Association of mild traumatic brain injury, post-traumatic stress disorder, and other comorbidities on photosensitivity.

SIGNIFICANCE: Photosensitivity is common after mild traumatic brain injury. However, this study demonstrates that photosensitivity is also impacted by common comorbidities that often occur with mild traumatic brain injury. Understanding how physical and psychological traumas impact photosensitivity can help improve provider care to trauma survivors and guide novel therapeutic interventions. PURPOSE: This study aimed to characterize the association between mild traumatic brain injury and common comorbidities on photosensitivity in post-9/11 veterans. METHODS: Existing data from the Translational Research Center for TBI and Stress Disorders cohort study were analyzed including traumatic brain injury history and post-traumatic stress disorder clinical diagnostic interviews; sleep quality, anxiety, and depression symptoms self-report questionnaires; and photosensitivity severity self-report from the Neurobehavioral Symptom Inventory. Analysis of covariance and multiple ordinal regression models were used to assess associations between mild traumatic brain injury and common comorbidities with photosensitivity severity. RESULTS: Six hundred forty-one post-9/11 veterans were included in this study. An initial analysis showed that both mild traumatic brain injury and current post-traumatic stress disorder diagnosis were independently associated with higher photosensitivity ratings compared with veterans without either condition, with no interaction observed between these two conditions. Results of the ordinal regression models demonstrated positive associations between degree of photosensitivity and the number of mild traumatic brain injuries during military service and current post-traumatic stress disorder symptom severity, particularly hyperarousal symptoms, even when controlling for other factors. In addition, the degree of sleep disturbances and current anxiety symptoms were both positively associated with photosensitivity ratings, whereas depression symptoms, age, and sex were not. CONCLUSIONS: Repetitive mild traumatic brain injury, post-traumatic stress disorder, anxiety, and sleep disturbances were all found to significantly impact photosensitivity severity and are therefore important clinical factors that eye care providers should consider when managing veterans with a history of deployment-related trauma reporting photosensitivity symptoms.

Associations between changes in somatic and psychiatric symptoms and disability alterations in recent-era U.S. veterans.

Cross-sectional work suggests that deployment-related posttraumatic sequelae are associated with increased disability in U.S. veterans deployed following the September 11, 2001 (9/11), terrorist attacks. However, few studies have examined the psychiatric and somatic variables associated with changes in functional disability over time. A total of 237 post-9/11 veterans completed comprehensive assessments of psychiatric and cognitive functioning, as well as a disability questionnaire, at baseline and 2-year follow-up. At baseline, higher levels of PTSD, depressive, and pain-related symptoms were associated with baseline global functional disability, semipartial r2 = .036-.044. Changes in symptoms of PTSD, depression, pain, and sleep, but not anxiety or alcohol use, were independently associated with changes in functional disability, semipartial r2 = .017-.068. Baseline symptoms of these conditions were unrelated to changes in disability, and cognitive performance was unrelated to disability at any assessment point. Together, this suggests that changes in psychiatric and somatic symptoms are tightly linked with changes in functional disability and should be frequently monitored, and even subclinical symptoms may be a target of intervention.

The impact of image degradation and temporal dynamics on sustained attention.

Many clinical populations that have sustained attention deficits also have visual deficits. Therefore, it is necessary to understand how the quality of visual input and different forms of image degradation can contribute to worse performance on sustained attention tasks, particularly those with dynamic and complex visual stimuli. This study investigated the impact of image degradation on an adapted version of the gradual-onset continuous performance task (gradCPT), where participants must discriminate between gradually fading city and mountain scenes. Thirty-six normal-vision participants completed the task, which featured two blocks of six resolution and contrast levels. Subjects either completed a version with gradually fading or static image presentations. The results show decreases in image resolution impair performance under both types of temporal dynamics, whereas performance is only impaired under gradual temporal dynamics for decreases in image contrast. Image similarity analyses showed that performance has a higher association with an observer's ability to gather an image's global spatial layout (i.e. gist) than local variations in pixel luminance, particularly under gradual image presentation. This work suggests that gradually fading attention paradigms are sensitive to deficits in primary visual function, potentially leading to these issues being misinterpreted as attentional failures.

Impaired executive function exacerbates neural markers of posttraumatic stress disorder.

BACKGROUND: A major obstacle in understanding and treating posttraumatic stress disorder (PTSD) is its clinical and neurobiological heterogeneity. To address this barrier, the field has become increasingly interested in identifying subtypes of PTSD based on dysfunction in neural networks alongside cognitive impairments that may underlie the development and maintenance of symptoms. The current study aimed to determine if subtypes of PTSD, based on normative-based cognitive dysfunction across multiple domains, have unique neural network signatures. METHODS: In a sample of 271 veterans (90% male) that completed both neuropsychological testing and resting-state fMRI, two complementary, whole-brain functional connectivity analyses explored the link between brain functioning, PTSD symptoms, and cognition. RESULTS: At the network level, PTSD symptom severity was associated with reduced negative coupling between the limbic network (LN) and frontal-parietal control network (FPCN), driven specifically by the dorsolateral prefrontal cortex and amygdala Hubs of Dysfunction. Further, this relationship was uniquely moderated by executive function (EF). Specifically, those with PTSD and impaired EF had the strongest marker of LN-FPCN dysregulation, while those with above-average EF did not exhibit PTSD-related dysregulation of these networks. CONCLUSION: These results suggest that poor executive functioning, alongside LN-FPCN dysregulation, may represent a neurocognitive subtype of PTSD.

The Impact of Common Psychiatric and Behavioral Comorbidities on Functional Disability Across Time and Individuals in Post-9/11 Veterans.

Returning veterans often face multiple concurrent psychiatric and behavioral conditions that negatively impact reintegration into civilian life and are associated with functional disability. Understanding how conditions interact to negatively impact functioning is an important step toward developing holistic treatment approaches optimized for this population. This study utilized a cross-sectional and prospective longitudinal cohort design, applying regression algorithms to understand the relative contribution of common clinical issues to functional disability in U.S. veterans who served after the September 11, 2001 (9/11), terror attacks. Community-dwelling post-9/11 veterans (N = 397) completed detailed assessments, including common clinical condition diagnoses, combat experience, and demographics, which were used to predict functional disability (World Health Organization Disability Assessment Schedule); 205 participants were reassessed approximately 1-2 years after enrollment. Regression analyses showed a strong association between the predictor variables and functional disability, f 2 = 1.488. Validation analyses showed a high prediction ability of functional disability to independent samples, r = .719, and across time in the same individuals, r = .780. The strongest predictors included current posttraumatic stress disorder, depressive disorder, sleep disturbance, and pain diagnoses. These results demonstrate the importance of considering multiple common co-occurring conditions when assessing functional disability in post-9/11 veterans and suggest that certain syndromes contribute the most unique information to predicting functional disability with high confidence. As most U.S. veterans utilize private healthcare systems, these results have clinical utility for both Veterans Affairs and civilian healthcare practitioners in assessing and monitoring functional disability in post-9/11 veterans over time.

Tracking behavioral and neural fluctuations during sustained attention: A robust replication and extension.

Novel paradigms have allowed for more precise measurements of sustained attention ability and fluctuations in sustained attention over time, as well as the neural basis of fluctuations and lapses in performance. However, in recent years, concerns have arisen over the replicability of neuroimaging studies and psychology more broadly, particularly given the typically small sample sizes. One recently developed paradigm, the gradual-onset continuous performance task (gradCPT) has been validated behaviorally in large samples of participants. Yet neuroimaging studies investigating the neural basis of performance on this task have only been collected in small samples. The present study completed both a robust replication of the original neuroimaging findings and extended previous results from the gradCPT task using a large sample of 140 Veteran participants. Results replicate findings that fluctuations in attentional stability are tracked over time by BOLD activity in task positive (e.g., dorsal and ventral attention networks) and task negative (e.g., default network) regions. Extending prior results, we relate this coupling between attentional stability and on-going brain activity to overall sustained attention ability and demonstrate that this coupling strength, along with across-network coupling, could be used to predict individual differences in performance. Additionally, the results extend previous findings by demonstrating that temporal dynamics across the default and dorsal attention networks are associated with lapse-likelihood on subsequent trials. This study demonstrates the reliability of the gradCPT, and underscores the utility of this paradigm in understanding attentional fluctuations, as well as individual variation and deficits in sustained attention.

Sustained Attention Across the Life Span in a Sample of 10,000: Dissociating Ability and Strategy.

Normal and abnormal differences in sustained visual attention have long been of interest to scientists, educators, and clinicians. Still lacking, however, is a clear understanding of how sustained visual attention varies across the broad sweep of the human life span. In the present study, we filled this gap in two ways. First, using an unprecedentedly large 10,430-person sample, we modeled age-related differences with substantially greater precision than have prior efforts. Second, using the recently developed gradual-onset continuous performance test (gradCPT), we parsed sustained-attention performance over the life span into its ability and strategy components. We found that after the age of 15 years, the strategy and ability trajectories saliently diverge. Strategy becomes monotonically more conservative with age, whereas ability peaks in the early 40s and is followed by a gradual decline in older adults. These observed life-span trajectories for sustained attention are distinct from results of other life-span studies focusing on fluid and crystallized intelligence.

Individual differences in visual field shape modulate the effects of attention on the lower visual field advantage in crowding.

It has previously been reported that visual crowding of a target by flankers is stronger in the upper visual field than in the lower, and this finding has been attributed to greater attentional resolution in the lower hemifield (He, Cavanagh, & Intriligator, 1996). Here we show that the upper/lower asymmetry in visual crowding can be explained by natural variations in the borders of each individual's visual field. Specifically, asymmetry in crowding along the vertical meridian can be almost entirely accounted for by replacing the conventional definition of visual field location, in units of degrees of visual angle, with a definition based on the ratio of the extents of an individual's upper and lower visual field. We also show that the upper/lower crowding asymmetry is eliminated when stimulus eccentricity is expressed in units of percentage of visual field extent but is present when the conventional measure of visual angle is used. We further demonstrate that the relationship between visual field extent and perceptual asymmetry is most evident when participants are able to focus their attention on the target location. These results reveal important influences of visual field boundaries on visual perception, even for visual field locations far from those boundaries.

The configural shape illusion.

A new illusion, called the configural shape illusion (CSI), is described in which the apparent shape of an object (the "target") is systematically distorted by the presence of an adjacent shape (the "inducer") that is distinct from, but perceptually grouped with, the target. The target is selectively elongated in a direction consistent with the extension of the larger configuration that includes both target and inducer. Experiments 1 and 2 show that the CSI magnitude varies systematically with factors known to influence grouping strength between configural elements, including proximity, good continuation, positional alignment, lightness similarity, hue similarity, and common fate. Experiments 3 through 5 examine the influence of relative inducer size and target size on illusion magnitude. We suggest that the CSI is caused by edge assimilation modulated by similarity between the target and inducer arising from population coding of edge positions. This assimilation account fits well with previous explanations of one-dimensional illusions of linear extent (e.g., the Müller-Lyer and Baldwin illusions), which are extended to account for the present two-dimensional illusion of shape.

The functional relevance of visuospatial processing speed across the lifespan.

Visuospatial processing speed underlies several cognitive functions critical for successful completion of everyday tasks, including driving and walking. While it is widely accepted that visuospatial processing speed peaks in early adulthood, performance across the lifespan remains incompletely characterized. Additionally, there remains a lack of paradigms available to assess visuospatial processing speed in unsupervised web-based testing environments. To address these gaps, we developed a novel visuospatial processing speed (VIPS) task adapted from two tests sensitive to visuospatial processing speed declines in older adults, the Useful Field of View paradigm and the PERformance CEntered Portable Test. The VIPS task requires participants to make a central orientation discrimination and complete a simultaneous peripheral visual search task. Data were collected from 86 in-lab volunteers (18-30 years) to compare performance to traditional neuropsychological measures. Consistent with previous literature, performance on the novel VIPS task significantly correlated with measures of selective attention, executive functioning, visual speed, and working memory. An additional 4395 volunteers (12-62 years) were recruited on TestMyBrain.org to establish lifespan trajectories of visuospatial processing speed and associations with functional disability. VIPS task performance peaked in the early 20's, and steadily decreased such that thresholds doubled in 60-year-olds relative to 20-year-olds (817 ms vs. 412 ms). VIPS task performance significantly correlated with self-reported cognitive functioning deficits broadly across the lifespan but was specifically related to mobility issues in middle-age. These findings have important implications for early detection of cognitive decline and provide insights into potential early intervention targets for younger and middle-aged adults.

Exploring the edges of visual space: the influence of visual boundaries on peripheral localization.

Previous studies of localization of stationary targets in the peripheral visual field have found either underestimations (foveal biases) or overestimations (peripheral biases) of target eccentricity. In the present study, we help resolve this inconsistency by demonstrating the influence of visual boundaries on the type of localization bias. Using a Goldmann perimeter (an illuminated half-dome), we presented targets at different eccentricities across the visual field and asked participants to judge the target locations. In Experiments 1 and 2, participants reported target locations relative to their perceived visual field extent using either a manual or verbal response, with both response types producing a peripheral bias. This peripheral localization bias was a non-linear scaling of perceived location when the visual field was not bounded by external borders induced by facial features (i.e., the nose and brow), but location scaling was linear when visual boundaries were present. Experiment 3 added an external border (an aperture edge placed in the Goldmann perimeter) that resulted in a foveal bias and linear scaling. Our results show that boundaries that define a spatial region within the visual field determine both the direction of bias in localization errors for stationary objects and the scaling function of perceived location across visual space.

Attentional Capture from Looming Alters Perception.

Studies suggest looming motion represents a special class of attentional capture stimulus due to behavioral urgency: the need to act upon objects moving toward us in an environment. In particular, one theory suggests that faster reaction times to targets cued by looming relative to receding motion are driven by post-attentional, motor-priming processes beyond the attentional capture effects seen with other stimulus qualities such as color pop-out. The present study tested this theory using a relative size judgment task where targets were pre-cued by looming and receding optic flow fields. Results show systematic increases in the perceived size of targets that were cued by looming flow fields, consistent with previous attentional capture studies using onset cues. These results challenge theories attributing behavioral changes from looming motion to motor-priming alone.

Blast mild traumatic brain injury is associated with increased myopia and chronic convergence insufficiency.

While chronic visual symptom complaints are common among Veterans with a history of mild traumatic brain injury (mTBI), research is still ongoing to characterize the pattern of visual deficits that is most strongly associated with mTBI and specifically, the impact of blast-related mTBI on visual functioning. One area that has not been well explored is the potential impact of blast mTBI on refractive error. While myopic shifts have been documented following head injuries in civilian populations, posttraumatic myopic shifts have not been explored in participants with military mTBI. This study investigated the impact of blast mTBIs on a range of visual function measures including distance acuity and refractive error, in a well-characterized cohort of thirty-one Post-9/11 veterans for whom detailed clinical interviews regarding military and TBI history were available. Seventeen participants had a history of blast-related mTBI (blast mTBI + group) while 14 did not (blast mTBI- group). Results show an increased frequency of convergence insufficiency and myopia in the blast mTBI + group relative to the blast mTBI- group. Linear regression analyses further show that deficits in distance acuity and refractive error are associated with the number of blast mTBIs during military service but not the number of non-blast mTBIs or the number of lifetime non-blast TBIs and cannot be accounted for by PTSD. These results are consistent with long-lasting damage following blast mTBI to subcortical visual structures that support both vergence movements and the accommodative functions needed to see clearly objects at varying distances.

Association between metabolic syndrome and resting-state functional brain connectivity.

The objective of this study is to examine whether metabolic syndrome (MetS), the clustering of 3 or more cardiovascular risk factors, disrupts the resting-state functional connectivity (FC) of the large-scale cortical brain networks. Resting-state functional magnetic resonance imaging data were collected from seventy-eight middle-aged and older adults living with and without MetS (27 MetS; 51 non-MetS). FC maps were derived from the time series of intrinsic activity in the large-scale brain networks by correlating the spatially averaged time series with all brain voxels using a whole-brain seed-based FC approach. Participants with MetS showed hyperconnectivity across the core brain regions with evidence of loss of modularity when compared with non-MetS individuals. Furthermore, patterns of higher between-network MetS-related effects were observed across most of the seed regions in both right and left hemispheres. These findings indicate that MetS is associated with altered intrinsic communication across core neural networks and disrupted between-network connections across the brain due to the co-occurring vascular risk factors in MetS.

Connectome-based functional connectivity markers of suicide attempt.

BACKGROUND: Functional brain markers of suicidality can help identify at-risk individuals and uncover underlying neurocognitive mechanism(s). Although some converging evidence has implicated dysfunction in several brain networks, suicide-related neuroimaging markers are inconsistent across studies, due to heterogeneity of neuroimaging approaches, clinical populations, and experimental methods. METHODS: The current study aimed to address these limitations by examining resting-fMRI connectivity in a sample of post-9/11 veterans with a past suicide attempt (SA; n = 16) compared to a psychiatric control group (PC; n = 124) with no SA history but comparable past and present symptomatology, as well as a trauma control group (TC; n = 66) of trauma-exposed healthy controls. We used both a novel graph-analytic and seed-based approach to characterize SA-related connectivity differences across brain networks. RESULTS: First, the graph-analytic approach identified the right amygdala and a region in the cognitive control network (right middle temporal gyrus; MTG) as regional SA-related hubs of dysfunction (HoD), or regions that exhibited a high number of SA-related connections. Aberrant SA-related connectivity between these hubs spanned multiple networks, including the cognitive control, default mode and visual networks. Second, the seed-based connectivity analysis that identifies SA-related differences in the strength of neural connections across the whole brain further implicated the right amygdala. LIMITATIONS: Small sample size and potential underreporting of SA. CONCLUSIONS: These two analytic approaches preliminarily suggest that the right amygdala and right MTG may be specific neural markers of SA that can be differentiated from neural markers of psychopathology more broadly.

Where does attention go when it moves? Spatial properties and locus of the attentional repulsion effect.

Reliable effects of spatial attention on perceptual measures have been well documented, yet little is known about how attention affects perception of space per se. The present study examined the effects of involuntary shifts of spatial attention on perceived location using a paradigm developed by S. Suzuki and P. Cavanagh (1997) that produces an attentional repulsion effect (ARE). The ARE refers to the illusory displacement of two vernier lines away from briefly presented cues. In Experiment 1, we show that the magnitude of the ARE depends on cue-target distance, indicating that the effects of attention on perceived location are not uniform across the visual field. Experiments 2 and 3 tested whether repulsion occurs away from cue center of mass or from cue contour. Perceived repulsion always occurred away from the cues' center of mass, regardless of the arrangement of the cue contours relative to the vernier lines. Moreover, the magnitude of the ARE varied with shifts in the position of the cues' center of mass. These experiments suggest that the onset of the cue produces a shift of attention to its center of mass rather than to the salient luminance contours that define it, and that this mechanism underlies the ARE.

Evaluating the evidence for a neuroimaging subtype of posttraumatic stress disorder.

A recent study used functional neuroimaging and cognitive tasks to identify posttraumatic stress disorder (PTSD) subtypes. Specifically, this study found that a subgroup of patients with verbal memory impairment had a unique neural signature, namely, decreased ventral attention network (VAN) resting-state functional connectivity, and these same individuals responded poorly to psychotherapy. Although this represents one of the first studies to propose a neurocognitive subtype of PTSD and has far-reaching translational potential, the generalizability and specificity of the observed neural network and cognitive domain remain unclear. We attempted to conceptually replicate and extend these findings in a similar cohort of combat-exposed veterans (n = 229) tested using a standardized battery of neuropsychological tests and a priori criteria for cognitive impairments. First, we conducted identical and complementary analyses to determine whether subjects with PTSD and neuropsychologically defined verbal memory deficits exhibited the VAN connectivity biomarker. Second, we examined whether cognitive deficits in other domains implicated in PTSD (executive functioning and attention) exhibited the VAN signature. Across multiple measures of verbal memory, we did not find that the subgroup of individuals with PTSD and memory impairments had lower VAN connectivity. However, a subgroup of individuals with PTSD and attentional impairments did have lower VAN connectivity, suggesting that the original subtype could have been related to attention and not memory impairments. Overall, our findings suggest that the previously identified memory-impaired PTSD subtype may not generalize. Further consideration of neuropsychological methods will be important for neurocognitive markers to be implemented clinically.

The attentional repulsion effect and relative size judgments.

Rapid shifts of involuntary attention have been shown to induce mislocalizations of nearby objects. One pattern of mislocalization, termed the Attentional Repulsion Effect (ARE), occurs when the onset of peripheral pre-cues lead to perceived shifts of subsequently presented stimuli away from the cued location. While the standard ARE configuration utilizes vernier lines, to date, all previous ARE studies have only assessed distortions along one direction and tested one spatial dimension (i.e., position or shape). The present study assessed the magnitude of the ARE using a novel stimulus configuration. Across three experiments participants judged which of two rectangles on the left or right side of the display appeared wider or taller. Pre-cues were used in Experiments 1 and 2. Results show equivalent perceived expansions in the width and height of the pre-cued rectangle in addition to baseline asymmetries in left/right relative size under no-cue conditions. Altering cue locations led to shifts in the perceived location of the same rectangles, demonstrating distortions in perceived shape and location using the same stimuli and cues. Experiment 3 demonstrates that rectangles are perceived as larger in the periphery compared to fixation, suggesting that eye movements cannot account for results from Experiments 1 and 2. The results support the hypothesis that the ARE reflects a localized, symmetrical warping of visual space that impacts multiple aspects of spatial and object perception.

Trauma-related psychiatric and behavioral conditions are uniquely associated with sustained attention dysfunction.

OBJECTIVE: It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. METHOD: To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. RESULTS: Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. CONCLUSION: These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).