| ObjectiveWith the development of science and technology,our living environment and quality have been continuously improved.However,we also have to be quite aware that we are faced with some extreme environmental and unexpected events more often than ever.Some special individuals of special positions,such as troop warriors,fire officers and soldiers and coal miners,have to judge and deal with all kinds of emergencies.The incidence of mild traumatic brain injury is increasing on these occasions.Because mild traumatic brain injury was in the early stage of mild injury,conventional imaging examination could be a negative result,and the patient’s self-consciousness recovered quickly.So they were often easily ignored by the patients and the clinicians.Mild traumatic brain injury has a different prognosis.It mainly includes the following aspects:(1)disturbance of consciousness: the duration can range from several hours to several days.In the process of waking,illusions and illusions of nervousness,fear,excitement and uneasiness can occur.(2)Defect or loss of focal motor function: According to the location of traumatic brain injury,the patient may have transient partial motor dysfunction or loss;(3)Amnesia: When the patient’s consciousness is restored,there is often a manifestation of memory impairment.(4)It was often accompanied by personality changes: lack of active initiative,emotional irritability or irritability,euphoria,loss of shame,etc.;(5)cognitive impairment: the performance of patients without the orientation,judgment and ability to respond to the environment weakened.Among them,cognitive impairment is one of the most persistent and severe symptoms that cause the social function of patients.Mild traumatic brain injury(mTBI)remains a poorly und erstood clinical phenomenon,despite lifetime incidence rates between 110 and 550 per 100,000 individuals.Previous studies indicated that mTBI was associated with subtle cognitive deficits during the semi-acute phase of injury,but that these deficits typically improved within 3-6 months.Common deficits include problems with executive functioning,working memory and attention,all of which are mediated by distributed fronto-parietal circuits.To date people are exploring the putative neurobiological changes that may underlie this temporary disruption in cognitive functioning.Results from traditional neuroimaging techniques such as computed tomography(CT)and magnetic resonance imaging(MRI)are usually negative,indicating overt pathology in only 5-12% of cases.McAllister et al.reported hyperactivation in right dorsolateral prefrontal cortex and lateral parietal regions for mTBI patients compared to healthy controls(HC)for moderate processing loads,but hypoactivation for the easy task.Results indicated hypoactivation in the prefrontal cortex and anterior cingulate gyrus for concussed individuals compared to healthy controls coupled with hyperactivation in temporal and parietal lobes for the concussed group.The reduction in activation was also shown to be negatively related to scores on a post-concussion scale,suggesting that greater self-reported symptom severity predicts the magnitude of the BOLD response abnormality.Previous behavioral studies have demonstrated that both visual-spatial orienting and gap saccades are typically impaired in the acute stages of mTBI,whereas more severely injured populations are both generally slower to identify targets during top-down orienting and exhibit deficits in engaging attentional focus.Although many researchers have demonstrated that cognitive impairment was demostrated in patients with mild traumatic brain injury,the methods used in their study were relatively simple,No multi-temporal multimodal studies were applied andthey lacked of patients with mild traumatic brain injury.In order to understand comprehensive research and in-depth analysis,our study also combined behavioral,event-related potential,functional magnetic resonance imaging and other different modes for the attentional network and its three sub-networks for analysis for patients with mild traumatic brain injury from the acute and chronic phase.Cognitive changes and their prognosis provide strong evidence and detection methods.Further in-depth study on the functional evaluation of the incidence of mild traumatic brain injury not only helps to deepen the understanding and mastery of the disease,but also the establishment of the evaluation system has certain guiding significance for clinical treatment and rehabilitation training.MethodsIn this study,152 patients with mild traumatic brain injury were selected by co-operation of neurosurgeons,psychologists and imaging physicians in order to study the attentinal cognitive impairment of patients with mild traumatic brain injury.At the same time,by means of advertising etc.,recruitment of healthy people as a control group was included in the study.The subjects were investigated with event-related potential,attention network test,behavior test,resting-state function imaging and functional Magnetic Resonance(Diffusion Weighted Imaging).The behavior test is carried out using the Anttentional Network Test(ANT)paradigm designed by Fan et al.In the study of event-related potentials,the mismatch negative wave was selected as the index,and the changes of the pre-attentive processing capacity were tested.In the behavior test,the correct rate was selected as the research index,as well as the alertness and orientation ability of the patients.And the ability of performing control was tested.In the study of rest-state brain function imaging,the change of the function of network function was analyzed by the change of ALFF value.In the study of diffusion weighted functional magnetic resonance imaging,the mean dispersion rate was selected.So the relationship of mild traumatic brain injury and post-traumatic stress disorder was studied.ResultsThe results showed that in the acute phase of mild traumatic brain injury,alert function and orientation function are not affected,and the implementation of control function had been significantly affected.The pre-attentive processing function of information in mild traumatic brain injury patients decreased in the early stage of injury.Compared with the healthy control group,the decrease of ALFF value in the mild traumatic brain injury group included regions of the posterior cerebellum,the cerebellar tonsil,the second half of the leaflet,the right superior temporal gyrus,the right temporal gyrus,the parietal lobe,the central back,etc.Areas of ALFF with function increase mainly include edge leaves,cingulate gyrus,wedge anterior lobe,left temporal gyrus,left temporal gyrus,right frontal gyrus,right middle frontal gyrus,the right side of the amount of the next back.Mild traumatic brain injury patients with significant changes in DTI indicators covered from acute to chronic stages.These changes were highly related to the formation of posttraumatic stress disorder.MD measurements were regareded as predictive biomarkers in subacute periods that could provide an ideal mechanism for monitoring potential changes associated with post-traumatic stress disorder.This may benefit the management of patients with mild traumatic brain injury because early diagnosis and treatment can reduce the risk of post-traumatic stress disorder formation.ConclusionIn this study,we investigated the effects attention cognitive dysfunction of mild traumatic brain injury patients with event-related potentials,behavioral tests,and magnetic resonance imaging.The attention cognitive imparement of mild traumatic brain injury patients underwent its corresponding underlying neural mechanisms.Mild traumatic brain injury damaged the patient’s pre-attentive processing ability which had extended its range to the early stage of cognition.The implementation of control capacity reduction existed in the behavioral study.In the rest-state functional MRI study,the results showed that ALLF changes were closely related with the dysfunction of the attentional network in the acute stage.Diffuse Weighted Imaging provided a comprehensive index for patients with mild traumatic brain injury from acute to chronic phase.At the same time,the establishment of the evaluation system has certain guiding significance for clinical treatment and rehabilitation training. |
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