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26 Alexithymia Predicts Affect Recognition after Acquired Brain Injury
- Robiann R Broomfield, Lisa J Rapport, Rebecca De La Garza, Darius Vann, Jo Blocton, Lauren J Radigan
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 135
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Objective:
Alexithymia is characterized by difficulty identifying and describing one’s emotions. Alexithymia is more prevalent and severe after acquired brain injury (ABI; Fynn et al., 2021). Additionally, studies have shown frequent impairment of affect recognition after ABI (Neumann et. al, 2014). Research examining the relationship between the subjective experience of alexithymia and the objective ability to recognize emotion in others has been limited, especially among individuals with ABI. Some research indicates that alexithymia is more common following traumatic brain injury (TBI) than non-traumatic brain injury such as stroke; however, no previous research has examined the relationship between alexithymia and affect perception comparing adults with TBI and stroke. Accordingly, this study aimed to fill that gap.
Participants and Methods:Participants were 218 adults in three groups: healthy adults (HA; n = 99), TBI (n = 63), and stroke (n = 56).
Participants completed a neuropsychological battery that included the Toronto Alexithymia Scale-20 (TAS; Bagby et al., 1994), and a multicultural Face Emotion Perception Test (MFEPT). The MFEPT used images from the Montreal Set of Facial Displays of Emotion (Beaupre et al., 2000) to assess recognition accuracy for anger, sadness, fear, disgust, and neutral expressions. The Recognition Memory Test (RMT; Warrington, 1984) was included to account for variance in facial affect recognition associated with face recognition only.
Results:Analysis of variance indicated a significant difference among the means on TAS (p < .001, n2 = .09. Tukey post hoc tests indicated lower TAS among HA than Stroke (d = -0.73, p = .001) and TBI (d = -0.56, p = .002) groups; however, TBI and Stroke did not differ significantly (d = -0.15, p = .667). Chi-square tests indicated that the percent of HA with clinically-elevated alexithymia (7.1%) was lower than Stroke (21.4%, p = .009) and TBI (25.8%, p = .001), who did not differ significantly (p = .610). Pearson correlations indicated medium inverse correlations between alexithymia and affect recognition for Stroke (r = -.39, p = .002) and TBI (r = -.36, p = .002). For HA, who showed low alexithymia, the relationship was not significant (r = -.15, p = .070). Examination of the TAS subscales indicated that TAS-Total correlations with MFEPT were driven primarily by Difficulty Identifying Feelings (DIF), as compared to Difficulty Describing Feelings or Externally-oriented Thinking. Partial correlations between TAS-DIF and MFEPT accounting for RMT remained significant for both TBI (rp = -.23, p = .036) and Stroke (rp = -.39 p = .002).
Conclusions:Consistent with prior research, alexithymia was more prevalent and severe among adults with TBI and stroke as compared to healthy adults. Adults with TBI and stroke showed similar levels of alexithymia, and the pattern of associations is consistent with the theory that alexithymia disrupts recognition of emotion displayed by others. This link may partly explain the robust findings of diminished and impaired social and interpersonal outcomes after ABI. Future research should test these links directly, to support the development of interventions to maximize social and interpersonal well-being after ABI.
3 The Menopause Transition in Women with Traumatic Brain Injury
- Lisa J. Rapport, Claire Z. Kalpakjian, Robin A Hanks, Elisabeth H. Quint
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 99-100
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Objective:
All premenopausal women who survive traumatic brain injury (TBI) will eventually experience menopause. Challenges experienced by women with TBI are superimposed on challenges associated with hormonal changes in midlife. Some women with stressful life contexts such as TBI are more vulnerable to the added burdens of the menopause transition, potentiating its effects. Although it may be argued that TBI research correctly overrepresents the male experience given disparities in injury rates (4:1), there are important differences in how females and males age, their specific health needs, and the psychosocial context of midlife. Development of evidence-based interventions begins with understanding the experience of menopause after TBI, including where and when key problems may emerge.
Participants and Methods:All participants were women 40-60 years old, not taking hormones (i.e., replacement therapy or other systematic hormones), with intact ovaries. Women with TBI were > 2 years post injury, whose menstrual period returned after injury, and were living in the community. Severity of injury ranged from complicated-mild to severe TBI. Pre/peri and postmenopausal status was determined by presence/absence of menstrual period in previous 6 months, respectively. Eighteen common menopause symptoms (vasomotor, somatic, psychological, and cognitive) were assessed for presence and frequency (rarely-always), along with Quality of Life in Neurological Disorders (Neuro-QOL) Sleep Disturbance and Traumatic Brain Injury Quality of Life (TBIQOL) Anxiety, Depression, and Fatigue scales.
Results:Overall, women with TBI (n = 68) showed greater presence and frequency of symptoms than women without TBI (n = 153), with fewer within-group differences by menopausal status. Among pre/peri-menopausal women, TBI and non-TBI groups did not significantly differ and showed small effect sizes on symptoms associated with changes in estrogen during menopause, including hot flashes, night sweats, bowel and bladder sequelae, and breast tenderness. However, pre/peri-menopausal women with TBI also endorsed body aches and headaches, as well as troubles with memory, focus, fatigue, cognitive concerns, sleep, and anxiety significantly more than their pre/peri-menopausal counterparts (all medium effect sizes). Among postmenopausal women, those with TBI had significantly greater frequency of hot flashes, crying spells, poor memory, worry, moodiness, panic attacks, sleep disturbance, and anxiety than women without TBI. Within TBI, only hot flashes and breast tenderness were greater in postmenopausal versus pre/peri-menopausal women. Within non-TBI, postmenopausal status was associated with significantly greater hot flashes, night sweats, restlessness, poor memory, irritability, sleep disturbance, and anxiety, with greater fatigue but not significantly.
Conclusions:The findings support a model of TBI and menopause in which symptoms most closely associated with estrogen decline in pre/peri-menopause are generally similar between women with and without TBI, and symptoms that overlap with common TBI sequelae were generally more often present and frequently experienced among women with TBI versus non-TBI. We did not observe a synergistic or potentiating effect of TBI on menopause symptoms in post-menopause. These findings offer insight that contextualizes the experience of menopause symptoms among women with TBI. Such insights are essential for the development of treatment approaches that maximize health and wellbeing during the menopause transition for women with TBI.
89 Detecting Feigned Cognitive Impairment Using Pupillometry on the Warrington Recognition Memory Test for Words
- Sarah D Patrick, Lisa J Rapport, Robin A Hanks, Robert J Kanser
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 761-762
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Objective:
Traditional methods of assessing performance validity have numerous weaknesses, among them, results can be consciously manipulated by examinees who wish to feign cognitive impairment. This study tested the ability of pupillary dilation patterns during a performance validity test (PVT) to enhance diagnostic accuracy in discriminating true from feigned impairment of traumatic brain injury (TBI). Pupillometry provides information about physiological and psychological processes related to cognitive load, familiarity, and deception and is outside of conscious control. Patrick, Rapport, Kanser, Hanks, and Bashem (2021) established proof of concept for the utility of pupillometry with PVTs applied to the Test of Memory Malingering (TOMM). This study replicated and extended this work by evaluating the incremental utility of pupillary-derived indices on the Warrington Recognition Memory Test for Words (RMT).
Participants and Methods:Participants included 214 adults in three groups: adults with bona fide TBI (TBI; n = 51) healthy comparisons instructed to perform their best (HC; n = 72), and healthy adults instructed and incentivized to simulate cognitive impairment due to TBI (SIM; n = 91). Moreover, this study examined pupillary pattern differences among successful (i.e., failed < 1 PVT and performed impaired on cognitive tests) and unsuccessful (i.e., failed > 2 PVTs or did not score impaired on a cognitive test) SIM, including SIM who did and did not fail the RMT. The RMT was administered in the context of a comprehensive neuropsychological battery. Indices included two pure pupil dilation (PD) indices: a simple measure of baseline arousal (PD-Baseline) and a nuanced measure of dynamic engagement (PD-Range). A pupillo-behavioral index was also evaluated: Dilation-response inconsistency (DRI) captured the frequency with which examinees displayed a pupillary familiarity response to the correct answer but selected the unfamiliar stimulus (incorrect answer).
Results:The results generally replicated Patrick et al. (2021), as all three indices were useful in discriminating between groups and provided incremental utility to traditional accuracy scores. PD-Baseline appeared sensitive to oculomotor dysfunction due to TBI (i.e., increasing accurate identification of that group); adults with TBI displayed significantly lower chronic arousal as compared to the two groups of healthy adults (SIM, HC). In fact, the TBI group showed significantly lower PD-Baseline than both unsuccessful simulators who were detected as feigners and successful simulators who passed PVTs but effectively feigned TBI on other tests. Dynamic engagement (PD-Range) yielded a hierarchical structure such that SIM were more dynamically engaged than TBI followed by HC. As predicted, simulators engaged in DRI significantly more frequently than other groups. Moreover, DRI added unique information to RMT accuracy in classifying unsuccessful simulators from all other groups. Each of these three pupillary indices showed large effect sizes, and logistic regressions indicated that each contributed unique variance in predicting group membership on one or more of the paired contrasts (i.e., SIM-TBI, SIM-HC, HC-TBI).
Conclusions:Taken together, the findings support continued research on the application of pupillometry to performance validity assessment: Pupillometry provided unique information in enhancing classification accuracy beyond traditional PVT accuracy scores. Overall, the findings highlight the promise of biometric indices in multimethod assessments of performance validity.
38 Assessing Memory for Emotions Separately from Emotion Recognition
- Gavin Sanders, Lisa J. Rapport, Robiann Broomfield, Sarah D. Patrick, Emily Flores, Robin A. Hanks, Mark A. Lumley, Scott A. Langenecker, Lauren J. Radigan
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 826-827
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Objective:
Accurate processing of facial displays of emotion is critical for effective communication. A robust literature has documented impairment in the ability to recognize facial affect in people with traumatic brain injury (TBI), but research is scarce about memory for facial affect. Disruptions in recognizing and remembering the emotions of others can undermine relationship quality and may result in psychosocial dysfunction. Importantly, the extant literature indicates that facial affect recognition dissociates from other cognitive abilities such that it is likely a distinct neuronal process. Thus, explicit measurement of affect recognition and memory for emotions may be critical for implementing and refining rehabilitation interventions. The present study examined the relationship between recognition and memory for emotions using a novel computerized task and explored its associations with other cognitive abilities.
Participants and Methods:Participants were adults who were neurologically healthy (n = 31) or had a history of moderate to severe TBI (n = 26). The battery included the novel Assessment of Facial Affect Recognition and Memory (AFARM), Cambridge Face Memory Test (face memory without emotion), Wechsler Test of Adult Reading, Rey Auditory Verbal Learning Test, Judgment of Line Orientation, Oral Symbol Digit Modalities, Digit Span, FAS, Animal Fluency, and the Affect Intensity Measure (experienced emotion). Spearman correlations examined the relationship of AFARM performance with the test battery. Logistic regression models examined whether immediate-delay (ID-EM) and long-delay face emotion-memory (LD-EM) accounted for unique variance in group membership beyond recognition accuracy of facial affect and memory for faces.
Results:AFARM demonstrated relationships with neuropsychological and mood variables in the expected directions across and within groups, with the strongest associations observed for memory for verbal information (rs = .51 to .58) and processing speed (rs = .48 to .57). Consistent with traditional list-learning tests, ID- and LD-EM were highly correlated (r = .85). Experienced affect intensity was inversely associated with ID-EM (r = -.29) and LD-EM (r = -.38) but not with recognition accuracy (r = -.10). Logistic regression examining ID-EM was significant, χ2(3) = 26.05, p < .001, Nagelkerke R2 = .49. ID-EM accounted for unique variance in group status (p = .006; OR = 0.65) after accounting for recognition accuracy and face memory. Similarly, the model examining LD-EM was significant χ2(3) = 27.70, p < .001, Nagelkerke R2 = .43; LD-EM was significant after accounting for other variables (p = .017; OR = 0.69).
Conclusions:The findings are consistent with the hypothesis that memory for emotions represents a unique component of social cognition that is separate from recognition. Accuracy in identifying emotions, face recognition memory, and memory for emotions are strongly related but not wholly redundant processes. Consistent with prior literature, subjective experience of emotion had substantial effects on objective performance tasks, indicating that an individual's intense experience of their own emotions can disrupt sensitivity to the emotions of others. Future research should assess the extent to which memory for emotions relates to psychosocial outcomes such as the quality and quantity of interpersonal relationships.
Was the COVID-19 Pandemic Associated with Gender Disparities in Authorship of Manuscripts Submitted to Clinical Neuropsychology Journals?
- Michelle A. Babicz, Anastasia Matchanova, Robiann Broomfield, Libby A. DesRuisseaux, Michelle M. Gereau, Stacey L. Brothers, Lauren Radigan, Erik Porter, Gregory P. Lee, Lisa J. Rapport, Yana Suchy, Keith Owen Yeates, Steven Paul Woods
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 09 December 2021, pp. 105-109
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Objective:
The COVID-19 pandemic exacerbated gender disparities in some academic disciplines. This study examined the association of the pandemic with gender authorship disparities in clinical neuropsychology (CN) journals.
Method:Author bylines of 1,018 initial manuscript submissions to four major CN journals from March 15 through September 15 of both 2019 and 2020 were coded for binary gender. Additionally, authorship of 40 articles published on pandemic-related topics (COVID-19, teleneuropsychology) across nine CN journals were coded for binary gender.
Results:Initial submissions to these four CN journals increased during the pandemic (+27.2%), with comparable increases in total number of authors coded as either women (+23.0%) or men (+25.4%). Neither the average percentage of women on manuscript bylines nor the proportion of women who were lead and/or corresponding authors differed significantly across time. Moreover, the representation of women as authors of pandemic-related articles did not differ from expected frequencies in the field.
Conclusions:Findings suggest that representation of women as authors of peer-reviewed manuscript submissions to some CN journals did not change during the initial months of the COVID-19 pandemic. Future studies might examine how risk and protective factors may have influenced individual differences in scientific productivity during the pandemic.