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backwards (5.7 SD1.9 progesterone, 5.7 SD2.2 placebo), and timed

phonemic fluency (31.9 SD-11 progesterone, 29.9 SD-11 placebo).

Correlations between neuropsychological and Glasgow Outcome

Scale Extended (GOSE) scores were strongest for immediate and

delayed recall and sequencing speed.

Conclusion:

Consistent with findings using the trial’s primary

outcome measure (GOSE) in ProTECT III, progesterone did not result

in improved cognitive performance 6 months after injury Neu-

ropsychological testing was not shown to be more sensitive to a

treatment effect.

Keywords: ProTECT III Clinical Trial, Outcomes, Neuropsycho-

logical outcomes, Traumatic Brain Injury, Moderate to severe TBI

C1-05

NEUROANATOMICAL AND COGNITIVE DIFFERENCES IN

MILD TRAUMATIC BRAIN INJURY PATIENTS WITH AND

WITHOUT POST-TRAUMATIC STRESS DISORDER

Katherine Lopez

2

, John Dsurney

2

, Jacob Leary

1

, Dzung Pham

2

, Yi-

Yu Chou,

3

, Andre vander Merwe,

2

, Leighton Chan

1,2

1

National Institutes of Health, Clinical Center, Bethesda, USA

2

Center for Neuroscience and Regenerative Medicine, Phenotyping

Core, Rockville, USA

Introduction:

Research has revealed increased prevalence of post-

traumatic stress disorder (PTSD) following mild traumatic brain injuries

(mTBI). While recent studies have focused on characterizing the clin-

ical features of comorbid mTBI and PTSD, few efforts have been made

to examine the neuroanatomical sequelae when these conditions occur

together. The present analysis seeks to examine volumetric measure-

ments (e.g., frontotemporal cortices and limbic structures) and cognitive

functioning in mTBI patients with and without PTSD. We hypothesize

that mTBI/PTSD patients will show greater neuroanatomical and cog-

nitive disruptions than mTBI-only patients.

Methods:

A total of 23 subjects (78% male) were evaluated between

6–12 months after a mTBI. The subjects completed an MRI and a

comprehensive battery of neuropsychological tests assessing attention,

learning, memory, executive functions, and processing speed. All par-

ticipants passed embedded and stand alone measures of effort. Partici-

pants were divided into two groups based scores on the PTSD Checklist

(PCL). Participants with a PCL score

44 were included in the PTSD

positive group (n

=

11) while participants with score

£

20 were included

in the PTSD negative group (n

=

22). Volumetric analysis was per-

formed using T1-weighted MPRAGE scans acquired on a Siemens

Biograph MR 3T. Images were segmented using the longitudinal

pipeline within the FreeSurfer software package (Version 5.3).

Results:

Our analyses showed patients with mTBI/PTSD exhibited

greater reductions in brain volumes and poorer performance on neu-

ropsychological tests relative to mTBI-only patients. Specifically,

mTBI/PTSD patients showed localized reductions in the middle

frontal (F

=

12.9, p

=

.001), middle temporal (F

=

7.15, p

=

.012) and

parahippocampal gyri (F

=

4.38, p

=

.045). Additionally, impairments

in processing speed (Trails Making Test A, Symbol Search, Coding;

p’s

<

.01) and memory encoding (California Verbal Learning Test,

p

=

.022) were evident in the mTBI/PTSD group.

Conclusions:

Individuals with combined mTBI/PTSD have ab-

normalities beyond those evident in mTBI alone. These changes in-

clude impairments in processing speed, memory, and anatomic

changes in regions resembling the default mode network (Lanius

et al., 2010).

Keywords: Post Traumatic Stress Disorder, Neuropsychological,

Brain Volume, Comorbid disorders

C1-06

THE EFFECT OF SINGLE VS. MULTIPLE HEAD INJURIES

ON BEHAVIORAL AND COGNITIVE OUTCOMES

Tanvi Devi

1,2

,

Christian Shenouda

2

, Mitra Yousefi

2

, Dingfen Han

1

,

John Dsurney

2

, Leighton Chan

1,2

1

National Institutes of Health, Clinical Center, Bethesda, USA

2

Center for Neuroscience and Regenerative Medicine, N/A, Bethesda,

USA

Traumatic brain injury (TBI) can result in functional impairment and

neuropathological changes. Research suggests that repetitive injury may

result in chronic traumatic encephalopathy (CTE). However, the rela-

tionship of repetitive TBI and subconcussive blows in the neurodegen-

erative process is unclear. This study analyzed behavioral and cognitive

outcomes in patients reporting single versus multiple traumatic brain

injuries, and also examined the effect of reported subconcussive blows.

The subjects were enrolled in a longitudinal study and were seen at

baseline (30, 90, or 180 days after brain injury) and followed up at one

year. The Ohio State University TBI Identification Method was used to

determine number and severity of TBIs. The outcomes assessed at one

year included: Neurobehavioral Symptom Inventory (NBSI), Beck De-

pression Inventory (BDI), Booklet Category Test (BCT), Brief Symptom

Inventory (BSI-18), Finger Tapping Test, and Wechsler Adult In-

telligence Scale 4

th

Edition (WAIS-IV). Thirty-six patients were enrolled

in the study (64%male, average age 44.0 years). Twenty eight percent of

the patients had mild injuries, 56% had moderate, and 17% had severe

injuries. Sixty one percent had a single injury, while 39% had two or

more TBIs. Fifty percent of patients reported no subconcussive blows,

33% reported one or two subconcussive blows, and 17% reported three or

more. Those with multiple head injuries had 7-point higher NBSI, 6-point

higher BDI, and 6-point higher BSI scores compared to those with single

head injuries (p

=

0.02, p

=

.003, and p

<

.0001, respectively) after con-

trolled for age, severity, and sex. There were no significant differences in

cognitive outcomes for single versus multiple injuries or subconcussive

blows in working memory, processing speed, or motor functioning. Our

results suggest that individuals with a history of multiple TBIs are at risk

for worsened behavioral outcomes compared to those with a single in-

jury. However, repetitive injury (including subconcussive blows) did not

appear to affect cognitive outcomes at 1 year.

Keywords: Behavioral Outcomes, Multiple Head Injuries, TBI,

Subconcussive blows

C1-07

MICE, TRAUMATIC BRAIN INJURY, AND COGNITIVE EF-

FECTS OF ENRICHED ENVIRONMENT

Chaim Pick

1

, Shaul Schreiber

2,3

, Vardit Rubovitch

1

, Ran Lin

1

1

Tel Aviv University, Anatomy, Tel-Aviv, Israel

2

Tel Aviv Sourasky Medical Center, Psychaiatry, Tel-Aviv, Israel

3

Tel Aviv University, Psychaiatry, Tel-Aviv, Israel

To date, there is yet no established effective treatment (medication or

cognitive intervention) for post-traumatic brain injury (TBI) patients

with chronic sequelae. Enriched Environment (EE) has been recognized

of importance in brain regulation, behaviour and physiology. Rodents

reared in, or pre-exposed to EE, recovered better from brain insults.

Using the concussive head trauma model of minimal TBI in mice, we

evaluated the effect of transition to EE following a weight-drop (30 gr

or 50 gr) induced mTBI on behavioural and cognitive parameters in

mice in the Novel Object Recognition task, the Y- and the Elevated Plus

mazes. In all assays, both mTBI groups (30 gr, 50 gr) housed in normal

A-73