Brain-injured patients need therapies based on cognitive neuroscience

April 29, 2015, University of Illinois at Urbana-Champaign
Specific diagnoses likely reflect damage to different brain networks, researchers argue. Credit: Julie McMahon

Patients with traumatic brain injuries are not benefiting from recent advances in cognitive neuroscience research - and they should be, scientists report in a special issue of Current Opinion in Behavioral Sciences.

Those who treat brain-injured patients rarely make use of new scientific discoveries about the workings of the brain. Instead, doctors, nurses and emergency personnel rely on a decades-old tool, the Glasgow coma scale, to categorize brain injuries as mild, moderate or severe. Brain scans are sometimes performed to help identify damaged regions, and then most patients receive one or more of the following four diagnoses: coma (no response to sensory stimulation), delirium (impaired ability to sustain attention), amnesia (impaired memory) and dysexecutive syndrome (impaired ability to engage in goal-directed thought).

These crude classifications reveal little about the underlying brain mechanisms that are damaged as a result of brain trauma, said Aron Barbey, a University of Illinois professor of neuroscience, of psychology, and of speech and hearing science. He and his colleagues propose that doctors take a deeper look at the brain networks that enable the regulation and control of attention, memory and thought - termed " processes" - and use this knowledge to develop more targeted treatment strategies. Barbey is a professor in the Beckman Institute for Advanced Science and Technology and in the Carl R. Woese Institute for Genomic Biology at the U. of I.

"Traumatic is a global public health epidemic with an incidence that continues to rise," Barbey said. "By 2020, the World Health Organization projects TBI will be the world's leading cause of neurological disability across all age groups.

"An emerging area of research seeks to develop better ways to assess traumatic brain injury. Recent findings demonstrate that multiple, interdependent brain networks drive and organize cognition. It is these networks that are highly susceptible to brain injury," he said.

Cognitive neuroscientists have identified dozens of brain networks, each of which engages a specific set of brain structures to perform particular tasks. Each node in a network communicates with the others via axons, the nerve fibers that bundle together to form white-matter tracts.

"There are three core networks that support cognitive control processes that often are impaired in traumatic brain injury," Barbey said. "The 'salience network' directs attention to significant events in our environment and is known to enable coordinated behavior. The 'default mode network' supports an internal focus of attention, enabling autobiographical memory and the ability to envision future events. Finally, the 'central executive network' directs attention to the external environment and supports goal-directed thought, such as planning and problem solving."

Disruption of the salience network corresponds to symptoms seen in those diagnosed with delirium, Barbey said. A diagnosis of amnesia corresponds to disruption of the default mode network, and dysexecutive syndrome is associated with damage to the central executive network, he said.

A coma diagnosis reflects systemwide failure, Barbey said.

Understanding which brain networks are damaged in brain-injured patients will help doctors better predict the kinds of impairments their patients will experience, and will guide clinical treatment and therapy.

To that end, the researchers recommend therapies that have shown promise in strengthening specific cognitive control functions.

Many methods that are familiar to but little-used in patient therapy should be tested in patient populations, the researchers wrote. These include interventions that target specific brain networks, such as transcranial direct-current brain stimulation, and approaches that deliver global benefits to brain health, such as physical fitness training.

Research indicates that brain stimulation can be applied to specific to enhance their ability to respond optimally to cognitive rehabilitation, Barbey said. Physical fitness is known to promote brain health and therefore may enhance resilience to brain injury, he said.

"The goal is to develop more precise assessment standards for and to translate discoveries from cognitive neuroscience into effective clinical therapies that promote recovery from injury," he said.

Explore further: Study of brain networks shows differences in children with OCD

Related Stories

Study of brain networks shows differences in children with OCD

April 1, 2015
A new study by scientists at the Wayne State University School of Medicine demonstrates that communication between some of the brain's most important centers is altered in children with obsessive-compulsive disorder.

One gene influences recovery from traumatic brain injury

February 26, 2014
Researchers report that one change in the sequence of the BDNF gene causes some people to be more impaired by traumatic brain injury (TBI) than others with comparable wounds.

Signal variability and cognitive performance in the aging human brain

April 9, 2015
As we age, the physical make up of our brains changes. This includes changes in neural processing in grey matter, but also in the deterioration of structural connections in the brain, which allow communication between distinct ...

Even mild traumatic brain injury may cause brain damage

July 16, 2014
Even mild traumatic brain injury may cause brain damage and thinking and memory problems, according to a study published in the July 16, 2014, online issue of Neurology, the medical journal of the American Academy of Neurology.

Researchers map brain areas vital to understanding language

November 21, 2013
When reading text or listening to someone speak, we construct rich mental models that allow us to draw conclusions about other people, objects, actions, events, mental states and contexts. This ability to understand written ...

Brain abnormalities found among those experiencing blast-related mild traumatic brain injury

April 22, 2015
Individuals with mild Traumatic Brain Injury (mTBI), particularly those who have had loss of consciousness (LOC), show structural brain abnormalities in their white matter as measured by Diffusion Tensor Imaging (DTI).

Recommended for you

Environmental factors may trigger onset of multiple sclerosis

October 16, 2018
A new Tel Aviv University study finds that certain environmental conditions may precipitate structural changes that take place in myelin sheaths in the onset of multiple sclerosis (MS). Myelin sheaths are the "insulating ...

Study points to possible new therapy for hearing loss

October 15, 2018
Researchers have taken an important step toward what may become a new approach to restore hearing loss. In a new study, out today in the European Journal of Neuroscience, scientists have been able to regrow the sensory hair ...

Scientists examine how neuropathic pain responds to Metformin

October 15, 2018
Scientists seeking an effective treatment for one type of chronic pain believe a ubiquitous, generic diabetes medication might solve both the discomfort and the mental deficits that go with the pain.

Sugar, a 'sweet' tool to understand brain injuries

October 15, 2018
Australian researchers have developed ground-breaking new technology which could prove crucial in treating brain injuries and have multiple other applications, including testing the success of cancer therapies.

Abnormal vision in childhood can affect brain functions

October 13, 2018
A research team has discovered that abnormal vision in childhood can affect the development of higher-level brain areas responsible for things such as attention.

Study: Ketogenic diet appears to prevent cognitive decline in mice

October 12, 2018
We've all experienced a "gut feeling"—when we know deep down inside that something is true. That phenomenon and others (like "butterflies in the stomach") aptly describe what scientists have now demonstrated: that the gut ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.