Slowing of Parameterized Resting-State Electroencephalography After Mild Traumatic Brain Injury.

Reported changes in electroencephalography (EEG)-derived spectral power after mild traumatic brain injury (mTBI) remains inconsistent across existing literature. However, this may be a result of previous analyses depending solely on observing spectral power within traditional canonical frequency bands rather than accounting for the aperiodic activity within the collected neural signal. Therefore, the aim of this study was to test for differences in rhythmic and arrhythmic time series across the brain, and in the cognitively relevant frontoparietal (FP) network, and observe whether those differences were associated with cognitive recovery post-mTBI. Resting-state electroencephalography (rs-EEG) was collected from 88 participants (56 mTBI and 32 age- and sex-matched healthy controls) within 14 days of injury for the mTBI participants. A battery of executive function (EF) tests was collected at the first session with follow-up metrics collected approximately 2 and 4 months after the initial visit. After spectral parameterization, a significant between-group difference in aperiodic-adjusted alpha center peak frequency within the FP network was observed, where a slowing of alpha peak frequency was found in the mTBI group in comparison to the healthy controls. This slowing of week 2 (collected within 2 weeks of injury) aperiodic-adjusted alpha center peak frequency within the FP network was associated with increased EF over time (evaluated using executive composite scores) post-mTBI. These findings suggest alpha center peak frequency within the FP network as a candidate prognostic marker of EF recovery and may inform clinical rehabilitative methods post-mTBI.

Axonal injury, sleep disturbances, and memory following traumatic brain injury.

OBJECTIVES: Traumatic brain injury (TBI) is associated with sleep deficits, but it is not clear why some report sleep disturbances and others do not. The objective of this study was to assess the associations between axonal injury, sleep, and memory in chronic and acute TBI. METHODS: Data were acquired from two independent datasets which included 156 older adult veterans (69.8 years) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with prior moderate-to-severe TBIs and 90 (69.2 years) controls and 374 (39.6 years) from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) with a recent mild TBI (mTBI) and 87 controls (39.6 years), all who completed an MRI, memory assessment, and sleep questionnaire. RESULTS: Older adults with a prior TBI had a significant association between axonal injury and sleep disturbances [ß = 9.52, 95% CI (4.1, 14.9), p = 0.01]. Axonal injury predicted changes in memory over 1-year in TBI [ß = -8.72, 95% CI (-18, -2.7), p = 0.03]. We externally validated those findings in TRACK-TBI where axonal injury within 2 weeks after mTBI was significantly associated with higher sleep disturbances in the TBI group at 2 weeks[ß = -7.2, 95% CI (-14, -0.50), p = 0.04], 6 months [ß = -16, 95% CI (-24, -7.6), p ≤ 0.01], and 12 months post-injury [ß = -11, 95% CI (-19, -0.85), p = 0.03]. These associations were not significant in controls. INTERPRETATIONS: Axonal injury, specifically to the left anterior internal capsule is robustly associated with sleep disturbances in multiple TBI populations. Early assessment of axonal injury following mTBI could identify those at risk for persistent sleep disturbances following injury.

Subjective Cognitive Complaints in Concussion.

Studies of symptoms after concussion have been focused heavily on athletic and military populations; generalizability to "civilians" has not recently been demonstrated. We selected cognitive symptoms as an important target to assess because of impact on school and employment. We evaluated cognitive complaints in a highly symptomatic (Rivermead Post-Concussion Symptoms Questionnaire [PCSQ], mean [M] = 29.5) civilian sample (n = 100; age: M = 41.4; 36 male/64 female; days post-injury: range 14-154, M = 51.4) of consecutive referrals to a concussion specialty clinic. The Behavior Rating of Executive Functions-Adult version (BRIEF-A) was used to assess subjective cognitive symptoms. Independent variables were prior neurologic and psychiatric history, current neurological symptoms, objective neuropsychological tests and several measures of depression (Beck Depression Inventory, Second Edition [BDI2]), anxiety (Beck Anxiety Inventory), and stress (Post-Traumatic Stress Checklist-Civilian form). No demographic characteristic, injury measure, or past or current neurological history had any association with cognitive symptoms. Prior psychiatric history (57% of patients) was associated with abnormal BRIEF-A. Cognitive tests were overall in the average range, with only mild and sporadic associations with BRIEF-A elevations. All psychological measures showed significant associations with BRIEF-A elevations. Regression analyses for the BRIEF-A revealed depression was the significant contributor (BDI2, ß = 0.73) with prior psychiatric history (ß = 0.16) and age (ß = 0.14) accounting to a lesser extent. In this civilian cohort, subjective cognitive symptoms appear to be due to psychological distress (in particular, depression) and prior psychiatric history more than actual cognitive impairment or other presenting symptoms. These findings illuminate the importance of early diagnosis and treatment of mood/emotional symptoms after injury.

Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study.

BACKGROUND: Former American football players have a higher prevalence of cognitive impairment than that of the US general population. It remains unknown what aspects of playing football are associated with neuropsychiatric outcomes. HYPOTHESIS: It was hypothesized that seasons of professional football, playing position, and experience of concussions were associated with cognition-related quality of life (QOL) and indicators of depression and anxiety. STUDY DESIGN: Descriptive epidemiology study. METHODS: The authors examined whether seasons of professional football, playing position, and experience of concussions, as measured by self-report of 10 symptoms, were associated with cognition-related QOL and indicators of depression and anxiety in a cross-sectional survey conducted 2015 to 2017. Cognition-related QOL was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition-General Concerns. The Patient Health Questionnaire-4 measured depression and anxiety symptoms. Of 13,720 eligible men with apparently valid contact information, 3506 players returned a questionnaire at the time of this analysis (response rate = 25.6%). RESULTS: Seasons of professional play (risk ratio [RR] per 5 seasons = 1.19, 95% CI = 1.06-1.34) and playing position were associated with cognition-related QOL. Each 5 seasons of play was associated with 9% increased risk of indicators of depression at borderline statistical significance (P = .05). When compared with former kickers, punters, and quarterbacks, men who played any other position had a higher risk of poor cognition-related QOL, depression, and anxiety. Concussion symptoms were strongly associated with poor cognition-related QOL (highest concussion quartile, RR = 22.3, P < .001), depression (highest quartile, RR = 6.0, P < .0001), and anxiety (highest quartile, RR = 6.4, P < .0001), even 20 years after last professional play. CONCLUSION: The data suggest that seasons of play and playing position in the NFL are associated with lasting neuropsychiatric health deficits. Additionally, poor cognition-related QOL, depression, and anxiety appear to be associated with concussion in the long term.

Specificity of social support for back pain patients: do patients care who provides what?

This study examined low back pain patients' (N=50) perceptions of what they considered to be helpful and unhelpful social support from various sources over the previous six months. Among types of social support, tangible support was most likely to be rated as helpful, whereas emotional support was the type of support most likely to be rated as unhelpful. Patients reported only rare instances of dissatisfaction with tangible support across various providers. Among support sources, instances of tangible support from physicians, and emotional support from friends, family, and spouses were recalled as most helpful. Physical therapists were named as providing the greatest amount of all three types of social support and were rated as rarely providing unhelpful social support. These findings suggest that the desirability of different types of social support varies as a function of the source of support and indicate that physical therapists are perceived by back pain patients as particularly helpful in their provision of social support.