severity (measurement based care) during evidence-based psychotherapy is crucial to allow a therapist to tailor the speed and intensity of treatment. COVID clinic closures mandated we create a flexible, remote system to conduct measurement-based care, which was accomplished via RedCap. METHODS: RedCap was used to create a semi-automated workflow allowing all clinically-indicated evidence-based surveys (including the PHQ-9) to be delivered via email to patients; with results automatically sent to their provider. Importantly, indications of suicidal ideation were automatically escalated to the provider. RESULTS: PHQ-9 completion improved, while provider burden for collecting surveys was greatly reduced; however, depending largely upon initial provider-patient 'training', overall compliance could still be significantly improved. CONCLUSION: This workflow gave providers additional information compared to the typical telemedicine environment, and in fact, improved data collection rates over our in-person environment. However, when patients did not complete measures on their own, the burden on providers increased.
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COVID-19 , Conducta Autodestructiva , Humanos , Participación del Paciente , Salud Mental , COVID-19/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Cognitive and emotional deficits have been documented in youth with pediatric bipolar disorder (PBD); however, to date, a systematic evaluation of comprehension and memory for verbally presented information has not been conducted. The effect of emotion on comprehension and memory for verbally presented material also has not been examined. We examined whether youth with PBD have difficulty recalling the big picture (macrostructure) as well as the story details (microstructure). METHODS: A total of 35 youth with PBD and 25 healthy controls completed an Affective Story Task. A psychological processing model allowed for the examination of both the macrostructure and microstructure of language comprehension. RESULTS: Youth with PBD were capable of comprehending the gist of the stories and were not impaired by emotion when comprehending and remembering macrostructure. However, negative emotional material was found to proactively interfere with the encoding and recall of microstructure. Level of depression appeared to impact recall of microstructure, but not macrostructure. CONCLUSIONS: Negatively valenced material may impair subsequent comprehension and memory for details among youth with PBD. This deficit could impact the daily functioning of these youth, as the perception of negative affect may derail aspects of successful comprehension and learning.
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Trastorno Bipolar/complicaciones , Trastornos del Conocimiento/etiología , Comprensión/fisiología , Trastornos de la Memoria/etiología , Recuerdo Mental/fisiología , Adolescente , Análisis de Varianza , Niño , Trastornos del Conocimiento/diagnóstico , Discapacidades del Desarrollo/etiología , Emociones , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Aprendizaje VerbalRESUMEN
That learning and memory deficits persist many years following mild traumatic brain injury (mTBI) is controversial due to inconsistent objective evidence supporting subjective complaints. Our prior work demonstrated significant reductions in performance on the initial trial of a verbal learning task and overall slower rate of learning in well-motivated mTBI participants relative to demographically matched controls. In our previous work, we speculated that differences in strategy use could explain the differences in rate of learning. The current study serves to test this hypothesis by examining strategy use on the California Verbal Learning Test-Second Edition. Our present findings support the primary hypothesis that mTBI participants under-utilize semantic clustering strategies during list-learning relative to control participants. Despite achieving comparable total learning scores, we posit that the persisting learning and memory difficulties reported by some mTBI patients may be related to reduced usage of efficient internally driven strategies that facilitate learning. Given that strategy training has demonstrated improvements in learning and memory in educational and occupational settings, we offer that these findings have translational value in offering an additional approach in remediation of learning and memory complaints reported by some following mTBI.
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Lesiones Encefálicas/psicología , Aprendizaje Verbal/fisiología , Adulto , Algoritmos , Análisis por Conglomerados , Femenino , Humanos , Masculino , Memoria/fisiología , Recuerdo Mental/fisiología , Pruebas NeuropsicológicasRESUMEN
Highly fluorescent CdSe quantum dots (qdots) can serve as a platform for tethering multiple copies of a receptor-targeted ligand, affording study of how the level of multivalency affects receptor binding. We previously showed that qdots conjugated with long PEG chains terminated by muscimol, a known GABA(C) agonist, exhibit specific binding to the surface membrane of GABA(C) receptor-expressing Xenopus oocytes. The present report addresses the effect of varying the number, i.e., valency, of muscimol- (M-) terminated PEG chains attached to the qdot on binding of the resulting conjugate to GABA(C) receptors. M-PEG-qdots of differing muscimol valency were prepared by conjugating AMP-CdSe/ZnS qdots with muscimol-terminated and methylamine-terminated PEG chains in proportions designed to yield varying percentages of muscimol-terminated chains among the total approximately 150-200 chains bound to the qdot. The investigated valencies represented 0%, approximately 25%, approximately 50%, and 100% loading with muscimol (preparations termed M-PEG-qdot0, M-PEG-qdot25, M-PEG-qdot50, and M-PEG-qdot100, respectively. Binding of a given conjugate to surface membranes of GABA(C) receptor-expressing oocytes was analyzed by quantitative fluorescence microscopy following defined incubation with approximately 30 nM of the conjugate. With 5-20 min incubation, the fluorescence signal resulting from incubation with M-PEG-qdot25 exceeded, by approximately 6-fold, the fluorescence level obtained with M-PEG-qdot preparations that lacked muscimol-terminated chains (M-PEG-qdot0). M-PEG-qdot50 yielded a net signal roughly similar to that of M-PEG-qdot25, and that produced by M-PEG-qdot100 exceeded, by approximately 30-50%, those for M-PEG-qdot25 and M-PEG-qdot50. The time course of changes in oocyte surface membrane fluorescence resulting from the introduction of and removal of M-PEG-qdots in the medium bathing the oocyte indicated only a modest dependence of both binding and wash-out kinetics on muscimol valency. The results demonstrate a dependence of the binding activity of the M-PEG-qdot conjugates on muscimol valency, presumably reflecting higher GABA(C) avidity and/or affinity of the muscimol at high valency, and provide insight on the interactions of membrane receptor proteins with qdot conjugates containing multiple copies of a receptor-targeting ligand.
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Compuestos de Cadmio/química , Puntos Cuánticos , Receptores de GABA/química , Compuestos de Selenio/química , Sitios de Unión , Fluorescencia , Ligandos , Metilaminas/química , Estructura Molecular , Muscimol/química , Polietilenglicoles/química , Sulfuros/química , Compuestos de Zinc/químicaRESUMEN
Following mild traumatic brain injury (TBI), a percentage of individuals report chronic memory and attention difficulties. Traditional neuropsychological assessments often fail to find evidence for such complaints. We hypothesized that mild TBI patients may, in fact, experience subtle cognitive deficits that reflect diminished initial acquisition that can be explained by changes in cerebral white matter microstructure. In the data presented here, a sample of nonlitigating and gainfully employed mild TBI patients demonstrated statistically significant differences from age and education matched control participants in performance on the first trial of a verbal learning task. Performance on this trial was associated with reduced fractional anisotropy in the uncinate fasciculus and the superior longitudinal fasciculus providing an anatomical correlate for the cognitive findings. Mild TBI patients were not impaired relative to control participants on total learning or memory composite variables. Performance on the first learning trial was not related to any psychological variables including mood. We concluded that patients with mild TBI demonstrate diminished verbal learning that is not often interpreted in standard neuropsychological assessment.
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Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/fisiopatología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Aprendizaje Verbal , Adulto , Lesiones Encefálicas/diagnóstico , Enfermedad Crónica , Imagen de Difusión Tensora , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To characterize integrity of fronto-striatal circuitry in chronic traumatic brain injury (TBI). BACKGROUND: Due to both direct and indirect effects, TBI is hypothesized to affect frontal and striatal function. On the basis of elegant animal, lesion, and neuroimaging literatures, oculomotor testing can provide a useful tool for in vivo assessments of neurophysiologic function. The predictive saccade paradigm in oculomotor function is well established to provide assessment of this fronto-striatal circuit. METHODS: Sixty patients with a history of chronic TBI completed 2 specific tests of oculomotor function, including a test of reflexive visually guided saccades to assess basic oculomotor function and a predictive saccade test to assess procedural learning. RESULTS: TBI (mild and moderate/severe) was associated with a decrease in rates of procedural learning, with degree of impairment increasing with injury severity. This was observed as a decrease in the proportion of anticipatory saccades (primary measure of learning). CONCLUSIONS: This abnormal oculomotor performance supports the hypothesis that TBI results in chronic impairment of frontal-striatal functions proportionally to injury severity and demonstrate that oculomotor testing is sensitive to all severities of closed-head injury.
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Lesiones Encefálicas/psicología , Lesión Encefálica Crónica/psicología , Discapacidades para el Aprendizaje/psicología , Movimientos Sacádicos/fisiología , Adulto , Lesiones Encefálicas/complicaciones , Lesión Encefálica Crónica/complicaciones , Movimientos Oculares/fisiología , Femenino , Fijación Ocular/fisiología , Humanos , Discapacidades para el Aprendizaje/etiología , Masculino , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Desempeño Psicomotor/fisiología , Fumar/psicología , Factores SocioeconómicosRESUMEN
OBJECTIVE: Vasomotor symptoms (VMS) are associated with decreased memory performance and alterations in brain function. We conducted a preliminary examination of VMS and patterns of brain activity during a verbal memory task to provide insights into the VMS-related brain mechanisms that can contribute to memory problems in midlife women. METHODS: Fourteen postmenopausal women (mean age 53.5, 64% African-American) with moderate-to-severe VMS (>35/wk) and not taking hormone therapy completed functional magnetic resonance imaging (fMRI) assessments during word encoding and recognition, 24-hour physiologic VMS monitoring, symptom questionnaires, and two verbal memory tests. RESULTS: In regression analyses, a higher number of physiologic VMS, but not reported VMS, was associated with worse verbal memory on immediate and delayed logical memory (râ=â0.53 and râ=â0.72, Pâ<â0.05). On fMRI assessments, a higher number of physiologic VMS, but not subjective VMS, was associated with greater activation in the left orbitofrontal cortex, left medial and superior frontal gyrus, right superior frontal gyrus, and right parahippocampal gyrus during the encoding task (Pâ<â0.005). During the recognition task, physiologic VMS were associated with greater activation in the left medial and superior frontal gyrus, left parahippocampal gyrus and hippocampus, right medial and superior frontal gyrus, right parahippocampal gyrus and hippocampus (Pâ<â0.005), and with decreased activation in the ventral medial prefrontal cortex (Pâ<â0.005). Those associations were independent of symptoms and hormone levels. CONCLUSIONS: Preliminary data suggest that VMS may contribute to memory performance through effects on the hippocampus and prefrontal cortex. Larger studies are warranted to determine the robustness of these initial observations. : Video Summary:http://links.lww.com/MENO/A508.
Video Summary:http://links.lww.com/MENO/A508.
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Sofocos/fisiopatología , Trastornos de la Memoria/fisiopatología , Posmenopausia/psicología , Femenino , Hipocampo/fisiopatología , Sofocos/psicología , Humanos , Imagen por Resonancia Magnética , Memoria/fisiología , Trastornos de la Memoria/etiología , Persona de Mediana Edad , Corteza Prefrontal/fisiopatología , Análisis y Desempeño de Tareas , Sistema Vasomotor/fisiopatología , Aprendizaje VerbalRESUMEN
BACKGROUND: Persistent inflammation is a life-long complication of HIV infection, even in virally suppressed individuals. Elevated plasma concentrations of soluble(s) CD14 and CD163 have been established as biomarkers of chronic inflammation, conferring higher risk for cognitive, neurovascular, and structural abnormalities. METHODS: Structural magnetic resonance imaging (frontal and temporal regions) as well as plasma inflammatory biomarkers of monocyte activation (sCD14 and sCD163), general inflammation (plasma C-reactive protein, interleukin[IL]-6), and gut microbial translocation (plasma intestinal fatty acid-binding protein) were available on 38 women (25 with HIV) from the Chicago Women's Interagency HIV Study site. Partial least-squares models adjusting for relevant covariates (eg, age, education, and race) were conducted to evaluate the relationship between inflammatory biomarkers and brain volume in the overall sample and among women with HIV (WWH). RESULTS: In the total sample, higher plasma sCD14 was associated with smaller volumes in multiple frontal and temporal lobe regions. In the WWH-only sample, sCD163 was associated with smaller volumes only in one region of the left frontal lobe. C-reactive protein, IL-6, and intestinal fatty acid-binding protein were not associated with brain volumes for either group of women. CONCLUSIONS: Of the inflammatory monocyte markers evaluated, sCD14 was associated with smaller frontal and temporal cortical volume in the overall and WWH-only samples, while plasma sCD163 was only associated with smaller left caudal middle frontal gyrus in the WWH-only group. Validating these monocyte proteins as neurological biomarkers of structural brain deficits in a larger sample is critical for understanding HIV-associated neurobiological complications.
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Lóbulo Frontal/diagnóstico por imagen , Infecciones por VIH/sangre , Infecciones por VIH/patología , Lóbulo Temporal/diagnóstico por imagen , Adulto , Antígenos CD/sangre , Antígenos de Diferenciación Mielomonocítica/sangre , Biomarcadores/sangre , Femenino , Lóbulo Frontal/patología , Infecciones por VIH/psicología , Humanos , Inflamación/sangre , Receptores de Lipopolisacáridos/sangre , Imagen por Resonancia Magnética , Persona de Mediana Edad , Receptores de Superficie Celular/sangre , Lóbulo Temporal/patología , Adulto JovenRESUMEN
Behavioral and electrophysiological studies of schizophrenia have consistently demonstrated impairments in the integration of visual features into unified perceptual representations. Specific brain regions involved in this dysfunction, however, remain to be clarified. This study used functional Magnetic Resonance Imaging (fMRI) to examine the relative involvement of visual cortex areas (involved in form perception) and parietal and frontal regions (involved in attention), in the visual integration impairment in schizophrenia. Fourteen patients with schizophrenia and 14 healthy controls were compared on behavioral performance and data acquired via fMRI while completing a contour integration task that had previously been used to identify a visual integration deficit in schizophrenia. The schizophrenia patients demonstrated poorer visual integration than controls. Analyses of peak signal change indicated that while the groups were equivalent in area V1, the schizophrenia group demonstrated reduced signal in areas V2-V4, which are the earliest regions sensitive to global configurations of stimuli. Moreover, whereas the control group demonstrated greater recruitment of prefrontal and parietal areas during perception of integrated forms compared to random stimuli, the schizophrenia group demonstrated greater recruitment of frontal regions during perception of random stimuli. The two groups differed on brain regions involved in form perception even when they were matched on accuracy levels. The visual integration disturbance in schizophrenia involves both deficient basic visual processes (beginning as early as occipital region V2), as well as reduced feedback from visual attention regions that normally serves to amplify relevant visual representations relative to irrelevant information.
Asunto(s)
Trastornos de la Percepción/fisiopatología , Esquizofrenia/fisiopatología , Corteza Visual/fisiopatología , Percepción Visual/fisiología , Adolescente , Adulto , Atención/fisiología , Mapeo Encefálico/métodos , Retroalimentación/fisiología , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Reconocimiento Visual de Modelos/fisiología , Trastornos de la Percepción/etiología , Estimulación Luminosa , Psicología del Esquizofrénico , Corteza Visual/anatomía & histología , Vías Visuales/fisiopatología , Adulto JovenRESUMEN
PURPOSE: To compare the cortical networks that underlie oculomotor function in patients with age-related macular degeneration (AMD) with those in normally sighted control subjects, using functional magnetic resonance imaging (fMRI). METHODS: Six patients with bilateral geographic retinal atrophy due to AMD (age range, 55-83 years) were recruited for the study. The visual acuities of the patients ranged from 20/76 (0.58 logMAR) to 20/360 (1.26 logMAR). An additional six younger (age range, 22-31 years) and six older (age range, 54-78 years) normally sighted individuals were recruited as control subjects. fMRI data were acquired on a 3.0-Tesla, scanner while subjects performed visually guided saccade (VGS) and smooth-pursuit (SmP) tasks. RESULTS: Contrasts between VGS and fixation on a stationary target identified a network of activation that included the frontal eye fields (FEFs), supplementary eye fields (SMA/SEFs), prefrontal cortex (PFC), intraparietal sulci (IPS), and the areas of the visual cortex (MT/V5, V2/V3, and V1) in control subjects and patients. A similar network was identified for comparisons between SmP and periods of fixation. Marked variability was observed in the performance of both tasks across all patients. For both tasks, the patients generally showed increased PFC and IPS activation, with decreased activation in visual cortex compared with the control subjects. The patients showed significantly increased activation of the FEFs and SMA/SEFs in the SmP task, compared with the control subjects. CONCLUSIONS: These data suggest that performance of both eye movement tasks required greater involvement of the cortical regions generally implicated in attention and effort in patients with AMD.
Asunto(s)
Envejecimiento/fisiología , Degeneración Macular/fisiopatología , Imagen por Resonancia Magnética , Movimientos Sacádicos/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nervio Oculomotor/fisiología , Desempeño Psicomotor , Agudeza Visual , Corteza Visual/fisiologíaRESUMEN
PURPOSE: The ABCR protein of the rod outer segment is thought to facilitate movement of the all-trans retinal photoproduct of rhodopsin bleaching out of the disc lumen. This study was undertaken to investigate the extent to which ABCR deficiency affects the post-bleach recovery of the rod photoresponse in ABCR-deficient (abcr-/-) mice. METHODS: Electroretinographic (ERG) a-wave responses were recorded from abcr-/- mice and two control strains. A bright probe flash was used to examine the course of rod recovery after fractional rhodopsin bleaches of approximately 10(-6), approximately 3 x 10(-5), approximately 0.03, and approximately 0.30 to approximately 0.40. RESULTS: Dark-adapted abcr-/- mice and control animals exhibited similar normalized near-peak amplitudes of the paired-flash-ERG-derived, weak-flash response. Response recovery after approximately 10(-6) bleaching exhibited an average exponential time constant of 319, 171, and 213 ms, respectively, in the abcr-/- and the two control strains. Recovery time constants determined for approximately 3 x 10(-5) bleaching did not differ significantly among strains. However, those determined for the approximately 0.03 bleach indicated significantly faster recovery in abcr-/- mice (2.34 +/- 0.74 minutes) than in the controls (5.36 +/- 2.20 and 5.92 +/- 2.44 minutes). After approximately 0.30 to approximately 0.40 bleaching, the initial recovery in the abcr-/- mice was, on average, faster than in control mice. CONCLUSIONS: By comparison with control animals, abcr-/- mice exhibit faster rod recovery after a bleach of approximately 0.03. The data suggest that ABCR in normal rods may directly or indirectly prolong all-trans retinal clearance from the disc lumen over a significant bleaching range, and that the essential function of ABCR may be to promote the clearance of residual amounts of all-trans retinal that remain in the discs long after bleaching.
Asunto(s)
Transportadoras de Casetes de Unión a ATP/fisiología , Recuperación de la Función , Células Fotorreceptoras Retinianas Bastones/fisiología , Visión Ocular/fisiología , Animales , Adaptación a la Oscuridad/fisiología , Electrorretinografía , Femenino , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Estimulación Luminosa , Células Fotorreceptoras Retinianas Bastones/efectos de la radiación , Rodopsina/metabolismoRESUMEN
Traumatic brain injury (TBI) is a serious public health problem. Even injuries classified as mild, the most common, can result in persistent neurobehavioural impairment. Diffuse axonal injury is a common finding after TBI, and is presumed to contribute to outcomes, but may not always be apparent using standard neuroimaging. Diffusion tensor imaging (DTI) is a more recent method of assessing axonal integrity in vivo. The primary objective of the current investigation was to characterize white matter integrity utilizing DTI across the spectrum of chronic TBI of all severities. A secondary objective was to examine the relationship between white matter integrity and cognition. Twenty mild, 17 moderate to severe TBI and 18 controls underwent DTI and neuropsychological testing. Fractional anisotropy, axial diffusivity and radial diffusivity were calculated from the DTI data. Fractional anisotropy was the primary measure of white matter integrity. Region of interest analysis included anterior and posterior corona radiata, cortico-spinal tracts, cingulum fibre bundles, external capsule, forceps minor and major, genu, body and splenium of the corpus callosum, inferior fronto-occipital fasciculus, superior longitudinal fasciculus and sagittal stratum. Cognitive domain scores were calculated from executive, attention and memory testing. Decreased fractional anisotropy was found in all 13 regions of interest for the moderate to severe TBI group, but only in the cortico-spinal tract, sagittal stratum and superior longitudinal fasciculus for the mild TBI group. White Matter Load (a measure of the total number of regions with reduced FA) was negatively correlated with all cognitive domains. Analysis of radial and axial diffusivity values suggested that all severities of TBI can result in a degree of axonal damage, while irreversible myelin damage was only apparent for moderate to severe TBI. The present data emphasize that white matter changes exist on a spectrum, including mild TBI. An index of global white matter neuropathology (White Matter Load) was related to cognitive function, such that greater white matter pathology predicted greater cognitive deficits. Mechanistically, mild TBI white matter changes may be primarily due to axonal damage as opposed to myelin damage. The more severe injuries impact both. DTI provides an objective means for determining the relationship of cognitive deficits to TBI, even in cases where the injury was sustained years prior to the evaluation.