Blast-Related Mild Traumatic Brain Injury: A Bayesian Random-Effects Meta-Analysis on the Cognitive Outcomes of Concussion among Military Personnel

Justin E. Karr, Corson N. Areshenkoff, Emily C. Duggan, Mauricio A. Garcia-Barrera

Research output: Contribution to journalReview articlepeer-review

54 Scopus citations

Abstract

Throughout their careers, many soldiers experience repeated blasts exposures from improvised explosive devices, which often involve head injury. Consequentially, blast-related mild Traumatic Brain Injury (mTBI) has become prevalent in modern conflicts, often occuring co-morbidly with psychiatric illness (e.g., post-traumatic stress disorder [PTSD]). In turn, a growing body of research has begun to explore the cognitive and psychiatric sequelae of blast-related mTBI. The current meta-analysis aimed to evaluate the chronic effects of blast-related mTBI on cognitive performance. A systematic review identified 9 studies reporting 12 samples meeting eligibility criteria. A Bayesian random-effects meta-analysis was conducted with cognitive construct and PTSD symptoms explored as moderators. The overall posterior mean effect size and Highest Density Interval (HDI) came to d = −0.12 [−0.21, −0.04], with executive function (−0.16 [−0.31, 0.00]), verbal delayed memory (−0.19 [−0.44, 0.06]) and processing speed (−0.11 [−0.26, 0.01]) presenting as the most sensitive cognitive domains to blast-related mTBI. When dividing executive function into diverse sub-constructs (i.e., working memory, inhibition, set-shifting), set-shifting presented the largest effect size (−0.33 [−0.55, −0.05]). PTSD symptoms did not predict cognitive effects sizes, βPTSD = −0.02 [−0.23, 0.20]. The results indicate a subtle, but chronic cognitive impairment following mTBI, especially in set-shifting, a relevant aspect of executive attention. These findings are consistent with past meta-analyses on multiple mTBI and correspond with past neuroimaging research on the cognitive correlates of white matter damage common in mTBI. However, all studies had cross-sectional designs, which resulted in universally low quality ratings and limited the conclusions inferable from this meta-analysis.

Original languageEnglish
Pages (from-to)428-444
Number of pages17
JournalNeuropsychology Review
Volume24
Issue number4
DOIs
StatePublished - Dec 2014

Bibliographical note

Publisher Copyright:
© 2014, Springer Science+Business Media New York.

Keywords

  • Blast-related
  • Cognition
  • Concussion
  • Executive function
  • mild Traumatic Brain Injury (mTBI)

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology

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