Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T12:09:19.126Z Has data issue: false hasContentIssue false
  • English
  • Français

Postconcussive Symptoms After Blast and Nonblast-Related Mild Traumatic Brain Injuries in Afghanistan and Iraq War Veterans

Published online by Cambridge University Press:  04 August 2010

SARA M. LIPPA ,
NICHOLAS J. PASTOREK ,
JARED F. BENGE  and
G. MATTHEW THORNTON
SARA M. LIPPA
Affiliation:
Rehabilitation Care Line, Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, Texas Department of Psychology, University of Houston, Houston, Texas
NICHOLAS J. PASTOREK*
Affiliation:
Rehabilitation Care Line, Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, Texas Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
JARED F. BENGE
Affiliation:
Rehabilitation Care Line, Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, Texas The Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas
G. MATTHEW THORNTON
Affiliation:
Rehabilitation Care Line, Michael E. DeBakey Veteran’s Affairs Medical Center, Houston, Texas Department of Psychology, University of Houston, Houston, Texas
*
*Correspondence and reprint requests to: Nicholas J. Pastorek, Ph.D., ABPP-CN, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd. (RCL 117), Houston, Texas 77030. E-mail: nicholas.pastorek@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Blast injury is common in current warfare, but little is known about the effects of blast-related mild traumatic brain injury (mTBI). Profile analyses were conducted investigating differences in self-reported postconcussive (PC) symptoms in 339 veteran outpatients with mTBI histories reporting current symptoms based on mechanism of injury (blast only, nonblast only, or both blast and nonblast), number of blast injuries, and distance from the blast. Veterans with any blast-related mTBI history were younger and reported higher posttraumatic stress symptoms than veterans with nonblast-related mTBI histories, with a marginally significant difference in posttraumatic stress symptom report between veterans reporting blast-related mTBI only and those reporting nonblast-related mTBI. The groups did not differ in terms of PC symptom severity or PC symptom cluster profiles. Among veterans with blast-related mTBI histories, PC symptom report did not vary by number of blast-related mTBIs or proximity to blast. Overall, posttraumatic stress symptoms accounted for a substantial portion of variance in PC symptom report. In veteran outpatients with remote mTBI histories who have enduring symptom complaints related to the mTBI, mechanism of injury did not clearly contribute to differential PC symptom severity or PC symptom cluster profile. Proximal rather than distal factors may be important intervention targets in returning symptomatic veterans with mTBI histories. (JINS, 2010, 16, 856–866.)

Keywords

Blast injuryHead injuryConcussionPosttraumatic stressPolytraumaNeurobehavioral Symptom Inventory
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 5 , September 2010 , pp. 856 - 866
Copyright
Copyright © The International Neuropsychological Society 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM IV (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Belanger, H.G., Curtis, G., Demery, J.A., Lebowitz, B.K., & Vanderploeg, R.D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of the International Neuropsychological Society, 11, 215–227.CrossRefGoogle ScholarPubMed
Belanger, H.G., Kretzmer, T., Vangerploeg, R.D., & French, L.M. (2010). Symptom complaints following combat-related traumatic brain injury: Relationship to traumatic brain injury severity and posttraumatic stress disorder. Journal of the International Neuropsychological Society, 16, 194–199.CrossRefGoogle ScholarPubMed
Belanger, H.G., Kretzmer, T., Yoash-Gantz, R., Pickett, T., & Tupler, L.A. (2009). Cognitive sequelae of blast-related versus other mechanisms of brain trauma. Journal of the International Neuropsychological Society, 15, 1–8.CrossRefGoogle ScholarPubMed
Belanger, H.G., Spiegel, E., & Vanderploeg, R.D. (2010). Neuropsychological performance following a history of multiple self-reported concussions: A meta-analysis. Journal of the International Neuropsychological Society, 16, 262–267.CrossRefGoogle ScholarPubMed
Belanger, H.G., Uomoto, J.M., & Vanderploeg, R.D. (2009). The Veterans Health Administration system of care for mild traumatic brain injury: Cost, benefits, and controversies. Journal of Head Trauma Rehabilitation, 24, 4–13.CrossRefGoogle Scholar
Benge, J.F., Pastorek, N.J., & Thornton, G.M. (2009). Postconcussive symptoms in OEF-OIF veterans: Factor structure and impact of posttraumatic stress. Rehabilitation Psychology, 54, 270–278.CrossRefGoogle ScholarPubMed
Binder, L.M., Rohling, M.L., & Larrabee, G.J. (1997). A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies, Journal of Clinical and Experimental Neuropsychology, 19, 421–431.Google Scholar
Blanchard, E.B., Jones-Alexander, J., Buckley, T.C., & Forneris, C.A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669–673.Google Scholar
Bliese, P.D., Wright, K.M., Adler, A.B., Cabrera, O., Castro, C.A., & Hoge, C.W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76, 272–281.CrossRefGoogle ScholarPubMed
Brenner, L.A., Ivins, B.J., Schwab, K., Warden, D., Nelson, L.A., Jaffee, M., et al. . (2009). (Epub ahead of print). Traumatic brain injury, posttraumatic stress disorder, and postconcussive symptom reporting among troops returning from Iraq. Journal of Head Trauma Rehabilitation.Google Scholar
Carroll, L.J., Cassidy, J.D., Peloso, P.M., Borg, J., von Holst, H., Holm, L., et al. . (2004). Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 43, 84–105.Google Scholar
Centers for Disease Control and Prevention. (2003). National Center for Injury Prevention and Control. Report to Congress. Mild traumatic brain injury in the United States: Steps to prevent a serious public health problem. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
Cernak, I., Savic, J., Ignjatovic, D., & Jevtic, M. (1999). Blast-related mTBI from explosive munitions. The Journal of Trauma, 47, 96–104.CrossRefGoogle Scholar
Cernak, I., Wang, Z., Jiang, J., Bian, X., & Savic, J. (2001a). Cognitive deficits following blast injury-induced neurotrauma: Possible involvement of nitric oxide. Brain Injury, 1, 593–612.CrossRefGoogle Scholar
Cernak, I., Wang, Z., Jiang, J., Bian, X., & Savic, J. (2001b). Ultrastructural and functional characteristics of blast-related mTBI-induced neurotrauma. The Journal of Trauma, 50, 695–706.CrossRefGoogle Scholar
Cicerone, K.D., & Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 10, 1–17.CrossRefGoogle Scholar
Collie, A., McCrory, P., & Makdissi, M. (2006). Does history of concussion affect current cognitive status? British Journal of Sports Medicine, 40, 550–551.Google Scholar
Defense and Brain Injury Center. (2009). Blast-related mTBI FAQs. Retrieved July 12, 2009 from http://www.dvbic.org/blastinjury.php.Google Scholar
DePalma, R.G., Burris, D.G., Champion, H.R., & Hodgson, M.J. (2005). Blast-related mTBIs. The New England Journal of Medicine, 352, 1335–1342.CrossRefGoogle Scholar
Frencham, K.A., Fox, A.M., & Mayberry, M.T. (2005). Neuropsychological studies of mild traumatic brain injury: A meta-analytic review of research since 1995. Journal of Clinical Experimental Neuropsychology, 27, 334–351.CrossRefGoogle ScholarPubMed
Gondusky, J.S., & Reiter, M.P. (2005). Protecting military convoys in Iraq: An examination of battle injuries sustained by a mechanized battalion during Operation Iraqi Freedom II. Military Medicine, 170, 546–549.Google Scholar
Guskiewicz, K.M., Marshall, S.W., Broglio, S.P., Cantu, R.C., & Kirkendall, D.T. (2002). No evidence of impaired neurocognitive performance in collegiate soccer players. The American Journal of Sports Medicine, 30, 157–162.Google Scholar
Guskiewicz, K.M., McCrea, M., Marshall, S.W., Cantu, R.C., Randolph, C., Barr, W., et al. . (2003). Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. Journal of American Medical Association, 290, 2549–2555.CrossRefGoogle ScholarPubMed
Hoge, C.W., Goldberg, H.M., & Castro, C.A. (2009). Care of war veterans with mild traumatic brain injury-flawed perspectives. The New England Journal of Medicine, 360, 1588–1591.Google Scholar
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., & Castro, C.A. (2008). Mild traumatic brain injury in U.S. Soldiers returning from Iraq. The New England Journal of Medicine, 358, 453–463.CrossRefGoogle ScholarPubMed
Hollnagl, H., & Norrelund, M. (1980). Headache in 40-year-old persons in Glastrup, Denmark. Ugeskr Laeger, 142, 3071–3077.Google Scholar
Iverson, G.L. (2006). Misdiagnosis of the persistent postconcussion syndrome in participants with depression. Archives of Clinical Neuropsychology, 21, 303–310.CrossRefGoogle ScholarPubMed
Iverson, G.L., Brooks, B.L., Lovell, M.R., & Collins, M.W. (2006). No cumulative effects for one or two previous concussions. British Journal of Sports Medicine, 40, 72–75.Google Scholar
Iverson, G.L., Gaetz, M., Lovell, M.R., & Collins, M.W. (2004). Cumulative effects of concussion in amateur athletics. Brain Injury, 18, 433–443.CrossRefGoogle Scholar
Iverson, G.L., & McCracken, L.M. (1997). “Post-concussive” symptoms in persons with chronic pain. Brain Injury, 11, 783–790.CrossRefGoogle Scholar
Jakupcak, M., Luterek, J., Hunt, S., Conybeare, D., & McFall, M. (2008). Posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan war veterans seeking postdeployment VA health care. Journal of Nervous and Mental Disease, 196, 425–428.CrossRefGoogle Scholar
Kashdan, T.B., Uswatte, G., Steger, M.F., & Julian, T. (2006). Fragile self-esteem and affective instability in posttraumatic stress disorder. Behaviour Research and Therapy, 44, 1609–1619.CrossRefGoogle ScholarPubMed
Kaur, C., Singh, J., Lim, M.K., Ng, B.L., Yap, E.P., & Ling, E.A. (1995). The response of neurons and microglia to blast-related mTBI in the rat brain. Neuropathology and Applied Neurobiology, 21, 369–377.CrossRefGoogle Scholar
Lees-Haley, P.R., Fox, D.D., & Courtney, J.C. (2001). A comparison of complaints by mild brain injury claimants and other claimants describing subjective experiences immediately following their injury. Archives of Clinical Neuropsychology, 16, 689–695.CrossRefGoogle ScholarPubMed
Levin, J.R., Serlin, R.C., & Searman, M.A. (1994). A controlled, powerful multiple-comparison strategy for several situations. Psychological Bulletin, 115, 153–159.Google Scholar
Loftus, E.F., Levidow, B., & Duensing, S. (2002). Who remembers best? Individual differences in memory for events that occurred in a science museum. Applied Cognitive Psychology, 6, 93–107.CrossRefGoogle Scholar
Mayo, A., & Kluger, Y. (2006). Blast-induced injury of air-containing organs. Emergency Medicine, 7, 40–44.Google Scholar
Moochhala, S.M., Md, S., Lu, J., Teng, C., & Greengrass, C. (2004). Neuroprotective role of aminoguanidine in behavioral changes after blast-related mTBI. The Journal of Trauma, 56, 393–403.Google Scholar
Pellman, E.J., Lovell, M.R., Viano, D.C., Casson, I.R., & Tucker, A.M. (2004). Concussion in professional football: Neuropsychological testing—Part 6. Neurosurgery, 55, 1290–1305.Google Scholar
Ruff, R.L., Ruff, S.S., & Wang, X. (2008). Headaches among Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury associated with exposures to explosions. Journal of Rehabilitation, Research, and Development, 45, 941–952.CrossRefGoogle ScholarPubMed
Säljö, A., Bao, F., Haglid, K.G., & Hansson, H.A. (2000). Blast exposure causes redistribution of phosphorylated neurofilament subunits in neurons of the adult rat brain. Journal of Neurotrauma, 17, 719–726.Google Scholar
Schneiderman, A.L., Braver, E.R., & Kang, H.K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167, 1446–1452.Google Scholar
Schretlen, D.J., & Shapiro, A.M. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychiatry, 15, 341–349.CrossRefGoogle ScholarPubMed
Tabacknick, B.G., & Fidell, L.S. (2001). Using multivariate statistics. Allyn & Beacon: Needham Heights, MA.Google Scholar
Terrio, H., Brenner, L.A., Ivins, B.J., Cho, J.M., Helmick, K., Schwab, K., et al. . (2009). Traumatic brain injury screening: Preliminary findings in a US Army Brigade Combat Team. The Journal of Head Trauma Rehabilitation, 24, 14–23.CrossRefGoogle Scholar
Vasterling, J.J., Schumm, J., Proctor, S.P., Gentry, E., King, D.W., & King, L.A. (2008). Posttraumatic stress disorder and health functioning in a non-treatment-seeking sample of Iraq war veterans: A prospective analysis. Journal of Rehabilitation Research and Development, 45, 347–358.CrossRefGoogle Scholar
Weathers, F.W., Huska, J.A., & Keane, T.M. (1991). The PTSD checklist-military version (PCL-M). Boston: National Center for PTSD.Google Scholar
Wilk, J.E., Thomas, J.L., McGurk, D.M., Riviere, L.A., Castro, C.A., & Hoge, C.W. (2010). Mild traumatic brain injury (concussion) during combat: Lack of association of blast mechanism with postconcussive symptoms. Journal of Head Trauma Rehabilitation, 25, 9–14.CrossRefGoogle ScholarPubMed
Yehuda, R., Keefe, R.S.E., Harvey, P.D., Levengood, R.A., Gerber, D.K., Geni, J., & Siever, L.J. (1995). Learning and memory in combat veterans with posttraumatic stress disorder. The American Journal of Psychiatry, 152, 137–139.Google Scholar