INS NYC 2024 Program

Poster	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #80 Exploring the Relationship Between Symptom Etiology and Subjective Cognition in Veterans with a History of Traumatic Brain Injury: Insights from the Million Veteran Program Erin Ozturk, San Diego State University/UC San Diego, San Diego, United States Catherine Chanfreau-Coffinier, VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, United States Victoria Merritt, VA San Diego Healthcare System (VASDHS), San Diego, United States Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult) Keyword 1: traumatic brain injury Keyword 2: cognitive functioning Keyword 3: concussion/ mild traumatic brain injury Objective: As a result of the high prevalence of traumatic brain injury (TBI) among Iraq/Afghanistan-era Veterans, the Veterans Health Administration (VHA) introduced a nationwide screening program in 2007 to systematically evaluate TBI following military deployment. This program, known as the “TBI Screening and Evaluation Program,” includes two components: (1) the TBI Clinical Reminder Screen (“TBI Screen”), a brief, 4-item TBI screener, and (2) the Comprehensive Traumatic Brain Injury Evaluation (“CTBIE”), a clinician-administered TBI interview. Any Veteran screening positive on the TBI Screen is referred to a TBI specialist who completes the CTBIE. At the conclusion of the CTBIE, the TBI specialist is responsible for making clinical determinations about the Veteran’s TBI diagnostic status as well as their current symptom etiology, assigning Veterans to one of five symptom etiology groups: TBI; Behavioral Health; Combination TBI and Behavioral Health (Comorbid); Symptom Resolution; or Other. Despite widespread clinical use of the CTBIE within the VHA, limited research has evaluated the prognostic utility of these symptom etiology assignments. The purpose of this study was to examine the relationship between clinician-rated TBI symptom etiology groupings and subjective cognition in a large sample of military Veterans enrolled in the Veterans Affairs Million Veteran Program (MVP). Participants and Methods: Participants included 2,453 Veterans who screened positive for TBI and underwent the CTBIE, often before MVP enrollment. Veterans completed the Medical Outcomes Study Cognitive Functioning Scale (MOS-Cog-R), a self-report measure of cognitive symptoms, upon enrollment in MVP. Analyses of covariance (ANCOVAs), adjusting for sociodemographic characteristics, were used to evaluate the association between clinician-rated symptom etiology group and the MOS-Cog-R total score (higher scores on the MOS-Cog-R reflect worse subjective cognitive functioning). Results: Participants were, on average, 40.2 years of age (SD=0.21) and the majority were male (87%). The average time between CTBIE completion and MVP enrollment was approximately 2 years. Participant distribution into the symptom etiology groups was: Behavioral Health (n=1,159; 47.2%); Comorbid (n=616; 25.1%); Other (n=369; 15.0%); Symptom Resolution (n=167; 6.8%); and TBI (n=142; 5.8%). Results showed a significant association of symptom etiology group with the MOS-Cog-R total score (p<.001, h_p²=.04). Specifically, Veterans in the Comorbid group endorsed the poorest subjective cognitive functioning (M=20.5, SD=0.32), followed by the Behavioral Health (M=19.3, SD=0.24), TBI (M=18.0, SD=0.68), Other (M=17.0, SD=0.43), and Symptom Resolution (M=14.7, SD=0.62) symptom etiology groups. Conclusions: The results of this epidemiological MVP study highlight that clinician-determined symptom etiology groupings from the CTBIE are indeed associated with subsequent functioning on the MOS-Cog-R, suggesting potential prognostic utility. Moreover, our results strengthen previous research indicating that comorbid TBI and behavioral health significantly contribute to the expression and maintenance of symptoms, especially in the chronic phase following TBI. Findings also underscore the significance of prioritizing mental health screenings and interventions for this susceptible group of Veterans. Follow-up analyses are planned to evaluate the genetic underpinnings of these findings in MVP.

Poster

02/15/2024
02:30 pm - 03:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #80

Exploring the Relationship Between Symptom Etiology and Subjective Cognition in Veterans with a History of Traumatic Brain Injury: Insights from the Million Veteran Program

Erin Ozturk, San Diego State University/UC San Diego, San Diego, United States
Catherine Chanfreau-Coffinier, VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, United States
Victoria Merritt, VA San Diego Healthcare System (VASDHS), San Diego, United States

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult)

Keyword 1: traumatic brain injury
Keyword 2: cognitive functioning
Keyword 3: concussion/ mild traumatic brain injury

Objective:

As a result of the high prevalence of traumatic brain injury (TBI) among Iraq/Afghanistan-era Veterans, the Veterans Health Administration (VHA) introduced a nationwide screening program in 2007 to systematically evaluate TBI following military deployment. This program, known as the “TBI Screening and Evaluation Program,” includes two components: (1) the TBI Clinical Reminder Screen (“TBI Screen”), a brief, 4-item TBI screener, and (2) the Comprehensive Traumatic Brain Injury Evaluation (“CTBIE”), a clinician-administered TBI interview. Any Veteran screening positive on the TBI Screen is referred to a TBI specialist who completes the CTBIE. At the conclusion of the CTBIE, the TBI specialist is responsible for making clinical determinations about the Veteran’s TBI diagnostic status as well as their current symptom etiology, assigning Veterans to one of five symptom etiology groups: TBI; Behavioral Health; Combination TBI and Behavioral Health (Comorbid); Symptom Resolution; or Other. Despite widespread clinical use of the CTBIE within the VHA, limited research has evaluated the prognostic utility of these symptom etiology assignments. The purpose of this study was to examine the relationship between clinician-rated TBI symptom etiology groupings and subjective cognition in a large sample of military Veterans enrolled in the Veterans Affairs Million Veteran Program (MVP).

Participants and Methods:

Participants included 2,453 Veterans who screened positive for TBI and underwent the CTBIE, often before MVP enrollment. Veterans completed the Medical Outcomes Study Cognitive Functioning Scale (MOS-Cog-R), a self-report measure of cognitive symptoms, upon enrollment in MVP. Analyses of covariance (ANCOVAs), adjusting for sociodemographic characteristics, were used to evaluate the association between clinician-rated symptom etiology group and the MOS-Cog-R total score (higher scores on the MOS-Cog-R reflect worse subjective cognitive functioning).

Results:

Participants were, on average, 40.2 years of age (SD=0.21) and the majority were male (87%). The average time between CTBIE completion and MVP enrollment was approximately 2 years. Participant distribution into the symptom etiology groups was: Behavioral Health (n=1,159; 47.2%); Comorbid (n=616; 25.1%); Other (n=369; 15.0%); Symptom Resolution (n=167; 6.8%); and TBI (n=142; 5.8%). Results showed a significant association of symptom etiology group with the MOS-Cog-R total score (p<.001, h_p²=.04). Specifically, Veterans in the Comorbid group endorsed the poorest subjective cognitive functioning (M=20.5, SD=0.32), followed by the Behavioral Health (M=19.3, SD=0.24), TBI (M=18.0, SD=0.68), Other (M=17.0, SD=0.43), and Symptom Resolution (M=14.7, SD=0.62) symptom etiology groups.

Conclusions:

The results of this epidemiological MVP study highlight that clinician-determined symptom etiology groupings from the CTBIE are indeed associated with subsequent functioning on the MOS-Cog-R, suggesting potential prognostic utility. Moreover, our results strengthen previous research indicating that comorbid TBI and behavioral health significantly contribute to the expression and maintenance of symptoms, especially in the chronic phase following TBI. Findings also underscore the significance of prioritizing mental health screenings and interventions for this susceptible group of Veterans. Follow-up analyses are planned to evaluate the genetic underpinnings of these findings in MVP.