brain_chemistryWomen display more persistent memory impairment after experiencing mild traumatic brain injuries (MTBIs) when compared to their male counterparts, according to a recent study evaluating gender differences.

Published online in Radiology, “Sex Differences in Working Memory after Mild Traumatic Brain Injury: A Functional MR Imaging study” used functional magnetic resonance imaging (fMRI) in its exploration of MTBIs, commonly known as concussions.

MTBIs can affect cognitive function and quality of life in individuals. Frequently, patients who experience MTBI will have a full recovery, usually within three months. Nevertheless, 10 to 15 percent of MTBI patients will still experience persistent disabling problems beyond three months. Symptoms can include post-traumatic headache, sleep disturbance, loss of balance, memory and other cognitive impairments, fatigue, and mood or affective disorders.

“In clinical practice, more women than men seek medical attention due to persistent symptoms after MTBI at a ratio of almost 2:1,” said lead author Chi-Jen Chen, MD, from the Department of Diagnostic Radiology and Brain and Consciousness Research Center at Taipei Medical University Shuang-Ho Hospital and superintendent at Chia-Yi Hospital in Taiwan. “We started to wonder whether there might be differences in MTBI outcomes between men and women.”

Using fMRI to analyze brain activation patterns during working memory tasks, researchers studied 30 patients with MTBI and 30 control patients with an equal breakdown of men and women.

“Difficulty with working memory is a commonly reported impairment after MTBI,” Dr. Chen said. “Since working memory is important for a wide variety of cognitive skills, compromised working memory could have significant effects on everyday life.”

Within one month after injury, patients underwent an fMRI exam, and at six weeks after first scan, they had a follow-up fMRI exam. All participants underwent neuropsychological tests, including digit span and continuous performance test (CPT). Digit span is a short-term memory test measuring how many numbers a person can remember in sequence, while CPT measures an individual’s sustained and selective attention and impulsivity.

Initial fMRI results of the MTBI patients showed that women had decreased activation in working memory brain circuits, while men displayed increased activation, compared to the controls. Although, at follow-up, men with MTBI returned to a normal activation pattern similar to the controls, women showed persistent hypoactivation. suggesting ongoing working memory problems.

Neuropsychological results showed that among the women, the total digit span score was lower in the MTBI group, compared to the control group.

“These findings provide evidence that female gender may be a risk factor for working memory impairment after MTBI,” Chen said. “If so, more aggressive management should be initiated once MTBI is diagnosed in female patients.”

Chen concludes that incorporation of fMRI into treatment protocol for MTBI may be advisable in the future because of its potential to detect working memory impairment, predict outcome and monitor treatment effect. Still, further study needs to be done to validate these preliminary findings, he continued.

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