Methods for transition toward computer assisted cognitive examination.

INTRODUCTION: We present a software framework which enables the extension of current methods for the assessment of cognitive fitness using recent technological advances. BACKGROUND: Screening for cognitive impairment is becoming more important as the world's population grows older. Current methods could be enhanced by use of computers. Introduction of new methods to clinics requires basic tools for collection and communication of collected data. OBJECTIVES: To develop tools that, with minimal interference, offer new opportunities for the enhancement of the current interview based cognitive examinations. METHODS: We suggest methods and discuss process by which established cognitive tests can be adapted for data collection through digitization by pen enabled tablets. We discuss a number of methods for evaluation of collected data, which promise to increase the resolution and objectivity of the common scoring strategy based on visual inspection. By involving computers in the roles of both instructing and scoring, we aim to increase the precision and reproducibility of cognitive examination. RESULTS: The tools provided in Python framework CogExTools available at http://bsp. brain.riken.jp/cogextools/ enable the design, application and evaluation of screening tests for assessment of cognitive impairment. The toolbox is a research platform; it represents a foundation for further collaborative development by the wider research community and enthusiasts. It is free to download and use, and open-source. CONCLUSION: We introduce a set of open-source tools that facilitate the design and development of new cognitive tests for modern technology. We provide these tools in order to enable the adaptation of technology for cognitive examination in clinical settings. The tools provide the first step in a possible transition toward standardized mental state examination using computers.

Monitoring item and source information: evidence for a negative generation effect in source memory.

Item memory and source memory were assessed in a task that simulated a social conversation. Participants generated answers to questions or read statements presented by one of three sources (faces on a computer screen). Positive generation effects were observed for item memory. That is, participants remembered topics of conversation better if they were asked questions about the topics than if they simply read statements about topics. However, a negative generation effect occurred for source memory. That is, remembering the source of some information was disrupted if participants were required to answer questions pertaining to that information. These findings support the notion that item and source memory are mediated, as least in part, by different processes during encoding.

In search of a unified definition for mild traumatic brain injury.

Discrepant criteria are utilized by various disciplines for the diagnosis of mild traumatic brain injury (TBI). This study evaluates 76 patients, all of whom were diagnosed as having sustained a mild TBI according to the diagnostic criteria set forth by the American Congress of Rehabilitation Medicine (ACRM); yet only 34% of these patients were classified as having a concussion according to DSM-IV. A unified definition is proposed which is comprised of grades: Type I for ACRM, Type III for DSM-IV, and Type II to bridge the two discrepant definitions. An examination of the patients, subdivided into the three types, revealed no significant differences for (1) number of subjective complaints, (2) neurocognitive performances, and (3) pre-existing emotional risk factors. Thus, the proposed gradation unifies the definitions across the heterogeneity of mild TBI. However, further research is indicated for their clinical validation.

Estimation of premorbid functioning after traumatic brain injury.

Estimation of premorbid functioning in patients with traumatic brain injury (TBI) is a difficult but necessary step both in the assessment of neurological impairment and in planning treatment. Because the estimation process is almost always retrospective, its reliability is questionable. The use of multiple sources of information improves the likelihood of an accurate estimate. The effects of TBI cross a number of domains in the victim's life. Thus, premorbid functioning must be estimated in the physical, cognitive, emotional, social, financial and vocational spheres. Knowledge of baseline or premorbid functioning levels allows the clinician to appreciate the severity of injury, provide a prognosis, and shape treatment goals that are specific to the individual. In this article, we present the key questions to be addressed, suggest sources of information to obtain the answers, describe the processes through which answers should be obtained, and outline the uses for this important information in working with victims of TBI.

Susceptibility to Memory Interference Effects following Frontal Lobe Damage: Findings from Tests of Paired-Associate Learning.

Abstract Patients with frontal lobe lesions were adminstered tests of paired-associate learning in which cue and response words are manipulated to increase interference across two study lists. In one test of paired-associate learning (AB-AC test), cue words used in one list are repeated in a second list but are associated with different response words (e.g., LION-HUNTER, LION-CIRCUS). In another test (AB-ABr test), words used in one list are repeated in a second list but are rearranged to form new pairs. Compared to control subjects, patients with frontal lobe lesions exhibited disproportionate impairment of second-list learning as a result of interference effects. In particular, patients exhibited the poorest performance during the initial trial of the second list, a trial in which interference effects from the first list would be most apparent. These findings suggest that the on-line control of irrelevant or competing memory associations is disrupted following frontal lobe lesions. This disruption may be indicative of an impaired gating or filtering mechanism that affects not only memory function but other cognitive function as well.

Intact implicit memory in patients with frontal lobe lesions.

Patients with frontal lobe lesions and control subjects were administered tests of word-stem completion priming. In this implicit memory test, subjects are first presented words (e.g. MOTEL, PARADE) in an incidental learning paradigm. Following word presentation, subjects are shown word stems (e.g. MOT, PAR) and asked to produce the first word that comes to mind. Patients with frontal lobe lesions exhibited normal levels of word-stem completion. These findings indicate that implicit memory can operate normally despite damage to the prefrontal cortex. The present results substantiate previous neuropsychological and positron emission tomography findings which indicate that word priming depends critically on posterior cortical areas.