109 / 198
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