B – 40 Identifying Executive Function Impairment in Current and Former Military Special Operators

Abstract Objective United States military special operators are exposed to training and missions in extreme conditions highly demanding of higher-level executive skills, such as planning, organization, problem-solving, rapid decision making, and inhibitory control. Injuries sustained in such conditions can affect those executive skills, as well as their physical and psychological functioning. We applied algorithms for identifying executive function impairment in military special operators undergoing neuropsychological evaluations. Method Algorithms were derived from 1,028 individuals between the ages of 16 and 89 from the Delis-Kaplan Executive Function System (D-KEFS) standardization sample. Tests included seven primary scores derived from Letter Fluency, Category Fluency, Category Fluency Switching, Trail Making Test Part 4, and Color Word Inhibition subtests. The algorithms for defining executive function impairment were applied to 57 current and former military special operators undergoing a clinical neuropsychological evaluation. Results Most special operators (70.2%) self-reported having significant executive function problems over the past year. Having three or more executive function scores ≤16th percentile (scaled score [SS]≤7) occurred in 18.7% of the D-KEFS normative sample and 3.5% of the military special operators. Having three or more executive function scores ≤9th percentile (SS≤6) occurred in 11.4% of the D-KEFS normative sample compared to 3.5% of the military special operators. Conclusion Subjectively experienced executive function problems were very common, but objectively measured executive function impairment was very uncommon, in military special operators undergoing neuropsychological evaluations. Targeting modifiable factors for treatment and rehabilitation might lead to improved cognitive functioning and quality of life.