9 neuropsychology

Question 1

What is neuropsychology?

Answer 1

• spepcialisation of clinical psychology (country dependant)
• recent and rapidly growing speciality field
• relationship between brain and behaviour/cognition
• linked to cognitive psych, neuroscience

Question 2

What are the main statistics of the brain?

Answer 2

weights 3pounds
60% fat
40% carbohydrates, water, protein, salts

contains blood vessels and nerves

Question 3

What is gray and white matter?

Answer 3

gray matter -> outer portion, neuron somas (cell bodies)
- processing and interpreting info

white matter -> inner portion, axons (connecting neurons)
-> transmission of information

Question 4

What function does the cerebellum have?

Answer 4

movement
balance

Question 5

What function does the brainstem have?

Answer 5

connects cerebrum with spinal cord

midbrain
pons
medulla

Question 6

What function does the midbrain have?

Answer 6

The midbrain (or mesencephalon) is a very complex structure with a range of different neuron clusters (nuclei and colliculi), neural pathways and other structures. These features facilitate various functions, from hearing and movement to calculating responses and environmental changes. The midbrain also contains the substantia nigra, an area affected by Parkinson’s disease that is rich in dopamine neurons and part of the basal ganglia, which enables movement and coordination.

Question 7

What function does the pons have?

Answer 7

The pons is the origin for four of the 12 cranial nerves, which enable a range of activities such as tear production, chewing, blinking, focusing vision, balance, hearing and facial expression. Named for the Latin word for “bridge,” the pons is the connection between the midbrain and the medulla.

Question 8

What function does the medulla have?

Answer 8

At the bottom of the brainstem, the medulla is where the brain meets the spinal cord. The medulla is essential to survival. Functions of the medulla regulate many bodily activities, including heart rhythm, breathing, blood flow, and oxygen and carbon dioxide levels. The medulla produces reflexive activities such as sneezing, vomiting, coughing and swallowing.

Question 9

What is the cerebrum?

Answer 9

cerebrum = most higher cognitive functions, bodily functions, …

cerebral cortex = outer gray matter covering the cerebrum
- divided into two hemispheres
- ridges (gyri) and folds (sulci)
- hemispheres communicate through corpus callosum

Question 10

What function does the frontal lobe have?

Answer 10

The largest lobe of the brain, located in the front of the head, the frontal lobe is involved in personality characteristics, decision-making and movement. Recognition of smell usually involves parts of the frontal lobe. The frontal lobe contains Broca’s area, which is associated with speech ability.

Question 11

What function does the parietal lobe have?

Answer 11

The middle part of the brain, the parietal lobe helps a person identify objects and understand spatial relationships (where one’s body is compared with objects around the person). The parietal lobe is also involved in interpreting pain and touch in the body. The parietal lobe houses Wernicke’s area, which helps the brain understand spoken language.

Question 12

What function does the occipital love have?

Answer 12

vision

Question 13

What function does the temporal lobe have?

Answer 13

short-term memory, speech, musical rhythm and some degree of smell recognition.

Question 14

What function does the hypothalamus have?

Answer 14

It regulates body temperature, synchronizes sleep patterns, controls hunger and thirst and also plays a role in some aspects of memory and emotion

part of the limbic system
hormone control
homeostasis

Question 15

What function does the amygdala have?

Answer 15

part of the limbic system
emotion
stress, fear
reward system
memory

Question 16

What function does the hippocampus have?

Answer 16

memory (new neurons), learning, navigation, perception of space

Question 17

What are the pituitary gland and the pineal gland?

Answer 17

hormone flow

light/dark -> secretes melatonin

Question 18

How does the brain get supplied with blood?

Answer 18

external carotid arteries extend up the sides of the neck
branch into the skill and circulate blood to the front part of the brain

vertebral arteries follow the spinal column into the skull and supply blood to the rear portions of the brain

circle of willis is a loop of blood vessels at the bottom of the brain
-> blood circulation

Question 19

What are the twelve cranial nerves?

Answer 19

1. olfactory nerve
2. optic nerve
3. oculomotor nerve
   -> pupil response and other eye movements
4. trochlear nerve
   -> eye muscle control
5. trigeminal nerve
   -> largest and most complex
   -> sensory and motor functions
6. abducens nerve
   -> innervates eye muscles
7. facial nerve
   face movement, taste, glandular function, …
8. vestibulocochlear nerve
   -> balance and hearing
9. glossopharyngeal nerve
   -> taste, ear, throat movement, …
10. vagus nerve
    -> sensation around the ear and digestive system
    motor activity
11. accessory nerve
    -> innervates muscles in head, neck, shoulder
12. hypoglossal nerve
    -> motor activity to tongue

Question 20

What is neurorehabilitation?

Answer 20

process
focus on disability = functional activities limitation
optimise functioning and minimise distress
need to be holistic
multidisciplinary

Question 21

What are different approaches to neurorehabilitation?

Answer 21

restorative
-> priming
-> task-specific

compensatory
-> modification of environment
-> internal strategies
-> aids and appliance

Question 22

What is neuropsychological assessment?

Answer 22

NA is a performance based method to assess cognitive functioning

examine cognitive consequences of brain damage

despite neuroimaging, NA will continue to be used
→ brain lesions + normal cognitive functioning
→ no lesions + substantial cognitive limitations

Question 23

What is a meaningful cognitive deficit?

Answer 23

average or composite score across multiple ability areas provides an overall index of how well a person functions cognitively at the current time

widely accepted rule of for a clinically meaningful difference between two ability areas is about one-half of a standard deviation.

changes seen in many neuropsychiatric conditions are much more substantial than this 0.5 SD threshold

Question 24

What is a traumatic and non-traumatic cognitive deficit?

Answer 24

caused by and external force, either penetrating or non-penetrating

caused by internal factors (toxins, tumor, stroke, substance abuse, lack of O2)

Question 25

What are some difficulties in assessing cognitive deficits?

Answer 25

within-individual variation
→ reliability of the measures, the normative standards for the measures, and the level of performance of the individual

co-normed (single sample, or separate)

extremes in performance

Question 26

What information can be obtained from neuropsychological assessment?

Answer 26

Situations where an illness or injury has the potential to adversely impact on cognitive functioning is one where neuropsychological assessment is indicated

→ degenerative diseases, traumatic brain injuries, chemotherapy (treatment of the illness impacts cognition)

→ secondary changes by mood and motivation changes

Question 27

What is a straightforward diagnosis in NA?

Answer 27

• some conditions are defined by the presence of cognitive impairment
• dementia, postconcussion syndrome, mental retardation

Question 28

What is a differential diagnosis in NA?

Answer 28

• rule out presence of certain conditions
• much more challenging
• for many conditions there is very little differential diagnostic information contained in a neuropsychological assessment that even allows for differentiation between healthy populations and patients with a variety of neuropsychiatric conditions (data until 1997)
• difference between differential diagnosis and statistical significant difference
  average difference of 2.5 SD is required

Question 29

How can predictions of functional potential be made?

Answer 29

association between cognitive performance and achievements and everyday functioning

• reduced cognitive impairment post TBI predicts greater potential
• progression of cognitive impairment leads to functional decline in AD, PD, …
• cognitive impairments predict deficits in schizophrenia
• cognitive impairments in schizophrenia and bipolar disorders have nearly identical relationships with everyday functioning
• cognitive impairments in PD are associated with functional deficits consistent with dementia

Question 30

How can treatment response be measured?

Answer 30

reliable change index method RCI
→ adjusts for expected practice effects and unreliability of measures to develop an index of change
- the lack of definitive information as to how much change is required to be important
- how much worsening due to illness or injury is significant

clinical correlations of imaging findings
- deriving explanations for conditions from the physical manifestations

Question 31

What is neurocognitive testing?

Answer 31

measure brain function non-invasively

not asking, giving specific tests

measuring subtle aspects of brain function, researchers and clinicians can get a powerful microscope into what’s happening under the hood

standardised way of getting a snapshot of your health

it doesn’t take much time to complete, and unlike brain scans that are very costly, or surgeries that involve risks, this kind of testing can be done at a desk or on a tablet.

Question 32

What are common domains of neuropsychological assessment?

Answer 32

Sensation
Perception
Motor skills and construction
Attention and concentration
Memory
Executive functioning
Processing speed
Language/verbal skills

Question 33

What is the difference between sensation and perception?

Answer 33

Sensation = ability of a person to detect a stimulus in one of the five sensory modalities
visual, auditory, tactile, gustatory, and olfactory senses

Perception = ability to identify a meaningful stimulus, processing sensory information

Question 34

What sensational or perceptional deficits can occur?

Answer 34

• blindness, deafness
  → illnesses, experiences, trauma, congenital abnormalities
• agnosia = inability to recognise previously identifiable objects, sounds, smells, tastes

→ multiple subtypes
inability to perform sensory-specific recognition, spatial stimuli

Question 35

How can motor skills be assessed?

Answer 35

different basic elements of motor activity:
fine motor abilities, including manual dexterity and motor speed, reaction time, balance

finger tapping, pegboard tasks, both simple and grooved, and assessments of grip strength

Construction = ability to copy or produce drawings of common objects

Rey Complex Figure
Mini-Mental State Examination
Montreal Cognitive Assessment

Question 36

what is selective attention?

Answer 36

SelA - attending to information that is relevant and important, ignoring other nonrelevant information

global-local tasks
two concurrent information streams (attentional control)

automaticity - without apparent resource costs

Question 37

What is sustained attention?

Answer 37

SusA - concentration

detection of simple stimuli, presented infrequently in the midst of a stream of other stimuli
continuous performance task
missed target stimuli (errors of omission), and responses to nontarget stimuli (errors of commission)

Question 38

What neuropsychiatric conditions show attentional problems?

Answer 38

psychosis - errors of omission

ADHD - increases in errors of commission

Schizophrenia - fail to develop normal bias (responding to nontargets)
challenges in dual-task demands

Question 39

What is working memory?

Answer 39

hold info in consciousness for adaptive use
maintenance and manipulation of info
digit span task
mani: operating on information stored in working memory storage
digit span task - backwards
delayed response paradigms

Question 40

What is peisodic/declarative/explicit memory?

Answer 40

interacts with working memory storage processes to encode, maintain,
and retrieve information into and out of longer-term storage

Encoding
taking info contained in working memory and process it for longer term storage
listening to a list of words and recalling it later
semantic organisation, drawing and visualisation, implicit strategies
→ can all enhance memory abilities

Rey Auditory verbal Learning test (RAVLT)
California Verbal Learning test (CVLT)

Storage
retention of information after encoding
all info learned is stored
→ retrieval failures
brain change needs to happen so storage is affected

Question 41

What is procedural memory?

Answer 41

memory for motor actions or skills
AD - learn and retain procedural skills, not verbal information

Question 42

what is semantic memory?

Answer 42

process of long-term storage of verbal information
declarative memory system

Question 43

what is prospective memory?

Answer 43

remember to perform tasks in the future, medication, scheduled stuff, …
event-based and time-based
immediate and delayed response prospective memories

Question 44

What is executive functioning?

Answer 44

reasoning and problem solving

management of multiple cognitive abilities

ability that can be less affected by age as other cognitive functions

Question 45

How is processing speed assessed?

Answer 45

cognitive processing assessments that require rapid performance of tasks that range from very simple to complex

Scoring is often in terms of elapsed time or number of correct responses

this is most impaired in several neuropsychiatric conditions

cognitive speed is a prerequisite for many other functions

Question 46

What can be said about the validity of cognitive domains?

Answer 46

conventional domains of cognitive dysfunction are not truly separable

the larger the study of the factorial structure, the more likely it is that a single, global ability factor arises from factor analyses

Cognitive domains should not be viewed as lacking validity if they are intercorrelated

Finding a strong correlation between global executive functioning measures and other tasks that require executive control (eg, selective attention) is actually evidence of the validity of executive functioning.

Question 47

What are examples of NCTs?

Answer 47

• Flanker tast
  (arrow surrounded by congruent/incongruent arrows, need to say which direction the middle one points towards)
• Trail making
  (visual attention, task switching, click on numbers in the right order)
• Stroop task
  (name of a color has a different color)
• Coordination
  (keep waterbubble ball in a circle on a tablet)

Question 48

What are approaches of specific interventions for cognitive rehabilitation?

Answer 48

(1) reinforcing, strengthening, or reestablishing previously learned patterns of behavior;
(2) establishing new patterns of cognitive activity through compensatory cognitive mechanisms for impaired neurological systems;
(3) establishing new patterns of activity through external compensatory mechanisms such as personal orthoses or environmental structuring and support; and
(4) enabling persons to adapt to their cognitive disability, even though
it may not be possible to directly modify or compensate for cognitive impairments, in order to improve their overall level of functioning and quality of life. (Cicerone et al., 2000, pp. 1596-1597)

Question 49

What is the forced-use concept?

Answer 49

chronic deficits are in part because of learned disuse

Question 50

What is concextualised cognitive rehabilitation?

Answer 50

cognitive functions are contextualised not as isolated modules but as interactive with one another, with other aspects of intrapersonal function

Question 51

What creates treatment effects in the domain of attention?

Answer 51

functional skill training with gradually increasing demands on attention

not direct attention training!

Attention Process Training (APT)
hierarchy of exercises requiring attention skills that are hypothesised to be successively more difficult: sustained, selective, alternating, divided attention

time pressure management for speed of processing
generic concentration training method
planning ahead to prevent information overload

Question 52

What produces treatment effects in the domain of memory?

Answer 52

common functions that help with memory (reminder stuff)
external memory aids have strong evidence-support
acceptance of the need for these
education on how to use them effectively

memory functions cannot be restored through practice

mnemonic strategy = visual imagery

errorless learning - maximal cues during the process

routines!!

Question 53

What training enhances executive function?

Answer 53

Self-management training - self-reward, self-monitoring, …

Fleming and Ownsworth (2006) highlights the value of selecting key tasks and environments; providing clear feedback and structured learning experiences, including peer feedback via group therapy; and carefully considering the emotional consequences of improving self-awareness.

cognitive-affective regulatory processes that enable purposeful, goal-directed behaviour in complex social environments

Question 54

How can visuospatial function be restored?

Answer 54

most commonly left neglect

after stroke

neglect is primarily a disorder of visual attention, which might be overcome by teaching explicit strategies to direct visual attention toward left hemispace.

scanning to the left of their visual field

defective representation of space at the level of the neural substrate

Limb activation method - inducing active movements

prism adaptation method
wears lenses that shift the visual display toward the right field → adaptation → overrides it to interact with the environment correctly

Question 55

How can language be restored?

Answer 55

practice or stimulation

language therapies can produce strong treatment effects, dose-dependent

circumlocution - talking around words that cannot be retrieved

Question 56

what is comprehensive-holistic cognitive restoration?

Answer 56

These programs offered a variety of cognitive rehabilitation methods, including direct retraining of “core” functions such as attention, blended into a
therapeutic milieu emphasizing peer support and feedback, group as well as individual therapy, and family interventions. Vocational training was also
included, first in “protected” work trials to maximize success.

group or milieu treatment model

for people with chronic limitations who have derived maximum benefit from discipline-specific therapies and need additional help resuming a productive lifestyle.