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Elevated Intraindividual Variability in Executive Functions and Associations with White Matter Microstructure in Veterans with Mild Traumatic Brain Injury

Published online by Cambridge University Press:  24 September 2020

Scott F. Sorg Open the ORCID record for Scott F. Sorg [Opens in a new window] ,
Victoria C. Merritt Open the ORCID record for Victoria C. Merritt [Opens in a new window] ,
Alexandra L. Clark ,
Madeleine L. Werhane ,
Kelsey A. Holiday ,
Dawn M. Schiehser ,
Mark Bondi  and
Lisa Delano-Wood
Scott F. Sorg
Affiliation:
Psychology and Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
Victoria C. Merritt
Affiliation:
Psychology and Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Alexandra L. Clark
Affiliation:
Psychology and Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Madeleine L. Werhane
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
Kelsey A. Holiday
Affiliation:
San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
Dawn M. Schiehser
Affiliation:
Psychology and Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Mark Bondi
Affiliation:
Psychology and Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
Lisa Delano-Wood*
Affiliation:
Psychology and Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
*
*Correspondence and reprint requests to: Lisa Delano-Wood, Ph.D., VA San Diego Healthcare System (151B), 3350 La Jolla Village Drive, San Diego, CA92161, USA. Email: [email protected]
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Abstract

Objective:

We examined whether intraindividual variability (IIV) across tests of executive functions (EF-IIV) is elevated in Veterans with a history of mild traumatic brain injury (mTBI) relative to military controls (MCs) without a history of mTBI. We also explored relationships among EF-IIV, white matter microstructure, and posttraumatic stress disorder (PTSD) symptoms.

Method:

A total of 77 Veterans (mTBI = 43, MCs = 34) completed neuropsychological testing, diffusion tensor imaging (DTI), and PTSD symptom ratings. EF-IIV was calculated as the standard deviation across six tests of EF, along with an EF-Mean composite. DSI Studio connectometry analysis identified white matter tracts significantly associated with EF-IIV according to generalized fractional anisotropy (GFA).

Results:

After adjusting for EF-Mean and PTSD symptoms, the mTBI group showed significantly higher EF-IIV than MCs. Groups did not differ on EF-Mean after adjusting for PTSD symptoms. Across groups, PTSD symptoms significantly negatively correlated with EF-Mean, but not with EF-IIV. EF-IIV significantly negatively correlated with GFA in multiple white matter pathways connecting frontal and more posterior regions.

Conclusions:

Veterans with mTBI demonstrated significantly greater IIV across EF tests compared to MCs, even after adjusting for mean group differences on those measures as well as PTSD severity. Findings suggest that, in contrast to analyses that explore effects of mean performance across tests, discrepancy analyses may capture unique variance in neuropsychological performance and more sensitively capture cognitive disruption in Veterans with mTBI histories. Importantly, findings show that EF-IIV is negatively associated with the microstructure of white matter pathways interconnecting cortical regions that mediate executive function and attentional processes.

Keywords

Brain concussionTBIMild TBImTBICognitionAssessmentPatient outcomediffusion tensor imagingNeuroimagingExecutive control
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 27 , Issue 4 , April 2021 , pp. 305 - 314
Copyright
Copyright © INS. Published by Cambridge University Press, 2020

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