Citation

Lippa SM, French LM, Brickell TA, Driscoll A, Glazer ME, Tippett CE, Sullivan J, Lange R. J. Neurotrauma 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2021.0120

PMID

unavailable

Abstract

Although post-traumatic stress disorder (PTSD) has been associated with worse cognitive outcomes following mild traumatic brain injury (TBI), its impact has not been evaluated following more severe TBI. This study aimed to determine whether PTSD symptoms are related to cognition following complicated mild, moderate, severe, and penetrating TBI. Service members (n=137) with a history of complicated mild/moderate TBI (n=64) or severe/penetrating TBI (n=73) were prospectively enrolled from United States Military Treatment Facilities. Participants completed a neuropsychological assessment one year or more post-injury. Six neuropsychological composite scores and an overall test battery mean (OTBM) were considered. Participants were excluded if there was evidence of invalid responding. Hierarchical linear regressions were conducted evaluating neuropsychological performance. The interaction between TBI severity and PCL-C was significant for processing speed (β=.208, p=.034) and delayed memory (β=.239, p=.021) and trended toward significance for immediate memory (β=.190, p=.057) and the OTBM (β=.181, p=.063). For each of these composite scores, the relationship between PTSD symptoms and cognition was stronger in the complicated mild/moderate TBI group than the severe/penetrating TBI group. Within the severe/penetrating TBI group, PTSD symptoms were unrelated to cognitive performance. In contrast, within the complicated mild/moderate TBI group, PTSD symptoms were significantly related to processing speed (R2Δ=.077, β=-.280, p=.019), immediate memory (R2Δ=.197, β=-.448, p<.001) , delayed memory (R2Δ=.176, β=-.423, p<.001), executive functioning (R2Δ=.100, β=-.317, p=.008), and the OTBM (R2Δ=.162, β=-.405, p<.001). PTSD symptoms were significantly related to neuropsychological test performance in service members and veterans with complicated mild/moderate TBI. The potential impact of PTSD symptoms on cognition, over and above the impact of brain injury alone, should be considered with these patients. Additionally, in research comparing cognitive outcomes between patients with histories of complicated-mild, moderate, severe, and/or penetrating TBI, it will be important to account for PTSD symptoms.

Language: en

Keywords

MILITARY INJURY; ADULT BRAIN INJURY; COGNITIVE FUNCTION; NEUROPSYCHOLOGY; Penetrating Ballistic-like Brain Injury