What is the impact of Minor Traumatic Brain Injury (mTBI) on cognitive function?

From the Guidelines

Mild traumatic brain injury (mTBI) has a significant impact on morbidity, mortality, and quality of life, with approximately 70% to 90% of patients with head injuries presenting to the emergency department being diagnosed with mTBI 1.

Key Points

• The initial severity of a TBI may range from mild to severe, with mTBI being associated with a wide range of functional short- or long-term changes that may affect cognition, sensation, language, and/or emotion 1.
• The costs for all severity levels of TBI are not purely limited to economics, but also include dynamic societal, psychosocial, physical, mental, medicolegal, and other quality of life factors that are often challenging to quantify 1.
• Approximately 5% to 15% of patients with a head injury will have intracranial injuries on imaging and be classified as having moderate or severe TBI, with roughly 1% of these patients requiring surgical intervention and fewer dying (0.1%) 1.
• The development of a single parsimonious bedside tool to risk stratify individuals in the ED for referral to neuropsychiatric clinical follow-up or the ability to predict potentially protracted symptoms and sequelae would be beneficial 1.
• Studies have shown that female gender, previous psychiatric history, GCS score of <15, etiology of assault, and alcohol intoxication are associated with prolonged symptoms and worse outcomes in recovery 1.
• Elevated baseline high-sensitivity C-reactive protein (hs-CRP) was associated with a statistically significant increase in persistent postconcussive symptoms (PCS), persistent psychological problems, and persistent cognitive impairment 1.
• Nonpharmacological interventions such as early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of neck and spine, oculomotor vision treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment may be effective in treating persistent postconcussion symptoms (PPCS) 1.

Recommendations

• Early recognition and management of mTBI are crucial to reducing the economic and societal burden on the lives of Americans 1.
• A comprehensive approach to mTBI management should include a combination of nonpharmacological interventions, such as graded physical exercise, vestibular rehabilitation, and psychological treatment, to address the physical, cognitive, and emotional symptoms of PPCS 1.
• Further research is needed to develop a single parsimonious bedside tool to risk stratify individuals in the ED for referral to neuropsychiatric clinical follow-up or the ability to predict potentially protracted symptoms and sequelae 1.

From the Research

MOTS-c Impact

• MOTS-c is a mitochondrial-derived peptide that has been shown to have beneficial effects on glucose metabolism, insulin resistance, and aging-related diseases 2, 3, 4.
• The peptide is encoded by the 12S rRNA region of the mitochondrial genome and is transferred to the nucleus during metabolic stress, where it regulates the expression of nuclear genes to promote cell balance 2, 3.
• MOTS-c has been found to improve glucose metabolism in skeletal muscle, which indicates its potential benefits for diseases such as diabetes, obesity, and aging 2, 4.
• The peptide has also been shown to have anti-inflammatory effects and to regulate energy metabolism, stress homeostasis, and aging-related pathological processes 3, 4.
• However, MOTS-c has been used less frequently in disease treatment, and no effective method of applying MOTS-c in the clinic has been developed 2.
• Further research is needed to fully understand the molecular mechanisms and therapeutic potentials of MOTS-c and to develop effective methods for its application in disease treatment 2, 3, 4.

Related Studies

• A study published in the Journal of Translational Medicine found that MOTS-c acts through the Folate-AICAR-AMPK pathway to influence energy metabolism, insulin resistance, and inflammatory response 3.
• Another study published in the International Journal of Molecular Sciences found that MOTS-c has beneficial effects on age-related diseases, including diabetes, cardiovascular diseases, osteoporosis, and Alzheimer's disease 4.
• However, studies on the combined use of aspirin, statins, and blood pressure-lowering agents, such as the one published in the American Heart Journal, are not directly related to MOTS-c 5.
• Similarly, a study on drug-drug interactions between antiplatelet therapy and lipid-lowering agents, published in Thrombosis and Haemostasis, is not directly related to MOTS-c 6.