Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T15:18:27.722Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychological Outcomes of U.S. Veterans with Report of Remote Blast-Related Concussion and Current Psychopathology

Published online by Cambridge University Press:  12 June 2012

Nathaniel W. Nelson ,
James B. Hoelzle ,
Bridget M. Doane ,
Kathryn A. McGuire ,
Amanda G. Ferrier-Auerbach ,
Molly J. Charlesworth ,
Gregory J. Lamberty ,
Melissa A. Polusny ,
Paul A. Arbisi  and
Scott R. Sponheim
Nathaniel W. Nelson*
Affiliation:
Graduate School of Professional Psychology, University of St. Thomas, Minneapolis, Minnesota Minneapolis VA Health Care System, Minneapolis, Minnesota
James B. Hoelzle
Affiliation:
Department of Psychology, Marquette University, Milwaukee, Wisconsin
Bridget M. Doane
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota
Kathryn A. McGuire
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
Amanda G. Ferrier-Auerbach
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
Molly J. Charlesworth
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota
Gregory J. Lamberty
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
Melissa A. Polusny
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota
Paul A. Arbisi
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
Scott R. Sponheim
Affiliation:
Minneapolis VA Health Care System, Minneapolis, Minnesota Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
*
Correspondence and reprint requests to: Nathaniel W. Nelson, Graduate School of Professional Psychology, University of St. Thomas, MOH 217, 1000 LaSalle Avenue, Minneapolis, MN 55403. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This study explored whether remote blast-related MTBI and/or current Axis I psychopathology contribute to neuropsychological outcomes among OEF/OIF veterans with varied combat histories. OEF/OIF veterans underwent structured interviews to evaluate history of blast-related MTBI and psychopathology and were assigned to MTBI (n = 18), Axis I (n = 24), Co-morbid MTBI/Axis I (n = 34), or post-deployment control (n = 28) groups. A main effect for Axis I diagnosis on overall neuropsychological performance was identified (F(3,100) = 4.81; p = .004), with large effect sizes noted for the Axis I only (d = .98) and Co-morbid MTBI/Axis I (d = .95) groups relative to the control group. The latter groups demonstrated primary limitations on measures of learning/memory and processing speed. The MTBI only group demonstrated performances that were not significantly different from the remaining three groups. These findings suggest that a remote history of blast-related MTBI does not contribute to objective cognitive impairment in the late stage of injury. Impairments, when present, are subtle and most likely attributable to PTSD and other psychological conditions. Implications for clinical neuropsychologists and future research are discussed. (JINS, 2012, 18, 1–11)

Keywords

Operation Iraqi FreedomMild Traumatic Brain InjuryPost-traumatic Stress DisorderCognition
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 5 , September 2012 , pp. 845 - 855
Copyright
Copyright © The International Neuropsychological Society 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Belanger, H.G., Curtiss, G., Demery, J.A., Lebowitz, B.K., Vanderploeg, R.D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of the International Neuropsychological Society, 11, 215–227.Google Scholar
Belanger, H.G., Kretzmer, T., Yoash-Gantz, R., Pickett, T., Tupler, L.A. (2009). Cognitive sequelae of blast-related versus other mechanisms of brain trauma. Journal of the International Neuropsychological Society, 15, 1–8.CrossRefGoogle ScholarPubMed
Belanger, H.G., Spiegel, E., Vanderploeg, R.D. (2010). Neuropsychological performance following a history of multiple self-reported concussions: A meta-analysis. Journal of the International Neuropsychological Society, 16, 262–267.Google Scholar
Belanger, H.G., Vanderploeg, R.D. (2005). The neuropsychological impact of sports-related concussion: A meta-analysis. Journal of the International Neuropsychological Society, 11, 345–357.Google Scholar
Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., Keane, T.M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.Google ScholarPubMed
Boone, K.B., Salazar, X., Lu, P., Warner-Chacon, K., Razani, J. (2002). The Rey 15-Item Recognition Trial: A technique to enhance sensitivity of the Rey 15-Item Memorization Test. Journal of Clinical and Experimental Neuropsychology, 24, 561–573.Google Scholar
Brenner, L.A., Terrio, H., Homaifar, B.Y., Gutierrez, P.M., Staves, P.J., Harwood, J.E.F., Warden, D. (2010). Neuropsychological test performance in soldiers with blast-related mild TBI. Neuropsychology, 24, 160–167.CrossRefGoogle ScholarPubMed
Brewin, C.R., Kleiner, J.S., Vasterling, J.J., Field, A.P. (2007). Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation. Journal of Abnormal Psychology, 116, 448–463.Google Scholar
Calhoun, P.S., Elter, J.R., Jones, E.R., Kudler, H., Straits-Troester, K. (2008). Hazardous alcohol use and receipt of risk—reduction counseling among U.S. veterans of the wars in Iraq and Afghanistan. Journal of Clinical Psychiatry, 69, 1686–1693.CrossRefGoogle ScholarPubMed
Delis, D.C., Kaplan, E., Kramer, J., Ober, B.A. (2000). California Verbal Learning Test – Second Edition (CVLT-II). San Antonio, TX: The Psychological Corporation.Google Scholar
DePalma, R.G., Burris, D.G., Champion, H.R., Hodgson, M.J. (2005). Blast injuries. The New England Journal of Medicine, 352, 1335–1342.Google Scholar
Erbes, C.R., Curry, K.T., Leskela, J. (2009). Treatment presentation and adherence of Iraq/Afghanistan era veterans in outpatient care for posttraumatic stress disorder. Psychological Services, 6, 175–183.Google Scholar
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.S.W. (2007). Structured clinical interview for DSM-IV-TR Axis I Disorders – Nonpatient edition (SCID-I/NP, 1/2007 revision). New York: Biometrics Research Department.Google Scholar
Frencham, K.A., Fox, A.M., Maybery, M.T. (2005). Neuropsychological studies of mild traumatic brain injury: A meta-analytic review of research since 1995. Journal of Clinical and Experimental Neuropsychology, 27, 334–351.CrossRefGoogle ScholarPubMed
Gladsjo, J.A., Schuman, C.C., Evans, J.D., Peavy, G.M., Miller, S.W., Heaton, R.K. (1999). Norms for letter and category fluency: Demographic corrections for age, education, and ethnicity. Assessment, 6, 147–178.CrossRefGoogle ScholarPubMed
Golden, C.J. (1978). Stroop Color and Word Test: A manual for clinical and experimental uses. Chicago, IL: Stoelting Co.Google Scholar
Gordon, S.N., Fitzpatrick, P.J., Hilsabeck, R.C. (2011). No effect of PTSD and other psychiatric disorders on cognitive functioning in veterans with mild TBI. The Clinical Neuropsychologist, 25, 337–347.CrossRefGoogle ScholarPubMed
Green, P., Rohling, M.L., Lees-Haley, P.R., Allen, L.M. (2001). Effort has a greater effect on test scores than severe brain injury in compensation claimants. Brain Injury, 15, 1045–1060.CrossRefGoogle Scholar
Grote, C.L., Kooker, E.K., Garron, D.C., Nyenhuis, D.L., Smith, C.A., Mattingly, M.L. (2000). Performance of compensation seeking and non-compensation seeking samples on the Victoria Symptom Validity Test: Cross-validation and extension of a standardization study. Journal of Clinical and Experimental Neuropsychology, 22, 709–719.Google Scholar
Guskiewicz, K.M., McCrea, M., Marshall, S.W., Cantu, R.C., Randolph, C., Barr, W., Kelly, J.P. (2003). Cumulative effects associated with recurrent concussion in collegiate football players. Journal of the American Medical Association, 290, 2549–2555.Google Scholar
Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine, 351, 13–22.Google Scholar
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., Castro, C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. The New England Journal of Medicine, 358, 453–463.CrossRefGoogle ScholarPubMed
Iverson, G.L. (2005). Outcome from mild traumatic brain injury. Current Opinion in Psychiatry, 18, 301–317.Google Scholar
Iverson, G.L. (2006). Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Archives of Clinical Neuropsychology, 21, 303–310.Google Scholar
Iverson, G.L., Lange, R.T. (2003). Examination of “postconcussion-like” symptoms in a healthy sample. Applied Neuropsychology, 10, 137–144.Google Scholar
Iverson, G.L., McCracken, L.M. (1997). ‘Postconcussive’ symptoms in persons with chronic pain. Brain Injury, 11, 783–790.Google Scholar
Kay, T., Harrington, D.E., Adams, R., Anderson, T., Berrol, S., Cicerone, K., Malec, J. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8, 86–87.Google Scholar
Lezak, M.D., Howieson, D., Loring, D. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.Google Scholar
Luethcke, C.A., Bryan, C.J., Morrow, C.E., Isler, W.C. (2011). Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast- versus nonblast-induced mild traumatic brain injury. Journal of the International Neuropsychological Society, 17, 36–45.CrossRefGoogle ScholarPubMed
Marx, B.P., Brailey, K., Proctor, S.P., MacDonald, H.Z., Graefe, A.C., Amoroso, P., Vasterling, J.J. (2009). Association of time since deployment, combat intensity, and posttraumatic stress symptoms with neuropsychological outcomes following Iraq War deployment. Archives of General Psychiatry, 66, 996–1004.Google Scholar
Meares, S., Shores, E.A., Taylor, A.J., Batchelor, J., Bryant, R.A., Baguley, I.J., Marosszeky, J.E. (2008). Mild traumatic brain injury does not predict acute postconcussion syndrome. Journal of Neurology, Neurosurgery, and Psychiatry, 79, 300–306.Google Scholar
McCrea, M., Barr, W.B., Guskiewicz, K., Randolph, C., Marshall, S.W., Cantu, R., Kelly, J.P. (2005). Standard regression-based methods for measuring recovery after sport-related concussion. Journal of the International Neuropsychological Society, 11, 58–69.Google Scholar
Meyers, J., Meyers, K. (1995). The Meyers scoring system for the Rey Complex Figure and the Recognition Trial: Professional manual. Odessa, TX: Psychological Assessment Resources.Google Scholar
Miller, L.S., Rohling, M.L. (2001). A statistical interpretive method for neuropsychological test data. Neuropsychology Review, 11, 143–169.CrossRefGoogle ScholarPubMed
Murray, C.K., Reynolds, J.C., Schroeder, J.M., Harrison, M.B., Evans, O.M., Hospenthal, D.R. (2005). Spectrum of care provided at an echelon II medical unit during Operation Iraqi Freedom. Military Medicine, 170, 516–520.Google Scholar
Nelson, L.A., Yoash-Gantz, R.E., Pickett, T.C., Campbell, T.A. (2009). Relationship between processing speed and executive functioning performance among OEF/OIF veterans: Implications for postdeployment rehabilitation. Journal of Head Trauma Rehabilitation, 24, 32–40.CrossRefGoogle ScholarPubMed
Nelson, N.W., Hoelzle, J.B., McGuire, K.A., Ferrier-Auerbach, A.G., Charlesworth, M.J., Sponheim, S.R. (2010). Evaluation context impacts neuropsychological performance of OEF/OIF veterans with reported combat-related concussion. Archives of Clinical Neuropsychology, 25, 713–723.CrossRefGoogle ScholarPubMed
Nelson, N.W., Hoelzle, J.B., McGuire, K.A., Ferrier-Auerbach, A.G., Charlesworth, M.J., Sponheim, S.R. (2011). Neuropsychological evaluation of blast-related concussion: Illustrating the challenges and complexities through OEF/OIF case studies. Brain Injury, 25, 511–525.Google Scholar
Nelson, N.W., Lamberty, G.J., Sim, A.H., Doane, B.M. (in press). Blast from the past and present: A review of blast-related injury in military personnel and veterans. In S.S. Bush (Ed.), Neuropsychological practice for veterans. New York, NY: Springer.Google Scholar
Nelson, N.W., Lamberty, G.J., Sim, A.H., Doane, B.M., Vanderploeg, R.D. (in press). Traumatic brain injury in veterans. In S.S. Bush (Ed.), Neuropsychological practice for veterans. New York, NY: Springer.Google Scholar
Owens, B.D., Kragh, J.F., Wenke, J.C., Macaitis, J., Wade, C.E., Holcomb, J.B. (2008). Combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom. Journal of Trauma, 64, 295–299.Google Scholar
Paniak, C., Reynolds, S., Phillips, K., Toller-Lobe, G., Melnyk, A., Nagy, J. (2002). Patient complaints within 1 month of traumatic brain injury: A controlled study. Archives of Clinical Neuropsychology, 17, 319–334.Google Scholar
Polusny, M.A., Kehle, S.M., Nelson, N.W., Erbes, C.R., Arbisi, P.A., Thuras, P. (2011). Longitudinal effects of mild TBI and PTSD comorbidity on post-deployment outcomes in National Guard soldiers deployed to Iraq. Archives of General Psychiatry, 68, 79–89.CrossRefGoogle Scholar
Reitan, R.M., Wolfson, D. (1993). The Halstead-Reitan Neuropsychological Test Battery: Theory and clinical interpretation (2nd ed.). Tucson, AZ: Neuropsychology Press.Google Scholar
Rohling, M.L., Demakis, G.J. (2010). Bowden, Shores, & Mathias (2006): Failure to replicate or just failure to notice. Does effort still account for more variance in neuropsychological test scores than TBI severity? The Clinical Neuropsychologist, 24, 119–136.CrossRefGoogle ScholarPubMed
Rohling, M.L., Binder, L.M., Demakis, G.J., Larrabee, G.J., Ploetz, D.M., Langhinrichsen-Rohling, J. (2011). A meta-analysis of neuropsychological outcome after mild traumatic brain injury: Re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009). The Clinical Neuropsychologist, 25, 608–623.CrossRefGoogle ScholarPubMed
Sayer, N.A., Chiros, C.E., Sigford, B., Scott, S., Clothier, B., Pickett, T., Lew, H.L. (2008). Characteristics and rehabilitations outcomes among patients with blast and other injuries sustained during the global war on terror. Archives of Physical Medicine and Rehabilitation, 89, 163–170.CrossRefGoogle ScholarPubMed
Schneiderman, A.I., Braver, E.R., Kang, H.K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167, 1446–1452.Google Scholar
Schretlen, D.J., Shapiro, A.M. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychiatry, 15, 341–349.Google Scholar
Strauss, E., Sherman, E.M.S., Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (2nd ed.). New York: Oxford University Press.Google Scholar
Tanielian, T., Jaycox, L.H. (Eds). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: Rand Corporation.Google Scholar
Terrio, H., Brenner, L.A., Ivins, B.J., Cho, J.M., Schwab, K., Scally, K., Warden, D. (2009). Traumatic brain injury screening: Preliminary findings in a U.S. Army Brigade combat team. Journal of Head Trauma Rehabilitation, 24, 14–23.Google Scholar
The Psychological Corporation (2001). Wechsler test of adult reading. San Antonio, TX: Harcourt Assessment.Google Scholar
Vasterling, J.J., Proctor, S.P., Amoroso, P., Kane, R., Heeren, T., White, R.F. (2006). Neuropsychological outcomes of Army personnel following deployment to the Iraq War. Journal of the American Medical Association, 296, 519–529.Google Scholar
Warden, D. (2006). Military TBI during the Iraq and Afghanistan wars. Journal of Head Trauma Rehabilitation, 21, 398–402.CrossRefGoogle ScholarPubMed
Weathers, F.W., Keane, T.M., Davidson, J. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13, 132–156.Google Scholar
Wechsler, D.A. (1997). Wechsler Adult Intelligence Scale III (WAIS-III). New York: The Psychological Corporation.Google Scholar
Wilk, J.E., Thomas, J.L., McGurk, D.M., Riviere, L.A., Castro, C.A., Hoge, C.W. (2010). Mild traumatic brain injury (concussion) during combat: Lack of association of blast mechanism with persistent postconcussive symptoms. Journal of Head Trauma Rehabilitation, 25, 9–14.Google Scholar
Zakzanis, K.K., Leach, L., Kaplan, E. (1998). On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 11, 111–119.Google ScholarPubMed