The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans

Elsa K. Mattson; Nathaniel W. Nelson; Scott R. Sponheim; Seth G. Disner

doi:10.1037/neu0000560

The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans

Elsa K. Mattson, Nathaniel W. Nelson, Scott R. Sponheim, Seth G. Disner

Psychiatry & Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline.

METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses.

RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (β = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (β= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI.

CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Original language	English (US)
Pages (from-to)	913-921
Number of pages	9
Journal	Neuropsychology
Volume	33
Issue number	7
DOIs	https://doi.org/10.1037/neu0000560
State	Published - Oct 2019

Bibliographical note

Funding Information:
This work was supported by Congressionally Directed Medical Research Program Grant W81XWH-08-2-0038 (principal investigator [PI]: Scott R. Sponheim) and Department of Veterans Affairs, Rehabilitation R&D Program Grants 101RX000622 (PI: Scott R. Sponheim) and 1IK1RX002325 (PI: Seth G. Disner).

Publisher Copyright:
© 2019 American Psychological Association.

Keywords

Cognition
Neuropsychology
PTSD
mTBI
Reproducibility of Results
Iraq War, 2003-2011
Cognition Disorders/psychology
United States
Humans
Middle Aged
Brain Concussion/complications
Veterans/psychology
Combat Disorders/psychology
Male
Stress Disorders, Post-Traumatic/complications
Afghan Campaign 2001-
Young Adult
Psychiatric Status Rating Scales
Blast Injuries/psychology
Adult
Female

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title = "The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans",

abstract = "OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline.METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses.RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (β = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (β= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).",

keywords = "Cognition, Neuropsychology, PTSD, mTBI, Reproducibility of Results, Iraq War, 2003-2011, Cognition Disorders/psychology, United States, Humans, Middle Aged, Brain Concussion/complications, Veterans/psychology, Combat Disorders/psychology, Male, Stress Disorders, Post-Traumatic/complications, Afghan Campaign 2001-, Young Adult, Psychiatric Status Rating Scales, Blast Injuries/psychology, Adult, Female",

author = "Mattson, {Elsa K.} and Nelson, {Nathaniel W.} and Sponheim, {Scott R.} and Disner, {Seth G.}",

note = "Funding Information: This work was supported by Congressionally Directed Medical Research Program Grant W81XWH-08-2-0038 (principal investigator [PI]: Scott R. Sponheim) and Department of Veterans Affairs, Rehabilitation R&D Program Grants 101RX000622 (PI: Scott R. Sponheim) and 1IK1RX002325 (PI: Seth G. Disner). Publisher Copyright: {\textcopyright} 2019 American Psychological Association.",

year = "2019",

month = oct,

doi = "10.1037/neu0000560",

language = "English (US)",

volume = "33",

pages = "913--921",

journal = "Neuropsychology",

issn = "0894-4105",

publisher = "American Psychological Association",

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T1 - The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans

AU - Mattson, Elsa K.

AU - Nelson, Nathaniel W.

AU - Sponheim, Scott R.

AU - Disner, Seth G.

N1 - Funding Information: This work was supported by Congressionally Directed Medical Research Program Grant W81XWH-08-2-0038 (principal investigator [PI]: Scott R. Sponheim) and Department of Veterans Affairs, Rehabilitation R&D Program Grants 101RX000622 (PI: Scott R. Sponheim) and 1IK1RX002325 (PI: Seth G. Disner). Publisher Copyright: © 2019 American Psychological Association.

PY - 2019/10

Y1 - 2019/10

N2 - OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline.METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses.RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (β = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (β= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

AB - OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline.METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses.RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (β = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (β= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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KW - Reproducibility of Results

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KW - United States

KW - Humans

KW - Middle Aged

KW - Brain Concussion/complications

KW - Veterans/psychology

KW - Combat Disorders/psychology

KW - Male

KW - Stress Disorders, Post-Traumatic/complications

KW - Afghan Campaign 2001-

KW - Young Adult

KW - Psychiatric Status Rating Scales

KW - Blast Injuries/psychology

KW - Adult

KW - Female

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The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans

Abstract

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