Introduction Traumatic brain injury (TBI) may alter dementia progression, although co-occurring neuropsychiatric symptoms (NPS) have received less attention. The mild behavioral impairment (MBI) construct relates NPS to underlying neural circuit disruptions, representing an important area of inquiry regarding TBI and dementia. Objectives (1) to examine the influence of prior TBI history (preceding study enrollment) on MBI incidence in all-cause dementia (prior to dementia diagnosis, i.e. MBI’s original definition) and (2) to utilize MBI domains as a construct for examining the influence of TBI on related NPS across the course of dementia onset and progression. Methods Using National Alzheimer’s Coordinating Center data, individuals progressing from normal cognition to all-cause dementia over 7.6±3.0 years were studied to estimate MBI incidence and symptom domains in 124 participants with prior TBI history compared to 822 without. Results Moderate-severe TBI was associated with the social inappropriateness MBI domain (OR adj. =4.034; p =0.024) prior to dementia onset, and the abnormal perception/thought content domain looking across dementia progression (HR adj. =3.703, p =0.005). TBI (all severities) was associated with the decreased motivation domain looking throughout dementia progression (HR adj. =1.546, p =0.014). Conclusions TBI history is associated with particular MBI domains prior to onset and throughout progression of dementia. Understanding TBI’s impact on inter-related NPS may help elucidate underlying neuropathology. Disclosure No significant relationships.
Abstract Background Professional boxers and Mixed Martial Arts (MMA) fighters regularly sustain blunt force trauma to the head leading to Traumatic Brain Injury (TBI) and concussion; therefore, fighters are at high risk for chronic traumatic encephalopathy and neurodegenerative disease. Family history of dementia (fhD) may significantly modulate fighter response to TBI. Genetic polymorphisms associated with dementia have been reported to modulate an individual’s response to brain injury and to influence emotionality, risk‐taking, and cognition. A recent study in male college athletes found that fhD predisposed athletes to poorer recovery after concussion and to decrements in impulse control following injury. Furthermore, in a population‐based cohort study from the Netherlands, researchers found that parental history of dementia led to increased rates of depression in mid‐life. The present study aims to investigate how fhD in fighters may relate to history of symptomatic concussions, depression, and impulsivity. Methods Using data from the Professional Fighters Brain Health Study (longitudinal cohort study of fighters), we included active, professional boxers and MMA fighters (n = 198) for cross‐sectional analyses. The latest study visits with available data were utilized to generate multivariate regression analyses examining the number of self‐reported symptomatic concussions in a fighter’s career, Patient Health Questionnaire (PHQ)‐9 scores, and Barratt Impulsiveness Scale Version 11 (BIS‐11) scores, adjusting for age, sex, education, and number of professional fights. Results FhD was significantly associated with more symptomatic concussions during one’s career (p<0.05), higher PHQ‐9 scores (p<0.01), and higher BIS‐11 scores (p<0.01). Conclusions Our findings suggest that professional boxers and MMA fighters with fhD may be more likely to experience symptomatic concussions, depression, and impulsivity during their active fighting career. We postulate that fhD may predispose fighters to experience a higher burden of neuropsychiatric symptoms after sustaining a TBI, potentially due to differences in the brain’s response to injury. These findings may be used to advise those with fhD to minimize possible exposures to TBI and to educate fighters with fhD regarding risks of chronic neurotrauma exposure. Future research should evaluate potential genetic and/or molecular mechanisms behind these trends and behavioral outcomes associated with the sequelae of TBI in those with fhD.
Human papillomavirus (HPV) is the most common sexually transmitted infection in the world, with the ability to cause external genital warts and cancers. The HPV vaccine, first released in the United States of America (USA) in 2006, has been shown to protect against the highest risk HPV strains responsible for the majority of HPV-related cancers. In mainland China, the HPV vaccine was only recently approved in 2016 and is therefore not readily available. As a result, Chinese international students (CIS) studying in the USA continue to have low HPV vaccination rates. This study completed in person and online surveying of 396 CIS at a large Southern California university, with the goal of better understanding CIS knowledge and awareness of HPV disease, vaccination and healthcare behaviors, and sexual activity. Among participants, the reported HPV vaccination rate was 61% (females: 85%; males: 32%). HPV vaccination was significantly correlated with a past visit to the on-campus student health center, having university-sponsored student health insurance, higher self-perceived HPV knowledge, and increased willingness to pay for vaccination. A large portion of participants portrayed low levels of sexual activity, which suggests that CIS can take advantage of catch-up HPV vaccination recommendations through 26 years of age. The results of this study can be used to inform policy initiatives, particularly at the campus level, that attempt to improve HPV vaccination rates amongst CIS.
Introduction Neuroimaging has been a highly utilized technique for studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) independently of one another, however, neuroimaging has increasingly been identified as a useful tool in better understanding TBI-related psychiatric conditions, such as PTSD. Objectives To complete a systematic review of the literature examining neuroimaging findings in TBI-related PTSD and to highlight the current literature’s limitations in order to strengthen future research. Methods A PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May of 2019. The initial database query yielded 4388 unique articles, which were narrowed down based on specified inclusion criteria (e.g., clear TBI definition, clinician-diagnosed PTSD, statistically analyzed relationship between neuroimaging and PTSD, quantified time interval between TBI and neuroimaging). Results A final cohort of 10 articles met inclusion criteria, comprising the findings of 482 participants with TBI. Key neuroanatomical findings among the included articles suggest that PTSD is associated with significant changes in whole-brain networks of resting state connectivity and disruptions in bilateral frontal and temporal white matter tracts, fronto-limbic pathways, the internal capsule, and the uncinate fasciculus (Figure 1). Figure 1a: Neuroimaging Findings in TBI-related PTSD. Figure 1b. Replicated Neuroimaging Findings in TBI-related PTSD in the Right Uncinate Fasciculus. Conclusions Additional inquiry with attention to specified imaging timing post-injury, consistent TBI definitions, clinician-diagnosed TBI and PTSD, and control groups is crucial to extrapolating discrepancies between primary and TBI-related PTSD. Prospective studies could further differentiate predisposing factors from sequelae of TBI-related PTSD. Disclosure No significant relationships.
Neuroimaging is widely utilized in studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The risk for PTSD is greater after TBI than after non-TBI trauma, and PTSD is associated with worse outcomes after TBI. Studying the neuroimaging correlates of TBI-related PTSD may provide insights into the etiology of both conditions and help identify those TBI patients most at risk of developing persistent symptoms. The objectives of this systematic review were to examine the current literature on neuroimaging in TBI-related PTSD, summarize key findings, and highlight strengths and limitations to guide future research. A Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) compliant literature search was conducted in PubMed (MEDLINE®), PsycINFO, Embase, and Scopus databases prior to January 2022. The database query yielded 4486 articles, which were narrowed based on specified inclusion criteria to a final cohort of 16 studies, composed of 854 participants with TBI. There was no consensus regarding neuroimaging correlates of TBI-related PTSD among the included articles. A small number of studies suggest that TBI-related PTSD is associated with white matter tract changes, particularly in frontotemporal regions, as well as changes in whole-brain networks of resting-state connectivity. Future studies hoping to identify reliable neuroimaging correlates of TBI-related PTSD would benefit from ensuring consistent case definition, preferably with clinician-diagnosed TBI and PTSD, selection of comparable control groups, and attention to imaging timing post-injury. Prospective studies are needed and should aim to further differentiate predisposing factors from sequelae of TBI-related PTSD.
White matter signal abnormalities have been associated with traumatic brain injury (TBI) and repetitive head impacts (RHI) in contact sports (e.g. American football, rugby). However, previous studies of mixed martial arts (MMA) fighters from the Professional Fighters Brain Health Study have not found greater white matter signal abnormalities in fighters versus controls.
Motor dysfunction, which includes changes in gait, balance, and/or functional mobility, is a lesser-known feature of Alzheimer's Disease (AD), especially as it relates to the development of neuropsychiatric symptoms (NPS). This study (1) compared rates of NPS between autopsy-confirmed AD patients with and without early-onset motor dysfunction and (2) compared rates of non-AD dementia autopsy pathology (Lewy Body disease, Frontotemporal Lobar degeneration) between these groups. This retrospective longitudinal cohort study utilized National Alzheimer's Coordinating Center (NACC) data. Participants (N = 856) were required to have moderate-to-severe autopsy-confirmed AD, Clinical Dementia Rating-Global scores of ≤1 at their index visit, and NPS and clinician-rated motor data. Early motor dysfunction was associated with significantly higher NPI-Q total scores (T = 4.48, p < .001) and higher odds of delusions (OR [95%CI]: 1.73 [1.02–2.96]), hallucinations (2.45 [1.35–4.56]), depression (1.51 [1.11–2.06]), irritability (1.50 [1.09–2.08]), apathy (1.70 [1.24–2.36]), anxiety (1.38 [1.01–1.90]), nighttime behaviors (1.98 [1.40–2.81]), and appetite/eating problems (1.56 [1.09–2.25]). Early motor dysfunction was also associated with higher Lewy Body disease pathology (1.41 [1.03–1.93]), but not Frontotemporal Lobar degeneration (1.10 [0.71–1.69]), on autopsy. Our results suggest that motor symptoms in early AD are associated with a higher number and severity of NPS, which may be partially explained by comorbid non-AD neuropathology.
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