Skip to main content Accessibility help
×
Home
Hostname: page-component-55597f9d44-2qt69 Total loading time: 0.71 Render date: 2022-08-12T21:46:12.781Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Neuropsychological Profile of Lifetime Traumatic Brain Injury in Older Veterans

Published online by Cambridge University Press:  04 October 2016

Allison R. Kaup*
Affiliation:
Research Service, San Francisco VA Healthcare System and Department of Psychiatry, University of California San Francisco, San Francisco, California
Carrie Peltz
Affiliation:
NCIRE-The Veterans Health Research Institute and the San Francisco VA Healthcare System, San Francisco, California
Kimbra Kenney
Affiliation:
Department of Neurology, Uniformed Services University of the Health Sciences, Rockville, Maryland
Joel H. Kramer
Affiliation:
Departments of Neurology, University of California San Francisco, San Francisco, California
Ramon Diaz-Arrastia
Affiliation:
Department of Neurology, Uniformed Services University of the Health Sciences, Rockville, Maryland
Kristine Yaffe
Affiliation:
Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, California
*
Correspondence and reprint requests to: Allison R. Kaup, San Francisco VA Healthcare System, 4150 Clement Street, 116B, San Francisco, CA 94121. E-mail: allison.kaup@ucsf.edu

Abstract

Objectives: The aim of this study was to characterize the neuropsychological profile of lifetime traumatic brain injury (TBI) in older Veterans. Methods: Participants were 169 older Veterans [mean age=79.1 years (range, 51–97 years), 89% male, 92% Caucasian], 88 with lifetime TBI and 81 without TBI, living in Veterans’ retirement homes in independent residence. TBI history was ascertained with the Ohio State TBI Identification Method structured interview. Cognition was assessed with neuropsychological tests: Raw scores were converted to Z-scores compared to age-corrected normative data and combined into five domain composite Z-scores (attention/working memory, learning/memory, language, processing speed, executive functioning). We investigated the association between TBI and performance in each cognitive domain in linear mixed effects models, with and without adjustment for demographics, medical comorbidities, and psychiatric variables. Results: Compared to those without TBI, older Veterans with TBI had greater deficits in processing speed (estimate=−.52; p=.01; f2=.08 in fully adjusted model) and executive functioning (estimate=−.41; p=.02; f2=.06 in fully adjusted model) but performed similarly in the attention/working memory, learning/memory, and language domains (all p>.05). TBI-associated deficits were most prominent among individuals with multiple mild TBIs and those with any moderate-to-severe TBI, but were not clearly present among those with single mild TBI. Conclusions: The neuropsychological profile of lifetime TBI in older Veterans is characterized by slowed processing speed and executive dysfunction, especially among those with greater injury burden. This pattern may reflect long-standing deficits or a TBI-associated cognitive decline process distinct from Alzheimer’s disease. (JINS, 2017, 23, 56–64)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2016. This is a work of the U.S. Government and is not subject to copyright protection in the United States. 

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

Ashman, T.A., Cantor, J.B., Gordon, W.A., Sacks, A., Spielman, L., Egan, M., & Hibbard, M.R. (2008). A comparison of cognitive functioning in older adults with and without traumatic brain injury. Journal of Head Trauma Rehabilitation, 23(3), 139148.CrossRefGoogle ScholarPubMed
Barnes, D.E., Kaup, A.R., Kirby, K., Byers, A.L., Diaz-Arrastia, R., & Yaffe, K. (2014). Traumatic brain injury and risk for dementia in older veterans. Neurology, 83, 312319.CrossRefGoogle ScholarPubMed
Bieniek, K.F., Ross, O.A., Cormier, K.A., Walton, R.L., Soto-Ortolaza, A., Johnston, A.E., & Wszolek, Z.K. (2015). Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank. Acta Neuropathologica, 130(6), 877889.CrossRefGoogle 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(8), 669673.CrossRefGoogle Scholar
Bogner, J., & Corrigan, J.D. (2009). Reliability and predictive validity of the Ohio State University TBI identification method with prisoners. Journal of Head Trauma Rehabilitation, 24(4), 279291.CrossRefGoogle ScholarPubMed
Bondi, M.W., Jak, A.J., Delano-Wood, L., Jacobson, M.W., Delis, D.C., & Salmon, D.P. (2008). Neuropsychological contributions to the early identification of Alzheimer’s disease. Neuropsychology Review, 18(1), 7390.CrossRefGoogle ScholarPubMed
Byers, A.L., & Yaffe, K. (2011). Depression and risk of developing dementia. Nature Reviews. Neurology, 7(6), 323331.CrossRefGoogle Scholar
Chan, R.C. (2005). Sustained attention in patients with mild traumatic brain injury. Clinical Rehabilitation, 19(2), 188193.CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
Corrigan, J.D., & Bogner, J. (2007). Initial reliability and validity of the Ohio State University TBI identification method. Journal of Head Trauma Rehabilitation, 22(6), 318329.CrossRefGoogle ScholarPubMed
Curtiss, G., Vanderploeg, R.D., Spencer, J., & Salazar, A.M. (2001). Patterns of verbal learning and memory in traumatic brain injury. Journal of the International Neuropsychological Society, 7(5), 574585.CrossRefGoogle ScholarPubMed
Dams-O’Connor, K., Spielman, L., Hammond, F., Sayed, N., Culver, C., & Diaz-Arrastia, R. (2013). An exploration of clinical dementia phenotypes among individuals with and without traumatic brain injury. NeuroRehabilitation, 32(2), 199.Google Scholar
Department of Veterans Affairs, & Department of Defense. (2009). Clinical practice guidelines: Management of concussion / Mild traumatic brain injury. Retrieved from http://www.healthquality.va.gov/management_of_concussion_mtbi.asp.Google Scholar
Eramudugolla, R., Bielak, A.A., Bunce, D., Easteal, S., Cherbuin, N., & Anstey, K.J. (2014). Long-term cognitive correlates of traumatic brain injury across adulthood and interactions with APOE genotype, sex, and age cohorts. Journal of the International Neuropsychological Society, 20(04), 444454.CrossRefGoogle Scholar
Finnanger, T.G., Skandsen, T., Andersson, S., Lydersen, S., Vik, A., & Indredavik, M. (2013). Differentiated patterns of cognitive impairment 12 months after severe and moderate traumatic brain injury. Brain Injury, 27(13-14), 16061616.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189198.CrossRefGoogle ScholarPubMed
Gardner, R.C., Burke, J.F., Nettiksimmons, J., Kaup, A., Barnes, D.E., & Yaffe, K. (2014). Dementia risk after traumatic brain injury vs nonbrain trauma: The role of age and severity. JAMA Neurology, 71(12), 14901497.CrossRefGoogle ScholarPubMed
Gavett, B.E., Stern, R.A., & McKee, A.C. (2011). Chronic traumatic encephalopathy: A potential late effect of sport-related concussive and subconcussive head trauma. Clinics in Sports Medicine, 30(1), 179188.CrossRefGoogle ScholarPubMed
Guskiewicz, K.M., Marshall, S.W., Bailes, J., McCrea, M., Cantu, R.C., Randolph, C., & Jordan, B.D. (2005). Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery, 57(4), 719726.CrossRefGoogle ScholarPubMed
Hayes, J.P., Bigler, E.D., & Verfaellie, M. (2016). Traumatic brain injury as a disorder of brain connectivity. Journal of the International Neuropsychological Society, 22(02), 120137.CrossRefGoogle ScholarPubMed
Himanen, L., Portin, R., Isoniemi, H., Helenius, H., Kurki, T., & Tenovuo, O. (2006). Longitudinal cognitive changes in traumatic brain injury: A 30-year follow-up study. Neurology, 66(2), 187192.CrossRefGoogle ScholarPubMed
Ivnik, R.J., Malec, J., Smith, G.E., Tangalos, E.G., Petersen, R.C., Kokmen, E., & Kurland, L.T. (1992). Mayo’s older americans normative studies: Updated AVLT norms for ages 56 to 97. Clinical Neuropsychologist, 6, 83104.CrossRefGoogle Scholar
Ivnik, R.J., Malec, J.F., Tangalos, E.G., Petersen, R.C., Kokmen, E., & Kurland, L.T. (1990). The Auditory-Verbal Learning Test (AVLT): Norms for ages 55 years and older. Psychological Assessment, 2(3), 304.CrossRefGoogle Scholar
Johnson, V.E., Stewart, W., & Smith, D.H. (2010). Traumatic brain injury and amyloid-β pathology: A link to Alzheimer’s disease? Nature Reviews. Neuroscience, 11(5), 361370.Google Scholar
Kaplan, E., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test. Philadelphia: Lea & Febiger.Google Scholar
Karr, J.E., Areshenkoff, C.N., & Garcia-Barrera, M.A. (2014). The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology, 28(3), 321.CrossRefGoogle ScholarPubMed
Kramarow, E.A., & Pastor, P.N. (2012). The health of male veterans and nonveterans aged 25–64: United States, 2007-2010 National Center for Health Statistics (NCHS) Data Brief, no 101. Hyattsville, MD: National Center for Health Statistics.Google Scholar
Kramer, J.H., Mungas, D., Possin, K.L., Rankin, K.P., Boxer, A.L., Rosen, H.J., & Widmeyer, M. (2014a). [NIH-EXAMINER battery test performances among healthy controls by age group]. Unpublished raw data.Google Scholar
Kramer, J.H., Mungas, D., Possin, K.L., Rankin, K.P., Boxer, A.L., Rosen, H.J., & Widmeyer, M. (2014b). NIH EXAMINER: Conceptualization and development of an executive function battery. Journal of the International Neuropsychological Society, 20(01), 1119.CrossRefGoogle ScholarPubMed
Mathias, J.L., Beall, J.A., & Bigler, E.D. (2004). Neuropsychological and information processing deficits following mild traumatic brain injury. Journal of the International Neuropsychological Society, 10(2), 286297.CrossRefGoogle ScholarPubMed
McAllister, T.W., Flashman, L.A., McDonald, B.C., & Saykin, A.J. (2006). Mechanisms of working memory dysfunction after mild and moderate TBI: Evidence from functional MRI and neurogenetics. Journal of Neurotrauma, 23(10), 14501467.CrossRefGoogle ScholarPubMed
McDonald, B.C., Flashman, L.A., & Saykin, A.J. (2002). Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies. NeuroRehabilitation, 17(4), 333344.Google ScholarPubMed
Moretti, L., Cristofori, I., Weaver, S.M., Chau, A., Portelli, J.N., & Grafman, J. (2012). Cognitive decline in older adults with a history of traumatic brain injury. The Lancet Neurology, 11(12), 11031112.CrossRefGoogle Scholar
Morris, J., Heyman, A., Mohs, R., Hughes, J., van, B., Fillenbaum, G., & Clark, C. (1989). The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I: Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology, 39, 11591165.Google Scholar
National Institute of Neurological Disorders and Stroke (NINDS). (2012). NINDS Common Data Elements: Traumatic Brain Injury. Retrieved from https://commondataelements.ninds.nih.gov/TBI.aspx#tab=Data_Standards.Google Scholar
Okie, S. (2005). Traumatic brain injury in the war zone. New England Journal of Medicine, 352(20), 20432047.CrossRefGoogle ScholarPubMed
Ommaya, A.K., Ommaya, A.K., Dannenberg, A.L., & Salazar, A.M. (1996). Causation, incidence, and costs of traumatic brain injury in the US military medical system. The Journal of Trauma and Acute Care Surgery, 40(2), 211217.CrossRefGoogle Scholar
Peltz, C.B., Gardner, R.C., Kenney, K., Diaz-Arrastia, R., Kramer, J.H., & Yaffe, K. (2016). Neurobehavioral characteristics of older veterans with remote traumatic brain injury. Journal of Head Trauma Rehabilitation, doi:10.1097/HTR.0000000000000245 [Epub ahead of print] Google ScholarPubMed
Perry, D.C., Sturm, V.E., Peterson, M.J., Pieper, C.F., Bullock, T., Boeve, B.F., & Kramer, J.H. (2015). Association of traumatic brain injury with subsequent neurological and psychiatric disease: A meta-analysis. Journal of Neurosurgery, 124, 511526.CrossRefGoogle ScholarPubMed
Plassman, B.L., & Grafman, J. (2015). Traumatic brain injury and late-life dementia. Handbook of Clinical Neurology, 128, 711722.CrossRefGoogle ScholarPubMed
Plassman, B.L., Havlik, R., Steffens, D., Helms, M., Newman, T., Drosdick, D., & Burke, J. (2000). Documented head injury in early adulthood and risk of Alzheimer’s disease and other dementias. Neurology, 55(8), 11581166.CrossRefGoogle ScholarPubMed
Qiu, C., & Fratiglioni, L. (2015). A major role for cardiovascular burden in age-related cognitive decline. Nature Reviews. Cardiology, 12(5), 267277.CrossRefGoogle Scholar
Raymont, V., Salazar, A.M., Krueger, F., & Grafman, J. (2011). “Studying injured minds”–the Vietnam head injury study and 40 years of brain injury research. Frontiers in Neurology, 2, 15.CrossRefGoogle Scholar
Reitan, R.M., & Wolfson, D. (1985). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation (Vol. 4). Mesa, AZ: Reitan Neuropsychology.Google Scholar
Rey, A. (1941). L’examen psychologique dans les cas d’encéphalopathie traumatique.(Les problems.). Archives de psychologie.Google Scholar
Rochat, L., Ammann, J., Mayer, E., Annoni, J.M., & Linden, M. (2009). Executive disorders and perceived socio‐emotional changes after traumatic brain injury. Journal of Neuropsychology, 3(2), 213227.CrossRefGoogle ScholarPubMed
Sayer, N.A. (2012). Traumatic brain injury and its neuropsychiatric sequelae in war veterans. Annual Review of Medicine, 63, 405419.CrossRefGoogle ScholarPubMed
Scholten, A.C., Haagsma, J.A., Cnossen, M.C., Olff, M., Van Beeck, E.F., & Polinder, S. (2016). Prevalence and risk factors of anxiety and depressive disorders following traumatic brain injury: A systematic review. Journal of Neurotrauma, [Epub ahead of print].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(4), 341349.CrossRefGoogle Scholar
Selya, A.S., Rose, J.S., Dierker, L.C., Hedeker, D., & Mermelstein, R.J. (2012). A practical guide to calculating Cohen’s f2, a measure of local effect size, from PROC MIXED. Frontiers in Psychology, 3, 111.CrossRefGoogle ScholarPubMed
Setnik, L., & Bazarian, J.J. (2007). The characteristics of patients who do not seek medical treatment for traumatic brain injury. Brain Injury, 21(1), 19.CrossRefGoogle Scholar
Shirk, S.D., Mitchell, M.B., Shaughnessy, L.W., Sherman, J.C., Locascio, J.J., Weintraub, S., & Atri, A. (2011). A web-based normative calculator for the uniform data set (UDS) neuropsychological test battery. Alzheimer’s Research and Therapy, 3(6), 3232.CrossRefGoogle ScholarPubMed
Shively, S., Scher, A.I., Perl, D.P., & Diaz-Arrastia, R. (2012). Dementia resulting from traumatic brain injury: What is the pathology? Archives of Neurology, 69(10), 12451251.CrossRefGoogle ScholarPubMed
Smith, D.H., Johnson, V.E., & Stewart, W. (2013). Chronic neuropathologies of single and repetitive TBI: Substrates of dementia? Nature Reviews. Neurology, 9, 211221.CrossRefGoogle Scholar
Spitz, G., Maller, J.J., O’Sullivan, R., & Ponsford, J.L. (2013). White matter integrity following traumatic brain injury: The association with severity of injury and cognitive functioning. Brain Topography, 26(4), 648660.CrossRefGoogle ScholarPubMed
Stern, R.A., Daneshvar, D.H., Baugh, C.M., Seichepine, D.R., Montenigro, P.H., Riley, D.O., & McHale, L. (2013). Clinical presentation of chronic traumatic encephalopathy. Neurology, 81(13), 11221129.CrossRefGoogle ScholarPubMed
Taylor, E.M. (1959). Psychological appraisal of children with cerebral defects.Google Scholar
U.S. Department of Veterans Affairs, & National Center for PTSD. (2014). Using the PTSD Checklist for DSM-IV(PCL). Retrieved from http://www.ptsd.va.gov/professional/pages/assessments/assessment-pdf/PCL-handout.pdf.Google Scholar
Verma, M., & Howard, R. (2012). Semantic memory and language dysfunction in early Alzheimer’s disease: A review. International Journal of Geriatric Psychiatry, 27(12), 12091217.CrossRefGoogle ScholarPubMed
Wechsler, D. (1981). WAIS-R manual: Wechsler adult intelligence scale-revised. San Antonio, TX: Psychological Corporation.Google Scholar
Wechsler, D. (1987). WMS-R: Wechsler memory scale-revised. San Antonio, TX: Psychological Corporation.Google Scholar
Weintraub, S., Salmon, D., Mercaldo, N., Ferris, S., Graff-Radford, N.R., Chui, H., & Galasko, D. (2009). The Alzheimer’s disease centers’ uniform data set (UDS): The neuropsychological test battery. Alzheimer Disease and Associated Disorders, 23(2), 91.CrossRefGoogle Scholar
Yaffe, K., Vittinghoff, E., Lindquist, K., Barnes, D., Covinsky, K.E., Neylan, T., & Marmar, C. (2010). Posttraumatic stress disorder and risk of dementia among US veterans. Archives of General Psychiatry, 67(6), 608613.CrossRefGoogle Scholar
Yesavage, J.A., Brink, T., Rose, T.L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 3749.CrossRefGoogle Scholar
18
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Neuropsychological Profile of Lifetime Traumatic Brain Injury in Older Veterans
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Neuropsychological Profile of Lifetime Traumatic Brain Injury in Older Veterans
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Neuropsychological Profile of Lifetime Traumatic Brain Injury in Older Veterans
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *