Latent Neuropsychological Profiles to Discriminate Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Active-Duty Service Members

Esopenko, Carrie; Souza, Nicola L de; Jia, Yuane; Parrott, J. Scott; Merkley, Tricia L.; Dennis, Emily; Hillary, Frank G.; Vélez, Carmen; Cooper, Douglas B.; Kennedy, Jan E.; Lewis, Jeffrey D.; York, Gerald E.; Menefee, Deleene S.; McCauley, Stephen R.; Bowles, Amy O.; Wilde, Elisabeth A.; Tate, David F.

doi:10.1097/htr.0000000000000779

Cited by 4 publications

(18 citation statements)

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“…These effects are often exacerbated in those with a history of mTBI and comorbid PTSD 27–29,31–33. We previously showed that neuropsychological performance can differentiate military personnel with mTBI and/or PTSD into distinct symptom profiles 34. Here, we extended that work to examine whether the addition of whole brain GM and WM neuroimaging metrics with neuropsychological performance better cluster military personnel with mTBI and PTSD into distinct profiles.…”

Section: Discussionmentioning

confidence: 85%

“…[27][28][29][31][32][33] We previously showed that neuropsychological performance can differentiate military personnel with mTBI and/or PTSD into distinct symptom profiles. 34 Here, we extended that work to examine whether the addition of whole brain GM and WM neuroimaging metrics with neuropsychological performance better cluster…”

Section: Discussionmentioning

confidence: 98%

“…Significant ANOVAs were followed with Tukey's HSD (honestly significant difference) post hoc tests to determine significant differences between classes ( P < .05). Semantic labels for class profiles were assigned based on previous findings in the larger sample 34. Labels were determined by 2 neuropsychologists who were blinded to participant representation (ie, clinical diagnosis group) and based on performance across neuropsychological indicators within each class.…”

Section: Methodsmentioning

confidence: 99%

“…The distribution was similar to the GM model as well as the neuropsychological model. 34 Exploratory post hoc analyses showed that the psychological symptoms and combined cognitive and psychological symptom groups demonstrated reduced FA in the splenium of the CC, CR, and SLF compared with the cognitive symptoms and high functioning groups. Further, the psychological symptoms group had reduced FA in the IC and PTR compared with the cognitive symptoms and high functioning groups (see Supplemental Material, available at: http://links.lww.…”

Section: Diagnostic Classificationmentioning

confidence: 97%

“…[31][32][33] We previously used latent profile analysis (LPA) to characterize cognitive and psychological performance in Active-Duty US Service Members with mTBI, PTSD, and mTBI with comorbid PTSD. 34 The neuropsychological indicators identified 5 classes based on symptom presentation: high functioning, normal functioning, cognitive symptoms, psychological symptoms, and combined cognitive and psychological symptoms. These symptom clusters closely aligned with the diagnostic classifications, but also demonstrated heterogeneity within diagnostic groups.…”

Section: E256mentioning

confidence: 99%

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

Souza

Esopenko

Jia

et al. 2022

Journal of Head Trauma Rehabilitation

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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.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Diagnostic Classificationmentioning

confidence: 97%

Section: E256mentioning

confidence: 99%

See 3 more Smart Citations

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

Souza

Esopenko

Jia

et al. 2022

Journal of Head Trauma Rehabilitation

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Executive functioning in posttraumatic stress disorder: Understanding how inhibition, switching, and test modality affect reaction times.

Swick,

Lwi,

Larsen

et al. 2024

Neuropsychology

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Objective: Posttraumatic stress disorder (PTSD) has been linked to deficits in executive functioning, but the literature suggests these associations are inconsistent. Results vary depending on the task used, test modality, and the specific subdomain being measured, such as inhibitory control (interference resolution, response inhibition) or set shifting (task switching, rule switching). Notably, deficits are more consistently observed in computerized tasks that measure precise reaction times (RTs) than in classic paper-and-pencil measures, but few studies have parsed specific executive functioning deficits in PTSD using detailed analyses of RT data. Method: The present study used a cued-switching Stroop Task to examine both interference resolution and task switching in 28 veterans with PTSD and 28 age-matched controls. Each trial required attending to a randomly presented cue and responding to the specified target while ignoring irrelevant or opposing information. Analyses of RT distributions estimated both Gaussian (normal) and ex-Gaussian (exponential) parameters. Results: Veterans with PTSD had slower and more variable RTs than the controls on trials that required ignoring conflicting information (interference resolution, d′ = .68). These effects were confined to the normal distribution, not to excessively slow responses (as estimated by ex-Gaussian parameters). Veterans with PTSD also showed modestly slower RTs on trials that required switching between cues, but Bayesian evidence for this was weak, and measures by ex-Gaussian parameters were not significant. Conclusions: These results highlight the importance of examining executive functioning in PTSD with a more nuanced approach, as clarity around these deficits may have important implications for future intervention and rehabilitation strategies. Key PointsQuestion: Can reaction time data from computerized tasks help clarify the contradictory results often seen when examining executive function in posttraumatic stress disorder (PTSD)? Findings: Compared with the controls, the participants with PTSD had slower and more variable reaction times on trials that required inhibitory control (Stroop interference), but not on trials that required switching between sets. Importance: The results highlight the importance of examining multiple facets of executive functioning, as simpler measures may lead to mixed or overgeneralized findings. Next Steps: Directly compare tests of executive functioning that differ in modality (e.g., article, computerized) and type (e.g., inhibitory control, switching) to clarify the cognitive strengths and weaknesses in participants with PTSD.

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Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps

Esopenko,

Jain,

Adhikari

et al. 2024

Journal of Neurotrauma

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Latent Neuropsychological Profiles to Discriminate Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Active-Duty Service Members

Cited by 4 publications

References 51 publications

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

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

Executive functioning in posttraumatic stress disorder: Understanding how inhibition, switching, and test modality affect reaction times.

Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps

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