Poster 124 Prevalence of Headache Following Mild Traumatic Brain Injury

2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS

sion (PCLC) PCLC scores. Results: All patients were classified into the following three groups: ASD present (n⫽39; 22.7%), ASD absent (n⫽64; 37.2%), and ASD subsyndromal (n⫽69; 40.1%). Those in the ASD present group were more likely to be injured during their first deployment (p⬍.003) and injured by a blast (p⬍.04) than those in the ASD absent group. Patients with ASD, compared to those in the ASD absent group, were statistically significantly younger, had less severe bodily injuries, and were less likely to have a structural abnormality on neuroimaging. Amputation rates were evenly distributed across the three groups. The rates of postconcussional disorder were as follows: ASD Absent⫽4.7%, ASD subsyndromal⫽20.3%, and ASD present⫽59.0%. Conclusions: Approximately 23% of polytrauma patients who sustained a mild or moderate TBI screened positive for Acute Stress Disorder. Acute stress can likely mimic, overlap with, or exacerbate a postconcussional disorder. Key Words: Brain injuries; Traumatic stress; Rehabilitation. Poster 122 Mortality after Traumatic Brain Injury in an Older and Ethnically Diverse Urban Population. Chari Hirshson (Mount Sinai School of Medicine, New York, NY), Pascale Josama, Kristen DamsO’Connor, Joshua Cantor, Theodore Tsaousides, Lisa Spielman, Wayne Gordon. Disclosure: None disclosed. Objective: The purpose of this study is to identify predictors of mortality in an ethnically diverse sample of individuals who sustained a TBI, as it is understood that sustaining TBI increases long-term mortality and reduces life expectancy. Demographic risk factors that influence duration of survival post-injury were explored to further understand TBI as a disease process and aim to extend and replicate findings previously found by Harrison-Felix (2004; 2009). Design: Retrospective analysis of medical/research records of participants enrolled in TBI Model Systems (TBIMS) program, a multi-site, longitudinal study of outcomes in individuals with TBI whose data was collected 2003-2011. Setting: Urban medical research center. Participants: Individuals enrolled in TBIMS (N⫽30) at Mount Sinai who died at any point after enrolment (age at injury⫽77.8 (10.2), men⫽75%, white 62.5%). Interventions: Not applicable. Main Outcome Measures: Mortality was measured by retrospective review of demographic, medical, and injury information obtained through semi-structured interviews and medical record extraction. Results: Descriptive statistics were used to characterize the study population (Mean age at injury⫽77.8 (SD⫽10.2), length of time between injury and death, 1 to 60 months (M⫽22.8 months (SD⫽18.6); Mean age at death⫽79.7 (SD⫽10.1). The Mount Sinai sample differs from the overall TBIMS population as participants are on average, older, more diverse and died sooner than reported by Harrison-Felix. Logistic regression found demographic factors previously reported, such as age, are meaningful predictors of mortality in this older and ethnically more diverse sample. Other factors were also found to be predictors. Conclusions: Sustaining a TBI in late life is associated with increased mortality, and demographic factors are associated with survival. Key Words: TBI; Aging; Mortality; Rehabilitation. Poster 123 Traumatic Brain Injuries as a Risk Factor for Alzheimer’s Disease. Giulio Pasinetti (Mount Sinai School Of Medicine, New York, NY, James J. Peters Veterans Affairs Medical Center, Bronx, NY). Disclosure: None disclosed. Objectives: To explore whether clinically accessible molecular biomarkers of traumatic brain injury (TBI) might reflect molecular alterations in the brain that contribute to increased risk for Alzheimer’s disease (AD). Design: We analyzed mRNA and protein levels in blood components to identify TBI biomarkers that are differentially regulated in TBI vs. control cases. We correlated TBI biomarker levels with TBI severity, clinical assessments and brain imaging. Moreover,

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we explored the regulation of TBI biomarkers in postmortem brain specimens of subjects, with mild cognitive impairment (MCI), who are at high risk for AD. Participants: 6 female TBI and 5 age-matched female control cases. Main Outcome Measures: mRNA and protein levels were assessed using microarray and antibody arrays and confirmed using qRT-PCR and ELISA. The Brain Injury Screening Questionnaire was used for self-reported clinical assessments. Myelin density was assessed by fractional anisotropy diffusion (DTI) imaging. Results: We identified a panel of biomarker genes capable of separating all cases into TBI and non-TBI. Blood levels for subsets of biomarkers correlated significantly with TBI severity and select clinical assessments. We found elevated blood content of a specific biomarker correlated with reduced myelin density in the frontal cortex in TBI cases by DTI. We found significantly elevated expression of this biomarker in postmortem frontal cortex of MCI cases. Conclusions: Our observation suggests that regulation of select “biomarkers” in the periphery may reflect molecular alteration in the brain following TBI. Some of these molecular changes might be “predisposition” factors that impose higher risks for subsequent progression to AD. Since epigenetic mechanisms in postmitotic neurons are important in synaptic plasticity and memory, we are currently exploring if TBI-mediated epigenetic modifications might contribute to AD. Key Words: Rehabilitation; TBI biomarkers; Alzheimer’s disease predisposition. Poster 124 Prevalence of Headache Following Mild Traumatic Brain Injury. Jeanne Hoffman (University of Washington, Seattle, WA), Sylvia Lucas, Kathleen Bell, Sureyya Dikmen. Disclosure: None disclosed. Objective: To describe the prevalence of headache after mild traumatic brain injury (mTBI). Design: Prospective enrollment of 216 subjects admitted to the hospital after trauma and assessed within the first 7 days following mTBI. Setting: Level I Trauma Hospital. Patients: 216 subjects admitted to the hospital who were found to have mTBI based on ACRM criteria: loss of consciousness ⬍30 minutes, or period of confusion, or post-traumatic amnesia ⬍ 24 hours. Interventions: None. Main Outcome Measures: Prevalence of headache within one week following mTBI and history of headache prior to mTBI. Results: Subjects were 76% male, 75% Caucasian, with an average age of 44. The majority were injured in vehicle related accidents (59%) and were employed at the time of injury (53%). 54% of subjects reported new (N⫽110) or worse (N⫽8) headaches after injury. Pre-injury headaches were reported in 17% of subjects, with 25% of those reporting having headaches daily or several times per week before their injury. Of the group who had headache prior to the injury, 8 reported worsening of their headache, 8 reported that their headache was the same, 9 reporting improvement, and 8 reported no current headache since injury. Conclusions: Early headaches after mTBI are very common with 54% of subjects reporting new or worsening headaches. For those with a history of headache prior to injury, improvement or worsening could occur following injury. Additional study of the natural history of headache following mTBI will assist with design of prevention and treatment protocols. Key Words: Brain injury; Traumatic; Headache; Rehabilitation. Poster 125 Sleep Diagnoses among A TBI Cohort Referred for Polysomnography During Inpatient Rehabilitation. Tracy S. Kretzmer (Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital, Tampa, FL, University of South Florida, Department of Psychology, Tampa, FL), Risa Nakase-Richardson, Praveen K. Gootam, Marissa McCarthy, Bryan Merritt, William M. Anderson. Disclosure: None disclosed. Objective: The purpose of this study was to examine the frequency of sleep disorder diagnoses among a series of TBI patients referred for overnight Polysomnography (PSG) during inpatient rehabilitation. DeArch Phys Med Rehabil Vol 92, October 2011