Cognitive complaint and objective cognition during the post-acute period after mild traumatic brain injury in pre-morbidly healthy adults

ABSTRACT

Primary Objective:

The most widely used proxies of cognitive complaint after mTBI are post-concussion syndrome (PCS) symptom checklists, which do not have a clear relationship with cognition. This study investigated whether an mTBI-specific cognitive complaint measure would have clearer associations with objective cognition than a widely used PCS symptom checklist.

Research Design:

An observational design was used. A sample of 109 participants (52 mTBI and 57 healthy controls) completed a PCS symptom checklist, a cognitive complaint measure, and measures of information processing speed, attention, memory, executive function, depression and anxiety.

Main Outcomes and Results:

In the healthy control group, cognitive complaint was significantly associated with objective cognitive performance and was not associated with psychological status. In contrast, PCS endorsement was unrelated to objective cognition but was associated with psychological status. For the mTBI group, neither PCS endorsement nor cognitive complaint was associated with cognitive performance, but both measures were associated with psychological status.

Conclusions:

This study indicates that neither cognitive nor PCS symptom measures are reliable indicators of underlying cognitive function in the post-acute period after mTBI. Further, suffering an mTBI may affect the linear relationship that exists between cognitive symptom endorsement and cognitive function in healthy adults.

KEYWORDS:

• Cognition
• complaint
• mild traumatic brain injury
• outcome
• post-concussion syndrome
• recovery

Acknowledgments

The author would like to acknowledge the contribution of post-graduate students and research assistants: Georgia Bolt, Emily Cockle, Emma Gust, Lana Higson, Nicolette Ingram, Arielle Levy, Courtney Lewis, Katie Priestley; Joshua Nash, Lucy Oehr, Aimee Savage, Nicola Singleton and Patrick Summerell for their assistance in collecting this data.

Disclosure Of Interest

The author reports no conflict of interest.

Compared with 2 weeks before the injury …

_______________________________________________________________________

1. My ability to organize things at home or at work is … ….

   1. Much better

   2. Better

   3. Same

   4. Worse

   5. Much worse

2. The time it takes me to catch up when someone has changed the topic of conversation is … ….

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

3. The speed at which the world seems to be going past me is … ….

   1. Much faster

   2. Faster

   3. Same

   4. Slower

   5. Much slower

4. My ability to plan my day is … ….

   1. Much better

   2. Better

   3. Same

   4. Worse

   5. Much worse

Compared with 2 weeks before the injury …

_______________________________________________________________________

1. The tendency for my mind to wander while I am supposed to be concentrating on a specific task is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

2. I find myself wishing that everything would slow down … ….

   1. Much more often

   2. More often

   3. Same amount

   4. Less often

   5. Much less often

3. I find it difficult to solve everyday problems … …

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

4. My ability to learn my way around an unfamiliar area or building is … ….

   1. Much better

   2. Better

   3. Same

   4. Worse

   5. Much worse

Compared with 2 weeks before the injury …

_______________________________________________________________________

1. My tendency to do something impulsively without giving it much thought is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

2. People have told me that I have slowed down … ….

   1. Much more often

   2. More often

   3. The same

   4. Less often

   5. Much less often

3. I find it difficult to maintain concentration on everyday tasks … ….

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

4. My ability to follow a conversation when there is more than one person speaking is … ….

   1. Much worse

   2. Worse

   3. Same

   4. Better

   5. Much better

Compared with 2 weeks before the injury …

_______________________________________________________________________

1. I feel that I am disorganized … ….

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

2. My ability to remember the content of news articles/broadcasts is … ….

   1. Much better

   2. Better

   3. Same

   4. Worse

   5. Much worse

3. The tendency to repeat myself in conversation (e.g. by asking the same question twice) is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

4. My ability to plan a new project is … ….

   1. Much better

   2. Better

   3. Same

   4. Worse

   5. Much worse

Compared with 2 weeks before the injury …

_______________________________________________________________________

1. The tendency to lose track of where I’m up to, for instance, in cooking from a recipe or reading a book, is … ….

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

2. My ability to follow a storyline in a movie or television program without being distracted is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

3. My need to place things in the same location in order to find them again (e.g. keys on a hook by the door) is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

Compared with 2 weeks before the injury …

________________________________________________________________________

1. I feel that the time it takes me to do the same tasks as before is ….

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

2. My ability to solve problems is … ….

   1. Much worse

   2. Worse

   3. Same

   4. Better

   5. Much better

3. My ability to concentrate on what I’m doing and ignore distractions is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

4. When a lot is happening around me it seems that the speed that these things are happening is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

Compared with 2 weeks before the injury …

_______________________________________________________________________

1. My reliance on notes to remember to do things (e.g. attend appointments, telephone a friend) is … …

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

2. My ability to follow a long conversation is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

3. My tendency to forget why I’ve gone into a room once I enter … …

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

4. If I’m waiting for something to happen, I find my mind wandering … …

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

Compared with 2 weeks before the injury …

_______________________________________________________________________

1. The degree to which forgetting interferes with my day-to-day activities is … ….

   1. Much less

   2. Less

   3. Same

   4. More

   5. Much more

2. I feel that my ability to think very quickly is … ….

   1. Much more

   2. More

   3. Same

   4. Less

   5. Much less

3. My ability to remember conversations I have had is … ….

   1. Much better

   2. Better

   3. Same

   4. Worse

   5. Much worse

_____________________________________________

End Of Questionnaire

_____________________________________________

Scoring Key

Reverse score items: 2, 6, 7, 10, 11, 12, 13, 17, 18, 20, 21, 22, 24, 25, 27