Neurocognition after motor vehicle collision and adverse post-traumatic neuropsychiatric sequelae within 8 weeks: Initial findings from the AURORA study

Laura T Germine¹, Jutta Joormann², Eliza Passell³, Lauren A Rutter⁴, Luke Scheuer³, Paolo Martini⁵, Irving Hwang⁶, Sue Lee⁶, Nancy Sampson⁶, Deanna M Barch⁷, Stacey L House⁸, Francesca L Beaudoin⁹, Xinming An¹⁰, Jennifer S Stevens¹¹, Donglin Zeng¹², Sarah D Linnstaedt¹⁰, Tanja Jovanovic¹³, Gari D Clifford¹⁴, Thomas C Neylan¹⁵, Scott L Rauch¹⁶, Christopher Lewandowski¹⁷, Phyllis L Hendry¹⁸, Sophia Sheikh¹⁸, Alan B Storrow¹⁹, Paul I Musey²⁰, Christopher W Jones²¹, Brittney E Punches²², Meghan E McGrath²³, Jose L Pascual²⁴, Kamran Mohiuddin²⁵, Claire Pearson²⁶, David A Peak²⁷, Robert M Domeier²⁸, Steven E Bruce²⁹, Niels K Rathlev³⁰, Leon D Sanchez³¹, Robert H Pietrzak³², Diego A Pizzagalli¹⁶, Steven E Harte³³, James M Elliott³⁴, Karesten C Koenen³⁵, Kerry J Ressler³⁶, Samuel A McLean³⁷, Ronald C Kessler⁶

Affiliations

¹ Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; The Many Brains Project, Belmont, MA, USA. Electronic address: lgermine@mclean.harvard.edu.
² Department of Psychology, Yale University, New Haven, CT, USA.
³ Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA.
⁴ Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁵ The Many Brains Project, Belmont, MA, USA.
⁶ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁷ Department of Psychological and Brain Sciences, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, USA.
⁸ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁹ Department of Emergency Medicine and Health Services, Policy, and Practice, The Alpert Medical School of Brown University, USA; Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA; Department of Emergency Medicine, The Miriam Hospital, Providence, RI, USA.
¹⁰ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA.
¹² Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
¹³ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
¹⁴ Department of Biomedical Informatics, School of Medicine, Emory University, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
¹⁵ San Francisco VA Healthcare System, San Francisco, CA, USA; Departments of Psychiatry, University of California, San Francisco, CA, USA; Departments of Neurology, University of California, San Francisco, CA, USA.
¹⁶ Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA.
¹⁷ Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
¹⁸ Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.
¹⁹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
²¹ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
²² Department of Emergency Medicine, University of Cincinnati College of Medicine, University of Cincinnati College of Nursing, Cincinnati, OH, USA.
²³ Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA.
²⁴ Department of Surgery and Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
²⁵ Dept. of Emergency Medicine/Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
²⁶ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA.
²⁷ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
²⁸ Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA.
²⁹ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
³⁰ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
³¹ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
³² U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
³³ Chronic Pain and Fatigue Research Center, Departments of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
³⁴ The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
³⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³⁶ Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety Disorders, McLean hospital, Belmont, MA, USA.
³⁷ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 34800569
PMCID: PMC10878171
DOI: 10.1016/j.jad.2021.10.104

Neurocognition after motor vehicle collision and adverse post-traumatic neuropsychiatric sequelae within 8 weeks: Initial findings from the AURORA study

Laura T Germine et al. J Affect Disord. 2022.

. 2022 Feb 1;298(Pt B):57-67.

doi: 10.1016/j.jad.2021.10.104. Epub 2021 Nov 17.

Authors

Affiliations

¹ Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; The Many Brains Project, Belmont, MA, USA. Electronic address: lgermine@mclean.harvard.edu.
² Department of Psychology, Yale University, New Haven, CT, USA.
³ Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA.
⁴ Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁵ The Many Brains Project, Belmont, MA, USA.
⁶ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁷ Department of Psychological and Brain Sciences, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, USA.
⁸ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁹ Department of Emergency Medicine and Health Services, Policy, and Practice, The Alpert Medical School of Brown University, USA; Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA; Department of Emergency Medicine, The Miriam Hospital, Providence, RI, USA.
¹⁰ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA.
¹² Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
¹³ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
¹⁴ Department of Biomedical Informatics, School of Medicine, Emory University, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
¹⁵ San Francisco VA Healthcare System, San Francisco, CA, USA; Departments of Psychiatry, University of California, San Francisco, CA, USA; Departments of Neurology, University of California, San Francisco, CA, USA.
¹⁶ Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA.
¹⁷ Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
¹⁸ Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.
¹⁹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
²¹ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
²² Department of Emergency Medicine, University of Cincinnati College of Medicine, University of Cincinnati College of Nursing, Cincinnati, OH, USA.
²³ Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA.
²⁴ Department of Surgery and Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
²⁵ Dept. of Emergency Medicine/Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
²⁶ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA.
²⁷ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
²⁸ Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA.
²⁹ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
³⁰ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
³¹ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
³² U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
³³ Chronic Pain and Fatigue Research Center, Departments of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
³⁴ The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
³⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³⁶ Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety Disorders, McLean hospital, Belmont, MA, USA.
³⁷ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 34800569
PMCID: PMC10878171
DOI: 10.1016/j.jad.2021.10.104

Abstract

Background: Previous work has indicated that differences in neurocognitive functioning may predict the development of adverse post-traumatic neuropsychiatric sequelae (APNS). Such differences may be vulnerability factors or simply correlates of APNS-related symptoms. Longitudinal studies that measure neurocognitive functioning at the time of trauma are needed to determine whether such differences precede the development of APNS.

Methods: Here, we present findings from a subsample of 666 ambulatory patients from the AURORA (Advancing Understanding of RecOvery afteR trumA) study. All patients presented to EDs after a motor vehicle collision (MVC). We examined associations of neurocognitive test performance shortly after MVC with peritraumatic symptoms in the ED and APNS (depression, post-traumatic stress, post-concussive symptoms, and pain) 2 weeks and 8 weeks later. Neurocognitive tests assessed processing speed, attention, verbal reasoning, memory, and social perception.

Results: Distress in the ED was associated with poorer processing speed and short-term memory. Poorer short-term memory was also associated with depression at 2 weeks post-MVC, even after controlling for peritraumatic distress. Finally, higher vocabulary scores were associated with pain 2 weeks post-MVC.

Limitations: Self-selection biases among those who present to the ED and enroll in the study limit generalizability. Also, it is not clear whether observed neurocognitive differences predate MVC exposure or arise in the immediate aftermath of MVC exposure.

Conclusions: Our results suggest that processing speed and short-term memory may be useful predictors of trauma-related characteristics and the development of some APNS, making such measures clinically-relevant for identifying at-risk individuals.

Keywords: Cognition; Digital cognitive assessment; Digital neuropsychology; Longitudinal; Neuropsychology; Trauma.

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Figures

**Fig. 1.. Measures of Neurocognitive Performance.**
Performance-based neurocognitive assessments are administered in the Emergency Dept and 48 h after discharge. Tasks with blue shaded headings are administered three more times across the one-year duration of the AURORA study. The table gives polychoric correlations in the N = 666 person analytic sample, based on scores standardized to a mean of 0 and SD of 1. Factor loadings are given for two factors derived from exploratory factor analysis of neurocognitive data. Major outcomes measures from each task that are used in all analyses are indicated. For all measures, RT refers to reaction time and ACC refers to accuracy based on proportion correct. LnK (delay discounting) is the natural log of the hyperbolic discounting parameter, k, where higher scores reflect greater temporal discounting, or a preference for a smaller immediate reward. Dprime is a signal detection measure that reflects how well the participant was able to discriminate and accurately respond in the task. LogB is a signal detection measure of bias that reflects the tendency to select a rewarded response over a nonrewarded response, where higher scores indicate greater response bias to the rewarded response. Span is the number of digits the participant can accurately recall on at least one of two trials for each sequence length.

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Neurocognition after motor vehicle collision and adverse post-traumatic neuropsychiatric sequelae within 8 weeks: Initial findings from the AURORA study

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Neurocognition after motor vehicle collision and adverse post-traumatic neuropsychiatric sequelae within 8 weeks: Initial findings from the AURORA study

Authors

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Abstract

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LinkOut - more resources

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Medical