Neurocognitive problems associated with posttraumatic stress disorder (PTSD) can interact with impairment resulting from traumatic brain injury (TBI).We aimed to identify neurocognitive problems associated with probable PTSD following TBI in a civilian sample.The study is part of the CENTER-TBI project (Collaborative European Neurotrauma Effectiveness Research) that aims to better characterize TBI. For this cross-sectional study, we included patients of all severities aged over 15, and a Glasgow Outcome Score Extended (GOSE) above 3. Participants were assessed at six months post-injury on the PTSD Checklist-5 (PCL-5), the Trail Making Test (TMT), the Rey Auditory Verbal Learning Test (RAVLT) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Primary analysis was a complete case analysis. Regression analyses were performed to investigate the association between the PCL-5 and cognition.Of the 1134 participants included in the complete case analysis, 13.5% screened positive for PTSD. Probable PTSD was significantly associated with higher TMT-(B-A) (OR = 1.35, 95% CI: 1.14-1.60, p < .001) and lower RAVLT-delayed recall scores (OR = 0.74, 95% CI: 0.61-0.91, p = .004) after controlling for age, sex, psychiatric history, baseline Glasgow Coma Scale and education.Poorer performance on cognitive tests assessing task switching and, to a lesser extent, delayed verbal recall is associated with probable PTSD in civilians who have suffered TBI.
In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI). The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (< 72 h after injury) versus later (≥ 72 h after injury) based on recent guideline recommendations. We assessed factors associated with initiating WLSM early versus later, including geographic region, center, patient, injury, and treatment characteristics with univariable and multivariable (mixed effects) logistic regression. A total of 2022 patients aged 16 or older were admitted to the ICU. ICU mortality was 13% (n = 267). Of these, 229 (86%) patients died after WLSM, and were included in the analyses. The occurrence of WLSM varied between regions ranging from 0% in Eastern Europe to 96% in Northern Europe. In 51% of the patients, WLSM was early. Patients in the early WLSM group had a lower maximum therapy intensity level (TIL) score than patients in the later WLSM group (median of 5 versus 10) The strongest independent variables associated with early WLSM were one unreactive pupil (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.3–12.4) or two unreactive pupils (OR 5.8, CI 2.6–13.1) compared to two reactive pupils, and an Injury Severity Score (ISS) if over 41 (OR per point above 41 = 1.1, CI 1.0–1.1). Timing of WLSM was not significantly associated with region or center. WLSM occurs early in half of the patients, mostly in patients with severe TBI affecting brainstem reflexes who were severely injured. We found no regional or center influences in timing of WLSM. Whether WLSM is always appropriate or may contribute to a self-fulfilling prophecy requires further research and argues for reluctance to institute WLSM early in case of any doubt on prognosis.
The tendency to devalue rewards when offered later in time is known as time discounting and, although universal, shows interindividual differences that are proposed to be dependent on an individual's self-control abilities. In the current study we investigate how the neural correlates of delaying gratification during a time discounting task are associated with individual differences in self-control ability. We assess individual differences on the basis of a self-reported Effortful Control (Adult Temperament Questionnaire) and actual behavior during the task, while controlling for age. Using event-related fMRI, in a population of 41 healthy 18-24-year-old males, choosing for the delayed option activated a network including the inferior frontal gyrus, lateral and ventrolateral prefrontal cortices, and the lateral orbitofrontal cortex. Decisions of individuals who delay more often during the task are associated with more activity in the dorsolateral prefrontal cortex. They furthermore show correlated activity between the inferior frontal gyrus, dorsolateral prefrontal cortex and medial prefrontal regions during decision making compared with individuals who behave more impulsively. Choosing for the earlier reward was not associated with any increases in brain activation compared to choosing for the delayed reward. However, individuals who behave more impulsively show more activation in the medial prefrontal cortex (anterior cingulate cortex, medial frontal gyrus), and no correlated activity with the inferior frontal gyrus. These findings could not be replicated when groups were based on self-report data. We conclude that individual differences in self-control during time discounting may partly result from differential activation of the dorsolateral prefrontal cortex.
OBJECTIVE: Brain atrophy is part of the pathophysiology of Multiple Sclerosis (MS), correlates with clinical outcomes and is an important parameter of patients’ follow-up. In clinical practice both 1.5T and 3T MRI are used. Therefore, in this study we investigate the comparison between brain atrophy measurements performed on 1.5T and 3T systems.
BACKGROUND: The typical brain atrophy rate per year is around 0.7-1[percnt] in MS patients and around 0.1-0.3[percnt] in healthy subjects. The differences in brain atrophy measurements between 1.5 and 3T should be much smaller than the brain atrophy rate in order to be comparable.
DESIGN/METHODS: 18 MS patients were scanned on the same day on a 1.5T and 3T scanner (Philips Achieva systems). On both systems, 3D T1 and 3D FLAIR were acquired. Measurements were performed using a Jacobian integration-based software (MSmetrix). Lesions were segmented based on the FLAIR and filled on the T1 images before atrophy was measured. As no atrophy is expected within one day, these data sets can be used to evaluate the median percentage error of the brain atrophy measurement as well as the Intraclass Correlation (ICC) for gray matter (GM) volume and parenchymal volume (PV) between 1.5T and 3T scanners.
RESULTS: The median percentage error of the brain atrophy measurement is 0.52[percnt] for GM volume and 0.35[percnt] for PV. The ICC for GM volume is equal to 0.994 and for PV it is equal to 0,998.
CONCLUSIONS: Brain atrophy measurements performed at 1.5T and 3T can be considered to be equivalent in MS patients.
Study Supported by: - Disclosure: Dr. Lysandropoulos has received personal compensation for activities with Biogen Idec, Novartis, Genzyme, Merck & Company, and Teva Neuroscience. Dr. Ribbens has nothing to disclose. Dr. Jain has nothing to disclose. Dr. Maertens has nothing to disclose. Dr. Van Hecke has nothing to disclose. Dr. Mavroudakis has nothing to disclose. Dr. Absil has nothing to disclose. Dr. Metens has nothing to disclose. Dr. David has nothing to disclose.
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