Measuring executive function in control subjects and TBI patients with question completion time (QCT)

David L Woods, E William Yund, John M Wyma, Ron Ruff, Timothy J Herron, David L Woods, E William Yund, John M Wyma, Ron Ruff, Timothy J Herron

Abstract

Questionnaire completion is a complex task that places demands on cognitive functions subserving reading, introspective memory, decision-making, and motor control. Although computerized questionnaires and surveys are used with increasing frequency in clinical practice, few studies have examined question completion time (QCT), the time required to complete each question. Here, we analyzed QCTs in 172 control subjects and 31 patients with traumatic brain injury (TBI) who completed two computerized questionnaires, the 17-question Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) and the 25-question Cognitive Failures Questionnaire (CFQ). In control subjects, robust correlations were found between self-paced QCTs on the PCL and CFQ (r = 0.82). QCTs on individual questions correlated strongly with the number of words in the question, indicating the critical role of reading speed. QCTs increased significantly with age, and were reduced in females and in subjects with increased education and computer experience. QCT z-scores, corrected for age, education, computer use, and sex, correlated more strongly with each other than with the results of other cognitive tests. Patients with a history of severe TBI showed significantly delayed QCTs, but QCTs fell within the normal range in patients with a history of mild TBI. When questionnaires are used to gather relevant patient information, simultaneous QCT measures provide reliable and clinically sensitive measures of processing speed and executive function.

Keywords: aging; executive function; gender; head injury; reaction time; reading.

Figures

Figure 1
Figure 1
Question display. Responses were selected using the mouse cursor (green cross). As the mouse was moved over the rating scale, it highlighted Likert alternatives within a radius of 3.5 degrees of visual angle. Responses remained highlighted when selected by a subject. When satisfied with the response, subjects pressed the submit button. The highlighted Likert rating and “Submit” response are shown.
Figure 2
Figure 2
Median QCTs for the questions on the PCL and cognitive failures questionnaire (CFQ) as a function of the number of words in each question. The two longest QCTs (top center) occurred to the first question in each questionnaire.
Figure 3
Figure 3
Rating scores on the CFQ and PCL. Data are shown for control subjects (blue diamonds), patients with mild TBI (mTBI, filled red circles), and patients with severe TBI (sTBI, cross-hatched red circles).
Figure 4
Figure 4
Log median QCTs (averaged over the PCL and CFQ) as a function of subject age. Data are shown for control subjects (blue diamonds), patients with mild TBI (mTBI, filled red circles), and patients with severe TBI (sTBI, cross-hatched red circles). The linear fit to control data is shown.
Figure 5
Figure 5
Log-median question completion time (QCT) z-scores for control subjects and TBI patients on the PCL and CFQ. Linear regression was used to correct for the influence of age, education, computer use, and sex on z-scores. Red dashed lines show the upper limits (p < 0.05) of the control population. Data are shown for control subjects (blue diamonds), patients with mild TBI (mTBI, filled red circles), and patients with severe TBI (sTBI, cross-hatched red circles). The linear fit to control data is shown.

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