Wilson Steffanie H, Weaver Lindell K, Lindblad Anne S
The Emmes Corporation, Rockville, Maryland U.S.
Division of Hyperbaric Medicine Intermountain Medical Center, Murray, Utah, and Intermountain LDS Hospital, Salt Lake City, Utah U.S.
Undersea Hyperb Med. 2016 Aug-Sept;43(5):585-599.
Results of studies addressing the effect of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) on symptoms and neuropsychological assessments are mixed regarding cognitive deficits in these populations. Neuropsychological assessments were compared between U.S. military service members with mTBI only (n=36) vs. those with mTBI÷ PTSD (n=35) from a randomized interventional study of mTBI participants with persistent post-concussive symptoms (PCS). The mTBI group endorsed worse symptoms than published norms on PCS, PTSD and pain scales (⟩50% abnormal on Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Civilian, McGill Pain Questionnaire-Short Form) and some quality of life domains. Worse symptom reporting was found in the mTBI÷ PTSD group compared to mTBI (e.g., mean NSI total score in mTBI 27.5 (SD=12.7), mTBI÷ PTSD 39.9 (SD=13.6), p⟨0.001). The mTBI÷PTSD group performed worse than mTBI on the Weschler Adult Intelligence Scale digit span (mean difference -1.5, 95% CI[-2.9,-0.1], p=0.04) and symbol search (mean difference -1.5, 95% CI[-2.7,-0.2], p=0.03) and Grooved Pegboard (dominant hand mean difference -7.0, 95% CI[-11.5,-2.4], p=0.003; non-dominant mean difference -9.8, 95% CI[-14.9,-4.7], p⟨0.001). Differences were detected in ANAM simple reaction time (p=0.04) and mathematical processing (p=0.03) but not verbal fluency or visuospatial memory assessments. Results indicate increased symptom severity and some cognitive deficits in mTBI÷ PTSD compared to mTBI alone.
ClinicalTrials.gov Identifier: NCT01611194; https://clinicaltrials.gov/show/NCT01611194.
关于轻度创伤性脑损伤（mTBI）和创伤后应激障碍（PTSD）对这些人群症状及神经心理学评估影响的研究结果，在认知缺陷方面存在分歧。在一项针对有持续性脑震荡后症状（PCS）的mTBI参与者的随机干预研究中，对仅患有mTBI的美国军人（n = 36）与患有mTBI且并发PTSD的军人（n = 35）进行了神经心理学评估比较。mTBI组在PCS、PTSD和疼痛量表（在神经行为症状量表（NSI）、平民版PTSD检查表、麦吉尔疼痛问卷简表上超过50%异常）以及一些生活质量领域的症状比已发表的常模更严重。与mTBI组相比，mTBI并发PTSD组症状报告更严重（例如，mTBI组NSI总分均值为27.5（标准差 = 12.7），mTBI并发PTSD组为39.9（标准差 = 13.6），p < 0.001）。在韦氏成人智力量表数字广度（均值差异 -1.5，95%置信区间[-2.9, -0.1]，p = 0.04）、符号搜索（均值差异 -1.5，95%置信区间[-2.7, -0.2]，p = 0.03）和沟槽钉板测试（优势手均值差异 -7.0，95%置信区间[-11.5, -2.4]，p = 0.003；非优势手均值差异 -9.8，95%置信区间[-14.9, -4.7]，p < 0.001）方面，mTBI并发PTSD组表现比mTBI组差。在自动神经心理成套测试（ANAM）简单反应时间（p = 0.04）和数学处理（p = 0.03）方面检测到差异，但在语言流畅性或视觉空间记忆评估方面未检测到差异。结果表明，与单纯mTBI相比，mTBI并发PTSD症状严重程度增加且存在一些认知缺陷。
ClinicalTrials.gov标识符：NCT01611194；https://clinicaltrials.gov/show/NCT01611194 。
