Cognitive process scores associated with self-reported behavioral dysfunction on the Frontal Systems Behavior Scale (FrSBe) in chronic traumatic brain injury

Introduction: Individuals with traumatic brain injury (TBI) often experience long-term cognitive impairment that affects daily functioning, but neuropsychological tests are often not associated with functional outcomes in chronic TBI. To identify better neuropsychological test predictors of functional outcomes, we identified process-oriented neuropsychological test scores associated with behavioral dysfunction in chronic TBI. Method: Adults (N = 65, age = 49.9 years, education = 14.6 years, 80% male, 97% white) with a > 6-month (median = 55 months) history of TBI (31% complicated mild, 20% moderate, 49% severe) completed the self-reported Frontal Systems Behavior Scale (FrSBe) and a battery of neuropsychological tests. Cognitive scores significantly associated with FrSBe domain scores (Apathy, Disinhibition, Executive Dysfunction) were included in hierarchical linear regression analyses. Results: Pearson correlations were significant (|r| = .25 –.41, p < .05) between FrSBe Disinhibition and Executive Dysfunction domains and numerous cognitive scores, particularly cognitive process scores, including California Verbal Learning Test II (CVLT-II) and Letter (FAS) Fluency Intrusions and Repetitions. In the regression analyses, gender, injury severity, premorbid intelligence, time since injury, self-awareness, and depression status accounted for less than 1% (Disinhibition) and 6.1% (Executive Dysfunction) of the total adjusted variance in respective FrSBe domains. Cognitive process scores were the strongest factors associated with behavioral dysfunction, explaining an additional 22.9% of the total adjusted variance in Disinhibition [F(3, 50) = 6.28, p = .001]. For Executive Dysfunction, traditional scores explained 2.6% added variance on top of the base model, with cognitive process scores explaining an additional 17.2% [F(4, 48) = 6.79, p = .003] of the total adjusted variance. Conclusions: Less frequently utilized cognitive process scores from well-known neuropsychological tests may be better predictors of behavioral dysfunction in chronic TBI, as measured by the FrSBe. Future prospective study is required to validate these findings and test the sensitivity and specificity of these cognitive process scores for identifying risk for behavioral dysfunction.