Cognitive Dysfunction

Cognition refers to the underlying mental skills we utilize in our everyday lives. These skills are critical for comprehension, reading, thinking, planning, remembering, and organizing. Our cognitive abilities are constantly changing throughout our lives; cognitive abilities increase as we develop our brains from infancy to childhood to adulthood and may decline in old age. Because our cognition is flexible, it can be improved or weakened. Concussions are one of the most common causes of cognitive dysfunction; an?“estimated 1.6-3.8 million sports-and-recreation related concussions occur in the United States each year.” 5 in 10 concussions?go undiagnosed or unreported, so it is vital to understand the impacts concussions have. Below we discuss the Types of Cognitive Dysfunction, At-risk Populations, Recovery, Mental Health, and Treatments.

Table of Contents

Types of Cognitive Dysfunction

Executive Function and Decision-Making

Attention and Concentration

Memory

Processing

At-Risk Populations

How do cognitive impairments affect the recovery process?

How is cognitive dysfunction related to mental health issues?

Treatment and Self-Management Strategies

Types of Treatment

What can I do to help myself?

How can I help a loved one?

Other Approaches

Types of cognitive dysfunction

Executive function and decision-making

What is Executive Function?

Executive function?refers to cognitive abilities such as “planning, motivation, multitasking, flexible thinking, monitoring performance, memory, self-awareness, and detecting and correcting mistakes.”?

How does executive dysfunction affect everyday life?

Executive dysfunction can significantly affect daily activities, such as making it harder to go to work or school. Many executive functions, including memory, planning, organization, and flexible thinking, are crucial to performing school or work activities, such as writing papers, solving math problems, reading and understanding literature, building machines, organizing files, and coding or computer programming.

Possible social consequences of executive dysfunction

Additionally, because executive dysfunction is a cognitive deficit, it is not easily visible to others and can be mistaken for laziness or incompetence. This may make the concussed person feel angry and embarrassed and affect their relationships with others.?

Executive function and Decision Making: The Science

The brain area involved in executive function is the dorsolateral prefrontal cortex, located in the frontal lobe.?Neuroimaging studies have shown that this brain area is less activated in concussed individuals than non-concussed individuals when completing cognitive tasks. These studies indicate that cognitive abilities are typically implicated when someone becomes concussed. Thus, those who have?less activation in their prefrontal cortex?may have difficulties starting and completing tasks. They may also have problems with organization and may be unable to keep up with the how, when, where, etc of their daily tasks.

Natalie M. Zahr, Ph.D., and Edith V. Sullivan, Ph.D. "Translational Studies of Alcoholism Bridging the Gap" Alcohol Research & Health, Volume 31, Number 3, p.215- (2008)

Additionally, flexible thinking, or readily changing behavior based on new information, may be difficult. Instead, a concussed person may stick to using the same information, and employing the same behaviors and same strategies, even when situations change and new strategies would be helpful. They may also need help developing solutions to their problems or solving them in general. Concussed individuals may also have difficulties planning, thinking many steps ahead, and predicting the consequences of their actions, which often results in impulsiveness.?

A study by Ledwidge et al. compared 16 young adults with a concussion to a control group and found that the concussion group had lower language, memory, and executive function skills (but these were still in the normal range). In contrast, attention and visuospatial skills did not differ between the groups. However, using?EEG?while the study participants completed the cognitive tasks, researchers found an “enhanced negative N400 potential effect” in the frontal regions of the brain and less of a “negative N400 potential effect” in the “centroparietal” area. This potential appears when a person recognizes an “incongruence” at the end of sentences (“The kite flew in the sky” vs. “The kite flew in the cup”). An enhanced negative effect focused at the frontal regions instead of the centroparietal regions suggests that these concussed individuals may show a “compensatory” response.?

Attention and Concentration

What is attention?

Attention?refers to the cognitive ability of selecting and focusing on relevant stimuli within our environment.?

How does attention affect everyday life?

Driving is something that many people do every day that requires a tremendous amount of attention to do safely. For instance, changing lanes, deciding when to turn, looking in mirrors, using pedals, and turning simultaneously all require the appropriate amount of arousal, sustained attention, and divided attention. Similar to executive dysfunction, the inability to pay attention may also greatly affect an individual’s ability to do well in school and work, especially because reading, writing, and learning new information are all crucial aspects of doing well in school and completing work tasks on time. In general, a lack of attention can make people forget what they are supposed to do, when they are supposed to do it, why they are supposed to do it, and where things are and may masquerade as forgetfulness.?

Attention: How it Works

Different Ways Attention is Used

• Sustaining attention: Often, attention needs to be “sustained,” meaning a person would need to fully concentrate on the stimuli for an extended period.?
• Selective attention: Frequently, attention needs to be “selective,” meaning the person can ignore the distracting stimuli in the environment and focus on important information
• Alternating attention: Using “alternating” attention means that the person can switch their focus from one stimulus to another.
• Divided attention: Making use of “divided” attention means the person can focus on multiple stimuli at the same time.?

The Components of Attention Network?

Attention has three different components: alerting, orienting, and executing.?

• Alerting: The alerting component refers to the level of alertness and how alert the person can be. The?reticular formation is the primary brain structure that is involved.?
• Orienting: The orienting component refers to the person directing themselves to and keeping their attention on a particular stimulus. The?posterior parietal cortex?and?thalamus?are brain structures involved.?
• Executing: The execution component uses the necessary attentional processes, like sustaining, selecting, and dividing attention. The?prefrontal dorsolateral cortex and?orbitofrontal cortex (see the image above in the executive function section) are the brain structures involved in this process.?

One study found that individuals with a concussion have deficits in their orienting attentional network but not the alerting or executing attentional networks. This study team used several different tests to measure the various?attentional?networks in concussed individuals.

• The?Attentional Network Task (ATN) assessed these three networks together.?
• Additional tests for the attentional network: the?Digit Span task, Trail Making Task A, and Stroop Color task. The concussed individuals performed worse on these three tests when compared to controls, indicating they had greater impairments in overall attention abilities.?

However, another study?found that the executing component of attention is also affected by a concussion in addition to the orienting component, suggesting that some concussed people may take longer to actually “initiate a correct response” to the stimuli. Overall, it is evident that the brain’s attentional capabilities are affected by a concussion.?

To read more on Cognitive Dysfunction involving memory, processing, the populations at risk, the recovery process, mental health as well as treatment and self-management strategies, go to the Concussion Alliance website.