Amygdala response to emotional faces in adolescents with persistent post-concussion symptoms

Bohorquez‐Montoya, Luisa; España, Lezlie Y.; Nader, Amy M; Furger, Robyn E.; Mayer, Andrew R.; Meier, Timothy B.

doi:10.1016/j.nicl.2020.102217

Cited by 7 publications

(10 citation statements)

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“…51 While some studies have highlighted the role of the trigeminal cervical complex and pain neuropeptides in specific PPCS, such as headache, 52 depressive symptoms following a concussion could be a direct consequence of postinjury brain changes in the autonomic nervous system, more specifically the amygdala, a brain structure strongly connected to autonomic and neurohormonal axes that plays a crucial role in emotional processing. [53][54][55] From a psychosocial standpoint, individuals experiencing PPCS often face increased social isolation, academic difficulties, frustration surrounding activity limitations, anxiety related to prognosis uncertainties, and prolonged disengagement from usual roles and identity structures-all factors that may contribute to feelings of hopelessness and emotional distress. [56][57][58] These neurofunctional and psychosocial underpinnings of depressive symptoms in individuals with PPCS may interact with one another.…”

Section: Discussionmentioning

confidence: 99%

Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

et al. 2022

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ImportanceApproximately 15% to 30% of individuals with a history of concussion present with persistent postconcussion symptoms (PPCS). Individuals with PPCS are at greater risk of experiencing depressive symptoms.ObjectiveTo synthesize the association between depressive symptoms and PPCS in children, adolescents, and adults via meta-analysis and to investigate potential moderators of that association.Data SourcesSystematic search of Ovid Medline, CINAHL, PsycInfo, and Embase from 1995 to January 2022 was performed. Additionally, references from included studies were hand-searched to ensure relevant articles were captured in the search.Study SelectionStudies that involved participants who experienced PPCS and quantified depressive symptoms were included. The definition of PPCS was limited to physician-diagnosed or self-reported concussion, with symptoms lasting for a minimum of 4 weeks postinjury. Two authors independently screened all articles to determine study eligibility.Data Extraction and SynthesisStudy characteristics were extracted independently by 2 trained investigators. Study data were meta-analyzed using a random-effects meta-analysis.ExposurePPCS.Main Outcomes and MeasuresThe the primary outcome was depressive symptoms.ResultsData were extracted from 18 studies with a total of 9101 participants. Of the 18 studies, all were cohort studies, and 13 (72%) comprised adult populations. The mean (SD) time since concussion was 21.3 (18.7) weeks. After accounting for potential publication bias, the random-effects meta-analysis found a significant positive association between PPCS and depressive symptoms, (odds ratio, 4.56; 95% CI, 2.82-7.37; P &lt; .001). There were no significant moderators, likely due to the small number of studies included.Conclusions and RelevanceIn this meta-analysis, experiencing PPCS was associated with a higher risk of experiencing depressive symptoms. There are several important clinical and health policy implications of the findings. Most notably, the development of strategies for effective prevention and earlier intervention to optimize mental health recovery following a concussion should be supported.

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Section: Discussionmentioning

confidence: 99%

Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

et al. 2022

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“…This activity was more apparent in the left amygdala. 74 However, no differences between PPCS and either group (youth with acute concussion or typically developing controls) were found between amygdala activity and psychological measures. 74 …”

Section: Resultsmentioning

confidence: 92%

“…Task-based blood oxygenation level dependent imaging was utilized in 4 studies, 55 , 74 – 76 with varied or conflicting results. The types of tasks varied between studies, including perceptual emotion matching, 74 spatial navigation tasks, 55 , 75 and working memory tasks. 76 Using perceptual emotion matching, Bohorquez-Montoya and colleagues 75 aimed to investigate amygdala activation related to social and emotional recognition in youth with PPCS.…”

Section: Resultsmentioning

confidence: 99%

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A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations

et al. 2022

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Up to 30% of youth with concussion experience PPCSs (PPCS) lasting 4 weeks or longer, and can significantly impact quality of life. Magnetic resonance imaging (MRI) has the potential to increase understanding of causal mechanisms underlying PPCS. However, there are no clear modalities to assist in detecting PPCS. This scoping review aims to synthesize findings on utilization of MRI among children and youth with PPCS, and summarize progress and limitations. Thirty-six studies were included from 4907 identified papers. Many studies used multiple modalities, including (1) structural (n = 27) such as T1-weighted imaging, diffusion weighted imaging, and susceptibility weighted imaging; and (2) functional (n = 23) such as functional MRI and perfusion-weighted imaging. Findings were heterogeneous among modalities and regions of interest, which warrants future reviews that report on the patterns and potential advancements in the field. Consideration of modalities that target PPCS prediction and sensitive modalities that can supplement a biopsychosocial approach to PPCS would benefit future research.

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“…Normal affective function relies on limbic pathways that may be particularly vulnerable to the contusional and torsional forces of brain trauma, including less granular portions of the prefrontal and temporal cortices as well as their subcortical targets in the medial temporal lobe, striatum, hypothalamus, and brainstem ( 18 – 21 ). TBI-related aberrancies in limbic regions have been found using measures of brain macro- and microstructure ( 16 , 20 – 27 ), task-based fMRI ( 28 – 30 ), and resting-state fMRI ( 31 – 34 ). Furthermore, animal studies suggest brain injury has both local effects on the tissue at the site of the trauma, but also indirect effects on the connectional architecture of the brain that are remote from the site of trauma ( 35 ).…”

Section: Introductionmentioning

confidence: 99%

Frontoamygdala hyperconnectivity predicts affective dysregulation in adolescent moderate-severe TBI

Bickart¹,

Olsen

Dennis

et al. 2023

Front. Rehabil. Sci.

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In survivors of moderate to severe traumatic brain injury (msTBI), affective disruptions often remain underdetected and undertreated, in part due to poor understanding of the underlying neural mechanisms. We hypothesized that limbic circuits are integral to affective dysregulation in msTBI. To test this, we studied 19 adolescents with msTBI 17 months post-injury (TBI: M age 15.6, 5 females) as well as 44 matched healthy controls (HC: M age 16.4, 21 females). We leveraged two previously identified, large-scale resting-state (rsfMRI) networks of the amygdala to determine whether connectivity strength correlated with affective problems in the adolescents with msTBI. We found that distinct amygdala networks differentially predicted externalizing and internalizing behavioral problems in patients with msTBI. Specifically, patients with the highest medial amygdala connectivity were rated by parents as having greater externalizing behavioral problems measured on the BRIEF and CBCL, but not cognitive problems. The most correlated voxels in that network localize to the rostral anterior cingulate (rACC) and posterior cingulate (PCC) cortices, predicting 48% of the variance in externalizing problems. Alternatively, patients with the highest ventrolateral amygdala connectivity were rated by parents as having greater internalizing behavioral problems measured on the CBCL, but not cognitive problems. The most correlated voxels in that network localize to the ventromedial prefrontal cortex (vmPFC), predicting 57% of the variance in internalizing problems. Both findings were independent of potential confounds including ratings of TBI severity, time since injury, lesion burden based on acute imaging, demographic variables, and other non-amygdalar rsfMRI metrics (e.g., rACC to PCC connectivity), as well as macro- and microstructural measures of limbic circuitry (e.g., amygdala volume and uncinate fasciculus fractional anisotropy). Supporting the clinical significance of these findings, patients with msTBI had significantly greater externalizing problem ratings than healthy control participants and all the brain-behavior findings were specific to the msTBI group in that no similar correlations were found in the healthy control participants. Taken together, frontoamygdala pathways may underlie chronic dysregulation of behavior and mood in patients with msTBI. Future work will focus on neuromodulation techniques to directly affect frontoamygdala pathways with the aim to mitigate such dysregulation problems.

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Amygdala response to emotional faces in adolescents with persistent post-concussion symptoms

Cited by 7 publications

References 65 publications

Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations

Frontoamygdala hyperconnectivity predicts affective dysregulation in adolescent moderate-severe TBI

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