Examination of Congruity between Subjective and Objective Working Memory in Veterans with Mild TBI and Relation to Psychiatric Symptoms and Childhood Trauma

Lisa N Cruz; Nicole C Walker; Sonia S Rehman; M Windy McNerney; Michelle R Madore

doi:10.3390/bs14100932

Examination of Congruity between Subjective and Objective Working Memory in Veterans with Mild TBI and Relation to Psychiatric Symptoms and Childhood Trauma

Behav Sci (Basel). 2024 Oct 11;14(10):932. doi: 10.3390/bs14100932.

Authors

Lisa N Cruz^{1

2}, Nicole C Walker¹, Sonia S Rehman³, M Windy McNerney^{1

2}, Michelle R Madore^{1

2}

Affiliations

¹ Mental Illness Research, Education, and Clinical Center, VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA.
² Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
³ Chesapeake Center, Bethesda, MD 20817, USA.

Abstract

Objectives: There is conflicting evidence regarding congruence between subjective cognitive decline and objective cognitive performance for individuals with a history of mild traumatic brain injury (mTBI). The current study investigated the congruity between subjective and objective cognition, particularly working memory, among veterans with an mTBI history, accounting for post-traumatic stress disorder (PTSD) and childhood trauma.

Methods: Participants included 35 veterans with a history of mTBI sustained during deployment. Participants completed measures of subjective [i.e., Behavioral Inventory Rating of Executive Functioning (BRIEF)] and objective working memory (i.e., WAIS-IV working memory index). Congruity between subjective and objective working memory was examined using linear regression. Bonferroni-corrected correlations were run to explore relationships among working memory, psychiatric symptoms, mTBI severity, and childhood trauma.

Results: Among Veterans with mTBI, subjective working memory and objective working memory performance were not significantly related (p > 0.05); however, the overall model was significant (p < 0.0001), and childhood trauma was a notable predictor (p = 0.02). Greater PTSD, depression, and sleep symptoms were significantly related to increased subjective working memory concerns, even after Bonferroni adjustments (ps < 0.0001). Better objective working memory was significantly related to a fewer number of childhood traumatic events; however, this did not sustain corrections. The majority of individuals (67%) endorsed significant working memory complaints, despite objectively performing within normal limits (within 1 SD and above).

Conclusions: Subjective-objective working memory congruity among veterans with mTBI was limited. Subjective, but not objective, working memory concerns were associated with greater PTSD, depression, and sleep symptoms. Childhood trauma was a notable factor that contributed to both subjective and objective cognitive concerns. There remains clinical value in assessing subjective cognitive concerns given the strong relationships with psychiatric problems and, hence, a focus for intervention.

Keywords: executive functioning; mild TBI; subjective cognitive concerns; traumatic brain injury; veterans; working memory.

Grants and funding

This work was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Medical Research Service of the VA Palo Alto Health Care System, the Department of Veterans Affairs Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), and the War-Related Illness and Injury Study Center (WRIISC).