The cortical and subcortical substrates of quality of life through substrates of self-awareness and executive functions, in chronic moderate-to-severe TBI

ABSTRACT

Background

Moderate-to-severe traumatic brain injury (TBI) follows a chronic neuro-psychological sequelae, interfering with quality of life (QOL).

Objective

To investigate the chronic effects of moderate-to-severe TBI as expressed by greater atrophy in specific regions-of-interest relating to executive functions (EF) and self-awareness (SA); and whether this atrophy reflects on EF, SA deficits and QOL.

Methods

Thirty-one males with chronic moderate-to-severe TBI, aged 18–51, were compared to 24 non-injured males (age range = 21–49), matched on age and education. EF was assessed through a composite score. SA and QOL were assessed using generic and TBI-specific measures. Online masks were applied on magnetic resonance images to extract EF and SA – related regions-of-interest.

Results

Findings revealed that participants with TBI presented with less volume in fronto-temporal cortical and subcortical regions, than controls. An interrelation between EF and SA – related regions was revealed. Participants with TBI scored lower on neuropsychosocial measures, than controls. Differences in EF and SA were reflected on the related regions-of-interest. Satisfaction with QOL was predicted by these regions-of-interest.

Conclusion

Chronic TBI effects on brain volume extend on EF, SA, and QOL; highlighting the role of SA between EF and QOL, and the need for personalized interventions in improving recovery outcome.

KEYWORDS:

• Imaging
• neuropathology
• outcome

Acknowledgments

The authors wish to thank the Nicosia General Hospital Intensive Care Unit, and the Melathron Agoniston EOKA for the referrals, and all participants and their families for their participation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

This work was supported by the Cyprus Research Innovation Foundation and co-funded by the Republic of Cyprus and the European Regional Development Fund under the Framework Programme “RESTART 2016-2020/EXCELLENCE HUBS: PILLAR II” for Research, Technological Development and Innovation (EXCELLENCE/1216/0411) and a new infrastructure grant (NEW INFRASTRUCTURE/STRATEGIC/0309/37);Research and Innovation Foundation [EXCELLENCE/1216/0411, NEW INFRASTRUCTURE/STRATEGIC/0309/37];