Cognitive Impairment in Mild Traumatic Brain Injury: A Longitudinal Diffusional Kurtosis and Perfusion Imaging Study

Grossman, Elan J.; Jensen, Jens H.; Babb, James S.; Chen, Q.; Tabesh, Ali; Fieremans, Els; Xia, Ding; Inglese, Matilde; Grossman, R I

doi:10.3174/ajnr.a3358

Cited by 167 publications

(159 citation statements)

References 36 publications

(56 reference statements)

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“…The outcome of the study is compatible with findings from other studies. However, in contrast to previous studies [1,13,16,17,19,[20][21][22][23], the MTBI patients showed no significantly reduced speed of information processing as was evaluated with the PASAT. An overview of the results of this study can be seen in Table 1.…”

Section: Cognitive Problems After Mild Traumatic Brain Injurycontrasting

confidence: 51%

“…In MTBI patients, mild impairments in speed of information processing, (sustained, divided, focused and/or alternating) attention and (auditory-verbal and/or visuospatial) memory have been found [1,13,16,17,19,[20][21][22][23]. With regard to memory, most patients displayed deficits concerning the storage of new information into memory and/ or the reproduction of recently learned information from memory.…”

Section: Cognitive Problems After Mild Traumatic Brain Injurymentioning

confidence: 99%

“…With regard to cognitive functioning, WI and MTBI patients often complain of poor attention and memory [7]. Several studies have looked for objective findings concerning cognitive dysfunctions after WI [1,2,[8][9][10][11][12][13][14][15] and MTBI [16][17][18][19][20][21][22][23] and have found the presence of only mild cognitive deficits, if any, in both patient groups, mainly in the domain of attention, information processing and memory.…”

Section: Introductionmentioning

confidence: 99%

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Whiplash Injury and Mild Traumatic Brain Injury: Differential Effects on Cognitive Functioning?

Beeckmans¹,

Michiels²

2017

Int J Neurorehabilitation Eng

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With regard to whiplash injury (WI) patients, some studies documented mild attention problems and a reduced speed of information processing. Most patients showed problems with sustained and/or divided attention. However, some patients had also problems with focused and alternating attention. Regarding memory, some studies detected mild (auditory-verbal and/or visuospatial) memory difficulties. Visuospatial and executive functions appeared mostly preserved. In mild traumatic brain injury (MTBI) patients, mild impairments in speed of information processing, (sustained, divided, focused and/or alternating) attention and (auditory-verbal and/or visuospatial) memory have been found. Furthermore, mild deficits could also be seen on tests measuring executive functions whereas visuospatial functioning seemed to be preserved. Until today, only two studies were devoted to evaluate possible differences in cognitive functioning between WI and MTBI patients. In these studies, both patient groups did not differ significantly with regard to measurements of attention, memory, and visuospatial and executive functions. Therefore, these authors conclude that MTBI patients do not perform more poorly on cognitive tests than WI patients, as might be expected from severity of trauma.

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Section: Cognitive Problems After Mild Traumatic Brain Injurycontrasting

confidence: 51%

Section: Cognitive Problems After Mild Traumatic Brain Injurymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Whiplash Injury and Mild Traumatic Brain Injury: Differential Effects on Cognitive Functioning?

Beeckmans¹,

Michiels²

2017

Int J Neurorehabilitation Eng

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“…21 Grossman and colleagues also showed decreases in MK in subjects scanned within 1 year post-injury, compared with controls. 24 In contrast, Zhuo and colleagues showed increases in MK from baseline in rats scanned 7 days post-injury, which coincided with increases in K axial and decreases in K radial. 25 Concussion, or mild traumatic brain injury (mTBI), is typically a clinical diagnosis.…”

mentioning

confidence: 99%

Abnormalities in Diffusional Kurtosis Metrics Related to Head Impact Exposure in a Season of High School Varsity Football

Davenport

Apkarian

Whitlow

et al. 2016

Journal of Neurotrauma

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The purpose of this study was to determine whether the effects of cumulative head impacts during a season of high school football produce changes in diffusional kurtosis imaging (DKI) metrics in the absence of clinically diagnosed concussion. Subjects were recruited from a high school football team and were outfitted with the Head Impact Telemetry System (HITS) during all practices and games. Biomechanical head impact exposure metrics were calculated, including: total impacts, summed acceleration, and Risk Weighted Cumulative Exposure (RWE). Twenty-four players completed pre-and post-season magnetic resonance imaging, including DKI; players who experienced clinical concussion were excluded. Fourteen subjects completed pre-and post-season Immediate Post-Concussion Assessment and Cognitive Testing (Im-PACT). DKI-derived metrics included mean kurtosis (MK), axial kurtosis (K axial), and radial kurtosis (K radial), and white matter modeling (WMM) parameters included axonal water fraction, tortuosity of the extra-axonal space, extraaxonal diffusivity (D e axial and radial), and intra-axonal diffusivity (D a ). These metrics were used to determine the total number of abnormal voxels, defined as 2 standard deviations above or below the group mean. Linear regression analysis revealed a statistically significant relationship between RWE combined probability (RWE CP ) and MK. Secondary analysis of other DKI-derived and WMM metrics demonstrated statistically significant linear relationships with RWE CP after covariate adjustment. These results were compared with the results of DTI-derived metrics from the same imaging sessions in this exact same cohort. Several of the DKI-derived scalars (D a , MK, K axial, and K radial) explained more variance, compared with RWE CP , suggesting that DKI may be more sensitive to subconcussive head impacts. No significant relationships between DKI-derived metrics and ImPACT measures were found. It is important to note that the pathological implications of these metrics are not well understood. In summary, we demonstrate a single season of high school football can produce DKI measurable changes in the absence of clinically diagnosed concussion.Keywords: concussion; diffusion kurtosis imaging; football; Head Impact Telemetry System; Risk Weighted Cumulative Exposure Introduction F ootball has the highest concussion rate of any competitive contact sport.1 Parents, coaches, and physicians of youth athletes are becoming increasingly concerned about the effects of head impacts. These concerns are reflected in the recent 9.5% decrease in participation in the Pop Warner youth football program.2 While concussion can represent a serious and immediate clinical manifestation of any head impact, the effects of repeated subconcussive impacts on youth and high school populations are largely unknown.Previous research has focused primarily on collegiate football players. [3][4][5][6][7] Recent biomechanical studies of head impacts have shown impact distributions for youth and high school players to ...

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“…109,110,112,119,122,132,133 Evidence and Recommendations for Perfusion Imaging. All the studies above have involved only limited numbers of patients, and further research is required to validate the findings described above and determine how relevant they are in the management of individual patients with TBI (class IIb recommendation).…”

Section: Perfusion Imagingmentioning

confidence: 99%

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Wintermark

Sanelli

Anzai

et al. 2014

AJNR Am J Neuroradiol

109

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SUMMARY:Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge. ABBREVIATIONS:BOLD ϭ blood oxygen level-dependent; FA ϭ fractional anisotropy; MD ϭ mean diffusivity; MEG ϭ magnetoencephalography; TBI ϭ traumatic

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Cognitive Impairment in Mild Traumatic Brain Injury: A Longitudinal Diffusional Kurtosis and Perfusion Imaging Study

Cited by 167 publications

References 36 publications

Whiplash Injury and Mild Traumatic Brain Injury: Differential Effects on Cognitive Functioning?

Whiplash Injury and Mild Traumatic Brain Injury: Differential Effects on Cognitive Functioning?

Abnormalities in Diffusional Kurtosis Metrics Related to Head Impact Exposure in a Season of High School Varsity Football

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

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