Evidence for Cognitive Decline in Chronic Pain: A Systematic Review and Meta-Analysis

Background: People with chronic pain (CP) sometimes report impaired cognitive function, including a deficit of attention, memory, executive planning, and information processing. However, the association between CP and cognitive decline was still not clear. Our study aimed to assess the association of CP as a risk factor with cognitive decline among adults.Methods: We included data from clinical studies. Publications were identified using a systematic search strategy from PubMed, Embase, and Cochrane Library databases from inception to October 10, 2020. We used the mean cognitive outcome data and the standard deviations from each group. The standardized mean difference (SMD) or odds ratio (OR), and 95% confidence intervals (CI) were performed for each cognitive decline outcome. I2-values were assessed to quantify the heterogeneities.Results: We included 37 studies with a total of 52,373 patients with CP and 80,434 healthy control participants. Because these studies used different evaluative methods, we analyzed these studies. The results showed CP was associated with cognitive decline when the short-form 36 health survey questionnaire (SF-36) mental component summary (SMD = −1.50, 95% CI = −2.19 to −0.81), the Montreal cognitive assessment (SMD = −1.11, 95% CI = −1.60 to −0.61), performance validity testing (SMD = 3.05, 95% CI = 1.74 to 4.37), or operation span (SMD = −1.83, 95% CI = −2.98 to −0.68) were used. However, we got opposite results when the studies using International Classification of Diseases and Related Health Problems classification (OR = 1.58, 95% CI = 0.97 to 2.56), the Mini-Mental State Examination (SMD = −0.42, 95% CI = −0.94 to 0.10; OR = 1.14, 95% CI = 0.91 to 1.42), and Repeatable Battery for the Assessment of Neuropsychological Status memory component (SMD = −0.06, 95% CI = −0.37 to 0.25).Conclusion: There may be an association between CP and the incidence of cognitive decline when some cognitive, evaluative methods were used, such as short-form 36 health survey questionnaire, Montreal cognitive assessment, performance validity testing, and operation span.

A-109 Anxiety Influences Traumatic Brain Injury Survivors and Healthy Comparison Adult Bilinguals Stroop Color Word Test Performance

Objective We evaluated symptoms of anxiety (via the Hospital Anxiety and Depression Scale; HADS, HADS-A) on Stroop Color Word Test (SCWT) performances in traumatic brain injury (TBI) survivors, as compared to healthy comparison participants (HC). Method The sample consisted of 40 acute TBI survivors [ATBI; 30 normal symptoms of anxiety (NSA); 10 abnormal symptoms of anxiety (ASA)], 30 chronic TBI survivors (CTBI; 16 NSA; 14 ASA), and 50 HC’s (28 NSA; 22 ASA). All participants passed performance validity testing. The SCWT included the word (SCWT-W), color (SCWT-C), and color-word (SCWT-CW) conditions. A series of ANOVAs were used to evaluate SCWT performances. Results ANOVA revealed a main effect group on the SCWT-C, p = .011, and SCWT-CW, p = .018, with HC’s outperforming the ATBI group. Furthermore, HC outperformed both TBI groups on the SCWT-W, p = .004. We also found that the ASA outperformed the NSA group on the SCWT-W, p = .036. No interactions emerged between group and anxiety. Conclusion The HC group outperformed both TBI groups on the SCWT-W, but only the ATBI group on SCWT-C and SCWT-CW. Furthermore, we found that there were only differences between the anxiety groups on the SCWT-W. Our findings highlight that anxiety impacts HC and TBI groups differently on the SCWT.

A-212 The Relationships between PAI over-reporting SVTs and PVTs in a Military Sample

Objective Recent research has worked to explore the relationships between symptom and performance validity testing. The current study sought to examine the association between PAI over-reporting SVTs and well validated stand-alone and embedded PVTs. Methods Retrospective review of 468 active duty Army cases referred for outpatient neuropsychological testing at a Military Health Center. Each subject was administered the PAI, MSVT, NV-MSVT, and RBANS Effort Index. Groups were defined in two ways, as valid (0 PVT failures) or invalid (1 or more PVT failures) and based on the number of failed PVTs (0, 1, 2, and 3). Results Partial results are summarized here for the valid/invalid analysis. The PAI Negative Impression Management (NIM), Multi-Feigning Index (MFI), and Malingering Index (MAL) differed significantly as a function of PVT performance (p < .05). Differences on Rogers Discriminant Function were not significant. AUC for NIM, MAL, and MFI were .69, .66, and .54 (respectively). AUC for RDF was unacceptable at .49. At a T-score of 64 the NIM scale had specificity of .91, sensitivity of .32 and at a T-score of 59 the MAL had specificity of .91 and sensitivity of .14. Conclusions There appears an association between PVTs and PAI over-reporting scales, such that elevations on the NIM, MAL, and MFI scales are related to PVT failure. However, the sensitives of these scales are limited in predicting PVT failure. To this end, the current data are in line with previous studies that indicate the need to administer both performance and symptom validity scales.

Patterns of Cognitive Test Scores and Symptom Complaints in Persons with TBI Who Failed Performance Validity Testing

Objective:To determine clinically meaningful subgroups of persons with traumatic brain injury (TBI) who have failed performance validity testing.Method:Study participants were selected from a cohort of 674 participants with definitive medical evidence of TBI. Participants were those who failed performance validity testing (the Word Memory Test, using the standard cutoffs). Participants were administered cognitive tests and self-report questionnaires. Test and questionnaire results were summarized as 12 dimension scores. Cluster analysis using the k-means method was performed.Results:Cluster analysis for the 143 retained participants indicated three subgroups. These subgroups differed on patterns of scores. Subgroup 1 was impaired for memory and had no excessive complaints. Subgroup 2 had impaired memory and processing speed as well as concern regarding cognition function. Subgroup 3 showed impairment on all cognitive tests and excess complaints in multiple areas.Conclusions:These results provide a preliminary basis for improved understanding of poor performance validity.

The Impact of Self-Efficacy and Health Locus of Control on Performance Validity Testing

Objective Recent research has examined potential influences to performance validity testing beyond intentional feigning. The current study sought to examine the hypothesized relationships of two psychological constructs (self-efficacy and health locus of control) with performance validity testing (PVT). Method Retrospective review of 158 mild traumatic brain injury (mTBI) cases referred to an Army outpatient clinic for neuropsychological evaluation. The mTBI cases were classified according to passing or failing the Medical Symptom Validity Test (MSVT) or Non-Verbal Medical Symptom Validity Test (NV-MSVT). Group comparisons were performed utilizing one-way ANOVA to evaluate the differences between the PVT-Pass and PVT-Fail groups on self-efficacy (MMPI-2-RF Inefficacy scale) and locus of control (Multi-Dimensional Health Locus of Control). Results There was no relationship between self-efficacy or health locus of control and passing/failing PVTs. Conclusions Further research is warranted to explore potential influences on PVT performance, which we conceptualize as analogous to experimental nuisance variables that may be amenable to intervention.