Brain Imaging and Behavior

, Volume 11, Issue 5, pp 1548–1554 | Cite as

Cognitive fatigue is associated with reduced anterior internal capsule integrity in veterans with history of mild to moderate traumatic brain injury

  • Alexandra L. Clark
  • Lisa Delano-Wood
  • Scott F. Sorg
  • Madeleine L. Werhane
  • Karen L. Hanson
  • Dawn M. Schiehser
Brief Communication


No known studies have directly examined white matter microstructural correlates of cognitive fatigue post-TBI in a Veteran sample. We therefore investigated the relationship between cognitive fatigue and white matter integrity in Veterans with history of mild to moderate TBI (mmTBI). 59 Veterans (TBI = 34, Veteran Controls [VCs] = 25]) with and without history of mmTBI underwent structural 3T DTI scans and completed questionnaires related to cognitive fatigue and psychiatric symptoms. Tractography was employed on six regions of interest, including the anterior and posterior limbs of the internal capsule; genu; body and splenium of the corpus callosum; and cingulum bundle. Group analyses revealed that those with history of mmTBI displayed significantly greater levels of cognitive fatigue relative to those with no history of head injury (p = .02). Within the mmTBI group, independent of psychiatric symptoms, decreased white matter microstructural integrity of the left anterior internal capsule was associated with greater levels of cognitive fatigue (p = .01). Results show that the subjective experience of cognitive fatigue following neurotrauma may be linked to the disruption of striato-thalamo-cortical tracts that are important in mediating arousal and higher-order cognitive processes. These findings build upon those from existing functional neuroimaging studies in those with history of TBI, providing further evidence for the neural basis of cognitive fatigue in head injured adults.


Fatigue Cognitive fatigue White matter microstructure TBI 



The authors would like to thank all OEF/OIF/OND Veterans for their service and are extremely appreciative of those who volunteered to participate in this study and the wonderful research assistants (Russell Kim, Elisa Lanni, Nicole Evangelitsa, Norman Luc) who dedicate their time to our research laboratory.

Compliance with ethical standards

All procedures involved in this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975. Informed consent was obtained from all patients included in the study. Alexandra Clark, Lisa Delano-Wood, Scott Sorg, Madeleine Werhane, Karen Hanson, and Dawn Schiehser declare no conflicts of interest.


This work was supported by grants awarded by the Veterans Affairs: a Career Development Award to D.S. (2–065-10S) and Merit Award to L.D.-W (829-MR-NB-25,860). This work was further supported by a Department of Defense Investigator-Initiated Research Grant to L.D.-W. (W81XWH-10-2-0169). Dr. Delano-Wood also received resources from the VA Center of Excellence for Stress and Mental Health.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Alexandra L. Clark
    • 1
    • 2
  • Lisa Delano-Wood
    • 2
    • 3
    • 4
  • Scott F. Sorg
    • 2
    • 4
  • Madeleine L. Werhane
    • 1
    • 2
  • Karen L. Hanson
    • 2
    • 4
  • Dawn M. Schiehser
    • 2
    • 3
    • 4
  1. 1.Joint Doctoral Program in Clinical PsychologySan Diego State University/University of California, San Diego (SDSU/UCSD)San DiegoUSA
  2. 2.VA San Diego Healthcare System (VASDHS)San DiegoUSA
  3. 3.Center of Excellence for Stress and Mental HealthVASDHSSan DiegoUSA
  4. 4.School of Medicine, Department of PsychiatryUniversity of California San DiegoLa JollaUSA

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