Discriminating Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Using Latent Neuroimaging and Neuropsychological Profiles in Active-Duty Military Service Members

Abstract

Objective: Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) commonly occur among military Service Members and Veterans and have heterogenous, but also overlapping symptom presentations, which often complicate the diagnoses of underlying impairments and development of effective treatment plans. Thus, we sought to examine whether the combination of whole brain gray matter (GM) and white matter (WM) structural measures with neuropsychological performance can aid in the classification of military personnel with mTBI and PTSD. Methods: Active-Duty US Service Members (n = 156; 87.8% male) with a history of mTBI, PTSD, combined mTBI+PTSD, or orthopedic injury completed a neuropsychological battery and T1- and diffusion-weighted structural neuroimaging. Cortical, subcortical, ventricular, and WM volumes and whole brain fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated. Latent profile analyses were performed to determine how the GM and WM indicators, together with neuropsychological indicators, classified individuals. Results: For both GM and WM, respectively, a 4-profile model was the best fit. The GM model identified greater ventricular volumes in Service Members with cognitive symptoms, including those with a diagnosis of mTBI, either alone or with PTSD. The WM model identified reduced FA and elevated RD in those with psychological symptoms, including those with PTSD or mTBI and comorbid PTSD. However, contrary to expectation, a global neural signature unique to those with comorbid mTBI and PTSD was not identified. Conclusions: The findings demonstrate that neuropsychological performance alone is more robust in differentiating Active-Duty Service Members with mTBI and PTSD, whereas global neuroimaging measures do not reliably differentiate between these groups.

Influence of cognitive functioning on the effectiveness of treatment of veterans with post-traumatic stress disorder and mild traumatic brain injury

“…N.L. de Souza et al [23] described the neuroimaging and neuropsychological profile only in active military personnel, unlike the present study, which examined veterans and demobilised military personnel.…”

Are the Post-COVID-19 Posttraumatic Stress Disorder (PTSD) Symptoms Justified by the Effects of COVID-19 on Brain Structure? A Systematic Review

“…Significant negative correlations between ptsD symptom severity and fractional anisotropy values were found in the left corticospinal tract and left inferior cerebellar peduncle [79], matching some of the results of our review. The most recent study on this subject reported reduced fractional anisotropy and increased radial diffusivity in patients with ptsD or mild traumatic brain injury who displayed psychological symptoms [80]. Making sense of all these findings, white matter alterations in ptsD match white matter alterations that accompany COVID-19.…”

Long Noncoding RNA VLDLR-AS1 Levels in Serum Correlate with Combat-Related Chronic Mild Traumatic Brain Injury and Depression Symptoms in US Veterans

“…Fewer than 10% of patients with mTBI seek care for these symptoms in the following years [11,12]. While several tools, such as self-administered questionnaires and psychological tests, are available to measure neurobehavioral performances [13], it is difficult to evaluate whether changes in neurological behavior are related to the rmTBI events or occur independently due to other personal psychological traumas [14,15]. According to the updated Lancet Neurology Commission's report of 2022 [16], there is a growing interest in identifying patients who have a history of mTBI and who will benefit from personalized treatment plans during their long-term care.…”