Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan
OBJECTIVE:To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery. METHODS:Prospective observational s...
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| Veröffentlicht in: | Neurology 2015-07, Vol.85 (3), p.219-227 |
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| creator | Adam, Octavian Mac Donald, Christine L Rivet, Dennis Ritter, John May, Todd Barefield, Maria Duckworth, Josh LaBarge, Donald Asher, Dean Drinkwine, Benjamin Woods, Yvette Connor, Michael Brody, David L |
| description | OBJECTIVE:To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery.
METHODS:Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI.
RESULTS:Significantly greater impairment was observed in participants with mTBI vs controlsRPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control −11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005).
CONCLUSIONS:Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely. |
| doi_str_mv | 10.1212/WNL.0000000000001758 |
| format | Article |
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METHODS:Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI.
RESULTS:Significantly greater impairment was observed in participants with mTBI vs controlsRPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control −11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005).
CONCLUSIONS:Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely.]]></description><identifier>ISSN: 0028-3878</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000001758</identifier><identifier>PMID: 26109715</identifier><language>eng</language><publisher>United States: American Academy of Neurology</publisher><subject>Acute Disease ; Adult ; Afghan Campaign 2001 ; Afghanistan ; Brain Injuries - diagnosis ; Brain Injuries - epidemiology ; Brain Injuries - etiology ; Diffusion Tensor Imaging - methods ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Young Adult</subject><ispartof>Neurology, 2015-07, Vol.85 (3), p.219-227</ispartof><rights>2015 American Academy of Neurology</rights><rights>2015 American Academy of Neurology.</rights><rights>2015 American Academy of Neurology 2015 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4908-9e0aa689c37fa71135a4c2ac9c5939b2a69f75d478f395f410e75cd852bbc89e3</citedby><cites>FETCH-LOGICAL-c4908-9e0aa689c37fa71135a4c2ac9c5939b2a69f75d478f395f410e75cd852bbc89e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26109715$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Adam, Octavian</creatorcontrib><creatorcontrib>Mac Donald, Christine L</creatorcontrib><creatorcontrib>Rivet, Dennis</creatorcontrib><creatorcontrib>Ritter, John</creatorcontrib><creatorcontrib>May, Todd</creatorcontrib><creatorcontrib>Barefield, Maria</creatorcontrib><creatorcontrib>Duckworth, Josh</creatorcontrib><creatorcontrib>LaBarge, Donald</creatorcontrib><creatorcontrib>Asher, Dean</creatorcontrib><creatorcontrib>Drinkwine, Benjamin</creatorcontrib><creatorcontrib>Woods, Yvette</creatorcontrib><creatorcontrib>Connor, Michael</creatorcontrib><creatorcontrib>Brody, David L</creatorcontrib><title>Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan</title><title>Neurology</title><addtitle>Neurology</addtitle><description><![CDATA[OBJECTIVE:To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery.
METHODS:Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI.
RESULTS:Significantly greater impairment was observed in participants with mTBI vs controlsRPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control −11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005).
CONCLUSIONS:Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely.]]></description><subject>Acute Disease</subject><subject>Adult</subject><subject>Afghan Campaign 2001</subject><subject>Afghanistan</subject><subject>Brain Injuries - diagnosis</subject><subject>Brain Injuries - epidemiology</subject><subject>Brain Injuries - etiology</subject><subject>Diffusion Tensor Imaging - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Young Adult</subject><issn>0028-3878</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EotvCP0DIRy4p_oi_LkjVqlCkFVxagbhYE8fZdXGcYjtU_fek2lK1PcBc5jDPPJrRi9AbSo4po-z9ty-bY_KgqBL6GVpRwWQjOfv-HK0IYbrhWukDdFjK5cIIpsxLdMAkJUZRsUI_1jGk4CBiSD0OI2xD2mIoxZcy-lTxNGBwc_XYTWMHFY8h9rhmmEeoweEuQ0g4pMs53ywNnwzbHaRQKqRX6MUAsfjXd_0IXXw8PV-fNZuvnz6vTzaNaw3RjfEEQGrjuBpAUcoFtI6BM04YbjoG0gxK9K3SAzdiaCnxSrheC9Z1ThvPj9CHvfdq7kbfu-XqDNFe5eWbfGMnCPbxJIWd3U6_bSuoZNosgnd3gjz9mn2pdgzF-Rgh-WkuliqphVRGsP-j0mjCSctvre0edXkqJfvh_iJK7G2CdknQPk1wWXv78Jv7pb-RLYDeA9dTrD6Xn3G-9tnuPMS6-7f7D_FaqSA</recordid><startdate>20150721</startdate><enddate>20150721</enddate><creator>Adam, Octavian</creator><creator>Mac Donald, Christine L</creator><creator>Rivet, Dennis</creator><creator>Ritter, John</creator><creator>May, Todd</creator><creator>Barefield, Maria</creator><creator>Duckworth, Josh</creator><creator>LaBarge, Donald</creator><creator>Asher, Dean</creator><creator>Drinkwine, Benjamin</creator><creator>Woods, Yvette</creator><creator>Connor, Michael</creator><creator>Brody, David L</creator><general>American Academy of Neurology</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope><scope>5PM</scope></search><sort><creationdate>20150721</creationdate><title>Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan</title><author>Adam, Octavian ; Mac Donald, Christine L ; Rivet, Dennis ; Ritter, John ; May, Todd ; Barefield, Maria ; Duckworth, Josh ; LaBarge, Donald ; Asher, Dean ; Drinkwine, Benjamin ; Woods, Yvette ; Connor, Michael ; Brody, David L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4908-9e0aa689c37fa71135a4c2ac9c5939b2a69f75d478f395f410e75cd852bbc89e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Afghan Campaign 2001</topic><topic>Afghanistan</topic><topic>Brain Injuries - diagnosis</topic><topic>Brain Injuries - epidemiology</topic><topic>Brain Injuries - etiology</topic><topic>Diffusion Tensor Imaging - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adam, Octavian</creatorcontrib><creatorcontrib>Mac Donald, Christine L</creatorcontrib><creatorcontrib>Rivet, Dennis</creatorcontrib><creatorcontrib>Ritter, John</creatorcontrib><creatorcontrib>May, Todd</creatorcontrib><creatorcontrib>Barefield, Maria</creatorcontrib><creatorcontrib>Duckworth, Josh</creatorcontrib><creatorcontrib>LaBarge, Donald</creatorcontrib><creatorcontrib>Asher, Dean</creatorcontrib><creatorcontrib>Drinkwine, Benjamin</creatorcontrib><creatorcontrib>Woods, Yvette</creatorcontrib><creatorcontrib>Connor, Michael</creatorcontrib><creatorcontrib>Brody, David L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adam, Octavian</au><au>Mac Donald, Christine L</au><au>Rivet, Dennis</au><au>Ritter, John</au><au>May, Todd</au><au>Barefield, Maria</au><au>Duckworth, Josh</au><au>LaBarge, Donald</au><au>Asher, Dean</au><au>Drinkwine, Benjamin</au><au>Woods, Yvette</au><au>Connor, Michael</au><au>Brody, David L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2015-07-21</date><risdate>2015</risdate><volume>85</volume><issue>3</issue><spage>219</spage><epage>227</epage><pages>219-227</pages><issn>0028-3878</issn><eissn>1526-632X</eissn><abstract><![CDATA[OBJECTIVE:To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery.
METHODS:Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI.
RESULTS:Significantly greater impairment was observed in participants with mTBI vs controlsRPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control −11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005).
CONCLUSIONS:Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely.]]></abstract><cop>United States</cop><pub>American Academy of Neurology</pub><pmid>26109715</pmid><doi>10.1212/WNL.0000000000001758</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Afghan Campaign 2001 Afghanistan Brain Injuries - diagnosis Brain Injuries - epidemiology Brain Injuries - etiology Diffusion Tensor Imaging - methods Female Humans Male Middle Aged Prospective Studies Young Adult |
| title | Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan |
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