Cognitive Outcomes Following Traumatic Brain Injury in African American and Black Populations: A Narrative Review

Background and/or Objectives: Traumatic brain injury (TBI) disproportionately affects African American and/or Black (AAB) populations, despite this disparity post-TBI cognitive outcomes for AAB remains underexplored. This narrative review examines cognitive impairment and dementias following TBI in AAB individuals, highlighting key study elements and identifying gaps in research.

Design: Studies were identified in PubMed using search terms derived from the following key words: traumatic brain injury, dementia, cognitive impairment, African American and/or Black.

Setting : 23 studies met the inclusion criteria.

Participants : Original research assessing cognitive outcomes in AAB individuals with TBI history were included.

Interventions: N/A.

Main Outcome Measures: Post-TBI cognitive outcomes, including cognitive impairment, dementia, and deficits in attention, executive function, and processing. Studies investigating post-traumatic stress disorder as a primary outcome measure were excluded.

Results: Although race was often included as a covariate in regression analyses, few studies directly focused on AAB populations. One study on African American patients (n = 2,487) found that AAB individuals who experienced TBI were more likely to develop MCI compared to those without reported TBI. TBI with loss of consciousness was associated with an earlier onset of Alzheimer’s disease, occurring 3.4 years earlier in AAB patients (n = 46) and 2.3 years earlier in non-Hispanic Caucasian patients (n = 669). In a study of former NFL players (ages 40-69; n = 27 Black, n = 41 White), Black players with repetitive head impacts had lower cognitive scores and smaller hippocampal volumes than their White peers, even after controlling for age, education, cardiovascular risk factors, APOEε4, and intracranial volume. Comorbidities such as cerebrovascular disease, hypertension, depression, and diabetes-disproportionately affecting AAB persons-further contribute to cognitive decline following TBI.

Conclusions: Racial disparities in post-TBI cognitive outcomes were evident. Yet, critical gaps remain in our understanding of how genetic, social, and healthcare factors drive these differences. Future research should prioritize this population to address disparities and guide targeted interventions.