Risk Factors for Alzheimer Disease Development After Traumatic Brain Injury: A Preliminary Study.

Traumatic brain injury (TBI) is increasingly recognized as a major risk factor for developing neurocognitive disorders, though this association remains controversial. Determination of risk factors for post-traumatic neurodegeneration in patients with TBI is critical given the high incidence of TBI. We hypothesized that cardiovascular and metabolic comorbidities, in addition to TBI severity, are associated with the risk of post-traumatic development of Alzheimer disease dementia (ADD). A case-controlled retrospective study was conducted using medical records and medical insurance data of 5642 patients with TBI admitted to a tertiary trauma center over a 12-year period, to assess risk factors of developing ADD after TBI. Logistic regression shows that presence of post-traumatic amnesia ( P= 0.03) and chronic vascular lesions ( P= 0.04) are significantly associated with development of ADD after TBI. This innovative preliminary study is the first to explore risk factors for post-traumatic ADD. Further association studies are essential to optimize care following TBI.

Dancers' Perceptions of Accessibility and Quality of the Relationship with Healthcare Professionals in Quebec.

OBJECTIVE: To understand dancers' perception of accessibility to care and quality of the relationship with healthcare practitioners in Quebec; to identify the key elements of an optimal dancer-physician relationship; and to propose recommendations for improvement. METHODS: An online questionnaire consisting of multiple choice, "yes/no," and short answer questions was sent to professional dance organizations, companies, agencies, and schools in Quebec, Canada. Information regarding the dance artists' sociodemographics, dance background, dance-related injuries, and access to a primary care physician were collected. Experiences and expectations regarding the dancer-physician relationship were surveyed. One-way ANOVA analyses and Pearson correlations were performed to assess differences of perception between dancers' demographic characteristics and associations between the variables. RESULTS: Out of 161 participants, 144 met inclusion criteria, consisting of largely French-speaking females, North American or European decent, self-employed contemporary dancers with an average age of 33.13 ± 10.81 yrs. Dance artists sought medical care from osteopaths (47.9%) and physiotherapists (36.1%) more frequently than from physicians (8.3%). Fully employed dancers had more favorable perceptions of the dancer-physician relationship compared to self-employed dancers and those who had mixed streams of income. The perception of most participants was that physicians do not comprehend the unique dance-associated impacts on health (81.8%). The most important aspect affecting perception of the relationship with the physician was diagnostic acumen (41.3%). Most participants (79.0%) selected "works with other health professionals [...] and gives expert advice" as an important expectation from physicians. CONCLUSION: This research is the first investigation of the dancer-physician relationship in Quebec. It reveals a desire amongst the dance artist community to improve the dancer-physician relationship and the overall quality of their unique healthcare requirements.

Longitudinal recovery of executive functions and social participation prediction following traumatic brain injury.

There is heterogeneity across studies and a lack of knowledge about recovery of EFs over time following traumatic brain injury (TBI). Also, EFs are associated with functional outcome, but there is still a gap in knowledge concerning the association between EFs and social participation following TBI. For this reason, we aim to (1) measure the recovery of the three executive function subcomponents of Miyake's model, namely flexibility, updating and inhibition between the acute phase (T1) and 6 months post TBI (T2) and (2) measure the relationship between EFs and social participation after TBI. Thus, a prospective longitudinal study that included 75 patients with TBI (mild and moderate-severe) and 50 patients with orthopedic injuries (controls) without brain damage was carried out. An extensive EFs test battery was administered at T1 and T2 whereas the Mayo-Portland Adaptability Inventory-4 (MPAI-4) was administered only at T2. In contrast with the controls, both TBI groups improved significantly between T1 and T2 on WMS-III Mental Control test (MC) and the D-KEFS Category Switching Condition of the Verbal Fluency task (SVF). Results also showed a simple time effect for the WAIS-IV Digit span and the Hayling tests. Moreover, there was an association between the SVF test and social participation (MPAI-4) at T2. In conclusion, the MC and SVF tests were found to be the best tools for measuring recovery of EFs following TBI. The SVF test was the most likely measure of EFs to give the neuropsychologist an idea of the patient's social participation.

Narrative Review of the Pathophysiology of Headaches and Photosensitivity in Mild Traumatic Brain Injury and Concussion.

The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms. The ultimate purpose is to better understand the pathophysiology of these symptoms in order to provide better and more targeted care to afflicted patients. A review of the literature was conducted using the databases CINAHL, EMBASE, PubMed. All papers were screened for sections on pathophysiology of PTH or photophobia in mTBI patients. Our paper summarizes current hypotheses. Although the exact pathophysiology of PTH and photophobia in mTBI remains to be determined, we highlight several interesting findings and avenues for future research, including central and peripheral explanations for PTH, neuroinflammation, cortical spreading depolarization and the role of glutamate excitotoxicity. We discuss the possible neuroanatomical pathways for photophobia and hypothesize a possible common pathophysiological basis between PTH and photophobia.

Revue non systématique de la pathophysiologie des céphalées et de la photosensibilité dans le cas de traumatismes crânio-cérébraux légers. Les symptômes les plus courants du syndrome post-commotionnel (SPC) sont des céphalées post-traumatiques (CPT) accompagnées de photophobie. Ce type de céphalée est à l'heure actuelle considéré comme un trouble de nature secondaire dont le phénotype clinique et les caractéristiques ressemblent à ceux des céphalées dites primaires: tensions, migraines, maux de tête qui ressemblent à des migraines, algies vasculaires du visage, etc. Bien que les CPT soient souvent traitées par une médication utilisée dans le cas des céphalées dites primaires, il nous reste encore à élucider le mécanisme sous-jacent des CPT. L'objectif de cette revue non-systématique est de déterminer, chez des patients victimes de traumatismes crânio-cérébraux (TCC) légers, l'état actuel des connaissances concernant ce type de maux de tête et la photophobie qui y est associée, et ce, afin d'orienter les recherches ultérieures et de pouvoir découvrir les mécanismes qui président à l'apparition de ces deux symptômes. L'objectif ultime qui est le nôtre est de mieux comprendre la pathophysiologie de ces symptômes en vue de pouvoir offrir aux patients qui en sont atteints des soins mieux ciblés et de meilleure qualité. Nous avons ainsi mené une revue de la littérature au moyen des bases de données suivantes: CINAHL, Embase et PubMed. Tous les articles ont été passés au peigne fin en vue d'identifier, dans le cas de patients victimes de TCC légers, des passages portant sur la pathophysiologie des CPT ou sur la photophobie. Notre article entend aussi résumer les hypothèses actuelles qui portent sur cette question. Quoique la pathophysiologie précise des CPT et de la photophobie associée aux TCC légers restent à déterminer, nous avons mis en lumière plusieurs pistes et constats intéressants en vue d'activités de recherche futures, ce qui inclut des facteurs explicatifs d'origine centrale et périphérique, de la neuro-inflammation, des ondes lentes de dépolarisation (OLD) et le rôle de l'excitotoxicité du glutamate. Nous avons aussi abordé les possibles voies neuro-anatomiques de la photophobie en plus d'émettre l'hypothèse qu'il existe une pathophysiologie commune entre les CPT et la photophobie.

Comparative Outcomes of Traumatic Brain Injury from Biking Accidents With or Without Helmet Use.

OBJECTIVE: To determine if health outcomes and demographics differ according to helmet status between persons with cycling-related traumatic brain injuries (TBI). METHODS: This is a retrospective study of 128 patients admitted to the Montreal General Hospital following a TBI that occurred while cycling from 2007-2011. Information was collected from the Quebec trauma registry and the coroner's office in cases of death from cycling accidents. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated were length of stay (LOS), extended Glasgow outcome scale (GOS-E), injury severity scale (ISS), discharge destination and death. RESULTS: 25% of cyclists wore a helmet. The helmet group was older, more likely to be university educated, married and retired. Unemployment, longer intensive care unit (ICU) stay, severe intracranial bleeding and neurosurgical interventions were more common in the no helmet group. There was no significant association between the severity of the TBI, ISS scores, GOS-E or death and helmet wearing. The median age of the subjects who died was higher than those who survived. CONCLUSION: Cyclists without helmets were younger, less educated, single and unemployed. They had more severe TBIs on imaging, longer LOS in ICU and more neurosurgical interventions. Elderly cyclists admitted to the hospital appear to be at higher risk of dying in the event of a TBI.

Societal cost of traumatic brain injury: A comparison of cost-of-injuries related to biking with and without helmet use.

OBJECTIVE: The goal of this study is to determine if a difference in societal costs exists from traumatic brain injuries (TBI) in patients who wear helmets compared to non-wearers. METHODS: This is a retrospective cost-of-injury study of 128 patients admitted to the Montreal General Hospital (MGH) following a TBI that occurred while cycling between 2007-2011. Information was collected from Quebec Trauma Registry. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated societal costs. RESULTS: The median costs of hospitalization were significantly higher (p = 0.037) in the no helmet group ($7246.67 vs. $4328.17). No differences in costs were found for inpatient rehabilitation (p = 0.525), outpatient rehabilitation (p = 0.192), loss of productivity (p = 0.108) or death (p = 1.000). Overall, the differences in total societal costs between the helmet and no helmet group were not significantly different (p = 0.065). However, the median total costs for patients with isolated TBI in the non-helmet group ($22, 232.82) was significantly higher (p = 0.045) compared to the helmet group ($13, 920.15). CONCLUSION: Cyclists sustaining TBIs who did not wear helmets in this study were found to cost society nearly double that of helmeted cyclists.

Acute global outcome in patients with mild uncomplicated and complicated traumatic brain injury.

PRIMARY OBJECTIVE: This study assesses the influence of socio-demographic, psychosocial, clinical and radiological variables on the outcome of patients with mild traumatic brain injury (MTBI) in an acute care inpatient setting. RESEARCH DESIGN: Retrospective cohort study. METHODS AND PROCEDURE: A total of 2127 inpatients with MTBI were included. Outcomes measured were Extended Glasgow Outcome Scale (GOS-E), the FIM® instrument, length of stay (LOS) and discharge destination. MAIN OUTCOMES AND RESULTS: Fifty-four per cent of patients with MTBI with a median GOS-E of 2 were discharged home with no need for further follow-up. Age, LOS, lower Glasgow score (GCS) at admission, insurance coverage and positive CT scans were associated with rehabilitation referrals on discharge. Age, LOS, alcohol and drug abuse, motor vehicle collision and lower GCS at admission were associated with greater physical disabilities and functional impairment at discharge. FIM® cognitive functional scores were higher in women, younger patients and patients without psychiatric disorders. Brain lesions were correlated with longer LOS. CT scan findings in patients with MTBI may help clinicians predict the final outcome and resources required for patient care during their hospitalization and on discharge. CONCLUSION: This study can help healthcare professionals in treating and planning future care of patients with MTBI.

Neuroanatomical correlates of the clock drawing test in patients with traumatic brain injury.

OBJECTIVE: The clock drawing test (CDT) is a quick and easy to administer test that has traditionally shown parietal lobe dysfunction. The aim of this study was to correlate performance on the CDT with the presence of acute traumatic cerebral injuries sustained after traumatic brain injury (TBI). METHODS: A retrospective study was conducted on 170 patients with TBI of all severity admitted to an acute care setting. These patients sustained different types of injuries (epidural haematoma, subdural haematoma, subarachnoid haemorrhage, intraparenchymal haematoma and brain oedema) in different sites (frontal, temporal, parietal, occipital lobes, bilateral and right or left hemisphere). RESULTS: The CDT total score was significantly lower for subjects presenting subarachnoid haemorrhage (4.80 ± 3.34 vs 7.04 ± 3.14, t(168df) = 4.477, p < 0.001) and for those presenting brain oedema (4.50 ± 3.06 vs 6.69 ± 3.38, t(168df) = 4.214, p < 0.001), parietal injury (5.15 ± 3.17 vs 6.42 ± 3.52, t(168df) = 2.416, p = 0.017) or bilateral injuries (5.28 ± 3.31 vs 6.62 ± 3.44, t(168df) = 2.569, p = 0.011) compared to those who did not. CONCLUSION: This study provides empirical evidence of the relationship between TBIs and results on the CDT, supporting previous studies done with other populations.

Global outcome in acute phase of treatment following moderate-to-severe traumatic brain injury from motor vehicle collisions vs assaults.

PRIMARY OBJECTIVE: To compare socio-demographic, medical characteristics and acute outcomes between patients with traumatic brain injuries (TBIs) from motor vehicle collision (MVC) or assault in an acute care setting. RESEARCH DESIGN: This descriptive, comparative retrospective cohort study included 415 patients with moderate and severe TBI secondary to an assault (n»91) vs a motor vehicle collision (n=324). METHODS AND PROCEDURES: Outcome measures were length of stay (LOS) in the intensive care unit and in hospital, Extended Glasgow Outcome Scale (GOS-E), FIM® instrument ('FIM') and discharge destination. MAIN OUTCOMES AND RESULTS: Patients with TBI from MVC had a higher percentage of polytrauma, higher injury severity scores, required more orthopaedic surgeries and thoracic drain insertions. Patients with TBI from assault were more often non-Caucasian, young single men, less educated with higher unemployment rates and criminal records, with a history of alcohol and drug abuse and were more often intoxicated on admission. There was no significant group difference in the LOS and FIM ratings, but patients with assault-related TBI were more often discharged home and had a more favourable GOS-E. CONCLUSION: Variables such as injury severity, age, level of intoxication on admission and presence of surgeries should be considered when determining acute outcome.