Apathy in a high prevalence population of moderate to severe traumatic brain injury: An investigation in Vietnam.

Quang, Halle; McDonald, Skye; Huynh-Le, Phuong; Nguyen, Tuong-Vu; Le, Ngoc‐Anh; Lam-Nguyen, Nha-Truc; Kumfor, Fiona

doi:10.1037/neu0000781

Cited by 7 publications

(7 citation statements)

References 62 publications

(84 reference statements)

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“…The demonstrated relationship between apathy, disinhibition and communication found in our study is new but is in line with initial evidence in the literature. Apathy, both after TBI and in healthy people, is recognised to have multiple dimensions including executive, emotional and behavioural apathy (Quang et al, 2022(Quang et al, , 2022b, with all these dimensions potentially affecting communication. Executive apathy is related to the ability to plan and organise thoughts, while emotional apathy refers to emotion expression and social engagement.…”

Section: Discussionmentioning

confidence: 99%

Exploring neuropsychological underpinnings of poor communication after traumatic brain injury: The role of apathy, disinhibition and social cognition

Filipčíková

Quang

Cassel

et al. 2022

Intl J Lang & Comm Disor

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BackgroundDysarthria, aphasia and executive processes have been examined for their role in producing impaired communicative competence post traumatic brain injury (TBI). Less understood is the role of emotional dysregulation, that is, apathy and disinhibition, and social cognition, that is, reading and interpreting social cues.Methods & ProceduresIn this study, we examined 49 adults with moderate to severe TBI and 18 neurologically healthy adults. We hypothesised that apathy and disinhibition would predict communication outcomes as would social cognition. We also predicted that apathy and disinhibition would influence social cognition. Communication outcomes were measured by the La Trobe Communication Questionnaire (LCQ) and the Social Skills Questionnaire‐TBI (SSQ‐TBI). Apathy and disinhibition were measured by the Frontal Systems Behavior Scale (FrSBe). We measured four aspects of social cognition: emotion perception and theory of mind using The Awareness of Social Inference Test (TASIT) and the Complex Audio‐Visual Evaluation of Affect Test (CAVEAT), empathy using the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Balanced Emotional Empathy Scale (BEES), and alexithymia using the Toronto Alexithymia Scale (TAS‐20) and the Bermond–Vorst Alexithymia Questionnaire.Outcomes & ResultsConsistent with predictions, the LCQ and SSQ‐TBI were associated with disinhibition and the LCQ was also associated with apathy. The LCQ was associated with the full range of social cognition constructs although the SSQ‐TBI was not. Finally, apathy and disinhibition predicted a number of social cognition measures.Conclusions and ImplicationsThese results are discussed in relation to understanding the nature of communication disorders following TBI and how they are measured, as well as the interrelation between emotion dysregulation and social cognition.What this study addsWhat is already known on this subjectThe role of emotional dysregulation and social cognition in producing impaired communicative competence post traumatic brain injury (TBI) is not well understood. Although most adults with severe TBI have minimal or possibly no language impairment, they often struggle with functional communication in everyday situations. Many have been reported to be overtalkative, insensitive, childish and self‐centred, displaying an inappropriate level of self‐disclosure and making tangential and irrelevant comments. Conversely, some speakers with TBI have been noted to have impoverished communication, producing little language either spontaneously or in response to the speaker’s questions and prompts.What this paper adds to existing knowledgeWe found that both apathy and disinhibition were strongly associated with the Latrobe Communication Questionnaire both empirically and conceptually, despite the LCQ being developed from a different, pragmatic orientation. Disinhibition was also associated with the Social Skills Questionnaire for TBI. We also found that poor social cognition scores predicted communication difficulties. Finally, we found that behavioural dysregulation itself, i.e., both apathy and disinhibition, predicted poor social cognition.What are the potential or actual clinical implications of this work?Our findings highlight the central role that apathy and disinhibition play in both communication and social cognition. These insights point to the importance of remediation to target behavioural and autonomic dysregulation as a means to improve everyday social function.

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Section: Discussionmentioning

confidence: 99%

Exploring neuropsychological underpinnings of poor communication after traumatic brain injury: The role of apathy, disinhibition and social cognition

Filipčíková

Quang

Cassel

et al. 2022

Intl J Lang & Comm Disor

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“…Therefore, clinical measures that modulate the intensity of intrinsic and extrinsic rewards (e.g., making the task more challenging, increasing the amount of material values earned or increasing levels of praise) may not be successful in increasing motivation after TBI. Instead, methods that support patients’ values, beliefs, and self-esteem, such as motivational interviewing, may be more appropriate (Arnould et al, 2013; Lane-Brown & Tate, 2010; Quang, McDonald, et al, 2022). Given that previous studies are case reports or correlational observations, future clinical trials which comprehensively incorporate motivational interviewing techniques may offer a reliable avenue for effective treatment and management of apathy post TBI.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, although these concepts of extrinsic and intrinsic reward underlying motivation and goal-directed behavior have been extensively utilized in industrial and educational psychology to understand and improve human productivity and goal-directed actions (Benabou & Tirole, 2003; Ryan & Deci, 2020), they have yet to be considered in motivational deficits related to brain disorders. Traumatic brain injury (TBI) is a form of acquired brain injury that commonly affects goal-directed behavior, with up to 72% of people with TBI experiencing apathy (Andersson & Bergedalen, 2002; Andersson et al, 1999; Kant et al, 1998; Lane-Brown & Tate, 2009; Quang, McDonald, et al, 2022). TBI commonly impairs the prefrontal cortex and its connections to subcortical structures which has been demonstrated to associate with clinical apathy and reward processing (Chib et al, 2009; Hogeveen et al, 2021).…”

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confidence: 99%

Contributions of intrinsic and extrinsic reward sensitivity to apathy: Evidence from traumatic brain injury.

Quang¹,

Kumfor²,

Balleine³

et al. 2022

Neuropsychology

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Objective: Apathy is a key feature of traumatic brain injury (TBI). However, mechanisms underlying apathy are poorly understood. Evidence suggests that changes in reward may be a crucial factor. Rewards can come from two important sources: extrinsic reward (e.g., money) and intrinsic reward (e.g., enjoyment). Here, we used an experimental paradigm to examine the contributions of intrinsic–extrinsic reward sensitivity to apathy post-TBI and neurocognitive processes associated with these reward processing components. Method: Fifty-seven patients with TBI (TBI with clinical/severe apathy [TBI+sA], TBI with subclinical/moderate apathy [TBI+mA] and TBI without apathy [TBI-A] groups), and 30 healthy individuals completed the “birthday-gift task.” In the “intrinsic reward” condition, participants chose to “go” to collect the gift or “wait” for the same gift to be delivered. In the “extrinsic reward” condition, the task was identical, however, participants received monetary incentives when choosing “going” instead of “waiting.” The Montreal Cognitive Assessment was utilized for cognitive examination. Results: A smaller proportion of people in the TBI+sA group had high sensitivity to both intrinsic and extrinsic rewards than the TBI+mA, TBI-A and healthy comparison groups. The TBI+sA group also perceived the “go” option on the intrinsic reward condition as more effortful and made fewer “go” decisions on the extrinsic condition. Attention was the only predictor of intrinsic reward sensitivity, whereas executive functioning, attention and group predicted extrinsic reward. Conclusion: This study demonstrates the relationship between intrinsic–extrinsic reward hyposensitivity and apathy post-TBI. These results may be integrated into future trials to improve apathy in clinical practice.

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“…Considering the established connections between NPS and impairment to the frontal brain network (Robert, 2020), this search was performed utilizing the keyword “frontal contusion” and encompassed hospital admissions recorded from 2016 to 2019, with the patients’ time of injury ranging from 9 to 51 months upon participating in this study. The full recruitment procedure was fully reported in one previous study by Quang, McDonald, et al (2022). Inclusion criteria were: (a) aged from 18 to 65 at the time of the TBI, (b) Glasgow Coma Scale Score <13 (moderate-to-severe coma) administered within 24 hours of injury, (c) brain scan evidence documented by computed tomography.…”

Section: Methodsmentioning

confidence: 99%

“…Despite the recognition that neuropsychiatric symptoms (NPSs) after TBI mainly arise from neuropathology and so should be generalized to cultures other than the West, empirical evidence from Asian populations, including Vietnamese, is very limited. To date, only apathy has been directly examined in Vietnamese individuals with moderate-to-severe TBI (Quang, McDonald et al, 2022). Importantly, initial evidence has suggested that cultural factors, such as family roles and expectations, personal perspectives, and cultural values, may contribute to the way in which NPSs are reported (Quang, Sin et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric symptoms after moderate-to-severe traumatic brain injury in Vietnam: Assessment, prevalence, and impact on caregivers

Nguyen,

Pham,

Nguyen

et al. 2023

J Int Neuropsychol Soc

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Objective:Neuropsychiatric symptoms (NPSs) after moderate-to-severe traumatic brain injury (TBI) have been well documented in WEIRD (Western, educated, industrialized, rich, and democratic) populations. In non-WEIRD populations, such as Vietnam, however, patients with TBI clinically remain uninvestigated with potential neuropsychiatric disorders, limiting on-time critical interventions. This study aims to (1) adapt the Vietnamese Neuropsychiatric Inventory (V-NPI), (2) examine NPSs after moderate-to-severe TBI and (3) evaluate their impact on caregiver burden and well-being in Vietnam.Method:Caregivers of seventy-five patients with TBI completed the V-NPI, and other behavior, mood, and caregiver burden scales.Results:Our findings demonstrated good internal consistency, convergent validity, and structural validity of the V-NPI. Caregivers reported that 78.7% of patients with TBI had at least three symptoms and 16.0% had more than seven. Behavioral and mood symptoms were more prevalent (ranging from 44.00% to 82.67% and from 46.67% to 66.67%, respectively) and severe in the TBI group. Importantly, NPSs in patients with TBI uniquely predicted 55.95% and 33.98% of caregiver burden and psychological well-being, respectively.Conclusion:This study reveals the first evidence for the presence and severity of NPSs after TBI in Vietnam, highlighting an urgent need for greater awareness and clinical assessment of these symptoms in clinical practice. The adapted V-NPI can serve as a useful tool to facilitate such assessments and interventions. In addition, given the significant impact of NPS on caregiver burden and well-being, psychosocial support for caregivers should be established.

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Apathy in a high prevalence population of moderate to severe traumatic brain injury: An investigation in Vietnam.

Cited by 7 publications

References 62 publications

Exploring neuropsychological underpinnings of poor communication after traumatic brain injury: The role of apathy, disinhibition and social cognition

Exploring neuropsychological underpinnings of poor communication after traumatic brain injury: The role of apathy, disinhibition and social cognition

Contributions of intrinsic and extrinsic reward sensitivity to apathy: Evidence from traumatic brain injury.

Neuropsychiatric symptoms after moderate-to-severe traumatic brain injury in Vietnam: Assessment, prevalence, and impact on caregivers

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