Kristen Dams-O'Connor

Background: Alzheimer disease and related dementias can impact emotional distress and individual and relational health among persons living with dementia and their romantic partners. There are limited skill-based interventions that can help couples build resilience while navigating dementia-related challenges. Objective: We aim to assess the feasibility, acceptability, and preliminary signal of improvement of Resilient Together for Alzheimer’s Disease and Related Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. Methods: Couples are randomized to complete either (1) six weekly conjoint intervention sessions of RT-ADRD or (2) a minimally enhanced usual care condition involving a self-guided pamphlet. Both partners must demonstrate capacity to consent to research participation, and at least 1 partner must exhibit clinically elevated emotional distress. Partners living with dementia must have received their diagnosis in the past 6 months. Participants complete baseline and posttest assessments of resiliency skills, emotional distress, relationship functioning, and quality of life and assessments of treatment satisfaction at posttest only. Results: This is aim 3 of a 5-year funded study that initially began in July 2022. Participant recruitment and data collection for this phase began in October 2024 and will continue until 40 couples (80 individuals) are randomized and complete the posttest. As of manuscript submission (July 2026), 25 couples have been enrolled and 25 couples have been randomized. Data collection is currently underway, and study completion is expected by early 2027. Conclusions: This study will gather comprehensive information on the feasibility and acceptability of RT-ADRD relative to minimally enhanced usual care and assess the preliminary signal of improvement in proximal outcomes. Findings will directly inform plans for a larger efficacy trial.

BACKGROUND Alzheimer’s disease and related dementias (ADRDs) can impact emotional distress and individual and relational health among persons living with dementia and their romantic partners. There are limited skills-based interventions that can help couples build resilience while navigating dementia-related challenges. OBJECTIVE We aim to assess the feasibility, acceptability, and preliminary signal of improvement of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. METHODS Couples are randomized to complete either: 1) six weekly conjoint intervention sessions of RT-ADRD; or 2) a minimally enhanced usual care (MEUC) condition involving a self-guided pamphlet. Both partners must demonstrate capacity to consent to research participation, and at least one partner must exhibit clinically elevated emotional distress. Partners living with dementia must have received their diagnosis in the past 6 months. Participants complete baseline and post-test assessments of resiliency skills, emotional distress, relationship functioning, and quality of life, and treatment satisfaction at post-test only. RESULTS We will continue the trial until N=40 couples (80 individuals) are randomized and complete post-test assessments. CONCLUSIONS This study will gather comprehensive information on the feasibility and acceptability of RT-ADRD relative to MEUC and assess preliminary signal of improvement on proximal outcomes. Findings will directly inform plans for a larger efficacy trial. Data collection is currently under way, and study completion is expected by late-2026. CLINICALTRIAL This study is approved by the Icahn School of Medicine at Mount Sinai Independent Review Board and was registered on ClinicalTrials.gov (NCT06619327) on 09/2/2024).

Background: Traumatic brain injury (TBI) is associated with increased dementia risk, yet its relationship to Alzheimer's disease (AD) neuropathology is unclear. Prior autopsy studies show inconsistent results, constrained by limited TBI ascertainment, semi-quantitative neuropathology methods, and selection bias. Objective: To examine whether TBI with loss of consciousness (TBI-LOC) is associated with quantitative measures of tau and amyloid-β ₄₂ (Aβ ₄₂ ) pathology in a community-based autopsy cohort. Methods: The analytic sample included 810 Adult Changes in Thought study brain donors with baseline TBI-LOC ascertainment and quantitative neuropathology data, weighted to represent the full living cohort (n = 5763). Modified Poisson regression estimated rate ratios (RRs) and 95% confidence intervals (CIs) for associations of TBI-LOC with percent-positive AT8 tau immunoreactivity and soluble Aβ ₄₂ (GuHCl and RIPA fractions) across brain regions. Models were adjusted for age at death, sex, education, and enrollment cohort; sensitivity analyses included unweighted and quantile models. Results: Weighted models showed lower frontal tau (RR = 0.50, p = 0.047) and lower soluble Aβ ₄₂ in temporal and occipital cortices (p = 0.019–0.037) among donors with baseline TBI-LOC. In unweighted sensitivity analyses, lower temporal RIPA Aβ ₄₂ remained significant (p < 0.001), and select inverse associations were observed in duration-stratified analyses, particularly in small >1 h LOC subgroups. Quantile analyses of pathology burden similarly suggest reduced parietal Aβ ₄₂ (p = 0.02–0.04); effects were small and driven by sparse subgroups. Conclusions: TBI-LOC was not associated with greater tau or amyloid burden, and inverse associations likely reflect data sparsity rather than biological protection. These findings suggest that links between TBI and late-life cognitive decline may involve non-AD pathological processes.

Brain injuries often have lifelong consequences that include long-term impairments and disability. Policy-, community-, and society-level interventions are a critical path to survivor impact. A recent qualitative study highlighted the potential of a new tool, Brain Injury Identification Cards, for enhancing survivor safety, self-advocacy, and well-being. The primary purpose of our study was to conduct a quantitative assessment of perceived benefits and self-reported credibility, expectancy, and acceptability to inform future trials. In this cross-sectional study, we assessed the impressions of current owners (N = 99) of Brain Injury Identification Cards. We administered online self-report questionnaires and characterized perceived experiences, acceptability, and utility using descriptive statistics. Most (>67%) had favorable impressions about their own use of the Brain Injury Identification Cards, although approximately 19% perceived the cards as stigmatizing or embarrassing, and 22% said the cards were not helpful for their stress and anxiety surrounding traumatic brain injury symptoms. Overall, participants rated treatment credibility and expectancy as high, and all respondents who completed survey items (n = 96) indicated that they would recommend cards to others with traumatic brain injury and other medical conditions. Our findings highlight the perceived benefits of using a Brain Injury Identification Card among established Card owners. Future studies in representative samples of survivors assessing user experiences before and after the receipt of Brain Injury Identification Cards are needed to assess potential intervention effects. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Traumatic brain injury (TBI) is heterogeneous, complicating efforts to develop standardized diagnostic and therapeutic approaches. Conventional group-based analyses often obscure individual differences by averaging across diverse injury patterns. By contrast, by comparing deviation from the expected distribution observed in healthy controls, normative modeling can capture patient-specific deviations from expected neuroanatomical norms. The aim of this research was to use normative modeling to capture individual variability in brain morphometry on individuals who have experienced a TBI. In this study, we applied traditional case-control and a normative modeling approach to cortical and subcortical MRI. Data were analyzed from the Enhancing NeuroImaging Genetics through Meta-Analysis Consortium Adult Moderate-to-Severe TBI working group. Primary outcome measures were cortical thickness and subcortical volumes, derived from the Destrieux and Freesurfer subcortical atlases. Case-control tests were conducted using linear models controlling for age, sex, site, and intracranial volume. Normative modeling was carried out by accessing the Predictive Clinical Neuroscience Portal, estimating individual deviations using a model of Bayesian linear regression with likelihood warping. A total of 631 (407 patients with TBI, 224 healthy controls) MR images were processed. Conventional case-control analyses identified significant group differences in 153 regions of possible 178 cortical or subcortical regions. Normative modeling revealed far greater heterogeneity. No more than 23% of patients with TBI shared an extreme deviation (z-score >2 or z < -2) in the same region, but every region experienced at least 1 extreme positive or negative deviation across individuals. Stratifying by Glasgow Coma Scale (GCS) severity sustained this pattern; even within GCS 13-15, GCS 9-12, and GCS 3-8 subgroups, regional convergence did not exceed 34%. The median number of deviations increased with injury severity (GCS 13-15 = 9, GCS 9-12 = 19, GCS 3-8 = 22), demonstrating that group averages mask highly individualized morphologic abnormalities as injury severity increases. Normative modeling detects participant-specific cortical and subcortical abnormalities that conventional group comparisons overlook, better representing the true diversity of TBI-related morphologic changes. Generating individualized "morphologic fingerprints" may ultimately advance prognostic accuracy and lay the foundation for personalized interventions in research and clinical practice.

Traumatic brain injury (TBI) mechanisms are often grouped together in research. Differences in acute and long-term outcomes across mechanisms of injury (MOIs) remain unclear, partly because of confounding by age. Modeling MOI-specific effects can inform clinical triage and prognostication. We examined the relationship between motor vehicle accidents (MVAs) vs falls, the 2 most common MOIs, and acute and 1-year post-injury outcomes, after rigorous control of demographic and preinjury personal factors. Data were analyzed from individuals with moderate-to-severe TBI requiring inpatient rehabilitation from the TBI Model Systems National Database, a multicenter prospective longitudinal cohort study. The analytic sample was restricted to individuals aged 16-79 years with an MOI due to MVA or fall occurring between April 2010 and January 2023. We used inverse probability of treatment weighting, based on propensity scores, to adjust for 14 demographic and preinjury personal characteristics and estimate the causal effect of MOI on acute and 1-year outcomes after TBI. Acute hospital and rehabilitation outcomes included the following: Glasgow Coma Scale (GCS), sedation, intubation, post-traumatic amnesia duration, time to follow commands (TFC), length of hospital stay (LOS), and Functional Independence Measure (FIM) cognitive and motor scores. One-year outcomes included the following: Disability Rating Scale and Participation Assessment with Recombined Tools Objective. Among 5,181 participants (mean age 45.1 ± 19.5, 70% male), 48.4% sustained their injury from MVAs and 51.6% from falls. After weighting and multiple comparisons adjustment, the MVA group had lower GCS total scores by 1.27 points (95% CI -1.92 to -0.61; adjusted p = 0.001), greater odds of receiving sedation (odds ratio 1.43, 95% CI 1.11-1.85; adjusted p = 0.014), longer TFC by 1.64 days (95% CI 0.39-2.89; adjusted p = 0.017), and lower discharge FIM motor scores by 4.28 points (95% CI -7.50 to -1.26; adjusted p = 0.014). At 1 year after injury, disability levels and community participation did not differ. MVA-related TBI was associated with worse acute outcomes. However, by 1 year after injury, disability level and community participation do not differ. This work highlights novel findings in short-term and long-term outcomes after falls and MVAs, the leading TBI causes, which are not explained by confounders such as age. Findings may not generalize beyond patients receiving inpatient rehabilitation for TBI.

Background: People with traumatic brain injury (TBI) morbidity (impaired cognition and behavioral regulation) and polytrauma comorbidity (depression, posttraumatic stress disorder [PTSD], chronic pain, and sleep disorders) experience health care inequities. Among Veterans and Service Members (V/SMs), TBI morbidity or polytrauma comorbidity may impact access and meaningful engagement in the high-quality health care needed to reduce poor health care outcomes. The National Academy of Science, Engineering, and Medicine Report on Accelerating Progress in TBI highlights a dearth of implementation science research in TBI that may help overcome health care access challenges. Implementation science uses a mixed methods approach to understand, implement, and examine outcomes associated with using evidence-based care in practice. Objective: The I-HEAL (Improving Health Care Access and Engagement for Veterans and Service Members with TBI Morbidity) protocol includes 4 synergistic projects with the goal of addressing key knowledge gaps that will improve access and engagement in high-quality, evidence-based health care services for V/SMs with TBI morbidity. Collectively, the 4 projects propose to: (1) adapt existing interventions to promote access and engagement in health care; (2) engage stakeholder communities to maximize uptake and translation; (3) promote research translation that informs policy and practice through knowledge translation products and deliverables targeting key partners (clinicians, V/SMs, caregivers, policymakers, and researchers); (4) facilitate research and implementation to enhance access to high-quality health care for V/SMs with TBI-related morbidity; and (5) foster the development of early/mid-career researchers in advancing implementation science research on access to care for V/SMs with TBI. Methods: Project 1 will involve the development of a nudge intervention (electronic health care reminder) for providers to engage health care proxies when interacting with cognitive disability at risk for poor health care engagement. Project 2 will involve the development of a provider toolkit of adaptations of guideline-endorsed behavioral health interventions for common polytrauma comorbidities to meet the needs of cognitively impaired individuals. Project 3 will involve the adaptation and dissemination of evidence-based team interventions for managing maladaptive behaviors after TBI. Project 4 will involve evaluation and recommendations for policy for virtual health modalities among persons with TBI and polytrauma comorbidity. Results: I-HEAL has been funded as an implementation science Focused Program Award by Congressionally Directed Medical Research Programs, and start-up activities began in October 2023. All 4 projects are currently underway with funding through September 2027. Project 1 has enrolled 48 participants, and project 3 has enrolled 34 participants through September 2025. Conclusions: TBI is associated with increased health care utilization, comorbid health conditions, and premature mortality. This study has proposed to utilize strategies from the implementation science field to help overcome barriers to physical and psychological health care in order to reduce health care disparities associated with TBI disability.

UNSTRUCTURED People with traumatic brain injury (TBI)-related morbidity (impaired cognition, behavioral regulation) and polytrauma comorbidity (depression, posttraumatic stress disorder (PTSD), chronic pain, sleep disorders) experience healthcare inequities leading to poor health outcomes. Our work has highlighted that Veterans and Service Members (V/SMs) with TBI have high rates of rehospitalization, unique healthcare needs, and distinct causes of early mortality (self-inflicted deaths and preventable injuries). Any TBI morbidity or polytrauma comorbidity may impact access and meaningful engagement in the high-quality healthcare needed to reduce poor healthcare outcomes. The National Academy of Science, Engineering, and Medicine Report on Accelerating Progress in TBI recognizes and calls for action to improve healthcare access for persons with TBI and highlights a dearth of implementation science research in TBI that may help overcome healthcare access challenges. Implementation science uses a mixed methods approach to understand, implement, and examine outcomes associated with using evidence-based care in practice. It also uses evidence-based practice for adaptations or innovations in how care is delivered (to retain technical quality, fidelity) across healthcare systems (e.g., Veterans Affairs, Department Of Defense, civilian settings) and populations (e.g., disabled vs healthy cohorts) to achieve healthcare equity. The I-HEAL protocol includes four synergistic projects with the goal to address key knowledge gaps that will improve access and engagement in high-quality, evidence-based healthcare services for V/SM with TBI morbidity. Specific foci include the following: Project 1) development of a nudge intervention (electronic healthcare reminder) for providers to engage healthcare proxies when interacting with cognitive disability at risk for poor healthcare engagement; Project 2) development of a provider toolkit of adaptations of guideline-endorsed behavioral health interventions for common polytrauma comorbidities (sleep, PTSD, depression, chronic pain) to meet the needs of cognitively impaired individuals; Project 3) adaptation and dissemination of evidence-based team interventions for managing maladaptive behaviors after TBI; and Project 4) evaluation and recommendations for policy for virtual health modalities for persons with TBI and polytrauma comorbidity. Collectively the four projects propose to accomplish the following overarching objectives: 1) adapt existing interventions to promote access and engagement in healthcare; 2) engage stakeholder communities to maximize uptake and translation; 3) promote research translation that informs policy and practice through knowledge translation products and deliverables targeting key partners (clinicians, Veterans, Service Members, caregivers, policymakers, and other researchers); 4) facilitate research and implementation to enhance access to high-quality healthcare for V/SM with TBI-related morbidity; and 5) foster development of early/mid-career researchers in advancing implementation science research on access to care for V/SM with TBI. TBI is associated with increased healthcare utilization, comorbid health conditions, and premature mortality. This study proposed to utilize strategies from the implementation science field to help overcome barriers to physical and psychological healthcare to reduce healthcare disparities associated with TBI disability.

Moderate-to-severe traumatic brain injury (TBI) can result in disability across physical, social, and cognitive domains. The Glasgow Outcome Scale-Extended (GOSE), which evaluates global function, is the most frequently used TBI outcome measure. However, the GOSE may not capture all domains of recovery. We evaluated the relationship between the GOSE and domain-specific measures of life satisfaction, participation, and psychological health 1 year after TBI. We analyzed prospectively collected data from participants of the TBI Model Systems (TBIMS) study enrolled between 2010 and 2022 who completed the GOSE and at least 1 additional outcome measure 1 year after injury. We conducted pairwise comparisons to determine whether adjacent GOSE categories (e.g., GOSE 3 vs 4) are associated with different Satisfaction With Life Scale (SWLS), Participation Assessment of Recombined Tools-Objective (PART-O), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scores. We report median differences (MDs) with 95% CIs. We also dichotomized each measure and calculated the proportion of participants above and below cut points associated with "favorable" compared with "unfavorable" GOSE outcomes. Among 19,245 participants enrolled in the TBIMS study, 7,568 participants (median [interquartile range] age 44 [27-61] years, 73% [5,541/7,568] male, 27% [2,020/7,568] female, 66% [5,007/7,568] White) met inclusion criteria. After correcting for multiple comparisons, there were no differences in median scores on SWLS between GOSE 3 vs 4 (MD = -1.00 [CI -1.00, 0.00]; p = 0.21) and GOSE 4 vs 5 (0.00 [-1.00, 1.00]; p = 0.5); PART-O between GOSE 7 vs 8 (-0.10 [-0.13, -0.06]; p = 0.0084); PHQ-9 between GOSE 3 vs 4 (0.00 [-1.00, 1.00]; p = 0.91) and GOSE 4 vs 5 (0.00 [0.00, 1.00]; p = 0.42); and GAD-7 between GOSE 3 vs 4 (0.00 [0.00, 0.10]; p = 0.07), GOSE 4 vs 5 (0.00 [0.00, 0.00]; p = 0.66), and GOSE 5 vs 6 (0.00 [0.00, 0.00]; p = 0.40). Among those with an "unfavorable" outcome (GOSE score ≤4), 44% (601/1,371), 8% (191/2,491), 67% (536/803), and 75% (602/807) had scores in the normative range for SWLS, PART-O, PHQ-9, and GAD-7, respectively. Overreliance on functional outcome measures such as the GOSE in postacute TBI assessment fails to capture critically important aspects of recovery that fall outside this domain. Persons with more functional disability often report similar levels of life satisfaction, participation, and psychological health as those with less disability. Clinicians should recognize that bidirectional dissociations between level of disability and ratings of well-being are common and should be evaluated accordingly.