Higher Anxiety Symptoms Predict Progressive Hippocampal Atrophy in the Chronic Stages of Moderate to Severe Traumatic Brain Injury

Neurorehabil Neural Repair. 2017 Dec;31(12):1063-1071. doi: 10.1177/1545968317736817. Epub 2017 Nov 19.


Background: In the chronic stages of moderate-severe traumatic brain injury (TBI), progressive hippocampal volume loss-continuing well after acute neurological insults have resolved-has now been well documented. Previous research in other populations suggests that elevated anxiety symptoms are associated with compromise to the medial temporal lobes.

Objective: To examine whether higher anxiety symptoms predict greater hippocampal volume loss in moderate-severe TBI.

Methods: We conducted an analysis of prospectively collected, longitudinal behavioral and magnetic resonance imaging (MRI) data from 5 to 12 to 30 months post-injury. Eighty participants were included in the study, with anxiety symptom and MRI data collected at a minimum of 2 time points. Correlational and bivariate latent difference score (with imputation) analyses were used to examine the relationship of Beck Anxiety Inventory scores with hippocampal volume loss, while controlling for depressive symptoms and total brain volume.

Results: Analyses revealed that higher anxiety symptoms at 5 and at 12 months following moderate-severe TBI predicted significant later volume loss in the right hippocampal complex and the right hippocampal head. Right hippocampal volume and volume change did not predict subsequent anxiety scores or anxiety change scores.

Conclusions: These novel findings implicate anxiety symptoms as a possible predictor of progressive hippocampal volume loss in the chronic stages of moderate-severe TBI.

Keywords: anxiety; hippocampal atrophy; neurodegeneration; rehabilitation; traumatic brain injury.

MeSH terms

  • Adult
  • Anxiety / diagnostic imaging*
  • Atrophy
  • Brain Injuries, Traumatic / diagnostic imaging*
  • Brain Injuries, Traumatic / pathology
  • Brain Injuries, Traumatic / psychology*
  • Brain Injuries, Traumatic / rehabilitation
  • Chronic Disease
  • Disease Progression
  • Female
  • Functional Laterality
  • Hippocampus / diagnostic imaging*
  • Hippocampus / pathology
  • Humans
  • Longitudinal Studies
  • Magnetic Resonance Imaging
  • Male
  • Organ Size
  • Prognosis
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Severity of Illness Index