Personality change after traumatic brain injury: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of observational studies.
PubMed 42547613 · doi:10.1007/s00415-026-14028-0
What was done
Authors conducted a pre-registered systematic review (CRD42023440990) across four databases (MEDLINE, PsycINFO, EMBASE, and CINAHL) for primary studies on personality change following traumatic brain injury (TBI). They synthesized conceptualization, prevalence, longitudinal outcome, lesion location, and treatment. Prevalence was calculated using a random-effects meta-analysis (Paule-Mandel estimator) with subgroup, meta-regression, and robustness analyses.
What was found
A total of 101 studies were included, with 17 eligible for meta-analysis. The estimated prevalence of secondary personality disorder was 29.1% (95% CI 22.5% to 36.2%) and broad personality change was 68.1% (95% CI 53.4% to 81.2%). Frequently reported symptoms included irritability, depression, emotional instability, anger outbursts, social withdrawal, anxiety, impulsivity, restlessness, aberrant motor behaviors, and aggression. Longitudinal studies indicated that personality change remained stable over long follow-up periods. No clear association with specific lesion locations was identified, and very few systematic studies evaluated treatment.
Why it matters
This review establishes pooled prevalence figures confirming that personality changes are common and chronic after TBI, while highlighting critical evidence gaps regarding neuroanatomical correlates and effective interventions.
Limits
The estimate for broad personality change was unstable after adjustment for risk of bias and potential publication bias. Definitions of personality change were inconsistent across studies, lesion-mapping research was of poor methodological quality, and total participant sample size was not reported in the abstract.
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