Suboptimal Incorporation of Context during Decision Making in Post-9/11 Veterans with Chronic Comorbid Blast mTBI and PTSD
Year: 2025
Type: preprint
Study design: Observational Study
Abstract: Background. Cognitive decrements (executive function, processing speed) have been found in post-9/11 Veterans who have mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD). Decision making (DM) involves the coordination of cognitive sub-processes involving different brain regions known to be impacted by mTBI and/or PTSD, and so may be expected to be compromised. However, DM abilities, including DM that requires taking context into account, are not typically assessed or investigated in Veterans. The ability to incorporate context is important because it plays a role in almost every cognitive and social process.Methods. In the current study, Veterans with mTBI and comorbid PTSD (mTBI+PTSD) and Veterans without mTBI or PTSD performed the Cognitive Bias Task, a DM task in which participants are asked to make a decision based on preference, and the extent to which choices are influenced by contextual information is measured. To further understand any association between DM and mTBI+PTSD, participants also filled out questionnaires to measure postconcussive and PTSD symptoms. To limit heterogeneity in small samples, Veterans were screened to have: no TBI prior to deployment, mTBI due to blast only, current PTSD (diagnosed within 6 months), and be under 55 years of age.Results. While Veterans without mTBI+PTSD based their choices on the provided context, Veterans with mTBI+PTSD did not, p=.034), similar to individuals with severe TBI and frontal lesions. As expected, Veterans with mTBI+PTSD also demonstrated elevated scores on the symptom measures. Scores reflecting the extent to which context impacted decisions were significantly negatively associated with cognitive and somatic postconcussive and PTSD arousal symptoms across groups. Conclusions. Veterans whose mTBI was due to only blast explosion(s) an average of 3.77 years after injury and who had active PTSD (mTBI+PTSD) and reported elevated cognitive and somatic postconcussive and arousal symptoms did not incorporate contextual information when making their decisions. Because understanding context is required in many everyday activities, if findings replicate in studies with larger samples, cognitive training for context assimilation may contribute to improving everyday life in Veterans.
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7117560980
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