Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF/OEF veterans

Abstract

Abstract-Mild traumatic brain injury (mTBI) is not uncommon among Operation Iraqi Freedom/Operation EnduringFreedom (OIF/OEF) veterans, and many individuals within this group report lingering cognitive difficulties following their injury. For Department of Veterans Affairs clinicians, an accurate assessment of cognitive symptoms is important in providing appropriate clinical care. Although self-assessment is commonly employed to screen for difficulties in cognitive functioning, little is known about the accuracy of self-report in this population. This study collected cognitive, psychiatric, and self-report data from 105 OIF/OEF veterans with mTBI to examine the relationship between self-reported cognitive functioning and objective neuropsychological test performance. Additionally, clinicians who frequently work with OIF/OEF veterans were asked to predict the magnitude of these associations. Self-reported cognitive functioning was not significantly correlated with objective cognitive abilities, suggesting that objective neuropsychological testing should be used when cognitive weakness is suspected. Perceived cognitive deficits were associated with depression, anxiety, and posttraumatic stress disorder, illustrating the additional importance of adequate assessment and treatment of psychiatric symptoms. Clinicians tended to overestimate the association between selfreport and test performance.

Subjective cognitive complaints and neuropsychological test performance following military-related traumatic brain injury

“…In a sample of veterans with a history of mTBI, self-ratings on a neurobehavioral symptom checklist were compared with the results of a brief neuropsychological examination. Self-ratings of attention and thinking/organization were not significantly correlated with test findings, but were related to increased reporting of psychiatric symptoms [15].…”

Neuropsychological Sequelae of PTSD and TBI Following War Deployment among OEF/OIF Veterans

“…Self-reported ratings of memory impairment were only modestly correlated (r = −.20) with verbal delayed recall and were unrelated to verbal immediate recall and delayed recall of non-verbal information (Spencer et al, 2010). Moreover, self-reported cognitive problems were positively correlated with the number of symptoms of depression, PTSD, and anxiety these Veterans endorsed (Spencer et al, 2010). These findings highlight the influence of psychological distress on subjective perceptions of cognitive difficulties following mTBI.…”

“…Specifically, subjective ratings of attention/ concentration and thinking/organization were unrelated to objective tests of these domains. Self-reported ratings of memory impairment were only modestly correlated (r = −.20) with verbal delayed recall and were unrelated to verbal immediate recall and delayed recall of non-verbal information (Spencer et al, 2010). Moreover, self-reported cognitive problems were positively correlated with the number of symptoms of depression, PTSD, and anxiety these Veterans endorsed (Spencer et al, 2010).…”

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

“…Historically, Veterans returning from war have reported cognitive complaints, which, in the vast majority of cases, are not attributable to TBI [26][27]. Cognitive postconcussive symptoms often lack objective neurocognitive findings, and studies in civilians have shown that these symptoms occur at similar rates in persons with mTBI as in those with no TBI [28][29].…”

“…In fact, mTBI had only a very modest additional effect on cognitive impairment when it co-occurred with PTSD and depression. Self-reported cognitive symptoms following mTBI have been shown to be poorly associated with neuropsychological performance in combat Veterans [26][27]31]. Moreover, neuropsychological deficits following mTBI typically resolve in weeks to months following the injury [32].…”