Abstract
Objective
To undertake a systematic review and meta-analysis of the relationship between microstructural
damage and cognitive function after hospitalized mixed-mechanism (HMM) mild traumatic
brain injury (mTBI).
Data Sources
PsycInfo, EMBASE, and MEDLINE were used to find relevant empirical articles published
between January 2002 and January 2016.
Study Selection
Studies that examined the specific relationship between diffusion tensor imaging (DTI)
and cognitive test performance were included. The final sample comprised previously
medically and psychiatrically healthy adults with HMM mTBI.
Data Extraction
Specific data were extracted including mTBI definitional criteria, descriptive statistics,
outcome measures, and specific results of associations between DTI metrics and cognitive
test performance.
Data Synthesis
Of the 248 original articles retrieved and reviewed, 8 studies met all inclusion criteria
and were included in the meta-analysis. The meta-analysis revealed statistically significant
associations between reduced white matter integrity and poor performance on measures
of attention (fractional anisotropy [FA]: d=.413, P<.001; mean diffusivity [MD]: d=−.407, P=.001), memory (FA: d=.347, P<.001; MD: d=−.568, P<.001), and executive function (FA: d=.246, P<.05), which persisted beyond 1 month postinjury.
Conclusions
The findings from the meta-analysis provide clear support for an association between
in vivo markers of underlying neuropathology and cognitive function after mTBI. Furthermore,
these results demonstrate clearly for the first time that in vivo markers of structural
neuropathology are associated with cognitive dysfunction within the domains of attention,
memory, and executive function. These findings provide an avenue for future research
to examine the causal relationship between mTBI-related neuropathology and cognitive
dysfunction. Furthermore, they have important implications for clinical management
of patients with mTBI because they provide a more comprehensive understanding of factors
that are associated with cognitive dysfunction after mTBI.
Keywords
List of abbreviations:
DAI (diffuse axonal injury), DTI (diffusion tensor imaging), FA (fractional anisotropy), HMM (hospitalized mixed-mechanism), MD (mean diffusivity), MRI (magnetic resonance imaging), mTBI (mild traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 20, 2017
Footnotes
Supported by an Australian Government Research Training Program Scholarship and a Melbourne Neuroscience Institute Australian Government Research Training Program Scholarship.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
