Influence of negative stereotypes and beliefs on neuropsychological test performance in a traumatic brain injury population

Psychological correlates of the good old days bias in mild traumatic brain injury

Non-neurological factors such as the "expectation as etiology" or the "good old days" bias (EE/GOD bias) may partially explain persistent symptoms following mild traumatic brain injury (MTBI). What is less clear from existing research is the degree to which EE/GOD bias is related to other psychological correlates of persistent post-concussive symptoms (PPCS). We examined whether the EE/GOD bias was related to illness perception beliefs, intolerance of uncertainty, suggestibility, and domain identification. Participants with MTBI history and without (controls) reported frequency and severity of current PPCS; the MTBI group additionally reported premorbid PPCS. Participants also completed measures of psychological factors potentially associated with PPCS. Consistent with previous studies of the EE/GOD bias, the MTBI group endorsed less premorbid PPCS than current PPCS and when compared to the current symptom report of the control group. The MTBI group also endorsed more current PPCS than the control group. Higher EE/GOD bias was associated with several aspects of illness identity, including belief that symptoms would be more chronic, greater illness-related psychological distress, and greater cogniphobia. Higher EE/GOD bias was also related to higher intolerance of uncertainty and stronger personal identification with memory abilities. Regression showed that perceived symptom timeline, cogniphobia, and domain identification were unique predictors of EE/GOD bias. Findings confirm that the EE/GOD bias is seen in individuals with self-reported history of MTBI and corresponds to other psychological processes that potentially explain ongoing MTBI symptoms, providing greater insight into the potential mechanisms of PPCS. Future studies should examine the EE/GOD bias and associated psychological correlates in a clinical population and also assess for potential neuropsychological correlates. Findings suggest that psychological factors and premorbid symptom report should be considered in clinical assessment and also suggest potential mechanisms of treatment of individuals with acute MTBI or prolonged MTBI symptoms.

Memory self-efficacy and working memory

Dementia affects multiple aspects of cognitive functioning, including working memory and executive functioning. Memory self-efficacy (MSE) has previously been related to episodic memory performance and to executive functioning, but little research has examined the relations between MSE and working memory. United States older adults (N  = 197) were recruited via MTurk to complete an MSE questionnaire before completing a digit span working memory task. Hierarchical regression results revealed that the model accounted for a significant amount of variance in working memory performance after statistically controlling for several covariates, F(11, 179) = 4.94, p < .001, adjusted R2 = .19. MSE explained a large and unique portion of variance (B = 1.02, SE = 0.17, p < .001). Based on our findings, one's beliefs about their memory are positively associated with their working memory performance. These novel findings provide support for neuropsychologists to consider using MSE measures and utilizing MSE interventions.

The Power of Perception: Beliefs About Memory Ability Uniquely Contribute to Memory Performance and Quality of Life in Adults Aging with Traumatic Brain Injury

OBJECTIVE

Personal beliefs about memory ability, which comprise memory self-efficacy (MSE), can influence memory performance in healthy older adults. Self-efficacy theory also predicts that MSE biases self-perceptions of functioning more globally, potentially impacting daily activity beyond cognitive performance. People with traumatic brain injury (PwTBI) frequently report debilitating memory problems long after acute recovery, but little is known about how MSE affects health outcomes in this population. We examined demographic and clinical correlates of MSE, as well as its relationship to memory test performance and health-related quality of life (QOL), in older adults with chronic moderate-to-severe TBI (msTBI).

METHOD

One hundred fourteen adults, aged 50+ and at least 1 year post-msTBI, underwent neuropsychological testing to assess their memory functioning. Participants also self-reported levels of psychological distress, MSE (Cognitive Confidence subscale of the Metacognitions Questionnaire), and health-related QOL (Quality of Life after Brain Injury questionnaire).

RESULTS

Demographic and injury-related predictors showed weak correlations with MSE. Although the relationship between MSE and general psychological distress was robust, only the former significantly predicted memory performance. Bivariate analyses revealed significant relationships between MSE and five out of the six QOL domains assessed. Multivariate linear regression revealed a significant impact of MSE on overall QOL independent of demographic and clinical variables.

CONCLUSIONS

Our findings support a unique role for MSE in both the objective cognitive performance and subjective health of PwTBI. Increased focus on self-perceptions of ability and their impact on measured outcomes is an important step towards personalized rehabilitation for adults with chronic msTBI.

Toward a New Approach to Investigate the Role of Working Memory in Stereotype Threat Effects

Stereotype threat arises when the activation of negative stereotypes about a group impairs performance of stigmatized individuals on stereotype relevant tasks. There is ample evidence that stereotype threat leads to performance detriments by consuming executive resources. Several studies indeed showed that working memory (WM) mediates stereotype threat effects among young adults. More recently, researchers have sought to understand whether the same mechanisms underlie age-based stereotype threat, but findings are mixed regarding the role of WM and some authors rather favor a motivational explanation based on regulatory fit. The present review critically appraises the empirical support for distinct forms of stereotype threat effects mediated by distinct mechanisms. We propose a novel approach based on one of the most recent WM models, the time-based resource sharing model, to evaluate the impact of stereotype threat on attentional resources in WM among both young and older adults.

Diagnostic accuracy of CompCog: reaction time as a screening measure for mild cognitive impairment

BACKGROUND

Reaction time is affected under different neurological conditions but has not been much investigated considering all types of mild cognitive impairment (MCI).

OBJECTIVE

This study investigated the diagnostic accuracy of CompCog, a computerized cognitive screening battery focusing on reaction time measurements.

METHODS

A sample of 52 older adults underwent neuropsychological assessments, including CompCog, and medical appointments, to be classified as a control group or be diagnosed with MCI. The accuracy of CompCog for distinguishing between the two groups was calculated.

RESULTS

The results from diagnostic accuracy analyses showed that the AUCs of ROC curves were as high as 0.915 (CI 0.837-0.993). The subtest with the highest sensitivity and specificity (choice reaction time subtest) had 91.7% sensitivity and 89.3% specificity. The logistic regression final model correctly classified 92.3% of individuals, with 92.9% specificity and 91.7% sensitivity, and included only four variables from different subtests.

CONCLUSIONS

In summary, the study showed that reaction time assessed through CompCog is a good screening measure to differentiate between normal aging and MCI. Reaction time measurements in milliseconds were more accurate than correct answers. This test can form part of routine clinical tests to achieve the objectives of screening for MCI, indicating further procedures for investigation and diagnosis and planning interventions.

Modulation of Metacognitive Confidence Judgments Through Provision of Performance Feedback in Moderate to Severe Traumatic Brain Injury

OBJECTIVE

Traumatic brain injury (TBI) may result in metacognitive impairments. Enhancing memory in healthy adults can improve metacognitive accuracy, but it is unclear whether such interventions apply to individuals with TBI. This study examined the effects of manipulating target memory experiences on metacognitive accuracy in TBI.

PARTICIPANTS

Fourteen community-dwelling adults with TBI and 17 healthy controls.

MAIN MEASURES

Memory was manipulated through performance feedback (monetary, nonmonetary, or none) presented during a word-pair learning task. Recognition of the word pairs was assessed, and metacognition was evaluated by retrospective confidence judgments.

RESULTS

Both groups demonstrated greater recognition performance for items learned with nonmonetary feedback. Healthy individuals demonstrated improved metacognitive accuracy for items learned with nonmonetary feedback, but this effect was not seen in individuals with TBI. A notable (but statistically nonsignificant) effect was observed whereby adults with TBI overestimated performance for items learned with monetary feedback compared with other feedback conditions.

CONCLUSION

Provision of feedback during learning enhances recognition performance. However, target memory experiences may be utilized differently after injury to facilitate confidence judgments. In addition, the type of feedback provided may have different effects on metacognitive accuracy. These results have implications for rehabilitative efforts in the area of memory and metacognition after injury.

How Negative Is Negative Information

Daily, we face a plenty of negative information that can profoundly affect our perception and behavior. During devastating events such as the current COVID-19 pandemic, negative messages may hinder reasoning at individual level and social decisions in the society at large. These effects vary across genders in neurotypical populations (being more evident in women) and may be even more pronounced in individuals with neuropsychiatric disorders such as depression. Here, we examine how negative information impacts reasoning on a social perception task in females with breast cancer, a life-threatening disease. Two groups of patients and two groups of matched controls (N_TOTAL = 80; median age, 50 years) accomplished a psychometrically standardized social cognition and reasoning task receiving either the standard instruction solely or additional negative information. Performance substantially dropped in patients and matched controls who received negative information compared to those who did not. Moreover, patients with negative information scored much lower not only compared with controls but also with patients without negative information. We suggest the effects of negative information are mediated by the distributed brain networks involved in affective processing and emotional memory. The findings offer novel insights on the impact of negative information on social perception and decision making during life-threatening events, fostering better understanding of its neurobiological underpinnings.

Demographic Characteristics, Motivation and Perception of Change as Determinants of Memory Compensation Self-Reports After Acquired Brain Injury

INTRODUCTION

Individuals with brain injuries experience cognitive and emotional changes that have long-lasting impacts on everyday life. In the context of rehabilitation, surveys have stressed the importance of compensating for memory disturbances to ease the impact of disorders on day-to-day autonomy. Despite extensive research on the nature of neurocognitive impairments following brain injury, few studies have looked at patients' perceptions of these day-to-day compensations. This study examines these perceptions; in particular, what brain-injured people believe they do to compensate for memory deficiencies in everyday life. It also investigates the determinants of reported compensation strategies (age, gender, perceived stress, change awareness and motivation to succeed).

METHODS

Eighty patients and 80 controls completed the French Memory Compensation Questionnaire, a self-report measure of everyday memory compensation. Five forms of compensation were investigated: External and Internal strategies, Reliance on social help, and investments in Time and Effort, along with two general factors: the degree of importance attached to Success (motivation) and perceptions of Change. Participants also completed measures of demographic and emotional aspects that may affect everyday compensation perceptions.

RESULTS

The brain-injured group reported significantly more frequent use of memory compensation strategies than controls, with the exception of External aids. Large effects were observed for Reliance and Effort. Demographic, motivation and perception of change determinants were found to have different effects depending on the compensation strategy, and mediated the direct effect of brain injury on reported compensation.

CONCLUSION

Clinical and rehabilitation neuropsychologists often seek to have a better sense of how their patients perceive their compensatory behaviors. In practice, such an understanding is needed to help select appropriate methods and improve the long-term impact of rehabilitation programs: memory rehabilitation will fail if neuropsychologists do not deal, first and foremost, with the emotional and metacognitive issues surrounding traumatic brain injury (TBI), rather than focusing on cognitive efficiency.

Impact of Diagnosis Threat on Neuropsychological Assessment of People with Acquired Brain Injury: Evidence of Mediation by Negative Emotions

Objective

Some studies have shown that diagnosis threat (DT) could negatively impact the cognitive performance of undergraduate students who had sustained a mild traumatic brain injury. This study was designed to examine DT in people with acquired brain injury (ABI). As a second goal, we investigated the effect of stereotype lift as a way to overcome DT's harmful impact. The purpose of this study was also to examine the mechanisms mediating stereotype effects.

Method

People with ABI and control participants were assigned to one of three conditions: DT, cognitive-neutral (in which the cognitive status of participants with ABI and the cognitive characteristics of the tasks were deemphasized), and stereotype lift (in which a downward comparison was made with another neurological group). Participants then completed neuropsychological tasks. Negative emotions, intrusive thoughts, task expectancy, and self-efficacy were assessed for mediation analyses.

Results

Instructions impacted the performance of people with ABI, but not control participants. Compared to the cognitive-neutral condition, participants with ABI in the DT condition performed worse on memory and executive tasks (but not on attention tasks). These effects were mediated by negative emotions. There was no increase in performance in the stereotype lift condition compared to the DT condition.

Conclusions

This study showed that DT can aggravate the cognitive difficulties of people with ABI during neuropsychological assessment. The mediating role of negative emotions and the selective impact of DT on tasks that rely heavily on executive functioning are discussed in the light of the stereotype threat model.

Effects of Media Sensationalization on Cognitive Performance and Post Concussive Symptoms

OBJECTIVES

The current study aimed to examine if televised media about mild traumatic brain injury (mTBI) framed in a sensationalized manner had a negative impact on cognitive functioning and persistent mTBI symptoms.

METHODS

One hundred two participants (M Age=37.16; SD=22.61) with a history of post-acute mTBI, recruited through a community research registry and an undergraduate recruitment system, were included in this study. Participants were assessed with a measure of health literacy, the Short Test of Functional Health Literacy in Adults (S-TOFHLA), and randomized to watch either a sensationalized or non-sensationalized news clip focused on mTBI. They were then assessed with the Paced Auditory Serial Addition Test (PASAT), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Patient Reported Outcome Measures Information System (PROMIS) Depression scale, and the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders 5th edition (PCL-5).

RESULTS

Bayesian analyses indicated that sensationalized media-alone (β PASAT=-0.08; β RPQ=-0.08) or in the context of covariates (β PASAT=-0.11; β RPQ=-0.14)-was not a strong predictor of PASAT score or post-concussion syndrome symptom severity.

CONCLUSIONS

Although media sensationalization of mTBI symptoms is not desirable, this study suggests that one brief exposure to sensationalized information may not have a meaningful immediate impact on the cognitive functioning or symptom reporting of individuals with a history of mTBI. Future research should examine long-term and downstream effects of sensationalized media reporting in samples with greater diversity of TBI history. (JINS, 2019, 25, 90-100).

Stereotype contrast effect on neuropsychological assessment of contact-sport players: The moderating role of locus of control

INTRODUCTION

Diagnosis threat has been shown to produce detrimental effects on neuropsychological performance in individuals with mild traumatic brain injury (mTBI). Focusing on contact-sport players who are at great risk of mTBI, our study was designed to examine the moderating role of internal locus of control. Specifically, we predicted that following diagnosis threat (reminder of their risk of sustaining mTBI and of its consequences), low-internal contact-sport players would underperform (assimilation to the stereotype), while their high-internal counterparts would outperform (contrast effect). We predicted that effort and anxiety would mediate these effects.

METHOD

Contact-sport players and non-contact-sport players ("control" group) were randomly assigned to one condition (diagnosis threat or neutral) and then completed attention, executive, episodic memory, and working memory tasks. Regarding mediating and moderating variables, participants rated their effort and anxiety (self-report measures) and completed the Levenson (1974) locus of control scale. Regression-based path analyses were carried out to examine the direct and indirect effects.

RESULTS

As expected, there was no effect of condition on the control group's performance. Contact-sport players with moderate and high levels of internal control outperformed (contrast effect) on executive and episodic memory tasks following diagnosis threat compared to the neutral condition. Additionally, the less anxiety moderate- and high-internal contact-sport participants felt, the better they performed on episodic memory and executive tasks. However, contact-sport players low in internal control did not underperform (assimilation effect) under diagnosis threat.

CONCLUSIONS

Our results suggest that diagnosis threat instructions may have challenged moderate- and high-internal contact-sport participants, leading them to outperform compared to the neutral condition. Individuals who have moderate and high levels of internal locus of control may have higher performance under diagnosis threat compared to the neutral condition because of their feeling of control over their cognitive performance.

High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes

CONTEXT

Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined.

OBJECTIVE

To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC.

DESIGN

Cohort study.

SETTING

High school and collegiate athletic programs.

PATIENTS OR OTHER PARTICIPANTS

A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68).

MAIN OUTCOME MEASURE(S)

Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment.

RESULTS

The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group.

CONCLUSIONS

Reported baseline symptoms may help identify athletes at risk for worse outcomes after SRC. Clinicians should examine baseline symptom levels to better identify patients for earlier referral and treatment for their injury. Additional investigation of baseline symptoms is warranted to help delineate the type and severity of premorbid symptoms.

Gender stereotype susceptibility

Gender affects performance on a variety of cognitive tasks, and this impact may stem from socio-cultural factors such as gender stereotyping. Here we systematically manipulated gender stereotype messages on a social cognition task on which no initial gender gap has been documented. The outcome reveals: (i) Stereotyping affects both females and males, with a more pronounced impact on females. Yet an explicit negative message for males elicits a striking paradoxical deterioration in performance of females. (ii) Irrespective of gender and directness of message, valence of stereotype message affects performance: negative messages have stronger influence than positive ones. (iii) Directness of stereotype message differentially impacts performance of females and males: females tend to be stronger affected by implicit than explicit negative messages, whereas in males this relationship is opposite. The data are discussed in the light of neural networks underlying gender stereotyping. The findings provide novel insights into the sources of gender related fluctuations in cognition and behavior.

The effect of varied test instructions on neuropsychological performance following mild traumatic brain injury: an investigation of "diagnosis threat"

Diagnosis threat is a psychosocial factor that has been proposed to contribute to poor outcomes following mild traumatic brain injury (mTBI). This threat is thought to impair the cognitive test performance of individuals with mTBI because of negative injury stereotypes. University students (N=45, 62.2% female) with a history of mTBI were randomly allocated to a diagnosis threat (DT; n=15), reduced threat (DT-reduced; n=15), or neutral (n=15) group. The reduced threat condition invoked a positive stereotype (i.e., that people with mTBI can perform well on cognitive tests). All participants were given neutral instructions before they completed baseline tests of objective cognitive function across a number of domains, psychological symptoms, and PCS symptoms, including self-reported cognitive and emotional difficulties. Participants then received either neutral, DT, or DT-reduced instructions before repeating the tests. Results were analyzed using separate mixed model analysis of variances (ANOVAs); one for each dependent measure. The only significant result was for the 2 × 3 ANOVA on an objective test of attention/working memory, Digit Span (p<0.05), such that the DT-reduced group performed better than the other groups, which were not different from each other. Although not consistent with predictions or earlier DT studies, the absence of group differences on most tests fits with several recent DT findings. The results of this study suggest that it is timely to reconsider the role of DT as a unique contributor to poor mTBI outcome.