scholarly journals The Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury on Visual Choice Reaction Time

Author(s):  
David L. Woods ◽  
John M. Wyma ◽  
E. W. Yund ◽  
Timothy J. Herron
Brain ◽  
2019 ◽  
Vol 142 (8) ◽  
pp. 2367-2379 ◽  
Author(s):  
Peter O Jenkins ◽  
Sara De Simoni ◽  
Niall J Bourke ◽  
Jessica Fleminger ◽  
Gregory Scott ◽  
...  

Abstract Cognitive impairment is common following traumatic brain injury. Dopaminergic drugs can enhance cognition after traumatic brain injury, but individual responses are highly variable. This may be due to variability in dopaminergic damage between patients. We investigate whether measuring dopamine transporter levels using 123I-ioflupane single-photon emission computed tomography (SPECT) predicts response to methylphenidate, a stimulant with dopaminergic effects. Forty patients with moderate-severe traumatic brain injury and cognitive impairments completed a randomized, double-blind, placebo-controlled, crossover study. 123I-ioflupane SPECT, MRI and neuropsychological testing were performed. Patients received 0.3 mg/kg of methylphenidate or placebo twice a day in 2-week blocks. Subjects received neuropsychological assessment after each block and completed daily home cognitive testing during the trial. The primary outcome measure was change in choice reaction time produced by methylphenidate and its relationship to stratification of patients into groups with normal and low dopamine transporter binding in the caudate. Overall, traumatic brain injury patients showed slow information processing speed. Patients with low caudate dopamine transporter binding showed improvement in response times with methylphenidate compared to placebo [median change = −16 ms; 95% confidence interval (CI): −28 to −3 ms; P = 0.02]. This represents a 27% improvement in the slowing produced by traumatic brain injury. Patients with normal dopamine transporter binding did not improve. Daily home-based choice reaction time results supported this: the low dopamine transporter group improved (median change −19 ms; 95% CI: −23 to −7 ms; P = 0.002) with no change in the normal dopamine transporter group (P = 0.50). The low dopamine transporter group also improved on self-reported and caregiver apathy assessments (P = 0.03 and P = 0.02, respectively). Both groups reported improvements in fatigue (P = 0.03 and P = 0.007). The cognitive effects of methylphenidate after traumatic brain injury were only seen in patients with low caudate dopamine transporter levels. This shows that identifying patients with a hypodopaminergic state after traumatic brain injury can help stratify the choice of cognitive enhancing therapy.


Author(s):  
D.T. Stuss ◽  
L.L. Stethem ◽  
T.W. Picton ◽  
E.E. Leech ◽  
G. Pelchat

ABSTRACT:The effects of traumatic brain injury (TBI) and aging were compared on tests of simple and complex reaction time (RT). Simple RT was not significantly affected by aging or TBI. TBI patients, however, tended to be slower on Simple RT tasks, and had a larger standard deviation. Individuals over age 60 and patients of any age with TBI demonstrated slower RT with choice RT tests. In addition, both groups (those over 60 and TBI patients) were less able than other groups to inhibit the processing of redundant information. For the TBI patients, this occurred primarily on reassessment. These results suggest that the deficit in both aging and TBI is not only a generalized neuronal slowing but a more specific impairment in attentional control processes, exhibited as a deficit in focused attention.


2017 ◽  
Vol 23 (4) ◽  
pp. 304-313 ◽  
Author(s):  
Vickie Plourde ◽  
Brian L. Brooks

AbstractObjectives: Children and adolescents with moderate-to-severe traumatic brain injury (TBI) present with short and long-term neuropsychological deficits following their injury. The aim of this study was to investigate the utility of a brief computerized test battery for evaluating cognitive functioning sub-acutely following a TBI. Methods: Participants (n=33) sustained a moderate-to-severe TBI, were between 8 and 18 years old, and were assessed using CNS Vital Signs (CNSVS) within 6 months post-injury (median=0.6 month). Participants with TBI were matched to 33 healthy controls based on age, sex, and handedness to compare their cognitive functioning on the CNSVS battery. Results: Children and adolescents with moderate-to-severe TBI had significantly lower scores and large effect sizes on Reaction Time, Complex Attention, and Cognitive Flexibility domains, as well as medium effect sizes on two Visual Memory test scores and one Psychomotor Speed test score. A significantly higher percentage of participants with TBI had cognitive impairment on Reaction Time domain score compared to the control group. Finally, CNSVS domain scores correctly categorized 76% of participants as either group with TBI or control group. Conclusions: CNSVS may be a useful tool for screening cognitive abilities in children and adolescents who are early in their recovery from a moderate-to-severe TBI, particularly when a rapid screening evaluation can help guide management, interventions, and track recovery. (JINS, 2017, 23, 304–313)


Brain Injury ◽  
2003 ◽  
Vol 17 (5) ◽  
pp. 413-426 ◽  
Author(s):  
Stefania Sarno ◽  
Lutz-Peter Erasmus ◽  
Berthold Lipp ◽  
Wolfgang Schlaegel

2021 ◽  
Vol 15 ◽  
Author(s):  
Lola Kaukas ◽  
Justin Krieg ◽  
Lyndsey Collins-Praino ◽  
Frances Corrigan

In adult pre-clinical models, traumatic brain injury (TBI) has been shown to prime microglia, exaggerating the central inflammatory response to an acute immune challenge, worsening depressive-like behavior, and enhancing cognitive deficits. Whether this phenomenon exists following mTBI during adolescence has yet to be explored, with age at injury potentially altering the inflammatory response. Furthermore, to date, studies have predominantly examined hippocampal-dependent learning domains, although pre-frontal cortex-driven functions, including attention, motivation, and impulsivity, are significantly affected by both adolescent TBI and acute inflammatory stimuli. As such, the current study examined the effects of a single acute peripheral dose of LPS (0.33 mg/kg) given in adulthood following mTBI in mid-adolescence in male Sprague–Dawley rats on performance in the 5-choice serial reaction time task (5-CSRTT). Only previously injured animals given LPS showed an increase in omissions and reward collection latency on the 5-CSRTT, with no effect noted in sham animals given LPS. This is suggestive of impaired motivation and a prolonged central inflammatory response to LPS administration in these animals. Indeed, morphological analysis of myeloid cells within the pre-frontal cortex, via IBA1 immunohistochemistry, found that injured animals administered LPS had an increase in complexity in IBA1+ve cells, an effect that was seen to a lesser extent in sham animals. These findings suggest that there may be ongoing alterations in the effects of acute inflammatory stimuli that are driven, in part by increased reactivity of microglial cells.


2017 ◽  
Vol 34 (8) ◽  
pp. 1539-1545 ◽  
Author(s):  
Kyle B. Womack ◽  
Christopher Paliotta ◽  
Jeremy F. Strain ◽  
Johnson S. Ho ◽  
Yosef Skolnick ◽  
...  

2017 ◽  
Vol 24 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Wesley R. Cole ◽  
Emma Gregory ◽  
Jacques P. Arrieux ◽  
F. Jay Haran

AbstractObjectives:The Automated Neuropsychological Assessment Metrics 4 TBI-MIL (ANAM4) is a computerized cognitive test often used in post-concussion assessments with U.S. service members (SMs). However, existing evidence remains mixed regarding ANAM4’s ability to identify cognitive issues following mild traumatic brain injury (mTBI). Studies typically examine ANAM4 using standardized scores and/ or comparisons to a baseline. A more fine-grained approach involves examining inconsistency within an individual’s performance (i.e., intraindividual variability).Methods:Data from 237 healthy control SMs and 105 SMs within seven days of mTBI who took the ANAM4 were included in analyses. Using each individual’s raw scores on a simple reaction time (RT) subtest (SRT1) that is repeated at the end of the battery (SRT2), we calculated mean raw RT and the intraindividual standard deviation (ISD) of trial-by-trial RT. Analyses investigated differences between groups in mean RT, RT variability (i.e., ISD), and change in ISD from SRT1 and SRT2.Results:Using regression residuals to control for demographic variables, analysis of variance, and pairwise comparisons revealed the control group had faster mean RT and smaller ISD compared to the mTBI group. Furthermore, the mTBI group had a significant increase in ISD from SRT1 to SRT2, with effect sizes exceeding the minimum practical effect for comparisons of ISD in SRT2 and change in ISD from SRT1 to SRT2.Conclusions:While inconsistencies in performance are often viewed as test error, the results suggest intraindividual cognitive variability may be more sensitive than traditional metrics in detecting changes in cognitive function after mTBI. Additionally, the findings highlight the utility of the ANAM4’s repeating a RT subtest at two points in the same session for exploring within-subject differences in performance variability. (JINS, 2018,24, 156–162)


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