Subtle sequelae of brain damage. Perplexity, distractibility, and fatigue.

Subtle problems of perplexity, distractibility, and fatigue accompany all kinds of brain injury for they appear to result from disruption of accustomed neural pathways and loss or change of mental function. Emotional disturbances may mask these subtle problems, but they can also result from them. Clinical experience indicates that these problems are more apt to become stressful when the patient misinterprets or copes ineffectively with them. That these common problems of brain injured adults may be overlooked in the usual clinical examination was shown in a comparison of clinical records of 50 patients referred for neuropsychological consultation with records of 46 patient-participants in a longitudinal neuropsychological study. Significantly more reports of these problems appeared in the latter group of records. However, consultation records did reflect emotional distress. Irritability, depression, or anxiety affected all but six consultation patients and appeared with equal frequency among working patients as among those unable to work or needing full-time care. This suggests that some of their emotional distress resulted from less obvious problems than those impairing mobility, strength, or competency. Counseling can reduce the patient's vulnerability to the psychologically crippling effects of perplexity, distractibility, and fatigue. Specific recommendations for patient and family counseling are offered.