Department of Veterans Affairs (VA), Edward Hines, Jr. VA Hospital: Spinal Cord Injury/Disorder Service (Dr Stika), Mental Health Service Line: Neuropsychology Service (Drs Riordan, Drzewiecki, and Urban) and Psychiatry Service (Dr Aaronson), Research Service (Drs Bender Pape, Herrold, Kletzel, and Ellison), Center of Innovation for Complex Chronic Healthcare (Drs Bender Pape, Herrold, Kletzel, Smith, and Evans), Hines, Illinois; Departments of Psychiatry & Behavioral Sciences (Drs Aaronson and Herrold), Physical Medicine and Rehabilitation (Dr Pape), and Pediatrics (Dr Smith), and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Dr Evans), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Clinical Research and Leadership, The George Washington University, Washington, District of Columbia (Dr Mallinson); Department of Veterans Affairs (VA), New Mexico VA Health Care System, Albuquerque (Dr High); Illinois Institute of Technology (IIT), Chicago (Dr Ellison); and Department of Veterans Affairs (VA), Southern AZ VA Health Care System (3-124), Tucson, Arizona (Dr Babcock-Parziale).
J Head Trauma Rehabil. 2021;36(1):44-55. doi: 10.1097/HTR.0000000000000611.
Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear.
We evaluated performance on tests of processing speed, executive functioning, attention, and memory as predictors of functioning on the World Health Organization Disability Assessment Scale (WHODAS) 2.0 in 288 veterans. Participants were placed in one of the following groups: PTSD-only, mTBI-only, mTBI + PTSD, and neither PTSD nor mTBI (deployed control group). Cognitive test performances were evaluated as predictors of WHODAS 2.0 functional ratings in regression models that included demographic variables and a range of mood, behavioral health, and postconcussive symptom ratings.
Multiple cognitive test performances predicted WHODAS 2.0 scores in the deployed control group, but they generally did not predict functioning in the clinical groups when accounting for demographics, mood, behavioral health, and postconcussive symptoms.
In veterans with mTBI and/or PTSD, cognitive test performances are less associated with everyday functioning than mood and postconcussive symptoms.
有轻度创伤性脑损伤(mTBI)和/或创伤后应激障碍(PTSD)病史的退伍军人经常报告日常功能受限。退伍军人的功能障碍与多种因素有关，包括抑郁、社会支持差、认知和物质使用。然而，这些因素，尤其是认知能力，对功能障碍的影响程度尚不清楚。
我们评估了 288 名退伍军人的处理速度、执行功能、注意力和记忆测试的表现，作为世界卫生组织残疾评估量表（WHODAS）2.0 功能的预测指标。参与者被分为以下几组：只有 PTSD、只有 mTBI、mTBI + PTSD 以及既没有 PTSD 也没有 mTBI（部署对照组）。在回归模型中，认知测试表现被评估为 WHODAS 2.0 功能评分的预测指标，该模型包括人口统计学变量以及一系列情绪、行为健康和脑震荡后症状评分。
在部署对照组中，多项认知测试表现可预测 WHODAS 2.0 评分，但在考虑人口统计学、情绪、行为健康和脑震荡后症状时，它们通常不能预测临床组的功能。
在患有 mTBI 和/或 PTSD 的退伍军人中，认知测试表现与日常功能的相关性不如情绪和脑震荡后症状。
