Neurocognitive outcomes and neural mechanisms in children with traumatic brain injury Towards personalized prognosis

Traumatic brain injury (TBI) is the leading cause of disability in children and young adults worldwide, with highly heterogeneous outcomes affecting daily life, including neurocognitive, behavioral, and academic functioning. This thesis aims to improve the assessment and understanding of neurocognitive outcomes and underlying neural mechanisms in children with TBI, and to move towards personalized prognosis.
In Part I, comprehensive computerized neurocognitive assessments revealed that even after mild TBI, children are at risk for long-term deficits in domains such as information processing stability, and longitudinal school performance data revealed deficits in technical reading up to two years post-injury. Network analysis showed that mild to severe TBI disrupts the global organization of the neurocognitive network, which was related to intelligence and behavioral outcomes. Furthermore, cluster analysis identified distinct subgroups with diverging neurocognitive outcome profiles, highlighting the heterogeneity of TBI sequelae.
Part II investigated neural mechanisms of impairment using advanced neuroimaging techniques, including quantitative EEG and resting-state fMRI. The findings showed widespread disruptions in brain network dynamics and organization following TBI, which were associated with neurocognitive and behavioral outcomes, and provided additional information beyond conventional clinical characteristics.
Part III systematically reviewed and proposes prediction models for neurocognitive outcome, integrating demographic, premorbid, clinical, and neuroimaging data. Findings underscore the limited predictive value of injury-related characteristics alone and emphasize the need for multimodal, machine learning-based approaches to achieve individualized prognosis.
Overall, this thesis contributes to a better understanding of the complex interplay between injury, neurocognitive functioning, and daily life outcomes in children with TBI, and highlights the importance of early identification and tailored follow-up to optimize recovery and development.