Hostname: page-component-f554764f5-8cg97 Total loading time: 0 Render date: 2025-04-21T06:52:14.576Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive sequelae of blast-related versus other mechanisms of brain trauma

Published online by Cambridge University Press:  01 January 2009

HEATHER G. BELANGER ,
TRACY KRETZMER ,
RUTH YOASH-GANTZ ,
TREVEN PICKETT  and
LARRY A. TUPLER
HEATHER G. BELANGER*
Affiliation:
Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital, Tampa, Florida Department of Psychology, University of South Florida, Tampa, Florida Defense and Veterans Brain Injury Center (DVBIC)
TRACY KRETZMER
Affiliation:
Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital, Tampa, Florida
RUTH YOASH-GANTZ
Affiliation:
Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC), North Carolina, Virginia, West Virginia Department of Mental Health and Behavioral Sciences, Hefner Veterans Affairs Medical Center, Salisbury, North Carolina Department of Psychiatry and Behavioral Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
TREVEN PICKETT
Affiliation:
Defense and Veterans Brain Injury Center (DVBIC) Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC), North Carolina, Virginia, West Virginia Mental Health Service, McGuire Veterans Affairs Medical Center, Richmond, Virginia Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia
LARRY A. TUPLER
Affiliation:
Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC), North Carolina, Virginia, West Virginia Mental Health Service, Durham Veterans Affairs Medical Center, Durham, North Carolina
*
*Correspondence and reprint requests to: Heather G. Belanger, James A. Haley Veterans Hospital Psychology Service, 116B 13000 Bruce B. Downs Boulevard, Tampa, Florida 33612. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

The use of improvised explosive devices has become the hallmark of modern warfare and has resulted in an ever-increasing number of blast-related traumatic brain injuries (TBIs). Despite this fact, very little is actually known about the cognitive sequelae of blast-related TBIs. The purpose of the current study was to compare patterns of performance on neuropsychological measures in subjects who have sustained TBIs as a result of blast (or explosion) with those who have sustained TBIs from non-blast or blunt force trauma (motor vehicle accident, fall, assault, etc.). Participants were categorized as blast-related TBI or non-blast-related TBI and according to severity of injury (mild or moderate-to-severe). No main effects were observed in analysis of covariance between blast-related TBI participants and non-blast-related TBI participants across any of the neuropsychological variables, although an interaction was observed on a visual memory test showing stronger performance for mild blast-related and poorer performance for moderate-to-severe blast-related participants compared with both non-blast groups. Overall, the results do not provide any strong evidence that blast is categorically different from other TBI mechanisms, at least with regard to cognitive sequelae on select measures. Additional findings included a marginally increased incidence of reported posttraumatic stress disorder symptoms among blast-injured participants. (JINS, 2009, 15, 1–8.)

Keywords

Blast injuryTraumatic brain injuryMild TBINeuropsychologicalConcussionPTSD
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 1 , January 2009 , pp. 1 - 8
Copyright
Copyright © INS 2009

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.)

Article purchase

Temporarily unavailable

References

REFERENCES

Barnfield, T.V. & Leathem, J.M. (1998). Neuropsychological outcomes of traumatic brain injury and substance abuse in a New Zealand prison population. Brain Injury, 12, 951–962.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Benedict, R.D. (1997). Brief Visuospatial Memory Test—Revised. Lutz, FL: Psychological Assessment Resources, Inc.Google Scholar
Binder, L.M., Rohling, M.L., & Larrabee, G.J. (1997). A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies. Journal of Clinical and Experimental Neuropsychology, 19, 421–431.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.CrossRefGoogle ScholarPubMed
Cernak, I., Savic, J., Malicevic, Z., Zunic, G., Radosevic, P., Ivanovic, I., & Davidovic, L. (1996). Involvement of the central nervous system in the general response to pulmonary blast injury. Journal of Trauma-Injury Infection & Critical Care, 40, 100–104.CrossRefGoogle ScholarPubMed
Cernak, I., Wang, Z., Jiang, J., Bian, X., & Savic, J. (2001). Cognitive deficits following blast injury-induced neurotrauma: Possible involvement of nitric oxide. Brain Injury, 15, 593–612.CrossRefGoogle ScholarPubMed
Chen, J.-K., Johnston, K.M., Petrides, M., & Ptito, A. (2008). Neural substrates of symptoms of depression following concussion in male athletes with persisting postconcussion symptoms. Archives of General Psychiatry, 65, 81–89.CrossRefGoogle ScholarPubMed
Coupland, R.M. & Meddings, D.R. (1999). Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: Literature review. British Medical Journal, 319, 407–410.CrossRefGoogle ScholarPubMed
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (2000). California Verbal Learning Test, (2nd ed.). San Antonio, TX: PsychCorp.Google Scholar
DePalma, R.G., Burris, D.G., Champion, H.R., & Hodgson, M.J. (2005). Blast injuries. New England Journal of Medicine, 352, 1335–1342.CrossRefGoogle ScholarPubMed
Dikmen, S.S., Machamer, J.E., Powell, J.M., & Temkin, N.R. (2003). Outcome 3 to 5 years after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84, 1449–1457.CrossRefGoogle ScholarPubMed
Dikmen, S.S., Machamer, J.E., Winn, H.R., & Temkin, N.R. (1995). Neuropsychological outcome at 1-year post head injury. Neuropsychology, 9, 80–90.CrossRefGoogle Scholar
Elsayed, N.M. (1997). Toxicology of blast overpressure. Toxicology, 121, 1–15.CrossRefGoogle ScholarPubMed
Erbes, C., Westermeyer, J., Engdahl, B., & Johnsen, E. (2007). Post-traumatic stress disorder and service utilization in a sample of service members from Iraq and Afghanistan. Military Medicine, 172, 359–363.CrossRefGoogle Scholar
Friedman, M.J. (2006). Posttraumatic stress disorder among military returnees from Afghanistan and Iraq. American Journal of Psychiatry, 163, 586–593.CrossRefGoogle ScholarPubMed
Glaesser, J., Neuner, F., Lütgehetmann, R., Schmidt, R., & Elbert, T. (2004). Posttraumatic stress disorder in patients with traumatic brain injury. Bmc Psychiatry, 4, 5.CrossRefGoogle ScholarPubMed
Green, P. (2003). Medical symptom validity test for windows: User’s manual and program. Edmonton, Canada: Green’s Publishing.Google Scholar
Green, P., Allen, L., & Astner, K. (1996). Manual for computerized Word Memory Test. Durham, NC: CogniSystem.Google Scholar
Greenspan, A.I., Stringer, A.Y., Phillips, V.L., Hammond, F.M., & Goldstein, F.C. (2006). Symptoms of post-traumatic stress: Intrusion and avoidance 6 and 12 months after TBI. Brain Injury, 20, 733–742.CrossRefGoogle ScholarPubMed
Heaton, R.K., Grant, I., & Matthews, C.G. (1991). Comprehensive norms for an expanded Halstead–Reitan Battery. Odessa, FL: Psychological Assessment Resources, Inc.Google Scholar
Hoge, C.W., Auchterlonie, J.L., & Milliken, C.S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA, 295, 1023–1032.CrossRefGoogle ScholarPubMed
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. New England Journal of Medicine, 358, 453–463.CrossRefGoogle ScholarPubMed
Jakupcak, M., Conybeare, D., Phelps, L., Hunt, S., Holmes, H.A., Felker, B., Klevins, M., & McFall, M.E. (2007). Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD. Journal of Traumatic Stress, 20, 945–954.CrossRefGoogle ScholarPubMed
Jones, C., Harvey, A.G., & Brewin, C.R. (2005). Traumatic brain injury, dissociation, and posttraumatic stress disorder in road traffic accident survivors. Journal of Traumatic Stress, 18, 181–191.CrossRefGoogle ScholarPubMed
Kaur, C., Singh, J., Lim, M.K., Ng, B.L., Yap, E.P., & Ling, E.A. (1995). The response of neurons and microglia to blast injury in the rat brain. Neuropathology and Applied Neurobiology, 21, 369–377.CrossRefGoogle ScholarPubMed
Kay, T., Harrington, D.E., Adams, R.E., Anderson, T.W., Berrol, S., Cicerone, K., Dahlberg, C., Gerber, D., Goka, R., Harley, P., Hilt, J., Horn, L., Lehmkuhl, D., & Malec, J. (1993). Definition of mild traumatic brain injury: Report from the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Journal of Head Trauma Rehabilitation, 8, 86–87.Google Scholar
Kolkow, T.T., Spira, J.L., Morse, J.S., & Grieger, T.A. (2007). Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan. Military Medicine, 172, 451–455.CrossRefGoogle ScholarPubMed
Mayorga, M.A. (1997). The pathology of primary blast overpressure injury. Toxicology, 121, 17–28.CrossRefGoogle ScholarPubMed
Milliken, C.S., Auchterlonie, J.L., & Hoge, C.W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA, 298, 2141–2148.CrossRefGoogle ScholarPubMed
Millis, S.R., Rosenthal, M., Novack, T.A., Sherer, M., Nick, T.G., Kreutzer, J.S., High, W.M., & Ricker, J.H. (2001). Long-term neuropsychological outcome after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16, 343–355.CrossRefGoogle ScholarPubMed
Moore, E.L., Terryberry-Spohr, L., & Hope, D.A. (2006). Mild traumatic brain injury and anxiety sequelae: A review of the literature. Brain Injury, 20, 117–132.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.CrossRefGoogle ScholarPubMed
Okie, S. (2005). Traumatic brain injury in the war zone. New England Journal of Medicine, 352, 2043–2047.CrossRefGoogle ScholarPubMed
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 ScholarPubMed
Reitan, R.M. & Wolfson, D. (1985). The Halstead-Reitan Neuropsychological Test Battery. Tucson, AZ: Neuropsychology Press.Google Scholar
Sayer, N.A., Chiros, C.E., Sigford, B., Scott, S., Clothier, B., Pickett, T., & Lew, H.L. (2008). Characteristics and rehabilitation 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
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.CrossRefGoogle ScholarPubMed
Scott, S.G., Vanderploeg, R.D., Belanger, H.G., & Scholten, J.D. (2005). Blast injuries: Evaluating and treating the postacute sequelae. Federal Practitioner, 22, 67–75.Google Scholar
Taber, K.H., Warden, D.L., & Hurley, R.A. (2006). Blast-related brain injury: What is known? Journal of Neuropsychiatry and Clinical Neuroscience, 18, 141–145.CrossRefGoogle ScholarPubMed
Trudeau, D.L., Anderson, J., Hansen, L.M., Shagalov, D.N., Schmoller, J., Nugent, S., & Barton, S. (1998). Findings of mild traumatic brain injury in combat veterans with PTSD and a history of blast concussion. Journal of Neuropsychiatry and Clinical Neurosciences, 10, 308–313.CrossRefGoogle Scholar
van der Kolk, B.A. (1996). The body keeps score: Approaches to the psychobiology of posttraumatic stress disorder. In van der Kolk, B.A., McFarlane, A.C., & Weisaeth, L. (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 214–241). New York: Guilford.Google Scholar
Warden, D. (2006). Military TBI during the Iraq and Afghanistan wars. Journal of Head Trauma and Rehabilitation, 21, 398–402.CrossRefGoogle ScholarPubMed
Warden, D.L., Labbate, L.A., Salazar, A.M., Nelson, R., Sheley, E., Staudenmeier, J., & Martin, E. (1997). Posttraumatic stress disorder in patients with traumatic brain injury and amnesia for the event? Journal of Neuropsychiatry and Clinical Neurosciences, 9, 18–22.Google ScholarPubMed
Warden, D.L., Ryan, L.M., Helmick, K.M., Schwab, K., French, L., Lu, W., Lux, W., Ling, G., & Ecklund, J. (2005). War neurotrauma: The Defense and Veterans Brain Injury Center (DVBIC) experience at Walter Reed Army Medical Center (WRAMC). Journal of Neurotrauma, 22, 1178.Google Scholar
Weathers, F.W., Huska, J.A., & Keane, T.M. (1991). PCL-C for DSM-IV. Boston: National Center for PTSD—Behavioral Science Division.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale—Administration and Scoring Manual (3rd ed.). San Antonio, TX: Harcourt Assessment, Inc.Google Scholar
Wechsler, D. (2001). Wechsler Test of Adult Reading. San Antonio, TX: Harcourt Assessment, Inc.Google Scholar