Transcript Style E 24 by 48

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
Introduction
Methods
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.
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:

Absence of 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 outpatient 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 premorbid (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:

No pre-injury neurological impairment such as stroke,
Alzheimer’s or Parkinson’s disease.
1. Compared to younger persons with mild-tomoderate TBI, older adults will have
increased SMC, after controlling for related
covariates.
2. 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.
Results

Ability to speak English;

No psychosis at the time of their neuropsychological
evaluation;
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)
Hypothesis 1:
Hypothesis 2:
 Older persons (40-60 yrs) showed significantly greater frequencies of
SMC than younger (< 40 yrs) persons showed.
 There were no significant group differences in depression severity.
 Time-since-injury showed a significant main effect on SMC, not
premorbid psychiatric history.
Hypothesis 3:
 SMC was explained by premorbid psychiatric history and increased age,
time-since-injury, chronic stress, somatic symptoms, and communication
difficulties.
1
2
Variables (M, SD)
Older
> 40, n = 78
CES-D total
PSS-14
NFI-Cognition
NFI –Somatic
NFI-Depression
NFI-Communication
NFI-Motor
Pain severity
Time since injury (in months)
20.80 (13.04)
26.14 (8.91)
45.11 (15.48)
23.01 (23.01)
30.72 (10.88)
22.96 (8.11)
17.65 (6.65)
1.03 (1.93)
10.13 (8.69)
21.00 (12.62)
26.13 (26.12)
53.41 (14.81)**
24.22 (7.54)
31.77 (10.61)
25.91 (8.37)*
21.10 (6.48)**
1.45 (1.82)
14.90 (10.05)**
*p < .p5; **p < .01

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
This study used an observational, cross-sectional design.
Younger
< 40 yrs, n = 81
Implications of Findings
 Importantly, depressive symptoms were not associated with SMC.
Model
Study Variables by Age
 Using ANOVA and the CES-D cut-off score for depression, SMC was
significantly explained by increased age, chronic stress, time-sinceinjury, as well as the presence of mental health history and the severity
group of depressive symptoms (adjusted R2 = 53%).
Variables
SRC*
T-statistic
Significance
Age
.182
2.48
0.014
Time-since-injury
.331
4.554
0.000
Psychiatric history
.161
2.227
0.027
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 < .001. Standard regression coefficient (SRC)*.
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.