The relationships among premilitary vocational aptitude assessment, traumatic brain injury, and postdeployment cognitive functioning in combat veterans.

Traumatic brain injury (TBI) in Iraq and Afghanistan war veterans is frequently associated with a variety of complaints, including cognitive problems and posttraumatic stress disorder. In this study, the authors explored the predictive impact of premilitary cognitive abilities on postdeployment cognitive functioning, as mitigated by posttraumatic stress symptoms in a sample of veterans with and without history of TBI. Measures included clinical interview, neuropsychological tests, the PTSD Checklist-Military Version, and the Armed Services Vocational Aptitude Battery. In contrast to history of TBI, premilitary abilities and posttraumatic stress symptoms emerged as significant predictors of postdeployment cognitive deficits.

Dimensionality, reliability, and validity of the combat experiences scale.

Few studies have measured combat exposure during deployment to a war zone. Valid, reliable, and specific measurement is needed to broaden existing knowledge of combat experiences to accurately answer clinically important questions regarding postcombat treatment and recovery, particularly with the recognition of new kinds of combat and resulting psychological sequelae. The Combat Experiences Scale (CES) is a 33-item measure that assesses deployment-related experiences. The psychometrics of this measure, however, were undefined before this study. The purpose of this study was to examine aspects of internal and external validity of the CES. Data were collected as part of a study of 500 veterans of the conflicts in Iraq and Afghanistan across five Veterans Affairs medical centers in Upstate New York. An exploratory factor analysis suggested that three factors represented the scale well: Exposure to Combat Environment, Physical Engagement, and Proximity to Serious Injury and Death. The CES scores showed adequate internal consistency, and evidence for convergent validity and discriminant validity was also found. This study underscores the importance of casting a wide net with regard to the assessment of deployment-related experiences and provides evidence that probable post-traumatic stress disorder, depression, and anxiety are highly correlated with all forms of deployment-related experiences.

Psychometric study of the Neurobehavioral Symptom Inventory.

The Department of Veterans Affairs (VA) uses the Neurobehavioral Symptom Inventory (NSI) to measure postconcussive symptoms in its comprehensive traumatic brain injury (TBI) evaluation. This study examined the NSI's item properties, internal consistency, and external validity. Data were obtained from a federally funded study of the experiences of combat veterans. Participants included 500 Operations Iraqi and Enduring Freedom veterans, 219 of whom sustained at least one TBI. Data were collected at five VA medical centers and one VA outpatient clinic across upstate New York. Measures included neuropsychological interview, NSI, Beck Anxiety Inventory, Beck Depression Inventory-II, and Posttraumatic Stress Disorder Checklist-Military Version. The NSI demonstrated high internal consistency (total alpha = 0.95; subscale alpha = 0.88 to 0.92). Subscale totals based on Caplan et al.'s factor analysis correlated highly with the NSI total score (r = 0.88 to 0.93). NSI scores differentiated veterans with TBI history from those without but were strongly influenced by variance associated with probable posttraumatic stress disorder, depression, and generalized anxiety. Results suggest that the NSI is a reliable and valid measure of postconcussive symptoms. Scale validity is evident in the differentiation of TBI and non-TBI classifications. The scale domain is not limited to TBI, however, and extends to detection of probable effects of additional affective disorders prevalent in the veteran population.

Reliability, sensitivity, and specificity of the VA traumatic brain injury screening tool.

OBJECTIVE: To provide item analyses, estimates of temporal reliability and internal consistency, and examination of the sensitivity and specificity of a traumatic brain injury-screening tool. PARTICIPANTS: Five hundred veterans of the wars in Iraq and Afghanistan enrolled in the study, approximately half of whom (248) volunteered. The remaining 252 participants were referred to Veteran Affairs (VA) neuropsychology or polytrauma clinics. DESIGN: This psychometric study constitutes part of a larger 4-year, multisite prospective cohort study of veterans returning from Iraq and Afghanistan. SETTING: Five VA medical centers and one VA outpatient clinic. MAIN MEASURES: Veteran traumatic brain injury screening tool (VATBIST), a structured diagnostic interview for traumatic brain injury; a military-oriented posttraumatic stress disorder checklist. RESULTS: The VATBIST appeared to have high-internal consistency (0.77) and test-retest reliability (0.80), high sensitivity (0.94) and moderate specificity (0.59). Diagnostic odds ratios for the screening tool ranged from 12.6 for the total sample to 24, when veterans with probable posttraumatic stress disorder were excluded from analysis. CONCLUSIONS: The VATBIST appears to be a reliable and valid instrument. The presence of significant posttraumatic stress disorder symptoms, however, reduces the accuracy of the measure and highlights the need for careful clinical follow-up of persons who screen positive.

Semantic clustering indexes for the Hopkins Verbal Learning Test-Revised: initial exploration in elder control and dementia groups.

This study examined the validity of semantic clustering indexes developed for the Hopkins Verbal Learning Test-Revised (HVLT-R). Participants were healthy adults and patients diagnosed with probable dementia of the Alzheimer's type (DAT) or vascular dementia (VaD). Neuropsychological test records, which included the HVLT-R, were collected from an archival database. Ratio semantic clustering (RSC) scores were calculated for each HVLT-R recall trial. Factor analysis including RSC and other HVLT-R scores yielded high loadings of RSC scores on a distinct clustering factor. Group comparisons showed that normal controls had higher HVLT-R recall and RSC scores than DAT and VaD patients. Only the DAT group showed significant decline in RSC from the final learning trial to delayed recall, and only the DAT group performed more poorly than controls on other semantic processing measures (e.g., HVLT-R semantically-related false positives, Boston Naming Test). Results suggest that these newly developed semantic clustering indexes are easily calculated and potentially useful for discriminating between elder controls and dementia patients.