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Moderate-to-severe traumatic brain injury (M/S TBI) is a growing public health concern with significant impact on the cognitive functioning of survivors. Cognitive control and deficits in awareness have been linked to poor recovery and rehabilitation outcomes. One way to research cognitive control is through awareness of errors using electroencephalogram and event-related potentials (ERPs). Both the error-related negativity and the post-error positivity components of the ERP are linked to error awareness and cognitive control processes. Attentional capacity and levels of apathy influence error awareness in those with M/S TBI. There are strong links between awareness, attention, and apathy. However, limited research has examined the role of attention, awareness, and apathy using electrophysiological indices of error awareness to further understand cognitive control in a M/S TBI sample. The current study sought to elucidate the role of apathy in error awareness in those with M/S TBI. Participants included 75 neurologically-healthy controls (divided randomly into two control groups) and 24 individuals with M/S TBI. All participants completed self-report measures of mood, apathy, and executive functioning, as well as a brief neuropsychological battery to measure attention and cognitive ability. To measure awareness, participants completed the error awareness task (EAT), a modified Stroop go/no-go task. Participants signaled awareness of errors committed on the previous trial. The M/S TBI group decreased accuracy while improving or maintaining error awareness compared to controls over time. There were no significant between-group differences for ERN and Pe amplitudes. Levels of apathy in the M/S TBI group were included in three multiple regression analyses predicting proportion of unaware errors, ERN amplitude, and Pe amplitude. Apathy was predictive of error awareness, although not in the predicted direction. Major analyses were replicated using two distinct control groups to determine potential sample effects. Results showed consistent results comparing both control groups to a M/S TBI group. Findings show variable levels of awareness and accuracy over time for those with M/S TBI when compared to controls. Conclusions include varying levels of attention and awareness from the M/S TBI group over time, evidenced by improving awareness of errors when they are happening, but an inability to regulate performance sufficiently to improve accuracy. Levels of apathy are playing a role in error awareness, however, not in predicted directions. The study provides support for the role of attentional impairments in error awareness and encourages future studies to look for varying levels of performance within a given task when using populations linked to elevated levels of apathy and attentional deficits.

Die zugrunde liegenden Prozesse altersbedingter Veränderungen exekutiver Funktionen werden vielfach untersucht. Für eine flexible Anpassung ist die Überwachung von Handlungen und deren Konsequenzen notwendig. Handlungsüberwachung wird mit ereigniskorrelierten Potentialen (EKP) wie der error-related negativity/error negativity (ERN/Ne) und der correct-related negativity/correct negativity (CRN) gemessen. Die Arbeit untersucht die Handlungsüberwachung bei jüngeren und älteren Erwachsenen mit dem Ziel, das Wissen über kompensatorische Strategien bei Älteren und deren Auswirkung auf die EKP Befunde zu erweitern. Ältere zeigten reduzierte ERN/Ne und größere oder vergleichbar große CRN Amplituden im Vergleich zu Jüngeren. Während nur die Jüngeren eine Reduktion der ERN/Ne mit größerer Aufgabenschwierigkeit zeigten, zeigten beide Gruppen eine ERN/Ne Reduktion unter der Instruktion, die Geschwindigkeit anstatt Genauigkeit erforderte. Nur bei Jüngeren variierte die CRN mit der Kompatibilität der Trials, mit der Aufgabenschwierigkeit und Instruktion. Ältere wiesen geringere Fehlerraten und längere Reaktionszeiten als Jüngere auf. Dieses Muster deutet auf eine kompensatorische oder strategische Anpassung in Folge von Defiziten in der Nutzung einer erfolgreichen Kombination von proaktiver und reaktiver Kontrolle hin. Es wird postuliert, dass ERN/Ne und CRN einen gemeinsamen Prozess darstellen, der allgemeine Überwachungsfunktionen reflektiert. Die ERN/Ne beinhaltet zusätzlich einen Prozess, der Fehlerüberwachung signalisiert. Daraus ergibt sich die Vermutung, dass die reduzierte ERN/Ne bei Älteren entweder auf eine Verringerung spezifischer Fehlerprozesse oder auf eine Beeinträchtigung allgemeiner Überwachungsfunktionen zurückzuführen ist. Altersbezogene Veränderungen der EKP Befunde könnten den veränderten Einsatz von kompensatorischer Kontrolle bei Älteren im Vergleich zu Jüngeren reflektieren. Dieser Frage sollte in zukünftigen Studien nachgegangen werden. / Executive functions decline with age and a growing body of research aims at investigating age-related changes of the underlying processes. One important function is to monitor actions and action outcomes, which is necessary for flexible adjustments and learning. This so-called performance monitoring can be measured with event-related potentials (ERP), namely the error-related negativity/error negativity (ERN/Ne) and the correct-related negativity/correct negativity (CRN). This work examined performance monitoring in younger and older adults with the aim to advance knowledge about compensatory strategies in older adults and their implications for ERP results. Findings revealed reduced ERN/Ne and larger or similar-sized CRN in older compared to younger adults. While only younger adults showed a decrease of ERN/Ne with higher task difficulty, both age groups showed a reduction of ERN/Ne in the speed compared to the accuracy condition. Additionally, only younger adults showed variations, in that the CRN was smaller for compatible compared to incompatible trials, in the easy compared to the difficult condition, and in the speed compared to the accuracy condition. Behaviorally, older adults had less errors and longer response latencies than younger adults. This pattern may reflect compensatory or strategic adjustments with age which may be due to deficits in the use of a successful combination of proactive and reactive control. It was further assumed that ERN/Ne and CRN share a common process that reflects general monitoring functions and ERN/Ne includes an additional process that reflects error-specific monitoring. Accordingly, the ERN/Ne attenuation in older adults is either caused by reduced error-specific processing or compromised general monitoring functions. Age-related changes in ERP findings indicate altered engagement of compensatory cognitive control in older compared to younger adults. However, this question has to be further clarified in future studies.