Regional brain volume prior to treatment is linked to outcome after cognitive rehabilitation in traumatic brain injury

Alexander Olsen, Emily L Dennis, Jan Stubberud, Elizabeth S Hovenden, Anne-Kristin Solbakk, Tor Endestad, Per Kristian Hol, Anne-Kristine Schanke, Marianne Løvstad, Sveinung Tornås, Alexander Olsen, Emily L Dennis, Jan Stubberud, Elizabeth S Hovenden, Anne-Kristin Solbakk, Tor Endestad, Per Kristian Hol, Anne-Kristine Schanke, Marianne Løvstad, Sveinung Tornås

Abstract

Cognitive rehabilitation is useful for many after traumatic brain injury (TBI), but we lack critical knowledge about which patients benefit the most from different approaches. Advanced neuroimaging techniques have provided important insight into brain pathology and systems plasticity after TBI, and have potential to inform new practices in cognitive rehabilitation. In this study, we aimed to identify candidate structural brain measures with relevance for rehabilitation of cognitive control (executive) function after TBI. Twenty-eight patients (9 female, mean age 40.5 (SD = 13.04) years) with TBI (>21 months since injury) that participated in a randomized controlled cognitive rehabilitation trial (NCT02692352) were included in the analyses. Regional brain volume was extracted from T1-weighted MRI scans before treatment using tensor-based morphometry. Both positive and negative associations between treatment outcome (everyday cognitive control function) and regional brain volume were observed. The most robust associations between regional brain volume and improvement in function were observed in midline fronto-parietal regions, including the anterior and posterior cingulate cortices. The study provides proof of concept and valuable insight for planning future studies focusing on neuroimaging in cognitive rehabilitation after TBI.

Keywords: Brain injury; Executive function; Magnetic resonance imaging; Personalized treatment; Rehabilitation medicine.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Lesion overlap map. This figure shows the anatomical distribution and overlap of manually segmented lesions visible on the T1 scan. Of the 28 participants included (who all had visible lesions on clinical imaging in the acute/subacute phase), 18 had visible lesions on the baseline (before treatment) T1w scan. Red-yellow scale indicates the degree of overlap between lesions from unique participants.
Fig. 2
Fig. 2
Associations between baseline (before treatment) regional brain volume and BRIEF-GEC score change (Δ). Associations between baseline regional brain volume and BRIEF-GEC score change (Δ), *adjusted for baseline BRIEF-GEC, GCS and TSI. Age and sex were also included as covariates in the model. Analyses were corrected for multiple comparisons across all voxels tested using Searchlight FDR [false discovery rate], q < 0.05 (Langers et al., 2007). BRIEF-GEC = Behavior Rating Inventory of Executive Function - Global Executive Composite. GCS = Glasgow coma scale. TSI = Time since injury.
Fig. 3
Fig. 3
Associations between baseline (before treatment) regional brain volume, GCS and TSI. Associations between baseline regional brain volume, injury severity (GCS) and time since injury (TSI). Age and sex were included as covariates in the model. Analyses were corrected for multiple comparisons across all voxels tested using Searchlight FDR [false discovery rate], q < 0.05 (Langers et al., 2007). GCS = Glasgow coma scale. TSI = Time since injury.
Fig. 4
Fig. 4
Associations between baseline (before treatment) regional brain volume and baseline cognitive control efficacy. Associations between baseline regional brain volume and baseline cognitive control (CC) efficacy. Age and sex were included as covariates in the model. Analyses were corrected for multiple comparisons across all voxels tested using Searchlight FDR [false discovery rate], q < 0.05 (Langers et al., 2007).

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