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White matter abnormalities are associated with chronic postconcussion symptoms in blast-related mild traumatic brain injury.
Hum Brain Mapp 2016; 37(1):220-9HB

Abstract

Blast-related mild traumatic brain injury (mTBI) is a common injury among Iraq and Afghanistan military veterans due to the frequent use of improvised explosive devices. A significant minority of individuals with mTBI report chronic postconcussion symptoms (PCS), which include physical, emotional, and cognitive complaints. However, chronic PCS are nonspecific and are also associated with mental health disorders such as posttraumatic stress disorder (PTSD). Identifying the mechanisms that contribute to chronic PCS is particularly challenging in blast-related mTBI, where the incidence of comorbid PTSD is high. In this study, we examined whether blast-related mTBI is associated with diffuse white matter changes, and whether these neural changes are associated with chronic PCS. Ninety Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans were assigned to one of three groups including a blast-exposed no--TBI group, a blast-related mTBI without loss of consciousness (LOC) group (mTBI--LOC), and a blast-related mTBI with LOC group (mTBI + LOC). PCS were measured with the Rivermead Postconcussion Questionnaire. Results showed that participants in the mTBI + LOC group had more spatially heterogeneous white matter abnormalities than those in the no--TBI group. These white matter abnormalities were significantly associated with physical PCS severity even after accounting for PTSD symptoms, but not with cognitive or emotional PCS severity. A mediation analysis revealed that mTBI + LOC significantly influenced physical PCS severity through its effect on white matter integrity. These results suggest that white matter abnormalities are associated with chronic PCS independent of PTSD symptom severity and that these abnormalities are an important mechanism explaining the relationship between mTBI and chronic physical PCS.

Authors+Show Affiliations

Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts. Memory Disorders Research Center, VA Boston Healthcare System, Boston, Massachusetts.National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts. Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, Massachusetts.Memory Disorders Research Center, VA Boston Healthcare System, Boston, Massachusetts. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, Massachusetts. Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts. Harvard Medical School, Harvard University, Boston, Massachusetts.Memory Disorders Research Center, VA Boston Healthcare System, Boston, Massachusetts. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

26497829

Citation

Miller, Danielle R., et al. "White Matter Abnormalities Are Associated With Chronic Postconcussion Symptoms in Blast-related Mild Traumatic Brain Injury." Human Brain Mapping, vol. 37, no. 1, 2016, pp. 220-9.
Miller DR, Hayes JP, Lafleche G, et al. White matter abnormalities are associated with chronic postconcussion symptoms in blast-related mild traumatic brain injury. Hum Brain Mapp. 2016;37(1):220-9.
Miller, D. R., Hayes, J. P., Lafleche, G., Salat, D. H., & Verfaellie, M. (2016). White matter abnormalities are associated with chronic postconcussion symptoms in blast-related mild traumatic brain injury. Human Brain Mapping, 37(1), pp. 220-9. doi:10.1002/hbm.23022.
Miller DR, et al. White Matter Abnormalities Are Associated With Chronic Postconcussion Symptoms in Blast-related Mild Traumatic Brain Injury. Hum Brain Mapp. 2016;37(1):220-9. PubMed PMID: 26497829.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - White matter abnormalities are associated with chronic postconcussion symptoms in blast-related mild traumatic brain injury. AU - Miller,Danielle R, AU - Hayes,Jasmeet P, AU - Lafleche,Ginette, AU - Salat,David H, AU - Verfaellie,Mieke, Y1 - 2015/10/24/ PY - 2015/05/07/received PY - 2015/08/10/revised PY - 2015/10/04/accepted PY - 2015/10/27/entrez PY - 2015/10/27/pubmed PY - 2016/10/12/medline KW - OEF/OIF KW - PTSD KW - diffusion tensor imaging KW - loss of consciousness SP - 220 EP - 9 JF - Human brain mapping JO - Hum Brain Mapp VL - 37 IS - 1 N2 - Blast-related mild traumatic brain injury (mTBI) is a common injury among Iraq and Afghanistan military veterans due to the frequent use of improvised explosive devices. A significant minority of individuals with mTBI report chronic postconcussion symptoms (PCS), which include physical, emotional, and cognitive complaints. However, chronic PCS are nonspecific and are also associated with mental health disorders such as posttraumatic stress disorder (PTSD). Identifying the mechanisms that contribute to chronic PCS is particularly challenging in blast-related mTBI, where the incidence of comorbid PTSD is high. In this study, we examined whether blast-related mTBI is associated with diffuse white matter changes, and whether these neural changes are associated with chronic PCS. Ninety Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans were assigned to one of three groups including a blast-exposed no--TBI group, a blast-related mTBI without loss of consciousness (LOC) group (mTBI--LOC), and a blast-related mTBI with LOC group (mTBI + LOC). PCS were measured with the Rivermead Postconcussion Questionnaire. Results showed that participants in the mTBI + LOC group had more spatially heterogeneous white matter abnormalities than those in the no--TBI group. These white matter abnormalities were significantly associated with physical PCS severity even after accounting for PTSD symptoms, but not with cognitive or emotional PCS severity. A mediation analysis revealed that mTBI + LOC significantly influenced physical PCS severity through its effect on white matter integrity. These results suggest that white matter abnormalities are associated with chronic PCS independent of PTSD symptom severity and that these abnormalities are an important mechanism explaining the relationship between mTBI and chronic physical PCS. SN - 1097-0193 UR - https://www.unboundmedicine.com/medline/citation/26497829/White_matter_abnormalities_are_associated_with_chronic_postconcussion_symptoms_in_blast_related_mild_traumatic_brain_injury_ L2 - https://doi.org/10.1002/hbm.23022 DB - PRIME DP - Unbound Medicine ER -