Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury.

OBJECTIVE: Persistent cognitive symptoms after mild traumatic brain injury (mTBI) often do not correlate with objective neuropsychological performance. Catastrophizing (i.e., excessively negative interpretations of symptoms) may help explain this discrepancy. We hypothesize that symptom catastrophizing will be associated with greater cognitive symptom reporting relative to neuropsychological test performance in people seeking treatment for mTBI. METHOD: Secondary analysis of baseline data from a randomized controlled trial. Adults with mTBI (N = 77) were recruited from two outpatient mTBI clinics in British Columbia, Canada. Questionnaires and assessments were administered at baseline (M = 17.7 weeks postinjury). The sample was 64% women with a mean age of 42 years (SD = 11.5). Validated questionnaires were used to assess catastrophizing, cognitive symptoms, and affective distress. Neuropsychological performance was assessed using the National Institutes of Health Toolbox Cognition Battery. Discrepancies between cognitive symptoms and cognitive functioning were operationalized using standard residuals from neuropsychological test performance scores regressed on cognitive symptom scores. Generalized linear models were run to measure the association between symptom catastrophizing, cognitive variables, and their discrepancy, with affective distress as a covariate. RESULTS: Symptom catastrophizing was associated with more severe cognitive symptoms when controlling for neuropsychological performance (ß = 0.44, 95% CI [0.23, 0.65]). Symptom catastrophizing was also associated with higher subjective-objective cognition residuals (ß = 0.43, 95% CI [0.22, 0.64]). Catastrophizing remained a significant predictor after affective distress was introduced as a covariate. CONCLUSIONS: Catastrophizing is associated with misperceptions of cognitive functioning following mTBI, specifically overreporting cognitive symptoms relative to neuropsychological performance. Symptom catastrophizing may be an important determinant of cognitive symptom reporting months after mTBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors perpetuating functional cognitive symptoms after mild traumatic brain injury.

INTRODUCTION: Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI. METHODS: A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group. RESULTS: Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group. CONCLUSIONS: This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.

Psychological Contributions to Symptom Provocation Testing After Concussion.

OBJECTIVE: Following concussion, symptoms such as headache, dizziness, and fatigue may transiently worsen or reemerge with increased exertion or activity. Standardized tests have been developed to assess symptom increases following aerobic, cognitive, or vestibular/oculomotor challenge. Although neurophysiological mechanisms are proposed to underlie symptom increases following exertion, psychological factors such as anxiety and misinterpretation of normal bodily sensations may also play a role. In this study, we examined the contribution of psychological factors to symptom provocation testing outcomes. SETTING: Two outpatient concussion clinics in British Columbia, Canada. PARTICIPANTS: Adults with persistent symptoms following concussion ( N = 79; 62% women). DESIGN: In a single session, participants completed self-report questionnaires measuring the psychological factors of interest and underwent symptom provocation testing including aerobic (Buffalo Concussion Bike Test; BCBT), cognitive (National Institutes of Health Toolbox-Cognition Battery; NIHTB-CB), and vestibular/oculomotor (Vestibular/Ocular Motor Screening for Concussion; VOMS) challenge. MAIN MEASURES: Psychological factors of interest included premorbid and current anxiety (Generalized Anxiety Disorder-7; GAD-7), catastrophizing (Pain Catastrophizing Scale-Adapted; PCS-A), fear avoidance behavior (Fear Avoidance Behavior after Traumatic Brain Injury; FAB-TBI), and somatization (Patient Health Questionnaire-15; PHQ-15). Our primary outcome variables were self-reported symptom change during each symptom provocation test. RESULTS: We found that current anxiety ( B = 0.034; 95% CI = 0.003, 0.065), symptom catastrophizing ( B = 0.013; 95% CI = 0.000, 0.026), fear avoidance behavior ( B = 0.029; 95% CI = 0.008, 0.050), and somatization ( B = 0.041; 95% CI = 0.007, 0.075) were associated with increased symptoms during the VOMS in univariate models adjusted for time postinjury but not in a multivariable model that included all covariates. The psychological variables of interest were not significantly related to symptom change during the BCBT or NIHTB-CB. CONCLUSION: Our findings suggest that symptom provocation test failure should be interpreted with caution because it might indicate psychological maladjustment rather than lingering brain injury or incomplete neurophysiological recovery.

Memory for forgetting in adults with persistent symptoms following concussion.

INTRODUCTION: Persistent memory complaints following concussion often do not coincide with evidence of objective memory impairment. To the extent this clinical presentation represents Functional Cognitive Disorder (FCD), we would expect preservation or even enhancement of memory for instances of forgetting, based on two lines of prior evidence. First, emotional arousal enhances autobiographical memory. People who experience memory lapses as worrisome may better remember them. Second, individuals with FCD can paradoxically provide detailed accounts of memory lapses compared to patients with neurodegenerative disease, who tend to provide vague examples. The current study aimed to better characterize the recall of forgetting events in people with subjective memory problems following concussion. METHODS: The study sample consisted of adults with chronic post-concussion symptoms (N = 37, M = 42.7 years old; 70.27% women; M = 24.9 months post-injury) and normal-range performance on conventional neuropsychological tests. Participants completed a measure of memory complaint severity and the Autobiographical Interview (AI). The AI was used to quantify the richness of narrative recollections of recent instances when they forgot something and (control) personal events that did not involve forgetting. Linear regression modeling assessed the relationship between memory complaint severity and AI variables, including narrative details, valence, arousal, and rehearsal of memories. RESULTS: There was no association between memory complaint severity and memory for forgetting vs. control events. We further found no association between memory complaint severity and AI performance overall (collapsing across forgetting and control events). Participants with greater memory complaints experienced past memory lapses as more negative than control memories, but did not consistently differ on other AI phenomenological variables. CONCLUSION: Autobiographical recall of memory lapses appears preserved but not selectively heightened in people who report experiencing severe memory problems long after concussion. This inconsistency supports conceptualization of persistent memory complaints after concussion as FCD.

Memory Perfectionism is Associated with Persistent Memory Complaints after Concussion.

OBJECTIVE: The etiology of persistent memory complaints after concussion is poorly understood. Memory perfectionism (highly valuing memory ability and intolerance of minor memory lapses) may help explain why some people report persistent subjective memory problems in the absence of corresponding objective memory impairment. This study investigated the relationship between memory perfectionism and persistent memory complaints after concussion. METHODS: Secondary analysis of baseline data from a randomized controlled trial. Adults (N = 77; 61% women) with persistent symptoms following concussion were recruited from outpatient specialty clinics. Participants completed the National Institutes of Health Toolbox Cognition Battery, Test of Memory Malingering-Trial 1, and questionnaires measuring memory perfectionism (Metamemory in Adulthood-Achievement subscale), forgetfulness and other postconcussion symptoms (Rivermead Postconcussion Symptoms Questionnaire; RPQ), and depression (Patient Health Questionnaire-2) at M = 17.8 weeks postinjury. Patients with versus without severe memory complaints (based on the RPQ) were compared. RESULTS: Memory perfectionism was associated cross-sectionally with severe memory complaint, after controlling for objective memory ability, overall cognitive ability, and depression (95% confidence interval for odds ratio = 1.11-1.40). Sensitivity analyses showed that this relationship did not depend on use of specific objective memory tests nor on inclusion of participants who failed performance validity testing. In a control comparison to test the specificity of identified relationships, memory perfectionism was not associated with severe fatigue (95% confidence interval for odds ratio = 0.91-1.07). CONCLUSIONS: Memory perfectionism may be a risk factor for persistent memory symptoms after concussion, with potential relevance to the spectrum of functional cognitive disorders more broadly.

Unexpected symptoms after concussion: Potential links to functional neurological and somatic symptom disorders.

OBJECTIVE: Reporting of unexpected symptoms after concussion might, in some people, reflect a Functional Neurological Disorder (FND), Somatic Symptom Disorder (SSD), or exaggeration (feigning). This study aimed to determine whether reporting unexpected symptoms after concussion was associated with risk factors for FND/SSD, exaggeration, or both. METHOD: Adults with persistent symptoms following concussion (N = 77; 61% women) rated the presence and severity of unexpected neurological symptoms (from the Screening for Somatoform Symptoms scale, e.g., paralysis) and somatic symptoms (from the Patient Health Questionnaire-15, e.g., stomach pain) that did not overlap with post-concussion symptom scale items. The independent variables were risk factors for exaggeration (neuropsychological performance validity test failure and personal injury litigation) and predisposing and perpetuating factors for developing FND and/or SSD (e.g., fear avoidance behavior). RESULTS: When adjusting for all covariates, fear avoidance behavior was most strongly related to unexpected neurological symptoms (B = 0.11, 95% confidence interval = 0.05-0.18, p < .001), while current anxiety scores were most strongly related to unexpected somatic symptoms (B = 0.34, 95% confidence interval = 0.15-0.52, p < .001). Performance validity test failure and litigation were not significant predictors in either model. CONCLUSION: Unexpected neurological and other somatic symptoms after concussion should not be dismissed as exaggeration. Psychological factors thought to perpetuate FND and SSD (e.g., fear avoidance behavior) may contribute to unexpected symptoms following concussion. More research is needed at the intersection of FND, SSD, and persistent post-concussive symptoms.

Visual illusions help reveal the primitives of number perception.

The human perceptual system is responsive to numerical information within visual and auditory scenes. For example, when shown 2 displays of dots, observers can instantly, albeit approximately, identify the set that is more numerous. Theories in perceptual and cognitive psychology have focused on 2 mechanisms for how vision accomplishes such a feat: Under the domain-specific encoding theory, number is represented as a primary visual feature of perception, much like motion or color, while under the domain-general theory, the visual system represents number indirectly, through a complex combination of features such as the size of the dots, their total cluster, and so forth. Evidence for the latter theory often comes from "congruency effects:" the finding that participants frequently select the side where the dots on the screen are denser, larger, or brighter, rather than the side that is actually more numerous. However, such effects could also stem from response conflicts between otherwise independent dimensions. Here, we test these 2 competing accounts by embedding numerical displays within visual illusions that create large conflicts between number and other non-numeric dimensions-including contour length, convex hull, and density-and contrast participants' performance on a number discrimination task (i.e., "Which side has more dots?") against a number estimation task (i.e., "How many dots are there?"), which should eliminate response conflicts. Across 3 experiments, we find that while contour length illusions only affect number perception in discrimination tasks, the influences of convex hull and density on number perception persist in both discrimination and estimation tasks, supporting a more domain-general account of number encoding. (PsycINFO Database Record (c) 2019 APA, all rights reserved).