Open Access Highly Accessed Research article

The pathophysiology of prospective memory failure after diffuse axonal injury - Lesion-symptom analysis using diffusion tensor imaging

Keita Kondo12, Masaharu Maruishi14, Hiroki Ueno12, Kozue Sawada1, Yukari Hashimoto13, Tomohiko Ohshita2, Tetsuya Takahashi2*, Toshiho Ohtsuki2 and Masayasu Matsumoto2

  • * Corresponding author: Tetsuya Takahashi

  • † Equal contributors

Author affiliations

1 Hiroshima Higher Brain Function Center, Hiroshima Prefectural Rehabilitation Center, 295-3, Taguchi, Saijo, Higashi-Hiroshima, Japan

2 Department of Clinical Neuroscience & Therapeutics, Hiroshima University Graduate School of Biomedical Science, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan

3 Department of Psychology, Fukuyama University, 958, Sanzo, Higashimura, Fukuyama, Japan

4 Department of Communication Sciences and Disorders, Hiroshima Prefectural College of Health Sciences, 1-1, Gakuen-chou, Mihara, Hiroshima, Japan

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Citation and License

BMC Neuroscience 2010, 11:147  doi:10.1186/1471-2202-11-147

Published: 20 November 2010



Prospective memory (PM) is one of the most important cognitive domains in everyday life. The neuronal basis of PM has been examined by a large number of neuroimaging and neuropsychological studies, and it has been suggested that several cerebral domains contribute to PM. For these activation studies, a constellation of experimental PM trials was developed and adopted to healthy subjects. In the present study, we used a widely used clinical PM assessment battery to determine the lesions attributable to PM failure, with the hypothesis that lesion-symptom analysis using diffusion tensor imaging (DTI) in subjects with diffuse axonal injury (DAI) can reveal the neuronal basis of PM in everyday life.


Fourteen DAI patients (age: range of 18-36, median 24) participated in this study. PM failure was scored in the range of 0-6 using three sub-tests of the Rivermead Behavioural Memory Test. The PM scores of DAI patients were in the range of 2-6 (median 4.5, inter-quartile range 2.25). The severity of axonal injury following DAI was examined using fractional anisotropy (FA), one of the DTI parameters, at voxel level in each subject. We then obtained clusters correlated with PM failure by conducting voxel-based regression analysis between FA values and PM scores. Three clusters exhibited significant positive correlation with PM score, the left parahippocampal gyrus, left inferior parietal lobe, and left anterior cingulate.


This is the first lesion-symptom study to reveal the neuronal basis of PM using DTI on subjects with DAI. Our findings suggest that the neuronal basis of PM is in the left parahippocampal gyrus, left inferior parietal lobe, and/or left anterior cingulate. These findings are similar to those of previous activation studies with loading experimental PM tasks.