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neuropsych > lesson 13 > Flashcards

lesson 13 Flashcards

1
Q

Prefrontal cortex

A

controls behavior depending on future plans, strategies, complex rules (e.g. social rules)

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2
Q

Prefrontal cortex lesion

A

does not lead to properly motor deficit

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3
Q

where is the prefrontal cortex in the phylogenetical perspective

A

Most recent cortex in phylogenetical perspective – difficult to define it and its functions based on animal studies

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4
Q

how is the prefrontal cortex different in humans versus other mammals

A

Highly developed in humans, it is what distinguishes us from animals

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5
Q

what is the prefrontal cortex involved in

A

Involved in many high-order cognitive processes for the regulation of cognition and behavior

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6
Q

when does the prefrontal cortex start to develop and how does it continue to develop

A

Start to develop before birth, progresses slowly throughout childhood, continuing synaptogenesis and myelination in adolescence, and finally completes their development process (myelinization) in late adolescence

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7
Q

Implication of pre-frontal slow development

A

children don’t have developed high-order cognitive abilities as adults

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8
Q

piaget’s four stages of cognitive developmet

A

sensorimotor stage, preoperational stage, concrete operational stage, formal operational stage

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9
Q

sensorimotor stage

A

0 - 2; infants and toddlers primarily learn through sensory experiences and manipulating objects

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10
Q

preoperational stage

A

2 - 7; children use symbols to represent words, images, and ideas, engage in pretend play, and their thinking is self-centered or egocentric2

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11
Q

concrete operational stage

A

7 - 1; children develop the ability to think logically and problem-solve, but can only apply these skills to objects they can physically see (things that are “concrete”)

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12
Q

formal operational stage

A

12+; individuals develop the ability to think abstractly, reason logically, and solve problems systematically. They can consider different solutions, including creative and abstract ones

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13
Q

prefrontal cortex connections

A

posterior association cortex,

thalamus,

hypothalamus, amygdala, hippocampus,

basal ganglia, cerebellum

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14
Q

posterior association cortex

A

for sensory processes

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15
Q

hypothalamus, amygdala, hippocampus

A

for emotion, motivation and memory

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16
Q

basal ganaglia and cerebellum

A

efferent connections from prefrontal cortex to these

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17
Q

Though basal ganglia, cerebellum and thalamus, the prefrontal cortex has

A

indirect connections to the motor areas of the frontal lobe

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18
Q

The notion of a unitary prefrontal function/syndrome

A

is not supported by clinical data

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19
Q

prefrontal functions can be divided into at least

A

3 ‘clusters’ leading to three different ‘cognitive-behavioral syndromes’ (which also show high interindividual variability)

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20
Q

three clusters of prefrontal functions

A

Dorsolateral region, mesial region, orbitofrontal region,

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21
Q

Dorsolateral region

A

abstract reasoning, working memory, cognitive control

(dorsal part – more cognitive | works with mesial region)

Excluding the precentral gyri (BA 4 and 6)

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22
Q

dorsal part of the 3 clusters

A

more cognitive

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23
Q

ventral part of the 3 clusters

A

more emotional

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24
Q

mesial region

A

(dorsal part – more cognitive | works with dorsolateral region)

response inhibition, behavioral and conflict monitoring

(ventral part – more emotional | works with orbitofrontal region)

self-relevant decision making, emotional and behavioral self-regulation

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25
Q

orbitofrontal region

A

(ventral part – more emotional | works with mesial region)

social and emotional processes, self-relevant decision making, reward evaluation, interface between emotions and cognition

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26
Q

Prefrontal Dysfunctions (dis-executive syndromes)

A

Dysexecutive syndrome, ‘Dorsolateral deficit’, ‘Orbitofrontal deficit’, ‘Anterior cingulum deficit’

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27
Q

‘Anterior cingulum deficit’ region

A

dorsal medial regions

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28
Q

‘Anterior cingulum deficit’ definition

A

loss of motivation and deficit in the inhibition of irrelevant stimuli and responses

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29
Q

‘Anterior cingulum deficit’ symptoms

A

Loss of initiation that may lead to mutism

Loss of attentional focus, inability to inhibit irrelevant response

Environmental dependency syndrome, utilization behavior, imitation, perseveration

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30
Q

Dysexecutive syndrome

A

consists of a group of symptoms, usually resulting from a brain damage, that fall into cognitive, behavioral, and emotional categories and tend to occur together

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31
Q

‘Dorsolateral deficit’ definition

A

deficits in planning, abstraction, and cognitive flexibility

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32
Q

‘Dorsolateral deficit’ symptoms

A

Distractibility, inability to focus attention, which is captured by irrelevant stimuli

Reduced critical reasoning

Reduced cognitive flexibility, cognitive rigidity, inability to find new strategies to solve a task

Inability to face complex situations

Deficit in organization and planning, not finalization to achieve specific aims

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33
Q

‘Orbitofrontal deficit’ definition

A

emotional dysregulation and deficits in self-relevant decision making

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34
Q

‘Orbitofrontal deficit’ symptoms

A

Inability to make appropriate decisions in everyday life, although traditional cognitive test show no cognitive deficit

Inability to inhibit impulse behaviors (disinhibition)

Confabulations

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35
Q

preftonal dysexecutive syndroms may be due

A

to several pathophysiological processes –> each present distinctive features

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36
Q

Vascular syndromes

A

anterior cerebral artery

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37
Q

Head trauma

A

orbitofrontal surface and frontal poles

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38
Q

Degenerative syndromes

A

fronto-temporal dementia in its frontal variant, some patients with Alzheimer’s disease, Parkinsons, multiple sclerosis

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39
Q

Infectious diseases

A

herpes, HIV

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40
Q

Psychiatric disorders

A

no lesion but frontal dysfunction

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41
Q

Specific features of prefrontal deficit depend on

A

modulatory effect

Specific localization of the dysfunction within the prefrontal regions

Laterality of the lesion/dysfunction (e.g., left-lateralized dysfunctions regarding verbal material, right-lateralized impaired emotional processing)

Patient’s gender

Patient’s pre-morbid personality, academic achievement and job placement (–> cognitive reserve)

Patient’s actual social environment (support)

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42
Q

dorsolateral deficit

A

Executive Functions (dorsolateral regions)

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43
Q

executive functions allow for

A

Identify objective

Develop new strategies to achieve them

Adapt to a continuously changing environment

Monitor goal-based behavior

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44
Q

Classical theories hypothesized

A

a unique common deficit in executive dysfunction –> now most theories identify sub-components in executive functions

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45
Q

sub-components in executive functions

A

inhibition, shifting, updating

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46
Q

Inhibition

A

ability to suppress irrelevant stimuli/behaviors

47
Q

Shifting

A

attention and task-shifting

48
Q

Updating

A

ability to update information to maintain in an activated state in working memory in addition to starting and monitoring processes

49
Q

executive functions process

A

Stimuli enter the sensory perceptual processing system and activate the “schema” (knowledge structures stored in long-term memory)

Activated schemas trigger possible automatic responses without requiring voluntary attention (automatic system)

SAS

The contention scheduling performs competitive selection of the best schema thanks to SAS

50
Q

Activated schemas trigger

A

possible automatic responses without requiring voluntary attention (automatic system)

51
Q

Supervisory attentional system (SAS) (also known as central executive)

A

allows schema relevant to our intended goal to take control of action (inappropriate schemas are suppressed)

52
Q

SAS is responsible for

A

decision making: planning strategies, inhibition of inappropriate automatic responses, adaption to new, difficult or dangerous situations

53
Q

Two independent systems with limited capacity

A

for the storage and manipulation of information during cognitive tasks are regulated by the Central Executive

54
Q

central executive

A

responsible for attentional focus, dividing and shifting attention between tasks

55
Q

Rostrolateral prefrontal cortex (RLPFC)

A

thought to play an important role in supporting the integration of abstract, often self-generated, thoughts

56
Q

Assessment of executive function

A

Wisconsin Card Sorting Test. Tower of London, TMT, CET

57
Q

WCST

A

128 response-cards with 1 – 4 colored figures (stars, crosses, triangles, circles)

Each trial: patient has to match a card with one of four stimulus cards placed on the table according to a strategy they are not aware of (feedback-based)

Each 10 correct trials the neurpsychologist changes the strategy

58
Q

WCST measures

A

Working-memory, feedback-based learning, the ability to select relevant information, flexibility, the inhibition of previously learned responses (versus perseveration), task shifting

59
Q

from WCST frontal patients show

A

perseverations, forget instructions, inability to maintain the target category

60
Q

Tower of London

A

assessment of deficit in planning, strategic decision-making adn cognitive rigidity

Problem of graduated difficulty that requires the subject to move perforated balls, placed in a certain configuration on a particular structure until reaching a new configuration

61
Q

what does Tower of London make it necessary to do

A

adopt appropriate strategies + maintaining them in working memory

62
Q

Tower of London operations

A

Three operations are required:

Formulating a general plan

Identifying subgoals and organizing them within a sequence of movements

Storing the subgoals and the general plan in working memory –> the Supervisory Attentional System

63
Q

The Trail Making Test (TMT)

A

2 parts; the times taken to complete each part are used to measure central executive functioning

64
Q

TMT part A

A

participant must draw a line to connect consecutive numbers, from 1 – 25

Records participants speed in executing a visuo-manual task

65
Q

TMT part B

A

connects numbers and letters in an alternating progressive sequence, 1 to A, A to 2, 2 to B, etc.

Stresses central executive processes of task-set inhibition, cognitive flexibility, and the ability to maintain a response set

66
Q

TMT measuring

A

To measure the central executive functioning, the difference in time taken to complete TMT-B and TMT-A is calculated

67
Q

The Cognitive Estimating Test (CET)

A

assesses abstract reasoning and critical answers

68
Q

CET in patients

A

Tendency to observed in some patients with frontal lobe lesions to produce bizarre estimates in response to questions to which people to not usually know exact answers, despite performing normally on standard intelligence tests

69
Q

orbito-frontal deficit

A

Behavioral Dysregulation in Frontal Patients

70
Q

orbito-frontal region

A

participates in impulse control, emotional processing, and social cognition

Rich connections with hypothalamus = mediates reward aspects of easting and self-regulation

71
Q

orbito-frontal deficit negative symptoms

A

Lack of initiative and spontaneity

Indifference

Apathy

Tendency not to complete any task

72
Q

orbito-frontal deficit positive symptoms

A

Restlessness

No goal-directed behavior

Euphoria, facetiousness

Excitement and disinhibition

Social inappropriateness

Irascibility and irritability

73
Q

orbito-frontal deficit other symptoms

A

Instability of humor, mood swings

74
Q

Changes in personality: the case of Phineas Gage

A

Large iron rod was driven completely through his head destroying his left orbitofrontal cortex

Did NOT lead to motor or cognitive deficit

DID make a change in his personality and behavior over the remaining 12 years of his life – friends did not see him as himself anymore

75
Q

Other similar cases: Case A.V.R.

A

Bilateral orbitofrontal lesion due to a tumor = marked changes in patient’s personality

Became unreliable, could not complete his usual work (lack of productivity); experienced relational difficulties (leading to divorce), took thoughtless economic decisions and experienced failure but showed no different in performance on neuropsychological test

76
Q

Lobotomy

A

discredited form of neurosurgical treatment for psychiatric or neurological disorders

In past was used for treating mental disorders as a mainstream procedure in some countries

Most patients were female or homosexual men

77
Q

lobotomy increase and decrease

A

Use of it dramatically increased from early 1940s and decreased in late 1970s

78
Q

Walter Freeman

A

coined the term “surgically induced childhood” since lobotomy left people with an “infantile personality”

79
Q

symptoms after lobotomy

A

Spontaneity, responsiveness, self-awareness, and self-control were reduced – replaced with inertia

Left emotionally blunted and restricted in their intellectual range

Some died, some committed suicide and some left with severe brain damage

80
Q

Iowa Gambling Test (IGT)

A

stimulates real-life decision making, measuring an individual’s approach to risk-taking, impulsivity, and ability to delay short-term gratification to achieve long-term rewards

81
Q

Iowa Gambling Test (IGT) method

A

Participants are presented with four virtual decks of cards on a computer screen; are told that each deck holds cards that will either reward or penalize them, using game money

Goal is to win as much money as possible

Some decks are “bad”, and some are good”

Participants should choose the decks with smaller rewards as they will also give significantly fewer penalties and give a better long-term payout

82
Q

Iowa Gambling Test (IGT) patients

A

Patients with orbitofrontal lesions prefer an immediate reward even if it leads to negative consequences

83
Q

dorso-medial deficit

A

Environmental dependency syndrome

84
Q

Environmental dependency syndrome

A

inability to inhibit automatic or impulses responses

85
Q

Environmental dependency syndrome lesion

A

Lesion of the dorsal medial prefrontal region or bilateral frontal regions

86
Q

Assessment of executive functions - dorso-medial deficit

A

stroop test, FAB, BADS

87
Q

stroop test

A

a test on cognitive inhibition (control of cognitive interference)

88
Q

The Frontal Assessment Battery (FAB)

A

six subtests exploring the following:

Conceptualization

Mental flexibility

Motor programming

Sensitivity to interference

Inhibitory control

Environmental autonomy

89
Q

The Behavioral Assessment of the Dysexecutive Syndrome (BADS)

A

six tests assess executive functioning in more complex, real life situations, which improves their ability to predict day-to-day difficulties:

Rule shift cards

Action Program

Key Search

Temporal judgment

Zoo Map

Modified Six Elements

90
Q

Rule shift cards

A

assesses the subject’s ability to ignore a prior rule after being given a new rule to follow

91
Q

Action Program

A

requires the use of problem solving to accommplish a new, practical task

92
Q

Key Search

A

this test reflects the real-life situation of needing to find something that has been lost

assesses the patient’s ability to plan how to accomplish the task and monitor their own progress

93
Q

Temporal judgment

A

asked to make estimated guesses to a series of questions such as, “how fast do racehorses gallop?”

tests the ability to make sensible guesses

94
Q

Zoo Map

A

tests the ability to plan while following a set of rules

95
Q

Modified Six Elements

A

assesses the subject’s ability to plan, organize and monitor behavior

Dysexecutive Questionnaire (DEX)

96
Q

Treatment of Dysexecutive Syndrome

A

Goal Management Training (GMT), Problem Solving Training, Behavior Modification Therapy (Token Economy Program)

97
Q

Goal Management Training (GMT)

A

well-established step-by-step rehabilitation technique involving setting goals and subgoals through a series of problem-solving questions and self-instruction, like goal setting used in behavioral programs

98
Q

GMT goal

A

Aim is to monitor and adjust goals during ongoing behavior

99
Q

GMT is based on

A

Based on a theory of sustained attention

100
Q

theory of sustained attention

A

the right fronto-thalamic-parietal network provides the neural support for ongoing activation of attention, which allows for the maintenance of higher-order goals in working memory

101
Q

stage 1 of GMT

A

orienting and assessing current state – stopping current activity and direct awareness toward the task

102
Q

Stage 2 of GMT

A

select the main goal

103
Q

Stage 3

A

partition the goals and make subgoals

104
Q

Stage 4

A

rehearse the steps necessary to complete the task – encode, rehearse, and retain goals and subgoals

105
Q

Stage 5

A

monitor the outcome – compare outcome of action with the stated goal

106
Q

Problem Solving Training

A

form of self-management training, in which the individual learns the most effective way of responding toward a problem, utilizing constructive coping skills

107
Q

five steps of problem solving training

A

Define the problem

College information about the problem

Generate different solutions

List advantages and disadvantages for each solution

Implement and evaluate the solution

108
Q

Behavior Modification Therapy (Token Economy Program)

A

through the different behavior modification techniques, individuals replace negative behavior patterns with desired and more healthy behaviors or promote behavior change

Rely on the idea that behaviors can be conditioned through intentional reinforcement

109
Q

Behavior Modification Therapy examples for addition

A

Positive reinforcement/Punishment, Negative Reinforcement/Punishment, Goal Setting, Conditioning

110
Q

Positive reinforcement/Punishment

A

praising or rewarding behavior that then associates the behavior as something to strive for

Celebrating adn praising healthy habits and sobriety can help individuals want to continue with these positive habits

111
Q

Negative Reinforcement/Punishment

A

negative feedback on poor habits, taking privileges away, or even in severe cases, a lock-up

While unlikely, the idea is that associating behavior with negativity and consequences will decrease the idea to entertain those habits

112
Q

Goal Setting

A

Setting goals can help individuals gain clear direction about where they want their lives and behaviors to go

By setting goals, individuals can increase the frequency of behaviors that help them reach their goals and decrease the habits that push them off track

113
Q

Conditioning

A

classical conditioning involves associating negative feelings with negative behaviors

Example: associating shame or guilt with drugs or things drugs cause some people to do will teach the individual to value sobriety

neuropsych (25 decks)

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