Abuse and Neglect, Brain Injury / 24.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50390" align="alignleft" width="128"]Fanny Lecuyer Giguère, PhD candidate Centre de Recherche en Neuropsychologie et Cognition (CERNEC) Université de Montréal Fanny Lecuyer Giguere[/caption] Fanny Lecuyer Giguère, PhD candidate Centre de Recherche en Neuropsychologie et Cognition (CERNEC) Université de Montréal MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous work on moderate-severe traumatic brain injury (TBI) showed clear olfactory impairments (OI) months and years after the trauma. Within these impairments, hyposmia (partial loss of smell) and anosmia (total loss of smell) were the most described OI. Moreover, TBI patients with OI generally developed more long-term anxiety and depression symptoms, when compared to patients without OI. Almost no study evaluated such impairments after a mild TBI, which is none to be the most prevalent form of TBI (80% of all TBI). We evaluated quantitative olfactory scores, post-concussive symptoms, anxiety and depression, within the first 24 hours and one year after the trauma, on a cohort of 20 mild TBI patients and compared these results with a 22 patients control orthopaedic group. Results showed that, within the first 24-hour post-trauma, more than 50% of the mild TBI patients had clinical sing of reduced olfactory capacities (hyposmia) compared to only 5% (1 patient) within the control group. Consequently, patients with mild traumatic brain injury had lower olfactory threshold and had more difficulty to discriminate and identify different odors. Also, when comparing the mild TBI patients with OI (OI+) to the mild TBI patients without OI (OI-), we realized that OI+ mild TBI patients reported more anxiety and post-concussion symptoms 1 year after the trauma.  
Author Interviews, Brain Injury, Cognitive Issues, Technology / 22.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49309" align="alignleft" width="165"]Dr.. Mahncke Dr. Mahncke[/caption] Dr. Henry W. Mahncke PhD Research neuroscientist CEO of Posit Science Corporation  MedicalResearch.com: What makes this study newsworthy?  Response: Mild Traumatic Brain Injury (mTBI) is a complex condition to treat. Patients can report many symptoms (e.g., cognitive deficits, depression, anxiety, stress, fatigue, pain, sleep difficulties, disorientation, emotional issues). Prior to this study, conducted at five military and veterans’ medical centers, there has been no highly-scalable intervention to treat the cognitive deficits associated with mTBI. This study showed that a plasticity-based, computerized, brain-training app can drive statistically and clinically significant gains in overall cognitive performance. Given the number of service members and vets with persistent cognitive deficits from TBIs, that’s a big deal.
Author Interviews, Medical Imaging, Mental Health Research, UCSD / 13.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49143" align="alignleft" width="150"]Dr. Mingxiong Huang, PhDProfessor, Electrical and Computer EngineeringUniversity of California, San Diego Dr. Huang[/caption] Dr. Mingxiong Huang, PhD Professor, Electrical and Computer Engineering University of California, San Diego MedicalResearch.com: What is the background for this study?   Response: Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members and Veterans. Yet, conventional neuroimaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) are typically insensitive to physiological alterations caused by mild and some moderate TBIs. With funding from the VA, we have pursued in developing sensitive imaging markers based on magnetoencephalography (MEG) for mTBI. This paper reflects the news MEG findings in this research field. 
Accidents & Violence, Author Interviews, Brain Injury / 29.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48921" align="alignleft" width="133"]Dr. Joseph A Schwartz PhD Public Affairs and Community Service, Criminology and Criminal Justice University of Nebraska Omaha, 6001 Dodge Street, Omaha, NE Dr. Schwartz[/caption] Dr. Joseph A Schwartz PhD Public Affairs and Community Service, Criminology and Criminal Justice University of Nebraska Omaha, Omaha, NE  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: My larger research agenda is focused on identifying the ways in which environmental and biological influences work collectively to shape behavioral patterns across major stages of the life course. I am particularly interested in identifying environmental influences that can change biological functioning or activity to result in behavioral change. Brain injury was a natural progression of these interests since brain injury is expected to result in changes in the structure and functioning of the brain, which has been linked to meaningful changes in behavior. There have also been a sizable number of studies that indicate that justice involved populations experience brain injury at a rate that is between five and eight times what is observed in the general population. I was fascinated by this finding and thought that brain injury may be a good candidate influence to investigate further.
Author Interviews, Brain Injury, Stem Cells, Surgical Research, University of Pittsburgh / 18.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48666" align="alignleft" width="133"]Dr. David Okonkwo, M.D., Ph.D., Professor of Neurological surgery Director of the Neurotrauma Clinical Trials CenterUniversity of Pittsburgh Dr. Okonkwo[/caption] Dr. David Okonkwo, M.D., Ph.D., Professor of Neurological surgery Director of the Neurotrauma Clinical Trials Center University of Pittsburgh Dr. Okonkwo discusses the results from the STEMTRA Phase 2 trial evaluating the efficacy and safety of SB623 in patients with chronic motor deficit from traumatic brain injury. The results were presented at the American Association of Neurological Surgeons (AANS), April 2019 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Traumatic brain injury (TBI) is a major cause of death and disability in the US and around the globe. The effects of TBI are often long-lasting, with more than one-third of severe TBI patients displaying a neuromotor abnormality on physical examination 2 years following injury and, yet, there are no effective treatments. The public health implications are staggering: there are approximately 1.4 million new cases of TBI in the US annually, resulting in over 50,000 deaths and 80,000 disabilities; over 5 million Americans currently suffer from long-term disability caused by TBI. A successful neuroregenerative or neurorestorative therapy, such as stem cell implantation, would have significant impact.
Author Interviews, Brain Injury / 08.11.2018

MedicalResearch.com Interview with: Clara E. Dismuke-Greer, PhD Health Equity and Rural Outreach Innovation Center Ralph H. Johnson Department of Veterans Affairs Medical Center Charleston, SC 29401 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study is that previous research we had published had shown that Hispanic U.S. Veterans diagnosed with Traumatic Brain Injury (TBI) had higher risk of mortality than non-Hispanic White U.S. Veterans, even after accounting for the effects of comorbidities as well as socio-demographics. This study sought to investigate further this apparent racial/ethnic disparity. Using a 10 year cohort followed for up to 14 years, and adjusting for TBI severity as well as comorbidities, socio-demographics and military factors, when we included location (urban vs. rural vs. highly rural vs. U.S. Territory (Puerto Rico, U.S. Virgin Islands, Guam, America Samoa and Mariana Islands), as well as race/ethnicity, we found that the racial/ethnic disparity disappeared, and that it was location which became statistically significant. Our main findings were that Veterans diagnosed with TBI residing in U.S. Territories have lower survival and higher risk of mortality relative to Veterans residing on the U.S. Mainland , even after statistical adjustment for the factors listed above.
Author Interviews, Brain Injury, Critical Care - Intensive Care - ICUs, JAMA / 25.10.2018

MedicalResearch.com Interview with: [caption id="attachment_45433" align="alignleft" width="200"]Jamie Cooper AO BMBS MD FRACP FCICM FAHMS Professor of Intensive Care Medicine Monash University Deputy Director & Head of Research,  Intensive Care & Hyperbaric Medicine The Alfred, Melbourne Prof. Cooper[/caption] Jamie Cooper AO BMBS MD FRACP FCICM FAHMS Professor of Intensive Care Medicine Monash University Deputy Director & Head of Research, Intensive Care & Hyperbaric Medicine The Alfred, Melbourne MedicalResearch.com: What is the background for this study? Response: 50-60 million people each year suffer a traumatic brain injury (TBI) . When the injury is severe only one half are able to live independently afterwards. Cooling the brain (hypothermia) is often used in intensive care units for decades to  decrease inflammation and brain swelling and hopefully to improve outcomes, but clinical staff have had uncertainty whether benefits outweigh complications. We conducted the largest randomised trial of hypothermia in TBI, in 500 patients, in 6 countries, called POLAR. We started cooling by ambulance staff, to give hypothermia the best chance to benefit patients. We continued for 3-7 days in hospital ind ICU. We measured functional outcomes at 6 months.
Author Interviews, Brain Injury, CDC, JAMA, Pediatrics / 24.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44746" align="alignleft" width="156"]Juliet Haarbauer-Krupa, PhD Senior Health Scientist Division of Unintentional Injury Prevention CDC Dr. Haarbauer-Krupa[/caption] Juliet Haarbauer-Krupa, PhD Senior Health Scientist Division of Unintentional Injury Prevention CDC MedicalResearch.com: What is the background for this study?
  • Traumatic brain injury in children results in a large number of emergency department visits each year and can result in long term difficulties
  • The purpose of this study was to estimate lifetime prevalence of TBI in children based on a nationally representative sample of U.S. parents/adults and to describe the association between TBI and other childhood health conditions.
  • CDC researchers examined the National Survey of Children’s Health, a cross-sectional telephone survey of U.S. households, to provide a national estimate of TBI in children.
ADHD, Author Interviews, Brain Injury, JAMA, Pediatrics / 20.03.2018

MedicalResearch.com Interview with: Dr. Megan E. Narad, PhD Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center | CCHMC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous research has shown that children with a history of traumatic brain injury (TBI) demonstrate difficulties with attention following injury; however, most studies only follow children 2-3 years after injury. Our study followed a group of children with a history of TBI 7-10 years after injury. The main finding is that those with severe TBI were at greater risk for developing secondary attention deficit hyperactivity disorder (SADHD) than those with orthopedic injury; however, it should also be noted that kids with less severe injuries were also at risk of developing SADHD. In addition to injury severity, environmental factors (maternal education and family functioning) also played a role in SADHD development. It should also be noted that a number of kids developed SADHD >3.5 years after injury suggesting that these difficulties may not surface until many years after injury.
Author Interviews, Brain Injury, Exercise - Fitness, JAMA / 25.07.2017

MedicalResearch.com Interview with: [caption id="attachment_36085" align="alignleft" width="150"]Daniel H. Daneshvar, M.D., Ph.D. Chronic Traumatic Encephalopathy Center Team Up Against Concussions | Founder Boston University Dr. Daneshvar[/caption] Daniel H. Daneshvar, M.D., Ph.D. Chronic Traumatic Encephalopathy Center Team Up Against Concussions | Founder Boston University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts. CTE was first described in JAMA in 1928. In the 99 years since, just over 100 cases of CTE have been described in the world’s literature. This study nearly doubles the number of reported cases of CTE, with 177 cases of CTE in football players. Of note, 110 of the 111 athletes who played in the NFL had CTE. This study represents the largest and the most methodologically rigorous description of a series of patients with CTE ever published. Such a richness of data regarding the clinical and pathological features of CTE has never been previously compiled. As such, this study represents an important advance to the medical literature and an enormous scientific advance in our understanding of  chronic traumatic encephalopathy.
Author Interviews, Biomarkers, Brain Injury / 10.07.2017

MedicalResearch.com Interview with: [caption id="attachment_35842" align="alignleft" width="200"]Dr Lisa J Hill PhD Institute of Inflammation and Ageing Research Fellow Neuroscience and Ophthalmology Institute of Inflammation and Ageing College of Medical and Dental Sciences University of Birmingham UK Dr. Hill[/caption] Dr Lisa J Hill PhD Institute of Inflammation and Ageing Research Fellow Neuroscience and Ophthalmology Institute of Inflammation and Ageing College of Medical and Dental Sciences University of Birmingham UK  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Traumatic brain injury (TBI) is the leading cause of death and disability among young adults and, according to the World Health Organization, by 2020 TBI will become the world’s leading cause of neurological disability across all age groups.  Early and correct diagnosis of traumatic brain injury is one of the most challenging aspects faced by clinicians. Being able to detect compounds in the blood that help to determine how severe the brain injury is would be of great benefit to patients and aid in their treatment.  Inflammatory markers are particularly suited for biomarker discovery as TBI leads to very early alterations in inflammatory proteins.  The discovery of reliable biomarkers for the management of TBI would improve clinical interventions. We collected blood samples from 30 injured patients within the first hour of injury prior to the patient arriving at hospital and analysed them. Analysis of protein biomarkers from blood taken within the first hour of injury has never been carried out until now. We used a panel of 92 inflammation-associated human proteins when analysing the blood samples. The analysis identified three inflammatory proteins, known as CST5AXIN1 and TRAIL, as novel biomarkers of TBI.
Author Interviews, Brain Injury / 02.12.2016

MedicalResearch.com Interview with: Dr. Charles Tator, Neurosurgeon Toronto Western Hospital and Director Canadian Concussion Centre  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The main findings of this study are that the number of symptoms of post-concussion syndrome (PCS) are related to how long PCS lasts. Furthermore, physicians need to be more vigorous in their treatment of PCS symptoms and use the treatments that exist for each symptom where possible such as headache, vertigo, anxiety. The sooner sufferers of PCS receive treatment for their symptoms, the better.
Author Interviews, Brain Injury, Pediatrics / 31.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24766" align="alignleft" width="200"]Kristy Arbogast, PhD Co-Scientific Director Center for Injury Research and Prevention The Children's Hospital of Philadelphia Research Professor Division of Emergency Medicine Department of Pediatrics University of Pennsylvania Philadelphia, PA 19104 Dr. Kristy Arbogast[/caption] Kristy Arbogast, PhD Co-Scientific Director Center for Injury Research and Prevention The Children's Hospital of Philadelphia Research Professor Division of Emergency Medicine Department of Pediatrics University of Pennsylvania Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Arbogast: The research team looked retrospectively at four recent years of data on children diagnosed with concussion at Children's Hospital of Philadelphia (CHOP) to determine how children access the health system for a concussion. For those 8,000 kids with a CHOP primary care provider, 82% entered the health system via a primary care location, 12% entered through the ER and 5% through a specialist. One-third of concussion diagnoses were to children under age 12. Many current counts of concussion injury among children are based on emergency room visits or organized high school and college athletics data. Thus, we are vastly underestimating child and youth concussions in the US.
Artificial Sweeteners, Author Interviews, Brain Injury, JAMA, Neurological Disorders, Ophthalmology / 12.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24260" align="alignleft" width="148"]Dr. T. Dianne Langford PhD Associate Professor, Neuroscience and Neurovirology Lewis Katz School of Medicine Temple University Dr. T. Dianne Langford[/caption] Dr. T. Dianne Langford PhD Associate Professor, Neuroscience and Neurovirology Lewis Katz School of Medicine Temple University MedicalResearch.com: What is the background for this study? Dr. Langford: The ocular-motor system has been shown to reflect neural damage, and one of ocular-motor functions, near point of convergence (NPC), was reported to worsen after a sport-related concussion (Mucha et al. Am J Sport Med). But the effects of subconcussive head impact, a milder form of head injury in the absence of outward symptoms remains unknown.  Prior to this study, we found that in a controlled soccer heading experimental paradigm decreased NPC function, and even 24h after the headings, NPC was not normalized back to baseline (Kawata et al. 2016 Int J Sport Med). To extend our findings from the human laboratory study, we launched longitudinal clinical studies in collaboration with the Temple football team, to see if repetitive exposure to subconcussive head impacts negatively affects NPC.
Author Interviews, Brain Injury, Mayo Clinic, Neurological Disorders / 02.12.2015

[caption id="attachment_19745" align="alignleft" width="125"]Kevin Bieniek Kevin Bieniek[/caption] MedicalResearch.com Interview with: Kevin Bieniek B.Sc. Biology and Psychology Neuroscience researcher Mayo Clinic’s campus in Florida.  Medical Research: What is the background for this study? What are the main findings? Response:  Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury often sustained through contact sports and military blast exposure.  While CTE was first described in boxers in the 1920s, to date many descriptions of CTE have been made in high-profile professional athletes, but the frequency of Chronic traumatic encephalopathy pathology in athletes with more modest contact sports participation is unknown.  For this study, researchers at the Mayo Clinic in Jacksonville, FL examined the Mayo Clinic Brain Bank, one of the largest brain banks of neurodegenerative diseases.  In searching through medical records of over 1,700 patients, 66 individuals with clinically-documented contact sports participation were identified.  Of these 66 former athletes, 21 or 32% had pathologic changes in their brains consistent with CTE.  By comparison, none of 198 control individuals that did not have contact sports documentation in their medical records (including 66 women) had CTE pathology.  These results have been recently published in the December issue of the journal Acta Neuropathologica <<hyperlink: http://www.springer.com/medicine/pathology/journal/401.
Author Interviews, Brain Injury, JAMA, Outcomes & Safety, UCLA / 23.07.2015

Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research, University of California Los Angeles Los Angeles, CA 90024MedicalResearch.com Interview with: Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research, University of California Los Angeles Los Angeles, CA 90024 Medical Research: What is the background for this study? What are the main findings? Dr. Dawes: In the fall of 2013, we formed the Los Angeles County Trauma Consortium, building upon a prior administrative relationship between LA County’s 14 trauma centers. We added health research researchers from UCLA and USC, and shifted the focus of the group from logistical issues to quality improvement. As a first project, our hospitals wanted to know if there was any variation in how traumatic brain injury patients are cared for across the county. Traumatic brain injury accounts for over 1/3 of all injury-related deaths in the U.S. and is the number one reason for ambulance transport to a trauma center in LA County. When we looked at the data, we found widespread variation in both how these patients were cared for at different hospitals and what happened to them as a result of that care. After adjusting for important differences in patient mix, we found that mortality rates varied by hospital from roughly 25% to 55%. As we tried to explain this variation, we looked into how often hospitals complied with two evidence-based guidelines from the Brain Trauma Foundation, hoping that we could eventually develop an intervention to boost compliance with these recommended care practices. While compliance rates varied even more widely than mortality—from 10 to 65% for intracranial pressure monitoring and 7 to 76% for craniotomy—they did not appear to be associated with risk-adjusted mortality rates. Put simply, we found no connection between how often hospitals complied with the guidelines and how likely their patients were to survive.
Author Interviews / 01.06.2015

Yuyuan Li, PhD Liaoning Provincial Key Laboratory of Brain Diseases Institute for Brain Disorders, Dalian Medical University College of Basic Medical Sciences, Dalian Medical University Dalian ChinaMedicalResearch.com Interview with: Yuyuan Li, PhD Liaoning Provincial Key Laboratory of Brain Diseases Institute for Brain Disorders, Dalian Medical University College of Basic Medical Sciences, Dalian Medical University Dalian China Medical Research: What is the background for this study? What are the main findings? Dr. Li: Traumatic brain injury (TBI) will become the leading cause of death and lifelong disability in the general population by the year 2020. Early determination of prognosis based on epidemiological data is the key to inform care of these patients. Neurobiochemical markers, like Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) have shown a prognostic value for outcome prediction. Recently, several studies have investigated the correlation between serum UCH-L1 concentrations and TBI, however the results thus far have been inconsistent. In the present study, we conducted a systematic review and meta-analysis to evaluate the prognostic value of serum UCH-L1 concentrations after traumatic brain injury. Five studies (including 673 TBI and 1004 controls) were included in the meta-analysis and the overall results reveal that the serum UCH-L1 level was significantly higher in patients with traumatic brain injury compared to those of the control group. Importantly, there was no statistical evidence of a publication bias among the contributing studies from the result of Egger’s test either.
Author Interviews, Brain Injury / 06.02.2015

Ashley Di Battista, Ph.D. Research Fellow Critical Care Medicine| Neurosciences & Mental Health Program The Hospital for Sick Children  Toronto, ON, CanadaMedicalResearch.com Interview with: Ashley Di Battista, Ph.D. Research Fellow Critical Care Medicine| Neurosciences & Mental Health Program The Hospital for Sick Children  Toronto, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Di Battista: Most of what is known about adolescent quality of life (QoL) after traumatic brain injury (TBI) doesn’t come from adolescents – it comes from their parents.  This profoundly non- concordant data (known as the “Proxy Problem”) is drawn from parent reported health-related quality of life (HRQoL) questionnaires (e.g. the PedsQL ™).  Parent report can be influenced by the parents’ own distress after their child’s traumatic brain injury – which results in parents providing poorer estimates of their child’s QoL.  Lack of insight is often purported to explain this difference, in the absence of direct examination of insight, or subsequent data, to support this claim.  HRQoL has been criticized in the broader wellbeing literature as incompatible with the QoL construct– due to the absence of core features of the overall QoL model, and an inherent suggestion that a lack of overt pathology is equivalent to a good outcome. Proxy reported, HRQoL focused research has generated a polarized view of quality of life after pediatric traumatic brain injury. This misrepresentation is due in part to the way in which we acquire this data (e.g. the tools) and who we ask (e.g. parents). The current study explored the individual adolescent experience of quality of life after traumatic brain injury and whether the tools commonly used to assess quality of life after brain injury are of capturing what adolescents define as relevant to their definition of quality of life. Our findings revealed that when adolescents did endorse changes in functioning on the PedsQL, they did not consider these changes to be relevant to, or impact on, their self-described QoL. While the PedsQL™ is capable of documenting changes post-injury, it does not seem to capture domains of relevance to the adolescent idea of QoL. The ability of these adolescents to reflect on their own circumstances, engage in pre-to-post injury analysis of their functioning challenges default positioning that lack of insight is the sole determinant for differences in reports between proxies and adolescents on quality of life .
Author Interviews, Brain Injury, Inflammation / 21.01.2015

Alan I Faden, M.D. David S. Brown Professor in Trauma Professor, Departments of Anesthesiology, Anatomy & Neurobiology, Neurosurgery, and Neurology Director, Center for Shock, Trauma & Anesthesiology Research (STAR) University of Maryland School of MedicineMedicalResearch.com Interview with: Alan I Faden, M.D. David S. Brown Professor in Trauma Professor, Departments of Anesthesiology, Anatomy & Neurobiology, Neurosurgery, and Neurology Director, Center for Shock, Trauma & Anesthesiology Research (STAR) University of Maryland School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Faden: Accumulating clinical and pre-clinical research data indicate that traumatic brain injury (TBI) can lead to chronic progressive neurodegeneration. In this regard, most attention has focused on the connections between TBI and with Alzheimer disease (AD) or Chronic Traumatic Encephalopathy (CTE). However, recent epidemiological studies raise questions about the association between TBI and AD, and CTE is likely a less common end-stage result resulting from complex pathobiological changes. In contrast, both older and newer studies underscore that traumatic brain injury can cause chronic neuroinflammation that leads to chronic neurodegeneration. In contrast to AD and CTE, the latter condition appears to be potentially treatable, even long after injury. Our paper critically assesses the mechanisms and treatment of chronic post traumatic neurodegeneration.
Author Interviews, Brain Injury, NEJM / 13.12.2014

MedicalResearch.com Interview with: Dr. Brett E. Skolnick PhD Department of Neurosurgery Cushing Neuroscience Institute Hofstra North Shore–LIJ School of Medicine, Manhasset, NY Medical Research: What is the background for this study? What are the main findings? Dr. Skolnick: The experimental evidence for a role of progesterone is based on extensive non-clinical studies in non-primate species (4 animal species such as rat, mice) the majority of which indicate that progesterone has a variety of neuroprotective properties. The animal models of injury in traumatic brain injury (TBI) have included models of blunt trauma, fluid percussion injury, cortical aspiration but similar effects have been seen stroke models and models of spinal cord injury. In these experiments progesterone has been shown to reduce cerebral edema thus limiting the effects or preventing intracranial pressure increases which can lead to secondary injury. Progesterone has also been shown to exert anti-inflammatory, anti-apopotic and perhaps even anti-oxidant effects. All of these effect are postulated to work synergistically to prevent cell death which could result in improved functional outcomes. Two small single center clinical trials provided the support in traumatic brain injury patients that progesterone could have impact on functional outcomes in larger, properly powered trials.  The results of which are summarized in the NEJM article. In the current trial evaluated the Glasgow Outcome Scale and the extended version of the Glasgow Outcome scale at 6 months following injury. These scales are well validated scales that are used to determine the degree of recovery in terms of disability and handicap due to TBI rather than the degree of impairment. The GOS has 5 levels: death, vegetative state, severe disability, moderate disability and good recovery with death and vegetative state typically collapsed because they are considered equally undesirable. The Extended GOS takes the three best levels of recovery and subdivides these into a upper and lower category to increase the granularity of the outcome measure. Progesterone was administered within 8 hour of injury (loading dose followed by continuous infusions) for a total of 120 hours.  Careful assessments were performed to ensure optimal patient management during the trial to provide the best background to evaluate the impact of the addition of progesterone or placebo (1  to 1 randomization).  No effect was seen on the GOS or the extended GOS. In addition a fairly new approach of categorizing patients based on prognostic factors known at time of randomization (such as Age, baseline GCS, pupillary response, hypoxia, hypotension, Marshall Classification or presence/absence of subarachnoid hemorrhage) as developed by Hukkelhoven and colleagues was used. This was expected to tease out improvements, if they existed in subgroups of patients where perhaps progesterone could work better in the most severe or less severe traumatic brain injury patients. But again no effects were seen. The unfavorable outcomes (see NEJM paper for details) were essentially identical between progesterone and placebo groups whether they had the worst prognosis or the best prognosis.
Author Interviews, Brain Injury, Memory / 04.12.2014

Joshua Sandry, Ph.D. Neuropsychology & Neuroscience Research Kessler Foundation, West Orange, NJ Assistant Professor, Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical SchoolMedicalResearch.com Interview with Joshua Sandry, Ph.D. Neuropsychology & Neuroscience Research Kessler Foundation, West Orange, NJ Assistant Professor, Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Sandry: We were interested in better understanding the relationship between cognitive reserve and long-term memory impairment in moderate to severe Traumatic Brain Injury, from a cognitive perspective. The theory of cognitive reserve suggests that individuals who engage in intellectually enriching activities may be less susceptible to the negative cognitive consequences of long-term memory impairment that often accompanies neurological disorders. There’s significant evidence in support of cognitive reserve; however, it’s somewhat unclear what particular cognitive processes are involved in this relationship and how those cognitive processes may differ across high and low reserve individuals. We derived our predictions on the basis of well-established cognitive theory and found that working memory capacity partially mediates the cognitive reserve – long-term memory relationship in Traumatic Brain Injury. Or to put it another way, working memory may be one underlying cognitive process involved in this relationship. Importantly, this finding corroborates some recent related work we have conducted in multiple sclerosis.
Author Interviews, Brain Injury, Cognitive Issues, JAMA, UCSF / 27.10.2014

Raquel C. Gardner, MD, Research Fellow San Francisco VA Medical Center Clinical Instructor Memory and Aging Center, Department of Neurology University of California, San FranciscoMedicalResearch.com Interview with: Raquel C. Gardner, MD, Research Fellow San Francisco VA Medical Center Clinical Instructor Memory and Aging Center, Department of Neurology University of California, San Francisco Medical Research: What are the main findings of the study? Dr. Gardner: We found that people who experience a  traumatic brain injury (TBI )when they are 55 or older have a 26% higher chance of getting dementia over the next 5 to 7 years compared to people who experience bodily trauma.