Cognition and Functional Capacity Following Traumatic Brain Injury in Veterans

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Objective: Performance-based tests of functional capacity are rarely used in research on mild to moderate traumatic brain injury (TBI), but they may function as a link between cognitive impairment and real-world functioning. We sought to examine the relationship between cognitive functioning and performance-based functional capacity, as measured by the University of California San Diego Performance-Based Skills Assessment–Brief (UPSA-B), in Veterans with TBI histories. Research Method: A total of 50 unemployed Operation Enduring Freedom/Operation Iraqi Freedom Veterans with mild to moderate TBI histories completed assessments of neuropsychological performance and functional capacity (UPSA-B total, financial subscale, and communication subscale scores). All participants were impaired in at least 1 neuropsychological domain on a prior clinical neuropsychological evaluation. A global deficit score was calculated based on neuropsychological performance on assessments of attention/working memory, processing speed, learning, delayed recall, prospective memory, and executive functioning. Deficit scores were also calculated for the executive-functioning domain and the processing-speed domain. Neuropsychological deficit scores were then correlated with UPSA-B performances. Results: Correlation coefficients indicated that worse global neuropsychological performance was related to worse overall functional capacity (rs = −.28, p = .046) and communication capacity (rs = −.34, p = .016). Worse executive functioning was related to worse functional capacity, r = −.37, p = .008, particularly in the domain of communication, r = −.44, p ≤ .001. Processing-speed performance was not related to functional capacity. Conclusions: Executive functioning was moderately associated with both communication and overall everyday functioning capacity. Improvement in executive-functioning deficits may improve functional capacity, specifically in communication tasks.

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