Long-Term Neurobehavioral Symptoms and Return to Productivity in Operation Enduring Freedom/Operation Iraqi Freedom Veterans With and Without Traumatic Brain Injury

Mortera, Marianne; Kinirons, Stacy A.; Simantov, Jessie; Klingbeil, Heidi

doi:10.1016/j.apmr.2016.11.026

Cited by 23 publications

(17 citation statements)

References 37 publications

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“…Similar group differences were seen for prediction of state fatigue (time constant during the constant effort task), with several FP edges predicting fatigue in the OC group. Interestingly, the weaker connectivity between the right superior temporal gyrus ( Mortera et al, 2018 ) and the left claustrum ( Bigler, 2017 ) in the mTBI group predicted more trait and state fatigue. Note: Edge thickness indicates predictive strength (absolute beta value) from the generalized linear model predicting FSS score (reported in Table 4 ) or the generalized mixed model predicting TC (reported in Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, the symptom of post concussive syndrome that is most strongly related to resilience is fatigue ( Losoi et al, 2015b ). While this symptom, in particular, has only been investigated in a few studies involving military service members (c.f., Ramage et al, 2019 ; Lewis et al, 2021 ), one study validates that persistent fatigue in this population is associated with poorer rates of return to productivity ( Mortera et al, 2018 ). Thus, relationships among mild TBI, fatigue, and potential for recovery are intertwined and particularly prevalent in military service members.…”

Section: Introductionmentioning

confidence: 89%

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Cingulo-Opercular and Frontoparietal Network Control of Effort and Fatigue in Mild Traumatic Brain Injury

Ramage

Ray

Franz

et al. 2022

Front. Hum. Neurosci.

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Neural substrates of fatigue in traumatic brain injury (TBI) are not well understood despite the considerable burden of fatigue on return to productivity. Fatigue is associated with diminishing performance under conditions of high cognitive demand, sense of effort, or need for motivation, all of which are associated with cognitive control brain network integrity. We hypothesize that the pathophysiology of TBI results in damage to diffuse cognitive control networks, disrupting coordination of moment-to-moment monitoring, prediction, and regulation of behavior. We investigate the cingulo-opercular (CO) and frontoparietal (FP) networks, which are engaged to sustain attention for task and maintain performance. A total of 61 individuals with mild TBI and 42 orthopedic control subjects participated in functional MRI during performance of a constant effort task requiring altering the amount of effort (25, 50, or 75% of maximum effort) utilized to manually squeeze a pneumostatic bulb across six 30-s trials. Network-based statistics assessed within-network organization and fluctuation with task manipulations by group. Results demonstrate small group differences in network organization, but considerable group differences in the evolution of task-related modulation of connectivity. The mild TBI group demonstrated elevated CO connectivity throughout the task with little variation in effort level or time on task (TOT), while CO connectivity diminished over time in controls. Several interregional CO connections were predictive of fatigue in the TBI group. In contrast, FP connectivity fluctuated with task manipulations and predicted fatigue in the controls, but connectivity fluctuations were delayed in the mild traumatic brain injury (mTBI) group and did not relate to fatigue. Thus, the mTBI group’s hyper-connectivity of the CO irrespective of task demands, along with hypo-connectivity and delayed peak connectivity of the FP, may allow for attainment of task goals, but also contributes to fatigue. Findings are discussed in relation to performance monitoring of prediction error that relies on internal cues from sensorimotor feedback during task performance. Delay or inability to detect and respond to prediction errors in TBI, particularly evident in bilateral insula-temporal CO connectivity, corresponds to day-to-day fatigue and fatigue during task performance.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

Cingulo-Opercular and Frontoparietal Network Control of Effort and Fatigue in Mild Traumatic Brain Injury

Ramage

Ray

Franz

et al. 2022

Front. Hum. Neurosci.

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“…1 A significant portion of OEF/OIF/OND soldiers experienced traumatic brain injury (TBI), and suffer from posttraumatic stress disorder (PTSD) and symptoms akin to "postconcussive syndrome" (see section below: "Traumatic Brain Injury" for description). [2][3][4] Furthermore, these comorbid conditions interact and can result in considerable personal suffering and impairment that continues to plague soldiers and their families long after they have left the military.…”

Section: A Conceptual Model For the Consequences Of Warmentioning

confidence: 99%

Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War

Dieter

Engel

2019

J Exp Neurosci

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Scientific literature is reviewed supporting a “consequence of war syndrome (CWS)” in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn soldiers. CWS constituents include chronic pain and insomnia, other physical complaints, posttraumatic stress disorder (PTSD), anxiety, depression, and neuropsychological deficits. The foundation of CWS lies with the chronic stressors inherent to deployment and the cascade of biological events mediated and maintained by hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Such dysregulation is modified by the individual’s specific experiences at war, difficulty reintegrating to post-deployment life, and the onset or exacerbation of the chronic and comorbid physical, emotional, and cognitive disorders. The circuit network between the prefrontal cortex (PFC), amygdala, and hippocampus is particularly sensitive to the consequences of war. The review’s specific conclusions are as follows: HPA axis dysregulation contributes to the chronic insomnia and hyperarousal seen in soldiers. There is considerable symptom overlap between PTSD and blast-related head injury, and it is difficult to determine the relative contributions of the two disorders to abnormal imaging studies. In some cases, traumatic brain injury (TBI) may directly precipitate PTSD symptoms. While not intuitive, the relationship between TBI and postconcussion syndrome appears indirect and mediated through PTSD. Blast-related or conventional head injury may have little long-term impact on neuropsychological functioning; contrarily, PTSD particularly accounts for current cognitive deficits. The psychological experience of CWS includes a “war-within” where soldiers continue to battle an internalized enemy. Successful treatment of CWS entails transdisciplinary care that addresses each of the constituent disorders.

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“…Often, study designs with limited sample sizes require restricted age ranges as a means of controlling for age effects. Nonetheless, the majority of those who sustain military‐related TBI are under 35 years of age at the time of injury (Mortera, Kinirons, Simantov, & Klingbeil, ). However, TBIs do occur at all ages in military personnel, especially if nondeployment injuries are accounted for (DePalma, ).…”

Section: Introductionmentioning

confidence: 99%

Structural neuroimaging in mild traumatic brain injury: A chronic effects of neurotrauma consortium study

Bigler

Abildskov

Eggleston

et al. 2019

Int J Methods Psych Res

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Objectives The chronic effects of neurotrauma consortium (CENC) observational study is a multisite investigation designed to examine the long‐term longitudinal effects of mild traumatic brain injury (mTBI). All participants in this initial CENC cohort had a history of deployment in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and/or their follow‐on conflicts (Operation Freedom's Sentinel). All participants undergo extensive medical, neuropsychological, and neuroimaging assessments and either meet criteria for any lifetime mTBI or not. These assessments are integrated into six CENC core studies—Biorepository, Biostatistics, Data and Study Management, Neuroimaging, and Neuropathology. Methods The current study outlines the quantitative neuroimaging methods managed by the Neuroimaging Core using FreeSurfer automated software for image quantification. Results At this writing, 319 participants from the CENC observational study have completed all baseline assessments including the imaging protocol and tertiary data quality assurance procedures. Conclusions/Discussion The preliminary findings of this initial cohort are reported to describe how the Neuroimaging Core manages neuroimaging quantification for CENC studies.

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Long-Term Neurobehavioral Symptoms and Return to Productivity in Operation Enduring Freedom/Operation Iraqi Freedom Veterans With and Without Traumatic Brain Injury

Cited by 23 publications

References 37 publications

Cingulo-Opercular and Frontoparietal Network Control of Effort and Fatigue in Mild Traumatic Brain Injury

Cingulo-Opercular and Frontoparietal Network Control of Effort and Fatigue in Mild Traumatic Brain Injury

Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War

Structural neuroimaging in mild traumatic brain injury: A chronic effects of neurotrauma consortium study

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