Frontal Lobe Injury and Executive Control of Cognition and Emotion

额叶损伤与认知和情绪的执行控制

• 批准号: 8595161
• 负责人: DIANE SWICK
• 金额: --
• 依托单位: VA NORTHERN CALIFORNIA HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8595161
• 关键词: Address; Affect; Affective; Afghanistan; Alcoholism; Attention Concentration; Basic Science; Behavioral; Biological Markers; Blast Injuries; Brain; Brain Concussion; Cognition; Cognitive; Coupled; Decision Making; Development; Diagnosis; Dimensions; Disease; Dissociation; Ducks; EP300 gene; Emotional; Emotions; Employment; Event-Related Potentials; Exhibits; Family; Feedback; Feeling suicidal; Freedom; Frequencies; Functional disorder; Future; Gambling; Goals; Health; Hybrids; Impairment; Impulsive Behavior; Impulsivity; Individual; Injury; Investigation; Iraq; Knowledge; Lead; Learning; Life; Literature; Major Depressive Disorder; Measures; Medial; Mediating; Memory; Mental Depression; Mental Health; Methods; Military Personnel; Monitor; Moods; Motor; Nature; Neurocognitive; Neurologic; Neurophysiology - biologic function; Occupational; Outcome; Participant; Patient Self-Report; Patients; Pattern; Performance; Personality; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Recovery; Rehabilitation therapy; Research; Rewards; Risk; Series; Services; Severities; Signal Transduction; Social Adjustment; Social Functioning; Substance abuse problem; Symptoms; System; Therapeutic Intervention; Time; Traumatic Brain Injury; Veterans; alternative treatment; cognitive rehabilitation; design; discounting; drinking; emotion regulation; executive function; experience; frontal lobe; improved; indexing; lexical; neuropsychological; novel; novel strategies; operation; productivity loss; psychosocial; public health relevance; rehabilitation strategy; relating to nervous system; research study; response; semantic processing; social; suicidal

DESCRIPTION (provided by applicant): This proposal will address a number of gaps in the neuropsychological literature that informs best practices for diagnosis and treatment of persistent post-concussive symptoms coupled with impairments in psychological health. Traumatic brain injury (TBI) is often considered the "signature injury" of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). By some estimates, 20% of previously deployed military personnel have sustained TBIs during their service in OEF and OIF, primarily due to blast injuries. The majority of these injuries can be classified as mild TBI or concussion. Furthermore, it is estimated that 14% of Veterans returning from Afghanistan and Iraq have post-traumatic stress disorder (PTSD), and a substantial percentage of Veterans have both conditions. Although most individuals with mild TBI show good recoveries, others can experience lingering deficits in memory, concentration, decision-making, and mood. The frontal lobes of the brain are particularly vulnerable to damage from TBI, and frontal lobe injuries can lead to a number of serious symptoms that can be disabling to the patients and their families. Alterations in attention, concentration, decision-making, personality, and emotion regulation can affect social functioning and employment. However, there is still substantial disagreement about the precise contribution of mild TBI to post- deployment problems. The overlap with PTSD symptoms is extensive, and disentangling the effects of each has been challenging. Furthermore, major depression is highly correlated with the severity of PTSD symptoms, and the frequency of problematic drinking is substantially elevated. Finally, the risk for suicidal ideation is increased in Veterans with PTSD, especially in those with two or more co-morbid disorders. Basic research that considers how all of these variables might interact to produce subtle changes in the brain is lacking. Therefore, this project intends to fill these gaps with a series of experiments that will identify specific deficits in inhibitory control, the ability to withhold inappropriate or ill-conceived responses. Impairments i the brain systems that mediate inhibitory control functions can ultimately lead to impulsive behaviors. Impulsivity is not a unitary construct, however, and separation into different domains will help identify and prioritize those that are the most troublesome for OEF/OIF veterans with mTBI/PTSD. The study will use non-invasive electrophysiological recording of the brain to examine the time course of neural activity underlying three specific inhibitory control functions: (1) motor response inhibition, or the ability to withhold pre-potent motor responses; (2) impulsive choice in the context of reward, or decision making without regard to future consequences; (3) emotion regulation, or the ability to control affective responses. The project will use novel, carefully designed tasks that are sensitive to subtle deficits and relevant to real world functioning, and will focus on different dimensions of impulsivity that can lead to negative psychosocial outcomes. Identifying neurological abnormalities associated with mTBI/PTSD - noninvasively recorded biomarkers of brain function - will further our understanding and inform efforts to develop improved cognitive rehabilitation and other therapeutic interventions. Learning more about the specific anatomical and functional substrates of inhibitory control functions will help in the development of improved diagnosis, treatment, and rehabilitation strategies for Veterans affected by cognitive and emotional dysregulation. Since these conditions can result in tremendous losses of productivity, the development of more sensitive assessments of brain health can assist in tailoring rehabilitation efforts to the needs of individual patients.

描述（由申请人提供）： 该建议将解决神经心理学文献中的许多差距，这些差距为诊断和治疗持续的脑震荡症状以及心理健康障碍的最佳实践提供了依据。创伤性脑损伤（TBI）通常被认为是持久自由（OEF）和伊拉克自由行动（OIF）操作的“签名伤害”。据一些估计，在OEF和OIF服务期间，有20％的先前部署的军事人员在其服务期间持续了TBI，这主要是由于爆炸受伤。这些伤害中的大多数可以归类为轻度TBI或脑震荡。此外，据估计，从阿富汗和伊拉克返回的退伍军人中有14％患有创伤后应激障碍（PTSD），并且很大一部分退伍军人具有这两种情况。尽管大多数轻度TBI的人表现出良好的恢复，但其他人可以在记忆，集中度，决策和情绪中遇到挥之不去的缺陷。大脑的额叶特别容易受到TBI损害的影响，额叶受伤会导致许多严重的症状，这些症状可能导致患者及其家人。注意力，集中，决策，个性和情绪调节的改变会影响社会功能和就业。 但是，关于轻度TBI对部署问题的精确贡献仍然存在实质性分歧。与PTSD症状的重叠是广泛的，并且消除每个症状的影响是具有挑战性的。此外，重度抑郁症与PTSD症状的严重程度高度相关，并且有问题饮酒的频率显着升高。最后，具有PTSD的退伍军人，尤其是在 患有两个或多个合并症的人。考虑所有这些变量如何相互作用以在大脑中产生细微变化的基础研究。因此，这个项目 打算通过一系列实验来填补这些空白，这些实验将确定抑制性控制中的特定缺陷，即保留不适当或不构思的响应的能力。介导抑制性控制功能的大脑系统的损害最终会导致冲动行为。但是，冲动性不是一个统一的结构，分为不同领域将有助于识别和优先考虑那些对具有MTBI/PTSD的OEF/OIF退伍军人最麻烦的人。该研究将使用大脑的非侵入性电生理记录来检查三种特定抑制性控制功能的神经活动的时间过程：（1）运动反应抑制作用或持续预弱运动前运动反应的能力； （2）冲动 在奖励或决策的背景下进行选择，而无需考虑未来的后果； （3）情绪调节或控制情感反应的能力。该项目将使用对微妙缺陷敏感并与现实世界功能相关的新颖，精心设计的任务，并将专注于冲动的不同维度，这可能导致负面的心理社会成果。确定与MTBI/PTSD相关的神经异常 - 无创记录的脑功能生物标志物 - 将进一步我们的理解，并为改善认知康复和其他治疗性干预措施提供帮助。了解有关抑制性控制功能的特定解剖和功能底物的更多信息，将有助于发展受认知和情绪失调影响的退伍军人的诊断，治疗和康复策略。由于这些条件可能会导致生产率巨大损失，因此对大脑健康的更敏感评估的发展可以帮助根据各个患者的需求来恢复工作。