Dual task performance after severe diffuse traumatic brain injury or vascular prefrontal damage

The ability to perform two tasks simultaneously is a key function of the central executive of working memory (Baddeley, 1986). This study addressed dual-task performance after diffuse very severe traumatic brain injury (TBI) (mean coma duration = 21 days, mean post-traumatic amnesia = 70 days) or prefrontal damage due to a ruptured aneurysm of the anterior communicating artery (AACA). Mean time since injury was 8 and 16 months in the TBI and the AACA group respectively. A simple visual reaction time and random number generation were used as single and dual tasks. Randomization was self-paced, to control for individual differences in speed. Both patient groups had greater reaction time decrements than controls under the dual-task condition, suggesting a divided attention deficit. In addition, patients with AACA performed significantly poorer in random generation. These results suggest that patients with AACA and with severe TBI suffer from an impairment of the central executive system.     

Dual Task Performance after Severe Diffuse Traumatic Brain Injury or Vascular Prefrontal Damage

The ability to perform two tasks simultaneously is a key function of the central executive of working memory (Baddeley, 1986). This study addressed dual-task performance after diffuse very severe traumatic brain injury (TBI) (mean coma duration = 21 days, mean post-traumatic amnesia = 70 days) or prefrontal damage due to a ruptured aneurysm of the anterior communicating artery (AACA). Mean time since injury was 8 and 16 months in the TBI and the AACA group respectively. A simple visual reaction time and random number generation were used as single and dual tasks. Randomization was self-paced, to control for individual differences in speed. Both patient groups had greater reaction time decrements than controls under the dual-task condition, suggesting a divided attention deficit. In addition, patients with AACA performed significantly poorer in random generation. These results suggest that patients with AACA and with severe TBI suffer from an impairment of the central executive system.     

Executive function oculomotor tasks in girls with ADHD

OBJECTIVE: To assess executive function in girls with attention-deficit/hyperactivity disorder (ADHD) using oculomotor tasks as possible trait markers for neurobiological studies. METHOD: Thirty-two girls aged 6 to 13 years with DSM-IV ADHD and 20 age-matched, normal control girls were tested on a variety of oculomotor tasks requiring attention, working memory, and response inhibition, which included smooth pursuit, delayed response, and go-no go tasks. RESULTS: Girls with ADHD performed the delayed response task correctly on 32% of trials as measured by number of memory-guided saccades, in contrast to 62% of trials for control subjects (p = .0009). Patients made twice as many commission errors to no go stimuli (p = .0001) and 3 times as many intrusion errors (saccades in the absence of go or no go stimuli; p = .004) during the go-no go task compared with controls. Smooth pursuit performance was statistically equivalent across subject groups. Repeated testing in a subgroup of 15 patients revealed substantial practice effects on go-no go performance. CONCLUSIONS: The data confirm that girls with ADHD exhibit impairments in executive function, as has been reported in boys, implying a similar pathophysiology of ADHD in both sexes. However, practice effects may limit the utility of the oculomotor go-no go task for some neurobiological studies.     

Increased attentional demands impair contralesional space awareness following stroke

Rate and severity of contralesional loss of awareness following stroke is highly variable across patients and assessment methods. We studied whether the degree of impairment for contralesional space awareness depends on the quantity of attentional resources that are available for task performance. A new computer-based paradigm was used to assess visual extinction and single-target detection rate in four right hemisphere stroke patients. In the single-task condition, they had to report only the position of the target(s) (“right”, “left”, or “both” sides). In the dual-task conditions, patients also performed a second task, visual or auditory, that recruited additional attentional resources. The same tasks were also performed by healthy controls and by a left hemisphere stroke patient. Patients’ performance was apparently unimpaired in the single-task condition. In contrast, dramatic failures to report the left-sided target emerged in the dual-task conditions. The performance of control participants was unaffected by the dual-task manipulation, whereas the left stroke patient showed the opposite pattern (i.e., unawareness of right-sided targets). Severe contralesional space unawareness under dual-task conditions reveals that visuospatial deficits can dramatically emerge when attentional resources are consumed by a concurrent task. Apparently spared contralesional awareness may simply reflect the availability of resources that are just sufficient to perform a single-task. This finding has important implications for the assessment of contralesional space awareness following stroke, because everyday life activities are often more demanding than most of the tests adopted for diagnosing space awareness disorders.     

Reduced processing resource availability in schizotypal personality disorder: evidence from a dual-task CPT study

Performance on a dual-task information processing task was investigated in 23 schizotypal personality disorder patients (SPD), 29 patients with other noncluster A personality disorders (OPD) and 8 non-psychiatric healthy controls (NC). All participants were assessed using a computer-based visual continuous performance test (CPT) and an auditory CPT individually, and administered again simultaneously in a dual-task condition. The SPD group showed a greater increase in the number of errors of omission than the OPD group or normal controls on the CPT tasks in the dual-task conditions. Performance operating characteristics indicated that the SPD patients did not allocate their attention in a manner different from the healthy controls, suggesting that poorer performance was due to resource limitations in the dual task condition and not strategic failures. These results are similar to previous studies of patients with schizophrenia, where performance deficits on information processing tests have been shown to be related to resource limitations more than failures in effective allocation of attention.     

Evidence of interhemispheric transmission in laterality effects

The study was aimed at testing various models that can explain visual lateral asymmetries due to hemispheric specialization. In Experiments 1-3 the subjects had to perform a lateralized "go-no go" discrimination of words (primary task) either alone or in association with secondary tasks that interfered with the processing of the left hemisphere (ordered tapping) or the right hemisphere (finger flexion). In Experiment 4 the primary task was one of lateralized "go-no go" discrimination of faces while the secondary tasks were again those of ordered tapping and finger flexion. The results showed that in the case of word discrimination the advantage in speed of response in favour of the right visual field/left hemisphere (RVF/LH), which was observed for the primary task alone, did not change when the secondary task was added. This held true irrespective of whether the secondary task loaded the left or right hemisphere. The advantage for the left visual field/right hemisphere (LVF/RH) observed for face discrimination alone, disappeared when the secondary task interfered with the processing of the right hemisphere and did not change when the secondary task concerned the left hemisphere. It was concluded that each hemisphere is able to elaborate in parallel the incoming information, but, in normal conditions, interhemispheric transmission is responsible for the lateral asymmetries in perception (conditional interhemispheric transmission model).     

Working memory after severe traumatic brain injury.

The aim of the present study was to assess the functioning of the different subsystems of working memory after severe traumatic brain injury (TBI). A total of 30 patients with severe chronic TBI and 28 controls received a comprehensive assessment of working memory addressing the phonological loop (forward and backward digit span; word length and phonological similarity effects), the visuospatial sketchpad (forward and backward visual spans), and the central executive (tasks requiring simultaneous storage and processing of information, dual-task processing, working memory updating). Results showed that there were only marginal group differences regarding the functioning of the two slave systems, whereas patients with severe TBI performed significantly poorer than controls on most central executive tasks, particularly on those requiring a high level of controlled processing. These results suggest that severe TBI is associated with an impairment of executive aspects of working memory. The anatomic substrate of this impairment remains to be elucidated. It might be related to a defective activation of a distributed network, including the dorsolateral prefrontal cortex.     

Dual-task interference during initial learning of a new motor task results from competition for the same brain areas

Cerebral patterns of activity elicited by dual-task performance throughout the learning of a complex bimanual coordination pattern were addressed. Subjects (N = 12) were trained on the coordination pattern and scanned using fMRI at early (PRE) and late (POST) learning stages. During scanning, the coordination pattern was performed either as a single task or in concurrence with a simultaneous visual search task (i.e. dual task). Kinematics data revealed a significant performance improvement as a result of learning. In PRE-scanning, the dual-task condition induced deterioration of motor performance, relative to the single-task condition. Activity in lateral frontal and parietal regions involved in both visual search and motor coordination tasks (i.e. ‘overlapping’ regions) was reduced when the tasks were performed simultaneously. In POST-scanning, kinematics performance was equivalent under single- and dual-task conditions, suggesting automaticity of the coordination pattern. Furthermore, overlap between regions involved in visual search and motor tasks was reduced, and dual-task performance was no longer associated with reduction of frontal and parietal activity. Our results suggest that behavioral interference between a complex motor coordination task and a simple simultaneous visual search task occurs when both tasks recruit overlapping regions in the frontal and parietal cortices. This may provide a neural basis for dissipation of dual-task interference following extensive motor practice, which is a traditional behavioral marker of motor automaticity.     

Willed action in schizophrenia

This study examined stimulus-driven and willed action in schizophrenic patients and healthy controls using an easy finger-tap task and a more demanding peg-placement task under unimanual, bimanual and dual-task conditions. Peg-placement externally cued by a metronome was also examined, as were practice effects. Patients with marked negative symptoms placed fewer pegs unimanually with and without practice and benefited most from metronome-cueing. Under dual-task conditions, when the participants placed pegs while concurrently finger-tapping, finger-tapping slowed down relative to unimanual scores in patients more than controls. Number of pegs placed also dropped off in controls and the patients with fewer negative symptoms. However, patients with more severe negative symptoms placed just as many pegs, and sometimes more, in the dual-task, compared to the unimanual, condition. These patients appeared to be using their finger-tapping just like an 'external' pacing-stimulus for peg-placement, thus rendering their peg-placement more stimulus-driven than willed. In contrast, patients with fewer negative symptoms and controls tried to self-generate maximal performance on both finger-tapping and peg-placement, with deleterious effects on both tasks. That the patients with marked negative symptoms performed best when their actions were more stimulus-driven than willed strengthens the case that negative schizophrenic symptoms reflect a disorder of willed action.     

Interhemispheric transfer of colour and shape information in the presence and absence of the corpus callosum

Two split-brained subjects, one (L.B.) with full forebrain commissurotomy and one (R.B.) with callosal agenesis, and a group of twenty neurologically intact subjects were tested in three discrimination tasks: a go-no go task, a two-choice task, and a three-choice task. The discriminations were based on colour in Experiment 1, and on shape in Experiment 2. The stimuli were presented in one or other visual field, and the subjects responded with the fingers of one or other hand, allowing the differences in reaction time between crossed and uncrossed responses (CUD) to be calculated. For the normal subjects the CUD tended to diminish with the complexity of the tasks, suggesting that both hemispheres were increasingly involved. Unlike R.B. and the normal controls, who made virtually no errors, L.B. had increasing difficulty as task complexity increased. He was better able to transfer information from the right to the left hemisphere than vice versa, but an analysis of his accuracy under the crossed conditions showed that the amount transferred was always well under one bit. This confirms previous evidence that L.B. has very limited subcortical transfer of either colour or shape.     

The pattern of attentional deficits in Parkinson's disease

BackgroundCognitive impairment without dementia is frequent in Parkinson's disease. It often presents as a dysexecutive syndrome with deficient attentional resource allocation. The nature of attention deficits in Parkinson's disease has rarely been investigated with robust, theory-based tasks. The main objective of the present study was to investigate attention disorders in Parkinson's disease patients by applying a paradigm based on a model of attention. We also sought to identify the main demographic and clinical characteristics associated with attention deficits in Parkinson's disease.MethodsEighty non-demented Parkinson's disease patients and 60 healthy controls participated in the study. Attention was assessed in a computer-controlled reaction time paradigm. The test session comprised a simple reaction time task and four choice reaction time tasks: a go/no-go task, a one-dimension, focused-attention task, a two-dimension, divided-attention task and an alternating task. Performance was assessed by composite measures: (i) cognitive reaction time, corresponding to the difference between the simple reaction time and the choice reaction time in the given condition, and (ii) reaction time variability, corresponding to the sum of the coefficients of variance of the reaction times. Accuracy was also considered.ResultsApart from an overall slowing and greater reaction time variability, Parkinson's disease patients were only significantly impaired in the alternating condition. This set-shifting impairment was associated with their performance in the go/no-go and divided-attention conditions.ConclusionOur systematic assessment of the different attentional subcomponents revealed that mental flexibility is particularly impaired in non-demented Parkinson's disease patients.     

Interactions between divided attention and working-memory load in patients with severe traumatic brain injury

The aim of this study was to assess the relationships between divided-attention deficits and working-memory limitations after severe traumatic brain injury (TBI). Severe TBI patients (n = 43) and controls were given a n-back task of three different load levels, which was performed as a single and a dual task. Patients demonstrated, as expected, a difficulty in dual-task processing and an increased susceptibility to high working-memory load, but dual-task performance and working-memory load did not interact as expected. These results are in accordance with recent findings suggesting that dual-task performance and other working-memory functions represent dissociable although interrelated abilities.     

Localization of executive functions in dual-task performance with fMRI

We report a study that investigated the neuroanatomical correlates of executive functions in dual-task performance with functional magnetic resonance imaging. Participants performed an auditory and a visual three-choice reaction task either separately as single tasks or concurrently as dual tasks. In the dual-task condition, two stimuli were presented in rapid succession to ensure interference between the component tasks (psychological refractory period). The behavioral data showed considerable performance decrements in the dual-task compared to the single-task condition. Dual-task-related activation was detected with two different neuroimaging methods. First, we determined dual-task-related activation according to the method of cognitive subtraction. For that purpose, activation in the dual-task was compared directly with activation in the single-task conditions. This analysis revealed that cortical areas along the inferior frontal sulcus (IFS), the middle frontal gyrus (MFG), and the intraparietal sulcus (IPS) are involved in dual-task performance. The results of the subtraction method were validated with the method of parametric manipulation. For this purpose, a second dual-task condition was introduced, where the difficulty of the dual-task coordination was increased compared with the first dual-task condition. As expected, behavioral dual-task performance decreased with increased dual-task difficulty. Furthermore, the increased dual-task difficulty led to an increase of activation in those cortical regions that proved to be dual-task related with the subtraction method, that is, the IFS, the MFG, and the IPS. These results support the conclusion that dorsolateral prefrontal and superior parietal cortices are involved in the coordination of concurrent and interfering task processing.     

Object versus spatial visual mental imagery in patients with schizophrenia

OBJECTIVE: Recent research has revealed a larger impairment of object perceptual discrimination than of spatial perceptual discrimination in patients with schizophrenia. It has been suggested that mental imagery may share processing systems with perception. We investigated whether patients with schizophrenia would show greater impairment regarding object imagery than spatial imagery. METHODS: Forty-four patients with schizophrenia and 20 healthy control subjects were tested on a task of object visual mental imagery and on a task of spatial visual mental imagery. Both tasks included a condition in which no imagery was needed for adequate performance, but which was in other respects identical to the imagery condition. This allowed us to adjust for nonspecific differences in individual performance. RESULTS: The results revealed a significant difference between patients and controls on the object imagery task (F(1,63) = 11.8, p = 0.001) but not on the spatial imagery task (F(1,63) = 0.14, p = 0.71). To test for a differential effect, we conducted a 2 (patients v. controls) small ha, Cyrillic 2 (object task v. spatial task) analysis of variance. The interaction term was statistically significant (F(1,62) = 5.2, p = 0.026). CONCLUSIONS: Our findings suggest a differential dysfunction of systems mediating object and spatial visual mental imagery in schizophrenia.     

Interference between postural control and mental task performance in patients with vestibular disorder and healthy controls

OBJECTIVES: To determine whether interference between postural control and mental task performance in patients with balance system impairment and healthy subjects is due to general capacity limitations, motor control interference, competition for spatial processing resources, or a combination of these. METHOD: Postural stability was assessed in 48 patients with vestibular disorder and 24 healthy controls while they were standing with eyes closed on (a) a stable and (b) a moving platform. Mental task performance was measured by accuracy and reaction time on mental tasks, comprising high and low load, spatial and non-spatial tasks. Interference between balancing and performing mental tasks was assessed by comparing baseline (single task) levels of sway and mental task performance with levels while concurrently balancing and carrying out mental tasks. RESULTS: As the balancing task increased in difficulty, reaction times on both low load mental tasks grew progressively longer and accuracy on both high load tasks declined in patients and controls. Postural sway was essentially unaffected by mental activity in patients and controls. CONCLUSIONS: It is unlikely that dual task interference between balancing and mental activity is due to competition for spatial processing resources, as levels of interference were similar in patients with vestibular disorder and healthy controls, and were also similar for spatial and non-spatial tasks. Moreover, the finding that accuracy declined on the high load tasks when balancing cannot be attributed to motor control interference, as no motor control processing is involved in maintaining accuracy of responses. Therefore, interference between mental activity and postural control can be attributed principally to general capacity limitations, and is hence proportional to the attentional demands of both tasks.     

Cerebrospinal fluid IgG profiles and multiple sclerosis in Japan

Simple reaction, single choice reaction, and paired choice reaction tasks were examined in 11 patients with Parkinson's disease (PD) and 12 controls. Subjects were given an auditory go/no-go signal in the single choice reaction task, and paired visual and auditory go/no-go signals in the paired choice reaction task. The response following the auditory go/no-go signal was analyzed. The reaction and movement times were prolonged in patients with PD. Differences between simple and choice reaction times in PD patients did not differ from those in control subjects. The difference in movement time between simple and paired choice reaction tasks in PD patients was longer than that in control subjects, although the difference between simple and single choice reaction tasks was not significant between PD and control subjects. Sequential choices of visual and auditory stimulation may disturb the motor activity in PD patients.     

Working memory in Down syndrome: is there a dual task deficit?

Background Recent studies have shown that individuals with Down syndrome (DS) are poorer than controls in performing verbal and visuospatial dual tasks. The present study aims at better investigating the dual task deficit in working memory in individuals with DS. Method Forty‐five individuals with DS and 45 typically developing children matched for verbal mental age completed a series of verbal and visuospatial working memory tasks, involving conditions that either required the combination of two tasks in the same modality (verbal or visual) or of cross‐modality pairs of tasks. Results and conclusions Two distinct deficits were found in individuals with DS: impairment in verbal tasks and further impairment in all dual task conditions. The results confirm the hypothesis of a central executive impairment in individuals with DS.     

Postural sway changes during static standing with concurrent task in children with traumatic brain injury

Objectives:To investigate the effects of concurrent tasks (motor and cognitive) on postural control performance in children with traumatic brain injury (TBI) compared to typically developing (TD) control subjects.Methods:Sixteen children with TBI (aged 11.63±1.89 years) and 22 TD controls (aged 11.41±2.24 years) participated in this case-control study. This study was conducted between May 2016 and March 2017. Each child performed static standing under 3 different conditions: single, concurrent motor, and concurrent cognitive task. Postural control performance measure includes sway area, anterior-posterior (AP) sway velocity, medio-lateral (ML) sway velocity, AP sway distance and ML sway distance as measured using the APDM® Mobility Lab (Oregon, Portland). A repeated-measure analysis of variance was used to analyse the data.Results:We found that children with TBI showed significantly more deterioration in postural control performance than TD children (p<0.05). Both concurrent tasks (motor and cognitive) significantly decreased postural control performance in both groups with more pronounced changes in children with TBI than that of the TD controls.Conclusion:The results demonstrated that, performing concurrent tasks (motor and cognitive) during upright standing resulted in deterioration of postural control performance. The existence of cognitive and balance impairment in children with TBI will possibly cause concurrent tasks to be more complex and demands greater attention compared to single task.

Traumatic brain injury is frequently referred to as a ‘silent epidemic’, with the majority of society being unaware on the magnitude a TBI can cause on an individual’s function.1 It remains a leading cause of death and long-term disability in children worldwide with approximately 3 million children experiencing TBI annually.2 Consequently, TBI may lead to neurological impairment which contributes to long-term disability among this group of children.With the cognitive and behavioral deficit, individuals with TBI are faced with a long-term functional disability including postural control instability.3,4 Postural control refers to the act of maintaining, achieving or restoring the line of gravity or centre of mass (COM) within the base of support (BOS).5 It is a complex collaboration of sensory, motor, and central nervous system. Disruption of any components such as visual, vestibular sensory inputs, muscle weakness and loss of proprioception will result in postural control instability. This impairment could seriously interfere with the child’s level of independence and lead to increased risk of falls.5The maintenance and control of posture and balance, whether in static or dynamic conditions, are essential requirements for daily activity. Postural control requires a lot of cognitive resources.6 The more challenging postural task required more cognitive processing in order to sustain the position. Children with TBI have both cognitive and information processing deficits that impact attention and functional abilities.7,8 In daily life, children encounter situations in which they must perform cognitive and motor tasks simultaneously, such as responding to verbal instructions or manipulating objects while sitting or standing. These situations may be complex and challenging for children with TBI as they present with both attention and information processing deficit. Using dual-task methodology, it can examine the effect of adding a concurrent task during a motor task. Trials using dual-task paradigm are commonly used in a clinical setting to measure automatic control of movement indirectly. It is crucial to understand the effects of a concurrent task on postural control performance while designing a dual-task paradigm intervention program in this population. The dual-task intervention during postural control could be more challenging and may improve the postural stability better as compared to single task intervention.Since attention is a limited resource, it may become overloaded by competing for attention demands and subsequently might lead to reduced performance in one or all tasks.9 Children with TBI may need more attention during postural control and as a result might be more vulnerable to falls while doing concurrent task. A recent study among healthy children and youth 5-18 years old showed concurrent cognitive task resulted in decreased postural stability.10 Comparing the effects of different surface (firm vs. foam surface) on postural stability during concurrent cognitive task reveals that the foam surface caused greater interference in postural stability.10 A normative database was created as a result of this study, which may benefit future investigations of post-concussion performances with potential to assess post-concussion severity. In addition, it also focuses on assessing both motor and cognitive domains simultaneously. This study also reports information regarding the effect of cognitive task on postural stability in healthy children & youth. The examined effect of concurrent cognitive and motor task conditions on postural control in children with TBI is limited. Therefore, the objective of the present study was to investigate the postural control performance under concurrent tasks in children with TBI and TD controls. We hypothesized that both concurrent motor and cognitive tasks would cause significant postural control deterioration compared to single task condition.     

Sensorimotor disinhibition in Parkinson's disease: effects of levodopa.

It has been known for some time that patients with Parkinson's disease (PD) have difficulty executing simultaneous motor acts, yet the pathophysiology underlying this impairment remains uncertain. We examined the possibility that these dual-task deficits stem from defective sensorimotor mechanisms producing interference between the motor programs underlying the two tasks. Patients with PD and normal control subjects were tested on their ability to maintain steady-state force with one hand while performing a force-reaction time task with the other hand. Although performance was worse on the dual-task than on the single-task condition for both subject groups, only the patients with PD demonstrated significant interference between the two tasks. The interference across tasks improved in 87% of the patients with PD when tested after treatment with carbidopa/levodopa (Sinemet). These findings support the contention that, in patients with PD, disturbances in the execution of simultaneous motor performance may be due to sensorimotor disinhibition.     

Dual task performance in HIV-1 infection

Fifty HIV-infected individuals and 20 uninfected controls participated in an investigation of dual task performance in HIV-1 infection. Participants first engaged in a simple auditory reaction time (RT) task followed by a visual choice RT task (single task condition), and then they simultaneously engaged in both tasks (dual task condition). Under single task conditions, the HIV+ participants did not significantly differ from controls on either simple or choice RT (though a trend was evident on single task choice RT). In contrast, under dual task conditions the HIV+ group's performance decrement, relative to controls, was significantly greater on both simple and choice RT. This dual task decrement was also significantly associated with slower performance on the interference condition of the Stroop. Patients with AIDS tended to have greater dual task decrements than did the pre-AIDS group, though this fell short of statistical significance. These results suggest that HIV-1 infection leads to deficits in divided attention and the simultaneous processing of competing stimuli, deficits which have been linked to disruption of the anterior attentional system.