A study of the influence of cognitive complaints, cognitive performance and symptoms of anxiety and depression on self-efficacy in patients with acquired brain injury.

OBJECTIVE:: To examine the relationship between self-efficacy for managing brain injury-specific symptoms and cognitive performance, subjective cognitive complaints and anxiety and depression symptoms in patients with acquired brain injury (ABI). DESIGN:: Clinical cohort study. SETTING:: General hospitals, rehabilitation centres. SUBJECTS:: A total of 122 patients with newly ABI (mean age = 54.4 years (SD, 12.2)) were assessed at discharge home from inpatient neurorehabilitation or at start of outpatient neurorehabilitation after discharge home from acute hospital. Mean time since injury was 14.1 weeks (SD, 8.6). MAIN MEASURES:: Self-efficacy was measured using the Traumatic Brain Injury (TBI) Self-Efficacy Questionnaire (SEsx), mean score = 82.9 (SD, 21.8). Objective cognitive performance was measured with the Symbol Digit Modalities Test (SDMT), mean z-score = -1.36 (SD, 1.31). Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale (HADS), cognitive complaints with the self-rating form of the Dysexecutive Questionnaire (DEX-P). RESULTS:: Higher levels of subjective cognitive complaints and higher levels of anxiety and depression symptoms were significantly associated with lower self-efficacy (ß = -0.35; P = .001 and ß =-0.43; P < .001, respectively). Objective cognitive performance was not significantly associated with self-efficacy (ß = 0.04, P = .53). DEX-P scores accounted for 42% and HADS scores for 7% of the total 57% variance explained. Objective cognitive performance did not correlate significantly with subjective cognitive complaints (r = -.13, P = .16). CONCLUSION:: Control over interfering emotions and mastery over brain injury-associated symptoms seems important in the development of self-efficacy for managing brain injury-specific symptoms.

The impact of fatigue on cognitive functioning in patients with multiple sclerosis.

OBJECTIVE: To study the impact of physical and mental fatigue on cognitive complaints and cognitive performance in patients with multiple sclerosis. DESIGN: Cross-sectional study. SETTING: An outpatient neurology clinic. SUBJECTS: Eighty patients diagnosed with clinically definite multiple sclerosis. MEASURES: The subscales physical and mental fatigue of the Multidimensional Fatigue Inventory; the Hospital Anxiety and Depression Scale and the Cognitive Failure Questionnaire. Cognitive performance was assessed by an extensive neuropsychological test battery, including several tasks requiring effortful information processing. RESULTS: Both anxiety and depression and mental fatigue significantly contributed to cognitive complaints, explaining respectively about 9% and 39% of the total variance. The contribution of physical fatigue to cognitive complaints was not significant. Both physical and mental fatigue did not significantly contribute to cognitive performance in terms of mental speed, attention, memory and executive functioning. CONCLUSIONS: To refine interventions for those patients with cognitive complaints, we advise adding measurements of anxiety, depression and fatigue to their neuropsychological assessment. Fatigue permits extensive neuropsychological assessment, which is needed to detect cognitive impairment in multiple sclerosis.