Posttraumatic Stress Disorder-Associated Cognitive Deficits on the Repeatable Battery for the Assessment of Neuropsychological Status in a Veteran Population
Nathan Hantke is a Clinical Neuropsychologist in the Mental Health and Clinical Neuroscience Division at the US Department of Veterans Affairs (VA) Portland Health Care System in Oregon. Dana Waltzman is a Postdoctoral Fellow, Jennifer Kong is a Clinical Director, John Ashford is the Director, and Jerome Yesavage is the Executive Director; all at the War Related Illness and Injury Study Center; Lisa Kinoshita is a Clinical Neuropsychologist at the VA Memory Clinic; Tong Sheng is a Program Analyst in Polytrauma System of Care; Sherry Beaudreau is an Investigator in the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC): J. Kaci Fairchild is an Associate Director, Jerome Yesavage is the Director; all at the MIRECC; Maheen Adamson is a Clincial Research Senior Scientific Director in the Rehabilitation Service, all at the VA Palo Alto Health Care System in California. Art Noda is a Research Data Analyst, J. Kaci Fairchild, Sherry Beaudreau, John Ashford, Jerome Yesavage, and Laura C. Lazzeroni are Professors, Dana Waltzman is a Postdoctoral Fellow, all in the Stanford Department of Psychiatry and Behavioral Sciences; Maya Yustis is a Clinical Neuropsychologist and Clinical Assistant Professor (affiliated) in the Stanford Neuroscience Institute, and Maheen Adamson is a Clinical Associate Professor in the Department of Neurosurgery, all at Stanford University School of Medicine in California. Nathan Hantke is an Assistant Professor in the Department of Neurology at Oregon Health and Science University in Portland. Correspondence: Nathan Hantke (hantke@ohsu.edu) *Colead authors.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Several limitations may affect the generalizability of the findings. The present study used a veteran sample referred to a specialty clinic for complicated postdeployment health concerns. Although findings may not be representative of an inpatient population or clinics that focus solely on TBI, they may more adequately reflect veterans using clinical services at VA medical centers. We also did not include measures of PTSD symptom severity (eg, Posttraumatic Stress Disorder Checklist), instead using diagnosis based on the gold standard CAPS. In addition, the likelihood of the presence of a remote TBI was based on a clinical interview with a neurologist and not on acute neurologic findings. TBI is a heterogenous diagnosis, with multiple factors that likely influence cognitive performance, including location of the injury, type of injury, and time since injury, which may be lost during group analysis. Further, the RBANS is not intended to serve as a method for a differential diagnosis of PTSD or TBI. Concordant with this, the intention of the current study was to capture the quality of cognitive function on the RBANS within individuals with PTSD.
Conslusions
The ability for veterans to remember a short story following a delay (ie, RBANS Story Recall subtest) was negatively associated with a diagnosis of PTSD. Further, the RBANS best captured cognitive deficits associated with PTSD compared with those with a history of mild TBI, or co-occurring mild TBI and PTSD. These findings may provide insight into the interpretation and attribution of cognitive deficits in the veteran population and holds potential to guide future research examining focused cognitive phenotypes to provide precision targets in individual treatment.
