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Research Letter: TBI Severity Moderates the Association Between Subjective and Objective Attention in Older Veterans
Peter Rantins1, Monica Ly, Alexandra L Clark
1VA San Diego Healthcare System, San Diego, California (Mr Rantins, Drs Ly, Merritt, Bangen, and Thomas and Ms Alshaheri Durazo); San Diego State University, San Diego, California (Mr Rantins and Ms Alshaheri Durazo); Department of Psychiatry, University of California, San Diego, La Jolla (Drs Ly, Merritt, Bangen, and Thomas); Department of Psychology, University of Texas at Austin, Austin (Dr Clark); Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego (Ms Weigand); Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California (Dr Merritt).
Objective:
This study examined the moderating effect of traumatic brain injury (TBI) history on subjective and objective cognition across multiple cognitive domains.
Setting, Participants, And Design:
Participants included 242 Vietnam-era veterans with a history of no TBI (n = 86), mild TBI (n = 74), or moderate-to-severe TBI (n = 82) from the observational Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study.
Main Measures:
Objective cognition was the outcome and was measured using neuropsychological measures in the domains of memory, attention/executive functioning, and language. Subjective cognition was measured using the memory, divided attention, and language subscales from the Everyday Cognition (ECog) measure. TBI severity status was the moderating variable.
Results:
Veterans with a history of moderate-to-severe TBI had a stronger negative association between subjective and objective attention relative to participants without a TBI ( P = .002). Although this association did not differ between mild TBI and no TBI history groups ( P = .100), the association between subjective and objective attention for the mild TBI group was intermediate to the no TBI and moderate-to-severe TBI history groups. TBI status did not moderate associations between subjective and objective memory or language.
Conclusion:
Results highlight the importance of assessing subjective and objective cognition in older veterans and the relevance of attention in the context of TBI history. More work is needed to better understand the intersection of TBI and aging and how these factors may be used to guide individualized assessment and treatment approaches for older veterans.
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