Suchergebnisse

Of troops returning from Iraq and Afghanistan, approximately 5–20% have PTSD, and another 11–23% have traumatic brain injury (TBI). Cognitive-behavioral therapies (CBTs) are empirically validated treatment strategies for PTSD. However, cognitive limitations may interfere with the ability to adhere to, and benefit from, CBTs. Co-morbid TBI has not been systematically taken into consideration in PTSD outcome research or in treatment planning guidance. We hypothesized that poorer pre-treatment cognitive abilities would be associated with poorer treatment outcomes from CBTs for PTSD. The present study was a naturalistic examination of "treatment as usual" in an outpatient clinic that provides manualized CBTs for PTSD to military service members and veterans. Participants were 23 veterans aged 18–50 years with combat-related PTSD and symptom duration more than 1 year; 16 of whom had mild TBI. Our predictor variables were well-normed objective tests of cognitive ability measured at baseline; our outcome variables were: a) individual slopes of change of the PTSD Checklist 5 (PCL-5) and the Clinician Assessment of PTSD Scale (CAPS-5) over weeks of treatment; and b) pre- to post-treatment change (Δ) in PCL-5 and CAPS-5. Contrary to our prediction, neither pre-treatment cognitive performance, nor the presence of co-morbid mild TBI, predicted poorer response to CBTs for PTSD. Our results discourage any notion of excluding PTSD patients with poorer cognitive ability from CBTs. Study limitations include a naturalistic treatment design, which did not allow for control of confounders, and an inability to completely rule out type II error because of small sample size.

Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are signature injuries of the wars in Iraq and Afghanistan and have been linked to an increased risk of Alzheimer's disease (AD) and other dementias. A meeting hosted by the Alzheimer's Association and the Veterans' Health Research Institute (NCIRE) in May 2012 brought together experts from the U.S. military and academic medical centers around the world to discuss current evidence and hypotheses regarding the pathophysiological mechanisms linking TBI, PTSD, and AD. Studies underway in civilian and military populations were highlighted, along with new research initiatives such as a study to extend the Alzheimer's Disease Neuroimaging Initiative (ADNI) to a population of veterans exposed to TBI and PTSD. Greater collaboration and data sharing among diverse research groups is needed to advance an understanding and appropriate interventions in this continuum of military injuries and neurodegenerative disease in the aging veteran.