Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Mental Health, VA St. Louis Healthcare System, St. Louis, Missouri, USA.
J Neuropsychol. 2024 Sep;18(3):333-348. doi: 10.1111/jnp.12360. Epub 2024 Jan 11.
Mild traumatic brain injury (mTBI) and posttraumatic stress are prevalent in military service members and share objective and subjective cognitive symptoms, complicating recovery. We investigated the effects of remote mTBI characteristics and current posttraumatic stress symptoms on neuropsychological performance in 152 veterans with a history of remote mTBI and current cognitive concerns. Participants completed clinical neuropsychological evaluations within a Veterans Affairs Level-II TBI/Polytrauma outpatient clinic (i.e. tertiary trauma care center for US military veterans outside of a research or teaching hospital setting). Archival data analysis of mTBI injury characteristics, clinical diagnoses, scores on the Posttraumatic Stress Disorder Checklist-Military Version (PCL-M) and performance on tests of processing speed, attention and executive function was conducted. Hierarchical linear regression demonstrated that elevated PCL-M scores were associated with slower performance on trail making test (TMT) Parts A and B (p < .016). PCL-M symptoms moderated the effect of alteration of consciousness (AOC) on TMT performance, with endorsement of AOC associated with better performance, but only when PCL-M scores were high (p < .005). Follow-up mediation analyses demonstrated that PCL-M score fully mediated the relationship between AOC and TMT-A performance and partially mediated the relationship between AOC and TMT-B performance. Post-hoc analyses meant to separate the impact of processing speed on TMT-B were all non-significant. Remote mTBI characteristics, specifically AOC, were not associated with decrements in cognitive performance. Posttraumatic symptoms were associated with worse processing speed, suggesting that psychological distress and psychopathology are contributing factors in understanding and treating persistent cognitive distress following remote mTBI.
轻度创伤性脑损伤（mTBI）和创伤后应激在军事人员中很常见，它们具有客观和主观的认知症状，使康复变得复杂。我们研究了远程 mTBI 特征和当前创伤后应激症状对 152 名有远程 mTBI 病史和当前认知问题的退伍军人神经心理学表现的影响。参与者在退伍军人事务部二级 TBI/多发伤门诊（即美国退伍军人的三级创伤护理中心，不在研究或教学医院环境中）内完成临床神经心理学评估。对 mTBI 损伤特征、临床诊断、创伤后应激障碍检查表-军事版（PCL-M）评分以及处理速度、注意力和执行功能测试的表现进行了档案数据分析。分层线性回归表明，较高的 PCL-M 分数与 Trail Making Test（TMT）A 和 B 部分的表现较慢有关（p<.016）。PCL-M 症状调节了意识改变（AOC）对 TMT 表现的影响，AOC 的确认与更好的表现相关，但仅在 PCL-M 分数较高时（p<.005）。后续的中介分析表明，PCL-M 分数完全介导了 AOC 和 TMT-A 表现之间的关系，部分介导了 AOC 和 TMT-B 表现之间的关系。旨在分离 TMT-B 上处理速度影响的事后分析均无统计学意义。远程 mTBI 特征，特别是 AOC，与认知表现下降无关。创伤后症状与处理速度下降有关，这表明心理困扰和精神病理学是理解和治疗远程 mTBI 后持续认知困扰的一个因素。
