Research Letter: Blast Exposure and Brain Volume.

OBJECTIVE: To determine whether blast exposure is associated with brain volume beyond posttraumatic stress disorder (PTSD) diagnosis and history of traumatic brain injury (TBI). SETTING: Veterans Affairs Medical Center. PARTICIPANTS: One hundred sixty-three Iraq and Afghanistan combat veterans, 86.5% male, and 68.10% with a history of blast exposure. Individuals with a history of moderate to severe TBI were excluded. MAIN MEASURES: Clinician-Administered PTSD Scale (CAPS-5), Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), Salisbury Blast Interview (SBI), and magnetic resonance imaging. Maximum blast pressure experienced from a blast event represented blast severity. METHODS: Hierarchical regression analysis evaluated effects of maximum pressure experienced from a blast event on bilateral volume of hippocampus, anterior cingulate cortex, amygdala, orbitofrontal cortex, precuneus, and insula. All analyses adjusted for effects of current and lifetime PTSD diagnosis, and a history of deployment mild TBI. RESULTS: Maximum blast pressure experienced was significantly associated with lower bilateral hippocampal volume (left: ΔR2 = 0.032, P < .001; right: ΔR2 = 0.030, P < .001) beyond PTSD diagnosis and deployment mild TBI history. Other characteristics of blast exposure (time since most recent exposure, distance from closest blast, and frequency of blast events) were not associated with evaluated volumes. CONCLUSION: Exposure to a blast is independently associated with hippocampal volume beyond PTSD and mild TBI; however, these effects are small. These results also demonstrate that blast exposure in and of itself may be less consequential than severity of the exposure as measured by the pressure gradient.

Brain Volume in Veterans: Relationship to Posttraumatic Stress Disorder and Mild Traumatic Brain Injury.

OBJECTIVE: Clarify associations between diagnosis of posttraumatic stress disorder (PTSD) and deployment traumatic brain injury (TBI) on salient regional brain volumes in returning combat veterans. PARTICIPANTS: Iraq and Afghanistan era combat veterans, N = 163, 86.5% male. MAIN MEASURES: Clinician-administered PTSD Scale (CAPS-5), Mid-Atlantic MIRECC Assessment of TBI (MMA-TBI), magnetic resonance imaging. METHODS: Hierarchical regression analyses evaluated associations and interactions between current and lifetime PTSD diagnosis, deployment TBI, and bilateral volume of hippocampus, anterior cingulate cortex, amygdala, orbitofrontal cortex, precuneus, and insula. RESULTS: Deployment TBI was associated with lower bilateral hippocampal volume (P = .007-.032) and right medial orbitofrontal cortex volume (P = .006). Neither current nor lifetime PTSD diagnosis was associated with volumetric outcomes beyond covariates and deployment TBI. CONCLUSION: History of deployment TBI is independently associated with lower volumes in hippocampus and medial orbitofrontal cortex. These results support TBI as a potential contributing factor to consider in reduced cortical volume in PTSD.

Teleneuropsychology clinic development and patient satisfaction.

Objective: Telehealth offers the opportunity to address a growing need to improve access to specialty services, such as neuropsychology, particularly for older adults and those in rural areas. Initial research has examined the validity and acceptability of teleneuropsychology (teleNP) in research settings, but there is less information about teleNP implementation in clinical practice. Here we describe the development of a teleNP clinic and compare patient satisfaction to those completing in-person neuropsychological evaluations. Method: A teleNP clinic was developed at the VA Bedford Healthcare System to serve older Veterans with referral questions focused on cognitive aging concerns. Patients presented to affiliated VA satellite clinics and were connected to neuropsychology clinicians at the main hospital campus through synchronous video. An evaluation battery was compiled to closely approximate in-person evaluations. Trained staff members at the satellite clinic assisted with administration of select tasks. Patient satisfaction was evaluated using a self-report questionnaire and responses were compared to a group undergoing in-person neuropsychological evaluations. Results: Self-reported satisfaction was high for all aspects of the patient experience, with no significant difference found between teleNP (n = 67) and in-person (n = 64) groups. In particular, 90% of patients in the teleNP group and 98% of patients in the in-person group agreed or strongly agreed with the statement, "I was overall satisfied with this visit.". Conclusions: TeleNP is a feasible and acceptable alternative to traditional in-person neuropsychological evaluations in clinical practice focused on older adults. Future research should continue to validate evaluation measures used in telehealth settings, identify the populations that would benefit most from teleNP services, and explore the expansion of teleNP services.