潜伏性神经心理学特征可区分现役军人中的轻度创伤性脑损伤和创伤后应激障碍。
Latent Neuropsychological Profiles to Discriminate Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Active-Duty Service Members.
机构信息
Departments of Rehabilitation and Movement Sciences (Dr Esopenko) and Interdisciplinary Studies (Drs Jia and Parrott), School of Health Professions, Rutgers Biomedical and Health Sciences; School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, New Jersey (Ms de Souza); Department of Psychology & Neuroscience Center, Brigham Young University, Provo, Utah (Dr Merkley); Department of Neurology, TBI and Concussion Center, University of Utah School of Medicine, Salt Lake City (Drs Merkley, Dennis, Wilde, and Tate and Ms Velez); George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah (Drs Dennis, Wilde, and Tate); Department of Psychology, Pennsylvania State University, University Park, and Social Life and Engineering Sciences Imaging Center, University Park, Pennsylvania (Dr Hillary); San Antonio VA Polytrauma Rehabilitation Center, San Antonio, and Departments of Rehabilitation Medicine and Psychiatry, UT Health San Antonio, San Antonio, Texas (Dr Cooper); General Dynamics Information Technology (GDIT) contractor for the Traumatic Brain Injury Center of Excellence (TBICoE), Neurology Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas (Dr Kennedy); Wright Patterson Air Force Base/Wright State University, Psychiatry Residency Program, Dayton, Ohio (Dr Lewis); Alaska Radiology Associates, Anchorage (Dr York); Michael E. DeBakey VA Medical Center, Houston, and The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas (Dr Menefee); Department of Neurology, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, and Department of Pediatrics, Baylor College of Medicine, Houston, Texas (Dr McCauley); and Brain Injury Rehabilitation Service, Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas (Dr Bowles).
出版信息
J Head Trauma Rehabil. 2022;37(6):E438-E448. doi: 10.1097/HTR.0000000000000779. Epub 2022 Apr 21.
OBJECTIVE
To determine whether cognitive and psychological symptom profiles differentiate clinical diagnostic classifications (eg, history of mild traumatic brain injury [mTBI] and posttraumatic stress disorder [PTSD]) in military personnel.
METHODS
US Active-Duty Service Members ( N = 209, 89% male) with a history of mTBI ( n = 56), current PTSD ( n = 23), combined mTBI + PTSD ( n = 70), or orthopedic injury controls ( n = 60) completed a neuropsychological battery assessing cognitive and psychological functioning. Latent profile analysis was performed to determine how neuropsychological outcomes of individuals clustered together. Diagnostic classifications (ie, mTBI, PTSD, mTBI + PTSD, and orthopedic injury controls) within each symptom profile were examined.
RESULTS
A 5-profile model had the best fit. The profiles differentiated subgroups with high (34.0%) or normal (21.5%) cognitive and psychological functioning, cognitive symptoms (19.1%), psychological symptoms (15.3%), and combined cognitive and psychological symptoms (10.0%). The symptom profiles differentiated participants as would generally be expected. Participants with PTSD were mainly represented in the psychological symptom subgroup, while orthopedic injury controls were mainly represented in the high-functioning subgroup. Further, approximately 79% of participants with comorbid mTBI and PTSD were represented in a symptomatic group (∼24% = cognitive symptoms, ∼29% = psychological symptoms, and 26% = combined cognitive/psychological symptoms). Our results also showed that approximately 70% of military personnel with a history of mTBI were represented in the high- and normal-functioning groups.
CONCLUSIONS
These results demonstrate both overlapping and heterogeneous symptom and performance profiles in military personnel with a history of mTBI, PTSD, and/or mTBI + PTSD. The overlapping profiles may underscore why these diagnoses are often difficult to diagnose and treat, but suggest that advanced statistical models may aid in identifying profiles representing symptom and cognitive performance impairments within patient groups and enable identification of more effective treatment targets.
目的
确定认知和心理症状特征是否能区分临床诊断分类（例如，轻度创伤性脑损伤[MTBI]和创伤后应激障碍[PTSD]病史）。
方法
共有 209 名美国现役军人（89%为男性）参与研究，其中 56 人有 MTBI 病史，23 人患有 PTSD，70 人同时患有 MTBI 和 PTSD，60 人患有骨科损伤对照组。参与者完成了神经心理学测试，以评估认知和心理功能。采用潜在剖面分析确定个体的神经心理学结果如何聚类。在每个症状特征内检查诊断分类（即 MTBI、PTSD、MTBI+PTSD 和骨科损伤对照组）。
结果
具有最佳拟合度的是 5 种症状特征模型。这些特征可以区分认知和心理功能高（34.0%）或正常（21.5%）、认知症状（19.1%）、心理症状（15.3%）和认知及心理症状同时存在（10.0%）的亚组。这些症状特征能够区分参与者，这与一般预期相符。患有 PTSD 的参与者主要存在于心理症状亚组，而骨科损伤对照组主要存在于功能高的亚组。此外，大约 79%患有 MTBI 和 PTSD 共病的参与者存在于有症状的组中（约 24%=认知症状、约 29%=心理症状、26%=认知和心理症状同时存在）。我们的研究结果还表明，大约 70%有 MTBI 病史的军人存在于高功能和正常功能组中。
结论
这些结果表明，患有 MTBI、PTSD 和/或 MTBI+PTSD 的军人存在重叠和异质的症状和表现特征。重叠的特征可能强调了为什么这些诊断通常难以诊断和治疗，但表明先进的统计模型可能有助于识别代表患者群体中症状和认知表现受损的特征，并确定更有效的治疗目标。
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