Executive dysfunction in a case of transoral-frontal self-inflicted gunshot injury

Neuropsychological and Linguistic Outcomes after Gunshot Injury to Cerebellum: A Case Report

Craniocerebral gunshot injuries (CGIs) are highly fatal and mostly seen in the military settings. CGIs to the posterior cortical regions and cerebellum in civilian population are uncommon. Cerebellum once thought to be mediating the motor and vestibular functions is increasingly seen as an important structure for human cognition and affect. We present a case of a 53-year-old police inspector who sustained a gunshot injury in the suboccipital region with resulting damage to predominantly left cerebellum and right occipital lobe. Patient presented with complaints of neck pain, reduced clarity of speech, and mild forgetfulness for day-to-day affairs after 7 months of injury. A comprehensive neuropsychological assessment revealed impairments in motor speed, processing speed, sustained attention, executive functions (verbal fluency, working memory), and encoding component of memory functions. The speech–language assessment revealed mild dysarthria and mild word finding difficulties. His profile with mild to moderate deficits in neuropsychological and speech language functioning was partly congruent with the cerebellar cognitive affective syndrome or Schmahmann’s syndrome. The spontaneous recovery and extent of damage to cerebellum may explain the milder form of the syndrome. The case highlights the need to routinely screen for cognitive-affective disturbances in patients with traumatic lesions to cerebellum.

Distinct performance profiles on the Brixton test in frontotemporal dementia

The Brixton Spatial Anticipation Test is a well-established test of executive function that evaluates the capacity to abstract, follow, and switch rules. There has been remarkably little systematic analysis of Brixton test performance in the prototypical neurodegenerative disorder of the frontal lobes: behavioural variant frontotemporal dementia (bvFTD) or evaluation of the test's ability to distinguish frontal from temporal lobe degenerative disease. We carried out a quantitative and qualitative analysis of Brixton performance in 76 patients with bvFTD and 34 with semantic dementia (SD) associated with temporal lobe degeneration. The groups were matched for demographic variables and illness duration. The bvFTD group performed significantly more poorly (U = 348, p < .0001, r = .58), 53% of patients scoring in the poor-impaired range compared with 6% of SD patients. Whereas bvFTD patients showed problems in rule acquisition and switching, SD patients did not, despite their impaired conceptual knowledge. Error analysis revealed more frequent perseverative errors in bvFTD, particularly responses unconnected to the stimulus, as well as random responses. Stimulus-bound errors were rare. Within the bvFTD group, there was variation in performance profile, which could not be explained by demographic, neurological, or genetic factors. The findings demonstrate sensitivity and specificity of the Brixton test in identifying frontal lobe degenerative disease and highlight the clinical value of qualitative analysis of test performance. From a theoretical perspective, the findings provide evidence that semantic knowledge and the capacity to acquire rules are dissociable. Moreover, they exemplify the separable functional contributions to executive performance.

Response suppression, strategy application, and working memory in the prediction of academic performance and classroom misbehavior: A neuropsychological approach

BACKGROUND

Neurological illness can produce a disorganization of behavior, including verbal disinhibition, despite apparent preserved intelligence. Neuropsychological tests of such behavioral control mechanisms may predict real-world performance of healthy people, such as success or misbehavior in educational contexts.

METHOD

In two separate studies, we examined how the Hayling Test of verbal response suppression predicts grades and classroom misbehavior.

RESULTS

Verbal suppression errors and spontaneous strategy use were significant predictors of undergraduate grades. Using a modified version of the Hayling Test designed to reduce strategic responding with high school students (mean age 16), higher grades were predicted by shorter response suppression latencies and better working memory scores, and classroom misbehavior was predicted by lower working memory scores.

CONCLUSION

Verbal response suppression and spontaneous strategy use, both closely linked to disorganized behavior in neuropsychological patients, predict academic achievement but seem unrelated to classroom misbehavior, which is associated with weakness in working memory.

Attempted suicide leading to acquired brain injury: a scoping review

Objective: Conduct a scoping review of literature surrounding acquired brain injury (ABI) sustained secondary to a suicide attempt to establish the current body of research on injury outcomes and rehabilitative needs for this population.Methods: A systematic search of the literature was conducted. Searches were conducted using terms relating to this injury etiology and search results with original or secondary data on individuals with an ABI were included for review.Results: Thirty-two articles were reviewed. Limited data characterizing this population exists in the literature. Findings indicate that this population have generally poorer injury outcomes compared with ABI sustained through other means. Rehabilitative needs are rarely addressed, but limited commentary suggests that extensive pre-morbid conditions, severity of injuries and psychosocial support needs of this population present implications for rehabilitative supports.Conclusion: There is a relative dearth of research examining ABI sustained secondary to a suicide attempt. Collated findings suggest these individuals are rarely recognized in the literature as a distinct ABI population with rehabilitative needs specific to this etiology. Future research should aim to address the gaps identified in the literature, including characterizing the population, establishing pre-morbid conditions and developing tailored rehabilitative support to address complex needs.