Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder

Monica M Stika; Patrick Riordan; Alexandra Aaronson; Amy A Herrold; Rachael L Ellison; Sandra Kletzel; Michelle Drzewiecki; Charlesnika T Evans; Trudy Mallinson; Walter M High; Judith Babcock-Parziale; Amanda Urban; Theresa Louise-Bender Pape; Bridget Smith

doi:10.1097/HTR.0000000000000611

Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder

J Head Trauma Rehabil. 2021 Jan-Feb;36(1):44-55. doi: 10.1097/HTR.0000000000000611.

Authors

Monica M Stika¹, Patrick Riordan, Alexandra Aaronson, Amy A Herrold, Rachael L Ellison, Sandra Kletzel, Michelle Drzewiecki, Charlesnika T Evans, Trudy Mallinson, Walter M High, Judith Babcock-Parziale, Amanda Urban, Theresa Louise-Bender Pape, Bridget Smith

Affiliation

¹ Department of Veterans Affairs (VA), Edward Hines, Jr. VA Hospital: Spinal Cord Injury/Disorder Service (Dr Stika), Mental Health Service Line: Neuropsychology Service (Drs Riordan, Drzewiecki, and Urban) and Psychiatry Service (Dr Aaronson), Research Service (Drs Bender Pape, Herrold, Kletzel, and Ellison), Center of Innovation for Complex Chronic Healthcare (Drs Bender Pape, Herrold, Kletzel, Smith, and Evans), Hines, Illinois; Departments of Psychiatry & Behavioral Sciences (Drs Aaronson and Herrold), Physical Medicine and Rehabilitation (Dr Pape), and Pediatrics (Dr Smith), and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Dr Evans), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Clinical Research and Leadership, The George Washington University, Washington, District of Columbia (Dr Mallinson); Department of Veterans Affairs (VA), New Mexico VA Health Care System, Albuquerque (Dr High); Illinois Institute of Technology (IIT), Chicago (Dr Ellison); and Department of Veterans Affairs (VA), Southern AZ VA Health Care System (3-124), Tucson, Arizona (Dr Babcock-Parziale).

Abstract

Background: Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear.

Methods: We evaluated performance on tests of processing speed, executive functioning, attention, and memory as predictors of functioning on the World Health Organization Disability Assessment Scale (WHODAS) 2.0 in 288 veterans. Participants were placed in one of the following groups: PTSD-only, mTBI-only, mTBI + PTSD, and neither PTSD nor mTBI (deployed control group). Cognitive test performances were evaluated as predictors of WHODAS 2.0 functional ratings in regression models that included demographic variables and a range of mood, behavioral health, and postconcussive symptom ratings.

Results: Multiple cognitive test performances predicted WHODAS 2.0 scores in the deployed control group, but they generally did not predict functioning in the clinical groups when accounting for demographics, mood, behavioral health, and postconcussive symptoms.

Conclusions: In veterans with mTBI and/or PTSD, cognitive test performances are less associated with everyday functioning than mood and postconcussive symptoms.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Afghan Campaign 2001-
Brain Concussion* / diagnosis
Cognition
Humans
Iraq War, 2003-2011
Neuropsychological Tests
Post-Concussion Syndrome*
Stress Disorders, Post-Traumatic* / diagnosis
Stress Disorders, Post-Traumatic* / epidemiology
Veterans*

Abstract

Publication types

MeSH terms

Grants and funding