Neuropsychological Impairments and Changes in Emotional and Social Behaviour Following Severe Traumatic Brain Injury

Abstract

Changes in emotional and social behaviour are relatively common following severe traumatic brain injury (TBI). Despite the serious consequences of these changes, little is known about the underlying neuropsychological deficits. In this study, we investigated which deficits might underlie these behavioural changes. The emotional and social behaviour of 17 patients with severe TBI was assessed with questionnaires, completed by the patient and a relative. Neuropsychological tests assessed recognition of emotional expressions, understanding of other people's mental states and cognitive fluency. Ratings from patients and relatives revealed changes in emotional and social behaviour after injury. Compared to matched healthy controls, the patients were impaired at recognising facial and vocal expressions of emotions, detecting social faux pas and nonverbal fluency. None of these impairments was significantly associated with the relatives' ratings of behavioural problems following TBI, although the correlation with detecting social faux pas was relatively high (r=-.61).

Social behavior following traumatic brain injury and its association with emotion recognition, understanding of intentions, and cognitive flexibility

“…Although few studies investigated the association between impairments in ToM and behavioral changes following brain injury, there are indications supporting such a relationship. Gregory et al (2002) reported an association between ToM impairments and maladaptive social and emotional behavior in patients with frontotemporal dementia, while in an earlier study we found a similar association in patients with severe TBI (Milders et al, 2003). Cicerone and Tanenbaum (1997) also described impaired performance on tests assessing interpretation of social situations in a patient with emotional and social behavior problems following TBI.…”

“…Associations between executive functioning and psychosocial outcome following TBI have been found with the Wisconsin Card Sorting Test (WCST: Vilkki et al, 1994), Trail Making Test (Nybo et al, 2004), Fluency tests (Ownsworth & Fleming, 2005;Tate, 1999), Tinker Toy Test (Martzke et al, 1991) and a Go-Nogo Task (Bogod et al, 2003). However, in other studies the WCST (Martzke et al, 1991;Mathias & Coats, 1999;Tate, 1999), Fluency tests (Milders et al, 2003;Vilkki et al, 1994) and Tinker Toy Test (Ownsworth & Fleming, 2005) failed to predict psychosocial outcome, and similar null results were found with the Stroop Test (Bogod et al, 2003;Vilkki et al, 1994), the Key Search Test (Ownsworth & Fleming, 2005;Wood & Liossi, 2006), and the Brixton Test (Wood & Liossi, 2006). These conflicting findings illustrate the difficulty of measuring executive functioning (Crawford & Henry, 2005), and specifically those aspects relevant for psychosocial outcome.…”

“…Impaired recognition of emotions as expressed in the face, the voice, or body posture has been reported in patients with TBI (Braun et al, 1989;Croker & McDonald, 2005;Green et al, 2004;Hopkins et al, 2002;Jackson & Moffat, 1987;McDonald & Saunders, 2005;Milders et al, 2003;Pettersen, 1991;Spell & Frank, 2000). Jackson and Moffat (1987) already speculated that the impairment in recognizing emotional expressions could play a role in the inadequate social behavior following TBI, without actually investigating that possibility.…”

“…Impaired performance in ToM tests has been reported in patients with TBI (Bibby & McDonald, 2005;Channon & Crawford, 2000;Channon et al, 2005;Milders et al, 2003Milders et al, , 2006. Although few studies investigated the association between impairments in ToM and behavioral changes following brain injury, there are indications supporting such a relationship.…”

Inability to empathize following traumatic brain injury

“…When empathy has been addressed it has mainly involved small samples and measured in the form of cognitive empathy (Grattan & Eslinger, 1989;Milders et al, 2003). Grattan & Eslinger, in a study containing 40 stroke and 10 TBI cases, found that 58% of patients reported low empathy, but data for the two groups were not reported separately.…”