White matter damage and cognitive impairment after traumatic brain injury

By Kirsi M. Kinnunen, R. Greenwood, Jane H. Powell, Robert Leech, Peter C T Hawkins, V. Bonnelle, Maneesh C. Patel, Serena J. Counsell, David J. Sharp. Brain : a journal of neurology, 2010

678 citations recorded by the source corpus.

White matter disruption is an important determinant of cognitive impairment after brain injury, but conventional neuroimaging underestimates its extent. In contrast, diffusion tensor imaging provides a validated and sensitive way of identifying the impact of axonal injury. The relationship between cognitive impairment after traumatic brain injury and white matter damage is likely to be complex. We applied a flexible technique—tract-based spatial statistics—to explore whether damage to specific white matter tracts is associated with particular patterns of cognitive impairment. The commonly affected domains of memory, executive function and information processing speed were investigated in 28 patients in the post-acute/chronic phase following traumatic brain injury and in 26 age-matched controls. Analysis of fractional anisotropy and diffusivity maps revealed widespread differences in white matter integrity between the groups. Patients showed large areas of reduced fractional anisotropy, as well as increased mean and axial diffusivities, compared with controls, despite the small amounts of cortical and white matter damage visible on standard imaging. A stratified analysis based on the presence or absence of microbleeds (a marker of diffuse axonal injury) revealed diffusion tensor imaging to be more sensitive than gradient-echo imaging to white matter damage. The location of white matter abnormality predicted cognitive function to some extent. The structure of the fornices was correlated with associative learning and memory across both patient and control groups, whilst the structure of frontal lobe connections showed relationships with executive function that differed in the two groups. These results highlight the complexity of the relationships between white matter structure and cognition. Although widespread and, sometimes, chronic abnormalities of white matter are identifiable following traumatic brain injury, the impact of these changes on cognitive function is likely to depend on damage to key pathways that link nodes in the distributed brain networks supporting high-level cognitive functions.

Subfields: Epidemiology, Neurology, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/4bb3c8d661fde64a9d638d8ef25d965f9762da19

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Citations in the corpus

The role of the posterior cingulate cortex in cognition and disease. (2014, background): “Head injuries frequently produce diffuse axonal injury, which disconnects brain regions and produces cognitive impairment (Kinnunen et al., 2011).”
How and how not to correct for CSF-contamination in diffusion MRI (2012, positive): “…Maller et al., 2010), attention deficit hyperactivity disorder and autism (for review see Konrad and Eickhoff, 2010), traumatic brain injury (e.g. Kinnunen et al., 2011; Lipton et al., 2008), small vessel disease (e.g. O'Sullivan et al., 2005; Patel and Markus, 2011), neurodegenerative diseases…”
Cognitive Network Neuroscience (2015, background): “, 2008), working memory (Palacios et al., 2012; Kinnunen et al., 2011; Wu et al., 2010), and motor skills (Leunissen et al.”
Inflammation after trauma: Microglial activation and traumatic brain injury (2011, background): “As a group, our patients showed evidence of generalized white matter damage, consistent with the presence of diffuse axonal injury.(19,20) However, the location of increased PK binding did not correlate with the white matter structural change detected by DTI.”