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Traumatic brain injury, what a concept! Working memory is also pretty cool. Whether you're a cognitive neuroscientist or someone who doesn't know what any of this means, this quiz will test your understanding of concussions, and how traumatic brain injuries affect someone's working memory (I.E. short term memory but not quite).

What Do You Really Know About Concussions?

King Henry VIII suffered from many traumatic brain injuries during sport, one of them causing him to be unconscious for 2 hours. Henry suffered from amnesia, impulse control, sociopathy, depression, headaches, insomnias and possibly low testosterone late in his life. In a study conducted by Muhammad Qaiser Ikram, Fazle Hakim Sajjad, and Arash Salardini (2015), Henry's characteristics as he aged are discussed through the eye of cognitive neuroscience as a direct result of brain damage throughout his early life.

King Henry VIII

First off, which of these crazy rulers suffered from traumatic brain injury, resulting in their tyranny?

All of these symptoms are included under the definition of a concussion used by a study in 2001 (Guskiewicz, Kevin M; Ross, Scott E; Marshall, Stephen W) that researched the importance of postural stability and neurocognitive function in athletes. The study also looked at how amnesia and loss of consciousness affects on recovery.

Alteration in brain functions

Which of these could be a symptom of a concussion?

Working memory is defined as the ability to store a limited amount of information while simultaneously using the information during another cognitive task. Working memory uses the prefrontal cortex, which is most often structurally and functionally damaged after traumatic brain injury. Above is a fMRI of the healthy and the TBI groups in an experiment conducted in 2001 to examine the patterns in the brain during working memory tasks of people with traumatic brain injury. The image shows more utilization of the right hemisphere in those who suffered from TBI, and overall more regionally dispersed activation. (C. Christodoulou, J. DeLuca, J. H. Ricker, N. K. Madigan, B. M. Bly, G. Lange, A. J. Kalnin, W-C. Liu, J. SteVener, B. J. Diamond, A. C. Ni, 2001)

Remembering the address of where you are going while deciding which route to take.

Which is an accurate example of working memory?

The DLPFC is found to be affected by working memory tasks in studies that use fMRI. However, some studies have found contradicting results of hypoactivation and hyperactivation during working memory tasks. These findings expose the issue of studying concussions through fMRI. Although fMRI is currently the best noninvasive option to study traumatic brain injury, there are many physiological changes that occur due to brain trauma, and they differ between people. Therefore, studying TBI with multiple imagery techniques is the most successful way of understanding someone’s physiological changes after brain damage. (Mayera, Andrew R., Bellgowand, Patrick S.F.; Hanlon, Faith M., 2014)

Dorsolateral Prefrontal Cortex (DLPFC)

Which area of the brain is found, in fMRI studies, to have hyperactivation (more brain activity) or hypoactivation (less brain activity) during working memory tasks post mTBI?

When put through three levels of working memory tasks (low processing, medium processing, and high processing), mTBI patients and healthy individuals were found to be fairly similar when comparing low processing. However, medium processing resulted in higher amounts of activation in the bilateral frontal and parietal regions of the brain in mTBI patients. High processing caused low levels of activation in people with mTBI. High amounts of working memory tasks resulted in more activation with healthy patients, especially in the biparietal cortical areas. People with traumatic brain injury differed from healthy people only in their response speed during working memory tasks, also. Put in simpler form: people suffering from brain injury are less able to perform high levels of working memory tasks, are a tad slower at performing these tasks, and they use their brains differently due to the damage they have. (McAllister T.W., Sparling M.B., Flashman L.A., Guerin S.J., Mamourian A.C., and Saykin A.J., 2000)

mTBI patients use their bilateral frontal and parietal regions of their brain more, and have a slightly lower response speed.

What are the differences seen on fMRI between a TBI patient and a healthy patient during working memory tasks?

OSPAN is used to study working memory capacity (WMC) in TBI patients. A patient is able to take the test on a computer, and it is free through Georgia Tech School of Psychology. OSPAN has high internal consistency, and high test-retest reliability. It presents a subject with several math problems. In between each math problem, a letter is quickly flashed on the screen. A person’s ability to recognize the word that the flashes spell out, or remember the order of letters, corresponds to their WMC. This test was used in a study in 2011 that looked at the effects of concussions in athletes, and if sports with higher levels of cognitive tasks result in higher levels of WMC. A majority of the TBI patients in the study had fully recovered from their concussion and brain trauma, therefore the OSPAN scores between non concussed patients and concussed patents weren’t significantly different. However, the study did find a significant difference between the WMC of athletes who play sports that require higher cognitive functions, and athletes that don’t. An example would be swimming (low cognitive demands) versus volleyball (high cognitive demands). (Mayers L. B., Redick T. S., Chiffriller S. H., Simone A. N., and Terraforte K. R., 2011) (Terry D. P., Faraco C. C., Smith D., Diadems M. J., Puente A. N., and Miller L. S., 2012)

Automated Operation Span (OSPAN)

What is one way of testing working memory capacity?

In the first longitudinal study on the effects of severe TBI on the working memory of patients, TBI patients were put through various working memory tests that assessed their accuracy and reaction time. The fMRI results showed significant improvement after the 6 months following the first assessment of the experiment. TBI patients showed increased accuracy and faster reaction times. This study shows that there is clear cognitive improvement with time following a concussion. The image to the right demonstrates increased activation in the brain following the 6 month period during the longitudinal study. (Sanchez-Carrion R., Fernandez-Espejo D., Junque C., Falcon C., Bargallo N., Roig T., Bernabeu M., Tormos J. M., Vendrell P., 2008)

All of the above

Which of the following is an improvement seen in the working memory of TBI patients 6 months after their original assessment?

A study that looked at working memory performance of young athletes aged 9-15 years found significantly abnormal recruitment of brain structures that are involved in working memory and multi-tasking. Decreased levels of performance (greater commission errors, decrease in accuracy, and slowed speed) were found in the young patients. Increasing the demands of the tasks especially lower the levels of efficiency in cognition. The study stresses the changes that occur in the brains of adolescents at a neuronal level following mTBI that don’t simply go away after the acute phase. (Sinopoli K. J., Chen J-K, Wells G., Fait P., Ptito A., Taha T., and Keightley M., 2014)

True

Differences exist in neural recruitment following mTBI in youth during working memory performance?

SPCN is a form of a event-related potential (ERP). ERPs are used to help find changes in someone’s cognitive ability following a concussion that would normally be unnoticed. The amplitude of the SPCN is influenced by the number of things in someone’s working memory. Athletes with a history of 3 or more concussions had changes in the amplitude of their SPCN. Athletes with less than 3 concussions perform insignificantly different from patients without TBI. (Thériault M., De Beaumont L., Tremblay S., Lassonde M., and Jolicoeur P., 2010)

How many concussions does it take to have significantly attenuated sustained posterior contralateral negativity (SPCN)?

There's no harm in not understanding half of what was just talked about, but hopefully you learned something from this short quiz!

You're no cognitive neuroscientist!

Wow you must be a cognitive neuroscientist!

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What Do You Really Know About Concussions?

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