Neurocognitive Assessment Tools for Military Personnel With Mild Traumatic Brain Injury: Scoping Literature Review

Abstract

Background Mild traumatic brain injury (mTBI) occurs at a higher frequency among military personnel than among civilians. A common symptom of mTBIs is cognitive dysfunction. Health care professionals use neuropsychological assessments as part of a multidisciplinary and best practice approach for mTBI management. Such assessments support clinical diagnosis, symptom management, rehabilitation, and return-to-duty planning. Military health care organizations currently use computerized neurocognitive assessment tools (NCATs). NCATs and more traditional neuropsychological assessments present unique challenges in both clinical and military settings. Many research gaps remain regarding psychometric properties, usability, acceptance, feasibility, effectiveness, sensitivity, and utility of both types of assessments in military environments. Objective The aims of this study were to explore evidence regarding the use of NCATs among military personnel who have sustained mTBIs; evaluate the psychometric properties of the most commonly tested NCATs for this population; and synthesize the data to explore the range and extent of NCATs among this population, clinical recommendations for use, and knowledge gaps requiring future research. Methods Studies were identified using MEDLINE, Embase, American Psychological Association PsycINFO, CINAHL Plus with Full Text, Psych Article, Scopus, and Military & Government Collection. Data were analyzed using descriptive analysis, thematic analysis, and the Randolph Criteria. Narrative synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guided the reporting of findings. The psychometric properties of NCATs were evaluated with specific criteria and summarized. Results Of the 104 papers, 33 met the inclusion criteria for this scoping review. Thematic analysis and NCAT psychometrics were reported and summarized. Conclusions When considering the psychometric properties of the most commonly used NCATs in military populations, these assessments have yet to demonstrate adequate validity, reliability, sensitivity, and clinical utility among military personnel with mTBIs. Additional research is needed to further validate NCATs within military populations, especially for those living outside of the United States and individuals experiencing other conditions known to adversely affect cognitive processing. Knowledge gaps remain, warranting further study of psychometric properties and the utility of baseline and normative testing for NCATs.

¹⁸F-fluorodeoxyglucose-positron emission tomography findings are not related to cognitive functioning in service members with remote history of mild traumatic brain injury.

“…It may be that glucose uptake would more strongly correlate with other metrics of functioning. Some have suggested that computerized tests that precisely assess accuracy and processing speed may be more sensitive to neuropsychological decline than standard neuropsychological tests (Jones et al, 2021). Particularly given the relatively high functioning of the sample (Full Scale Intelligence Quotient [FSIQ] = 110), we may have found significant results using computerized tests, though it is also noted that these tests have not been shown to have acceptable reliability, validity, and clinical utility in military mTBI (Jones et al, 2021).…”

“…Some have suggested that computerized tests that precisely assess accuracy and processing speed may be more sensitive to neuropsychological decline than standard neuropsychological tests (Jones et al, 2021). Particularly given the relatively high functioning of the sample (Full Scale Intelligence Quotient [FSIQ] = 110), we may have found significant results using computerized tests, though it is also noted that these tests have not been shown to have acceptable reliability, validity, and clinical utility in military mTBI (Jones et al, 2021). It is also possible that glucose uptake would be more likely to show a relationship with cognition if the patient performed the cognitive task during the scan, rather than at a separate time.…”

Military traumatic brain injury: a challenge straddling neurology and psychiatry

“…A concussion is defined as a temporary impairment of brain function caused by trauma to the head; the duration of the accompanying memory loss is mostly less than 24 h [20], and the vast majority of patients will achieve complete relief of symptoms within 7-10 days [21]. A commonly used psychometric tool for assessing the severity of concussion is the Glasgow Coma Scale (GCS), which mainly evaluates verbal and motor responses, as well as the ability to open eyes, and it can be used to initially determine the severity of concussion.…”

Particularities of Electrophysiological and Psychoneurological Assessment of Mild Traumatic Brain Injury

“…A recent scoping review (Jones et al, 2021) of the neurocognitive assessment tools (NCATs) revealed that the NCATs mostly used among the 33 studies were "Automated Neuropsychological Assessment Metric" (46%), "Defense Automated Neurobehavioral Assessment" (15%), and "Immediate Post-Concussion Assessment and Cognitive Testing" (10%). However, one challenging finding was that the diagnosis of mTBIs varied across all studies (and that could affect validity).…”

“…However, one challenging finding was that the diagnosis of mTBIs varied across all studies (and that could affect validity). One of the recommendations was that NCATs should be used cautiously and "only as one source of information from many other types of clinical tools and observations" (Jones et al, 2021).…”