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The Contributions of Self-reported Injury Characteristics and Psychiatric Symptoms to Cognitive Functioning in OEF/OIF Veterans with Mild Traumatic Brain Injury

Published online by Cambridge University Press:  06 March 2012

Lauren L. Drag ,
Robert J. Spencer ,
Sara J. Walker ,
Percival H. Pangilinan  and
Linas A. Bieliauskas
Lauren L. Drag*
Affiliation:
Research Service, VA Palo Alto Healthcare System, Palo Alto, California
Robert J. Spencer
Affiliation:
Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Sara J. Walker
Affiliation:
Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan
Percival H. Pangilinan
Affiliation:
Department of Physical Medicine and Rehabilitation, VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan
Linas A. Bieliauskas
Affiliation:
Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan
*
Correspondence and reprint requests to: Lauren L. Drag, 3801 Miranda Avenue (118J), Palo Alto, CA 94304. E-mail: lauren.drag@va.gov
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Abstract

Mild traumatic brain injury (mTBI) affects a significant number of combat veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Although resolution of mTBI symptoms is expected over time, some individuals continue to report lingering cognitive difficulties. This study examined the contributions of self-reported mTBI injury characteristics (e.g., loss of consciousness, post-traumatic amnesia) and psychiatric symptoms to both subjective and objective cognitive functioning in a sample of 167 OEF/OIF veterans seen in a TBI clinic. Injury characteristics were not associated with performance on neuropsychological tests but were variably related to subjective ratings of cognitive functioning. Psychiatric symptoms were highly prevalent and fully mediated most of the relationships between injury characteristics and cognitive ratings. This indicates that mTBI characteristics such as longer time since injury and loss of consciousness or post-traumatic amnesia can lead to increased perceived cognitive deficits despite having no objective effects on cognitive performance. Psychiatric symptoms were associated with both cognitive ratings and neuropsychological performance, illustrating the important role that psychiatric treatment can potentially play in optimizing functioning. Finally, subjective cognitive ratings were not predictive of neuropsychological performance once psychiatric functioning was statistically controlled, suggesting that neuropsychological assessment provides valuable information that cannot be gleaned from self-report alone. (JINS, 2012, 18, 576–584)

Keywords

NeuropsychologyHead injuriesAnxietyDepressionPTSDMilitary
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 3 , May 2012 , pp. 576 - 584
Copyright
Copyright © The International Neuropsychological Society 2012

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