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The association of reported cognitive symptoms and objective cognitive performance in patients with prolonged post-concussion symptoms

Objective Within a sample of patients with prolonged post-concussion symptoms, the current study evaluated the etiology of patients reported cognitive symptoms. Background Approximately 20% of individuals who sustain a concussion will go on to have prolonged post-concussion symptoms. There has been little research examining how patients' perceived symptoms relate to objective markers, especially in regard to perceived cognitive symptoms (e.g., difficulty concentrating). It is important to understand what contributes to patients' reported complaints in order inform prognosis as well as identify areas for intervention. We hypothesize that patients reported cognitive complaints are better accounted for by other concussion symptoms (e.g., somatic, affective, sleep) than by difficulties in their underlying cognitive abilities. Methods Thirty-seven patients between the ages of 12–23 were retrospectively included in the study based on the following: reported post-concussion symptoms, evaluated between 1 month and 1 year post-injury. Hierarchical linear regression analysis was used to test if objective cognitive performance, as measured by a verbal learning/memory task (RAVLT Total) and an attention/working memory task (WAIS-IV Digit Span Total), significantly predicted reported cognitive symptoms above and beyond somatic, sleep, and affective symptoms. Results Results of the regression analyses indicated somatic, sleep, and affective symptoms significantly explained 50.3% of the variance in reported cognitive symptoms. Objective cognitive performance did not significantly predict reported cognitive symptoms above and beyond the 3 other symptom factors (R2 Change = 0.04, F [2,31] = 1.45, p = 0.25). Additionally, objective cognitive performance was not a significant predictor of reported cognitive symptoms, explaining only 2.4% of the variance. Conclusions Results suggest cognitive difficulties are unlikely related to underlying neurocognitive pathology, but instead are related to functional challenges in the face of other symptoms (e.g., headache). Treatment of patients with cognitive complaints should focus on their entire symptom set, likely leading to a reduction in cognitive complaints.