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Brain Advance Access originally published online on November 17, 2004
Brain 2005 128(1):189-200; doi:10.1093/brain/awh352
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Brain Vol. 128 No. 1 © Guarantors of Brain 2004; all rights reserved

Cognitive sequelae of head injury: involvement of basal forebrain and associated structures

C. H. Salmond1,4, D. A. Chatfield2, D. K. Menon1,2, J. D. Pickard1,3 and B. J. Sahakian4

1 Wolfson Brain Imaging Centre and Departments of 2 Anaesthetics, 3 Neurosurgery and 4 Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK

Correspondence to: Dr Claire Salmond, Wolfson Brain Imaging Centre, Box 65, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK E-mail: chs20{at}wbic.cam.ac.uk

Traumatic brain injury is the most common cause of death and disability in young people and survivors often suffer from chronic cognitive deficits. From animal, post-mortem and cognitive studies, there is now increased evidence that abnormalities in the cholinergic system may be underlying some of these deficits. This study investigated this hypothesis in a group of survivors of moderate–severe head injury (n = 31). Patients completed a comprehensive neuropsychological assessment and an MRI scan. Compared with a group of controls (matched on age, sex and premorbid intelligence quotient), the patients showed deficits in sustained attention, paired associate learning and reaction time, but comparative preservation of spatial working memory. Voxel-based morphometry revealed reduced grey matter density in the head injured group in the basal forebrain, the hippocampal formation and regions of the neocortex. These cognitive and structural results are consistent with cholinergic dysfunction. These preliminary findings suggest that cholinergic enhancers may be an effective treatment of cognitive deficits post head injury.


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