8 - Premorbid Functioning Impacts the Discrepancy Between Subjective Cognitive Complaints and Neuropsychological Performance in Military Personnel with Traumatic Brain Injury
Student The Chicago School of Professional Psychology, Washington, D.C.
Abstract Text: Background/
Objective: The relationship between subjective reports of cognitive functioning and objective findings on neuropsychological evaluations has been studied across several patient populations, including TBI, with evidence suggesting that self-reported complaints often do not align with objective cognitive functioning. Several factors have been shown to contribute to a patient’s perception of their own cognitive abilities, such as depression, fatigue, and physical functioning. However, premorbid functioning may also play an important role in how patients assess their own cognition following illness or injury and has not yet been examined. Thus, the present study examined correlates of discrepancies between subjective and objective cognition in a sample of military personnel with and without TBI and analyzed the role of premorbid functioning in these relationships.
Methods: Participants were 235 U.S. military service members (Age M = 32.9 years, SD = 9.7; Education M = 14.6, SD = 2.3; 88.1% Male; 73.2% White) split into four injury groups: 31 non-injured controls (NIC), 69 injured controls (IC), 70 uncomplicated mild TBI (mTBI), and 65 complicated mild, moderate, severe, or penetrating TBI (sTBI). Participants were prospectively enrolled in the DVBIC-TBICoE 15-Year Longitudinal TBI Study. Participants demonstrating invalid performance or symptom validity were excluded. Measures included subscales from the TBI Quality-of-Life (TBI-QOL), PTSD Checklist-Civilian Version (PCLC), and subtests from the Weschler Adult Intelligence Scale-Fourth Edition (WAIS-IV), Weschler Memory Scale-Fourth Edition (WMS-IV), as well as measures of executive functioning. Two Cognitive Composite scores were calculated by averaging scores on the relevant subtests: 1) WAIS-IV/WMS-IV and 2) Executive Functioning. To calculate discrepancy scores, TBI-QOL Cognition-General Concerns and Executive Functioning Scales were subtracted from the WAIS-IV/WMS-IV and Executive Functioning Cognitive Composites, respectively. A similar set of calculations was also conducted that included the TOPF. Spearman correlations were calculated within each injury group to examine relationships between discrepancy scores with and without the TOPF, demographics, and psychological symptoms
Results: Group comparisons revealed significant main effects across the four injury groups for education (p = .003), time since injury (p < .001), and gender (p = .012). In the overall sample, TOPF was significantly related to General Cognition discrepancy score (ρ=.250, p < .001); individuals with higher TOPFs were more likely to underestimate their cognitive performance. Without consideration of the TOPF, General Cognition and Executive Functioning discrepancy scores were significantly correlated with PTSD symptoms, anxiety, fatigue, and pain in the NIC, TC, and sTBI groups (ps < .05), but not the mTBI group. In contrast, when factoring the TOPF into the discrepancy score calculation, significant correlations were found between all self-reported symptoms and discrepancy scores and neuropsychological measures in the mTBI subgroup (ps < .05). Specifically, those who reported higher levels of symptoms were more likely to underestimate their cognitive abilities.
Discussion: These findings provide a better understanding of the relationship between subjective cognitive complaints and objective cognition in a military TBI sample. Moreover, they suggest it is critical to consider premorbid functioning when assessing cognitive complaints. Individuals with higher premorbid functioning were more likely to underestimate their cognitive performance. When premorbid functioning was not considered, there was no relationship between self-reported behavioral health symptoms and the discrepancy between subjective and objective cognitive performance within the mTBI group. In contrast, when premorbid functioning was considered, all behavioral health symptoms assessed were related to the discrepancy between objective and subjective cognitive performance within the mTBI group. Additionally, those with higher self-reported symptoms were more likely to underestimate their cognitive abilities. Premorbid functioning and psychological distress are both important to consider when evaluating self-reported cognitive complaints.
Disclaimer: The views expressed in this abstract are those of the author(s) and do not necessarily reflect the official policy of the Department of Defense or the U.S. Government.
