Self-reported Fatigue was Associated with Increased White-matter Alterations in Long-term Traumatic Brain Injury and Posttraumatic Stress Disorder Patients

Abdalla Z Mohamed; Jim Lagopoulos; Fatima A Nasrallah; Zack Shan; Department of Defense Alzheimer's Disease Neuroimaging Initiative

doi:10.1016/j.neuroscience.2023.03.029

Self-reported Fatigue was Associated with Increased White-matter Alterations in Long-term Traumatic Brain Injury and Posttraumatic Stress Disorder Patients

Neuroscience. 2023 Jun 1:520:46-57. doi: 10.1016/j.neuroscience.2023.03.029. Epub 2023 Apr 18.

Authors

Abdalla Z Mohamed¹, Jim Lagopoulos², Fatima A Nasrallah³, Zack Shan²; Department of Defense Alzheimer's Disease Neuroimaging Initiative

Affiliations

¹ Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia. Electronic address: amohamed@usc.edu.au.
² Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia.
³ Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia.

PMID: 37080447
PMCID: PMC10357124 (available on 2024-06-01)
DOI: 10.1016/j.neuroscience.2023.03.029

Abstract

Fatigue is a long-lasting problem in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), with limited research that investigated the fatigue-related white-matter changes within TBI and/or PTSD cohorts. This exploratory cross-sectional study used diffusion tensor imaging (DTI) and neuropsychological data collected from 153 male Vietnam War veterans, as part of the Alzheimer's Disease Neuroimaging Initiative - Department of Defense, and were divided clinically into control veterans, PTSD, TBI, and with both TBI and PTSD (TBI + PTSD). The existence of fatigue was defined by the question "Do you often feel tired, fatigued, or sleepy during the daytime?". DTI data were compared between fatigue and non-fatigue subgroups in each clinical group using tract-based spatial statistics voxel-based differences. Fatigue was reported in controls (29.55%), slightly higher in TBI (52.17%, P_Benf = 0.06), and significantly higher in both TBI + PTSD (66.67%, P_Benf = 0.001) and PTSD groups (79.25%, P_Benf < 0.001). Compared to non-fatigued subgroups, no white-matter differences were observed in the fatigued subgroups of control or TBI, while the fatigued PTSD subgroup only showed increased diffusivity measures (i.e., radial and axial), and the fatigued TBI + PTSD subgroup showed decreased fractional anisotropy and increased diffusivity measures (P_FWE ≤ 0.05). The results act as preliminary findings suggesting fatigue to be significantly reported in TBI + PTSD and PTSD decades post-trauma with a possible link to white-matter microstructural differences in both PTSD and TBI + PTSD. Future studies with larger cohorts and detailed fatigue assessments would be required to identify the white-matter changes associated with fatigue in these cohorts.

Keywords: Diffusion Tensor Imaging (DTI); Tract Based Spatial Statistics (TBSS); fatigue; posttraumatic stress disorder; traumatic brain Injury.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Brain
Brain Injuries, Traumatic* / complications
Brain Injuries, Traumatic* / diagnostic imaging
Cross-Sectional Studies
Diffusion Tensor Imaging / methods
Humans
Male
Self Report
Stress Disorders, Post-Traumatic* / complications
Stress Disorders, Post-Traumatic* / diagnostic imaging
Stress Disorders, Post-Traumatic* / epidemiology
White Matter* / diagnostic imaging

Grants and funding

U01 AG024904/AG/NIA NIH HHS/United States