Psychological Injury and Law

, Volume 4, Issue 2, pp 140–146 | Cite as

Traumatic Brain Injury Alters Word Memory Test Performance by Slowing Response Time and Increasing Cortical Activation: An fMRI Study of a Symptom Validity Test

  • Mark D. AllenEmail author
  • Trevor ChuangKuo Wu
  • Erin D. Bigler


The Word Memory Test (WMT) is an established symptom validity test that relies on verbal memory performance to make inferences about “effort.” Previous studies, using a functional MRI (fMRI) adaptation of the WMT with healthy controls, have shown that successful completion of the WMT relies on a widespread network of neural systems associated with high cognitive effort. Additional studies using the same fMRI paradigm with patients with severe traumatic brain injury (TBI) suggest that increased activation of cortical regions associated with cognitive load are recruited to meet the cognitive challenges that the WMT places on a compromised neural system. This study builds on previous findings as a result of highly uncommon circumstances in which fMRI data on the WMT task were made available from the very same individual both 1 year before and 1 year after sustaining a TBI. Interestingly, the effect of TBI did not appear to impair performance on the WMT in terms of standard accuracy measurements, though response times were notably slower. The main fMRI finding was a significantly stronger and more widespread pattern of activation post-injury, particularly in the frontal and parietal brain regions, suggesting that stronger engagement of these networks was necessary to sustain accurate WMT performance compared to pre-injury testing. This unique source of data, together with previous findings, suggests a more complex relationship between effort and performance levels on the WMT than what is commonly assumed.


fMRI Word Memory Test Neuropsychological assessment Symptom validity testing Effort testing 


  1. Allen, M. D., & Fong, A. K. (2008). Clinical application of standardized cognitive assessment using fMRI. I. Matrix reasoning. Behavioural Neurology, 20, 127–140.PubMedGoogle Scholar
  2. Allen, M. D., Bigler, E., Larsen, J., Goodrich-Hunsaker, N., & Hopkins, R. (2007). Functional neuroimaging evidence for high cognitive effort on the Word Memory Test in the absence of external incentives. Brain Injury, 21, 1425–1428.PubMedCrossRefGoogle Scholar
  3. Braver, T. S., Cohen, J. D., Nystrom, L. E., Jonides, J., Smith, E. E., & Noll, D. C. (1997). A parametric study of prefrontal cortex involvement in human working memory. NeuroImage, 5, 49–62.PubMedCrossRefGoogle Scholar
  4. Crawford, J. R., & Howell, D. C. (1998). Comparing an individual’s test score against norms derived from small samples. Clinical Neuropsychology, 12, 482–486.CrossRefGoogle Scholar
  5. Flaro, L., Green, P., & Robertson, E. (2007). Word Memory Test failure 23 times higher in mild brain injury than in parents seeking custody: The power of external incentives. Brain Injury, 21, 373–383.PubMedCrossRefGoogle Scholar
  6. Gorissen, M., Sanz, J. C., & Schmand, B. (2005). Effort and cognition in schizophrenia patients. Schizophrenia Research, 78, 199–208.PubMedCrossRefGoogle Scholar
  7. Green, P. (2003). Manual for the Word Memory Test for Windows. Edmonton: Green’s Publishing.Google Scholar
  8. Hillary, F. G., Genova, H. M., Chiaravalloti, N. D., Rypma, B., & DeLuca, J. (2006). Prefrontal modulation of working memory performance in brain injury and disease. Human Brain Mapping, 27, 837–847.PubMedCrossRefGoogle Scholar
  9. Larsen, J., Allen, M., Bigler, E., Goodrich-Hunsaker, N., & Hopkins, R. (2010). Different patterns of cerebral activation in genuine and malingered cognitive effort during performance on the word memory test. Brain Injury, 24, 89–99.PubMedCrossRefGoogle Scholar
  10. Levine, B., Kovacevic, N., Nica, E., Cheung, G., Gao, F., Schwartz, M. L., et al. (2008). The Toronto traumatic brain injury study: Injury severity and quantified MRI. Neurology, 70, 771–778.PubMedCrossRefGoogle Scholar
  11. McAllister, T. W., Sparling, M. B., Flashman, L. A., Guerin, S. J., Mamourian, A. C., & Saykin, A. J. (2001). Differential working memory load effects after mild traumatic brain injury. NeuroImage, 14, 1004–1012.PubMedCrossRefGoogle Scholar
  12. McAllister, T. W., Flashman, L. A., McDonald, B. C., & Saykin, A. J. (2006). Mechanisms of working memory dysfunction after mild and moderate TBI: evidence from functional MRI and neurogenetics. Journal of Neurotrauma, 23, 1450–1467.PubMedCrossRefGoogle Scholar
  13. McGrath, R. E., Mitchell, M., Kim, B., & Hough, L. (2010). Evidence for response bias as a source of error variance in applied assessment. Psychological Bulletin, 136, 450–470.PubMedCrossRefGoogle Scholar
  14. Merten, T., Bossink, L., & Schmand, B. (2007). On the limits of effort testing: symptom validity tests and severity of neurocognitive symptoms in nonlitigant patients. Journal of Clinical and Experimental Neuropsychology, 29, 308–318.PubMedCrossRefGoogle Scholar
  15. Messe, A., Caplain, S., Paradot, G., Garrigue, D., Mineo, J. F., Soto Ares, G., et al. (2011). Diffusion tensor imaging and white matter lesions at the subacute stage in mild traumatic brain injury with persistent neurobehavioral impairment. Human Brain Mapping, 32, 999–1011.PubMedCrossRefGoogle Scholar
  16. Millis, S. R. (2009). Methodological challenges in assessment of cognition following mild head injury: response to Malojcic et al. 2008. Journal of Neurotrauma, 26, 2409–2410.PubMedCrossRefGoogle Scholar
  17. Newsome, M. R., Scheibel, R. S., Steinberg, J. L., Troyanskaya, M., Sharma, R. G., Rauch, R. A., et al. (2007). Working memory brain activation following severe traumatic brain injury. Cortex, 43, 95–111.PubMedCrossRefGoogle Scholar
  18. Pardini, M., Krueger, F., Raymont, V., & Grafman, J. (2010). Ventromedial prefrontal cortex modulates fatigue after penetrating traumatic brain injury. Neurology, 74, 749–754.PubMedCrossRefGoogle Scholar
  19. Parizel, P. M., Ozsarlak, Van Goethem, J. W., van den Hauwe, L., Dillen, C., Verlooy, J., et al. (1998). Imaging findings in diffuse axonal injury after closed head trauma. European Radiology, 8, 960–965.PubMedCrossRefGoogle Scholar
  20. Sánchez-Carrión, R., Gómez, P., Junqué, C., Fernández-Espejo, D., Falcon, C., Bargalló, N., et al. (2008). Frontal hypoactivation on functional magnetic resonance imaging in working memory after severe diffuse traumatic brain injury. Journal of Neurotrauma, 25, 479–494.PubMedCrossRefGoogle Scholar
  21. Scheibel, R. S., Pearson, D. A., Faria, L. P., Kotrla, K. J., Aylward, E. E., Bachevalier, J. J., et al. (2003). An fMRI study of executive functioning after severe diffuse TBI. Brain Injury, 17, 919–930.PubMedCrossRefGoogle Scholar
  22. Strangman, G. E., O’Neil-Pirozzi, T. M., Goldstein, R., Kelkar, K., Katz, D. I., Burke, D., et al. (2008). Prediction of memory rehabilitation outcomes in traumatic brain injury by using functional magnetic resonance imaging. Archives of Physical Medicine and Rehabilitation, 89, 974–981.PubMedCrossRefGoogle Scholar
  23. Turner, G. R., & Levine, B. (2008). Augmented neural activity during executive control processing following diffuse axonal injury. Neurology, 71(11), 812–818.PubMedCrossRefGoogle Scholar
  24. Tzourio-Mazoyer, N., Landeau, B., Papathanassiou, D., Crivello, F., Etard, O., Delcroix, N., et al. (2002). Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. NeuroImage, 15, 273–289.PubMedCrossRefGoogle Scholar
  25. Wu, T., Allen, M., Goodrich-Hunsaker, N., Hopkins, R., & Bigler, E. (2010). Functional neuroimaging of symptom validity testing in traumatic brain injury. Psychological Injury and Law, 3, 50–62.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC. 2011

Authors and Affiliations

  • Mark D. Allen
    • 1
    • 2
    • 5
    Email author
  • Trevor ChuangKuo Wu
    • 1
    • 2
  • Erin D. Bigler
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of PsychologyBrigham Young UniversityProvoUSA
  2. 2.Neuroscience CenterBrigham Young UniversityProvoUSA
  3. 3.The Brain Institute of UtahUniversity of UtahSalt Lake CityUSA
  4. 4.Department of PsychiatryUniversity of UtahSalt Lake CityUSA
  5. 5.Functional Imaging UnitRiverwoods Imaging CenterProvoUSA

Personalised recommendations