Imaging Shows Effects of TBI Related to Intimate Partner Violence on Women’s Cognitive Function

In 2003, research led by Eve Valera, PhD, a researcher in the Athinoula A. Martinos Center for Biomedical Imaging, reported in Journal of Consulting and Clinical Psychology that traumatic brain injuries (TBIs) are common in women who experience intimate partner violence, and are associated with lower scores on tasks related to memory, learning and cognitive flexibility. However, the mechanisms underlying the cognitive effects have never been investigated and therefore no standard therapeutic interventions have been proposed.

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Dr. Valera and her colleague Aaron Kucyi, PhD recently became the first to use neuroimaging to investigate the neurobiological effects of TBIs related to intimate partner violence. They found that such TBIs are associated with the functional connectivity of two brain networks that have key roles in cognitive performance.

The study published in Brain Imaging and Behavior examined 20 women recruited from women’s shelters, domestic violence programs and by word of mouth. All participants reported at least one partner-related TBI and 75% reported multiple TBIs, most of which would be considered mild TBIs or concussions.

Eighteen women (89%) had at least one current post-concussive symptom related to their most recent TBI. Excluding three mood-related symptoms, 53% of the women had a post-concussive syndrome (at least three of the 13 remaining possible symptoms on the Rivermead Post Concussion Symptom Questionnaire).

To assess cognitive function of the women, the researchers used the California Verbal Learning Test and the Trails B test. They also used structural and functional magnetic resonance imaging to examine brain-network organization.

They found that a greater number and recency of TBIs was negatively associated with functional connectivity of cognitive brain networks. Specifically, there was less positive/more negative connectivity between the default mode network and the salience network, which are both believed to be important to the ability to rapidly switch behavior. Lower connectivity between these brain networks was also associated with poorer cognitive performance on tests of memory and learning.

The relationship between TBIs and brain-network connectivity was not accounted for by severity of partner abuse, childhood trauma, psychopathology, current or recent substance dependence or medication use. This suggests that partner-related TBI has a specific effect on cognitive brain-network reorganization.

The researchers urge health care professionals to consider the effects of TBIs when planning interventions for intimate partner violence, from emergency first response to treatment plans. If a woman has an apparent cognitive or post-concussive symptom, neuropsychological assessment should be offered, just as it is for non-partner-related TBI. If testing results suggest impairment, neurorehabilitation should be considered.

Standard imaging technologies including CT and MRI do not have the sensitivity to detect typical mild TBI, even though many are repetitive in partner violence.  As such, special care needs to be taken to ask about possible hits to the head that may result in symptoms such as confusion, disorientation or loss of consciousness.

However, the researchers recommend that neuroimaging be considered on an individual basis, consistent with procedures that apply to non-partner-related TBI. They also suggest that cognitive training or possibly non-invasive neurostimulation could be appropriate for some women with partner-related TBIs.

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