The Effects of Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Combined Mild Traumatic Brain Injury/Post-Traumatic Stress Disorder on Returning Veterans

Abstract

United States veterans of the Iraqi (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in post-traumatic stress disorder (PTSD). A large number of returning service members have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/ OEF veterans to determine whether participants with a history of mTBI and current PTSD (mTBI + PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or veteran controls (VC), when groups are comparable on intelligence quotient, education, and age. The mTBI + PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI + PTSD on the same variables. Additionally, the mTBI + PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest that veterans with mTBI + PTSD perform significantly lower on neuropsychological and psychiatric measures than veterans with mTBI-o or PTSD-o. The results also raise the possibility of mild but persisting cognitive changes following mTBI sustained during deployment.

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury

“…Symptoms of PTSD and depression can overlap; indeed, in one study, subjects with major depressive disease reported comparable responses to as many classical PTSD items as patients who were diagnosed with PTSD. 51 In recent literature, 52 measures of cognitive effort were administered to validate cognitive and psychiatric symptoms. The current study utilizes measures arising from the TBI-CDEs, which currently do not include effort measures.…”

Preliminary Investigation of Sex Differences in Procedural Skill Learning in Veterans with Co-Morbidities

“…The prevalence of TBI in Veterans ranges from 15% -30% [5] [6], 10% -30% for PTSD [1] [7], and 11.5% -16% for depression [7]. These conditions are also related to impairments in cognition and memory [2] [8] [9] [10].…”

Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury

“…A diagnosis of a mild TBI (mTBI) suggests that most Service Members and Veterans will experience full cognitive and functional recovery [29, 69]. However, there are a number of individuals (~20 %) who continue to experience residual symptoms that could impact unit readiness, return to duty, safety of troop operations, and troop retention [13, 27, 67]. Thus, there is significant interest in improving diagnosis, prognostic accuracy, monitoring recovery or decline, and assessing treatment effects, especially for those experiencing persistent symptoms.…”