Title: Determinants of Subjective Memory Complaints in Community-dwelling Adults with Traumatic Brain Injury Esther Bay, PhD; Bruno Giordani, PhD; Claire Kalpakjian, PhD The University of Michigan, Ann Arbor, MI
1Determinants of Subjective Memory Complaintsin
Community-dwelling Adults with Traumatic Brain
Injury Esther Bay, PhD Bruno Giordani, PhD
Claire Kalpakjian, PhD The University of
Michigan, Ann Arbor, MI
Results
Methods
Introduction
- Individuals (N 159) aged 18-65 years, who
sustained mild-to-moderate TBI and had been
evaluated by a neuropsychologist with brain
injury expertise, were recruited from outpatient
rehabilitation clinics affiliated with tertiary
urban trauma facilities. The eligibility
criteria included - Ability to speak English
- No psychosis at the time of their
neuropsychological evaluation - Absence of severe TBI
- No pre-injury neurological impairment such as
stroke, Alzheimers or Parkinsons disease. - After being consented, and demographic
information collected, study participants were
placed in a room free of interruptions where
written questionnaires were completed with
assistance of trained research aides.
Instruments used included - Perceived Stress Scale-14 (PSS-14)
- Center for Epidemiological studies-Depression
(CES-D) - Neurobehavioural Functioning Inventory (NFI)
- Glasgow Coma Scale (GCS)
- This study used an observational, cross-sectional
design.
- Difficulties with memory, attention, arousal,
speed of information processing, and planning are
common and a frustrating consequence of traumatic
brain injury (TBI). When they persist, they
contribute to chronic stress and negative
outcomes. Chronic subjective memory complaints
(SMC) have been associated with organic changes,
malingering, expectancy, post-concussion
syndrome, and depression following less than
severe TBI. - The purpose of this study, conducted with persons
who sustained mild-to-moderate traumatic brain
injury (TBI) while in a chronic phase of their
recovery and referred for out-patient
rehabilitation therapy, was to determine the
extent to which chronic subjective memory
complaints (SMC) was associated with chronic
stress, depression and the neurobehavioral
consequences of TBI. The extent to which
pre-morbid (sex, education, co-morbidities,
employment or marital status) or injury-related
covariates, such as time-since-injury, Glasgow
Coma Scale (GCS) score (mild vs moderate), or
litigation status affected these relationships
was examined. The following hypotheses were
tested - Compared to younger persons with mild-to-moderate
TBI, older adults will have increased SMC, after
controlling for related covariates. - The effect of age on the positive and significant
relationship between chronic stress and SMC will
be determined by interactions between age group
and depression group severity. - 3. Increased levels of SMC will be associated
with increased age, time-since-injury, chronic
stress, somatic and depressive symptoms.
- Hypothesis 1
- Older persons (40-60 yrs) showed significantly
greater frequencies of SMC than younger (lt 40
yrs) persons showed. - Time-since-injury showed a significant main
effect on SMC, not premorbid psychiatric history.
- Hypothesis 2
- There were no significant group differences in
depression severity. - Using ANOVA and the CES-D cut-off score for
depression, SMC was significantly explained by
increased age, chronic stress, time-since-injury,
as well as the presence of mental health history
and the severity group of depressive symptoms
(adjusted R2 53).
- Hypothesis 3
- SMC was explained by premorbid psychiatric
history and increased age, time-since-injury,
chronic stress, somatic symptoms, and
communication difficulties. - Importantly, depressive symptoms were not
associated with SMC.
Implications of Findings
- SMC were significantly associated with
- Increased age
- Increased time-since-injury
- Worse self-reported chronic stress
- Heightened somatic symptoms and communication
difficulties. - SMC were not associated with
- Motor complaints
- Depressive symptoms.
Final Model and Results of Hypothesis 3 Final Model and Results of Hypothesis 3 Final Model and Results of Hypothesis 3 Final Model and Results of Hypothesis 3 Final Model and Results of Hypothesis 3
Model Variables SRC T-statistic Significance
1 Age .182 2.48 0.014
Time-since-injury .331 4.554 0.000
Psychiatric history .161 2.227 0.027
2 Age .098 2.395 0.018
Time-since-injury .110 2.614 0.010
Psychiatric history .072 1.847 NS
NFI-Cognition .558 9.081 0.000
NFI-Motor .018 0.271 NS
NFI-Somatic .161 2.628 0.009
NFI-Depression .005 .069 NS
Chronic stress (PSS-14) .200 3.629 0.000
NFI-Communication .558 9.081 0.000
Adjusted R2 .783, F 72.13 (df 8,150), p lt .001. Standard regression coefficient (SRC). Adjusted R2 .783, F 72.13 (df 8,150), p lt .001. Standard regression coefficient (SRC). Adjusted R2 .783, F 72.13 (df 8,150), p lt .001. Standard regression coefficient (SRC). Adjusted R2 .783, F 72.13 (df 8,150), p lt .001. Standard regression coefficient (SRC). Adjusted R2 .783, F 72.13 (df 8,150), p lt .001. Standard regression coefficient (SRC).
Study Variables by Age Study Variables by Age Study Variables by Age
Variables (M, SD) Younger lt 40 yrs, n 81 Older gt 40, n 78
CES-D total 20.80 (13.04) 21.00 (12.62)
PSS-14 26.14 (8.91) 26.13 (26.12)
NFI-Cognition 45.11 (15.48) 53.41 (14.81)
NFI Somatic 23.01 (23.01) 24.22 (7.54)
NFI-Depression 30.72 (10.88) 31.77 (10.61)
NFI-Communication 22.96 (8.11) 25.91 (8.37)
NFI-Motor 17.65 (6.65) 21.10 (6.48)
Pain severity 1.03 (1.93) 1.45 (1.82)
Time since injury (in months) 10.13 (8.69) 14.90 (10.05)
p lt .p5 p lt .01 p lt .p5 p lt .01 p lt .p5 p lt .01
Acknowledgements
This project was supported by an award (T32
HD007422) from the Eunice Kennedy Shriver
National Institute of Child Health Human
Development to Dr. Denise Tate. The content is
solely the responsibility of the authors and does
not necessarily represent the official views of
the National Institute of Child Health Human
Development , NIH.