British Columbia Mental Health & Addiction Services, PHSA Research and Networks, Vancouver, British Columbia, Canada.
J Clin Exp Neuropsychol. 2010 Nov;32(9):961-72. doi: 10.1080/13803391003645657. Epub 2010 Apr 30.
When considering a diagnosis of postconcussion syndrome, clinicians must systematically evaluate and eliminate the possible contribution of many differential diagnoses, comorbidities, and factors that may cause or maintain self-reported symptoms long after mild traumatic brain injury (MTBI). One potentially significant contributing factor is symptom exaggeration. The purpose of the study is to examine the influence of poor effort on self-reported symptoms (postconcussion symptoms and cognitive complaints) and neurocognitive test performance following MTBI. The MTBI sample consisted of 63 referrals to a concussion clinic, evaluated within 5 months post injury (M = 2.0, SD = 1.0, range = 0.6-4.6), who were receiving financial compensation from the Workers' Compensation Board. Participants completed the Post-Concussion Scale (PCS), British Columbia Cognitive Complaints Inventory (BC-CCI), selected tests from the Neuropsychological Assessment Battery Screening Module (S-NAB), and the Test of Memory Malingering (TOMM). Participants were divided into two groups based on TOMM performance (15 fail, 48 pass). There were significant main effects and large effect sizes for the PCS (p = .002, d = 0.79) and BC-CCI (p = .011, d = 0.98) total scores. Patients in the TOMM fail group scored higher than those in the TOMM pass group on both measures. Similarly, there were significant main effects and/or large effect sizes on the S-NAB. Patients in the TOMM fail group performed more poorly on the Attention (p = .004, d = 1.26), Memory (p = .006, d = 1.16), and Executive Functioning (p > .05, d = 0.70) indexes. These results highlight the importance of considering the influence of poor effort, in conjunction with a growing list of factors that can influence, maintain, and/or mimic the persistent postconcussion syndrome.
当考虑诊断脑震荡后综合征时，临床医生必须系统地评估和排除许多鉴别诊断、合并症和可能导致或维持轻度创伤性脑损伤 (MTBI) 后自我报告症状的因素。一个潜在的重要影响因素是症状夸大。本研究旨在研究努力不足对 MTBI 后自我报告的症状（脑震荡后症状和认知抱怨）和神经认知测试表现的影响。MTBI 样本由 63 名向脑震荡诊所转诊的患者组成，他们在受伤后 5 个月内接受评估（M = 2.0，SD = 1.0，范围 = 0.6-4.6），并从工人赔偿委员会获得经济补偿。参与者完成了脑震荡后量表（PCS）、不列颠哥伦比亚认知抱怨量表（BC-CCI）、神经心理评估电池筛查模块（S-NAB）中的选定测试和记忆欺骗测试（TOMM）。根据 TOMM 表现将参与者分为两组（15 人失败，48 人通过）。PCS（p =.002，d = 0.79）和 BC-CCI（p =.011，d = 0.98）总分均有显著的主效应和较大的效应量。TOMM 失败组的患者在这两个测量中得分均高于 TOMM 通过组的患者。同样，S-NAB 也有显著的主效应和/或较大的效应量。TOMM 失败组的患者在注意力（p =.004，d = 1.26）、记忆力（p =.006，d = 1.16）和执行功能（p >.05，d = 0.70）指数上的表现更差。这些结果强调了考虑努力不足的影响的重要性，同时还考虑了越来越多的可以影响、维持和/或模拟持续脑震荡后综合征的因素。
