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Neale AC, Aase DM, Soble JR, Baker JC, Phan KL. Disentangling subjective symptom complaints and objective cognitive performance in veterans: Impact of posttraumatic stress disorder and lifetime traumatic brain injury burden. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:948-963. [PMID: 35819927 DOI: 10.1080/23279095.2022.2096452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Self-reported histories of mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) symptoms are prevalent among post-9/11 veterans. Both are associated with subjective and often overlapping symptom complaints, but variably with objective neuropsychological test performances. These outcomes are seldom explored in relation to lifetime mTBI burden. This cross-sectional study examined associations of PTSD and lifetime mTBI with subjective (persistent symptoms after concussion and cognitive complaints) and objective (performances across five cognitive domains) measures among 46 veterans. Within this sample, 20 veterans had Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) confirmed PTSD (PTSD+), whereas 26 demographically-similar participants did not meet criteria (PTSD-). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) yielded total mTBI scores ranging from 0 to 8. Regressions showed PTSD was associated with increased subjective symptoms/cognitive complaints, along with reduced verbal fluency, visuospatial memory, and processing speed performances. Lifetime mTBI burden was associated with subjective symptoms, but not with objective cognitive test performance, after controlling for PTSD. No significant interactions were observed. Exploratory correlations suggested that all PTSD symptom clusters were generally associated with the subjective and objective measures. However, fewer significant associations emerged within the PTSD+/- groups separately, with each group yielding somewhat different patterns of relationships. PTSD and increasing mTBI burden are consistently associated with negative subjective symptoms, including cognitive complaints. Each condition likely explains some degree of unique variance in symptom reporting. PTSD is associated with poorer objective cognition on some tasks, including processing speed, executive functioning, and learning/memory. Implications are explored.
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Affiliation(s)
- Alec C Neale
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Darrin M Aase
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Jason R Soble
- Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
- Neurology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Justin C Baker
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - K Luan Phan
- Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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2
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Shahim P, Pham DL, van der Merwe AJ, Moore B, Chou Y, Lippa SM, Kenney K, Diaz‐Arrastia R, Chan L. Serum NfL and GFAP as biomarkers of progressive neurodegeneration in TBI. Alzheimers Dement 2024; 20:4663-4676. [PMID: 38805359 PMCID: PMC11247683 DOI: 10.1002/alz.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND We examined spatial patterns of brain atrophy after mild, moderate, and severe traumatic brain injury (TBI), the relationship between progression of brain atrophy with initial traumatic axonal injury (TAI), cognitive outcome, and with serum biomarkers of brain injury. METHODS A total of 143 patients with TBI and 43 controls were studied cross-sectionally and longitudinally up to 5 years with multiple assessments, which included brain magnetic resonance imaging, cognitive testing, and serum biomarkers. RESULTS TBI patients showed progressive volume loss regardless of injury severity over several years, and TAI was independently associated with accelerated brain atrophy. Cognitive performance improved over time. Higher baseline serum neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) were associated with greater rate of brain atrophy over 5 years. DISCUSSSION Spatial patterns of atrophy differ by injury severity and TAI is associated with the progression of brain atrophy. Serum NfL and GFAP show promise as non-invasive prognostic biomarkers of progressive neurodegeneration in TBI. HIGHLIGHTS In this longitudinal study of patient with mild, moderate, and severe traumatic brain injury (TBI) who were assessed with paired magnetic resonance imaging (MRI), blood biomarkers, and cognitive assessments, we found that brain atrophy after TBI is progressive and continues for many years even after a mild head trauma without signs of brain injury on conventional MRI. We found that spatial pattern of brain atrophy differs between mild, moderate, and severe TBI, where in patients with mild TBI , atrophy is mainly seen in the gray matter, while in those with moderate to severe brain injury atrophy is predominantly seen in the subcortical gray matter and whiter matter. Cognitive performance improves over time after a TBI. Serum measures of neurofilament light or glial fibrillary acidic protein are associated with progression of brain atrophy after TBI.
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Affiliation(s)
- Pashtun Shahim
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- National Institutes of Neurological Disorders and Stroke, NIHBethesdaMarylandUSA
- Department of NeurologyMedStar Georgetown University Hospital, Pasquerilla Healthcare CenterWashingtonDistrict of ColumbiaUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Dzung L. Pham
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Andre J. van der Merwe
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Brian Moore
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Yi‐Yu Chou
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Sara M. Lippa
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of Excellence, Walter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Kimbra Kenney
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of Excellence, Walter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Ramon Diaz‐Arrastia
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Leighton Chan
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
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Rantins P, Ly M, Clark AL, Weigand AJ, Durazo AA, Merritt VC, Bangen KJ, Thomas KR. Research Letter: TBI Severity Moderates the Association Between Subjective and Objective Attention in Older Veterans. J Head Trauma Rehabil 2024; 39:239-246. [PMID: 37712765 PMCID: PMC10920393 DOI: 10.1097/htr.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study examined the moderating effect of traumatic brain injury (TBI) history on subjective and objective cognition across multiple cognitive domains. SETTING, PARTICIPANTS, AND DESIGN Participants included 242 Vietnam-era veterans with a history of no TBI (n = 86), mild TBI (n = 74), or moderate-to-severe TBI (n = 82) from the observational Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study. MAIN MEASURES Objective cognition was the outcome and was measured using neuropsychological measures in the domains of memory, attention/executive functioning, and language. Subjective cognition was measured using the memory, divided attention, and language subscales from the Everyday Cognition (ECog) measure. TBI severity status was the moderating variable. RESULTS Veterans with a history of moderate-to-severe TBI had a stronger negative association between subjective and objective attention relative to participants without a TBI ( P = .002). Although this association did not differ between mild TBI and no TBI history groups ( P = .100), the association between subjective and objective attention for the mild TBI group was intermediate to the no TBI and moderate-to-severe TBI history groups. TBI status did not moderate associations between subjective and objective memory or language. CONCLUSION Results highlight the importance of assessing subjective and objective cognition in older veterans and the relevance of attention in the context of TBI history. More work is needed to better understand the intersection of TBI and aging and how these factors may be used to guide individualized assessment and treatment approaches for older veterans.
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Affiliation(s)
- Peter Rantins
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Monica Ly
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin,
Austin, TX, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Alin Alshaheri Durazo
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Victoria C. Merritt
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH),
VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
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Finley JCA, Cladek A, Gonzalez C, Brook M. Perceived cognitive impairment is related to internalizing psychopathology but unrelated to objective cognitive performance among nongeriatric adults presenting for outpatient neuropsychological evaluation. Clin Neuropsychol 2024; 38:644-667. [PMID: 37518890 DOI: 10.1080/13854046.2023.2241190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
Objective: This study investigated the relationship between perceived cognitive impairment, objective cognitive performance, and intrapersonal variables thought to influence ratings of perceived cognitive impairment. Method: Study sample comprised 194 nongeriatric adults who were seen in a general outpatient neuropsychology clinic for a variety of referral questions. The cognition subscale score from the WHO Disability Assessment Schedule served as the measure of perceived cognitive impairment. Objective cognitive performance was indexed via a composite score derived from a comprehensive neuropsychological battery. Internalizing psychopathology was indexed via a composite score derived from anxiety and depression measures. Medical and neuropsychiatric comorbidities were indexed by the number of different ICD diagnostic categories documented in medical records. Demographics included age, sex, race, and years of education. Results: Objective cognitive performance was unrelated to subjective concerns, explaining <1% of the variance in perceived cognitive impairment ratings. Conversely, internalizing psychopathology was significantly predictive, explaining nearly one-third of the variance in perceived cognitive impairment ratings, even after accounting for test performance, demographics, and number of comorbidities. Internalizing psychopathology was also highly associated with a greater discrepancy between scores on perceived and objective cognitive measures among participants with greater cognitive concerns. Clinically significant somatic symptoms uniquely contributed to the explained variance in perceived cognitive impairment (by ∼13%) when analyzed in a model with internalizing symptoms. Conclusions: These findings suggest that perceived cognitive impairment may be more indicative of the extent of internalizing psychopathology and somatic concerns than cognitive ability.
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Affiliation(s)
- John-Christopher A Finley
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea Cladek
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Michael Brook
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cherian KN, Keynan JN, Anker L, Faerman A, Brown RE, Shamma A, Keynan O, Coetzee JP, Batail JM, Phillips A, Bassano NJ, Sahlem GL, Inzunza J, Millar T, Dickinson J, Rolle CE, Keller J, Adamson M, Kratter IH, Williams NR. Magnesium-ibogaine therapy in veterans with traumatic brain injuries. Nat Med 2024; 30:373-381. [PMID: 38182784 PMCID: PMC10878970 DOI: 10.1038/s41591-023-02705-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/10/2023] [Indexed: 01/07/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of disability. Sequelae can include functional impairments and psychiatric syndromes such as post-traumatic stress disorder (PTSD), depression and anxiety. Special Operations Forces (SOF) veterans (SOVs) may be at an elevated risk for these complications, leading some to seek underexplored treatment alternatives such as the oneirogen ibogaine, a plant-derived compound known to interact with multiple neurotransmitter systems that has been studied primarily as a treatment for substance use disorders. Ibogaine has been associated with instances of fatal cardiac arrhythmia, but coadministration of magnesium may mitigate this concern. In the present study, we report a prospective observational study of the Magnesium-Ibogaine: the Stanford Traumatic Injury to the CNS protocol (MISTIC), provided together with complementary treatment modalities, in 30 male SOVs with predominantly mild TBI. We assessed changes in the World Health Organization Disability Assessment Schedule from baseline to immediately (primary outcome) and 1 month (secondary outcome) after treatment. Additional secondary outcomes included changes in PTSD (Clinician-Administered PTSD Scale for DSM-5), depression (Montgomery-Åsberg Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). MISTIC resulted in significant improvements in functioning both immediately (Pcorrected < 0.001, Cohen's d = 0.74) and 1 month (Pcorrected < 0.001, d = 2.20) after treatment and in PTSD (Pcorrected < 0.001, d = 2.54), depression (Pcorrected < 0.001, d = 2.80) and anxiety (Pcorrected < 0.001, d = 2.13) at 1 month after treatment. There were no unexpected or serious adverse events. Controlled clinical trials to assess safety and efficacy are needed to validate these initial open-label findings. ClinicalTrials.gov registration: NCT04313712 .
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Affiliation(s)
- Kirsten N Cherian
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jackob N Keynan
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Lauren Anker
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Afik Faerman
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | | | - Ahmed Shamma
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Or Keynan
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - John P Coetzee
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
- Polytrauma Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jean-Marie Batail
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Angela Phillips
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nicholas J Bassano
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Gregory L Sahlem
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jose Inzunza
- Ambio Life Sciences, Vancouver, British Columbia, Canada
| | - Trevor Millar
- Ambio Life Sciences, Vancouver, British Columbia, Canada
| | | | - C E Rolle
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jennifer Keller
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Maheen Adamson
- WRIISC-WOMEN & Department of Rehabilitation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Ian H Kratter
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nolan R Williams
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA.
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA.
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6
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Boyko M, Gruenbaum BF, Oleshko A, Merzlikin I, Zlotnik A. Diet's Impact on Post-Traumatic Brain Injury Depression: Exploring Neurodegeneration, Chronic Blood-Brain Barrier Destruction, and Glutamate Neurotoxicity Mechanisms. Nutrients 2023; 15:4681. [PMID: 37960334 PMCID: PMC10649677 DOI: 10.3390/nu15214681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Traumatic brain injury (TBI) has a profound impact on cognitive and mental functioning, leading to lifelong impairment and significantly diminishing the quality of life for affected individuals. A healthy blood-brain barrier (BBB) plays a crucial role in guarding the brain against elevated levels of blood glutamate, making its permeability a vital aspect of glutamate regulation within the brain. Studies have shown the efficacy of reducing excess glutamate in the brain as a treatment for post-TBI depression, anxiety, and aggression. The purpose of this article is to evaluate the involvement of dietary glutamate in the development of depression after TBI. We performed a literature search to examine the effects of diets abundant in glutamate, which are common in Asian populations, when compared to diets low in glutamate, which are prevalent in Europe and America. We specifically explored these effects in the context of chronic BBB damage after TBI, which may initiate neurodegeneration and subsequently have an impact on depression through the mechanism of chronic glutamate neurotoxicity. A glutamate-rich diet leads to increased blood glutamate levels when contrasted with a glutamate-poor diet. Within the context of chronic BBB disruption, elevated blood glutamate levels translate to heightened brain glutamate concentrations, thereby intensifying neurodegeneration due to glutamate neurotoxicity.
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Affiliation(s)
- Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna Oleshko
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Igor Merzlikin
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
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7
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Kim SY, Soumoff AA, Raiciulescu S, Kemezis PA, Spinks EA, Brody DL, Capaldi VF, Ursano RJ, Benedek DM, Choi KH. Association of Traumatic Brain Injury Severity and Self-Reported Neuropsychiatric Symptoms in Wounded Military Service Members. Neurotrauma Rep 2023; 4:14-24. [PMID: 36726873 PMCID: PMC9886188 DOI: 10.1089/neur.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The impact of traumatic brain injury (TBI) severity and loss of consciousness (LOC) on the development of neuropsychiatric symptoms was studied in injured service members (SMs; n = 1278) evacuated from combat settings between 2003 and 2012. TBI diagnoses of mild TBI (mTBI) or moderate-to-severe TBI (MS-TBI) along with LOC status were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and the Defense and Veterans Brain Injury Center Standard Surveillance Case Definition for TBI. Self-reported psychiatric symptoms were evaluated for post-traumatic stress disorder (PTSD) with the PTSD Checklist, Civilian Version for PTSD, the Patient Health Questionnaire-9 for major depressive disorder (MDD), and the Patient Health Questionnaire-15 for somatic symptom disorder (SSD) in two time periods post-injury: Assessment Period 1 (AP1, 0.0-2.5 months) and Assessment Period 2 (AP2, 3-12 months). mTBI, but not MS-TBI, was associated with increased neuropsychiatric symptoms: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP2. A subgroup analysis of mTBI with and without LOC revealed that mTBI with LOC, but not mTBI without LOC, was associated with increased symptoms as compared to non-TBI: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP1 and AP2. Moreover, mTBI with LOC was associated with increased MDD symptoms in AP2, and SSD symptoms in AP1 and AP2, compared to mTBI without LOC. These findings reinforce the need for the accurate characterization of TBI severity and a multi-disciplinary approach to address the devastating impacts of TBI in injured SMs.
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Affiliation(s)
- Sharon Y. Kim
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
| | - Alyssa A. Soumoff
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Biostatistics Consulting Center, Uniformed Services University, Bethesda, Maryland, USA
| | - Patricia A. Kemezis
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Elizabeth A. Spinks
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David L. Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Maryland, USA.,Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA
| | - Vincent F. Capaldi
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Robert J. Ursano
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - David M. Benedek
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Kwang H. Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Address correspondence to: Kwang H. Choi, PhD, Department of Psychiatry, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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8
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Disner SG, Mattson EK, Nelson NW, Armistead-Jehle P. The role of posttraumatic stress symptoms on memory complaints and performance in active-duty service members. Clin Neuropsychol 2023; 37:141-156. [PMID: 34779345 DOI: 10.1080/13854046.2021.1998635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Memory complaints are the most common form of cognitive limitation reported by military service members, but prior research suggests that posttraumatic stress symptoms (PTSS) may account for the link between subjective cognitive complaints and objective cognitive performance. The mechanisms underlying this relationship are largely unknown, including whether the finding applies to memory complaints and performance, which clinical dimensions are involved, and how the association varies when memory complaints are non-credible. METHOD Using a sample of 196 US military service members, the present study aims to address these gaps by modeling the relationship between objective memory performance and plausible/implausible subjective memory complaints, then evaluating how the association is influenced by PTSS and clinical traits commonly found within PTSS (e.g. depression, anxiety, and somatic concerns). RESULTS Overall memory complaints were associated with immediate and delayed recall, but both associations were fully mediated by PTSS (95% CI -0.14, -0.01; 95% CI -0.14, -0.02, respectively). Implausible memory complaints, however, were inconsistently linked to memory performance, and no PTSS mediation was observed. Of the clinical traits, only depression moderated the impact of PTSS, specifically by influencing the link between PTSS and overall memory complaints (β = -0.02, SE = 0.004, p < .001). CONCLUSIONS These results corroborate the importance of assessment for PTSS and depression in service members who report subjective memory complaints and highlight how targeted intervention for these conditions may play a key role in the management of memory complaints.
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Affiliation(s)
- Seth G Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Elsa K Mattson
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
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9
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Fink SJ, Davey DK, Sakamoto MS, Chanfreau-Coffinier C, Clark AL, Delano-Wood L, Merritt VC. Subjective cognitive and psychiatric well-being in U.S. Military Veterans screened for deployment-related traumatic brain injury: A Million Veteran Program Study. J Psychiatr Res 2022; 151:144-149. [PMID: 35483132 PMCID: PMC9406238 DOI: 10.1016/j.jpsychires.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine subjective cognitive and psychiatric functioning in post-deployed military Veterans who underwent the Veterans Health Administration's Traumatic Brain Injury (TBI) Screening and Evaluation Program and enrolled in the VA's Million Veteran Program (MVP). Veterans (N = 7483) were classified into three groups based on outcomes from the TBI Screening and Evaluation Program: (1) negative TBI screen ('Screen-'), (2) positive TBI screen but no TBI diagnosis ('Screen+/TBI-'), or (3) positive TBI screen and TBI diagnosis ('Screen+/TBI+'). Chi-square analyses revealed significant group differences across all self-reported cognitive and psychiatric health conditions (e.g., memory loss, depression), and ANCOVAs similarly showed a significant association between group and subjective symptom reporting. Specifically, the relationship between TBI group and clinical outcome (i.e., health conditions and symptoms) was such that the Screen+/TBI+ group fared the worst, followed by the Screen+/TBI- group, and finally the Screen- group. However, evaluation of effect sizes suggested that Veterans in the two Screen+ groups (Screen+/TBI+ and Screen+/TBI-) are faring similarly to one another on subjective cognitive and psychiatric functioning, but that both Screen+ groups are faring significantly worse than the Screen- group. Our results have meaningful clinical implications and suggest that Veterans who screen positive for TBI, regardless of ultimate TBI diagnosis, be eligible for similar clinical services so that both groups can benefit from valuable treatments and therapeutics. Finally, this research sets the stage for follow-up work to be conducted within MVP that will address the neurobiological underpinnings of cognitive and psychiatric distress in this population.
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Affiliation(s)
- Shayna J Fink
- Veterans Medical Research Foundation, San Diego, CA, United States
| | - Delaney K Davey
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - McKenna S Sakamoto
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Victoria C Merritt
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
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10
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Sorg SF, Werhane ML, Merritt VC, Clark AL, Holiday KA, Hanson KL, Jak AJ, Schiehser DM, Delano-Wood L. Research Letter: PTSD Symptom Severity and Multiple Traumatic Brain Injuries Are Associated With Elevated Memory Complaints in Veterans With Histories of Mild TBI. J Head Trauma Rehabil 2021; 36:418-423. [PMID: 33656481 PMCID: PMC8969182 DOI: 10.1097/htr.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The evaluation of memory complaints in mild traumatic brain injury (mTBI) remains an important clinical consideration, especially in the context of comorbid psychiatric symptoms such as posttraumatic stress disorder (PTSD). We compared subjective memory complaints in veterans with and without a history of mTBI, examined ratings between those with single versus multiple mTBIs, and investigated associations between memory complaints and PTSD symptom severity. METHODS 117 outpatient veterans (mTBI: n = 79 [single mTBI: n = 22, multiple mTBI: n = 57], military controls [MCs]: n = 38) completed a TBI history assessment, the Prospective-Retrospective Memory Questionnaire (PRMQ), and the PTSD Checklist-Military Version (PCL-M). RESULTS Hierarchical multiple regression showed that greater PCL-M scores significantly predicted elevated PRMQ-Total scores, accounting for 38% of the variance explained (P < .001). mTBI status predicted an additional 5% of variance in memory complaints (P < .01). The multiple-mTBI group endorsed more memory complaints than either MCs (P < .01) or the single-mTBI group (P < .05), who did not differ from MCs (P > .50). CONCLUSIONS Comorbid PTSD symptoms are an important factor when considering memory complaints in veterans with a reported history of mTBI. However, independent of comorbid PTSD symptoms, mTBI status-particularly in the context of repetitive neurotrauma-uniquely contributes to memory complaints. Findings suggest that veterans with a history of multiple mTBIs may be a particularly vulnerable group in need of specialized interventions and/or psychoeducation.
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Affiliation(s)
- Scott F Sorg
- Research and Psychology Services (Drs Sorg, Merritt, Clark, Hanson, Jak, Schiehser, and Delano-Wood) and Center of Excellence for Stress and Mental Health (Drs Jak, Schiehser, and Delano-Wood), VA San Diego Healthcare System, San Diego, California; SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California (Ms Holiday); Department of Psychiatry, University of California San Diego (Drs Sorg, Merritt, Clark, Hanson, Jak, Schiehser, and Delano-Wood); and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dr Werhane)
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11
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Donnelly K, Donnelly JP. Path Analysis of the Mediating Roles of Personality, Distress, and Cognitive Flexibility in the Subjective Well-Being of Combat Veterans With Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:E381-E390. [PMID: 33935226 DOI: 10.1097/htr.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the interrelationships among traumatic brain injury (TBI), maladaptive personality traits (MPT), psychological distress, and cognitive flexibility in the prediction of subjective well-being of post-9/11 veterans concurrently and over time. SETTING Five Veterans Affairs (VA) medical centers and 1 VA outpatient clinic in urban, suburban, and rural areas. PARTICIPANTS Five hundred Operation Enduring Freedom/Operation Iraqi Freedom veterans at baseline (219 with TBI), 292 at 18-month follow-up (108 with TBI), drawn from a regional registry and clinic referrals. DESIGN Path analysis of data from a prospective cohort study. MAIN MEASURES Satisfaction with Life Scale, 36-ltem Short-Form Health Survey (SF-36) Health Scale, Personality Assessment Screener, Beck Depression Inventory-II, Beck Anxiety Inventory, Posttraumatic Stress Disorder Checklist-Military, Trail Making Test, Part B, Delis-Kaplan Executive Function System (D-KEFS) Category-Switching Verbal Fluency, and D-KEFS Color-Word Interference Test. RESULTS There was no direct effect of TBI on well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had significant direct effects on well-being at baseline and 18 months. Baseline model accounted for 66% of the variance in well-being; follow-up model accounted for 43% of well-being variance. Negative influence of distress significantly decreased from baseline to follow-up. Direct negative effect of MPT diminished slightly over 18 months; effect of cognitive flexibility increased. Significant relationships were estimated in prediction of distress by MPT, cognitive flexibility, and TBI. TBI predicted MPT. MPT, cognitive flexibility, and TBI had indirect effects on well-being. TBI had a positive indirect influence on distress. Total effects included 4 significant predictors of well-being at baseline and 18 months: distress, MPT, cognitive flexibility, and TBI. CONCLUSION Experience of TBI alone did not predict subjective well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had direct effects on well-being at both time points. Interventions aimed at reducing distress and bolstering resilience and cognitive flexibility are recommended to increase subjective well-being in this population.
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Affiliation(s)
- Kerry Donnelly
- Behavioral VA Care Line, VA Western New York Healthcare System, and Department of Psychiatry, University at Buffalo/SUNY, Buffalo, New York (Dr K. Donnelly); and Department of Counseling and Human Services, Institute for Autism Research, Canisius College, Buffalo, New York (Dr J. P. Donnelly)
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12
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Garcia A, Miles SR, Reljic T, Silva MA, Dams-O'Connor K, Belanger HG, Bajor L, Richardson R. Neurobehavioral Symptoms in U.S. Special Operations Forces in Rehabilitation After Traumatic Brain Injury: A TBI Model Systems Study. Mil Med 2021; 187:1412-1421. [PMID: 34591087 DOI: 10.1093/milmed/usab347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/26/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Special Operations Forces (SOF) personnel are at increased risk for traumatic brain injury (TBI), when compared with conventional forces (CF). Prior studies of TBI in military samples have not typically investigated SOF vs. CF as specific subgroups, despite documented differences in premorbid resilience and post-injury comorbidity burden. The aim of the current study was to compare SOF vs. CF on the presence of neurobehavioral symptoms after TBI, as well as factors influencing perception of symptom intensity. MATERIALS AND METHODS This study conducted an analysis of the prospective veterans affairs (VA) TBI Model Systems Cohort, which includes service members and veterans (SM/V) who received inpatient rehabilitation for TBI at one of the five VA Polytrauma Rehabilitation Centers. Of those with known SOF status (N = 342), 129 participants identified as SOF (average age = 43 years, 98% male) and 213 identified as CF (average age = 38.7 years, 91% male). SOF vs. CF were compared on demographics, injury characteristics, and psychological and behavioral health symptoms. These variables were then used to predict neurobehavioral symptom severity in univariable and multivariable analyses. RESULTS SOF personnel reported significantly greater posttraumatic stress disorder (PTSD) symptoms but less alcohol and drug use than the CF. SOF also reported greater neurobehavioral symptoms. When examining those with TBIs of all severities, SOF status was not associated with neurobehavioral symptom severity, while race, mechanism of TBI, and PTSD symptoms were. When examining only those with mTBI, SOF status was associated with lower neurobehavioral symptoms, while PTSD severity, white race, and certain mechanisms of injury were associated with greater neurobehavioral symptoms. CONCLUSIONS Among those receiving inpatient treatment for TBI, SOF SM/V reported higher neurobehavioral and symptom severity. PTSD was the strongest predictor of neurobehavioral symptoms and should be considered an important treatment target in both SOF and CF with co-morbid PTSD/TBI. A proactive human performance approach towards identification and treatment of psychological and neurobehavioral symptoms is recommended for SOF.
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Affiliation(s)
- Amanda Garcia
- Traumatic Brain Injury Center of Excellence, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA
| | - Tea Reljic
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.,Department of Psychology, University of South Florida, Tampa, FL 33620, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine, New York, NY 10029, USA.,Department of Neurology, Icahn School of Medicine, New York, NY 10029, USA
| | - Heather G Belanger
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,United States Special Operations Command (USSOCOM), MacDill AFB, FL 33621, USA.,St Michael's Inc., Woodbridge, VA 22192, USA
| | - Laura Bajor
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,Harvard South Shore Psychiatry Residency Program, Brockton, MA 02301, USA
| | - Risa Richardson
- Traumatic Brain Injury Center of Excellence, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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13
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Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 103:1222-1232. [PMID: 34516996 DOI: 10.1016/j.apmr.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where "psychoeducation" was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation-the Rehabilitation Treatment Specification System-can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.
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14
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Yapici-Eser H, Yalcinay-Inan M, Kucuker MU, Kilciksiz CM, Yilmaz S, Dincer N, Kilic O, Ercan AC, Aydemir O. Subjective cognitive assessments and N-back are not correlated, and they are differentially affected by anxiety and depression. APPLIED NEUROPSYCHOLOGY-ADULT 2021:1-11. [PMID: 34505812 DOI: 10.1080/23279095.2021.1969400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive function (CF) is a core feature related to all psychiatric disorders. However, self-report scales of CF (SRSC) may not always correlate with CF's objective measures and may have different mediators. Tools to select for evaluating CF in diverse psychiatric populations and their determinants need to be studied. In this study, we aimed to assess the association of SRSC (Perceived Deficit Questionnaire-Depression (PDQ-D), and World Health Organization's Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) and its inattentiveness subscale) with Letter-N-back as an objective measure of CF, and to analyze their association with psychopathology. Two hundred nine (131 nonclinical, and 78 clinical with a psychiatric diagnosis of ICD10 F31-39 [mood disorders excluding Bipolar I] or F40-F49 [neurotic, stress-related or psychosomatic disorder] categories) participants were evaluated with PDQ-D, ASRS, Beck Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI), and N-back. Both groups' data were included in the analysis. PDQ-D showed a small correlation with N-back scores, whereas ASRS showed no correlation. PDQ-D and ASRS showed a large correlation. Age and BAI scores significantly predicted both PDQ-D and ASRS, whereas the cognitive subscale of BDI predicted PDQ-D, but not ASRS. Only BAI scores predicted N-back results. The mediation model revealed that 2-back scores of N-back task directly affects PDQ-D scores, independent of BDI scores. However, the cognitive subscale of BDI moderated 2-back and PDQ-D association. On the contrary, BAI scores significantly mediated the association of 2-back scores with PDQ-D. The direct effect of 2-back scores in PDQ-D was insignificant in the mediation of BAI scores. Our study validates the discordance between SRSC and an objective measurement of CF. Anxiety may affect both self-report and objective measurement of CF, whereas depressive thought content may lead to higher cognitive dysfunction reports in nondemented participants.
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Affiliation(s)
- Hale Yapici-Eser
- Department of Psychiatry, School of Medicine, Koç University, İstanbul, Turkey.,Research Center for Translational Medicine, Koç University, İstanbul, Turkey
| | | | | | | | - Sezen Yilmaz
- School of Medicine, Koç University, İstanbul, Turkey
| | - Neris Dincer
- School of Medicine, Koç University, İstanbul, Turkey
| | - Ozge Kilic
- Department of Psychiatry, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | | | - Omer Aydemir
- Department of Psychiatry, School of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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15
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Whyte J, Turkstra LS. Building a theoretical foundation for cognitive rehabilitation. Brain 2021; 144:1933-1935. [PMID: 34312661 DOI: 10.1093/brain/awab210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This scientific commentary refers to ‘A randomized clinical trial of plasticity-based cognitive training in mild traumatic brain injury’ by Mahncke et al. (doi:10.1093/brain/awab202).
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Affiliation(s)
- John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
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16
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Elevated Intraindividual Variability in Executive Functions and Associations with White Matter Microstructure in Veterans with Mild Traumatic Brain Injury. J Int Neuropsychol Soc 2021; 27:305-314. [PMID: 32967755 PMCID: PMC8462939 DOI: 10.1017/s1355617720000879] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We examined whether intraindividual variability (IIV) across tests of executive functions (EF-IIV) is elevated in Veterans with a history of mild traumatic brain injury (mTBI) relative to military controls (MCs) without a history of mTBI. We also explored relationships among EF-IIV, white matter microstructure, and posttraumatic stress disorder (PTSD) symptoms. METHOD A total of 77 Veterans (mTBI = 43, MCs = 34) completed neuropsychological testing, diffusion tensor imaging (DTI), and PTSD symptom ratings. EF-IIV was calculated as the standard deviation across six tests of EF, along with an EF-Mean composite. DSI Studio connectometry analysis identified white matter tracts significantly associated with EF-IIV according to generalized fractional anisotropy (GFA). RESULTS After adjusting for EF-Mean and PTSD symptoms, the mTBI group showed significantly higher EF-IIV than MCs. Groups did not differ on EF-Mean after adjusting for PTSD symptoms. Across groups, PTSD symptoms significantly negatively correlated with EF-Mean, but not with EF-IIV. EF-IIV significantly negatively correlated with GFA in multiple white matter pathways connecting frontal and more posterior regions. CONCLUSIONS Veterans with mTBI demonstrated significantly greater IIV across EF tests compared to MCs, even after adjusting for mean group differences on those measures as well as PTSD severity. Findings suggest that, in contrast to analyses that explore effects of mean performance across tests, discrepancy analyses may capture unique variance in neuropsychological performance and more sensitively capture cognitive disruption in Veterans with mTBI histories. Importantly, findings show that EF-IIV is negatively associated with the microstructure of white matter pathways interconnecting cortical regions that mediate executive function and attentional processes.
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17
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Hellewell SC, Beaton CS, Welton T, Grieve SM. Characterizing the Risk of Depression Following Mild Traumatic Brain Injury: A Meta-Analysis of the Literature Comparing Chronic mTBI to Non-mTBI Populations. Front Neurol 2020; 11:350. [PMID: 32508733 PMCID: PMC7248359 DOI: 10.3389/fneur.2020.00350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Mild traumatic brain injury (mTBI) is associated with depressed mood acutely post-injury, but there is little evidence regarding long-term depression. The aim of this study was to determine the odds ratio (OR) of depression chronically following mTBI. Methods: We searched Medline (PubMed), ProQuest, and Web of Science from date of database creation to January 23, 2019, for eligible studies examining depression at least 6 months post-injury in adult subjects with mTBI of any etiology, including civilians and military. Three authors independently reviewed titles and abstracts for study eligibility. Data were extracted and collated by two investigators. Risk of bias was assessed with the SIGN methodology. Study data were pooled using random-effects meta-analysis. The primary exposure was mTBI, and the primary outcome was depression. Secondary exploratory variables were time of assessment, age at injury, age at assessment, sex, and etiology. Results: We included 47 cross-sectional studies (n = 25,103 mTBI and 29,982 control), 26 cohort studies (n = 70,119 mTBI, 262,034 control), four prospective observational studies (n = 1,058 mTBI and 733 control), two prospective longitudinal studies (n = 119 mTBI, 81 control), two case-control studies (n = 56 mTBI, 56 control), and one randomized controlled trial (n = 252 mTBI, 3,214 control). mTBI was associated with a 3.29-fold increased risk of depression (OR 3.29, 95% CI 2.68–4.03, I2 = 96%). The OR for depression did not change when subjects were assessed at 6–12 months (OR 2.43, 1.45–4.07), years 1–2 (OR 4.12, 2.10–8.07); 2–10 (OR 3.28, 2.42–4.46), or 10+ (OR 3.42, 1.51–7.77). Similar risk of depression was sustained across different age at injury (<25: OR 2.26, 1.82–2.81; 25–35: OR 4.67, 3.06–7.14; >35: OR 2.69, 1.42–5.10) and different age at assessment (<40 years: OR 3.14, 2.48–3.99; >40 years: OR 4.57, 2.54–8.24). Female sex had a non-significant increase in OR (OR 19.97, 2.39–166.93) compared to male (OR 3.0, 2.33–3.86). mTBI etiology had no impact on depression. Conclusions: Those experiencing mTBI are more than three times more likely to experience depression compared to those without a history of mTBI, and this risk remains decades beyond the mTBI event. Future longitudinal studies are needed to identify and mitigate this risk.
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Affiliation(s)
- Sarah C Hellewell
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Caerwen S Beaton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Welton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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18
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Nelson NW, Disner SG, Anderson CR, Doane BM, McGuire K, Lamberty GJ, Hoelzle J, Sponheim SR. Blast concussion and posttraumatic stress as predictors of postcombat neuropsychological functioning in OEF/OIF/OND veterans. Neuropsychology 2020; 34:116-126. [PMID: 31545626 PMCID: PMC6940504 DOI: 10.1037/neu0000594] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Many combat veterans exhibit cognitive limitations of uncertain origin. In this study, we examined factors that predict cognitive functioning by considering effects of blast-related concussion (BRC), non-blast-related concussion (NBRC), and posttraumatic stress disorder (PTSD) symptoms. Analyses specifically tested whether (a) BRC and NBRC were distinct in their prediction of cognitive performance; (b) a dose-response relationship existed between recurrent concussion (BRC and NBRC) and cognitive impairment; and (c) PTSD symptoms mediated the relationship between BRC and cognitive performance. METHOD Two hundred eighty veterans with combat zone deployment histories completed semistructured clinical interviews to define BRC and NBRC histories, current and past mental health disorders, and dimensional ratings of PTSD symptomatology. Participants were also administered a number of neuropsychological measures to appraise cognitive functioning. RESULTS A structural equation model (SEM) suggested that BRC and NBRC were not distinct in their prediction of cognitive performance, and there was no evidence that recurrent concussion (blast or nonblast) was directly associated with cognitive performance. BRC was significantly associated with PTSD symptoms (r = .24), PTSD symptoms were significantly associated with cognitive performance in the SEM (r = -.27), and PTSD symptoms significantly mediated the link between BRC and cognitive performance (p = .03). CONCLUSIONS These results suggest that concussion history fails to directly contribute to cognitive performance, regardless of mechanism (blast or nonblast) and recurrence. BRC is nonetheless unique in its contribution to PTSD and PTSD-related cognitive deficits. Results support interventions specific to PTSD management in the interest of promoting neuropsychological functioning among war veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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19
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Mattson EK, Nelson NW, Sponheim SR, Disner SG. The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans. Neuropsychology 2019; 33:913-921. [PMID: 31192654 PMCID: PMC6763389 DOI: 10.1037/neu0000560] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline. METHOD A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses. RESULTS Subjective cognitive complaints and objective cognitive performance were significantly associated (β = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (β= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Scott R. Sponheim
- Minneapolis VA Health Care System, Minneapolis, Minnesota
- University of Minnesota
| | - Seth G. Disner
- Minneapolis VA Health Care System, Minneapolis, Minnesota
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20
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Jacob SN, Dodge CP, Vasterling JJ. Posttraumatic stress disorder and neurocognition: A bidirectional relationship? Clin Psychol Rev 2019; 72:101747. [DOI: 10.1016/j.cpr.2019.101747] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
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Khalili-Mahani N, Smyrnova A, Kakinami L. To Each Stress Its Own Screen: A Cross-Sectional Survey of the Patterns of Stress and Various Screen Uses in Relation to Self-Admitted Screen Addiction. J Med Internet Res 2019; 21:e11485. [PMID: 30938685 PMCID: PMC6465981 DOI: 10.2196/11485] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/05/2018] [Accepted: 12/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The relationship between stress and screen addiction is often studied by exploring a single aspect of screen-related behavior in terms of maladaptive dependency or the risks associated with the content. Generally, little attention is given to the pattern of using different screens for different types of stressors, and variations arising from the subjective perception of stress and screen addiction are often neglected. Given that both addiction and stress are complex and multidimensional factors, we performed a multivariate analysis of the link between individual's subjective perceptions of screen addiction, various types of stress, and the pattern of screen usage. OBJECTIVE Using the media-repertoires framework to study usage patterns, we explored (1) the relation between subjective and quantitative assessments of stress and screen addiction; and (2) differences in stress types in relation to subjective screen addiction and different types of needs for screens. We hypothesized that interindividual heterogeneity in screen-related behavior would reflect coping differences in dealing with different stressors. METHODS A multifactorial Web-based survey was conducted to gather data about screen-related behaviors (such as screen time, internet addiction, and salience of different types of screens and related activities), and different sources of stress (emotional states, perceptual risks, health problems, and general life domain satisfaction). We performed group comparisons based on whether participants reported themselves as addicted to internet and games (A1) or not (A0), and whether they had experienced a major life stress (S1) or not (S0). RESULTS Complete responses were obtained in 459 out of 654 survey responders, with the majority in the S1A0 (44.6%, 205/459) group, followed by S0A0 (25.9%, 119/459), S1A1 (19.8%, 91/459), and S0A1 (9.5%, 44/459). The S1A1 group was significantly different from S0A0 in all types of stress, internet overuse, and screen time (P<.001). Groups did not differ in rating screens important for short message service (SMS) or mail, searching information, shopping, and following the news, but a greater majority of A1 depended on screens for entertainment (χ23=20.5; P<.001), gaming (χ23=35.6; P<.001), and social networking (χ23=26.5; P<.001). Those who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress. In contrast, those who relied on screens for work and professional networking had up to 10% higher levels of life satisfaction. Regression models including age, gender, and 4 stress types explained less than 30% of variation in internet use and less than 24% of the likelihood of being screen addicted. CONCLUSIONS We showed a robust but heterogeneous link between screen dependency and emotional and perceptual stressors that shift the pattern of screen usage toward entertainment and social networking. Our findings underline the potential of using ludic and interactive apps for intervention against stress.
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Affiliation(s)
- Najmeh Khalili-Mahani
- PERFORM Centre, Design and Computation Arts, Concordia University, Montreal, QC, Canada.,McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Anna Smyrnova
- PERFORM Centre, Department of Mathematics and Statistics, Concordia University, Montreal, QC, Canada
| | - Lisa Kakinami
- PERFORM Centre, Department of Mathematics and Statistics, Concordia University, Montreal, QC, Canada
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22
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Wyse JJ, Pogoda TK, Mastarone GL, Gilbert T, Carlson KF. Employment and vocational rehabilitation experiences among veterans with polytrauma/traumatic brain injury history. Psychol Serv 2018; 17:65-74. [PMID: 30265073 DOI: 10.1037/ser0000283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evidence suggests that Iraq and Afghanistan war veterans with polytrauma/traumatic brain injury (TBI) history and neurobehavioral symptoms may face difficulties returning to work, yet also encounter barriers to accessing, navigating, and engaging in Department of Veterans Affairs (VA) vocational rehabilitation programs. This study utilized qualitative interviews and focus groups with veterans with documented polytrauma/TBI history to explore veterans' perceived barriers to employment and vocational rehabilitation program participation, as well as to solicit thoughts regarding interest in an evidence-based vocational rehabilitation program, the Individual Placement and Support model of Supported Employment (IPS-SE). Veterans identified physical, emotional, cognitive, and interpersonal barriers to finding and maintaining work that they described as linked with their polytrauma/TBI symptoms and sequelae. Communication and logistical issues were described as the primary barriers to vocational rehabilitation program access, while barriers to program utilization included eligibility characteristics, fear of losing financial benefits, and a military-cultural belief of self-sufficiency that made help-seeking difficult. Finally, veterans endorsed key aspects of IPS-SE, such as staff serving as translators, advocates, and navigators of the job search and maintenance process. Policy recommendations are addressed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
| | | | - Tess Gilbert
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care, and National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System
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23
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Bertenthal D, Yaffe K, Barnes DE, Byers AL, Gibson CJ, Seal KH. Do postconcussive symptoms from traumatic brain injury in combat veterans predict risk for receiving opioid therapy for chronic pain? Brain Inj 2018; 32:1188-1196. [PMID: 29985653 DOI: 10.1080/02699052.2018.1493535] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Opioid therapy is contraindicated in patients with traumatic brain injury (TBI) with neuropsychological impairment, yet guidelines do not consistently predict practice. We evaluated independent risk for initiation of opioid therapy among combat veterans with chronic pain diagnoses and persistent postconcussive symptoms. METHODS We assembled a retrospective cohort of 53 124 Iraq and Afghanistan veterans in Veterans Affairs (VA) healthcare between October 2007 and March 2015 who received chronic pain diagnoses, completed a Comprehensive TBI Evaluation (CTBIE) and had not received opioid therapy in the prior year. Primary exposure variables were self-reported severe or very severe Emotional, Vestibular, Cognitive and Somatic/Sensory symptoms measured using the Neurobehavioral Symptom Inventory. Outcome measures were initiation of short-term and long-term opioid therapy within the year following CTBIE. RESULTS Self-reported severe and very severe postconcussive symptoms predicted initiation of long-term and short-term opioid use for chronic pain in both unadjusted and adjusted analyses. In adjusted analyses, all four postconcussive symptom domains significantly predicted initiation of long-term opioid therapy, with Emotional symptoms being the strongest predictor [ARR = 1.68 (1.52, 1.86)]. CONCLUSIONS Increased opioid prescribing in veterans with self-reported severe persistent postconcussive symptoms indicates a need to educate prescribers and make non-opioid pain management options available for veterans with TBI and neuropsychological sequelae.
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Affiliation(s)
- Daniel Bertenthal
- a San Francisco Veterans Affairs Health Care System , San Francisco , CA, USA
| | - Kristine Yaffe
- a San Francisco Veterans Affairs Health Care System , San Francisco , CA, USA.,b Department of Psychiatry, University of California , San Francisco , CA, USA.,c Department of Epidemiology and Biostatistics, University of California , San Francisco , CA, USA.,d Department of Neurology, University of California , San Francisco , CA, USA
| | - Deborah E Barnes
- a San Francisco Veterans Affairs Health Care System , San Francisco , CA, USA.,b Department of Psychiatry, University of California , San Francisco , CA, USA.,c Department of Epidemiology and Biostatistics, University of California , San Francisco , CA, USA
| | - Amy L Byers
- a San Francisco Veterans Affairs Health Care System , San Francisco , CA, USA.,b Department of Psychiatry, University of California , San Francisco , CA, USA.,c Department of Epidemiology and Biostatistics, University of California , San Francisco , CA, USA
| | - Carolyn J Gibson
- a San Francisco Veterans Affairs Health Care System , San Francisco , CA, USA.,e Department of Medicine, University of California , San Francisco , CA, USA
| | - Karen H Seal
- a San Francisco Veterans Affairs Health Care System , San Francisco , CA, USA.,b Department of Psychiatry, University of California , San Francisco , CA, USA.,e Department of Medicine, University of California , San Francisco , CA, USA
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24
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Symptom Reporting and Management of Chronic Post-Concussive Symptoms in Military Service Members and Veterans. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0173-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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