Source 1

Source number: 1

AMA Citation: Damasio H, Grabowski T, Frank R, Galaburda AM, Damasio AR. The
Return of Phineas Gage: Clues About the Brain from the Skull of a Famous Patient.
antoniocasella. May 20, 1994. Available at
http://www.antoniocasella.eu/dnlaw/Damasio_1994.pdf. Accessed September 1, 2016

Source Validation: The article was found using Google Scholar. Hanna Damasio is a
leading scientist in the field of Cognitive Neuroscience, and her spouse Antonio Damasio
is a professor of neuroscience at the University of Southern California and an Adjunct
Professor at the Salk Institute. The other authors of the articles also have doctorates in
various fields.

How I found this source:I found this source through google scholar. While I did not
search up Nervous System Injuries but instead searched up a specific case related to my
topic, which brought me to studies surrounding the cases.

Audience: The audience of the source was geared towards an older and more educated
audience as it used many scientific terms that only people with a medical background
would understand.

Quotes:
o Our own interest in the case grew out of the idea that Gage exemplified a
particular type of cognitive and behavioral defect caused by damage to ventral
and medial sectors of prefrontal cortex, rather than to the left dorsolateral sector
as implicit in the traditional view.
o The assignment of frontal regions to different cognitive domains is compatible
with the idea that frontal neurons in any of those regions may be involved with
attention, working memory, and the categorization of contingent relationships
regardless of the domain.
o That it had damaged the left prefrontal cortex, and that such damage probably
explained Gages behavioral defects, which he aptly described as a mental
degradation.

Source 2

Source number: 2

AMA Citation: Neylan TC. Frontal Lobe Function: Mr.Phineas Gages Famous Injury.
Neuropsychiatry Classics. Spring 1999. Available
athttp://neuro.psychiatryonline.org/doi/pdf/10.1176/jnp.11.2.280. Accessed September 1,
2016

Source Validation: The article was found using Google Scholar, which makes it a
credible source. The author Thomas C. Neylan is also a professor at the University of
California San Francisco and has published multiple articles regarding neuropsychiatry.

How I found this source: I found this source by searching up a famous case surrounding
the topic of how nervous system injuries affect personality and behavior. Instead of
directly searching up nervous system injuries effect I searched up Phineas Gage
because I assumed there would be a lot more articles written about him right after the
incident occured. Since the case deals almost directly with my topic, the science behind
studies surrounding Phineas Gage held up to my topic as well.

Audience: The audience of the source was geared towards an older and more educated
audience as it used many scientific terms that only people with a medical background
would understand.

Quotes:
o Taking a direction upward and backward toward the median line, it penetrated
the integuments, the masseter and temporal muscles, passed under the zygomatic
arch, and (probably) fracturing the temporal portion of the sphenoid bone, and the
floor of the orbit of the left eye, entered the cranium, passing through the anterior
left lobe of the cerebrum, and made its exit in the median line, at the junction of
the coronal and sagittal sutures, lacerating the longitudinal sinus, fracturing the
parietal and frontal bones extensively, breaking up considerable portions of brain,
and protruding the globe of the left eye from its socket, by nearly one half its
diameter.

o driving the iron against the left side of the face, immediately anterior to the angle
of the inferior maxillary bone. This quote was describing the way the rod entered
his skull. Perhaps this will give insight on brain function and personality based on
how and where it entered.
o The end of the article is a transcript of what Dr. John Harlow witnessed days
following the accident. Doctor Harlow was the doctor looking over Gage after the
accident. While doing so, he documented all of Gages behaviors through his stay.
The end of the article is a detailed description of what Harlow saw, from the
changes in behavior to his delusions.

Source 3

Source Number: 3
AMA Citation: Stone J, Townend E, Kwan J, Haga K, Dennis MS, Sharpe M.
Personality change after stroke: some preliminary observations. Journal of Neurology,

Neurosurgery & Psychiatry. 2004;75(12):1708-1713. doi:10.1136/jnnp.2004.037887.

Source Validation: The paper was published in the Journal of Neurology, Neurosurgery

& Psychiatry and was found through google scholar.

How did you find this source: I found the source through google scholar. I searched up
the effects of strokes on personality because strokes are a very common occurrence
meaning there would be a lot more studies on this topic. In addition, through my summer
reading novel I learned that strokes can actually have drastic effects on a persons

personality.
Intended Audience: I believe the intended audiences of this paper are neuroscientists,
and potentially family or friends of stroke victims. The paper includes a lot of
experimentations around the topic which can be useful for scientists. The loved ones of
stroke victims might find the article useful because it provides the effects of strokes on a

persons personality.
Arguments: The paper was published more as a scientific experiment rather than an
actual article. For the most part, it remains unbiased in its studies. The authors of the
article sought to find the correlation between perceived personality change and strokes
through ratings by the caretaker. The patients that participated in the study had to go
through many measures to ensure that the study was as accurate as possible. Those who
suffered a very severe stroke, measured using the National Institute of Health stroke
score, were dismissed from the study. Those who were suffered from dementia, or had
communication disorders were also excluded from the study. The patients who were not
part of these groups had to go through further screening in order to assure that they were
mentally stable and living with a care taker. At the end of the study the conclusion was
not definite as only 31 of the initial 121 patients made it to the end of the 9 month study.
The scientists concluded that the care takers perception of change varied based on how

the care taker felt, however, disregarding this, most of the perceived changes seem to be

negative.
Quotes:
o The overall clinical problem of personality change after stroke has received
virtually no attention, although many of its likely constituents such as emotional
disorder, cognitive impairment, and brain injury related changes in behaviour
have been studied individually.
o In our study there were significant negatively perceived changes in the carers
perception of characteristics such as frustration, dissatisfaction, unhappiness,
worrying, patience, and being in control, energetic, confident, and easy going.
o Emotional disorder, disability, and cognitive impairment are likely to be
important components of personality change. However, it also appears to be
particularly important to consider the role of the carer factors such as emotional
distress as potentially magnifying perceptions of personality change

Source 4

Source Number: 4
AMA Citation: Brooks DN, Mckinlay W. Personality and behavioural change after
severe blunt head injury--a relative's view. Journal of Neurology, Neurosurgery &
Psychiatry. 1983;46(4):336-344. doi:10.1136/jnnp.46.4.336.

Source Validation: This paper was published in the Journal of Neurology, Neurosurgery
& Psychiatry, a valid journal and credible journal used by many neuroscientists and

doctors. I also found the paper through google scholar.

How did I find this source: I found this source when I looked up personality change
injuries on google scholar. This resulted in many articles related to my topic but I chose

this one specifically because it is dealing with external injuries rather than internal.
Intended Audience: I believe the intended audiences of this paper are neuroscientists,
and potentially family or friends of victims that suffered from external brain injuries. The
paper includes a lot of experimentations around the topic which can be useful for
scientists. The loved ones of these victims might find the article useful because it

provides the effects of external injuries on a persons personality.

Arguments: This paper was published as a scientific experiment rather than an article.
This paper was in fact very similar to the paper published about personality change after
strokes. The experiments were similarly conducted and the results yielded were similar as
well. In this experiment, the author sought to find a correlation between blunt force
injuries on the head and personality change. The experiment they conducted involved
asking relatives a series of questions based on the patients personality before and after
the injury occurred. The severity was rated in terms of duration of post traumatic
amnesia, and not by a certain scale or measurement, while the personality change was
measured through a series of numbers indicating relatively unnoticeable amount of
change to major change. The results, surprisingly, concluded that the severity of injury
does not affect the severity of personality change. This study also concluded that most of
the changes that do occur were negative changes. These results fall in line with the

previous experiment.
Quotes:
o there was therefore no association between severity of injury and the magnitude
of scores on any of the personality adjectives with the first year of injury.
o even in those cases where the relative does not judge there to be an overall
personality change, patients are still seen to have increased difficulty in emotional
control, together with a general reduction in energy and enthusiasm
o In those patients whom the relatives described as having shown personality
change, the changes were in a negative direction, with reduced self reliance,

reduced sensitivity, and increased irritability being strikingly evident even at 3

months after injury

Source 5

Source 5
AMA: Penke L, Denissen JJA, Miller GF. Erratum: The evolutionary genetics of
personality. Eur J Pers European Journal of Personality. 2007;21(5):i-i.
doi:10.1002/per.656.

Source Validation: I found the article through google scholars and it is published in the

European Journal of Personality, which is cited by many sources.

How I find this source: I found this source when I searched up, how personality

develops on google scholar.

Intended Audience: The intended audience for this article is people who are studying
personality. It is a published article in the European Journal of Personality and has many

useful information about the topic.

Arguments: According to psychology professor Lars Penke, in the early years of
examining personality, scientists studied the link between genetics and personality
through a series of experiments involving twins and siblings. While blood siblings share
roughly 50% of genetics, identical twins share nearly 100%. According to these studies,
there were a much higher correlation between the personalities of the twins than the
siblings. The scientists then concluded that when it comes to personality, genetics has a
huge impact. The question then arises, is there a personality gene? This is where it gets
difficult. After years of studies, scientists concluded that personality was too complex of a
trait for genetics to be the only factor. Another aspect that Penke talked about was how
Darwins evolutionary theory played a role in personality development. This means that
natural selection does not apply to personality if there is no environmental heterogeneity.

Quotes
o It is not enough for a trait to be neutral in some environments or during some
periods, because selection is very efficient at favoring polymorphism with higher
average fitness outcomes across all relevant environments. Only a fully balanced
effect of different alleles across space and time will work to maintain genetic
variations
o The article discussed twin studies conducted in the earlier years of personality
studies. The twin studies concluded that twins have a much more similar
personality than regular siblings due to their genes being 100% identical.
o We argue that the classical distinction between cognitive abilities and personality
traits is much more than just a historical convention or a methodological matter of
different measurement approaches (Cronbach, 1949), and instead reflects different
kinds of selection pressures that have shaped distinctive genetic architectures for
these two classes of personality differences.

Source 6

Source: 6
AMA Citation: Tang TZ, Derubeis RJ, Hollon SD, Amsterdam J, Shelton R, Schalet B.
Personality Change During Depression Treatment. Arch Gen Psychiatry Archives of

General Psychiatry. 2009;66(12). doi:10.1001/archgenpsychiatry.2009.166.

Source Validation: This article was found on google scholar, so it is a valid source. It is
also cited by multiple sources.

How I found this Source: I found this source when I looked up personality change on
google scholar. I chose this article to see if there are any chemical changes involved that

can cause personality change.

Intended Audience: The intended audiences of this paper are neuroscientists and people
who are studying the chemical changes of personality change. The paper explains with

great detail the results and procedures of the experiment.

Arguments: The article discusses an experiment that tested paroxetine and CTs effect
on personality. It talks about how extroversion and neuroticism are correlated to
depression and how paroxetine and CT (Cognitive Therapy) treat depression. The
experiment was a self-reported, randomized, and placebo- controlled clinical trial. There
were a total of 240 participants, a quarter of which received placebos. Depression was
measured with the HAM-D, which is a widely used diagnostic for depression. At the end
of the experiment, they expected a much more noticeable change in personality with the
people taking placebo pills than with the people being treated actual treatments. The
results showed that the neuroticism score (tendency to experience negative emotions) did
not change at all. They concluded that the personality change might have been a result of

either a third variable or by reverse causation.

Quotes:
o Paroxetine appears to have a specific pharmacological effect on personality that
is distinct from its effect on depression. If replicated, this pattern would
disconfirm the state effect hypothesis and instead support the notion that SSRIs
effects on personality go beyond and perhaps contribute to their antidepressant
effects.
o The state effect hypothesis exemplifies one causal interpretation of the
correlation between depression and personality: depression improvement directly
causes personality change. The cause-correction model integrates the 2 other
possible causal interpretations, which in the context of our findings would be (1)
reverse causation (personality change caused depression improvement) and (2)
causation by a third variable (changes in underlying neurobiological factors
caused both depression improvement and personality change).
o Cognitive therapy did not produce greater change in neuroticism than placebo
after controlling for change in depression, and neuroticism improvement during
CT did not predict subsequent relapse as it did among paroxetine responders

Source 7

Source: 7
AMA Citation: Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E.
Cognitive impairment after stroke: frequency, patterns, and relationship to functional
abilities. Journal of Neurology, Neurosurgery & Psychiatry. 1994;57(2):202-207.

doi:10.1136/jnnp.57.2.202.
Source Validation: This source is found through PubMed, a reliable medical database
used by medical professionals for research. It was also published in the Journal of

Neurology, Neurosurgery & Psychiatry.

How did I find this source: I found this source by searching up cognitive impairment
after stroke on PubMed, a medical database recommended to me by my outside mentor.

Intended Audience: The audiences for this article are people who are studying the
effects of strokes on cognitive functions and potentially family members of victims who

are trying to learn more.

Arguments: The article is detailing an experiment performed to see the relationship
between strokes and functional abilities. The experiment was conducted with elderly
patients over the age of 60 who have suffered an acute ischemic stroke in the 30 days
prior to the experiment. The patients were dismissed if certain clinical features
prevented a reliable assessment of neuropsychological function. They conducted several
neuropsychological and functional assessments to test for things such as memory,
orientation, recognition, repetition and attention. They then correlated the scores of these
tests with the severity and classification of the stroke. They found out that the most
significant areas of impairment for stroke victims were memory, orientation, language

and attention.
Quotes:
o The fi values and corresponding odds ratios may be interpreted as the risk of
impairment on those test items associated with stroke compared with subjects free
of stroke. When these test items were summarized into cognitive domains, the
most significant areas of impairment were memory, orientation, language, and
attention
o Comparing left-sided, right-sided and vertebrobasilar strokes, left-sided damage
was more common among those with cognitive impairment (46&3%) compared
with those without (30-6%) (x2, p < 0.001).
o Using a logistic model to identify the neuropsychological correlates
independently associated with stroke compared with control status, impairment in
the following tests was more likely to be associated with stroke.

Source 8

Source: 8
AMA Citation: Kinnunen KM, Greenwood R, Powell JH, et al. White matter damage
and cognitive impairment after traumatic brain injury. Brain. 2010;134(2):449-463.

doi:10.1093/brain/awq347.
Source Validation: The source is published by medical professionals in the Oxford

Journal of Neurology.
How did I find this source: I found this source through google scholar by searching up

cognitive impairment after injury.

Intended Audience: The audiences for this article are people who are studying the
effects of traumatic brain injuries on cognitive functions and potentially family members

of victims who are trying to learn more.

Arguments: The article discusses an experiment performed to see the correlation
between white matter damage and cognitive impairment after a traumatic brain injury.

The experiment included investigating differences in white matter structure in a group of

patients who have recently suffered from traumatic brain injury. They tested if the white
matter structure had any correlation with memory, executive function and information
processing speed. They concluded that white matter structure did indeed have a
correlation with memory but not with information processing speeds or executive
function. They also found out that white matter structure changes after traumatic brain

injury.
Quotes:
o Comparison of patients with traumatic brain injury and age-matched controls
revealed that the majority of the white matter showed some evidence of disruption
in the traumatic brain injury group.
o This is likely to be because damage to brain connectivity is a critical factor in the
development of cognitive impairment after traumatic brain injury. Functions
commonly impaired, such as memory and executive functions, depend on the
coherent activity of widely distributed brain networks
o Traumatic brain injury produces a complex pattern of diffuse axonal injury at
variable locations across individuals and so it is difficult to decide a priori where
to look for the white matter disruption.

Source 9

Source: 9
AMA Citation: Bu W, Ren H, Deng Y, et al. Mild Traumatic Brain Injury Produces
Neuron Loss That Can Be Rescued by Modulating Microglial Activation Using a CB2
Receptor Inverse Agonist. Frontiers in Neuroscience. 2016;10.

doi:10.3389/fnins.2016.00449.
Source Validation: The source is published by medical professionals in the frontiers of

neuroscience journal.
How did I find this source: I found this source through pubmed by searching up brain

injury treatment.
Intended Audience: The audiences for this article are people who are studying the
effects of traumatic brain injuries on cognitive functions and potentially family members

of victims who are trying to learn more how to treat them.

Arguments: The article discusses an experiment performed to see the correlation
between neuron loss and modulating microglial activation using a CB2 receptor. Prior to
the experiment, they reported that mild traumatic brain injuries create widespread axonal
injury, microglial activation and several functional deficits. During the experiment, they

utilized mice as the test subjects instead of humans, and from the experiments they found
out that SMM-189 treatment reduced fearfulness in rats. This in turn rescued damaged
neurons and alleviated functional deficits. From this they concluded that CB2 inverse

agonists are a promising approach for neurodegeneration.

Quotes:
o BLA is composed primarily of Thy1+ and Thy1-negative pyramidal neurons,
with several types of interneurons making up the remaining 10% of the total
neuronal population
o We have previously reported that our model of mild TBI produces diffuse axonal
injury, as evidenced by the presence of swollen axonal bulbs at a few days, and
degenerating axons at 12 weeks after blast
o The observed neuronal loss in our study was not obviously localized to a
restricted region and was not evident without stereological neuron counts. It thus
seems unlikely that neuronal loss occurred disproportionately in a particular
region
o observed that mild TBI results in a loss of Thy1+ neurons

Source 10

Source: 10
AMA Citation: Marion DW. Treatment of Traumatic Brain Injury With Moderate
Hypothermia. Journal of Neurosurgical Anesthesiology. 1998;10(1):55-56.

doi:10.1097/00008506-199801000-00013.
Source Validation: The source is published by medical professionals in the Journal of
Neurosurgical Anesthesiology. It was also published in the New England Journal of

Medicine.
How did I find this source: I found this source through google scholar by searching up

brain injury treatment.

Intended Audience: The audiences for this article are people who are studying the
effects of traumatic brain injuries on cognitive functions and potentially family members

of victims who are trying to learn more how to treat them.

Arguments: The article discusses an experiment performed to see how hypothermia
could limit some of the detrimental effects of traumatic brain injuries. In the experiment,
they compared the effects of hypothermia and normothermia in 82 patient who have
recently suffered from traumatic brain injuries. The patients were evaluated 3, 6 and 12
months after the treatment. The results showed that the patients in the hypothermia group
had a better outcome than the normothermia groups. From this, they concluded that

treatment with moderate hypothermia decreases some of the effects of traumatic brain

injuries.
Quotes:
o Traumatic brain injury initiates several metabolic processes that can exacerbate
the injury. There is evidence that hypothermia may limit some of these deleterious
metabolic responses.
o Treatment with moderate hypothermia for 24 hours in patients with severe
traumatic brain injury and coma scores of 5 to 7 on admission hastened
o

neurologic recovery and may have improved the outcome.

The hypothermia group had a lower mean intracranial pressure, cerebral blood
flow, and heart rate and a higher mean cerebral perfusion pressure