Attention in closed head injury: a critical review

Closed head injury (CHI) is one of the commonest causes of physical disability and cognitive impairment in young people. In patients with CHI both in the acute and sub-acute phases it is possible to demonstrate a disturbance of cognitive functions that affects their performance in a wide variety of neuropsychological tasks. The most frequent deficits pertain to attention and memory. In reviewing the literature on attention in CHI patients it appears that a debate is still alive about how to interpret the cognitive attentional defect, i. e. whether it is due to a slowing of information processing, to a deficit of 'executive' frontal functions, to a reduction of arousal level, to deficits of selective or divided attention, or to a combination of factors. After a brief general explanation of the neuropsychological cognitive models of attention, an overview of the various studies on attention in CHI will be provided. For the purposes of the review, the studies are grouped according to the different theoretical interpretations in the literature concerning the nature of attentional deficits in CHI patients. Finally, a tentative general interpretation of attentional deficits in CHI, in light of the anatomo-pathological aspects of the brain of CHI patients and of some methodological considerations, is offered.