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Relationship Between Processing Speed and Executive Functioning Performance Among OEF/OIF Veterans: Implications for Postdeployment Rehabilitation

Nelson, Lonnie A. PhD; Yoash-Gantz, Ruth E. PsyD; Pickett, Treven C. PsyD; Campbell, Thomas A. PhD

Section Editor(s): French, Louis M. PsyD

Journal of Head Trauma Rehabilitation: January/February 2009 - Volume 24 - Issue 1 - p 32–40
doi: 10.1097/HTR.0b013e3181957016

Background: Comorbid mild traumatic brain injury (mTBI) with posttraumatic stress disorder (PTSD) is a common clinical presentation among troops returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). This study examined processing speed and executive functioning in a sample of OEF/OIF veterans who had sustained mTBI, a subset of whom also had comorbid PTSD.

Methods: Fifty-three OEF/OIF veterans with a history of mTBI completed Wechsler Adult Intelligence Scale-III Symbol Search and Digit Symbol—Coding subscales, Stroop Word, color and color-word trials, and Trail Making Test, Parts A and B as part of a comprehensive neuropsychological test battery.

Results: Excluding from analysis those who scored poorly on effort testing, multiple regression showed that measures of processing speed accounted for 43% of the variance in performance on the Trail Making Test, Part B and 50% of the variance in performance on the Stroop task. Significant differences in processing speed and executive functioning were found on the basis of presence of comorbid PTSD. Stroop Color (F = 9.27, df = 52, P < .004) and Stroop Color Word (F = 7.19, df = 52, P < .01) scores differed significantly between the groups. Those having comorbid PTSD (+TBI/+PTSD) scored significantly poorer than the mTBI-only group (+TBI/−PTSD). Implications for treatment of the comorbid conditions are discussed.

From the Mental Health Service, Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, Virginia (Drs Nelson, Pickett, and Campbell); Defense and Veterans Brain Injury Center, Richmond, Virginia (Drs Nelson and Pickett); Hefner Veterans Affairs Medical Center, Salisbury, North Carolina (Dr Yoash-Gantz); Mental Illness Research, Education and Clinical Center (MIRECC), VISN6 (Drs Yoash-Gantz and Pickett); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond (Dr Pickett); and Department of Psychiatry & Behavioral Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Yoash-Gantz).

Corresponding author: Ruth E. Yoash-Gantz, PsyD, Hefner VA Medical Center, Mental Health & Behavioral Sciences 11M-2, 1601 Brenner Ave, Salisbury, NC 28144 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.