Traumatic brain injury (TBI) in women experiencing intimate-partner violence (IPV) is common, and IPV afflicts 30 % of women worldwide. However, the neurobiology and related sequelae of these TBIs have never been systematically examined. Consequently, TBI treatments are typically absent and IPV interventions are inadequate. There has been a call for a comprehensive assessment of IPV-related TBIs and their relationship to aspects of women’s cognitive and neural functioning. In response, we examined brain-network organization associated with TBI and its cognitive effects using clinical interviews and neuropsychological measures as well as structural and functional Magnetic Resonance Imaging (fMRI) in women experiencing IPV-related TBI. We hypothesized that TBI severity would be related to poorer cognitive performance and be associated with structural and functional connectivity between cognitive networks previously implicated in other TBI populations. As predicted, severity of TBI was negatively associated with inter-network intrinsic functional connectivity indicative of TBI, between the right anterior insula and posterior cingulate cortex/precuneus (FLAME1 + 2; family-wise error-corrected Z > 2.3, cluster- based p < 0.05). This association remained significant when controlling for partner-abuse severity, age, head motion, childhood trauma and psychopathology. Additionally, intrinsic functional connectivity between the same regions correlated positively with cognitive performance on indices of memory and learning. These data provide the first mechanistic evidence of TBI and its association with cognitive functioning in women sustaining IPV-related TBI. These data underscore the need to address and consider the role TBI may be playing in the efficacy of IPV interventions ranging from emergency first responder interactions to specific treatment plans.
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American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (4th ed., text rev.) Washington, DC: American Psychiatric Association.
Anticevic, A., Cole, M. W., Murray, J. D., Corlett, P. R., Wang, X. J., & Krystal, J. H. (2012). The role of default network deactivation in cognition and disease. Trends in Cognitive Sciences, 16, 584–592.
Banks, M. E. (2007). Overlooked but critical: traumatic brain injury as a consequence of interpersonal violence. Trauma, Violence & Abuse, 8, 290–298.
Banks, M. E. (2013). Optimal rehabilitation for women who receive traumatic brain injury following intimate partner violence. In H. Muenchberger, E. Kendall, & J. Wright (Eds.), Health and healing after traumatic brain injury: Understanding the power of family, friends, community, and other support systems (pp. 153–167). Santa Barbara, CA: Praeger.
Behzadi, Y., Restom, K., Liau, J., & Liu, T. T. (2007). A component based noise correction method (CompCor) for BOLD and perfusion based fMRI. NeuroImage, 37, 90–101.
Benson, R. R., Gattu, R., Sewick, B., Kou, Z., Zakariah, N., Cavanaugh, J. M., & Haacke, E. M. (2012). Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation. NeuroRehabilitation, 31, 261–279.
Bonnelle, V., Leech, R., Kinnunen, K. M., Ham, T. E., Beckmann, C. F., De Boissezon, X., Greenwood, R. J., & Sharp, D. J. (2011). Default mode network connectivity predicts sustained attention deficits after traumatic brain injury. The Journal of Neuroscience, 31, 13442–13451.
Bonnelle, V., Ham, T. E., Leech, R., Kinnunen, K. M., Mehta, M. A., Greenwood, R. J., & Sharp, D. J. (2012). Salience network integrity predicts default mode network function after traumatic brain injury. Proceedings of the National Academy of Sciences of the United States of America, 109, 4690–4695.
Buckner, R. L., Andrews-Hanna, J. R., & Schacter, D. L. (2008). The brain’s default network: anatomy, function, and relevance to disease. Annals of the New York Academy of Sciences, 1124, 1–38.
Cai W, Chen T, Ryali S, Kochalka J, Li CS, Menon V. 2015. Causal interactions within a frontal-cingulate-parietal network during cognitive control: Convergent evidence from a multisite-multitask investigation. Cereb Cortex.
Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., Coronado, V. G., & Injury WHOCCTFoMTB (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO collaborating Centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 113–125.
Chai, X. J., Castanon, A. N., Ongur, D., & Whitfield-Gabrieli, S. (2012). Anticorrelations in resting state networks without global signal regression. NeuroImage, 59, 1420–1428.
Committee on Mild Traumatic Brain Injury, American Congress of Rehabilitation Medicine (1993). Definition of mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 8, 48–59.
Demirtas-Tatlidede, A., Vahabzadeh-Hagh, A. M., Bernabeu, M., Tormos, J. M., & Pascual-Leone, A. (2012). Noninvasive brain stimulation in traumatic brain injury. The Journal of Head Trauma Rehabilitation, 27, 274–292.
Devries, K. M., Mak, J. Y., Garcia-Moreno, C., Petzold, M., Child, J. C., Falder, G., Lim, S., Bacchus, L. J., Engell, R. E., Rosenfeld, L., Pallitto, C., Vos, T., Abrahams, N., & Watts, C. H. (2013). Global health. The global prevalence of intimate partner violence against women. Science., 340, 1527–1528.
Eisenstat, S. A., & Bancroft, L. (1999). Domestic violence. The New England Journal of Medicine, 341, 886–892.
Eklund, A., Nichols, T. E., & Knutsson, H. (2016). Cluster failure: why fMRI inferences for spatial extent have inflated false-positive rates. Proceedings of the National Academy of Sciences of the United States of America, 113, 7900–7905.
Fox, M. D., & Raichle, M. E. (2007). Spontaneous fluctuations in brain activity observed with functional magnetic resonance imaging. Nature Reviews Neuroscience, 8, 700–711.
Goulden, N., Khusnulina, A., Davis, N. J., Bracewell, R. M., Bokde, A. L., McNulty, J. P., & Mullins, P. G. (2014). The salience network is responsible for switching between the default mode network and the central executive network: replication from DCM. NeuroImage, 99, 180–190.
Hammoud, D. A., & Wasserman, B. A. (2002). Diffuse axonal injuries: pathophysiology and imaging. Neuroimaging Clinics of North America, 12, 205–216.
Jenkinson, M., Beckmann, C. F., Behrens, T. E., Woolrich, M. W., & Smith, S. M. (2012). FSL. NeuroImage, 62, 782–790.
Jilka, S. R., Scott, G., Ham, T., Pickering, A., Bonnelle, V., Braga, R. M., Leech, R., & Sharp, D. J. (2014). Damage to the salience network and interactions with the default mode network. The Journal of Neuroscience, 34, 10798–10807.
Kasahara, M., Menon, D. K., Salmond, C. H., Outtrim, J. G., Tavares, J. V., Carpenter, T. A., Pickard, J. D., Sahakian, B. J., & Stamatakis, E. A. (2011). Traumatic brain injury alters the functional brain network mediating working memory. Brain Injury, 25, 1170–1187.
Kelly, A. M., Uddin, L. Q., Biswal, B. B., Castellanos, F. X., & Milham, M. P. (2008). Competition between functional brain networks mediates behavioral variability. NeuroImage, 39, 527–537.
Kim, Y. H., Yoo, W. K., Ko, M. H., Park, C. H., Kim, S. T., & Na, D. L. (2009). Plasticity of the attentional network after brain injury and cognitive rehabilitation. Neurorehabilitation and Neural Repair, 23, 468–477.
King, N. S., Crawford, S., Wenden, F. J., Moss, N. E., & Wade, D. T. (1995). The Rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242, 587–592.
Kinnunen, K. M., Greenwood, R., Powell, J. H., Leech, R., Hawkins, P. C., Bonnelle, V., Patel, M. C., Counsell, S. J., & Sharp, D. J. (2011). White matter damage and cognitive impairment after traumatic brain injury. Brain, 134, 449–463.
Klevens, J., Sadowski, L. S., Kee, R., Garcia, D., & Lokey, C. (2015). Effect of screening for partner violence on use of health services at 3-year follow-up of a randomized clinical trial. Journal of the American Medical Association, 314, 515–516.
Kondo, A., Shahpasand, K., Mannix, R., Qiu, J., Moncaster, J., Chen, C. H., Yao, Y., Lin, Y. M., Driver, J. A., Sun, Y., Wei, S., Luo, M. L., Albayram, O., Huang, P., Rotenberg, A., Ryo, A., Goldstein, L. E., Pascual-Leone, A., McKee, A. C., Meehan, W., Zhou, X. Z., & Lu, K. P. (2015). Antibody against early driver of neurodegeneration cis P-tau blocks brain injury and tauopathy. Nature, 523(7561), 431–436.
Kucyi, A., Hodaie, M., & Davis, K. D. (2012). Lateralization in intrinsic functional connectivity of the temporoparietal junction with salience- and attention-related brain networks. Journal of Neurophysiology, 108, 3382–3392.
Kucyi, A., Salomons, T. V., & Davis, K. D. (2013). Mind wandering away from pain dynamically engages antinociceptive and default mode brain networks. Proceedings of the National Academy of Sciences of the United States of America, 110, 18692–18697.
Kucyi, A., Hove, M. J., Biederman, J., Van Dijk, K. R., & Valera, E. M. (2015). Disrupted functional connectivity of cerebellar default network areas in attention-deficit/hyperactivity disorder. Human Brain Mapping, 36(9), 3373–3386.
Kwako, L. E., Glass, N., Campbell, J., Melvin, K. C., Barr, T., & Gill, J. M. (2011). Traumatic brain injury in intimate partner violence: a critical review of outcomes and mechanisms. Trauma, Violence & Abuse, 12, 115–126.
Leech, R., & Sharp, D. J. (2014). The role of the posterior cingulate cortex in cognition and disease. Brain, 137, 12–32.
Levin, H. S., & Diaz-Arrastia, R. R. (2015). Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurology, 14, 506–517.
Liebschutz, J. M., & Rothman, E. F. (2012). Intimate-partner violence--what physicians can do. The New England Journal of Medicine, 367, 2071–2073.
Mayer, A. R., Mannell, M. V., Ling, J., Gasparovic, C., & Yeo, R. A. (2011). Functional connectivity in mild traumatic brain injury. Human Brain Mapping, 32, 1825–1835.
Menon, V., & Uddin, L. Q. (2010). Saliency, switching, attention and control: a network model of insula function. Brain Structure & Function., 214, 655–667.
Murray, C.E., Lundgren, K., Olson, L.N., & Hunnicutt, G. (2016) Practice update: what professionals who are not brain injury specialists need to know about intimate partner violence-related traumatic brain injury. Trauma Violence Abuse, 17, 298–305. doi:10.1177/1524838015584364.
Nathan, D. E., Oakes, T. R., Yeh, P. H., French, L. M., Harper, J. F., Liu, W., Wolfowitz, R. D., Wang, B. Q., Graner, J. L., & Riedy, G. (2015). Exploring variations in functional connectivity of the resting state default mode network in mild traumatic brain injury. Brain Connectivity, 5, 102–114.
Palacios, E. M., Sala-Llonch, R., Junque, C., Roig, T., Tormos, J. M., Bargallo, N., & Vendrell, P. (2013). Resting-state functional magnetic resonance imaging activity and connectivity and cognitive outcome in traumatic brain injury. JAMA Neurology, 70, 845–851.
Potter, S., Leigh, E., Wade, D., & Fleminger, S. (2006). The Rivermead post concussion symptoms questionnaire: a confirmatory factor analysis. Journal of Neurology, 253, 1603–1614.
Power, J. D., Schlaggar, B. L., Lessov-Schlaggar, C. N., & Petersen, S. E. (2013). Evidence for hubs in human functional brain networks. Neuron, 79, 798–813.
Power, J. D., Schlaggar, B. L., & Petersen, S. E. (2015). Recent progress and outstanding issues in motion correction in resting state fMRI. NeuroImage, 105C, 536–551.
Rhodes, K. V., Rodgers, M., Sommers, M., Hanlon, A., Chittams, J., Doyle, A., Datner, E., & Crits-Christoph, P. (2015). Brief motivational intervention for intimate partner violence and heavy drinking in the emergency department: a randomized clinical trial. Journal of the American Medical Association, 314, 466–477.
Ruff, R. M., Iverson, G. L., Barth, J. T., Bush, S. S., Broshek, D. K., Policy, N. A. N., & Planning, C. (2009). Recommendations for diagnosing a mild traumatic brain injury: a National Academy of neuropsychology education paper. Archives of Clinical Neuropsychology, 24, 3–10.
Seeley, W. W., Menon, V., Schatzberg, A. F., Keller, J., Glover, G. H., Kenna, H., Reiss, A. L., & Greicius, M. D. (2007). Dissociable intrinsic connectivity networks for salience processing and executive control. Journal of Neuroscience, 27, 2349–2356.
Sharp, D. J., Beckmann, C. F., Greenwood, R., Kinnunen, K. M., Bonnelle, V., De Boissezon, X., Powell, J. H., Counsell, S. J., Patel, M. C., & Leech, R. (2011). Default mode network functional and structural connectivity after traumatic brain injury. Brain, 134, 2233–2247.
Sharp, D. J., Scott, G., & Leech, R. (2014). Network dysfunction after traumatic brain injury. Nature Reviews. Neurology, 10, 156–166.
Shenton, M. E., Hamoda, H. M., Schneiderman, J. S., Bouix, S., Pasternak, O., Rathi, Y., Vu, M. A., Purohit, M. P., Helmer, K., Koerte, I., Lin, A. P., Westin, C. F., Kikinis, R., Kubicki, M., Stern, R. A., & Zafonte, R. (2012). A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging and Behavior, 6, 137–192.
Shumskaya, E., Andriessen, T. M., Norris, D. G., & Vos, P. E. (2012). Abnormal whole-brain functional networks in homogeneous acute mild traumatic brain injury. Neurology, 79, 175–182.
Smith, S. M., Jenkinson, M., Johansen-Berg, H., Rueckert, D., Nichols, T. E., Mackay, C. E., Watkins, K. E., Ciccarelli, O., Cader, M. Z., Matthews, P. M., & Behrens, T. E. (2006). Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data. NeuroImage, 31, 1487–1505.
Sridharan, D., Levitin, D. J., & Menon, V. (2008). A critical role for the right fronto-insular cortex in switching between central-executive and default-mode networks. Proceedings of the National Academy of Sciences of the United States of America, 105, 12569–12574.
Stevens, M. C., Lovejoy, D., Kim, J., Oakes, H., Kureshi, I., & Witt, S. T. (2012). Multiple resting state network functional connectivity abnormalities in mild traumatic brain injury. Brain Imaging and Behavior, 6, 293–318.
Turner, G. R., & Levine, B. (2008). Augmented neural activity during executive control processing following diffuse axonal injury. Neurology, 71, 812–818.
Uddin, L. Q. (2015). Salience processing and insular cortical function and dysfunction. Nature Reviews. Neuroscience, 16, 55–61.
Uddin, L. Q., Supekar, K. S., Ryali, S., & Menon, V. (2011). Dynamic reconfiguration of structural and functional connectivity across core neurocognitive brain networks with development. The Journal of Neuroscience, 31, 18578–18589.
Valera, E. M., & Berenbaum, H. (2003). Brain injury in battered women. Journal of Consulting and Clinical Psychology, 71, 797–804.
Venkatesan, U. M., Dennis, N. A., & Hillary, F. G. (2015). Chronology and chronicity of altered resting-state functional connectivity after traumatic brain injury. Journal of Neurotrauma, 32, 252–264.
Whitfield-Gabrieli, S., & Ford, J. M. (2012). Default mode network activity and connectivity in psychopathology. Annual Review of Clinical Psychology, 8, 49–76.
World Health Organization. 1992. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.
Worsley, K. J., Liao, C. H., Aston, J., Petre, V., Duncan, G. H., Morales, F., & Evans, A. C. (2002). A general statistical analysis for fMRI data. NeuroImage, 15, 1–15.
Yarkoni, T. (2009). Big correlations in little studies: inflated fMRI correlations reflect low statistical power-commentary on Vul et al. (2009). Perspectives on Psychological Science, 4, 294–298.
Yeo, B. T., Krienen, F. M., Sepulcre, J., Sabuncu, M. R., Lashkari, D., Hollinshead, M., Roffman, J. L., Smoller, J. W., Zollei, L., Polimeni, J. R., Fischl, B., Liu, H., & Buckner, R. L. (2011). The organization of the human cerebral cortex estimated by intrinsic functional connectivity. Journal of Neurophysiology, 106, 1125–1165.
EMV and AK had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. We thank all of the women who participated in this study. We thank Brittany LeBlanc for data management assistance, Drs. Michael Alexander, Margaret O’Connor and Gregory Sorensen for helpful advice in developing this project, Dr. Steven Stufflebeam for performing the clinical reads of the imaging scans, Drs. Randy Buckner, Kevin Spencer, Martha Shenton and Michael Hove for helpful feedback in preparing the manuscript. This work was supported by a Harvard Medical School Center of Excellence grant from the HMS Fund for Women’s Health (EMV), the Canadian Institutes of Health Research (AK), and grants provided to the Athinoula A. Martinos Center for Biomedical Imaging, NCRR P41RR14075 and P41 EB015896. This work also involved the use of instrumentation supported by the NIH Shared Instrumentation Grant Program and/or High-End Instrumentation Grant Program; specifically, grant numbers 1S10RR023043 and 1S10RR023401.
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The authors report no conflicts of interest.
Research involving human participants and informed consent
Participants provided written informed consent and the local ethics committee (Partners IRB) approved the study.
This work was performed at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital.
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Valera, E., Kucyi, A. Brain injury in women experiencing intimate partner-violence: neural mechanistic evidence of an “invisible” trauma. Brain Imaging and Behavior 11, 1664–1677 (2017). https://doi.org/10.1007/s11682-016-9643-1