Karbasforoushan Haleh, Wren-Jarvis Jamie, Hwang Anna, Santiago Rachel, Raptentsetsang Sky, Cai Lanya T, Xiao Jaclyn, Maruyama Brian A, Abrams Gary M, Novakovic-Agopian Tatjana, Mukherjee Pratik
Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA.
Departments of Radiology and Neurology, School of Medicine, University of California, San Francisco, USA.
J Neurotrauma. 2025 Jan;42(1-2):46-56. doi: 10.1089/neu.2023.0229. Epub 2024 Oct 29.
Impaired attention is one of the most common, debilitating, and persistent consequences of traumatic brain injury (TBI), which impacts overall cognitive and executive functions in these patients. Previous neuroimaging studies, trying to understand the neural mechanism underlying attention impairment post TBI, have highlighted the role of prefrontal white matter tracts in attentional functioning in mild TBI (mTBI). Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training program that targets executive control functions in participants by applying mindfulness-based attention regulation and goal management strategies. GOALS training has been demonstrated to improve attention and executive functioning in patients with chronic TBI. However, its impact on microstructural integrity of attention-associated prefrontal white matter tracts is still unclear. Here, using diffusion magnetic resonance imaging in a pilot randomized controlled trial, we investigated the effect of GOALS training on prefrontal white matter microstructure in 19 U.S. military veterans with chronic mTBI, compared with a matched control group of 14 veterans with chronic mTBI who received standard of care brain health education. We also tested for an association between microstructural white matter changes and sustained attention ability in these patients pre- and post-GOALS training. Our results show significantly better white matter microstructural integrity in left and right anterior corona radiata (ACR) in the GOALS group compared with the control group post-training. Moreover, we found a significant correlation between sustained attention ability of GOALS training participants and white matter integrity of their right ACR pre- and post-training. Finally, our findings indicated that the improved white matter integrity of the ACR in GOALS training participants was the result of increased neurite density and decreased fiber orientation dispersion within this tract.
注意力受损是创伤性脑损伤（TBI）最常见、最使人衰弱且持续存在的后果之一，它会影响这些患者的整体认知和执行功能。以往的神经影像学研究试图了解TBI后注意力受损的神经机制，这些研究强调了前额叶白质束在轻度TBI（mTBI）注意力功能中的作用。目标导向性注意力自我调节（GOALS）是一种认知康复训练项目，通过应用基于正念的注意力调节和目标管理策略来针对参与者的执行控制功能。GOALS训练已被证明可以改善慢性TBI患者的注意力和执行功能。然而，其对与注意力相关的前额叶白质束微观结构完整性的影响仍不清楚。在此，在一项初步随机对照试验中，我们使用扩散磁共振成像，研究了GOALS训练对19名患有慢性mTBI的美国退伍军人前额叶白质微观结构的影响，并与14名接受标准脑健康护理教育的患有慢性mTBI的退伍军人匹配对照组进行了比较。我们还测试了这些患者在GOALS训练前后白质微观结构变化与持续注意力能力之间的关联。我们的结果显示，与训练后的对照组相比，GOALS组左右前放射冠（ACR）的白质微观结构完整性明显更好。此外，我们发现GOALS训练参与者的持续注意力能力与训练前后其右侧ACR的白质完整性之间存在显著相关性。最后，我们的研究结果表明，GOALS训练参与者ACR白质完整性的改善是该区域神经突密度增加和纤维方向离散度降低的结果。
