Item – Theses Canada

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OCLC number
191239032
Author
Davidson, Lara,1972-
Title
A meta-analysis of neurocognitive performance in mild-moderate traumatic brain injury and post traumatic stress disorder.
Degree
Ph. D. -- York University, 2005
Publisher
Ottawa : Library and Archives Canada = Bibliothèque et Archives Canada, [2006]
Description
2 microfiches
Notes
Includes bibliographical references.
Abstract
The presence and persistence of neuropsychological impairment in mild trauma is brain injury (TBI) is the subject of considerable debate. This debate is fueled by inconsistency in the diagnosis of mild-moderate TBI and in the results of individual neuropsychological studies. The cognitive impairments seen in some individuals with mild-moderate TBI have been attributed to organic damage and to stress reactions. PTSD represents a disorder with ongoing emotional distress in the absence of cerebral trauma. The comparison of individuals with posttraumatic stress disorder (PTSD) and mild-moderate TBI may help to elucidate the potential impact of stress and distress on cognitive functioning after mild-moderate TBI. The present investigation represents the first meta-analytic study to conduct a comprehensive moderator variable analysis of potential factors that might influence neuropsychological performance in individuals with mild-moderate TBI, and to compare this to the performance of individuals with PTSD. In addition, the present study is the first quantitative synthesis of neuropsychological performance in PTSD. In this meta-analysis, 77 studies on neuropsychological performance in mild-moderate TBI were synthesized, reflecting results from 2,230 individuals with TBI and 2,044 normal controls. Thirty-three studies on neuropsychological performance in PTSD were synthesized, reflecting results from 1424 patients with PTSD and 3276 normal controls. Cohen's ' d' was used to quantify case-control differences in neuropsychological performance across nine domains. Moderator variable analysis indexed the association of clinical and demographic factors to the magnitude of these differences. Cognitive impairment relative to controls was evident in a minority of patients with mild-moderate TBI and PTSD. Effect sizes in the TBI literature were not significantly different from those in the PTSD literature for any neuropsychological domain. The neuropsychological performance of mild-moderate TBI groups was related to the cognitive function measured, type of control group, age, education, time since injury, Glasgow Coma Scale score, presence of loss of consciousness, neurosurgical interventions, and positive imaging findings. The neuropsychological performance of PTSD groups was related to the cognitive function measured, gender, education, type of trauma, severity of PTSD symptoms, and a comorbid diagnosis of major depressive disorder. The meta-analytic results from the PTSD literature suggest that chronic stress in and of itself may cause cognitive impairment in a vulnerable minority of individuals. Cognitive impairment is neither a necessary nor a sufficient component for a diagnosis of mild-moderate TBI and when present, may reflect both the effects of a psychological trauma and/or pathophysiology.
ISBN
0494115645
9780494115640