Are self-reported symptoms of executive dysfunction associated with objective executive function performance following mild to moderate traumatic brain injury?

Abstract

Background and objective: We examined the relationship between self-reported pre- and post-injury changes in executive dysfunction, apathy, disinhibition, and depression, and performance on neuropsychological tests of executive function, attention/processing speed, and memory in relation to mood levels and effort test performance in individuals in the early stages of recovery from mild to moderate traumatic brain injury (TBI). Method: Participants were 71 noncombat military personnel who were in a semiacute stage of recovery (<3 months post injury) from mild to moderate TBI. Pre- and post-TBI behaviors were assessed with the Frontal Systems Behavior Scale (FrSBe; Grace & Malloy, 2001) and correlated with levels of depressive symptoms, effort test performance, and performance on objective measures of attention, executive function, and memory. Results: Self-reported symptoms of executive dysfunction generally failed to predict performance on objective measures of executive function and memory, although they predicted poorer performance on measures of attention/processing speed. Instead, higher levels of depressive symptomatology best predicted poorer performance on measures of executive function and memory. However, the relationship between memory performance and TBI symptoms was no longer significant when effort performance was controlled. Conclusions: Our findings suggest that, among individuals in early recovery from mild to moderate TBI, self-reported depressive symptoms, rather than patients' cognitive complaints, are associated with objective executive function. However, self-reported cognitive complaints may be associated with objectively measured inattention and slow processing speed.

Keywords:

• Traumatic brain injury
• Neuropsychology
• Cognition
• Behavior
• Depression

Acknowledgments

This study was supported by Merit Review Research Programs from the Medical Research Service and the Center of Excellence for Stress and Mental Health (CESAMH) of the Department of Veterans Affairs (M.W.B. and D.C.D.) and by the Defense and Veterans Brain Injury Center, San Diego, California, USA. The authors gratefully acknowledge the staff, patients, and volunteers at the Naval Medical Center San Diego and the U.S. Marine Corps Base Camp Pendleton for their assistance with this study. Dean C. Delis is a coauthor of the D-KEFS (Delis–Kaplan Executive Function System) and the California Verbal Learning Test–Second Edition (CVLT–II). There were no other actual or potential conflicts of interest for the authors that could have inappropriately influenced the present work. Subjects were recruited in accordance with Internal Review Board (IRB) approved policies and procedures. Standard ethical and professional guidelines were upheld during the research study and manuscript preparation. The views expressed in this article do not necessarily reflect those of the funding agency, the United States Navy, the United States Marine Corps, the Department of Defense, or the United States Government.