Journal Article

Cognitive sequelae of head injury: involvement of basal forebrain and associated structures

C. H. Salmond, D. A. Chatfield, D. K. Menon, J. D. Pickard and B. J. Sahakian

in Brain

Published on behalf of The Guarantors of Brain

Volume 128, issue 1, pages 189-200
Published in print January 2005 | ISSN: 0006-8950
Published online November 2004 | e-ISSN: 1460-2156 | DOI: http://dx.doi.org/10.1093/brain/awh352
Cognitive sequelae of head injury: involvement of basal forebrain and associated structures

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Traumatic brain injury is the most common cause of death and disability in young people and survivors often suffer from chronic cognitive deficits. From animal, post-mortem and cognitive studies, there is now increased evidence that abnormalities in the cholinergic system may be underlying some of these deficits. This study investigated this hypothesis in a group of survivors of moderate–severe head injury (n = 31). Patients completed a comprehensive neuropsychological assessment and an MRI scan. Compared with a group of controls (matched on age, sex and premorbid intelligence quotient), the patients showed deficits in sustained attention, paired associate learning and reaction time, but comparative preservation of spatial working memory. Voxel-based morphometry revealed reduced grey matter density in the head injured group in the basal forebrain, the hippocampal formation and regions of the neocortex. These cognitive and structural results are consistent with cholinergic dysfunction. These preliminary findings suggest that cholinergic enhancers may be an effective treatment of cognitive deficits post head injury.

Keywords: head injury; acetylcholine; MRI; neuropsychology; ACh = acetylcholine; BDI = Beck Depression Inventory; CANTAB = Cambridge Neuropsychological Test Automated Battery; CHAT = choline acetyltransferase; GCS = Glasgow Coma Score; GOS = Glasgow Outcome Score; ISS = Injury Severity Score; MMSE = Mini Mental State Examination; NART = National Adult Reading Test; VBM = voxel based morphometry

Journal Article.  9214 words.  Illustrated.

Subjects: Neurology ; Neuroscience

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