Projects

Concussion in Adolescents with Anxiety and Depression

Anne L. Wheeler, Hospital for Sick Children, Toronto.

The problem

White matter is known to be particularly susceptible to primary and secondary injury processes following concussion but there are two major unanswered questions about the role of white matter in persistent impairment after concussion. First, a body of literature has attributed persistent symptoms after concussion to white matter damage. However, none of these studies have accounted for pre-injury brain structure and it remains a possibility that cross-sectional post-injury comparisons of brain microstructure between individuals with and without concussion are picking up on pre-existing brain differences. Second, while most people recover quickly after a concussion some people experience persistent symptoms but the biological basis of this vulnerability is not known. The major limitation that has precluded previous studies from i) attributing impairment to injury-specific brain changes and ii) assessing vulnerable brain substrates is that pre-injury scans have not been available.

Hypothesis

Pre-existing white matter ‘fragility’ may make the brains of some people vulnerable to persistent symptoms after concussion by way of more extensive injury to and/or reduced capacity for recovery in affected white matter structures.

Objectives

By identifying adolescents with anxiety and depression prior to injury and following them prospectively to track and assess concussions, the objective of the study is to assess the role that white matter microstructure plays in persistent impairment. Specifically:

(1) Establish if pre to post-injury changes in white matter microstructure mediate changes in mental health after concussion.

(2) Evaluate if pre-injury white matter microstructure predicts persistent post-concussion symptoms.

Methods

This is a prospective nested Concussion Study within the Toronto Adolescent & Youth CAMH Cohort Study (TAY-CAMH Cohort Study), a longitudinal study of 1,500 youths who have a mental health concern or diagnosis who will be followed for five years.

Funding

A CIHR project grant for the study was funded in the Spring 2022 competition.