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Cognitive Outcome Following Traumatic Brain Injury

Dikmen, Sureyya S. PhD; Corrigan, John D. PhD, ABPP; Levin, Harvey S. PhD; Machamer, Joan MA; Stiers, William PhD, ABPP; Weisskopf, Marc G. PhD, ScD

Section Editor(s): Rutherford, George W. MD, Topical Editor

The Journal of Head Trauma Rehabilitation: November-December 2009 - Volume 24 - Issue 6 - p 430–438
doi: 10.1097/HTR.0b013e3181c133e9

Objective To determine whether an association exists between traumatic brain injury (TBI) sustained in adulthood and cognitive impairment 6 months or longer after injury.

Design Systematic review of the published, peer-reviewed literature.

Results From 430 articles, we identified 11 primary and 22 secondary studies that examined cognitive impairment by using performance measures for adults who were at least 6 months post-TBI. There was clear evidence of an association between penetrating brain injury and impaired cognitive function. Factors that modified this association included preinjury intelligence, volume of brain tissue lost, and brain region injured. There was also suggestive evidence that penetrating brain injury may exacerbate the cognitive effects of normal aging. We found clear evidence for long-term cognitive deficits associated with severe TBI. There was suggestive evidence that moderately severe brain injuries are associated with cognitive impairments. There was inadequate/insufficient evidence to determine whether an association exists between a single, mild TBI and cognitive deficits 6 months or longer postinjury.

Conclusion In adults, penetrating, moderate, and severe TBIs are associated with cognitive deficits 6 months or longer postinjury. There is insufficient evidence to determine whether mild TBI is associated with cognitive deficits 6 months or longer postinjury.

Supplemental Digital Content is available in the text

Departments of Rehabilitation Medicine (Dr Dikmen and Ms Machamer), Neurological Surgery, and Psychiatry & Behavioral Sciences (Dr Dikmen), University of Washington, Seattle, Washington; Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio (Dr Corrigan); Cognitive Neuroscience Laboratory, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Dr Levin); Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland (Dr Stiers); and Departments of Environmental Health and Epidemiology, Harvard School of Public Health, Boston, Massachusetts (Dr Weisskopf).

Corresponding Author: Sureyya S. Dikmen, PhD, Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195 (

The study was supported by a contract from the US Department of Veterans Affairs to the National Academy of Sciences, Institute of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site ( The tables in supplemental digital content have been reprinted with permission from Gulf War and Health: Volume 7. Long Term Consequences of Traumatic Brain Injury. Copyright 2009, National Academy of Sciences, Washington, DC.

© 2009 Lippincott Williams & Wilkins, Inc.