对患有创伤后应激障碍及轻度创伤性脑损伤病史的持久自由行动/伊拉克自由行动退伍军人执行功能障碍的影响因素
Contributions to Executive Dysfunction in Operation Enduring Freedom/Operation Iraqi Freedom Veterans With Posttraumatic Stress Disorder and History of Mild Traumatic Brain Injury.
作者信息
Jurick Sarah M, Crocker Laura D, Sanderson-Cimino Mark, Keller Amber V, Trenova Liljana S, Boyd Briana L, Twamley Elizabeth W, Rodgers Carie S, Schiehser Dawn M, Aupperle Robin L, Jak Amy J
机构信息
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (Ms Jurick and Mr Sanderson-Cimino); Veterans Medical Research Foundation, San Diego, California (Mss Jurick, Keller, and Trenova and Dr Boyd); Psychology Service (Drs Crocker and Jak), Center of Excellence for Stress and Mental Health (Drs Twamley, Rodgers, Schiehser, and Jak), and Research Service (Dr Schiehser), VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, La Jolla (Drs Twamley, Schiehser, and Jak); PsychArmor Institute, San Diego, California (Dr Rodgers); Laureate Institute for Brain Research, Tulsa, Oklahoma (Dr Aupperle); and The University of Tulsa, Tulsa, Oklahoma (Dr Aupperle).
出版信息
J Head Trauma Rehabil. 2018 Mar/Apr;33(2):E41-E52. doi: 10.1097/HTR.0000000000000313.
OBJECTIVE
Posttraumatic stress disorder (PTSD), history of mild traumatic brain injury (mTBI), and executive function (EF) difficulties are prevalent in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. We evaluated the contributions of injury variables, lower-order cognitive component processes (processing speed/attention), and psychological symptoms to EF.
PARTICIPANTS
OEF/OIF Veterans (N = 65) with PTSD and history of mTBI were administered neuropsychological tests of EF and self-report assessments of PTSD and depression.
RESULTS
Those impaired on one or more EF measures had higher PTSD and depression symptoms and lower processing speed/attention performance than those with intact performance on all EF measures. Across participants, poorer attention/processing speed performance and higher psychological symptoms were associated with worse performance on specific aspects of EF (eg, inhibition and switching) even after accounting for injury variables. Although direct relationships between EF and injury variables were equivocal, there was an interaction between measures of injury burden and processing speed/attention such that those with greater injury burden exhibited significant and positive relationships between processing speed/attention and inhibition/switching, whereas those with lower injury burden did not.
CONCLUSION
Psychological symptoms as well as lower-order component processes of EF (attention and processing speed) contribute significantly to executive dysfunction in OEF/OIF Veterans with PTSD and history of mTBI. However, there may be equivocal relationships between injury variables and EF that warrant further study. Results provide groundwork for more fully understanding cognitive symptoms in OEF/OIF Veterans with PTSD and history of mTBI that can inform psychological and cognitive interventions in this population.
目的
创伤后应激障碍（PTSD）、轻度创伤性脑损伤（mTBI）病史以及执行功能（EF）困难在持久自由行动/伊拉克自由行动（OEF/OIF）退伍军人中很常见。我们评估了损伤变量、低阶认知成分过程（处理速度/注意力）和心理症状对执行功能的影响。
参与者
对患有PTSD和mTBI病史的OEF/OIF退伍军人（N = 65）进行了执行功能的神经心理学测试以及PTSD和抑郁的自我报告评估。
结果
与在所有执行功能测量中表现正常的人相比，在一项或多项执行功能测量中受损的人具有更高的PTSD和抑郁症状，以及更低的处理速度/注意力表现。在所有参与者中，即使在考虑损伤变量后，较差的注意力/处理速度表现和较高的心理症状也与执行功能的特定方面（如抑制和转换）的较差表现相关。虽然执行功能与损伤变量之间的直接关系不明确，但损伤负担测量与处理速度/注意力之间存在相互作用，即损伤负担较大的人在处理速度/注意力与抑制/转换之间表现出显著的正相关，而损伤负担较小的人则没有。
结论
心理症状以及执行功能的低阶成分过程（注意力和处理速度）对患有PTSD和mTBI病史的OEF/OIF退伍军人的执行功能障碍有显著影响。然而，损伤变量与执行功能之间可能存在不明确的关系，值得进一步研究。研究结果为更全面地理解患有PTSD和mTBI病史的OEF/OIF退伍军人的认知症状奠定了基础，可为该人群的心理和认知干预提供参考。
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