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White matter abnormalities are associated with overall cognitive status in blast-related mTBI

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Abstract

Blast-related mild traumatic brain injury (mTBI) is a common injury of the Iraq and Afghanistan Wars. Research has suggested that blast-related mTBI is associated with chronic white matter abnormalities, which in turn are associated with impairment in neurocognitive function. However, findings are inconsistent as to which domains of cognition are affected by TBI-related white matter disruption. Recent evidence that white matter abnormalities associated with blast-related mTBI are spatially variable raises the possibility that the associated cognitive impairment is also heterogeneous. Thus, the goals of this study were to examine (1) whether mTBI-related white matter abnormalities are associated with overall cognitive status and (2) whether white matter abnormalities provide a mechanism by which mTBI influences cognition. Ninety-six Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OEF) veterans were assigned to one of three groups: no-TBI, mTBI without loss of consciousness (LOC) (mTBI-LOC), and mTBI with LOC (mTBI + LOC). Participants were given a battery of neuropsychological tests that were selected for their sensitivity to mTBI. Results showed that number of white matter abnormalities was associated with the odds of having clinically significant cognitive impairment. A mediation analysis revealed that mTBI + LOC was indirectly associated with cognitive impairment through its effect on white matter integrity. These results suggest that cognitive difficulties in blast-related mTBI can be linked to injury-induced neural changes when taking into account the variability of injury as well as the heterogeneity in cognitive deficits across individuals.

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Notes

  1. Data were unavailable for Digit Span Backwards because this measure was added after initiation of the study. Several other measures were not available because of shoulder or hand injury interfering with pegboard performance (four participants), invalidity of the test due to not following instructions (one participant), or testing being completed during a follow-up session consisting of a shorter battery in which the test was not incorporated (one participant). Data were missing for five participants in the mTBI + LOC group, five participants in the mTBI-LOC group, and two in the no-TBI group.

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Acknowledgments

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. This work was supported by VA Rehabilitation Research & Development grant I01RX000216 and I21RX001594, the VA Clinical Science Research and Development Service, and the National Center for PTSD. The authors would like to acknowledge Kathryn Bousquet, Keely Burke, and Aubrey Wank for assistance with imaging data collection.

Conflict of interest

Danielle R. Miller, Jasmeet P. Hayes, Ginette Lafleche, David H. Salat, and Mieke Verfaellie declare they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.

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Miller, D.R., Hayes, J.P., Lafleche, G. et al. White matter abnormalities are associated with overall cognitive status in blast-related mTBI. Brain Imaging and Behavior 11, 1129–1138 (2017). https://doi.org/10.1007/s11682-016-9593-7

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  • DOI: https://doi.org/10.1007/s11682-016-9593-7

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