Abstract
Background: Mild traumatic brain injuries (mTBIs) are a significant social, sport, and military health issue. In spite of advances in the clinical management of these injuries, the underlying pathophysiology is not well-understood. There is a critical need to advance objective biomarkers, allowing the identification and tracking of the long-term evolution of changes resulting from mTBI. Diffusion-weighted imaging (DWI) allows for the assessment of white-matter properties in the brain and shows promise as a suitable biomarker of mTBI pathophysiology.Methods: 34 individuals within a year of an mTBI (age: 24.4 ± 7.4) and 18 individuals with no history of mTBI (age: 23.2 ± 3.4) participated in this study. Participants completed self-report measures related to functional outcomes, psychological health, post-injury symptoms, and sleep, and underwent a neuroimaging session that included DWI. Whole-brain white matter was skeletonized using tract-based spatial statistics (TBSS) and compared between groups as well as correlated within-group with the self-report measures.Results: There were no statistically significant anatomical differences between the two groups. After controlling for time since injury, fractional anisotropy (FA) demonstrated a negative correlation with sleep quality scores (higher FA was associated with better sleep quality) and increasing depressive symptoms in the mTBI participants. Conversely, mean (MD) and radial diffusivity (RD) demonstrated positive correlations with sleep quality scores (higher RD was associated with worse sleep quality) and increasing depressive symptoms. These correlations were observed bilaterally in the internal capsule (anterior and posterior limbs), corona radiata (anterior and superior), fornix, and superior fronto-occipital fasciculi.Conclusion: The results of this study indicate that the clinical presentation of mTBI, particularly with respect to depression and sleep, is associated with reduced white-matter integrity in multiple areas of the brain, even after controlling for time since injury. These areas are generally associated not only with sleep and emotion regulation but also cognition. Consequently, the onset of depression and sleep dysfunction as well as cognitive impairments following mTBI may be closely related to each other and to white-matter integrity throughout the brain.
Highlights
Concussions and mild traumatic brain injuries represent a significant public and military health crisis. 1.6 to 3.8 million sport-related concussions (SRCs) are reported annually [1, 2], and more than 300,000 Mild traumatic brain injuries (mTBIs) have been documented in military personnel since the year 2000 [3]
Brain injured participants reported a median number of mTBIs, including the one used for referral, of 2
We found voxels with significant correlations in the mTBI participant group for the BDI-fractional anisotropy (FA), BDIMD, BDI-radial diffusivity (RD), Pittsburgh Sleep Quality Index (PSQI)-FA and PSQI-RD relationships
Summary
Concussions and mild traumatic brain injuries (mTBI) represent a significant public and military health crisis. 1.6 to 3.8 million sport-related concussions (SRCs) are reported annually [1, 2], and more than 300,000 mTBIs (hereafter referring to both mTBIs and SRCs) have been documented in military personnel since the year 2000 [3]. Concussions and mild traumatic brain injuries (mTBI) represent a significant public and military health crisis. Individuals sustaining an mTBI may exhibit any number of clinical features, including changes in cognitive and motor function as well as post-injury depression, somatic symptoms, and sleep-wake cycle disruption [6]. These clinical signs and symptoms are not generally associated with visible structural abnormalities when using traditional diagnostic/clinical neuroimaging techniques (e.g., structural magnetic resonance imaging (MRI) or computed tomography (CT) in the emergency department). Mild traumatic brain injuries (mTBIs) are a significant social, sport, and military health issue. Diffusion-weighted imaging (DWI) allows for the assessment of white-matter properties in the brain and shows promise as a suitable biomarker of mTBI pathophysiology
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