Features of cognitive impairments in different mechanisms of mild traumatic brain injury: a literature review

Keywords: Cognitive Dysfunction, Brain Concussion, Military Personnel, Neurological Rehabilitation, Explosions

Abstract

іn wartime, a significant number of military personnel and civilians experience mild traumatic brain injuries, which negatively affect their quality of life, social adaptation, and recovery rates. Functional limitations caused by mild traumatic brain injuries impact cognitive, motor, communicative, and social domains. This review aims to explore the impact of mild traumatic brain injury on the development of cognitive dysfunctions through a biblio-systematic analysis of scientific literature. The study utilizes data from PubMed, Scopus, and Web of Science to investigate the effects of mild traumatic brain injury on cognitive impairments. The article analyzes various mechanisms of mild traumatic brain injuries and their impact on cognitive functions. It characterizes the types of cognitive and behavioral impairments resulting from mild traumatic brain injuries, such as decreased attention, memory deficits, impaired executive functions, and reduced processing speed. Special attention is given to blast-induced trauma, which amplifies the consequences of mild traumatic brain injuries through the primary effects of the blast wave. The literature analysis identified pathophysiological mechanisms, including metabolic cascades, structural brain damage, and neurotransmitter imbalances. A decrease in prefrontal cortex activity and disruptions in connectivity with other brain regions were observed. The study found that recovery dynamics in mild traumatic brain injuries patients vary depending on factors such as age, recurrent injuries, and psychological conditions. Comorbidities like depression, sleep disturbances, and chronic pain can exacerbate recovery outcomes, while the level of education serves as an important predictor of cognitive recovery. The effectiveness of diagnosis and rehabilitation during wartime relies on the implementation of a comprehensive approach, including screening tests, neuroimaging methods, and rehabilitation programs. The article provides an in-depth review of tests for memory, attention, and executive functions, such as the Psychomotor Vigilance Test, Rey Auditory Verbal Learning Test, and Stroop Test, as well as modern gamified rehabilitation programs like FitMi Home Therapy Program and ImPACT, which combine physical and cognitive exercises. Future research should focus on the development and improvement of methods for monitoring the condition of patients after mild traumatic brain injury, as well as the creation and adaptation of cognitive testing scales and programs for Ukraine. The primary aim is to enhance the quality of life of military personnel, facilitate their social adaptation, accelerate recovery after injury, and develop individualized rehabilitation programs.

References

Mohammed, H. A. O., Reavis, K. M., Thapa, S., Thielman, E. J., Helt, W. J., Carlson, K. F., & Hughes, C. K. (2024). Blast exposure, tinnitus, hearing loss, and postdeployment quality of life in U.S. veterans: A longitudinal analysis. Otolaryngology–Neurotology. Advance online publication. https://doi.org/10.1097/MAO.0000000000004332

Carr, W., Kelley, A. L., Toolin, C. F., & Weber, N. S. (2020). Association of MOS-based blast exposure with medical outcomes. Frontiers in Neurology, 11, Article 619. https://doi.org/10.3389/fneur.2020.00619

Belding, J. N., Fitzmaurice, S., Englert, R. M., Koenig, H. G., Thomsen, C. J., & Olaghere da Silva, U. (2020). Self-reported concussion symptomology during deployment: Differences as a function of injury mechanism and low-level blast exposure. Journal of Neurotrauma, 37(20), 2219–2226. https://doi.org/10.1089/neu.2020.6997

Haran, F. J., Handy, J. D., Servatius, R. J., Rhea, C. K., & Tsao, J. W. (2021). Acute neurocognitive deficits in active duty service members following subconcussive blast exposure. Applied Neuropsychology: Adult, 28(3), 297–309. https://doi.org/10.1080/23279095.2019.1630627

Langlois, J. A., Rutland-Brown, W., & Wald, M. M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. Journal of Head Trauma Rehabilitation, 21(5), 375–378. https://doi.org/10.1097/00001199-200609000-00001

Kobeissy, F., Mondello, S., Tümer, N., et al. (2013). Assessing neuro-systemic and behavioral components in the pathophysiology of blast-related brain injury. Frontiers in Neurology, 4, Article 186. https://doi.org/10.3389/fneur.2013.00186

Halalmeh, D. R., Salama, H. Z., LeUnes, E., et al. (2024). The role of neuropsychology in traumatic brain injury: Comprehensive literature review. World Neurosurgery, 183, 128–143. https://doi.org/10.1016/j.wneu.2023.12.069

Shin, S. S., & Dixon, C. E. (2015). Alterations in cholinergic pathways and therapeutic strategies targeting cholinergic system after traumatic brain injury. Journal of Neurotrauma, 32(19), 1429–1440. https://doi.org/10.1089/neu.2014.3445

Mollica, R. F., Lyoo, I. K., Chernoff, M. C., et al. (2009). Brain structural abnormalities and mental health sequelae in South Vietnamese ex-political detainees who survived traumatic head injury and torture. Archives of General Psychiatry, 66(11), 1221–1232. https://doi.org/10.1001/archgenpsychiatry.2009.127

Wilde, M. C., Castriotta, R. J., Lai, J. M., et al. (2007). Cognitive impairment in patients with traumatic brain injury and obstructive sleep apnea. Archives of Physical Medicine and Rehabilitation, 88(10), 1284–1288. https://doi.org/10.1016/j.apmr.2007.07.012

Georges, A., & Das, J. M. (2024). Traumatic brain injury (Archive). In StatPearls. Treasure Island, FL: StatPearls Publishing. PMID: 29083790

Pagulayan, K. F., Petrie, E. C., Cook, D. G., et al. (2020). Effect of blast-related mTBI on the working memory system: A resting state fMRI study. Brain Imaging and Behavior, 14(4), 949–960. https://doi.org/10.1007/s11682-018-9987-9

Vincent, A. S., Roebuck-Spencer, T. M., & Cernich, A. (2014). Cognitive changes and dementia risk after traumatic brain injury: Implications for aging military personnel. Alzheimer’s & Dementia, 10(3 Suppl), S174–S187. https://doi.org/10.1016/j.jalz.2014.04.006

Purkayastha, S., Stokes, M., & Bell, K. R. (2019). Autonomic nervous system dysfunction in mild traumatic brain injury: A review of related pathophysiology and symptoms. Brain Injury, 33(9), 1129–1136.

O'Brien, M. C., Disner, S. G., Davenport, N. D., & Sponheim, S. R. (2024). The relationship between blast-related mild traumatic brain injury and executive function is moderated by white matter integrity. Brain Imaging and Behavior, 18(4), 764–772. https://doi.org/10.1007/s11682-024-00864-z

Jurick, S. M., Crocker, L. D., Merritt, V. C., et al. (2021). Independent and synergistic associations between TBI characteristics and PTSD symptom clusters on cognitive performance and postconcussive symptoms. The Journal of Neuropsychiatry and Clinical Neurosciences, 33(2), 98–108. https://doi.org/10.1176/appi.neuropsych.20050128

Martindale, S. L., Ord, A. S., & Rowland, J. A. (2020). Influence of blast exposure on cognitive functioning in combat veterans. Neuropsychology, 34(7), 735–743. https://doi.org/10.1037/neu0000672

Lu, L. H., Reid, M. W., Troyanskaya, M., et al. (2023). Close proximity to blast: No long-term or lasting effect on cognitive performance in service members with and without TBI during blast exposure. Journal of the International Neuropsychological Society, 29(6), 551–560. https://doi.org/10.1017/S1355617722000558

Terry, G., Pagulayan, K. F., Muzi, M., et al. (2024). Increased [18F]fluorodeoxyglucose uptake in the left pallidum in military veterans with blast-related mild traumatic brain injury. Journal of Neurotrauma, 41(13–14), 1578–1596. https://doi.org/10.1089/neu.2023.0429

Clausen, A. N., Bouchard, H. C., VA Mid-Atlantic MIRECC Workgroup, et al. (2021). Assessment of neuropsychological function in veterans with blast-related mild traumatic brain injury. Frontiers in Psychology, 12, Article 686330. https://doi.org/10.3389/fpsyg.2021.686330

Pierce, M. E., Hayes, J., Huber, B. R., et al. (2022). Plasma biomarkers associated with deployment trauma. Translational Psychiatry, 12(1), Article 80. https://doi.org/10.1038/s41398-022-01853-w

Wooten, T., Sullivan, D. R., Logue, M. W., et al. (2021). APOE ε4 status moderates the relationship between close-range blast exposure and cognitive functioning. Journal of the International Neuropsychological Society, 27(4), 315–328. https://doi.org/10.1017/S1355617720001034

Kurako, Y. L., & Bukina, V. V. (1989). Mild traumatic brain injury. Kyiv: Naukovе vydavnytstvo “Zdorov’ya.”

Iida, Y., Chiba, H., Ikeda, S., et al. (2021). Association between the Wechsler Adult Intelligence Scale III and early return to work after traumatic brain injury. Work, 68(4), 1101–1111. https://doi.org/10.3233/WOR-213440

Iverson, G. L., Ivins, B. J., Karr, J. E., et al. (2019). Comparing Composite Scores for the ANAM4 TBI-MIL for Research in Mild Traumatic Brain Injury. Archives of Clinical Neuropsychology, 35(1), 56–69. https://doi.org/10.1093/arclin/acz021

Elbin, R. J., D’Amico, N. R., McCarthy, M., et al. (2020). How do ImPACT Quick Test scores compare with ImPACT Online scores in non-concussed adolescent athletes? Archives of Clinical Neuropsychology, 35(3), 326–331. https://doi.org/10.1093/arclin/acz072

Wallace, J., Schatz, P., Covassin, T., & Iverson, G. L. (2020). Brief iPad-based assessment of cognitive functioning with ImPACT® Quick Test: Prevalence of low scores using multivariate base rates. Archives of Clinical Neuropsychology, 35(8), 1276–1282. https://doi.org/10.1093/arclin/acaa078

Williamson, J. B., Heilman, K. M., Porges, E. C., et al. (2013). A possible mechanism for PTSD symptoms in patients with traumatic brain injury: Central autonomic network disruption. Frontiers in Neuroengineering, 6, Article 13. https://doi.org/10.3389/fneng.2013.00013

Published
2025-09-29
How to Cite
1.
Sarazhyna K. Features of cognitive impairments in different mechanisms of mild traumatic brain injury: a literature review. USMYJ [Internet]. 2025Sep.29 [cited 2026Mar.21];157(3):40-187. Available from: https://mmj.nmuofficial.com/index.php/journal/article/view/566