The Cognitive Profile of Elderly Patients With Mild Traumatic Brain Injury: A Role for Cognitive Reserve?

OBJECTIVE: To assess cognitive status in elderly patients with mild traumatic brain injury (mTBI) in the subacute phase, examine the role of cognitive reserve, and investigate associations with cognitive complaints, mental distress, and functional outcomes. SETTING: A level 1 trauma center in the Netherlands. PARTICIPANTS: A total of 52 individuals with mTBI and 42 healthy controls. DESIGN: A prospective observational cohort study. MAIN MEASURES: Neuropsychological assessment in the subacute phase (2 weeks to 6 months post-injury) to objectively measure the cognitive functioning, the Head Injury Symptom Checklist for subjective cognitive complaints, the Hospital Anxiety and Depression Scale for anxiety and depression, the Cognitive Reserve Index questionnaire for cognitive reserve, the Community Integration Questionnaire for community integration, and the Glasgow Outcome Scale Extended for functional outcome. RESULTS: Cognitive impairments were observed in memory (P < .001) and attention, processing speed and executive control (P < .001). Cognitive reserve was not associated with neuropsychological test performance, except for one test measuring working memory. The relationship between injury severity and cognitive outcome was not moderated by cognitive reserve. Elderly patients reported significantly more complains than healthy controls regarding forgetfulness, concentration problems, and slowness. Complaints of concentration were associated with cognitive impairment. All cognitive complaints were significantly correlated with mental distress. CONCLUSIONS: Cognitive impairments may be present in elderly patients in the subacute phase after mTBI, and these impairments were not significantly associated with cognitive reserve. This suggests that cognitive reserve might not serve as a protective factor against the effects of mTBI in the elderly. Concentration complaints may serve as a specific indicator for cognitive impairment, while complaints of memory and mental slowness may represent more generic indicators of mental distress. These findings highlight the importance of careful screening in older adults with mTBI, guiding clinicians toward specific treatment targets encompassing cognitive impairment, diminished mental well-being, or both.

Effects of Mild Traumatic Brain Injury on Resting State Brain Network Connectivity in Older Adults.

Older age is associated with worsened outcome after mild traumatic brain injury (mTBI) and a higher risk of developing persistent post-traumatic complaints. However, the effects of mTBI sequelae on brain connectivity at older age and their association with post-traumatic complaints remain understudied.We analyzed multi-echo resting-state functional magnetic resonance imaging data from 25 older adults with mTBI (mean age: 68 years, SD: 5 years) in the subacute phase (mean injury to scan interval: 38 days, SD: 9 days) and 20 age-matched controls. Severity of complaints (e.g. fatigue, dizziness) was assessed using self-reported questionnaires. Group independent component analysis was used to identify intrinsic connectivity networks (ICNs). The effects of group and severity of complaints on ICNs were assessed using spatial maps intensity (SMI) as a measure of within-network connectivity, and (static) functional network connectivity (FNC) as a measure of between-network connectivity.Patients indicated a higher total severity of complaints than controls. Regarding SMI measures, we observed hyperconnectivity in left-mid temporal gyrus (cognitive-language network) and hypoconnectivity in the right-fusiform gyrus (visual-cerebellar network) that were associated with group. Additionally, we found interaction effects for SMI between severity of complaints and group in the visual(-cerebellar) domain. Regarding FNC measures, no significant effects were found.In older adults, changes in cognitive-language and visual(-cerebellar) networks are related to mTBI. Additionally, group-dependent associations between connectivity within visual(-cerebellar) networks and severity of complaints might indicate post-injury (mal)adaptive mechanisms, which could partly explain post-traumatic complaints (such as dizziness and balance disorders) that are common in older adults during the subacute phase.

Self-Reported Complaints as Prognostic Markers for Outcome After Mild Traumatic Brain Injury in Elderly: A Machine Learning Approach.

Self-reported complaints are common after mild traumatic brain injury (mTBI). Particularly in the elderly with mTBI, the pre-injury status might play a relevant role in the recovery process. In most mTBI studies, however, pre-injury complaints are neither analyzed nor are the elderly included. Here, we aimed to identify which individual pre- and post-injury complaints are potential prognostic markers for incomplete recovery (IR) in elderly patients who sustained an mTBI. Since patients report many complaints across several domains that are strongly related, we used an interpretable machine learning (ML) approach to robustly deal with correlated predictors and boost classification performance. Pre- and post-injury levels of 20 individual complaints, as self-reported in the acute phase, were analyzed. We used data from two independent studies separately: UPFRONT study was used for training and validation and ReCONNECT study for independent testing. Functional outcome was assessed with the Glasgow Outcome Scale Extended (GOSE). We dichotomized functional outcome into complete recovery (CR; GOSE = 8) and IR (GOSE ≤ 7). In total 148 elderly with mTBI (median age: 67 years, interquartile range [IQR]: 9 years; UPFRONT: N = 115; ReCONNECT: N = 33) were included in this study. IR was observed in 74 (50%) patients. The classification model (IR vs. CR) achieved a good performance (the area under the receiver operating characteristic curve [ROC-AUC] = 0.80; 95% CI: 0.74-0.86) based on a subset of only 8 out of 40 pre- and post-injury complaints. We identified increased neck pain (p = 0.001) from pre- to post-injury as the strongest predictor of IR, followed by increased irritability (p = 0.011) and increased forgetfulness (p = 0.035) from pre- to post-injury. Our findings indicate that a subset of pre- and post-injury physical, emotional, and cognitive complaints has predictive value for determining long-term functional outcomes in elderly patients with mTBI. Particularly, post-injury neck pain, irritability, and forgetfulness scores were associated with IR and should be assessed early. The application of an ML approach holds promise for application in self-reported questionnaires to predict outcomes after mTBI.

Electroencephalography, Magnetoencephalography, and Cognitive Reserve: A Systematic Review.

OBJECTIVE: Cognitive reserve (CR) is the capacity to adapt to (future) brain damage without any or only minimal clinical symptoms. The underlying neuroplastic mechanisms remain unclear. Electrocorticography (ECOG), electroencephalography (EEG), and magnetoencephalography (MEG) may help elucidate the brain mechanisms underlying CR, as CR is thought to be related to efficient utilization of remaining brain resources. The purpose of this systematic review is to collect, evaluate, and synthesize the findings on neural correlates of CR estimates using ECOG, EEG, and MEG. METHOD: We examined articles that were published from the first standardized definition of CR. Eleven EEG and five MEG cross-sectional studies met the inclusion criteria: They concerned original research, analyzed (M)EEG in humans, used a validated CR estimate, and related (M)EEG to CR. Quality assessment was conducted using an adapted form of the Newcastle-Ottawa scale. No ECOG study met the inclusion criteria. RESULTS: A total of 1383 participants from heterogeneous patient, young and older healthy groups were divided into three categories by (M)EEG methodology: Eight (M)EEG studies employed event-related fields or potentials, six studies analyzed brain oscillations at rest (of which one also analyzed a cognitive task), and three studies analyzed brain connectivity. Various CR estimates were employed and all studies compared different (M)EEG measures and CR estimates. Several associations between (M)EEG measures and CR estimates were observed. CONCLUSION: Our findings support that (M)EEG measures are related to CR estimates, particularly in healthy individuals. However, the character of this relationship is dependent on the population and task studied, warranting further studies.

A step forward in the quest for a mobile EEG-designed epoch for psychophysiological studies.

The aim of this study was to compare a reconfigurable mobile electroencephalography (EEG) system (M-EMOTIV) based on the Emotiv Epoc® (which has the ability to record up to 14 electrode sites in the 10/20 International System) and a commercial, clinical-grade EEG system (Neuronic MEDICID-05®), and then validate the rationale and accuracy of recordings obtained with the prototype proposed. In this approach, an Emotiv Epoc® was modified to enable it to record in the parieto-central area. All subjects (15 healthy individuals) performed a visual oddball task while connected to both devices to obtain electrophysiological data and behavioral responses for comparative analysis. A Pearson's correlation analysis revealed a good between-devices correlation with respect to electrophysiological measures. The present study not only corroborates previous reports on the ability of the Emotiv Epoc® to suitably record EEG data but presents an alternative device that allows the study of a wide range of psychophysiological experiments with simultaneous behavioral and mobile EEG recordings.