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TABLE 4. On the basis of review of available literature, a recent IOM report concluded that the presence, degree, and nature of cognitive impairments depend on the severity of the brain injury. Brailey conducted a prospective and longitudinal study that examined the effects of mild TBI on postdeployment cognitive performance.

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Although Grieger et al. Figure 4. The next published study was a controlled case series of four veterans who had a history of multiple blast or concussive injuries Goldstein et al. Several authors have tried to address the conceptual seeking of comorbidities, the controversy, and the causes for the complexity of the problem Kennedy et al.

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Pathologic findings were similar in two other case series of professional athletes McKee et al. The controversy centers on whether physical and emotional health-related symptoms and other adverse psychosocial outcomes reported sseking soldiers who have mild TBI and PTSD are due to the aftermath of the emotional trauma or to neurologic consequences of the mild TBI itself.

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A IOM report on TBI concludes that there is limited but suggestive evidence of an association between TBI of all severity levels and decreased drug and alcohol use, relative to preinjury use, in the 1—3 years after the TBI. Youngsr recently, the diagnosis has been extended to combat veterans.

Returning home from iraq and afghanistan: assessment of readjustment needs of veterans, service members, and their families.

The indicate that The suggestion is that the PCS might result from stress reactions after TBI rather than from the neurologic trauma itself Bryant, Current scientific research has yielded insufficient evidence to answer that important diagnostic question. In a more recent study of over 2, postdeployment active-duty service members, those who reported LOC had the highest rate of PTSD Those who reported one or more TBIs in their most recent deployment were divided into those reporting current symptoms and those who had no current symptoms at the postdeployment evaluation.

Another review notes that psychiatric disorders can contribute to disability in TBI and delay recovery Silver et al. For instance, Bombardier et al.

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Findings of a study indicate that Many of those who receive diagnoses of the outcomes discussed in this chapter will need support from family members and friends, treatment, and programs to assist them. Our diagnostic systems cannot capture that level of complexity youger, so we apply multiple diagnoses such as depression, PTSD, and TBI in our attempts to capture what is observed in the individual patient.

Traumatic Brain Injury and Social Functioning in Active-Duty Personnel and Veterans of Wars and in Civilians A recent review by IOM concluded that TBI j have adverse effects on all aspects of social functioning, including employment, social relationships, independent living, functional status, and leisure activities. Still, it is important to note that Brailey did not find a ificant association between tounger TBI and neuropsychologic performance even before adjusting for other factors, such as PTSD Vasterling et al.

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Ramchand et al. Depression was associated with brain injury and LOC Wilk et al. The committee focused on those outcomes as TBI and mental-health disorders were highlighted in the qomen directing its task. The of research on the cognitive effects of penetrating brain injuries in military populations in wars clearly and consistently show a decline in cognitive functioning as a result of brain injury Corkin et al.

Another complicating factor is a determination of the of possible TBIs and when they were sustained. The prevalence of PTSD before deployment was 5.

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Similar rates were reported in a very mild Amnsell sample 6 months after injury Bell et al. Studies that have examined other factors in relation to symptom reporting have concluded that symptom reporting is not specific to TBI alone and may be related to other co-occurring conditions or distressing experiences. The association could not be totally explained by depression before injury Fann et al.

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Positive responses on any two of the four questions indicated PTSD. TBI is often classified according to severity: mild, moderate, or severe. TBIs can also be penetrating or closed head injuries.

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Predictors of postdeployment cognitive outcome were entered into the regression in steps starting with the relevant predeployment cognitive function; then demographics, mild TBI, and emotional status such as PTSD or depression or deployment risk and resilience inventory ; and finally interactions between mild TBI and emotional status. DOD conducted a mental-health survey of Army soldiers and marines deployed in Iraq in, and The authors noted that PTSD prevalence in other Western countries is typically lower than in the United States, and they attributed that finding to differences in combat experience and in methods used to estimate prevalence and to sociopolitical and cultural factors.

For example, many studies have reported that lower IQ before trauma is associated with a higher risk of PTSD and other psychologic womeh Breslau et al.

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Neuropsychologic impairments were no longer found when testing occurred later than 7—10 days after injury. Those who reported no TBI or seekimg important injury during their most recent deployment formed the control group of 8, Furthermore, many of the studies of mild Youngee have involved small groups of subjects receiving clinical services typically in the VA health care system Belanger et al.

There are important contextual distinctions between civilian and combat trauma that might influence the difference in prevalence of the comorbidity of PTSD and TBI. A recent longitudinal study of a National Guard brigade combat team found much lower rates of mild TBI in theater than studies Polusny et al.

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The authors administered an adapted version of the Defense and Veterans Brain Injury Center screening tool to determine probable mild TBI in a large group of soldiers still in Iraq who would be returning from deployment in about 1 month and then again 1 year after their return from deployment. The subsections below discuss outcomes associated with mild TBI and outcomes of conditions that appear to be comorbid with mild TBI. It is hypothesized that some areas of the brain—including the hippocampus, amygdala, and medial and prefrontal cortex—are typically damaged in TBI and implicated in the development of PTSD; this suggests a common origin of the overlapping symptom profile Kennedy et al.

Delayed memory and fluency were the types of cognition most affected by mild TBI when measured less than 3 months after injury. A year later, the same investigators reported on a second autopsy case of a football player Frajpton et al.

Organization of the chapter

The determination of probable mild TBI in an active-duty soldier is by necessity through self-reporting with little or no acute-injury information from the field seekjng accompany or substantiate the diagnosis. ing for, understanding, and reconciling those differences to provide the insights and answers needed for effective public policy, prevention, treatment and readjustment purposes has proved difficult.

The first autopsy study appeared in and included findings in a professional football player 12 years after retirement. The 1, service members who reported having sustained one or more TBIs in the 4 years before deployment were excluded. The issue of comorbidity is a recurring theme in this chapter and adds complexity to a study of outcomes.