Key Takeaway

• A new study sheds light on persistent memory complaints presenting after concussion — a phenomenon that is poorly understood.

• Memory perfectionism — highly valuing memory ability and intolerance of minor memory lapses — may help clarify why some people report lasting subjective memory problems despite a lack of corresponding objective memory impairment.

• This research is published as a preprint and has not yet been peer-reviewed.

Why This Matters

• This is the first study to examine memory perfectionism in the context of post-concussion symptoms. The findings are consistent with studies assessing people with functional cognitive disorder, a clinical entity characterized by an internal inconsistency between subjective cognitive symptoms and objective cognitive performance.

Study Design

• The study recruited 77 adults (61% women) with persistent symptoms following concussion from outpatient specialty clinics.

• Participants completed the National Institutes of Health Toolbox Cognition Battery, Test of Memory Malingering-Trial 1, and questionnaires measuring memory perfectionism (Memory in Adulthood-Achievement subscale), forgetfulness and other post-concussion symptoms (Rivermead Postconcussion Symptoms Questionnaire; RPQ), and depression (Patient Health Questionnaire-2) at M = 17.8 weeks post injury.

• Patients with vs without severe memory complaints (based on the RPQ) were compared.

• This study is a secondary analysis of baseline data from a randomized control trial (Clinicaltrials.gov NCT03972579) as well as participants who were ineligible for this trial because they did not score highly on measures of maladaptive coping.

• Prior to randomization, participants completed an in-person evaluation with a research assistant, under the supervision of a board-certified neuropsychologist.

• Patients were eligible for inclusion if they were between 18 and 69 years old, had sustained a concussion, and self-reported three or more moderate-severe symptoms on the RPQ, a commonly used cutoff for “symptomatic” status.

• Investigators measured memory perfectionism using the Achievement subscale from the Metamemory in Adulthood Questionnaire (MIA).

• Researchers assessed depression with the Patient Health Questionnaire (PHQ-9).

• A trained examiner administered the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) with an iPad to assess standardized measures of cognitive abilities.

• Statistical analysis was performed using SPSS version 27. The primary outcome was subjective memory complaints as measured by the “forgetfulness” item on the RPQ.

Key Results

• Higher memory perfectionism was associated with severe memory complaints, when controlling for depression, objective memory ability, and global cognitive ability.

• Memory perfectionism may predispose people to long-term memory symptoms following a concussion.

• Sensitivity analyses showed that this relationship did not depend on use of specific objective memory tests.

Limitations

• Memory perfectionism and memory complaints were assessed concurrently, at an average of 4 months post injury. As a result, the investigators are uncertain to what extent memory perfectionism is a premorbid personality trait and predisposing (ie, vulnerability) factor or becomes (further) elevated after concussion. They also cannot rule out reverse causality — the possibility that people place importance on their memory ability and become intolerant of memory lapses because they experience memory problems.

• The primary outcome was a single rating of how much participants experienced problems with forgetfulness now, compared to before their concussion. This item has demonstrated test-retest stability and strong discrimination between concussion and orthopedic injury control groups, but it may not have comparable reliability and validity to longer patient-reported outcomes assessing subjective memory functioning.

• Participant characteristics that limit the findings’ generalizability include the high overall symptom burden and advanced level of education (half had a post-secondary degree), which are not surprising for participants who are seeking treatment and willing to volunteer in research, but may not be representative of the broader concussion population.

• The sample size limited the investigators from considering additional covariates that may be important, such as anxiety and medications.

• Performance on neuropsychological tests of memory are not sensitive enough to detect subtle real-world deficits that are reflected in people’s subjective experiences.

Study Disclosures

• The authors report receiving honoraria for continuing medical education lectures on functional neurological disorder, fees for medical-legal consulting involving patients with concussion, and honoraria for continuing medical education lectures on concussion and fees for medical-legal and clinical neuropsychological consultation.

This is a summary of a preprint study by Noah D. Silverberg and colleagues from the University of British Columbia, Vancouver, Canada, posted on medRxiv provided to you by Medscape. The research has not yet been peer reviewed. The full text of the study can be found at https://www.medrxiv.org/content/10.1101/2021.11.15.21266362v1.full.

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