Acute pediatric traumatic brain injury severity predicts long-term verbal memory performance through suppression by whit
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ORIGINAL RESEARCH
Acute pediatric traumatic brain injury severity predicts long-term verbal memory performance through suppression by white matter integrity on diffusion tensor imaging Hannah M. Lindsey 1,3 & Sanam J. Lalani 1 & Jonathan Mietchen 1 & Shawn D. Gale 1,2 & Elisabeth A. Wilde 3,4,5,6 & Jessica Faber 4 & Marianne C. MacLeod 4 & Jill V. Hunter 4,6,7 & Zili D. Chu 6,7 & Mary E. Aitken 8 & Linda Ewing-Cobbs 9 & Harvey S. Levin 4,5
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Mediation analysis was used to investigate the role of white matter integrity in the relationship between injury severity and verbal memory performance in participants with chronic pediatric traumatic brain injury (TBI). DTI tractography was used to measure fractional anisotropy (FA) within the corpus callosum, fornix, cingulum bundles, perforant pathways, and uncinate fasciculi. Injury severity was indexed using Glasgow Coma Scale (GCS) scores obtained at the time of the injury. Verbal memory was measured by performance on the long-delay free recall (LDFR) trial of the California Verbal Learning Test–Children’s version. Participants were between the ages of 10–18 and included 21 children with TBI (injured before age 9) and 19 typically-developing children (TDC). Children with TBI showed lower FA across all pathways and poorer LDFR performance relative to TDC. Within the TBI group, mediation analysis revealed neither a significant total effect of GCS on LDFR nor significant direct effects of GCS on LDFR across pathways; however, the indirect effects of GCS on LDFR through FA of the corpus callosum, left perforant pathway, and left uncinate fasciculus were significant and opposite in sign to their respective direct effects. These results suggests that the predictive validity of GCS for LDFR is initially suppressed by the substantial variance accounted for by FA, which is uncorrelated with GCS, and the predictive validity of GCS increases only when FA is considered, and the opposing path is controlled. These findings illustrate the complex associations between acute injury severity, white matter pathways, and verbal memory several years following pediatric TBI. Keywords Pediatric traumatic brain injury . Diffusion tensor imaging tractography . Fractional anisotropy . Injury severity . Verbal memory
Introduction Traumatic brain injury (TBI) is the most common cause of long-term disability in children and adolescents, both in the * Elisabeth A. Wilde [email protected] 1
2
Department of Psychology, Brigham Young University, Provo, UT, USA The Neuroscience Center, Brigham Young University, Provo, UT, USA
3
Department of Neurology, University of Utah, Salt Lake City, UT, USA
4
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
United States and in other countries (Cuff et al. 2007; Dewan et al. 2016). Several studies have investigated the efficacy of pediatric TBI severity indices as predictors of functional outcome and structural imaging, yet the literatur
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