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Discriminating Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Using Latent Neuroimaging and
Nicola L de Souza1, Carrie Esopenko, Yuane Jia
1School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, New Jersey (Dr de Souza); Departments of Rehabilitation and Movement Sciences (Dr Esopenko) and (Drs Jia and Parrott), School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey; Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah (Dr Merkley); Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City (Drs Merkley, Dennis, Wilde, and Tate and Ms Velez); George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah (Drs Dennis, Wilde, and Tate); Department of Psychology, Pennsylvania State University, University Park, and Social Life and Engineering Sciences Imaging Center, University Park, Pennsylvania (Dr Hillary); San Antonio VA Polytrauma Rehabilitation Center, San Antonio, Texas, and Departments of Rehabilitation Medicine and Psychiatry, UT Health San Antonio, San Antonio, Texas (Dr Cooper); TBI Center of Excellence at Joint Base San Antonio, Ft. Sam Houston, Texas AND Contractor, General Dynamics Information Technology, Silver Spring, Maryland (Dr Kennedy); Neurology Clinic, Wright Patterson Air Force Base, Wright Patterson AFB, Ohio (Dr Lewis); Alaska Radiology Associates, Anchorage, Alaska (Dr York); Michael E. DeBakey VA Medical Center, Houston, Texas (Dr Menefee); The Menninger Department of Psychiatry and Behavioral Sciences (Dr Menefee), Department of Neurology (Dr McCauley), H. Ben Taub Department of Physical Medicine and Rehabilitation (Drs McCauley and Wilde), and Department of Pediatrics (Dr McCauley), Baylor College of Medicine, Houston, Texas; and Brain Injury Rehabilitation Service, Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas (Dr Bowles). Drs de Souza and Esopenko are now at the Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York.
Objective:
Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) commonly occur among military Service Members and Veterans and have heterogenous, but also overlapping symptom presentations, which often complicate the diagnoses of underlying impairments and development of effective treatment plans. Thus, we sought to examine whether the combination of whole brain gray matter (GM) and white matter (WM) structural measures with neuropsychological performance can aid in the classification of military personnel with mTBI and PTSD.
Methods:
Active-Duty US Service Members ( n = 156; 87.8% male) with a history of mTBI, PTSD, combined mTBI+PTSD, or orthopedic injury completed a neuropsychological battery and T1- and diffusion-weighted structural neuroimaging. Cortical, subcortical, ventricular, and WM volumes and whole brain fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated. Latent profile analyses were performed to determine how the GM and WM indicators, together with neuropsychological indicators, classified individuals.
Results:
For both GM and WM, respectively, a 4-profile model was the best fit. The GM model identified greater ventricular volumes in Service Members with cognitive symptoms, including those with a diagnosis of mTBI, either alone or with PTSD. The WM model identified reduced FA and elevated RD in those with psychological symptoms, including those with PTSD or mTBI and comorbid PTSD. However, contrary to expectation, a global neural signature unique to those with comorbid mTBI and PTSD was not identified.
Conclusions:
The findings demonstrate that neuropsychological performance alone is more robust in differentiating Active-Duty Service Members with mTBI and PTSD, whereas global neuroimaging measures do not reliably differentiate between these groups.
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