Cognitive and brain connectivity trajectories in critically ill COVID-19 patients.

BACKGROUND: Multiple Organ failure (MOF) is one of the main causes of admission to the Intensive Care Unit (ICU) of patients infected with COVID-19 and can cause short- and long-term neurological deficits. OBJECTIVE: To compare the cognitive functioning and functional brain connectivity at 6-12 months after discharge in two groups of individuals with MOF, one due to COVID-19 and the other due to another cause (MOF-group), with a group of Healthy Controls (HC). METHODS: Thirty-six participants, 12 from each group, underwent a neuropsychological and neuroimaging assessment at both time-points. Functional connectivity of the resting state networks was compared between COVID-19 and HC while controlling for the effect of MOF. The association between functional connectivity and neuropsychological performance was also investigated. RESULTS: Compared to the HC, COVID-19 group demonstrated hypoconnectivity between the Default Mode Network and Salience Network. This pattern was associated with worse performance on tests of attention and information processing speed, at both time-points. CONCLUSION: The study of the association between cognitive function and brain functional connectivity in COVID-19 allows the understanding of the short- and long-term neurological alterations of this disease and promotes the development of intervention programs to improve the quality of life for this understudied population.

The NeuroBel: A Screening Test for Verbal Language Impairment in Spanish-Speaking Elderly People With Cognitive Decline.

PURPOSE: The NeuroBel is a short test that can detect cognitive decline using language tasks. This study replicated previous research using larger clinical samples from three Spanish-speaking countries. METHOD: Eight tasks were used to analyze verbal language functioning using a psycholinguistic approach. A total of 232 elderly, monolingual Spanish speakers from Spain, Cuba, and Colombia participated in this study. Of these, 76 had Alzheimer's disease (AD) in the initial phase, 75 had mild cognitive impairment (MCI), and 81 did not exhibit cognitive impairment (healthy controls). RESULTS: Significant differences were observed among the three clinical groups. The participants with AD and the participants with MCI had significantly lower NeuroBel scores than the control group on most of the tasks. However, repetition (in AD vs. MCI) and auditory lexical decision (in MCI vs. control) tasks were not significant in Tukey's post hoc tests. Discriminant analysis showed that 80.6% of the participants were correctly classified into the original groups and revealed the tasks that were the best and worst for differentiating among groups. The receiver-operating characteristic curves showed high sensitivity for AD and MCI. The area under the curve was .97 in the contrast of AD versus MCI + controls, .96 in the determination of overall cognitive decline (AD + MCI vs. controls), and .93 in the contrast of MCI and control groups. CONCLUSION: This study confirmed that the NeuroBel is a suitable test for detecting cognitive decline based on language impairment in Spanish-speaking elderly people.

Psychological Functioning in Youth With Spina Bifida Living in Colombia, South America.

OBJECTIVE: No studies have examined psychological functioning among youth with spina bifida (SB) living in a developing country where access to mental health resources is often scarce. This study compared self-reported psychological functioning between youth with SB living in Colombia, South America, and a demographically matched comparison group of healthy Colombian children. METHODS: 22 children with SB and 22 comparison children completed assessments of depression and anxiety. Most (68.81%) participants were male, and the sample had a mean age of 13.25 years (SD = 2.65 years). RESULTS: Results revealed that children with SB reported greater total symptoms of depression (p < .05), but fewer worry-related symptoms of anxiety (p < .05). In addition, mean total scores for both depression and anxiety were in the nonclinical range for youth with SB. CONCLUSIONS: These findings highlight the need for targeted mental health (i.e., depression) services for poor children with SB living in Colombia.

Multilevel modeling of partnered relationship trajectories and relationship stability at 1, 2, and 5 years after traumatic brain injury in Norway.

OBJECTIVES: The aims of this study were to examine (a) predictors of partnered relationship probability trajectories and relationship stability across 1, 2, and 5 years after traumatic brain injury, and (b) influences on the slopes of these trajectories. MATERIALS & METHODS: Individuals (n = 105) from Norway with acute TBI were assessed during admission to an urban trauma center and again at 1, 2 and 5 years after injury. The outcome measures were partnered relationship status (partnered vs. single) at 1, 2 and 5 years post-injury investigated through multilevel modelling, and relationship stability (stable, unstable, and single) investigated through multinomial logistic regression. Independent variables were sex, age at injury, partnered relationship at injury, having dependent children, education, employment and occupation status at time of injury, acute Glasgow Coma Scale score, posttraumatic amnesia, and length of stay in hospital. RESULTS: Partnered relationship status at injury and the interaction of relationship status at injury by time, employment at injury and the interaction of TBI severity by time were significant predictors of participants' relationship trajectories. Having dependent children at the time of injury, higher education, and being in a blue collar occupation at time of injury were significant predictors of relationship stability. CONCLUSIONS: The identification of these influences on partnered relationship probability trajectories and stability could help clinicians and researchers develop and refine early interventions to reduce relationship dissolution in the first several years after brain injury.

Multi-level modelling of employment probability trajectories and employment stability at 1, 2 and 5 years after traumatic brain injury.

PRIMARY OBJECTIVES: To examine trajectories of employment probability and stability over the first 5 years after traumatic brain injury (TBI) by using multi-level modelling and multinomial logistic regressions. RESEARCH DESIGN: A longitudinal cohort study. METHODS AND PROCEDURES: One hundred and five individuals with moderate-to-severe TBI who had been admitted to the Trauma Referral Centre for the Southeast region of Norway were followed up at 1, 2 and 5 years after the injury. MAIN OUTCOMES AND RESULTS: Employment status was dichotomized into employed and unemployed, while employment stability was categorized into stably employed, unstably employed and unemployed at 1, 2 and 5 years after injury. Being single, unemployment prior to injury, blue collar occupation, lower Glasgow Coma Scale (GCS) score at hospital admission and greater length of post-traumatic amnesia (PTA) were significantly associated with being unemployed at 1, 2 and 5 years post-injury. Further, younger patients, those with a lower GCS, greater length of PTA and greater length of hospital stay were negatively associated with employment stability. CONCLUSIONS: It could be wise to target patient population with these demographic and injury characteristics for more extensive follow-ups and vocational rehabilitation to help improve employment outcomes following injury.

Examining the relationship between health-related quality of life in individuals with spinal cord injury and the mental health of their caregivers in Colombia, South America.

Although considerable research has been carried out on family caregivers of individuals with various types of disabilities, spinal cord injury (SCI) caregivers have received considerably less attention in terms of research, especially in regions such as Latin America. This study examined the relationship between health-related quality of life (HRQOL) in individuals with SCI and their family caregiver's mental health in Neiva, Colombia. Thirty-four individuals with SCI and their primary caregivers (34 dyads; n=68) from the Foundation for the Integral Development of People with Disabilities in Neiva, Colombia, were included in this study. Individuals with SCI completed eight subscales of the SF-36 that assessed HRQOL. Five aspects of caregiver mental health were assessed, including burden (Zarit Burden Interview), satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State Trait Anxiety Inventory). A series of multiple regressions uncovered strong associations among the HRQOL of individuals with SCI and various aspects of caregiver mental health. In these regressions, patient physical functioning and pain were independently related to caregiver burden; patient pain and general health were independently related to caregiver satisfaction with life; and patient pain was independently related to caregiver anxiety. HRQOL in individuals with SCI was robustly related to their caregiver's mental health, suggesting that the two sets of variables are closely linked. These findings suggest that caregiver mental health should be a central part of SCI rehabilitation interventions, especially in Latin America.

Life expectancy following rehabilitation: a NIDRR Traumatic Brain Injury Model Systems study.

OBJECTIVE: To characterize overall and cause-specific mortality and life expectancy among persons who have completed inpatient traumatic brain injury rehabilitation and to assess risk factors for mortality. DESIGN: Prospective cohort study. SETTING: The Traumatic Brain Injury Model Systems. PARTICIPANTS: A total of 8573 individuals injured between 1988 and 2009, with survival status per December 31, 2009, determined. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Standardized mortality ratio (SMR), life expectancy, cause of death. RESULTS: SMR was 2.25 overall and was significantly elevated for all age groups, both sexes, all race/ethnic groups (except Native Americans), and all injury severity groups. SMR decreased as survival time increased but remained elevated even after 10 years postinjury. SMR was elevated for all cause-of-death categories but especially so for seizures, aspiration pneumonia, sepsis, accidental poisonings, and falls. Life expectancy was shortened an average of 6.7 years. Multivariate Cox regression showed age at injury, sex, race/ethnic group, marital status and employment status at the time of injury year of injury, preinjury drug use, days unconscious, functional independence and disability on rehabilitation discharge, and comorbid spinal cord injury to be independent risk factors for death. CONCLUSION: There is an increased risk of death after moderate or severe traumatic brain injury. Risk factors and causes of death have been identified that may be amenable to intervention.

Do racial and ethnic minority patients fare worse after SCI?: a critical review of the literature.

A number of researchers have identified differences in SCI outcomes between racial and ethnic groups, but findings have never been synthesized to give clinicians and researchers a coherent picture of the problem. The goals of the current project were to (1) conduct a critical literature review of studies specifically investigating racial and ethnic disparities in spinal cord injury care, services, and outcomes; (2) explore possible causative factors that may explain these disparities; (3) propose strategies that may reduce disparities and improve access, service, and outcomes for minority patients with SCI; and (4) generate ideas for future research in this area. A search using MEDLINE/PubMed, PsycINFO, CINAHL, and HealthSource resulted in 49 articles discussing hospital, mental health, physical functioning, employment, quality of life, and family outcomes. Results indicated that after an SCI, racial and ethnic minority groups have shorter hospital lengths of stay, higher rehospitalizations rates, higher levels of depression, more days in poor health, greater degrees of unemployment, more difficulties with mobility, lower self-reported subjective well-being and quality of life and life satisfaction, and greater risk of marital breakup. A variety of causative factors, intervention strategies, and directions for future research are presented.

Predictors of family caregivers' life satisfaction after traumatic brain injury at one and two years post-injury: a longitudinal multi-center investigation.

OBJECTIVE: To determine predictors of family caregiver life satisfaction at one and two years after traumatic brain injury (TBI). METHODS: Prospective collaborative longitudinal study of 336 family members caring for individuals with TBI participating in the National Institute on Disability and Rehabilitation Research (NIDRR) designated TBI Model Systems of Care (TBIMS). Survivors' medical and demographic information was obtained from the TBIMS database. Follow-up interviews were completed with both survivors and family caregivers at 1 year and 2 years post injury. The primary outcome variable, caregiver life satisfaction, was measured with the Satisfaction with Life Scale (SWLS). RESULTS: Repeated measures ordinal logistic regression showed that survivors' functional status at discharge, drug use, and neurobehavioral problems were significant predictors of family caregivers' life satisfaction at 1 and 2 years post injury. CONCLUSIONS: Family members of individuals with TBI often experience reduced life satisfaction in the first 2 years following their relatives' TBI. Psychiatric and neurobehavioral problems, such as drug use and depression, as well as motor dysfunction in survivors may be important contributors to decreased life satisfaction among their caregivers.

Practical approaches to effective family intervention after brain injury.

Rehabilitation professionals have become increasingly aware that traumatic brain injury has a long-term adverse impact on family members as well as on survivors. Family members often have a critical supporting role in the recovery process, and researchers have identified a relationship between caregiver well-being and survivor outcome. Drawing from the fields of family therapy, cognitive-behavioral therapy, and individual psychotherapy, this article provides information to help clinicians effectively serve families. First, historically important and widely cited publications are reviewed and their implications for practice are discussed. Recommendations for developing successful therapeutic alliances are provided along with a rationale for their importance. Descriptions of common challenges and issues faced by families are presented along with corresponding therapeutic goals. Intervention principles and strategies, selectively chosen to help family members achieve therapeutic goals, are discussed. The article concludes with a presentation of ideas to help practitioners and systems of care more effectively help family members adjust and live fulfilling lives.

Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury.

UNLABELLED: Gary KW, Arango-Lasprilla JC, Ketchum JM, Kreutzer JS, Copolillo A, Novack TA, Jha A. Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury. OBJECTIVES: To examine racial differences in competitive employment outcomes at 1, 2, and 5 years after traumatic brain injury (TBI) and to determine whether changes in not competitive employment rates over time differ between blacks and whites with TBI after adjusting for demographic and injury characteristics. DESIGN: Retrospective cohort study. SETTING: Sixteen TBI Model System Centers. PARTICIPANTS: Blacks (n=615) and whites (n=1407) with moderate to severe TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Employment status dichotomized as competitively employed versus not competitively employed. RESULTS: After adjusting for demographic and injury characteristics, repeated-measures logistic regression indicated that (1) the odds of not being competitively employed were significantly greater for blacks than whites regardless of the follow-up year (all P<.001); (2) the odds of not being competitively employed declined significantly over time for each race (P< or =.004); and (3) changes over time in the odds of not being competitively employed versus being competitively employed were not different between blacks and whites (P=.070). In addition, age, discharge FIM and Disability Rating Scale, length of stay in acute and rehabilitation, preinjury employment, sex, education, marital status, and cause of injury were significant predictors of employment status postinjury. CONCLUSIONS: Short- and long-term employment is not favorable for people with TBI regardless of race; however, blacks fare worse in employment outcomes compared with whites. Rehabilitation professionals should work to improve return to work for all persons with TBI, with special emphasis on addressing specific needs of blacks.