The Role of Potentially Malleable Factors in Post-Concussive Symptoms and Objective Cognitive Outcomes in Iraq and Afghanistan Veterans with History of Mild TBI

2019 ◽  
Vol 34 (6) ◽  
pp. 850-850
Author(s):  
S Jurick ◽  
V Merritt ◽  
L Crocker ◽  
G Iverson ◽  
S Hoffman ◽  
...  
Keyword(s):  
Brain Injury ◽  
Executive Functioning ◽  
Self Efficacy ◽  
Psychiatric Symptoms ◽  
Self Report ◽  
Cognitive Test ◽  
Performance Validity ◽  
Mild Brain Injury ◽  
History Of ◽  
Additional Variance

Abstract Objective We examined whether potentially malleable factors are associated with post-concussive symptoms (PCS) and cognition in Veterans with mild traumatic brain injury (mTBI) histories. Method Combat-exposed Iraq and Afghanistan Veterans with remote history of mTBI (N=48) completed a neuropsychological assessment and self-report questionnaires. Hierarchical linear regressions predicting PCS (Rivermead Post-Concussion Symptoms Questionnaire) and objective cognition included relevant demographic, injury, and psychiatric symptom variables in the first block and five malleable factors (TBI knowledge, self-efficacy, coping style, attribution of symptoms to mTBI, and uncommonly-endorsed symptoms [mild Brain Injury Atypical Symptoms (mBIAS) scale]) in the second block. Those with valid performance validity tests (n = 42) were included in the cognitive test analyses. Results With psychiatric symptoms and lifetime history of mTBIs entered first, malleable factors accounted for 14-17% of additional variance in PCS (p < .001). Lower self-efficacy (B = -.53, p < .001) and greater attribution of symptoms to mTBI (B = .21, p = .05) were associated with higher PCS, whereas an approach style of coping, TBI knowledge, and the mBIAS were not (p’s>.05). Regarding cognition, the malleable factors block accounted for 25% of additional variance in executive functioning (p = .04) with premorbid intelligence entered first. Specifically, higher mBIAS scores significantly predicted worse executive functioning (B = -.50, p = .004). No significant associations emerged when predicting attention/processing speed or memory (p’s>.05). Conclusions In combat-exposed Veterans with mTBI histories, potentially malleable factors contribute to clinical outcomes even after accounting for psychiatric symptoms. These malleable features are prime targets to augment during psychoeducation (e.g., uncommonly-endorsed symptoms, attribution of symptoms) and cognitive behavioral therapy (e.g., self-efficacy) in the context of chronic PCS.

scholarly journals A-56 Mild Cognitive Impairment in a Patient with a History of COVID-19 Positivity and co-Morbid Cerebrovascular Disease

2021 ◽  
Vol 36 (6) ◽  
pp. 1098-1098
Author(s):  
Franchezka Lapitan ◽  
Amanda Wisinger ◽  
Joseph Fink
Keyword(s):  
Cerebrovascular Disease ◽  
Post Infection ◽  
Psychiatric Symptoms ◽  
Disease Patient ◽  
Self Report ◽  
Residual Effects ◽  
Cognitive Test ◽  
Future Research ◽  
Neurocognitive Deficits ◽  
History Of

Abstract Objective Neurocognitive complaints have been observed in severe cases of post-COVID-19 diagnosis. However, limited information exists regarding specific neurocognitive deficits of patients reporting mild infection symptoms and persistent memory problems after infection. We report on a patient referred for worsening memory complaints 7-months after testing positive. Method Patient was a 74-year-old Caucasian female with a history of COVID-19. Relevant history was significant for sleep apnea, pulmonary embolism, hypertension, hyperlipidemia, and type-2 diabetes. Imaging pre-infection revealed mild cerebrovascular disease. Patient underwent a tele-neuropsychological evaluation to assess the extent of cognitive difficulties. Results Results indicated prominent difficulties were in the domains of immediate and delayed memory and executive functioning. Patient denied anxiety and depression on self-report measures, however, collateral information suggested she experienced a substantial increase in psychiatric symptoms following COVID-19. Activities of daily living (ADLs) were preserved, but she required increased assistance with complex ADLs. Post-infection cerebrovascular disease on imaging was documented as unchanged. Conclusions Although specific cognitive impairments were noted, discernment of direct residual effects of COVID-19 is limited in cases without a pre-COVID-19 neurocognitive baseline and with pre-existing conditions affecting the brain, such as cerebrovascular disease. This case illustrates the rising conundrum of clinical cases with stable underlying medical conditions but presence of cognitive deficits post-infection. Caution is needed to avoid over-interpretation of cognitive test results and necessity for a thorough clinical history that includes duration and clinical characteristics of COVID-19. Future research is needed on larger group studies comparing pre and post-COVID-19 neurocognitive results of patients with varying levels of vascular risk factors.

scholarly journals A-10 Self-Reported Post-Concussive Symptom Levels as Predictors of Performance Validity in a Sample of Active Duty Service Members with a History of Mild Traumatic Brain Injury

2020 ◽  
Vol 35 (6) ◽  
pp. 783-783
Author(s):  
J Trotta ◽  
L Hungerford ◽  
S Agtarap ◽  
M Ettenhofer
Keyword(s):  
Traumatic Brain Injury ◽  
Regression Analysis ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Active Duty ◽  
Performance Validity ◽  
Atypical Symptoms ◽  
Mild Brain Injury ◽  
History Of ◽  
Separate Regression

Abstract Objective The study investigated the relationship between levels of symptom reporting and performance validity testing (PVT) in Active Duty Service Members (ADSM) with mild traumatic brain injury (mTBI). Method A total of 70 ADSM with a history of mTBI completed the Neurobehavioral Symptom Inventory (NSI); the PTSD Check List for DSM-5 (PCL-5), Headache Impact Test (HIT-6), Patient Health Questionnaire (PHQ8), Pittsburgh Sleep Quality Index (PSQI), and Alcohol Use Disorders Identification Test (AUDIT-C); and a comprehensive neuropsychological evaluation including the Test of Memory Malingering (TOMM). A multiple regression was conducted with all self-reported symptom questionnaires as predictors of PVT performance. To further explore this relationship, the four NSI subscales (affective, cognitive, vestibular, somatosensory) plus the mild Brain Injury Atypical Symptoms (mBIAS) subscore were entered into a separate regression analysis. Results The NSI was the only significant predictor of TOMM Trial 1 performance (TOMMT1; R2 = .272, F(6,58) = 3.606, p &lt; .01; β = −.615, p &gt; .01). When the four NSI subscales (affective, cognitive, vestibular, somatosensory) plus the mild Brain Injury Atypical Symptoms (mBIAS) subscore were entered into a separate regression analysis, only the somatosensory subscore emerged as a significant predictor of TOMMT1 (R2 = .208, F(5,63) = 3.317, p &lt; .05; β = −.384, p &gt; .05). Conclusions Results suggest that performance validity measures in ADSM with mTBI may at times be more strongly influenced by patients’ health concerns than by overt dissimulation.

scholarly journals Clinical Outcomes and Satisfaction following Neuropsychological Assessment for Adults: A Community Hospital Prospective Quasi-Experimental Study

2019 ◽  
Vol 35 (8) ◽  
pp. 1303-1311
Author(s):  
Margaret Lanca ◽  
Anthony J Giuliano ◽  
Casey Sarapas ◽  
Anya I Potter ◽  
Michelle S Kim ◽  
...  
Keyword(s):  
Experimental Study ◽  
Self Efficacy ◽  
Repeated Measures ◽  
Psychiatric Symptoms ◽  
Cognitive Strategies ◽  
Brief Symptom Inventory ◽  
Self Report ◽  
Performance Validity ◽  
Feedback Session ◽  
Quasi Experimental

Abstract Objective Patients and other stakeholders generally report high satisfaction with neuropsychological evaluations (NPEs), but no research has examined effects of cognitive, emotional, and other factors that often prompt evaluations. A prospective, quasi-experimental study was conducted to examine self-reported cognitive and psychiatric symptoms, self-efficacy, motivation, and satisfaction following a NPE. Method Participants from a neuropsychology clinic who were diagnosed with AD/HD and/or a DSM-IV mood disorder based on a NPE were included, and excluded if diagnosed with dementia or failure on performance validity tests. Results To examine whether a NPE with an interventional feedback session was associated with outcomes, changes from baseline to post-feedback session were examined with repeated-measures analysis of variance. Pearson correlations determined whether changes in hypothesized mechanisms (i.e., self-efficacy, goal importance and confidence ratings, and use of cognitive strategies) were related to changes in cognitive or psychiatric symptom severity. At follow-up, participants reported reductions in psychiatric (change in Brief Symptom Inventory depression: M = -2.8, SD = 4.4, range = −11 to 8, ${\eta}_p^2$=.30; anxiety: M = 3.2, SD = 6.6, range = −21 to 10, ${\eta}_p^2$ = .20) and cognitive symptoms (change in Multiple Ability Self-Report Questionnaire attention: M = −0.3, SD = 0.5, range = −1.6 to 0.5, ${\eta}_p^2$ = .31; verbal memory: M = −0.3, SD = 0.5, range = −1.1 to 0.5, ${\eta}_p^2$ = .24; language: M = −0.4, SD = 0.4, range = −1.3 to 0.4, ${\eta}_p^2$ = .48), and improved cognition (change in Meta-Memory Questionnaire ability: M = 4.4,SD = 6.2, range = −10 to 16, ${\eta}_p^2$ = .35; contentment: M = 4.3, SD = 4.5, range = −7 to 14, ${\eta}_p^2$ = .49). Participants reported increased self-efficacy for general and evaluation-specific goals. Increased goal-specific self-efficacy was associated with large reductions in psychiatric symptoms. Conclusions Participants reported high levels of satisfaction with the NPE. Results support the clinical utility of NPE and feedback, and underscore the importance of individualized goal setting as part of the evaluation process.

The Role of Maternal Self-efficacy in the Link Between Childhood Maltreatment and Maternal Stress During Transition to Motherhood

2021 ◽  
pp. 088626052110428
Author(s):  
Gabriella Bentley ◽  
Osnat Zamir
Keyword(s):  
Childhood Abuse ◽  
Childhood Maltreatment ◽  
Parental Stress ◽  
Self Efficacy ◽  
Self Report ◽  
Convenience Sample ◽  
History Of Childhood ◽  
Transition To Motherhood ◽  
History Of

The transition to motherhood is a significant developmental milestone in many women’s lives. This transitional period may be more stressful for women with a history of childhood maltreatment (CM) than for women without such a history. This study tested whether parental self-efficacy (PSE) accounts for the link between CM and parental stress in mothers transitioning to motherhood. The study used a convenience sample of 1,306 first-time mothers of children aged two years or younger. Mothers filled out online self-report questionnaires assessing history of CM, PSE, and prenatal stress. Consistent with the hypotheses, exposure to CM was directly associated with greater parental stress. Also, PSE partially mediated the associations between CM and parental stress, such that mothers with a history of childhood abuse reported a lower level of PSE, which in turn was associated with greater parental stress. In conclusion, the study highlights the important role of negative cognitions related to parenting for maternal dysfunction following exposure to childhood abuse. These findings suggest a need to incorporate preventive interventions designed to promote PSE for mothers exposed to CM. Such programs may alleviate parental stress and further support the healthy development of the child.

Neurocognition, psychiatric symptoms, and lifetime homelessness among veterans with a history of traumatic brain injury

2019 ◽  
Vol 271 ◽  
pp. 167-170
Author(s):  
Elizabeth W. Twamley ◽  
Chelsea C. Hays ◽  
Ryan Van Patten ◽  
P. Michelle Seewald ◽  
Henry J. Orff ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Psychiatric Symptoms ◽  
History Of

scholarly journals A-146 A Comparison of Neuropsychological Assessment Results and Self-Reported Cognitive Deficits in Traumatic Brain Injury Patients with Variable Neurocognitive Impairment Severity

2020 ◽  
Vol 35 (6) ◽  
pp. 940-940
Author(s):  
Coddaire K ◽  
Peyton L ◽  
Powell J ◽  
Virden T
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functioning ◽  
Neuropsychological Assessment ◽  
Cognitive Deficits ◽  
Neurocognitive Impairment ◽  
Self Report ◽  
Neurocognitive Deficits ◽  
Cognitive Domains ◽  
The Relationship

Abstract Objective This study aimed to determine the relationship between symptom self-report accuracy and objective cognitive functioning in multiple cognitive domains for varying neurocognitive impairment (NCI) subsequent to Traumatic Brain Injury (TBI). Specifically, the discrepancy between self-report and objective findings among participants with mild, moderate, and severe NCI was examined within the cognitive domains of Attention, Executive Functioning, Learning/Memory, and Speech/Language. Method The sample included archival data consisting of neuropsychological scores and self-reported Ruff Neurobehavioral Inventory (RNBI) results of 135 adult TBI patients with mild, moderate, or severe NCI who received neuropsychological assessment at a private practice. Patients were grouped based on level of impairment using Halstead Impairment Index criteria. Results No main effect was found for Attention. Patients with severe NCI had greater discrepancies in Executive Functioning (p = 0.015), Learning/Memory (p = 0.015), and Speech/Language (p &lt; 0.001) function, when compared to those with mild NCI. Additionally, patients with severe NCI demonstrated greater discrepancies in Speech/Language (p &lt; 0.001) function when compared to those with moderate NCI. Conclusion These findings indicate as severity of neurocognitive impairment increases for TBI patients, self-reported cognitive symptomatology—specifically executive functioning, learning/memory, and speech/language—will become less accurate. Clinically, these findings suggest that when working with patients who have severe neurocognitive deficits subsequent to TBI, it is important to consider objective testing as self-reporting may not be accurate. Understanding patient’s genuine deficits will foster patient awareness and acceptance of TBI-related cognitive deficits with increased investment in treatment and improved neurorehabilitation outcomes.

Dementia after traumatic brain injury

2005 ◽  
Vol 17 (s1) ◽  
pp. S93-S107 ◽  
Author(s):  
Sergio E. Starkstein ◽  
Ricardo Jorge
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functioning ◽  
Prospective Studies ◽  
Retrospective Studies ◽  
Neuropsychological Deficits ◽  
Clinical Expression ◽  
History Of ◽  
Severe Tbi ◽  
Meta Analyses

Early retrospective studies suggested that individuals with a history of a traumatic brain injury (TBI) had a higher risk for dementia than those without a history of TBI. Two meta-analyses demonstrated that the risk for dementia is higher among men, but not women, with a history of TBI. More recent prospective studies, however, are providing discrepant findings, probably due to important methodological differences. TBI is usually associated with significant neuropsychological deficits, primarily in the domains of attention, executive functioning and memory. These deficits may not improve with time. TBI may also lower the threshold for the clinical expression of dementia among predisposed individuals, and the onset of Alzheimer's disease (AD)-like neuropathological and biochemical changes immediately after severe TBI may play an important role in this mechanism.

scholarly journals Metacognition in Individuals Aging with Traumatic Brain Injury

2021 ◽  
Author(s):  
Emily Grossner ◽  
Einat Brenner ◽  
Rachel Bernier ◽  
Amanda Rabinowitz ◽  
Frank Hillary
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Community Participation ◽  
Functional Outcomes ◽  
Significant Interaction ◽  
Psychiatric Symptoms ◽  
Self Report ◽  
Healthy Controls ◽  
Awareness Of Deficit ◽  
Post Hoc

OBJECTIVE: To measure metacognition in adults aging with moderate-severe traumatic brain injury (TBI) through objective (task-based) and subjective (self-report) measures to determine association between measures, and ability to predict executive functioning (EF), emotional functioning, and functional outcome.METHOD: 130 individuals (TBI n = 102; healthy controls (HC) n = 28) were included. Participants completed objective tasks of metacognition and EF, and self-reported measures of metacognition (MCQ-30), psychiatric symptoms (BSI-18), and community participation (PART-O). The objective metacognitive task and MCQ-30 subscales were used as predictors of EF, anxiety, and community participation. Post-hoc analyses examined the association between objective and subjective metacognitive measures in TBI subgroups (overconfident, metacognitively accurate). RESULTS: The objective metacognitive task and one self-report subscale predicted EF [F(2) = 9.69, p &lt; 0.001, R2 = 0.17]. Two self-report subscales predicted anxiety [F(2) = 19.15, p &lt; 0.001, R2 = 0.28]. No variables predicted community participation. There was a significant interaction between the metacognitive groups (overconfident, accurate) and MCQ-30 on objective metacognitive performance [R2 = 0.23, p = 0.037].CONCLUSION: Individuals aging with TBI demonstrated metacognitive deficit 45% of the time and when they did, ~90% over-estimated their ability. Both objective and subjective metacognitive measures predicted aspects of functional outcomes. However, self-report and objective metacognitive measures are related only when objective metacognitive performance is high, confirming long-standing concerns that self-report may be unreliable when awareness of deficit is present. These findings challenge the predictive validity of self-report measures of metacognition.

scholarly journals B-68 The Effect of Bilingualism on Stroop Performance in Traumatic Brain Injury Survivors and Healthy Adults

2019 ◽  
Vol 34 (6) ◽  
pp. 1016-1016
Author(s):  
J Knight ◽  
A Arzuyan ◽  
W Lopez-Hernandez ◽  
P Litvin ◽  
R Cervante ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Response Inhibition ◽  
Color Word ◽  
Cognitive Test ◽  
Control Group ◽  
Performance Validity ◽  
Post Injury ◽  
Main Effects ◽  
The Relationship

Abstract Objective Traumatic brain injury (TBI) affects neurocognition. Speaking multiple languages can also influence cognitive test performances. We examined the relationship between TBI and monolingualism/bilingualism on a task of attention and response inhibition (Stroop Color Word Test; SCWT). Method The sample (N = 96) consisted of 37 healthy controls (19 bilingual; 18 monolingual), 32 acute TBI participants (12 bilingual; 20 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. The SCWT included the word (SCWT-W), color (SCWT-C), and color-word interference (SCWT-I) conditions. All participants passed performance validity testing. 3X2 ANOVAs were conducted to examine the relationship between TBI and monolingualism/bilingualism on SCWT performances. Results Group effects (control and TBI groups) were found for all Stroop measures. We found main effects of TBI on SCWT-W, p = .013, ηp² = .09, SCWT-C, p = .001, ηp² = .14, and SCWT-I, p = .022, ηp² = .08, with the controls outperforming acute TBI survivors on SCWT-I, chronic TBI survivors on SCWT-W, and both TBI groups on SCWT-C. We also observed main effects of language for SCWT-C, p = .012, ηp² = .07, and SCWT-I, p = .003, ηp² = .09, with the monolinguals outperforming bilinguals on SCWT-C and SCWT-I. However, no significant interactions between TBI and language were found. Conclusion As expected, the control group outperformed TBI survivors on the SCWT. Monolinguals outperformed bilinguals on all Stroop measures except SCWT-W condition. Our findings seem to suggest that monolingual speakers may have better attention and response inhibition abilities that resulted in better SCWT performance.

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