Karr Justin E, Powell David K, White Agnes E, Leong Sharon E, Maisel Michael T, Bahrani Ahmed A
Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, USA.
Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, Kentucky, USA.
J Neurotrauma. 2025 Jul 21. doi: 10.1177/08977151251360777.
Many women survivors of intimate partner violence (IPV) experience traumatic brain injury (TBI) due to physical violence, with a large portion of these women exposed to repetitive IPV-TBI. Limited research has examined neurological outcomes following repetitive IPV-TBI among survivors. The few existing studies have observed both structural and functional effects on neuroimaging. This pilot investigation is the first case-control study to assess differences in white matter between women survivors of IPV with and without repetitive IPV-TBI history. Participants underwent diffusion tensor imaging (DTI) and cognitive testing to compare white matter integrity between groups and assess the association between white matter integrity and fluid cognitive functioning. Participants were recruited from shelters, IPV service organizations, and the local community in Kentucky, USA. The final sample included 11 women with repetitive IPV-TBI (mean [M] = 34.2 years old, standard deviation [SD] = 7.3; 54.5% White; 81.8% with ≥12 years of education) and 11 women survivors without IPV-TBI history (M = 28.4 years old, SD = 9.7; 72.7% White; 90.9% with ≥12 years of education). Women completed the Brain Injury Screening Questionnaire, NIH Toolbox Cognition Battery, and DTI. Women with and without repetitive IPV-TBI were compared using tract-based spatial statistics (TBSS), which involved voxel-wise comparisons of fractional anisotropy (i.e., estimating white matter integrity) across groups using threshold-free cluster enhancement. Group differences in the corpus callosum, primarily posterior, and anterior thalamic radiation, primarily left, were noted. Lower white matter integrity was associated with reduced fluid cognitive functioning in the full sample among clusters that differed across groups ( = -0.44, = 0.040), but this association was nonsignificant when stratified by group (repetitive IPV-TBI: = -0.37, = 0.259; no IPV-TBI: = 0.06, = 0.873). Results from this case-control study suggest that repetitive IPV-TBI history corresponded with lower white matter integrity, most prominently in the posterior corpus callosum. Lower white matter integrity also correlated with reduced fluid cognitive ability across the study sample, regardless of IPV-TBI status. Despite a small sample size and cross-sectional design, this study builds on early neuroimaging research on IPV-TBI, further documenting the physical neurological effects of repetitive IPV-TBI among women survivors. Future research on IPV-TBI should assess whether white matter integrity among survivors corresponds with functional impairment, remains stable or progressive over time, or responds to intervention to improve brain health in this community.
许多亲密伴侣暴力（IPV）的女性幸存者因身体暴力而遭受创伤性脑损伤（TBI），其中很大一部分女性遭受过重复性IPV-TBI。有限的研究调查了幸存者中重复性IPV-TBI后的神经学结果。现有的少数研究观察到了神经影像学上的结构和功能影响。这项初步调查是第一项病例对照研究，旨在评估有和没有重复性IPV-TBI病史的IPV女性幸存者之间白质的差异。参与者接受了扩散张量成像（DTI）和认知测试，以比较两组之间的白质完整性，并评估白质完整性与流体认知功能之间的关联。参与者从美国肯塔基州的庇护所、IPV服务组织和当地社区招募。最终样本包括11名有重复性IPV-TBI的女性（平均年龄[M]=34.2岁，标准差[SD]=7.3；54.5%为白人；81.8%接受过≥12年教育）和11名没有IPV-TBI病史的女性幸存者（M=28.4岁，SD=9.7；72.7%为白人；90.9%接受过≥12年教育）。女性完成了脑损伤筛查问卷、美国国立卫生研究院工具箱认知电池和DTI。使用基于束的空间统计学（TBSS）对有和没有重复性IPV-TBI的女性进行比较，该方法涉及使用无阈值聚类增强对各组之间的分数各向异性（即估计白质完整性）进行体素级比较。注意到胼胝体（主要是后部）和丘脑前辐射（主要是左侧）存在组间差异。在各组之间存在差异的簇中，较低的白质完整性与整个样本中流体认知功能的降低相关（r=-0.44，p=0.040），但按组分层时这种关联不显著（重复性IPV-TBI：r=-0.37，p=0.259；无IPV-TBI：r=0.06，p=0.873）。这项病例对照研究的结果表明，重复性IPV-TBI病史与较低的白质完整性相对应，最明显的是在胼胝体后部。无论IPV-TBI状态如何，较低的白质完整性也与整个研究样本中流体认知能力的降低相关。尽管样本量小且为横断面设计，但本研究建立在对IPV-TBI的早期神经影像学研究基础上，进一步记录了重复性IPV-TBI对女性幸存者的身体神经学影响。未来关于IPV-TBI的研究应评估幸存者中的白质完整性是否与功能损害相对应、随时间保持稳定或进展，或对改善该社区脑健康的干预措施有反应。
