1
|
Stika MM, Riordan P, Aaronson A, Herrold AA, Ellison RL, Kletzel S, Drzewiecki M, Evans CT, Mallinson T, High WM, Babcock-Parziale J, Urban A, Pape TLB, Smith B. Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. J Head Trauma Rehabil 2021; 36:44-55. [PMID: 32898030 PMCID: PMC8916049 DOI: 10.1097/htr.0000000000000611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear. METHODS We evaluated performance on tests of processing speed, executive functioning, attention, and memory as predictors of functioning on the World Health Organization Disability Assessment Scale (WHODAS) 2.0 in 288 veterans. Participants were placed in one of the following groups: PTSD-only, mTBI-only, mTBI + PTSD, and neither PTSD nor mTBI (deployed control group). Cognitive test performances were evaluated as predictors of WHODAS 2.0 functional ratings in regression models that included demographic variables and a range of mood, behavioral health, and postconcussive symptom ratings. RESULTS Multiple cognitive test performances predicted WHODAS 2.0 scores in the deployed control group, but they generally did not predict functioning in the clinical groups when accounting for demographics, mood, behavioral health, and postconcussive symptoms. CONCLUSIONS In veterans with mTBI and/or PTSD, cognitive test performances are less associated with everyday functioning than mood and postconcussive symptoms.
Collapse
Affiliation(s)
- Monica M Stika
- Department of Veterans Affairs (VA), Edward Hines, Jr. VA Hospital: Spinal Cord Injury/Disorder Service (Dr Stika), Mental Health Service Line: Neuropsychology Service (Drs Riordan, Drzewiecki, and Urban) and Psychiatry Service (Dr Aaronson), Research Service (Drs Bender Pape, Herrold, Kletzel, and Ellison), Center of Innovation for Complex Chronic Healthcare (Drs Bender Pape, Herrold, Kletzel, Smith, and Evans), Hines, Illinois; Departments of Psychiatry & Behavioral Sciences (Drs Aaronson and Herrold), Physical Medicine and Rehabilitation (Dr Pape), and Pediatrics (Dr Smith), and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Dr Evans), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Clinical Research and Leadership, The George Washington University, Washington, District of Columbia (Dr Mallinson); Department of Veterans Affairs (VA), New Mexico VA Health Care System, Albuquerque (Dr High); Illinois Institute of Technology (IIT), Chicago (Dr Ellison); and Department of Veterans Affairs (VA), Southern AZ VA Health Care System (3-124), Tucson, Arizona (Dr Babcock-Parziale)
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders. Neuropsychol Rev 2020; 30:407-424. [PMID: 32766940 DOI: 10.1007/s11065-020-09448-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
Abstract
Psychotic disorders are characterized by a generalized neurocognitive deficit (i.e., performance 1.5 SD below controls across neuropsychological domains with no specific profile of differential deficits). A motivational account of the generalized neurocognitive deficit has been proposed, which attributes poor neuropsychological testing performance to low effort. However, findings are inconsistent regarding effort test failure rate in individuals with psychotic disorders across studies (0-72%), and moderators are unclear, making it difficult to know whether the motivational explanation is viable. To address these issues, a meta-analysis was performed on data from 2205 individuals with psychotic disorders across 19 studies with 24 independent effects. Effort failure rate was examined along with moderators of effort test type, forensic status, IQ, positive symptoms, negative symptoms, diagnosis, age, gender, education, and antipsychotic use. The pooled weighted effort test failure rate was 18% across studies and there was a moderate pooled association between effort failure rate and global neurocognitive performance (r = .57). IQ and education significantly moderated failure rate. Collectively, these findings suggest that a nontrivial proportion of individuals with a psychotic disorder fail effort testing, and failure rate is associated with global neuropsychological impairment. However, given that effort tests are not immune to the effects of IQ in psychotic disorders, these results cannot attest to the viability of the motivational account of the generalized neurocognitive deficit. Furthermore, the significant moderating effect of IQ and education on effort test performance suggests that effort tests have questionable validity in this population and should be interpreted with caution.
Collapse
|
3
|
Nelson NW, Disner SG, Anderson CR, Doane BM, McGuire K, Lamberty GJ, Hoelzle J, Sponheim SR. Blast concussion and posttraumatic stress as predictors of postcombat neuropsychological functioning in OEF/OIF/OND veterans. Neuropsychology 2020; 34:116-126. [PMID: 31545626 PMCID: PMC6940504 DOI: 10.1037/neu0000594] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Many combat veterans exhibit cognitive limitations of uncertain origin. In this study, we examined factors that predict cognitive functioning by considering effects of blast-related concussion (BRC), non-blast-related concussion (NBRC), and posttraumatic stress disorder (PTSD) symptoms. Analyses specifically tested whether (a) BRC and NBRC were distinct in their prediction of cognitive performance; (b) a dose-response relationship existed between recurrent concussion (BRC and NBRC) and cognitive impairment; and (c) PTSD symptoms mediated the relationship between BRC and cognitive performance. METHOD Two hundred eighty veterans with combat zone deployment histories completed semistructured clinical interviews to define BRC and NBRC histories, current and past mental health disorders, and dimensional ratings of PTSD symptomatology. Participants were also administered a number of neuropsychological measures to appraise cognitive functioning. RESULTS A structural equation model (SEM) suggested that BRC and NBRC were not distinct in their prediction of cognitive performance, and there was no evidence that recurrent concussion (blast or nonblast) was directly associated with cognitive performance. BRC was significantly associated with PTSD symptoms (r = .24), PTSD symptoms were significantly associated with cognitive performance in the SEM (r = -.27), and PTSD symptoms significantly mediated the link between BRC and cognitive performance (p = .03). CONCLUSIONS These results suggest that concussion history fails to directly contribute to cognitive performance, regardless of mechanism (blast or nonblast) and recurrence. BRC is nonetheless unique in its contribution to PTSD and PTSD-related cognitive deficits. Results support interventions specific to PTSD management in the interest of promoting neuropsychological functioning among war veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
|
4
|
Shura RD, Epstein EL, Armistead-Jehle P, Cooper DB, Eapen BC. Assessment and Treatment of Concussion in Service Members and Veterans. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
5
|
Moore RA, Lippa SM, Brickell TA, French LM, Lange RT. Clinical utility of WAIS-IV 'excessive decline from premorbid functioning' scores to detect invalid test performance following traumatic brain injury. Clin Neuropsychol 2019; 34:512-528. [PMID: 31608766 DOI: 10.1080/13854046.2019.1668059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Excessive Decline from Premorbid Functioning (EDPF), an atypical discrepancy between demographically predicted and obtained Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) scores, has been recently proposed as a potential embedded performance validity test (PVT). This study examined the clinical utility of EDPF scores to detect invalid test performance following traumatic brain injury (TBI).Methods: Participants were 194 U.S. military service members who completed neuropsychological testing on average 2.4 years (SD = 4.0) following uncomplicated mild, complicated mild, moderate, severe, or penetrating TBI (Age: M = 34.0, SD = 9.9). Using TBI severity and PVT performance (i.e., PVT Pass/Fail), participants were classified into three groups: Uncomplicated Mild TBI-PVT Fail (MTBI-Fail; n = 21), Uncomplicated Mild TBI-PVT Pass (MTBI-Pass; n = 94), and Complicated Mild to Severe/Penetrating TBI-PVT Pass (CM/STBI-Pass; n = 79). Seven EDPF measures were calculated by subtracting WAIS-IV obtained index scores from the demographically predicted scores from the Test of Premorbid Functioning (TOPF). Cutoff scores to detect invalid test performance were examined for each EDPF measure separately.Results: The MTBI-Fail group had higher scores than the MTBI-Pass and CM/STBI-Pass groups on five of the seven EDPF measures (p<.05). Overall, the EDPF measure using the Processing Speed Index (EDPF-PSI) was the most useful score to detect invalid test performance. However, sensitivity was only low to moderate depending on the cutoff score used.Conclusions: These findings provide support for the use of EDPF as an embedded PVT to be considered along with other performance validity data when administering the WAIS-IV.
Collapse
Affiliation(s)
- Rich A Moore
- Neuropsychology Assessment Services, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Sara M Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Silver Spring, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Silver Spring, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Silver Spring, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Silver Spring, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Windle K, Sullivan KA. Towards an embedded symptom validity indicator for the rivermead postconcussion symptom questionnaire. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:512-524. [PMID: 34380355 DOI: 10.1080/23279095.2019.1660880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This simulation study aimed to develop and test an embedded symptom validity indicator for use with the Rivermead Post Concussion Symptoms Questionnaire (RPQ). Seven mild traumatic brain injury (mTBI) experts assisted in generating a shortlist of 15 atypical postconcussion symptoms. A modified RPQ (mRPQ) was constructed by embedding these items with the 16 standard RPQ items. Eighty-four mTBI simulators completed the mRPQ after random allocation to a symptom-exaggeration condition (ES group; n = 46) or simulation-only condition (S group; n = 38). They also completed the Test of Memory Malingering (TOMM) and the Recognition Memory Test (RMT), and the groups were re-formed and compared using modified criteria for Malingered Neurocognitive Dysfunction (mMND). There was no significant group by item-type interaction for either grouping methods (i.e. as allocated or as reclassified). Exploratory analyses of the main effects showed that ES group had higher mRPQ scores than the S group, and standard symptoms were endorsed more than atypical symptoms. If further developed, the mRPQ could eventually aid the screening of PCS over-reporting.
Collapse
Affiliation(s)
- Kristy Windle
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Karen A Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
7
|
Mooney SR, Stafford J, Seats E. Medical Evaluation Board Involvement, Non-Credible Cognitive Testing, and Emotional Response Bias in Concussed Service Members. Mil Med 2019; 183:e546-e554. [PMID: 29590406 DOI: 10.1093/milmed/usy038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Military Service Members (SMs) with post-concussive symptoms are commonly referred for further evaluation and possible treatment to Department of Defense Traumatic Brain Injury Clinics where neuropsychological screening/evaluations are being conducted. Understudied to date, the base rates of noncredible task engagement/performance validity testing (PVT) during cognitive screening/evaluations in military settings appears to be high. The current study objectives are to: (1) examine the base rates of noncredible PVTs of SMs undergoing routine clinical or Medical Evaluation Board (MEB) related workups using multiple objective performance-based indicators; (2) determine whether involvement in MEB is associated with PVT or symptom exaggeration/symptom validity testing (SVT) results; (3) elucidate which psychiatric symptoms are associated with noncredible PVT performances; and (4) determine whether MEB participation moderates the relationship between psychological symptom exaggeration and whether or not SM goes on to demonstrate PVTs failures - or vice versa. Materials and Methods Retrospective study of 71 consecutive military concussion cases drawn from a DoD TBI Clinic neuropsychology clinic database. As part of neuropsychological evaluations, patients completed several objective performance-based PVTs and SVT. Results Mean (SD) age of SMs was 36.0 (9.5), ranging from 19-59, and 93% of the sample was male. The self-identified ethnicity resulted in the following percentages: 62% Non-Hispanic White, 22.5% African American, and 15.5% Hispanic or Latino. The majority of the sample (97%) was Active Duty Army and 51% were involved in the MEB at the time of evaluation. About one-third (35.9%) of routine clinical patients demonstrated failure on one or more PVT indicators (12.8% failed 2) while PVT failure rates amongst MEB patients ranged from 15.6% to 37.5% (i.e., failed 2 or 1 PVTs, respectively). Base rates of failures on one or more PVT did not differ between routine clinical versus MEB patients (p = 0.94). MEB involvement was not associated with increased emotional symptom response bias as compared to routine clinical patients. PVT failures were positively correlated with somatization, anxiety, depressive symptoms, suspicious and hostility, atypical perceptions/alienation/subjective cognitive difficulties, borderline personality traits/features, and penchant for aggression in addition to symptom over-endorsement/exaggeration. No differences between routine clinical and MEB patients across other SVT indicators were found. MEB status did not moderate the relationship between any of the SVTs. Conclusion Study results are broadly consistent with the prior published studies that documented low to moderately high base rates of noncredible task engagement during neuropsychological evaluations in military and veteran settings. Results are in contrast to prior studies that have suggested involvement in MEB is associated with increased likelihood of poor PVT performances. This is the first to show that MEB involvement did not enhance/strengthen the association between PVT performances and evidence of SVTs. Consistent with prior studies, these results do highlight that the same SMs who fail PVTs also tend to be the ones who go on to endorse a myriad of psychiatric symptoms and proclivities. Implications of variable or poor task engagement during routine clinical and MEB neuropsychological evaluation in military settings on treatment and disposition planning cannot be overstated.
Collapse
Affiliation(s)
- Scott R Mooney
- Dwight D. Eisenhower Army Medical Center - TBI Clinic, Neuroscience & Rehabilitation Center, 300 E. Hospital Road, Fort Gordon, GA
| | - Jane Stafford
- University of South Carolina-Aiken, 471 University Parkway, Aiken, SC
| | - Elizabeth Seats
- University of South Carolina-Aiken, 471 University Parkway, Aiken, SC
| |
Collapse
|
8
|
Mattson EK, Nelson NW, Sponheim SR, Disner SG. The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans. Neuropsychology 2019; 33:913-921. [PMID: 31192654 DOI: 10.1037/neu0000560] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline. METHOD A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses. RESULTS Subjective cognitive complaints and objective cognitive performance were significantly associated (β = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (β= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
9
|
Maiman M, Del Bene VA, MacAllister WS, Sheldon S, Farrell E, Arce Rentería M, Slugh M, Nadkarni SS, Barr WB. Reliable Digit Span: Does it Adequately Measure Suboptimal Effort in an Adult Epilepsy Population? Arch Clin Neuropsychol 2019; 34:259-267. [PMID: 29659666 DOI: 10.1093/arclin/acy027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/21/2018] [Indexed: 01/19/2023] Open
Abstract
Objective Assessment of performance validity is a necessary component of any neuropsychological evaluation. Prior research has shown that cutoff scores of ≤6 or ≤7 on Reliable Digit Span (RDS) can detect suboptimal effort across numerous adult clinical populations; however, these scores have not been validated for that purpose in an adult epilepsy population. This investigation aims to determine whether these previously established RDS cutoff scores could detect suboptimal effort in adults with epilepsy. Method Sixty-three clinically referred adults with a diagnosis of epilepsy or suspected seizures were administered the Digit Span subtest of the Wechsler Adult Intelligence Scale (WAIS-III or WAIS-IV). Most participants (98%) passed Trial 2 of the Test of Memory Malingering (TOMM), achieving a score of ≥45. Results Previously established cutoff scores of ≤6 and ≤7 on RDS yielded a specificity rate of 85% and 77% respectively. Findings also revealed that RDS scores were positively related to attention and intellectual functioning. Given the less than ideal specificity rate associated with each of these cutoff scores, together with their strong association to cognitive factors, secondary analyses were conducted to identify more optimal cutoff scores. Preliminary results suggest that an RDS cutoff score of ≤4 may be more appropriate in a clinically referred adult epilepsy population with a low average IQ or lower. Conclusions Preliminary findings indicate that cutoff scores of ≤6 and ≤7 on RDS are not appropriate in adults with epilepsy, especially in individuals with low average IQ or below.
Collapse
Affiliation(s)
- Moshe Maiman
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Victor A Del Bene
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Ferkauf Graduate School of Psychology, Clinical Health Psychology Program, Yeshiva University, Bronx, NY, USA
| | - William S MacAllister
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA
| | - Sloane Sheldon
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Ferkauf Graduate School of Psychology, Clinical Health Psychology Program, Yeshiva University, Bronx, NY, USA
| | - Eileen Farrell
- Institute of Neurology and Neurosurgery, Saint Barnabas, Livingston, NJ, USA
| | - Miguel Arce Rentería
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Psychology Department, Fordham University, Bronx, NY, USA
| | - Mitchell Slugh
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,School of Psychology, Farleigh Dickinson University, Teaneck, NJ, USA
| | - Siddhartha S Nadkarni
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA
| | - William B Barr
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA
| |
Collapse
|
10
|
Lippa SM, Lange RT, French LM, Iverson GL. Performance Validity, Neurocognitive Disorder, and Post-concussion Symptom Reporting in Service Members with a History of Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2019; 33:606-618. [PMID: 29069278 DOI: 10.1093/arclin/acx098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/26/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To examine the influence of different performance validity test (PVT) cutoffs on neuropsychological performance, post-concussion symptoms, and rates of neurocognitive disorder and postconcussional syndrome following mild traumatic brain injury (MTBI) in active duty service members. Method Participants were 164 service members (Age: M = 28.1 years [SD = 7.3]) evaluated on average 4.1 months (SD = 5.0) following injury. Participants were divided into three mutually exclusive groups using original and alternative cutoff scores on the Test of Memory Malingering (TOMM) and the Effort Index (EI) from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): (a) PVT-Pass, n = 85; (b) Alternative PVT-Fail, n = 53; and (c) Original PVT-Fail, n = 26. Participants also completed the Neurobehavioral Symptom Inventory. Results The PVT-Pass group performed better on cognitive testing and reported fewer symptoms than the two PVT-Fail groups. The Original PVT-Fail group performed more poorly on cognitive testing and reported more symptoms than the Alternative PVT-Fail group. Both PVT-Fail groups were more likely to meet DSM-5 Category A criteria for mild and major neurocognitive disorder and symptom reporting criteria for postconcussional syndrome than the PVT-Pass group. When alternative PVT cutoffs were used instead of original PVT cutoffs, the number of participants with valid data meeting cognitive testing criteria for neurocognitive disorder or postconcussional syndrome decreased dramatically. Conclusion PVT performance is significantly and meaningfully related to overall neuropsychological outcome. By using only original cutoffs, clinicians and researchers may miss people with invalid performances.
Collapse
Affiliation(s)
- Sara M Lippa
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Louis M French
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.,Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Grant L Iverson
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| |
Collapse
|
11
|
Karr JE, Rau HK, Shofer JB, Hendrickson RC, Peskind ER, Pagulayan KF. Variables associated with subjective cognitive change among Iraq and Afghanistan war Veterans with blast-related mild traumatic brain injury. J Clin Exp Neuropsychol 2019; 41:680-693. [DOI: 10.1080/13803395.2019.1611740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Justin E. Karr
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
| | - Holly K. Rau
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
| | - Jane B. Shofer
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Rebecca C. Hendrickson
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Elaine R. Peskind
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathleen F. Pagulayan
- Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
12
|
Zimmer A, Heyanka D, Proctor-Weber Z. Concordance validity of PVTs in a sample of veterans referred for mild TBI. APPLIED NEUROPSYCHOLOGY. ADULT 2018; 25:385-394. [PMID: 28489416 DOI: 10.1080/23279095.2017.1319835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Concordance validity of commonly used performance validity tests (PVTs) was assessed in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans referred to an mTBI screening clinic in a south-eastern Veterans Affairs hospital. Veteran service members (total n = 184) completed the Rey-15, Repeatable Battery of the Assessment for Neuropsychological Status Effort Index (RBANS EI), and Reliable Digit Span (RDS) from the Wechsler Intelligence Scales. Kappa coefficients and percentage of agreement were established to determine the level of concordance between the three measures. PVT failure rate ranged from 7.4% of the sample (Rey-15) to 26.1% (RBANS EI Liberal). The highest concordance was found between the Rey 15 and RBANS EI "highly suspicious" cut-off, with the lowest agreement noted between all PVTs and the RBANS EI "liberal" cut-score. All concordance coefficients fell within the fair to moderate levels. Overall, the observed agreement between the explored measures was generally consistent with or greater than other studies of PVT concordance. Given the rates of concordance, the current results continue to suggest that PVTs are likely to measure a construct separate from the typical cognitive domains.
Collapse
Affiliation(s)
- Adam Zimmer
- a Neuropsychology Division - Pediatrics , University of South Florida , Tampa , FL , USA
| | - Daniel Heyanka
- b Department of Psychiatry & Behavioral Sciences , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Zoe Proctor-Weber
- c Mental Health , Bay Pines VA Healthcare System , Bay Pines , FL , USA
| |
Collapse
|
13
|
Armistead-Jehle P, Soble JR, Cooper DB, Belanger HG. Unique Aspects of Traumatic Brain Injury in Military and Veteran Populations. Phys Med Rehabil Clin N Am 2018; 28:323-337. [PMID: 28390516 DOI: 10.1016/j.pmr.2016.12.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury (TBI), in particular mild TBI (mTBI), is a relatively common injury experienced by service members across both deployed and nondeployed environments. Although many of the principles and practices used by civilian health care providers for identifying and treating this injury apply to military settings, there are unique factors that impact mTBI-related care in service members and Veterans. This article reviews several of these factors, including the epidemiology of TBI in the military/Veteran population, the influence of military culture on this condition, and identification and treatment of mTBI in the war zone.
Collapse
Affiliation(s)
- Patrick Armistead-Jehle
- Concussion Clinic, Munson Army Health Center, 550 Pope Avenue, Fort Leavenworth, KS 66027, USA.
| | - Jason R Soble
- Psychology Service, South Texas Veterans Healthcare System, 7400 Merton Minter, San Antonio, TX 78229, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center, Department of Neurology, San Antonio Military Medical Center, Joint Base San Antonio, MCHE-ZDM-N, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234-4504, USA; Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Heather G Belanger
- HSR&D, Tampa VA TBI/Polytrauma Rehabilitation Center, Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard - 116A, Tampa, FL 33612, USA; Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33612, USA; Defense and Veterans Brain Injury Center, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA
| |
Collapse
|
14
|
Lippa SM, Lange RT, Bailie JM, Kennedy JE, Brickell TA, French LM. Utility of the Validity-10 scale across the recovery trajectory following traumatic brain injury. ACTA ACUST UNITED AC 2018; 53:379-90. [PMID: 27273336 DOI: 10.1682/jrrd.2015.01.0009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/16/2015] [Indexed: 11/05/2022]
Abstract
The Validity-10 scale was recently developed to screen for symptom exaggeration in patients following traumatic brain injury (TBI). However, it has only been validated on patients with TBI largely in the chronic phase of recovery. The influence of time since injury on the Validity-10 scale was investigated in 2,661 male servicemembers with TBI presenting to six U.S. Defense and Veterans Brain Injury Centers. Participants completed the Neurobehavioral Symptom Inventory (NSI). The Validity-10 scale and NSI total score were both weakly statistically significantly (1) positively correlated with time since injury, (2) negatively correlated with bodily injury severity, and (3) higher in participants undergoing medical board evaluations than in participants who returned to duty or were still hospitalized. Participants were statistically more likely to screen positive for possible symptom exaggeration on the Validity-10 scale as time since injury increased. However, the Validity-10 scale was only weakly related to time since injury, TBI severity, bodily injury severity, disposition, age, and return to duty status. That false positives are not increased in the acute phase of recovery and that the Validity-10 scale is not strongly related to clinical factors support the use of the Validity-10 scale in the acute recovery phase and across the TBI recovery trajectory.
Collapse
|
15
|
Symptom Reporting and Management of Chronic Post-Concussive Symptoms in Military Service Members and Veterans. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0173-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
16
|
White Matter Associations With Performance Validity Testing in Veterans With Mild Traumatic Brain Injury: The Utility of Biomarkers in Complicated Assessment. J Head Trauma Rehabil 2018; 31:346-59. [PMID: 26360002 DOI: 10.1097/htr.0000000000000183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Failure on performance validity tests (PVTs) is common in Veterans with histories of mild traumatic brain injury (mTBI), leading to questionable validity of clinical presentations. PARTICIPANTS Using diffusion tensor imaging, we investigated white matter (WM) integrity and cognition in 79 Veterans with history of mTBI who passed PVTs (n = 43; traumatic brain injury [TBI]-passed), history of mTBI who failed at least 1 PVT (n = 13; TBI-failed), and military controls (n = 23; MCs) with no history of TBI. RESULTS The TBI-failed group demonstrated significantly lower cognitive scores relative to MCs and the TBI-passed group; however, no such differences were observed between MCs and the TBI-passed group. On a global measure of WM integrity (ie, WM burden), the TBI-failed group showed more overall WM abnormalities than the other groups. However, no differences were observed between the MCs and TBI-passed group on WM burden. Interestingly, regional WM analyses revealed abnormalities in the anterior internal capsule and cingulum of both TBI subgroups relative to MCs. Moreover, compared with the TBI-passed group, the TBI-failed group demonstrated significantly decreased WM integrity in the corpus callosum. CONCLUSIONS Findings revealed that, within our sample, WM abnormalities are evident in those who fail PVTs. This study adds to the burgeoning PVT literature by suggesting that poor PVT performance does not negate the possibility of underlying WM abnormalities in military personnel with history of mTBI.
Collapse
|
17
|
Gallagher K, Azuma T. Analysis of Story Recall in Military Veterans With and Without Mild Traumatic Brain Injury: Preliminary Results. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:485-494. [PMID: 29497758 DOI: 10.1044/2017_ajslp-16-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/21/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to determine whether detailed analysis of story recall performance reveals significant differences between veterans with and without history of mild traumatic brain injury (mTBI). METHOD Twenty-one military veterans participated, with 7 reporting history of mTBI. All participants were administered the Logical Memory I and II subtests from the Wechsler Memory Scale-Fourth Edition (Wechsler, 2009). Responses were scored for total correct ideas (TCI) and total words produced (TWP). RESULTS Although the groups did not differ in scaled scores, other measures did reveal significant differences. After a delay, the mTBI group showed a greater drop in TCI relative to the control group. Additionally, the control group showed an increase in TWP when the recall was delayed versus immediate; a pattern not observed for the mTBI group. CONCLUSIONS The mTBI and control groups did not significantly differ in scaled scores. However, group differences were observed in TCI and TWP. The findings suggest that, relative to the control group, the mTBI group were less successful in retrieving episodic information and eliciting self-cueing. Small sample size limited data interpretation, and larger sample sizes are needed to confirm the findings. The results indicate that veterans with mTBI may present with symptoms persisting beyond the acute state of the injury.
Collapse
Affiliation(s)
- Karen Gallagher
- Department of Speech and Hearing Science, Arizona State University, Tempe
| | - Tamiko Azuma
- Department of Speech and Hearing Science, Arizona State University, Tempe
| |
Collapse
|
18
|
Pogoda TK, Levy CE, Helmick K, Pugh MJ. Health services and rehabilitation for active duty service members and veterans with mild TBI. Brain Inj 2017; 31:1220-1234. [DOI: 10.1080/02699052.2016.1274777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Charles E. Levy
- Physical Medicine and Rehabilitation Service, Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Arts in Medicine, College of the Arts, University of Florida, Gainesville, Florida, USA
| | - Katherine Helmick
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Mary Jo Pugh
- South Texas Veterans Healthcare System, San Antonio, Texas, USA
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| |
Collapse
|
19
|
Denning JH, Shura RD. Cost of malingering mild traumatic brain injury-related cognitive deficits during compensation and pension evaluations in the veterans benefits administration. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 26:1-16. [DOI: 10.1080/23279095.2017.1350684] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- John H. Denning
- Department of Veteran Affairs, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Robert D. Shura
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, North Carolina, USA
- Mental Health and Behavioral Science Service Line, W. G. (Bill) Hefner Veterans Affairs Medical Center (VAMC), Salisbury, North Carolina, USA
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
20
|
Merz ZC, Roskos PT, Gfeller JD, Bucholz RD. Impact of psychiatric symptomatology on neuropsychological assessment performance in persons with TBI: A comparison of OEF/OIF veteran and civilian samples. Brain Inj 2017; 31:1422-1428. [DOI: 10.1080/02699052.2017.1339124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Zachary C. Merz
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - P. Tyler Roskos
- Department of Physical Medicine and Rehabilitation Oakwood, Wayne State University School of Medicine, Dearborn, MI, USA
| | | | | |
Collapse
|
21
|
Disner SG, Kramer MD, Nelson NW, Lipinski AJ, Christensen JM, Polusny MA, Sponheim SR. Predictors of Postdeployment Functioning in Combat-Exposed U.S. Military Veterans. Clin Psychol Sci 2017; 5:650-663. [PMID: 38027424 PMCID: PMC10663646 DOI: 10.1177/2167702617703436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/05/2017] [Indexed: 12/01/2023]
Abstract
Posttraumatic stress disorder (PTSD) and sequelae of mild traumatic brain injury (mTBI) are presumed to contribute to reintegration difficulties in combat-exposed veterans. Yet their relative impacts on postdeployment functioning are not well understood. The current study used structural equation modeling (SEM) to clarify the extent to which symptoms of internalizing disorders (e.g., depression, anxiety), mTBI symptoms, and cognitive performance are associated with functional impairment in 295 combat-exposed veterans. SEM results showed that internalizing symptoms most significantly predicted functional impairment (r = 0.72). Blast mTBI and cognitive performance were associated with internalizing (r = 0.24 and -0.25, respectively), but functional impairment was only modestly related to cognition (r = -0.17) and unrelated to mTBI. These results indicate that internalizing symptoms are the strongest predictor of functioning in trauma-exposed veterans, exceeding the effects of mTBI and cognitive performance. This evidence supports prioritizing interventions that target internalizing psychopathology to improve functioning in cases of co-occurring PTSD and mTBI.
Collapse
Affiliation(s)
- Seth G. Disner
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Mark D. Kramer
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | | | | | | | - Melissa A. Polusny
- Minneapolis VA Health Care System, Minneapolis, Minnesota
- University of Minnesota
| | - Scott R. Sponheim
- Minneapolis VA Health Care System, Minneapolis, Minnesota
- University of Minnesota
| |
Collapse
|
22
|
Rowland JA, Miskey HM, Brearly TW, Martindale SL, Shura RD. Word Memory Test Performance Across Cognitive Domains, Psychiatric Presentations, and Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2017; 32:306-315. [PMID: 27998904 DOI: 10.1093/arclin/acw107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/28/2016] [Indexed: 11/14/2022] Open
Abstract
Objective The current study addressed two aims: (i) determine how Word Memory Test (WMT) performance relates to test performance across numerous cognitive domains and (ii) evaluate how current psychiatric disorders or mild traumatic brain injury (mTBI) history affects performance on the WMT after excluding participants with poor symptom validity. Method Participants were 235 Iraq and Afghanistan-era veterans (Mage = 35.5) who completed a comprehensive neuropsychological battery. Participants were divided into two groups based on WMT performance (Pass = 193, Fail = 42). Tests were grouped into cognitive domains and an average z-score was calculated for each domain. Results Significant differences were found between those who passed and those who failed the WMT on the memory, attention, executive function, and motor output domain z-scores. WMT failure was associated with a larger performance decrement in the memory domain than the sensation or visuospatial-construction domains. Participants with a current psychiatric diagnosis or mTBI history were significantly more likely to fail the WMT, even after removing participants with poor symptom validity. Conclusions Results suggest that the WMT is most appropriate for assessing validity in the domains of attention, executive function, motor output and memory, with little relationship to performance in domains of sensation or visuospatial-construction. Comprehensive cognitive batteries would benefit from inclusion of additional performance validity tests in these domains. Additionally, symptom validity did not explain higher rates of WMT failure in individuals with a current psychiatric diagnosis or mTBI history. Further research is needed to better understand how these conditions may affect WMT performance.
Collapse
Affiliation(s)
- Jared A Rowland
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, W.G. "Bill" Hefner Veterans Affairs Medical Center, Salisbury, NC, USA.,Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Holly M Miskey
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, W.G. "Bill" Hefner Veterans Affairs Medical Center, Salisbury, NC, USA
| | - Timothy W Brearly
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, W.G. "Bill" Hefner Veterans Affairs Medical Center, Salisbury, NC, USA
| | - Sarah L Martindale
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, W.G. "Bill" Hefner Veterans Affairs Medical Center, Salisbury, NC, USA
| | - Robert D Shura
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, W.G. "Bill" Hefner Veterans Affairs Medical Center, Salisbury, NC, USA
| |
Collapse
|
23
|
Young G. PTSD in Court III: Malingering, assessment, and the law. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 52:81-102. [PMID: 28366496 DOI: 10.1016/j.ijlp.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/02/2017] [Indexed: 06/07/2023]
Abstract
This journal's third article on PTSD in Court focuses especially on the topic's "court" component. It first considers the topic of malingering, including in terms of its definition, certainties, and uncertainties. As with other areas of the study of psychological injury and law, generally, and PTSD (posttraumatic stress disorder), specifically, malingering is a contentious area not only definitionally but also empirically, in terms of establishing its base rate in the index populations assessed in the field. Both current research and re-analysis of past research indicates that the malingering prevalence rate at issue is more like 15±15% as opposed to 40±10%. As for psychological tests used to assess PTSD, some of the better ones include the TSI-2 (Trauma Symptom Inventory, Second Edition; Briere, 2011), the MMPI-2-RF (Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form; Ben-Porath & Tellegen, 2008/2011), and the CAPS-5 (The Clinician-Administered PTSD Scale for DSM-5; Weathers, Blake, Schnurr, Kaloupek, Marx, & Keane, 2013b). Assessors need to know their own possible biases, the applicable laws (e.g., the Daubert trilogy), and how to write court-admissible reports. Overall conclusions reflect a moderate approach that navigates the territory between the extreme plaintiff or defense allegiances one frequently encounters in this area of forensic practice.
Collapse
|
24
|
Sawyer RJ, Testa SM, Dux M. Embedded performance validity tests within the Hopkins Verbal Learning Test – Revised and the Brief Visuospatial Memory Test – Revised. Clin Neuropsychol 2016; 31:207-218. [DOI: 10.1080/13854046.2016.1245787] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R. John Sawyer
- Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
| | - S. Marc Testa
- Berman Brain and Spine Institute, Sinai Hospital, Baltimore, MD, USA
| | - Moira Dux
- Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
| |
Collapse
|
25
|
CVLT-II Forced Choice Recognition Trial as an Embedded Validity Indicator: A Systematic Review of the Evidence. J Int Neuropsychol Soc 2016; 22:851-8. [PMID: 27619108 DOI: 10.1017/s1355617716000746] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The Forced Choice Recognition (FCR) trial of the California Verbal Learning Test, 2nd edition, was designed as an embedded performance validity test (PVT). To our knowledge, this is the first systematic review of classification accuracy against reference PVTs. METHODS Results from peer-reviewed studies with FCR data published since 2002 encompassing a variety of clinical, research, and forensic samples were summarized, including 37 studies with FCR failure rates (N=7575) and 17 with concordance rates with established PVTs (N=4432). RESULTS All healthy controls scored >14 on FCR. On average, 16.9% of the entire sample scored ≤14, while 25.9% failed reference PVTs. Presence or absence of external incentives to appear impaired (as identified by researchers) resulted in different failure rates (13.6% vs. 3.5%), as did failing or passing reference PVTs (49.0% vs. 6.4%). FCR ≤14 produced an overall classification accuracy of 72%, demonstrating higher specificity (.93) than sensitivity (.50) to invalid performance. Failure rates increased with the severity of cognitive impairment. CONCLUSIONS In the absence of serious neurocognitive disorder, FCR ≤14 is highly specific, but only moderately sensitive to invalid responding. Passing FCR does not rule out a non-credible presentation, but failing FCR rules it in with high accuracy. The heterogeneity in sample characteristics and reference PVTs, as well as the quality of the criterion measure across studies, is a major limitation of this review and the basic methodology of PVT research in general. (JINS, 2016, 22, 851-858).
Collapse
|
26
|
Davis JJ. Reconsidering the Word Memory Test as a Memory Measure in Traumatic Brain Injury. Arch Clin Neuropsychol 2016; 31:802-810. [PMID: 27538439 DOI: 10.1093/arclin/acw058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examined relationships among traumatic brain injury (TBI) severity, the Word Memory Test (WMT), and California Verbal Learning Test-Second Edition (CVLT-II). METHOD Participants (N = 104) passed WMT validity indices and were categorized by TBI severity on the basis of medical records. Outcome measures included norm-referenced scores on the CVLT-II and WMT. RESULTS Participants grouped by TBI severity significantly differed on the CVLT-II but not WMT. Post-traumatic amnesia (PTA) significantly correlated with the CVLT-II but not WMT. In a non-medicolegal sample subset (N = 61), TBI severity groups significantly differed on CVLT-II and WMT FR; PTA significantly correlated with the CVLT-II and WMT FR. CVLT-II impairment groups differed on all WMT variables. Participants grouped by neuroimaging findings differed on CVLT-II but not WMT. WMT FR predicted two-level TBI severity using logistic regression but did not contribute in a model including the CVLT-II. CONCLUSION Overall, WMT memory subtests appeared less sensitive to TBI severity than the CVLT-II.
Collapse
|
27
|
Lippa SM, Lange RT, Bhagwat A, French LM. Clinical utility of embedded performance validity tests on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) following mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:73-80. [DOI: 10.1080/23279095.2015.1100617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
28
|
Young JC, Roper BL, Arentsen TJ. Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey. Clin Neuropsychol 2016; 30:497-514. [DOI: 10.1080/13854046.2016.1159730] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Brad L. Roper
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | | |
Collapse
|
29
|
Sullivan KA, Lange RT, Edmed SL. Utility of the Neurobehavioral Symptom Inventory Validity-10 index to detect symptom exaggeration: An analogue simulation study. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 23:353-62. [DOI: 10.1080/23279095.2015.1079714] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Karen A. Sullivan
- Clinical Neuropsychology Research Group, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rael T. Lange
- Defense and Veterans Brain Injury Center, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon L. Edmed
- Clinical Neuropsychology Research Group, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
30
|
Grills CE, Armistead-Jehle P. Performance validity test and neuropsychological assessment battery screening module performances in an active-duty sample with a history of concussion. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 23:295-301. [DOI: 10.1080/23279095.2015.1079713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
31
|
Armistead-Jehle P, Cooper DB, Vanderploeg RD. The role of performance validity tests in the assessment of cognitive functioning after military concussion: A replication and extension. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:264-73. [DOI: 10.1080/23279095.2015.1055564] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Douglas B. Cooper
- Defense and Veterans Brain Injury Center, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Rodney D. Vanderploeg
- Mental Health and Behavioral Sciences–Psychology Service, James A. Haley VAMC, Tampa, Florida, USA
- Defense and Veterans Brain Injury Center, Tampa, Florida, USA
- Departments of Psychology & Psychiatry, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
32
|
Shura RD, Miskey HM, Rowland JA, Yoash-Gantz RE, Denning JH. Embedded Performance Validity Measures with Postdeployment Veterans: Cross-Validation and Efficiency with Multiple Measures. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:94-104. [DOI: 10.1080/23279095.2015.1014556] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Robert D. Shura
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and Mental Health and Behavioral Sciences Service Line, W. G. “Bill” Hefner Veterans Affairs Medical Center, Salisbury, and Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Holly M. Miskey
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and Mental Health and Behavioral Sciences Service Line, W. G. “Bill” Hefner Veterans Affairs Medical Center, Salisbury, and Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jared A. Rowland
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and Research & Academic Affairs Service Line, W. G. “Bill” Hefner Veterans Affairs Medical Center, Salisbury, and Department of Psychiatry & Behavioral Sciences, Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth E. Yoash-Gantz
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and Mental Health and Behavioral Sciences Service Line, W. G. “Bill” Hefner Veterans Affairs Medical Center, Salisbury, and Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John H. Denning
- Tennessee Valley Healthcare System, Alvin C. York Veterans Affairs Medical Center, Mental Health Care Line, Murfreesboro, Tennessee
| |
Collapse
|
33
|
Lange RT, Brickell TA, French LM. Examination of the Mild Brain Injury Atypical Symptom Scale and the Validity-10 Scale to detect symptom exaggeration in US military service members. J Clin Exp Neuropsychol 2015; 37:325-37. [DOI: 10.1080/13803395.2015.1013021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
34
|
Vincent AS, Roebuck-Spencer TM, Cernich A. Cognitive changes and dementia risk after traumatic brain injury: implications for aging military personnel. Alzheimers Dement 2015; 10:S174-87. [PMID: 24924669 DOI: 10.1016/j.jalz.2014.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is recognized as an important risk factor for the long-term cognitive health of military personnel, particularly in light of growing evidence that TBI increases risk for Alzheimer's disease and other dementias. In this article, we review the neurocognitive and neuropathologic changes after TBI with particular focus on the potential risk for cognitive decline across the life span in military service members. Implications for monitoring and surveillance of cognition in the aging military population are discussed. Additional studies are needed to clarify the factors that increase risk for later life cognitive decline, define the mechanistic link between these factors and dementia, and provide empirically supported interventions to mitigate the impact of TBI on cognition across the life span.
Collapse
Affiliation(s)
- Andrea S Vincent
- Cognitive Science Research Center, Department of Psychology, University of Oklahoma, Norman, OK, USA.
| | - Tresa M Roebuck-Spencer
- Cognitive Science Research Center, Department of Psychology, University of Oklahoma, Norman, OK, USA
| | - Alison Cernich
- Mental Health Services, Department of Veterans Affairs, Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Washington, DC, USA
| |
Collapse
|
35
|
Nelson NW, Anderson CR, Thuras P, Kehle-Forbes SM, Arbisi PA, Erbes CR, Polusny MA. Factors associated with inconsistency in self-reported mild traumatic brain injury over time among military personnel in Iraq. Br J Psychiatry 2015; 206:237-44. [PMID: 25614533 DOI: 10.1192/bjp.bp.114.149096] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Estimates of the prevalence of mild traumatic brain injury (mTBI) among military personnel and combat veterans rely almost exclusively on retrospective self-reports; however, reliability of these reports has received little attention. AIMS To examine the consistency of reporting of mTBI over time and identify factors associated with inconsistent reporting. METHOD A longitudinal cohort of 948 US National Guard Soldiers deployed to Iraq completed self-report questionnaire screening for mTBI and psychological symptoms while in-theatre 1 month before returning home (time 1, T1) and 1 year later (time 2, T2). RESULTS Most respondents (n = 811, 85.5%) were consistent in their reporting of mTBI across time. Among those who were inconsistent in their reports (n = 137, 14.5%), the majority denied mTBI at T1 and affirmed mTBI at T2 (n = 123, 89.8%). Respondents rarely endorsed mTBI in-theatre and later denied mTBI (n = 14, 10.2% of those with inconsistent reports). Post-deployment post-traumatic stress symptoms and non-specific physical complaints were significantly associated with inconsistent report of mTBI. CONCLUSIONS Military service members' self-reports of mTBI are generally consistent over time; however, inconsistency in retrospective self-reporting of mTBI status is associated with current post-traumatic stress symptoms and non-specific physical health complaints.
Collapse
Affiliation(s)
- Nathaniel W Nelson
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Carolyn R Anderson
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Paul Thuras
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Shannon M Kehle-Forbes
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Paul A Arbisi
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Christopher R Erbes
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| |
Collapse
|
36
|
Bridging the gap between neurocognitive processing theory and performance validity assessment among the cognitively impaired: a review and methodological approach. J Int Neuropsychol Soc 2014; 20:873-86. [PMID: 25383483 DOI: 10.1017/s135561771400085x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Bigler (2012) and Larrabee (2012) recently addressed the state of the science surrounding performance validity tests (PVTs) in a dialogue highlighting evidence for the valid and increased use of PVTs, but also for unresolved problems. Specifically, Bigler criticized the lack of guidance from neurocognitive processing theory in the PVT literature. For example, individual PVTs have applied the simultaneous forced-choice methodology using a variety of test characteristics (e.g., word vs. picture stimuli) with known neurocognitive processing implications (e.g., the "picture superiority effect"). However, the influence of such variations on classification accuracy has been inadequately evaluated, particularly among cognitively impaired individuals. The current review places the PVT literature in the context of neurocognitive processing theory, and identifies potential methodological factors to account for the significant variability we identified in classification accuracy across current PVTs. We subsequently evaluated the utility of a well-known cognitive manipulation to provide a Clinical Analogue Methodology (CAM), that is, to alter the PVT performance of healthy individuals to be similar to that of a cognitively impaired group. Initial support was found, suggesting the CAM may be useful alongside other approaches (analogue malingering methodology) for the systematic evaluation of PVTs, particularly the influence of specific neurocognitive processing components on performance.
Collapse
|
37
|
Karr JE, Areshenkoff CN, Duggan EC, Garcia-Barrera MA. Blast-Related Mild Traumatic Brain Injury: A Bayesian Random-Effects Meta-Analysis on the Cognitive Outcomes of Concussion among Military Personnel. Neuropsychol Rev 2014; 24:428-44. [DOI: 10.1007/s11065-014-9271-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/15/2014] [Indexed: 12/14/2022]
|
38
|
Clark AL, Amick MM, Fortier C, Milberg WP, McGlinchey RE. Poor Performance Validity Predicts Clinical Characteristics and Cognitive Test Performance of OEF/OIF/OND Veterans in a Research Setting. Clin Neuropsychol 2014; 28:802-25. [DOI: 10.1080/13854046.2014.904928] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
39
|
King PR, Donnelly KT, Wade M, Donnelly JP, Dunnam M, Warner G, Kittleson CJ, Bradshaw CB, Alt M. The Relationships Among Premilitary Vocational Aptitude Assessment, Traumatic Brain Injury, and Postdeployment Cognitive Functioning in Combat Veterans. Arch Clin Neuropsychol 2014; 29:391-402. [DOI: 10.1093/arclin/acu011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
O'Neil ME, Carlson KF, Storzbach D, Brenner LA, Freeman M, Quiñones AR, Motu'apuaka M, Kansagara D. Factors Associated with Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review. J Int Neuropsychol Soc 2014; 20:1-13. [PMID: 24499707 DOI: 10.1017/s135561771300146x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A history of mild traumatic brain injury (mTBI) is common among military members who served in Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). We completed a systematic review to describe the cognitive, mental health, physical health, functional, social, and cost consequences of mTBI in Veteran and military personnel. Of 2668 reviewed abstracts, the 31 included studies provided very low strength evidence for the questions of interest. Cognitive, physical, and mental health symptoms were commonly reported by Veterans/military members with a history of mTBI. On average, these symptoms were not significantly more common in those with a history of mTBI than in those without, although a lack of significant mean differences does not preclude the possibility that some individuals could experience substantial effects related to mTBI history. Evidence of potential risk or protective factors moderating mTBI outcomes was unclear. Although the overall strength of evidence is very low due to methodological limitations of included studies, our findings are consistent with civilian studies. Appropriate re-integration services are needed to address common comorbid conditions, such as treatment for post-traumatic stress disorder, substance use disorders, headaches, and other difficulties that Veterans and members of the military may experience after deployment regardless of mTBI history. (JINS, 2014, 20, 1-13).
Collapse
Affiliation(s)
| | | | | | - Lisa A Brenner
- 5 Denver VA Medical Center, VISN 19 MIRECC, Denver, Colorado
| | | | | | | | | |
Collapse
|
41
|
Cooper DB, Vanderploeg RD, Armistead-Jehle P, Lewis JD, Bowles AO. Factors associated with neurocognitive performance in OIF/OEF servicemembers with postconcussive complaints in postdeployment clinical settings. ACTA ACUST UNITED AC 2014; 51:1023-34. [DOI: 10.1682/jrrd.2013.05.0140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 03/26/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | - Rodney D. Vanderploeg
- Defense and Veterans Brain Injury Center, Silver Spring, MD;James A. Haley Veterans’ Hospital, Tampa, FL; and Departments of Psychiatry and Neurosciences, and Psychology, University of South Florida, Tampa, FL
| | | | - Jeffrey D. Lewis
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Amy O. Bowles
- Department of Orthopedics & Rehabilitation, Traumatic Brain Injury Service, San Antonio Military Medical Center, Fort Sam Houston, TX
| |
Collapse
|
42
|
Cooper DB, Vanderploeg RD, Armistead-Jehle P, Lewis JD, Bowles AO. Factors associated with neurocognitive performance in OIF/OEF servicemembers with postconcussive complaints in postdeployment clinical settings. ACTA ACUST UNITED AC 2014. [DOI: 10.1682/jrrd.2013.05.0104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Rodney D. Vanderploeg
- Defense and Veterans Brain Injury Center, Silver Spring, MD;James A. Haley Veterans’ Hospital, Tampa, FL; and Departments of Psychiatry and Neurosciences, and Psychology, University of South Florida, Tampa, FL
| | | | - Jeffrey D. Lewis
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Amy O. Bowles
- Department of Orthopedics & Rehabilitation, Traumatic Brain Injury Service, San Antonio Military Medical Center, Fort Sam Houston, TX
| |
Collapse
|
43
|
|
44
|
Gfeller JD, Roskos PT. A comparison of insufficient effort rates, neuropsychological functioning, and neuropsychiatric symptom reporting in military veterans and civilians with chronic traumatic brain injury. BEHAVIORAL SCIENCES & THE LAW 2013; 31:833-849. [PMID: 24123226 DOI: 10.1002/bsl.2084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Abstract
Neuropsychological evaluation of persons with chronic traumatic brain injury (TBI) symptoms is complicated by multiple factors. The authors explored the impact of mechanism of injury, effort testing performance, and neuropsychiatric status in a sample of military veterans (V-TBI) and civilians (C-TBI) with chronic TBI. V-TBI (n = 74), C-TBI (n = 67), and healthy civilian control (C-HC) participants (n = 66), completed a battery of neuropsychological, effort, and self-report neuropsychiatric measures. Results indicated that C-HC and C-TBI participants exhibited comparably low failure rates on effort tests (6% and 3%, respectively). V-TBI participants exhibited significantly higher rates of failure (18%). Subgroups (n = 20) of effort-screened participants matched for demographics and disability level were compared regarding neuropsychological performance and neuropsychiatric self-report. Both TBI groups exhibited limited neuropsychological impairment, relative to the C-HC participants. The V-TBI group exhibited pronounced neuropsychiatric symptomology compared with the other participant groups. The implications of these findings are discussed for evaluation in the context of disability and litigation.
Collapse
Affiliation(s)
- Jeffrey D Gfeller
- Department of Psychology and Department of Neurosurgery, Saint Louis University
| | | |
Collapse
|
45
|
Lamberty GJ, Nelson NW, Yamada T. Effects and outcomes in civilian and military traumatic brain injury: similarities, differences, and forensic implications. BEHAVIORAL SCIENCES & THE LAW 2013; 31:814-832. [PMID: 24105940 DOI: 10.1002/bsl.2091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 06/02/2023]
Abstract
Traumatic brain injury (TBI) is a prominent public health problem in both civilian and military settings. This article discusses similarities and differences in the assessment and treatment of TBI and the attendant forensic implications. Acute care and management of moderate/severe TBI tend to be similar across environments, as is the recognition of disability status in affected individuals. By contrast, an increased focus on mild TBI in recent years has resulted in a reliance on self-report and screening measures to validate the occurrence of events leading to injury. This has complicated assessment, treatment and subsequent medicolegal proceedings. The neuropsychological literature has provided significant guidance on these difficult issues, although the complexity of disability adjudication for active duty members of the military and veterans continues to pose challenges for clinicians in evaluative and treatment contexts.
Collapse
Affiliation(s)
- Greg J Lamberty
- Minneapolis VA Health Care System, Mental Health Service, Minneapolis, MN
| | | | | |
Collapse
|
46
|
McCormick CL, Yoash-Gantz RE, McDonald SD, Campbell TC, Tupler LA. Performance on the Green Word Memory Test following Operation Enduring Freedom/Operation Iraqi Freedom-era military service: Test failure is related to evaluation context. Arch Clin Neuropsychol 2013; 28:808-23. [PMID: 23877970 DOI: 10.1093/arclin/act050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study investigates prior reports of high neuropsychological symptom validity test (SVT) failure rates in post-deployed Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) active and veteran military personnel, using a large, multi-site sample (N = 214) drawn from three levels of the Department of Defense/Department of Veterans Affairs (VA) Polytrauma System of Care. The sample failure rate and its relationship to research versus dual research/clinical context of evaluation were examined, in addition to secondary variables explored in prior studies. Results yielded an overall failure rate of 25%, lower than prior reports describing OEF/OIF active-duty and veteran military personnel. Findings also supported the hypothesis that SVT failure rates would differ by context (dual > research). Participants with traumatic brain injury (TBI) failed more frequently than those without TBI in the dual context but not in the research context. Secondary analyses revealed that failure rates increased in the presence of depression, posttraumatic stress disorder, and male sex but were unrelated to active versus veteran military status, service connection (SC) or percentage of SC, age, education, or ethnicity. Further research is required to elucidate the underpinnings of these findings in light of the limited literature and variability between OEF/OIF-related SVT studies, as well as the substantial diagnostic and treatment implications for VA.
Collapse
Affiliation(s)
- Cortney L McCormick
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | | | | | | | | |
Collapse
|
47
|
Berthelson L, Mulchan SS, Odland AP, Miller LJ, Mittenberg W. False positive diagnosis of malingering due to the use of multiple effort tests. Brain Inj 2013; 27:909-16. [DOI: 10.3109/02699052.2013.793400] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
48
|
Rienstra A, Klein Twennaar M, Schmand B. Neuropsychological Characterization of Patients with the WMT Dementia Profile. Arch Clin Neuropsychol 2013; 28:463-75. [DOI: 10.1093/arclin/act026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
49
|
Lange RT, Edmed SL, Sullivan KA, French LM, Cooper DB. Utility of the Mild Brain Injury Atypical Symptoms Scale to detect symptom exaggeration: An analogue simulation study. J Clin Exp Neuropsychol 2013; 35:192-209. [DOI: 10.1080/13803395.2012.761677] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
50
|
Chronic postconcussion symptoms and functional outcomes in OEF/OIF veterans with self-report of blast exposure. J Int Neuropsychol Soc 2013; 19:1-10. [PMID: 23095177 DOI: 10.1017/s1355617712000902] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Postconcussion symptoms (PCS) and functional outcomes were evaluated in 91 OEF/OIF outpatient veterans with reported histories of blast-exposure, with the goal of evaluating (1) the association between these outcomes and a clinical diagnosis of mild traumatic brain injury (mTBI) with or without loss of consciousness (LOC); and (2) the influence of post-traumatic stress disorder (PTSD) and depression on PCS reporting and perceived functional limitations. Individuals who reported mTBI with LOC had greater PCS complaints than individuals who reported mTBI without LOC or individuals without mTBI. However, after adjusting for severity of PTSD and depression symptoms, this group difference disappeared. Functional limitations were particularly prominent in the psychosocial domain. Again, PTSD was significantly associated with functional outcomes, but the mTBI with LOC group had greater psychosocial limitations than the other two groups, even when PTSD and depression symptoms were taken into account. These findings highlight the role of mental health in both outcomes, but additionally point to the impact of mTBI with LOC on long-term psychosocial adjustment.
Collapse
|