Anoxic Versus Traumatic Brain Injury: Amount of Tissue Loss, Not Etiology, Alters Cognitive and Emotional Function.

Research in neuropsychology suggests that the etiology of a neurologic injury determines the neuropathological and neuropsychological changes. This study compared neuropsychological outcome in subjects who had traumatic brain injury (TBI) with subjects who had anoxic brain injury (ABI), who were matched for age, gender, and ventricle-to-brain ratio. There were no group differences for morphologic or neuropsychological measures. Both groups exhibited impaired memory, attention, and executive function, as well as slowed mental processing speed. Intelligence correlated with whole brain volume, and measures of memory correlated with hippocampal atrophy. There was no unique contribution of hippocampal atrophy on neuropsychological outcome between the groups. In the absence of localized lesions, the amount of neural tissue loss, rather than etiology, may be the critical factor in neuropsychological outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological outcomes of traumatic brain injury and substance abuse in a New Zealand prison population

Fifty subjects with a history of traumatic brain injury (TBI) and/or substance use, completed neuropsychological measures of short and long term verbal and visual memory, information processing, motor speed and co-ordination, executive functioning, and malingering. All subjects performed below norms on tests of verbal memory and verbal abstract thinking, but overall no differences were found due to either severity of TBI or level of substance use. Maori subjects obtained the lowest scores on tests of verbal ability, but also reported higher rates of TBI and substance use, which is presumed to account for this result. In conclusion, prison populations seem to have disproportionately high rates of TBI, recurrent TBI, and substance use, compared to the general population. Further, there are a group of individuals who have experienced both TBI and substance abuse, with associated impairments in verbal memory and learning, abstract thinking, and who report problems with general memory and socialization. These difficulties may affect functioning both in prison and following release.     

strawberry notch encodes a conserved nuclear protein that functions downstream of Notch and regulates gene expression along the developing wing margin of Drosophila

Although many individuals with traumatic brain injury (TBI) perform well on standard neuropsychological tests, they often exhibit marked functional difficulties. The functions which are impaired seem to be analogous to the role of the central executive system (CES) in Baddeley's [Working Memory, 1986, Oxford University Press, New York] widely accepted model of working memory. The purpose of this study was to investigate CES function in individuals with TBI with a dual-task paradigm. We studied 25 non-demented persons who were at various stages in their recovery from severe TBI and compared their performance on a dual-task paradigm to a group of age-matched controls. Our dual-task paradigm measured performance on a simple visual reaction time task both alone (baseline) and during concurrent tasks of articulation or digit span. Subjects were also assessed with other neuropsychological tests of executive function. TBI patients had slower reaction times on the primary task when performed alone (P < 0.05) and greater decrements in performance during dual-task conditions (P < 0.01). They also exhibited significantly greater deficits than control subjects on other measures of executive function. Although correlations between dual-task performance and other executive measures were quite low, principle components analysis suggested that a common factor does exist between these measures. These findings support the conclusion that TBI patients have a working memory impairment that is due to dysfunction of the CES and which may be related to executive function deficits as measured by standard neuropsychological testing.     

Assessment of executive function in patients with mild traumatic brain injury

BACKGROUND: The nature of functional deficit after mild traumatic brain injury (TBI) defined by Glasgow Coma Score of 13-15 is not fully described. This study explored the sensitivity of several neuropsychological tests to identify sequelae of mild traumatic brain injury (TBI). METHODS: Eleven adult patients with mild TBI admitted to a Level 1 trauma center were studied. The battery of tests included the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Trails A and B, the Boston Naming Test, The Multilingual Aphasia Examination: Controlled Oral Word Association Test, and the Paced Auditory Serial Addition Task. RESULTS: Control subjects performed significantly better than patients with mild TBI on Trails A and B, the Controlled Oral Word Association Test, and Paced Auditory Serial Addition Task (subtests 2-4). No significant differences in performances between patients and controls was found for the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Boston Naming Test, and Paced Auditory Serial Addition Task Subtest 1. CONCLUSION: The results suggest that tests of specific frontal lobe executive functions are valuable in diagnosing and monitoring recovery from mild TBI.     

Executive functions and social competence in young children 6 months following traumatic brain injury.

Objective: This study examined the impact of traumatic brain injury (TBI) in young children on executive functions and social competence, and particularly on the role of executive functions as a predictor of social competence. Method: Data were drawn from a prospective, longitudinal study. Participants were children between the ages of 3 years 0 months and 6 years 11 months at time of injury. The initial sample included 23 with severe TBI, 64 with moderate TBI, and 119 with orthopedic injuries (OI). All participants were assessed at 3 and 6 months postinjury. Executive functions were assessed using neuropsychological tests (Delayed Alternation task and Shape School) and parent ratings on the Behavior Rating Inventory of Executive Function and Child Behavior Questionnaire. Parents rated children's social competence on the Adaptive Behavior Assessment System, Preschool and Kindergarten Behavior Scales, and Home and Community Social Behavior Scales. Results: Children with severe TBI displayed more negative outcomes than children with OI on neuropsychological tests, ratings of executive functions, and ratings of social competence (η2 ranged from .03 to .11). Neuropsychological tests of executive functions had significant but weak relationships with behavioral ratings of executive functions (ΔR2 ranged from .06 to .08). Behavioral ratings of executive functions were strongly related to social competence (ΔR2 ranged from .32 to .42), although shared rater and method variance likely contributed to these associations. Conclusions: Severe TBI in young children negatively impacts executive functions and social competence. Executive functions may be an important determinant of social competence following TBI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relationship between alcohol intake and immunoglobulin a immunoreactivity with acetaldehyde-modified bovine serum albumin

Acetaldehyde, the main metabolite of ethanol, is a highly reactive species that reacts with macromolecules to produce unstable and stable adducts. Acetaldehyde-modified proteins are immunogenic and have been detected in the liver and blood of alcoholics. Furthermore, antibodies reactive with acetaldehyde-modified proteins have been detected in the plasma of social drinkers and alcoholics. However, the class distribution of immunoglobulins reactive with modified proteins was different in the two groups, being predominantly immunoglobulin (Ig)M in social drinkers, but IgM and IgA in alcoholics. In this study, we demonstrate that heavy drinkers (alcohol intake > 130 g/week for females and 150 g/week for males) also exhibit IgA reactivity with acetaldehyde-modified proteins. The IgA adduct-specific reactivity (IgA reactivity with acetaldehyde-modified bovine serum albumin-reactivity with native bovine serum albumin) showed a moderate correlation with self-reported alcohol intake, but did not correlate with markers such as plasma transaminase, gamma-glutamyltransferase activity, or mean corpuscular volume. IgA adduct-specific reactivity had similar specificity to the conventional tests of alcohol abuse, but had higher sensitivity than the other tests, especially with heavy drinkers. Data presented herein demonstrate that elevated IgA reactivity with acetaldehyde-modified epitopes is associated with heavy drinking and is a potential marker for high alcohol intake.     

Long-term outcome from childhood traumatic brain injury: Intellectual ability, personality, and quality of life.

Objective: Only a handful of studies have attempted to explore very long-term outcomes from childhood traumatic brain injury (TBI). These studies have generally failed to fully consider the impact of injury severity or employ measures sensitive to the survivor's day-to-day function. This study examined outcomes in adulthood, with a focus on functional abilities including education, employment, and quality of life (QOL), and employed predictors including injury severity, age at injury, socioeconomic factors, intelligence, and personality. Method: The study was retrospective and cross-sectional and included 50 adult survivors of child TBI (31 males), aged 19–30 years at evaluation (M = 24.2, SD = 3.6), with injury on average 13.3 years prior to evaluation. Participants were divided according to injury severity—mild (n = 20), moderate (n = 12), and severe (n = 18)—completed an intellectual evaluation and questionnaires regarding educational and employment status, personality, and quality of life. Results: Intellectual and personality measures indicated good outcomes, with mean scores for all groups in the average range and few severity-based findings. In contrast, those with more severe TBI were more likely to have educational and employment problems. QOL was significantly reduced in the context of severe insult, with lower IQ and personality factors most predictive of outcome in this domain. Mild and moderate TBI were generally more benign. Conclusions: Findings suggest that, while TBI is a lifelong problem, its impact is most dramatic in the domain of QOL, where a complex interaction occurs between injury factors, cognition, and personality. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relations between dietary restraint and patterns of alcohol use in young adult women.

The present study examined relations between dietary restraint and self-reported patterns of alcohol use, including separate assessment of quantity and frequency of alcohol consumption. One hundred seventy-six female university undergraduates completed the Restraint Scale (RS) and measures of their usual quantity and frequency of alcohol consumption over the past year. Quantity and frequency self-reports were scored separately and were also used to calculate 3 additional drinking variables: a composite weekly alcohol consumption score (drinks per week), a binge drinking categorical variable (where participants were classified as either binge drinkers or non-binge drinkers), and a yearly excessive drinking score (number of times in the past year that each participant consumed at least 4 alcoholic beverages per drinking occasion). RS scores were significantly positively correlated with scores on 4 of the 5 drinking behavior measures (i.e., quantity, drinks per week, binge drinking, and yearly excessive drinking, but not frequency). Thus, chronic dieting appears to be related to a relatively heavy drinking pattern that can be characterized as potentially risky, due to its established associations with adverse health and social consequences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive functioning ten years following traumatic brain injury and rehabilitation.

Many previous studies investigating long-term cognitive impairments following traumatic brain injury (TBI) have focused on extremely severely injured patients, relied on subjective reports of change and failed to use demographically relevant control data. The aim of this study was to investigate cognitive impairments 10 years following TBI and their association with injury severity. Sixty TBI and 43 control participants were assessed on tests of attention, processing speed, memory, and executive function. The TBI group demonstrated significant cognitive impairment on measures of processing speed (Symbol Digit Modalities Test [SDMT], Smith, 1973; Digit Symbol Coding, Wechsler, 1997), memory (Rey Auditory Verbal Learning Test [RAVLT]; Rey, 1958; Lezak, 1976), Doors and People tests; Baddeley, Emslie & Nimmo-Smith, 1994) and executive function (Hayling C [Burgess & Shallice, 1997] and SART errors, Robertson, Manly, Andrade, Baddeley & Yiend, 1997). Logistic Regression analyses indicated that the SDMT, Rey AVLT and Hayling C and SART errors most strongly differentiated the groups in the domains of attention/processing speed, memory and executive function, respectively. Greater injury severity was significantly correlated with poorer test performances across all domains. This study shows that cognitive impairments are present many years following TBI and are associated with injury severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Double jeopardy! The additive consequences of negative affect on performance-monitoring decrements following traumatic brain injury.

Survivors of severe traumatic brain injury (TBI) are at increased risk for emotional sequelae. The current study utilized the error-related negativity (ERN) and posterror positivity (Pe) components of the event-related potential (ERP) to test the hypothesis that negative affect disproportionately impairs performance-monitoring following severe TBI. High-density ERPs were acquired while 20 survivors of severe TBI and 20 demographically matched controls performed a single-trial Stroop task. Response-locked ERPs were separately averaged for correct and error trials. Negative affect was measured as the single latent factor of measures of depression and anxiety. Groups did not differ on overall level of negative affect. Control and TBI participants did not differ on error rates as a function of negative affect, but differed in response times. ERP results revealed disproportionately smaller ERN amplitudes in participants with TBI relative to controls as a function of negative affect. Pe amplitude did not differ between groups. Negative affect inversely correlated with ERN amplitude in TBI but not control participants. Overall, results support a “double jeopardy” hypothesis of disproportionate impairments in performance monitoring when negative affect is overlaid on severe TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Event-related potentials as an index of cognitive function during recovery from severe closed head injury

OBJECTIVE: To evaluate the utility and neuropsychological correlates of serially performed recordings of event-related potentials (ERPs) in patients recovering from a severe closed head injury (CHI). DESIGN: Prospective longitudinal study. SETTING: Brain injury rehabilitation unit based in a national rehabilitation hospital. SUBJECTS: Sixteen patients with severe CHI (significant degree of impaired consciousness greater than 24 hours) subclassified into two severity groups according to initial Glasgow Coma Scale (GCS) score: those with initial GCS score < 9, consistent with a more severe injury; and those with initial GCS score > 8, indicating a less severe injury. METHODS: ERPs were elicited using the standard auditory P300 "oddball" detection paradigm. ERP recordings were carried out three times: 2 months after injury, 1 month later, and 2.5 months or more after the initial study. Parameters analyzed included latencies and amplitudes of the P3, N2, P2, and N1 components of the ERPs. Correlations between changes in these ERP parameters and specific neuropsychological test results were evaluated. RESULTS: Initial P3 latencies in the more severely injured group were significantly longer (P < .05) than those recorded in the less severely injured patients. In subsequent recordings, P3 latency was found to be significantly shorter compared with the initial P3 latency, and the difference in P3 latency between the two patient groups was no longer statistically significant by the time of the third recording. For the group as a whole, P3 latency decreased significantly on each repeated recording. N2 latency was found to be significantly shorter (P < .05) between the first and third recordings. Cognitive performance significantly improved between the first and third recordings. P3 latency shortening was correlated with improvement in neuropsychological test scores for short-term and long-term story recall and for word recall. N2 latency shortening was correlated with improvement in the neuropsychological test scores for word recall only. CONCLUSION: ERP recordings performed in the subacute stage after CHI may assist in evaluating injury severity. Moreover, serially performed recordings of P3 latency may be used as a physiologic index of brain activity that correlates with recovery from CHI.     

Effects of alcohol sensitivity on P3 event-related potential reactivity to alcohol cues.

Although alcoholics and individuals at risk for alcoholism often show smaller amplitude of the P3 event-related brain potential (ERP), recent data (K. Namkoong, E. Lee, C. H. Lee, B. O. Lee, & S. K. An, 2004) indicate that alcohol-related cues elicit larger P3 amplitude in alcoholics than in controls. Little is known concerning the ERP profiles or alcohol cue reactivity of social drinkers at risk for alcoholism due to low sensitivity to alcohol's effects. Participants differing in alcohol sensitivity viewed images of alcoholic and nonalcoholic beverages while ERPs were recorded and provided information about their alcohol use patterns at baseline and 4 months later. Compared to high-sensitivity participants, those low in sensitivity showed larger P3s to alcohol cues, even when recent alcohol use was statistically controlled for. Moreover, the P3 elicited by alcohol cues predicted alcohol use at follow-up, a finding supporting the idea that P3 amplitude reflects the motivational significance of substance-related cues. These findings point to risk status, not consumption history, as an important predictor of cue reactivity effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low blood alcohol discrimination and self-titration skills of social drinkers with widely varied drinking habits.

Six alcohol drinking sessions were administered to 20 males ranging widely in age (18-55 yrs) and classified as "light" or "heavy" social drinkers on the basis of their frequency of drinking and customary dose (ml absolute alcohol/kg). Pretraining measures of accuracy in discriminating low blood alcohol concentrations (BAC) were obtained on Session 1. Training in BAC discrimination (immediate feedback about actual BAC) occurred during Session 2, and Session 3 assessed posttraining effects. Sessions 4-6 tested "self-titration" skill (i.e., self-administration of alcohol to achieve a specific pre-assigned peak BAC). Discrimination of BAC on all posttraining sessions (3-6) was significantly more accurate than pretraining performance. The accuracy with which Ss self-titrated their alcohol to hit a particular peak BAC was consistent over Sessions 4-6 and was comparable to their accuracy in BAC discrimination. The development of these skills had no significant relation to age or drinking habits, suggesting that the training technique may be applicable to a broad spectrum of social drinkers. The importance of feedback in establishing BAC discrimination is discussed, and the consequences of this training, as well as the definition of "light" and "heavy" social drinkers, are identified as important areas for further research. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries.     

Correlates of social problem solving during the first year after traumatic brain injury in children.

Effects of pediatric traumatic brain injury (TBI) on social problem-solving were examined in a longitudinal study of 103 children with moderate-to-severe TBI (n = 52) or orthopedic injury (OI; n = 51) using the Interpersonal Negotiation Strategies task (INS). Children solved age-appropriate hypothetical social conflicts, with responses for four problem-solving steps scored by developmental level. The OI group performed better than the TBI group, but rate of change in performance over time did not differ between groups, suggesting improvement in children with TBI was not due to recovery from injury. Strong relations between INS performance and memory and language skills emerged, but emotional processing was only weakly related to INS performance. Frontal focal lesions influenced INS performance in younger (but not older) children with TBI. Diffusion tensor imaging (DTI), revealed strong relationships between the INS and increased apparent diffusion coefficient (ADC) measures indexing connectivity in the dorsolateral and cingulate regions in both TBI and OI groups, and in the temporal and parietal regions in the TBI group. These findings inform studies of social problem-solving skills during the first year post TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of social context and gender on drinking patterns of young adults.

The social context of alcohol use involves both motivational and situational factors that influence drinking behavior among young adults. In this study, a significant multivariate interaction involving gender and alcohol use intensity was found on 6 social context factors. Among women, the social context of Emotional Pain most clearly separated lower intensity from higher intensity drinkers, whereas for men, the clearest separating factor was the context of Social Facilitation. Higher intensity drinkers were more likely than lower intensity drinkers to use alcohol in these contexts. Significant interaction effects involving gender were not found for driving under the influence or riding with an impaired driver; however, significant main effects for these 2 factors were discovered. The implications of the findings for counseling alcohol-abusing young adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term neuropsychological outcome following uncomplicated mild TBI: Effects of day-of-injury intoxication and pre-injury alcohol abuse.

Research suggests that individuals who are intoxicated at the time of traumatic brain injury (TBI) have worse cognitive outcome compared with those who are sober. Worse outcome in patients with day-of-injury intoxication might (a) be related to the increased magnitude of brain injury resulting from a variety of negative responses not present following TBI in nonintoxicated individuals, or (b) reflect the effect of pre-injury alcohol abuse that is prevalent in individuals intoxicated at the time of injury. Most studies in this area have focused on patients with moderate to severe TBIs, and on medium- to long-term neuropsychological outcome. The purpose of this study was to examine the relative contributions of day-of-injury intoxication versus pre-injury alcohol abuse on short-term cognitive recovery following mild TBI. Participants were 169 patients with uncomplicated mild TBIs who were assessed on 13 cognitive measures within 7 days postinjury. The prevalence of intoxication at the time of injury was 54.4%. The prevalence of possible pre-injury alcohol abuse was 46.2%. Overall, the results suggest that pre-injury alcohol abuse, compared with day-of-injury alcohol intoxication, had the most influence on short-term neuropsychological outcome from uncomplicated mild TBI. However, the influence of pre-injury alcohol abuse was considered small at best. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impairments in theory of mind shortly after traumatic brain injury and at 1-year follow-up.

Most studies into acquired theory of mind (ToM) deficits assessed patients once, long after the onset of brain injury. As a result, the time course of acquired ToM impairments is largely unknown. The present study examined whether ToM impairments following traumatic brain injury (TBI) recover, remain stable, or worsen over time. Because of the alleged association between ToM and social communication, ToM impairments may deteriorate because of changes in patients' social environment following injury. ToM ability and executive functioning were assessed shortly after injury and at 1-year follow-up. Compared with the orthopedic control group, the TBI group was impaired on ToM and executive functioning tasks at both assessments. Furthermore, the ToM impairments in the TBI group remained stable over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modeling influences in social drinking: An experimental analogue.

48 male college students classified as heavy social drinkers were assigned to 1 of 6 groups in a 3 * 2 factorial design. The 1st factor consisted of 3 modeling conditions: exposure to a model who was a heavy consumer of alcohol; a light drinking model; and a no-model control condition. For the 2nd factor, Ss engaged in a brief prior social interaction with the model who played a role that was either warm or cold in emotional quality. Modeling effects were then assessed in a laboratory wine-tasting task in which the S and the model participated together. Ss exposed to the heavy drinking model drank significantly more alcohol than Ss in the low-consumption model and no-model conditions, which did not differ from each other. The prior interaction conditions did not affect drinking behavior. Results are discussed within a theoretical framework that emphasizes the social learning determinants of drinking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)