A small percentage of people with a mild traumatic brain injury (MTBI) report persistent symptoms and problems many months or even years following injury. Preliminary research suggests that people who sustain an injury often underestimate past problems (i.e., "good old days" bias), which can impact their perceived level of current problems and recovery. The purpose of this study was to examine the influence of the good old bays bias on symptom reporting following MTBI. The MTBI sample consisted of 90 referrals to a concussion clinic (mean time from injury to evaluation = 2.1 months, SD = 1.5, range = 0.8-8.1). All were considered temporarily fully disabled from an MTBI and they were receiving financial compensation through the Worker's Compensation system. Patients provided post-injury and pre-injury retrospective ratings on the 16-item British Columbia Post-concussion Symptom Inventory (BC-PSI). Ratings were compared to 177 healthy controls recruited from the community and a local university. Consistent with the good old bays bias, MTBI patients retrospectively endorsed the presence of fewer pre-injury symptoms compared to the control group. Individuals who failed effort testing tended to retrospectively report fewer symptoms pre-injury compared to those patients who passed effort testing. Many MTBI patients report their pre-injury functioning as better than the average person. This can negatively impact their perception of current problems, recovery from injury, and return to work.
When considering a diagnosis of postconcussion syndrome, clinicians must systematically evaluate and eliminate the possible contribution of many differential diagnoses, comorbidities, and factors that may cause or maintain self-reported symptoms long after mild traumatic brain injury (MTBI). One potentially significant contributing factor is symptom exaggeration. The purpose of the study is to examine the influence of poor effort on self-reported symptoms (postconcussion symptoms and cognitive complaints) and neurocognitive test performance following MTBI. The MTBI sample consisted of 63 referrals to a concussion clinic, evaluated within 5 months post injury (M = 2.0, SD = 1.0, range = 0.6-4.6), who were receiving financial compensation from the Workers' Compensation Board. Participants completed the Post-Concussion Scale (PCS), British Columbia Cognitive Complaints Inventory (BC-CCI), selected tests from the Neuropsychological Assessment Battery Screening Module (S-NAB), and the Test of Memory Malingering (TOMM). Participants were divided into two groups based on TOMM performance (15 fail, 48 pass). There were significant main effects and large effect sizes for the PCS (p = .002, d = 0.79) and BC-CCI (p = .011, d = 0.98) total scores. Patients in the TOMM fail group scored higher than those in the TOMM pass group on both measures. Similarly, there were significant main effects and/or large effect sizes on the S-NAB. Patients in the TOMM fail group performed more poorly on the Attention (p = .004, d = 1.26), Memory (p = .006, d = 1.16), and Executive Functioning (p > .05, d = 0.70) indexes. These results highlight the importance of considering the influence of poor effort, in conjunction with a growing list of factors that can influence, maintain, and/or mimic the persistent postconcussion syndrome.
Normative test scores often are corrected for demographic variables that can have an impact on neurocognitive abilities (e.g., gender, age, education, and ethnicity). The purpose of this study is to determine whether there are gender differences on the CNS Vital Signs computerized neurocognitive test battery. Participants, selected from a large normative database, were 100 healthy adults aged 18 to 68 years old (M(age) = 35.8 years, SD = 13.6) with 15.5 years of education (SD = 2.2). Men (n = 50) and women (n = 50) were individually and precisely matched on age, education, ethnicity, computer use, occupation, and handedness. This battery of seven tests yields 23 test scores, 5 domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility), and a total score. Men had significantly better scores than did women on the Finger-Tapping Test for the right hand (p = .006, Cohen's d = 0.57). No other scores were significantly different, although there were small-medium effect sizes in favor of women on Symbol-Digit Coding (d = .39) and Verbal Memory (d = .37). The trends toward gender differences in word-list recognition memory and processing speed are consistent with the literature, but because they were nonsignificant and the effect sizes were modest, the clinician likely does not need to factor this into test interpretation.
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