A-16 Impact of Modifiable Mood and Health Factors on Cognitive Functioning among Veterans with History of Mild Traumatic Brain Injury

Objective

Veterans presenting to neuropsychology clinics with subjective cognitive complaints often attribute these complaints to history of mild Traumatic Brain Injury (mTBI). However, many of these Veterans also have co-occurring mood, sleep, and pain concerns – all of which negatively impact cognition, but are also modifiable. Here, we investigated the relative contributions of demographic factors, behavioral health and mood symptoms, and history of mTBI on neuropsychological test performance.

Method

Across three Veterans Affairs Polytrauma Network Sites, 250 Veterans who deployed to Iraq and/or Afghanistan conflicts and had not received treatment for concussion in the preceding 30 days were enrolled between 8/1/2010 and 9/30/2011. Separate multiple regression models were used to examine specified predictor variables (estimated pre-injury IQ, demographics, behavioral health ratings, insomnia, alcohol use, pain, positive mTBI history, anxiety, depression, presence of Posttraumatic Stress Disorder [PTSD]) and their impact on neuropsychological test performances.

Results

When predicting cognitive functioning, history of mTBI was not a significant predictor in any of the cognitive models. Rather, presence of PTSD was a significant predictor for both immediate (p < 0.001) and delayed (p < 0.001) memory performance on the California Verbal Learning Test – 2nd Edition. Additional analyses found that mood symptoms, insomnia, and pain were also significant predictors of cognitive functioning.

Conclusion

Modifiable factors may play a greater role in objective cognitive abilities (i.e., performance on neuropsychological tests) than mTBI history. These findings inform ongoing efforts to improve patient education regarding the expected recovery course from mTBI and the relationship between mood and health on daily cognitive efficiency.

Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder

BACKGROUND

Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear.

METHODS

We evaluated performance on tests of processing speed, executive functioning, attention, and memory as predictors of functioning on the World Health Organization Disability Assessment Scale (WHODAS) 2.0 in 288 veterans. Participants were placed in one of the following groups: PTSD-only, mTBI-only, mTBI + PTSD, and neither PTSD nor mTBI (deployed control group). Cognitive test performances were evaluated as predictors of WHODAS 2.0 functional ratings in regression models that included demographic variables and a range of mood, behavioral health, and postconcussive symptom ratings.

RESULTS

Multiple cognitive test performances predicted WHODAS 2.0 scores in the deployed control group, but they generally did not predict functioning in the clinical groups when accounting for demographics, mood, behavioral health, and postconcussive symptoms.

CONCLUSIONS

In veterans with mTBI and/or PTSD, cognitive test performances are less associated with everyday functioning than mood and postconcussive symptoms.

Brain Games for Dementia: Do They Help?

Brain Gaming (BG) Interventions have been shown to improve the cognitive function of older adults with cognitive impairments (CIs). However, rigorous evaluation supporting BG effectiveness is needed. Thus, we used meta-analysis to evaluate the effectiveness of BG. Several search databases (i.e. Pubmed) were used to identify relevant randomized controlled trials (RCTs). Cochrane RoB tool evaluated risk of bias. The main outcome was the composite score of cognitive function. Inverse-variance random effects model was used to compare the pooled standardized mean difference (SMD) across studies. A total of 16 RCTs included 909 participants. The RCTs varied in sample size, gaming platform, training prescription, and cognition. The meta-analysis showed no significant effects of BG on overall cognitive function (pooled SMD = 0.08, 95% CI [-0.24 – 0.41], p = 0.61, I2 = 77%. However, due to high heterogeneity, we cannot confidently refute that BG is an effective cognitive training approach.