Combining ecological momentary assessment and diffusion MRI in patients with traumatic brain injury
Poster No:
137
Submission Type:
Abstract Submission
Authors:
Karen Caeyenberghs1, Jake Burnett1, Annalee Cobden1, Hamed Akhlaghi2, Juan Dominguez1
Institutions:
1Deakin University, Burwood, Victoria, 2St Vincent's Hospital, Melbourne, Victoria
First Author:
Co-Author(s):
Introduction:
Symptoms (such as mental health issues and cognitive deficits) fluctuate over time and are subject to daily rhythms and varying contexts in patients with mild traumatic brain injury (mTBI) (e.g., Elbin et al., 2022). However, assessments of behavioral outcomes are often limited to a single test session and are frequently conducted in lab-based environments. Characterization of behavioral deficits therefore typically lacks reliability, robustness, sensitivity to natural variation and ecological validity, which may, in turn, explain difficulties in identifying biomarkers of symptoms in mTBI. Complementing neuroimaging with ecological momentary assessment (EMA), which involves short daily assessments completed in the participant's own environment, may improve our capacity to unveil the neurobiological underpinnings of symptoms in mTBI patients (McGowan et al., 2023). In the present study, we have combined EMA and diffusion magnetic resonance imaging (dMRI) to explore daily symptom dynamics and their underling neural basis in mTBI.
Methods:
11 patients who sustained mTBI approximately 1 year prior to testing (M = 360 days, SD = 83.59) (age range = 26 to 61, Mage = 40.27 [SD = 11.93]; 5 females) and 22 healthy controls (age range = 21 to 57 years; Mage = 34.36 [SD = 10.90]; 11 females) were recruited. Post-concussive symptoms (including emotional symptoms, cognitive symptoms, and somatic symptoms) and cognitive performance (including attention, working memory and executive functioning) were assessed for 30 days (1 session/day, 8min/session) using our in-house developed EMA smartphone app (MindTrax). Intraindividual variability of the different EMA variables were calculated as the intra-individual standard deviation (iSD), with a higher iSD indicating greater variability. Multi-shell diffusion weighted imaging [1.8mm isotropic voxels; TE/TR = 98ms/3275ms; multiband acceleration factor = 4; b-values = 0, 1600, 5000 with 8 / 25 / 64 volumes] was acquired on a 3T Siemens PRISMA scanner with a 64-channel head coil. Fixel-based analysis (FBA), an advanced dMRI analysis technique (D'Hollander et al., 2021), was used to compute specific markers of white matter fibre density (FD) and morphology (fibre cross-section, FC) of the superior longitudinal fasciculus (SLF).
Results:
Overall, mTBI patients completed an average of 76.06% (SD = 14.66) EMA sessions (SD = 10.84), with similar compliance rates observed in the HC group (M = 79.24%, SD = 10.63). Our results revealed that mTBI patients exhibited higher iSD in EMA daily cognitive measures (p's < 0.05 for the working memory and processing speed tasks, moderate effect sizes rpb = 0.34-0.49) and higher iSD in emotional symptom and total post-concussion symptom measures (p's < 0.05, moderate effect sizes, rpb = 0.35-0.42). Also, daily intraindividual variability in cognitive performance was correlated with daily fluctuations in post-concussive symptoms in the mTBI group. For example, iSD in RT of the processing speed EMA task was positively associated with iSD in somatic symptoms (r = 0.62, p = .04). Our FBA analysis revealed that mTBI patients had reduced FD (pFWE = .02) and FDC values (pFWE = .04) in the left superior longitudinal fasciculus-II (SLF-II) compared to controls (average reductions of 30% for FD and 38% for FDC; see Figure 1). Finally, higher iSD in visual working memory performance was negatively associated with lower FD values in the bilateral SLF-I (r = -0.82) and right SLF-II (r = -0.85) in the HC group (p's <.01).
·Figure 1
Conclusions:
Our findings suggest that mTBI results in fluctuations in cognitive performance, even in the chronic phase of injury. In addition, the white matter organization of a major fronto-parietal tract seems to play an important role in supporting the consistency of cognitive performance over time, highlighting its potential as a biomarker for understanding cognitive dynamics in healthy adults and clinical populations.
Disorders of the Nervous System:
Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s) 1
Higher Cognitive Functions:
Executive Function, Cognitive Control and Decision Making
Learning and Memory:
Working Memory
Modeling and Analysis Methods:
Diffusion MRI Modeling and Analysis 2
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
White Matter Anatomy, Fiber Pathways and Connectivity
Keywords:
ADULTS
DISORDERS
Memory
MRI
Tractography
Trauma
White Matter
WHITE MATTER IMAGING - DTI, HARDI, DSI, ETC
1|2Indicates the priority used for review
Abstract Information
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Healthy subjects only or patients (note that patient studies may also involve healthy subjects):
Was this research conducted in the United States?
Were any human subjects research approved by the relevant Institutional Review Board or ethics panel? NOTE: Any human subjects studies without IRB approval will be automatically rejected.
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Provide references using APA citation style.
Elbin, R.J. (2022). Ambulatory Assessment in Concussion Clinical Care and Rehabilitation. Frontiers in Digital Health, 4, 924965.
McGowan, A.L. (2023). Dense Sampling Approaches for Psychiatry Research: Combining Scanners and Smartphones. Biological psychiatry, 93(8), 681–689.