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Using Functional Magnetic Resonance Imaging to Detect Chronic Fatigue in Patients With Previous Traumatic Brain Injury: Changes Linked to Altered Striato-Thalamic-Cortical Functioning

Berginström, Nils, MSc; Nordström, Peter, PhD; Ekman, Urban, PhD; Eriksson, Johan, PhD; Andersson, Micael, MSc; Nyberg, Lars, PhD; Nordström, Anna, PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Malec, James PhD, ABPP

The Journal of Head Trauma Rehabilitation: July/August 2018 - Volume 33 - Issue 4 - p 266–274
doi: 10.1097/HTR.0000000000000340
Focus on Clinical Research and Practice

Objective: To investigate whether functional magnetic resonance imaging (fMRI) can be used to detect fatigue after traumatic brain injury (TBI).

Setting: Neurorehabilitation clinic.

Participants: Patients with TBI (n = 57) and self-experienced fatigue more than 1 year postinjury, and age- and gender-matched healthy controls (n = 27).

Main Measures: Self-assessment scales of fatigue, a neuropsychological test battery, and fMRI scanning during performance of a fatiguing 27-minute attention task.

Results: During testing within the fMRI scanner, patients showed a higher increase in self-reported fatigue than controls from before to after completing the task (P < .001). The patients also showed lower activity in several regions, including bilateral caudate, thalamus, and anterior insula (all P < .05). Furthermore, the patients failed to display decreased activation over time in regions of interest: the bilateral caudate and anterior thalamus (all P < .01). Left caudate activity correctly identified 91% of patients and 81% of controls, resulting in a positive predictive value of 91%.

Conclusion: The results suggest that chronic fatigue after TBI is associated with altered striato-thalamic-cortical functioning. It would be of interest to study whether fMRI can be used to support the diagnosis of chronic fatigue in future studies.

Department of Community Medicine and Rehabilitation, Geriatric Medicine (Mr Berginström and Dr Nordström), Umeå Center for Functional Brain Imaging and Physiology Section, Department of Integrative Medical Biology (Drs Ekman, Eriksson, and Nyberg and Mr Andersson), Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine (Dr Nordström), and Department of Radiation Sciences (Dr Nyberg) Umeå University, Umeå, Sweden; and Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden (Dr Ekman).

Corresponding Author: Nils Berginström, MSc, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå 90187, Sweden (

Drs Nyberg and Nordström contributed equally to this article.

Funding for this study was provided through regional agreement between Umeå University and Västerbotten County Council on cooperation in the field of Medicine, Odontology, and Health, and Torsten & Ragnar Söderberg's Foundation.

The authors would like to thank Erik Edin, Gustav Gezelius, and Mikael Stiernstedt for assistance in data collection.

The authors declare no conflicts of interest.

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