Gulf War Medical before Psych Brain

American Congress of Rehabilitation Medicine Criteria
Definition of Mild TBI
 Traumatically induced physiologic disruption of
brain function as indicated by at least one of the
following:
 Any period of loss of consciousness
 Any loss of memory for events immediately before or after the
accident
 Any alteration in mental state at the time of the accident
 Focal neurologic deficits that may or may not be transient
 Severity of the injury does not exceed:
 Loss of consciousness of 30 min
 GCS score of 13-15 after 30 min
 Posttraumatic amnesia of 24 hr
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Postconcussion Symptoms
 Physical
 Headache, dizziness, fatigue, noise/light
intolerance, insomnia
 Cognitive
 Memory complaints, poor concentration
 Emotional
 Depression, anxiety, irritability, lability

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Mild TBI:
Five Meta-analytic Studies: I
(Binder, Rohling, & Larrabee, 1997; Binder & Rohling,
1996; respectively)
 Found the long-term cognitive impairment
effect size for mild TBI was very small (0.1 -
0.2) and not statistically significant
 In contrast the long-term effect of financial
incentives on cognitive impairment in a mild
TBI population was larger (0.5) and significant

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PTSD and Cognitive Deficits
 Persian Gulf War veterans
 PTSD was associated with relative
performance deficiencies on tasks of:
 sustained attention
 mental manipulation
 verbal learning
 executive control, and
 performances were characterized by errors
of commission and intrusion
Vasterling et al., Neuropsychology, 1998;12:125-33

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Cognitive Sequelae
post concussion