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Brain Scans May Predict Adolescent Drug Use
By Jason von Stietz, M.A.
February 26, 2017
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Is it possible to predict who will face significant drug problems in their adolescence? Some adolescents battle with addictions broadcast all the warning signs whereas others appear to show no warnings at all. In an effort to predict drug use, researchers examined the relationship between brain scans, novelty seeking, and future drug use. The study was discussed in a recent article in Medical Xpress: 


There's an idea out there of what a drug-addled teen is supposed to look like: impulsive, unconscientious, smart, perhaps – but not the most engaged. While personality traits like that could signal danger, not every adolescent who fits that description becomes a problem drug user. So how do you tell who's who?


There's no perfect answer, but researchers report February 21 in Nature Communications that they've found a way to improve our predictions – using brain scans that can tell, in a manner of speaking, who's bored by the promise of easy money, even when the kids themselves might not realize it.


That conclusion grew out of a collaboration between Brian Knutson, a professor of psychology at Stanford, and Christian Büchel, a professor of medicine at Universitätsklinikum Hamburg Eppendorf. With support from the Stanford Neurosciences Institute's NeuroChoice program, which Knutson co-directs, the pair started sorting through an intriguing dataset covering, among other things, 144 European adolescents who scored high on a test of what's called novelty seeking – roughly, the sorts of personality traits that might indicate a kid is at risk for drug or alcohol abuse.


Novelty seeking in a brain scanner


Novelty seeking isn't inherently bad, Knutson said. On a good day, the urge to take a risk on something new can drive innovation. On a bad day, however, it can lead people to drive recklessly, jump off cliffs and ingest whatever someone hands out at a party. And psychologists know that kids who score high on tests of novelty seeking are on average a bit more likely to abuse drugs. The question was, could there be a better test, one both more precise and more individualized, that could tell whether novelty seeking might turn into something more destructive.


Knutson and Büchel thought so, and they suspected that a brain-scanning test called the Monetary Incentive Delay Task, or MID, could be the answer. Knutson had developed the task early in his career as a way of targeting a part of the brain now known to play a role in mentally processing rewards like money or the high of a drug.


The task works like this. People lie down in an MRI brain scanner to play a simple video game for points, which they can eventually convert to money. More important than the details of the game, however, is this: At the start of each round, each player gets a cue about how many points he stands to win during the round. It's at that point that players start to anticipate future rewards. For most people, that anticipation alone is enough to kick the brain's reward centers into gear.


A puzzle and the data to solve it


This plays out differently – and a little puzzlingly – in adolescents who use drugs. Kids' brains in general respond less when anticipating rewards, compared with adults' brains. But that effect is even more pronounced when those kids use drugs, which suggests one of two things: Either drugs suppress brain activity, or the suppressed brain activity somehow leads youths to take drugs.


If it's the latter, then Knutson's task could predict future drug use. But no one was sure, mainly because no one had measured brain activity in non-drug-using adolescents and compared it to eventual drug use.


No one, that is, except Büchel. As part of the IMAGEN consortium, he and colleagues in Europe had already collected data on around 1,000 14-year-olds as they went through Knutson's MID task. They had also followed up with each of them two years later to find out if they'd become problem drug users – for example, if they smoked or drank on a daily basis or ever used harder drugs like heroin. Then, Knutson and Büchel focused their attention on 144 adolescents who hadn't developed drug problems by age 14 but had scored in the top 25 percent on a test of novelty seeking.


Lower anticipation


Analyzing that data, Knutson and Büchel found they could correctly predict whether youngsters would go on to abuse drugs about two-thirds of the time based on how their brains responded to anticipating rewards. This is a substantial improvement over behavioral and personality measures, which correctly distinguished future drug abusers from other novelty-seeking 14-year-olds about 55 percent of the time, only a little better than chance.


"This is just a first step toward something more useful," Knutson said. "Ultimately the goal – and maybe this is pie in the sky – is to do clinical diagnosis on individual patients" in the hope that doctors could stop drug abuse before it starts, he said.


Knutson said the study first needs to be replicated, and he hopes to follow the kids to see how they do further down the line. Eventually, he said, he may be able not just to predict drug abuse, but also better understand it. "My hope is the signal isn't just predictive, but also informative with respect to interventions."


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Gist Reasoning and Traumatic Brain Injury
By Jason von Stietz, M.A.
February 24, 2017


The ability to understand the “gist” of things is an important and likely underappreciated skill. Gist reasoning, or the ability to look at complex, concrete information and make deeper level abstract interpretations is an essential part of each person’s daily activities. Researchers at Texas Woman’s University and University of Texas Dallas studied the relationship between gist reasoning and cognitive deficits in individual’s with traumatic brain injury. The study was discussed in a recent article in Medical Xpress:     


The study, published in Journal of Applied Biobehavioral Research, suggests the gist reasoning test may be sensitive enough to help doctors and clinicians identify previously undiagnosed cognitive changes that could explain the daily life difficulties experienced by TBI patients and subsequently guide appropriate therapies.


The gist reasoning measure, called the Test of Strategic Learning, accurately identified 84.7 percent of chronic TBI cases, a much higher rate than more traditional tests that accurately identified TBI between 42.3 percent and 67.5 percent of the time.


"Being able to 'get the gist' is essential for many day-to-day activities such as engaging in conversation, understanding meanings that are implied but not explicitly stated, creating shopping lists and resolving conflicts with others," said study lead author Dr. Asha Vas of Texas Woman's University who was a postdoctoral fellow at the Center for BrainHealth at the time of the study. "The gist test requires multiple cognitive functions to work together."


The study featured 70 participants ages 18 to 55, including 30 who had experienced a moderate to severe chronic traumatic brain injury at least one year ago. All the participants had similar socioeconomic status, educational backgrounds and IQ.


Researchers were blinded to the participant's TBI status while administering four different tests that measure abstract thinking—the ability to understand the big picture, not just recount the details of a story or other complex information. Researchers used the results to predict which participants were in the TBI group and which were healthy controls.


During the cognitive tests, the majority of the TBI group easily recognized abstract or concrete information when given prompts in a yes-no format. But the TBI group performed much worse than controls on tests, including gist reasoning, that required deeper level processing of information with fewer or no prompts.


The gist reasoning test consists of three texts that vary in length (from 291 to 575 words) and complexity. The test requires the participant to provide a synopsis of each of the three texts.


Vas provided an example of what "getting the gist" means using Shakespeare's play Romeo and Juliet.


"There are no right or wrong answers. The test relies on your ability to derive meaning from important story details and arrive at a high-level summary: Two young lovers from rival families scheme to build a life together and it ends tragically. You integrate existing knowledge, such as the concept of love and sacrifice, to create a meaning from your perspective. Perhaps, in this case, 'true love does not conquer all,'" she said.


Past studies have shown that higher scores on the gist reasoning test in individuals in chronic phases of TBI correlate to better ability to perform daily life functions.


"Perhaps, in the future, the gist reasoning test could be used as a tool to identify other cognitive impairments," said Dr. Jeffrey Spence, study co-author and director of biostatistics at the Center for BrainHealth. "It may also have the potential to be used as a marker of cognitive changes in aging."



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Long-Term Effects of TBI Studied
By Jason von Stietz, M.A.
February 19, 2017
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The long-term effects of traumatic brain injury (TBI) are just now beginning to be understood. Researchers from Cincinnati Children’s Hospital Medical Center examined the impact of TBI on pediatric patients about seven years after the injury. The findings indicated that children who have suffered a mild to moderate TBI are twice as likely to have issues with attention than their healthy counterparts. The study was discussed in a recent issue in Medical Xpress:  


In a study to be presented Friday Feb. 10 at the annual meeting of the Association of Academic Physiatrists in Las Vegas, researchers from Cincinnati Children's will present research on long-term effects of TBI—an average of seven years after injury. Patients with mild to moderate brain injuries are two times more likely to have developed attention problems, and those with severe injuries are five times more likely to develop secondary ADHD. These researchers are also finding that the family environment influences the development of these attention problems.


  • Parenting and the home environment exert a powerful influence on recovery. Children with severe TBI in optimal environments may show few effects of their injuries while children with milder injuries from disadvantaged or chaotic homes often demonstrate persistent problems.



  • Early family response may be particularly important for long-term outcomes suggesting that working to promote effective parenting may be an important early intervention.
  • Certain skills that can affect social functioning, such as speed of information processing, inhibition, and reasoning, show greater long-term effects.
  • Many children do very well long-term after brain injury and most do not have across the board deficits.

More than 630,000 children and teenagers in the United States are treated in emergency rooms for TBI each year. But predictors of recovery following TBI, particularly the roles of genes and environment, are unclear. These environmental factors include family functioning, parenting practices, home environment, and socioeconomic status. Researchers at Cincinnati Children's are working to identify genes important to recovery after TBI and understand how these genes may interact with environmental factors to influence recovery.


  • They will be collecting salivary DNA samples from more than 330 children participating in the Approaches and Decisions in Acute Pediatric TBI Trial.
  • The primary outcome will be global functioning at 3, 6, and 12 months post injury, and secondary outcomes will include a comprehensive assessment of cognitive and behavioral functioning at 12 months post injury.
  • This project will provide information to inform individualized prognosis and treatment plans.

Using neuroimaging and other technologies, scientists are also learning more about brain structure and connectivity related to persistent symptoms after TBI. In a not-yet-published Cincinnati Children's study, for example, researchers investigated the structural connectivity of brain networks following aerobic training. The recovery of structural connectivity they discovered suggests that aerobic training may lead to improvement in symptoms.


Over the past two decades, investigators at Cincinnati Children's have conducted a series of studies to develop and test interventions to improve cognitive and behavioral outcomes following pediatric brain injury. They developed an innovative web-based program that provides family-centered training in problem-solving, communication, and self-regulation.


  • Across a series of randomized trials, online family problem-solving treatment has been shown to reduce behavior problems and executive dysfunction (management of cognitive processes) in older children with TBI, and over the longer-term improved everyday functioning in 12-17 year olds.
  • Web-based parenting skills programs targeting younger children have resulted in improved parent-child interactions and reduced behavior problems. In a computerized pilot trial of attention and memory, children had improvements in sustained attention and parent-reported executive function behaviors. These intervention studies suggest several avenues for working to improve short- and long-term recovery following TBI.


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