Abstract
Abstract Mild head injury can result in the development of persistent symptoms including impairments of memory and attention in a small but significant minority. The problem in assessing these difficulties in such cases is the likely interaction of psychogenic and organic causes. The aim of the present research is to more accurately characterize the nature of these cognitive deficits. Twelve asymptomatic volunteers, who had experienced a mild head injury in the last 3.5 years, were compared to a matched control group. ERPs were recorded during the performance of the paced auditory serial addition task (PASAT) and a 3-stimulus auditory “oddball” task. Verbal paired associate. Trails A and B, Digit Symbol, Rey Figure Recall, NART, and Digit Span were also administered. The mild head injured group showed evidence of a mild impairment of episodic memory, slowing of attention shifting, but no changes in reaction time or error rates in either the “oddball” task or the PASAT. Although there was no evidence of impairment of brain orienting responses in the 3-stimulus auditory oddball task, there was evidence of reduced frontal negativity associated with changes in task demand in the PASAT. This particular ERP feature appears similar to those associated with activation of selective attention mechanisms, thus suggesting that these asymptomatic individuals may be showing signs of a mild impairment of allocation of attention resources.
References
Baribeau, J. , Ethier, M. , Braun, C. , Decary, A. (1990). Nd correlates of selective binaural listening after treatment in traumatic brain injury. In C.H.M. Brunia, A.W.K. Gaillard, & A. Kok, (Eds.), Psychophysiological brain research (pp. 161-165). Tilburg, NL: Tilburg University Press .Barrett, K. , Ward, A.B. , Boughey, A. , Jones, M. , Mychalkiw, W. (1994). Sequelae of minor head injury: The natural history of post-concussive symptoms and its relationship to loss of consciousness and follow-up. Journal of Accident and Emergency Medicine, 11, 79– 84 .Barth, J.T. , Macciocchi, S.N. , Giordiani, B.G. , Rimel, R. , Jane, J.A. , Boll, T.J. (1983). Neuropsychological sequelae of minor head injury. Neurosurgery, 13, 529– 533 .Binder, L.M. (1986). Persisting symptoms after mild head injury: A review of the postconcussive syndrome. Journal of Clinical and Experimental Neuropsychology, 8, 323– 346 .Bohnen, N. , Jolles, J. , Twijnstra, A. (1992). Neuropsychological deficits in patients with persistent symptoms six months after mild head injury. Neurosurgery, 30, 692– 696 .Bohnen, N. , Twijnstra, A. , Jolles, J. (1992a). Performance in the Stroop colour word test in relationship to persistence of symptoms following mild head injury. Acta Neurologica Scandinavica, 85, 116– 121 .Bohnen, N. , Twijnstra, A. , Jolles, J. (1992b). Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury. Brain Injury, 6, 481– 487 .Campbell, K.B. , Houle, S. , Lorrain, D. , Deacon-Elliot, D. , Proulx, G. (1986). Event-related potentials as an index of functioning in head injured outpatients. In W.C. McCallum, R. Zappoli, & F. Denoth (Eds.), Cerebral psychophysiology: Studies in event-related potentials (pp. 486-488). Amsterdam: Elsevier .Campbell, K.B. , Suffield, J.B. , Deacon, D.L. (1990). Electrophysiological assessment of cognitive disorder in closed-head injured outpatients. In P.M. Rossini & F. Mauguière (Eds.), New trends and advanced techniques in clinical neurophysiology (pp. 202-215). Amsterdam: Elsevier .Campbell, K.B. , de Lugt, D.R. (1995). Event-related potential measures of cognitive function following closed head injury. In F. Boller & J. Grafman (Eds.), Handbook of neuropsychology, Vol. 10. Amsterdam: Elsevier .Craik, F. , Govoni, R. , Naveh-Benjamin, M. (1993, November). The effects of divided attention at encoding and retrieval . Paper presented at the 34th Annual Meeting of the Psychonomic Society, Washington, DC .Curry, S.H. (1980). Event-related potentials as indicators of structural and functional damage in closed head injury. In H.H. Kornhuber & L. Deeke (Eds.), Motivation, motor and sensory processes of the brain: Electrical potentials, behaviour and clinical use (pp. 507-515). Amsterdam: Elsevier .Davidoff, D. , Kessler, H. , Laibstain, D. , Mark, V. (1988). Neurobehavioral sequelae of minor head injury: A consideration of post concussive syndrome versus post-traumatic stress disorder. Cognitive Rehabilitation, 6, 8– 13 .Dikmen, S. , McLean, A. , Temkin, N. (1986). Neuropsychological and psychosocial consequences of mild head injury. Journal of Neurology, Neurosurgery & Psychiatry, 49, 1227– 1232 .Elson, L.M. , Ward, C.C. (1994). Mechanisms and pathophysiology of mild head injury. Seminars in Neurology, 14, 8– 18 .Evans, R.W. (1992). The postconcussion syndrome and the sequelae of mild head injury. Neurologic Clinics, 10, 815– 847 .Fisher, J.M. , Williams, A.D. (1994). Neuropsychologic investigation of mild head injury: Ensuring diagnostic accuracy in the assessment process. Seminars in Neurology, 14, 53– 59 .Gentilini, M. , Nichelli, P. , Schönhuber, R. (1989). Assessment of attention in mild head injury. In H.S. Levin, H.M. Eisenberg, & A.L. Benton (Eds.), Mild head injury (pp. 163-175). New York: Oxford University Press .Goodman, J.C. (1994). Pathologic changes in mild head injury. Seminars in Neurology, 14, 19– 24 .Gronwall, D. (1986). Rehabilitation programs for patients with mild head injury: Components, problems and evaluation. Journal of Head Trauma Rehabilitation, 1, 53– 62 .Gronwall, D. (1989). Cumulative and persisting effects of concussion on attention and cognition. In H.S. Levin, H.M. Eisenberg, & A.L. Benton (Eds.), Mild head injury (pp. 153-162). New York: Oxford University Press .Hall, S. , Bornstein, R.A. (1991). Serial-position effects in paragraph recall following mild closed-head injury. Perceptual and Motor Skills, 72, 1295– 1298 .Hayes, R.L. , Dixon, C.E. (1994). Neurochemical changes in mild head injury. Seminars in Neurology, 14, 25– 31 .Heinze, H.-J. , Munte, T.F. , Gobiet, W. , Niemann, H. , Ruff, R.M. (1992). Parallel and serial visual search after closed head injury: Electrophysiological evidence for perceptual dysfunctions. Neuropsychologia, 30, 495– 514 .Hugenholtz, H. , Stuss, D.T. , Stethem, L.L. , Richard, M.T. (1988). How long does it take to recover from a mild concussion?. Neurosurgery, 22, 853– 858 .Jennett, B. , MacMillan, R. (1981). Epidemiology of head injury. British Medical Journal, 282, 101– 104 .Johnson, R. (1988). The amplitude of the P300 event-related potential: Review and synthesis. In P.K. Ackles, J.R. Jennings, & M.G.H. Coles (Eds.), Advances in psychophysiology (pp. 69-137). Greenwich, CT: JAI Press .Kaplan, E. , Fein, D. , Morris, R. , Delis, D. (1991). WAIS-R as a neuropsychological instrument . San Antonio, TX: The Psychological Corporation .King, N. (1997). Mild head injury: Neuropathology, sequelae, measurement and recovery. British Journal of Clinical Psychology, 36, 161– 184 .Knight, R.T. (1984). Decreased response to novel stimuli after pre-frontal lesions in man. Electroencephalography and Clinical Neurophysiology, 59, 9– 20 .Leininger, B.E. , Gramling, S.E. , Farrell, A.D. , Kreutzer, J.S. , Peck, E.A. (1990). Neuropsychological deficits in symptomatic mild head injury patients after concussion and mild concussion. Journal of Neurology, Neurosurgery, & Psychiatry, 53, 293– 296 .Miller, E. (1970). Simple and choice reaction time following severe head injury. Cortex, 6, 121– 127 .Miller, L. (1993). Psychotherapy of the brain injured patient . London: W. W. Norton & Co. .Nelson, H.E. (1982). The National Adult Reading Test (NART): Test Manual . Windsor Berks, UK: NFER-Nelson .Newcombe, F. , Rabbitt, P. , Briggs, M. (1994). Minor head injury: Pathophysiological or iatrogenic sequelae. Journal of Neurology, Neurosurgery, & Psychiatry, 57, 709– 716 .Näätänen, R. (1990). The role of attention in auditory processing as revealed by event-related potentials and other brain measures of cognitive function. Behavioural and Brain Sciences, 13, 201– 288 .Osterreith, P.A. (1944). Le test de copie d'une figure complexe. Archives de Psychologie, 30, 206– 356 (Translated by J.Corwin & F.W. Bylsma (1993). The Clinical Neuropsychologist, 7, 9-15.) .O'Toole, D.M. , Iacano, W.G. (1987). An evaluation of different techniques for removing eye-blink artifact from visual evoked response recordings. Psychophysiology, 24, 487– 497 .Packard, R.C. , Ham, L.P. (1994). Promising techniques in the assessment of mild head injury. Seminars in Neurology, 14, 74– 83 .Parasuraman, R. , Mutter, S.A. , Molloy, R. (1991). Sustained attention following mild closed-head injury. Journal of Clinical and Experimental Neuropsychology, 13, 789– 811 .Polich, J. , Kok, A. (1995). Cognitive and biological determinants of P300: An integrative review. Biological Psychology, 41, 103– 146 .Potter, D.D. , Barrett, K. (1994, July). Exploring the effects of mild head injury using the PASAT working memory task and event-related potentials . Presented at the “Mapping cognition in time and space” conference, Magdeburg, Germany .Potter, D.D. (1996). The role of attention in working memory function: Effects of mild head injury. Journal of Psychophysiology, 10, 79– 79 .Pratap-Chand, R. , Sinniah, M. , Salem, F.A. (1988). Cognitive evoked potential (P300): A metric for cerebral concussion. Acta Neurologica Scandinavica, 78, 185– 189 .Ruff, R.M. , Wylie, T.F. (1986). The San Diego Neuropsychology Test Battery: Administration Manual . University of California at San Diego. Head Injury Center .Rugg, M.D. , Cowan, C.P. , Nagy, M.E. , Milner, A.D. , Jacobsen, I. , Brooks, D.N. (1988). Event-related potentials from closed-head injury patients in an auditory “oddball” task: Evidence of dysfunction in stimulus categorization. Journal of Neurology, Neurosurgery, & Psychiatry, 51, 691– 698 .Rugg, M.D. , Cowan, C.P. , Nagy, M.E. , Milner, A.D. , Jacobson, I. , Brooks, D.N. (1989). CNV abnormalities in closed head injury. Brain, 112, 489– 506 .Rugg, M.D. , Pickles, C.D. , Potter, D.D. , Doyle, M.C. , Pentland, B. , Roberts, R.C. (1993). Cognitive brain potentials in a three-stimulus auditory “oddball” task after closed head injury. Neuropsychologia, 31, 373– 393 .Rugg, M.D. , Doyle, M.C. (1994). Event related potentials and stimulus repetition in direct and indirect tests of memory. In H. Heinze, T. Munte, & G.R. Mangun (Eds.), Cognitive electrophysiology (pp. 124-128). Cambridge, MA: Birkhauser Boston .Rutherford, W.H. (1989). Postconcussion symptoms: Relationship to acute neurological indices, individual differences, and circumstances of injury. In H.S. Levin, H.M. Eisenberg, & A.L. Benton (Eds.), Mild head injury (pp. 217-228). New York: Oxford University Press .Schönhuber, R. , Gentilini, M. (1989). Neurophysiological assessment of mild head injury. In H.S. Levin, H.M. Eisenberg, & A.L. Benton (Eds.), Mild head injury (pp. 142-152). New York: Oxford University Press .Segalowitz, S.J. , Unsal, A. , Dywan, J. (1992). CNV evidence for the distinctiveness of frontal and posterior neural processes in a traumatic brain-injured population. Journal of Clinical and Experimental Neuropsychology, 14, 545– 565 .Semlitsch, H.V. , Anderer, P. , Schuster, P. , Presslich, O. (1986). A solution for reliable and valid reduction of ocular artifacts, applied to the P300 ERP. Psychophysiology, 23, 695– 703 .Spreen, O. , Strauss, E. (1991). A compendium of neuropsychological tests . New York: Oxford University Press .Squires, N.K. , Squires, K.C. , Hillyard, S.A. (1975). Two varieties of long-latency positive waves evoked by unpredictable auditory stimuli in man. Electroencephalography and Clinical Neurophysiology, 8, 387– 401 .Van Petten, C. , Kutas, M. , Klueneder, R. , Mitchiner, M. , McIsaac, H. (1991). Fractionating the word repetition effect with event-related potentials. Journal of Cognitive Neuroscience, 3, 129– 150 .Van Zomeren, A.H. , Brouwer, W.H. , Deelman, B.G. (1984). Attentional deficits: The riddles of selectivity, speed, and alertness. In N. Brooks (Ed.), Closed head injury: Psychological, social and family consequences (pp. 74-107). Oxford: Oxford University Press .Van Zomeren, A.H. , Van den Burg, W. (1985). Residual complaints of patients two years after severe head injury. Journal of Neurology, Neurosurgery, & Psychiatry, 48, 21– 28 .Verleger, R. (1988). Event-related potentials and cognition: A critique of the context updating hypothesis and an alternative explanation of P3. Behavioural Brain Sciences, 11, 343– 356 .Verleger, R. (1997). On the utility of the P3 latency as an index of mental chronometry. Psychophysiology, 34, 131– 156 .Wechsler, D. (1981). WAIS-R manual . New York: The Psychological Corporation .Wechsler, D. (1987). Wechsler Memory Scale-Revised manual . San Antonio, TX: The Psychological Corporation .Woods, D.L. (1990). The physiological basis of selective attention: Implications of event-related potential studies. In J.W. Rohrbaugh, R. Parasuraman, & R. Johnson (Eds.), Event-related brain potentials (pp. 178-209). New York: Oxford University Press .Young, W.B. , Silberstein, S.D. (1994). Imaging and electrophysiologic testing in mild head injury. Seminars in Neurology, 14, 46– 52 .