Cognitive performance after Mild Traumatic Brain Injury: The impact of poor effort on test results and its relation to distress, personality and litigation

Abstract

Even in a sample of non-referred MTBI patients, poor effort was common and was strongly associated with inferior test performance. These findings imply that effort testing should be part of all cognitive assessments, also outside mediolegal settings. Behavioural factors like distress and personality should be considered as potential threats to the validity of neuropsychological testing after MTBI.

A General Propensity to Psychological Distress Affects Cardiovascular Outcomes

“…81 Although one study found that depression and not Type D was related to atrial fibrillation, 51 another reported that Type D predicted poor outcome of atrial fibrillation. 82 In patients with pulmonary disease, depressive symptoms and not Type D predicted mortality, 83 whereas other research groups showed that Type D was associated with impaired health status in patients with sleep apnea, 75 mild brain injury, 76 Parkinson disease, 84 gastrointestinal disorders, 85 or medical comorbidities 78 and in individuals from the general population. 86 Our group showed that Type D was related to poor health status in melanoma survivors.…”

“…Lately, the number of Type D studies from other research groups has increased rapidly. Although some have reported negative findings, 51,56,83 most of these studies support the role of Type D personality as a determinant of mechanisms of disease 53,54,66 -79 and impaired health status in clinical 59,61,75,76,78,82,84,85 and nonclinical 73,74,77,79,86 populations. This summary indicates that in addition to depression, a general propensity to distress, as defined by standing on negative affectivity and social inhibition in the Type D model, affects cardiovascular outcomes.…”

“…Hence, replication in other cultures and by other research groups is needed. Recent publications from independent research groups are promising and support the role of Type D as a determinant of genetic, 66 biological, 53,54,[67][68][69][70][71][72] and behavioral [73][74][75][76][77][78][79] pathways of disease that promote a better understanding of the effect of psychological distress on cardiac disorder. There are also mixed findings on Type D personality.…”

“…90 Type D personality is characterized by high neuroticism, low extraversion, and low conscientiousness, but these traits and Type D share less than 50% variance 15 and thus are not interchangeable. Head-to-head comparisons of neuroticism, extraversion, and Type D indicated that Type D had unique empirical value in patients with brain injury 76 or medical comorbidities 78 and that Type D independently predicted posttraumatic stress 91 and adverse events 92 in cardiac patients. Type D is also related to increased stress reactivity 68 and poor health behavior, 73 adjusting for hostility or neuroticism.…”

“…Findings from Type D research indicate that individual differences in general distress should also be accounted for when quantifying these outcomes. [31][32][33][34][35][36][37][38][39][40][57][58][59][60] In addition, Type D has been related to poor health in conditions such as sleep apnea, 75 brain injury, 76 or cancer. 87 Finally, Type D has been associated with an increased risk of suicidal ideation, adjusting for depressive symptoms.…”