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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:
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.

Author Information

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.