Regional Brain Morphometry Predicts Memory Rehabilitation Outcome after Traumatic Brain Injury

Cognitive deficits following traumatic brain injury (TBI) commonly include difficulties with memory, attention, and executive dysfunction. These deficits are amenable to cognitive rehabilitation, but optimally selecting rehabilitation programs for individual patients remains a challenge. Recent methods for quantifying regional brain morphometry allow for automated quantification of tissue volumes in numerous distinct brain structures. We hypothesized that such quantitative structural information could help identify individuals more or less likely to benefit from memory rehabilitation. Fifty individuals with TBI of all severities who reported having memory difficulties first underwent structural MRI scanning. They then participated in a 12 session memory rehabilitation program emphasizing internal memory strategies (I-MEMS). Primary outcome measures (HVLT, RBMT) were collected at the time of the MRI scan, immediately following therapy, and again at 1-month post-therapy. Regional brain volumes were used to predict outcome, adjusting for standard predictors (e.g., injury severity, age, education, pretest scores). We identified several brain regions that provided significant predictions of rehabilitation outcome, including the volume of the hippocampus, the lateral prefrontal cortex, the thalamus, and several subregions of the cingulate cortex. The prediction range of regional brain volumes were in some cases nearly equal in magnitude to prediction ranges provided by pretest scores on the outcome variable. We conclude that specific cerebral networks including these regions may contribute to learning during I-MEMS rehabilitation, and suggest that morphometric measures may provide substantial predictive value for rehabilitation outcome in other cognitive interventions as well

Immediate Memory and Electrophysiologic Effects of Prefrontal Cortex Transcranial Direct Current Stimulation on Neurotypical Individuals and Individuals with Chronic Traumatic Brain Injury: A Pilot Study.

PURPOSE/AIM: Memory impairment post-TBI is common, frequently persistent, and functionally debilitating. The purposes of this pilot study were to assess and to compare immediate behavioral auditory working memory and electrophysiologic effects of three different, randomized, conditions of left dorsolateral prefrontal cortex (LDLPFC) transcranial direct current stimulation (tDCS) applied to four neurotypical adults and four adults with chronic traumatic brain injury (TBI). MATERIALS/METHODS: Pre- and post- anodal, cathodal, and sham tDCS auditory memory performance, auditory event-related potentials (P300 amplitude and latency) and power of alpha and theta EEG bands were measured across individuals in each group. RESULTS: Post-anodal tDCS only, the neurotypical and TBI groups both demonstrated significantly improved immediate auditory memory function. Also post-anodal tDCS, the TBI group demonstrated significantly increased P300 amplitude versus post-sham tDCS. The neurotypical group demonstrated no pre- post tDCS electrophysiologic changes across conditions. CONCLUSIONS: These findings are consistent with findings of other studies of immediate tDCS effects on other types of memory in neurotypical individuals and in individuals with Parkinson's disease, Alzheimer's disease, and stroke and suggest that individuals with memory impairments second to chronic TBI may benefit from LDLPFC anodal tDCS. Pairing tDCS with traditional behavioral memory interventions may facilitate TBI rehabilitation outcomes and warrants continued investigation

Relationship Stability After Traumatic Brain Injury Among Veterans and Service Members: A VA TBI Model Systems Study

Objective: To explore stability of relationships and predictors of change in relationship status 2 years following TBI/polytrauma. Setting: Five Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRCs). Participants: A total of 357 active duty service members and Veterans enrolled in the Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems database with complete marital status information at 2 years postinjury. Design: Prospective, longitudinal, multisite. Main Measures: Relationship status change was defined as change in marital status (single/never married; married; divorced/separated) at 2-year follow-up, compared with status at enrollment. Results: At the time of enrollment, 134 participants (38%) were single/never married; 151 (42%) were married, and 72 (20%) were divorced/separated. Of those married at enrollment, 78% remained married at year 2 while 22% underwent negative change. Multivariable analyses revealed that age and education at the time of injury and mental health utilization prior to injury were significant predictors of relationship change. Among those who were single/divorced/separated at the time of enrollment, 87% remained so at year 2 while 13% underwent positive change. Injury during deployment significantly predicted positive relationship change. Conclusions: The unmalleable, preinjury characteristics identified may be used as potential triggers for education, prevention, surveillance, and couples therapy, if needed

The Importance of Motivation to Older Adult Physical and Cognitive Exercise Program Development, Initiation, and Adherence

Brain health is essential to successful aging, and exercise is essential to brain health. Evidence supports the benefits of regular physical and cognitive exercise in preventing or delaying progressin of mild cognitive impairment and dementia. Despite known benefits, motivation to initiate and adhere to an exercise program can be challenging to older adults. We propose that assessment of motivation in the older adult population be part of individualized physical and cognitive exercise program initial development and ongoing precision health coaching to facilitate initiation of-and adherence to-individualized multi-modal exercise programs and sustained exercise engagement. We suggest one published, physical exercise motivation questionnaire and present a new, psychometrically supported, parallel cognitive exercise questionnaire to do so. Needs for-and implications of-continued exercise motivation research using neurophysiologic and neuropsychologic metrics are discussed

Neurocognitive Status and Return to Work After Moderate to Severe Traumatic Brain Injury

Purpose/Objective: To examine the relationship of cognitive status to employment outcomes at 1-year post moderate-severe traumatic brain injury (TBI), using a brief telephone-administered instrument. Research Method/Design: Prospective longitudinal study in which 320 people with moderate-severe TBI, all employed at injury, were enrolled during inpatient rehabilitation and evaluated at 1-year postinjury. Follow-up measures included whether and when participants had returned to work (RTW), and cognitive status assessed with the Brief Test of Adult Cognition by Telephone (BTACT). Multivariable logistic regression and survival analyses were used to assess the contribution of BTACT (overall and subscale scores) to employment outcomes, controlling for covariates with known associations to those outcomes, including demographic variables, injury severity, and driving status. Results: Fewer than 40% of participants (n = 124) were employed at 1-year follow-up. BTACT scores were strongly associated with RTW even after controlling for known covariates. Females had faster and higher rates of RTW compared to males. Resumption of driving and injury severity were also related to RTW. Conclusions/Implications: Neurocognitive status is a potentially modifiable factor with an important relationship to RTW following TBI. Vocational rehabilitation efforts should provide cognitive remediation or compensation as well as addressing transportation barriers. As a brief telephone-based assessment, the BTACT offers a new and efficient tool for evaluation of episodic memory and executive function. Impact and Implications It is important to assess modifiable factors for their relationship to return to work (RTW) following moderate to severe traumatic brain injury (TBI). Cognitive impairments are potentially modifiable and strongly related to RTW; thus, vocational rehabilitation should incorporate evidence-based cognitive remediation or compensation as well as addressing other modifiable obstacles such as transportation limitations. A brief, telephone-based assessment of episodic memory and executive function has the potential to add significantly to the evaluation of readiness to return to work at 1 year following moderate to severe TBI

Influence of Prior and Intercurrent Brain Injury on 5-Year Outcome Trajectories After Moderate to Severe Traumatic Brain Injury

To characterize the influence of additional (both prior and subsequent) traumatic brain injuries (TBIs) on recovery after a moderate to severe index TBI. Traumatic Brain Injury Model Systems centers. Persons with moderate to severe TBI (N = 5054) enrolled in the TBI Model Systems National Database with complete outcome data for the outcomes of interest at 1-, 2-, and 5-year follow-up. Secondary analysis of a prospective longitudinal data set. Prior and intercurrent TBI from the Ohio State University TBI Identification Method (OSU TBI-ID), Disability Rating Scale (DRS), and Functional Independence Measure (FIM). Prior moderate-severe TBIs significantly predicted overall level of functioning on the DRS, FIM Cognitive, and FIM Motor for participants with less severe index injuries. Moderate-severe intercurrent TBIs (TBIs subsequent to the index injury) were predictive of poorer functioning for both Index Severity groups, reflected in higher mean scores on the DRS in participants with less severe index injuries and lower mean Cognitive FIM in participants with more severe index injuries. Multiple brain injuries, particularly those of moderate or greater severity, have a significantly greater impact on patients' level of functioning compared with a single injury, but not the rate or shape of recovery

The Feasibility of Telephone-Administered Cognitive Testing in Individuals 1 and 2 Years after Inpatient Rehabilitation for Traumatic Brain Injury

Traumatic brain injury (TBI) often results in cognitive impairment, and trajectories of cognitive functioning can vary tremendously over time across survivors. Traditional approaches to measuring cognitive performance require face-to-face administration of a battery of objective neuropsychological tests, which can be time- and labor-intensive. There are numerous clinical and research contexts in which in-person testing is undesirable or unfeasible, including clinical monitoring of older adults or individuals with disability for whom travel is challenging, and epidemiological studies of geographically dispersed participants. A telephone-based method for measuring cognition could conserve resources and improve efficiency. The objective of this study is to examine the feasibility and usefulness of the Brief Test of Adult Cognition by Telephone (BTACT) among individuals who are 1 and 2 years post-moderate-to-severe TBI. A total of 463 individuals participated in the study at Year 1 post-injury, and 386 participated at Year 2. The sample was mostly male (73%) and white (59%), with an average age of (mean ± standard deviation) 47.9 ± 20.9 years, and 73% experienced a duration of post-traumatic amnesia (PTA) greater than 7 days. A majority of participants were able to complete the BTACT subtests (61-69% and 56-64% for Years 1 and 2 respectively); score imputation for those unable to complete a test due to severity of cognitive impairment yields complete data for 74-79% of the sample. BTACT subtests showed expected changes between Years 1-2, and summary scores demonstrated expected associations with injury severity, employment status, and cognitive status as measured by the Functional Independence Measure. Results indicate it is feasible, efficient, and useful to measure cognition over the telephone among individuals with moderate-severe TBI