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Performance on measures of executive function following pediatric traumatic brain injury
Beth S Slomine1, Joan P Gerring, Marco A Grados
1Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD 21205, USA. slomine@kennedykrieger.org
Insights
Younger children with traumatic brain injury (TBI) show worse executive function (EF) outcomes. Lesion location outside the frontal lobes and increased lesion number significantly impact EF performance in pediatric TBI survivors.
Area of Science:
- Neuroscience
- Pediatric Traumatic Brain Injury Research
- Cognitive Psychology
Background:
- Traumatic brain injury (TBI) in children can lead to long-term executive function (EF) deficits.
- Understanding the impact of injury characteristics on EF is crucial for targeted interventions.
Purpose of the Study:
- To examine the correlation between age at injury, lesion location, and executive function (EF) in pediatric TBI.
- To identify neuroanatomic predictors of EF deficits following moderate-to-severe TBI in children.
Main Methods:
- Assessed EF in 68 children (7-15 years) with TBI using tests like the Tower of Hanoi and Wisconsin Card Sorting Test.
- Utilized MRI data to determine lesion location, volume (frontal and extrafrontal), and total lesion count.
- Controlled for pre-injury factors including special education services and ADHD.
Main Results:
- Younger age at injury correlated with poorer performance on measures of problem-solving and word generation.
- Frontal lobe lesion volume did not predict EF outcomes.
- Increased extrafrontal lesion volume and a higher total number of lesions were associated with worse EF, particularly on fluency tasks.
Conclusions:
- Early age at injury increases the risk of executive function impairment after TBI.
- Executive function deficits are influenced by extrafrontal brain regions and the overall burden of injury (total lesion number), not solely frontal lobe damage.
- Extrafrontal lesions may disrupt cognitive processes mediated by parietal or temporal lobes, impacting EF, while multiple lesions may cause system-wide disconnections.
Objective:
To investigate the relationships among age at injury, neuroanatomic lesion location, and measures of executive function (EF) following paediatric traumatic brain injury (TBI).
Methods:
EF was assessed in 68 children (aged 7-15) with moderate-to-severe TBI 1 year post-injury. EF tests included: (1) Tower of Hanoi (TOH), a measure of problem solving ability, (2) Wisconsin Card Sorting Test (WCST), a measure of categorization and ability to shift cognitive strategies, (3) Letter Fluency (LF), a measure of novel lexical search and rule-governed word generation. EF variables included number of moves needed to achieve a 3-ring solution on the TOH, number of perseverative and non-perseverative errors on the WCST, and number of words generated on LF. Intellectual functioning was also assessed using the Verbal Intellectual Quotient (VIQ) from the Wechsler Intelligence Scale from Children-3rd edn (WISC-III). Data from standardized MRIs, performed at 3-months post-injury, were available for all subjects and were used to determine lesion location, lesion volumes, and total number of lesions. The relationships among EF, lesion variables (frontal lesion volume, extrafrontal lesion volume, total number of lesions) and age at injury were examined. Pre-injury special education services and attention deficit hyperactivity disorder (ADHD) were controlled for.
Results:
Younger age at injury was associated with more perseverative errors on the WCST and worse performance on LF. Frontal lesion volume was not predictive of performance on any measures of EF. Greater extrafrontal lesion volume and total number of lesions were predictive of worse performance on LF. When controlling for pre-injury special education placement and pre-injury ADHD, there was little change in the results.
Conclusions:
Younger age at injury places children at greater risk of impairment on measures of EF. Performance on measures of EF depends on brain variables other than frontal lobes including extrafrontal cortical brain areas and total number of lesions. The relationship between extrafrontal brain regions and EF suggests that domain-specific cognitive content (i.e. language or visuospatial analysis), mediated by the parietal or temporal lobes, may disrupt underlying cognitive processes necessary for successful performance on measures of EF. In addition, the association between total number of lesions and EF may be related to disconnections and disruption of frontal/subcortical systems.
