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 - PowerPoint PPT Presentation

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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

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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


1
Determinants 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.
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