Personality

Frontal Lobe Damage “Pseudopsychotic” Two new classification of frontal lobe damage Early diagnosis results in better patient outcomes. “Pseudodepressed” Characterized by apathy, lack of drive, inability to plan ahead, and limited insight. “Pseudopsychotic” Decreased social awareness, hyperactivity, and sexually disinhibited humor.

Personality Disorders (PD) A 30 year follow up study of TBI patients found a sharp increase in major depression, alcohol abuse or dependence, panic disorder, specific phobia, and psychotic disorders. Results show 55% of TBI patients without prior personality disorder diagnosis were later diagnosed with at least one disorder US national average 9.1%

Personality Disorders Paranoid personality disorder Avoidant personality disorder Dependent personality disorder Obsessive compulsive disorder Borderline personality disorder Narcissistic personality disorder

Personality change Testimonies from patient family’s as well as researchers who studied patients for extended periods of time report patients with traumatic brain injuries exhibit: Uncontrolled emotional outburst Impaired judgement Decision making abilities Lack of organizational skills

Criticism Criticism facing these findings include: Subjective information Researcher interpretation Validity of measurements Measures only overall change not degree Unable to assess patients prior to TBI

Facial Emotion Recognition Deficit 51 patients with TBI’s versus 33 patients without Patients were shown randomized face showing emotions such as Surprise Joy Anger Disgust The FEEST test recorded patients accuracy as well as time taken to answer

Results Results show decreased scores in facial emotional recognition Possible cause to perceived personality change due to inability to read social interaction appropriately

Effect on Cognition Now, for my section, I will be discussing two studies done to determine if Traumatic brain injuries had a long lasting effect on one’s cognitive function.

Cognition The mental process of acquiring and understanding knowledge Do head injuries impact cognition over a prolonged period of time( >1 year)? For the purpose of these studies; cognition will be defined as the mental process of acquiring and understanding knowledge. The question we tried to answer for this portion of our research is: Do head injuries impact cognition or cognitive function over a prolonged period of time (more than one year) after the time of injury?

PCS and TBI’s Effect on Cognition Long-term effects of mild traumatic brain injury on cognitive performance Phillip J. Dean & Annette Sterr Four groups TBI + PCS TBI + No PCS Control + PCS Control + No PCS Cognitive Function Tests NBACK (Working Memory) PVSAT (Processing Speed) Significant impairment in the TBI groups on both tests The first study we looked as was conducted by Phillip J Dean and Annette Sterr, titled “long term effects of mild traumatic brain injury on cognitive performance. This study’s purpose was to determine the long term effect of TBIs on cognitive function. This study compared the following four groups: Those suffering a TBI with Post Concussion Symptoms, those with a TBI and no PCS, an uninjured control group with symptoms of PCS and an uninjured control with no PCS. They tested all groups using two tests; the NBACK for working memory which involves memorizing the position of a different number of items “N” on a grid. For example a 1-back involves memorizing the position of the item one turn back, 2-back involves memorizing the position of the item two turns back, so on. The other test used was the PVSAT (Paced Visual Series Addition Task) which measured processing speed. The PVSAT involves showing subjects a series of numbers, one at a time, and asking them to add the number they are looking at with the number shown before. Their study, as shown in the graph, demonstrated that patients with TBI, as seen in the black, performed significantly worse on both tests than did the uninjured control group.

Association of Age and Lapsed Time Impact of age on long-term cognitive function after traumatic brain injury Dawn Senathi-Raja, Jennie Ponsford, Michael Schönberger TBI group compared to an matched, uninjured control group. 5-22 years following a TBI Tested: processing speed, working memory, verbal and visual memory, attention, and executive functioning. Poorer Performance by all subjects suffering a TBI Determined: After recovery from a TBI, poorer cognitive functioning is associated with: Older age at time of injury Elapsed time since injury. Tested using: Wechler Test of Adult Reading Digital Symbol Coding Task Symbol Digital Modalities Test Trail Making Test Rey Auditory Verbal Learning Test People and Names Test Doors Test Hayling Sentence Completion Test Brixton Spatial Anticipitation Test Controlled Oral Word Association Porteus Maze Test Sustained Attention to Response Task The second study pertaining to cognition to be discussed was conducted by Dawn Senathi-Raja, Jennie Ponsford, and Michael Schönberg, Titled “Impact of age on long term cognitive function after traumatic brain injury”. This study measured the impact of age in relation to cognitive function after 5-22 years following a TBI. The groups used were the injured TBI suffering group 5-22 years post injury, and an uninjured control group matched to their TBI counterpart on age, gender, education, and estimated IQ. They were tested with a large variety of tests, as shown in the box, measuring different aspects of cognitive function such as processing speed, working memory, verbal and visual memory, attention, and executive functioning. Their data proved not only that patients suffering a TBI demonstrated poorer cognitive performance but they also determined that after recovery from a TBI, poorer cognitive functioning is associated with older age at time of injury and elapsed time since injury.

Effect on Academic Performance

Exploring the Study Skills and Accommodations Used by College Student Survivors of Traumatic Brain Injury

Criteria Sustained injuries between the ages of 14–17 Sustained injuries between 4-10 years ago Graduated from public high schools despite the seriousness of their injuries. No history of neurological problems other than those associated with TBI Period of coma extending 1 week or greater

Lasting deficits in cognitive processes: Executive functioning Impulse control, Emotional control, flexible thinking, self monitoring, planning, prioritizing, task initiation, organization skills Memory Attention Concentration

Academically Relevant Issues Unpredictable periods of improvement Day-to-day Variability Medical Complications Pharmacological side-effects Concomitant Physical Sensory and/or motor deficits

Cerebrovascular Accident

Effects on Cerebrovascular Accident Stroke is the second leading cause of death worldwide and the leading cause of acquired disability in adults in most regions. About 20% of strokes occur in adults under age 65.

Stroke Risk and Outcome Two nationwide studies were conducted to show the correlation between patients with traumatic brain injuries and an increased risk of having a stoke.

Stroke Risk Factors Cardiac disease Smoking Hypertension Alcohol Diabetes Psychosocial stress Age Depression

Occurrence Men had higher risks of TBI and stroke than women due to greater exposure to dangerous activities, unhealthy lifestyles, and coexisting medical conditions. In contrast, better outcomes in women after TBI or stroke might be due to female hormones or supplemental estrogen therapy.

Prevention In order to reduce the risk of stroke in brain injured patients, rehabilitation should include stroke prevention strategies like increasing physical activities and regular checkups to monitor recovery.

Effects of Repetitive Head Injury in Athletes

Chronic Traumatic Encephalopathy (CTE) and Repetitive Head Injury The effects of repetitive head injuries have been recognized since the late 1920’s Precipitates a condition known as CTE Leads to cognitive, physical, and psychiatric impairment Evidenced by chemical and structural changes in the brain In the 1920’s, the effects of repetitive head injuries was recognized as a syndrome coined “punch drunk” or dementia pugilistica because of it’s association with the sport of boxing While its existence was first noted as a risk of the sport of boxing, dementia pugilistica has since been recognized as a consequence of other impact sports such as: football, hockey, wrestling, and soccer We now know the condition precipitated by repetitive head injury as a condition known as chronic traumatic encephalopathy, or CTE CTE leads to cognitive, physical and psychiatric impairment And it is evidenced by chemical and structural changes in the brain

Manifestations Paranoia Depression Social withdrawal Aggressive behavior Poor judgement Agitation Altered gait Parkinsonism Dementia Poor memory Suicidal behavior Manifestations of CTE include, but are not limited to: Paranoia Depression Social withdrawal Aggressive behavior Poor judgement Agitation Altered gait Parkinsonism Dementia Poor memory and Suicidal behavior With depression being the most common manifestation

Cognitive Impairment Occurring later in the course of CTE Impaired: Orientation Language Attention Processing speed As mentioned before, CTE leads to cognitive impairments as wells These changes have been recognized as later effects of the condition and Lead to impairments in: Orientation Language Attention Processing speed

Structural and Chemical Changes β-amyloid deposits τ-positive neurofibrillary tangles Changes similar to that of Alzheimer’s Disease Lower brain weight Frontal and temporal atrophy Thinning of the corpus callosum A 1973 examination of 15 former boxers’ brains revealed some of the structural changes we are more familiar with in CTE Since then, 14 of the 15 brains previously examined were reviewed along with an additional 6 Of these brains, 19 of them had shown beta-amyloid deposits and tau protein positive neurofibrillary tangles similar to those found in Alzheimer’s Disease 2 of the brains contained neurofibrillary tangles that were identical to those found in Alzheimer’s Disease These changes are ones that are consistently found in people who have been found to have CTE Other changes that occur with CTE include: Lower brain weight Frontal and temporal atrophy and Thinning of the corpus callosum

Study of Professional Athletes Study of 6 retired Canadian Football League players Study of deceased professional American football players Average age of onset of 42.8 Onset on average 8 years after retirement In 2013 a study of 6 retired Canadian Football League players revealed 3 of the 6 fell under diagnosis for CTE The remaining 3 were diagnosed Alzheimer’s, ALS, and Parkinson’s 12 deceased professional American football players that had died between 2008 and 2010 were selected for autopsy Boston University All 12 showed signs consistent with CTE diagnosis Even if all of the remaining 321 players that died during this time were negative for CTE, these findings would still reveal a 3.7% rate of occurrence Overall, the age of onset for the condition is 42.8 and it arises 8 years after the athlete has left the sport; In some cases, signs of CTE are noticeable at the time of retirement

Conclusion Patients with mTBI and post-concussion syndrome demonstrated working memory and processing speed impairment Survivors of severe traumatic brain injuries report lasting deficits in cognitive processes such as executive function, memory, attention and concentration After reevaluating patients with traumatic brain injuries, there have been significant personality changes. Research into repetitive mTBIs has revealed chronic traumatic encephalopathy as a long term consequence Patients who experienced a TBI had double the risk of developing a stroke compared to non-brain injured patients

References Dean, P. J., & Sterr, A. “Long-term effects of mild traumatic brain injury on cognitive performance”. Frontiers in Human Neuroscience Front. Hum. Neurosci.,7. February 2013. Web. 29 Mar. 2016 Edwards, J. C., & Bodle, J. D. (2014). Causes and consequences of sports concussion. Journal of Law, Medicine, and Ethics, 42(2), 128-132. Retrieved March 21, 2016. Fowler Marc, McCabe Paul C. “Traumatic Brain Injury and Personality Change” Pediatric School Psychology National Association of School Psychologists, May 2011. Web. 25 Mar. 2016. Gardner, A., Iverson, G. L., & McCrory, P. (2013). Chronic Traumatic Encephalopathy: A Systemic Review. British Journal of Sports Medicine, 48, 84-90. Retrieved March 21, 2016. Gavett, B. E., Stern, R. A., & McKee, A. C. (2011). Chronic traumatic enchephalopathy: A potential late effect of sport-related concussive and subconcussive head trauma. Clinics in Sports Medicine, 30(1), 179-188. Retrieved March 21, 2016. Hux, K., Bush, E., Zickerfoose, S., Holmeberg, M., Henderson, A., & Simanek, G. (2010). Exploring the Study Skills and Accommodations Used by College Student Survivors of Traumatic Brain Injury. Informa Healthcare, 24(1), 13-26. Retrieved March 15, 2016. Konrad, C., Geburek, A. J., Rist, F., Blumenroth, H., Fischer, B., Husstedt, I., . . . Lohmann, H. (2010). Long-term cognitive and emotional consequences of mild traumatic brain injury. Psychological Medicine Psychol. Med., 41(06), 1197-1211. Web. Retrieved March 28, 2016. Liao, C., Chou, Y., Yeh, C., Hu, C., Chiu, W., & Chen, T. (2014). Stroke Risk and Outcomes in Patients With Traumatic Brain Injury: 2 Nationwide Studies. Mayo Clinic Proceedings, 89(2), 163-172. Web. Retrieved March 28, 2016. Senathi-Raja, D., Ponsford, J., & Schönberger, M. (2010). Impact of age on long-term cognitive function after traumatic brain injury. Neuropsychology, 24(3). May 2010. Web. 30 Mar. 2016 Spikman, Jacoba M., Maarten V. Milders, Annemarie C. Visser-Keizer, Hemma J. Westerhof-Evers, Meike Herben-Dekker, and Joukje Van Der Naalt. "Deficits in Facial Emotion Recognition Indicate Behavioral Changes and Impaired Self-Awareness after Moderate to Severe Traumatic Brain Injury." PLOS ONE:. N.p., 12 June 2016. Web. 26 Mar. 2016. Volkers, N. (2015, December). Back to School- With a TBI. The Asha Leader. Retrieved March 15, 2016, from leader.pubs.asha.org