Audrey McKinlay

Prevalence of traumatic brain injury among children, adolescents and young adults: Prospective evidence from a birth cohort

Background: Little is known about the incidence and prevalence of traumatic brain injury (TBI), particularly for infants, children and young adults. Primary objective: The purpose of this study was to provide an accurate estimate of the incidence and prevalence of TBIs for individuals between 0–25 years of age. Method and procedures: A birth cohort of 1265 individuals was used, for which information regarding TBI events, both hospitalized and non-hospitalized, had been recorded. Main outcomes and results: The average incidence for this age group ranged from 1.10–2.36 per 100 per year, with an overall prevalence of ∼30%. The most common source of injury was falls for individuals 0–14 years of age and contact sports and motor vehicle accidents for 15–25 year olds. Approximately one third of the individuals who experienced a TBI went on to have one or more additional injuries. Conclusions: The incidence rates reported here are much higher than those previously found. It is clear that TBIs constitute a major health issue and therefore it is important to have accurate information to enable planning for primary healthcare services and to inform prevention programmes.

Long term psychosocial outcomes after mild head injury in early childhood

Objectives: The question of whether any adverse cognitive or psychosocial outcomes occur after mild head injury in early childhood has evoked considerable controversy. This study examined mild head injury before age 10 and potential differences in late childhood/early adolescence as a function of severity of mild injury and age at injury. Methods: A fully prospective longitudinal design tracked a large birth cohort of children. Confirmed cases of mild head injury before age 10 were divided on the basis of outpatient medical attention (n=64–84) or inpatient observation (hospital overnight; n=26–28 ) and compared with the non-injured remainder of the cohort (reference group; n=613–807). A range of pre-injury and post-injury child and family characteristics were used to control for any potential confounds. Outcome after injury before and after age 5 was also assessed. Results: After accounting for several demographic, family, and pre-injury characteristics, the inpatient but not the outpatient group displayed increased hyperactivity/inattention and conduct disorder between ages 10 to 13, as rated by both mothers and teachers. Psychosocial deficits were more prevalent in the inpatient subgroup injured before age 5. No clear effects were evident for various cognitive/academic measures, irrespective of severity of mild injury or age at injury. Conclusions: Most cases of mild head injury in young children do not produce any adverse effects, but long term problems in psychosocial function are possible in more severe cases, perhaps especially when this event occurs during the preschool years. The view that all mild head injuries in children are benign events requires revision and more objective measures are required to identify cases at risk.

Adolescent psychiatric symptoms following preschool childhood mild traumatic brain injury: evidence from a birth cohort.

ObjectiveTo determine whether childhood mild traumatic brain injury (MTBI) is associated with behavioral problems in adolescence. ParticipantsChildren from a longitudinal birth cohort (initial N = 1265) were assigned to 1 of 3 groups: (1) inpatient group (n = 19) comprised children admitted to hospital for MTBI before age 5 years; (2) outpatient group (n = 57), children with any incidence of MTBI before age 5 seen by a general practitioner or at an accident and emergency department and sent home; (3) reference control group (n = 839). Outcome measuresMaternal and self-report regarding attention deficit/hyperactivity disorder, conduct disorder, anxiety disorder, mood disorder, and alcohol or illicit substance abuse/dependence obtained using Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) criteria. ResultsAt age 14 to 16 years, children who had been hospitalized for MTBI during preschool years were significantly more likely to show symptoms of attention deficit/hyperactivity disorder (odds ratio = 4.2), conduct disorder/oppositional defiant disorder (odds ratio = 6.2), substance abuse (odds ratio = 3.6), and mood disorder (odds ratio = 3.1) but not anxiety disorder. ConclusionsPreschool MTBI is associated with persistent negative effects on psychosocial development. These continuing problems are consistent with the view that preschool years represent a period of particular vulnerability following MTBI.

Characteristics of executive function impairment in Parkinson's disease patients without dementia.

Executive function impairments in Parkinsons disease (PD) are well documented. However, uncertainties remain regarding the impact of these deficits on other areas of cognitive functioning. The goal of this study was to provide a comprehensive assessment of cognitive characteristics in patients with PD without dementia and to assess how any such deficits affected other areas of cognitive functioning. Forty PD patients without dementia were compared to healthy controls using measures of attention and speed of processing and a comprehensive set of executive function tests including working memory, planning, and problem solving. Measures of memory/learning and visuospatial skills were also included to examine the relationship between aspects of executive function and other areas of cognition. Patients with PD showed deficits on measures of executive function, problem solving, and visuospatial skills. However, they were unimpaired on measures of planning, attention, and memory/learning. Deficits in problem solving were only evident for tasks with a high visuospatial content and were no longer significant when visuospatial skills were controlled for. While deficits in executive function and visuospatial skills were apparent for PD patients compared to controls, many aspects of cognition remained intact. These can provide a focus for cognitive intervention strategies that can be effective in delaying decline for PD patients.

Long-term behavioural outcomes of pre-school mild traumatic brain injury.

Abstract Background Mild traumatic brain injury (MTBI) is a leading cause of injury for children during their pre-school years. However, there is little information regarding the long-term outcomes of these injuries. Method We used fully prospective data from an epidemiological study of a birth cohort to examine behavioural effects associated with MTBI during the pre-school years. Cases of confirmed MTBI were divided into two groups, those that had received outpatient medical attention, and those that had been admitted to hospital for a brief period of observation (inpatient cases). The remainder of the cohort served as a reference control group. Results Mother/teacher ratings for behaviours associated with attention deficit/hyperactivity disorder and oppositional defiant/conduct disorder, obtained yearly from age 7 to 13, revealed evidence of deficits after inpatient MTBI (n = 21), relative to more minor outpatient injury MTBI (n = 55) and the reference control group (n = 852). For the inpatient group there was evidence of increasing deficits over years 7-13. Conclusions More severe pre-school MTBI may be associated with persistent negative effects in terms of psychosocial development. The vulnerability of pre-school children to MTBI signals a pressing need to identify high-risk cases that may benefit from monitoring and early intervention.

Public knowledge of 'concussion' and the different terminology used to communicate about mild traumatic brain injury (MTBI).

Primary objective: The primary objective was to investigate the publics general knowledge about concussion (mild traumatic brain injury) and to examine whether terminology influenced attributions made about individuals who experience concussion. Design: A random selection of the community was polled to identify public understanding of concussion. To encourage candid responses, a self-report survey method was used. Methods and procedures: One hundred and three members of the general public were asked to indicate if they associated specific attributes with brain injury or head injury, depending on the randomly assigned questionnaire they completed. Participants also completed a questionnaire about their knowledge of concussion and were asked to indicate whether they or someone they knew had experienced an injury to the head. Main outcomes and results: Participants incorrectly evaluated 20% (2/10) of statements regarding concussion knowledge and were relatively uncertain about another 20% (2/10) of statements. Negative attributes were associated more with brain than head injury, although those with prior experience made more positive attributions than those without. Fifty-nine per cent of participants who had experienced a concussion stated they had no brain/head injury. Conclusions: Overall, public knowledge about concussion and different terminology associated with this injury type is substantially inaccurate. More accurate information is required to increase understanding.

Cognitive Characteristics Associated with Mild Cognitive Impairment in Parkinson's Disease

Background: Cognitive deficits are common in Parkinson’s disease (PD), but the range of deficits is variable. The aim of this study was to identify different cognitive subgroups associated with PD. Methods: A broad range of neuropsychological measures and cognitive domains were used in a cluster analysis to identify subgroups of patients. Results: Three subgroups of patients were identified. Compared to controls, one PD subgroup showed no or minimal cognitive impairment (PD-NCI), a second group showed a variable or uncertain pattern of mild to severe cognitive impairments (PD-UCI), and a third group had evidence of severe cognitive impairment across most cognitive domains (mild cognitive impairment; PD-MCI). The subgroups did not differ with regard to age, motor impairment, or disease duration. Conclusions: Patients with PD are heterogeneous with regard to cognitive presentation and it may be possible to identify patients in the preclinical stage of dementia. The identification of preclinical dementia in PD patients (PD-MCI) provides an opportunity to understand cognitive decline in PD and its progression to dementia.

Neuropsychiatric problems in Parkinson's disease: Comparisons between self and caregiver report

Introduction: This study examined the level of agreement between caregiver and Parkinsons disease (PD) patient reports of neuropsychiatric problems. Method: Forty-three patients and 43 informants who knew the patient well (caregivers) participated in the study. Caregivers rated patients’ behaviour, as well as their own stress, using the Neuropsychiatric Inventory (NPI). Information from patients was obtained using commonly used scales (Beck Depression Inventory, Apathy Scale, Unified Parkinsons Disease Rating Scale and the Hamilton Anxiety Depression Scale). Both the patients and the caregivers also completed the Frontal Systems Behavior Scale, which assesses behaviours associated with apathy, disinhibition and executive dysfunction. Results: The level of agreement between these self and caregiver reports was low, with only 45.8% agreement for depression, 45.0% for apathy, 28.6% for hallucinations, 26.9% for sleep problems and 6.7% for anxiety. Conclusions: Given this low level of agreement between self and other report, these two methods of assessment cannot be considered interchangeable.

An investigation of the pre-injury risk factors associated with children who experience traumatic brain injury

Background and Objective Traumatic brain injury (TBI) is a frequently occurring event in childhood that may have significant ongoing effects. Little is known about the child and family characteristics that predispose children to these injuries. A greater understanding of the risk factors associated with childhood TBI may provide an opportunity to prevent their occurrence. Methods Information provided by a large birth cohort study (n=1265) was used to determine the child and family risk factors of TBI in children aged 0–15 years (n=187). All information regarding child, family, and injury events were collected prospectively and unrelated to the injury event itself. Child variables included in the analysis were sex and the level of behavioural problems. Parental variables included were family socioeconomic status, mothers age, education level, depressive symptoms, number of adverse life events experienced by the family, and parenting style. Results The most important risk factors were sex, adverse life events, and parenting style. The results suggest evidence of modest increases in the rate of TBI for those in the highest risk categories (male, ≥4 life events per annum, high maternal punitiveness) compared to the lowest risk categories, with hazard ratios in the region of 1.4–1.6. Conclusions Overall characteristics of both the family and child predicted a TBI event. An increased understanding of risks associated with TBI in childhood will provide an avenue to prevent these injuries by targeting at-risk families and aiding the development of appropriate intervention strategies.

Planning in Parkinson's disease: A matter of problem structure?

Although the Tower of London (TOL) has been extensively used to assess planning ability in patients with Parkinsons disease (PD), the reported presence or extent of any planning deficits has been inconsistent. This may partly be due to the heterogeneity of the TOL tasks used and a failure to consider how structural problem parameters may affect task complexity. In the present study, planning in PD patients was assessed by systematically manipulating TOL problem structure. Results clearly disprove the identity assumption of problems with an equal number of minimum moves. Instead, substantial parts of planning performance were related to more subtle aspects of problem structure, such as subgoaling patterns and goal hierarchy. Planning in PD patients was not impaired in general but was affected when the information provided by the problem states was ambiguous in terms of the sequential order of subgoals, but not by increases in search depth.