Article

Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience

Psychology Service and VA National Center for PTSD, VA Boston Healthcare System, (116B), 150 S. Huntington Ave., Boston, MA 02130, USA.
Clinical psychology review (Impact Factor: 7.18). 09/2009; 29(8):674-84. DOI: 10.1016/j.cpr.2009.08.004
Source: PubMed

ABSTRACT

A significant proportion of military personnel deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has been exposed to war-zone events potentially associated with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). There has been significant controversy regarding healthcare policy for those service members and military veterans who returned from OEF/OIF deployments with both mild TBI and PTSD. There is currently little empirical evidence available to address these controversies. This review uses a cognitive neuroscience framework to address the potential impact of mild TBI on the development, course, and clinical management of PTSD. The field would benefit from research efforts that take into consideration the potential differential impact of mild TBI with versus without persistent cognitive deficits, longitudinal work examining the trajectory of PTSD symptoms when index trauma events involve TBI, randomized clinical trials designed to examine the impact of mild TBI on response to existing PTSD treatment interventions, and development and examination of potential treatment augmentation strategies.

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Available from: Mieke Verfaellie, Aug 19, 2015
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    • "The relatively reduced coherence in blast narratives is consistent with the hypothesis that transient symptoms of mTBI experienced at the time of blast exposure (i.e., transient LOC, confusion, or disorientation) disrupt the encoding or integration of memories (Bryant et al., 2009; Vasterling, Verfaellie, & Sullivan, 2009). Elevated recall of episodic details for the blast event in participants with associated mTBI may seem hard to reconcile with this interpretation . "
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    ABSTRACT: Although loss of consciousness associated with moderate or severe traumatic brain injury (TBI) is thought to interfere with encoding of the TBI event, little is known about the effects of mild TBI (mTBI), which typically involves only transient disruption in consciousness. Blast-exposed Afghanistan and Iraq War veterans were asked to recall the blast event. Participants were stratified based on whether the blast was associated with probable mTBI (n = 50) or not (n = 25). Narratives were scored for organizational structure (i.e., coherence) using the Narrative Coherence Coding Scheme (Reese et al., 2011) and episodic recollection using the Autobiographical Interview Coding Procedures (Levine et al., 2002). The mTBI group produced narratives that were less coherent but contained more episodic details than those of the no-TBI group. These results suggest that mTBI interferes with the organizational quality of memory in a manner that is independent of episodic detail generation. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Apr 2015 · Neuropsychology
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    • "The relatively reduced coherence in blast narratives is consistent with the hypothesis that transient symptoms of mTBI experienced at the time of blast exposure (i.e., transient LOC, confusion, or disorientation) disrupt the encoding or integration of memories (Bryant et al., 2009; Vasterling, Verfaellie, & Sullivan, 2009). Elevated recall of episodic details for the blast event in participants with associated mTBI may seem hard to reconcile with this interpretation . "
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    ABSTRACT: Objective: Although loss of consciousness associated with moderate or severe traumatic brain injury (TBI) is thought to interfere with encoding of the TBI event, little is known about the effects of mild TBI (mTBI), which typically involves only transient disruption in consciousness. Method: Blast-exposed Afghanistan and Iraq War veterans were asked to recall the blast event. Participants were stratified based on whether the blast was associated with probable mTBI (n=50) or not (n =25). Narratives were scored for organizational structure (i.e., coherence) using the Narrative Coherence Coding Scheme (Reese et al., 2011) and episodic recollection using the Autobiographical Interview coding procedures (Levine et al., 2002). Results: The mTBI group produced narratives that were less coherent but contained more episodic details than those of the no-TBI group. Conclusions: These results suggest that mTBI interferes with the organizational quality of memory in a manner that is independent of episodic detail generation.
    Full-text · Article · Feb 2015 · Neuropsychology
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    • "As mentioned above the neurocircuitry models of PTSD implicate frontal and limbic (amygdala and hippocampus) structures as neurobiological substrates responsible for fear response and formation of fear associations. A large body of evidence supports an exaggerated responsivity of the amygdala with the concurrent dampening of the (inhibitory) prefrontal cortex and hippocampal activity (van der Kolk and Fisler, 1995; Rauch et al., 2006; Diamond et al., 2007; Vasterling et al., 2009; Shin and Liberzon, 2010). In mTBI cases, studies have demonstrated a vulnerability of the hippocampus, frontal white matter, and subcortical structures with white matter projections to the frontal cortex (Povlishock, 1993). "
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    ABSTRACT: Co-morbid mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) has become the signature disorder for returning combat veterans. The clinical heterogeneity and overlapping symptomatology of mTBI and PTSD underscore the need to develop a preclinical model that will enable the characterization of unique and overlapping features and allow discrimination between both disorders. This study details the development and implementation of a novel experimental paradigm for PTSD and combined PTSD-mTBI. The PTSD paradigm involved exposure to a danger-related predator odor under repeated restraint over a 21day period and a physical trauma (inescapable footshock). We administered this paradigm alone, or in combination with a previously established mTBI model. We report outcomes of behavioral, pathological and biochemical profiles at an acute timepoint. PTSD animals demonstrated recall of traumatic memories, anxiety and an impaired social behavior. In both mTBI and combination groups there was a pattern of disinhibitory like behavior. mTBI abrogated both contextual fear and impairments in social behavior seen in PTSD animals. No major impairment in spatial memory was observed in any group. Examination of neuroendocrine and neuroimmune responses in plasma revealed a trend towards increase in corticosterone in PTSD and combination groups, and an apparent increase in Th1 and Th17 proinflamatory cytokine(s) in the PTSD only and mTBI only groups respectively. In the brain there were no gross neuropathological changes in any groups. We observed that mTBI on a background of repeated trauma exposure resulted in an augmentation of axonal injury and inflammatory markers neurofilament L and ICAM-1. Our observations thus far suggest that this novel stress-trauma-related paradigm may be a useful model for investigating further the overlapping and distinct spatio-temporal and behavioral/biochemical relationship between mTBI and PTSD experienced by combat veterans.
    Full-text · Article · Jun 2014 · Frontiers in Behavioral Neuroscience
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