Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-22T22:11:54.408Z Has data issue: false hasContentIssue false

The effects of focal and diffuse brain damage on strategy application: Evidence from focal lesions, traumatic brain injury and normal aging

Published online by Cambridge University Press:  01 May 1998

BRIAN LEVINE
Affiliation:
Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, ON, Canada
DONALD T. STUSS
Affiliation:
Rotman Research Institute, Baycrest Centre for Geriatric Care and University of Toronto, Toronto, ON, Canada
WILLIAM P. MILBERG
Affiliation:
Harvard Medical School, Department of Psychiatry and the Geriatric Research, Education, and Clinical Center, Veterans Administration Medical Center, West Roxbury, MA, USA
MICHAEL PAXSON ALEXANDER
Affiliation:
Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, ON, Canada Memory Disorders Research Center, Boston VAMC and Harvard Medical School (Neurology), Boston, MA, USA
MICHAEL SCHWARTZ
Affiliation:
Department of Neurosurgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
RON MACDONALD
Affiliation:
Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, ON, Canada

Abstract

A new test of strategy application was designed to be relatively free of the constraints that limit the standard neuropsychological assessment of supervisory abilities. The validity of the test was assessed in 3 samples of participants with varying degrees of supervisory deficits and frontal systems dysfunction: focal frontal lesions, traumatic brain injury (TBI), and normal aging. Inefficient strategy application varied systematically across the 3 groups and was not due to extraneous factors such as forgetting the test instructions. Previous case studies have emphasized strategy application deficits in the face of normal neuropsychological test performance. In this study, it was shown that strategically impaired participants from a consecutive series can include those both with and without deficient neuropsychological test performance. When neuropsychological impairment was present, it was greatest on executive functioning tasks. Among participants with nonstrategic performance, there was evidence for a dissociation of knowledge from action. This finding was not specific to focal frontal lesions. A number of supervisory processes contributing to strategy application were identified. Exploratory analyses indicated differential effects of lesion location on these processes, especially inferior medial frontal and right hemisphere lesions. Overall, the results supported the use of unstructured tasks in the assessment of supervisory abilities. (JINS, 1998, 4, 247–264.)

Type
Research Article
Copyright
© 1998 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)