Neuropsychological sequelae of PTSD and TBI following war deployment among OEF/OIF veterans

Abstract

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent among Veterans of the conflicts in Iraq and Afghanistan. These conditions are associated with common and unique neuropsychological and neuroanatomical changes. This review synthesizes neuropsychological and neuroimaging studies for both of these disorders and studies examining their co-occurrence. Recommendations for future research, including use of combined neuropsychological and advanced neuroimaging techniques to study these disorders alone and in concert, are presented. It is clear from the dearth of literature that addiitonal studies are required to examine and understand the impact of specific factors on neurocognitive outcome. Of particular relevance are temporal relationships between PTSD and mTBI, risk and resilience factors associated with both disorders and their co-occurrence, and mTBI-specific factors such as time since injury and severity of injury, utilizing comprehensive, yet targeted cognitive tasks.

Figures

Figure 1

Depiction of neural structures thought to be involved in combat-related PTSD. Here, the amygdala is depicted in red, the hippocampus in blue, and the anterior cingulate in green. The white matter tracts associated with PTSD are the uncinate fasciculus (shown as pink), the forceps minor and major (in yellow), and the anterior thalamic radiation (shown in cyan). Panels A and C are sagittal depictions. Panel B is an anterior view, and Panel D is a superior view of the cognitive-affective network implicated in PTSD.

Figure 2

White matters tracts susceptible to mTBI. These include the anterior limb of the internal capsule, the cingulum bundle, the middle cerebellar peduncle, and the uncincate fasciculus.

Figure 3

Neural structures that have been positively (red) or negatively (blue) associated with PTSD symptomatology. Regions in black have shown mixed results in the literature.