A Cognitive Concerns Phenotype Remains Common In Chronic Phases of mTBI and is Uncoupled from Cognitive Screening Performance

Abstract Background Cognitive concerns are common after mild traumatic brain injury (mTBI). We hypothesized that a cognitive concern phenotype (CCP) persists across time-since-injury groups, with limited association with Montreal Cognitive Assessment (MoCA) performance. Methods We retrospectively analyzed 190 mTBI clinic patients. CCP defined as primary disabling cognitive concern and a Rivermead Post-Concussion Symptoms Questionnaire cognitive item score > 2. CCP prevalence across time-since-injury groups (< 6 months, 6–12 months, 1–2 years, 2–5 years and > 5 years post-injury) was evaluated using descriptive and spline analyses. Exploratory analyses compared four CCP/MoCA groups on Center for Epidemiologic Studies Depression Scale (CES-D), Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy, PROMIS psychosocial illness impact, and Glasgow Outcome Scale-Extended (GOSE). Results CCP prevalence was 32.6% (62/190) and remained common across time-since-injury groups (25.4%, 50.0%, 46.7%, 50.0%, and 36.8%). Odds of CCP were higher at ≥ 1 versus < 1 year after injury (odds ratio 1.96, 95% confidence interval [CI] 1.00–3.84; p = 0.048). Among 111 patients with MoCA data, 62 (55.9%) scored < 26: 23/38 (60.5%) with CCP and 39/73 (53.4%) without CCP. CCP was not significantly associated with MoCA impairment (p = 0.608) or adjusted MoCA scores (β=-1.06, 95% CI -2.74 to 0.62; p = 0.213). Self-efficacy and GOSE differed across groups (both p = 0.005); CES-D did not. Conclusions CCP remains common and disabling, years after mTBI, and is not fully captured by MoCA. Self-efficacy and functional differences suggest symptom-burden beyond screening performance.