Cognitive complaints in closed-head injury: relationship to memory test performance and emotional disturbance

Self-appraisal of cognitive difficulties by a sample of 63 male patients with closed-head injury (CHI) was examined in relation to their performance on the Wechsler Memory Scale - Revised (WMS-R; Wechsler, 1987), WAIS-R Digit Span (Wechsler, 1981), and to their scores on MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) measures of anxiety and depression. In an initial step, the Cognitive Difficulties Scale (CDS; McNair & Kahn, 1983), consisting of 39 self-report items, was factor analyzed using a sample of 255 consecutive neuropsychological referrals with documented brain impairment. Seven orthogonal dimensions emerged: Attention and Concentration, Orientation and Memory, Praxis, Domestic Activities, Facial Recognition, Task Efficiency, and Errand and Name Recall. Within a sample subset consisting of 63 patients with CHI, subjective complaints on the CDS were predictive of WMS-R Logical Memory performance (r = -.51, p < .0005). In contrast, CDS scores were generally poor predictors of Digit Span and Visual Reproduction scores (rs < .31). Cognitive complaints were also associated with emotional distress on the MMPI-2. The CDS appears to be a useful measure of self-appraised cognitive difficulties in patients with CHI, and may assist in the assessment of their self-reflective insight.