Distinguishing the Relative Impact of Post-Traumatic Stress Disorder and Traumatic Brain Injury on iPad-Measured Cognitive Function

Dunbar, Kerri; Raboy, Annabel Lee; Kirby, Zena M.; Taylor, Patricia; Roy, Michael J.

doi:10.1089/cyber.2019.0296

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…Veterans completed a brief assessment of neuropsychological functioning using the National Institutes of Health (NIH) Toolbox Cognition Battery (see nihtoolbox.org ) (Hodes et al, 2013 ), which compares favorably to traditional gold standard measures on convergent and discriminant validity (Weintraub et al, 2014 ; Zelazo et al, 2014 ), and been used to assess neuropsychological functioning in military populations (Walker et al, 2016 ; Dunbar et al, 2019 ). Based on findings from previous research, we focused our assessment of neuropsychological functioning on domains previously identified in relation to mTBI and PTSD including assessment of intelligence (IQ), processing speed (Pattern Comparison), executive function (Dimensional Change Card Sort), attention and response inhibition (Flanker Inhibitory Control and Attention), and working memory (List Sorting Working Memory).…”

Section: Methodsmentioning

confidence: 99%

Assessment of Neuropsychological Function in Veterans With Blast-Related Mild Traumatic Brain Injury and Subconcussive Blast Exposure

et al. 2021

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Objective: The majority of combat-related head injuries are associated with blast exposure. While Veterans with mild traumatic brain injury (mTBI) report cognitive complaints and exhibit poorer neuropsychological performance, there is little evidence examining the effects of subconcussive blast exposure, which does not meet clinical symptom criteria for mTBI during the acute period following exposure. We compared chronic effects of combat-related blast mTBI and combat-related subconcussive blast exposure on neuropsychological performance in Veterans.Methods: Post-9/11 Veterans with combat-related subconcussive blast exposure (n = 33), combat-related blast mTBI (n = 26), and controls (n = 33) without combat-related blast exposure, completed neuropsychological assessments of intellectual and executive functioning, processing speed, and working memory via NIH toolbox, assessment of clinical psychopathology, a retrospective account of blast exposures and non-blast-related head injuries, and self-reported current medication. Huber Robust Regressions were employed to compare neuropsychological performance across groups.Results: Veterans with combat-related blast mTBI and subconcussive blast exposure displayed significantly slower processing speed compared with controls. After adjusting for post-traumatic stress disorder and depressive symptoms, those with combat-related mTBI exhibited slower processing speed than controls.Conclusion: Veterans in the combat-related blast mTBI group exhibited slower processing speed relative to controls even when controlling for PTSD and depression. Cognition did not significantly differ between subconcussive and control groups or subconcussive and combat-related blast mTBI groups. Results suggest neurocognitive assessment may not be sensitive enough to detect long-term effects of subconcussive blast exposure, or that psychiatric symptoms may better account for cognitive sequelae following combat-related subconcussive blast exposure or combat-related blast mTBI.

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Section: Methodsmentioning

confidence: 99%

Assessment of Neuropsychological Function in Veterans With Blast-Related Mild Traumatic Brain Injury and Subconcussive Blast Exposure

et al. 2021

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“…To date, few studies have directly evaluated the iPad NIHTB‐CB. A comprehensive literature search yielded only three studies using the iPad NIHTB‐CB: (1) a direct comparison of the computer and iPad versions of the NIHTB‐CB in a sample of combat veterans, 8 (2) iPad NIHTB‐CB cognitive evaluation of individuals with comorbid post‐traumatic stress disorder (PTSD) and traumatic brain injury (TBI), 9 and (3) a simulated clinical trial of the iPad NIHTB‐CB battery compared with the Cogstate‐C3 battery 10 Brearly and colleagues 8 administered both the iPad‐ and computer‐based versions of the NIHTB‐CB on the same day to combat veteran participants.…”

Section: Introductionmentioning

confidence: 99%

“…The iPad norm‐referenced scores for the Flanker subtest fell approximately 1 SD below the computer‐based administration. Modality concordance rates were low to moderate. Dunbar and colleagues 9 evaluated cognitive functioning in 326 active and retired military participants with and without history of TBI and PTSD. From the NIHTB‐CB data, they found cognitive symptoms were present in those with comorbid diagnoses of PTSD and TBI, whereas those with history of TBI demonstrated intact cognitive functioning 9 …”

Section: Introductionmentioning

confidence: 99%

“…Modality concordance rates were low to moderate. Dunbar and colleagues 9 evaluated cognitive functioning in 326 active and retired military participants with and without history of TBI and PTSD. From the NIHTB‐CB data, they found cognitive symptoms were present in those with comorbid diagnoses of PTSD and TBI, whereas those with history of TBI demonstrated intact cognitive functioning 9 Buckley and colleagues 11 compared the iPad version of the NIHTB‐CB to the Cogstate‐C3 10 .…”

Section: Introductionmentioning

confidence: 99%

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Utility of the iPad NIH Toolbox Cognition Battery in a clinical trial of older adults

Parsey

Bagger

Trittschuh

et al. 2021

J American Geriatrics Society

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Background To demonstrate feasibility and utility of the iPad version of the NIH Toolbox Cognition Battery (NIHTB‐CB) in a clinical trial of older adults. Methods Fifty‐one adults, aged 55 and older without dementia were tested twice on NIHTB‐CB and more traditional paper‐and‐pencil neuropsychological measures after meal ingestion, with approximately a 4‐week interval. We also compared performances at Time 1 and Time 2 for significant change. We also extracted the response times and errors for available NIHTB‐CB subtests to determine subtle changes in performance. Results Over the interval, improvement in fluid cognitive measures was noted at Time 2 (t = −3.07, p = 0.004), whereas crystallized measures were unchanged. Tests of fluid cognition negatively correlated with age, particularly for the second visit. Analysis of the average speed per item showed that, for two of the tests, speed increased at Time 2. Traditional neuropsychological tests correlated with many of the NIHTB‐CB measures. Response times for all five timed tests decreased at Time 2, although only statistically significant for Picture Sequence and Picture Vocabulary. Conclusions The iPad version of the NIH Toolbox Cognition Battery appears to be an adequate measure to assess cognitive functioning in a clinical trial of older adults. Psychometric analyses suggest stability in measures of crystallized functioning, whereas measures of fluid abilities revealed improvements over the short time frame of the study. Response times and errors for individual tests revealed intriguing relationships that should be further evaluated to determine the utility in clinical sample analysis, as this could aid identification of subtle cognitive change over short periods. Additional studies with larger sample sizes will be helpful to understanding the reliability, sensitivity, and specificity of the NIHTB‐CB sub‐scores in older adults. In addition, further evaluations with clinical populations, including individuals with cognitive impairment, are warranted.

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“…Psychiatric conditions further complicate the neuropsychological assessment of military personnel (40)(41)(42)(43)(44). Deployment-related TBIs have been linked to an increased risk of developing psychiatric disorders making it difficult to dissect changes in neuropsychological function due to psychiatric versus post-concussive symptoms (28,45,46).…”

mentioning

confidence: 99%

Assessment of Neuropsychological Function in Veterans with Blast-related Mild Traumatic Brain Injury and Sub-concussive Blast Exposure

Clausen

Bouchard

Workgroup

et al. 2020

Preprint

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Objective: Nearly 20% of Veterans report deployment-related traumatic brain injury (TBI) with most deployment injuries stemming from blast exposure. While Veterans with TBI report cognitive complaints and may acutely display impaired neuropsychological performance, there is little evidence examining the effects of so-called sub-concussive blast exposure, which does not meet clinical symptom criteria for mild TBI during the acute period following exposure. We compared chronic effects of combat blast-related mild TBI and combat-related sub-concussive injuries on neuropsychological performance in Veterans.Methods: Post-9/11 Veterans with sub-concussive (n=33) and mild TBI (n=26) from combat-related blast-exposure in addition to and without control Veterans (n=33) without combat-related blast-exposure, completed neurocognitive assessments of intellectual and executive functioning, processing speed, response inhibition, and working memory via NIH toolbox. Veterans also completed assessment of current clinical psychopathology. The Quantification of Cumulative Blast Exposure was used to assess the number of blast exposure and their severity as well as non-blast-related head injuries. Veteran’s self-reported their history of non-blast head injuries and current medication. Huber Robust Regressions were employed to compare neuropsychological performance across groups. Results: Veterans with combat-related mild TBI and sub-concussive blast exposure displayed significantly poorer performance on measures of processing speed compared to controls. After adjusting for PTSD symptoms, those with combat-related mild TBI exhibited slower processing speed than controls; however, this result was not statistically significant after FDR correction.Conclusion: Veterans in the mild TBI group exhibited poorer processing speed and working memory relative to controls even when controlling for PTSD. However, cognition did not significantly differ between the sub-concussive and control groups or between sub-concussive and mild TBI groups. These results suggest that traditional cognitive assessment may not be sensitive enough to detect long-term effects of sub-concussive blast exposure.

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Distinguishing the Relative Impact of Post-Traumatic Stress Disorder and Traumatic Brain Injury on iPad-Measured Cognitive Function

Cited by 8 publications

References 24 publications

Assessment of Neuropsychological Function in Veterans With Blast-Related Mild Traumatic Brain Injury and Subconcussive Blast Exposure

Assessment of Neuropsychological Function in Veterans With Blast-Related Mild Traumatic Brain Injury and Subconcussive Blast Exposure

Utility of the iPad NIH Toolbox Cognition Battery in a clinical trial of older adults

Assessment of Neuropsychological Function in Veterans with Blast-related Mild Traumatic Brain Injury and Sub-concussive Blast Exposure

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