Effects of divided attention on implicit and explicit memory performance following severe closed head injury.

This study investigated the relation between attentional limitations and memory impairments in patients with closed head injuries (CHI). Twenty-seven CHI participants ( > 1 year postinjury) and 27 matched controls rated their liking of target words under conditions of full and divided attention. Participants then completed an implicit test of tachistoscopic identification (TI) and an explicit test of recognition for the target words As expected, the results revealed impaired explicit memory but preserved perceptually driven implicit memory performance following a CHI. Contrary to what was hypothesized, a reduction in attention available at encoding did not disproportionately impair the recognition performance of the CHI patients. Finally, unlike controls, the CHI participants' priming scores on the TI task were significantly affected by dividing attention at encoding. However, this finding interacted with CHI participants perceptual processing rates, suggesting that nonmemory cognitive factors may influence measured performances on implicit memory tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sustained attention after severe closed head injury.

Sustained attention was assessed in 20 patients with severe closed head injury (CHI) and 20 normal matched controls. Participants were presented with a visual continuous performance task (CPT) with 3 levels of complexity. Performance was assessed by examining response latencies and error rates. Across all levels of complexity, the CHI patients demonstrated a vigilance decrement, whereas the performance of the matched controls was stable across time. The vigilance decrement was not differentially affected by the manipulation of task complexity in the CHI patients. However, findings suggest that the overall vigilance performance of CHI patients was differentially affected by increasing the complexity of the task. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term psychosocial adjustment following very severe closed head injury.

Examined the cognitive, psychological, and social functioning of 18 community-dwelling male patients who had experienced a severe closed head injury (CHI) at least 18 mo previously and still required contact with rehabilitation services. Results from Ss with CHI were compared with those from 27 normal control Ss. Information on Ss' behavior was also obtained from their significant others. Results show that Ss with CHI exhibited deficits in their cognitive and social functioning but showed no signs of emotional or psychiatric disturbance. Attempts to find a relationship between the cognitive impairment and social functioning of Ss with CHI were partially successful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major depression in patients with closed head injury.

Interviewed 120 patients with closed head injury (CHI) with regard to depressive symptoms at least 2 yrs after the date of injury. 92 Ss met Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for major depressive disorder. Half of the depressed CHI Ss did not manifest depressive symptoms until at least 6 mo after being injured. Bipolar affective disorder and schizophrenia were uncommon following CHI. CHI patients may be at increased risk for development of major depressive disorder. CHI patients should be screened for depressive symptoms after they appear to have made a "full" recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of divided attention on automatic and controlled components of memory after severe closed-head injury.

The relation between attention available at encoding and automatic and consciously controlled aspects of memory was investigated using the process-dissociation procedure. Twenty-four severely closed-head injured (CHI) participants (> 1 year postinjury) and 24 matched controls studied word lists in full- and divided-attention conditions. Recall cued with word stems was tested. In contrast to consciously controlled memory, the CHI group did not perform more poorly than the controls in estimates of automatic memory. Furthermore, for both groups, the divided-attention manipulation reduced the controlled estimates of memory, whereas automatic influences remained invariant. These results suggest that automatic memory processes may remain partially immune to the deleterious effects of severe CHI or show recovery by 1 year postinjury. They also indicate that automatic memory processes do not require additional attentional resources following severe CHI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory remediation after severe closed head injury: Notebook training versus supportive therapy.

Evaluated the effectiveness of a 9-wk memory notebook treatment for closed-head injured (CHI) participants with documented memory deficits. Eight participants who had sustained a severe CHI more than 2 yrs earlier were allocated to receive either notebook training or supportive therapy. The notebook training group reported significantly fewer observed everyday memory (EMF) failures on a daily checklist measure than the supportive therapy group. Although in the same direction, this finding no longer reached significance at follow-up. No significant treatment effects were found for the laboratory-based memory measures at posttreatment or follow-up. Although the present results are to be considered preliminary because of the small sample size, they suggest that notebook training has the potential to help individuals compensate for everyday memory problems and that the methods used to measure training efficacy are important. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interhemispheric transfer after spontaneous recovery in 43 cases of severe closed head injury.

Examined the possibility of frequent callosal disconnection following closed head injury. Interhemispheric transfer was evaluated in 43 severe closed-head-injured patients (aged 18–51 yrs) using a wide-ranging battery of untimed behavioral tasks, after the period of spontaneous recovery. Only 1 S showed signs of callosal disconnection. Much effective interhemispheric transfer occurred in closed-head-injured Ss after the period of spontaneous recovery. More frequent occurrence of the disconnection syndrome in its acute phase is a possibility that cannot be excluded. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD.

Attention deficit hyperactivity disorder (ADHD) comprises a deficit in behavioral inhibition. A theoretical model is constructed that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution: (a) working memory, (b) self-regulation of affect–motivation–arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, the model predicts that ADHD should be associated with secondary impairments in these 4 executive abilities and the motor control they afford. The author reviews evidence for each of these domains of functioning and finds it to be strongest for deficits in behavioral inhibitions, working memory, regulation of motivation, and motor control in those with ADHD. Although the model is promising as a potential theory of self-control and ADHD, far more research is required to evaluate its merits and the many predictions it makes about ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Actual versus self-reported scholastic achievement of litigating postconcussion and severe closed head injury claimants.

Psychologists typically rely on patients' self-report of premorbid status in litigated settings. The authors examined the fidelity between self-reported and actual scholastic performance in litigating head injury claimants. The data indicated late postconcussion syndrome (LPCS) and severe closed head injury litigants retrospectively inflated scholastic performance to a greater degree than nonlitigating control groups. The LPCS group showed the highest magnitude of grade inflation, but discrepancy scores did not significantly correlate with a battery of malingering measures or with objective cerebral dysfunction. These findings support previous studies, which showed self-report is not a reliable basis for estimation of preinjury cognitive status. Retrospective inflation may represent a response shift bias shaped by an adversarial context rather than a form of malingering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Semantic priming after severe closed head trauma: Automatic and attentional processes.

The 2-process theory of semantic priming (J. H. Neely, 1977; M. I. Posner and C. R. Snyder, 1975) was used to determine the maintenance of automatic processes after severe closed head injury (CHI) and to determine whether processes that demand attention suffer a deficit. Ss with severe CHI (N?=?18,?>?2 yrs postinjury) and 18 matched control Ss completed a lexical decision task in which a category prime was followed by a target. Automatic and attentional priming were determined by orthogonally varying prime–target relatedness, expectancy, and stimulus onset asynchrony. Although the CHI Ss had slower reaction times (RTs) overall, there were no significant group differences in the magnitude of either the automatic or attentional component of semantic priming. The present results indicate the integrity of semantic processes and normal semantic priming in long-term patients with severe CHI. The results are discussed in relation to an attentional resource hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of spatial working memory in inhibition of return: evidence from divided attention tasks

Inhibition of return (IOR) refers to a bias against returning attention to a location that has been recently attended. In the present experiments, we examined the role of working memory in IOR by introducing secondary tasks (in the temporal interval between the cue and the target) that involved a working memory component. When the secondary task was nonspatial in nature (monitoring odd digits or adding digits), IOR was present, although overall reaction times were greater in the presence of the secondary task. When the task involved a spatial working memory load (remembering the directionality of arrows or the orientation of objects), IOR was eliminated. However, when the participants had incentive to process the directionality of an arrow but did not have to use any memory system, IOR persisted at peripheral locations. Overall, the results suggest that IOR is partially mediated by a spatial working memory system.     

Motor, visual-spatial, and somatosensory skills after closed head injury in children and adolescents: A study of change.

Correlational studies of recovery of function following traumatic brain injury have revealed weak, nonspecific relationships between outcome and injury variables. In order to better identify factors affecting recovery, 49 children (aged 6–15 yrs) were followed prospectively with repeated neuropsychological assessment of motor, visual–spatial, and somatosensory skills up to 5 yrs postinjury. Variability among growth patterns related robustly to injury variables. Younger children with severe injuries showed slower growth on visual–spatial and motor tasks than did older children of similar severity or similarly-aged children with less severe injuries. These findings support a hypothesis of increased vulnerability of rapidly emerging skills in young children and argue against an explanation of lowered recovery rates due to concomitant maturational influences on development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An experimental model of closed head injury in mice: pathophysiology, histopathology, and cognitive deficits

The present study describes the characterization of an experimental model of closed head injury (CHI) in the mouse. This model is a modification of a setup described and used previously in the rat. The weight-drop device was modified and adapted to the size and weight of the mouse and the typical parameters that define the severity of the injury and its outcome were evaluated. The posttraumatic accumulation of water, i.e., cerebral edema, the disruption of the blood-brain barrier (BBB), histopathology, motor and cognitive functions were studied up to 30 days following CHI. Increases in cerebral water content and of BBB permeability were observed in the injured hemisphere at 4 h (p < 0.05) and 24 h (p < 0.01) postinjury, respectively. By 7 days, edema disappeared, while the BBB remained open for up to 30 days. The motor function was evaluated by a set of criteria termed neurological severity score (NSS). NSS was severely impaired immediately after CHI and later showed a spontaneous progressive recovery, although some residual deficits, mainly of beam-walk and balance, were still present at 30 days. Mice trained in the Morris water maze before the injury demonstrated highly significant deficits in memory retention up to at least 11 days postinjury (p < 0.01). Histopathological analysis revealed significant neuronal cell death in CA1, CA2, and CA3 regions of the left hippocampus following CHI. However, in the right hippocampus, overt neuronal cell death was observed only in area CA3 at 7 days after CHI. These results suggest that the modified model of CHI in mice can reproduce the posttraumatic sequelae observed in rats and show that some of the data obtained in this model are essentially similar to those observed in human head injury. The experimental model of CHI in mice may be a useful tool for studies in animals that carry specific genetic alterations, aimed at manipulating neurochemical pathways involved in the pathophysiology of brain damage.     

Frontal lobe changes after severe diffuse closed head injury in children: a volumetric study of magnetic resonance imaging

In view of the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of < or = 8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study.(ABSTRACT TRUNCATED AT 250 WORDS)     

Topography of axonal injury as defined by amyloid precursor protein and the sector scoring method in mild and severe closed head injury

Axonal injury (AI), as defined by amyloid precursor protein (APP) positive axonal swellings, was recorded on a series of line diagrams of standard brain sections divided into 116 sectors to provide an Axonal Injury Sector Score (AISS) ranging from 0 to 116. This sector scoring method of recording axonal damage and providing a topographic overview of AI was applied to a series of 6 mild head injury cases [Glasgow Coma Scale (GCS) 13-15] and six severe head injury cases (GCS 3-8). The AISS ranged from 4 to 107 overall and varied from 4 to 88 in the mildly injured group and 76 to 107 in the severe head injury group, supporting the concept that there is a spectrum of AI in traumatic head injury and that the AISS is a measure of the extent of AI. APP immunostaining demonstrated positive axonal swellings 1.75 h after head injury and analysis of the pattern of AI in the mild and severe head injury groups showed that axons were more vulnerable than blood vessels and that the axons in the corpus callosum and fornices were the most vulnerable of all.     

Working-memory capacity, proactive interference, and divided attention: Limits on long-term memory retrieval.

Two experiments examined how individual differences in working-memory capacity (WM) relate to proactive interference (PI) susceptibility. We tested high and low WM-span participants in a PI-buildup task under single-task or dual-task ("load") conditions. In Experiment 1, a finger-tapping task was imposed during encoding and retrieval of each list; in Experiment 2, tapping was required during encoding or retrieval. In both experiments, low spans showed greater PI than did high spans under no load, but groups showed equivalent PI under divided attention. Load increased PI only for high spans, suggesting they use attention at encoding and retrieval to combat PI. In Experiment 2, only low spans showed a dual-task cost on List 1 memory, before PI built up. Results indicate a role for attentional processing, perhaps inhibitory in nature, at encoding and retrieval, and are discussed with respect to theories of WM and prefrontal cortex function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early ischaemia after severe head injury. Preliminary results in patients with diffuse brain injuries

Ischaemic brain lesions still have a high prevalence in fatally head injured patients and are the single most important cause of secondary brain damage. The present study was undertaken to explore the acute phase of severely head injured patients in order to detect early ischaemia using Robertson's approach of estimating cerebral blood flow (CBF) from calculated arterio-jugular differences of oxygen (AVDO2), lactates (AVDL), and the lactate-oxygen index (LOI). Twenty-eight cases with severe head injury were included (Glasgow Coma Scale Score below or equal to 8). All patients but one had a non-missile head injury. All the patients had a diffuse brain injury according to the admission CT scan. ICP measured at the time of admission was below 20 mmHg in 17 cases (61%). All patients were evaluated with the ischaemia score (IS) devised in our center to evaluate risk factors for developing ischaemia. Mean time from injury to the first AVDO2/AVDL study was 23.9 +/- 9.9 hours. According to Robertson's criteria, 13 patients (46%) had a calculated LOI (-AVDL/AVDO2) value above or equal to 0.08 and therefore an ischaemia/infarction pattern in the first 24 hours after the accident. Of the 15 patients without the ischaemia/infarction pattern, in three cases the CBF was below the metabolic demands and therefore in a situation of compensated hypoperfusion. No patient in our series had hyperaemia. Comparing different variables in ischaemic and non-ischaemic patients, only arterial haemoglobin and ischaemia score (IS) was significantly different in both groups. The ischaemia score had mean of 4.3 +/- 1.7 in the ischaemic group and 2.7 +/- 1.4 in non-ischaemic patients (p = 0.01). It is concluded that ischaemia is highly prevalent in the early period after severe head injury. Factors potentially responsible of early ischaemia are discussed.     

Neuropsychological effects of closed head injury in older adults: A comparison with Alzheimer's disease.

In this study, neuropsychological profiles of 14 older adult patients with mild or moderate closed head injury (CHI). 14 patients with probable Alzheimer's disease (AD), and 14 community residing elderly controls were compared. The groups were similar in demographic features, and the CHI and AD patients had comparable Mini-Mental State Examination scores. Tests of verbal learning and memory, letter and category fluency, and naming were administered. Relative to the CHI group, AD patients exhibited more devastated memory and did not show a normal facilitation on the category retrieval task. The patient groups exhibited similar levels of categorical clustering and naming accuracy for both high- and low-frequency words. These results suggest that neuropsychological markers of memory and semantic processing may be useful in differentiating the cognitive effects from AD versus early recovery from CHI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)