Clarifying perceptions of cognitive functioning in normal aging and after mild traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
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Date
2021
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Massey University
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Abstract
The cognitive symptoms reported more than 3 months after a mild traumatic brain injury (mTBI) are often found to have no association with objective cognitive functioning as evaluated by formal assessment measures. They are believed to relate more to physical symptoms such as pain or fatigue, psychological factors such as affective distress, and misattributions regarding the causes of ongoing subjective difficulties. This is similar to normal aging where for similar reasons, subjective complaints of worsening of cognitive function are also often not supported by objective assessment.
The present research aimed to explore factors which have been suggested in the literature as potentially contributing to the development of subjective cognitive complaints (SCCs) in both populations. These factors included level of awareness of age-related change in cognition, affective distress, processing speed (PS), cognitive reserve (CR), and use of compensatory strategies.
The present research consisted of two parts. In Part A, secondary analyses of two databases were conducted to inform development of a survey and model in Part B. The results supported inclusion of CR, PS, and compensatory strategies in the survey, and indicated the need for inclusion of a measure of psychological stress.
Part B consisted of two studies which examined the hypothesized model of factors that influence reporting of SCCs. Data from a total of 659 individuals recruited from the New Zealand population was split into two groups - normal aging (n=436) and mTBI (n=223). Structural equation modelling (SEM) was employed to assess the relationships between the identified factors and SCCs in each of these groups. The results provided support for the hypothesized model in that this model explained 47.6% of variance in reporting of SCCs in normal aging, and 62.5% of variance in reporting of SCCs in mTBI. Psychoeducation-based interventions, compensatory strategy training, and in some instances individual psychological assessment and therapy are recommended as potentially helpful in reducing the reporting of SCCs.
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Keywords
Aging, Brain damage, Cognition