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      Lifetime Multiple Mild Traumatic Brain Injuries Are Associated with Cognitive and Mood Symptoms in Young Healthy College Students

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          Abstract

          Background/objectives

          Repetitive mild traumatic brain injury (mTBI, also known as concussion) has been associated with a range of long-term mood and cognitive deficits, including executive dysfunction. Previous research in athletes suggests that cognitive and mood problems are associated with a history of repetitive mTBI. However, to date, no studies have examined the impact of a lifetime accumulation of repetitive mTBIs on cognition, particularly executive functioning, and mood in a sample of young adults who were not athletes. Therefore, the present study looked at potential effects of repetitive mTBIs on self-reported cognitive complaints, executive functioning, and mood in young adults.

          Methods

          Eighty-four total students responded, and 26 of those were excluded from analyses due to reporting only 1 mTBI. The final sample consisted of 58 healthy young adults (mean age = 22.84, STD = 4.88) who completed the Cognitive Complaint Index (CCI), the Behavior Rating Inventory of Executive Function, adult version (BRIEF-A), and the Beck Depression Inventory, second edition (BDI-II). Twenty-nine participants denied having an mTBI history, and 29 reported 2 or more lifetime mTBIs (range 2–7).

          Results

          Young otherwise healthy adults with a lifetime history of repetitive mTBI compared to those that reported no history of mTBI reported more change in cognitive functioning over the past 5 years, worse executive functioning, and more symptoms of depression. As the number of lifetime mTBIs increased, scores on the CCI, BRIEF-A, and BDI-II also increased, indicating worse functioning.

          Conclusion

          These findings suggest that a lifetime accumulation of two or more mTBIs as compared to a history of no reported mTBIs may result in worse cognitive functioning and symptoms of depression in young adults.

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          Most cited references 13

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          Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury.

          Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic encephalopathy (CTE). We review 48 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 profession althletes, 1 football player and 2 boxers. Clinically, CTE is associated with memory disturbances, behavioral and personality changes, parkinsonism, and speech and gait abnormalities. Neuropathologically, CTE is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain. The neurofibrillary degeneration of CTE is distinguished from other tauopathies by preferential involvement of the superficial cortical layers, irregular patchy distribution in the frontal and temporal cortices, propensity for sulcal depths, prominent perivascular, periventricular, and subpial distribution, and marked accumulation of tau-immunoreactive astrocytes. Deposition of beta-amyloid, most commonly as diffuse plaques, occurs in fewer than half the cases. Chronic traumatic encephalopathy is a neuropathologically distinct slowly progressive tauopathy with a clear environmental etiology.
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            The epidemiology and impact of traumatic brain injury: a brief overview.

            Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their efforts to return to a full and productive life. This article presents an overview of the epidemiology and impact of TBI.
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              Traumatic brain injury screening: preliminary findings in a US Army Brigade Combat Team.

              The objective of this article is to report the proportion of soldiers in a Brigade Combat Team (BCT) with at least 1 clinician-confirmed deployment-acquired traumatic brain injury (TBI) and to describe the nature of sequelae associated with such injuries. Members of an Army unit (n = 3973) that served in Iraq were screened for history of TBI. Those reporting an injury (n = 1292) were further evaluated regarding sequelae. Of the injuries suffered, 907 were TBIs and 385 were other types of injury. The majority of TBIs sustained were mild. Postdeployment, responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT) facilitated clinical interviews regarding injury history and associated somatic (ie, headache, dizziness, balance) and neuropsychiatric symptoms (ie, irritability, memory). Traumatic brain injury diagnosis was based on the American Congress of Rehabilitation Medicine mild TBI criteria, which requires an injury event followed by an alteration in consciousness. A total of 22.8% of soldiers in a BCT returning from Iraq had clinician-confirmed TBI. Those with TBI were significantly more likely to recall somatic and/or neuropsychiatric symptoms immediately postinjury and endorse symptoms at follow-up than were soldiers without a history of deployment-related TBI. A total of 33.4% of soldiers with TBI reported 3 or more symptoms immediately postinjury compared with 7.5% at postdeployment. For soldiers injured without TBI, rates of 3 or more symptoms postinjury and postdeployment were 2.9% and 2.3%, respectively. In those with TBI, headache and dizziness were most frequently reported postinjury, with irritability and memory problems persisting and presenting over time. Following deployment to Iraq, a clinician-confirmed TBI history was identified in 22.8% of soldiers from a BCT. Those with TBI were significantly more likely to report postinjury and postdeployment somatic and/or neuropsychiatric symptoms than those without this injury history. Overall, symptom endorsement decreased over time.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/359812
                URI : http://frontiersin.org/people/u/371243
                URI : http://frontiersin.org/people/u/361106
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                31 October 2016
                2016
                : 7
                Affiliations
                1Neuropsychology Laboratory, University of New Hampshire Manchester , Manchester, NH, USA
                Author notes

                Edited by: Lisa Anne Brenner, University of Colorado Denver, USA

                Reviewed by: Tessa Hart, Moss Rehabilitation Research Institute, USA; Audrey Lafrenaye, Virginia Commonwealth University, USA

                *Correspondence: Daniel R. Seichepine, daniel.seichepine@ 123456unh.edu

                Specialty section: This article was submitted to Neurotrauma, a section of the journal Frontiers in Neurology

                Article
                10.3389/fneur.2016.00188
                5086577
                Copyright © 2016 Vynorius, Paquin and Seichepine.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 24, Pages: 6, Words: 3746
                Categories
                Neuroscience
                Original Research

                Neurology

                cognition, executive function, neuropsychology, mild traumatic brain injury

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