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Neuropsychological Profile of Lifetime Traumatic Brain Injury in Older Veterans

Published online by Cambridge University Press:  04 October 2016

Allison R. Kaup ,
Carrie Peltz ,
Kimbra Kenney ,
Joel H. Kramer ,
Ramon Diaz-Arrastia  and
Kristine Yaffe
Allison R. Kaup*
Affiliation:
Research Service, San Francisco VA Healthcare System and Department of Psychiatry, University of California San Francisco, San Francisco, California
Carrie Peltz
Affiliation:
NCIRE-The Veterans Health Research Institute and the San Francisco VA Healthcare System, San Francisco, California
Kimbra Kenney
Affiliation:
Department of Neurology, Uniformed Services University of the Health Sciences, Rockville, Maryland
Joel H. Kramer
Affiliation:
Departments of Neurology, University of California San Francisco, San Francisco, California
Ramon Diaz-Arrastia
Affiliation:
Department of Neurology, Uniformed Services University of the Health Sciences, Rockville, Maryland
Kristine Yaffe
Affiliation:
Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco and San Francisco VA Healthcare System, San Francisco, California
*
Correspondence and reprint requests to: Allison R. Kaup, San Francisco VA Healthcare System, 4150 Clement Street, 116B, San Francisco, CA 94121. E-mail: [email protected]
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Abstract

Objectives: The aim of this study was to characterize the neuropsychological profile of lifetime traumatic brain injury (TBI) in older Veterans. Methods: Participants were 169 older Veterans [mean age=79.1 years (range, 51–97 years), 89% male, 92% Caucasian], 88 with lifetime TBI and 81 without TBI, living in Veterans’ retirement homes in independent residence. TBI history was ascertained with the Ohio State TBI Identification Method structured interview. Cognition was assessed with neuropsychological tests: Raw scores were converted to Z-scores compared to age-corrected normative data and combined into five domain composite Z-scores (attention/working memory, learning/memory, language, processing speed, executive functioning). We investigated the association between TBI and performance in each cognitive domain in linear mixed effects models, with and without adjustment for demographics, medical comorbidities, and psychiatric variables. Results: Compared to those without TBI, older Veterans with TBI had greater deficits in processing speed (estimate=−.52; p=.01; f2=.08 in fully adjusted model) and executive functioning (estimate=−.41; p=.02; f2=.06 in fully adjusted model) but performed similarly in the attention/working memory, learning/memory, and language domains (all p>.05). TBI-associated deficits were most prominent among individuals with multiple mild TBIs and those with any moderate-to-severe TBI, but were not clearly present among those with single mild TBI. Conclusions: The neuropsychological profile of lifetime TBI in older Veterans is characterized by slowed processing speed and executive dysfunction, especially among those with greater injury burden. This pattern may reflect long-standing deficits or a TBI-associated cognitive decline process distinct from Alzheimer’s disease. (JINS, 2017, 23, 56–64)

Keywords

Traumatic brain injuryHead injuryAgingVeteransCognitionCognitive deficits
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 23 , Issue 1 , January 2017 , pp. 56 - 64
Copyright
Copyright © The International Neuropsychological Society 2016. This is a work of the U.S. Government and is not subject to copyright protection in the United States. 

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