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J Int Neuropsychol Soc. 2017 Jan;23(1):56-64. doi: 10.1017/S1355617716000849. Epub 2016 Oct 4.

Neuropsychological Profile of Lifetime Traumatic Brain Injury in Older Veterans.

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1Research Service,San Francisco VA Healthcare System and Department of Psychiatry,University of California San Francisco,San Francisco,California.
2NCIRE-The Veterans Health Research Institute and the San Francisco VA Healthcare System,San Francisco,California.
3Department of Neurology,Uniformed Services University of the Health Sciences,Rockville,Maryland.
4Departments of Neurology,University of California San Francisco,San Francisco,California.
5Departments of Psychiatry,Neurology,and Epidemiology and Biostatistics,University of California San Francisco and San Francisco VA Healthcare System,San Francisco,California.



The aim of this study was to characterize the neuropsychological profile of lifetime traumatic brain injury (TBI) in older Veterans.


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.


Compared to those without TBI, older Veterans with TBI had greater deficits in processing speed (estimate=-.52; p=.01; f 2=.08 in fully adjusted model) and executive functioning (estimate=-.41; p=.02; f 2=.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.


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).


Aging; Cognition; Cognitive deficits; Head injury; Traumatic brain injury; Veterans

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