White Matter Associations With Performance Validity Testing in Veterans With Mild Traumatic Brain Injury: The Utility of Biomarkers in Complicated Assessment

Abstract

Objective Failure on performance validity tests (PVTs) is common in Veterans with histories of mild traumatic brain injury (mTBI), leading to questionable validity of clinical presentations. Participants Using diffusion tensor imaging (DTI), we investigated white matter (WM) integrity and cognition in 79 Veterans with history of mTBI who passed PVTs (n = 43; TBI-Passed), history of mTBI who failed at least one PVT (n = 13; TBI-Failed), and military controls (n = 23; MCs) with no history of TBI. Results The TBI-Failed group demonstrated significantly lower cognitive scores relative to MCs and the TBI-Passed group; however, no such differences were observed between MCs and the TBI-Passed group. On a global measure of WM integrity (i.e., white matter burden), the TBI-Failed group showed more overall WM abnormalities than the other groups. However, no differences were observed between the MCs and TBI-Passed group on white matter burden. Interestingly, regional WM analyses revealed abnormalities in the anterior internal capsule and cingulum of both TBI subgroups relative to MCs. Moreover, compared to the TBI-Passed group, the TBI-Failed group demonstrated significantly decreased WM integrity in the corpus callosum. Conclusions Findings revealed that, within our sample, WM abnormalities are evident in those who fail PVTs. This study adds to the burgeoning PVT literature by suggesting that poor PVT performance does not negate the possibility of underlying WM abnormalities in military personnel with history of mTBI.

Fatigue Is Associated With Global and Regional Thalamic Morphometry in Veterans With a History of Mild Traumatic Brain Injury

“…Each participant underwent a TBI history interview that was conducted by a post-baccalaureate or graduate-level research assistant. TBI history interviews included assessment of both non-military (i.e., prior to or after discharge from the military) and military-related (i.e., during enlistment in the US armed services) head injuries (see 34 for more comprehensive details). This interview was adapted from the VA Structured Clinical Interview for TBI 35 and involves assessment of any injuries in which participants may have fallen, suffered a blow to the head, or experienced a blast-wave detonation (i.e., overpressure or shock waves resulting from an explosive detonation) within 100 meters (i.e., length of a professional football field).…”

Inflammatory Biomarkers of Traumatic Brain Injury

“…Biomarkers are specific proteins that are used as indicators of the status of different physiological processes in an individual [33][34][35][36][37][38][39]. Biomarkers are often used to determine the stage or severity of an underlying disease or injury [40][41][42][43][44][45][46].…”

Neuroimaging as a biomarker in symptom validity and performance validity testing

“…Of note in the Clark et al (2015) study, the TBI-Passed group had a mean BDI score of 19.0 (standard deviation=1.1) but the TBI-Passed group had a BDI score of 28.3 (S.D. = 13.3).…”

“…Clark et al (2015) examined white matter integrity and its association with cognition in Veterans with history of mTBI who passed PVTs (TBI-Passed), history of mTBI who failed at least one PVT (TBI-Failed), and military controls (MCs). The TBI-Failed subgroup showed significantly greater white matter damage when compared to the other groups based on DTI analyses.…”