Deep white matter hyperintensities affect verbal memory independent of PTSD symptoms in veterans with mild traumatic brain injury

Brain Inj. 2016;30(7):864-71. doi: 10.3109/02699052.2016.1144894. Epub 2016 Apr 8.


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.

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.

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / diagnostic imaging*
  • Brain Injuries, Traumatic / psychology
  • Cognition / physiology
  • Female
  • Humans
  • Injury Severity Score
  • Magnetic Resonance Imaging
  • Male
  • Memory / physiology*
  • Neuropsychological Tests
  • Organ Size
  • Stress Disorders, Post-Traumatic / complications
  • Stress Disorders, Post-Traumatic / diagnostic imaging*
  • Stress Disorders, Post-Traumatic / psychology
  • Veterans / psychology*
  • White Matter / diagnostic imaging*
  • Young Adult