Making a Difference: Affective Distress Explains Discrepancy Between Objective and Subjective Cognitive Functioning After Mild Traumatic Brain Injury

Abstract

Objective: To assess the relationship between subjective cognitive symptoms and objective cognitive test scores in patients after concussion. We additionally examined factors associated with subjective and objective cognitive dysfunction, as well as their discrepancy. Participants: Eighty-six individuals (65.1% female; 74.4% adult) from an interdisciplinary concussion clinic. Methods: Subjective and objective cognitive functioning was measured via the SCAT-Symptom Evaluation and the CNS Vital Signs Neurocognition Index (NCI), respectively. Cognitive discrepancy scores were derived by calculating standardized residuals (via linear regression) using subjective symptoms as the outcome and NCI score as the predictor. Hierarchical regression assessed predictors (age, education, time postinjury, attention-deficit/hyperactivity disorder, affective distress, and sleep disturbance) of cognitive discrepancy scores. Nonparametric analyses evaluated relationships between predictor variables, subjective symptoms, and NCI. Results: More severe affective and sleep symptoms (large and medium effects), less time postinjury (small effect), and older age (small effect) were associated with higher subjective cognitive symptoms. Higher levels of affective distress and less time since injury were associated with higher cognitive discrepancy scores (β = .723, P < .001; β = −.204, P < .05, respectively). Conclusion: Clinical interpretation of subjective cognitive dysfunction should consider these additional variables. Evaluation of affective distress is warranted in the context of higher subjective cognitive complaints than objective test performance.

Memory perfectionism is associated with persistent memory complaints after concussion

“…Following this logic, relatively severe memory performance decrements (i.e., those detectable on neuropsychological testing) should be associated with more severe subjective memory problems. We and others [5][6][7][8][9] have not observed this association.…”

“…People may also misremember having fewer memory lapses before their concussion than they actually did, an example of the "good-old-days" bias 34 . Additionally, post-injury stress, sleep problems, psychiatric disorders, and chronic pain may all contribute to both subjective and objective cognitive difficulties misattributed to brain injuy 8,9,12,[35][36][37][38] .…”

“…The etiology of these complaints is not clear. The relationship between cognitive complaints and objective cognitive performance on neuropsychological testing, cross-sectionally or longitudinally, is weak or not significant in most studies [5][6][7][8][9] . The minority of studies that reported an association between subjective and objective cognitive functioning on testing did not control for symptom or performance validity, which could have affected their results 10,11 .…”

Severity and correlates of brain fog in people with traumatic brain injury

“…depressive symptoms, contributes to the lack of correspondence between self-reported cognitive symptoms and objective cognition after mild TBI (Hromas et al, 2021). A significant correlation between brain fog and depressive symptoms in the mild TBI group may contribute to a lack of alignment between brain fog and objective cognition in people with mild TBI.…”

Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches

“…15 Patients with mTBI often present with cognitive symptoms that do not coincide with objective evidence of cognitive impairment (e.g., on neuropsychological testing), particularly those with psychological distress. [117][118][119] In this case, treatment should be directed at psychological distress and/or negative beliefs about cognition (as discussed in the previous section) rather than at remediating or compensating for cognitive impairment. Indeed, improved postconcussion symptoms following cognitive rehabilitation may be mediated by reductions in psychological distress.…”