Current standardized neuropsychological tests may fail to accurately capture real-world executive deficits. We developed a computer-based Cooking Task (CT) assessment of executive functions and trialed the measure with a normative group before use with a head-injured population. Forty-six participants completed the computerized CT and subtests from standardized neuropsychological tasks, including the Tower and Sorting Tests of executive function from the Delis-Kaplan Executive Function System (D-KEFS) and the Cambridge prospective memory test (CAMPROMPT), in order to examine whether standardized executive function tasks, predicted performance on measurement indices from the CT. Findings showed that verbal comprehension, rule detection and prospective memory contributed to measures of prospective planning accuracy and strategy implementation of the CT. Results also showed that functions necessary for cooking efficacy differ as an effect of task demands (difficulty levels). Performance on rule detection, strategy implementation and flexible thinking executive function measures contributed to accuracy on the CT. These findings raise questions about the functions captured by present standardized tasks particularly at varying levels of difficulty and during dual-task performance. Our preliminary findings also indicate that CT measures can effectively distinguish between executive function and Full Scale IQ abilities. Results of the present study indicate that the CT shows promise as an ecologically valid measure of executive function for future use with a head-injured population and indexes selective executive function’s captured by standardized tests.
The impact of poor nutrition on physiological health is well understood (Costarelli et al., 2013 ). Less is known about the effects of diet on brain function and cognition in the general population (Ames, 2010 ; Parletta et al., 2013 ; White et al., 2017 ) and we are still in the early stages of understanding the role of specific nutrients to normal and pathological neuronal functioning. In the present study, the putative effect of a multivitamin/mineral or vitamin D supplement on cognitive function over an 8-week period was compared with volunteers taking vitamin C. Healthy adults ( N = 60) were recruited, age range 21–59 years ( = 39.07 years, SD = 11.46), with participants randomly allocated to conditions in a double-blind protocol. Participants also completed a 14-day food diary to gather information on micronutrient intake. The cognitive test battery included measures from the Wechsler Adult Intelligence Scale-III (WAIS-III; Wechsler et al., 2008 ), Wechsler Memory Scale-IV (WMS-IV; Wechsler, 2009 ) and Delis-Kaplan Executive Function System (D-KEFS; Delis et al., 2001 ), along with the Doors and People (Baddeley et al., 1994 ) and a serial reaction time task. Analyses showed better performance on some tasks in all groups following the intervention period, notably on measures of verbal and visual memory and visuomotor processing speed. The Multivitamin group showed significant improvements on tasks of visual strategy generation (along with the Vitamin C group), motor planning, explicit and implicit learning, and working memory. This evidence suggests that sub-optimal micronutrient intake may have a negative effect on cognition across the lifespan.
Traumatic brain injuries result in a complex pathophysiological cascade that includes neuroinflammation, cellular energy dysregulation and axonal injury (Werner & Engelhard, 2007). Nineteen essential vitamins and minerals, along with omega-3 polyunsaturated fatty acids, are required by the body for competent cellular function. These cannot be synthesized by the body and must therefore be ingested either as part of the diet or through supplementation. Previous research has highlighted a relationship between micronutrient (vitamins, minerals, omega-3) levels and cognition in a range of neurological conditions (Bitarafan et al., 2014; Moore et al., 2012; Veronese et al., 2016), however there is very little research in post-acute traumatic brain injury (TBI). The aims of this thesis were to investigate the effects of micronutrient supplementation on cognition in both a normative and a TBI population, while also gaining an insight into the levels of micronutrients present in the diets of these participants. In the TBI population the hypothesis was that by nutritionally supporting these individuals this would improve cellular functioning and neuronal repair following injury, reducing the effects of ongoing secondary cascade mechanisms, with improved cognitive function as the outcome. Study one (normative study) demonstrated significant improvements in cognition, specifically memory and executive functions, following a relatively short eight-week intervention period, particularly in those taking a broad-spectrum multimicronutrient. Study two (TBI population) used a cross-over study design (omega-3 and multimicronutrient) with parallel placebo group. The omega-3 intervention consistently resulted in improved learning, attention, processing speed and set shifting, whereas improvements following the multimicronutrient intervention were more limited. Analyses of food diaries from participants in both studies indicated that levels of fat-soluble vitamins, some B vitamins, and minerals are below recommended intake in diet. Results of these studies indicate that micronutrient interventions can result in cognitive improvement in a relatively short period of time. This evidence provides a solid foundation for future micronutrient research in TBI populations which have the potential to serve as an adjunct to traditional rehabilitation strategies.
An estimated sixty-nine million people sustain a traumatic brain injury each year. Trauma to the brain causes the primary insult and initiates a secondary biochemical cascade as part of the immune and reparative response to injury. The secondary cascade, although a normal physiological response, may also contribute to ongoing neuroinflammation, oxidative stress and axonal injury, continuing in some cases years after the initial insult. In this review, we explain some of the biochemical mechanisms of the secondary cascade and their potential deleterious effects on healthy neurons including secondary cell death. The second part of the review focuses on the role of micronutrients to neural mechanisms and their potential reparative effects with regards to the secondary cascade after brain injury. The biochemical response to injury, hypermetabolism and excessive renal clearance of nutrients after injury increases the demand for most vitamins. Currently, most research in the area has shown positive outcomes of vitamin supplementation after brain injury, although predominantly in animal (murine) models. There is a pressing need for more research in this area with human participants because vitamin supplementation post-trauma is a potential cost-effective adjunct to other clinical and therapeutic treatments. Importantly, traumatic brain injury should be considered a lifelong process and better evaluated across the lifespan of individuals who experience brain injury.
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