# The Impact of Intracranial Pressure on Cortical Functioning and Cognitive Outcome after Traumatic Brain Injury

> **NIH NIH K23** · UNIVERSITY OF CINCINNATI · 2020 · $198,141

## Abstract

Project Summary
 Traumatic brain injury (TBI) affects 1.7 million individuals in the US each year and when TBI is severe
(sTBI), nearly all survivors experience cognitive dysfunction at 6 months. Trials aimed at lowering elevated
intracranial pressure (ICP) through surgery or aggressive medical therapies have failed to show benefit in
functional outcome, but the measurement of ICP as a marker for secondary brain injury remains a cornerstone
of modern neurocritical care. We hypothesize that elevations in ICP impact cognition, a more biologically
plausible result of elevations in ICP that contribute to brain ischemia, and that measurements of ICP-related
cortical dysfunction can provide more precise targets of intervention to improve cognitive dysfunction in survivors
of sTBI. Dr. Foreman will use data from a large, ongoing multicenter TBI study (Transforming Research and
Clinical Knowledge, or TRACK-TBI; NIH/NINDS U01 NS086090) and an embedded multicenter EEG-based
study (Spreading Depolarizations II: Development and Validation of Spreading Depolarization Monitoring for TBI
Management, or SD II; DOD W81XWH-16-2-0020) to examine the effects of elevated ICP on domain-specific
cognitive dysfunction (Aim 1). Dr. Foreman will then use intracranial and scalp electroencephalography (EEG)
to stratify ICP based on the presence of ischemic EEG changes in cortical signaling (Aim 2). This research plan
will leverage the clinical research infrastructure of TRACK-TBI, the physiologic data collection of SDII, and the
expertise of National Science Foundation-funded engineering partners to analyze time-locked ICP and EEG
signals, defining novel physiology with the potential to individualize ICP therapy to reduce the need for surgery
or aggressive medical therapies, and to improve cognitive disability in survivors of sTBI.
 This K23 award will establish Dr. Foreman as a clinician-scientist with expertise in 1) understanding time-
series physiologic relationships in those with sTBI and 2) developing individualized physiologic targets for
therapeutic intervention in order to improve clinically important outcomes, i.e. cognition after sTBI. This career
development award will support Dr. Foreman’s short-term goals, including 1) a detailed understanding of
cognitive outcome assessments and their application as primary endpoints in clinical and translational research;
2) acquisition of skills necessary to analyze and interpret EEG and other biological sensor data; 3) obtaining
knowledge in statistical techniques necessary to link physiology with outcome. Dr. Foreman will meet these
objectives under the guidance of a Mentorship Committee, including Dr. Daniel Woo (primary mentor), a
federally-funded clinician-scientist and established faculty mentor; Dr. Opeolu Adeoye, an Emergency Physician
and Neurointensivist with expertise in clinical research and trial design; and Dr. Jed Hartings, a neurophysiologist
an international expert in intracranial EEG after sTBI. Dr. Forema...

## Key facts

- **NIH application ID:** 9990854
- **Project number:** 5K23NS101123-04
- **Recipient organization:** UNIVERSITY OF CINCINNATI
- **Principal Investigator:** Brandon Foreman
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $198,141
- **Award type:** 5
- **Project period:** 2017-09-25 → 2021-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9990854

## Citation

> US National Institutes of Health, RePORTER application 9990854, The Impact of Intracranial Pressure on Cortical Functioning and Cognitive Outcome after Traumatic Brain Injury (5K23NS101123-04). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9990854. Licensed CC0.

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