The cortical and subcortical substrates of quality of life through substrates of self-awareness and executive functions, in chronic moderate-to-severe TBI

Background Moderate-to-severe traumatic brain injury (TBI) follows a chronic neuro-psychological sequelae, interfering with quality of life (QOL). Objective To investigate the chronic effects of moderate-to-severe TBI as expressed by greater atrophy in specific regions-of-interest relating to executive functions (EF) and self-awareness (SA); and whether this atrophy reflects on EF, SA deficits and QOL. Methods Thirty-one males with chronic moderate-to-severe TBI, aged 18-51, were compared to 24 non-injured males (age range = 21-49), matched on age and education. EF was assessed through a composite score. SA and QOL were assessed using generic and TBI-specific measures. Online masks were applied on magnetic resonance images to extract EF and SA - related regions-of-interest. Results Findings revealed that participants with TBI presented with less volume in fronto-temporal cortical and subcortical regions, than controls. An interrelation between EF and SA - related regions was revealed. Participants with TBI scored lower on neuropsychosocial measures, than controls. Differences in EF and SA were reflected on the related regions-of-interest. Satisfaction with QOL was predicted by these regions-of-interest. Conclusion Chronic TBI effects on brain volume extend on EF, SA, and QOL; highlighting the role of SA between EF and QOL, and the need for personalized interventions in improving recovery outcome.