Self-awareness TBI Self-awareness, depression and neurocognitive functions in patients with moderate and severe traumatic brain injury

  • Lisandro Heber Vales Instituto de Fundamentos y Métodos en Psicología, Facultad de Psicología - Universidad de la República (Montevideo, Uruguay)
  • Silveira Brussain Hospital Pasteur de Montevideo (Montevideo, Uruguay)
  • Fabian Roman Red Iberoamericana de Neurociencia Cognitiva, Buenos Aires, Argentina

Abstract

Introduction: Traumatic Brain Injury (TBI) is the most common cause of disability in youngpatients. In the  self-awareness deficits that can arise after TBI, patients experience difficulties in understanding the disabilities resulting from their injury. This is an important problem that affects the rehabilitation processes. Materials and methods: Self-awareness, neurocognitive functions and depressive symptoms were observed in 31 outpatients with a diagnosis of moderate or severe TBI, aged between 16 and 45 years. Instruments: Patient Competency Rating Scale (PCRS), Neurocognitive Assessment and Hamilton Depression Rating Scale (HDRS). Results: Correlations were found between self-awareness and its dimensions with visuospatial skills, executive functions (double task and cognitive inhibition), episodic memory (Rey Auditory-Verbal Learning Test and Montevideo short story) and depressive symptoms. Conclusions: Patients who have suffered a moderate or severe TBI may have impaired self-awareness. Self-awareness is the ability to objectively perceive (perceive our own self), while maintaining a sense of subjectivity, It is a complex function that needs to use executive functions and episodic memory. The relationship found between interpersonal self-awareness and depressive symptoms does not seem to be conclusive, since this association is probably more complex, and involves other variables not considered in this study.

Keywords: Depression; neurocognitive functions; self-awareness; traumatic brain injury

References

Azouvi, P., Arnould, A., Dromer, E. & Vallat Azouvi, C. (2017). Neuropsychology of traumatic brain injury: An expert overview. Revue Neurologique, 173(7- 8), 1–12. https://doi.org/10.1016/j.neurol.2017.07.006

Bach, L. J. & David, A. S. (2006). Selfawareness after acquired and traumatic brain injury. Neuropsychological

Rehabilitation, 16(4), 397–414. https://doi.org/10.1080/09602010500412830

Bivona, U., Costa, A., Contrada, M., Silvestro, D., Azicnuda, E., Aloisi, M., Catania, G., Ciurli, P., Guariglia, C.,

Caltagirone, C., Formisano, R. & Prigatano, G. (2019). Depression, apathy and impaired self-awareness following

severe traumatic brain injury: a preliminary investigation. Brain Injury, 33(9), 1245–1256. https://doi.org/10.10

/02699052.2019.1641225

Bivona, U., Formisano, R., De Laurentiis, S., Accetta, N., Di Cosimo, M. R., Massicci, R., Ciurli, P., Azicnuda, E., Silvestro, D., Sabatini, U., Falletta Caravasso, C., Carlesimo, G. A., Caltagirone, C. & Costa, A. (2015). Theory of mind impairment after severe traumatic brain injury and its relationship with caregivers’ quality of life. Restorative Neurology and Neuroscience, 33(3), 335–345. https://doi.org/10.3233/RNN-140484

Bivona, U., Riccio, A., Ciurli, P., Carlesimo, G.-A., Donne, V.-D., Pizzonia, E., Caltagirone,C., Formisano, R. & Costa,

A. (2014). Low Self-Awareness of Individuals With Severe Traumatic Brain

Injury Can Lead to Reduced Ability to Take Another Person ’ s Perspective. Journal of Head Trauma

Rehabilitation, 29(2), 157–171. https://doi.org/10.1097/HTR.0b013e3182864f0b

Carroll, E. & Coetzer, R. (2011). Identity, grief and self-awareness after traumatic brain injury. Neuropsychological

Rehabilitation, 21(3), 289–305. https://doi.org/10.1080/09602011.2011.555972

Chesnel, C., Jourdan, C., Bayen, E., Ghout, I., Darnoux, E., Azerad, S., Charanton, J., Aegerter, P., Pradat-Diehl, P.,

Ruet, A., Azouvi, P. & Vallat-Azouvi, C. (2018). Self-awareness four years after severe traumatic brain injury: discordance between the patient’s and relative’s complaints. Results from the PariS-TBI study. Clinical Rehabilitation, 32(5), 692–704. https://doi.org/10.1177/0269215517734294

Dalmás, J. F., Fontán, L. y Bocos, L. (1989). Evaluación neuropsicológica de la función mnésica: protocolo de Montevideo. Documento presentado al Primer Congreso Latinoamericano de Neuropsicología.

Sociedad latinoamericana de neuropsicología, Buenos Aires, Argentina.

Damasio, A. (2010). Y el cerebro creó al hombre. Barcelona: Destino. De Guise, E., Gosselin, N., Leblanc, J., Champoux, M.-C., Couturier, C., Lamoureux, J., Dagher, J., Marcoux, J., Maleki, M. & Feyz, M. (2011). Clock drawing and mini-mental state examination in patients with traumatic brain injury. Applied Neuropsychology,

(3), 179–190. https://doi.org/10.1080/09084282.2011.595444

De Guise, E., LeBlanc, J., Gosselin, N., Marcoux, J., Champoux, M.-C., Couturier, C., Lamoureux, J., Dagher, J.

H., Maleki, M. & Feyz, M. (2010). Neuroanatomical correlates of the clock drawing test in patients with traumatic

brain injury. Brain Injury, 24(13– 14), 1568–1574. https://doi.org/10.3109/02699052.2010.523052

Denny, B. T., Kober, H., Wager, T. D. & Ochsner, K. N. (2012). A meta-analysis of functional neuroimaging studies of self- and other judgments reveals a spatial gradient for mentalizing in medial prefrontal cortex. Journal of Cognitive Neuroscience, 24(8), 1742–1752. https://doi.org/10.1162/jocn_a_00233

Diarce, X., Dansilio, S. y Vales, L. (octubre, 2016). Evaluación de los cambios conductuales post-tec mediante el Patient Competency Raiting Scale. Estudio Piloto. Poster presentado al XII Congreso Argentino de Neuropsicología, SONEPSA. Universidad de Buenos Aires, Buenos Aires, Argentina. Disponible en https://sifp.psico.edu.uy/evaluaci%C3%B3n-de-los-cambiosconductuales-post-tec-mediante-la-patientcompetency-rating-scale-estudio

Fleming, J. M., Strong, J. & Ashton, R. (1996). Self-awareness of deficits in adults with traumatic brain injury: how best to measure? Brain Injury, 10(1), 1–15. https://doi.org/10.1080/026990596124674

Geytenbeek, M., Fleming, J., Doig, E. & Ownsworth, T. (2017). The occurrence of early impaired self-awareness after traumatic brain injury and its relationship with emotional distress and

psychosocial functioning. Brain Injury, 31(13–14), 1791–1798. https://doi.org/10.1080/02699052.2017.1346297

Ham, T. E., Bonnelle, V., Hellyer, P., Jilka, S., Robertson, I. H., Leech, R. & Sharp, D. J. (2014). The neural basis of impaired self-awareness after traumatic brain injury. Brain, 137(2), 586–597. https://doi.org/10.1093/brain/awt350

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23(1), 56.

https://doi.org/10.1136/jnnp.23.1.56

Lamberts, K. F., Fasotti, L., Boelen, D. H. E. & Spikman, J. M. (2017). Self- Awareness after Brain Injury: Relation with Emotion Recognition and Effects of Treatment. Brain Impairment, 18(1), 130–137. https://doi.org/10.1017/

BrImp.2016.28

Lezak, M. D., Howieson, D. B., Bigler, E. D., & Daniel, T. (2012). Neuropsychological assessment. New York: Oxford university press.

Malec, J.-F., Testa, J.-A., Rush, B.-K., Brown, A.-W. & Moessner, A.-M. (2007). Selfassessment of impairment, impaired self-awareness, and depression after traumatic brain injury. The Journal of

Head Trauma Rehabilitation, 22(3), 156–166. https://doi.org/10.1097/01.HTR.0000271116.12028.af

Marino, J. C. y Alderete, A. M. (2010). Valores Normativos de Pruebas de Fluidez Verbal Categoriales, Fonológicas,

Gramaticales y Combinadas y Análisis Comparativo de la Capacidad de Iniciación. Revista Neuropsicología, Neuropsiquiatría y Neurociencias, 10(1), 79–93. Recuperado de http://nebula.wsimg.com/784156971be8bc86021717e54949fe35?AccessKeyId=F7A1C842D9C24A6CB962&disposition=0&alloworigin=1

Mauri, M. C., Paletta, S., Colasanti, A., Miserocchi, G. & Altamura, A. C. (2014). Clinical and neuropsychological correlates of major depression following post-traumatic brain injury, a prospective study. Asian Journal of Psychiatry, 12(1), 118–124. https://doi.org/10.1016/j.ajp.2014.07.003

Noé, E., Ferri, J., Caballero, M. C., Villodre, R., Sanchez, A. & Chirivella, J. (2005). Self-awareness after acquired brain injury: Predictors and rehabilitation. Journal of Neurology, 252(2), 168–175. https://doi.org/10.1007/s00415-005-0625-2

Northoff, G., Heinzel, A., de Greck, M., Bermpohl, F., Dobrowolny, H. & Panksepp, J. (2006). Self-referential processing in our brain--a meta-analysis of imaging studies on the self. NeuroImage, 31(1), 440–457. https://doi.

org/10.1016/j.neuroimage.2005.12.002 Prigatano, G. (2005). Disturbances of Selfawareness and Rehabilitation of Patients with Traumatic Brain Injury: a 20-year perspective. Journal of Head trauma Rehabilitation, 20(1), 19–29.

https://doi.org/10.1097/00001199-200501000-00004

Prigatano, G. & Fordyce, D. J. (1986). Cognitive dysfunction and psychosocial adjustment after brain injury. In: G. P.

Prigatano, D.J. Fordyce, H. K. Zeiner, J. R. Roueche, M. Pepping & B. Wood

(Eds.), Neuropsychological Rehabilitation after Brain Injury, (pp. 1–17). Baltimore: The Johns Hopkins University Press.

Prigatano, G. & Schacter, D. L. (1991).Awareness of deficit after brain injury: Clinical and theoretical issues. New York: Oxford University Press. Prigatano, G. & Sherer, M. (2020). Impaired Self-Awareness and Denial

During the Postacute Phases After Moderate to Severe TraumaticnBrain Injury. Frontiers in Psychology,

, 1–12. https://doi.org/10.3389/fpsyg.2020.01569

Ramírez, M. y Ostrosky, F. (2008). Datos Normativos de la Escala PCRS para la Autoconsciencia en México y la Influencia de la Cultura. Revista Neuropsicología, Neuropsiquiatría y Neurociencias, 8, 21–33. Recuperado de

http://nebula.wsimg.com/3e48cf32a271a139946142ae5c1c4568?AccessKeyId=F7A1C842D9C24A6CB962&disposit

ion=0&alloworigin=1

Ramos-Brieva, J. A. & Cordero-Villafafila, A. (1988). A new validation of the Hamilton Rating Scale for Depression. Journal of Psychiatric Research, 22(1), 21–28. https://doi.org/10.1016/0022-3956(88)90024-6

Rey, A. (1964). L’examen clinique en psychologie [The clinical psychological examination]. París: Presses Universitaires de France.

Roozenbeek, B., Maas, A. I. R. & Menon, D. K. (2013). Changing patterns in the epidemiology of traumatic brain injury. Nature Reviews Neurology, 9(4), 231–236. https://doi.org/10.1038/nrneurol.2013.22

Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology,

(6), 643–662. https://doi.org/10.1037/h0054651

Tirapu-Ustárroz, J. & Goñi-Sáez, F. (2016). El problema cerebro-mente (II): sobre la conciencia. Revista de Neurología, 63(4), 176–185. https://doi.org/10.33588/rn.6304.2016231

Tombaugh, T. N. (2004). Trail Making Test A and B: Normative data stratified by age and education. Archives

of Clinical Neuropsychology, 19(2), 203–214. https://doi.org/10.1016/S0887-6177(03)00039-8

Vales, L. (2020). Neuropsicoanálisis: el “nuevo paso”, diálogo fructífero entre el psicoanálisis y las neurociencias.

Cuadernos de Neuropsicología / Panamerican Journal of Neuropsychology/ Panamerican Journal of Neuropsychology, 14(1), 112–128. Disponible en http://www.cnps.cl/index.php/cnps/article/view/405

Wechsler, D. (2002). Test de Inteligencia para Adultos. WAIS-III. Buenos Aires: Paidós.

Ylvisaker, M. & Feeney, T. (2000). Reconstruction of identity after brain injury. Brain Impairment, 1(1), 12–28. https:// doi.org/10.1375/brim.1.1.12

Zimmermann, N., Mograbi, D. C., Hermes- Pereira, A., Fonseca, R. P., & Prigatano, G. P. (2017). Memory and executive functions correlates of self-awareness in traumatic brain injury. Cognitive Neuropsychiatry, 22(4), 346–360.https://doi.org/10.1080/13546805.2017.1330191

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Published
2020-12-12
How to Cite
Vales, L., Brussain, S., & Roman, F. (2020). Self-awareness TBI Self-awareness, depression and neurocognitive functions in patients with moderate and severe traumatic brain injury. Journal of Applied Cognitive Neuroscience, 1(1), 69-80. Retrieved from https://revistascientificas.cuc.edu.co/JACN/article/view/3326