Fatigue – but not mTBI history,PTSD, or sleep quality – directly contributes to reduced prospective memory performance in Iraq and Afghanistan era Veterans

Abstract

Objective: Memory problems that affect daily functioning are a frequent complaint among Veterans reporting a history of repetitive mild traumatic brain injury (mTBI), especially in cohorts with comorbid PTSD. Here, we test the degree to which subjective sleep impairment and daytime fatigue account for the association of PTSD and self-reported mTBI history with prospective memory. Method: 82 Veterans with and without personal history of repeated blast-related mTBI during deployment were administered the Clinician Administered PTSD Scale (CAPS), Memory for Intentions Test (MIST), Patient Health Questionnaire-9 (PHQ-9), Neurobehavioral Symptom Inventory (NSI), and the Pittsburgh Sleep Quality Index (PSQI). Relationships between self-reported mTBI, PTSD, self-reported poor sleep and daytime fatigue, and MIST performance were modeled using partial least squares structural equation modeling (PLS-SEM). Results: Reported daytime fatigue was strongly associated with poorer prospective memory performance. Poor subjective sleep quality was strongly and positively associated with reported daytime fatigue, but had no significant direct effect on prospective memory performance. PTSD diagnosis and self-reported mTBI history were only associated with prospective memory via their impact on subjective sleep quality and daytime fatigue. Conclusions: Results suggest that daytime fatigue may be a mediating factor by which both mTBI and PTSD can interfere with prospective memory. Additional attention should be given to complaints of daytime fatigue, independent of subjective sleep quality, in the clinical care of those with a self-reported history of mTBI, and/or PTSD. Further research into whether interventions that decrease daytime fatigue lead to improvement in prospective memory and subjective cognitive functioning is warranted.     

Repetitive Transcranial Magnetic Stimulation for Depression and Posttraumatic Stress Disorder in Veterans With Mild Traumatic Brain Injury

ObjectivesMild traumatic brain injury (mTBI) is a signature injury of military conflicts and is prevalent in veterans with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Although therapeutic transcranial magnetic stimulation (TMS) can reduce symptoms of depression and PTSD, whether traumatic brain injury (TBI) affects TMS responsiveness is not yet known. We hypothesized mTBI would be associated with higher pretreatment symptom burden and poorer TMS response.Materials and MethodsWe investigated a registry of veterans (N = 770) who received TMS for depression across the US Veterans Affairs system. Of these, 665 (86.4%) had data on TBI and lifetime number of head injuries while 658 had complete data related to depression outcomes. Depression symptoms were assessed using the nine-item Patient Health Questionnaire and PTSD symptoms using the PTSD Checklist for DSM-5. Linear mixed effects models and t-tests evaluated whether head injuries predicted symptom severity before treatment, and how TBI status affected clinical TMS outcomes.ResultsOf the 658 veterans included, 337 (50.7%) reported previous mTBI, with a mean of three head injuries (range 1–20). TBI status did not predict depressive symptom severity or TMS-associated changes in depression (all p’s > 0.1). TBI status was associated with a modest attenuation of TMS-associated improvement in PTSD (in patients with PTSD Checklist for DSM-5 scores > 33). There was no correlation between the number of head injuries and TMS response (p > 0.1).ConclusionsContrary to our hypothesis, presence of mTBI did not meaningfully change TMS outcomes. Veterans with mTBI had greater PTSD symptoms, yet neither TBI status nor cumulative head injuries reduced TMS effectiveness. Limitations include those inherent to retrospective registry studies and self-reporting. Although these findings are contrary to our hypotheses, they support the safety and effectiveness of TMS for MDD and PTSD in patients who have comorbid mTBI.     

Apolipoprotein E (APOE) ε4 genotype is associated with reduced neuropsychological performance in military veterans with a history of mild traumatic brain injury

Introduction: The purpose of this study was to investigate the effect of the apolipoprotein E (APOE) ε4 allele on neuropsychological functioning in military Veterans with a remote history of mild traumatic brain injury (mTBI).

Method: This cross-sectional study included 99 Veterans (mTBI = 53; military controls, MC = 46) who underwent neuropsychological assessment and APOE genotyping. Three neurocognitive composite scores—memory (α = .84), speed (α = .85), and executive functioning (α = .76)—were computed from 24 norm-referenced variables, and the total number of impaired scores (>1.5 SDs below mean) for each participant was calculated.

Results: Analyses of covariance adjusting for ethnicity and posttraumatic stress disorder (PTSD) symptoms revealed that although no significant differences were observed between mTBI ε4 allele groups on the executive functioning composite (p > .05), mTBI ε4+ Veterans performed more poorly than ε4? Veterans on the memory (p = .045, η_p² = .083) and speed (p = .023, η_p² = .106) composites. Furthermore, Mann–Whitney U tests showed that ε4+ mTBI Veterans displayed a significantly greater number of impaired scores than did ε4? mTBI Veterans (p = .010, r = .355). In contrast, there were no significant differences across any of the cognitive variables between ε4+ and ε4? MCs (all p > .05).

Conclusions: Results suggest that APOE ε4 genotype is related to reduced memory and processingspeed performance, as well as overall cognitive impairment, in those with a history of mTBI, but does not appear to have the same negative effects on cognition in the absence of neurotrauma. Although results are preliminary, the present study advances understanding of genetic influences on cognitive functioning in Veterans with remote mTBIs. Future longitudinal work is needed to elucidate the underlying brain-based mechanisms of ε4 allelic effects on cognitive and clinical outcomes following TBI.     

Variables associated with subjective cognitive change among Iraq and Afghanistan war Veterans with blast-related mild traumatic brain injury

Introduction: This study investigated variables associated with subjective decline in executive function among Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) following a history of blast-related mild traumatic brain injury (mTBI).

Method: Fifty-six male U.S. Veterans (M_Age = 35.3 ± 8.8 years) with a history of blast-related mTBI (6.6 ± 3.2 years post injury) completed a battery of self-report questionnaires and neuropsychological measures. Participants rated current and retrospectively estimated pre-mTBI executive function difficulties on the Frontal Systems Behavior Scale (FrSBe). A difference score (post- minus pre-mTBI ratings) was the dependent variable (?FrSBe). Linear regression models examined variables predicting ?FrSBe, including: pre-injury characteristics (education, premorbid intelligence), injury-related characteristics (number of blast exposures, losses of consciousness), post-injury clinical symptoms (PTSD Checklist–Military version; Pittsburgh Sleep Quality Index), and post-injury neuropsychological performances on executive function measures (Trail Making Test Part B; Controlled Oral Word Association Test; Auditory Consonant Trigrams; Wisconsin Card Sorting Test).

Results: While 11% of participants had a clinically elevated pre-injury FrSBe total score, 82% had a clinically elevated post-injury FrSBe total score. Only self-reported PTSD symptom severity independently predicted perceived change in executive function.

Conclusions: Many OEF/OIF/OND Veterans with a history of blast-related mTBI experience subjective decline in executive function following injury. Perceived executive function decline was associated with higher PTSD symptom severity, aligning with previous research associating PTSD with cognitive complaints. Results did not support a correspondence between perceived cognitive change and neuropsychological performances.     

Detection of symptom over-reporting on the Neurobehavioral Symptom Inventory in OEF/OIF/OND veterans with history of mild TBI

Objective: As part of routine care at Veterans Affairs facilities, veterans with a service-related traumatic brain injury (TBI) are administered a self-report post-concussive symptom measure, the Neurobehavioral Symptom Inventory (NSI). Interpreting the NSI can be problematic given that over-reporting on self-report measures is often found in both civilian and military patient populations. This study investigates embedded scales on the NSI that identify possible and probable symptom exaggeration. Method: 183 veterans with a history of mild TBI were administered the Minnesota Multiphasic Personality Inventory, 2nd edition, Restructured Form (MMPI-2-RF) and the NSI. The participants were divided into symptom validity testing pass and fail groups based on their performance on the MMPI-2-RF symptom validity scales. Cut scores on the NSI Total and Validity-10 scores were then established and applied to two additional veteran populations. Results: Sensitivity and specificity values were derived for all NSI Total and Validity-10 values. Optimal cut scores were determined based on specificity levels of ≥95%. The NSI Total cut score was ≥57 for possible and ≥67 for probable symptom exaggeration and the Validity-10 cut score was ≥22 for possible and ≥27 for probable symptom exaggeration, with sensitivity ranging from 27 to 43%. Applying these cut scores to a broader clinical and research sample resulted in lower rates of suspected exaggeration. Conclusions: Both the NSI Total and Validity-10 cut scores consistently identified potential symptom exaggeration across three mild TBI samples. Clinicians and researchers who use the NSI are encouraged to utilize either embedded validity measure in their practice.     

Psychological factors are associated with subjective cognitive complaints 2 months post-stroke

The aim of this study was to investigate which psychological factors are related to post-stroke subjective cognitive complaints, taking into account the influence of demographic and stroke-related characteristics, cognitive deficits and emotional problems. In this cross-sectional study, 350 patients were assessed at 2 months post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24) to identify cognitive complaints. Psychological factors were: proactive coping, passive coping, self-efficacy, optimism, pessimism, extraversion, and neuroticism. Associations between CLCE-24 cognition score and psychological factors, emotional problems (depressive symptoms and anxiety), cognitive deficits, and demographic and stroke characteristics were examined using Spearman correlations and multiple regression analyses. Results showed that 2 months post-stroke, 270 patients (68.4%) reported at least one cognitive complaint. Age, sex, presence of recurrent stroke(s), comorbidity, cognitive deficits, depressive symptoms, anxiety, and all psychological factors were significantly associated with the CLCE-24 cognition score in bivariate analyses. Multiple regression analysis showed that psychological factors explained 34.7% of the variance of cognitive complaints independently, and 8.5% (p?p?相似文献   

The contributions of self-reported injury characteristics and psychiatric symptoms to cognitive functioning in OEF/OIF veterans with mild traumatic brain injury

Mild traumatic brain injury (mTBI) affects a significant number of combat veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Although resolution of mTBI symptoms is expected over time, some individuals continue to report lingering cognitive difficulties. This study examined the contributions of self-reported mTBI injury characteristics (e.g., loss of consciousness, post-traumatic amnesia) and psychiatric symptoms to both subjective and objective cognitive functioning in a sample of 167 OEF/OIF veterans seen in a TBI clinic. Injury characteristics were not associated with performance on neuropsychological tests but were variably related to subjective ratings of cognitive functioning. Psychiatric symptoms were highly prevalent and fully mediated most of the relationships between injury characteristics and cognitive ratings. This indicates that mTBI characteristics such as longer time since injury and loss of consciousness or post-traumatic amnesia can lead to increased perceived cognitive deficits despite having no objective effects on cognitive performance. Psychiatric symptoms were associated with both cognitive ratings and neuropsychological performance, illustrating the important role that psychiatric treatment can potentially play in optimizing functioning. Finally, subjective cognitive ratings were not predictive of neuropsychological performance once psychiatric functioning was statistically controlled, suggesting that neuropsychological assessment provides valuable information that cannot be gleaned from self-report alone.     

The role of subjective cognitive complaints and depressive symptoms in social re-integration following stroke: a mediation explanation in a cross-sectional sample

Background: For long-term stroke survivors, objective neuropsychological impairments and subjective cognitive difficulties are common, and may contribute to ongoing difficulties in community reintegration. However, subjective cognitive complaints have been as much associated with low mood as with actual cognitive performance.

Objective: The objective of our study was to investigate the extent to which subjective cognitive complaints predicted community reintegration following a stroke, and whether this relationship would be mediated by emotional status.

Methods: Using a cross-sectional design, patients with a primary diagnosis of stroke (n = 102; age range 25–89 years) were recruited from the register of a neurological rehabilitation service if they were at least 6 months post-stroke and had been discharged home following the stroke. Exclusions included history of dementia, co-morbid psychiatric or neurological disorder, or significant aphasia. Assessments included the Subjective Cognitive Complaints Questionnaire, the Community Integration Questionnaire, and the Depression Anxiety and Stress Scale.

Results: Subjective cognitive complaints were common, with moderate to high levels of complaint most frequent for working memory (58.9%), and information processing speed (53%). Subjective cognitive complaints were significantly associated with social integration (r = ?.23, p < .05). However, examination of relationships using statistical mediation revealed that depressive symptoms fully mediated the relationship between subjective cognitive complaints and social integration.

Conclusions: Subjective cognitive complaints are common in long-term outcome following stroke and predict difficulty in community reintegration. However, this relationship is mediated by variation in emotional status. Therefore, addressing cognitive complaints through cognitive rehabilitation programs that include components to improve mood (for example, building self-efficacy or confidence) may also improve community reintegration post-stroke.     

Cognitive complaints after mild traumatic brain injury: Things are not always what they seem

ObjectiveTo compare nonreferred, emergency department (ED)-admitted mild traumatic brain injury (MTBI) patients with and without self-reported cognitive complaints on (1) demographic variables and injury characteristics; (2) neuropsychological test performance; (3) 12-day self-monitoring of perceived cognitive problems; and (4) emotional distress, physical functioning, and personality.Methods(Neuro)psychological assessment was carried out 6 months post-injury in 79 patients out of a cohort of 618 consecutive MTBI patients aged 18–60, who attended the ED of our level I trauma centre. Cognitive complaints were assessed with the Rivermead Postconcussional Symptoms Questionnaire (RPSQ). In addition, patients monitored concentration problems and forgetfulness during 12 consecutive days.ResultsSelf-reported cognitive complaints were reported by 39% of the patients. These complaints were strongly related to lower educational levels, emotional distress, personality, and poorer physical functioning (especially fatigue) but not to injury characteristics. Severity of self-reported cognitive complaints was neither associated with the patients' daily observations of cognitive problems nor with outcome on a range of neuropsychological tests.ConclusionSelf-reported cognitive complaints were more strongly related to premorbid traits and physical and emotional state factors than to actual cognitive impairments. In line with previous work, this suggests that treatment of emotional distress and fatigue may also reduce cognitive complaints. Cognitive outcome assessment of symptomatic MTBI patients should not be restricted to checklist ratings only, but also include a (neuro)psychological screening. In addition, daily monitoring of complaints is a useful method to gather information about the frequency and pattern of cognitive problems in daily life.     

Recovery of episodic memory subprocesses in mild and complicated mild traumatic brain injury at 1 and 12 months post injury

Introduction: Episodic memory complaints are commonly reported after traumatic brain injury (TBI). The contributions of specific memory subprocesses (encoding, consolidation, and retrieval), however, are not well understood in mild TBI (mTBI). In the present study, we evaluated subprocesses of episodic memory in patients with mTBI using the item-specific deficit approach (ISDA), which analyzes responses on list learning tasks at an item level. We also conducted exploratory analyses to evaluate the effects of complicated mTBI (comp-mTBI) on memory. Method: We compared episodic verbal memory performance in mTBI (n = 92) at approximately 1 and 12 months post TBI, as well as in a healthy comparison (HC) group (n = 40) at equivalent time points. Episodic memory was assessed using the California Verbal Learning Test–2nd Edition (CVLT–II), and both standard CVLT–II scores and ISDA indices were evaluated. Results: Compared to the HC group, the mTBI group showed significantly poorer encoding and learning across time, as measured by ISDA and CVLT–II. Further analyses of these mTBI subgroups [(noncomplicated mTBI (NC-mTBI, n = 77) and comp-mTBI (n = 15)], indicated that it was the comp-mTBI group who continued to demonstrate poorer encoding ability than the HC group. When the patient groups were directly compared, the NC-mTBI group improved slightly on the ISDA Encoding Deficit Index. While the comp-mTBI group worsened slightly over time, their poorer encoding ability was not likely clinically meaningful. Conclusions: These findings indicate that, while the NC-mTBI and HC groups’ performances were comparable by 12 months, a primary, long-term deficit in encoding of auditory verbal information remained problematic in the comp-mTBI group.     

Functional connectivity in mild traumatic brain injury

Objectives: Research suggests that the majority of mild traumatic brain injury (mTBI) patients exhibit both cognitive and emotional dysfunction within the first weeks of injury, followed by symptom resolution 3–6 months postinjury. The neuronal correlates of said dysfunction are difficult to detect with standard clinical neuroimaging, complicating differential diagnosis and early identification of patients who may not recover. This study examined whether resting state functional magnetic resonance imaging (fMRI) provides objective markers of injury and predicts cognitive, emotional, and somatic complaints in mTBI patients semiacutely (<3 weeks postinjury) and in late recovery (3–5 month) phases. Methods: Twenty‐seven semiacute mTBI patients and 26 gender, age, and education‐matched controls were studied. Fifteen of 27 patients returned for a follow‐up visit 3–5 months postinjury. The main dependent variables were spontaneous fluctuations (temporal correlation) in the default‐mode (DMN) and fronto‐parietal task‐related networks as measured by fMRI. Results: Significant differences in self‐reported cognitive, emotional, and somatic complaints were observed (all P < 0.05), despite normal clinical (T1 and T2) imaging and neuropsychological testing results. Mild TBI patients demonstrated decreased functional connectivity within the DMN and hyper‐connectivity between the DMN and lateral prefrontal cortex. Measures of functional connectivity exhibited high levels of sensitivity and specificity for patient classification and predicted cognitive complaints in the semi‐acute injury stage. However, no changes in functional connectivity were observed across a 4‐month recovery period. Conclusions: Abnormal connectivity between the DMN and frontal cortex may provide objective biomarkers of mTBI and underlie cognitive impairment. Hum Brain Mapp, 2011. © 2011 Wiley‐Liss, Inc.     

Correlates of psychological distress in study partners of older people with and without mild cognitive impairment (MCI) – the Sydney Memory and Ageing Study

Objectives: Psychological effects of supporting someone with mild cognitive impairment (MCI) are often overlooked. We aimed to establish correlates of psychological distress in study partners of individuals with and without nonclinical MCI.Methods: Demographic, psychosocial and health measures were obtained cross-sectionally from 714 participants (39% MCI) and study partners of a longitudinal community-based study on cognitive aging. Study partners (i.e. family members/friends) were categorized as providing support with instrumental everyday activities or not. Psychological distress was measured by the Kessler psychological distress scale. Multiple hierarchical regressions examined determinants of psychological distress within Pearlin's stress process model.Results: Psychological distress was generally low and not associated with MCI or whether study partners provided support or not. Instead, distress was greater if participants were male irrespective of study partners’ sex and if study partners reported negative reactions to participants’ behavioral symptoms, felt burdened by providing support and showed worse coping abilities; overall explaining 37% variance. Self-rated disability and aspects of health-related quality of life explained additional 7%.Conclusion: Objective impairment measures were not associated with distress in partners or supporters. However, study partners’ appraisals of functional and behavioral symptoms were linked to increased distress even in this very mildly affected community cohort.     

Neurobehavioral symptom validity in U.S. Department of Veterans Affairs (VA) mild traumatic brain injury evaluations

Introduction: The use of the Neurobehavioral Symptom Inventory (NSI) by U.S. Department of Defense and Veterans Affairs (VA) providers for all mild traumatic brain injury (mTBI) evaluations led to the development of methods to screen for symptom exaggeration. The present study was designed to explore the clinical utility of three metrics—the Validity–10 scale, the NSI total score, and the mild Brain Injury Atypical Symptoms Scale (mBIAS)—relative to the results of several different criterion measures of symptom validity.

Method: Participants in this study were 82 U.S. military veterans referred for evaluations by a VA polytrauma clinic in the context of a history of mTBI. All participants were administered the Minnesota Multiphasic Personality Inventory–Second Edition–Restructured Form (MMPI–2–RF), NSI, and mBIAS.

Results: None of the three scales displayed adequate accuracy at predicting failure on cognitive performance validity tests or on the MMPI–2–RF Fp-r scale. For the remaining MMPI–2–RF overreporting indices (F-r, Fs, FBS-r, RBS) and for an index based on elevation of any single MMPI–2–RF overreporting index, both the NSI total score and Validity–10 displayed high positive predictive power with adequate to good sensitivity values (39% to 76%).

Conclusion: These findings support the use of Validity–10 and NSI total score as symptom validity tests (SVTs) that can be used to assess for neurobehavioral symptom exaggeration.     

The relationship between medical and psychological status in newly diagnosed gay men with AIDS

We assessed current medical and psychological status in 50 homosexual/bisexual males who were within 3 months of the diagnosis of AIDS. Subjects had typically impaired cellular immunity, relatively well-maintained physical performance capacity, and reported surprisingly good current health status, in spite of significant numbers of medical symptoms. While as a group they reported moderate levels of psychological distress, intact self-esteem, and a high quality of life, a significant minority reported high psychological distress, low self-esteem, and low quality of life. Psychological distress was correlated with subjective, but not objective, measures of current health status.     

Psychological distress and its correlates in older care-dependent persons living at home

Objectives: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined. Method: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale.

Results: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis.

Conclusion: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.     

Mindfulness-based stress reduction in middle-aged and older adults with memory complaints: a mixed-methods study

ABSTRACT

Objectives: In a rapidly aging world population, an increasingly large group faces age-related decline in cognitive functioning. Cognitive complaints of older adults are often related to worries and concerns associated with age-related functional decline. Mindfulness-Based Stress Reduction (MBSR) can successfully target stress, worry and ruminative thinking, but the applicability of this method in middle-aged and older adults with memory complaints is unclear.

Method: Patients of a university hospital memory clinic (n = 13), aged 45–85 years, with memory complaints but no diagnosis of cognitive disorder, participated in a standard 8-week MBSR program, consisting of weekly group meetings and a one-day silent retreat. After completion, semi-structured qualitative interviews were conducted. Questionnaires (administered before, one week after and five weeks after the intervention) assessed quality of life, psychological distress (stress, anxiety and depressive symptoms), mindfulness, self-compassion, and subjective memory functioning. Neurocognitive functioning was assessed online, before and after the intervention.

Results: The qualitative analysis showed positive effects of the training (e.g. increased serenity), many participants worrying less about memory complaints. The self-reported measures were in line with the results of the qualitative analysis.

Conclusion: This exploratory mixed-methods study suggests that MBSR is feasible and well received among older individuals with cognitive complaints.     

Middle age cognition and vocational outcome of childhood brain injury

OBJECTIVES: In this almost four-decade follow-up we studied the cognitive performance of a cohort of 22 traumatic brain injury (TBI) patients in relation to vocational outcome. The patients had suffered a moderate to severe TBI in traffic accidents as preschoolers. METHODS: The neuropsychological assessment included the Profile of Mood States questionnaire and the Neurobehavioral Rating Scale. The cognitive performance of full-time working patients was compared with that of those not working. RESULTS: Full-time working patients had significantly better intellectual performance than the patients not at work. Memory performance was partly defective in both groups but neither group had subjective memory complaints. All patients working full time lived in a marital relationship and had less neurobehavioral problems than the patients not at work. CONCLUSIONS: Good intellectual capacity, verbal memory, and marital status were connected with a positive outcome. We suggest that as late as in middle age in spite of moderate to severe childhood TBI, it is still possible for a subgroup of patients to live a normal productive life.     

Fatigue in the first year after traumatic brain injury: course,relationship with injury severity,and correlates

ABSTRACT

The objectives of this study were to document the evolution of fatigue in the first year after traumatic brain injury (TBI), and to explore correlates of fatigue. Participants were 210 adults who were hospitalised following a TBI. They completed questionnaires 4, 8, and 12 months post-injury, including the Multidimensional Fatigue Inventory (MFI). Participants with severe TBI presented greater mental and physical fatigue, and reduced activity compared to participants with moderate TBI. For all MFI subscales except reduced motivation, the general pattern was a reduction of fatigue levels over time after mild TBI, an increase of fatigue after severe TBI, and stable fatigue after moderate TBI. Fatigue was significantly associated with depression, insomnia, cognitive difficulties, and pain at 4 months; the same variables and work status at 8 months; and depression, insomnia, cognitive difficulties, and work status at 12 months. These findings suggest that injury severity could have an impact on the course of fatigue in the first year post-TBI. Depression, insomnia, and cognitive difficulties remain strong correlates of fatigue, while for pain and work status the association with fatigue evolves over time. This could influence the development of intervention strategies for fatigue, implemented at specific times for each severity subgroup.     

Subjective cognitive decline: Self and informant comparisons

BackgroundIt is unclear whether self- or informant-based subjective cognition better distinguishes emotional factors from early-stage Alzheimer's disease (AD).MethodsHealthy members (n = 447) of the Arizona apolipoprotein E (APOE) cohort and their informants completed the self and informant paired Multidimensional Assessment of Neurodegenerative Symptoms questionnaire (MANS).ResultsDecline on the MANS was endorsed by 30.6% of members and 26.2% of informants. Self- and informant-based decliners had higher scores of psychological distress and slightly lower cognitive scores than nondecliners. Over the next 6.7 years, 20 developed mild cognitive impairment (MCI). Converters were older at entry than nonconverters (63.8 [7.0] vs 58.8 [7.3] years, P = .003), 85% were APOE ε4 carriers (P < .0001), and they self-endorsed decline earlier than informants (58.9 [39.2] vs 28.0 [40.4] months before MCI; P = .002).ConclusionsSelf- and informant-based subjective decline correlated with greater psychological distress and slightly lower cognitive performance. Those with incident MCI generally self-endorsed decline earlier than informants.