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Fatigue and Cognitive Fatigability in Mild Traumatic Brain Injury are Correlated with Altered Neural Activity during Vigilance Test Performance.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Univ Dept Rehabil Med, Danderyd Hosp, Stockholm, Sweden.; Karolinska Inst, Div Rehabil Med, Dept Clin Sci, Stockholm, Sweden..
Karolinska Univ Hosp Huddinge, Dept Diagnost Med Phys, Stockholm, Sweden.; Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
Univ Dept Rehabil Med, Danderyd Hosp, Stockholm, Sweden.; Karolinska Inst, Div Rehabil Med, Dept Clin Sci, Stockholm, Sweden..
Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
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2017 (English)In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 8, article id 496Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Fatigue is the most frequently reported persistent symptom following a mild traumatic brain injury (mTBI), but the explanations for the persisting fatigue symptoms in mTBI remain controversial. In this study, we investigated the change of cerebral blood flow during the performance of a psychomotor vigilance task (PVT) by using pseudo-continuous arterial spin labeling (PCASL) MRI technique to better understand the relationship between fatigability and brain activity in mTBI.

MATERIAL AND METHODS: Ten patients (mean age: 37.5 ± 11.2 years) with persistent complaints of fatigue after mTBI and 10 healthy controls (mean age 36.9 ± 11.0 years) were studied. Both groups completed a 20-min long PVT inside a clinical MRI scanner during simultaneous measurements of reaction time and regional cerebral blood flow (rCBF) with PCASL technique. Cognitive fatigability and neural activity during PVT were analyzed by dividing the performance and rCBF data into quintiles in addition to the assessment of self-rated fatigue before and after the PVT.

RESULTS: The patients showed significant fatigability during the PVT while the controls had a stable performance. The variability in performance was also significantly higher among the patients, indicating monitoring difficulty. A three-way ANOVA, modeling of the rCBF data demonstrated that there was a significant interaction effect between the subject group and performance time during PVT in a mainly frontal/thalamic network, indicating that the pattern of rCBF change for the mTBI patients differed significantly from that of healthy controls. In the mTBI patients, fatigability at the end of the PVT was related to increased rCBF in the right middle frontal gyrus, while self-rated fatigue was related to increased rCBF in left medial frontal and anterior cingulate gyri and decreases of rCBF in a frontal/thalamic network during this period.

DISCUSSION: This study demonstrates that PCASL is a useful technique to investigate neural correlates of fatigability and fatigue in mTBI patients. Patients suffering from fatigue after mTBI used different brain networks compared to healthy controls during a vigilance task and in mTBI, there was a distinction between rCBF changes related to fatigability vs. perceived fatigue. Whether networks for fatigability and self-rated fatigue are different, needs to be investigated in future studies.

Place, publisher, year, edition, pages
2017. Vol. 8, article id 496
Keywords [en]
cerebral blood flow, fatigue, functional magnetic resonance imaging, mild traumatic brain injury, pseudo-continuous arterial spin labeling
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-332695DOI: 10.3389/fneur.2017.00496ISI: 000411258800001PubMedID: 28983280OAI: oai:DiVA.org:uu-332695DiVA, id: diva2:1153784
Funder
Swedish Research CouncilAvailable from: 2017-10-31 Created: 2017-10-31 Last updated: 2017-12-13Bibliographically approved

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