The 20-item dysexecutive questionnaire after severe traumatic brain injury: Distribution of the total score and its significance

ABSTRACT

The Dysexecutive questionnaire (DEX), a 20-item ecological measure used by patients (DEX-S) or significant others (DEX-SO) to assess dysexecutive syndrome, often complements performance-based executive functions (EF) tests. Previous studies highlighted its internal consistency, score variability across samples, weak DEX-S correlations with EF tests, but strong associations with self-assessments of anxiety/depression.

This study examined DEX-S and DEX-SO scores from the PariS-TBI study, analyzing data from 76 severe TBI participants and 40 proxies assessed 8-years postinjury compared to matched healthy controls.

DEX scores in the control group followed a normal distribution, but severe TBI participants reported significantly higher percentages of very low DEX scores and significantly higher percentages of extremely high scores in both self-reports and proxy-reports. Strong correlations were found between DEX-S and self-reported anxiety/depression (rho = 0.65, p < 0.001).

These findings suggest a possible lack of self-awareness in some TBI participants, a probable tendency of some TBI-proxies to underestimate EF difficulties, and the presence of EF difficulties in the TBI group compared to controls. The tendency among some TBI participants and proxies to respond to the DEX questions based on their positive or negative valence (presence of a “valence bias”), rather than specific content, potentially elucidates our results and prior published DEX findings.

Trial registration

ClinicalTrials.gov identifier: NCT01437683..

KEYWORDS:

• Dysexecutive questionnaire
• Severe traumatic brain injury
• Adults
• Anxiety
• Depression
• Valence bias

Acknowledgements

The authors thank all members of the CRFTC Steering Committee (Centre Ressource Francilien du Traumatisme Crânien) and of the Unité de Recherche Clinique (URC), GHU Paris Saclay (AP-HP) for their valuable help.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [HCC], upon reasonable request.

Additional information

Funding

The first part of the PariS-TBI study and the eight-year evaluation was funded by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2004 and 2012, AOM04084) and sponsored by AP–HP (Département de la recherche clinique et du développement). The second part of this study (4-year outcome) was funded by a grant from the Institut de Recherche en Santé Publique (IRESP).