Differential effects of deployment and nondeployment mild TBI on neuropsychological outcomes.

Abstract

Objective: Mild traumatic brain injury (TBI) that occurs in a deployment environment is characteristically different from mild TBI that occurs outside of deployment. This study evaluated differential and interaction effects of deployment and nondeployment mild TBI on cognitive and behavioral health outcomes. Research Method: Combat veterans (N ϭ 293) who passed performance-validity measures completed the Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS-5), a neuropsychological assessment battery, and self-report questionnaires. A 2 ϫ 2 ϫ 2 analysis of variance (ANOVA) was conducted to evaluate the main and interaction effects across mild TBI groups and PTSD diagnosis. Results: Deployment TBI was associated with poorer outcomes on several cognitive tests: Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV); Working Memory Index (WMI; p ϭ .018); Trail Making Test A (TMT-A; p Ͻ .001); and Trail Making Test B (TMT-B; p ϭ .002). Deployment TBI and PTSD were also associated with increased PTSD, depressive, and neurobehavioral symptoms; pain interference; and poorer sleep quality. Nondeployment TBI had no effect on cognitive performance and was associated only with poorer sleep quality. PTSD had the strongest associations with symptom measures and deployment TBI with cognitive outcomes. There were no significant interaction effects after adjusting for multiple comparisons. Conclusions: Remote outcomes associated with mild deployment TBI are different from those associated with nondeployment mild TBI and are robust beyond PTSD. This suggests that the environment surrounding a TBI event influences cognitive and symptom sequelae. Veterans who experience mild TBI during deployment may report changes in cognition, but most will continue to function within the expected range. Impact and ImplicationsMild deployment traumatic brain injury (TBI) was associated with lower performance on measures of attention and processing speed. Veterans who experience mild TBI during deployment may be more likely to report changes in cognition to providers. Although most will function in an expected range, implementation of skill building, compensatory strategies, and patient education about recovery from mild TBI may be beneficial in supporting recovery.

Altered Lateralization of the Cingulum in Deployment-Related Traumatic Brain Injury: An ENIGMA Military-Relevant Brain Injury Study

“…58,66,67 Prior studies have shown that deployment-related TBI is associated with poorer TMT performance, even when compared to non-deployment TBI. 8 Altered asymmetry of the cingulum in our sample appeared to be primarily driven by deficits in the right cingulum, leading to an exaggerated laterality index. Lower FA of the left cingulum was linked with slower processing speed and set shifting, as measured by the TMT in the TBI group.…”

“…3 TBI occurring during deployment has been associated with a greater variety of outcomes than TBI sustained outside deployment. [4][5][6][7][8] Blast-related TBI in particular has been called the "signature injury" of post-9/11 conflicts (e.g., OEF/OIF/OND). Understanding brain structural changes and their relation to neurobehavioral sequelae following blast-related injuries, however, requires further elucidation as research on mTBI due to impact may not apply as the injury mechanisms differ.…”

Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial

“…Many individuals with pain may not recognize that the domains in the M2H model (Fig. 1 ) are relevant to the pain experience [ 10 , 28 – 35 ]. Helping persons with LBP understand the connections between holistic aspects of health and pain is foundational to the application of M2H as a strategy to manage chronic LBP.…”

Factors associated with recovery from posttraumatic stress disorder in combat veterans: The role of deployment mild traumatic brain injury (mTBI).

“…Some studies have shown that cognitive outcomes do not differ based solely on history of mTBI (Brenner et al, 2010;Verfaellie et al, 2014) but are rather associated with PTSD (Shandera- Ochsner et al, 2013;Storzbach et al, 2015;Verfaellie et al, 2014). Conversely, other research has reported that history of deployment TBI-but not current PTSD-may be associated with poorer cognitive functioning (Martindale et al, 2021). Given inconsistent findings regarding neuropsychological outcomes of comorbid mTBI and PTSD, additional research is warranted to further investigate these multifaceted relationships.…”

“…For example, individuals with both PTSD and TBI report more severe neurocognitive symptoms (Tanev et al, 2014). Moreover, both PTSD and deployment TBI have been linked to worse behavioral health outcomes (Martindale et al, 2018) and worse cognitive functioning (Martindale et al, 2021). However, less work has focused on the role of deployment TBI in PTSD recovery and in the relationship between PTSD and functional outcomes.…”