lecture 6 - cognitive neuropsychology Flashcards
Study of functional deficits after acquired brain injury
- Brain injury due to stroke, infection, closed head injury, etc.
- Brain disease due to neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease etc
- Single case studies (or small groups)
- Generalisable?
- Difficulties knowing exact location and extent of damage?
- Brain imaging with magnetic resonance imaging
- Impairments after damage doesn’t necessarily mean that the damaged region is the ‘locus’ of the function
- What precise function/process is being measured (e.g., a function isn’t the same as a task)
An issue for all psychology – not just neuropsychology
neuropsychology - cognitive neuroscience
- Study of the loss of cognitive functions after brain injury or disease
- To find out which regions of the brain are specialised for what functions “Localisation of cognition”
- To find out how cognitive functions are organised
- Modern neuroscience: All functions are mediated by networks of brain regions
Impairments after damage doesn’t necessarily mean that the damaged region is the ‘locus’ of the function could be due to disconnection
previous topic
- Attention and distraction -> 1. Neglect
- Learning and memory -> 2. Amnestic syndrome
- Speech and language -> 3. Aphasia
Concepts and categories (aka semantic memory) -> 4. Semantic Dementia
1 - impairments of attention
- Unilateral neglect - defects one size and usually arises due to a stroke
- Patients don’t seem to notice (be able to attend to) information contralateral to the injury
○ Cancellation test
○ Copying test
- Patients don’t seem to notice (be able to attend to) information contralateral to the injury
- Hemispatial neglect syndrome - after stroke or in alzcheimers -representation issues on one side - either goes after a few weeks or long term. they are not aware they are missing something as imagination space is not on that side
- RE attention lecture: unable to move the ‘spotlight’ of attention to certain regions in order to process the information there.
- RE spatial cueing in Posner paradigm – unable to use cue that directs attention (not eyes) to one or other side of fixation leading to enhanced processing in congruent trials
Looks as if people are unable to attend to a region of space, but it’s not space per se, but the region of individual objects, regardless of where in ‘space’ they are - neglect also effects internal representation
hemianopia - damage in occipital lobe and can’t see in LVF and are aware they can’t see it and move their heads
Unilateral neglect
- Patients don’t seem to notice (be able to attend to) information contralateral to the injury
○ Cancellation test
○ Copying test- Do we attend to locations or to objects?
- No explicit knowledge, but evidence that neglected information is processed
○ E.g., priming
Contrast between explicit and implicit tests of processing. Explicit – explicitly tell P to attend to/act upon (cross out/copy) stimulus, P does it deliberately (explicitly). Implicit test – doesn’t explicitly require P to attend to/act upon stimulus as required in the explicit form. Whether or not information is processed isn’t judged by whether P can deliberately process it according to instructions. Processing revealed by indirect/implicit measure (re all other examples in attention, meory etc of explicit/implicit distinction
‘representational’ neglect
Patient PS was asked to imaging standing on Piazza in front of dome and to describe
Scene -> reveals neglect of imagined information; when asked to turn around revealed
Neglect of imaged information on the other side -> attention to ”internal” information - described everything on right side and left out left side
As attention to “external” world
Bisiach, E. & Luzzati, C. (1978). Unilateral neglect of representational space. Cortex, 14, 129-133
* Neglect even when attending to ‘internal’ scenes. Ps required to imagine standing at one end (e.g., on steps of Duomo) of the Piazza and describe what they see – reveals neglect of info (buildings, shops, statues etc) on one side. Then imagine standing at the other end – now they describe the neglected info from the previous perspective and fail to describe the info they can describe when adopting the original perspective.
What does impaired attention tell us about unimpaired – role of objects, attention to ‘internal’ information similar to attention to external
damage to right side inferior parietal lobe causes the most severe problems
memory impairments
anterograde and retrograde amnesia
diagram in notes
organic amnestic syndrome
- Disorientation in time
- Profound anterograde amnesia
- Loss of recent memory
- Impairment in recall and recognition
- Retrograde amnesia to certain degree
- Intact IQ
- Preserved implicit memory/ procedural learning - skills
- Supposedly, anterograde amnesia – not being able to form ‘new memories’, but…
RE importance of kind of test – whether something ‘leaves a trace’ depends on how we test if (RE different tests discussed in L&M lecture – recall, cued, recall, recognition). Plus implicit/explicit distinction again – if amnesic previously saw ‘rubble’ on a list, more likely to complete stem with that – vice versa if they saw ‘rubber’ previously. Evidence that the information has been learned/stored, even though there’s no conscious awareness that it has been.
famous case HM
H.M. (died 3/12/08) Bilateral surgery 1953 aged 27 (first minor seizure at 10), medial temporal resections for epilepsy
HM important as (Corkin 2002)
1) Selectivity of memory loss – IQ spared – memory and language dissociable as comprehension spared
2) Short term memory spared, e.g., digit span, ability to hold a conversation
3) Sparing of skill learning – procedural memory – and sparing of most priming tasks
4) Directed attention to the importance of the hippocampus, but his pathology was not selective
5) Some debate about how much of his childhood memories remained intact, i.e., sparing of already stored memories – clearly some but unsure how much – seem to lack detail
Most studied amnesic – will remain unique for that reason alone
case of Clive wearing
- English musician/musicologist
- In 1985 had brain infection due to herpes simplex encephalitis
- Herpes virus destroyed hippocampus and parts of frontal lobes
- This resulted in a dense amnestic syndrome with memory only lasting for a few seconds
- 8:31 AM: Now I am really, completely awake.
9:06 AM: Now I am perfectly, overwhelmingly awake.
9:34 AM: Now I am superlatively, actually awake. - Supposedly, anterograde amnesia – not being able to form ‘new memories’, but…
RE importance of kind of test – whether something ‘leaves a trace’ depends on how we test if (RE different tests discussed in L&M lecture – recall, cued, recall, recognition). Plus implicit/explicit distinction again – if amnesic previously saw ‘rubble’ on a list, more likely to complete stem with that – vice versa if they saw ‘rubber’ previously. Evidence that the information has been learned/stored, even though there’s no conscious awareness that it has been.
Amnesia is not the same as not being able to learn new things - dissociation between explicit and implicit
- Incidental learning of 6-letter words
- Explicit test
- Recall as many of the words as possible
- Requires reference to previous learning event
- Implicit test
- word stem completion
○ Say first word that comes to mind in response to first 3 letter
□ E.g., RUB— (RUBBER/RUBBLE)
Doesn’t require reference to past event but people with anterograde amnesia still show influence of previous words.
- word stem completion
3 - impairments of speech and language
- Broca’s aphasia - production
Wernicke’s aphasia - comprehension
brain diagram in notes
brocas aphasia
- Understands meaning of questions
- Knows what he wants to say
- Able to say individual words (no simple motor
impairment) - Great difficulty assembling utterances
- Impoverished speed limited to single words/short
utterances such as “ don’t know”
wernicke’s aphasia
- Very fluent speech production but meaningless
- Problem with understanding?
- Knows meaning of words/objects
i.e. knows how to use them - Poor at responding to meaning of spoken words
Problem with producing meaningful speech
Different regions seem to play different role in different aspects of a function
complexity of language/speech (as for any cognitive function) – fallacy of talking about the ‘speech centre’ or the ‘memory’ centre or any other broad ‘centre’ i.e., need to think carefully about what specific processes need to be accomplished in order to carry any task
4 - impairments on conceptual processing
- Superordinate concepts less susceptible than ‘basic’ level concepts
- e.g., Alzheimer’s patients refer to picture of an apple as ‘fruit’
‘Is a cabbage an animal, plant or man-made object?’ versus ‘Is a cabbage brown, grey, or green?’
- e.g., Alzheimer’s patients refer to picture of an apple as ‘fruit’
semantic dementia
- Progressive, selective loss of semantic knowledge (meaning) in any modality
- Profound loss of word meanings: evident in comprehension & production (empty speech)
- Inability to recognise objects (agnosia)
Other cognitive abilities (e.g., episodic memory) and other aspects of language (syntax, phonology, pragmatics) seem to be much better preserved.
Everyday effects of semantic difficulties
- DM (surgeon) presented because he couldn’t remember the names of his surgical instruments.
- AM presented with difficulties in naming people and objects.
- Ate defrosting raw salmon for pudding after his lunch
- Poured orange juice on his pasta and added sugar to his wine
- JL presented with similar difficulties as AM.
- Asked his wife what the stuff was growing on his face everyday
Frightened by finding a snail in the garden
- Asked his wife what the stuff was growing on his face everyday
Impairments of conceptual processing
- Category-specific impairments
- E.g., patients unable to name only body parts
- Impaired knowledge for living things, with unimpaired knowledge of non-living things?
○ Different places in the brain for different categories?
○ Different types of defining attribute important for different categories?
□ E.g., physical versus functional attributes
○ Different organisation of knowledge for different categories
E.g., living things might share more features (be more similar to each other) than nonliving things
Does losing knowledge of certain categories mean that those categories were stored in the damaged bit of the brain?
Or are there other differences between the impaired and unimpaired categories.
E.g., different kinds of features that are most important to our concepts: Artefacts/non-living things conceived mostly WRT their function attributes (e.g., what is a kettle? It’s for boiling water) versus living things, maybe physical features (what’s a giraffe? Long neck, brown and beige patched fur).
Or, different sizes/shapes of ‘clusters’ (RE exemplar/instance theories) of instances for different kinds of things – e.g., living things might tend to be more similar to each other (more shared features, closer together along dimensions) than artefacts? (dog, cat, cow…)
key points
- Loss of function due to brain damage may highlight the various component processes involved in accomplishing functions in the ‘normal’ brain
- Caution needed in interpretation of findings - often there is more than one explanation - brain connectivity, individual differences in the developmental organisation of brain function.
There’s always more than one interpretation of any finding
selective attention - neglect
episodic memory - amnesia
semantic memory - semantic dementia
language production - broca
language perception - wernicke
but very specific/ localised disorders are rare
Methods in psychobiology and neuroscience
Researchers in neuroscience have a variety of techniques and methods they use to study behaviour. They can identify neurons that contain specific chemicals. They can take photographs of particular ions entering neurons when the appropriate ion channels open, as well as images of brain structure and function. They can inactivate individual genes to see what happens to behaviour when they no longer function. They can also witness the activity of the brain as it behaves, or can observe functions related to the behaviour of neurons such as blood flow or oxygen consumption.
lesioning
- The earliest research methods in psychobiology – and one that is still the most commonly used – involves correlating an impairment in function with damage to a specific part of the nervous system. The damage can be studied in one of two ways.
- A neuropsychologist may examine the effects of brain damage caused by injury or disease on function (acquired brain injury), such as the effect of damage to the front part of the brain on a person’s ability to create and adhere to plans, for example.
- The second way involves the investigator producing an experimental brain lesion or ablation, -damage to a particular part of the brain, but only in an animal’s brain. Of course, neurosurgeons do lesion parts of the brain to alleviate some forms of suffering.
- One recent, successful treatment for the movement disorder Parkinson’s disease, for example, has involved lesioning a small structure deep within the brain. A similar technique ‘lesions’ in another way (the procedure is called deep brain stimulation, DBS).
- In Parkinson’s disease, a person may behave rigidly or be unable to walk properly or exhibit tremors or engage in excessive, repetitive, involuntary motor behaviour. Treatment by Levodopa (mentioned earlier) provides some respite but there are off periods when the drug does not work. DBS overstimulates parts of a collection of structures called the basal ganglia, described below. This has been found to be more successful than lesioning the parts directly (Liu et al, 2008). Why lesioning and overstimulation seem to work (i.e. produce the same effect) is still a mystery.
- One theory is that surgery reduces the inhibitory effects of neurons in the basal ganglia and increases them in another structure, the thalamus and cortex (Liu et al, 2008).
- When an animal’s brain is experimentally lesioned, the investigator hypothesises that this lesion might have specific consequences; they then study the effects of the lesion on the animal’s behaviour. If particular behaviours are disrupted, then the reasoning suggests, the damaged part of the brain must be involved in those behaviours.
- Some lesioning techniques are used in both experimental and neurosurgical work. For example, to reach the region to be lesioned, the experimenter or surgeon uses a device called a stereotaxic apparatus to insert a fine wire (called an electrode) into a particular location in the brain. The term ‘stereotaxic’ refers to the ability to manipulate an object in three-dimensional space. The researcher passes an electrical current through the electrode, which produces heat that destroys a small portion of the brain around the tip of the electrode. After a few days, the animal recovers from the operation, and the researcher can assess its behaviour.
- A stereotaxic apparatus can also be used to insert wires for recording the electrical activity of neurons in particular regions of the brain. But an electrode placed in an animal’s brain can also be used to lead electrical current into the brain as well as out of it. If an electrical connector on the animal’s skull is attached to an electrical stimulator, current can be sent to a portion of the animal’s brain. This current activates neurons located near the tip of the electrode. The experimenter can then see how this artificial stimulation affects the animal’s behaviour
Neurosurgeons sometimes use stereotaxic apparatus to operate on humans. Neurosurgeons can also insert electrodes into the human brain and record the electrical activity of particular regions to try to find locations that might be responsible for triggering epileptic seizures.
Studying brain injury - clinical neuropsychology
- Although we can, under very careful conditions, experimentally lesion the brains of non-humans, we cannot do this in humans, for obvious reasons. We have, therefore, relied on studies of accidental brain injury to help us build a picture of the role of damaged brain regions in specific functional impairments.
- This approach usually utilises the single-case study design. Brain injury usually results from accident or disease and, because it is more difficult to obtain information of this kind, scientists have studied a small number of individuals intensively over a long period of time. The approach allows neuroscientists to observe how localised brain damage can impair intellectual or emotional function.
- Most human brain lesions are the result of natural causes, such as a stroke. A stroke (also known as a cerebrovascular accident, or CVA) occurs when a blood clot obstructs an artery in the brain or when a blood vessel in the brain bursts open. In the first case, the clot blocks the supply of oxygen and nutrients to a particular region and causes that region to die. In the second case, the blood that accumulates in the brain directly damages neural tissue, partly by exerting pressure on the tissue and partly through its toxic effects on cells. The most common causes of strokes are high blood pressure and high levels of cholesterol in the blood.
Lesions also occur as a result of injury to the brain by missiles or objects. Approximately 750 in every 100,000 people will experience traumatic brain injury annually (Anderson et al, 2011). Young men and boys are at a higher risk of brain injury than are girls and young women: 1.4 times higher in the under 10s and 2.2 times higher in those between 10 and 20 years old (Thurman, 2016). The most common cause of injury in the under 5s is falls; in the over 15s, it is motor vehicle accidents (Thurman, 2016).