Back home after an acquired brain injury: building a "low-cost" team to provide theory-driven cognitive rehabilitation after routine interventions.

BACKGROUND: Individuals with Acquired Brain Injury (ABI) could benefit from further cognitive rehabilitation, after they have returned home. However, a lack of specialist services to provide such rehabilitation often prevents this. This leads to reduced reintegration of patients, increased social disadvantages and ultimately, higher economic costs. METHOD: 10 months post-stroke, a 69 year-old woman was discharged from an inpatient rehabilitation program and returned home with severe cognitive impairments. We describe a pilot project which provided an individualised, low cost rehabilitation program, supervised and trained by a neuropsychologist. Progress was monitored every 3 months in order to decide on continuation of the program, based on the achieved results and predicted costs. RESULTS: Post intervention, despite severe initial impairment, cognitive and most notably daily functioning had improved. Although the financial investment was moderately high for the family, the intervention was still considered cost-effective when compared with the required costs of care in a local non-specialist care home. Moreover, the pilot experience was used to build a "local expert team" available for other individuals requiring rehabilitation. CONCLUSIONS: These results encourage the development of similar local "low cost" teams in the community, to provide scientifically-grounded cognitive rehabilitation for ABI patients returning home.

Metacognitive and online error awareness deficits after prefrontal cortex lesions.

Awareness of deficits after brain injury represents a significant clinical and theoretical challenge, but relatively little is known about the neuroanatomical correlates of specific types of deficit awareness. We examined the awareness correlates of left versus right prefrontal cortex lesions in comparison to left and right posterior lesions including two types of awareness measures--metacognitive and online error monitoring. Frontal lobe frontal lesion patients exhibited impaired metacognitive awareness and also showed deficits in monitoring errors as they occurred. In addition, frontal lobe lesion patients also showed reduced autonomic response to aware errors. Online and metacognitive awareness were not, however, significantly correlated, suggesting that distinct neuroanatomical systems may underpin these two types of awareness deficit. We hypothesize that while metacognitive awareness depends on both left and right frontal regions, accurate moment-to-moment processing of errors depends more on the right than on the left prefrontal cortex.

A NOS1 variant implicated in cognitive performance influences evoked neural responses during a high density EEG study of early visual perception.

BACKGROUND: The nitric oxide synthasase-1 gene (NOS1) has been implicated in mental disorders including schizophrenia and variation in cognition. The NOS1 variant rs6490121 identified in a genome wide association study of schizophrenia has recently been associated with variation in general intelligence and working memory in both patients and healthy participants. Whether this variant is also associated with variation in early sensory processing remains unclear. METHODS: We investigated differences in the P1 visual evoked potential in a high density EEG study of 54 healthy participants. Given both NOS1's association with cognition and recent evidence that cognitive performance and P1 response are correlated, we investigated whether NOS1's effect on P1 response was independent of its effects on cognition using CANTAB's spatial working memory (SWM) task. RESULTS: We found that carriers of the previously identified risk "G" allele showed significantly lower P1 responses than non-carriers. We also found that while P1 response and SWM performance were correlated, NOS1 continued to explain a significant proportion of variation in P1 response even when its effects on cognition were accounted for. CONCLUSION: The schizophrenia implicated NOS1 variants rs6490121 influences visual sensory processing as measured by the P1 response, either as part of the gene's pleiotropic effects on multiple aspects of brain function, or because of a primary influence on sensory processing that mediates the effects already seen in higher cognitive processes.

Effects of the anticonvulsant topiramate on language abilities in people with epilepsy: a cross-sectional study.

OBJECTIVES: The aim of this study was to investigate the effects of topiramate (TPM) on cognitive function, specifically language, in patients with epilepsy, and to determine whether a specifically designed neuropsychological test battery can show such effects. METHOD: Twenty patients taking TPM, 25 epilepsy controls (taking medication other than TPM) and 25 healthy controls were recruited. We used a specific neuropsychological battery, including measures of visual and verbal memory, attention, fluency and comprehension. Separate one way between group ANOVAs were performed for each neuropsychological measure. RESULTS: Bonferroni comparisons revealed that the TPM group performed significantly worse than epilepsy controls on digits forward (p<0.001), digits backward (p<0.05), controlled oral word association (COWA) (p<0.05) and token test (p<0.05). The TPM group also needed more multiple choice cues in the Boston naming test (p<0.05). CONCLUSIONS: The present study indicates that 15% of the sample tested had impaired language abilities and raises interesting questions regarding the nature of this effect. Furthermore, we have identified some short neuropsychological tasks that can be performed in routine clinical situations that can reliably identify patients who have negative linguistic effects of TPM.

Neuropsychology of self-awareness in young adults.

Disorders of self-awareness are common following cortical damage, particularly to the frontal lobes, but there have been few studies of individual differences in self-awareness in the normal population. In the current study, we explored patterns of metacognitive awareness among healthy young adults, based on discrepancies of self- and other-ratings on the Frontal Systems Behavior Scale (FrSBe; Grace and Malloy, 2002). Those who showed poor metacognitive awareness showed more frequent lapses of attention, and higher levels of everyday absentmindedness, than those who accurately appraised their own behavior or those who overestimated their own FrSBe scores. Furthermore, among those with poor metacognitive awareness, online emergent awareness correlated positively with prospective memory performance, and negatively with anxiety scores. Our results suggest that accurate self-awareness in non-neurological participants relies on efficient sustained attention functioning, supporting the role of frontal control systems in neuroanatomical models of self-awareness.