Cognitive Difficulties

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The presence and persistence of cognitive symptoms following concussion can affect an individual’s ability to function in everyday life, including work, academic and social activities.1,2 Concussion is associated with disruptions in cognitive skills that include difficulties with attention/concentration, processing speed, learning/memory and executive function.3-6 In the acute phase of injury there are changes in cerebral metabolic activity and perfusion, particularly in the frontal lobes associated with cognitive changes.7-12 However,15%-33% of individuals3,6,7,13 experience persistent cognitive symptoms beyond the acute phase of recovery, which significantly disrupts their capacity to resume many pre-morbid activities.

It is important to document cognitive symptoms in order to characterize the nature of these symptoms and to track progress over time. When cognitive dysfunction does not resolve with treatment of potentially contributing factors or if cognitive symptoms persist past 1 month, practitioners should consider referral for neuropsychological assessment. This assessment could  aid in identifying the nature of cognitive strengths and challenges, setting goals for treatment, career and education planning, or provide information about independent functioning.7,14 Deficits identified on neuropsychological assessment may be amenable to specific rehabilitation strategies (e.g., compensatory cognitive strategies) as well as facilitation of more effective coping strategies and integration of cognitive compensatory strategies.14 This combination has demonstrated reductions in the presence of persistent symptoms.4,7,15,16

While there are currently no pharmaceutical interventions that are approved for use with cognitive symptoms post concussion, the off -label use of methylphenidate has been shown in some studies to positively impact certain cognitive issues17.

References supporting introduction:

  1. Vanderploeg RD, Curtiss G, Luis CA, Salazar AM. Long-term morbidities following self-reported mild traumatic brain injury. J Clin Exp Neuropsychol. 2007;29(6):585-598.
  2. Theadom A, Parag V, Dowell T, et al. Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. Br J Gen Pract. 2016;66(642):e16-23.
  3. McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One. 2017;12(4):e0174847.
  4. Hadanny A, Efrati S. Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions. Expert Rev Neurother. 2016;16(8):875-887.
  5. Cooper DB, Bunner AE, Kennedy JE, et al. Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging Behav. 2015;9(3):403-420.
  6. Nordström A, Edin BB, Lindström S, Nordström P. Cognitive function and other risk factors for mild traumatic brain injury in young men: nationwide cohort study. BMJ. 2013;346:f723.
  7. Rabinowitz AR, Levin HS. Cognitive sequelae of traumatic brain injury. Psychiatr Clin North Am. 2014;37(1):1-11.
  8. Metting Z, Rödiger LA, Stewart RE, Oudkerk M, De Keyser J, van der Naalt J. Perfusion computed tomography in the acute phase of mild head injury: regional dysfunction and prognostic value. Ann Neurol. 2009;66(6):809-816.
  9. Bartnik BL, Hovda DA, Lee PW. Glucose metabolism after traumatic brain injury: estimation of pyruvate carboxylase and pyruvate dehydrogenase flux by mass isotopomer analysis. J Neurotrauma. 2007;24(1):181-194.
  10. Leddy JJ, Baker JG, Willer B. Active Rehabilitation of Concussion and Post-concussion Syndrome. Phys Med Rehabil Clin N Am. 2016;27(2):437-454.
  11. Wylie GR, Freeman K, Thomas A, et al. Cognitive Improvement after Mild Traumatic Brain Injury Measured with Functional Neuroimaging during the Acute Period. PLoS One. 2015;10(5):e0126110.
  12. Liu SW, Huang LC, Chung WF, et al. Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study. Int J Environ Res Public Health. 2017;14(3).
  13. McMahon P, Hricik A, Yue JK, et al. Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma. 2014;31(1):26-33.
  14. Mani K, Cater B, Hudlikar A. Cognition and return to work after mild/moderate traumatic brain injury: A systematic review. Work. 2017;58(1):51-62.
  15. Tiersky LA, Anselmi V, Johnston MV, et al. A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury. Arch Phys Med Rehabil. 2005;86(8):1565-1574.
  16. Al Sayegh A, Sandford D, Carson AJ. Psychological approaches to treatment of postconcussion syndrome: a systematic review. J Neurol Neurosurg Psychiatry. 2010;81(10):1128-1134.
  17. Lee H, Kim SW, Kim JM, Shin IS, Yang SJ, Yoon JS. Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injury. Hum Psychopharmacol. 2005 Mar;20(2):97-104. doi: 10.1002/hup.668. PMID: 15641125.
9.1

Patients with concussion should be screened for the presence of cognitive symptoms through a focused clinical interview and a validated post-concussion symptom questionnaire (e.g., Rivermead [Appendix 1.5], PCSS [Appendix 1.6], or SCAT5 [Appendix 3.1]).

It is important to screen for the presence of cognitive symptoms with a standardized symptom inventory and clinical interview for the purpose of assessing and tracking symptoms. The clinical interview should assess the impact of cognitive symptoms on functional areas such as performance at work or school and completing tasks within the home and community. These standardized measures listed in recommendation 9.1 may also be used for continued monitoring of symptoms.

Level of Evidence B
Last updated  
9.2

Patients with pre-existing conditions and comorbid symptoms (e.g., anxiety, mood disorders, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, sleep disturbances, fatigue, pain) should be provided with education highlighting that these pre-existing conditions may contribute to having an increased risk of more severe and persistent cognitive symptoms.

Prolonged cognitive symptoms following concussion are often generated and exacerbated by other pre-existing and comorbid conditions such as headache, insomnia, and disturbances in mood. If a patient presents with prolonged symptoms, they should be made aware that the presence of comorbidities may be interfering with recovery. Patients should be encouraged to pursue targeted interventions geared towards these comorbid conditions with the aim of facilitating the resolution of their cognitive symptoms.

References supporting context:

  1. Quinn, D. K., Mayer, A. R., Master, C. L., & Fann, J. R. Prolonged Postconcussive Symptoms. The American journal of psychiatry. 2018;175(2), 103–111.
  2. Van Patten, R., & Iverson, G. L. Examining associations between concussion history, subjectively experienced memory problems, and general health factors in older men. The Clinical neuropsychologist. 2021;1–22. Advance online publication.
  3. Waldron-Perrine, B., McGuire, A. P., Spencer, R. J., Drag, L. L., Pangilinan, P. H., & Bieliauskas, L. A. The influence of sleep and mood on cognitive functioning among veterans being evaluated for mild traumatic brain injury. Military medicine. 2021;177(11), 1293–1301.
Level of Evidence B
( Sleep )
Level of Evidence B
( Fatigue )
Level of Evidence B
( Pain )
Level of Evidence B
( Mood )
Level of Evidence B
( Hearing impairment )
Level of Evidence B
( Hyperglycemia )
Level of Evidence B
( ADHD )
Last updated  
9.3

Referral for specialized cognitive assessment (e.g., neuropsychological assessment) may be considered with the following conditions:     

  • There is functionally limiting cognitive impairment     

  • Comorbidities potentially impacting cognition have been optimally managed   

  • There is no ongoing cognitive symptom improvement     

  • Cognitive symptoms are prolonged (i.e., beyond 4 weeks)   

For those patients with prolonged cognitive symptoms, it may be challenging to identify the contribution of multiple conditions and their impact on cognitive function. Specialized cognitive assessment may assist in clarifying diagnoses and appropriate treatment options based on individual patient characteristics and conditions. While neuropsychology assessment is the current gold standard for cognitive assessment, there are often barriers (i.e., financial or limited resource issues) preventing access to this type of assessment.  Due to long waitlists for neuropsychological assessment, referral should only be considered after other comorbidities potentially impacting cognition have been managed. Other options for cognitive assessment include referral to an occupational therapist or speech language pathologist with specific training in concussion rehabilitation.

Level of Evidence C
Last updated  
9.4

If there is ongoing persistence and complexity of cognitive symptom presentation, refer to a specialized program and/or regulated health care provider. 

Alternatively, patients reporting cognitive symptoms may be provided with self-directed compensatory strategies (i.e., internal, external, environmental).

Patients may benefit from compensatory strategies to improve cognitive impairments following concussion. These may include internal strategies, comprising of instructional (e.g., repeated practice, retrieval practice) and metacognitive methods (e.g., self-awareness and regulation). Additionally, external compensatory strategies such as the use of environmental supports and reminders (e.g., mobile/smartphones, notebooks) may also be employed. Physicians may refer to the INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory for more information about cognitive compensatory strategies.

References supporting context:

  1. Jak AJ, Jurick S, Crocker LD, et al. SMART-CPT for veterans with comorbid post-traumatic stress disorder and history of traumatic brain injury: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2019;90(3):333-341.
  2. Pagulayan KF, O'Neil M, Williams RM, et al. Mental Health Does Not Moderate Compensatory Cognitive Training Efficacy for Veterans With a History of Mild Traumatic Brain Injury. Arch Phys Med Rehabil. 2017;98(9):1893-1896.e2.
  3. Velikonja D, Ponsford J, Janzen S, et al. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory. J Head Trauma Rehabil. 2023;38(1):83-102.
Level of Evidence A
( Mindfulness )
Level of Evidence A
( Other cognitive training programs )
Level of Evidence A
( Compensatory strategies )
Last updated  
9.5

If cognitive symptoms are persisting beyond the initial return to work or school accommodation time period, then review, modify, and extend work/school accommodations as appropriate. These accommodations must be monitored frequently and adjusted as required. See Section 12.

While return to school and work are encouraged, cognitive symptoms may be limiting this successful return. The aim is to return to school or work with appropriate restrictions and accommodations in place to optimize reintegration. Individual workplaces and academic institutions may have resources available to facilitate reintegration.

Level of Evidence C
Last updated  
9.6

Trial of methylphenidate may be considered as a treatment option if:

  • Non-pharmacological treatment options have not been effective

  • The patient is experiencing functionally limiting cognitive fatigue for more than 3 months post-concussion

*NOT AN ORIGINAL RECOMMENDATION- REPEAT OF 11.8

Methylphenidate is a central nervous system stimulant considered a second-line treatment for narcolepsy in adults. This substance may stimulate alertness and improve cognitive function (i.e., processing speed, attention, working memory). This medication should only be prescribed by those familiar with its use. We did not find any evidence for other stimulants. In terms of dosing, the patient should initially be prescribed with the short-acting form to determine how well they respond. They should start at 5mg every morning, so not to affect sleep, for 1 week then increase to 5mg every morning and 5mg daily at noon and continue at this dose. It should be taken 30-45 minutes before meals. Patients should notice it helping with focus and concentration as well as fatigue almost right away. They should be advised to not stop suddenly without speaking with their health care provider.

References supporting context:

  1. Lee H, Kim SW, Kim JM, Shin IS, Yang SJ, Yoon JS. Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injury. Hum Psychopharmacol. 2005;20(2):97-104.
  2. Johansson B, Wentzel AP, Andréll P, Rönnbäck L, Mannheimer C. Long-term treatment with methylphenidate for fatigue after traumatic brain injury. Acta Neurol Scand. 2017;135(1):100-107.
  3. Verghese C, Abdijadid S. Methylphenidate. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 12, 2022.
Level of Evidence A
Last updated  
9.7

A patient with concussion should be advised that the majority of patients will experience full recovery, including cognitive functioning, and return to usual activities within one month. Some patients may experience prolonged symptoms beyond this timeframe. Information and reassurance should be available through written, verbal, and pictorial education.

A large proportion of patients will recover from concussion-related symptoms within the first few weeks following injury; however, a smaller percentage of individuals (20-30%) will experience prolonged symptoms. Providing early education about concussion symptoms and recovery to patients (and their families/significant others) has been demonstrated to positively influence recovery. Education should be offered in multiple formats to ensure information is accessible and comprehensible (View Concussion Information for Patients and Families). 

References supporting context:

  1. Dwyer B, Katz DI. Postconcussion syndrome. Handb Clin Neurol. 2018;158:163-178.
  2. Eliyahu L, Kirkland S, Campbell S, Rowe BH. The Effectiveness of Early Educational Interventions in the Emergency Department to Reduce Incidence or Severity of Postconcussion Syndrome Following a Concussion: A Systematic Review. Acad Emerg Med. 2016;23(5):531-542. 
  3. Remigio-Baker, R. A., Gregory, E., Cole, W. R., Bailie, J. M., McCulloch, K. L., Cecchini, A., Stuessi, K., Andrews, T. R., Mullins, L., & Ettenhofer, M. L. Beliefs about the influence of rest during concussion recovery may predict activity and symptom progression within an active duty military population. Archives of Physical Medicine and Rehabilitation. 2020;101(7), 1204–1211.
  4. Theadom A, Parag V, Dowell T, McPherson K, Starkey N, Barker-Collo S, et al. Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. Br J Gen Pract J R Coll Gen Pract. 2016;66(642):e16–23.
  5. Varner C, Thompson C, de Wit K, Borgundvaag B, Houston R, McLeod S. Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department. CJEM. 2021;23(3):365–73.
  6. Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA. 2016;315(10):1014–25.
Level of Evidence B
( Recovery and return to activity )
Level of Evidence B
( Information and reassurance )
Last updated  
Appendix 1.5
Rivermead Post Concussion Symptoms Questionnaire
appendix-1-5.pdf
Appendix 1.6
Post Concussion Symptom Scale
appendix-1-6.pdf
Appendix 3.1
SCAT5
appendix-3-1.pdf
To learn more about strengths and limitations of the evidence informing each recommendation, click here.

Nelson LD, Barber JK, Temkin NR, et al. Validity of the Brief Test of Adult Cognition by Telephone in Level 1 Trauma Center Patients Six Months Post-Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma. 2021;38(8):1048-1059.

STROBE: 18/23

Associated with recommendation 9.1

Ngwenya LB, Gardner RC, Yue JK, et al. Concordance of common data elements for assessment of subjective cognitive complaints after mild-traumatic brain injury: a TRACK-TBI Pilot Study. Brain Inj. 2018;32(9):1071-1078.   

STROBE: 18/23

Associated with recommendation 9.1

Anderson JFI, Jordan AS. An observational study of the association between sleep disturbance, fatigue and cognition in the post-acute period after mild traumatic brain injury in prospectively studied premorbidly healthy adults. Neuropsychol Rehabil. 2021;31(9):1444-1465.   

STROBE: 18/23

Associated with recommendation 9.2 (sleep, fatigue)

Anderson JFI. The association between pain type, cognition and complaint after mild traumatic brain injury in prospectively studied premorbidly healthy adults admitted to hospital. Neuropsychology. 2020;34(1):53-62.   

STROBE: 17/23

Associated with recommendation 9.2 (pain)

Broggi M, Ready RE. Academic skills, self-perceptions, and grades in university students with a history of multiple concussions: The mediating roles of processing speed and psychological symptoms. Clin Neuropsychol. 2022;36(8):2188-2204.   

STROBE: 16/23 

Associated with recommendation 9.2 (mood)

Crocker LD, Keller AV, Jurick SM, et al. Mild Traumatic Brain Injury Burden Moderates the Relationship Between Cognitive Functioning and Suicidality in Iraq/Afghanistan-Era Veterans. J Int Neuropsychol Soc. 2019;25(1):79-89.   

STROBE: 17/23

Associated with recommendation 9.2 (mood)

Hromas GA, Houck ZM, Asken BM, et al. Making a Difference: Affective Distress Explains Discrepancy Between Objective and Subjective Cognitive Functioning After Mild Traumatic Brain Injury. J Head Trauma Rehabil. 2021;36(3):186-195.   

STROBE: 16/23

Associated with recommendation 9.2 (mood)

Hwang PH, Nelson LD, Sharon JD, et al. Association Between TBI-Related Hearing Impairment and Cognition: A TRACK-TBI Study. J Head Trauma Rehabil. 2022;37(5):E327-E335.   

STROBE: 20/23

Associated with recommendation 9.2 (hearing impairment)

Jurick SM, Crocker LD, Merritt VC, et al. Independent and Synergistic Associations Between TBI Characteristics and PTSD Symptom Clusters on Cognitive Performance and Postconcussive Symptoms in Iraq and Afghanistan Veterans. J Neuropsychiatry Clin Neurosci. 2021;33(2):98-108.   

STROBE: 19/23

Associated with recommendation 9.2 (mood)

Karr JE, Iverson GL, Huang SJ, Silverberg ND, Yang CC. Perceived Change in Physical, Cognitive, and Emotional Symptoms after Mild Traumatic Brain Injury in Patients with Pre-Injury Anxiety or Depression. J Neurotrauma. 2020;37(10):1183-1189.   

STROBE: 20/23 

Associated with recommendation 9.2 (mood)

Schneider ALC, Huie JR, Boscardin WJ, et al. Cognitive Outcome 1 Year After Mild Traumatic Brain Injury: Results From the TRACK-TBI Study. Neurology. 2022;98(12):e1248-e1261.   

STROBE: 22/23

Associated with recommendations 9.2 (mood, hyperglycemia) and 9.7 (recovery and return to activity)

Stenberg J, Karr JE, Terry DP, et al. Change in self-reported cognitive symptoms after mild traumatic brain injury is associated with changes in emotional and somatic symptoms and not changes in cognitive performance. Neuropsychology. 2020;34(5):560-568.   

STROBE: 18/23

Associated with recommendation 9.2 (mood)

Van Patten R, Iverson GL. Examining associations between concussion history, subjectively experienced memory problems, and general health factors in older men [published online ahead of print, 2021 Oct 20]. Clin Neuropsychol. 2021;1-22.   

STROBE: 19/23

Associated with recommendation 9.2 (fatigue, pain, mood, sleep)

Van Patten R, Keith C, Bertolin M, Wright JD. The effect of premorbid attention-deficit/hyperactivity disorder on neuropsychological functioning in individuals with acute mild traumatic brain injuries. J Clin Exp Neuropsychol. 2016;38(1):12-22.  

DOWNS & BLACK: 16/32

Associated with recommendation 9.2 (ADHD)

Waldron-Perrine B, McGuire AP, Spencer RJ, Drag LL, Pangilinan PH, Bieliauskas LA. The influence of sleep and mood on cognitive functioning among veterans being evaluated for mild traumatic brain injury. Mil Med. 2012;177(11):1293-1301.  

DOWNS & BLACK: 14/32

Associated with recommendation 9.2 (sleep, mood)

Disner, S. G., Kramer, M. D., Nelson, N. W., Lipinski, A. J., Christensen, J. M., Polusny, M. A., & Sponheim, S. R. (2017). Predictors of postdeployment functioning in combat-exposed U.S. Military veterans. Clinical Psychological Science, 5(4), 650–663.

STROBE: 16/23

Associated with recommendation 9.2 (mood)

Terry DP, Brassil M, Iverson GL, Panenka WJ, Silverberg ND. Effect of depression on cognition after mild traumatic brain injury in adults. Clin Neuropsychol. 2019;33(1):124-136.

STROBE: 19/23

Associated with recommendation 9.2 (mood)

Saksvik SB, Smevik H, Stenberg J, et al. Poor sleep quality is associated with greater negative consequences for cognitive control function and psychological health after mild traumatic brain injury than after orthopedic injury [published online ahead of print, 2021 Aug 12]. Neuropsychology.

STROBE: 20/23

Associated with recommendation 9.2 (sleep)

Garcia A, Reljic T, Pogoda TK, et al. Obstructive Sleep Apnea Risk Is Associated with Cognitive Impairment after Controlling for Mild Traumatic Brain Injury History: A Chronic Effects of Neurotrauma Consortium Study. J Neurotrauma. 2020;37(23):2517-2527.

STROBE: 19/23

Associated with recommendation 9.2 (sleep)

Acabchuk RL, Brisson JM, Park CL, Babbott-Bryan N, Parmelee OA, Johnson BT. Therapeutic Effects of Meditation, Yoga, and Mindfulness-Based Interventions for Chronic Symptoms of Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Appl Psychol Health Well Being. 2021;13(1):34-62.   

AMSTAR 2: 13/20

Associated with recommendation 9.4 (mindfulness)

Cooper DB, Bunner AE, Kennedy JE, et al. Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging Behav. 2015;9(3):403-420.

PRISMA: 10/27

Associated with recommendations 9.4 (compensatory strategies) and 9.7 (information and reassurance)

Fure SCR, Howe EI, Andelic N, et al. Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial. Ann Phys Rehabil Med. 2021;64(5):101538.   

DOWNS & BLACK: 26/28

Associated with recommendation 9.4 (compensatory strategies, other cognitive training programs)

Jak AJ, Jurick S, Crocker LD, et al. SMART-CPT for veterans with comorbid post-traumatic stress disorder and history of traumatic brain injury: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2019;90(3):333-341.   

DOWNS & BLACK: 21/28

Associated with recommendation 9.4 (compensatory strategies, other cognitive training programs)

Pagulayan KF, O'Neil M, Williams RM, et al. Mental Health Does Not Moderate Compensatory Cognitive Training Efficacy for Veterans With a History of Mild Traumatic Brain Injury. Arch Phys Med Rehabil. 2017;98(9):1893-1896.e2.   

DOWNS & BLACK: 17/28

Associated with recommendation 9.4 (compensatory strategies)

Samuelson KW, Engle K, Abadjian L, et al. Cognitive Training for Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. Front Neurol. 2020;11:569005. Published 2020 Nov 26.   

DOWNS & BLACK: 24/28

Associated with recommendation 9.4 (other cognitive training programs)

Storzbach D, Twamley EW, Roost MS, et al. Compensatory Cognitive Training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans With Mild Traumatic Brain Injury. J Head Trauma Rehabil. 2017;32(1):16-24.  

PEDro: 8/11

Associated with recommendation 9.4 (compensatory strategies)

Twamley EW, Jak AJ, Delis DC, Bondi MW, Lohr JB. Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial. J Rehabil Res Dev. 2014;51(1):59-70.  

PEDro: 6/11

Associated with recommendation 9.4 (other cognitive training programs)

Twamley EW, Thomas KR, Gregory AM, et al. CogSMART Compensatory Cognitive Training for Traumatic Brain Injury: Effects Over 1 Year. J Head Trauma Rehabil. 2015;30(6):391-401.  

PEDro: 6/11

Associated with recommendation 9.4 (other cognitive training programs)

Brown J, Hux K, Hey M, Murphy M. Exploring cognitive support use and preference by college students with TBI: A mixed-methods study. NeuroRehabilitation. 2017;41(2):483-499.   

CASP: 8/9

Associated with recommendation 9.5

Lee H, Kim SW, Kim JM, Shin IS, Yang SJ, Yoon JS. Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injury. Hum Psychopharmacol. 2005;20(2):97-104.   

DOWNS & BLACK: 19/28

Associated with recommendation 9.6

Johansson B, Andréll P, Rönnbäck L, Mannheimer C. Follow-up after 5.5 years of treatment with methylphenidate for mental fatigue and cognitive function after a mild traumatic brain injury. Brain Inj. 2020;34(2):229-235.

Downs & Black: 17/28

Associated with recommendation 9.6

Ali A, Morfin J, Mills J, et al. Fatigue After Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil. 2022;37(4):E249-E257.  

AMSTAR 2: 12/20

Associated with recommendation 9.6

Dean PJ, Sterr A. Long-term effects of mild traumatic brain injury on cognitive performance. Front Hum Neurosci. 2013;7:30.  

DOWNS & BLACK: 17/32

Associated with recommendation 9.7 (recovery and return to activity)

Karlsen RH, Saksvik SB, Stenberg J, et al. Examining the Subacute Effects of Mild Traumatic Brain Injury Using a Traditional and Computerized Neuropsychological Test Battery. J Neurotrauma. 2021;38(1):74-85. 

STROBE: 16/23

Associated with recommendation 9.7 (recovery and return to activity)

O'Neil ME, Carlson K, Storzbach D, et al. Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review. VA Evidence-based Synthesis Program Reports. 2013.  

PRISMA: 18/27

Associated with recommendation 9.7 (recovery and return to activity)

Barker-Collo S, Theadom A, Jones K, et al. Three methods for examining trajectories in neuropsychological performance across the first 4 years after mild Traumatic Brain Injury. Brain Impairment. 2021;22(1):20-33.

STROBE: 19/23

Associated with recommendation 9.7 (recovery and return to activity)