Exploration of correlates of self-reported personality change after moderate-severe traumatic brain injury

Comparison of spouse and patient personality change judgments following MS onset

OBJECTIVES

This is the first study to estimate the prevalence and predictors of spouse and patient perceptions of global/overall personality change (PC) in patients with multiple sclerosis (MS).

METHODS

69 clinic patients and their spouses completed parallel measures of perceived PC and semantic differential scales measuring pre-MS and current specific behaviours. We correlated perceived personality changes with the following measures of perceived physical, cognitive, emotional, and social functioning: MS Impact Scale, MS Neuropsychological Questionnaire, Beck Depression Inventory-FastScreen; Hospital Anxiety and Depression Scale; Family Questionnaire, McMaster Assessment Device; and Social Provisions Scale.

RESULTS

Spouses and patients reported comparable levels of substantial change. Both associated PC with patient distress, perceived cognitive impairment, spouse distress, and poorer family functioning. Spouse, but not patient, PC ratings predicted severity of physical symptoms and social support. Principal component analysis of semantic differential ratings yielded a Compassionate Empathy component correlating with PC within spouse, but not patient, data.

CONCLUSIONS

These partially overlapping potential triggers for spouse and patient PC judgments raise questions about the extent they overlap with clinicians' criteria for PC, since spouses did not link impulsivity with PC. It is also suggested that the initial focus of treatment of PC should focus on partner-agreed changes.

Personality Predictors of Sports-Related Concussion Incidence: Analysis of Data From a Large, Heterogeneous Undergraduate Sample

OBJECTIVE

Studies investigating the associations between personality and sports-related concussion are limited. The current study aimed to address this gap by examining whether specific personality dimensions predicted self-reported sports-related concussion outcomes.

DESIGN

This study included 1141 undergraduate students ( Mage = 19.47, SD = 2.14, female = 64.5%) who completed a battery of online personality measures and self-reported sports-related concussion items. The self-reported sports-related concussion outcomes included a single diagnosed sports-related concussion incident (i.e., "diagnosed sports-related concussion incidence") and incidents of multiple diagnosed sports-related concussions (i.e., "multiple diagnosed sports-related concussion incidents"). Analyses included splitting data randomly into training and validation data sets. Multivariate logistic regression models were then fit to each data set to determine predictors of sports-related concussion.

RESULTS

In both training and validation data sets, extraversion and experience seeking were found to be positively and most strongly associated with both sports-related concussion outcomes, whereas motor inhibition was found to be negatively associated with both outcomes. Additional personality dimensions showed differential relations with each sports-related concussion outcome.

CONCLUSIONS

The current study highlights the importance of considering personality dimensions in the context of self-reported sports-related concussion outcomes, as there are differential relations between personality dimensions and these outcomes. Thus, prevention efforts for sports-related concussion may benefit from evaluating additional athlete factors, like personality traits.

Personality changes after acquired brain injury and their effects on rehabilitation outcomes

Acquired brain injury (ABI) is often associated with personality changes. Pre- as well as post-injury personality traits are related to rehabilitation outcomes. However, it largely remains unclear whether post-injury personality shows any associations with rehabilitation outcomes over and above pre-injury personality. Using a case-control design, this study investigated (1) personality changes after ABI from patients' and significant others' perspective, and (2) relations of pre- and post-ABI personality traits to rehabilitation outcomes in the short- and long-term. 40 patients with ABI (85% stroke, 15% traumatic brain injury), 46 healthy controls and their significant others participated. Personality was assessed with NEO-FFI, rehabilitation outcomes (activities, participation, depression) were measured at two and ten months after ABI. Patient-ratings indicated decreases in extraversion and a trend towards reduced conscientiousness. Significant others reported increases in patients' neuroticism. Pre- as well as post-injury personality traits were associated with depression and activities at both short- and long-term timepoints after ABI. The association was strongest for long-term depressive symptoms where personality trait variables accounted for 49% of variance (Radjusted2). Our results confirm that ABI patients and significant others perceive personality changes, albeit in different dimensions. Pre- and post-ABI personality traits showed associations with rehabilitation outcomes, especially with emotional adjustment after the injury.

The Relationship Between Cognitive Functioning and Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder in Adults with a Traumatic Brain Injury: a Meta-Analysis

A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.

P300 as a Potential Indicator in the Evaluation of Neurocognitive Disorders After Traumatic Brain Injury

Few objective indices can be used when evaluating neurocognitive disorders after a traumatic brain injury (TBI). P300 has been widely studied in mental disorders, cognitive dysfunction, and brain injury. Daily life ability and social function are key indices in the assessment of neurocognitive disorders after a TBI. The present study focused on the correlation between P300 and impairment of daily living activity and social function. We enrolled 234 patients with neurocognitive disorders after a TBI according to ICD-10 and 277 age- and gender-matched healthy volunteers. The daily living activity and social function were assessed by the social disability screening schedule (SDSS) scale, activity of daily living (ADL) scale, and scale of personality change following a TBI. P300 was evoked by a visual oddball paradigm. The results showed that the scores of the ADL scale, SDSS scale, and scale of personality change in the patient group were significantly higher than those in the control group. The amplitudes of Fz, Cz, and Pz in the patient group were significantly lower than those in the control group and were negatively correlated with the scores of the ADL and SDSS scales. In conclusion, a lower P300 amplitude means a greater impairment of daily life ability and social function, which suggested more severity of neurocognitive disorders after a TBI. P300 could be a potential indicator in evaluating the severity of neurocognitive disorders after a TBI.

Correlates of the personality change judgments of individuals who have MS

Objectives: This is the first study to estimate prevalence of self-reported personality change (PC) in people with multiple sclerosis (MS). Methods developed in traumatic brain injury studies explore physical, and psychosocial triggers for PC judgments.Participants: 69 MS clinic attendees living with their partner.Measures: Participants rated the degree of PC. 28 Current and pre-MS characteristics were rated. The Multiple Sclerosis Impact Scale, the MS Neuropsychological Questionnaire, the Beck Depression Inventory-FastScreen, and the Hospital Anxiety and Depression Scale quantified neuropsychological status. The Family Questionnaire, McMaster Assessment Device and the Social Provisions Scale sampled perceived social influences.Results: 54% perceived substantial PC. Current characteristics predicted PC better than perceived behavior changes. PC was associated with specific characteristics denoting stress reactions, emotional distress, perceived cognitive impairment and poorer family functioning. PC was not significantly related to severity of physical symptoms or social support. This study also suggested that the specific characteristics questionnaire probed at least 2 components of reconstructed identity: PC/Reactivity and Disability.Conclusions: This study raises methodological concerns about measures that simply sum ratings of characteristics related to self-identity. It also proposes possible ways of collaborating with individuals in their efforts to respond constructively to PC and other changes. .

Clinical Approach to Personality Change Due to Another Medical Condition

BACKGROUND

Medical personality change (MPC) is a codable diagnosis (i.e., F07.0) that deserves consideration when a patient is inexplicably no longer "acting like him/herself." Its presentation ranges from subtle to severe and is often characterized by bafflingly poor judgment and impairment in several aspects of a person's life. Despite the global impact that MPC can have on a patient's functioning, occupation, and relationships, this condition receives far less clinical consideration than better known syndromes such as depression or anxiety and is often likely incorrectly formulated as such.

OBJECTIVE/METHODS

This article provides a clinically focused review of MPC. We review its clinical assessment followed by a review of its subtypes, which we have categorized to reflect the behavioral correlates of known frontotemporal-subcortical circuits. These include the apathetic type (ventromedial prefrontal cortex), the labile and disinhibited types (orbitofrontal cortex), and the aggressive and paranoid types (medial temporal lobes).

RESULTS

For each of these 3 categories, we describe the clinical presentation and review management strategies. For each category, we focus on 3 common causes for MPC-traumatic brain injury, Huntington disease, and brain tumors-which we have selected because clinical features of MPC due to these conditions generalize to many other etiologies of MPC.

CONCLUSIONS

MPC warrants clinical attention for the range of dysfunction and distress it can cause. It also deserves further scientific study to better characterize its phenotypes, to tailor instruments for its clinical assessment, and to identify effective treatments.

Measuring Neurobehavioral Disabilities Among Severe Brain Injury Survivors: Reports of Survivors and Proxies in the Chronic Phase

Background: Neurobehavioral disability (NBD) has a major influence on long-term psychosocial outcome following acquired brain injury, as it affects not only the survivor of the brain injury, but the whole family.

Objectives: To investigate (1) the frequency of NBD among survivors of severe brain injury measured by the Danish version of the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) rated by patients and proxies, (2) factors associated with NBD, and (3) concordance between reports of NBD completed by patients and proxies.

Methods: SASNOS was administered at an outpatient unit as a part of a follow-up assessment after discharge from intensive neurorehabilitation. SASNOS consists of five factors describing the following domains: Interpersonal Behavior, Cognition, Aggression, Inhibition and Communication, and both the patient and a proxy were asked to complete the questionnaire. Data collection was conducted over a period of 2 years, and 32 patients and 31 proxies completed the questionnaire. Mean time since injury was 19.4 months (10.0 SD). Most patients were male (68.8%), and most proxies were female (58.1%). Most of the patients had suffered a traumatic brain injury (68.8%).

Results: A fourth of this patient group reported themselves below the normal range on the major domains of Interpersonal Behavior and Cognition. Significant associations between proxies' reports and time since injury, cohabitant status, and the patient's score on the Extended Glasgow Outcome Scale were found. Furthermore, significant differences were found between patient and proxy ratings. Proxies rated patients as having fewer problems on the Interpersonal Behavior domain, and more problems in relation to Cognition. Cognition was the only domain, where patients rated themselves higher indicating fewer problems, compared with their proxies. On both the Aggression and Communication domains, proxies rated patients higher indicating fewer problems than the patients themselves.

Conclusion: Danish brain injury survivors experienced NBD as measured by SASNOS. Differences were found between patient and proxy ratings in relation to Cognition and Interpersonal Behavior. The NBDs identified can affect the survivor's ability to reintegrate and participate in activities of daily living, emphasizing how a systematic assessment is required.

Perceived personality change after traumatic brain injury II: comparing participant and informant perspectives

OBJECTIVE

The objective of this paper was to correlate informant personality change (PC) judgements following moderate-severe traumatic brain injury with quantitative neurobehavioural measures and to contrast the neurobehavioural correlates of informant and participant judgements of PC.

PARTICIPANTS

Informant-participant pairs were recruited from a medico-legal clinic passing effort tests (N = 31) and a National Health Service clinic (N = 40).

MEASURES

Participants were assessed on Wechsler tests of general ability, tests of executive functioning (Zoo Map and Fluency) and emotional distress (Beck Depression Inventory-FastScreen, Hospital Anxiety and Depression Scale and State-Trait Anger Expression Inventory-II). Informants' expressed emotion towards participants was assessed with the family questionnaire. Both completed the DEX, the Frontal and Social Behavior Questionnaire and PC ratings.

RESULTS

The correlates of participant and informant ratings of participant PC partially overlapped. For example, participant self-reported PC was associated with self-reported dysexecutive symptoms and emotional distress. In contrast, informant report of participant PC was associated with lower perceived emotional recognition and empathy, informant report of dysexecutive symptoms and high informant expressed emotion.

CONCLUSIONS

It is argued that whilst researchers aim to exhaustively quantify specific neurobehavioural changes and their clusters, partially overlapping subsets of these changes evoke the PC judgements of participants and informants. The clinical implications of this are briefly considered.

Sleep and Psychiatric Disorders in Persons With Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI) frequently challenges the integrity of sleep function by affecting multiple brain areas implicated in controlling the switch between wakefulness and sleep and those involved in circadian and homeostatic processes; the malfunction of each causes a variety of disorders. In this review, we discuss recent data on the dynamics between disorders of sleep and mental/psychiatric disorders in persons with mTBI. This analysis sets the stage for understanding how a variety of physiological, emotional and environmental influences affect sleep and mental activities after injury to the brain. Consideration of the intricate links between sleep and mental functions in future research can increase understanding on the underlying mechanisms of sleep-related and psychiatric comorbidity in mTBI.