3 results
59 Neuropsychiatric Clustering of Veterans with TBI: The Link Between Neuropsychological Test Validity and Somatic Post-Concussive Symptoms
- Nathalie Dugas, Morgan Caudle, Amber Keller, Jessica Bomyea, Amy Jak
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 164-165
-
- Article
-
- You have access Access
- Export citation
-
Objective:
There is a wide variability in the neuropsychiatric presentation of mild traumatic brain injury (mTBI), and accurate diagnosis and treatment is complicated by within-condition heterogeneity and overlapping symptoms of common comorbidities (e.g., PTSD). Such diagnostic complexities can obfuscate clinical decision-making and lead to suboptimal treatment response. In contrast to traditional diagnostic categories, person-centered analysis methods create data-derived groupings wherein individuals within a cluster are similar and individuals across clusters are different. The current study sought to apply clustering to dimensional emotional and neuropsychological features in treatment-seeking Veterans with mTBI, with the goal of identifying more precise, homogeneous clinical profiles.
Participants and Methods:Study participants were 190 Veterans with mTBI history participating in a clinical neuropsychological assessment of cognitive complaints (Mean age: 34.38, 89.6% male, average years of education: 13.14). Participants completed a diagnostic interview, neuropsychological tests, and symptom questionnaires (NBSI, PCL, BDI, BAI, AUDIT, PSQI). To identify clusters of similar neuropsychiatric presentations, we first conducted dimension reduction on data from the cognitive tests and self-report measures using principal components analysis. Second, cluster analysis and cluster validation was performed on the resultant principal components (R: kmeans, clusterboot, clusterValid) to find homogeneous subgroups of participants.
Results:The clinical data was best represented by principal components reflecting anxious arousal, depressive cognitions, somatic post-concussive symptoms, reexperiencing and avoidance symptoms, and objective cognitive deficits. Cluster analysis using bootstrapping and cluster validity indices (e.g., Silhouette width, Dunn index) indicated that a 6-subgroup solution was optimal (subgroups were labeled Group A-Group F). Group A was characterized by moderate levels across all dimension scores. Group B was characterized by elevated somatic post-concussive symptoms and cognitive deficits. Group C was characterized by intact cognitive performance and low somatic post concussive symptoms. Group D was characterized by elevated depressive cognitions. Group E was characterized by high anxious arousal but low depressive cognitions and reexperiencing and avoidance. Group F was characterized by elevated reexperiencing and avoidance. The subgroups did not differ statistically on any demographic items, such as years of education, age, or gender. However, there were statistically significant differences across groups in performance validity failure (x2(10) = 27.17, p=.002); Group B showed the highest rate of failure.
Conclusions:Results demonstrate that phenotypically similar subgroups of individuals can be identified within treatment-seeking Veterans with mTBI. Data suggest that somatic post-concussive symptoms may be linked to cognitive deficits, however the rate of validity failure indicates that neuropsychological test scores may not reflect true cognitive ability. In contrast to prior studies that treat mTBI as a unitary construct that accounts for symptoms, our data suggest that a nuanced evaluation yields vastly diverse clinical presentations. Cluster analytic frameworks hold promise for better assessment and treatment planning for Veterans, as both patients and their treating clinicians would be greatly served by the ability to use common clinical assessment tools to better identify a given individual’s clinical needs. A critical next step is to validate subgroups using novel samples and data sources (e.g., neurobiology, genetics) and to determine if these subgroupings can be effectively utilized to personalize treatment assignment.
33 Depressive Symptoms Drive the Underutilization of Cognitive Reappraisal in Veterans with PTSD
- Krupali R. Patel, Morgan Marvin Caudle, Danielle Dun, Jessica Bomyea
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 822-823
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Adaptive emotional regulation strategies, such as cognitive reappraisal, are related to better neuropsychological functioning in the general population. Individuals with PTSD demonstrate difficulty with both emotional regulation and cognitive performance that contribute to clinical presentation (e.g., negative mood, irritability). However the extent to which neuropsychological functioning is associated with emotion regulation, alone and in concert with common comorbid symptoms like depression, remains understudied in this population. Better understanding how specific neuropsychological functions relate to cognitive reappraisal could point to novel treatment targets given preliminary evidence that certain cognitive training techniques can improves neuropsychological and affective outcomes. The present study aims to investigate the relationship between clinical symptoms of PTSD and depression, working memory capacity, and cognitive reappraisal in Veterans with PTSD. We hypothesized that clinical symptoms and working memory capacity would interact to predict cognitive reappraisal, such that elevated depression would relate to worse cognitive reappraisal, particularly for individuals with poor working memory capacity.
Participants and Methods:Measures of working memory (symmetry span task), mental health symptomatology (Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Beck Depression Inventory-II (BDI-II), and emotional regulation (Emotion Regulation Questionnaire (ERQ)) were collected in 38 Veterans. A regression analysis was conducted with total CAPS score, total BDI score, total symmetry span score, and the interaction between BDI score and symmetry span score as the independent variables and total ERQ cognitive reappraisal score as the dependent variable.
Results:When examining each predictor independently, cognitive reappraisal was not associated with working memory (t=1.42, p=.165), but was significantly associated with PTSD (t=-3.17, p<.003) and depressive (t=-4.15, p<.001) symptom severity. The multiple regression model (F(4, 35)=4.45, p<.005, R2=.26) did not support the hypothesized relationship between working memory and depressive symptoms (t=0.56, p=.579). Depression independently predicted utilization of cognitive reappraisal in veterans with PTSD (t=2.43, p=.020) but PTSD symptom severity and working memory scores did not. However, additional investigation revealed that independently, greater PTSD symptom severity did predict less utilization of cognitive reappraisal (t=-3.17, p<.005).
Conclusions:While depressive symptoms did not moderate the relationship between working memory and cognitive reappraisal, depressive symptoms did best predict utilization of cognitive reappraisal in a population with PTSD. Contrary to the hypothesized outcome, neither working memory nor PTSD symptoms were significant predictors of cognitive reappraisal when controlling for depressive symptoms. This suggests that the phenomenon of lower cognitive reappraisal rates in individuals with PTSD may be due to the presence of depressive symptoms rather than traumatic stress symptoms or neuropsychological ability. Due to the sample size and homogeneous diagnosis of the current study it is possible that the predicted relationship between working memory, PTSD severity, and cognitive reappraisal was not observed due to low power or a restricted range. Further investigation specifically in clinical populations on factors that predict utilization of cognitive reappraisal could expand on these findings in populations experiencing other stress-based disorders.
Mild Traumatic Brain Injury Burden Moderates the Relationship Between Cognitive Functioning and Suicidality in Iraq/Afghanistan-Era Veterans
- Laura D. Crocker, Amber V. Keller, Sarah M. Jurick, Jessica Bomyea, Chelsea C. Hays, Elizabeth W. Twamley, Amy J. Jak
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 25 / Issue 1 / January 2019
- Published online by Cambridge University Press:
- 16 November 2018, pp. 79-89
-
- Article
- Export citation
-
Objectives: Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. Methods: Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N = 282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. Results: Individuals who endorsed SI reported more severe post-traumatic stress disorder (PTSD), depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. Conclusions: Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for veterans with history of multiple mTBIs. (JINS, 2019, 25, 79–89)