A Cognitive Concerns Phenotype Remains Common In Chronic Phases of mTBI and is Uncoupled from Cognitive Screening Performance
Year: 2026
Type: preprint
Abstract: Background Cognitive concerns are common after mild traumatic brain injury (mTBI). We hypothesized that a cognitive concern phenotype (CCP) persists across time-since-injury groups, with limited association with Montreal Cognitive Assessment (MoCA) performance. Methods We retrospectively analyzed 190 mTBI clinic patients. CCP defined as primary disabling cognitive concern and a Rivermead Post-Concussion Symptoms Questionnaire cognitive item score > 2. CCP prevalence across time-since-injury groups (< 6 months, 6–12 months, 1–2 years, 2–5 years and > 5 years post-injury) was evaluated using descriptive and spline analyses. Exploratory analyses compared four CCP/MoCA groups on Center for Epidemiologic Studies Depression Scale (CES-D), Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy, PROMIS psychosocial illness impact, and Glasgow Outcome Scale-Extended (GOSE). Results CCP prevalence was 32.6% (62/190) and remained common across time-since-injury groups (25.4%, 50.0%, 46.7%, 50.0%, and 36.8%). Odds of CCP were higher at ≥ 1 versus < 1 year after injury (odds ratio 1.96, 95% confidence interval [CI] 1.00–3.84; p = 0.048). Among 111 patients with MoCA data, 62 (55.9%) scored < 26: 23/38 (60.5%) with CCP and 39/73 (53.4%) without CCP. CCP was not significantly associated with MoCA impairment (p = 0.608) or adjusted MoCA scores (β=-1.06, 95% CI -2.74 to 0.62; p = 0.213). Self-efficacy and GOSE differed across groups (both p = 0.005); CES-D did not. Conclusions CCP remains common and disabling, years after mTBI, and is not fully captured by MoCA. Self-efficacy and functional differences suggest symptom-burden beyond screening performance.
Source: Research Square
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225610524