Cognitive Improvement after Mild Traumatic Brain Injury Measured with Functional Neuroimaging during the Acute Period.
Cognitive Improvement after Mild Traumatic Brain Injury Measured with Functional Neuroimaging during the Acute Period.
复制标题
在急性期间通过功能性神经影像学测量的轻度外伤性脑损伤后的认知改善。
DOI：
10.1371/journal.pone.0126110
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Naylor MR
中科院分区：
文献类型：
--
作者：
Wylie GR;Freeman K;Thomas A;Shpaner M;OKeefe M;Watts R;Naylor MR
轻度创伤性脑损伤（mTBI）的功能性神经影像学研究在很大程度上仅限于持续性脑震荡后症状的患者，使用实际头部创伤后数月至数年获得的图像。我们试图区分轻度创伤性脑损伤（mTBI）后72小时内和一周后轻度创伤性脑损伤对工作记忆功能脑激活模式的急性和延迟影响。我们假设，在损伤后< 72小时评估的症状性mTBI患者中，工作记忆的临床和fMRI测量将异常，大多数患者显示临床恢复（即，这些措施的改善）在初步评估后1周内。我们还假设，与临床完全恢复的患者相比，损伤后1周增加的记忆负荷将暴露持续性脑震荡后症状的mTBI患者的不同皮层激活模式。我们进行了一项前瞻性队列研究，研究对象为急诊科孤立性脑损伤患者和临床诊断为脑震荡的患者，并与对照组（未受伤的志愿者和急诊科四肢受伤且无头部创伤的患者）进行了比较。认知恢复的主要结局定义为报告的认知障碍的消退，并通过对受试者报告的1周脑震荡后认知症状进行评分进行量化。次要结局包括额外的脑震荡后症状和神经认知测试结果。我们招募了46名受试者：27名轻度TBI和19名对照。首次神经影像学检查时间为48（+22 S.D.）伤后1小时（时间1）。随访时（8.7，± 1.2 S.D.，损伤后10天，时间2），18名mTBI受试者（64%）报告中度至完全认知恢复，其中8名在初始和随访成像之间完全恢复。从时间1到时间2的fMRI变化显示，与对照组相比，mTBI受试者的后扣带回激活增加。在那些没有认知恢复的mTBI受试者中，激活的增加更大。随着mTBI受试者工作量的增加，右半球皮质区域的激活增加。总之，我们在轻度创伤性脑损伤后的第一周内发现了工作记忆缺陷的神经影像学证据。在脑损伤后1周，mTBI后持续认知症状的受试者对后扣带回激活的需求增加，以完成记忆任务。这些结果提供了深入了解从mTBI初始恢复过程中的功能激活模式，并暴露了可能参与工作记忆缺陷的区域激活网络。
Functional neuroimaging studies in mild traumatic brain injury (mTBI) have been largely limited to patients with persistent post-concussive symptoms, utilizing images obtained months to years after the actual head trauma. We sought to distinguish acute and delayed effects of mild traumatic brain injury on working memory functional brain activation patterns < 72 hours after mild traumatic brain injury (mTBI) and again one-week later. We hypothesized that clinical and fMRI measures of working memory would be abnormal in symptomatic mTBI patients assessed < 72 hours after injury, with most patients showing clinical recovery (i.e., improvement in these measures) within 1 week after the initial assessment. We also hypothesized that increased memory workload at 1 week following injury would expose different cortical activation patterns in mTBI patients with persistent post-concussive symptoms, compared to those with full clinical recovery. We performed a prospective, cohort study of working memory in emergency department patients with isolated head injury and clinical diagnosis of concussion, compared to control subjects (both uninjured volunteers and emergency department patients with extremity injuries and no head trauma). The primary outcome of cognitive recovery was defined as resolution of reported cognitive impairment and quantified by scoring the subject’s reported cognitive post-concussive symptoms at 1 week. Secondary outcomes included additional post-concussive symptoms and neurocognitive testing results. We enrolled 46 subjects: 27 with mild TBI and 19 controls. The time of initial neuroimaging was 48 (+22 S.D.) hours after injury (time 1). At follow up (8.7, + 1.2 S.D., days after injury, time 2), 18 of mTBI subjects (64%) reported moderate to complete cognitive recovery, 8 of whom fully recovered between initial and follow-up imaging. fMRI changes from time 1 to time 2 showed an increase in posterior cingulate activation in the mTBI subjects compared to controls. Increases in activation were greater in those mTBI subjects without cognitive recovery. As workload increased in mTBI subjects, activation increased in cortical regions in the right hemisphere. In summary, we found neuroimaging evidence for working memory deficits during the first week following mild traumatic brain injury. Subjects with persistent cognitive symptoms after mTBI had increased requirement for posterior cingulate activation to complete memory tasks at 1 week following a brain injury. These results provide insight into functional activation patterns during initial recovery from mTBI and expose the regional activation networks that may be involved in working memory deficits.
登录
查看更多内容
影响因子：
11
作者：
Chen, Jen-Kai;Johnston, Karen M.;Ptito, Alain
通讯作者：
Ptito, Alain
影响因子：
2.7
作者：
Chen, Jen-Kai;Johnston, Karen M.;Ptito, Alain
通讯作者：
Ptito, Alain
影响因子：
14.5
作者：
Hillary, Frank G.;Medaglia, John D.;Good, David C.
通讯作者：
Good, David C.
影响因子：
4.2
作者：
McAllister, Thomas W.;Flashman, Laura A.;Saykin, Andrew J.
通讯作者：
Saykin, Andrew J.
DOI：
10.1196/annals.1440.011
发表时间：
2008-01-01
期刊：
YEAR IN COGNITIVE NEUROSCIENCE 2008
影响因子：
--
作者：
Buckner, Randy L.;Andrews-Hanna, Jessica R.;Schacter, Daniel L.
通讯作者：
Schacter, Daniel L.