Stewart-Willis Jada J, Heyanka Daniel, Proctor-Weber Zoe, England Heather, Bruhns Maya
Neuropsychology Service, Bay Pines VA Health Care System, C. W. Bill Young VA Medical Center, Bay Pines, FL 33744, USA.
Rehabilitation Service, JFK/Johnson Rehabilitation Institute, Center for Head Injuries Edison, NJ 08820, USA.
Arch Clin Neuropsychol. 2018 Mar 1;33(2):206-215. doi: 10.1093/arclin/acx053.
Extant literature has demonstrated that symptoms of postconcussive syndrome (PCS) persist well beyond the expected 3-month post-injury recovery period in a minority of individuals with mild traumatic brain injury (mTBI). Suboptimal performance on validity measures and pre- and post-injury psychosocial stressors - rather than actual mTBI or current cognitive functioning - have been identified as predictors of chronic PCS. Whether premorbid IQ has any influence on chronic PCS has been understudied, in the context of established psychogenic etiologies.
The sample included 31 veterans, who underwent mTBI neuropsychological evaluations six or more months post-injury in a VA outpatient neuropsychology clinic. A two-step multiple linear regression was conducted to examine the effects on the outcome variable, PCS (Neurobehavioral Symptom Inventory), of the following predictors: cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status; Attention, Immediate Memory, and Delayed Memory Indices), performance validity, depression (Beck Depression Inventory-Second Edition), posttraumatic stress disorder (PTSD Checklist, Civilian Version), quality of sleep (Pittsburgh Sleep Quality Index), pain (Brief Pain Inventory), education, and Premorbid IQ (Wechsler Test of Adult Reading).
The overall regression model containing all nine predictor variables was statistically significant. Depression (p < .05) and premorbid IQ (p < .05) were the most salient predictors of chronic PCS; in that lower premorbid IQ and greater endorsed symptoms of depression were associated with higher PCS scores. In Step 2 of the multiple linear regression, the WTAR explained an additional 6.7% of the variance in PCS after controlling for psychosocial stressors and current cognitive ability.
The findings support premorbid IQ as a unique and relevant predictor of chronic PCS, with significance variance accounted for beyond education, cognitive functioning, and psychosocial variables. Given the predictive relationship between premorbid IQ and PCS, adapting postconcussive interventions to meet the specific needs of individuals with varying levels of intellect may be important in minimizing ongoing symptomatology.
现有文献表明，在少数轻度创伤性脑损伤（mTBI）患者中，脑震荡后综合征（PCS）的症状在受伤后预期的3个月恢复期之后仍会持续存在。效度测量以及受伤前后的心理社会应激源表现不佳——而非实际的mTBI或当前的认知功能——已被确定为慢性PCS的预测因素。在既定的心因性病因背景下，病前智商对慢性PCS是否有任何影响尚未得到充分研究。
样本包括31名退伍军人，他们在退伍军人事务部（VA）门诊神经心理学诊所受伤6个月或更长时间后接受了mTBI神经心理学评估。进行了两步多元线性回归，以检验以下预测因素对结果变量PCS（神经行为症状量表）的影响：认知功能（可重复神经心理状态评估量表；注意力、即时记忆和延迟记忆指数）、表现效度、抑郁（贝克抑郁量表第二版）、创伤后应激障碍（创伤后应激障碍检查表，平民版）、睡眠质量（匹兹堡睡眠质量指数）、疼痛（简明疼痛量表）、教育程度和病前智商（韦氏成人阅读测验）。
包含所有九个预测变量的总体回归模型具有统计学意义。抑郁（p < .05）和病前智商（p < .05）是慢性PCS最显著的预测因素；即较低的病前智商和较高的抑郁症状评分与较高的PCS评分相关。在多元线性回归的第二步中，在控制了心理社会应激源和当前认知能力后，韦氏成人阅读测验解释了PCS变异的另外6.7%。
研究结果支持病前智商是慢性PCS的一个独特且相关的预测因素，其显著变异超过了教育程度、认知功能和心理社会变量。鉴于病前智商与PCS之间的预测关系，调整脑震荡后干预措施以满足不同智力水平个体的特定需求，对于最大限度地减少持续症状可能很重要。
