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

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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, β PTSD  = −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.

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A reference marked with an asterisk indicates a study included in the meta-analysis.

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Acknowledgments

Justin E. Karr is a Vanier Canada Graduate Scholar and thanks the Natural Sciences and Engineering Research Council of Canada for their support of his graduate studies. The authors of this article have no conflicts of interest to report and received no funding to conduct this research.

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  1. Department of Psychology, University of Victoria, P.O. Box 1700, Victoria, BC, V8W 2Y2, Canada

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

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Karr, J.E., Areshenkoff, C.N., Duggan, E.C. et al. Blast-Related Mild Traumatic Brain Injury: A Bayesian Random-Effects Meta-Analysis on the Cognitive Outcomes of Concussion among Military Personnel. Neuropsychol Rev 24, 428–444 (2014). https://doi.org/10.1007/s11065-014-9271-8

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