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The aim of this study was to determine the sociodemographic and MTBI-related variables associated with executive functioning (EF). Based on the theoretical model of Hou and colleagues, data on predisposing (age, education, premorbid IQ), precipitating (post-traumatic amnesia, loss of consciousness, presence of frontal lesions, post-accident time to evaluation) and perpetuating (anxious and depressive affects and post-concussive symptoms) factors were retrospectively collected from the medical records of 172 patients with MTBI. EF data based on the 3 processes included in Miyake's prediction model (2000) (updating, cognitive flexibility and inhibition) were collected using respectively the Digit span task of the Weschler – 4th edition, the Trails A and B as well as the initiation time on the Tower of London- Drexel University. Updating was significantly associated with education, premorbid IQ, age, anxiety, and depressive affect. Inhibition was associated with education and age. No variable was associated with cognitive flexibility. Following a MTBI, clinicians should consider that level of education and pre-morbid IQ may "predispose" patients to higher EF performances. They should also measure level of anxiety and depressive affect knowing that these may "perpetuate" some EF impairments (specifically the updating process). [ABSTRACT FROM AUTHOR]

Purpose: Compared to studies on moderate and severe traumatic brain injury (TBI), less literature exists concerning the consequences of mild traumatic brain injury (mTBI) on community integration and life satisfaction, especially in the early phase of recovery. Moreover, a better understanding of the variables that contribute to community integration and life satisfaction is still needed. The aim of the study was to assess the association of mood, fatigue and post-concussive symptoms with community integration and life satisfaction early following mTBI. Research method: A total of 85 participants aged between 18 and 61 years who sustained mTBI were included. Participants answered web-based questionnaires measuring anxiety and depression symptoms, fatigue, post-concussive symptoms, community integration and life satisfaction in the first three months post mTBI. Results: Post-concussive symptoms, fatigue and anxiety were not associated with community integration or life satisfaction. However, depressive symptoms were negatively associated with community integration and life satisfaction. Conclusions: Among all acute post-concussive symptoms following mTBI, depressive symptoms seem to have strongest relationship with community integration and life satisfaction. Acute psychological intervention targeting these symptoms is strongly recommended. [ABSTRACT FROM AUTHOR]

Self-determination theory proposes that the satisfaction of basic psychological needs (competence, autonomy, and relatedness) is essential to psychological well-being. This study aims to explore the acute impact of a mild traumatic brain injury on the perception of need satisfaction as well as to better understand which variables among post-concussion symptoms and mood are associated with the satisfaction of these psychological needs. A total of 179 adults with mild traumatic brain injury were included. The Basic Psychological Needs Satisfaction Scale (BPNS) was completed retrospectively to assess need satisfaction pre-injury and after the injury to assess need satisfaction post-injury. The Rivermead Post Concussion Symptoms Questionnaire as well as the Hospital Anxiety and Depression Scale were also completed post injury. A significant difference between the perception of need satisfaction pre- and post- was found on the total BPNS score, with lower scores on the post-injury evaluation (less satisfaction). Moreover, higher levels of depression and anxiety were associated with less satisfaction. These results suggest that sustaining a mild traumatic brain injury may have a negative impact on the satisfaction of competence, autonomy, and relatedness needs. To conclude, it is recommended that these concepts be included in psychological intervention programs following mild traumatic brain injury. A significant decrease in psychological need satisfaction is highlighted following mild traumatic brain injury. It is recommended that the needs of autonomy, competence, and relatedness in intervention programs following mild traumatic brain injury needs to be addressed. The more mild traumatic brain injury patients are anxious and depressed the more likely it is that they will present a diminished satisfaction of needs, expressed by a lower level of perception of their autonomy, competence, and relatedness. Thus, integrative intervention for anxiety as well as depression following mild traumatic brain injury is also recommended. [ABSTRACT FROM AUTHOR]

To compare the visual memory performance of uncomplicated and complicated mild TBI (mTBI) groups with that of a control group on the Rey Complex Figure Test (RCFT). We also aimed to explore the influence of factors such as age, gender, education, occupation, and intellectual functioning on visual memory in individuals with mTBI. The RCFT and the Wechsler Abbreviated Scale of Intelligence (WASI-II) were administered to 138 participants (90 uncomplicated mTBI patients, 19 complicated mTBI patients, and 29 controls). The mTBI patients demonstrated significantly lower scores than control participants on both immediate and delayed RCFT recall conditions, with performance in the low average and borderline range. However, there was no difference in performance between the two mTBI groups on the recall conditions. In addition, no significant differences were observed across the three groups on the recognition condition. The WASI-II Performance and Verbal IQ scales explained most of the variance in the immediate and delayed RCFT recall conditions but were not associated with performance on the recognition condition. In contrast with the recognition processes involved in visual memory, recall processes seem to be more vulnerable following mTBI and both verbal and performance IQ seem to be related to visual memory performance. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine if the Rivermead Postconcussion Symptoms Questionnaire (RPQ) is a better tool for outcome prediction than an objective neuropsychological assessment following mild traumatic brain injury (mTBI). The study included 47 patients with mTBI referred to an outpatient rehabilitation clinic. The RPQ and a brief neuropsychological battery were performed in the first few days following the trauma. The outcome measure used was the Mayo-Portland Adaptability Inventory-4 (MPAI-4) which was completed within the first 3 months. The only variable associated with results on the MPAI-4 was the RPQ score (p < .001). The predictive outcome model including age, education, and the results of the Trail-Making Test-Parts A and B (TMT) had a pseudo-R(2) of .02. When the RPQ score was added, the pseudo-R(2) climbed to .19. This model indicates that the usefulness of the RPQ score and the TMT in predicting moderate-to-severe limitations, while controlling for confounders, is substantial as suggested by a significant increase in the model chi-square value, delta (1df) = 6.517, p < .001. The RPQ and the TMT provide clinicians with a brief and reliable tool for predicting outcome functioning and can help target the need for further intervention and rehabilitation following mTBI. [ABSTRACT FROM AUTHOR]

Posttraumatic migraine may represent an important subtype of headache among the traumatic brain injury (TBI) population and is associated with increased recovery times. However, it is underdiagnosed in patients with mild traumatic brain injury (mTBI). This study examined the effectiveness of the self-administered Nine-Item Screener (Nine-Item Screener-SA), the Headache Impact Test- 6 (HIT-6), the 3-Item Migraine Screener, and the Rivermead Post-Concussion Questionnaire (RPQ) at discriminating between mTBI patients with (n = 23) and without (n = 20) migraines. The Nine-Item Screener demonstrated significant differences between migraine patients with and without migraine on nearly every question, especially on Question 9 (disability), sensitivity: 0.95 and specificity: 0.65 (95% CI, 0.64–0.90). The HIT-6 demonstrated significant differences between migraine and no-migraine patients on disability and pain severity, with disability having a sensitivity of 0.70 and specificity of 0.75 (95% CI, 0.54–0.83). Only Question 3 of the 3-Item ID Migraine Screener (photosensitivity) showed significant differences between migraine and no-migraine patients, sensitivity: 0.84 and specificity: 0.55 (CI, 0.52–0.82). The RPQ did not reveal greater symptoms in migraine patients compared with those without. Among headache measures, the Nine-Item Screener-SA best differentiated between mTBI patients with and without migraine. Disability may best identify migraine sufferers among the TBI population. [ABSTRACT FROM AUTHOR]

Objective: To explore the characteristics and outcome of patients with TBI over 65 years old admitted to an acute care Level 1 Trauma centre in Montreal, Canada. Methods: Data were retrospectively collected on patients ( n = 1812) who were admitted post-TBI to the McGill University Health Centre-Montreal General Hospital from 2000-2011. The cohort was composed of four groups over 65 years old (65-75; 76-85; 86-95; and 96 and more). Outcome measures used were the extended Glasgow Outcome Scale (GOSE) as well as discharge destination. Results: As the patients got older, the odds of having a poor outcome increased (OR = 2.344 for those 75-85 years old, 4.313 for those 86-95 years of age and 3.465 for those aged 96 years of age or older). Also, the proportion of patients going home or going home with out-patient rehabilitation decreased as age increased ( p = 0.001 and p < 0.001, respectively). In contrast, the proportion of patients being discharged to long-term care facilities increased significantly as age increased ( p < 0.001). Conclusion: This descriptive study provides a better understanding of characteristics and outcome of different age groups of patients with TBI all over 65 years old in Montreal, Canada. [ABSTRACT FROM AUTHOR]

Primary objective: To predict which characteristics are associated with patients at risk of discharge against medical advice (AMA). Research design: Data were retrospectively collected on individuals ( n = 5642) admitted to the Traumatic Brain Injury Program of the MUHC-MGH. Methods and procedures: Outcome measures used were length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE) as well as the Functional Independence Measure (FIM®). Main outcomes: The overall rate of patients leaving AMA was 1.9% ( n = 108). Age was negatively associated with AMA discharge (95% CI OR = [0.966;0.991]). Patients with a history of substance abuse were ∼2-times more likely to leave AMA than those not using substances before injury (95% CI OR = [1.172;3.314]) and the homeless were ∼3-times more likely to leave AMA compared to those who were not homeless (95% CI OR = [1.260;7.138]). Length of stay (LOS) was shorter for patients leaving AMA ( p < 0.001) and they showed better outcome (GOSE: p < 0.001; FIM®: p = 0.032). Conclusions: Knowing the profile of patients with TBI leaving AMA hospitalized in an urban Level 1 Trauma centre will help in the development of effective strategies based on patient needs, values and pre-injury psychosocial situation to encourage them to complete their treatment course in hospital. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to compare acute outcome between men and women after sustaining a traumatic brain injury (TBI). Methods. A total of 5,642 patients admitted to the Traumatic Brain Injury Program of the McGill University Health Centre-Montreal General Hospital between 2000 and 2011 and diagnosed with a TBI were included in the study. The overall percentage of women with TBI was 30.6% (n = 1728). Outcome measures included the length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE), the functional independence measure instrument (FIM), discharge destination, and mortality rate. Results. LOS, GOSE, the FIM ratings, and discharge destination did not show significant differences between genders once controlling for several confounding variables and running the appropriate diagnostic tests (P < 0.05). However, women had less chance of dying during their acute care hospitalization than men of the same age, with the same TBI severity and following the same mechanism of injury. Although gender was a statistically significant predictor, its contribution in explaining variation in mortality was small. Conclusion. More research is needed to better understand gender differences in mortality; as to date, the research findings remain inconclusive. [ABSTRACT FROM AUTHOR]

Objective. The goal of this study was to explore the relationship between acute psychological reactions and cognition as well as postconcussive symptoms in patients with MTBI. Research Methods. Sociodemographic andmedical history data were gathered for 59 patients diagnosed with MTBI. Validated and standardized tools were used to assess anxiety, depression, and cognitive function two weeks after trauma. Postconcussive symptoms were assessed with the Rivermead postconcussive questionnaire. Results. Despite the absence of significant neuropsychological deficits, a very high level of anxiety and depression was observed in our cohort. Level of anxiety and depression were positively related to cognitive performances and to postconcussive symptoms. Moreover, patients with preexisting alcohol and psychological problems were more likely to present with acute depression after MTBI. Conclusions. Early psychological rehabilitation should be provided to decrease the intensity and frequency of postconcussive symptoms and diminish the risk of these problems becoming chronic. [ABSTRACT FROM AUTHOR]

To compare the acute clinical profile of patients with uncomplicated vs complicated mild TBI (MTBI), socio-demographic and medical history variables were gathered for 176 patients diagnosed with MTBI and with (complicated, N = 45) or without (uncomplicated, N = 131) positive findings on cerebral imaging. Neurological examination, neuropsychological assessment and self-evaluation of post-concussive symptoms were done at 2 weeks post trauma. Patients with complicated MTBI were more likely to show auditory and vestibular system dysfunction. Surprisingly, the uncomplicated group reported more severe post-concussive symptoms than patients with positive CT scans. The groups showed no other difference in neurological, psychological, or cognitive outcome. A complete neurological examination should be done acutely in patients with MTBI to determine more specific follow-up required. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to compare acute outcome between men and women after sustaining a traumatic brain injury (TBI). Methods. A total of 5,642 patients admitted to the Traumatic Brain Injury Program of the McGill University Health Centre-Montreal General Hospital between 2000 and 2011 and diagnosed with a TBI were included in the study. The overall percentage of women with TBI was 30.6% (n = 1728). Outcome measures included the length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE), the functional independence measure instrument (FIM), discharge destination, and mortality rate. Results. LOS, GOSE, the FIM ratings, and discharge destination did not show significant differences between genders once controlling for several confounding variables and running the appropriate diagnostic tests (P < 0.05). However, women had less chance of dying during their acute care hospitalization than men of the same age, with the same TBI severity and following the same mechanism of injury. Although gender was a statistically significant predictor, its contribution in explaining variation in mortality was small. Conclusion. More research is needed to better understand gender differences in mortality; as to date, the research findings remain inconclusive.

Objective: Traumatic brain injury (TBI) is the single largest cause of death and disability following injury worldwide. The aim of this study was to determine the demographic, clinical, medical and accident related trends for patients with TBI hospitalized in an urban level 1 Trauma Centre., Methods: Data were retrospectively collected on individuals (n = 5,642) who were admitted to the Traumatic Brain Injury Program of the McGill University Health Centre - Montreal General Hospital from 2000 to 2011., Results: Regression analysis showed a significant upward trend in the yearly number of cases as well as an upward trending by year in the proportion of TBI cases aged 70-years-old or more. The Injury Severity Scale scores were positively associated with year indicating a slight increase in injury severity over the years and there was an increase in patient psychological, social and medical premorbid complexity. In addition, the Extended Glasgow Outcome Scale score tended to become more severe over the years. There was a slight decrease in the proportion of discharges home and in the proportion of deaths., Conclusions: These results will help to understand the impact of TBI in an urban Canadian level 1 Trauma Centre. This information should be used to develop public prevention strategies and to educate the community about the risk of TBI especially the risk of falls in the ageing population. These findings can also provide information to help health policy makers plan for future resources.

More than 75% of patients with mild traumatic brain injury (MTBI) report chronic pain whose potential detrimental effects on cognitive recovery need to be identified. The objective of this study was to investigate the relationship between pain, performance on a working memory task, gray matter density, and mid-dorsolateral prefrontal cortex (mid-DLPFC) activation in subjects with a MTBI. For comparison purposes, we performed identical correlation analyses with a group of subjects without MTBI who sustained sports injuries. Twenty-four subjects who experienced a MTBI in the past 12 months, 16 control subjects, and 29 subjects with sport injuries were included. One hour prior to entering the magnetic resonance scanner, the subjects were asked to fill out the pain Visual Analogue Scale. Subsequently, a high-resolution T1-weighted image was acquired followed by a functional magnetic resonance imaging session using the visual externally ordered working memory task. Results showed that MTBI subjects reporting severe pain in the hour preceding the testing had reduced mid-DLPFC activation during the working memory task and poorer performance on the task. Subjects with sport injuries and severe levels of pain showed the reverse pattern: pain was associated with higher activation in the mid-DLPFC and did not correlate with performance. Gray matter density measures were independent of pain level. This study showed that behavioral performance and cerebral functioning are affected by pain after a MTBI. Moreover, this study suggests that pain, cognition, and cerebral functioning interactions could not easily be generalized from one clinical population to another.

Symptoms persisting beyond the acute phase (>2 months) after a mild traumatic brain injury (MTBI) are often reported, but their origin remains controversial. Some investigators evoke dysfunctional cerebral mechanisms, while others ascribe them to the psychological consequences of the injury. We address this controversy by exploring possible cerebral dysfunction with functional magnetic resonance imaging (fMRI) and event-related potentials (ERP) in a group of patients during the post-acute phase. Fourteen MTBI symptomatic patients (5.7±2.9 months post-injury) were tested with fMRI and ERP using a visual externally ordered working memory task, and were compared with 23 control subjects. Attenuated blood oxygen level dependent (BOLD) signal changes in the left and right mid-dorsolateral prefrontal cortex (mid-DLPFC), the putamen, the body of the caudate nucleus, and the right thalamus were found in the MTBI group compared with the control group. Moreover, symptom severity and BOLD signal changes were correlated: patients with more severe symptoms had lower BOLD signal changes in the right mid-DLPFC. For ERP, a group×task interaction was observed for N350 amplitude. A larger amplitude for the working memory task than for the control task was found in control subjects, but not in MTBI subjects, who had weak amplitudes for both tasks. This study confirms that persistent symptoms after MTBI cannot be uniquely explained by psychological factors, such as depression and/or malingering, and indicates that they can be associated with cerebral dysfunction. ERP reveals decreased amplitude of the N350 component, while fMRI demonstrates that the more severe the symptoms, the lower the BOLD signal changes in the mid-DLPFC.