Effect of Post-Traumatic Stress Disorder on Cognitive Function and Covert Hepatic Encephalopathy Diagnosis in Cirrhotic Veterans

Abstract

Background

In veterans, post-traumatic stress disorder (PTSD) is often associated with substance abuse, which in turn can lead to cirrhosis. Cirrhotic patients are prone to cognitive impairment, which is typically due to covert hepatic encephalopathy (CHE), but can also be affected by PTSD. The aim was to define the impact of PTSD on cognitive performance and the diagnosis of CHE in cirrhotic patients.

Methods

Outpatient veterans with cirrhosis underwent two separate modalities for CHE cognitive testing [Psychometric Hepatic Encephalopathy Scale (PHES) and Inhibitory Control Test (ICT)]. ICT tests for inhibitory control and response inhibition, while PHES tests for attention and psychomotor speed. Comparisons were made between patients with/without PTSD. Multivariable logistic regression with CHE on PHES and CHE on ICT as dependent variables including prior OHE, demographics, PTSD and psychotropic medications was performed.

Results

Of 402 patients with cirrhosis, 88 had evidence of PTSD. Fifty-five of these were on psychoactive medications, 15 were undergoing psychotherapy, while no specific PTSD-related therapy was found in 28 patients. Cirrhotic patients with/without PTSD were statistically similar on demographics and cirrhosis severity, but cirrhotic subjects with PTSD had a higher frequency of alcoholic cirrhosis etiology and psychotropic drug use. PTSD cirrhosis had higher ICT lure and switching errors (NCT-B response), but on regression, there was no significant impact of PTSD on CHE diagnosis using either the ICT or PHES.

Conclusions

Veterans with cirrhosis and PTSD have a higher frequency of psychotropic drug use and alcoholic cirrhosis etiology. CHE diagnosis using PHES or ICT is not affected by concomitant PTSD.

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The new genetics of intelligence

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Muscle molecular adaptations to endurance exercise training are conditioned by glycogen availability: a proteomics-based analysis in the McArdle mouse model

Abstract

McArdle disease is an inborn disorder of skeletal muscle glycogen metabolism that results in blockade of glycogen breakdown due to mutations in the myophosphorylase gene. We recently developed a mouse model carrying the homozygous p.R50X common human mutation (McArdle mouse), facilitating the study of how glycogen availability affects muscle molecular adaptations to endurance exercise training. Using quantitative differential analysis by liquid chromatography with tandem-mass spectrometry, we analysed the quadriceps muscle proteome of 16-week-old McArdle (n = 5) and wild-type (WT) (n = 4) mice previously subjected to 8-week moderate-intensity treadmill training or to an equivalent control (no training) period. Protein networks enriched within the differentially expressed proteins with training in WT and McArdle mice were assessed by hypergeometric enrichment analysis. Whereas endurance exercise training improved the estimated maximal aerobic capacity of both WT and McArdle mice as compared with controls, it was ∼50% lower than normal in McArdle mice before and after training. We found a remarkable difference in the protein networks involved in muscle tissue adaptations induced by endurance exercise training with/without glycogen availability, and training induced the expression of only three proteins common to McArdle and WT mice: LIM and calponin homology domains-containing protein 1 (LIMCH1), poly [ADP-ribose] polymerase 1 (PARP1–although the training effect was more marked in McArdle mice), and tigger transposable element derived 4 (TIGD4). Trained McArdle mice presented strong expression of mitogen-activated protein kinase 12 (MAPK12). Through an in-depth proteomic analysis, we provide mechanistic insight into how glycogen availability affects muscle protein signalling adaptations to endurance exercise training.

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Contact heat evoked potentials: reliable acquisition from lower extremities

Publication date: Available online 7 January 2018
Source:Clinical Neurophysiology
Author(s): J Rosner, M Hubli, P Hostettler, PS Scheuren, J Rinert, JLK Kramer, M Hupp, A Curt, CR Jutzeler
ObjectiveTo investigate test-retest reliability of contact heat evoked potentials (CHEPs) from lower extremities using two different stimulation protocols, i.e., normal and increased baseline temperature.MethodsA total of 32 able-bodied subjects were included and a subset (N=22) was retested. CHEPs were recorded from three different dermatomes of the lower extremity (i.e., L2, L5, and S2). Test-retest reliability of CHEPs acquisition after simulation in various lower limb dermatomes using different stimulation protocolswas analyzed.ResultsThe study revealed an improved acquisition of CHEPS employing the increased baseline protocol, particularly when stimulating more distal sites, i.e., dermatome L5 and S2. Based on repeatability coefficients, CHEP latency (N2 potential) emerged as the most robust CHEP parameter. Although CHEP amplitudes (N2P2 complex) and pain ratings were decreased in the retest, amplitudes still showed fair to excellent intraclass correlation coefficients (ICCs) using normal baseline or increased baseline temperature, respectively.ConclusionsThis is the first study to demonstrate that CHEPs acquisition from the lower extremities is improved by increasing the baseline temperature of the thermode.SignificanceThis study highlights the usability of CHEPs as a viable diagnostic method to study small fiber integrity.



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Contact heat evoked potentials: reliable acquisition from lower extremities

Contact heat evoked potentials (CHEPs) reflect cortical responses of Aδ-nociceptors activated by noxious heat stimuli (Greffrath et al. 2007; Baumgartner et al. 2012). In addition to Aδ-fibers, C-fibers are also known to be involved in the perception of contact heat. The reliable recording of C-fiber volley is, however, extremely challenging (Magerl et al. 1999).

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Cluster Analysis of Vulnerable Groups in Acute TBI Rehabilitation

Publication date: Available online 6 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Erkut N. Kucukboyaci, Coralynn Long, Michelle Smith, Joseph F. Rath, Tamara Bushnik
ObjectiveTo analyze the complex relationship between various social indicators that contribute to socioeconomic status and healthcare barriers.DesignCluster analysis of historical patient data obtained from inpatient visits.SettingSetting: Inpatient rehabilitation unit in a large, urban university hospitalParticipantsAdult patients receiving acute inpatient care, predominantly for closed head injury.InterventionsNot applicableMain outcome measuresWe examined the membership of TBI patients in various "vulnerable group" (VG) clusters (e.g., homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of the patients (e.g., duration of stay, changes in Functional Independence Measure [FIM] scores between admission to inpatient stay and discharge).ResultsAnalysis revealed four major clusters (i.e., Clusters A-D) separated by VG memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the four clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple SES vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores.ConclusionsApplication of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various "at-risk" groups. Results identified patients (i.e., cluster B, with minority patients and Cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. Results also suggested that systemic (e.g., duration of stay) or clinical service improvements (e.g., staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals or liaise with intensive social work services or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation following traumatic brain injury.



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Determining Reliability of a Dual-task Functional Mobility Protocol for Individuals with Lower Extremity Amputations

Publication date: Available online 6 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Courtney Frengopoulos, Michael WC. Payne, Jeffrey Holmes, Ricardo Viana, Susan W. Hunter
ObjectivesTo determine the relative and absolute reliability of a dual-task functional mobility assessment.DesignCross-sectional study.SettingAcademic Rehabilitation Hospital.ParticipantsSixty individuals with lower extremity amputation (LEA) attending an outpatient amputee clinic (age= 58.21±12.59; 80.0% male). Subjects were stratified into three groups: 1) transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of non-vascular etiology (TTA-nonvas); transfemoral or bilateral amputees (TFA/bilat) of any etiology.InterventionsN/AMain Outcome MeasuresTime to complete the L Test measured functional mobility under single- and dual-task conditions. Addition of a cognitive task (serial subtractions by 3s) created dual-task conditions. Single task performance on the cognitive task was also reported. Intra-class correlation coefficients (ICC) measured relative reliability; standard error of measurement (SEM) and minimal detectable change with a 95% confidence interval (MDC95) measured absolute reliability. Bland and Altman plots measured agreement between assessments.ResultsRelative reliability results were excellent for all three groups. Values for the dual-task L Test for those with TTA-vas (n=20, age=60.36±7.84, 90.0% male) were ICC=0.98 (95% CI, 0.94-0.99), with SEM=1.36s and MDC95 of 3.76s; for those with TTA-nonvas (n=20, age=55.85±14.08, 85.0% male), were ICC=0.93 (95% CI, 0.80-0.98), SEM=1.34s and MDC95 of 3.71s; and for those with TFA/bilat group (n=20, age=58.21±14.88, 65.0% male) were ICC=0.998 (95% CI, 0.996-0.999), SEM=1.03s and an MDC95 of 2.85s. Bland-Altman plots indicated that assessments did not vary systematically for each group.ConclusionsThis dual-task assessment protocol achieved approved levels of relative reliability values for the three groups tested. This protocol may be used clinically or in research settings to assess the interaction between cognition and functional mobility in the LEA population.



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