Clinical Neuropsych - Test 1 Flashcards
What is Clinical Neuropsychology?
-** relationship between brain structure/function and behavior** (“clinical” adds another piece)
- use knowledge of brain structure/function to predict behavior (e.g. treatment planning with patient)
- use observation/knowledge of behavioral symptom profiles to make determinations about brain health and integrity (e.g., make a diagnosis)
1.23.24 Intro
Perspective that brain function is about location. See Franz Gall, Broca, Wernicke.
1 of 3 historical perspectives of brain/behavior
Localization
1.23.24 Intro
“equal potential” to have any function. See Marie Jean Pierre Flourens and Karl Lashley.
Equipotentiality
Integrationist
1.25.24_Methods.pdf
- father of phrenology
- brain “organs” have innate mental faculties and psychological traits
Franz Gall
1.23.24 Intro and 1.25.24_Methods.pdf
- an obsolete theory proposing that if a - given brain area was larger in an individual, then the corresponding skull at that point should be enlarged, indicating a well-developed area of the brain. Conversely, a depression signaled underdeveloped area of the cortex
- involved reading of cranial bumps to ascertain which of the cerebral areas were largest
Phrenology
1.25.24_Methods.pdf
What are some flaws with the theory of phrenology?
- when you feel the head, you’re feeling the skull, not the brain (a misshapen skull does not say anything about the brain)
- multiple places in the brain might be responsible for one trait
- swelling is actually indicative of inflammation (bump would not actually indicate a strength)
“Tan”
1.25.24_Methods.pdf
Cortical localization
- landmark contribution was in understanding the origins of aphasia
- localizationist
- “Tan”
- Broca’s area
Paul Broca
1.25.24_Methods.pdf
- announced that understanding of speech was located in the superior, posterior aspects of the temporal lobe
- no motor deficit accompanied a loss of speech comprehension caused by damage in this area, only the ability to understand speech was interrupted
- fluent aphasia
Carl Wernicke
1.25.24_Methods.pdf
inability to talk because the musculature of speech organs do not receive appropriate brain signals
Broca’s aphasia
patient is still able to talk, but speech makes no sense and sounds like some unknown foreign language; Wernicke
Fluent aphasia
- size over location (how much brain is more important than its placement)
- remaining brain can take over functions of missing tissue (equipotneiality)
- See ablation studies with birds and rats
- proponent of equipotentiality
- “brain operates in integrated fashion, not in discrete faculties, and that mental functions depend on the brain functioning as a whole”
- attacked Broca’s theory (indicated that patient could not speak because lesion had caused general loss of intellect, rather than a specific inability to speak
Marie Jean Pierre Flourens
1.25.24_Methods.pdf
What did Marie Jean Pierre Flourens find?
In ablation studies with rats and birds, Flourens found that removing any part of the brain would cause gneralized disorders of behavior in birds; their brains could make up for lesion in the brain. “if you have sufficient enough brain, it can take over some functions”
- Principle of mass action - the extent behavioral impairments is directly proportional to the mass of the removed tissue.
- Multipotentiality: each part of the brain participates in more than one function.
- More brain that was taken out = more function was lost
- injury location is less important than how much brain is impacted
- See equipotentiality.
Karl Lashley
1.25.24_Methods.pdf
The extent behavioral impairments is directly proportional to the mass of the removed tissue. See Karl Lashley.
Principle of mass action
1.25.24_Methods.pdf
each part of the brain participates in more than one function.
See Karl Lashley.
Multipotentiality
1.25.24_Methods.pdf
What are advantages and disadvantages of explaining behavior using the localization theory?
advantages: you are better able to pinpoint the functions that might be impacted when certain parts of the brain are impacted
disadvantage: you might not think of other possibilities of functional deficits if they are not associated with the area directly impacted
1.25.24_Methods.pdf
What are the advantages and disadvantages of explaining behavior using the equipotentiality theory?
disadvantages - you might have difficulty predicting which functions will be impacted as result of an injury;
advantage: remaining brain can take over functions of missing tissue; may be able to more confidently speak to the amount and severity of function that will be lost (more brain lost = more significant deficits)
1.23.24 Intro
disctinction between the ability to recognize an object and an inability to name it; Freud coinded this term (Freud = founder of psychoanalysis)
agnosia
Consider – you are a neuropsychologist working with a patient recovering from brain injury to their left temporal lobe. What does your conversation look like if you ascribe to localization versus equipotentiality theories of brain organization?
Localization gives you a clearer expectation of what you can expect; This might help you to better prepare and arrange for appropriate treatment to accommodate functional deficits.
Equipotentiality gives you more hope that your brain may be able to regain function through neuroplasticity. MIght be more focused on “how to rebuild” but also may not be able to prepare patients adequately for what deficits to expect.
1.25.24_Methods.pdf
- integrationist theory (both size and location matters in the brain)
- idea of functional units and systems requiring Luria’s 3 areas of brain working together
- behavior results from integration of functional systems – a disruption at any stage can cause deficits, but also plasticity
Alexander Luria
1.25.24_Methods.pdf
Flourens experiments on birds and rats – removing any part of the brain led to generalized disorders of behavior
led to idea that size of injury is more important than the location in determining brain injury’s effects
ablation experiments
Brain stem; responsible for arousal and maintenance of muscle tone
ex. in snowboarding, brain stem needs to be intact so you are conscious, able to stand and maintain muscle tone; arousal; being conscious
Luria’s 1st functional unit
1.25.24_Methods.pdf
Posterior portion of the brain is responsible for reception, integration, and analysis of sensory information
ex. in snowboarding, posterior area needs to be intact so you can sense where you are in relation to your environment, avoid obstacles and other people, be aware of worsening whether etc.; also gives you some enjoyment (wind in hair, pretty mountains, feeling of cold on face)
Luria’s 2nd functional unit
1.25.24_Methods.pdf
Frontal portion of brain is responsible for planning, executing and verifying behavior.
ex. in snowboarding, frontal area needs to be intact so you can choose which routes to take, when to stop for the day, make plans for afterward
Luria’s 3rd functional unit
1.25.24_Methods.pdf
concept that patter of interaction among various areas of the brain is necessary to complete a behavior – each area in the brain can operate only in conjunction with other areas of the brain, thus each area of the brain may play a specific role in many behaviors. See Luria.
functional systems
Luria’s 2nd functional unit is believed to be responsible for receiving and integrating sensory information. True or False?
True
1.25.24_Methods.pdf
any area of the brain can be involved in relatively few or many behaviors
Pluripotentiality
According to the localizationist view, impairments in behavior depend entirely on what exact structures/regions of the brain are injured. True or False?
True
1.25.24_Methods.pdf
The principle of mass action is consistent with the localization viewpoint of brain function. True or False?
False (it is consistent with the equipotentiality theory)
1.25.24_Methods.pdf
- pass through certain tissues of the body easier than others, providing contast to the tissues and substances that the x-rays are not passing through/absorbing the X-ray (i.e., bones)
- depending on tissue density, may show up in grayscale
X-rays
1.25.24_Methods.pdf
- takes X-ray images from different perspectives/angles, then pieces together images to produce a better idea of what is happening in the brain
- ADD TO THIS - supplement with information from the text
Computed transaxial tomography (CT)
1.25.24_Methods.pdf
- Based on measurement of what atoms are doing in different brain tissue
- involves using magnetic field to manipulate how atoms are behaving in the brain
- MRI measures how H atoms align with magnet at different rates – different tissues = different rates of returning to re-alignment – this is what the MRI is capturing
- magnets are always on and are very strong
- much more detail than CT or X-ray
Magnetic Resonance Imaging (MRI)
1.25.24_Methods.pdf
Clinical Considerations of MRI
Resolution - MRI has much more detail than CT or X-ray
Speed - take longer than CTs and X-rays
Contraindications/risks: MRIs are low-risk (no radiation involved, not as risky as X-rays)
Invasiveness - non-invasive; relatively tolerable
Cost - can be expensive
Age - people with claustrophobia, movement disorders (restless leg syndrome); children may not tolerate MRI as
Type of Injury: are you looking at a fracture or an internal injury
MRI is looking at Hydrogen atoms in brain. At rest, H atoms will have electromagentic properties and will rotate around/have magnetic direction to them. When in the MRI, all atoms align to the same magnetic field and are spinning in the same direction. Technologist adds radiofrequency (RF) pulse, which knocks the atoms out of alignment with the MRI’s magnetic field. When the RF pulse is turned off again, the atoms will realign with the magnet. the MRI is measuring how the atoms realign at different rates. Different tissues will have different rates of re-alignment with magnet.
LOOK at book
MRI Physics
1.25.24_Methods.pdf
MRI magnets are always on. True or False?
True
1.25.24_Methods.pdf
Clinical Considerations for Neuroimaging Methods
- Resolution
- Speed
- Contra-indications and risks
- Invasiveness
- Cost
1.25.24_Methods.pdf
Infers white matter organization by measuring direction and magnitude of water diffusion
Looks at ratio of anistropic diffusion to isotropic diffusion, which indicates white matter integrity (if white matter tracts are injured/have holes, water may diffuse isotropically instead)
- LOOK for more information in the book
Diffusion Tensor Imaging (DTI)
1.30.24 Methods Part 2 pdf
- ratio of anistropic to isotropic diffusion (quantitative and “qualitative”)
- DTI allows for analysis of fractional anisotropy (FA), a meausre indicating the overall directionality of water diffusion that is grater in organized white matter tracts and lower in CSF and disorganized fibers
- method used to evaluate white matter fiber tracts
-
can get both quantitative ratio (anistropic to isotropic is 0:1) and qualitative (through FA mapping, you can determine more than just how much water is diffusing, but the direction in which it is diffusing also)
- high FA = white matter is more intact - bright white areas have higher FA
Fractional Anisotropy
3-D reconstruction technique used to assess the neural tracts using data collected by DTI
Maps out tracts of white matter bundles, FA
Tractography
Method of staining brain tissue that marks a few selected individual cells, differentiating the cell body and its extensions. Discovered by Camillo Golgi.
Golgi stain
A dye that stains the cell body of the neuron and is particularly useful for detecting the distribution of cell bodies in specific regions of the brain. Discovered by Franz Nissl
Nissl stain
shows the myelin coating of axons, rendering it useful for mapping pathways in brain tissue
Myelin stain
Considerations about DTI
- Not currently used in standard clinical practice (takes a long time to acquire scan and potentially render image)
- But some significant potential – may be more sensitive to picking up lesions in white matter
1.30.24_Methods_part2.pdf
Isotropic diffusion vs. Anistropic diffusion
isotropic - water will disperse in 360 degrees if it is in free space (what water naturally does)
anistropic - water is operating within barriers and has some directionality
- white matter tracts allow for diffusion in a particular direction and DTI measures how much anistropic diffusion there is compared to isotropic diffusion )if