Theses and Dissertations from DePaul University

Date of Award

Spring 2026

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Science and Health

First Advisor

Susan McMahon

Abstract

Adults are expected to recover from cognitive symptoms following mild traumatic brain injury (mTBI) within three months; however, a subset report persistent symptoms. Previous meta-analyses have found that these symptoms are due to factors aside from the mTBI itself, and additional research is needed to determine what factors may contribute to objective cognitive functioning in the chronic stage of mTBI. This review examined biopsychosocial and injury-related correlates of objective cognitive functioning in adults with a history of mTBI. A systematic search was conducted in APA PsycINFO, CINAHL, PubMed, SCOPUS, MEDLINE, and SPORTDiscus to identify studies published since 2015 examining associations between these factors and objective cognition in adults ≥3 months post-injury. Studies were screened and extracted using Covidence by multiple reviewers, with risk of bias assessed using ROBINS-E. Meta-analyses were conducted using random-effects and multilevel models, with narrative synthesis when pooling was not feasible. The search yielded 5,339 articles after removing duplicates, with 22 studies meeting eligibility criteria. Of these, 15 were included in meta-analyses. Systematic review findings showed substantial variability across studies, with PTSD and depression most consistently associated with poorer cognitive performance. Injury-related variables (e.g., number of TBIs, loss of consciousness), physical health, and environmental factors demonstrated weak or inconsistent relationships with objective cognition. Meta-analytic results indicated most factors were not significantly associated with objective cognition; however, PTSD was linked to poorer memory and executive functioning performance, and blast exposure and lower age were related to poorer overall performance. Overall, cognitive outcomes following mTBI appear more strongly associated with psychological factors than other factors studied, underscoring the importance of these factors in understanding persistent cognitive difficulties. Implications are discussed, including the need for longitudinal studies, studies focused on mechanisms impacting cognition, comprehensive clinical and forensic evaluations, and access to evidence-based interventions for psychological factors associated with cognition following mTBI.

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