The bridge between cognition and behavior in acquired brain injury: A graph theoretical approach.

Frank Jonker,Erik Scherder,Kim Rauwerda,Wouter Weeda

doi:10.1002/brb3.1208

Frank Jonker, Erik Scherder + Show 2 more

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https://doi.org/10.1002/brb3.1208

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Abstract

BackgroundThe assumption is that executive dysfunctions (EF), associated with frontal lobe injury, are responsible for behavioral disturbances. Some studies do not find a relationship between EF and behavior following frontal lobe lesions. Our main goal of this study was to use a novel statistical method, graph theory, to analyze this relationship in different brain injury groups; frontal lobe damage, non‐frontal lobe damage, and controls. Within the frontal group, we expect to find a pattern of executive nodes that are highly interconnected.MethodsFor each group, we modeled the relationship between executive functions and behavior as a network of interdependent variables. The cognitive tests and the behavioral questionnaire are the “nodes” in the network, while the relationships between the nodes were modeled as the correlations between two nodes corrected for the correlation with all other nodes in the network. Sparse networks were estimated within each group using graphical LASSO. We analyzed the relative importance of the nodes within a network (centrality) and the clustering (modularity) of the different nodes.ResultsNetwork analysis showed distinct patterns of relationships between EF and behavior in the three subgroups. The performance on the verbal learning test is the most central node in all the networks. In the frontal group, verbal memory forms a community with working memory and fluency. The behavioral nodes do not differentiate between groups or form clusters with cognitive nodes. No other communities were found for cognitive and behavioral nodes.ConclusionThe cognitive phenotype of the frontal lobe damaged group, with its stability and proportion, might be theoretically interpreted as a potential “buffer” for possible cognitive executive deficits. This might explain some of the ambiguity found in the literature. This alternative approach on cognitive test scores provides a different and possibly complimentary perspective of the neuropsychology of brain‐injured patients.

Highlights

Acquired brain injury (ABI) is a broad term to indicate brain injury after birth with different etiology, not including degenerative disor‐ ders such as Alzheimer's, Parkinson's, or Huntington's disease
The question arises why some behavioral problems after acquired brain injury of the frontal cortex do not correlate with executive dysfunction
All patients were outpatients that were referred to this institute because of neuropsy‐ chiatric, social, and/or neuropsychological difficulties, which are ex‐ pected to be a consequence of acquired brain injury

Summary

Introduction

Acquired brain injury (ABI) is a broad term to indicate brain injury after birth with different etiology, not including degenerative disor‐ ders such as Alzheimer's, Parkinson's, or Huntington's disease. The assumption is that in particu‐ lar executive dysfunctions (EF), known to be associated with frontal lobe injury, are responsible for behavioral disturbances (Alvarez & Emory, 2006; Barkley, 2001; Reid‐Arndt, Nehl, & Hinkebein, 2007). These cognitive and behavioral changes after frontal lobe damage are paraphrased as a “dysexecutive syndrome” (Chan, 2001). Conclusion: The cognitive phenotype of the frontal lobe damaged group, with its stability and proportion, might be theoretically interpreted as a potential “buffer” for possible cognitive executive deficits This might explain some of the ambiguity found in the literature. This alternative approach on cognitive test scores provides a differ‐ ent and possibly complimentary perspective of the neuropsychology of brain‐injured patients

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Discussion

Conclusion