title: Neural activation during response inhibition differentiates blast from mechanical causes of mild to moderate traumatic brain injury.
abstract: Military personnel involved in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) commonly experience blast-induced mild to moderate traumatic brain injury (TBI). In this study, we used task-activated functional MRI (fMRI) to determine if blast-related TBI has a differential impact on brain activation in comparison with TBI caused primarily by mechanical forces in civilian settings. Four groups participated: (1) blast-related military TBI (milTBI; n=21); (2) military controls (milCON; n=22); (3) non-blast civilian TBI (civTBI; n=21); and (4) civilian controls (civCON; n=23) with orthopedic injuries. Mild to moderate TBI (MTBI) occurred 1 to 6 years before enrollment. Participants completed the Stop Signal Task (SST), a measure of inhibitory control, while undergoing fMRI. Brain activation was evaluated with 2 (mil, civ)×2 (TBI, CON) analyses of variance, corrected for multiple comparisons. During correct inhibitions, fMRI activation was lower in the TBI than CON subjects in regions commonly associated with inhibitory control and the default mode network. In contrast, inhibitory failures showed significant interaction effects in the bilateral inferior temporal, left superior temporal, caudate, and cerebellar regions. Specifically, the milTBI group demonstrated more activation than the milCON group when failing to inhibit; in contrast, the civTBI group exhibited less activation than the civCON group. Covariance analyses controlling for the effects of education and self-reported psychological symptoms did not alter the brain activation findings. These results indicate that the chronic effects of TBI are associated with abnormal brain activation during successful response inhibition. During failed inhibition, the pattern of activation distinguished military from civilian TBI, suggesting that blast-related TBI has a unique effect on brain function that can be distinguished from TBI resulting from mechanical forces associated with sports or motor vehicle accidents. The implications of these findings for diagnosis and treatment of TBI are discussed.
authors.affiliation: 1 Geriatric Research Education and Clinical Center (GRECC), Wm. S. Middleton Memorial Veterans Affairs Hospital , Madison, Wisconsin.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Fischer
authors.forename: Michael
authors.initials: M
authors.lastname: Parsons
authors.forename: Sally
authors.initials: S
authors.lastname: Durgerian
authors.forename: Christine
authors.initials: C
authors.lastname: Reece
authors.forename: Lyla
authors.initials: L
authors.lastname: Mourany
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Lowe
authors.forename: Erik B
authors.initials: EB
authors.lastname: Beall
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Koenig
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Jones
authors.forename: Mary R
authors.initials: MR
authors.lastname: Newsome
authors.forename: Randall S
authors.initials: RS
authors.lastname: Scheibel
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Wilde
authors.forename: Maya
authors.initials: M
authors.lastname: Troyanskaya
authors.forename: Tricia L
authors.initials: TL
authors.lastname: Merkley
authors.forename: Mark
authors.initials: M
authors.lastname: Walker
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Levin
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Rao
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000150:complications / Q000503:physiopathology*; D001921:Brain / Q000378:metabolism* / Q000503:physiopathology*; D001930:Brain Injuries / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D059907:Functional Neuroimaging / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007266:Inhibition, Psychological; D054542:Iraq War, 2003-2011; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D015599:Trauma Severity Indices; D014481:United States; D014728:Veterans / Q000523:psychology*
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