Injured brain regions associated with anxiety in Vietnam veterans

• Published in: Neuropsychologia Vol. 51; no. 4; pp. 686 - 694
• Main Authors: Knutson, Kristine M., Rakowsky, Shana T., Solomon, Jeffrey, Krueger, Frank, Raymont, Vanessa, Tierney, Michael C., Wassermann, Eric M., Grafman, Jordan
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.03.2013; Elsevier
• Subjects: Adult and adolescent clinical studies; Amygdala - pathology; Anxiety; Anxiety - pathology; Anxiety - psychology; Anxiety disorders. Neuroses; Biological and medical sciences; Brain Injuries - pathology; Brain Injuries - psychology; Brain Mapping; Cohort Studies; Data Interpretation, Statistical; Depressive Disorder, Major - pathology; Depressive Disorder, Major - psychology; Humans; Image Processing, Computer-Assisted; Injuries of the nervous system and the skull. Diseases due to physical agents; Longitudinal Studies; Male; Medical sciences; Middle Aged; Miscellaneous; Neuropsychological Tests; Organic mental disorders. Neuropsychology; Prefrontal Cortex - pathology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Stress Disorders, Post-Traumatic - pathology; Stress Disorders, Post-Traumatic - psychology; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Traumatic brain injury; Veterans; Vietnam Conflict; Voxel-based lesion symptom mapping; Voxel-based lesion symptom mapping; Anxiety; Traumatic brain injury; Human; Affect affectivity; Symptomatology; Nervous system diseases; Central nervous system disease; Anxiety disorder; Head trauma; Veteran; Cerebral disorder
• ISSN: 0028-3932; 1873-3514
• DOI: 10.1016/j.neuropsychologia.2013.01.003

Anxiety negatively affects quality of life and psychosocial functioning. Previous research has shown that anxiety symptoms in healthy individuals are associated with variations in the volume of brain regions, such as the amygdala, hippocampus, and the bed nucleus of the stria terminalis. Brain lesion data also suggests the hemisphere damaged may affect levels of anxiety. We studied a sample of 182 male Vietnam War veterans with penetrating brain injuries, using a semi-automated voxel-based lesion-symptom mapping (VLSM) approach. VLSM reveals significant associations between a symptom such as anxiety and the location of brain lesions, and does not require a broad, subjective assignment of patients into categories based on lesion location. We found that lesioned brain regions in cortical and limbic areas of the left hemisphere, including middle, inferior and superior temporal lobe, hippocampus, and fusiform regions, along with smaller areas in the inferior occipital lobe, parahippocampus, amygdala, and insula, were associated with increased anxiety symptoms as measured by the Neurobehavioral Rating Scale (NRS). These results were corroborated by similar findings using Neuropsychiatric Inventory (NPI) anxiety scores, which supports these regions' role in regulating anxiety. In summary, using a semi-automated analysis tool, we detected an effect of focal brain damage on the presentation of anxiety. We also separated the effects of brain injury and war experience by including a control group of combat veterans without brain injury. We compared this control group against veterans with brain lesions in areas associated with anxiety, and against veterans with lesions only in other brain areas. ► We studied anxiety symptoms in Vietnam War veterans with brain injuries. ► Anxiety was measured using the Neurobehavioral Rating Scale. ► Damage in temporal lobes and left limbic area associated with increased anxiety.