The Structure of Postconcussion Symptoms on the Neurobehavioral Symptom Inventory

Vanderploeg, Rodney D.; Silva, Marc A.; Soble, Jason R.; Curtiss, Glenn; Belanger, Heather G.; Donnell, Alison; Scott, Steven

doi:10.1097/htr.0000000000000009

Cited by 111 publications

(74 citation statements)

References 35 publications

(30 reference statements)

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“…In particular, we demonstrated that factors within the higher-order model have limited discriminant validity. The high correlation of factors in this model, consistent with other work (Joyce et al, 2015; Potter et al, 2006; Sady et al, 2014; Vanderploeg et al, 2015), suggests that researchers should avoid statistically forcing lower-order factors to be uncorrelated (i.e., through orthogonal rotation), as it parses symptoms that are highly coherent and thus properly represented by correlated dimensions (as in the higher-order model of our study) or a broad common factor (as in the bifactor model we presented). In contrast to a bifactor model, these types of models may mask the importance/dominance of a single, broad dimension accounting for large proportions of variance in the domain.…”

Section: Discussionsupporting

confidence: 92%

Modeling the Structure of Acute Sport-Related Concussion Symptoms: A Bifactor Approach

Nelson

Kramer

Patrick

et al. 2018

J Int Neuropsychol Soc

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The SCAT3 contains items that appear unidimensional, suggesting that it is appropriate to quantify concussion symptoms with total scores. However, evidence of multidimensionality was revealed using bifactor modeling. Additional work is needed to clarify the nature of factors identified by this model, explicate their clinical and research utility, and determine to what degree the model applies to other stages of injury recovery and patient subgroups. (JINS, 2018, 24, 793-804).

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Section: Discussionsupporting

confidence: 92%

Modeling the Structure of Acute Sport-Related Concussion Symptoms: A Bifactor Approach

Nelson

Kramer

Patrick

et al. 2018

J Int Neuropsychol Soc

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“…4 Summing these ratings yielded a global PCS score (PCS-8) ranging from 0 to 32. Because persistent PCS affect multiple neurobehavioral domains (i.e., vestibular, somatic/ sensory, cognitive, and emotional), 2 we also calculated two alternative PCS measures: a ''physical'' PCS score and a ''cognitive/ emotional'' PCS score. The physical PCS score (PCS-5; range = 0-20) included vestibular and somatic/sensory PCS items: balance problems or dizziness, sensitivity to noise, sensitivity to light, memory problems, and headaches.…”

Section: Army Starrs Cohortmentioning

confidence: 99%

“…1 TBI is also a risk factor for adverse consequences in various other neurobehavioral functions including vestibular, somatic/sensory, cognitive, and emotional. 2 Indeed, a subset of individuals can experience persistent physical, cognitive, and emotional post-concussive symptoms (PCS) after single or multiple TBI. 3,4 Numerous epidemiological studies have investigated prognostic factors and adverse consequences of persistent PCS.…”

Section: Introductionmentioning

confidence: 99%

Cross-Phenotype Polygenic Risk Score Analysis of Persistent Post-Concussive Symptoms in U.S. Army Soldiers with Deployment-Acquired Traumatic Brain Injury

Polimanti

Chen

Ursano

et al. 2017

Journal of Neurotrauma

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Traumatic brain injury (TBI) contributes to the increased rates of suicide and post-traumatic stress disorder in military personnel and veterans, and it is also associated with the risk for neurodegenerative and psychiatric disorders. A cross-phenotype high-resolution polygenic risk score (PRS) analysis of persistent post-concussive symptoms (PCS) was conducted in 845 U.S. Army soldiers who sustained TBI during their deployment. We used a prospective longitudinal survey of three brigade combat teams to assess deployment-acquired TBI and persistent physical, cognitive, and emotional PCS. PRS was derived from summary statistics of large genome-wide association studies of Alzheimer's disease, Parkinson's disease, schizophrenia, bipolar disorder, and major depressive disorder (MDD); and for years of schooling, college completion, childhood intelligence, infant head circumference (IHC), and adult intracranial volume. Although our study had more than 95% of statistical power to detect moderate-to-large effect sizes, no association was observed with neurodegenerative and psychiatric disorders, suggesting that persistent PCS does not share genetic components with these traits to a moderate-to-large degree. We observed a significant finding: subjects with high IHC PRS recovered better from cognitive/emotional persistent PCS than the other individuals (R = 1.11%; p = 3.37 × 10). Enrichment analysis identified two significant Gene Ontology (GO) terms related to this result: GO:0050839∼Cell adhesion molecule binding (p = 8.9 × 10) and GO:0050905∼Neuromuscular process (p = 9.8 × 10). In summary, our study indicated that the genetic predisposition to persistent PCS after TBI does not have substantial overlap with neurodegenerative and psychiatric diseases, but mechanisms related to early brain growth may be involved.

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“…The NSI total score represents the sum of severity ratings of 22 symptoms, and cluster scores (i.e., vestibular, somatic, cognitive, and affective) were derived per Merterko et al (2012). Recently, Vanderploeg et al (2015) validated the 4-factor model in military TBI populations.…”

Section: Participants and Sample Characteristicsmentioning

confidence: 99%

Brainstem white matter integrity is related to loss of consciousness and postconcussive symptomatology in veterans with chronic mild to moderate traumatic brain injury

Delano‐Wood

Bangen

Sorg

et al. 2015

Brain Imaging and Behavior

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We investigated associations between DTI indices of three brainstem white matter tracts, traumatic brain injury (TBI) injury characteristics, and postconcussive symptomatology (PCS) in a well-characterized sample of veterans with history of mild to moderate TBI (mTBI). 58 military veterans (mTBI: n = 38, mean age = 33.2, mean time since injury = 90.9 months; military controls [MC]; n = 20; mean age = 29.4) were administered 3T DTI scans as well as a comprehensive neuropsychiatric evaluation including evaluation of TBI injury characteristics and PCS symptoms (e.g., negative mood, dizziness, balance and coordination difficulties). Tractography was employed by seeding ROIs along 3 brainstem white matter tracts (i.e., medial lemniscus-central tegmentum tract [ML-CTT]; corticospinal tracts [CST], and pontine tegmentum [PT]), and mean DTI values were derived from fractional anisotropic (FA) maps. Results showed that there were no significant difference in FA between the MC and TBI groups across the 3 regions of interest; however, among the TBI group, CST FA was significantly negatively associated with LOC duration. Additionally, lower FA of certain tracts-most especially the PT-was significantly associated with increased PCS symptoms (i.e., more severe vestibular symptoms, poorer physical functioning, and greater levels of fatigue), even after adjusting for PTSD symptoms. Our findings show that, in our sample of veterans with mTBI, tractography-based DTI indices of brainstem white matter tracts of interest are related to the presence and severity of PCS symptoms. Findings are promising as they show linkages between brainstem white matter integrity and injury severity (LOC), and they raise the possibility that the pontine tegmentum in particular may be a useful marker of PCS symptoms. Collectively, these data point to important neurobiological substrates of the chronic and complex constellation of symptoms following the 'signature injury' of our combat-exposed veterans.

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The Structure of Postconcussion Symptoms on the Neurobehavioral Symptom Inventory

Abstract: These findings extend the findings of Meterko et al to other samples. Because findings were consistent across sample and subsamples, the current findings are applicable to both Department of Veteran Affairs and Department of Defense postdeployment medical evaluation settings.

Cited by 111 publications

References 35 publications

Modeling the Structure of Acute Sport-Related Concussion Symptoms: A Bifactor Approach

Modeling the Structure of Acute Sport-Related Concussion Symptoms: A Bifactor Approach

Cross-Phenotype Polygenic Risk Score Analysis of Persistent Post-Concussive Symptoms in U.S. Army Soldiers with Deployment-Acquired Traumatic Brain Injury

Brainstem white matter integrity is related to loss of consciousness and postconcussive symptomatology in veterans with chronic mild to moderate traumatic brain injury

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