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Wechsler Adult Intelligence Scale-Third Edition Characteristics of a Military Traumatic Brain Injury Sample

Military Medicine, Dec 2003 by Clement, Pamelia F, Kennedy, Jan E

This article describes the postinjury cognitive functioning of a sample of active duty, retired, and military beneficiaries who received traumatic brain injuries. Patients were seen in the neuropsychology clinic at Brooke Army Medical Center for a detailed cognitive and personality assessment. The scores on a major component of this evaluation, the Wechsler Adult Intelligence Scale, third edition, are summarized. The results are compared with those reported in the Wechsler Adult Intelligence Scale, third edition technical manual for a smaller, less diverse sample. The findings are consistent with the formulation that stable verbal skills are most resistant to brain injury, followed by nonverbal reasoning and visuospatial ability, and then working memory with speed of information processing being the most vulnerable to the effects of brain injury.

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Introduction

The incidence and characterization of individuals experiencing a traumatic brain injury (TBI) are of particular relevance to the military. Adolescent and young adult men are at increased risk for TBI, making the active duty military population a particularly vulnerable group.1 TBI among active duty troops account for at least 14% of surviving war casualties and require a disproportionate amount of acute and long-term care resources (http://www.biausa.org/Pages/For%20Military%20%26%20Veterans.html).2 The sequelae of severe brain injuries often lead to retirement and separation from the military on medical grounds. Even after mild TBI, subtle deficits in thinking and judgment can affect duty performance, rank advancement, and worldwide qualification status.

In the military setting, clinical neuropsychologists are responsible for cognitive evaluations of brain-injured patients. The Wechsler Intelligence Scales have long been a cornerstone of such evaluations. In 1997, the Wechsler Adult Intelligence Scale, third edition (WAIS-III), became available for use.3 With the previous edition of the WAIS, neuropsychologists were able to determine verbal intelligence quotient (IQ), performance IQ, and subtest scores. In the newer WAIS-III, subtests are also grouped into four indexes based on factor analysis. Scores on these indexes would appear to provide the neuropsychologist with an opportunity for a finer-grained analysis of intellectual functioning after TBI. This study presents WAIS-III IQ, index, and subtest scores for 61 active duty and military health care beneficiaries who were referred to the neuropsychological service of a major military medical center subsequent to a TBI. Severity of the TBIs ranged from mild through severe. The relationship of these scores to the individual's demographic characteristics and severity of the brain injury is examined. These data supplement those presented in the WAIS-III technical manual for a small group (N = 22) of moderate to severe TBI cases.4

Methods

Patients

A retrospective chart review was conducted on 61 adult military service members and military dependents that received outpatient neuropsychological evaluation at Brooke Army Medical Center in San Antonio, Texas. The sample selected for study was composed of individuals evaluated between June 1998 and June 2001 with a primary diagnosis of TBI. The final sample of 61 was reached after excluding a few cases because of the presence of confounding diagnoses, such as anoxia and cerebrovascular disorders. Reasons for referral included assessment of reported deficits, documentation of cognitive impairments, evaluation for return to duty determination, and medical board review for military separation. Table I presents the sample characteristics on basic demographic variables.

The present group is more racially heterogeneous than the TBI standardization sample reported in the WAIS-III manual. Whereas the standardization sample was entirely Caucasian, the present sample is approximately 60% Caucasian, 20% African American, and 20% Hispanic and other. Consistent with the demographics of both TBI and military populations, the present sample included proportionately more men (88% compared with 64% in the standardization sample). Age and education are relatively equivalent for the standardization and present samples. It can be seen in Table I that over one-third of the sample was undergoing medical/physical evaluation board process at the time of evaluation. Approximately one-third was on temporary disability leave, and slightly less than one-third was serving on active duty.

As shown in Table II, compared with the clinical TBI standardization sample, the present sample was more heterogeneous in terms of severity of injury and time since injury. The standardization sample included only individuals who had an initial Glasgow Coma Scale score less than 13 and loss of consciousness of at least 60 minutes, excluding all mild TBI cases. The standardization sample was evaluated between 6 and 18 months after injury, whereas the present sample included cases evaluated from 1 to 204 months after injury. Over one-half of the present cases incurred TBI from a motor vehicle accident. Other major causes of TBI in the current sample included falls and assaults, each accounting for 15% to 20% of the injuries.

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Wechsler Adult Intelligence Scale-Third Edition Characteristics of a Military Traumatic Brain Injury Sample

Military Medicine, Dec 2003 by Clement, Pamelia F, Kennedy, Jan E

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