Neuropsychology- Lectures 9-12 Flashcards

1
Q

What is Evolution?

A

“Biological evolution is concerned with inherited changes in populations of organisms over time leading to differences among them.”

Or, change over time.

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2
Q

Darwin’s Theory of Evolution

A

Two central concepts:

Adaptation – the ability to adapt to changing environments.

Natural selection – process by which some species’ variations are passed on and others are not.

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3
Q

The Four Principals of Darwin’s Theory.

A

Plant and animal species are dynamic over time (change is inevitable)

Evolution is gradual and continuous (environment > species modification)
But, sudden dramatic changes to the environment can challenge species’ ability to adapt

Natural selection occurs with and without environmental change

Universal common ancestry

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4
Q

Survival of the fittest

A

Survival and Reproduction Process.

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5
Q

Fittest Means:

A

Fittest’ can refer to different traits and behaviours in different species.

Variation and competition influence reproductive success.

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6
Q

Variation

A

Variability in traits (e.g., colouration).

Genetic variation – mutations in DNA.

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7
Q

Competition

A

Overproduction of offspring – not all will survive/reach maturity.

The environment cannot support unlimited population growth.

Struggle for survival:
Competition between and within species for resources, predation, climate.

Selection – traits are passed on.

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8
Q

Universal Common Ancestry

A

“I should infer from analogy that probably all the organic beings which have ever lived on this earth have descended from some one primordial form, into which life was first breathed”

(Darwin, 1859, p. 484)

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9
Q

Evidence for universal common ancestry:

Brown et al. (2001):

A

Focused on 45 species of archaea, bacteria and eukaryotes

Identified 23 proteins conserved in all 45 species

Constructed a universal tree that provided a link between the three domains of life

Inferred from the tree = one species providing the genetic code for all later forms of life

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10
Q

Mendel and his pea plant experiments.

A

Dominant and recessive genes.

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11
Q

What is a gene?

A
DNA = molecule with a double helix
Gene = section of DNA (~200 – 2 million base pair)
Codon = 3 x nucleobase (unit of DNA code)
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12
Q

Gene Expression: From Genes to Proteins

A

Transcription: segment of DNA is copied into messenger ribonucleic acid (mRNA)

Translation: a process of protein synthesis

Transfer RNA (tRNA): carries an amino acid to the ribosome

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13
Q

Mendel Experiments

A

Gene for flower colour: 2 alternative versions.
An alternative version of a gene: Allele (inherit from each parent).

Gene for flower colour has a specific location on the chromosome.

If the alleles at a locus differ: Dominant allele will be expressed.

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14
Q

Mendel and his Laws of Heredity

A

The Law of Segregation:
Each inherited trait is defined by a gene pair.
Offspring inherit one genetic allele from each parent when sex cells unite in fertilization.

The Law of Independent Assortment:
Genes for different traits are sorted separately from one another.
Inheritance of one trait is not dependent on the inheritance of another.

The Law of Dominance:
If the alleles at a locus differ, the dominant allele will be expressed.

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15
Q

Evolution: Modern Synthesis (Huxley, 1942)

A

Darwin + Mendel = The Genetical Theory of Natural Selection (Fisher, 1918, cited in Moran & Smith, 1966; 1930)

Variation and competition → survival and reproduction
Genetic mutations = essential for natural selection

Genetic mutation:
Majority due to error in DNA replication.

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16
Q

Epigenetics: Study of Heritable Phenotypic Change

A

Epigenome:
Chemical compounds that can regulate the activity of genes (turn off / on)

Not part of the DNA sequence – attached or added to DNA.

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17
Q

Culture and Evolution: Role of Social Learning

A

Culture
Adaptation to the environment:
E.g., hunting strategies in killer whales (ecotype)
Gene variants linked with different strategies (Foote et al., 2016)

Can help survival and, therefore, the ability to reproduce

Behaviours learnt → over time → selection for these behaviours

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18
Q

Structure of Grey Matter

A

Cortical layers are regionally specific. Primary sensory cortex, association cortex and primary motor cortex.

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19
Q

Oligodendrocytes

A

Send projections that wrap axons with myelin to speed up signal conduction.

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20
Q

Microglia

A

Immune cells of the brain. Monitor cells for damage and clearance of cell debris.

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21
Q

Astrocytes

A

Monitor neural activity along axons at synapses and will signal to blood vessels to dilate blood vessels to increase blood flow to provide energy to the neurons.

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22
Q

How does the brain work?

A

Electrical activity allows for communication between neurons.

The brain is composed of 86 billion neuron.

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23
Q

What is an action potential?

A

A movement of electrical activity down the Axon.

  • Membrane becomes depolarised
  • Action potential and repolarisation
  • Refractory period
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24
Q

Action potential: All or nothing response

A

Excitatory postsynaptic potential (EPSP)
EPSP ↑ likelihood of an AP
Positively charged ions flow into cell
Additive effect = depolarisation

Inhibitory postsynaptic potential (IPSP)
IPSP ↓ likelihood of an AP
Negatively charged ions flow into cell
Or, positively charged ions flow out of cell
Additive effect = hyperpolarisation
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25
Q

Glutamate and GABA

A

Cortical excitability:
Balance between excitation and inhibition

Glutamate (glutamic acid)
Major excitatory NT

Gamma-aminobutyric acid (GABA)
Major inhibitory NT (brain and spinal cord)

Linked with seizures:
↑ glutamate or
↓GABA or GABA receptor dysfunction
= neural hyperexcitability > seizures

But, synchronicity of neuronal populations also needed

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26
Q

Acetylcholine

A

Acetylcholine synthesis:

Acetylcholine (ACh) is made from choline and coenzyme acetyl (CoA)

Synaptic cleft – ACh is broken down by the enzyme acetylcholinesterase

Choline is transported back into the axon terminal and used to make more ACh

Cholinergic pathways in the brain:

Linked with arousal, attention, memory
↑ sensory perception on waking
Damage = memory deficits, AD

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27
Q

Dopamine

A

Dopamine synthesis:

L-Tyrosine (amino-acid) converted into L-DOPA converted to dopamine

Synaptic cleft – enzyme degradation
monoamine oxidase (MAO), catechol-O-methyl transferase (COMT) > homovanillic acid (HVA)

Dopamine is transported back into the axon terminal via dopamine transporters (DAT)

Dopaminergic pathways in the brain:

Linked with reward motivated behaviour
↑Involved in motor control
Role in addiction, PD and ADHD

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28
Q

Norepinephrine (AKA noradrenaline)

A

Norepinephrine (NE) synthesis:

NE is converted from dopamine within the vesicle

NE pathways in the brain:

Mobilises brain and body for action (fight or flight)
Regulates arousal and alertness
Linked with memory and attention

29
Q

Serotonin

A

Serotonergic pathways in the brain:
Predominantly linked with mood
Links with cognition and health outcomes?
Indirect effect(s) of mood?

30
Q

Agonist and Antagonist Drug Mechanisms

A

Agonist Drugs:
Nicotine
↑ ACh activity
↑ attention

Opioids
Analgesia (pain relief)
Sedation
Antagonist Drugs:
Botulinum Toxin (Botox) 
Blocks acetylcholine release in PNS 
Prevents muscle contractions 

Caffeine
Blocks adenosine receptors
↑ wakefulness

Indirect agonist = enhances action or release of neurotransmitter(s), but has no individual effect on receptors
Alcohol
↑ GABA (inhibitory neurotransmitter) > ↓ CNS activity
↑ dopamine, endogenous opioids = reward pathways in brain

31
Q

Antidepressants:

A
Tricyclic antidepressants (TCAs):
Developed 1950’s, common treatment until SSRIs

Side effects:
Sedation caused by histamine H1 receptor blockade;
Postural hypotension due to α adrenoreceptor blockade
Blurred vision, dry mouth and constipation due to muscarinic acetylcholine receptor blockade.

32
Q

Antidepressants pt2:

A

Selective Serotonin Reuptake Inhibitors (SSRIs)
MDD, social anxiety disorder, panic disorder, OCD, eating disorders, PTSD

Controversy over efficacy:
Mild to moderate depression (d = .11)
Severe depression (d = .17)
Very severe depression (d = .47)
See Fournier et al. (2010)
Methodological issues relate to:
Baseline assessment of depression
Length of follow-up
Attrition (drop-out)
Relapse rates
33
Q

Cipriani et al. (2018):

A

522 double blind studies
116, 477 participants

All drugs ↑ efficacious than placebo
Modest effect sizes in adults with MDD

Escitalopram, mirtazapine, paroxetine, agomelatine, and sertraline
= ↑ response and ↓ dropout rate than the other antidepressants

Reboxetine, trazodone, and fluvoxamine
= ↓ efficacy and acceptability profiles compared with the other antidepressants

34
Q

Concerns with SSRIs

A

Serotonin Syndrome:
Serotonin toxicity = typically caused by taking 2+ serotonergic medications

Concern with OTC drugs

Concern of suicide risk in children and adolescents:
But, suicide is rare
Suicide rates ↓ with ↑ drug prescriptions

35
Q

3,4-Methylenedioxymethamphetamine (MDMA)

A

MDMA targets specific neurons (monoamine)

Presynaptic releasing agent of specific neurotransmitters
Serotonin, dopamine, norepinephrine and release of hormones (e.g. oxytocin and cortisol)
Linked with mood, pleasure and energy
Oxytocin = ‘love hormone’, stress (arousal)

Subjective effects 30-45 minutes after oral ingestion
Dependent on dose, setting, user
Maximal concentration 1.5 to 3 hours after ingestion
Duration of action 4-6 hours (depletion of serotonin)

36
Q

Positive Effects of MDMA

A

Euphoria

Increased energy

Feelings of belonging and closeness

Increased openness

Feelings of love and empathy

Bright, intense visual perceptions

Heightened sensations (touch, taste, smell, hearing)

Musical appreciation

Fear dissolution

“Profound” thought

37
Q

Other Effects of MDMA

A

Appetite loss

Vertical nystagmus

Bruxism and trismus

Moderate increases in HR and BP

Mild visual hallucinations

Mind racing

Changes in thermoregulation

Restlessness, nervousness, shivering

38
Q

Negative Effects of MDMA

A

Short-memory loss

Confusion

Vertigo

Muscle tension

Nausea & vomiting

Concentration difficulties

“Crash” - come down

Hangover lasting days to weeks

Depression and fatigue for up to a week

Psychological addiction

Panic attacks

39
Q

Prevalence of MDMA use: EU

A

Most recent estimate = ~1.8 million young adults (aged 15–34) used MDMA/ecstasy in the last year (1.4 % of this age group).

EU national estimates = 0.3 % to 5.6 % (EMCDDA, 2015).

40
Q

Prevalence of MDMA use: US

A

In 2014, more than 17 million people (12 years +) reported using MDMA at least once in their lifetime
Increased from 11 million people in 2004

660,000 people reported using MDMA in the last month
Increased from 450,000 in 2004

41
Q

Hatzidimitriou et al. (1999):

A

10 squirrel monkeys used:
4 control
6 given 5 mg/kg twice daily for 4 consecutive days. Dosage selected as known to produce moderate to severe 5-HT lesions.

2/3 euthanized at 2 weeks and 6-7 years

2 weeks: 85-95% ↓ in neocortex
7 years: 34-56%

Evidence of long term damage, but not as bad as previously thought.

42
Q

Fantegrossi et al. (2004):

A

No differences in 5-HT concentration in brain tissue in any brain region
7 adult rhesus monkeys used:
3 MDMA-naïve controls
4 self-administered MDMA (IV catheter; stimulus = red light)

PET scanned for VMAT binding after 2 months abstinence
Euthanized 7-10 days after scanning

43
Q

Studies on MDMA with humans

A

Can’t make direct comparisons with animal research (e.g. toxic dosages)

Can’t assess 5-HT or axons in vivo, but can PET scan for SERT

SERT reductions in MDMA users compared to polydrug using controls (Roberts et al., 2016)
FC (+ DLPFC), TC, PC, OP limbic regions (thalamus, hippocampus, anterior cingulate, amygdala)

Medium sized effects in FC, limbic areas; large effects in TC, PC, OC, DLPFC

No differences in midbrain regions
What does this mean? Greater sensitivity for mood disorders - speculation

Issues with the literature:
Small sample sizes

Variable MDMA use and polydrug use

Variable abstinence (days, weeks, months)

Reliant on self-report of usage (unknown dosage (mg) of MDMA; tablets; episodes)

44
Q

Structural and Functional Brain Changes

A

Moderate MDMA use
Average of <50 lifetime episodes of ecstasy use or
Average lifetime consumption of <100 ecstasy tablets
Abstinence assessed by urine drug screening

No evidence for structural (MRI) or functional (fMRI) differences between MDMA users and age-matched controls.

Issues with the literature:
Small sample sizes restricts generalizability
Controls not matched for other drug use
Some studies looked at amphetamine-like stimulants (not specifically MDMA)
MRI/fMRI scanning cannot determine neurotoxicity (GM, WM volumes and BOLD)
Heavy use = higher use of other drugs, other lifestyle and environmental factors

45
Q

Effects of MDMA on cognition

A

Neurocognition: fMRI, fNIRS, EEG (Roberts et al., 2018)
Some evidence of increased brain activity in MDMA users
Equivalent cognitive task performance = brain is working harder
ERP components = amplitude ↓ in MDMA users (sensitive to post-synaptic voltage changes)

Variable results of cognitive deficits with MDMA use (Parrott, 2000):

Memory deficits – immediate and delayed recall, recognition and spatial recall

Controls: drug naïve and matched for other drug use

MDMA users report subjective memory impairments

Deficits in reasoning and planning (ToL and WCST)

More impulsive (self-report questionnaires)

Other information processing abilities (RT, Stroop, Trails) – not different to controls
Mixed results – not all studies find memory deficits
Deficits correlate with amount of MDMA consumed
Deficits can improve with abstinence

46
Q

So how dangerous is MDMA?

A
Low dependence (psychological dependence) and low physical harm (see Nutt et al., 2007) 
Adverse events (see Nutt, 2009):
Horse riding = 1 in 350 episodes
MDMA = 1 in 10,000 episodes 

Death (1994-2003 in UK; Schifano et al., 2006)
394 ecstasy mentioned
165 sole drug mentioned

Mainly caused by dehydration and increased body temperature

Confounded by other drug use and alcohol consumption, other risk behaviours

18th in harmfulness out of 20 recreational drugs

47
Q

Can MDMA be beneficial?

A

Was used in psychotherapy/psychiatry before it was illegal

Potential as a treatment for PTSD (see Feduccia et al., 2018)

Evidence that MDMA can enhance positive emotional bias

Double blind repeated measures design (MDMA/placebo)
19 participants (5 female) with previous use of MDMA
Used participant provided best and worst autobiographical memories
After MDMA:
Best memories = more vivid, emotionally intense and more positive, increased brain activity
Worst memories = reported as less negative, reduced brain activity
See Carhart-Harris et al. (2014)

48
Q

Electroencephalography

A

Electroencephalogram (EEG) records post-synaptic voltage changes.

The column-like organisation of pyramidal cells transmits electrical activity to the scalp.

Summation of large groups of neurons firing in synchrony.

Volume conductor:
Scalp, skull, brain, CSF
= unknown location of signal generation

49
Q

Clinical Applications: Epilepsy

A
Neurological condition:
Characterised by repeated seizures
↓ inhibition → excessive firing of neurons
Hyper-excitation 
Range of seizure types
50
Q

Clinical Applications: Sleep

A

Polysomnography (sleep EEG):

Narcolepsy (sudden falling asleep)

Sleep apnoea (breathing stops during sleep)

Insomnia (falling asleep / staying asleep)

Parasomnia (terrors; nightmares; sleep walking / paralysis)

EEG activity is used to characterise sleep stages:

Awake = alpha and beta (15–60 Hz; ~30 μV)
REM = beta (paradoxical sleep – high frequency, low voltage)
Stage 1 = theta (4–8 Hz; 50–100 μV)
Stage 2 = sleep spindles (10–15 Hz oscillations; 50–150 μV)
Stage 3 = delta (2–4 Hz; 100–150 μV)
Stage 4 = delta (0.5–2 Hz; 100–200 μV)

51
Q

EEG Pros and Cons

A

Advantages:
Excellent temporal resolution (milliseconds) > ‘online’ functioning
Distinguish timing of different processes (sensory > cognitive)
Low cost
Mobile – but with limitations

Disadvantages:
Poor spatial resolution
Numbers of individual trials needed for averaging (40+ pp x condition)
Fatigue and boredom
Movement artifacts
52
Q

Positron Emission Tomography (PET)

A

Fluorodeoxyglucose (FDG) = glucose analogue (isotope = Fluorine-18)

Absorbed by high glucose using cells (e.g., brain) > prevents glucose from leaving cell (until radioactive decay)

Intracellular concentration = glucose metabolism
Less ‘active’ cells = hypometabolism

53
Q

11C-labeled benzothiazole Pittsburgh Compound B (11C-PiB)

A

11C-PiB is a fluorescent derivative of thioflavin T

Targets and binds to beta amyloid (Aβ40 and Aβ42 fibrils) and insoluble plaques containing Aβ40 and Aβ42 (high affinity)

Most commonly used radioligand used in Aβ deposition imaging

Klunk et al. (2004) – first study

54
Q

Disease Progression: Imaging Evidence

A

Amyloid deposition = spectrum, need cut-off for meaningful burden

PiB- and PiB+ using the DVR (1.08; see Villeneuve et al., 2015. Brain)

DVR = Distribution Volume Ratio of a receptor-containing region to a non-receptor region

55
Q

PET Pros and Cons

A

Advantages:
Widely used in oncology (diagnosis, staging and treatment)
Distinguish areas of hypometabolism / Aβ deposition in the brain (e.g., AD)
Identify areas of activity with cognitive processes
Examination of neurotransmitter systems
Dopamine, serotonin and opioid receptors (ligand binding to receptors)

Disadvantages:
Radiotracer is radioactive (109 minutes half-life)
Unable to be used in some populations (e.g., during pregnancy)
High cost:
Creation of isotopes and ligands
Medical team / environment needed

56
Q

MRI Pros and Cons

A

Advantages:
Excellent spatial resolution
Calculation of GM and WM volumes; correlations with cognitive functions
Non-invasive and does not involve radiotracers

Disadvantages:
Only informs on structure, not function
Lengthy scanning time (40-60 minutes)
Expensive
Not suitable for young children, people with claustrophobia, pacemakers, metal implants etc.
Due to noise, bore (60cm), magnetisation of metal objects

57
Q

fMRI Pros and Cons

A

Main advantage:
Excellent spatial resolution

Main disadvantage:
Poor temporal resolution (timing of the haemodynamic response)

Concerns over the multiple comparisons problem:
Compare vast numbers of voxels to assess if voxel is ‘activated’
Issues with false positives, need to correct for multiple comparisons
Dead salmon = brain and spinal cord activity

58
Q

London Taxi Driver Study

A

Investigated spatial memory (navigation) in response to environmental challenges (e.g., learning)
Used London taxi drivers (n = 16)

Also found that ↑ experience
↑ posterior volumes
↓anterior volumes

Posterior hippocampus:
Supports spatial navigation
Can expand with experience

59
Q

Case Studies: The Hippocampus

A
Clive Wearing (1938 - )
Viral encephalitis destroyed his hippocampus
= anterograde and retrograde amnesia (inability to form or maintain new memories and the loss of previous memories)
Henry Molaison (1926-2008)
H.M. - removal of hippocampus (for treatment of epilepsy)
60
Q

Alcohol-Related Brain Disease (ARBD)

A

Umbrella term = caused by long-term alcohol misuse
Direct neurotoxic effects of alcohol
Thiamine (vitamin B1) deficiency:
Inadequate nutrition, malabsorption of thiamine (from gastro-intestinal tract), impaired utilisation of thiamine in cells

Wernicke Encephalopathy (WE):
Eye movement disorders
Ataxia – impaired coordination, balance
Confusion (+ other altered mental status)

UK prevalence 0.5% (Harper et al., 1995)
But, autopsy studies identified 75-80% more cases than clinical examination (undiagnosed)
Approx. 80-90% PwAUD with WE > develop KS (Victor et al., 1989)

61
Q

Alcohol-Related Brain Disease

A

Korsakoff Syndrome (KS):
Severe retrograde and anterograde amnesia
Confabulation
Spatiotemporal disorientation
Executive dysfunction
25%: complete /significant / slight / no recovery (Smith & Hillman, 1999)
25% need long-term residential care (Kopelman et al., 2006)

Wernicke-Korsakoff Syndrome (WKS):
2 Stages: WE (acute, reversible stage) > KS (chronic, irreversible stage) / co-occurence

Brain abnormalities (lesions) characteristic of WKS present in ~13% of PwAUD (Harper et al., 1988)
Clinical diagnosis, autopsy confirmation (~20% autopsy confirmed WKS had clinical diagnosis; Harper, 1998)
62
Q

Functional Neuroanatomy

A

Visual Area:
Sight
Image perception
Image recognition

Temporal Area:
Memory
Limbic system - hippocampus

Motor Area:
Initiation of voluntary muscles

Broca’s Area:
Language – speech production

Auditory Area:
Hearing

Cingulate cortex:
Limbic system –
ACC = conflict monitoring

Parietal Area:
Integrates sensory information

Olfactory Area:
Smelling

Primary Somatosensory Area:
Inputs of touch and feeling

Somatosensory Association Area:
Integrates and analyses different somatic inputs

Wernicke’s Area:
Language – comprehension (written and spoken)

Supplementary Motor Area:
Preparation and initiation of goal-driven behaviour

Prefrontal Regions:
Targeting attention
Working memory processes
Planning initiation of activity 
Initiation and control of deliberate action
Decision making 
Problem solving and reasoning 

Cerebellum:
Coordination of movement
Balance and equilibrium, posture

63
Q

What is neuropsychology?

A

Neuropsychology is concerned with the relationships between brain and behaviour.

Research investigates how brain structure and function can influence affect, behaviour and cognition (ABC).

Clinical research focuses on the links between brain damage and changes in ABC.

64
Q

The Heart vs. Brain Hypothesis

A

The Brain Hypothesis:
Aristotle – nonmaterial psyche > heart to produce action
Hippocrates – link between brain and behaviour
Brain = seat of intelligence
Galen – anatomist, clinical observations of gladiators, spinal nerves and treating wounds

Localisation of Function: Evidence against Heart Hypothesis
Renaissance and the Scientific Revolution > Biology and Anatomy
Gall – brain controlled mental functions, not the heart
Different parts of the brain are linked with specific functions

65
Q

Localisation of Function

A

Gall (1758-1828) and Spurzheim (1776-1832):

Brain dissections identified the corticospinal tract:

Hemispheric control of contralateral movement

Brain sends messages to spinal cord to produce movement

Cortex is a distinctly functioning part of the brain

The corpus callosum connected the two hemispheres

Phrenology: bumps = personality
Scientifically inaccurate, but influential

66
Q

Localisation and Lateralisation of Language

A

Clinical observations (19th C): Speech disorders linked with lesions in the left hemisphere.

Left hemisphere = dominant hemisphere. Speech and language are considered to be central to consciousness

Auburtin (1861): pressure on exposed frontal lobe = abolished speech production.

Broca: identified case studies (n = 8) = left frontal lesions and speech deficits.

Broca’s area = region linked with speech production

Broca’s aphasia = syndrome linked with damage to Broca’s area (a = not and phasia = speech)

67
Q

Organisation of Language

A

Wernicke: hearing and speech = related

Cases: people with aphasia + lesions in auditory projection area
Fluent speech but impaired comprehension of spoken words and sentences
Wernicke’s area
Wernicke’s aphasia (fluent aphasia or receptive aphasia)

Model of Language Organisation:
Auditory information travels from ears to primary auditory area

Processed into sound representations in Wernicke’s area

Sound representations sent to Broca’s area (where representations of sound movements are stored)

Neural signals from Broca’s area to motor cortex = mouth movements to produce correct sounds

68
Q

Case Study: Phineas Gage

A

Phineas Gage (1823-1860)

Railroad construction worker
Metal rod blasted through his frontal lobe (1848)

Post-injury changes:
Preserved memory and general intelligence

Linked damage to the prefrontal cortex (PFC) with personality changes

Challenges in establishing the extent and duration of post-injury changes

De Schotten et al. (2015) argue that white matter damage was more significant than grey matter damage

Evidence that functioning depends on the connectivity and coordination of different brain regions

69
Q

Experimental Methods

A

Experiment: Cause and effect

Flourens (1794-1867)
Surgical ablation (removal of brain tissue) = lesions in rabbits and pigeons
Cortex = loss of perception, movement and judgement
Cerebellum = loss of balance and motor coordination
Brainstem (medulla oblongata) = death

Ferrier (1843-1928)
Electrical stimulation of cortex in dogs and monkeys
Ablation of specific brain regions > confirmed stimulation results
Mapping of cortical regions responsible for movement
Translated to humans = predicted regions damaged by tumours