146| Persistent Symptoms After Concussion – A Conversation with Dr. Noah Silverberg
Jul 1, 2024
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Dr. Noah Silverberg discusses persisting symptoms after concussion, including prevalence, risk factors, mental health importance, TBI vs. functional cognitive disorder, assessment, and treatment. The conversation explores psychological factors, resilience, overlap with FCD, management strategies, and improving neuropsychological tests.
Understanding Persistent Symptoms After Concussion
Persistent symptoms after a concussion, known as persistent post-concussive symptoms (PPCS), occur in a subset of individuals despite most recovering fully. Statistics indicate that 18-31% of individuals may experience PPCS at three to six months post-injury, with symptoms like headaches, fatigue, and cognitive issues. Diagnosis of PPCS involves considering predisposing, precipitating, perpetuating, and protective factors, highlighting the complex biopsychosocial nature of the condition.
Psychological Factors and Symptom Presentation
Psychological factors play a significant role in PPCS, including negative expectations, maladaptive beliefs, and coping styles like catastrophizing and fear avoidance. These factors interact with cognitive symptoms, showing the importance of psychological constructs. For instance, behaviors related to avoiding triggers or cognitive exertion can exacerbate symptoms, underscoring the need to address psychological aspects in treatment.
Overlap with Functional Cognitive Disorder and Treatment Implications
There is a notable intersection between PPCS and Functional Cognitive Disorder (FCD), where cognitive symptoms persist despite intact neuropsychological performance. Understanding FCD within the context of PPCS can offer insights into mechanisms underlying persistent symptoms. Psychological constructs like memory perfectionism and cognitive distortions are relevant to both conditions, highlighting the need for treatments addressing maladaptive thought patterns and coping strategies to improve outcomes.
Functional Cognitive Disorder Diagnosis
When cognitive symptoms persist post-concussion, a diagnosis of Functional Cognitive Disorder (FCD) may be communicated, especially in neuropsychology service referrals. However, in concussion clinics, FCD isn't typically addressed as most patients have multiple symptoms with cognitive issues not being the primary concern. The conceptualization of FCD is relatively recent, with diagnostic criteria published in 2020, making it challenging to diagnose directly using DSM models. While the mechanisms leading to FCD and post-concussion syndrome (PPCS) may share similarities across various factors like mild COVID-19 infection or exposure to toxins, individual symptom patterns may differ.
Assessment and Treatment Recommendations
To comprehensively assess patients after concussion, it is essential to evaluate psychological symptoms, illness beliefs, and coping mechanisms. Early cognitive screening might be unnecessary, except in specific circumstances like sports-related concussions for immediate diagnosis support. Neuropsychological testing is recommended if symptoms persist beyond a month and affect daily function, provided that management of contributing conditions like depression and pain is optimized. Treatment approaches may include graded exposure therapy to target fear avoidance behavior and cognitive rehabilitation techniques tailored to individual cognitive impairments.
This episode is a conversation with Dr. Noah Silverberg about persisting symptoms following concussion. The discussion covers prevalence of persistent postconcussive symptoms, risk factors for persisting symptoms, the importance of mental health symptoms and psychological constructs, the relationship between TBI and functional cognitive disorder, assessment, and treatment.
Thanks for listening, and join us next time as we continue to navigate the brain and behavior!
[Note: This podcast and all linked content is intended for general educational purposes only and does not constitute the practice of psychology or any other professional healthcare advice and services. No professional relationship is formed between hosts and listeners. All content is to be used at listeners’ own risk. Users should always seek appropriate medical and psychological care from their licensed healthcare provider.]
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