• Douglas B Cooper, Glenn Curtiss, Patrick Armistead-Jehle, Heather G Belanger, David F Tate, Matthew Reid, Amy O Bowles, Carmen S Velez, Jan E Kennedy, and Rodney D Vanderploeg.
• Defense and Veterans Brain Injury Center, Silver Spring, Maryland (Drs Cooper, Curtiss, Belanger, Reid, Kennedy, and Vanderploeg); Departments of Neurology (Drs Cooper, Reid, and Kennedy) and Rehabilitation (Dr Bowles), San Antonio Military Medical Center, Fort Sam Houston, Texas; Department of Psychiatry, University of Texas Health Science Center at San Antonio (Dr Cooper); Departments of Psychology (Drs Curtiss and Belanger) and Psychiatry and Behavioral Neurosciences (Drs Belanger and Vanderploeg), University of South Florida, Tampa; James A. Haley VA Medical Center, Tampa, Florida (Drs Curtiss, Belanger, and Vanderploeg); Concussion Clinic, Munson Army Health Center, Ft Leavenworth, Kansas (Dr Armistead-Jehle); Missouri Institute of Mental Health, University of Missouri-St Louis, Berkeley, (Dr Tate and Ms Velez); Department of Psychiatry, University of Missouri-St Louis, St Louis (Dr Tate and Mr Velez); and Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, Maryland (Dr Bowles).
• J Head Trauma Rehabil. 2018 Mar 1; 33 (2): 81-90.

ObjectiveTo examine differences in objective neurocognitive performance and subjective cognitive symptoms in individuals with a history of a single concussion, multiple concussions, orthopedic injuries, and posttraumatic stress disorder (PTSD).MethodParticipants included 116 military service members who sustained a mild traumatic brain injury (mTBI) during combat deployment. Subjects were subdivided into groups based on concussion frequency: a single concussion (n = 42), 2 concussions (n = 21), and 3 or more concussions (n = 53). Eighty-one subjects sustained an orthopedic injury (n = 60) during deployment or were diagnosed with PTSD (n = 21), but had no history of mTBI. Subjects completed a battery of neuropsychological tests and self-report measures of postconcussive symptoms, PTSD symptoms, and psychopathology.ResultsNo differences were found among the concussion groups on a composite neuropsychological measure. The PTSD group had the highest number of symptom complaints, with the 2-concussion and 3-plus-concussion groups being most similar to the PTSD group. The concussion groups showed a nonsignificant pattern of increasing distress with increasing number of concussions.ConclusionsThe current findings are consistent with meta-analytic results showing no differential effect on neuropsychological functioning due to multiple concussions. Results also support the burden of adversity hypothesis suggesting increasing symptom levels with increasing psychological or physically traumatic exposures.

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