Browsing by Author "Rosenblatt, Andrew S."
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Item An Investigation of Relationships between PTSD Symptoms, Blast Exposure, and Neuropsychological Outcomes among U.S. Veterans(2019-12) Rosenblatt, Andrew S.; Massman, Paul J.; Jorge, Ricardo; Woods, Steven P.; Gallagher, Matthew W.Previous studies of U.S. military veterans have consistently demonstrated a significant effect of increased PTSD on decreased neuropsychological functioning. While studies have not consistently demonstrated a relationship between combat-related blast exposure (BE) and neuropsychological outcomes, alterations in neuronal function of white matter pathways associated with cognitive function have been associated with greater BE severity. The aim of this study was to evaluate the effect of PTSD symptoms on neuropsychological functioning in a cohort of US military veterans from recent military conflicts (N=480), and to also examine the effects of PTSD symptom clusters (i.e., reexperiencing, avoidance, numbing, and hyperarousal symptoms) on neuropsychological functioning. An additional aim was to assess for a potential additive moderation effect of BE severity on the relationship between PTSD symptoms and neuropsychological functioning. These interrelationships were evaluated in a sample of 348 U.S. veterans (Mage=31.8 years, Meducation=14.0 years) via path analysis. Inclusion of BE severity as a moderator did not significantly increase the effect of PTSD on neuropsychological function, and effect sizes were small for each of the four neuropsychological domains after accounting for confounders (Attentional Processing Speed: R2=.066; Executive Function: R2=.038; Fine Motor Function: R2=.064; Verbal Memory: R2=.055). When examining the moderation effect of BE severity on PTSD symptom clusters, a small but significant moderation effect was found on the relationship between Avoidance symptoms and Executive Function (β=-.183 [95% CI=-.356, -.010], SE=.088, p<.05). BE severity did not have an additive effect for any other relationships between PTSD symptom clusters and neuropsychological performances. This study replicated the greater effect that PTSD symptoms have on neuropsychological functioning in comparison to combat-related BE. Differences in relationships between individual PTSD symptom clusters and neuropsychological outcomes supported ongoing investigation of symptom clusters rather than just total PTSD symptoms. Future studies of these conditions will benefit from use of structural equation modeling techniques in order to evaluate the effects of latent variables on these interrelationships.Item EVIDENCE FOR CLINICAL UTILITY OF NEUROPSYCHOLOGICAL DATA DESPITE PERFORMANCE VALIDITY FAILURES(2017-05) Rosenblatt, Andrew S.; Massman, Paul J.; Pastorek, Nicholas J.; Woods, Steven P.The purpose of this study was to examine neuropsychological performance by the number of PVT failures and the extent of failing performance on a PVT. Previous research has demonstrated that in relevant patient samples, performance validity tests (PVT’s) account for a significant amount of the variance in neuropsychological test performance, with relevant factors including the number of PVT failures and designated cut scores. The literature is unclear regarding recommendations for whether testing should continue despite evidence of test invalidity early in an assessment. However, patients with poor PVT performances often still perform within at least the average range on some measures (i.e., within normal limits, WNL), implicating the possibility of ruling out frank neuropsychological impairment despite PVT failures. 257 OEF/OIF/OND Veterans with a history of mild traumatic brain injury (mTBI) were seen for a comprehensive clinical neuropsychological evaluation. Standardized neuropsychological test scores were utilized to calculate global deficit scores (GDS), which were then used to classify individuals as neuropsychologically impaired or WNL. Placement in a PVT “pass” or “fail” group was determined by cutoffs of between 1 and 4+ out of 5 PVT fails. GDS was also compared when failure on the WMT or TOMM was determined by common cut scores or at-or-below chance level of performance. While chi-square analyses demonstrated significant relationships between GDS and PVT performance, moderately high rates of individuals with WNL GDS occurred among those failing multiple PVTs. The relationship between GDS and PVT failure severity was also found to be significant, and more modest yet notable rates of GDS falling WNL were observed even when PVT performance was at-or-below chance level. This study demonstrated that despite the relationship between PVT failures and poor neuropsychological performance, multiple PVT failures and at-or-below-chance level PVT performance may coincide with sufficient effort on other tests. These results demonstrate that neuropsychological test data may still be clinically useful even when multiple PVTs are failed even at-or-below chance level of performance.