Noah Silverberg

Introduction: Subjective memory problems - forgetting names, leaving important objects at home - are a common post concussion symptom. Memory complaints after concussion are largely unrelated to injury severity, objective memory performance, or neuroimaging metrics of the brain’s structural integrity and may be a manifestation of a functional cognitive disorder (FCD). Several possible mechanisms for FCD have been proposed, including metacognitive bias or factors that interfere with attention, as well as anxiety-related explanations. This study aims to explore several theories as to why people develop persistent memory problems after concussion, despite having normal neuropsychological test scores. Methods: A cross-sectional study of 54 participants (n=34 with concussion and n=20 healthy controls). Subgroups were formed to compare participants suspected FCD after concussion (n=28) and healthy controls with no concerns about their memory (n=13). Independent sample t-tests compared these two subgroups on candidate predisposing/perpetuating factors in FCD theorical models. Simple linear regressions tested the relationship between these predisposing/perpetuating factors and FCD symptom severity in the full concussion sample. Results: Contrary to expectations, there was no evidence of a metacognitive deficit or bias associated with FCD symptoms after concussion. The healthy control group and suspected FCD after concussion subgroup differed on measures of somatization, depression, anxiety, memory perfectionism, and certain coping behaviours (checking to turn off electrical appliances and asking someone for reminders). However, within the full concussion sample, only asking for reminders, increased depression, and memory perfectionism, was significantly associated with FCD symptoms. Conclusions: The current study highlights some promising (e.g., memory perfectionism) and unlikely candidates (e.g., metacognitive bias towards underconfidence) to guide future research on the etiology of FCD after concussion, and possibly FCD in other clinical settings.

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