Mild traumatic brain injury does not predict acute postconcussion syndrome

Meares, Susanne; Shores, E. Arthur; Taylor, Alan; Batchelor, Jennifer; Bryant, Richard A.; Baguley, Ian; Chapman, Jennifer; Gurka, Joseph; Dawson, Katie; Capon, L.; Marosszeky, J. E.

doi:10.1136/jnnp.2007.126565

Cited by 306 publications

(214 citation statements)

References 32 publications

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“…Historically, Veterans returning from war have reported cognitive complaints, which, in the vast majority of cases, are not attributable to TBI [26][27]. Cognitive postconcussive symptoms often lack objective neurocognitive findings, and studies in civilians have shown that these symptoms occur at similar rates in persons with mTBI as in those with no TBI [28][29]. More recently, Polusny et al showed that deployment-related mTBI was significantly associated with two self-reported cognitive outcomes (memory and concentration problems) among National Guard servicemembers deployed to Iraq [30].…”

Section: Memory and Attentionmentioning

confidence: 99%

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

Seal¹,

Bertenthal²,

Samuelson³

et al. 2016

J Rehabil Res Dev

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Abstract-The Department of Veterans Affairs traumatic brain injury (TBI) screening program is intended to detect and expedite treatment for TBI and postconcussive symptoms. Between April 14, 2007, and May 31, 2012, of 66,089 Iraq and Afghanistan Veterans who screened positive on first-level TBI screening and later completed comprehensive TBI evaluation that includes the Neurobehavioral Symptoms Inventory, 72% reported moderate to very severe cognitive impairment (problems with attention, concentration, memory, etc.) that interfered with daily activities. This included 42% who were found not to have sustained combat-related mild TBI (mTBI). In contrast, 70.0% received a posttraumatic stress disorder (PTSD) diagnosis and 45.8% received a depression diagnosis. Compared with Veterans without mTBI, PTSD, or depression diagnoses, the lowest risk for self-reported cognitive impairment was in Veterans with confirmed mTBI only; a greater risk was found in those with PTSD diagnoses, with the greatest risk in Veterans with PTSD, depression, and confirmed mTBI, suggesting only a weakly additive effect of mTBI. These findings suggest that Veterans with multiple mental health comorbidities, not just those with TBI, report moderate to very severe cognitive impairment. Mental health treatment for conditions such as PTSD and depression (with or without TBI) may result in improvements in cognitive functioning and/or include assessment and support for Veterans experiencing cognitive problems.

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Section: Memory and Attentionmentioning

confidence: 99%

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

Seal¹,

Bertenthal²,

Samuelson³

et al. 2016

J Rehabil Res Dev

View full text Add to dashboard Cite

show abstract

“…Other authors have reported similar findings. 9,23,55,56 Meares et al 9 studied a sample of consecutive trauma patients admitted to a level 1 trauma center, including 90 patients with mild TBI and 85 with non-brain injury trauma: both groups had the same incidence of symptoms, with the strongest predictor of symptoms in either group being a previous affective disorder. A correlation between pain and NBS has been reported, and pain has been associated with the persistence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…A correlation between pain and NBS has been reported, and pain has been associated with the persistence of symptoms. 9,56 Hart et al 56 reported that pain after TBI was associated with cognitive impairment, including deficits in attention, memory, processing speed, and reaction time. The occurrence of cognitive complaints in non-TBI chronic pain patients has been demonstrated, and this once again questions the relationship between TBI per se and NBS.…”

Section: Discussionmentioning

confidence: 99%

“…Some of the risk factors that have been identified for the development of NBS include female gender, advanced age, pain, and prior affective or anxiety diagnoses. 9 In approximately 15% of mild TBI patients, NBS persist beyond 3 months and may contribute to long-term social and occupational difficulties. 10 -12 Cognitive dysfunction in the form of impaired attention, memory, and executive function has a predominant role in patients who experience persistent symptoms.…”

Section: Clinical Presentationsmentioning

confidence: 99%

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Neurobehavioral sequelae of traumatic brain injury

Riggio

Wong

2009

Mount Sinai J Medicine

106

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The neurobehavioral sequelae of traumatic brain injury consist of a spectrum of somatic and neuropsychiatric symptoms. The neuropsychiatric symptoms are divided into cognitive and behavioral presentations. In the literature, these neurobehavioral sequelae have been called postconcussive symptoms, postconcussive syndrome, and postconcussive disorder; however, the authors of this review do not use this terminology because the symptoms are not restricted to patients with concussion but instead can be found in all traumatic brain injury patients of all injury severities. The development of neurobehavioral sequelae after traumatic brain injury is a multifactorial process. The patient evaluation requires a multidisciplinary approach in order to delineate physiologic dysfunction and place deficits in the context of the patient's preinjury and postinjury psychiatric status. Consequently, the evaluation of the posttraumatic brain injury patient with neurobehavioral sequelae requires a carefully structured history and physical examination with an emphasis on neurological and psychiatric function. Adjunctive evaluations must be tailored to the patient with neuroimaging, neurophysiological, and neuropsychiatric testing. Maximized outcomes may be achieved by the performance of a careful and detailed assessment that places complaints within the context of the individual.

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“…Recovery after mTBI usually occurs within a period of days to weeks [2,4]; however, a sizable minority (18%-30%) of individuals in certain samples continues to report persistent postconcussive complaints, such as headache, light sensitivity, depressed mood, and reduced attention, many months to years after injury [5][6][7]. Persistent postconcussive symptoms are associated with poor functional outcomes [8][9][10], such as difficulty returning to work or school. Pain [11], secondary gain [12], and psychiatric comorbidities, such as posttraumatic stress disorder (PTSD) and depression, notably contribute to poor prognoses [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury

et al. 2016

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Abstract-A comprehensive evaluation, including the assessment of neurobehavioral symptoms, has been instituted at the Department of Veterans Affairs (VA) healthcare system to address the large number of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans returning with mild traumatic brain injuries (mTBIs). The Validity-10 is a measure of symptom overreporting embedded within the Neurobehavioral Symptom Inventory, a component of the comprehensive evaluation that assesses postconcussive symptom severity. The Validity-10 is composed of 10 unlikely/low-frequency items and a validated cutoff score to identify postconcussive symptom overreporting. We examined the items and cutoff used in the initial development and validation study of the Validity-10 through retrospective chart reviews of 331 treatment-seeking Veterans who sustained an mTBI. The Validity-10 exhibited significant relationships with psychiatric variables, VA service connection, and neuropsychological performance validity (all p < 0.01), but nonsignificant relationships with demographic and injury variables (all p > 0.05). Furthermore, the Validity-10 modestly predicted neuropsychological performance validity test failure over and above psychiatric comorbidities and VA service connection. The present study supports the use of the Validity-10 to assess symptom validity in treatment-seeking OIF/OEF Veterans with a history of mTBI.

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Mild traumatic brain injury does not predict acute postconcussion syndrome

Abstract: There is a high rate of acute PCS in both mTBI and non-brain injured trauma patients. PCS was not found to be specific to mTBI. The use of the term PCS may be misleading as it incorrectly suggests that the basis of PCS is a brain injury.

Cited by 306 publications

References 32 publications

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

Neurobehavioral sequelae of traumatic brain injury

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury

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