Both therapist-directed CR and integrated CR with CBT reduced functional cognitive symptoms in service members after mTBI beyond psychoeducation and medical management alone.

The findings of the present study suggest that non-brain injury-related factors, such as high-levels of combat stress, may impact post-concussive symptom reporting in this population, further confounding the accuracy of the post-concussion syndrome (PCS) diagnosis. Considerable caution should be exercised in making the diagnosis of PCS in concussed service members with co-occurring combat-stress disorders.

Evaluation of post-deployment conditions such as post-concussive syndrome (PCS) and posttraumatic stress disorder (PTSD) frequently relies upon brief, self-report checklists which are face valid and highly susceptible to potential symptom validity issues such as symptom exaggeration. We investigated the psychometric prope1rties of a 5-item measure of symptom exaggeration (mild brain injury atypical symptoms [mBIAS] scale) embedded in commonly used PCS and PTSD screening instruments in a sample of 403 patients seen in a brain injury clinic at a large military medical center. Exploratory factor analysis, examining measures of posttraumatic stress, post-concussive symptoms, and symptom over-reporting revealed a 6-factor model with the mBIAS scale items representing a unique factor. Analysis of psychometric properties demonstrated that a score of 8 on the mBIAS was optimal for the detection of symptom over-reporting (sensitivity = 0.94, specificity = 0.92) and appears to be the most favorable cut score for interpretive use. The findings provide a strong initial support for the use of the mBIAS in post-deployment populations.

Mild traumatic brain injury (mTBI) is a major health concern among active duty service members and Veterans returning from combat operations, and it can result in variable clinical and cognitive outcomes. Identifying biomarkers that can improve diagnosis and prognostication has been at the forefront of recent research efforts. The purpose of this study was to compare the sensitivity and specificity of abnormalities identified using more traditional magnetic resonance imaging (MRI) sequences such as fluid attenuation inversion recovery (FLAIR) to more advanced MRI sequences such as susceptibility weighted imaging (SWI) among a cohort of active duty service members experiencing persistent cognitive symptoms after mTBI. One-hundred and fifty-two active duty service members (77 mTBI, 58 orthopedically injured [OI] only, 17 post-traumatic stress disorder [PTSD] only) underwent MRI and neuropsychological evaluation at a large military treatment facility. Results demonstrated that FLAIR white matter hyperintensities (WMHs) were present in all three groups at statistically similar rates (41% mTBI, 49% OI, and 29% PTSD). With the exception of a single OI participant showing a small discrete SWI lesion, SWI abnormalities were overwhelmingly present in mTBI patients (22% mTBI, 1% OI, and 0% PTSD). Functionally, mTBI participants with and without SWI abnormalities did not differ in demographics, symptom reporting, or cognitive performance. However, mTBI participants with and without WMH did differ for on measures of working memory with the mTBI participants with WMH having worse cognitive performance. No other significant differences were noted for those participants with and without imaging abnormalities for either the OI or PTSD only cohorts. These results appear to illustrate the sensitivity and specificity of SWI findings though these results did not have any significant functional impact in this cohort. In contrast, WMHs noted on FLAIR imaging were not sensitive or specific findings, but functionally relevant among mTBI participants. These findings emphasize the complexity of injury and functional outcome in mTBI patients that requires additional examination.