Trauma-Related Psychiatric and Behavioral Conditions Are Uniquely Associated With Sustained Attention Dysfunction


Michael Esterman, Francesca C. Fortenbaugh, Meghan E. Pierce, Jennifer R. Fonda, Joseph DeGutis, William Milberg, and Regina McGlinchey. 2019. “Trauma-Related Psychiatric and Behavioral Conditions Are Uniquely Associated With Sustained Attention Dysfunction.” Neuropsychology, 33, 5, Pp. 711-724. Publisher's Version


Objective: It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. Method: To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. Results: Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. Conclusion: These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control.