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Prevalence of Memory, Concentration, and Attention Problems After Whiplash Not Predicted Through Testing

People who experience whiplash are rated on a grading system called the Whiplash-Associated Disorders (WADs) system. Using the symptoms and physical findings, patients are rated as grade I (neck pain but no other physical findings), II (pain and some findings, such as difficulty moving neck from side to side), III (neurologic, or nerve, injury), and IV (major injury like a fracture). Most patients who sustain a whiplash from a car accident, about 90 percent, fall into grades I and II.

Physicians have found that many patients who are WADs grade I or II end up having some cognitive (thinking) problems, such as difficulty with memory or concentration. The authors of this study noted that there is some evidence that patients with WADs do show some decrease in testing regarding attention and memory, but findings of previous tests haven't been consistent. The investigators in this study wanted to evaluate the findings of testing these patients to see if they could predict who would experience cognitive difficulties.

There were 203 patients who were WADs, grades I or II, in the study. The patients had to have had neck pain as a result of a car accident within two or three months of the study, had not been admitted to the hospital following the accident, had not lost consciousness as a result of the accident, and had no substance abuse.

The patients were asked to check off a list of symptoms and complete questionnaires that evaluated their pain and mental status, such as anxiety or depression. The physicians used the Wechsler Memory Scale - Third Edition (WSC-III) to check for hearing, sight, recognition, and memory. The Trail-Making Test (TST) checked to see the ability of people to connect numbers and letters as directed.

The investigators found that 32 percent of the patients complained of memory problems and 41 percent complained of problems concentrating. However, 54 percent denied either problem. Most patients had either both problems (called group CS+) or neither (called CS-).

The CS+ group had a higher incidence of pain severity, depression, catostrophizing (thinking things are worse than they are), fear of specific movements, and perceived disability. However, there were no differences in the test results, either the WSC-III or the TMT, between either the CS+ or the CS- groups.

In conclusion, the authors stated that the 46 percent finding of patients reporting memory and concentration problems was in line with other study findings. The investigators' search to find if testing could predict the outcome of these complaints was not met. They recommended that watchful waiting, with reassurance and educating the patients about potential problems following whiplash may be enough for patients with WADs grades I and II.


James P. Robinson, MD, PhD, et al. Perceived and Actual Memory, Concentration, and Attention Problems After Whiplash-Associated Disorders (Grades I and II): Prevalence and Predictors. In Archives of Physical Medicine and Rehabilitation. June 2007. Vol. 88. Pp. 774-779.

06/21/2007

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