Effects of Chronic Brain Injury on Quality of Life: A Study in Patients With Left- or Right-Sided Lesion.

OBJECTIVES: To test the hypothesis that quality of life (QOL) is made up of different components, and each of these has different anatomic and demographic contributors. DESIGN: Questionnaire-based study. SETTING: Center for Cognitive Neuroscience, University of Pennsylvania. PARTICIPANTS: People with chronic brain injury (N=52) volunteered for the study. After excluding patients with severe communication deficits, bilateral lesions, and incomplete data, 42 patients with focal lesions were included in the final study: 22 patients with left hemisphere injury (LHI) (9 women and 13 men; mean age ± SD, 60.6±11.2y [range: 36-83]; mean chronicity ± SD, 11.5±4.2y) and 20 patients with right hemisphere injury [RHI] (16 women and 4 men; mean age ± SD [62.7±12.8y] [range: 31-79]; mean chronicity ± SD 10.1±4.3y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We administered the RAND36-Item Health Survey (RAND-Version-1.0), Stroke Impact Scale (version 3.0), Positive Affect and Negative Affect Scale, and Distress Thermometer to measure QOL in LHI and RHI patients. Exploratory factor analysis with principal component method reduced these measures to 5 factors, roughly categorized as-(1) physical functioning; (2) general health; (3) emotional health; (4) social functioning; and (5) cognitive functioning. Exploratory analyses attempted to relate these factor scores to demographic variables, neuroanatomical data, and neuropsychological measures. RESULTS: Physical functioning was the biggest contributor to reduced QOL, explaining 32.5%, of the variance. Older age, less education, and larger lesion size predicted poorer physical functioning (P<.001). Age also affected emotional health. (P=.019). Younger patients reported poorer emotional health than older patients. LHI patients reported less satisfaction with their cognitive functioning (P=.009) and RHI patients with their physical functioning (P=.06). Exploratory neuroanatomical analyses hinted at brain areas that may be associated with the perception of disability in each QOL component. CONCLUSIONS: QOL is composed of 5 components. Clinical and demographic factors appear to differentially affect these aspects of patients' perceived QOL, providing hypotheses for further testing and suggesting potential relations for therapeutic interventions to consider.

Impaired Voluntary Control in PTSD: Probing Self-Regulation of the ACC With Real-Time fMRI.

Background: Post-traumatic stress disorder (PTSD) is characterized by deficits in the self-regulation of cognitions and emotions. Neural networks of emotion regulation may exhibit reduced control mediated by the anterior cingulate cortex (ACC), contributing to aberrant limbic responses in PTSD. Methods: Real-time fMRI neurofeedback (rt-fMRI NF) assessed self-regulation of the ACC in nine patients with PTSD after single trauma exposure and nine matched healthy controls. All participants were instructed to train ACC upregulation on three training days. Results: Both groups achieved regulation, which was associated with wide-spread brain activation encompassing the ACC. Compared to the controls, regulation amplitude and learning rate was lower in patients, correlating with symptom severity. In addition, a frontopolar activation cluster was associated with self-regulation efforts in patients. Conclusions: For the first time, we tested self-regulation of the ACC in patients with PTSD. The observed impairment supports models of ACC-mediated regulation deficits that may contribute to the psychopathology of PTSD. Controlled trials in a larger sample are needed to confirm our findings and to directly investigate whether training of central regulation mechanisms improves emotion regulation in PTSD.