Cognitive complaints in patients after whiplash injury: the impact of malingering
- aDepartment of Psychology, Slotervaartziekenhuis, Amsterdam, bDepartment of Neurology, Academic Medical Centre, University of Amsterdam, cDepartment of Medical Psychology, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, dDepartments of Neurology and Clinical Neurophysiology, Slotervaartziekenhuis, Amsterdam
- Dr Ben Schmand, Academic Medical Center, University of Amsterdam, Department of Neurology, H2–214, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Telephone 0031 20 566 3590; fax 0031 20 697 1438; email b.schmand{at}amc.uva.nl
- Received 12 June 1997
- Revised 8 September 1997
- Accepted 26 September 1997
Abstract
OBJECTIVES The validity of memory and concentration complaints that are often reported after a whiplash trauma is controversial. The prevalence of malingering or underperformance in post-whiplash patients, and its impact on their cognitive test results were studied.
METHODS The Amsterdam short term memory (ASTM) test, a recently developed malingering test, was used as well as a series of conventional memory and concentration tests. The study sample was a highly selected group of patients, who were examined either as part of a litigation procedure (n=36) or in the normal routine of an outpatient clinic (n=72).
RESULTS The prevalence of underperformance, as defined by a positive score on the malingering test, was 61% (95% CI: 45–77) in the context of litigation, and 29% (95% CI: 18–40) in the outpatient clinic (p=0.003). Furthermore, the scores on the memory and concentration test of malingering post-whiplash patients (n=43) and non-malingering post-whiplash patients (n=65) were compared with the scores of patients with closed head injury (n=20) and normal controls (n=46). The malingering post-whiplash patients scored as low as the patients with closed head injury on most tests.
CONCLUSIONS The prevalence of malingering or cognitive underperformance in late post-whiplash patients is substantial, particularly in litigation contexts. It is not warranted to explain the mild cognitive disorders of whiplash patients in terms of brain damage, as some authors have done. The cognitive complaints of non-malingering post-whiplash patients are more likely a result of chronic pain, chronic fatigue, or depression.
