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

Baseline Characteristics Associated with Posttraumatic Stress in Caregivers of Pediatric Transplant Recipients: A Multi-Site, Multi-Regional Study

The objective of this study was to identify demographic, medical, psychosocial, and behavioral factors associated with parental post-traumatic stress (PTSS) within the pediatric transplant setting. Identification of these factors can aid in the ongoing development of the Integrative Trajectory Model (ITM), which provides a framework in which to understand posttraumatic stress within the medical setting. Participants included 386 parents who were enrolled in the Medication Adherence in Children who had a Liver Transplant (MALT) study, a longitudinal study that recruited from five transplant clinics across the U.S. The majority of participants were non-Hispanic, Caucasian, married, privately insured, and female. Most had school-aged children and completed, at minimum, some years of college or completed vocational school. Time since transplant ranged from 1 to 17 years, with the majority of transplants coming from deceased donors. Both mothers and fathers reported, on average, elevated levels of PTSS, and a minority of parents reported clinically indicated levels of depressive symptoms. Results from the primary analyses revealed that overall PTSS, avoidance symptoms, and intrusion symptoms were not significantly associated with parental gender or donor type. Overall PTSS, avoidance, and intrusion were positively associated with depressive symptoms and barriers to medication adherence. Results from post-hoc analyses show that intrusive symptoms were negatively associated with time since transplant and avoidance scores were positively associated with non-married status and lower education level. Results of this study indicate potential correlates of PTSS to include within the Integrative Trajectory Model (i.e., depressive symptoms, perceived barriers to treatment adherence, and time since transplant). Other factors that are in need of further exploration are education level and non-married status, which have been shown to be associated with PTSS avoidance. These findings indicate the clinical need to assess for and address PTSS and its potential correlates, such as depression and perceived barriers to medication adherence, within the transplant setting. Additionally, the results suggest a need to assess for PTSS in both mothers and fathers and to monitor whether intrusive symptoms are decreasing over time and, if not, to assess further as to what may be contributing to their maintenance

PTSD in solid organ transplant recipients: Current understanding and future implications.

PTSS are quite prevalent in transplant recipients, although full-scale PTSD may not be that common. Those symptoms have been linked to poor transplant outcomes, perhaps owing to non-adherence to medications and other recommendations, brought about by the avoidance dimension of the PTSD/PTSS construct (patients may avoid taking their medications because they serve as reminder of the emotionally traumatic event--the transplant). It is possible to treat PTSD via specific psychotherapeutic techniques, and the treatment has been shown to be safe and likely effective in other populations. Therefore, practitioners who treat transplant recipients should be familiar with the presentation and treatment of those symptoms. This manuscript provides a systematic literature review of the PTSD/PTSS presentation in the pediatric transplant setting, a synthesis of available research findings, and suggestions for current care and future research

PTSD in solid organ transplant recipients: Current understanding and future implications.

PTSS are quite prevalent in transplant recipients, although full-scale PTSD may not be that common. Those symptoms have been linked to poor transplant outcomes, perhaps owing to non-adherence to medications and other recommendations, brought about by the avoidance dimension of the PTSD/PTSS construct (patients may avoid taking their medications because they serve as reminder of the emotionally traumatic event--the transplant). It is possible to treat PTSD via specific psychotherapeutic techniques, and the treatment has been shown to be safe and likely effective in other populations. Therefore, practitioners who treat transplant recipients should be familiar with the presentation and treatment of those symptoms. This manuscript provides a systematic literature review of the PTSD/PTSS presentation in the pediatric transplant setting, a synthesis of available research findings, and suggestions for current care and future research