Cognitive "success" in the setting of performance validity test failure.

Background: Although studies have shown unique variance contributions from performance invalidity, it is difficult to interpret the meaning of cognitive data in the setting of performance validity test (PVT) failure. The current study aimed to examine cognitive outcomes in this context.

Method: Two hundred and twenty-two veterans with a history of mild traumatic brain injury referred for clinical evaluation completed cognitive and performance validity measures.

A pilot study of olfactory function in veterans with a history of deployment-related mild traumatic brain injury.

Olfactory impairment in military populations is highly prevalent and often attributed to the long-term effects of mild traumatic brain injury (mTBI) and chronic psychiatric disorders. The main goal of this investigation was to examine olfactory function in a cohort of combat veterans using a quantitative smell test.Participants underwent a neurological examination, completed performance validity testing (PVT), provided deployment history, and their medical records were reviewed.

Varying failure criteria on performance validity tests influences interpretation of cognitive outcomes.

Objective: The present study examined the effects of applying various performance validity tests (PVT) failure criteria on the relationship between cognitive outcomes and posttraumatic stress (PTS) symptomology.

Method: One hundred and ninety-nine veterans with a history of mild traumatic brain injury referred for clinical evaluation completed cognitive tests, PVTs, and self-report measures of PTS symptoms and symptom exaggeration. Normative T scores of select cognitive tests were averaged into memory, attention/processing speed, and executive functioning composites.

Harmonizing PTSD severity scales across instruments and sites.

Objective: The variety of instruments used to assess posttraumatic stress disorder (PTSD) allows for flexibility, but also creates challenges for data synthesis. The objective of this work was to use a multisite mega analysis to derive quantitative recommendations for equating scores across measures of PTSD severity.

Method: Empirical Bayes harmonization and linear models were used to describe and mitigate site and covariate effects.

Risk factors for decline in cognitive performance following deployment-related mild traumatic brain injury: A preliminary report.

Thorough identification of risk factors for delayed decline in cognitive performance following combat-related mild traumatic brain injury (mTBI) is important for guiding comprehensive post-deployment rehabilitation. In a sample of veterans who reported at least one deployment-related mTBI, preliminary results indicate that factors including a history of loss of consciousness over 1 min, current obesity and hypertension, and Black race were more prevalent in those with decreased scores on a measure of memory function. These factors should be considered by clinicians and researchers working with current and former military personnel.

Role of deployment-related mTBI and resilience in perceived participation limitations among Veterans.

Problems with social functioning are common following combat deployment, and these may be greater among individuals with a history of traumatic brain injury (TBI). The present investigation examined the impact of mild TBI (mTBI), deployment-related characteristics, and resilience on perceived participation limitations among combat Veterans. This was a cross-sectional study of 143 participants with a history of at least one deployment-related mTBI (TBI group) and 80 without a history of lifetime TBI (Comparison group).

Predictive utility of the Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) in differentiating psychogenic nonepileptic seizures and epileptic seizures in male veterans.

Objective: While psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) often present similarly, they are etiologically distinct, and correct diagnosis is essential for ensuring appropriate treatment and improving outcomes. The Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) may assist in differential diagnosis, but prior investigations have been limited by disproportionately female samples, inconsistent accounting for profile invalidity, and limited intra-scale variability from dichotomizing variables. The current investigation addressed these gaps by assessing diagnostic utility of the MMPI-2-RF in differentiating PNES and ES in a male sample of veterans while conservatively accounting for profile invalidity and using a statistical approach that allows for consideration of continuous independent variables to better appreciate intra-scale variance.

Vocational Rehabilitation in the Veterans Health Administration Polytrauma System of Care: Current Practices, Unique Challenges, and Future Directions.

Objective/purpose: Veterans and service members (V/SMs) with traumatic brain injury (TBI) and comorbid conditions are treated in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC). These V/SMs comprise a unique population with distinct needs for restoring community reintegration, including participation in meaningful employment. Low employment rates after TBI vary and are influenced by many factors.

Providing Care for Comorbid Mental Health Conditions in the Polytrauma System of Care.

Objective: To summarize challenges and best practices relevant to providing care for mental health comorbidities in veterans and service members (V/SM) treated in the Polytrauma System of Care (PSC) and to review themes that emerged during a May 2017 meeting of rehabilitation professionals on this topic. Management of comorbid mental health conditions remains a critical issue within the PSC, given the high rate of these comorbidities and the impact of mental health conditions on treatment planning and outcomes.

Design: To identify the challenges of concomitantly treating TBI-related symptoms and mental health comorbidities in V/SM treated within the PSC, describe specialty programs within the Veterans Health Administration designed to treat these comorbid conditions, and report on the themes and recommendations identified by rehabilitation professionals at the 2017 meeting.

Detection of symptom over-reporting on the Neurobehavioral Symptom Inventory in OEF/OIF/OND veterans with history of mild TBI.

Objective: As part of routine care at Veterans Affairs facilities, veterans with a service-related traumatic brain injury (TBI) are administered a self-report post-concussive symptom measure, the Neurobehavioral Symptom Inventory (NSI). Interpreting the NSI can be problematic given that over-reporting on self-report measures is often found in both civilian and military patient populations. This study investigates embedded scales on the NSI that identify possible and probable symptom exaggeration.

Delivery of mental health treatment to combat veterans with psychiatric diagnoses and TBI histories.

Traumatic brain injury (TBI) and mental health (MH) disorders are prevalent in combat veterans returning from Afghanistan and/or Iraq (hereafter referred to as returning veterans). Accurate estimates of service utilization for veterans with and without TBI exposure (referred to as TBI history) are imperative in order to provide high quality healthcare to returning veterans. We examined associations between TBI history and MH service utilization in a subsample of returning veterans who were newly diagnosed with posttraumatic stress disorder (PTSD), depression, and/or anxiety in the 2010 fiscal year (N = 55,458).

Choosing appropriate comparison group participants in studies of veterans: Characteristics of orthopedically injured and uninjured Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans.

Introduction: Research addressing deployment-related traumatic brain injury (TBI) is fairly complex due to a high prevalence of comorbid conditions, multiple exposures, and the lack of acute medical records. Therefore, there is a need for a well-defined, matching comparison group. This study compared deployment-related characteristics, everyday functioning, and cognitive performance in recently deployed veterans who had not sustained any injuries with those who had orthopedic injuries during deployment, but who were without a history of TBI.

Factors related to satisfaction with life in veterans with mild traumatic brain injury.

Purpose/objective: Satisfaction with life (SWL) is an important measure of outcome in rehabilitation. Previous research suggests that those with a history of traumatic brain injury (TBI), even mild TBI, report lower levels of life satisfaction when compared with the noninjured population. Although is it possible that TBI has a direct effect on SWL, various medical and psychosocial factors commonly affecting those recovering from TBI likely contribute to SWL.

Relative Utility of Performance and Symptom Validity Tests.

This investigation adds to the burgeoning body of research concerned with discriminating performance and symptom validity tests (SVTs) through examination of their differential relationships with cognitive performance and symptom self-report measures. To the authors' current knowledge, prior studies have not assessed differences between participants who fail either a performance validity test (PVT) or an SVT but not both. As part of their neuropsychological evaluations at four Veterans Affairs medical centers across the United States, participants were administered a fixed, standardized battery that consisted of performance validity, symptom validity, cognitive performance, and symptom self-report measures.

Comparison of domain-specific cognitive function after carotid endarterectomy and stenting.

Background: Observational data indicate that carotid artery stenting (CAS) is associated with higher incidence of subclinical cerebral microemboli than carotid endarterectomy (CEA). We hypothesized that CEA would be associated with superior performance on detailed domain-specific cognitive testing compared with CAS.

Methods: Patients with >80% asymptomatic carotid artery stenosis were randomized to CEA or CAS with side of stenosis balanced across condition.

Factors Associated with Word Memory Test Performance in Persons with Medically Documented Traumatic Brain Injury.

Objectives: (1) To examine the rate of poor performance validity in a large, multicenter, prospectively accrued cohort of community dwelling persons with medically documented traumatic brain injury (TBI), (2) to identify factors associated with Word Memory Test (WMT) performance in persons with TBI.

Method: This was a prospective cohort, observational study of 491 persons with medically documented TBI. Participants were administered a battery of cognitive tests, questionnaires on emotional distress and post-concussive symptoms, and a performance validity test (WMT).

A Factor Analytic Approach to the Validation of the Word Memory Test and Test of Memory Malingering as Measures of Effort and Not Memory.

Research has demonstrated the utility of performance validity tests (PVTs) as a method of determining adequate effort during a neuropsychological evaluation. Although some studies affirm that forced-choice PVTs measure effort rather than memory, doubts remain in the literature. The purpose of the current study was to evaluate the relationship between effort and memory variables in a mild traumatic brain injury (TBI) sample (n = 160) by separating memory and effort as distinct factors while statistically controlling for the shared covariance between the variables.

The suppression of brain activation in post-deployment military personnel with posttraumatic stress symptoms.

Previous research using cognitive paradigms has found task-related activation that includes prefrontal brain structures and that is attenuated in association with posttraumatic stress symptoms (PTSS). The present investigation used a cognitive control paradigm, the Arrows Task, to study subjects who had not sustained a traumatic brain injury during deployment and who had a wide range of scores on the Posttraumatic Stress Disorder Checklist (PCL). During the Arrows Task there was no significant activation within the full sample of 15 subjects, but deactivation was found within areas that are likely to be involved in cognitive control, including the dorsal anterior cingulate gyrus and parietal cortex.

Combat exposure, PTSD symptoms, and cognition following blast-related traumatic brain injury in OEF/OIF/OND service members and Veterans.

Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are frequently documented among the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans. This study will investigate both combat exposure and PTSD as factors that may influence objective cognitive outcomes following blast-related mild TBI (mTBI). Participants included 54 OEF/OIF/OND veterans who had been exposed to blast and reported symptoms consistent with mTBI and 43 combat-deployed control participants who had no history of blast exposure or TBI.

Neuropsychological and behavioral correlates of impulsiveness in veterans with and without mild traumatic brain injury.

Introduction: Previous research has identified a relation between impulsiveness and substance use, as well as performance on certain tests of executive functioning. However, no prior research has investigated these relations in Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn (OEF/OIF/OND) veterans with and without a history of mild traumatic brain injury (mTBI).

Method: The present study utilized a sample of 127 veterans (55 controls, 72 mTBI).

Accuracy of self-reported length of coma and posttraumatic amnesia in persons with medically verified traumatic brain injury.

Objective: To determine the accuracy of self-reported length of coma and posttraumatic amnesia (PTA) in persons with medically verified traumatic brain injury (TBI) and to investigate factors that affect self-report of length of coma and PTA duration.

Design: Prospective cohort study.

Setting: Specialized rehabilitation center with inpatient and outpatient programs.

The dangers of failing one or more performance validity tests in individuals claiming mild traumatic brain injury-related postconcussive symptoms.

Evaluating performance validity is important in any neuropsychological assessment, and prior research recommends a threshold for invalid performance of two or more performance validity test (PVT) failures. However, extant findings also indicate that failing a single PVT is associated with significant changes in neuropsychological performance. The current study sought to determine if there is an appreciable difference in neuropsychological testing results between individuals failing different numbers of PVTs.

Effect of clinical characteristics on cognitive performance in service members and veterans with histories of blast-related mild traumatic brain injury.

Objective: To examine the relationship between clinical characteristics and cognitive performance in service members and veterans with histories of blast-related mild traumatic brain injury (mTBI).

Design: This study consisted of 40 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) service members and veterans; 20 participants reported blast exposure and alteration of mental status consistent with mTBI and 20 participants denied blast exposure and had no history of traumatic brain injury (TBI), but could have experienced extra-cranial injuries. Measures of simple reaction time, processing speed, visual attention, working memory and mathematical processing were used to assess long-term effects of mTBI.

Clinician versus Veteran ratings on the Mayo-Portland Participation Index in veterans with a history of mild traumatic brain injury.

Background: The Department of Veterans Affairs is encouraging administration of the Mayo-Portland Adaptability Inventory-4 Participation Index (M2PI) to identify long-term psychosocial outcomes of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with a history of traumatic brain injury (TBI).

Objective: To evaluate clinician and Veteran interrater reliability and how response validity influences M2PI item ratings.

Participants: A total of 122 OEF/OIF/OND Veterans who reported a history consistent with mild TBI during deployment and were referred for neuropsychological evaluation following Comprehensive TBI Evaluation.

Ecological validity of performance validity testing.

Performance validity tests (PVTs) have been shown to relate to neuropsychological performance, but no studies have looked at the ecological validity of these measures. Data from 131 veterans with a history of mild traumatic brain injury from a multicenter Veterans Administration consortium were examined to determine the relation between scores on a self-report version of the Mayo-Portland Adaptability Inventory Participation Index, a measure of community participation, and the Word Memory Test, a PVT. A restricted regression model, including education, age, history of loss of consciousness, cognitive measures, and a measure of symptom validity test performance, was not significantly associated with self-reported community reintegration.