An experiment is reported in which young and older adults performed a visual orienting task and a cue discrimination task. In the visual orienting task symbolic cues (letters) provided predictive information concerning the likely location of a target stimulus. Two letters, drawn from a pool of four ‘valid’ and four ‘invalid’ letters, were presented bilaterally, at either central or peripheral locations. In the cue discrimination task participants were presented with the same bilateral letter stimuli, and indicated whether these represented a valid letter on the right with an invalid letter on the left, or vice versa. In the visual orienting task young adults shifted attention appropriately in response to the letter cues, but older adults failed to do this. Older participants also performed more poorly on the cue discrimination task. However, even older participants who performed as well as young participants on the cue discrimination task failed to orient in response to the letter cues. Results are discussed in terms of effects of ageing on the ability to forge functionally effective links between different task components in the course of learning how to perform new perceptuomotor skills.

The present investigation aimed to assess whether a generalised inhibitory breakdown (Hasher & Zacks, 1988) can account for the well-documented age-related episodic memory deficits. It was argued that, according to whether significant correlations were found among all or between some of the measures of episodic memory and of inhibition included in the present investigation, it would be possible to assume that either a general or a specific, for instance, frontal lobe dependent inhibitory deficit (Dempster, 1992), was responsible for age-related memory deficit. At an empirical level, results from this investigation complement the large number of studies indicating an episodic memory deficit and an early deterioration of frontal lobes in the elderly. At a theoretical level, however, the failure to find age-related differences in the negative priming task challenges the hypothesis that cognitive ageing is due to a generalised inhibitory deficit. Furthermore, the failures to find significant correlations among performance on different tasks assumed to reflect the operation of inhibition processes support the hypothesis for the existence of multiple dissociable inhibitory processes (e.g., Kramer, Humphrey, Larish, Logan, and Strayer, 1994).

Rising healthcare expenditure and more explicit rationing of healthcare resources is a central feature of healthcare systems globally. In Australia, reform efforts have targeted the high cost areas such as the public hospital system. This has increased the demands on professionals to reduce length of stay and complicated post-hospital referral of people with complex and severe injury. In the area of traumatic brain injury (TBI), pressures on existing rehabilitation resources and a changing healthcare environment, with greater emphasis on efficiency and evidence-based practice, confront professionals' efforts to provide equitable care. In this paper, some of the key issues important in understanding patterns of referral in TBI are presented. It is argued that referral decisions exemplify a negotiation of professional claims and value judgements that not only conceal the uncertainty in decision-making, but also more notably, reflect the lack of attention to equity in the broader politics of care. Case studies are used to illustrate these issues and to discuss the implications for equitable care in the contemporary healthcare environment in Australia. The paper concludes by outlining the challenges and opportunities in applying evidence-based decision-making in TBI and some future directions for attaining more equitable patterns of referral.

Within the experimental literature there is substantial evidence of larger age-related deficits in retrieving source information relative to item-based information. However, this evidence is potentially subject to methodological criticism given that several studies have argued for the presence of source-monitoring deficits by examining source memory contingent on correct recall of item information but not the reverse. In order to address this potential shortcoming our study examines recall of both item information contingent on correct source judgement and source-based information contingent on correct recall of item information. We demonstrate that when this novel type of analysis is conducted, there are age deficits for both source and item information, and no evidence of a selectively greater source-monitoring deficit in the elderly. The results are discussed with reference to two overarching theoretical positions concerning age-related deficits in memory performance.

Community integration is often cited as the ultimate aim of rehabilitation. However, outcome studies show that following severe traumatic brain injury (TBI), many people do not return to valued life roles or reach previous levels of integration within their community. More recent research, in association with extensive clinical experience, reveals significant variability in outcomes within this group. Although some people return to productive activity and maintain a network of family and friends, others lead lives characterised by boredom and loneliness. This paper has two aims. The first is to examine TBI community integration outcome literature and selected theoretical models. The second is to describe a Community Approach to Participation (CAP), an individualised and collaborative model of community-based practice, which endeavours to address the poor outcomes identified following TBI. The CAP will be illustrated in the detailed case study of Sarah.

Community-based rehabilitation for people with acquired brain injury (ABI) is largely driven by goals set in the course of rehabilitation by clients and service providers. A preliminary study investigating the perspectives and practice of experienced rehabilitation coordinators was undertaken to explore issues that influence goal-setting in community rehabilitation settings. Detailed interviews and subsequent rounds of clarification were conducted with six experienced rehabilitation coordinators. Key themes identified through inductive analysis include cognitive influences, other client influences, service provider influences and the client-service provider relationship in the goal-setting process. Based on the findings, a preliminary descriptive schema of goal-setting in a community-based rehabilitation service for people with acquired brain injury is suggested. Factors such as training, experience, and values of the rehabilitation coordinators are also discussed in terms of their influence on goal-setting. Some strategies to assist a person with ABI to identify and work towards achieving realistic goals are identified. Suggestions for enhancing community-based rehabilitation practices with people with ABI, and scope for future research are noted. This paper constitutes a general overview of goal-setting in community-based ABI rehabilitation.

Considerable research has been devoted to the issue of whether the ingestion of glucose enhances cognitive performance in both younger and older adults. However, it has proven difficult to draw firm conclusions from this literature due to the diversity of methodologies that have been used, and it is therefore still unclear what factors might moderate the facilitative effect. The present study investigates methodological variations and their impact on the magnitude of the glucose enhancement effect. In particular, age group (young vs. old) and task domain (memory vs. nonmemory tasks) were considered as moderator variables. In addition, differences in experimental design, glucose dose and fasting regime were examined. The effect size d was extracted from studies comparing cognitive performance after the ingestion of either a glucose or control solution. Subsequent meta-analyses were conducted (using the procedures outlined by Hedges & Olkin, 1985) to examine potential moderators. A moderate overall effect size was found (d = 0.56), which clearly demonstrated the value of glucose ingestion as a cognitive enhancer. However, this effect size was not representative of the 104 individual effect sizes reported. Secondary analyses found larger effect sizes for memory compared to nonmemory tasks. Unexpectedly, no evidence was provided for greater beneficial effects of glucose on cognitive performance for older compared to younger adults. The impact of other methodological variables and the need for further exploration in an elderly population are discussed.

The ABI Behaviour Consultancy (the Consultancy) is a community-based service specialising in the management of challenging behaviour following acquired brain injury (ABI). Although there are many accounts in the literature of behaviour management techniques, very few describe how to tailor and implement programs to work in nonspecialised community settings where a client's environment has little structure and few resources. The Consultancy is often called upon to manage situations where existing behaviour interventions have not been successful, often because of incorrect assumptions about the client with ABI or because of unrealistic expectations of the setting. The Consultancy has developed a six-stage framework for the management of challenging behaviours that includes site visit, crisis management, engagement, intervention, education, and ongoing review. Case examples are used to illustrate each of these stages.

The potential role of supplementing sex steroids for the prevention and delay of age-related cognitive decline has received a great deal of recent interest. Although the biological plausibility of hormone treatment has received considerable support, clinical studies of cognitive functioning after hormonal treatment in postmenopausal women with and without dementia have produced mixed results. Much less attention has been given to the corresponding role of androgens in men. In order to establish the relevance of hormonal supplementation for men in delaying or preventing cognitive decline, it is of importance to evaluate both adrenal and gonadal contributions to androgen status. Additionally, consideration must also be given to the potential interactions of androgens with risk and protective factors (e.g., apolipoprotein E genotype and education). Here we review experimental and epidemiological studies of the significance of androgens for cognitive function.

Qualitative aspects of verbal fluency may be more useful in discerning the precise cause of any quantitative deficits in phonetic or category fluency, especially in the case of mild cognitive impairment (MCI), a possible intermediate stage between normal performance and Alzheimer's disease (AD). The aim of this study was to use both quantitative and qualitative (switches and clusters) methods to compare the phonetic and category verbal fluency performance of elderly adults with no cognitive impairment (n = 51), significant memory impairment (n = 16), and AD (n = 16). As expected, the AD group displayed impairments in all quantitative and qualitative measures of the two fluency tasks relative to their age- and education-matched peers. By contrast, the amnestic MCI group produced fewer animal names on the semantic fluency task than controls and showed normal performance on the phonetic fluency task. The MCI group's inferior category fluency performance was associated with a deficit in their category-switching rate rather than word cluster size. Overall, the results indicate that a semantic measure such as category fluency when used in conjunction with a test of episodic memory may increase the sensitivity for detecting preclinical AD. Future research using external cues and other measures of set shifting capacity may assist in clarifying the origin of the amnestic MCI-specific category-switching deficiency.

Many individuals require long-term community-based support following acquired brain injury (ABI). However, very few studies have examined individuals' perceptions of these support needs. The present exploratory study examined individuals' perceptions of community-based support following severe ABI. Participants included eight individuals (aged 20–48 years) with severe ABI, seven relatives and three case managers. The individuals were receiving long-term specialised lifestyle support ranging from 3–70 hours per week. A structured interview with open and closed questions was developed to explore perceptions of individuals' support needs across the areas of personal and home-based activities, community-based activities, self-organisation and vocational activities and social and psychological well-being. The questions investigated whether support was needed, the importance of support, the sources of support, the effectiveness of support and the need for change. A comparison of the three respondent groups' perceptions of support indicated a general consensus that community-based activities were the most important and most effective area of support. When the issues raised by the three respondent groups were compared and contrasted two main themes emerged from the data, which were labelled “relationships” and “individual choice versus support needs”. These themes are discussed in relation to the provision of long-term community-based support services following ABI.

The present study investigated the relationship between anosognosia for cognitive, functional and psychopathological disorders in Alzheimer's disease (AD) and vascular dementia (VD). Ten patients with probable Alzheimer's disease and 10 patients with probable vascular dementia were matched for age, education, illness duration and dementia severity. Cognitive, functional and psychopathological characteristics of the patients were assessed by means of different self-rating scales. The same questionnaires were submitted to patients' caregivers, blind to the patients' answers. Anosognosia was defined as the positively signed difference between patients' and caregivers' ratings. Three anosognosia indices for each domain investigated were obtained. We found lack of insight to be a common and consistent feature of AD and VD. However, unawareness for cognitive and functional domains was more severe in AD than in VD. Furthermore, in AD patients anosognosia for cognitive, functional and psychopathological domains dissociated from one another, as shown by lack of significant correlations between the three indices. Conversely, in VD patients these three anosognosic domains were closely related, indicating a generalised unawareness. These findings suggest that heterogeneity of anosognosic deficits may help differentiate AD from VD.