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Post-Traumatic Stress Disorder Is Associated with Neuropsychological Outcome but Not White Matter Integrity after Mild Traumatic Brain Injury
Journal of Neurotrauma ( IF 3.9 ) Pub Date : 2020-12-14 , DOI: 10.1089/neu.2019.6852
Rael T Lange 1, 2, 3 , Sara M Lippa 2 , Tracey A Brickell 1, 2, 4 , Ping-Hong Yeh 2 , John Ollinger 2 , Megan Wright 1, 2 , Angela Driscoll 1, 2 , Jamie Sullivan 1, 2 , Samantha Braatz 1, 2 , Rachel Gartner 5 , Elizabeth Barnhart 1, 2 , Louis M French 1, 2, 4
Affiliation  

The aim of this study was to examine neuropsychological functioning and white matter integrity, in service members and veterans (SMVs) after mild traumatic brain injury (MTBI), with versus without post-traumatic stress disorder (PTSD). Participants were 116 U.S. military SMVs, prospectively enrolled from the Walter Reed National Military Medical Center (Bethesda, MD), who had sustained an MTBI (n = 86) or an injury without TBI (i.e., Injured Control [IC]; n = 30). Participants completed a battery of neuropsychological measures (neurobehavioral and -cognitive), as well as diffusion tensor imaging (DTI) of the brain, on average 6 years post-injury. Based on diagnostic criteria for PTSD, participants in the MTBI group were classified into two subgroups: MTBI/PTSD-Present (n = 21) and MTBI/PTSD-Absent (n = 65). Participants in the IC group were included only if they were classified as PTSD-Absent. The MTBI/PTSD-Present group had a significantly higher number of self-reported symptoms on all neurobehavioral measures (e.g., depression), and lower scores on more than half of the neurocognitive domains (e.g., processing speed), compared to the MTBI/PTSD-Absent and IC/PTSD-Absent groups. There were no significant group differences for the vast majority of DTI measures, with the exception of a handful of regions (i.e., superior longitudinal fascicle and superior thalamic radiation). These results suggest that there is 1) a strong relationship between PTSD and poor neuropsychological outcome after MTBI and 2) a lack of a relationship between PTSD and white matter integrity, as measured by DTI, after MTBI. Concurrent PTSD and MTBI should be considered a risk factor for poor neuropsychological outcome that requires early intervention.

中文翻译:

创伤后应激障碍与轻度创伤性脑损伤后的神经心理结果有关,但与白质完整性无关

本研究的目的是检查轻度创伤性脑损伤 (MTBI) 后服役人员和退伍军人 (SMV) 的神经心理功能和白质完整性,与没有创伤后应激障碍 (PTSD)。参与者是 116 名从 Walter Reed 国家军事医疗中心(马里兰州贝塞斯达)前瞻性招募的美国军用 SMV,他们患有 MTBI(n  = 86)或没有 TBI 的损伤(即,受伤控制 [IC];n  = 30 )。参与者在受伤后平均 6 年完成了一系列神经心理学测量(神经行为和认知),以及大脑的弥散张量成像 (DTI)。根据 PTSD 的诊断标准,MTBI 组的参与者被分为两个亚组:MTBI/PTSD-Present ( n = 21) 和 MTBI/PTSD 缺席 ( n = 65)。仅当他们被归类为 PTSD 缺席时,才包括 IC 组的参与者。与 MTBI/PTSD-Present 组相比,MTBI/PTSD-Present 组在所有神经行为测量(例如抑郁)上的自我报告症状数量明显更多,并且在超过一半的神经认知领域(例如处理速度)上得分较低。 PTSD-Absent 和 IC/PTSD-Absent 组。除了少数区域(即上纵束和上丘脑放射)外,绝大多数 DTI 测量没有显着的组间差异。这些结果表明 1) PTSD 与 MTBI 后不良的神经心理结果之间存在密切关系,2) PTSD 与 MTBI 后的 DTI 测量的白质完整性之间缺乏相关性。
更新日期:2021-01-05
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