P300 event-related potential decrements in well-functioning university students with mild head injury

Neurophysiological signatures of mild traumatic brain injury in the acute and subacute phase

BACKGROUND

Mild traumatic brain injury (mTBI) affects 48 million people annually, with up to 30% experiencing long-term complaints such as fatigue, blurred vision, and poor concentration. Assessing neurophysiological features related to visual attention and outcome measures aids in understanding clinical symptoms and prognostication.

METHODS

We recorded EEG and eye movements in mTBI patients during a computerized task performed in the acute (< 24 h, TBI-A) and subacute phase (4-6 weeks thereafter). We estimated the posterior dominant rhythm, reaction times (RTs), fixation duration, and event-related potentials (ERPs). Clinical outcome measures were assessed using the Head Injury Symptom Checklist (HISC) and the Extended Glasgow Outcome Scale (GOSE) at 6 months post-injury. Similar analyses were performed in an age-matched control group (measured once). Linear mixed effect modeling was used to examine group differences and temporal changes within the mTBI group.

RESULTS

Twenty-nine patients were included in the acute phase, 30 in the subacute phase, and 19 controls. RTs and fixation duration were longer in mTBI patients compared to controls (p < 0.05), but not between TBI-A and TBI-S (p < 0.05). The frequency of the posterior dominant rhythm was significantly slower in TBI-A (0.6 Hz, p < 0.05) than TBI-S. ERP mean amplitude was significantly lower in mTBI patients than in controls. Neurophysiological features did not significantly relate to clinical outcome measures.

CONCLUSION

mTBI patients demonstrate impaired processing speed and stimulus evaluation compared to controls, persisting up to 6 weeks after injury. Neurophysiological features in mTBI can assist in determining the extent and temporal progression of recovery.

Comprehensive behavioral and physiologic assessment of peripheral and central auditory function in individuals with mild traumatic brain injury

Auditory complaints are frequently reported by individuals with mild traumatic brain injury (mTBI) yet remain difficult to detect in the absence of clinically significant hearing loss. This highlights a growing need to identify sensitive indices of auditory-related mTBI pathophysiology beyond pure-tone thresholds for improved hearing healthcare diagnosis and treatment. Given the heterogeneity of mTBI etiology and the diverse peripheral and central processes required for normal auditory function, the present study sought to determine the audiologic assessments sensitive to mTBI pathophysiology at the group level using a well-rounded test battery of both peripheral and central auditory system function. This test battery included pure-tone detection thresholds, word understanding in quiet, sentence understanding in noise, distortion product otoacoustic emissions (DPOAEs), middle-ear muscle reflexes (MEMRs), and auditory evoked potentials (AEPs), including auditory brainstem responses (ABRs), middle latency responses (MLRs), and late latency responses (LLRs). Each participant also received magnetic resonance imaging (MRI). Compared to the control group, we found that individuals with mTBI had reduced DPOAE amplitudes that revealed a compound effect of age, elevated MEMR thresholds for an ipsilateral broadband noise elicitor, longer ABR Wave I latencies for click and 4 kHz tone burst elicitors, longer ABR Wave III latencies for 4 kHz tone bursts, larger MLR Na and Nb amplitudes, smaller MLR Pb amplitudes, longer MLR Pa latencies, and smaller LLR N1 amplitudes for older individuals with mTBI. Further, mTBI individuals with combined hearing difficulty and noise sensitivity had a greater number of deficits on thalamic and cortical AEP measures compared to those with only one/no self-reported auditory symptoms. This finding was corroborated with MRI, which revealed significant structural differences in the auditory cortical areas of mTBI participants who reported combined hearing difficulty and noise sensitivity, including an enlargement of left transverse temporal gyrus (TTG) and bilateral planum polare (PP). These findings highlight the need for continued investigations toward identifying individualized audiologic assessments and treatments that are sensitive to mTBI pathophysiology.

EEG reveals deficits in sensory gating and cognitive processing in asymptomatic adults with a history of concussion

OBJECTIVE

Individuals with a concussion history tend to perform worse on dual-tasks compared controls but the underlying neural mechanisms contributing to these deficits are not understood. This study used event-related potentials (ERPs) to investigate sensory gating and cognitive processing in athletes with and without a history of concussion while they performed a challenging dual-task.

METHODS

We recorded sensory (P50, N100) and cognitive (P300) ERPs in 30 athletes (18 no previous concussion; 12 history of concussion) while they simultaneously performed an auditory oddball task and a working memory task that progressively increased in difficulty.

RESULTS

The concussion group had reduced auditory performance as workload increased compared to the no-concussion group. Sensory gating and cognitive processing were reduced in the concussion group indicating problems with filtering relevant from irrelevant information and appropriately allocating resources. Sensory gating (N100) was positively correlated with cognitive processing (P300) at the hardest workload in the no-concussion group but negatively correlated in the concussion group.

CONCLUSION

Concussions result in long-term problems in behavioral performance, which may be due to poorer sensory gating that impacts cognitive processing.

SIGNIFICANCE

Problems effectively gating sensory information may influence the availability or allocation of attention at the cognitive stage in those with a concussion.

Mild Traumatic Brain Injury: Long-Term Follow-Up of Central Auditory Processing After Auditory Training

Background and Objectives

Even a mild traumatic brain injury can impair the peripheral and central parts of the auditory system. The objective was to compare the performance of individuals with mild traumatic brain injury in behavioral and electrophysiological central auditory tests before and after formal auditory training, and to verify the stability of these measures over time.

Subjects and Methods

Ten 16- to 64-year-old individuals diagnosed with mild traumatic brain injury underwent behavioral and electrophysiological assessment of the central auditory processing in three stages: before, right after, and six months after formal auditory training.

Results

Statistically significant differences were observed for speech by white noise, synthetic sentence identification, sound localization, verbal sequential memory, and duration pattern tests in the assessment six months after formal auditory training. No statistically significant differences were observed between the P300 assessments, either with tone-burst or speech stimulus, in N2 and P3 latencies, and P3 amplitude.

Conclusions

The results of the behavioral assessment of the central auditory processing improved, while the P300 remained stable with both stimuli, six months after completing formal auditory training. This demonstrates that auditory training has long-term benefits for people with mild traumatic brain injury.

Auditory evoked brain potentials as markers of chronic effects of mild traumatic brain injury in mid-life

OBJECTIVE

Auditory event-related potential (ERP) correlates of pre-dementia in late-life may also be sensitive to chronic effects of mild traumatic brain injury (mTBI) in mid-life. In addition to mTBI history, other clinical factors may also influence ERP measures of brain function. This study's objective was to evaluate the relationship between mTBI history, auditory ERP metrics, and common comorbidities.

METHODS

ERPs elicited during an auditory target detection task, psychological symptoms, and hearing sensitivity were collected in 152 combat-exposed veterans and service members, as part of a prospective observational cohort study. Participants, with an average age of 43.6 years, were grouped according to positive (n = 110) or negative (n = 42) mTBI history. Positive histories were subcategorized into repetitive mTBI (3 + ) (n = 40) or non-repetitive (1-2) (n = 70).

RESULTS

Positive history of mTBI was associated with reduced N200 amplitude to targets and novel distractors. In participants with repetitive mTBI compared to non-repetitive and no mTBI, P50 was larger in response to nontargets and N100 was smaller in response to nontargets and targets. Changes in N200 were mediated by depression and anxiety symptoms and hearing loss, with no evidence of a supplementary direct mTBI pathway.

CONCLUSIONS

Auditory brain function differed between the positive and negative mTBI groups, especially for repetitive injury, which implicated more basic, early auditory processing than did any mTBI exposure. Symptoms of internalizing psychopathology (depression and anxiety) and hearing loss are implicated in mTBI's diminished brain responses to behaviorally relevant and novel stimuli.

SIGNIFICANCE

A mid-life neurologic vulnerability conferred by mTBI, particularly repetitive mTBI, may be detectable using auditory brain potentials, and so auditory ERPs are a target for study of dementia risk in this population.

Prospective Exploration of Cognitive-Communication Changes With Woodcock-Johnson IV Before and After Sport-Related Concussion

Purpose The purpose of this study was to evaluate changes in cognitive-communication performance using Woodcock-Johnson IV Tests (WJIV) from pre-injury baseline to post sport-related concussion. It was hypothesized that individual subtest performances would decrease postinjury in symptomatic individuals. Method This prospective longitudinal observational nested cohort study of collegiate athletes assessed cognitive-communicative performance at preseason baseline and postinjury. Three hundred and forty-two male and female undergraduates at high risk for sport-related concussion participated in preseason assessments, and 18 individuals met criteria post injury. WJIV subtest domains included Word Finding, Speeded Reading Comprehension, Auditory Comprehension, Verbal Working Memory, Story Retell, and Visual Processing (letter and number). The power calculation was not met, and therefore data were conservatively analyzed with descriptive statistics and a planned subgroup analysis based on symptomatology. Results Individual changes from baseline to postinjury were evaluated using differences in standard score performance. For symptomatic individuals, mean negative decreases in performance were found for Retrieval Fluency, Sentence Reading Fluency, Pattern Matchings, and all cluster scores postinjury. Individual performance declines also included decreases in story retell, verbal working memory, and visual processing. Conclusions This study identified within-subject WJIV performance decline in communication domains post sport-related concussion and reinforces that cognitive-communication dysfunction should be considered in mild traumatic brain injury. Key cognitive-communication areas included speeded naming, reading, and verbal memory, though oral comprehension was not sensitive to change. Future clinical research across diverse populations is needed to expand these preliminary findings.

N2b Reflects the Cognitive Changes in Executive Functioning After Concussion: A Scoping Review

Objectives: The N2b is an event-related potential (ERP) component thought to index higher-order executive function. While the impact of concussion on executive functioning is frequently discussed in the literature, limited research has been done on the role of N2b in evaluating executive functioning in patients with concussion. The aims of this review are to consolidate an understanding of the cognitive functions reflected by the N2b and to account for discrepancies in literature findings regarding the N2b and concussion.

Methods: A scoping review was conducted on studies that used the N2b to measure cognitive functioning in healthy control populations, as well as in people with concussions.

Results: Sixty-six articles that met inclusion criteria demonstrated that the N2b effectively represents stimulus-response conflict management, response selection, and response inhibition. However, the 19 included articles investigating head injury (using terms such as concussion, mild head injury, and mild traumatic brain injury) found widely varied results: some studies found the amplitude of the N2b to be increased in the concussion group, while others found it to be decreased or unchanged.

Conclusion: Based on the available evidence, differences in the amplitude of the N2b have been linked to response selection, conflict, and inhibition deficits in concussion. However, due to large variations in methodology across studies, findings about the directionality of this effect remain inconclusive. The results of this review suggest that future research should be conducted with greater standardization and consistency.

Effects of Signal Type and Noise Background on Auditory Evoked Potential N1, P2, and P3 Measurements in Blast-Exposed Veterans

OBJECTIVES

Veterans who have been exposed to high-intensity blast waves frequently report persistent auditory difficulties such as problems with speech-in-noise (SIN) understanding, even when hearing sensitivity remains normal. However, these subjective reports have proven challenging to corroborate objectively. Here, we sought to determine whether use of complex stimuli and challenging signal contrasts in auditory evoked potential (AEP) paradigms rather than traditional use of simple stimuli and easy signal contrasts improved the ability of these measures to (1) distinguish between blast-exposed Veterans with auditory complaints and neurologically normal control participants, and (2) predict behavioral measures of SIN perception.

DESIGN

A total of 33 adults (aged 19-56 years) took part in this study, including 17 Veterans exposed to high-intensity blast waves within the past 10 years and 16 neurologically normal control participants matched for age and hearing status with the Veteran participants. All participants completed the following test measures: (1) a questionnaire probing perceived hearing abilities; (2) behavioral measures of SIN understanding including the BKB-SIN, the AzBio presented in 0 and +5 dB signal to noise ratios (SNRs), and a word-level consonant-vowel-consonant test presented at +5 dB SNR; and (3) electrophysiological tasks involving oddball paradigms in response to simple tones (500 Hz standard, 1000 Hz deviant) and complex speech syllables (/ba/ standard, /da/ deviant) presented in quiet and in four-talker speech babble at a SNR of +5 dB.

RESULTS

Blast-exposed Veterans reported significantly greater auditory difficulties compared to control participants. Behavioral performance on tests of SIN perception was generally, but not significantly, poorer among the groups. Latencies of P3 responses to tone signals were significantly longer among blast-exposed participants compared to control participants regardless of background condition, though responses to speech signals were similar across groups. For cortical AEPs, no significant interactions were found between group membership and either stimulus type or background. P3 amplitudes measured in response to signals in background babble accounted for 30.9% of the variance in subjective auditory reports. Behavioral SIN performance was best predicted by a combination of N1 and P2 responses to signals in quiet which accounted for 69.6% and 57.4% of the variance on the AzBio at 0 dB SNR and the BKB-SIN, respectively.

CONCLUSIONS

Although blast-exposed participants reported far more auditory difficulties compared to controls, use of complex stimuli and challenging signal contrasts in cortical and cognitive AEP measures failed to reveal larger group differences than responses to simple stimuli and easy signal contrasts. Despite this, only P3 responses to signals presented in background babble were predictive of subjective auditory complaints. In contrast, cortical N1 and P2 responses were predictive of behavioral SIN performance but not subjective auditory complaints, and use of challenging background babble generally did not improve performance predictions. These results suggest that challenging stimulus protocols are more likely to tap into perceived auditory deficits, but may not be beneficial for predicting performance on clinical measures of SIN understanding. Finally, these results should be interpreted with caution since blast-exposed participants did not perform significantly poorer on tests of SIN perception.

A Review of the Role of Auditory Evoked Potentials in Mild Traumatic Brain Injury Assessment

Around 75% to 90% of people who experience a traumatic brain injury (TBI) are classified as having a mild TBI (mTBI). The term mTBI is synonymous with concussion or mild head injury (MHI) and is characterized by symptoms of headache, nausea, dizziness, and blurred vision. Problems in cognitive abilities such as deficits in memory, processing speed, executive functioning, and attention are also considered symptoms of mTBI. Since these symptoms are subtle in nature and may not appear immediately following the injury, mTBI is often undetected on conventional neuropsychological tests. Current neuroimaging techniques may not be sensitive enough in identifying the array of microscopic neuroanatomical and subtle neurophysiological changes following mTBI. To this end, electrophysiological tests, such as auditory evoked potentials (AEPs), can be used as sensitive tools in tracking physiological changes underlying physical and cognitive symptoms associated with mTBI. The purpose of this review article is to examine the body of literature describing the application of AEPs in the assessment of mTBI and to explore various parameters of AEPs which may hold diagnostic value in predicting positive rehabilitative outcomes for people with mTBI.

Impaired auditory processing and neural representation of speech in noise among symptomatic post-concussion adults

Background: The purpose of the study was to examine auditory event-related potential (AERP) evidence of changes in earlier and later stages of auditory processing in individuals with long-term post-concussion problems compared to healthy controls, with a secondary aim of comparing AERPs by functional auditory behavioral outcomes. Methods: P1-N1-P2 complex and P300 components recorded to speech in quiet and background noise conditions were completed in individuals with ongoing post-concussion symptoms following mTBI and healthy controls. AERPs were also examined between sub-groups with normal or impaired auditory processing by behavioral tests. Results: Group differences were present for later stages of auditory processing (P300). Earlier components did not significantly differ by group overall but were more affected by noise in the mTBI group. P2 amplitude in noise differed between mTBI sub-groups with normal or impaired auditory processing. Conclusion: AERPs revealed differences between healthy controls and those with chronic post-concussion symptoms following mTBI at a later stage of auditory processing (P300). Neural processing at the earlier stage (P1-N1-P2) was more affected by noise in the mTBI group. Preliminary evidence suggested that it may be only the proportion of individuals with functional evidence of central auditory dysfunction with changes in AERPs at earlier stages of processing.

The use of event-related potential (P300) and neuropsychological testing to evaluate cognitive impairment in mild traumatic brain injury patients

Background:

The aim of the study is to compare the amplitude and latency of the P300 event-related potential (ERP) component between a control group and patients after mild traumatic brain injury (mTBI) during 1–7 days (short duration) and 2–3 months (long duration), and to compare the outcome of neuropsychological tests between the long duration postinjury and control study groups.

Materials and Methods:

We studied responses to auditory stimulation in two main and one subgroups, namely the control healthy group (19 patients, both ERP and neuropsychology test done), the mTBI 1 group (17 patients, only ERP done within 7 days after injury), and the mTBI 2 subgroup (the 17 mTBI 1 patients in whom a repeated ERP together with neuropsychological testing was done at 2–3 months postinjury). Auditory evoked responses were studied with two different stimuli (standard and target stimuli), where the P300 amplitude and latency were recorded from three midline sites and results were compared between the groups, as were the neuropsychological test results.

Results:

There was a significant prolongation of the target P300 latency values shown by the MBI 1 group measured at the central electrode when compared to the control group, which was also seen when the mTBI 1 and mTBI 2 groups were compared. The results of the P300 amplitude values measured at the frontal electrode showed the control group to have higher readings during the presentation of standard tones when compared to the mTBI 1 group. The mTBI 2 group performed better on some neuropsychological tests.

Conclusion:

The latency of P300 was significantly prolonged in early mTBI patients who improved over time, and the neuropsychological testing on mTBI 2 patients showed them to be comparable to the control group. The study indicates that ERP should be used as an additional modality of investigation in mTBI patients.

The Application of the International Classification of Functioning, Disability and Health to Functional Auditory Consequences of Mild Traumatic Brain Injury

This article reviews the auditory consequences of mild traumatic brain injury (mTBI) within the context of the International Classification of Functioning, Disability and Health (ICF). Because of growing awareness of mTBI as a public health concern and the diverse and heterogeneous nature of the individual consequences, it is important to provide audiologists and other health care providers with a better understanding of potential implications in the assessment of levels of function and disability for individual interdisciplinary remediation planning. In consideration of body structures and function, the mechanisms of injury that may result in peripheral or central auditory dysfunction in mTBI are reviewed, along with a broader scope of effects of injury to the brain. The activity limitations and participation restrictions that may affect assessment and management in the context of an individual's personal factors and their environment are considered. Finally, a review of management strategies for mTBI from an audiological perspective as part of a multidisciplinary team is included.

Do self-reported concussions have cumulative or enduring effects on drivers' anticipation of traffic hazards?

AIM

To investigate the cumulative effect of multiple self-reported concussions and the enduring effect of concussion on drivers' hazard perception ability. It was hypothesized: (1) that individuals reporting multiple previous concussions would be slower to anticipate traffic hazards than individuals reporting either one previous concussion or none; and (2) that individuals reporting a concussion within the past 3 months would be slower to anticipate traffic hazards than individuals reporting either an earlier concussion or no prior concussion.

METHOD

Two hundred and eighty-two predominantly young drivers (nconcussed = 68, Mage = 21.57 years, SDage = 6.99 years, 66% female) completed a validated hazard perception test (HPT) and measures of emotional, cognitive, health and driving status.

RESULTS

A one-way analysis of variance showed that there was no significant effect of concussion number on HPT response times. Similarly, pairwise comparisons showed no significant differences between the HPT response times of individuals reporting a concussion within the previous 3 months, individuals reporting an earlier concussion and the never concussed group.

CONCLUSION

The findings suggest that previous concussions do not adversely affect young drivers' ability to anticipate traffic hazards; however, due to reliance on self-reports of concussion history, further prospective longitudinal research is needed.

FMRI hypoactivation during verbal learning and memory in former high school football players with multiple concussions

Multiple concussions before the age of 18 may be associated with late-life memory deficits. This study examined neural activation associated with verbal encoding and memory retrieval in former athletes ages 40-65 who received at least two concussions (median = 3; range = 2-15) playing high school football and a group of former high school football players with no reported history of concussions matched on age, education, and pre-morbid IQ. Functional magnetic resonance imaging data collected during a modified verbal paired associates paradigm indicated that those with concussive histories had hypoactivation in left hemispheric language regions, including the inferior/middle frontal gyri and angular gyrus compared with controls. However, concussive history was not associated with worse memory functioning on neuropsychological tests or worse behavioral performance during the paradigm, suggesting that multiple early-life concussions may be associated with subtle changes in the verbal encoding system that limits one from accessing higher-order semantic networks, but this difference does not translate into measurable cognitive performance deficits.

Traumatic brain injury detection using electrophysiological methods

Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI). This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: (1) Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. (2) ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are non-disclosing. (3) The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including non-linear dynamical analysis, complexity measures, analysis of causal interactions, graph theory, and information dynamics. (4) Reports of high specificity in qEEG evaluations of TBI must be interpreted with care. High specificities have been reported in carefully constructed clinical studies in which healthy controls were compared against a carefully selected TBI population. The published literature indicates, however, that similar abnormalities in qEEG measures are observed in other neuropsychiatric disorders. While it may be possible to distinguish a clinical patient from a healthy control participant with this technology, these measures are unlikely to discriminate between, for example, major depressive disorder, bipolar disorder, or TBI. The specificities observed in these clinical studies may well be lost in real world clinical practice. (5) The absence of specificity does not preclude clinical utility. The possibility of use as a longitudinal measure of treatment response remains. However, efficacy as a longitudinal clinical measure does require acceptable test-retest reliability. To date, very few test-retest reliability studies have been published with qEEG data obtained from TBI patients or from healthy controls. This is a particular concern because high variability is a known characteristic of the injured central nervous system.

ERP correlates of malingered executive dysfunction

Assessment of malingering has become an integral part of many neuropsychological evaluations, particularly in forensic settings. However, traditional malingering measures are known to be vulnerable to both manipulation and coaching. Consequently, recent research has attempted to identify physiological indices of cognitive functioning that are less susceptible to overt manipulation. While prior studies have explored the validity of physiological assessment of memory deficits, this study evaluates the effectiveness of a physiological measure of executive functioning. This study used EEG recording in conjunction with a three-stimulus oddball design to compare neural responses in simulated malingerers feigning cognitive deficits associated with traumatic brain injury (TBI) and controls. Specifically, the study explored the efficacy of an event-related potential (ERP) known as P3a, which is believed to be an index of frontal lobe executive processes, specifically the attentional orienting response. The results of this study demonstrated that simulated malingerers did not produce a P3a response that was significantly different from control participants. Furthermore, the P3a in simulated malingerers did not demonstrate any of the properties reported in prior studies with TBI patients. Not only were malingerers unable to produce a significant change in their basic orienting response, but the very process of attempting to employ additional strategies to appear impaired produced other physiological markers of deception. Therefore, the P3a component appeared to be unaffected by an individual's motivation or overt performance, which suggests that it may have potential for development as a physiological measure for differentiating between malingerers and those with genuine TBI.

Lack of long-term fMRI differences after multiple sports-related concussions

INTRODUCTION

Mild traumatic brain injury (mTBI) or concussion has been acutely associated with several cognitive symptoms, including deficits in response inhibition, working memory and motor performance. The pervasiveness of these cognitive symptoms has been more controversial. The effects of multiple concussions on neuropsychological functioning and brain activation following at least 6-months post-mTBI were examined.

METHODS

Twenty right-handed male athletes with a history of at least two concussions and 20 age/pre-morbid IQ/athletic-experience matched controls underwent neuropsychological assessment and fMRI scanning where they performed versions of a colour-word Stroop interference task, an operation-span working memory task and a finger-tapping task.

RESULTS

The Attention index score on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was lower for the concussion group, but only at liberal statistical threshold. Total RBANS score approached statistical significance. Reaction time during neurobehavioural tasks was similar across groups, but accuracy was reduced in the concussed group on the working memory task. Despite expected activation patterns within each group, there were no group differences in neural activation on any functional tasks using either whole-brain or ROI-specific analyses at liberal statistical thresholds.

CONCLUSION

There were minimal differences between the two closely matched groups. Results point to the relative plasticity of younger adults' cognitive abilities following concussion.

Long-term effects of mild traumatic brain injury on cognitive performance

Although a proportion of individuals report chronic cognitive difficulties after mild traumatic brain injury (mTBI), results from behavioral testing have been inconsistent. In fact, the variability inherent to the mTBI population may be masking subtle cognitive deficits. We hypothesized that this variability could be reduced by accounting for post-concussion syndrome (PCS) in the sample. Thirty-six participants with mTBI (>1 year post-injury) and 36 non-head injured controls performed information processing speed (Paced Visual Serial Addition Task, PVSAT) and working memory (n-Back) tasks. Both groups were split by PCS diagnosis (4 groups, all n = 18), with categorization of controls based on symptom report. Participants with mTBI and persistent PCS had significantly greater error rates on both the n-Back and PVSAT, at every difficulty level except 0-Back (used as a test of performance validity). There was no difference between any of the other groups. Therefore, a cognitive deficit can be observed in mTBI participants, even 1 year after injury. Correlations between cognitive performance and symptoms were only observed for mTBI participants, with worse performance correlating with lower sleep quality, in addition to a medium effect size association (falling short of statistical significance) with higher PCS symptoms, post-traumatic stress disorder (PTSD), and anxiety. These results suggest that the reduction in cognitive performance is not due to greater symptom report itself, but is associated to some extent with the initial injury. Furthermore, the results validate the utility of our participant grouping, and demonstrate its potential to reduce the variability observed in previous studies.

Reduced N400 semantic priming effects in adult survivors of paediatric and adolescent traumatic brain injury

The immediate and long-term neural correlates of linguistic processing deficits reported following paediatric and adolescent traumatic brain injury (TBI) are poorly understood. Therefore, the current research investigated event-related potentials (ERPs) elicited during a semantic picture-word priming experiment in two groups of highly functioning individuals matched for various demographic variables and behavioural language performance. Participants in the TBI group had a recorded history of paediatric or adolescent TBI involving injury mechanisms associated with diffuse white matter pathology, while participants in the control group never sustained any insult to the brain. A comparison of N400 Mean Amplitudes elicited during three experimental conditions with varying semantic relatedness between the prime and target stimuli (congruent, semantically related, unrelated) revealed a significantly smaller N400 response in the unrelated condition in the TBI group, indicating residual linguistic processing deviations when processing demands required the quick detection of a between-category (unrelated) violation of semantic expectancy.

Effects of complexity of visual distracters on attention and information processing speed reflected in auditory p300

OBJECTIVES

The primary aim of this study was to assess the effects of continuous, visual distracters that change systematically in complexity on P300 responses generated by an auditory oddball paradigm. In addition, the type of attention given to the visual distracter was explored. It was hypothesized that P300 amplitudes would be smallest, latencies longest, and changes in scalp distribution greatest when the most complex visual distracter requiring active attention was used versus the simple visual distracter requiring passive attention.

DESIGN

Auditory-evoked P300s were collected in a sample of 10 healthy adults (mean age = 19.90 years) using a two-toned oddball paradigm (1500 Hz "frequent" tone, probability of occurrence: 0.88, and 2000 Hz "rare" target tone, probability of occurrence: 0.12). The oddball paradigm was paired with three different visual distracters, increasing in complexity. The simplest was a black fixation cross on a white background that participants were asked to view passively as they performed the auditory task of counting the target stimulus. The second visual distracter increased in complexity by introducing color and motion, as tan and medium pink squares were alternated on the screen. Participants had to actively attend to the alternating squares by looking for a hidden text message while simultaneously counting the target auditory stimulus. The third visual distracter condition increased complexity again by introducing not only color and motion, but also biological relevance as participants viewed a mouth producing nonsense syllables. Participants had to actively attend to the moving mouth to determine what it was producing while simultaneously counting the rare auditory stimulus.

RESULTS

The two more complex visual distracters that required active attention caused reductions in auditory-evoked P300 amplitudes relative to those recorded while the participants passively viewed a fixation cross. P300 amplitudes were similar whether the two more complex visual distracters (squares versus mouth) were used. P300 latencies and scalp distribution were not influenced by complexity of, or type of attention to, the visual distracter. Regardless of distracter condition, P300 amplitude was significantly smaller and P300 latency was significantly shorter at frontal sites when compared with central and parietal sites.

CONCLUSIONS

Findings indicate that endogenous attentional resource allocation abilities can be effectively monitored through the addition of a complex, visually distracting task to a "classic" auditory P300 paradigm. Biological relevance of the distracting task does not seem to have an effect on the event-related potentials measured in this study, suggesting other aspects, such as whether or not a stimulus contains color or motion, may determine the efficiency of the distracter. Last, by increasing the complexity of, and amount of attention to, a visual distracter while evoking P300s using auditory stimuli, the cognitive load for the normal, healthy listener seems to be increased and the response amplitude subsequently reduced. Evoking P300s under similar conditions from disordered populations with subtle cognitive deficits (e.g., mild traumatic brain injury) may allow for increased diagnostic specificity and sensitivity over that found for P300s to classic, auditory oddball paradigms alone.

Avaliação eletrofisiológica da audição em indivíduos após traumatismo cranioencefálico

OBJETIVO: caracterizar o potencial evocado auditivo de tronco encefálico e de longa latência em pacientes pós traumatismo cranioencefálico, comparando-os com indivíduos normais. MÉTODO: estudo clínico transversal realizado com 20 indivíduos audiologicamente normais divididos em dois grupos pareados por idade e sexo: a) 10 indivíduos que sofreram traumatismo cranioencefálico (grupo pesquisa); b) 10 indivíduos sem qualquer tipo de alteração neurológica (grupo controle). Foram submetidos à avaliação audiológica básica, ao potencial evocado auditivo de tronco encefálico e ao potencial evocado auditivo de longa latência (P300). RESULTADOS: observou-se no potencial evocado auditivo de tronco encefálico, latências absolutas das ondas I, III e V e intervalo interpico I-III mais prolongados no grupo pesquisa do que no grupo controle, sendo estatisticamente significante para as latências absolutas das ondas I e III à direita e para a onda III e intervalo interpico I-III à esquerda. A amplitude das ondas I, III e V na orelha direita e das ondas III e V na orelha esquerda foram maiores no grupo controle. Em relação ao P300, o grupo pesquisa apresentou maior latência e menor amplitude em ambas as orelhas, sem significância estatística, quando comparado ao grupo controle. CONCLUSÃO: indivíduos que sofreram traumatismo cranioencefálico apresentam alterações no potencial evocado auditivo de tronco encefálico e não apresentam diferenças significantes no potencial evocado auditivo de longa latência (P300) quando comparados a indivíduos sem lesões cerebrais.

Mild head injury and sympathetic arousal: investigating relationships with decision-making and neuropsychological performance in university students

SUMMARY

The purpose of this study was to examine the relationships between neuropsychological performance, physiological arousal and decision-making in university students who have or have not reported a history of mild head injury (MHI).

METHODS

Forty-four students, 18 (41%) reporting a history of MHI, performed a design fluency task and the Iowa Gambling Task (IGT) while electrodermal activity (EDA) was recorded.

RESULTS

General cognitive ability and overall choice outcomes did not differ between groups. However, self-reported MHI severity predicted decision-making performance such that the greater the neural indices of trauma, the more disadvantageous the choices made by participants. As expected, both groups exhibited similar base levels of autonomic arousal and physiological responses to reward and punishment outcomes; however, those reporting MHI produced significantly lower levels of EDA during the anticipatory stages of decision-making.

CONCLUSIONS

Overall, these findings encourage the acceptance of head injury as being on a continuum of brain injury severity, as MHI can emulate neurophysiological and neuropsychological features of more traumatic cases and may be impacting mechanisms which sustain adaptive social decision-making.

P3 event-related potentials and childhood maltreatment in successful and unsuccessful psychopaths

Although P3 event-related potential abnormalities have been found in psychopathic individuals, it is unknown whether successful (uncaught) psychopaths and unsuccessful (caught) psychopaths show similar deficits. In this study, P3 amplitude and latency were assessed from a community sample of 121 male adults using an auditory three-stimulus oddball task. Psychopathy was assessed using the Psychopathy Checklist-Revised (Hare, 2003) while childhood physical maltreatment was assessed using the Conflict Tactic Scale (Straus, 1979). Results revealed that compared to normal controls, unsuccessful psychopaths showed reduced parietal P3 amplitudes to target stimuli and reported experienced more physical abuse in childhood. In contrast, successful psychopaths exhibited larger parietal P3 amplitude and shorter frontal P3 latency to irrelevant nontarget stimuli than unsuccessful psychopaths. This is the first report of electrophysiological processing differences between successful and unsuccessful psychopaths, possibly indicating neurocognitive and psychosocial distinctions between these two subtypes of psychopathy.

Long-term cognitive and emotional consequences of mild traumatic brain injury

BACKGROUND

The objective of this study was to investigate long-term cognitive and emotional sequelae of mild traumatic brain injury (mTBI), as previous research has remained inconclusive with respect to their prevalence and extent.

METHOD

Thirty-three individuals who had sustained mTBI on average 6 years prior to the study and 33 healthy control subjects were matched according to age, gender and education. Structural brain damage at time of testing was excluded by magnetic resonance imaging (MRI). A comprehensive neuropsychological test battery was conducted to assess learning, recall, working memory, attention and executive function. Psychiatric symptoms were assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Beck Depression Inventory (BDI). Possible negative response bias was ruled out by implementing the Word Memory Test (WMT).

RESULTS

The mTBI individuals had significant impairments in all cognitive domains compared to the healthy control subjects. Effect sizes of cognitive deficits were medium to large, and could not be accounted for by self-perceived deficits, depression, compensation claims or negative response bias. BDI scores were significantly higher in the patient group, and three patients fulfilled DSM-IV criteria for a mild episode of major depression.

CONCLUSIONS

Primarily, well-recovered individuals who had sustained a minor trauma more than half a decade ago continue to have long-term cognitive and emotional sequelae relevant for everyday social and professional life. mTBI may lead to a lasting disruption of neurofunctional circuits not detectable by standard structural MRI and needs to be taken seriously in clinical and forensic evaluations.

Electrophysiological assessments of cognition and sensory processing in TBI: applications for diagnosis, prognosis and rehabilitation

Traumatic brain injuries are often associated with damage to sensory and cognitive processing pathways. Because evoked potentials (EPs) and event-related potentials (ERPs) are generated by neuronal activity, they are useful for assessing the integrity of neural processing capabilities in patients with traumatic brain injury (TBI). This review of somatosensory, auditory and visual ERPs in assessments of TBI patients is provided with the hope that it will be of interest to clinicians and researchers who conduct or interpret electrophysiological evaluations of this population. Because this article reviews ERP studies conducted in three different sensory modalities, involving patients with a wide range of TBI severity ratings and circumstances, it is difficult to provide a coherent summary of findings. However, some general trends emerge that give rise to the following observations and recommendations: 1) bilateral absence of somatosensory evoked potentials (SEPs) is often associated with poor clinical prognosis and outcome; 2) the presence of normal ERPs does not guarantee favorable outcome; 3) ERPs evoked by a variety of sensory stimuli should be used to evaluate TBI patients, especially those with severe injuries; 4) time since onset of injury should be taken into account when conducting ERP evaluations of TBI patients or interpreting results; 5) because sensory deficits (e.g., vision impairment or hearing loss) affect ERP results, tests of peripheral sensory integrity should be conducted in conjunction with ERP recordings; and 6) patients' state of consciousness, physical and cognitive abilities to respond and follow directions should be considered when conducting or interpreting ERP evaluations.

Decreased prefrontal cortex activity in mild traumatic brain injury during performance of an auditory oddball task

Up to one-third of patients with mild traumatic brain injury (TBI) demonstrate persistent cognitive deficits in the 'executive' function domain. Mild TBI patients have shown prefrontal cortex activity deficits during the performance of executive tasks requiring active information maintenance and manipulation. However, it is unclear whether these deficits are related to the executive processes themselves, or to the degree of mental effort. To determine whether prefrontal deficits also would be found during less effortful forms of executive ability, fMRI images were obtained on 31 mild TBI patients and 31 control participants during three-stimulus auditory oddball task performance. Although patients and controls had similar topographical patterns of brain activity, region-of-interest analysis revealed significantly decreased activity in right dorsolateral prefrontal cortex for mild TBI patients during target stimulus detection. Between-group analyses found evidence for potential compensatory brain activity during target detection and default-mode network dysfunction only during the detection of novel stimuli.

Electrophysiological abnormalities in well functioning multiple concussed athletes

OBJECTIVE

The present study was aimed at characterizing the short- and long-term effects of multiple concussions using an electrophysiological approach.

METHOD

Participants for this study were recruited from college football teams. They included athletes who never sustained concussions compared to two groups of asymptomatic multiple concussed athletes, one that sustained their last concussion within the year and the other more than 2 years prior to testing. All participants were submitted to an auditory three-tone Oddball paradigm while event-related potentials (ERP) were recorded.

RESULTS

Results from ERP recordings reveal significantly reduced P3a and P3b amplitudes in the recent concussed group in the three-tone task compared to control athletes. In contrast, athletes who sustained their concussions more than 2 years prior to testing had equivalent P3a and P3b amplitude to that of controls.

CONCLUSION

These findings suggest that, despite functioning normally in their daily lives, concussed athletes still show subtle neuronal changes in information processing. Thus, the persistence of sub-clinical abnormalities on ERP components despite normal overt functioning may indicate sub-optimal compensation in multiple concussed athletes and leave them vulnerable to subsequent concussions.

Reduction of functional brain connectivity in mild traumatic brain injury during working memory

Working memory deficits are present in patients with mild traumatic brain injury (MTBI). Functional connectivity of different brain regions is required for adequate working memory. Brain injury is associated with disrupted connectivity due to microscopic axonal damage. In this investigation, we sought to investigate functional brain connectivity during working memory in MTBI patients. A sample of 30 MTBI patients and 30 age-, education-, and gender-matched normal controls were studied. Working memory was assessed with the Sternberg's verbal and visuo-spatial working memory tasks. Electro-encephalography (EEG) was recorded from 128 channels while subjects performed working memory tasks and during eyes closed resting condition. EEG coherence was computed in theta; lower and upper alpha; and lower and upper beta frequency bands during the encoding, retention, and retrieval stages of working memory as well as during eyes-closed rest. We found that the MTBI patients had impaired verbal and visuo-spatial working memory. The different stages of working memory were associated with poor intrahemispheric coherence in long-range (fronto-parietal) and mid-range (fronto-temporal and temporo-parietal) regions as well as poor interhemispheric coherence in the frontal and temporal regions in the MTBI patients. The deficit in coherence was present in theta, alpha, and beta frequency bands. However, the MTBI and the control group had comparable coherence values in intra- and inter-hemispheric regions during eyes closed rest. We suggest that the inter- and intra-hemispheric functional connectivity is impaired in MTBI during working memory performance.

Return to work following traumatic brain injury: Trends and challenges

PURPOSE

The aim of this paper is to present the current knowledge regarding return to work (RTW) following traumatic brain injury (TBI).

METHOD

Based on a Medline search, the authors reviewed the current TBI rehabilitation literature regarding (a) predictive factors for successful RTW, and (b) current concepts in rehabilitative strategies for successful RTW.

RESULTS

The functional consequences to the victim of traumatic brain injury (TBI) can be severe. Intensive rehabilitative efforts typically emphasize the early phase and address mainly the accompanying functional deficits in the realm of basic activities of daily living and mobility. An otherwise successful medical rehabilitation may end unsuccessfully because of the failure to return to work, with profound consequences to the individual and family, both economic and psychosocial. Even mild TBI may cause lasting problems in tasks calling for sustained attention. There appears to be a complex interaction between pre-morbid characteristics, injury factors, post injury impairments, personal and environmental factors in TBI patients, which influences RTW outcomes in ways that make prediction difficult. Injury severity and lack of self-awareness appear to be the most significant indicators of failure to RTW. Several medical, psychosocial and rehabilitative therapies are currently being implemented in rehabilitation settings which improve the chances of returning to work.

CONCLUSION

Accurate prediction of whether a particular TBI patient will successfully return to work is not feasible, with RTW rates in the 12 - 70% range. A significant proportion of TBI patients, including those who are severely injured, are able to return to productive employment if sufficient and appropriate effort is invested. A comprehensive approach - medical and psychosocial - eventually entailing adequate vocational rehabilitation with supported employment can improve outcomes.

Neurophysiological assessment prior to and following sports-related concussion during childhood: a case study

The goal of this study was to measure the neurophysiological and cognitive functions of a sport-concussed child and to longitudinally assess the recovery pattern. An 8-year-old girl suffered a concussion while playing soccer. Visual evoked potentials (VEPs) were recorded at 7 weeks pre-injury and 24 h, 7, 22, 32 and 55 weeks post-injury. A neuropsychological assessment performed at 24 h post-injury reveals cognitive impairments, mainly attentional, that resolved within 22 weeks. VEPs and spectral analyses confirm the presence of cortical impairments up to 1 year post-injury, especially affecting vigilance and attention, which were reflected in school performance.