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

Abstract

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.