Neuroimaging correlates of novel psychiatric disorders after pediatric traumatic brain injury
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Published on: February 7, 2025
Jeffrey E Max1, Elisabeth A Wilde, Erin D Bigler
1University of California-San Diego, San Diego, CA 92123, USA. jmax@ucsd.edu
Insights
New-onset psychiatric disorders are more common after traumatic brain injury (TBI) than orthopedic injury (OI). Lowered white matter integrity, not injury severity or gray matter changes, is linked to these disorders following TBI.
Area of Science:
- Neuroscience
- Psychiatry
- Radiology
Background:
- Novel psychiatric disorders (NPD) can arise after injury.
- Understanding the neurobiological underpinnings of NPD post-injury is crucial.
Purpose of the Study:
- To investigate magnetic resonance imaging (MRI) correlates of NPD following traumatic brain injury (TBI) and orthopedic injury (OI) in adolescents.
- To compare MRI findings between TBI and OI groups who develop NPD.
Main Methods:
- Prospective, longitudinal study of 88 participants (ages 7-17) hospitalized for TBI or OI.
- Standardized psychiatric assessments at baseline and 3 months post-injury.
- MRI including diffusion tensor imaging (DTI) for fractional anisotropy (FA), volumetric, and cortical thickness measures.
Main Results:
- NPD occurred significantly more often in the TBI group (48%) than the OI group (14%).
- Lower fractional anisotropy (FA) in white matter regions was significantly associated with NPD in TBI patients.
- NPD occurrence was not related to injury severity, lesion volume, or gray/white matter volume changes.
Conclusions:
- White matter integrity, specifically reduced FA, appears critical in the pathophysiology of NPD after TBI.
- Gray matter volume, lesion size, and cortical thickness are less associated with NPD development post-injury.
- These findings highlight the importance of white matter integrity in psychiatric sequelae of TBI.
Objective:
To study magnetic resonance imaging (MRI) correlates of novel (new-onset) psychiatric disorders (NPD) after traumatic brain injury (TBI) and orthopedic injury (OI).
Method:
Participants were 7 to 17 years of age at the time of hospitalization for either TBI or OI. The study used a prospective, longitudinal, controlled design with standardized psychiatric assessments conducted at baseline (reflecting pre-injury function) and 3 months post-injury. MRI assessments including diffusion tensor imaging (DTI)-derived fractional anisotropy (FA), volumetric measures of gray and white matter regions, volumetric measures of lesions, and cortical thickness were conducted. Injury severity was assessed by standard clinical scales. The outcome measure was the presence of an NPD identified during the first 3 months after injury.
Results:
There were 88 participants (TBI, 44; OI, 44). NPD occurred more frequently in the TBI (21/44; 48%) versus the OI (6/44; 14%) group (Fisher's exact test, p = .001). NPD in TBI participants was not related to injury severity. Multivariate analysis of covariance of the relationship between FA in hypothesized regions of interest (bilateral frontal and temporal lobes, bilateral centrum semiovale, bilateral uncinate fasciculi) and NPD and group (TBI versus OI) was significant, and both variables (NPD, p < .05; group, p < .001) were jointly significantly related to FA. NPD was not significantly related to volumetric measures of white or gray matter structures, volumetric measures of lesions, or cortical thickness measures.
Conclusions:
Lowered white matter integrity may be more important in the pathophysiology of NPD than indices of gray matter or white matter atrophic changes, macroscopic lesions, and injury severity.
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