title: Deep white matter hyperintensities affect verbal memory independent of PTSD symptoms in veterans with mild traumatic brain injury.
abstract: OBJECTIVE
  Although white matter hyperintensity (WMH) pathology has been observed in the context of traumatic brain injury (TBI), the contribution of this type of macrostructural damage to cognitive and/or post-concussive symptomatology (PCS) remains unclear.
  
  
  METHODS
  Sixty-eight Veterans (mTBI = 46, Military Controls [MCs] = 22) with and without history of mild TBI (mTBI) underwent structural MRI and comprehensive cognitive and psychiatric assessment. WMH volume was identified as deep (DWMH) or periventricular (PVWMH) on fluid-attenuated inversion recovery (FLAIR) images.
  
  
  RESULTS
  Group analyses revealed that mTBI history was not associated with increased WMH pathology (p's > 0.05). However, after controlling for post-traumatic stress disorder (PTSD) and intracranial volume, DWMH was associated with reduced short-and long-delayed memory performance within the mTBI group (p's < 0.05). Additionally, after adjusting for PTSD and time since injury, regression analyses revealed that WMH was not associated with self-reported ratings of PCS (p's > 0.05) in the mTBI group.
  
  
  CONCLUSIONS
  The results demonstrate that, in relatively young Veterans with mTBI, DWMH differentially and negatively affects memory performance above and beyond the effects of PTSD symptoms. The findings may help to clarify prior mixed results as well as offer focused treatment implications for Veterans with history of neurotrauma and evidence of macrostructural white matter damage.
authors.affiliation: a San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology , San Diego State University/University of California , San Diego , CA , USA.|b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Clark
authors.affiliation: b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|c Department of Psychiatry , UCSD School of Medicine , San Diego , CA , USA.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Sorg
authors.affiliation: b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|c Department of Psychiatry , UCSD School of Medicine , San Diego , CA , USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Schiehser
authors.affiliation: b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Luc
authors.affiliation: b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|c Department of Psychiatry , UCSD School of Medicine , San Diego , CA , USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Bondi
authors.affiliation: b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sanderson
authors.affiliation: a San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology , San Diego State University/University of California , San Diego , CA , USA.|b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.
authors.forename: Madeleine L
authors.initials: ML
authors.lastname: Werhane
authors.affiliation: b VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|c Department of Psychiatry , UCSD School of Medicine , San Diego , CA , USA.|d Center of Excellence for Stress and Mental Health , VASDHS , San Diego , CA , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Delano-Wood
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology; D003071:Cognition / Q000502:physiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology*; D009483:Neuropsychological Tests; D009929:Organ Size; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology; D014728:Veterans / Q000523:psychology*; D066127:White Matter / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: DWMH; DWML; PCS; PVL; PVWMH; TBI; WMH; WML; White matter hyperintensities; cognition; deep white matter lesions; head trauma; neuropsychology; periventricular lesions; postconcussive symptoms; traumatic brain injury; white matter lesions