Physical Activity and Neuropsychological Functioning in Older Adults.

Research has identified a positive relationship between physical activity and neuropsychological functioning across the lifespan. The present study further examined the relationship between physical activity, depression, anxiety, and cognitive functioning in community-dwelling older adults (ages 65-96) who completed an outpatient neuropsychological evaluation (N = 526). Psychometrically sound and validated measures were used to assess depression, anxiety, and cognitive functioning. Analyses of covariance (ANCOVA) were conducted to examine differences between individuals who reported regularly engaging in physical activity and those who did not, after adjusting for demographic variables (age, education, and gender). Results indicated that physical activity was associated with better scores on measures of depression, anxiety, and cognitive functioning. Effect sizes for total scores on all measures were large, but there was a sizeable range of effect sizes (from small to large) for various cognitive domains. Smallest effect sizes were observed for subtests measuring language skills and visuospatial abilities, whereas largest effect sizes were seen in processing speed and memory. Results suggest that engaging in physical activity may be a beneficial non-pharmacological intervention for older adults. These findings underscore the importance of integrating physical activity programs in community and healthcare settings to foster mental and cognitive health in older populations.

A systematic review of the utility of continuous performance tests among adults with ADHD.

OBJECTIVE: The clinical utility of continuous performance tests (CPTs) among adults with attention-deficit/hyperactivity disorder (ADHD) has increasingly been brought under question. Therefore, the objective of this study was to systematically review the literature to investigate the clinical utility of various commercially available CPTs, including the Conner's Continuous Performance Test (CCPT), Test of Variables of Attention (TOVA), Gordon Diagnostic System (GDS), and Integrated Visual and Auditory Continuous Performance Test (IVA) in the adult ADHD population. METHODS: This systematic review followed the a priori PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were gathered from PsycINFO, PsycARTICLES, Academic Search Complete, and Google Scholar on 11 April 2022. Sixty-nine articles were included in the final review. Risk of bias was assessed using the National Institute of Health Quality Assessment Took for Observational Cohort and Cross-Sectional Studies. RESULTS: Most articles demonstrated high risk of bias, and there was substantial heterogeneity across studies. Overall, the reviewed CPTs appeared to have limited diagnostic utility and classification accuracy. Although many studies showed differing scores between adults with ADHD and comparison groups, findings were not consistent. Characteristics of CPT performances among adults with ADHD were mixed, with little consistency and no evidence of a clear profile of performances; however, CCPT commission errors appeared to have the most utility when used a treatment or experimental outcome measure, compared to other CCPT scores. CONCLUSION: Overall, CPTs should not be used in isolation as a diagnostic test but may be beneficial when used as a component of a comprehensive assessment.

Subjective cognitive complaints and objective cognitive functioning in combat veterans: Effects of PTSD and deployment mild TBI.

OBJECTIVES: (1) Examine the relationship between subjective cognitive complaints and objective cognitive functioning in combat veterans; and (2) evaluate conditional effects of posttraumatic stress disorder (PTSD) and deployment-related mild traumatic brain injury (TBI) within that relationship. METHOD: Combat veterans (N = 225, 86.22% male) completed a lifetime TBI interview, a structured interview assessing PTSD symptoms, a neuropsychological assessment battery, and a self-report measure of cognitive symptoms. RESULTS: All correlations between subjective cognitive complaints and objective cognitive measures were not statistically significant. Hierarchical linear regression indicated that cognitive performance was not significantly related to cognitive complaints, but both PTSD diagnosis and history of deployment mild TBI explained a significant amount of unique variance in self-reported cognitive symptoms. Interactions between the studied variables were not significant. CONCLUSIONS: PTSD and history of deployment mild TBI were uniquely related to cognitive complaints, but cognitive test performance was not. No confounding effects of PTSD or deployment mild TBI were observed in the relationship between cognitive performance and cognitive complaints. This provides support that symptom distress may be a better explanatory factor for perception of lower cognitive functioning than actual cognitive performance.

Symptom validity indices in the Posttraumatic Stress Disorder Checklist for DSM-5.

The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self-report measures. To date, no embedded SVTs have been identified in the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). This research aimed to develop and validate PCL-5 SVTs in two samples of veterans. Participants completed one of two prospective research studies that included cognitive and psychological tests. Participants in Study 1 were veterans (N = 464) who served following the September 11, 2001, terrorist attacks; participants in Study 2 were veterans or service members (N = 338) who had been deployed to Iraq and/or Afghanistan. Both studies included the PCL-5 and the Structured Inventory of Malingered Symptomatology (SIMS), the latter of which served as the criterion for identifying PCL-5 SVTs. For Study 1, two separate SVTs were developed: the PCL-5 Symptom Severity scale (PSS), based on the PCL-5 total score, and the PCL-5 Rare Items scale (PRI), based on PCL-5 items infrequently endorsed at the highest item ratings. At the most conservative SIMS cutoff score, the PSS achieved excellent discrimination for both the Study 1, AUC = .840, and Study 2 samples, AUC = .858, with specific cutoff scores of ≥ 51 and ≥ 56 maximizing sensitivity while maintaining a specificity of .90. The PRI achieved good discrimination, AUCs = .760 and.726, respectively, with a cutoff score of 2 or higher indicated by both studies. The results of these two studies provide provisional support for these two embedded SVTs in the PCL-5.

Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes.

BACKGROUND: Exposure to blasts is common among service members and history of these exposures has been associated with chronic psychiatric and health outcomes. Evidence suggests that distress tolerance (DT) may moderate this relationship and be a valuable treatment target in this population. The purpose of this manuscript was to evaluate DT as a modifying factor in the association between posttraumatic stress disorder (PTSD), mild traumatic brain injury (TBI), blast exposure, and functional indicators. METHOD: Participants were 275 (86.55% male) combat veterans who served in Iraq or Afghanistan after September 11, 2001. Clinical interviews for PTSD diagnosis, TBI history, and blast exposure were administered, and participants completed self-report questionnaires (DT, PTSD symptom severity, depressive symptom severity, neurobehavioral symptom severity, sleep quality, pain interference, and quality of life). RESULTS: DT was significantly associated with all functional indicators beyond PTSD diagnosis, mild TBI, and blast severity. There were significant interaction effects between DT and PTSD diagnosis for posttraumatic stress symptom severity, sleep quality, and quality of life. Specifically, there were significant differences in these reported functional indicators between individuals with and without a PTSD diagnosis as DT increases, such that reported symptoms were lower (quality of life better) for individuals without PTSD as DT improved. CONCLUSION: Our results demonstrate that DT might be a key factor in postdeployment function for military service members. Treatments targeting DT may be particularly effective in individuals who attribute psychiatric symptoms to history of blast exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preliminary evidence for digit span performance validity indicators within the neuropsychological assessment battery.

The purpose of this study was to evaluate multiple embedded performance validity indicators within the Digits Forward and Digits Backward subtests of the Neuropsychological Assessment Battery (NAB), including Reliable Digit Span (RDS), as no published papers have examined embedded digit span validity indicators within these subtests of the NAB. Retrospective archival chart review was conducted at an outpatient neuropsychology clinic. Participants were 92 adults (ages 19-68) who completed NAB Digits Forward and Digits Backward, and the Word Choice Test (WCT). Receiver operating characteristic (ROC) curves, t-tests, and sensitivity and specificity analyses were conducted. Analyses showed that RDS demonstrated acceptable classification accuracy between those who passed the WCT and those who did not. The area under the curve (AUC) value for RDS was 0.702; however, AUC values for all other digit span indices were unacceptably low. The optimal cutoff for RDS was identified (<8). RDS for the NAB appears to be an adequate indicator of performance validity; however, considering the very small number of participants who were invalid on the WCT (n = 15), as well as the utilization of only one stand-alone PVT to classify validity status, these findings are preliminary and in need of replication.

Factors associated with recovery from posttraumatic stress disorder in combat veterans: The role of deployment mild traumatic brain injury (mTBI).

OBJECTIVE: Examine factors associated with recovery from posttraumatic stress disorder (PTSD) and evaluate the role of deployment mild traumatic brain injury (mTBI) in the relationship between PTSD recovery and functional outcomes. METHOD: Post 9/11 combat veterans with lifetime history of PTSD (N = 124, 84.7% male) completed the Mid-Atlantic MIRECC Assessment of Traumatic Brain Injury (MMA-TBI), Salisbury Blast Interview (SBI), Clinician Administered PTSD scale (CAPS-5), cognitive assessment battery, and measures of depression, PTSD symptoms, neurobehavioral symptoms, sleep quality, pain interference, and quality of life. RESULTS: Analyses of variance (ANOVA) results revealed significant differences in most behavioral health outcomes based on PTSD recovery, with participants who have recovered from PTSD showing less severe neurobehavioral and depressive symptoms, better sleep quality, less functional pain interference, and higher quality of life. No differences were found in cognitive functioning between those who have recovered from PTSD and those who have not. History of deployment mTBI did not significantly moderate the relationship between PTSD recovery and most functional and cognitive outcomes with the exception of 2 measures of processing speed. Specifically, among participants with history of deployment mTBI, those who have recovered from PTSD displayed better cognitive functioning than those who have not. Additionally, participants who have not recovered from PTSD had higher levels of blast exposure during military service. CONCLUSIONS: PTSD recovery was associated with better psychological functioning and higher quality of life, but not with objective cognitive functioning. Deployment mTBI history moderated only the relationship between PTSD recovery status and tests of processing speed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Symptom burden, validity, and cognitive performance in Iraq and Afghanistan veterans.

INTRODUCTION: The present study evaluates the complex relationships between symptom burden, validity, and cognition in a sample of Iraq and Afghanistan veterans to identify key characteristic symptoms and validity measures driving cognitive performance. We hypothesized that symptom and performance validity would account for poorer outcomes on cognitive performance beyond psychological symptoms. METHODS: Veterans (n = 226) completed a cognitive test battery, Personality Assessment Inventory (PAI), Word Memory Test (WMT), and Miller Forensic Assessment Symptom Test (M-FAST). Partial least squares structural equation modeling (PLS-SEM) modeled the fully-adjusted relationships among PAI subscales, validity, and cognitive performance. RESULTS: 23.45% of participants failed validity indices (19.9% WMT; 7.1% M-FAST). PLS-SEM indicated PAI subscales were not directly associated with performance or symptom validity measures, and there were no direct effects between validity performance and cognitive performance. Several PAI subscales were directly associated with measures of verbal abstraction, visual processing, and verbal learning and memory. CONCLUSION: Contrary to hypotheses, symptom and performance validity did not account for poorer outcomes on cognitive performance beyond symptom burden in the PLS-SEM model. Results highlight the association between psychiatric symptoms and cognitive performance beyond validity status.

The Development and Validation of the Embedded Validity Indicator for the Neuropsychological Assessment Battery.

OBJECTIVE: The purpose of this study was to develop and validate an embedded measure of performance validity within the Neuropsychological Assessment Battery (NAB). METHOD: This study involved a retrospective chart review at an outpatient neuropsychology clinic. Participants were 183 adults (ages 18-70) who completed the attention and memory modules of the NAB, as well as the Word Choice Test, Green's Medical Symptom Validity Test (MSVT), and Green's Non-Verbal MSVT, as part of a clinical neuropsychological assessment (n = 147) or as part of a forensic neuropsychological evaluation (n = 36). Replicating methodology utilized by Silverberg et al. (2007) for the development of the Effort Index within the Repeatable Battery for the Assessment of Neuropsychological Status, an Embedded Validity Indictor (EVI) for the NAB was developed in the present study based on Digits Forward and List Learning Long Delayed Forced-Choice Recognition (list recognition) subtests. RESULTS: Receiver operating characteristic curve analyses indicated the newly developed NAB EVI was able to significantly differentiate between valid and invalid status on stand-alone performance-validity tests, with area under the curve values ranging from 0.797 to 0.977. Optimal cutoffs for medical, forensic, and mixed samples were identified. CONCLUSIONS: The newly developed NAB EVI shows promise as an embedded performance validity measure; however, due to moderate sensitivity, it should be used in combination with stand-alone performance validity tests to detect invalid performance.

Lifestyle Factors, Cognitive Functioning, and Functional Capacity in Older Adults.

Research suggests that clinical management of cognitive impairment can occur through interventions targeting lifestyle factors, such as physical exercise and sleep quality. The present study examined the associations among lifestyle factors (exercise and sleep quality), cognition, and functional capacity in older adults (ages 56-94) who completed an outpatient neuropsychological evaluation (N = 356). Exercise habits and sleep quality were accessed using a self-report questionnaire and a clinical interview. Cognitive functioning was assessed using the Dementia Rating Scale-2 (DRS-2). Functional capacity was measured by the Texas Functional Living Scale (TFLS). Results indicated that physical exercise and sleep quality were positively associated with better cognitive functioning and functional capacity. Further research is needed to elucidate the relationship between lifestyle factors, cognition, and functional capacity in older adults.

Effects of blast exposure on psychiatric and health symptoms in combat veterans.

Blast exposure is common among service members, but the chronic psychiatric effects associated with blast exposure are not well-characterized independent of a resulting mild traumatic brain injury (TBI). This analysis evaluated whether blast exposure severity was independently associated with or exacerbated symptom report beyond posttraumatic stress disorder (PTSD) and mild TBI. Participants were Iraq and Afghanistan combat veterans (N = 275; 86.55% male), 71.27% with history of blast exposure, 29.82% current diagnosis of PTSD, and 45.45% with mild TBI. All participants completed diagnostic interviews for PTSD, lifetime TBI, and lifetime blast exposure. Self-reported psychiatric and health outcomes included posttraumatic stress symptoms, depressive symptoms, neurobehavioral symptoms, sleep quality, pain interference, and quality of life. Blast severity was associated with PTSD (B = 2.00), depressive (B = 0.76), and neurobehavioral (B = 1.69) symptoms beyond PTSD diagnosis and mild TBI history. Further, blast severity accounted entirely (i.e., indirect/mediation effect) for the association between TBI and posttraumatic stress (B = 1.62), depressive (B = 0.61), and neurobehavioral (B = 1.38) symptoms. No interaction effects were present. Exposure to blast is an independent factor influencing psychiatric symptoms in veterans beyond PTSD and mild TBI. Results highlight that blast exposure severity may be a more relevant risk factor than deployment mild TBI in combat veterans and should be considered in the etiology of psychiatric symptom presentation and complaints. Further, severity of psychological distress due to the combat environment may be an explanatory mechanism by which blast exposure mediates the relationship between mild TBI and symptom outcomes.

Alterations in the Topology of Functional Connectomes Are Associated with Post-Traumatic Stress Disorder and Blast-Related Mild Traumatic Brain Injury in Combat Veterans.

Post-traumatic stress disorder (PTSD) is a common condition in post-deployment service members (SM). SMs of the conflicts in Iraq and Afghanistan also frequently experience traumatic brain injury (TBI) and exposure to blasts during deployments. This study evaluated the effect of these conditions and experiences on functional brain connectomes in post-deployment, combat-exposed veterans. Functional brain connectomes were created using 5-min resting-state magnetoencephalography data. Well-established clinical interviews determined current PTSD diagnosis, as well as deployment-acquired mild TBI and history of exposure to blast. Linear regression examined the effect of these conditions on functional brain connectomes beyond covariates. There were significant interactions between blast-related mild TBI and PTSD after correction for multiple comparisons including number of nodes (non-standardized parameter estimate [PE] = -12.47), average degree (PE = 0.05), and connection strength (PE = 0.05). A main effect of blast-related mild TBI was observed on the threshold level. These results demonstrate a distinct functional connectome presentation associated with the presence of both blast-related mild TBI and PTSD. These findings suggest the possibility that blast-related mild TBI alterations in functional brain connectomes affect the presentation or progression of recovery from PTSD. The current results offer mixed support for hyper-connectivity in the chronic phase of deployment TBI.

Performance validity and symptom validity tests: Are they measuring different constructs?

OBJECTIVE: To evaluate the relationships among performance validity, symptom validity, symptom self-report, and objective cognitive testing. METHOD: Combat Veterans (N = 338) completed a neurocognitive assessment battery and several self-report symptom measures assessing depression, posttraumatic stress disorder (PTSD) symptoms, sleep quality, pain interference, and neurobehavioral complaints. All participants also completed two performance validity tests (PVTs) and one stand-alone symptom validity test (SVT) along with two embedded SVTs. RESULTS: Results of an exploratory factor analysis revealed a three-factor solution: performance validity, cognitive performance, and symptom report (SVTs loaded on the third factor). Results of t tests demonstrated that participants who failed PVTs displayed significantly more severe symptoms and significantly worse performance on most measures of neurocognitive functioning compared to those who passed. Participants who failed a stand-alone SVT also reported significantly more severe symptomatology on all symptom report measures, but the pattern of cognitive performance differed based on the selected SVT cutoff. Multiple linear regressions revealed that both SVT and PVT failure explained unique variance in symptom report, but only PVT failure significantly predicted cognitive performance. CONCLUSIONS: Performance and symptom validity tests measure distinct but related constructs. SVTs and PVTs are significantly related to both cognitive performance and symptom report; however, the relationship between symptom validity and symptom report is strongest. SVTs are also differentially related to cognitive performance and symptom report based on the utilized cutoff score. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Benefits of Computer Engagement in Older Adults with Dementia.

Objectives: Two pilot studies aimed to determine the effects of individual computer engagement on behavioral health outcomes in individuals with dementia. The focus was on participants' mental health, challenging behaviors, antipsychotic medications, and professional caregiver stress. Methods: Two pilot randomized control trials were conducted. First trial involved residents with advanced dementia in a long-term care facility. The second trial involved residents with mild dementia in an assisted living setting. The participants in the experimental group in both studies were provided with guided iN2L computer engagement followed by unrestricted use. Results: Statistically reliable improvements were found in both studies for participants' emotional well-being and professional caregiver stress. Reliable improvements in cognition and depression were found in the mild dementia study, but not in the advanced dementia study. No statistically reliable changes were observed for antipsychotic medications or challenging behaviors. Discussion: Computer engagement was associated with improvements in participants' emotional well-being and with a reduction in professional caregiver stress. Results should be interpreted with caution in the context of high attrition. Future studies may build upon these pilot findings and examine effects of technology use on mood and cognition in larger samples of older adults across a wider range of outcome measures.

Sleep moderates symptom experience in combat veterans.

BACKGROUND: Though sleep disturbance has shown to negatively affect outcomes related to post-deployment conditions, it is unclear whether and how sleep disturbance affects mental health symptoms beyond these conditions. We evaluated the independent and moderating effects of sleep quality on posttraumatic stress disorder (PTSD), depressive, and neurobehavioral symptoms beyond mild traumatic brain injury (TBI) and PTSD diagnosis. METHODS: Participants were 274 US combat veterans who deployed after 9/11. All completed diagnostic TBI and PTSD interviews and self-report measures of sleep quality, as well as PTSD, depressive, and neurobehavioral symptoms. Only those who passed symptom validity were included in analyses. Hierarchical regression evaluated the contribution of sleep quality to outcomes beyond PTSD and mild TBI. Moderation analyses evaluated interactions between mild TBI, PTSD, and sleep quality on symptom outcomes. RESULTS: Mild TBI was only significantly associated with PTSD (p = .006) and neurobehavioral (p = .003) symptoms. PTSD diagnosis was associated with PTSD (p < .001), depressive (p < .001), and neurobehavioral symptoms (p < .001) beyond mild TBI. Sleep quality explained additional significant variance in all three outcome measures (p < .001), and also significantly moderated the effects of PTSD diagnosis on neurobehavioral symptoms (ΔR2 = .01, p = .023). LIMITATIONS: Sleep was evaluated subjectively and therefore must be interpreted in this context. CONCLUSIONS: These results provide support that sleep quality is an independent contributing factor to health outcomes in post-deployment veterans and should be considered in etiology of complaints.

Differential effects of deployment and nondeployment mild TBI on neuropsychological outcomes.

Objective: Mild traumatic brain injury (TBI) that occurs in a deployment environment is characteristically different from mild TBI that occurs outside of deployment. This study evaluated differential and interaction effects of deployment and nondeployment mild TBI on cognitive and behavioral health outcomes. Research Method: Combat veterans (N = 293) who passed performance-validity measures completed the Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS-5), a neuropsychological assessment battery, and self-report questionnaires. A 2 × 2 × 2 analysis of variance (ANOVA) was conducted to evaluate the main and interaction effects across mild TBI groups and PTSD diagnosis. Results: Deployment TBI was associated with poorer outcomes on several cognitive tests: Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV); Working Memory Index (WMI; p = .018); Trail Making Test A (TMT-A; p < .001); and Trail Making Test B (TMT-B; p = .002). Deployment TBI and PTSD were also associated with increased PTSD, depressive, and neurobehavioral symptoms; pain interference; and poorer sleep quality. Nondeployment TBI had no effect on cognitive performance and was associated only with poorer sleep quality. PTSD had the strongest associations with symptom measures and deployment TBI with cognitive outcomes. There were no significant interaction effects after adjusting for multiple comparisons. Conclusions: Remote outcomes associated with mild deployment TBI are different from those associated with nondeployment mild TBI and are robust beyond PTSD. This suggests that the environment surrounding a TBI event influences cognitive and symptom sequelae. Veterans who experience mild TBI during deployment may report changes in cognition, but most will continue to function within the expected range. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Can deficits in functional capacity and practical judgment indicate cognitive impairment in older adults?

Neuropsychological literature has demonstrated a significant relationship between cognitive decline and functional capacity, but the directionality of this relationship is still not well understood. Further, the construct of practical judgment has been linked to both cognitive impairment and functional capacity, but these associations are still under-researched. Moreover, few studies to date have examined the relationships among all three constructs utilizing performance-based, ecologically valid and psychometrically sound measures. The present study aimed to address this gap in published literature and investigated whether a practical judgment and functional capacity can help differentiate individuals with cognitive dysfunction from those without. Participants were 270 community-dwelling individuals aged 56-95 years referred for neuropsychological evaluation in an outpatient setting. Bivariate correlations revealed moderate to strong relationships among the three studied variables. Additionally, logistic regression analysis indicated that ability to make sound practical judgments and ability to perform instrumental activities of daily living (IADL) can be used as indicators of cognitive impairment. The clinical implications of these findings are discussed.

Examining embedded validity indicators in Conners continuous performance test-3 (CPT-3).

OBJECTIVE: Prior research has identified a variety of embedded performance validity indicators on the Conners' Continuous Performance Test-II (CPT-II). The purpose of this study was to examine embedded validity indicators within the updated third edition of the Conners Continuous Performance Test (CPT-3). METHOD: This study used a retrospective chart review from an ADHD evaluation clinic at a Mid-Atlantic VA hospital. Participants were 197 military veterans who completed a clinical assessment for ADHD. All participants were consecutive referrals to the ADHD clinic who completed the CPT-3 and the Test of Memory Malingering, Trial 1 (TOMM1). RESULTS: Logistic regression analyses indicated that the following five variables were able to significantly predict validity status on the TOMM1: detectability (d'), omissions (OMI), commissions (COM), hit reaction time (HRT) standard deviation (SD), and HRT inter-stimulus interval (ISI) change. Among these measures, HRT SD and HRT ISI change were identified as the scores with the highest AUC values. Optimal cutoffs for all significant predictors were identified. A number of composite EVIs were created using various combinations of CPT-3 scores. All composite EVIs significantly differentiated between pass and fail status on the TOMM1. CONCLUSIONS: Several CPT-3 variables have clinical utility as embedded validity indicators; however, due to low sensitivity, they should not be used in isolation. These scores may be used as indicators of invalid performance but should not be used to rule out invalid performance. Identified CPT-3 scores may be useful as one component in a multivariate, multi-point continuous approach to performance validity sampling.

Pain interference and quality of life in combat veterans: Examining the roles of posttraumatic stress disorder, traumatic brain injury, and sleep quality.

OBJECTIVE: The goal of this study was to examine the associations among posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), sleep quality, pain interference, and quality of life in combat veterans. METHOD: Veterans (N = 289, 86.51% male) completed the Mid-Atlantic MIRECC Assessment of Traumatic Brain Injury, the Clinician-Administered PTSD Scale for DSM-5, and measures of sleep quality, pain interference, and quality of life. RESULTS: Hierarchical linear regressions evaluated associations between PTSD severity, deployment TBI severity, sleep quality, and the outcomes of pain interference and quality of life after adjusting for demographic variables and the number of nondeployment TBIs. PTSD severity, B = 0.15, SE B = 0.04, deployment TBI severity, B = 3.98, SE B = 1.01, and sleep quality, B = 0.74, SE B = 0.13, were significantly associated with pain interference, p < .001. PTSD severity, B = -0.57, SE B = 0.07, and pain interference, B = -0.45, SE B = 0.11, were significantly, independently associated with quality of life, p < .001. However, pain interference, B = -0.24, SE B = 0.11, was no longer significantly associated with quality of life when sleep quality, B = -1.56, SE B = 0.25, was included in the model. There was no significant association between deployment TBI severity and quality of life. Interactions among the studied variables were not significant for either of the outcome variables. CONCLUSIONS: PTSD symptom severity, deployment TBI history, and sleep quality may be important to consider in treatment planning for veterans experiencing pain-related functional interference. For veterans with numerous conditions comorbid with pain, treatment plans may include interventions targeting sleep and PTSD to maximize quality of life improvements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Number of Concussions Does Not Affect Treatment Response to Cognitive Rehabilitation Interventions Following Mild TBI in Military Service Members.

OBJECTIVE: The study objective was to determine whether number of concussions would affect symptom improvement following cognitive rehabilitation (CR) interventions. METHOD: Service members (N = 126) with concussion history completed a 6-week randomized control trial of CR interventions. Participants were stratified based on self-reported lifetime concussion frequency. Outcome measures included the Paced Auditory Serial Addition Test (PASAT), the Global Severity Index (GSI) from the Symptom Checklist-90-Revised, and the Key Behaviors Change Inventory (KBCI). RESULTS: Mixed-model analyses of variance revealed a significant main effect for time on cognitive, psychological, and neurobehavioral functioning. A significant main effect for the number of concussions was observed for GSI and KBCI, but not PASAT. Interactions between the number of concussions and time were not significant for any of the outcome variables. CONCLUSIONS: Over the 6-week interval, improvements were found for all participants across all outcome measures. Number of concussions did not affect improvements over time.