9 neuropsychology Flashcards
What is neuropsychology?
- spepcialisation of clinical psychology (country dependant)
- recent and rapidly growing speciality field
- relationship between brain and behaviour/cognition
- linked to cognitive psych, neuroscience
What are the main statistics of the brain?
weights 3pounds
60% fat
40% carbohydrates, water, protein, salts
contains blood vessels and nerves
What is gray and white matter?
gray matter -> outer portion, neuron somas (cell bodies)
- processing and interpreting info
white matter -> inner portion, axons (connecting neurons)
-> transmission of information
What function does the cerebellum have?
movement
balance
What function does the brainstem have?
connects cerebrum with spinal cord
midbrain
pons
medulla
What function does the midbrain have?
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.
What function does the pons have?
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.
What function does the medulla have?
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.
What is the cerebrum?
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
What function does the frontal lobe have?
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.
What function does the parietal lobe have?
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.
What function does the occipital love have?
vision
What function does the temporal lobe have?
short-term memory, speech, musical rhythm and some degree of smell recognition.
What function does the hypothalamus have?
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
What function does the amygdala have?
part of the limbic system
emotion
stress, fear
reward system
memory
What function does the hippocampus have?
memory (new neurons), learning, navigation, perception of space
What are the pituitary gland and the pineal gland?
hormone flow
light/dark -> secretes melatonin
How does the brain get supplied with blood?
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
What are the twelve cranial nerves?
- olfactory nerve
- optic nerve
- oculomotor nerve
-> pupil response and other eye movements - trochlear nerve
-> eye muscle control - trigeminal nerve
-> largest and most complex
-> sensory and motor functions - abducens nerve
-> innervates eye muscles - facial nerve
face movement, taste, glandular function, … - vestibulocochlear nerve
-> balance and hearing - glossopharyngeal nerve
-> taste, ear, throat movement, … - vagus nerve
-> sensation around the ear and digestive system
motor activity - accessory nerve
-> innervates muscles in head, neck, shoulder - hypoglossal nerve
-> motor activity to tongue
What is neurorehabilitation?
process
focus on disability = functional activities limitation
optimise functioning and minimise distress
need to be holistic
multidisciplinary
What are different approaches to neurorehabilitation?
restorative
-> priming
-> task-specific
compensatory
-> modification of environment
-> internal strategies
-> aids and appliance
What is neuropsychological assessment?
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
What is a meaningful cognitive deficit?
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
What is a traumatic and non-traumatic cognitive deficit?
caused by and external force, either penetrating or non-penetrating
caused by internal factors (toxins, tumor, stroke, substance abuse, lack of O2)
What are some difficulties in assessing cognitive deficits?
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
What information can be obtained from neuropsychological assessment?
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
What is a straightforward diagnosis in NA?
- some conditions are defined by the presence of cognitive impairment
- dementia, postconcussion syndrome, mental retardation
What is a differential diagnosis in NA?
- 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
How can predictions of functional potential be made?
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
How can treatment response be measured?
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
What is neurocognitive testing?
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.
What are common domains of neuropsychological assessment?
Sensation
Perception
Motor skills and construction
Attention and concentration
Memory
Executive functioning
Processing speed
Language/verbal skills
What is the difference between sensation and perception?
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
What sensational or perceptional deficits can occur?
- 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
How can motor skills be assessed?
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
what is selective attention?
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
What is sustained attention?
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)
What neuropsychiatric conditions show attentional problems?
psychosis - errors of omission
ADHD - increases in errors of commission
Schizophrenia - fail to develop normal bias (responding to nontargets)
challenges in dual-task demands
What is working memory?
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
What is peisodic/declarative/explicit memory?
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
What is procedural memory?
memory for motor actions or skills
AD - learn and retain procedural skills, not verbal information
what is semantic memory?
process of long-term storage of verbal information
declarative memory system
what is prospective memory?
remember to perform tasks in the future, medication, scheduled stuff, …
event-based and time-based
immediate and delayed response prospective memories
What is executive functioning?
reasoning and problem solving
management of multiple cognitive abilities
ability that can be less affected by age as other cognitive functions
How is processing speed assessed?
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
What can be said about the validity of cognitive domains?
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.
What are examples of NCTs?
- 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)
What are approaches of specific interventions for cognitive rehabilitation?
(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)
What is the forced-use concept?
chronic deficits are in part because of learned disuse
What is concextualised cognitive rehabilitation?
cognitive functions are contextualised not as isolated modules but as interactive with one another, with other aspects of intrapersonal function
What creates treatment effects in the domain of attention?
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
What produces treatment effects in the domain of memory?
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!!
What training enhances executive function?
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
How can visuospatial function be restored?
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
How can language be restored?
practice or stimulation
language therapies can produce strong treatment effects, dose-dependent
circumlocution - talking around words that cannot be retrieved
what is comprehensive-holistic cognitive restoration?
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.
