The neuropsychology of co-occurring posttraumatic stress disorder, traumatic brain injury, and substance use disorders in OEF/OIF/OND veterans.
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Martindale, Sarah L.
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A significant minority of military personnel are returning from the wars in Iraq and Afghanistan with physical and psychological injuries that affect their cognitive functioning. Among these conditions, posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and substance use disorders (SUD) are frequently seen and commonly co-occur, complicating diagnosis and treatment. While our knowledge about the effects of these conditions on neuropsychological functioning is increasing, less is known about these impairments in veterans with either alone or in combination. Little to no information is available about specific effects of various combinations of these disorders on neuropsychological functioning in veterans, including executive functioning. The purpose of this study was to learn how symptoms of these conditions, and the complicating factors of sleep quality, anxiety symptoms, and depressive symptoms, affect cognitive functioning in OEF/OIF/OND veterans. A total of 129 veterans completed a 2.5-hour assessment of mental health and neuropsychological functioning. In the absence of PTSD symptoms, veterans with TBI and greater substance use problems had greater difficulties with attention. Additionally, PTSD symptoms were significantly associated with overall executive functioning regardless of presence of other conditions. Both PTSD symptoms and substance use problems were related to a type of complex attention (set loss errors) when TBI was absent, and TBI status was related to executive functioning (set-shifting) deficits. Finally, greater combat experiences were related to worse sleep quality that, in turn, negatively impacted processing speed and other neuropsychological functions. This study has implications for future research and treatment considerations in patients with symptoms of these conditions. First, executive functioning should be considered as a part of all neuropsychological batteries, and analyses may want to concentrate on individual aspects of executive functioning. Second, substance use problems have now shown to also impact cognitive functioning and should be considered in research. Third, combat experience has a negative impact on cognitive functioning, independent of other conditions, and exploring the effects of combat experiences can provide more information about veterans without symptoms, who still experience problems. Finally, neuropsychological deficits have behavioral consequences and an evaluation of neuropsychological functioning in veterans can aid in treatment planning.