School of Psychology and Public Health, La Trobe University, Victoria, 3086, Australia.
Neuropsychol Rev. 2022 Dec;32(4):758-806. doi: 10.1007/s11065-021-09524-1. Epub 2021 Oct 25.
A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.
全面了解创伤性脑损伤（TBI）患者的认知测试表现与抑郁、焦虑或创伤后应激障碍（PTSD）症状之间的关系非常重要，因为这些情绪症状在受伤后非常普遍。了解这些关系是否受 TBI 严重程度的影响以及测试表现和症状报告的有效性也很重要。本荟萃分析旨在调查这些症状是否与 TBI 成人的认知测试表现改变有关。本荟萃分析前瞻性地在 PROSPERO 国际系统评价注册中心网站（注册号：CRD42018089194）进行了注册。检索了 Medline、PsycINFO 和 CINAHL 电子数据库中截至 2020 年 5 月发表的期刊文章。共纳入 61 项研究，这些研究能够计算出即时记忆（言语和视觉）、近期记忆（言语和视觉）、注意力、执行功能、处理速度和语言等认知领域的汇总效应大小。抑郁与大多数认知领域呈小的负相关。当单独分析仅有轻度 TBI（mTBI）的样本时，这些关系大多仍然存在，但对于仅有重度 TBI（sTBI）的样本则不然。在焦虑分析中也发现了类似的结果模式。在仅有 mTBI 的样本中，PTSD 与言语记忆呈小的负相关。没有 sTBI 样本的 PTSD 分析数据。调节分析表明，情绪症状与认知测试表现之间的关系可能在一定程度上受到排除表现异常的测试参与者的影响，这些参与者表现异常的测试包括绩效有效性测试（PVTs）或症状有效性测试（SVTs），但研究数量较少，且效应大小的变化无统计学意义。这些发现有助于综合目前已知的 TBI 成人认知测试表现与情绪症状之间的关系，表明在多个领域中，情绪症状与认知测试表现之间存在显著但较小的关系，且这些关系在非军事样本中也是如此。其中一些关系似乎在一定程度上受到控制绩效或症状有效性的影响，但这是基于使用有效性测试的相对较少的研究。需要更多的研究包括 PVT 和 SVT，同时检查情绪症状和认知结果之间的关系。
