Objective: To demonstrate that two tests of sustained attention were sensitive to attention deficits in patients with mild traumatic brain injury (TBI).
Design: A cross-sectional study recruiting 51 patients with TBI and 51 matched controls.
Outcome measures: The Sustained Attention to Response Task (SART) and Monotone Counting Test.
Results: The patient groups performed significantly worse than the normal controls in both sustained attention tests. The SART performance was also correlated with pathology severity in the patient group in terms of loss of consciousness (r=0.247, p=0.05). A cut-off of less than 1 standard deviation (SD) gives optimal diagnostic information in terms of sensitivity in the present sample (0.61 for Monotone Counting Test; 0.75 for SART).
Conclusion: These findings suggest that the SART and Monotone Counting Test are sensitive to patients with mild TBI. The SART-assessed sustained attention is also sensitive enough to detect attention impairment in this clinical group regardless of diagnosis and may provide clinicians with an alternative method of assessing sustained attention in these clinical groups.
2 Levin HS, High WM, Williams DH et al. Dichotic listening and manual performance in relation to magnetic resonance imaging after closed head injury. J Neurol Neurosurg Psychiatry1989; 52: 1162-1169.
3.
3 Wilkins AJ, Shallice T, McCarthy R. Frontal lesions and sustained attention. Neuropsychologia1987; 25: 359-365.
4.
4 Robertson IH, Ward T, Ridgeway V, Nimmo-Smith I. The structure of normal human attention: the Test of Everyday Attention. J Int Neuropsychol Soc1996; 2: 525-534.
5.
5 Rueckert L, Grafman J. Sustained attention deficits in patients with right frontal lesions. Neuropsychologia1996; 34: 953-963.
6.
6 Chan RCK, Hoosain R, Lee TMC. Talking while performing a task: a better attentional performance in patients with closed head injury?J Clin Exp Neuropsychol2002; 24: 695-704.
7.
7 Robertson IH, Manly T, Andrade J, Baddeley BT, Yiend J. ‘Oops!’: performance correlates of everyday attentional failures in traumatic brain injured and normal subjects. Neuropsychologia1997; 35: 747-758.
8.
8 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet1974; 81-83.
9.
9 Manly T, Robertson IH, Galloway M, Hawkins K. The absent mind: further investigations of sustained attention to response. Neuropsychologia1999; 37: 661-670.
10.
10 Norman DA, Shallice T. Attention to action: willed and automatic control of behaviour. In: Davidson RJ, Schwartz GE, Shapiro D eds. Consciousness and self-regulation: advances in research and theory, Volume 4. New York: Plenum, 1986: 1-18.
11.
11 Chan RCK. A further study on the Sustained Attention Response to Task: the effect of age, education, and gender. Brain Injury2001; 15: 819-829.
12.
12 Chen EYH, Lam LCW, Chen RYL, Nguyen DGH, Chan CKY, Wilkins AJ. Neuropsychological correlates of sustained attention in schizophrenia. Schizophr Res1997; 24: 299-310.
13.
13 Chen EYH, Lam LCW, Chen RYL, Nguyen DGH, Kwok CL, Au UWY. Neurological signs and sustained attention impairment in schizophrenia. Eur Arch Psychiatry Clin Neurosci2001; 251:1-5.
14.
14 Robertson IH, Ward T, Ridgeway V, Nimmo-Smith I. The Test of Everyday Attention. Bury St. Edmunds: Thames Valley Test Company, 1994.
15.
15 Chan RCK, Hoosain R, Lee TMC. Reliability and validity of the Cantonese version of the Test of Everyday Attention among normal Hong Kong Chinese: a preliminary report. Clin Rehabil2002; 16: 900-909.
16.
16 Cohen J. Statistical power analysis for the behavioural sciences, second edition. New York: Academic Press, 1988.
17.
17 Kurtz MM, Ragland JD, Bilker W, Gur RC, Gur RE. Comparison of the continuous performance test with and without working memory demands in healthy controls and patients with schizophrenia. Schizophr Res2001; 48: 307-316.
18.
18 Holdnack JA, Moberg PJ, Arnold SE, Gur RC, Gur RE. Speed of processing and verbal learning deficits in adults diagnosed with attention deficit disorder. Neuropsychiatry Neuropsychol Behav Neurol1995; 8: 282-292.
19.
19 Chan RCK, Chen EYH, Cheung EFC, Chen RYL, Cheung HK. A study of sensitivity of the Sustained Attention to Response Task in patients with schizophrenia. Clin Neuropsychol2004; 18: 114-121.
20.
20 Snedecor GW, Cochran WG. Statistical methods. Ames, IA: Iowa State University Press, 1980.
21.
21 Chan RCK. Attentional deficits in patients with closed head injuries: a further study to the discriminative validity of the Test of Everyday Attention. Brain Inj2000; 14: 227-236.
22.
22 Chan RCK, Hoosain R, Lee TMC, Fan YW, Fong DTS. Are there subtypes of attentional deficits in patients with persisting postconcussive complaints? A cluster analytical study. Brain Inj2003; 17: 131-148.
