Task-induced subjective fatigue and resting-state striatal connectivity following traumatic brain injury.

BACKGROUND: People with traumatic brain injury (TBI) often experience fatigue, but an understanding of the neural underpinnings of fatigue following TBI is still lacking. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to examine associations between functional connectivity (FC) changes and task-induced changes in subjective fatigue in people with moderate-severe TBI. METHODS: Sixteen people with moderate-severe TBI and 17 matched healthy controls (HC) performed an adaptive N-back task (working memory task) to induce cognitive fatigue. Before and after the task they rated their state fatigue level and underwent rs-fMRI. Seed-to-voxel analyses with seeds in areas involved in cognitive fatigue, namely the striatum and default mode network (DMN) including, medial prefrontal cortex and posterior cingulate cortex, were performed. RESULTS: The adaptive N-back task was effective in inducing fatigue in both groups. Subjective task-induced fatigue was positively associated with FC between striatum and precuneus in people with TBI, while there was a negative association in HC. In contrast, subjective task-induced fatigue was negatively associated with FC between striatum and cerebellum in the TBI group, while there was no association in HC. Similar associations between task-induced subjective fatigue and DMN FC were found across the groups. CONCLUSIONS: Our results suggest that the subjective experience of fatigue was linked to DMN connectivity in both groups and was differently associated with striatal connectivity in people with moderate-severe TBI compared to HC. Defining fatigue-induced neuronal network changes is pertinent to the development of treatments that target abnormal neuronal activity after TBI.

Effectiveness of a process-oriented patient-tailored outpatient neuropsychological rehabilitation programme for patients in the chronic phase after ABI.

The objective of this prospective cohort study was to examine the effectiveness of an outpatient neuropsychological rehabilitation programme for patients with acquired brain injury (ABI) and their relatives. The participants were 26 ABI patients with a mean age of 44.7 (SD 11.7) years and 24 caregivers. Mean time since injury was 3.0 (SD 3.6) years. The intervention consisted of a patient-tailored process-oriented neuropsychological rehabilitation programme focusing on facilitation of the adaptation process. Repeated measurements were taken prior to treatment (T0), directly after treatment (T1) and 6 months later (T2). Primary outcome measures were cognitive failures (CFQ), quality of life (SA-SIP30), and individualised goals (GAS). Patients improved significantly on individualised goals between T0 and T1 (p < .01). This effect retained at T2. There were no significant differences on CFQ and SA-SIP30. The programme had a positive effect on attainment of the patient's individual goals. This was not associated with a higher level of participation or a better quality of life.

[The post-concussion syndrome: understanding and treating a disease process]. / Het postcommotioneel syndroom: begrijpen en behandelen van een ziekteproces.

BACKGROUND: The consequences of mild traumatic brain injury have been well described and are considered to be benign symptoms. So far, little is known about the chronicity of the symptoms (post-concussion syndrome) and about the treatment of the symptoms. AIM: To review the consequences of mild traumatic brain injury and the course and treatment of the post-concussion syndrome for the purpose of improving treatment. METHOD: Recent literature was reviewed and the findings were integrated into the existing knowledge about post-concussion syndrome. results The literature reveals a dichotomy in the interpretation of post-concussion symptoms - they are regarded as being psychogenic or neurogenic. The description of the post-concussion syndrome in terms of a disease process is not new, but has been largely neglected in the literature, and represents an attempt to integrate the extreme positions. CONCLUSION: Scientific research into post-concussion syndrome has given considerable attention to diagnostic issues, but has given much less attention to the development of treatment. Future research into the treatment of the post-concussion syndrome should result from the integration of current viewpoints and a description of the syndrome in terms of a disease process.

MR imaging, single-photon emission CT, and neurocognitive performance after mild traumatic brain injury.

BACKGROUND AND PURPOSE: Mild traumatic brain injury (mTBI) (Glasgow Coma Scale = 14-15) is a common neurologic disorder and a common cause of neurocognitive deficits in the young population. Most patients recover fully from mTBI, but 15% to 29% of patients have persistent neurocognitive problems. Although a partially organic origin is considered likely, little brain imaging evidence exists for this assumption. The aims of the present study were to establish the prevalence of posttraumatic lesions in mTBI patients on MR images and to assess the relation between these imaging findings and posttraumatic symptoms. Secondly, we explored the value of early posttraumatic single-photon emission CT (SPECT) for the evaluation of mTBI. METHODS: Twenty-one consecutive patients were included in the study. Patients underwent MR examination, technetium-99m hexamethylpropylene amine oxime SPECT, and neurocognitive assessment within 5 days after injury. Neurocognitive follow-up was conducted 2 and 6 months after injury, and MR imaging was repeated after 6 months. Lesion size and brain atrophy were measured on the MR studies. RESULTS: Twelve (57%) of 21 patients had abnormal MR findings, and 11 (61%) of 18 had abnormal SPECT findings. Patients with abnormal MR or SPECT findings had brain atrophy at follow-up. The mean neurocognitive performance of all subjects was within normal range. There was no difference in neurocognitive performance between patients with normal and abnormal MR findings. Patients with abnormal MR findings only showed significantly slower reaction times during a reaction-time task. Seven patients had persistent neurocognitive complaints and one patient met the criteria for a postconcussional syndrome. CONCLUSION: Brain lesions are common after mTBI; up to 77% of patients may have abnormal findings either on MR images or SPECT scans, and these lesions may lead to brain atrophy. The association between hypoperfusion seen on acute SPECT and brain atrophy after 6 months suggests the possibility of (secondary) ischemic brain damage. There is only a weak correlation between neuroimaging findings and neurocognitive outcome.

Whiplash associated disorders: is there a place for psychiatrists and psychologists?

Between 25 and 30% of the victims of a whiplash injury have complaints after one year. This condition is referred to as late whiplash syndrome. This syndrome is characterized by pain of the neck, headache, forgetfulness, poor concentration, mental fatigue, and affective symptoms. The causes of the persistent symptoms are unknown. In all, the evidence that late-whiplash syndrome is a neurological disorder is flimsy. Current opinion holds that the acute basis is the painful injury of the neck. In the months following the accident, pain is the substrate on which psychological and social factors may act. Emotional symptoms such as lability of affect and disturbed mood, or posttraumatic stress disorders are common after whiplash. Although there is definitely a place for psychiatrists and psychologists in the treatment of late whiplash syndrome, these professionals are not involved in late whiplash disorder as much as they should be. Brief psychological treatment has proven to significantly reduce the severity and duration of symptoms. Optimal management must cover the treatment of pain, depression, anxiety, and fatigue; adequate psycho-education, stressing the good long-term outcome; and education of patients and relatives on possible cognitive symptoms.