OBJECTIVES: To evaluate neuropsychologic test performance of people with whiplash-associated disorders (WADs) and to compare the performance of those who report cognitive symptoms (CS+) with those who do not (CS-). DESIGN: Cross-sectional analysis of a convenience sample. SETTING: Outpatient research center. PARTICIPANTS: People with recent WADs (N=203) who responded to advertisements to participate in a treatment study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed a history form including information about demographics, medical history, description of the collision, litigation status, a set of instruments designed to assess neck disability, pain severity, depressed mood, pain-related anxiety, and fear of potentially stressful neck movements and completed a generic 38-item symptom checklist that included items about memory and concentration problems. They also were administered the third revision of the Wechsler Memory Scale (WMS-III) and the Trail-Making Test (TMT). Participants were designated CS+ if they endorsed memory problems or concentration problems on the symptom checklist and CS- if they did not endorse either type of problem. RESULTS: CS+ and CS- participants performed equally well on the TMT and on all WMS-III indexes. Univariate analyses revealed that CS+ participants scored higher than CS- participants in neck disability, pain severity, depression, pain-related anxiety, and fear of neck movements. They also endorsed more items on the symptom checklist, including items (eg, skin rash) that had no obvious connection with WADs. In a multivariate analysis, CS+ versus CS- status was predicted only by the total number of items endorsed on the symptom checklist. CONCLUSIONS: Reports of memory or concentration problems appear to be indicators of heightened somatic vigilance rather than indicators of actual neuropsychologic deficits. Our results suggest that it is reasonable for physicians to defer neuropsychologic testing or advanced imaging studies on WAD patients who report cognitive symptoms but no other indicators of brain injuries and instead to rely on reassurance and education about the normal aftermath of motor vehicle collisions.
OBJECTIVES: To evaluate neuropsychologic test performance of people with whiplash-associated disorders (WADs) and to compare the performance of those who report cognitive symptoms (CS+) with those who do not (CS-). DESIGN: Cross-sectional analysis of a convenience sample. SETTING:Outpatient research center. PARTICIPANTS: People with recent WADs (N=203) who responded to advertisements to participate in a treatment study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed a history form including information about demographics, medical history, description of the collision, litigation status, a set of instruments designed to assess neck disability, pain severity, depressed mood, pain-related anxiety, and fear of potentially stressful neck movements and completed a generic 38-item symptom checklist that included items about memory and concentration problems. They also were administered the third revision of the Wechsler Memory Scale (WMS-III) and the Trail-Making Test (TMT). Participants were designated CS+ if they endorsed memory problems or concentration problems on the symptom checklist and CS- if they did not endorse either type of problem. RESULTS:CS+ and CS- participants performed equally well on the TMT and on all WMS-III indexes. Univariate analyses revealed that CS+participants scored higher than CS- participants in neck disability, pain severity, depression, pain-related anxiety, and fear of neck movements. They also endorsed more items on the symptom checklist, including items (eg, skin rash) that had no obvious connection with WADs. In a multivariate analysis, CS+ versus CS- status was predicted only by the total number of items endorsed on the symptom checklist. CONCLUSIONS: Reports of memory or concentration problems appear to be indicators of heightened somatic vigilance rather than indicators of actual neuropsychologic deficits. Our results suggest that it is reasonable for physicians to defer neuropsychologic testing or advanced imaging studies on WADpatients who report cognitive symptoms but no other indicators of brain injuries and instead to rely on reassurance and education about the normal aftermath of motor vehicle collisions.
Authors: Neill K J Adhikari; Mary Pat McAndrews; Catherine M Tansey; Andrea Matté; Ruxandra Pinto; Angela M Cheung; Natalia Diaz-Granados; Aiala Barr; Margaret S Herridge Journal: Chest Date: 2009-03 Impact factor: 9.410