MRI imaging and behavioral testing reveal emotional problems in female children post-concussion may be related to injury-caused delay in maturation of white matter
By Esmeralda Carcia-Ramirez. This article was initially published in the 2/1/24 edition of our Concussion Update newsletter; please consider subscribing.
A study published in Biological Psychiatry found that female children aged 11-12 who had suffered a concussion after age 9-10 scored higher emotional problem scores (depression and anxiety) than female children who hadn’t suffered a concussion. Males, on the other hand, didn’t show a difference in emotional problem scores after a concussion. (The researchers controlled for pre-injury emotional problem scores for all the children.) Researchers suggest that, after a concussion, emotional problems may be a “consequence” of a concussion in females, while in males, it “may have been pre-existing.”
Additionally, authors Eman Nishat et al. sought to investigate whether “disruption of white matter maturation” leads to more emotional or behavioral issues after a concussion. They found that “The effects of concussion on white matter maturation may depend on the age of injury, with different effects observed depending on the developmental stage of the brain.” However, after assessing the images and emotional scores together, it appears that there was a relationship between underdeveloped superficial white matter and higher behavioral problem scores in females with a concussion; in female children who had sustained a concussion, less maturation of white matter was associated with higher depression and anxiety after the concussion. These findings indicate that concussions may alter the trajectory of white matter maturation in female children and that this alteration may play a role in the onset of new depression and anxiety after concussion.
Nishat et al. used a subset of data on children from the Adolescent Brain Cognitive Development Study (the ABCD study). The ABCD study assessed thousands of children at age 9-10 (baseline) and then again two years later. Nishat et al. investigated a subset of this study, comparing 239 children (90 female) who sustained a concussion after baseline with 6,438 children (3,245 female) of the same age without any brain injuries. The Child Behavior Checklist (CBCL) was given at baseline and follow-up. The team studied the development of white matter in the brain by visualizing “neurite density” changes through “RSI modeling of diffusion MRI” over two years compared to children who hadn’t experienced a concussion. They found that the type of white matter affected was primarily superficial white matter, which consists of “short-range association fibers, which lies directly below the outer (cortical) surface of the brain.”
On a separate note, and consistent with previous studies, Eman Nishat et al. found that children who have suffered a concussion had higher pre-existing and post-concussion emotional and behavioral problem scores than children who had not experienced a concussion. The team also looked at behavioral problems (as opposed to emotional problems such as depression and anxiety) and found that, when controlling for pre-existing behavioral problems, behavioral issues do not appear to be a consequence of concussion.
The researchers mentioned numerous previously identified factors that may “predispose the female brain” to the greater effects of concussion than males, for example, the“greater neck strength in males,” which allows them to control where their head goes, lessening the impact to the head.
This new link between superficial white matter and behaviors reveals a potential future biomarker that could be used in “therapeutic studies” for female children after being diagnosed with a concussion. However, further research is needed.
