Research Service, VA Palo Alto Healthcare System, Palo Alto, California, USA.
J Int Neuropsychol Soc. 2012 May;18(3):576-84. doi: 10.1017/S1355617712000203. Epub 2012 Mar 6.
Mild traumatic brain injury (mTBI) affects a significant number of combat veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Although resolution of mTBI symptoms is expected over time, some individuals continue to report lingering cognitive difficulties. This study examined the contributions of self-reported mTBI injury characteristics (e.g., loss of consciousness, post-traumatic amnesia) and psychiatric symptoms to both subjective and objective cognitive functioning in a sample of 167 OEF/OIF veterans seen in a TBI clinic. Injury characteristics were not associated with performance on neuropsychological tests but were variably related to subjective ratings of cognitive functioning. Psychiatric symptoms were highly prevalent and fully mediated most of the relationships between injury characteristics and cognitive ratings. This indicates that mTBI characteristics such as longer time since injury and loss of consciousness or post-traumatic amnesia can lead to increased perceived cognitive deficits despite having no objective effects on cognitive performance. Psychiatric symptoms were associated with both cognitive ratings and neuropsychological performance, illustrating the important role that psychiatric treatment can potentially play in optimizing functioning. Finally, subjective cognitive ratings were not predictive of neuropsychological performance once psychiatric functioning was statistically controlled, suggesting that neuropsychological assessment provides valuable information that cannot be gleaned from self-report alone.
轻度创伤性脑损伤（mTBI）影响了从持久自由行动/伊拉克自由行动（OEF/OIF）返回的大量作战老兵。尽管预计 mTBI 症状会随着时间的推移而缓解，但一些人仍继续报告存在挥之不去的认知困难。本研究在 TBI 诊所中检查了 167 名 OEF/OIF 退伍军人样本中自我报告的 mTBI 损伤特征（例如，失去意识，创伤后遗忘症）和精神症状对主观和客观认知功能的影响。损伤特征与神经心理测试的表现无关，但与认知功能的主观评定呈不同程度相关。精神症状普遍存在，并且大多数情况下都可以调节损伤特征与认知评定之间的关系。这表明，尽管对认知表现没有客观影响，但 mTBI 的特征（例如，受伤后时间更长，失去意识或创伤后遗忘症）可能导致感知到的认知缺陷增加。精神症状与认知评定和神经心理表现均有关，说明了精神治疗在优化功能方面可能发挥的重要作用。最后，一旦从统计学上控制了精神功能，主观认知评定就不能预测神经心理表现，这表明神经心理评估提供了无法仅从自我报告中获得的有价值信息。
