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Relationship between white matter integrity and post-traumatic cognitive deficits: a systematic review and meta-analysis
  1. Jie Zhang1,
  2. Liang Tian1,
  3. Li Zhang1,
  4. Ruidong Cheng1,
  5. Ruili Wei2,
  6. Fangping He2,
  7. Juebao Li1,
  8. Benyan Luo2,
  9. Xiangming Ye1
  1. 1 Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
  2. 2 Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
  1. Correspondence to Professor Xiangming Ye, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China; yexmdr{at}


Objective To investigate relationships between cognitive domains and white matter changes in different regions in patients with cognitive deficits after traumatic brain injury (TBI).

Methods Databases including PubMed, Embase, Web of Science and CENTRAL were searched for studies published before 5 August 2017. Correlation coefficients between cognition and white matter integrity, measured by diffusion metrics, including fractional anisotropy (FA), were pooled from 49 studies including 1405 patients. The influence of demographic factors was assessed by meta-regression analysis.

Results Significant pooled FA–executive correlations (p<0.001) were found across various regions, including the corpus callosum (CC) (r=0.42, 95% CI 0.30 to 0.54), superior longitudinal fasciculus (r=0.50, 95% CI 0.41 to 0.59) and internal capsule (IC) (r=0.49, 95% CI 0.37 to 0.61). The fornix (r=0.62, 95% CI 0.45 to 0.78) and cingulum (r=0.57, 95% CI 0.34 to 0.81) particularly correlated with memory (p<0.001). The CC and IC also showed significant relationships with attention and processing speed (p<0.001). Demographic factors had no influence overall, except that studies with a greater proportion of males had stronger correlations between memory and white matter (p<0.05).

Conclusions FA is the most sensitive metric for detecting post-TBI cognitive decline across various domains. Representative white matter regions, such as the CC and IC, perform better than whole-brain white matter for reflecting a wide range of cognitive domains, including memory, attention and executive functions. Moreover, the fornix and cingulum particularly reflect memory function. They yield insights into particular imaging indicators that have neuropsychological value.

  • traumatic brain injury
  • cognitive dysfunction
  • white matter
  • diffusion tensor imaging

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  • Contributors JZ was involved in the study concept and design, analysis and interpretation. LT and LZ were involved in the assessment of methodological quality. RC, RW and FH took part in the data extraction and analysis. BL, JL and XY were responsible for the study concept and revision of the manuscript.

  • Funding This work was supported by the grants from the Science and Technology Planning Project of Zhejiang Province, China (2017C03011).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Local Research Ethics Committee of the First Affiliated Hospital of Zhejiang University.

  • Provenance and peer review Not commissioned; externally peer reviewed.