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Neuropsychological Functioning in Veterans with Posttraumatic Stress Disorder: Associations with Performance Validity, Comorbidities, and Functional Outcomes

Published online by Cambridge University Press:  19 February 2016

Kristen M. Wrocklage ,
Brian C. Schweinsburg ,
John H. Krystal ,
Marcia Trejo ,
Alicia Roy ,
Valerie Weisser ,
Tyler M. Moore ,
Steven M. Southwick  and
J. Cobb Scott
Kristen M. Wrocklage
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, West Haven, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut
Brian C. Schweinsburg
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, West Haven, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
John H. Krystal
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, West Haven, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut Psychiatry Services, Yale-New Haven Hospital, New Haven, Connecticut
Marcia Trejo
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, West Haven, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut
Alicia Roy
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, West Haven, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
Valerie Weisser
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, West Haven, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut
Tyler M. Moore
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Steven M. Southwick
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, West Haven, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
J. Cobb Scott*
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, Pennsylvania
*
Correspondence and reprint requests to: J. Cobb Scott, MIRECC/116, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104. E-mail: scott1@upenn.edu
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Abstract

Objectives: Numerous studies have shown that individuals with posttraumatic stress disorder (PTSD) display reduced performances on neuropsychological tests, although most prior research has not adequately accounted for comorbidities or performance validity concerns that are common in this population and could partially account for the observed neurocognitive findings. Moreover, few studies have examined the functional implications of neuropsychological results in PTSD. Methods: We examined neuropsychological functioning in 44 veterans with PTSD and 40 veteran trauma comparison (TC) participants with combat exposure and no PTSD. Results: After excluding four veterans with PTSD for performance validity concerns, multivariate analyses of variance by neurocognitive domain revealed significantly worse performance by the PTSD group in the domains of speed of information processing (p=.035) and executive functions (p=.017), but no group differences in attention/working memory, verbal/language functioning, visuoconstruction, or episodic memory. Group differences by PTSD status were still present after covarying for depression, a history of head injuries, and substance use disorders. Executive functioning performance was associated with poorer self-reported occupational functioning and physical health-related quality of life, while speed of information processing performance was associated with poorer physical health-related quality of life. Discussion: These results are generally consistent with a fronto-limbic conceptualization of PTSD-associated neuropsychological dysfunction and show that cognitive functioning may be associated with critical functional outcomes. Taken together, results suggest that consideration of neurocognitive functioning may enhance the clinical management of individuals with PTSD. (JINS, 2016, 22, 399–411)

Keywords

Posttraumatic stress disorderNeuropsychologyCognitive abilitiesMemoryExecutive functionsQuality of lifeOccupational functioning
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 22 , Issue 4 , April 2016 , pp. 399 - 411
Copyright
Copyright © The International Neuropsychological Society 2016 

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