Veterans Affairs San Diego Healthcare System (VASDHS), San Diego, CA, USA.
VASDHS Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.
Clin Neuropsychol. 2020 Aug;34(6):1070-1087. doi: 10.1080/13854046.2020.1730975. Epub 2020 Mar 16.
To investigate the biological, cognitive, and psychological presentations of combat-exposed Veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) using a novel white matter imaging technique and comprehensive neuropsychological assessment.
74 Iraq and Afghanistan Veterans (mean age 33.89, 90.5% male) with history of mTBI (average 7.25 years since injury), PTSD, both, or neither underwent magnetic resonance imaging (MRI) exams including acquisition of a novel imaging technique, multicomponent-driven equilibrium single-pulse observation of T1/T2 (mcDESPOT) to quantify myelin water fraction (MWF), a surrogate measure of myelin content. Participants also underwent comprehensive neuropsychological assessment and three cognitive composite scores (memory, working memory/processing speed, and executive functioning) were created.
There were no significant group differences on the neuropsychological composite scores. ANCOVAs revealed a main effect of PTSD across all regions of interest (ROI) in which PTSD was associated with higher MWF. There was no main effect of mTBI history or TBI by PTSD interaction on any ROI. Significant positive associations were observed between myelin and PTSD symptoms, but no significant associations were found between myelin and neurobehavioral symptoms. No significant associations were found between myelin in the ROIs and the cognitive composite scores.
This study did not find neuropsychological or MWF differences in combat Veterans with a remote history of mTBI but did find myelin alterations related to PTSD. Psychological trauma should be a primary target for intervention in Veterans with comorbid PTSD and mTBI reporting subjective complaints, given its salience.
利用一种新的白质成像技术和全面的神经心理学评估，研究有创伤后应激障碍（PTSD）和/或轻度创伤性脑损伤（mTBI）病史的参战老兵的生物学、认知和心理表现。
74 名有 mTBI（受伤后平均 7.25 年）、PTSD、两者或两者均有的伊拉克和阿富汗退伍军人（平均年龄 33.89，90.5%为男性）接受了磁共振成像（MRI）检查，包括一种新的成像技术，多分量驱动平衡单脉冲观察 T1/T2（mcDESPOT），以量化髓鞘水分数（MWF），这是髓鞘含量的替代测量指标。参与者还接受了全面的神经心理学评估，并创建了三个认知综合评分（记忆、工作记忆/处理速度和执行功能）。
在神经心理学综合评分上，各组之间没有显著差异。方差分析显示 PTSD 在所有感兴趣区域（ROI）都存在主要影响，其中 PTSD 与更高的 MWF 相关。mTBI 病史或 TBI 与 PTSD 相互作用对任何 ROI 均无主要影响。在与 PTSD 相关的髓鞘和症状之间观察到显著的正相关，但在髓鞘和神经行为症状之间没有发现显著的关联。在 ROI 中的髓鞘与认知综合评分之间没有发现显著的关联。
本研究在有 mTBI 病史的参战老兵中未发现神经心理学或 MWF 差异，但发现与 PTSD 相关的髓鞘改变。鉴于 PTSD 的重要性，应将心理创伤作为 PTSD 合并 mTBI 报告主观症状的退伍军人的主要干预目标。
