Caregivers' perspectives of the challenges faced with survivors of traumatic brain injury: A scoping review.

INTRODUCTION: Traumatic brain injury (TBI) has wide-ranging neuropsychological, physical, social and financial implications. The impact on caregivers of moderate to severe TBI survivors, particularly in low- and middle-income countries, is under-investigated. AIM: Identify and describe the experiences of caregivers' of moderate to severe TBI survivors postdischarge from healthcare facilities. METHODS: A scoping review was conducted utilising seven electronic databases. Two reviewers screened articles using eligibly criteria related to setting (postdischarge), caregiving (informal), age of TBI survivors (> 18 years) and injury severity (moderate-severe). Studies published in English between 1999 -2018 were included. RESULTS: Fourteen articles met the inclusion criteria. Articles reporting on the same sample were merged during data charting. The final analyses included 11 articles comprised of qualitative, quantitative and mixed-methods studies. Ten themes were identified: psychological distress, social functioning, financial burden, family experiences, coping strategies, access to services, time burdens and physical, cognitive and behavioural difficulties. Characteristics of caregivers and TBI survivors were also reported. CONCLUSION: Caregivers of moderate to severe TBI survivors experience challenges in various life domains, and there is limited research concerning caregivers in low- and middle-income countries. Future research should focus on understanding more nuanced experiences across various environments, which may increase comprehensive, flexible and long-term support.

The role of the basolateral amygdala in dreaming.

Neuroimaging studies have repeatedly shown amygdala activity during sleep (REM and NREM). Consequently, various theorists propose central roles for the amygdala in dreaming - particularly in the generation of dream affects, which seem to play a major role in dream plots. However, a causal role for the amygdala in dream phenomena has never been demonstrated. The traditional first step in determining this role is to observe the functional effects of isolated lesions to the brain structure in question. However, circumscribed bilateral amygdala lesions are extremely rare. Furthermore, the treatment of the amygdala as a unitary structure is problematic, as the basolateral and centromedial amygdala (BLA and CMA) may serve very different functions. We analysed 23 dream reports collected from eight adult patients with bilateral calcification of the BLA as a result of a very rare genetic condition called Urbach-Wiethe Disease (UWD). We compared these dream reports to 52 reports collected from 17 matched controls. Given that the BLA has been implicated in various affective processes in waking life, we predicted that the emotional content of the patients' dreams would differ from that of controls. Due to the exploratory nature of this research, a range of different dream characteristics were analysed. A principal components analysis run on all data returned three key factors, namely pleasantness, length and danger. The UWD patients' dream reports were significantly more pleasant and significantly shorter and less complex than control reports. No differences were found in levels of threat or danger. The results support some current hypotheses concerning the amygdala's role in dreaming, and call others into question. Future research should examine whether these UWD patients show generally impaired emotional episodic memory due to BLA damage, which could explain some of the current findings.

Improving Traumatic Brain Injury Outcomes: The Development of an Evaluation and Referral Tool at Groote Schuur Hospital.

BACKGROUND: The Western Cape Province of South Africa has a great shortage of diagnostic expertise, rehabilitative infrastructure, and support services for patients with traumatic brain injury (TBI). The neurosurgical outpatient setting is busy and often chaotic, and patients are frequently lost to follow-up. This study sought to continue with the design and development of a comprehensive, yet brief tool to aid patient referrals and ensure that no consequence of TBI is left unidentified and unaddressed. METHODS: There were 47 patients with TBI (mean age, 35 years; range, 18-75 years) assessed. The study was designed in 3 distinct phases, each representing a different stage in the tool's development. RESULTS: The Groote Schuur Traumatic Brain Injury Evaluation was shortened and simplified. Overall, 81% of the participants indicated cognitive dysfunction. There was a high prevalence of psychological/psychiatric sequelae, with 85% of participants reporting at least 1 such problem. CONCLUSIONS: The findings further highlight the prevalence of the cognitive, behavioral, and psychological consequences of TBI and shed additional light on the particular types of problems that patients with TBI face. Following the identified changes, the questionnaire and algorithm combination are now ready to be validated in the neurosurgical clinical setting.

Sweating away depression? The impact of intensive exercise on depression.

BACKGROUND: In periods of prolonged stress and pain the body produces endorphins to help endure pain. The PANIC system is built on the same pathways as the pain system and is characterized by behaviour that looks like depression. The term 'mental pain' in the context of feelings of loss is arguably justified in light of this relationship between the physical pain and social loss systems. It is reasonable to expect that endorphin release ameliorates depression. METHODS: Moderately depressed males (n=30) were randomly assigned to one of three groups of varying exercise intensity. Each underwent a six-week exercise programme for three days per week, one hour per day. The HAM-D, MADRS, and ANPS were administered weekly and ß-endorphin levels measured. RESULTS: Moderate- and high-intensity exercise improved depression levels, while very-low intensity exercise did not have as beneficial an effect. ß-endorphin results were inconclusive. Participants showed a slight decrease in PANIC and FEAR, and increased SEEKING. LIMITATIONS: The potential insensitivity of the assays that were utilized, and the known problems with measuring ß-endorphins, may have contributed to the findings. The lack of a state measure of the basic emotion systems is problematic, as a trait measure has to be relied upon, and this likely affected the ability to accurately detect changes over time. CONCLUSIONS: The demonstrated improvements in depressive symptoms have important implications for the clinical treatment of patients despite the hypothesis that the PANIC system is involved in the genesis and maintenance of depression not having been conclusively confirmed.

Evaluation of the potential of inducing neurocognitive changes in patients receiving intracranial stereotactic irradiation for benign tumors: a preliminary study.

OBJECTIVE: To fully evaluate the efficacy of intracranial stereotactic irradiation, tumour control needs to be assessed in conjunction with the effects of radiation on normal tissue and the potential for changes in physiology, cognition and quality of life. This prospective pilot study investigated whether intracranial stereotactic irradiation induces cognitive changes in patients with cranial and base of skull lesions that did not directly involve the brain parenchyma. The value of a software-based psychometric approach to neurocognitive testing was also examined. METHODS: Thirty-four patients were enrolled, with 23 having sufficient data for statistical analyses. Pre-treatment baseline composite test score results for memory, attention, motor, language, executive function, and social function were compared to post-radiotherapy scores at final evaluation (median follow-up 24 months, range 12-59 months). Testing was done using the Brain Resource Company® (BRC) Internet accessed cognitive function test batteries, namely the WebNeuro® and IntegNeuro®, and the BRISC® (Brain Resource Inventory for Social Cognition). RESULTS: Quantitative results revealed no overall decline in cognitive function, and improvement in both executive functioning (p = 0.0002) and social functioning (p = 0.0016). Qualitatively, 6 patients at the final endpoint, and 4 patients at 12 months, were found to have a decline in one or more domains of function; with some of the patients who declined also showing improvement in certain domains. CONCLUSION: Overall, no statistically significant evidence of cognitive decline was observed following intracranial stereotactic irradiation, at either 12 months or beyond.