Variables associated with subjective cognitive change among Iraq and Afghanistan war Veterans with blast-related mild traumatic brain injury

Justin E. Karr, Holly K. Rau, Jane B. Shofer, Rebecca C. Hendrickson, Elaine R. Peskind, Kathleen F. Pagulayan

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Introduction: This study investigated variables associated with subjective decline in executive function among Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) following a history of blast-related mild traumatic brain injury (mTBI). Method: Fifty-six male U.S. Veterans (MAge = 35.3 ± 8.8 years) with a history of blast-related mTBI (6.6 ± 3.2 years post injury) completed a battery of self-report questionnaires and neuropsychological measures. Participants rated current and retrospectively estimated pre-mTBI executive function difficulties on the Frontal Systems Behavior Scale (FrSBe). A difference score (post- minus pre-mTBI ratings) was the dependent variable (∆FrSBe). Linear regression models examined variables predicting ∆FrSBe, including: pre-injury characteristics (education, premorbid intelligence), injury-related characteristics (number of blast exposures, losses of consciousness), post-injury clinical symptoms (PTSD Checklist–Military version; Pittsburgh Sleep Quality Index), and post-injury neuropsychological performances on executive function measures (Trail Making Test Part B; Controlled Oral Word Association Test; Auditory Consonant Trigrams; Wisconsin Card Sorting Test). Results: While 11% of participants had a clinically elevated pre-injury FrSBe total score, 82% had a clinically elevated post-injury FrSBe total score. Only self-reported PTSD symptom severity independently predicted perceived change in executive function. Conclusions: Many OEF/OIF/OND Veterans with a history of blast-related mTBI experience subjective decline in executive function following injury. Perceived executive function decline was associated with higher PTSD symptom severity, aligning with previous research associating PTSD with cognitive complaints. Results did not support a correspondence between perceived cognitive change and neuropsychological performances.

Original languageEnglish
Pages (from-to)680-693
Number of pages14
JournalJournal of Clinical and Experimental Neuropsychology
Issue number7
StatePublished - Aug 9 2019

Bibliographical note

Funding Information:
This work was supported by Career Development Award #IK2CX000516 from the United States (U.S.) Department of Veterans Affairs Clinical Science Research and Development Service, Merit Review #I01 RX000521 from the U.S. Department of Veterans Affairs Rehabilitation Research and Development Service, the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, and the Veterans Affairs Northwest Network Mental Illness, Research, Education, and Clinical Center.

Publisher Copyright:
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.


  • Brain concussion
  • blast injury
  • executive function
  • mild traumatic brain injury
  • veteran

ASJC Scopus subject areas

  • Clinical Psychology
  • Neurology
  • Clinical Neurology


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