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Sex Differences in Working Memory after Mild Traumatic Brain Injury: A Functional MR Imaging Study
Hui-Ling Hsu1, David Yen-Ting Chen1, Ying-Chi Tseng1
1From the Department of Diagnostic Radiology and Brain and Consciousness Research Center, Taipei Medical University Shuang-Ho Hospital, No. 291, Jhong-Jheng Road, 235 Jhonghe District, New Taipei City, Taiwan, ROC.
Purpose:
To evaluate sex differences in mild traumatic brain injury (MTBI) with working memory functional magnetic resonance (MR) imaging.
Materials And Methods:
Research ethics committee approval and patient written informed consent were obtained. Working memory brain activation patterns were assessed with functional MR imaging in 30 patients (15 consecutive men and 15 consecutive women) with MTBI and 30 control subjects (15 consecutive men and 15 consecutive women). Two imaging studies were performed in patients: the initial study, which was performed within 1 month after the injury, and a follow-up study, which was performed 6 weeks after the first study. For each participant, digit span and continuous performance testing were performed before functional MR imaging. Clinical data were analyzed by using Kruskal-Wallis, Mann-Whitney U, Wilcoxon signed rank, and Fisher exact tests. Within- and between-group differences of functional MR imaging data were analyzed with one- and two-sample t tests, respectively.
Results:
Among female participants, the total digit span score was lower in the MTBI group than in the control group (P = .044). In initial working memory functional MR imaging studies, hyperactivation was found in the male MTBI group and hypoactivation was found in the female MTBI group compared with control male and female groups, respectively. At the 6-week follow-up study, the female MTBI group showed persistent hypoactivation, whereas the male MTBI group showed a regression of hyperactivation at visual comparison of activation maps. The male MTBI group was also found to have a higher initial ß value than the male control group (P = .040), and there was no significant difference between the male MTBI group and the male control group (P = .221) at follow-up evaluation, which was comparable to findings on activation maps. In the female MTBI group, average ß values at both initial and follow-up studies were lower compared with those in the female control group but were not statistically significant (P = .663 and P = .191, respectively).
Conclusion:
Female patients with MTBI had lower digit span scores than did female control subjects, and functional MR imaging depicted sex differences in working memory functional activation; hypoactivation with nonrecovery of activation change at follow-up studies may suggest a worse working memory outcome in female patients with MTBI.
Insights
Mild traumatic brain injury (MTBI) affects working memory differently in men and women. Women with MTBI showed poorer working memory activation on functional MRI, with no improvement over time.
Area of Science:
- Neuroscience
- Radiology
- Psychology
Background:
- Mild traumatic brain injury (MTBI) can impact cognitive functions, including working memory.
- Sex-based differences in brain injury outcomes are increasingly recognized.
- Functional magnetic resonance imaging (fMRI) offers insights into brain activity patterns.
Purpose of the Study:
- To investigate sex-specific differences in working memory function after MTBI using fMRI.
- To compare brain activation patterns between male and female MTBI patients and controls.
Main Methods:
- Functional MRI assessed working memory activation in 30 MTBI patients (15 men, 15 women) and 30 controls.
- Two fMRI scans were performed on patients: within 1 month and 6 weeks post-injury.
- Cognitive tests (digit span, continuous performance) were administered before fMRI.
Main Results:
- Female MTBI patients had lower digit span scores than controls.
- Initial fMRI showed hyperactivation in male MTBI patients and hypoactivation in female MTBI patients compared to respective controls.
- Female MTBI patients exhibited persistent hypoactivation at follow-up, while male MTBI patients showed reduced hyperactivation.
Conclusions:
- Sex differences exist in working memory activation patterns following MTBI.
- Persistent hypoactivation in female MTBI patients suggests a potentially worse long-term working memory outcome.
- fMRI reveals distinct neural responses to working memory tasks in male versus female MTBI populations.
