1115 — Cognitive, Affective, and Behavioral Differences between OEF/OIF Veterans with and without Traumatic Brain Injury
Donnelly KT, VA WNY Healthcare System; Donnelly JP, Hospice Buffalo; Dunnam M, Stratton VAMC; Warner GC, Canandaigua VAMC; Kittleson CJ, Bath VAMC; Bradshaw C, Syracuse VAMC; Alt M, VA WNY Healthcare System;
Traumatic brain injury (TBI) has consistently been identified as one of the most common injuries sustained by OEF/OIF service members. Cognitive and affective complaints are pervasive among Veterans returning from battle. The purpose of this study is to describe cognitive, affective, and neurobehavioral symptoms; pain level; combat exposure; and patterns of substance use, based on TBI status, in a cohort of OEF/OIF Veterans.
This investigation is part of a larger four-year, multisite prospective cohort study of 500 OEF/OIF Veterans in VISN 2. TBI status was determined by a structured diagnostic interview. Additional measures included WAIS III Digit Span and Digit Symbol, Trail Making Test (TMT), D-KEFS Verbal Fluency, Design Fluency, and Color-Word Tests, California Verbal Learning Test-2 (CVLT), Combat Experiences Scale (CES), Neurobehavioral Symptom Inventory (NSI), 0-10 Pain Scale, Beck Depression Inventory-2 (BDI), Beck Anxiety Inventory (BAI), PTSD Checklist (PCL), AUDIT C, and the Concordia Lifetime Drinking Questionnaire modified for substance use.
Two hundred nineteen (43.8%) Veterans out of 500 were clinically confirmed to have sustained at least one TBI. Veterans with TBI performed worse than those without on several cognitive measures (Digit Span, TMT, Digit Symbol, CVLT), yet all scores remained grossly within normal limits. As time since injury averaged more than three years, it is not surprising that cognitive deficits related to mild TBI were largely resolved. Effect sizes for differences between the groups on the cognitive measures were modest, ranging from .01 (95 percent CI: -.16 - -.20) for D-KEFS Design Fluency Composite to .46 (95 percent CI .28-.65) on CVLT long delayed recall. In contrast, more significant differences were found for the affective and behavioral measures. Veterans with TBI reported more combat exposure than those without (t = -11.21, p <.001, d = -1.04). The TBI positive group also endorsed more symptoms on the NSI, PCL, chronic pain scale, BDI, and BAI, with effect sizes ranging from -.52 on the pain scale to -.87 on the NSI. The groups did not differ on alcohol or illegal drug use, as both groups reported significant alcohol use and little misuse of other drugs.
While cognitive complaints are common among returning Veterans, performance across several measures of attention, memory, and executive control was normal in this sample, regardless of TBI status. Veterans with TBI, however, reported significantly more emotional distress, pain, and combat exposure than Veterans without such injuries, and both groups endorsed significant alcohol use. Cognitive complaints in this cohort may be more related to emotional distress and pain than to remote TBI.
Emotional distress, alcohol misuse, and pain may be more enduring than cognitive impairment among Veterans who sustain mild TBI. Post-deployment screening and treatment should focus on these areas.