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皮质病变和局灶性白质损伤与慢性创伤性脑损伤的注意力表现相关。

Cortical lesions and focal white matter injury are associated with attentional performance in chronic traumatic brain injury.

作者信息

Snider Samuel B, Gilmore Natalie, Freeman Holly J, Maffei Chiara, Atalay Alexander, Kumar Raj G, Li Lucia M, Shi Hui, Bodien Yelena G, Mac Donald Christine L, Dams-O'Connor Kristen, Edlow Brian L

机构信息

Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

出版信息

Brain Commun. 2024 Nov 21;7(1):fcae420. doi: 10.1093/braincomms/fcae420. eCollection 2025.

Abstract

Cognitive impairment, often due to attentional deficits, is a primary driver of disability after traumatic brain injury. It remains unclear whether attentional deficits are caused by injury to specific brain structures or the total burden of injury. In this cross-sectional, multicentre cohort study, we tested whether the association between brain injury and attentional performance varies by neuroanatomic location. Participants in the late effects of traumatic brain injury study were at least 18 years old and at least 1 year after a mild, moderate or severe traumatic brain injury. They underwent MRI and neuropsychological assessment at one of two sites. The primary and secondary outcomes, each measuring aspects of attentional performance, were the Trails A -score and the standardized score on California Verbal Learning Test 2 Immediate Recall Trial 1. Imaging variables included the size and location (seven regions and seven networks) of encephalomalacic brain lesions and regional white matter fractional anisotropy measured with diffusion MRI (14 regions). We used ANOVA to test whether attentional performance differed by lesion location and linear mixed models to test whether attentional performance differed based on regional fractional anisotropy. One hundred eighty-eight participants met inclusion criteria (mean age 57, 69% male, 88% White). Participants with encephalomalacic brain lesions [ = 73 (39%)] had worse Trails A [mean (95% confidence interval) difference: 4.7 (0.3, 9.1); = 0.036] but not secondary outcome performance [-0.3 (-0.1, 0.7); = 0.17]. Among participants with lesions, Trails A performance did not differ by lesion size ( = 0.07) or location ( = 0.41 by region; = 0.78 by network). We identified a significant interaction between regional fractional anisotropy and attentional performance on both primary ( = 0.001) and secondary ( = 0.001) outcome measures. testing identified the strongest associations with Trails A performance in the sagittal stratum [1 SD decrement in Trails A: -0.2 (-0.3, -0.1) SD change in fractional anisotropy; = 0.0057] and external capsule [-0.1 (-0.2, -0.1); = 0.042] and the strongest association with secondary attentional scores in the corpus callosum [0.2 (0.1, 0.3); = 0.014]. In a multivariate model, white matter integrity in the sagittal stratum ( = 0.008), but not encephalomalacic lesions ( = 0.3), was independently associated with Trails A performance. Diminished white matter integrity and cortical injury were each associated with attentional test performance, but only white matter injury demonstrated independent and region-specific effects. The peak statistical association with attentional test performance was in the sagittal stratum, a widely connected white matter region. Further investigation into the connections spanning this and nearby regions may reveal therapeutic targets for neuromodulation.

摘要

认知障碍通常由注意力缺陷引起,是创伤性脑损伤后导致残疾的主要因素。目前尚不清楚注意力缺陷是由特定脑结构损伤还是损伤的总负担所致。在这项横断面、多中心队列研究中,我们测试了脑损伤与注意力表现之间的关联是否因神经解剖位置而异。创伤性脑损伤后期效应研究的参与者年龄至少18岁,且在轻度、中度或重度创伤性脑损伤后至少1年。他们在两个地点之一接受了磁共振成像(MRI)和神经心理学评估。主要和次要结局均衡量注意力表现的各个方面,分别为连线测验A得分和加利福尼亚言语学习测验第2版即时回忆试验1的标准化得分。成像变量包括脑软化性脑损伤的大小和位置(七个区域和七个网络)以及通过扩散MRI测量的区域白质分数各向异性(14个区域)。我们使用方差分析来测试注意力表现是否因损伤位置而异,并使用线性混合模型来测试注意力表现是否因区域分数各向异性而异。188名参与者符合纳入标准(平均年龄57岁,69%为男性,88%为白人)。有脑软化性脑损伤的参与者[ = 73(39%)]的连线测验A表现较差[平均(95%置信区间)差异:4.7(0.3,9.1); = 0.036],但次要结局表现无差异[-0.3(-0.1,0.7); = 0.17]。在有损伤的参与者中,连线测验A表现不因损伤大小( = 0.07)或位置(按区域 = 0.41;按网络 = 0.78)而异。我们在主要( = 0.001)和次要( = 0.001)结局指标上均发现区域分数各向异性与注意力表现之间存在显著交互作用。检验发现矢状层与连线测验A表现的关联最强[连线测验A降低1个标准差:分数各向异性变化-0.2(-0.3,-0.1)个标准差; = 0.0057],外囊与连线测验A表现的关联次之[-0.1(-0.2,-0.1); = 0.042],胼胝体与次要注意力得分的关联最强[0.2(0.1,0.3); = 0.014]。在多变量模型中,矢状层的白质完整性( = 0.008)而非脑软化性损伤( = 0.3)与连线测验A表现独立相关。白质完整性降低和皮质损伤均与注意力测试表现相关,但只有白质损伤表现出独立的区域特异性效应。与注意力测试表现的峰值统计关联出现在矢状层,这是一个广泛连接的白质区域。对跨越该区域和附近区域的连接进行进一步研究可能会揭示神经调节的治疗靶点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf0a/11806419/7805f2ae8ca5/fcae420_ga.jpg

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