From the Department of Rehabilitation and Human Performance (N.L.D., K.D., C.E.), Icahn School of Medicine at Mount Sinai, New York, NY; Traumatic Brain Injury and Concussion Center (H.M.L., E.L.D., D.F.T., E.A.W.), Department of Neurology, University of Utah School of Medicine, Salt Lake City; George E. Wahlen VA Salt Lake City Healthcare System (H.M.L., E.L.D., D.F.T., E.A.W.), UT; VA Salt Lake City Health Care System (E.K., M.J.V.P.), Informatics, Decision-Enhancement and Analytic Sciences Center, UT; Department of Medicine (E.K., M.J.V.P.), Division of Epidemiology, University of Utah School of Medicine, Salt Lake City; Michael E. DeBakey VA Medical Center (D.S.M., R.S.S., M.T.), Houston, TX; The Menninger Psychiatric and Behavioral Services Department (D.S.M.), Baylor College of Medicine, Houston, TX; Department of Interdisciplinary Studies (J.S.P., Y.J.), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ; Department of Physical Medicine and Rehabilitation (W.C.W., D.X.C.), School of Medicine, Virginia Commonwealth University, Richmond; Physical Medicine and Rehabilitation Service (W.C.W., D.X.C.), Richmond Veterans Affairs Medical Center, VA; Traumatic Brain Injury Center of Excellence (J.M.B.), Bethesda, MD; Naval Hospital Camp Pendleton (J.M.B.), Camp Pendleton, CA; General Dynamics Information Technology (J.M.B.), Fairfax, VA; Minneapolis VA Health Care System (N.D.D.), MN; Department of Psychiatry and Behavioral Sciences (N.D.D., S.R.S.), University of Minnesota, Minneapolis; Research and Academic Affairs Service Line (S.L.M., J.A.R.), W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC; Department of Translational Neuroscience (S.L.M., J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; VA Portland Health Care System (M.O.), Portland, OR; Oregon Health & Science University (M.O.), Department of Psychiatry and Department of Medicine Informatics and Clinical Epidemiology, Portland; Mid-Atlantic (VISN-6) Mental Illness Research, Education, and Clinical Center (MIRECC) (S.L.M., J.A.R.), Durham, NC; Department of Neurobiology and Anatomy (J.A.R.), Wake Forest School of Medicine, Winston-Salem, NC; H. Ben Taub Department of Physical Medicine and Rehabilitation (R.S.S., M.T.), Baylor College of Medicine, Houston, TX; Minneapolis VA Health Care System (S.R.S.), MN.
Neurology. 2024 Jun 25;102(12):e209417. doi: 10.1212/WNL.0000000000209417. Epub 2024 Jun 4.
BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date. METHODS: We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership. RESULTS: The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators ( < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD. DISCUSSION: Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.
背景与目的：外伤性脑损伤（TBI）是美国军人和退伍军人（SMV）关注的问题，导致心理和认知结果存在异质性。我们旨在确定迄今为止最大的 SMV 样本中轻度 TBI（mTBI）和创伤后应激障碍（PTSD）的神经心理学特征。
方法：我们分析了参加正在进行的长期军事相关脑损伤联盟-神经创伤慢性影响联盟前瞻性纵向研究的有既往战斗部署史的 SMV 的横断面基线数据。潜在剖面分析使用 35 个指标识别症状特征，包括身体症状、抑郁、生活质量、睡眠质量、脑震荡后症状和认知表现。重要的是要注意，这些特征是独立于 mTBI 和可能的 PTSD 状态确定的。在确定特征后，我们检查了人口统计学变量、mTBI 特征和 PTSD 症状与症状特征成员之间的关系。
结果：分析样本包括 1659 名 SMV（平均年龄 41.1±10.0 岁；87%为男性）；其中 29%（n=480）有非部署相关 mTBI 史，14%（n=239）有部署相关 mTBI 史，36%（n=602）有非部署和部署相关 mTBI 史，30%（n=497）符合可能的 PTSD 标准。6 个特征模型具有最佳拟合度，所有指标均有分离（<0.001）。该模型揭示了不同的神经心理学特征，代表了自我报告功能模式的组合：高（HS）、中（MS）和低（LS），以及认知表现模式：高（HC）和低（LC）。特征包括：（1）HS/HC：n=301，占 18.1%；（2）HS/LC：n=294，占 17.7%；（3）MS/HC：n=359，占 21.6%；（4）MS/LC：n=316，占 19.0%；（5）LS/HC：n=228，占 13.7%；和（6）LS/LC：n=161，占 9.7%。有部署相关 mTBI 的 SMV 倾向于分组为功能较低的特征，更有可能符合可能的 PTSD 标准。相反，没有 mTBI 暴露或非部署相关 mTBI 的 SMV 集中在功能更高的特征中，符合可能的 PTSD 标准的可能性较低。
讨论：研究结果表明，SMV 的症状和功能特征存在差异，受损伤背景和可能的 PTSD 共病的影响。尽管存在诊断挑战，但对功能和认知的全面评估可以检测到与 mTBI 和 PTSD 相关的细微差异，揭示出不同的神经心理学特征。根据这些特征进行早期治疗可能会改善预后并支持有效的恢复。
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