White Matter Hyperintensities and Mild TBI in Post-9/11 Veterans and Service Members

Authors

David F Tate
Erin D Bigler
Gerald E York
Mary R Newsome
Brian A Taylor
Andrew R Mayer
Mary Jo Pugh
Angela P Presson
Zhining Ou
Elizabeth S Hovenden
Josephine Dimanche
Tracy J Abildskov
Rajan Agarwal
Heather G Belanger
Aaron M Betts
Timothy Duncan
Blessen C Eapen
Carlos A Jaramillo
Michael Lennon
Jennifer E Nathan
Randall S Scheibel
Matthew B Spruiell
William C Walker
Elisabeth A Wilde

Publication Date

11-5-2024

Journal

Military Medicine

Abstract

Introduction: The neurobehavioral significance of white matter hyperintensities (WMHs) seen on magnetic resonance imaging after traumatic brain injury (TBI) remains unclear, especially in Veterans and Service Members with a history of mild TBI (mTBI). In this study, we investigate the relation between WMH, mTBI, age, and cognitive performance in a large multisite cohort from the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium.

Materials and methods: The neuroimaging and neurobehavioral assessments for 1,011 combat-exposed, post-9/11 Veterans and Service Members (age range 22-69 years), including those with a history of at least 1 mTBI (n = 813; median postinjury interval of 8 years) or negative mTBI history (n = 198), were examined.

Results: White matter hyperintensities were present in both mTBI and comparison groups at similar rates (39% and 37%, respectively). There was an age-by-diagnostic group interaction, such that older Veterans and Service Members with a history of mTBI demonstrated a significant increase in the number of WMHs present compared to those without a history of mTBI. Additional associations between an increase in the number of WMHs and service-connected disability, insulin-like growth factor-1 levels, and worse performance on tests of episodic memory and executive functioning-processing speed were found.

Conclusions: Subtle but important clinical relationships are identified when larger samples of mTBI participants are used to examine the relationship between history of head injury and radiological findings. Future studies should use follow-up magnetic resonance imaging and longitudinal neurobehavioral assessments to evaluate the long-term implications of WMHs following mTBI.

Keywords

Humans, Middle Aged, Male, Adult, Female, Veterans, White Matter, Magnetic Resonance Imaging, Aged, Brain Concussion, Military Personnel, Neuropsychological Tests, Cohort Studies, Brain Injuries, Traumatic

DOI

10.1093/milmed/usae336

PMID

39002108

PMCID

PMC11536319

PubMedCentral® Posted Date

7-13-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes