SAN FRANCISCO—Self-reported cognitive impairment, such as problems with attention, concentration and memory in veterans, is more likely to occur with depression and posttraumatic stress disorder (PTSD) than with combat-related traumatic brain injury (TBI).

That’s according to a new study published recently in The Journal of Rehabilitation Research and Development.1

To reach that conclusion, San Francisco VAMC-led researchers analyzed data from 66,089 VA-enrolled Iraq and Afghanistan veterans who screened positive on initial TBI screening upon returning from combat between 2007 and 2012.

TBI screening is typically administered by VA primary care to all combat veterans returning to a VA healthcare facility for the first time after completing a deployment. Veterans who self-report signs of TBI, such as problems with memory and concentration after a head injury, are then referred for more extensive TBI evaluation.

Of the veterans surveyed in the study, 72% reported moderate to very severe cognitive impairment that interfered with their daily lives, although 42% of veterans in that group were not found to have sustained combat-related TBI.

Yet, 70% of the veterans with self-reported cognitive impairment received a PTSD diagnosis, and 46% of them received a depression diagnosis.

Results indicate that surveyed veterans with a PTSD diagnosis were found to be at an elevated risk for cognitive impairment, but veterans with only a TBI diagnosis and no accompanying mental health complaints were much less likely to report cognitive impairment. The study suggests mental health treatment for conditions such as PTSD and depression could result in improvements for veterans with cognitive impairment, according to study authors.

“So many of these young veterans are taking advantage of their GI Bill benefits and going to school when they return from combat,” noted lead author Karen Seal, MD, MPH, director of the Integrated Pain Team and Integrated Care Clinic for Iraq and Afghanistan Veterans, at the San Francisco VAMC and a professor at the University of California, San Francisco. “The cognitive impairment they are experiencing is preventing them from keeping up with their classes and can be incredibly frustrating.”

Seal suggested the study “reveals some limitations of our TBI screening program. On the one hand, screening brings to light problems that otherwise might have gone undetected, but on the other hand, screening may convey that cognitive problems are due to brain injury, whereas these problems may be best addressed with mental health treatment.”

She advised healthcare providers to offer good counseling about the possible causes of cognitive impairment, adding, “We may be missing opportunities for effective treatment. Too often, veterans learn that they do not have TBI and ultimately do not seek the mental health treatment that could help them manage their cognitive symptoms.”


1 Seal KH, Bertenthal D, Samuelson K, Maguen S, Kumar S, Vasterling JJ. Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans. J Rehabil Res Dev. 2016;53(2):185-98. doi: 10.1682/JRRD.2014.12.0301. PubMed PMID:27148692.