Changes in check details cognition Initial and persistent cognitive deficits are the most common complaints after TBI57,58 and can present significant challenges to independent living, social readaptation, family life, and return to work.59,60 Frontal executive functions (problem solving, set shifting, impulse control, self-monitoring), attention,

short-term memory and learning, speed of information processing, and speech and language functions are the cognitive domains typically Inhibitors,research,lifescience,medical impaired.61-67 Injury to medial temporal regions, the dorsolateral prefrontal cortex, and subcortical white matter connecting these regions readily account for these difficulties. Changes in personality The term “personality change” is often used by survivors and family/caregivcrs to describe alterations in emotional and behavioral regulation after brain injury. Inhibitors,research,lifescience,medical In some individuals, this presents as exaggeration of

preinjury traits (eg, irritability). It is important in this context to ask about changes in the frequency and/or intensity of behaviors or traits that may have been present before the injury took place. Alternatively, these behaviors can present as fundamental changes in response Inhibitors,research,lifescience,medical patterns. Several common clusters of symptoms that characterize the “personality changes” are recognizable. Impulsivity This may be manifest in verbal utterances, physical actions, snap decisions, and poor judgment flowing from the failure Inhibitors,research,lifescience,medical to fully consider the implications of a given action. This is closely related to the concept of stimulus boundcdness, in which the individual responds to the most salient cue in the environment or attaches exaggerated salience to a particular cue, without regard to previously determined foci of attention or priorities, a syndrome commonly seen in individuals with frontal cortical damage or degeneration from a variety of disorders. Irritability Survivors are often described as more irritable or more Inhibitors,research,lifescience,medical easily angered.

Responses can range from verbal outbursts to aggressive and assaultive tuclazepam behavior. Although a particular cue might be perceived as a legitimate aggravation, the response is characteristically out of proportion to the precipitating stimulus. This modulatory deficit differs in intensity, onset, and duration from the pre-injury pattern for many individuals. This behavioral disinhibition is most likely attributable to damage to orbital frontal regions and white matter connections along the orbitofrontal subcortical circuitry of social comportment. Affective instability Survivors and family/caregivers frequently describe exaggerated displays of emotional expression, out of proportion to the precipitating stimulus and the preinjury range of responses. Additional characteristics include a paroxysmal onset, brief duration, and subsequent remorse.