Journal of neurotrauma
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Journal of neurotrauma · Jul 2023
History of traumatic brain injury in relation to cognitive functioning, memory complaints and brain structure in mid-life.
In this study, we investigated history of traumatic brain injury with loss of consciousness in relation to cognitive functioning, subjective memory complaints, and brain structure in mid-life. This study included 2005 participants (mean age: 47.6 years, standard deviation: 5.0, women: 65%) from the Origins of Alzheimer's Disease Across the Life Course (ORACLE) study between 2017 and 2020. History of traumatic brain injury was defined as at least one lifetime self-reported brain injury with loss of consciousness. ⋯ Additionally, the association was stronger in those with >30 min loss of consciousness (OR: 3.57; 95% CI: 1.48, 8.59) than in those with <30 min loss of consciousness (OR: 1.85; 95% CI: 1.25, 2.74), when compared with those without history of traumatic brain injury. Lastly, we found no associations between history of traumatic brain injury and any of the structural brain MRI outcomes. In conclusion, our study suggests that at least one lifetime traumatic brain injury with loss of consciousness in mid-life is associated with long-term subjective memory complaints, but not with cognitive functioning or brain structure.
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Journal of neurotrauma · Jul 2023
ReviewGrowth Hormone Deficiency Following Traumatic Brain Injury in Pediatric and Adolescent Patients: Presentation, Treatment, and Challenges of Transitioning From Pediatric to Adult Services.
Abstract Traumatic brain injury (TBI) is increasingly recognized, with an incidence of approximately 110 per 100,000 in pediatric populations and 618 per 100,000 in adolescent and adult populations. TBI often leads to cognitive, behavioral, and physical consequences, including endocrinopathies. Deficiencies in anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropins, and growth hormone [GH]) can negatively impact health outcomes and quality of life post-TBI. ⋯ We place particular emphasis on the ways in which testing and dosage recommendations may change during the transition phase. We conclude with a review of the challenges faced by transition-age patients and how these may be addressed to improve access to adequate healthcare. Little information is currently available to help guide patients with TBI and GHD through the transition phase and there is a risk of interrupted care; therefore, a strength of this review is its emphasis on this critical period in a patient's healthcare journey.
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Journal of neurotrauma · Jul 2023
Clinical characteristics of and treatment strategy for hydrocephalus in patients with severe disorders of consciousness.
Abstract Making an appropriate diagnosis and administering effective treatment for hydrocephalus in patients with severe disorders of consciousness (DOC) remains controversial and difficult. Given that the typical symptoms are usually concealed by the limited behavioral responsiveness of patients with severe DOC, hydrocephalus diagnosis is likely to be missed in the clinic. Even if not, the presence of hydrocephalus may reduce the likelihood of DOC recovery, posing a conundrum for clinicians. ⋯ Secondary hydrocephalus in patients with DOC had been largely ignored, hampering their neurological rehabilitation. Even months or years after the onset of severe DOC, active treatment of hydrocephalus can significantly improve patients' consciousness and neurological function. This study summarized several evidence-based treatment experiences of hydrocephalus in patients with DOC.
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Journal of neurotrauma · Jul 2023
Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study.
Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. ⋯ The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.
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Journal of neurotrauma · Jul 2023
Brain Targeted Xenon Protects Cerebral Vasculature After Traumatic Brain Injury.
Abstract Cerebrovascular dysfunction following traumatic brain injury (TBI) is a well-characterized phenomenon. Given the therapeutic potential of xenon, we aimed to study its effects after localized delivery to the brain using microbubbles. We designed xenon-containing microbubbles stabilized by dibehenoylphosphatidylcholine (DBPC) and polyethylene glycol (PEG) attached to saturated phospholipid (DPSE-PEG5000). ⋯ Endothelial cell culture experiments showed that glutamate reduces tight junction protein zona occludens-1 (ZO-1), but treatment with xenon microbubbles attenuates this effect. Xenon treatment protects cerebrovasculature and reduces astroglial reactivity after TBI. Further, these data support the future use of localized delivery of various therapeutic agents for brain injury using microbubbles in order to limit systemic side effects and reduce costs.