Although post-traumatic stress disorder (PTSD) has been associated with worse cognitive outcomes after mild traumatic brain injury (TBI), its impact has not been evaluated after more severe TBI. This study aimed to determine whether PTSD symptoms are related to cognition after complicated mild, moderate, severe, and penetrating TBI. Service members (n = 137) with a history of complicated mild/moderate TBI (n = 64) or severe/penetrating TBI (n = 73) were prospectively enrolled from United States Military Treatment Facilities. Participants completed a neuropsychological assessment one year or more post-injury. Six neuropsychological composite scores and an overall test battery mean (OTBM) were considered. Participants were excluded if there was evidence of invalid responding. Hierarchical linear regressions were conducted evaluating neuropsychological performance. The interaction between TBI severity and PTSD Checklist-Civilian version total score was significant for processing speed (β = 0.208, p = 0.034) and delayed memory (β = 0.239, p = 0.021) and trended toward significance for immediate memory (β = 0.190, p = 0.057) and the OTBM (β = 0.181, p = 0.063). For each of these composite scores, the relationship between PTSD symptoms and cognition was stronger in the complicated mild/moderate TBI group than the severe/penetrating TBI group. Within the severe/penetrating TBI group, PTSD symptoms were unrelated to cognitive performance. In contrast, within the complicated mild/moderate TBI group, PTSD symptoms were significantly related to processing speed (R²Δ = 0.077, β = -0.280, p = 0.019), immediate memory (R²Δ = 0.197, β = -0.448, p < 0.001), delayed memory (R²Δ = 0.176, β = -0.423, p < 0.001), executive functioning (R²Δ = 0.100, β = -0.317, p = 0.008), and the OTBM (R²Δ = 0.162, β = -0.405, p < 0.001). The potential impact of PTSD symptoms on cognition, over and above the impact of brain injury alone, should be considered with service members and veterans with a history of complicated mild/moderate TBI. In addition, in research comparing cognitive outcomes between patients with histories of complicated-mild, moderate, severe, and/or penetrating TBI, it will be important to account for PTSD symptoms.

中文翻译：

---

创伤后应激障碍症状与复杂性轻度和中度创伤性脑损伤后的认知有关，但不严重和穿透性创伤性脑损伤

尽管创伤后应激障碍 (PTSD) 与轻度创伤性脑损伤 (TBI) 后较差的认知结果相关，但尚未评估其在更严重的 TBI 后的影响。本研究旨在确定复杂的轻度、中度、重度和穿透性 TBI 后 PTSD 症状是否与认知有关。 有复杂轻度/中度 TBI ( n =  64) 或重度/穿透性 TBI ( n = 73) 从美国军事治疗设施前瞻性招募。参与者在受伤一年或更长时间后完成了神经心理学评估。考虑了六个神经心理学综合分数和一个整体测试电池平均值（OTBM）。如果有证据表明响应无效，则参与者被排除在外。进行分层线性回归评估神经心理表现。TBI 严重程度与 PTSD Checklist-Civilian 版本总分之间的相互作用对处理速度（β = 0.208，p  = 0.034）和延迟记忆（β = 0.239，p  = 0.021）具有显着性，并趋向于对即时记忆（β = 0.190）的显着性, p  = 0.057) 和 OTBM (β = 0.181, p = 0.063)。对于这些综合评分中的每一个，复杂轻度/中度 TBI 组的 PTSD 症状和认知之间的关系比重度/穿透性 TBI 组更强。在严重/穿透性 TBI 组中，PTSD 症状与认知表现无关。相比之下，在复杂的轻度/中度 TBI 组中，PTSD 症状与处理速度（R ² Δ = 0.077，β = -0.280，p  = 0.019）、即刻记忆（R ² Δ = 0.197，β = -0.448 ）显着相关, p  < 0.001), 延迟记忆 (R ² Δ = 0.176, β = -0.423, p  < 0.001), 执行功能 (R ² Δ = 0.100, β = -0.317, p  = 0.008) 和 OTBM (R² Δ = 0.162，β = -0.405，p  < 0.001）。有复杂轻度/中度 TBI 病史的服役人员和退伍军人应考虑 PTSD 症状对认知的潜在影响，而不仅仅是脑损伤的影响。此外，在比较具有复杂轻度、中度、重度和/或穿透性 TBI 病史的患者的认知结果的研究中，考虑 PTSD 症状将很重要。