Early metabolic crisis-related brain atrophy and cognition in traumatic brain injury
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ORIGINAL RESEARCH
Early metabolic crisis-related brain atrophy and cognition in traumatic brain injury Matthew J. Wright & David L. McArthur & Jeffry R. Alger & Jack Van Horn & Andrei Irimia & Maria Filippou & Thomas C. Glenn & David A. Hovda & Paul Vespa
# Springer Science+Business Media New York 2013
Abstract Traumatic brain injury often results in acute metabolic crisis. We recently demonstrated that this is associated with chronic brain atrophy, which is most prominent in the frontal and temporal lobes. Interestingly, the neuropsychological profile of traumatic brain injury is often characterized as ‘frontal-temporal’ in nature, suggesting a possible link between acute metabolic crisis-related brain atrophy and neurocognitive impairment in this population. While focal lesions and diffuse axonal injury have a well-established role in the neuropsychological deficits observed following traumatic brain injury, no studies to date have examined the possible contribution of acute metabolic crisis-related atrophy in the neuropsychological sequelae of traumatic brain injury. In the current study we employed positron emission tomography, magnetic resonance imaging, and neuropsychological
M. J. Wright (*) Los Angeles Biomedical Research Institute, Psychology Division, Department of Psychiatry, Harbor-University of California, Los Angeles Medical Center, 1124 W. Carson St., B-4 South (Box 490), Torrance, CA 90502, USA e-mail: [email protected] M. J. Wright Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA D. L. McArthur : M. Filippou : T. C. Glenn : D. A. Hovda : P. Vespa Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA J. R. Alger : J. Van Horn : A. Irimia : P. Vespa Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
assessments to ascertain the relationship between acute metabolic crisis-related brain atrophy and neurocognitive outcome in a sample of 14 right-handed traumatic brain injury survivors. We found that acute metabolic crisis‐related atrophy in the frontal and temporal lobes was associated with poorer attention, executive functioning, and psychomotor abilities at 12 months post-injury. Furthermore, participants with gross frontal and/or temporal lobe atrophy exhibited numerous clinically significant neuropsychological deficits in contrast to participants with other patterns of brain atrophy. Our findings suggest that interventions that reduce acute metabolic crisis may lead to improved functional outcomes for traumatic brain injury survivors. Keywords Traumatic brain injury . Metabolic crisis . Neuropsychology . Brain atrophy . Neuroimaging
Introduction While there is great heterogeneity in the etiology and neuropathology of traumatic brain injury (TBI; National Institutes of Health 1999; Williamson et al. 1996), most cases are associated with acceleration-deceleration forces and result in diffuse axonal injury (DAI; Adams et al. 1989; Adams
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