Riley Elizabeth, Mitko Alex, Stumps Anna, Robinson Meghan, Milberg William, McGlinchey Regina, Esterman Michael, DeGutis Joseph
Department of Human Development.
Translational Research Center for TBI and Stress Disorders, VA RR&D TBI Center of Excellence, VA Boston Healthcare System.
Neuropsychology. 2019 May;33(4):534-546. doi: 10.1037/neu0000529. Epub 2019 Apr 4.
Cognitive performance in trauma-exposed populations, such as combat Veterans, has been shown to be worse than in nonexposed peers. However, cognitive performance has typically been within the normal range (within 1 SD of normative mean), and the prevalence of clinically significant cognitive dysfunction (i.e., performance more than 1 SD below the mean on multiple measures in a domain) in younger adults with trauma exposure remains unknown. The objective of our study was to measure this.
We applied Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) cutoffs for clinically significant cognitive dysfunction (>1 SD below the mean in multiple measures within a domain) in the domains of memory, executive function, and attention to a sample of combat-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND; N = 368, mean age = 31.7 years, 90% men) Veterans. We then compared psychiatric, physiological, and neural measures, as well as functional outcomes, between those with and without cognitive dysfunction.
Veterans with cognitive dysfunction (n = 129, 35.1%) had lower premorbid reading ability and more severe psychological distress, including increased anxiety, depression, posttraumatic stress disorder (PTSD), sleep difficulties, pain, and alcohol consumption. Those with cognitive dysfunction also had worse functional outcomes, with mild but significant disability. In contrast, we found associations between outcome and age, traumatic brain injury, physiological and neural measures to be weak or not significant.
Together, this suggests that premorbid abilities and trauma-related psychological symptoms contribute significantly to cognitive dysfunction in OEF/OIF/OND Veterans, and that neurological insult and aging may play less of a role. Cognitive dysfunction may be at least partially ameliorated by treating trauma-related symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
研究表明，经历过创伤的人群，如退伍军人，其认知表现比未经历过创伤的同龄人更差。然而，其认知表现通常处于正常范围内（在标准均值的1个标准差以内），且创伤暴露的年轻成年人中具有临床意义的认知功能障碍（即，在某一领域的多项测量中表现比均值低1个标准差以上）的患病率尚不清楚。我们研究的目的就是测量这一患病率。
我们将《精神疾病诊断与统计手册》（第5版；DSM-5）中关于记忆、执行功能和注意力领域具有临床意义的认知功能障碍（某一领域多项测量中比均值低1个标准差以上）的临界值应用于一组经历过战斗的持久自由行动/伊拉克自由行动/新黎明行动（OEF/OIF/OND；N = 368，平均年龄 = 31.7岁，90%为男性）退伍军人样本。然后，我们比较了有认知功能障碍和无认知功能障碍者的精神、生理和神经学指标以及功能结局。
有认知功能障碍的退伍军人（n = 129，35.1%）病前阅读能力较低，心理困扰更严重，包括焦虑、抑郁、创伤后应激障碍（PTSD）、睡眠困难、疼痛和饮酒增加。有认知功能障碍者的功能结局也更差，存在轻度但显著的残疾。相比之下，我们发现结局与年龄、创伤性脑损伤、生理和神经学指标之间的关联较弱或不显著。
总体而言，这表明病前能力和创伤相关的心理症状对OEF/OIF/OND退伍军人的认知功能障碍有显著影响，而神经损伤和衰老可能起的作用较小。通过治疗创伤相关症状，认知功能障碍可能至少会部分得到改善。（PsycINFO数据库记录（c）2019美国心理学会，保留所有权利）
