Depressive Symptoms and White Matter Dysfunction in Retired NFL Players With Concussion History.

Depressive symptoms and white matter dysfunction in retired NFL players with concussion history.

Neurology. 2013 May 24;
Strain J, Didehbani N, Cullum CM, Mansinghani S, Conover H, Kraut MA, Hart J, Womack KB

OBJECTIVE: To determine whether correlates of white matter integrity can provide general as well as specific insight into the chronic effects of head injury coupled with depression symptom expression in professional football players. METHOD: We studied 26 retired National Football League (NFL) athletes who underwent diffusion tensor imaging (DTI) scanning. Depressive symptom severity was measured using the Beck Depression Inventory II (BDI-II) including affective, cognitive, and somatic subfactor scores (Buckley 3-factor model). Fractional anisotropy (FA) maps were processed using tract-based spatial statistics from FSL. Correlations between FA and BDI-II scores were assessed using both voxel-wise and region of interest (ROI) techniques, with ROIs that corresponded to white matter tracts. Tracts demonstrating significant correlations were further evaluated using a receiver operating characteristic curve that utilized the mean FA to distinguish depressed from nondepressed subjects. RESULTS: Voxel-wise analysis identified widely distributed voxels that negatively correlated with total BDI-II and cognitive and somatic subfactors, with voxels correlating with the affective component (p < 0.05 corrected) localized to frontal regions. Four tract ROIs negatively correlated (p < 0.01) with total BDI-II: forceps minor, right frontal aslant tract, right uncinate fasciculus, and left superior longitudinal fasciculus. FA of the forceps minor differentiated depressed from nondepressed athletes with 100% sensitivity and 95% specificity. CONCLUSION: Depressive symptoms in retired NFL athletes correlate negatively with FA using either an unbiased voxel-wise or an ROI-based, tract-wise approach. DTI is a promising biomarker for depression in this population. HubMed – depression


Does Venous Thromboembolism Affect Rehabilitation after Hip Fracture Surgery?

Yonsei Med J. 2013 Jul 1; 54(4): 1015-1019
Lee YK, Choi YH, Ha YC, Lim JY, Koo KH

Purpose: Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a serious and life-threatening complication in elderly (older than 65 years) patients undergoing hip fracture surgery (HFS). However, few have reported on the influences of VTE on postoperative rehabilitation in these patients. This study was performed to determine whether VTE affects clinical outcomes in patients who underwent HFS. Materials and Methods: We retrospectively evaluated 330 HFSs in 325 consecutive patients, which were performed from January 2009 to June 2010. From chart review, we identified 15 patients with symptomatic VTE. We compared Geriatric depression scale, Modified Barthel index and Berg balance scale scores as well as 10 meter gait speed at discharge and hospital stay between a symptomatic VTE group and a non-VTE group. Results: No significant difference in clinical outcomes at discharge between the two groups was found, although hospital stay was longer in patients with symptomatic VTE (p=0.012). Conclusion: East Asian patients have a low incidence of symptomatic VTE after HFS, and the clinical outcomes of patients with symptomatic VTE were similar to patients without VTE, although there was a longer rehabilitation period. HubMed – depression


Psychopathological Influence of Lumbar Disc Herniation in Male Adolescent.

Yonsei Med J. 2013 Jul 1; 54(4): 813-818
Kim TW, Oh CH, Shim YS, Yoon SH, Park HC, Park CO

Purpose: There is no report about psychopathological effect causing by disc herniation. The disease could impose psychopathological influence on the social life, the treatment period, and response to the treatment. This study was to evaluate retrospectively the psychopathological influence of lumbar disc herniation (LDH) among Korean 19-year-old males. Materials and Methods: We compared the Korean military multiphasic personality inventory (KMPI) profiles of 74 LDH cases with the KMPI profiles of 150 controls. The LDH groups were categorized to 2 groups according to the presence of thecal sac compression by disc materials, and evaluated the relation between the KMPI and LDH. Results: The decrease of the faking-good response scale and increase of the faking-bad response scale were observed more in the LDH group than in the normal volunteer group (p<0.05). The neurosis set such as anxiety, depression and somatization was markedly increased in the LDH group compared to the normal volunteers group (p<0.05). The scale of personality disorder was also increased more in the LDH group (p=0.002). The differences of KMPI scales were not correlated with the severe pathology of LDH. Conclusion: Young male with LDH may tend to have more abnormal results of multiphasic personality inventory test compared to the normal volunteers, suggesting that LDH may be related to the psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate and treat the psychopathological aspects in patients with LDH. HubMed – depression


Effects of Brain-Directed Nutrients on Cerebral Blood Flow and Neuropsychological Testing: A Randomized, Double-blind, Placebo-controlled, Crossover Trial.

Adv Mind Body Med. 2013 Spring; 27(2): 24-33
Amen DG, Taylor DV, Ojala KS, Kaur J, Willeumier KC

Context In a prior open trial of professional football players who displayed the effects of traumatic brain injury, the current reserach team reported significant improvements in clinical symptoms, neuropsychological testing and regional cerebral blood flow (rCBF) following the use of brain-directed nutrients (BDNs) and lifestyle interventions. Objective The current study intended to determine whether supplementation with BDNs improved rCBF and neuropsychological function in healthy individuals. Design • The current study was a randomized, doubleblind, placebo-controlled, crossover trial, which was a more rigorous reseach design than the prior study and did not include lifestyle interventions. Setting • Participants underwent evaluation and testing at the Amen Clinics, Inc, a private medical facility in Newport Beach, CA. Participants Thirty healthy adult (15 male and 15 female) participants were recruited from the community though local advertising and met the requirements for eligibility into the study. Twenty-five individuals completed the study, with dropout due to events unrelated to the study itself. Intervention The participants were randomly assigned to a treatment order for intervention, either placebo or brain supplements first. The BDNs treatment was comprised of three supplements: fish oil; a high-potency, multiple vitamin/mineral supplement; and a brainenhancement supplement. The placebo treatment was two supplements comprised of rice flour to replace the multiple vitamin/mineral complex and the brain-enhancement supplement and one supplement made of other oils to replace the fish-oil mixture. After 2 mo of this first intervention, a crossover intervention occurred for a final 2 mo, in which participants formerly receiving BDNs received a placebo treatment and participants formerly treated with placebo received the BDNs treatment. Outcome Measures Primary outcome measures included (1) an analysis of the changes in rCBF using SPECT and (2) an assessment of the differences in cognitive and emotional function using the MicroCog (cognitive performance), the WebNeuro (emotional state), and three psychological inventories-the Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI), and Quality of Life Inventory (QOLI). Results A region of interest (ROI) analysis for each of the 2-mo phases (baseline, then placebo and treatment according to randomized order) showed significant improvement in rCBF for the BDNs as compared to the placebo (as assigned at the start of the first intervention) in the prefrontal cortex, anterior and posterior cingulate gyrus, hippocampus, and cerebellum. Significant improvements were observed for the BDNs (1) on the MicroCog-reasoning, P = .008; memory, P = .014; information processing accuracy, P = .027; (2) on the WebNeuro-executive function, P = .002, information processing efficiency, P = .015; depressed mood, P = .017, and emotional identification, P = .041; and (3) on the BSI-positive symptom total, P = .024 and reduced hostility, P = .018. For the last, significance occurred upon accounting for the effect of order. Conclusion This study demonstrates the potential effectiveness of BDNs in enhancing rCBF and neuropsychological function across various cognitive and psychological domains. HubMed – depression


Multi-Site Six Month Outcome Study of Complex Psychiatric Patients Evaluated with Addition of Brain SPECT Imaging.

Adv Mind Body Med. 2013 Spring; 27(2): 6-16
Amen DG, Boeger ML, Taylor DV, Pigott HE, Willeumier KC

Background Psychiatric diagnoses are made primarily through clinical histories, with psychiatrists searching for DSM (Diagnostic and Statistical Manual of Mental Disorders)-driven symptom clusters, and outcomes for patients have not substantially improved in decades for many disorders. Primary Study Objective In this study, the research team examined the outcome impact of the addition of single photon emission computed tomography (SPECT) to the assessment of complex patients. Design The research team designed a multisite, prospective, 6-mo outcome study. The study was completed after final outcome measures were obtained on 500 participants. Setting The study occurred in four psychiatric clinics, the Amen Clinics in Newport Beach and San Francisco, CA; Bellevue, WA; and Reston, VA. Participants Participants were new outpatients at the four clinics who were entered into the study between January 2011 and August 2012. Primary Outcome Measures Evaluations included (1) histories, (2) mental-status examinations, (3) a Structured Clinical Interview for DSM-IV (SCID-IV), (4) the Beck Depression Inventory-II (BDI-II), (5) the Brief Symptom Inventory (BSI), (6) the Quality of Life Inventory (QOLI), and (7) brain SPECT scans during rest and concentration. At 6 mo, standardized outcome measurements were readministered (BDI-II, BSI, QOLI), and the research team asked questions about improvement and compliance. Results Seventy-five percent of participants reported significant clinical improvement; 55% reported being “very compliant,” 41% “somewhat compliant,” and 4% “noncompliant.” Significant improvements were observed across all three assessments: (1) BDI, 360 out of 500 (72%) participants decreased, mean difference = -6.92; (2) BSI, 367 out of 461 (80%) participants decreased, mean difference = -0.39.; (3) QOLI, 427 (85%) of participants improved) at 6 mo (Hotelling T2= 460; P < .0001), mean difference = +1.65. Net improvement was measured at 81% (n = 405). Conclusions To the research team's knowledge, this study is the first outcome study of complex psychiatric patients using SPECT as an additional diagnostic tool and demonstrating significant improvement. Further studies comparing the addition of brain SPECT to "treatment as usual" groups are warranted. HubMed – depression