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Hippocampal volume and mood disorders after traumatic brain injury.
Biol Psychiatry 2007; 62(4):332-8BP

Abstract

BACKGROUND

Recent evidence from clinical studies and animal models of traumatic brain injury (TBI) suggest that neuronal and glial loss might progress after the initial insult in selectively vulnerable regions of the brain such as the hippocampus. There is also evidence that hippocampal dysfunction plays a role in the pathogenesis of mood disorders. We examined the relationship between hippocampal damage and mood disorders after TBI and the effect of hippocampal atrophy on the outcome of TBI patients.

METHODS

The study group consisted of 37 patients with closed head injury who were evaluated at baseline and at 3, 6, and 12 months after trauma. Psychiatric diagnosis was made with a structured clinical interview and DSM-IV criteria. Quantitative magnetic resonance imaging scans were obtained at 3-months follow-up.

RESULTS

Patients with moderate to severe head injury had significantly lower hippocampal volumes than patients with mild TBI. Patients who developed mood disorders had significantly lower hippocampal volumes than patients without mood disturbance. Furthermore, there was a significant interaction between mood disorders diagnosis and severity of TBI, by which patients with moderate to severe TBI who developed mood disorders had significantly smaller hippocampal volumes than patients with equivalent severe TBI who did not develop mood disturbance. Finally, reduced hippocampal volumes were associated with poor vocational outcome at 1-year follow-up.

CONCLUSIONS

Our findings are consistent with a "double-hit" mechanism by which neural and glial elements already affected by trauma are further compromised by the functional changes associated with mood disorders (e.g., the neurotoxic effects of increased levels of cortisol or excitotoxic damage resulting from overactivation of glutaminergic pathways). Finally, patients with greater hippocampal damage were less likely to return to a productive life 1 year after trauma.

Authors+Show Affiliations

Department of Psychiatry, University of Iowa, Iowa City, IA 52242-1000, USA. ricardo-jorge@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17123480

Citation

Jorge, Ricardo E., et al. "Hippocampal Volume and Mood Disorders After Traumatic Brain Injury." Biological Psychiatry, vol. 62, no. 4, 2007, pp. 332-8.
Jorge RE, Acion L, Starkstein SE, et al. Hippocampal volume and mood disorders after traumatic brain injury. Biol Psychiatry. 2007;62(4):332-8.
Jorge, R. E., Acion, L., Starkstein, S. E., & Magnotta, V. (2007). Hippocampal volume and mood disorders after traumatic brain injury. Biological Psychiatry, 62(4), pp. 332-8.
Jorge RE, et al. Hippocampal Volume and Mood Disorders After Traumatic Brain Injury. Biol Psychiatry. 2007 Aug 15;62(4):332-8. PubMed PMID: 17123480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hippocampal volume and mood disorders after traumatic brain injury. AU - Jorge,Ricardo E, AU - Acion,Laura, AU - Starkstein,Sergio E, AU - Magnotta,Vincent, Y1 - 2006/11/21/ PY - 2006/04/20/received PY - 2006/07/17/revised PY - 2006/07/19/accepted PY - 2006/11/25/pubmed PY - 2007/9/26/medline PY - 2006/11/25/entrez SP - 332 EP - 8 JF - Biological psychiatry JO - Biol. Psychiatry VL - 62 IS - 4 N2 - BACKGROUND: Recent evidence from clinical studies and animal models of traumatic brain injury (TBI) suggest that neuronal and glial loss might progress after the initial insult in selectively vulnerable regions of the brain such as the hippocampus. There is also evidence that hippocampal dysfunction plays a role in the pathogenesis of mood disorders. We examined the relationship between hippocampal damage and mood disorders after TBI and the effect of hippocampal atrophy on the outcome of TBI patients. METHODS: The study group consisted of 37 patients with closed head injury who were evaluated at baseline and at 3, 6, and 12 months after trauma. Psychiatric diagnosis was made with a structured clinical interview and DSM-IV criteria. Quantitative magnetic resonance imaging scans were obtained at 3-months follow-up. RESULTS: Patients with moderate to severe head injury had significantly lower hippocampal volumes than patients with mild TBI. Patients who developed mood disorders had significantly lower hippocampal volumes than patients without mood disturbance. Furthermore, there was a significant interaction between mood disorders diagnosis and severity of TBI, by which patients with moderate to severe TBI who developed mood disorders had significantly smaller hippocampal volumes than patients with equivalent severe TBI who did not develop mood disturbance. Finally, reduced hippocampal volumes were associated with poor vocational outcome at 1-year follow-up. CONCLUSIONS: Our findings are consistent with a "double-hit" mechanism by which neural and glial elements already affected by trauma are further compromised by the functional changes associated with mood disorders (e.g., the neurotoxic effects of increased levels of cortisol or excitotoxic damage resulting from overactivation of glutaminergic pathways). Finally, patients with greater hippocampal damage were less likely to return to a productive life 1 year after trauma. SN - 0006-3223 UR - https://www.unboundmedicine.com/medline/citation/17123480/Hippocampal_volume_and_mood_disorders_after_traumatic_brain_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0006-3223(06)00935-8 DB - PRIME DP - Unbound Medicine ER -