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PubMed1990

Comparison of plasticity in sensory and cognitive processing systems.

The term "brain plasticity" can be applied to a number of processes, each with its own set of complex mechanisms. The plasticity of the human brain during postnatal development has been contrasted for a sensory, i.e., auditory, and cognitive system by comparing the development of two different evoked potential components. The short-latency auditory brainstem responses (ABRs), which are generated by auditory neurons within the brainstem auditory pathway, are mature by 1 to 2 years after birth. The rate of ABR development, as shown by longitudinal recordings from preterm infants, appears to be equally rapid in intrauterine and extrauterine environments. In contrast, the long-latency P300 cognitive potential, which reflects such processes as sequential information processing and short-term memory, does not show a mature waveform and latency until 14 to 17 years of age. This protracted rate of development cannot yet be related to a brain substrate, as the generator origins of the P300 are unknown. Clinical and animal data suggest, however, that limbic structures are critically involved. The long developmental history of the P300, in contrast to the ABRs, provides a functional measure of developmental plasticity in a cognitive versus a sensory brain system.

Adolescent↗
PubMed2004

The think aloud method: a guide to user interface design.

OBJECTIVES: Clinical use of computer systems has been hampered by their poorly designed user interfaces. The objective of this study was to design a user interface for a pediatric oncologists' computerized patient record with great consideration of their working behavior and of human computer interfacing principles so as to contribute to oncologists' efficiency and satisfaction in interaction with the system. METHODS: The think aloud method was used in combination with video recording to get a deep understanding of the way in which four pediatric oncologists searched through the paper-based patient record in preparing a patient visit. Protocol and video analyses was used to develop a cognitive task model reflecting pediatric oncologists' task behavior. This model was input for a prototype user interface, which was subsequently evaluated by eight other pediatric oncologists. RESULTS: The resulting computerized medical record system proved to meet pediatric oncologists' information needs and task behavior patterns. The design of the user interface minimized pediatric oncologists' work load and was highly efficient in supporting the pediatric oncologists in preparing their patient visits. The pediatric oncologists were very much satisfied with the computer system. CONCLUSIONS: It is argued that early involvement of cognitive engineering methods in the system design process may be of great help in designing systems that fully support health care professionals' work practices. The think aloud method, if applied under prescribed conditions, is a valuable information source of human task-behavior and as such a useful technique for requirements analysis in designing clinical computer systems.

Ambulatory Care Facilities↗
PubMed2004

Assessing the cognitive abilities that differentiate patients with Alzheimer's disease from normals: single and multiple factor models.

BACKGROUND: Understanding the structure of cognitive abilities in Alzheimer's disease (AD) has considerable practical and theoretical importance. Some investigators have argued that a single cognitive process underlies the deficits seen in AD, while others have argued for multiple cognitive processes. As deficits in cognitive abilities may reflect the pathological process or processes occurring in AD, determination of the structure of abilities in AD is important. OBJECTIVES: The purpose of this study was to assess the utility of single and multiple ability factor models in differentiating patients with AD from normals. RESULTS: Findings show that although a single factor model accounts for a large part of the variability of a battery of measures used to differentiate patients and normals, a multiple factor model performed substantially better based on multiple fit criteria. CONCLUSIONS: At least in this sample, a multiple ability factor model of cognitive abilities fit data better than a single factor model in differentiating patients with AD from normals.

Activities of Daily Living↗
PubMed2002

Under-recruitment and nonselective recruitment: dissociable neural mechanisms associated with aging.

Frontal contributions to cognitive decline in aging were explored using functional MRI. Frontal regions active in younger adults during self-initiated (intentional) memory encoding were under-recruited in older adults. Older adults showed less activity in anterior-ventral regions associated with controlled use of semantic information. Under-recruitment was reversed by requiring semantic elaboration suggesting it stemmed from difficulty in spontaneous recruitment of available frontal resources. In addition, older adults recruited multiple frontal regions in a nonselective manner for both verbal and nonverbal materials. Lack of selectivity was not reversed during semantically directed encoding even when under-recruitment was diminished. These findings suggest two separate forms of age-associated change in frontal cortex: under-recruitment and nonselective recruitment. The former is reversible and potentially amenable to cognitive training; the latter may reflect a less malleable change associated with cognitive decline in advanced aging.

Adolescent↗
PubMed1984

Pediatric residents' attitudes and cognitive knowledge, and faculty ratings.

We compared pediatric residents' psychosocial attitude, personality, and in-training examination (American Board of Pediatrics) scores with faculty evaluations of the residents' clinical performance (clinical skills, medical knowledge, interpersonal skills and relationship with other staff) in inpatient, outpatient, and intensive care settings. We found no relationship between psychosocial attitudes and the in-training examination scores or among aggregate faculty ratings, attitudes, and examination scores, but faculty ratings grouped by setting yielded more discriminating results. On inpatient rotations, cognitive knowledge (as reflected by in-training examination scores) was positively correlated with faculty ratings. On intensive care and outpatient rotations, knowledge did not correlate with faculty ratings. Residents' attitudes favoring a psychosocial approach to medical practice were associated with positive evaluations on outpatient rotations but with negative evaluations on intensive care rotations. Psychosocial attitudes seemed to be determined by the social orientation of the resident's personality styles. Our results emphasize the importance of clinical setting to faculty rating and suggest that valued resident characteristics vary by setting. These findings have significant implications for both improving the clinical evaluation of residents and creating a better understanding of the interaction of personality, attitude, and cognitive variables in rated clinical performance.

Attitude of Health Personnel↗
PubMed2003

Equivalence of cognitive processes in brain imaging and behavioral studies: evidence from task switching.

A growing number of studies on the higher-order cognitive functions of the human brain use brain-imaging techniques, such as functional magnetic resonance imaging (fMRI). For the validity and generality of fMRI results, it is important that the relevant cognitive processes are equivalent to those functioning in typical settings used in behavioral research. This equivalence could be, for example, endangered by different spatial frames of reference when lying in the scanner. In the present study, we tested whether the cognitive processes, as reflected in behavioral data in brain-imaging settings, are indeed functionally equivalent to those reflected in "purely" behavioral settings. To this end, we used a task-switching paradigm with a spatial component, increasing the likelihood to find effects of experimental setting. We compared the data of three different groups that only differed in testing environments (real, operating fMRI vs simulated fMRI vs standard behavioral with upright position of participants) but used otherwise strictly equivalent experimental conditions. Of importance for our validation purposes, unlike previous studies, we included a group with a behavioral setting, and we tested whether we would replicate a nontrivial, complex three-way interaction across all three groups. We replicated the predicted complex data pattern in all groups, suggesting functional equivalence of the underlying cognitive processes. We also found strongly increased reaction time (RT) levels in the two fMRI groups. We attribute this increase to unspecific distracting factors affecting late motor processes and discuss potential methodological implications of this increased baseline RT in the scanner.

Adolescent↗
PubMed2006

Shared cognitive processes underlying performance on the Wisconsin Card Sorting Test and the Stroop Test in patients with schizophrenia: a measurement artifact?

We explored the hypothesis that, while sensitive to different aspects of executive functioning in patients with schizophrenia, the Wisconsin Card Sorting Test (WCST) and the Stroop Test also measure the same construct, namely, inhibitory control. Specifically, our goal was to confirm and extend previous findings [A. Rossi, E. Daneluzzo, P. Mattei, M. Bustini, M. Cassachia, P. Stratta, Wisconsin Card Sorting Test and Stroop performance in schizophrenia: a shared construct, Neurosci. Lett. 226 (1997) 87-90] by demonstrating the independence of this construct from other abilities necessary to successfully perform the tasks. More importantly, we sought to improve on this previous study by eliminating the influence of the variance of speed of responding. We examined 55 patients with schizophrenia and initially found that performance on the Stroop Color-Word condition could, indeed, be predicted only by the percentage of perseverative errors on the WCST, and not variables reflective of other cognitive skills, thus replicating and extending previous findings. Once we removed the influence of speed of responding from our measure, however, thus isolating the inhibitory process, this finding disappeared. Therefore, our findings highlight the importance of isolating the individual components of interest from complex measures before drawing conclusions regarding the cognitive processes underlying particular test performance.

Artifacts↗
PubMed2004

[Neuropsychological correlates of cerebral atrophy in Alzheimer's dementia].

This study aims to systematically analyze the relationship between neuropsychological deficits and regional cerebral atrophic changes in Alzheimer's dementia (AD). As an extension of previous studies we not only investigated substructures of the medial temporal lobe but also included other relevant cerebral regions such as frontal, temporal, and parietal lobes. This approach was based on the assumption that morphological correlates of global and specific cognitive dysfunction might reflect to a certain degree the neuronal basis of the respective function. Accordingly, the functional role assigned to a certain cerebral structure or region can be further elucidated which might lead to a better understanding of the clinical and neuropsychological heterogeneity of AD. Fifty patients with AD (NINCDS-ADRDA criteria) and 20 healthy elderly control subjects were included. All patients and controls were examined on a standardized neuropsychological test battery. In addition, magnetic resonance imaging (MRI) of the brain was performed. Volumes of the whole brain, CSF-spaces, amygdala-hippocampus complex, frontal lobes, temporal lobes, and parietal lobes were measured using a standardized protocol. AD-patients were characterized by neuropsychological deficits with respect to memory, language, praxia, cognitive speed as well as attention and concentration. These deficits were differentially correlated with regional atrophic changes. In particular, volumes of the right amygdala-hippocampus complex were correlated with declarative memory performance in the non-verbal visual domain. Furthermore, an association between left temporo-parietal regions and aspects of semantic memory, as well as verbal recall and left frontal regions could be established. The validity of our results is supported by recent findings from neuropathological and functional neuroimaging studies. In conclusion, our data indicate that MRI-based volumetry can be successfully used to detect morphological correlates of neuropsychological heterogeneity in AD and that this methodological approach allows to fruitfully study the neuronal basis of cognitive functions.

Aged↗
PubMed1998

Effects of mild traumatic brain injury on narrative discourse production.

Mild traumatic brain injury (MTBI) and postconcussive syndrome can result in difficult to document complaints regarding subtle language use. Narrative discourse production has been shown to be a sensitive index of linguistic and cognitive deficits in the more severe TBI population. The narrative discourse production of MTBI subjects was investigated to determine whether cognitive changes were reflected in linguistic production. Eight MTBI, five moderate TBI, and five neurologically normal subjects were matched for age, education, and gender. The TBI subjects were matched on a number of neuropsychological measures. The subjects produced narratives about their correct picture sequences on five items from the Wechsler Adult Intelligence Scale-Revised picture arrangement subtest. The narratives were scored for correct arrangement, content essential information, correct story, and implied meaning. Significant differences were found between the normal control group and both the TBI groups on accuracy of narrative description of the correct picture sequences. Although differences in generation of implied meaning failed to reach significance, a trend was noted for both the TBI groups to produce fewer implied meanings than the control group. The results suggest that cognitive disruptions associated with MTBI may affect the quality of narrative discourse.

Adult↗
PubMed2006

Time perception: manipulation of task difficulty dissociates clock functions from other cognitive demands.

Previous studies suggest the involvement in timing functions of a surprisingly extensive network of human brain regions. But it is likely that while some of these regions play a fundamental role in timing, others are activated by associated task demands such as memory and decision-making. In two experiments, time perception (duration discrimination) was studied under two conditions of task difficulty and neural activation was compared using fMRI. Brain activation during duration discrimination was contrasted with activation evoked in a control condition (colour discrimination) that used identical stimuli. In the first experiment, the control task was slightly easier than the time task. Multiple brain areas were activated, in line with previous studies. These included the prefrontal cortex, cerebellum, inferior parietal lobule and striatum. In the second experiment, the control task was made more difficult than the time task. Much of the differential time-related activity seen in the first experiment disappeared and in some regions (inferior parietal cortex, pre-SMA and parts of prefrontal cortex) it reversed in polarity. This suggests that such activity is not specifically concerned with timing functions, but reflects the relative cognitive demands of the two tasks. However, three areas of time-related activation survived the task-difficulty manipulation: (i) a small region at the confluence of the inferior frontal gyrus and the anterior insula, bilaterally, (ii) a small portion of the left supramarginal gyrus and (iii) the putamen. We argue that the extent of the timing "network" has been significantly over-estimated in the past and that only these three relatively small regions can safely be regarded as being directly concerned with duration judgements.

Adolescent↗
PubMed2004

Neuropsychological outcome after selective amygdalohippocampectomy with transsylvian versus transcortical approach: a randomized prospective clinical trial of surgery for temporal lobe epilepsy.

PURPOSE: Selective amygdalohippocampectomy (SAH) is a surgical treatment option for patients with medically intractable mesial temporal lobe epilepsy. In contrast to standard anterior temporal lobectomy, resection of unaffected tissue is limited, although it achieves equal seizure outcomes in selected patients. In SAH, the mesial structures can be approached by different routes, the transsylvian approach and the transcortical approach. Advantages or disadvantages with respect to postoperative cognitive outcome are still a matter of debate. METHODS: Eighty randomized patients were included in the analyses. In 41 patients, the transsylvian approach, and in 39 patients, the transcortical approach was performed. All patients received comprehensive neuropsychological testing of verbal and nonverbal memory, attention, and executive functions before and 6 months or 1 year after SAH. RESULTS: Seventy-five percent of patients became completely seizure free with no difference depending on the chosen approach. Repeated measures multivariate analysis of variance (MANOVA) showed that cognitive outcomes after both approaches were essentially the same. The only exception was phonemic fluency, which was significantly improved after transcortical but not after transsylvian SAH. CONCLUSIONS: The results indicate that either surgical approach can be chosen independent of cognitive outcome criteria. Improvement in phonemic fluency after transcortical SAH may reflect selective normalization of cognitive function after epilepsy surgery, whereas frontal lobe manipulation might have hindered recovery of this function after transsylvian SAH.

Adolescent↗
PubMed2002

Cognitive functioning among infants of alcoholic fathers.

Although there is considerable evidence that suggests that children of alcoholic fathers are at risk for maladaptive developmental outcomes, there is a large amount of heterogeneity in these outcomes. This study examined this hypothesis using broad measures of mental and language development during the toddler period as a function of fathers' alcoholism and associated risk factors. Participants included 102 families in which the father was alcoholic, 20 families in which the father was alcoholic and the mother was a heavy drinker and 104 control families matched in terms of maternal education, race/ethnicity, child gender, marital status and number of children. Families, in which the mother engaged in significant prenatal drinking or drug use, were excluded. Infants were tested at 12, 18 and 24 months old. Analyses revealed no significant differences between controls and infants of severe alcoholics, antisocial alcoholics, depressed alcoholics or family history positive alcoholics. There were also no differences between controls and infants in families with an alcoholic father/heavy drinking mother. The results suggest that overall mental development was not associated with paternal alcoholism. This raises the possibility that later problems in these areas may reflect more specific cognitive processes or the impact of parenting and behavioral problems among these children.

Adult↗
PubMed2003

Learning support for the consultation: information support and decision support should be placed in an educational framework.

BACKGROUND: Advances in information technology mean that it is now possible to provide contextually relevant, evidence-based information during the course of the consultation. As a consequence, the practitioner has to consider the new information (from the computer) in the situation of the present consultation and in the light of his or her own experience. This task has to be carried out in a short time, in the presence of the patient. METHOD: Drawing on experience of the development of one decision support system, this paper places that task for the practitioner in an educational framework. We begin by reviewing theories of professional experience and knowledge and go on to look at schema theory and the role of cognitive dissonance and reflection in learning. CONCLUSION: This paper considers the provision of real time decision support in the light of learning and the experienced practitioner. We conclude that framing the implementation of decision support in this way provides useful insights. The key process is learning by the practitioner, in the course of the consultation. This process should be supported by decision support and information support software. There are implications here for the design of such software, and also for the way in which practitioners are trained to use it.

Cognitive Dissonance↗
PubMed1984

Event related brain potentials and human pain: a first objective overview.

Since 1960 systematic studies of the human scalp-conducted cerebral slow-wave response to painful stimulation have shown only amplitude augmentation of the vertex components of the somatosensory evoked potential (SEP) to be indicators of subjective perception of a noxious or aversive quality in the stimulus. The vertex potential (VP) of the SEP occurs relatively late after onset of either transient or maintained stimuli (100-400 ms depending on stimulus mode and site), is amplitude-focal at vertex on scalp, and may be asymmetrically distributed hemispherically for unilateral stimulation of the hands. Its functional neuroanatomy seems undeterminable by scalp macroelectrodes, and its relationship to analogous vertex potentials in the auditory and visual modalities (AEP and VEP) unknown. Studies of the nociceptive SEP (SEPn) since 1977 concur that VP amplitude is more readily correlatable with subjective pain magnitude estimate than with objective stimulus parameters. They also suggest that the VP is amplitude-sensitive to (a) interstimulus-intervals less than about 350 ms; (b) analgesics and their antagonists; and (c) subjective cognitive status with regard to both the expected aversiveness of the stimulus and the previous experience of chronic pain. These studies have included electrical stimulation of toothpulp and teeth, mechanical and transcutaneous electrical stimulation of palmar and digital glabrous skin, noxious thermal stimulation of hands and forearms, and electrical stimulation of lips, fingers, toes, and anogenital perineum of both sexes. They have been done in the context of both classical and signal-detectability (TSD) methods for concurrent reports of painful versus painless, and in the methodological contexts of conventionally signal-averaged SEP and of single-epoch SEP recovered both raw and processed. Studies designed to analyze differences in the early-intermediate (25-95 ms) and late (500-1000 ms) time-segments of SEP for painful and painless stimulation have provided no convincing evidence of cortical nociceptive signals. Therefore existing data on the SEPn imply that the only cortical slow-wave sign of nociception reflects perceptual-cognitive and endogenous, rather than sensory-discriminative and exogenous, aspects of the conscious pain experience.

Brachial Plexus↗
PubMed1999

Contingent negative variation in children with anorexia nervosa.

BACKGROUND: Central catecholamines, particularly dopaminergic and noradrenergic systems, have affected the appetitive behavior in patients with anorexia nervosa (AN). The purpose of this study is to distinguish the characteristics of contingent negative variation (CNV) and postimperative negative variation (PINV), which may reflect the level of catecholamine in children with AN. METHODS: Eight children with AN aged 10 to 15 years and 23 age-matched healthy children were recruited. Contingent negative variation was recorded from the frontal midline (Fz), central midline (Cz) and parietal midline (Pz) referenced to linked earlobes during 30 trials consisting of a warning stimulus and an imperative stimulus with an interstimulus interval of 2 s and an intertrial interval of 10 s. The imperative stimulus of each trial required a button press. RESULTS: Children with AN had a diminished amplitude of the CNV. They had a significantly more attenuated early CNV and late CNV amplitude at Cz than normal children. No significant differences were observed between AN children and normal children in the amplitude of PINV at all three electrode sites. No difference could be found between the two groups in the frequencies of normal and abnormal duration of PINV. CONCLUSION: These findings suggest that early CNV may be diminished by norepinephrine deficiency and late CNV may be attenuated by dopaminergic deficiency in children with AN. Reduced CNV may represent impaired cognitive processes which reflect impaired appetitive behavior in AN children.

Adolescent↗
PubMed2005

Separating multiple processes in implicit social cognition: the quad model of implicit task performance.

The authors argue that implicit measures of social cognition do not reflect only automatic processes but rather the joint contributions of multiple, qualitatively different processes. The quadruple process model proposed and tested in the present article quantitatively disentangles the influences of 4 distinct processes on implicit task performance: the likelihood that automatic bias is activated by a stimulus; that a correct response can be determined; that automatic bias is overcome; and that, in the absence of other information, a guessing bias drives responses. The stochastic and construct validity of the model is confirmed in 5 studies. The model is shown to provide a more nuanced and detailed understanding of the interplay of multiple processes in implicit task performance, including implicit measures of attitudes, prejudice, and stereotyping.

Automatism↗
PubMed2005

Use of a maze to detect cognitive dysfunction in a porcine model of hypothermic circulatory arrest.

BACKGROUND: Hypothermic circulatory arrest (HCA) can result in cognitive impairment not reflected by histopathology or gross neurologic observation. We tested the sensitivity of two multi-room maze tasks in detecting cerebral dysfunction after HCA in pigs. METHODS: Twenty-seven pigs were studied, divided between two tasks. 13 underwent 90 minutes HCA at 20 degrees C and were trained from postoperative day (POD) 7; 14 were unoperated controls. The maze includes a holding area, 8 rooms, and a center hallway. One piece of apple is placed in each baited room on each of 10 days of learning evaluation. After a pig enters a room, doors to all other rooms close, and the pig must return to the holding area. In task 1, 6 of 8 rooms were baited, and each day's session ended when each baited room had been entered, or after 20 trials. In task 2, initially only the right- or left-sided rooms were baited. Pigs were evaluated each day until they entered 4 baited rooms, or for 15 trials; the process was then repeated, baiting the other side. RESULTS: Intraoperative physiology and postoperative recovery showed no differences between task 1 or 2 pigs. Task 1 did not distinguish between control and HCA groups (p = 0.5), but task 2 revealed significantly (p = 0.04) better learning in controls. CONCLUSIONS: The significantly poorer performance of pigs after HCA suggests that the reversal of baited rooms in task 2 provides the sensitivity to detect cognitive dysfunction. The maze is a promising tool to investigate in pigs the mild cerebral damage often seen after HCA.

Animals↗