Impact of psychiatric symptomatology on neuropsychological assessment performance in persons with TBI: A comparison of OEF/OIF veteran and civilian samples

Merz, Zachary C.; Roskos, P. Tyler; Gfeller, Jeffrey D.; Bucholz, Richard D.

doi:10.1080/02699052.2017.1339124

Cited by 10 publications

(10 citation statements)

References 28 publications

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“…452 Moreover, interactions might exist between cognitive performance and the presence of psychological disorders such as post-traumatic stress disorder or depressive symptoms, which might affect the reliability of neuropsychological assessment results. 453 The use of different approaches and combinations of instruments would depend on the level of disabilityeg, patients who have persistent postconcussion symptoms after mild TBI would have assessment needs different from those with disorders of consciousness after severe TBI. This need to accommodate different outcomes or levels of severity of impairment is concordant with the concept of the sliding dichotomy for outcome analysis of GOS or GOSE scores, in which the point of dichotomy of this measure is differentiated by initial baseline risk.…”

Section: Figure 12: Classification Of Outcome Of Traumatic Brain Injumentioning

confidence: 99%

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Maas¹,

Menon²,

Adelson³

et al. 2017

The Lancet Neurology

1,843

1,261

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A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world's population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs). It has been estimated that TBI costs the global economy approximately $US400 billion annually. Deficiencies in prevention, care, and research urgently need to be addressed to reduce the huge burden and societal costs of TBI. This Commission highlights priorities and provides expert recommendations for all stakeholders—policy makers, funders, health-care professionals, researchers, and patient representatives—on clinical and research strategies to reduce this growing public health problem and improve the lives of people with TBI.Additional co-authors: Endre Czeiter, Marek Czosnyka, Ramon Diaz-Arrastia, Jens P Dreier, Ann-Christine Duhaime, Ari Ercole, Thomas A van Essen, Valery L Feigin, Guoyi Gao, Joseph Giacino, Laura E Gonzalez-Lara, Russell L Gruen, Deepak Gupta, Jed A Hartings, Sean Hill, Ji-yao Jiang, Naomi Ketharanathan, Erwin J O Kompanje, Linda Lanyon, Steven Laureys, Fiona Lecky, Harvey Levin, Hester F Lingsma, Marc Maegele, Marek Majdan, Geoffrey Manley, Jill Marsteller, Luciana Mascia, Charles McFadyen, Stefania Mondello, Virginia Newcombe, Aarno Palotie, Paul M Parizel, Wilco Peul, James Piercy, Suzanne Polinder, Louis Puybasset, Todd E Rasmussen, Rolf Rossaint, Peter Smielewski, Jeannette Söderberg, Simon J Stanworth, Murray B Stein, Nicole von Steinbüchel, William Stewart, Ewout W Steyerberg, Nino Stocchetti, Anneliese Synnot, Braden Te Ao, Olli Tenovuo, Alice Theadom, Dick Tibboel, Walter Videtta, Kevin K W Wang, W Huw Williams, Kristine Yaffe for the InTBIR Participants and Investigator

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Section: Figure 12: Classification Of Outcome Of Traumatic Brain Injumentioning

confidence: 99%

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Maas¹,

Menon²,

Adelson³

et al. 2017

The Lancet Neurology

1,843

1,261

View full text Add to dashboard Cite

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“…It measures multiple aspects of cognitive functioning, and consists of five testing composites, that is, verbal memory, visual memory, processing speed, reaction time and impulse control 19The screening module of neuropsychological assessment battery (Digit Span) 18Wechsler Adult Intelligence Scale Version 4 (Digit Symbol Coding and Symbol Search) 20…”

Section: Methods and Analysismentioning

confidence: 99%

“…At present, the mainstream assessment of mTBI both in sports and in the primary/secondary healthcare setting involves the functional and symptomatic assessment of an individual using neurocognitive tests 15. These tests have significant limitations, particularly the lack of baseline/premorbid measurement in terms of sensitivity and specificity16 17 and the susceptibility to multiple confounding factors18 such as musculoskeletal injury and/or premorbid disability. This together with their requirement for a high level of engagement and concentration limits their application in outpatient clinic or pitch-side.…”

Section: Introductionmentioning

confidence: 99%

Investigation into repetitive concussion in sport (RECOS): study protocol of a prospective, exploratory, observational cohort study

Yakoub

Davies

et al. 2019

BMJ Open

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IntroductionSport-related concussion management remains a diagnostic dilemma to clinicians in all strata of care, coaching staff and players alike. The lack of objective diagnostic and prognostic biomarkers and over-reliance on subjective clinical assessments carries a significant health risk of undiagnosed concussive episodes and early return to play before full recovery increasing the risk of sustaining additional concussion, and leading to long-term sequelae and/or unfavourable outcome.ObjectiveTo identify a set of parameters (neuroimaging with neurophysiological, biological and neuropsychological tests) that may support pitch-side and outpatient clinical decision-making in order to objectively diagnose concussion, determine the severity of injury, guide a safe return to play and identify the potential predictors of the long-term sequelae of concussion.Methods and analysisAn exploratory, observational, prospective, cohort study recruiting between 2017 and 2020. The participants will have a baseline preseason screening (brain imaging, neuropsychological assessments, serum, urine and saliva sampling). If a screened player later suffers a concussion and/or multiple concussions then he/she will be assessed again with the same protocol within 72 hours, and their baseline data will be used as internal control as well as normative data. Inferential statistical analysis will be performed to determine correlations between biological, imaging techniques and neuropsychological assessments.Ethics and disseminationThis study was approved by the East of England—Essex Research Ethics Committee on 22 September 2017—REC 17/EE/0275; IRAS 216703. The results of this study will be presented at national and international conferences and submitted for publication in peer reviewed journals.Trial registration numberISRCTN16974791; Pre-results.

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“…A sample of the studies reviewed found: mTBI was not responsible for poor performance on measures of attention, information processing, working memory, and mental calculation; i nstead, cognitive deficits were significantly related to current PTSD symptom-severity; 99,100 no significant difference was observed between veterans in a mTBI-only condition and the control group; 100 after controlling for their PTSD symptomatology, group differences disappeared between veterans with past TBI and control participants, 101,102 and that factors such as number of lifetime concussions, and if the veteran experienced AOC versus LOC did not affect cognitive test performance. 103 The conclusions offered by a number of the authors could be quite strong and included: That neurocognitive differences in OEF/OIF veterans might be better explained by PTSD than blast exposure history; in agreement with other investigations remote combat-related mTBI does not in and of itself contribute to objective cognitive impairment, 104 and findings fall within those of numerous meta-analyses conducted on general TBI data sets that acute neurocognitive effects resolve within several weeks to months and that there is no dose-response relationship between the effects of a single and multiple concussions on neuropsychological functioning.…”

Section: Neuropsychological Functioningmentioning

confidence: 99%

Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War

Dieter

Engel

2019

J Exp Neurosci

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Scientific literature is reviewed supporting a “consequence of war syndrome (CWS)” in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn soldiers. CWS constituents include chronic pain and insomnia, other physical complaints, posttraumatic stress disorder (PTSD), anxiety, depression, and neuropsychological deficits. The foundation of CWS lies with the chronic stressors inherent to deployment and the cascade of biological events mediated and maintained by hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Such dysregulation is modified by the individual’s specific experiences at war, difficulty reintegrating to post-deployment life, and the onset or exacerbation of the chronic and comorbid physical, emotional, and cognitive disorders. The circuit network between the prefrontal cortex (PFC), amygdala, and hippocampus is particularly sensitive to the consequences of war. The review’s specific conclusions are as follows: HPA axis dysregulation contributes to the chronic insomnia and hyperarousal seen in soldiers. There is considerable symptom overlap between PTSD and blast-related head injury, and it is difficult to determine the relative contributions of the two disorders to abnormal imaging studies. In some cases, traumatic brain injury (TBI) may directly precipitate PTSD symptoms. While not intuitive, the relationship between TBI and postconcussion syndrome appears indirect and mediated through PTSD. Blast-related or conventional head injury may have little long-term impact on neuropsychological functioning; contrarily, PTSD particularly accounts for current cognitive deficits. The psychological experience of CWS includes a “war-within” where soldiers continue to battle an internalized enemy. Successful treatment of CWS entails transdisciplinary care that addresses each of the constituent disorders.

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Impact of psychiatric symptomatology on neuropsychological assessment performance in persons with TBI: A comparison of OEF/OIF veteran and civilian samples

Cited by 10 publications

References 28 publications

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Investigation into repetitive concussion in sport (RECOS): study protocol of a prospective, exploratory, observational cohort study

Traumatic Brain Injury and Posttraumatic Stress Disorder: Comorbid Consequences of War

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