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The effects of combat-related mild traumatic brain injury (mTBI): Does blast mTBI history matter?
Anthony P Kontos1, R J Elbin, Russ S Kotwal
1From the Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical College Sports Medicine Concussion Program (A.P.K., M.W.C.), Pittsburgh, Pennsylvania; Office for Sport Concussion Research (R.E.), University of Arkansas, Fayetteville, Arkansas; Joint Trauma System (R.S.K.), US Army Institute of Surgical Research, Joint Base, San Antonio, Texas; and US Army Special Operations Command (R.H.L., S.K., P.J.B.), Fort Bragg, North Carolina; US Army Pacific (R.D.F.), Fort Shafter, Hawaii.
Background:
The effects of mild traumatic brain injury (mTBI) have received significant attention since the beginning of the conflicts in Afghanistan and Iraq. Surprisingly, little is known about the temporal nature of neurocognitive impairment, mTBI, and posttraumatic stress (PTS) symptoms following combat-related mTBI. It is also unclear as to the role that blast exposure history has on mTBI and PTS impairments and symptoms. The purposes of this study were to examine prospectively the effects of mTBI on neurocognitive performance as well as mTBI and PTS symptoms among US Army Special Operations Command personnel and to study the influence of history of blast mTBI on these effects.
Methods:
Eighty US Army Special Operations Command personnel with (n = 19) and without (n = 61) a history of blast-related mTBI completed the military version of the Immediate Post-concussion Assessment Cognitive Test (ImPACT), Post Concussion Symptom Scale (PCSS), and the PTSD Checklist (PCL) at baseline as well as 1 day to 7 days and 8 days to 20 days following a combat-related mTBI.
Results:
Results indicated that verbal memory (p = 0.002) and processing speed (p = 0.003) scores were significantly lower and mTBI symptoms (p = 0.001) were significantly higher at 1 day to 7 days after injury compared with both baseline and 8 days to 20 days after injury. PTS remained stable across the three periods. Participants with a history of blast mTBI demonstrated lower verbal memory at 1 day to 7 days after mTBI compared with participants without a history of blast mTBI (p = 0.02).
Conclusion:
Decreases in neurocognitive performance and increased mTBI symptoms are evident in the first 1 day to 7 days following combat-related mTBI, and a history of blast-related mTBI may influence these effects.
Level Of Evidence:
Epidemiologic/prognostic study, level II.
Insights
Mild traumatic brain injury (mTBI) impairs neurocognitive function and increases symptoms in the first week after combat. A history of blast exposure may worsen these effects, impacting verbal memory.
Area of Science:
- Neuroscience
- Military Medicine
- Traumatology
Background:
- Combat-related mild traumatic brain injury (mTBI) is prevalent in military conflicts.
- Limited understanding exists regarding the temporal dynamics of neurocognitive deficits and posttraumatic stress (PTS) symptoms post-mTBI.
- The influence of blast exposure history on mTBI outcomes requires further investigation.
Purpose of the Study:
- To prospectively evaluate the impact of mTBI on neurocognitive performance and symptomology in special operations personnel.
- To assess the influence of blast exposure history on mTBI and PTS-related outcomes.
Main Methods:
- Prospective cohort study involving 80 US Army Special Operations personnel.
- Utilized the Immediate Post-concussion Assessment Cognitive Test (ImPACT), Post Concussion Symptom Scale (PCSS), and PTSD Checklist (PCL).
- Assessments conducted at baseline, 1–7 days, and 8–20 days post-combat-related mTBI.
Main Results:
- Significant declines in verbal memory and processing speed were observed 1–7 days post-mTBI compared to baseline and later periods.
- mTBI symptoms were significantly elevated during the 1–7 day post-injury window.
- Posttraumatic stress symptoms remained stable across assessment periods.
- Individuals with a history of blast mTBI exhibited lower verbal memory scores at 1–7 days post-injury.
Conclusions:
- Combat-related mTBI leads to transient neurocognitive deficits and increased symptom burden within the first week.
- A history of blast exposure may exacerbate neurocognitive impairments following mTBI.
- Findings highlight the importance of early assessment and monitoring of personnel following combat-related mTBI.
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