Research Reports - Resting-state functional magnetic resonance imaging activity and connectivity and cognitive outcome in traumatic brain injury

JAMA Neurol. 2013 Jul 1;70(7):845-51

Palacios EM, Sala-Llonch R, Junque C, Roig T, Tormos JM, Bargallo N, Vendrell P

IMPORTANCE The study of brain activity and connectivity at rest provides a unique
opportunity for the investigation of the brain substrates of cognitive outcome
after traumatic axonal injury. This knowledge may contribute to improve clinical
management and rehabilitation programs. OBJECTIVE To study functional magnetic
resonance imaging abnormalities in signal amplitude and brain connectivity at
rest and their relationship to cognitive outcome in patients with chronic and
severe traumatic axonal injury. DESIGN Observational study. SETTING University of
Barcelona and Hospital Clinic de Barcelona, Barcelona, and Institut
Guttmann-Neurorehabilitation Hospital, Badalona, Spain. PARTICIPANTS Twenty
patients with traumatic brain injury (TBI) were studied, along with 17 matched
healthy volunteers. INTERVENTIONS Resting-state functional magnetic resonance
imaging and diffusion tensor imaging data were acquired. After exploring group
differences in amplitude of low-frequency fluctuations (ALFF), we studied
functional connectivity within the default mode network (DMN) by means of
independent component analysis, followed by a dual regression approach and
seed-based connectivity analyses. Finally, we performed probabilistic
tractography between the frontal and posterior nodes of the DMN. MAIN OUTCOMES
AND MEASURES Signal amplitude and functional connectivity during the resting
state, tractography related to DMN, and the association between signal amplitudes
and cognitive outcome. RESULTS Patients had greater ALFF in frontal regions,
which was correlated with cognitive performance. Within the DMN, patients showed
increased connectivity in the frontal lobes. Seed-based connectivity analyses
revealed augmented connectivity within surrounding areas of the frontal and left
parietal nodes of the DMN. Fractional anisotropy of the cingulate tract was
correlated with increased connectivity of the frontal node of the DMN in patients
with TBI. CONCLUSIONS AND RELEVANCE Increased ALFF is related to better cognitive
performance in chronic TBI. The loss of structural connectivity produced by
damage to the cingulum tract explained the compensatory increases in functional
connectivity within the frontal node of the DMN.

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