Abstract
Mild traumatic brain injury (mTBI) is one of the most common neurological disorders worldwide. Posttraumatic complaints are frequently reported, interfering with outcome. However, a consistent neural substrate has not yet been found. We used graph analysis to further unravel the complex interactions between functional brain networks, complaints, anxiety and depression in the sub-acute stage after mTBI. This study included 54 patients with uncomplicated mTBI and 20 matched healthy controls. Posttraumatic complaints, anxiety and depression were measured at two weeks post-injury. Patients were selected based on presence (n = 34) or absence (n = 20) of complaints. Resting-state fMRI scans were made approximately four weeks post-injury. High order independent component analysis resulted in 89 neural components that were included in subsequent graph analyses. No differences in graph measures were found between patients with mTBI and healthy controls. Regarding the two patient subgroups, degree, strength, local efficiency and eigenvector centrality of the bilateral posterior cingulate/precuneus and bilateral parahippocampal gyrus were higher, and eigenvector centrality of the frontal pole/ bilateral middle & superior frontal gyrus was lower in patients with complaints compared to patients without complaints. In patients with mTBI, higher degree, strength and eigenvector centrality of default mode network components were related to higher depression scores, and higher degree and eigenvector centrality of executive network components were related to lower depression scores. In patients without complaints, one extra module was found compared to patients with complaints and healthy controls, consisting of the cingulate areas. In conclusion, this research extends the knowledge of functional network connectivity after mTBI. Specifically, our results suggest that an imbalance in the function of the default mode- and executive network plays a central role in the interaction between emotion regulation and the persistence of posttraumatic complaints.
Highlights
Cognitive and affective complaints reported by patients with mild traumatic brain injury still puzzle clinicians and scientists worldwide [1,2,3,4]
Graph analysis of functional brain networks was performed in patients with uncomplicated mild traumatic brain injury (mTBI) in the sub-acute phase after injury, aimed to improve our understanding of the presence of posttraumatic complaints related to anxiety and depression after mTBI
A novel approach, consisting of high order independent component analysis (ICA) followed by graph analysis, was used to investigate functional brain networks in relation to complaints, anxiety and depression after mTBI
Summary
Cognitive and affective complaints reported by patients with mild traumatic brain injury (mTBI) still puzzle clinicians and scientists worldwide [1,2,3,4]. A growing number of functional MRI (fMRI) studies suggest that (persistent) posttraumatic complaints after mTBI are associated with alterations in functional brain networks, especially with regard to the interaction between frontal/parietal networks, such as the default mode network, executive network and salience network [12,13,14,15,16] This is not surprising, since these networks converge on prefrontal midline areas, which are vulnerable to traumatic brain injury [17,18,19], and because these networks and regions are important for emotion regulation [20,21]. This analysis technique covers a wider range of network aspects compared to traditional methods
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