Multi-level assessment and rehabilitation of combat mild traumatic brain injury

战斗轻度颅脑损伤的多层次评估与康复

• 批准号: 9918765
• 负责人: Pratik Mukherjee
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9918765
• 关键词: Address; Affect; Amygdaloid structure; Area; Attention; Base of the Brain; Behavior; Behavioral; Brain; Brain Injuries; Chronic; Cognition; Cognitive; Complex; Data; Diffusion Magnetic Resonance Imaging; Effectiveness; Emotional; Emotions; Foundations; Freedom; Functional Magnetic Resonance Imaging; Future; Goals; Image; Individual; Informal Social Control; Intervention; Intervention Studies; Learning; Life; Long-Term Effects; Magnetic Resonance Imaging; Measures; Memory; Neural Pathways; Neurocognitive; Neuronal Plasticity; Neuropsychology; Participant; Pathway interactions; Patient Self-Report; Pattern; Performance; Pharmacological Treatment; Prefrontal Cortex; Problem Solving; Process; Quality of life; Randomized; Recording of previous events; Regimen; Regulation; Rehabilitation therapy; Reporting; Research Design; Residual state; Rest; Short-Term Memory; Structure; Task Performances; Testing; Training; Training Programs; Transcranial magnetic stimulation; Veterans; attentional control; base; cognitive control; cognitive performance; cognitive training; combat; comorbidity; daily functioning; design; emotion regulation; executive function; extrastriate visual cortex; improved; improved functioning; individual variation; information processing; mild traumatic brain injury; mindfulness; neuroimaging; neuromechanism; neuroregulation; operation; predictive marker; rehabilitation paradigm; relating to nervous system; response; treatment as usual; white matter

Combat-related mild traumatic brain injury (mTBI) and co-morbid conditions are prevalent in returning Veterans with the reported rates ranging from 14- 22%. Chronic sequela of mTBI can be highly debilitating due to deficits in the cognitive control processes, including attention, executive functions, and memory. In prior studies, individuals with chronic acquired brain injury who participated in a cognitive training program, Goal- Oriented Attentional Self-Regulation (GOALS), which targets executive control functions of applied mindfulness-based attention regulation and goal management, improved cognitive performance in areas of: complex attention/executive function and memory, complex functional task performance, and daily functioning. Furthermore, functional MRI (fMRI) results after training indicated significantly enhanced modulation of neural processing. Preliminary data from recently completed randomized-control GOALS study in 32 Veterans with chronic TBI also show both short and longer term (up to 2 years) improvements in attention and executive function, complex real-life tasks, and emotional regulation. The primary objectives of this study are to investigate the potential short and longer term effects of GOALS cognitive training program, and to use advanced MRI to investigate changes in brain structure and function in the circuits that regulate attention, memory, executive function and emotion in Veterans with chronic mTBI. We postulate that 1) GOALS training will improve neurocognitive function in attention and executive function domains, complex functional task performance, and emotional regulation in Veterans with chronic mTBI; 2) improved neurocognitive function will be correlated with macrostructural, microstructural and functional changes in the corresponding brain networks on high field (3T) and ultra-high field (7T) structural MR imaging, diffusion tensor imaging (DTI) and resting state fMRI performed pre- and post-training; 3) Changes in both behavioral function and imaging measures will be maintained at 6 months post-training and be associated with improvements in activities and participation. AIM 1: To determine the short and long term effects of GOALS training on neuro-cognitive performance and neural plasticity of attention and executive control networks in mTBI. AIM 2: To determine the short and long term effects of GOALS training on complex functional task performance and daily functioning, and on plasticity in pathways related to memory function, in mTBI. AIM 3: To determine the short and long term effects of GOALS training on measures of emotional regulation, and on plasticity of frontolimbic networks related to emotion processing, in mTBI In a randomized, controlled interventional study design, 36 Veterans with a history of chronic (> 6 month) mTBI and residual cognitive difficulties will be randomized to participate in 5 weeks of cognitive training (GOALS) or a treatment as usual (TAU) comparison. At baseline, week 5 (post GOALS), and at 6 months, participants will undergo a multi-level assessment battery consisting of: 1) neuroimaging with high field (3T) and ultra-high field (7T) structural MR imaging, diffusion tensor imaging (DTI) and resting state fMRI; 2) neuropsychological assessment focusing on complex attention and executive function; 3) complex `real life' functional task performance; and 4) self-report measures of daily functioning and emotional regulation/heath. When completed, this project will determine whether training core attentional self-regulatory control functions via personally-relevant activities will be effective in improving quality of life and daily functioning for Veterans with mTBI. The study design will provide a test of potential benefits on real-life functioning, and also determine to what extent these benefits are related to actual changes in hypothetically targeted cognitive/behavioral functions and brain networks corresponding to these functions.

与战斗相关的轻度创伤性脑损伤 (mTBI) 和合并症在退伍军人中很常见 报告的比率范围为 14-22%。 mTBI 的慢性后遗症可能会导致高度衰弱，原因是 认知控制过程的缺陷，包括注意力、执行功能和记忆力。在之前的 研究中，患有慢性获得性脑损伤的个体参加了认知训练计划，目标- 定向注意自我调节（GOALS），其目标是应用程序的执行控制功能 基于正念的注意力调节和目标管理，改善了以下领域的认知表现： 复杂的注意力/执行功能和记忆力、复杂的功能性任务表现和日常功能。 此外，训练后的功能性磁共振成像 (fMRI) 结果表明，神经调节能力显着增强。 加工。最近完成的随机对照目标研究的初步数据，该研究对 32 名患有以下疾病的退伍军人进行了研究 慢性 TBI 还显示出短期和长期（长达 2 年）注意力和执行力的改善 功能、复杂的现实生活任务和情绪调节。 本研究的主要目的是调查目标的潜在短期和长期影响 认知训练计划，并使用先进的 MRI 来研究大脑结构和功能的变化 患有慢性 mTBI 的退伍军人中调节注意力、记忆力、执行功能和情绪的回路。 我们假设 1) 目标训练将改善注意力和执行功能方面的神经认知功能 患有慢性 mTBI 的退伍军人的领域、复杂功能任务表现和情绪调节； 2） 神经认知功能的改善将与宏观结构、微观结构和功能相关 高场（3T）和超高场（7T）结构磁共振成像相应大脑网络的变化， 在训练前和训练后进行弥散张量成像 (DTI) 和静息态 fMRI； 3）两者的变化 行为功能和影像测量将在培训后 6 个月保持，并与 活动和参与方面的改进。 目标 1：确定目标训练对神经认知表现和能力的短期和长期影响 mTBI 中注意力和执行控制网络的神经可塑性。 目标 2：确定目标训练对复杂功能任务的短期和长期影响 mTBI 中的表现和日常功能，以及与记忆功能相关的通路的可塑性。 目标 3：确定目标训练对情绪调节措施的短期和长期影响， 以及 mTBI 中与情绪处理相关的额边缘网络的可塑性 在一项随机对照干预研究设计中，36 名有慢性（> 6 个月）mTBI 病史的退伍军人 残留的认知困难将被随机参加5周的认知训练（GOALS）或 照常治疗 (TAU) 比较。在基线、第 5 周（目标后）和第 6 个月时，参与者将 接受多级评估，包括：1) 高场 (3T) 和超高场神经影像 (7T)结构MR成像、扩散张量成像(DTI)和静息态fMRI； 2）神经心理学 评估侧重于复杂的注意力和执行功能； 3）复杂的“现实生活”功能任务 表现; 4) 日常功能和情绪调节/健康的自我报告测量。 完成后，该项目将确定是否训练核心注意力自我调节控制功能 通过与个人相关的活动将有效改善退伍军人的生活质量和日常功能 与 mTBI。研究设计将提供对现实生活功能的潜在益处的测试，并确定 这些益处在多大程度上与假设的目标认知/行为的实际变化相关 功能以及与这些功能相对应的大脑网络。