{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T08:18:10Z","timestamp":1758442690400,"version":"3.44.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","funder":[{"name":"Veterans Health Administration"},{"DOI":"10.13039\/100006379","name":"Office of Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006379","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006380","name":"Rehabilitation Research and Development Service","doi-asserted-by":"publisher","award":["N3197","C2361-C"],"award-info":[{"award-number":["N3197","C2361-C"]}],"id":[{"id":"10.13039\/100006380","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Clinical Science Research and Development Service","award":["CX002097"],"award-info":[{"award-number":["CX002097"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Veterans with traumatic brain injuries (TBIs) may have a heightened risk of neurocognitive impairment and early onset of neurodegenerative diseases. Exposure to opioid analgesics may also be associated with a reduction in neurocognitive function. To understand the potential interplay between TBI and opioid exposure on neurocognitive performance, we measured associations between lifetime opioid exposure and neurocognitive performance and examined potential interaction\/effect measure modification by Veterans\u2019 mild TBI (mTBI) history.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Participants included combat Veterans enrolled at the Veterans Affairs Portland Health Care System site of the Long-term Impact of Military-Relevant Brain Injury Consortium\/Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study. Lifetime opioid exposure was measured using survey responses and prescription data and was categorized as moderate\/high versus low\/no. Neurocognitive performance was measured using 9 neuropsychological component test scores. Associations between lifetime opioid exposure and neurocognitive performance were estimated using bivariable and multivariable linear regression models; multivariable models controlled for demographic, military, and clinical characteristics. Stratified analyses were performed to examine associations by mTBI history.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 282 participants, 84 (29.8%) had moderate or high lifetime opioid exposure and 198 (70.2%) had low or no lifetime opioid exposure; 31.3% had deployment-related mTBI history, 45.7% non-deployment-related mTBI, and 33.0% no mTBI. There were no associations between lifetime opioid exposure and neurocognitive performance. However, among participants with deployment-related mTBI, those with moderate or high lifetime opioid exposure demonstrated improved performance on executive functioning neuropsychological component tests compared to those with low or no lifetime opioid exposure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although lifetime opioid exposure did not appear to be significantly associated with neurocognitive performance among this sample of Veterans, there are indications that the relationship between opioid exposure and neurocognitive function is modified by deployment-related mTBI history. Continued research exploring the interplay between mTBI and opioid exposure on neurocognitive performance is needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf317","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T07:54:16Z","timestamp":1749196456000},"page":"729-737","source":"Crossref","is-referenced-by-count":0,"title":["Lifetime Opioid Exposure and Neurocognitive Performance Among a Sample of Combat Veterans With and Without Mild Traumatic Brain Injury"],"prefix":"10.1093","volume":"190","author":[{"given":"Tess A","family":"Gilbert","sequence":"first","affiliation":[{"name":"VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66) , Portland, OR 97239,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J","family":"Claypool","sequence":"additional","affiliation":[{"name":"VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66) , Portland, OR 97239,","place":["United States"]},{"name":"VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR) , Portland, OR 97239,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Carag","sequence":"additional","affiliation":[{"name":"VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66) , Portland, OR 97239,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Edmunds","sequence":"additional","affiliation":[{"name":"VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66) , Portland, OR 97239,","place":["United States"]},{"name":"VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR) , Portland, OR 97239,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9261-7742","authenticated-orcid":false,"given":"Kathleen F","family":"Carlson","sequence":"additional","affiliation":[{"name":"VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66) , Portland, OR 97239,","place":["United States"]},{"name":"VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR) , Portland, OR 97239,","place":["United States"]},{"name":"Oregon Health and Science University\u2014Portland State University School of Public Health , Portland, OR, 97239,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"2025092002194740000_usaf317-B1","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1001\/jamaneurol.2018.0815","article-title":"Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans","volume":"75","author":"Barnes","year":"2018","journal-title":"JAMA Neurol"},{"key":"2025092002194740000_usaf317-B2","doi-asserted-by":"publisher","first-page":"e0169650","DOI":"10.1371\/journal.pone.0169650","article-title":"Head Injury as a Risk Factor for Dementia and Alzheimer's Disease: A Systematic Review and Meta-Analysis of 32 Observational Studies","volume":"12","author":"Li","year":"2017","journal-title":"PLoS One"},{"key":"2025092002194740000_usaf317-B3","doi-asserted-by":"publisher","first-page":"S242","DOI":"10.1016\/j.jalz.2014.04.003","article-title":"Military-related traumatic brain injury and neurodegeneration","volume":"10","author":"McKee","year":"2014","journal-title":"Alzheimers Dement"},{"key":"2025092002194740000_usaf317-B4","doi-asserted-by":"publisher","first-page":"511","DOI":"10.3171\/2015.2.JNS14503","article-title":"Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis","volume":"124","author":"Perry","year":"2016","journal-title":"J Neurosurg"},{"key":"2025092002194740000_usaf317-B5","doi-asserted-by":"publisher","first-page":"e0174847","DOI":"10.1371\/journal.pone.0174847","article-title":"Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review","volume":"12","author":"McInnes","year":"2017","journal-title":"PLoS One"},{"year":"2024","key":"2025092002194740000_usaf317-B6"},{"key":"2025092002194740000_usaf317-B7","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.jpain.2018.03.005","article-title":"Traumatic Brain Injury and Receipt of Prescription Opioid Therapy for Chronic Pain in Iraq and Afghanistan Veterans: Do Clinical Practice Guidelines Matter?","volume":"19","author":"Seal","year":"2018","journal-title":"J Pain"},{"key":"2025092002194740000_usaf317-B8","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1097\/HTR.0000000000000712","article-title":"Opioid and Sedative-Hypnotic Prescriptions Among Post-9\/11 Veteran VA Users Nationwide With Traumatic Brain Injury, 2012-2020","volume":"36","author":"Holmer","year":"2021","journal-title":"J Head Trauma Rehabil"},{"key":"2025092002194740000_usaf317-B9","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1111\/jgs.13562","article-title":"Prescription Opioids and Risk of Dementia or Cognitive Decline: A Prospective Cohort Study","volume":"63","author":"Dublin","year":"2015","journal-title":"J Am Geriatr Soc"},{"key":"2025092002194740000_usaf317-B10","doi-asserted-by":"publisher","first-page":"3526","DOI":"10.1111\/jgs.18030","article-title":"Prescription opioids and longitudinal changes in cognitive function in older adults: A population-based observational study","volume":"70","author":"Warner","year":"2022","journal-title":"J Am Geriatr Soc"},{"key":"2025092002194740000_usaf317-B11","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1016\/j.jamda.2023.06.035","article-title":"Long-Term Opioid Use and Dementia Risk in Patients With Chronic Pain","volume":"24","author":"Sun","year":"2023","journal-title":"J Am Med Dir Assoc"},{"key":"2025092002194740000_usaf317-B12","doi-asserted-by":"publisher","first-page":"1826","DOI":"10.1080\/07853890.2022.2092896","article-title":"U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts","volume":"54","author":"Bennett","year":"2022","journal-title":"Ann Med"},{"year":"2016","author":"Gellad","key":"2025092002194740000_usaf317-B13"},{"key":"2025092002194740000_usaf317-B14","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1097\/j.pain.0000000000000837","article-title":"Impact of the Opioid Safety Initiative on opioid-related prescribing in veterans","volume":"158","author":"Lin","year":"2017","journal-title":"Pain"},{"key":"2025092002194740000_usaf317-B15","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1001\/jamainternmed.2017.0147","article-title":"Addressing the Opioid Epidemic in the United States: Lessons From the Department of Veterans Affairs","volume":"177","author":"Gellad","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2025092002194740000_usaf317-B16","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1080\/02699052.2016.1219061","article-title":"The Chronic Effects of Neurotrauma Consortium (CENC) multi-centre observational study: Description of study and characteristics of early participants","volume":"30","author":"Walker","year":"2016","journal-title":"Brain Inj"},{"year":"2024","key":"2025092002194740000_usaf317-B17"},{"key":"2025092002194740000_usaf317-B18","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1089\/neu.2014.3433","article-title":"Structured interview for mild traumatic brain injury after military blast: inter-rater agreement and development of diagnostic algorithm","volume":"32","author":"Walker","year":"2015","journal-title":"J Neurotrauma"},{"year":"2021","key":"2025092002194740000_usaf317-B19"},{"key":"2025092002194740000_usaf317-B20","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"year":"2013","author":"Weathers","key":"2025092002194740000_usaf317-B21"},{"key":"2025092002194740000_usaf317-B22","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1037\/pas0000254","article-title":"Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans","volume":"28","author":"Bovin","year":"2016","journal-title":"Psychol Assess"},{"key":"2025092002194740000_usaf317-B23","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1093\/milmed\/usae120","article-title":"Lifetime Psychotropic Medication Use Among Service Members and Veterans With and Without History of Mild Traumatic Brain Injury: A Pilot Study","volume":"189","author":"Carlson","year":"2024","journal-title":"Mil Med"},{"year":"2023","key":"2025092002194740000_usaf317-B24"},{"key":"2025092002194740000_usaf317-B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1037\/neu0000855","article-title":"Can mild traumatic brain injury alter cognition chronically? A LIMBIC-CENC multicenter study","volume":"37","author":"Walker","year":"2023","journal-title":"Neuropsychology"},{"volume-title":"Medical Symptom Validity Test for Windows: User\u2019s Manual and Program","year":"2003","author":"Green","key":"2025092002194740000_usaf317-B26"},{"key":"2025092002194740000_usaf317-B27","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1177\/1073191111428764","article-title":"Reliable Digit Span: a systematic review and cross-validation study","volume":"19","author":"Schroeder","year":"2012","journal-title":"Assessment"},{"key":"2025092002194740000_usaf317-B28","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1080\/02699050410001672350","article-title":"Predictors of invalid neuropsychological test performance after traumatic brain injury","volume":"18","author":"Moore","year":"2004","journal-title":"Brain Inj"},{"key":"2025092002194740000_usaf317-B29","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1097\/00001648-199901000-00008","article-title":"Causal Diagrams for Epidemiologic Research","volume":"10","author":"Greenland","year":"1999","journal-title":"Epidemiology"},{"key":"2025092002194740000_usaf317-B30","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1097\/AJP.0000000000000536","article-title":"The Relationship Between Chronic Pain and Neurocognitive Function: A Systematic Review","volume":"34","author":"Higgins","year":"2018","journal-title":"Clin J Pain"},{"key":"2025092002194740000_usaf317-B31","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1093\/pm\/pnab005","article-title":"A Systematic Review and Meta-Analysis of Cognitive Performance among People with Chronic Use of Opioids for Chronic Non-Cancer Pain","volume":"22","author":"Akhurst","year":"2021","journal-title":"Pain Med"},{"key":"2025092002194740000_usaf317-B32","doi-asserted-by":"publisher","first-page":"506","DOI":"10.30773\/pi.2020.0002","article-title":"Protagonist Role of Opioidergic System on Post-Traumatic Stress Disorder and Associated Pain","volume":"17","author":"Nikbakhtzadeh","year":"2020","journal-title":"Psychiatry Investig"},{"key":"2025092002194740000_usaf317-B33","first-page":"9","article-title":"Evidence of specific cognitive deficits in patients with chronic low back pain under long-term substitution treatment of opioids","volume":"17","author":"Schiltenwolf","year":"2014","journal-title":"Pain Physician"},{"key":"2025092002194740000_usaf317-B34","doi-asserted-by":"publisher","first-page":"628782","DOI":"10.3389\/fneur.2021.628782","article-title":"Potential health and performance effects of high-level and low-level blast: a scoping review of two decades of research","volume":"12","author":"Belding","year":"2021","journal-title":"Front Neurol"},{"key":"2025092002194740000_usaf317-B35","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s12207-010-9066-z","article-title":"Re-examination of the Controversial Coexistence of Traumatic Brain Injury and Posttraumatic Stress Disorder: Misdiagnosis and Self-Report Measures","volume":"3","author":"Sbordone","year":"2010","journal-title":"Psychol Inj Law"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/Supplement_2\/729\/64287784\/usaf317.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/Supplement_2\/729\/64287784\/usaf317.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T06:20:17Z","timestamp":1758349217000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/Supplement_2\/729\/8256223"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":35,"journal-issue":{"issue":"Supplement_2","published-online":{"date-parts":[[2025,9,16]]},"published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf317","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,9,1]]}}}