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Cognitive sequelae of blast-related versus other mechanisms of brain trauma

  • HEATHER G. BELANGER (a1) (a2) (a3), TRACY KRETZMER (a1), RUTH YOASH-GANTZ (a4) (a5) (a6), TREVEN PICKETT (a3) (a4) (a7) (a8) and LARRY A. TUPLER (a4) (a9)...
Abstract
Abstract

The use of improvised explosive devices has become the hallmark of modern warfare and has resulted in an ever-increasing number of blast-related traumatic brain injuries (TBIs). Despite this fact, very little is actually known about the cognitive sequelae of blast-related TBIs. The purpose of the current study was to compare patterns of performance on neuropsychological measures in subjects who have sustained TBIs as a result of blast (or explosion) with those who have sustained TBIs from non-blast or blunt force trauma (motor vehicle accident, fall, assault, etc.). Participants were categorized as blast-related TBI or non-blast-related TBI and according to severity of injury (mild or moderate-to-severe). No main effects were observed in analysis of covariance between blast-related TBI participants and non-blast-related TBI participants across any of the neuropsychological variables, although an interaction was observed on a visual memory test showing stronger performance for mild blast-related and poorer performance for moderate-to-severe blast-related participants compared with both non-blast groups. Overall, the results do not provide any strong evidence that blast is categorically different from other TBI mechanisms, at least with regard to cognitive sequelae on select measures. Additional findings included a marginally increased incidence of reported posttraumatic stress disorder symptoms among blast-injured participants. (JINS, 2009, 15, 1–8.)

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Corresponding author
*Correspondence and reprint requests to: Heather G. Belanger, James A. Haley Veterans Hospital Psychology Service, 116B 13000 Bruce B. Downs Boulevard, Tampa, Florida 33612. E-mail: heather.belanger@va.gov.
References
Hide All
Barnfield T.V. & Leathem J.M. (1998). Neuropsychological outcomes of traumatic brain injury and substance abuse in a New Zealand prison population. Brain Injury, 12, 951962.
Belanger H.G., Curtiss G., Demery J.A., Lebowitz B.K., & Vanderploeg R.D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of the International Neuropsychological Society, 11, 215227.
Benedict R.D. (1997). Brief Visuospatial Memory Test—Revised. Lutz, FL: Psychological Assessment Resources, Inc.
Binder L.M., Rohling M.L., & Larrabee G.J. (1997). A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies. Journal of Clinical and Experimental Neuropsychology, 19, 421431.
Brewin C.R., Kleiner J.S., Vasterling J.J., & Field A.P. (2007). Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation. Journal of Abnormal Psychology, 116, 448463.
Cernak I., Savic J., Malicevic Z., Zunic G., Radosevic P., Ivanovic I., & Davidovic L. (1996). Involvement of the central nervous system in the general response to pulmonary blast injury. Journal of Trauma-Injury Infection & Critical Care, 40, 100104.
Cernak I., Wang Z., Jiang J., Bian X., & Savic J. (2001). Cognitive deficits following blast injury-induced neurotrauma: Possible involvement of nitric oxide. Brain Injury, 15, 593612.
Chen J.-K., Johnston K.M., Petrides M., & Ptito A. (2008). Neural substrates of symptoms of depression following concussion in male athletes with persisting postconcussion symptoms. Archives of General Psychiatry, 65, 8189.
Coupland R.M. & Meddings D.R. (1999). Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: Literature review. British Medical Journal, 319, 407410.
Delis D.C., Kramer J.H., Kaplan E., & Ober B.A. (2000). California Verbal Learning Test, (2nd ed.). San Antonio, TX: PsychCorp.
DePalma R.G., Burris D.G., Champion H.R., & Hodgson M.J. (2005). Blast injuries. New England Journal of Medicine, 352, 13351342.
Dikmen S.S., Machamer J.E., Powell J.M., & Temkin N.R. (2003). Outcome 3 to 5 years after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84, 14491457.
Dikmen S.S., Machamer J.E., Winn H.R., & Temkin N.R. (1995). Neuropsychological outcome at 1-year post head injury. Neuropsychology, 9, 8090.
Elsayed N.M. (1997). Toxicology of blast overpressure. Toxicology, 121, 115.
Erbes C., Westermeyer J., Engdahl B., & Johnsen E. (2007). Post-traumatic stress disorder and service utilization in a sample of service members from Iraq and Afghanistan. Military Medicine, 172, 359363.
Friedman M.J. (2006). Posttraumatic stress disorder among military returnees from Afghanistan and Iraq. American Journal of Psychiatry, 163, 586593.
Glaesser J., Neuner F., Lütgehetmann R., Schmidt R., & Elbert T. (2004). Posttraumatic stress disorder in patients with traumatic brain injury. Bmc Psychiatry, 4, 5.
Green P. (2003). Medical symptom validity test for windows: User’s manual and program. Edmonton, Canada: Green’s Publishing.
Green P., Allen L., & Astner K. (1996). Manual for computerized Word Memory Test. Durham, NC: CogniSystem.
Greenspan A.I., Stringer A.Y., Phillips V.L., Hammond F.M., & Goldstein F.C. (2006). Symptoms of post-traumatic stress: Intrusion and avoidance 6 and 12 months after TBI. Brain Injury, 20, 733742.
Heaton R.K., Grant I., & Matthews C.G. (1991). Comprehensive norms for an expanded Halstead–Reitan Battery. Odessa, FL: Psychological Assessment Resources, Inc.
Hoge C.W., Auchterlonie J.L., & Milliken C.S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA, 295, 10231032.
Hoge C.W., McGurk D., Thomas J.L., Cox A.L., Engel C.C., & Castro C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine, 358, 453463.
Jakupcak M., Conybeare D., Phelps L., Hunt S., Holmes H.A., Felker B., Klevins M., & McFall M.E. (2007). Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD. Journal of Traumatic Stress, 20, 945954.
Jones C., Harvey A.G., & Brewin C.R. (2005). Traumatic brain injury, dissociation, and posttraumatic stress disorder in road traffic accident survivors. Journal of Traumatic Stress, 18, 181191.
Kaur C., Singh J., Lim M.K., Ng B.L., Yap E.P., & Ling E.A. (1995). The response of neurons and microglia to blast injury in the rat brain. Neuropathology and Applied Neurobiology, 21, 369377.
Kay T., Harrington D.E., Adams R.E., Anderson T.W., Berrol S., Cicerone K., Dahlberg C., Gerber D., Goka R., Harley P., Hilt J., Horn L., Lehmkuhl D., & Malec J. (1993). Definition of mild traumatic brain injury: Report from the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Journal of Head Trauma Rehabilitation, 8, 8687.
Kolkow T.T., Spira J.L., Morse J.S., & Grieger T.A. (2007). Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan. Military Medicine, 172, 451455.
Mayorga M.A. (1997). The pathology of primary blast overpressure injury. Toxicology, 121, 1728.
Milliken C.S., Auchterlonie J.L., & Hoge C.W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA, 298, 21412148.
Millis S.R., Rosenthal M., Novack T.A., Sherer M., Nick T.G., Kreutzer J.S., High W.M., & Ricker J.H. (2001). Long-term neuropsychological outcome after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16, 343355.
Moore E.L., Terryberry-Spohr L., & Hope D.A. (2006). Mild traumatic brain injury and anxiety sequelae: A review of the literature. Brain Injury, 20, 117132.
Murray C.K., Reynolds J.C., Schroeder J.M., Harrison M.B., Evans O.M., & Hospenthal D.R. (2005). Spectrum of care provided at an echelon II Medical Unit during Operation Iraqi Freedom. Military Medicine, 170, 516520.
Okie S. (2005). Traumatic brain injury in the war zone. New England Journal of Medicine, 352, 20432047.
Owens B.D., Kragh J.F., Wenke J.C., Macaitis J., Wade C.E., & Holcomb J.B. (2008). Combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom. Journal of Trauma, 64, 295299.
Reitan R.M. & Wolfson D. (1985). The Halstead-Reitan Neuropsychological Test Battery. Tucson, AZ: Neuropsychology Press.
Sayer N.A., Chiros C.E., Sigford B., Scott S., Clothier B., Pickett T., & Lew H.L. (2008). Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror. Archives of Physical Medicine and Rehabilitation, 89, 163170.
Schretlen D.J. & Shapiro A.M. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychiatry, 15, 341349.
Scott S.G., Vanderploeg R.D., Belanger H.G., & Scholten J.D. (2005). Blast injuries: Evaluating and treating the postacute sequelae. Federal Practitioner, 22, 6775.
Taber K.H., Warden D.L., & Hurley R.A. (2006). Blast-related brain injury: What is known? Journal of Neuropsychiatry and Clinical Neuroscience, 18, 141145.
Trudeau D.L., Anderson J., Hansen L.M., Shagalov D.N., Schmoller J., Nugent S., & Barton S. (1998). Findings of mild traumatic brain injury in combat veterans with PTSD and a history of blast concussion. Journal of Neuropsychiatry and Clinical Neurosciences, 10, 308313.
van der Kolk B.A. (1996). The body keeps score: Approaches to the psychobiology of posttraumatic stress disorder. In van der Kolk B.A., McFarlane A.C., & Weisaeth L. (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 214241). New York: Guilford.
Warden D. (2006). Military TBI during the Iraq and Afghanistan wars. Journal of Head Trauma and Rehabilitation, 21, 398402.
Warden D.L., Labbate L.A., Salazar A.M., Nelson R., Sheley E., Staudenmeier J., & Martin E. (1997). Posttraumatic stress disorder in patients with traumatic brain injury and amnesia for the event? Journal of Neuropsychiatry and Clinical Neurosciences, 9, 1822.
Warden D.L., Ryan L.M., Helmick K.M., Schwab K., French L., Lu W., Lux W., Ling G., & Ecklund J. (2005). War neurotrauma: The Defense and Veterans Brain Injury Center (DVBIC) experience at Walter Reed Army Medical Center (WRAMC). Journal of Neurotrauma, 22, 1178.
Weathers F.W., Huska J.A., & Keane T.M. (1991). PCL-C for DSM-IV. Boston: National Center for PTSD—Behavioral Science Division.
Wechsler D. (1997). Wechsler Adult Intelligence Scale—Administration and Scoring Manual (3rd ed.). San Antonio, TX: Harcourt Assessment, Inc.
Wechsler D. (2001). Wechsler Test of Adult Reading. San Antonio, TX: Harcourt Assessment, Inc.
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Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
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