Relationship Between Diffusion Tensor Imaging (DTI) Findings and Cognition Following Pediatric TBI: A Meta-Analytic Review

Figures & data

Figure 1. Flow of included studies.

Table 1. Demographic and imaging data.

	Nstudies	Nparticipants	Mean (SD)	Range
Sample size	14	358	25.6 (17.7)	6–74
Age (years)	14	358	13.5 (1.9)	7.9–15.3
Injury severity
GCS	9	197	9.8 (2.9)	6.3–15
Time since injury (years)
DTI/MRI scan	14	358	1.4 (1.6)	0.01–4.9
Cognitive test	14	358	1.6 (1.6)	0.01–4.9
Time of imaging post-TBI			Nstudies reporting FA	Nstudies reporting MD/ADC
Short term (<4 weeks)	3	80	2	2
Medium–long term/chronic (>4 weeks)	11	246	10	3
	Nstudies	Nparticipants	% participants
Sex
Males	13	229	67%
Females	13	112	33%
Injury severity
Mild TBI	2	28	8%
Mild–moderate TBI	1	14	4%
Mild, moderate, severe TBI	1	17	5%
Complicated mild, moderate, severe TBI	6	227	63%
Moderate–severe TBI	3	39	11%
Severe TBI	1	34	9%
MRI strength
1.5T	4	112	31%
3T	10	246	69%
MRI brand
Phillips	8	195	54%
Siemens	4	56	16%
Handedness
Right	6	174	88%
Left	6	24	12%
Ethnicity	4	157	44%
Caucasian/European	4	81	52%
Hispanic	4	55	35%
African American	4	13	8%
Other/biracial/American Indian	4	8	5%
Country
U.S.	12	301	84%
Belgium	1	24	7%
UK	1	33	9%

Table 2. Summary information relating to the cognitive domains and regions of interest assessed in the short and medium to long term.

	Cognitive domains assessed by studies reporting FA (Nstudies)	Brain regions assessed with FA (Nstudies)
Short term (<4 weeks)	academic achievement (1) attention/information processing (1) concept formation (1) executive functions (1) memory (2)	Cerebral peduncle (1) Cingulate gyrus (1) Corpus callosum—body (1) Internal capsule (1) Corpus callosum—splenium (1)	Anterior corona radiata (1) Superior corona radiata (1) Corpus callosum—genu/anterior (1) Left cingulate (1)
Medium–long term (>4 weeks)	academic achievement (2) attention/information processing (7) construction (1) executive functions (2) general cognition (2) memory (2) motor function (2)	Anterior corona radiata (1) Anterior limb internal capsule (3) Brainstem (1) Cerebellum (1) Cerebral peduncle (2) Cingulate gyrus (1) Composite whole brain (2) Corpus callosum—Body (5) Corpus callosum—Genu/anterior (7) Corpus callosum—Isthmus (1) Corpus callosum—Splenium (6) Corpus callosum—Total (1) Cortico spinal tract (2) External capsule (1) Fornix (1) Fornix (column and body) (1) Fornix (striata terminalus) (1) Frontal white matter (1) Hippocampus (1) Inferior fronto-occipital fasciculus (1) Inferior peduncle (2) Left cingulate (1)	Left frontal lobe (3) Left uncinate fasciculus (2) Medial lemniscus (2) Middle peduncle (2) Optic radiation (1) Pons (1) Pontine crossing tract (1) Posterior corona radiata (1) Posterior Limb Internal Capsule (3) Posterior thalamic radiation (2) Retrolenticular internal capsule (1) Right cingulate (1) Right frontal lobe (3) Right uncinate fasciculus (2) Sagittal Stratum (1) Superior corona radiata (1) Superior fronto-occipital fasciculus (1) Superior longitudinal fasciculus (2) Superior peduncle (1) Supracallosal (2) Tapetum (1)
	Cognitive domains assessed by studies reporting ADC/MD (Nstudies)	Brain regions assessed with ADC/MD (Nstudies)
Short term (<4 weeks)	academic achievement (1) attention/information processing (1) construction (1) executive functions (1) general cognition (1) memory (2) motor function (1) verbal function (1)	Composite brain regions (1) Left cingulate (1)
Medium–long term (>4 weeks)	attention/information processing (1) construction (1) memory (2)	Corpus callosum—Anterior (2) Left cingulate (2) Left frontal lobe (3) Left uncinate fasciculus (1)	Right cingulate (1) Right frontal lobe (2) Right uncinate fasciculus (1)

Table 3. Pearson r effect sizes (moderate-to-large only) measuring the relationship between FA/ADC and cognitive function in specific ROI in the short term (<4 weeks) post-TBI.^a

Cognitive domain	Nstudies	Nparticipants	Effect size r	95% CI		Nfs	Study references
				Lower limit	Upper limit
FA
Concept formation
Corpus callosum—Body	1	16	.75**	.41	.91	10	#1
Executive
Cerebral peduncle	1	16	−.60**	−.85	−.15	7	#1
Internal capsule	1	16	−.55*	−.82	−.08	6	#1
Cingulate gyrus	1	16	−.47	−.78	.03	4	#1
Superior corona radiata	1	16	−.33	−.71	.20	3	#1
Corpus callosum—Genu/anterior	1	16	.32	−.21	.70	2	#1
Memory
Left cingulate	1	12	−.56	−.86	.02	6	#2
Internal capsule	1	16	−.47	−.78	.03	4	#1
Cerebral peduncle	1	16	−.41	−.75	.11	4	#1
Cingulate gyrus	1	16	−.40	−.75	.12	3	#1
Superior corona radiata	1	16	−.36	−.73	.17	3	#1
Corpus callosum—Splenium	1	16	−.29	−.69	.24	2	#1
Corpus callosum—Genu/anterior	1	16	.27	−.26	.68	2	#1
ADC
Academic achievement
Composite brain regions	1	17	−.27	−.66	.24	2	#3
Attention and information processing
Composite brain regions	1	17	−.32	−.69	.19	2	#3
Construction
Composite brain regions	1	17	−.45	−.77	.04	4	#3
Executive
Composite brain regions	1	17	−.34	−.71	.17	3	#3
General cognition
Composite brain regions	1	17	−.38	−.73	.12	3	#3
Memory
Left cingulate	1	12	.59*	.02	.87	6	#2
Motor function
Composite brain regions	1	17	−.31	−.69	.20	2	#3
Verbal functions
Composite brain regions	1	17	−.31	−.69	.20	2	#3

Note. N_studies = Number of studies included in an analysis, N_participants = total number of participants, N_fs = Failsafe N, Study references: #1 Mayer et al. (2012), #2 Wu, Wilde, Bigler, Yallampalli, et al. (2010), #3 Babikian et al. (2009). ADC = apparent diffusion coefficient; FA = fractional anisotropy; ROI = regions of interest; TBI = traumatic brain injury.

^aModerate-to-large effect sizes—which, when rounded to 1 decimal place to compare against Cohen’s (1992) benchmarks, are <−.3 or >.3—only provided here. See Table G, supplementary material, for a complete set of results (small, medium, and large effects).

*p < .05. **p < .01.

Table 4. Pearson r effect sizes (moderate-to-large only) measuring the relationship between FA and cognitive function in specific ROI in the medium to long term (>4 weeks) post-TBI.^a

Cognitive domain	Nstudies	Nparticipants	Effect size r	95% CI		Nfs	Study references
				Lower limit	Upper limit
FA
Academic achievement
Corpus callosum—Splenium	2	56	.34**	0.08	.55	5	#1, #2
Corpus callosum—Isthmus	1	41	.33*	.03	.58	3	#2
Superior fronto-occipital fasciculus	1	17	.29	−.22	.68	2	#1
Superior corona radiata	1	17	.28	−.23	.67	2	#1
Attention and information processing
Composite whole brain	1	32	.73**	.51	.86	10	#3
Corpus callosum—Total	1	23	.55**	.18	.78	6	#4
Corpus callosum—Splenium	5	164	.46**	.16	.68	21	#1, #2, #4, #5, #6
Left frontal lobe	1	9	.40	−.36	.84	3	#5
Corpus callosum—Body	4	141	.38	−.05	.69	12	#1, #2, #5, #6
Corpus callosum—Isthmus	1	41	.34*	.04	.59	3	#2
Corpus callosum—Genu/anterior	4	141	.30	−.19	.66	9	#1, #2, #5, #6
Construction
Corpus callosum—Genu/anterior	1	33	.40*	.07	.65	3	#7
Executive
Left uncinate fasciculus	1	17	.30	−.21	.68	2	#1
General cognition
Corpus callosum—Isthmus	1	41	.32*	.01	.57	2	#2
Memory
Right uncinate fasciculus	1	40	.44**	.15	.66	4	#8
Left cingulate	1	40	.39**	.09	.63	3	#8
Corpus callosum—Genu/anterior	1	33	.33	−.02	.61	3	#7
Left uncinate fasciculus	1	40	.26	−.02	.50	2	#8
Motor function
Optic radiation	1	17	.80**	.52	.93	12	#9
Cortico spinal tract	1	24	.70**	.41	.86	9	#9, #10
Posterior thalamic radiation	1	17	.69**	.31	.88	9	#9, #10
Composite whole brain	1	17	.68**	.30	.88	8	#9
Medial lemniscus	1	17	.63**	.21	.85	7	#9, #10
Cerebellum	1	24	.59**	.25	.80	6	#10, #11
Superior peduncle	1	17	.59**	.15	.83	6	#9, #10
Posterior limb internal capsule	1	12	.56	−.02	.86	6	#10
Corpus callosum—Splenium	1	41	.53**	.27	.72	5	#2
Pons	1	12	.52	−.08	.84	5	#10
Cerebral peduncle	1	12	.51	−.09	.84	5	#10
Brainstem	1	12	.47	−.14	.82	4	#10
Corpus callosum—Isthmus	1	41	.46**	−.18	.62	4	#2
Inferior peduncle	1	17	.46	−.03	.77	4	#9, #10
Middle peduncle	1	12	.43	−.19	.81	4	#10
Corpus callosum—Body	1	41	.39**	.09	.62	3	#2

Note. N_studies = Number of studies included in analysis, N_participants = total number of participants, N_fs = Failsafe N, Study references: #1 Adamson et al. (2013), #2 Ewing-Cobbs et al. (2008), #3 Levin et al. (2008), #4 Wu, Wilde, Bigler, Li, et al. (2010), #5 Kurowski et al. (2009), #6 Treble et al. (2013), #7 Wozniak et al. (2007), #7 Tasker, Westland, White, and Williams (2010), #8 McCauley et al. (2011), #9 Caeyenberghs et al. (2010a), #10 Caeyenberghs et al. (2010b), #11 Caeyenberghs et al. (2011). FA = fractional anisotropy; ROI = regions of interest; TBI = traumatic brain injury.

^aModerate-to-large effect sizes—which, when rounded to 1 decimal place to compare against Cohen’s (1992) benchmarks, are <−.3 or >.3—only provided here. See Table H, supplementary material, for a complete set of results (small, medium, and large effects).

*p < .05. **p < .01.

Table 5. Pearson r effect sizes (moderate-to-large only) measuring the relationship between ADC/MD and cognitive function in specific ROI in the medium to long term (>4 weeks) post-TBI.^a

Cognitive domain	Nstudies	Nparticipants		Effect size r	95% CI		Nfs	Study References
					Lower limit	Upper limit
ADC/MD
Attention and information processing
Left frontal lobe	1	6	−1.00**		−1.00	−.99	69		#1
Left cingulate	1	6	−0.94**		−.94	−.54	27		#1
Construction
Right frontal lobe	1	33	−0.51**		−.73	−.20	4		#2
Left frontal lobe	1	33	−0.40*		−.65	−.06	3		#2
Anterior corpus callosum	1	33	−0.36*		−.63	−.02	3		#2
Memory
Right frontal lobe	2	73	−0.40		−.40	.06	6		#2, #3
Left frontal lobe	2	73	−0.34**		−.53	−.11	5		#2, #3
Left uncinate fasciculus	1	40	−0.32*		−.57	−.01	2		#3
Anterior corpus callosum	1	33	−0.32		−.60	.03	2		#2

Note. N_studies = Number of studies included in analysis, N_participants = total number of participants, N_fs = Failsafe N, Study references: #1 Wilde et al. (2011), #2 Tasker et al. (2010), #3 McCauley et al. (2011).

^aModerate-to-large effect sizes—which, when rounded to 1 decimal place to compare against Cohen’s (1992) benchmarks, are <−.3 or >.3—only provided here. See Table H, supplementary material, for a complete set of results (small, medium & large effects). ADC/MD = apparent diffusion coefficient/mean diffusivity; ROI = regions of interest; TBI = traumatic brain injury.

*p < .05. **p < .01.

Table A1. Logic grid for PubMed.

DTI	TBI	Child	Cognitive function
(Diffusion tensor imaging[mh] OR diffusion tensor imaging[tiab] OR dti[tiab] OR diffusion magnetic resonance imaging[mh] OR diffusion magnetic resonance imaging[tiab] OR diffusion weighted imaging[tiab] OR dwi[tiab])	(Brain injuries[mh:noexp] OR Brain hemorrhage, traumatic[mh:noexp] OR Craniocerebral trauma[mh:noexp] OR brain injur*[tiab] OR tbi[tiab] OR brain trauma[tiab])	(Child[mh] OR child*[tw] OR adolescent[mh] OR adolesce*[tw] OR teen*[tiab] OR paediatric[tiab] or pediatric[tiab])	(Neuropsychological tests[mh] OR Mental processes[mh] OR mental process*[tiab] OR cognition[mh] OR cognition[tiab] OR executive function[mh] OR executive function[tiab] OR learning[mh] OR learning[tiab] OR perception[mh] OR perception[tiab] OR executive control[tiab] OR human information processing[tiab] OR cognitive[tiab] OR attention[tiab] OR memory[tiab] OR speed[tiab] OR intelligence[tiab] OR iq[tiab] OR development[tiab] OR academic[tiab] OR achievement[tiab] OR motor[tiab] OR visual[tiab] OR spatial[tiab] OR visuospatial[tiab] OR language[tiab] OR sensory[tiab] OR neuropsych*[tiab] OR neurocognitive[tiab])

Table A2. Logic grid for PsycINFO.

DTI	TBI	Child	Cognitive function
diffusion tensor imaging.TI OR diffusion tensor imaging.AB OR dti .TI OR dti.AB OR diffusion magnetic resonance imaging.TI OR diffusion magnetic resonance imaging.AB OR diffusion weighted imaging.TI OR diffusion weighted imaging.AB OR dwi.TI OR dwi.AB	brain damage.DE OR traumatic brain injury.DE OR brain injur*.AB OR brain injur*.TI OR tbi.TI OR tbi.AB OR brain trauma.TI OR brain trauma.AB	child*.TI OR child*.AB OR adolesce*.TI OR adolesce*.AB OR teen*.TI OR teen*.AB OR pediatric*.TI OR pediatric*.AB OR paediatric*.TI OR paediatric*.AB	Cognition.DE OR cognition.DE OR cognition.AB OR cognitive ability.DE OR cognitive abilit*.TI OR cognitive abilit*.AB OR cognitive.TI OR cognitive.AB OR executive function.DE OR executive function*.TI OR executive function*.AB OR cognitive processes.DE OR cognitive process*.TI OR cognitive process*.AB OR neuropsychological assessment.DE OR neuropsych*.TI OR neuropsych*.AB OR neurocognitive.TI OR neurocognitive.AB OR intelligence.DE OR intelligence.TI OR intelligence.AB OR iq.TI OR iq.AB OR attention.TI OR attention.AB OR memory.TI OR memory.AB OR speed.TI OR speed.AB OR development.TI OR development.AB OR academic.TI OR academic.AB OR achievement.TI OR achievement.AB OR motor.TI OR motor.AB OR visual.TI OR visual.AB OR spatial.TI OR spatial.AB OR visuospatial.TI OR visuospatial.AB OR perception.TI OR perception.AB OR language.TI OR language.AB OR sensory.TI OR sensory.AB

Table A3. Logic grid for Scopus.

DTI	TBI	Child	Cognitive function
TITLE-ABS-KEY(diffusion tensor imaging) OR TITLE-ABS-KEY(dti) OR TITLE-ABS-KEY(diffusion magnetic resonance imaging) OR INDEXTERMS(diffusion tensor imaging) OR INDEXTERMS(diffusion magnetic resonance imaging) OR TITLE-ABS-KEY(diffusion weighted imaging) OR TITLE-ABS-KEY(dwi)	INDEXTERMS(brain injuries) OR TITLE-ABS-KEY(brain injur*) OR TITLE-ABS-KEY(tbi) OR TITLE-ABS-KEY(traumatic brain injury) OR INDEXTERMS(craniocerebral trauma) OR TITLE-ABS-KEY(brain trauma) OR INDEXTERMS(brain hemorrhage, traumatic)	INDEXTERMS(child) OR TITLE-ABS-KEY(child*) OR INDEXTERMS(adolescent) OR TITLE-ABS-KEY(adolesce*) OR TITLE-ABS-KEY(teen*) OR TITLE-ABS-KEY(pediatric*) OR TITLE-ABS-KEY(paediatric*)	INDEXTERMS(mental processes) OR INDEXTERMS(cognition) OR INDEXTERMS(executive function) OR INDEXTERMS(neuropsychological tests) OR INDEXTERMS(learning) OR INDEXTERMS(perception) OR INDEXTERMS(memory) OR INDEXTERMS(attention) OR TITLE-ABS-KEY(mental process*) OR TITLE-ABS-KEY(cognitive ability*) OR TITLE-ABS-KEY(cognition) OR TITLE-ABS-KEY(cognitive) OR TITLE-ABS-KEY(executive function*) OR TITLE-ABS-KEY(executive control) OR TITLE-ABS-KEY(human information processing) OR TITLE-ABS-KEY(cognitive process*) OR TITLE-ABS-KEY(attention) OR TITLE-ABS-KEY(memory) OR TITLE-ABS-KEY(speed) OR TITLE-ABS-KEY(intelligence) OR TITLE-ABS-KEY(iq) OR TITLE-ABS-KEY(development) OR TITLE-ABS-KEY(academic) OR TITLE-ABS-KEY(achievement) OR TITLE-ABS-KEY(motor) OR TITLE-ABS-KEY(visual) OR TITLE-ABS-KEY(spatial) OR TITLE-ABS-KEY(visuospatial) OR TITLE-ABS-KEY(perception) OR TITLE-ABS-KEY(language) OR TITLE-ABS-KEY(sensory) OR TITLE-ABS-KEY(neuropsych*) OR TITLE-ABS-KEY(neurocognitive)

Table A4. Logic grid for Embase.

DTI	TBI	Child	Cognitive function
“diffusion tensor imaging”/de OR “diffusion weighted imaging”/de OR “diffusion tensor imaging”:ti,ab OR dti:ti,ab OR “diffusion weighted imaging”:ti,ab OR “diffusion magnetic resonance imaging”:ti,ab OR dwi:ti,ab	“Brain injury”/de OR “traumatic brain injury”/de OR “traumatic brain injury”:ti,ab OR tbi:ti,ab OR “brain injuries”:ti,ab OR “craniocerebral trauma”:ti,ab OR “brain trauma”:ti,ab	Child/de OR child*:ti,ab OR adolescent/de OR adolesce*:ti,ab OR teen*:ti,ab OR pediatric*:ti,ab OR paediatric*:ti,ab	Cognition/de OR cognition:ti,ab OR cognitive:ti,ab OR “executive function”/de OR “executive function”:ti,ab OR “executive control”:ti,ab OR “cognitive control”:ti,ab OR “cognitive function”:ti,ab OR “mental function”/de OR “mental function”:ti,ab OR “mental processes”:ti,ab OR attention/de OR attention:ti,ab OR learning/de OR learning:ti,ab OR perception/de OR perception:ti,ab OR memory/de OR memory:ti,ab OR speed:ti,ab OR intelligence:ti,ab OR iq:ti,ab OR development:ti,ab OR academic:ti,ab OR achievement:ti,ab OR motor:ti,ab OR visual:ti,ab OR spatial:ti,ab OR visuospatial:ti,ab OR language:ti,ab OR sensory:ti,ab OR “neuropsychological test”/de OR neuropsych*:ti,ab OR neurocognitive:ti,ab

Table A5. Logic grid for Web of Science.

DTI	TBI	Child	Cognitive function
TS = “diffusion tensor imaging” OR TS = dti OR TS = ”diffusion magnetic resonance imaging” OR TI = “diffusion tensor imaging” OR TI = dti OR TI = ”diffusion magnetic resonance imaging” OR TI = “diffusion weighted imaging” OR TI = dwi OR TS = ”diffusion weighted imaging” OR TS = dwi	TS = “brain injur*” OR TS = tbi OR TS = “traumatic brain injury” OR TS = “brain trauma” OR TS = ”craniocerebral trauma” OR TI = “brain injur*” OR TI = tbi OR TI = “traumatic brain injury” OR TI = “brain trauma”	TS = (child OR child*) OR TS = (adolescent OR adolesce*) OR TS = teen* OR TI = (child OR child*) OR TI = (adolescent OR adolesce*) OR TI = teen* OR TS = (pediatric OR paediatric) OR TI = (pediatric OR paediatric)	TS = mental process* OR TS = cognition OR TS = cognitive function* OR TS = executive function* OR TS = executive control OR TS = cognitive abilit* OR TS = cognitive OR TS = attention OR TS = memory OR TS = speed OR TS = intelligence OR TS = iq OR TS = development OR TS = academic OR TS = achievement OR TS = motor OR TS = visual OR TS = spatial OR TS = visuospatial OR TS = perception OR TS = language OR TS = sensory OR TS = neuropsych* OR TS = neuropsychological tests OR TS = neurocognitive OR TI = mental process* OR TI = cognition OR TI = cognitive function* OR TI = executive function* OR TI = executive control OR TI = cognitive abilit* OR TI = cognitive OR TI = attention OR TI = memory OR TI = speed OR TI = intelligence OR TI = iq OR TI = development OR TI = academic OR TI = achievement OR TI = motor OR TI = visual OR TI = spatial OR TI = visuospatial OR TI = perception OR TI = language OR TI = sensory OR TI = neuropsych* OR TI = neuropsychological tests OR TI = neurocognitive

Table A6. Logic grid for CINAHL.

DTI	TBI	Child	Cognitive function
TI “diffusion tensor imaging” OR AB “diffusion tensor imaging” OR TI dti OR AB dti OR TI ”diffusion magnetic resonance imaging” OR AB “diffusion magnetic resonance imaging” OR TI “diffusion weighted imaging” OR AB “diffusion weighted imaging” OR TI dwi OR AB dwi	MH “Brain injuries” OR TI “brain injur*” OR AB “brain injur*” OR TI tbi OR AB tbi OR TI “traumatic brain injury” OR AB “traumatic brain injury” OR TI “craniocerebral trauma” OR AB “craniocerebral trauma” OR TI “brain trauma” OR AB “brain trauma”	MH child OR TI child* OR AB child* OR TI adolesce* OR AB adolesce* OR TI teen* OR AB teen* OR TI pediatric OR AB pediatric OR TI paediatric OR AB paediatric	MH “mental processes+” OR MH “cognition+” OR MH learning OR MH perception OR TI “mental process*” OR AB “mental process*” OR TI cognition OR AB cognition OR TI cognitive OR AB cognitive OR TI “cognitive abilit*” OR AB “cognitive abilit*” OR TI “executive function*” OR AB “executive function*” OR TI “cognitive process*” OR AB “cognitive process*” OR TI attention OR AB attention OR TI memory OR AB memory OR TI speed OR AB speed OR TI intelligence OR AB intelligence OR TI iq OR AB iq OR TI development OR AB development OR TI academic OR AB academic OR TI achievement OR AB achievement OR TI motor OR AB motor OR TI visual OR AB visual OR TI spatial OR AB spatial OR TI perception OR AB perception OR TI visuospatial OR AB visuospatial OR TI language OR AB language OR TI sensory OR AB sensory OR TI neuropsych* OR AB neuropsych* OR TI neurocognitive OR AB neurocognitive OR MH “neuropsychological tests” OR TI “neuropsychological test*” OR AB “neuropsychological test*”

Table A7. Logic grid for Informit (health databases).

DTI	TBI	Child	Cognitive function
(SU = Diffusion tensor imaging OR TI,AB = diffusion tensor imaging OR TI,AB = dti OR SU = Diffusion magnetic resonance imaging OR TI,AB = diffusion magnetic resonance imaging)	(SU = acquired brain injuries OR TI,AB = tbi OR TI,AB = brain injur* OR SU = traumatic brain injury)	(SU = Child OR TI,AB = child* OR SU = Adolescent OR TI,AB = adolesce* OR TI,AB = teen*)	(SU = Cognition OR TI,AB = cognition OR TI,AB = cognitive abilit* OR SU = Executive function OR TI,AB = executive function* OR TI,AB = executive control OR SU = mental processes OR TI,AB = mental process*)

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