ERP indicators of disturbed attention in mild closed head injury: a frontal lobe syndrome?

The purpose of the study was to examine the hypothesis that distractibility is a fundamental characteristic of mild closed head injury (MHI). The claim that cognitive symptoms in MHI are due to a mild type of frontotemporal injury was also investigated. Cognitive event-related potentials (ERPs), accuracy and reaction time to target stimuli in a dichotic listening paradigm, and neuropsychological test results were studied in patients with MHI (N = 15), patients with verified frontal lobe damage (N = 10), and healthy controls (N = 13). Information processing reflecting target detection (N2, P3b) and sustained selective attention (processing negativity) was studied. The MHI and frontal patients did not differ on behavioral measures, except that the MHI group had significantly longer reaction times to target stimuli in the ERP task. Both patient groups had deviant ERPs compared with controls, but their ERP patterns differed in important respects. Contrary to expectations, the MHI patients had the most abnormal ERPs. They showed significantly smaller N2 and Nd amplitudes than frontal patients and controls, indicating that the mediating cognitive mechanisms were not equivalent in MHI and frontal injury. The data suggest that MHI patients allocated less processing resources to the task than either the control subjects or the patients with frontal lobe damage.