The influence of different error estimates in the detection of post-operative cognitive dysfunction using reliable change indices with correction for practice effects.

The reliable change index (RCI) expresses change relative to its associated error, and is useful in the identification of post-operative cognitive dysfunction (POCD). This paper examines four common RCIs that each account for error in different ways. Three rules incorporate a constant correction for practice effects and are contrasted with the standard RCI that had no correction for practice. These rules are applied to 160 patients undergoing coronary artery bypass graft (CABG) surgery who completed neuropsychological assessments preoperatively and 1 week post-operatively using error and reliability data from a comparable healthy non-surgical control group. The rules all identify POCD in a similar proportion of patients, but the use of the within subject standard deviation, expressing the effects of random error, as an error estimate is a theoretically appropriate denominator when a constant error correction, removing the effects of systematic error, is deducted from the numerator in a RCI.     

Goal-directed selective attention and response competition monitoring: evidence from unilateral parietal and anterior cingulate lesions

Competing visual stimuli lead to slower responses to targets. This response competition must be resolved before correct responses are executed. Neuroimaging suggests that response competition monitoring may be subserved by an integrated neural network including the anterior cingulate cortex (ACC). In this study, 1 patient with a parietal lesion (Patient J.S.) and 1 with an ACC lesion (Patient G.M.) were presented with 2 flanker tasks; 1 required verbal identification of color targets, and the other required an opposite response to targets (e.g., see red and say "green"); a control group was also tested. For controls, perceptually incongruent flankers interfered with the ability to inhibit prepotent responses to targets. Patient J.S. performed in a similar manner, even when flankers appeared in the neglected field. Patient G.M. demonstrated reduced interference effects for contralesional flankers. Results are discussed in terms of goal-directed selective attention and response competition monitoring.     

The gap effect and express saccades in the auditory modality

Latencies of eye movements to peripheral targets are reduced when there is a short delay (typically 200 ms) between the offset of a central visual fixation point and the target onset. This has been termed the gap effect. In addition, some subjects, usually with practice, exhibit a separate population of very short latency saccades, called express saccades. Both these phenomena have been attributed to disengagement of visual attention when the fixation point is extinguished. A competing theory of the gap effect attributes it to disengagement of oculomotor fixation during the temporal gap. It is known that auditory targets are effective in eliciting saccadic eye movements, and also that covert attention operates in the auditory modality. If the gap effect and express saccades are due to disengagement of spatial attention, both should persist in the auditory modality. However, fixation of gaze is largely under visual control. If the gap effect results from disengagement of fixation, then at least a reduced effect should be seen in the auditory modality. Human subjects performed the gap task and a control task in the dark, using auditory fixation points and saccadic targets, on five successive days. Despite this practice, express saccades were not observed. There was a reliable gap effect, but the reduction in saccadic latency was only 17 ms, compared with 32 ms for the same subjects in the visual modality. This suggests that about half the gap effect is due to disengagement of visual fixation. The remainder was not due to non-specific warning effects and could be attributed to offset of the auditory fixation stimulus. Received: 1 March 1996 / Accepted: 11 July 1997     

An investigation of visuospatial memory impairment in children with attention deficit hyperactivity disorder (ADHD), combined type

BACKGROUND: Memory impairment is not considered a core cognitive feature of attention deficit hyperactivity disorder, combined type (ADHD-CT), although it is associated with impairments in attentional and executive functions. This study investigates visuospatial memory impairment, in particular encoding and retrieval aspects, in children with ADHD-CT who are stimulant-medication naive and medicated with stimulant medication. METHOD: A cross-sectional study of visuospatial memory in 6- to 12-year-old children with stimulant-medication-naive ADHD-CT (n = 62) and medicated ADHD-CT (n = 58) compared to an age- and gender-matched healthy control group (n = 39) was completed. RESULTS: Both medication-naive and medicated ADHD-CT groups demonstrated subtle yet significant impairment in visuospatial memory. The memory impairment was delay-independent, which, along with other factors, suggest dysfunction of the encoding rather than retrieval phase of visuospatial memory. CONCLUSIONS: Careful study of large ADHD-CT samples does detect deficits in a visuospatial memory task, but these reflect attentional deficits rather than being specifically due to dysfunction of the medial temporal lobe explicit memory system. Children with ADHD-CT may benefit from cognitive and behavioural strategies focused on improving encoding of relevant information rather than retrieval strategies.     

Impairment of olfactory identification in obsessive-compulsive disorder

BACKGROUND: Olfactory identification ability has been associated with processing in the orbitofrontal cortex (OFC), an area that has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD). Although olfactory sensitivity is normal in patients with OCD, no study has investigated olfactory identification in this disorder. METHODS: A group of 20 subjects with OCD and 23 age- and education-matched controls performed a standardized test of olfactory identification. They also performed computerized tests of spatial memory span, spatial working memory and spatial recognition memory that have been shown previously to be sensitive to cognitive deficits in patients with OCD. RESULTS: Performance on the olfactory identification task, spatial recognition task and spatial span task was significantly worse in the OCD group than controls. CONCLUSIONS: While impairment in spatial cognition is consistent with previous studies of OCD, its significance for brain-behaviour models of OCD is unclear. However, the finding of abnormal olfactory identification in patients with OCD is consistent with the hypothesis that there is a disruption to processing at the level of the OFC in the disorder.     

Long-term plasticity in adult somatosensory cortex: functional reorganization after surgical removal of an arteriovenous malformation

The temporal scale of neuroplasticity following acute alterations in brain structure due to neurosurgical intervention is still under debate. We conducted a longitudinal study with the objective of investigating the postoperative changes in a patient who underwent cerebrovascular surgery and who subsequently lost proprioception in the fingers of her right hand. The results show increased activation in contralesional somatosensory areas, additional recruitment of premotor and posterior parietal areas, and changes in functional connectivity with left postcentral gyrus. These findings demonstrate long-term modifications of cortical organization and as such have important implications for treatment strategies for patients with brain injury.     

Evaluation of communication assessment practices during the acute stages post stroke

Rationale, aims and objectives Early detection of communication impairment post stroke is an important prognostic indicator and promotes the use of individualized treatment protocols. Therefore, the methods for speech and language assessment used by communication experts in acute settings following stroke were investigated. Methods A survey was conducted among 254 speech and language pathologists providing acute care for patients following stroke in all states and territories across Australia and New Zealand. Respondent attitudes and practices in speech and language assessment post stroke were recorded with a standardized questionnaire collected online. Results A total of 174 (68.5%) speech and language pathologists responded. Over 70% of participants assessed language and 80% assessed speech using their own clinical assessments. Respondents identified limited test repeatability and poor sensitivity to change over acute periods as key areas of concern for currently available standardized assessments. Conclusions Subjective and/or un‐standardized assessments were the most commonly used measures of communication during the acute phases post stroke. These results highlight a critical need for the development of population‐specific communication assessments that build on existing clinician derived techniques and expertise while considering the acute time demands and transient nature of patient's communicative functioning.     

Cortical activation associated with the experience of auditory hallucinations and perception of human speech in schizophrenia: a PET correlation study

A [H(2)(15)O] PET correlation analysis technique was employed to correlate brain activations associated with self-reports of auditory hallucinations in hallucinating patients (n=8) and perception of transient, random human speech in non-hallucinating (n=7) patients and normal control subjects (n=8). Perception of externally generated human speech amongst the non-hallucinating and normal control participants was associated with a consistent pattern of extensive bilateral auditory cortex activation (Brodmann areas 40/41/42/22). Hallucinating participants demonstrated a network of cortical activations including bilateral auditory cortex, left limbic regions, right medial frontal and right prefrontal regions. The observed pattern of activation is consistent with models of auditory hallucinations as mis-remembered episodic memories of speech.     

The effect of an external load on the force and timing components of mentally represented actions

The chronometry of real and imagined movements was investigated in a group of eight subjects under varying conditions. The visually-guided pointing task was used to investigate the speed for accuracy trade-offs that occur as target size is varied for both real and imagined performance. The task was performed both with and without an external load of 2 kg. For the no-load condition and load conditions, the speed for accuracy trade-off for both real and imagined performance conformed to Fitts' law. Movement durations of real movements remained largely unaffected by the addition of the load, however, movement durations of imagined movements increased significantly with the addition of the load. These patterns of results suggest that the weight disrupted the force calculation component of imagined movements but not the relative timing.     

Computerised cognitive assessment of athletes with sports related head injury

Professional and amateur participants in many sports are at risk of brain injury caused by impact with other players or objects. In many cases, mild cognitive deficits may persist after the common neurological signs of brain injury have passed. In recent years, the athlete's cognitive status after concussion has been measured with conventional "paper and pencil" neuropsychological tests. However, such tests are not ideal for sporting settings, as they are designed for the detection of gross cognitive impairments at a single assessment, not for the identification of mild cognitive deficits on repeated assessment. A number of computerised cognitive assessment tests and test batteries have been developed over the past two decades. These batteries offer major scientific and practical advantages over conventional neuropsychological tests which make them ideal for the assessment of cognitive function in sportspeople. This review first describes the problems associated with cognitive assessment of people with sports related cognitive deficits, and then critically examines the utility of conventional neuropsychological and computerised cognitive tests in sporting settings.