Evaluation of Mild Traumatic Brain Injury Patients

轻度创伤性脑损伤患者的评估

• 批准号: 8518476
• 负责人: HARVEY LEVIN
• 金额: $ 6.39万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8518476
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Adolescent; Age; Amnesia; Attention; Biological Markers; Blood; Brain; Brain Concussion; Brain Stem; Brain imaging; Brain region; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cerebrospinal Fluid; Cerebrum; Clinical Management; Cognition; Cognitive; Conscious; Controlled Study; Data; Data Analyses; Diffuse Axonal Injury; Diffusion Magnetic Resonance Imaging; Emergency Situation; Emotional; Environmental Risk Factor; Episodic memory; Evaluation; Exhibits; Facilities and Administrative Costs; Family member; Friends; Funding; Glasgow Coma Scale; Hand; Health; Healthcare Systems; Hospitals; Hour; Image; Impairment; Incidence; Injury; Investigation; Lesion; Longitudinal Studies; Magnetic Resonance Imaging; Measures; Mediation; Medical; Memory; Modeling; Morbidity - disease rate; Neurobehavioral Manifestations; Orthopedics; Outcome; Patients; Persons; Post-Concussion Syndrome; Predisposition; Productivity; Quality of life; Recovery; Relative (related person); Research; Schools; Selection Criteria; Serum; Short-Term Memory; Stress; Surveys; Symptoms; TBI Patients; Traumatic Brain Injury; Unconscious State; United States; United States National Institutes of Health; Visit; Weight; Work; X-Ray Computed Tomography; base; cognitive recovery; cost; disability; emotional distress; executive function; functional outcomes; functional status; gray matter; health related quality of life; indexing; information processing; life time cost; neurobehavioral; neurobehavioral test; processing speed; prospective; statistics; white matter; white matter injury; young adult

Traumatic brain injury (TBI) is a leading cause of death and disability in adolescents and young adults and therefore represents a major health problem. Although mild traumatic brain injury (MTBI) is generally nonfatal in this age range, the neurobehavioral effects can persist for months and their mediation by changes in the brain is poorly understood. To gain understanding of changes in brain imaging and neurobehavioral function over three months post-MTBI relative to orthopedic injury (Ol), Aim 1 addresses changes in the integrity of cerebral white matter as measured by diffusion tensor imaging (DTI), hemorrhagic lesions seen on susceptibility weighted imaging, and the magnetization transfer ratio on magnetization transfer imaging. Aim 1 also addresses changes in brain region volumes of white matter, gray matter, and cerebrospinal fluid by analysis of magnetic resonance imaging. Aim 1 also investigates the relation of serum biomarkers of MTBI obtained from a blood draw at baseline to the brain imaging variables and whether the concentrations of these biomarkers differentiate MTBI and Ol groups. Aim 2 measures change over three months post-injury in MTBI patients relative to the Ol group in information processing speed, working memory, episodic memory, and executive functions and the relation of changes in these cognitive domains to brain imaging findings and to functional outcome. Aim 3 measures change over three months in post-concussion symptoms, posttraumatic stress symptoms, emotional status, functional status, and health-related quality of life (HRQL). Aim 3 also studies change in cognitive post-concussion symptoms in relation to brain imaging variables and the relation of change in cognitive, emotional, and somatic post-concussion symptoms to functional outcome and HRQL. We propose a prospective, longitudinal study of 220 right-handed patients, age 14-30 years old, including 88 with MTBI, 44 patients with TBI associated with moderate impairment of consciousness, and 88 patients with Ol without brain insult. Selection criteria for the two TBI groups include computed tomography within 24 hours post-injury that shows no brain lesions. All groups would undergo a baseline assessment within 96 hours post-injury, including assessment of pre-injury status, brain imaging, blood draw for surrogate biomarkers, and neurobehavioral testing including cognition, post-concussion and posttraumatic stress symptoms, emotional status, functional status, and HRQL. Brain imaging would be repeated at three months post-injury, and neurobehavioral assessment would be repeated at both one and three months post-injury. Multivariate statistics and the general linear mixed model would be used to analyze the data. By helping to understand the relation of changes in brain imaging to neurobehavioral changes after MTBI in young persons, this study's findings may suggest ways to reduce morbidity and enhance outcomes.

创伤性脑损伤是青少年和青壮年死亡和残疾的主要原因。 因此，这是一个重大的健康问题。虽然轻度创伤性脑损伤一般不致命 在这个年龄段，神经行为的影响可以持续几个月，并通过 人们对大脑知之甚少。了解脑成像和神经行为功能的变化 在MTBI术后三个多月，相对于骨科损伤(Ol)，Aim 1解决了骨科创伤(Ol)后骨盆完整性的变化 弥散张量成像(DTI)测量脑白质，可见出血性病变 磁化率加权成像和磁化传递成像上的磁化传递比。目标1 还通过以下方式解决脑区白质、灰质和脑脊液体积的变化 磁共振成像分析。目的1探讨MTBI患者血清标志物之间的关系 从基线抽血获得的脑部成像变量和浓度是否 这些生物标志物可区分MTBI组和OL组。目的2损伤后3个月内的测量变化 MTBI患者在信息加工速度、工作记忆、情景记忆、 和执行功能，以及这些认知域的变化与脑成像结果的关系 到功能结果。目的3测量脑震荡后3个月内症状的变化， 创伤后应激症状、情绪状态、功能状态和健康相关生活质量(HRQL)。 目的3还研究了脑震荡后认知症状的变化与脑成像变量和 脑震荡后认知、情绪和躯体症状的变化与功能结局的关系 和HRQL.我们提出了一项对220名右撇子患者的前瞻性纵向研究，年龄在14-30岁之间， 包括88例MTBI，44例合并中度意识障碍的TBI患者，88例 无脑侮辱的OL患者。两个脑外伤组的选择标准包括计算机断层扫描 伤后24小时内未发现脑部损伤。所有小组都将接受基线评估 在受伤后96小时内，包括受伤前状态评估、脑成像、代孕采血 生物标志物和神经行为测试，包括认知、脑震荡后和创伤后应激 症状、情绪状态、功能状态和HRQL。脑成像将在三个月后重复进行 并在伤后1个月和3个月重复神经行为评估。 采用多元统计和一般线性混合模型对数据进行分析。通过帮助 了解年轻人MTBI后脑成像变化与神经行为变化的关系， 这项研究的发现可能会提出减少发病率和提高结果的方法。