EVALUATION OF MILD TRAUMATIC BRAIN INJURY PATIENTS

这个子项目是利用资源的许多研究子项目之一。 由NIH/NCRR资助的中心拨款提供。对子项目的主要支持 子项目的首席调查员可能是由其他来源提供的， 包括美国国立卫生研究院的其他来源。为子项目列出的总成本可能 表示该子项目使用的中心基础设施的估计数量， 不是由NCRR赠款提供给次级项目或次级项目工作人员的直接资金。 摘要 创伤性脑损伤(TBI)是青少年和年轻人死亡和残疾的主要原因，因此是一个主要的健康问题。虽然轻度创伤性脑损伤(MTBI)在这个年龄段通常不是致命的，但其神经行为影响可以持续几个月，而且人们对其通过大脑变化的调节知之甚少。为了了解MTBI后三个月内与骨科损伤(OI)相关的脑成像和神经行为功能的变化，目标1讨论了弥散张量成像(DTI)测量的脑白质完整性的变化、磁化率加权成像上所见的出血性病变以及磁化传递成像上的磁化传递比。目的1通过磁共振成像分析，探讨脑白质、灰质和脑脊液等脑区体积的变化。目的1探讨基线抽血获得的MTBI血清生物标志物与脑成像指标的关系，以及这些生物标志物的浓度是否区分MTBI和OI组。目的2测量MTBI患者伤后3个月信息加工速度、工作记忆、情景记忆和执行功能的变化，以及这些认知领域的变化与脑影像表现和功能结局的关系。目的3测量脑震荡后症状、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)的变化。目的3还研究了脑震荡后认知症状的变化与脑成像变量的关系，以及认知、情绪和躯体症状的变化与功能结局和HRQL的关系。我们提出了一项前瞻性的纵向研究，对象为220名右利手患者，年龄14-30岁，其中包括88名MTBI患者，44名合并中度意识障碍的TBI患者，以及88名无脑损伤的OI患者。两组颅脑损伤的选择标准包括在受伤后24小时内进行计算机断层扫描，显示无脑损伤。所有组都将在伤后96小时内接受基线评估，包括伤前状态评估、脑成像、替代生物标记物的抽血以及神经行为测试，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。在损伤后3个月重复脑成像，并在损伤后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，这项研究结果可能会提出减少发病率和提高预后的方法。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. ABSTRACT 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 (OI), 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 OI groups. Aim 2 measures change over three months post-injury in MTBI patients relative to the OI 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 OI 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 studys findings may suggest ways to reduce morbidity and enhance outcomes.