Venza Erin, Spence Jeffrey S, Zientz Jennifer, Devlin Cole, Bailie Jason, Darr Andrew, Babakhanyan Ida, Chapman Sandra Bond
Center for BrainHealth, Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, United States.
Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United States.
Front Hum Neurosci. 2025 May 9;19:1542422. doi: 10.3389/fnhum.2025.1542422. eCollection 2025.
This randomized clinical trial (RCT) compared the efficacy of two cognitive rehabilitation (CR) protocols-Strategic Memory Advanced Reasoning Training (SMART) and Study of Cognitive Rehabilitation Effectiveness (SCORE)-in improving higher-order cognitive functions among active-duty service members (ADSMs) with mild traumatic brain injury (mTBI) and varying levels of post-traumatic stress disorder (PTSD) symptoms. The study also examined the relationship between PTSD symptom severity and cognitive outcomes.
A total of 148 ADSMs with mTBI and persistent cognitive complaints were randomized to receive either SMART (20 h over 4 weeks) or SCORE (60 h over 6 weeks). High-level cognitive abilities were assessed with the Test of Strategic Learning and the Visual Selective Learning Task, and PTSD symptoms were measured using the PTSD Checklist (PCL-M). PTSD symptoms were accounted for as a covariate in all analyses. Outcomes were measured at baseline, post-treatment, and at 3-month follow-up.
Both SMART and SCORE groups showed significant improvements in complex memory and strategic learning, with no between-group differences in overall cognitive gains. Notably, SMART participants achieved these outcomes in one-third of the treatment hours. SMART also demonstrated greater immediate gains in fluency of high-level interpretations compared to SCORE ( = 0.04), reflecting enhanced possibility thinking. PTSD symptom severity was negatively correlated with performance on cognitive measures; however, the cognitive gains were comparable regardless of baseline PTSD symptoms.
SMART is an efficient and effective CR protocol for improving higher-order cognitive abilities in ADSMs with mTBI, achieving comparable outcomes to SCORE in 60% fewer treatment hours. Also of note, training-based cognitive gains were consistent across PTSD severity levels, suggesting CR is a potentially reliable tool for populations with mTBI plus concomitant PTSD. By promoting rapid cognitive improvement and adaptability, this study supports the potential for SMART to enhance the operational readiness of warfighters. Future research should explore hybrid delivery models and integration with PTSD-focused interventions to optimize accessibility and outcomes.
这项随机临床试验（RCT）比较了两种认知康复（CR）方案——战略记忆高级推理训练（SMART）和认知康复效果研究（SCORE）——在改善患有轻度创伤性脑损伤（mTBI）和不同程度创伤后应激障碍（PTSD）症状的现役军人（ADSM）的高阶认知功能方面的疗效。该研究还考察了PTSD症状严重程度与认知结果之间的关系。
共有148名患有mTBI且持续存在认知问题的ADSM被随机分配接受SMART方案（4周内20小时）或SCORE方案（6周内60小时）。使用战略学习测试和视觉选择性学习任务评估高阶认知能力，使用PTSD检查表（PCL-M）测量PTSD症状。在所有分析中，PTSD症状作为协变量。在基线、治疗后和3个月随访时测量结果。
SMART组和SCORE组在复杂记忆和战略学习方面均有显著改善，总体认知增益在组间无差异。值得注意的是，SMART组的参与者在三分之一的治疗时间内就取得了这些成果。与SCORE组相比，SMART组在高级解释流畅性方面也有更大的即时增益（P = 0.04），反映出可能性思维增强。PTSD症状严重程度与认知测量表现呈负相关；然而，无论基线PTSD症状如何，认知增益都是可比的。
SMART是一种有效且高效的CR方案，可改善患有mTBI的ADSM的高阶认知能力，在少60%的治疗时间内取得与SCORE方案相当的结果。同样值得注意的是，基于训练的认知增益在PTSD严重程度水平上是一致的，这表明CR对于患有mTBI加伴发PTSD的人群是一种潜在可靠的工具。通过促进快速的认知改善和适应性，本研究支持SMART增强战士作战准备状态的潜力。未来的研究应探索混合交付模式以及与以PTSD为重点的干预措施相结合，以优化可及性和结果。
