neuropsychology week 1 Flashcards
How can you get a neurological disorder (3 ways)?
Disease, Physical trauma, Genetic predisposition causing irreversible damage to brain and CNS
What is grey matter largely for?
Cognitive processes
What is White matter largely for?
Connectivity processes
Name 3 types of cerebral infections
Encephalitis, Meningitis, Mad cow disease
How can viruses enter the Central nervous system?
Through blood brain barrier (haematogenous). Or by travelling axon (retrograde axonal transport)
How can you confirm if the infection in brain is viral?
Lumbar puncture- do a cell count of lymphocytes, glucose and protein. Can also test for specific viruses using PCR or serology or by growing a viral culture.
Name two brain imaging processes
MRI with contrast, EEG (measures electrical activity)
Symptoms of encephalitis
Headaches, high temperature, confusion, drowsiness, aversion to bright lights, seizures
Autoimmune encephalitis
Psychosis, hallucinations
How does brain injury occur?
Injury can occur when brain comes into contact with a hard surface (body decelerates yet brain keeps going). Or stretching and jarring due to rapid changes in motion.
Name 2 types of traumatic brain injury
Closed head TBI ( Skull intact) Open head TBI (both skull and brain penetrated)
Phineas B Gage
Pole went through their head. Changes in behaviour, went from a god fearing man to an alcoholic.
What is a stroke
Blockage or breaking of blood vessels in the brain. This occlusion leads to ischaemia (blood/ oxygen shortage)
What are symptoms of stroke
Sudden numbness or weakness on one side of body (hemiplegia), sudden confusion , speech deficits, dizziness, loss of coordination
Name 3 types of stroke treatment
Acute stroke therapies- stops stroke as its happening by dissolving blood clots.
Post stroke rehabilitation- helps individuals overcome disabilities that result from stroke damage (speech therapists)
Drug therapy with blood thinners (daily aspirin)
FAST acronym
Face starts to droop
Arm weakness and legs (occasionally)
Speech (slurring, trouble understanding)
Time (call 999 immediately)
What are 4 modifiable risk factors of stroke?
High blood pressure
smoking doubles risk for stroke
diabetes damages blood vessels
High cholesterol leads to narrowing of blood vessels
depression (May et al 2002)
What impairments result from Vascular dementia.
Impairments of attention, executive functioning, speed of functioning
What is vascular dementia a result of
post stroke dementia or cumulative impact of lots of mini strokes
What is pseudobulbar effect
Uncontrollable laughing/ crying. (JOKER)
What are the 5 main types of neurological disorder?
Cerebral infections (encephalitis, viral infection of the brain or CNS)
Traumatic brain Injury (brain coming into contact with hard surface or stretching/jarring of skull)
Neurodegenerative disease (stepwise deterioration of brain areas due to ageing or dementia)
Cardiovascular accidents ( strokes, blood clots in the brain, must be tackled immediately)
Brain tumours (abnormal and uncontrolled cell division)
What are the three main types of intervention?
Cognitive rehabilitaition, biological intervention and caregiver support programmes
What are the three main types of treatment (Zangwill version)
Substitution ( Teaching usage of another sense or using technology to do tasks previously accomplished by the sense or skill that is in deficit) E.g. Tactile kinaesthetic feedback
Compensation (Reorganisation of psychological function so as to minimise or avoid a particular disability. E.g. memory aid
direct retraining- restoring performance of the damaged function. e.g. movement via physiotherapy
Brain tumours
Caused by abnormal and uncontrolled cell division in brain or meninges, depression is a cause and consequence. some people can get acquired sociopathy
What is a degenerative disorder?
Slow general deterioration in cognitive, physical and emotional functioning. Usually a feature of old age (accelerated in degenerative). memory often impaired
Difficulties in diagnosis of degenerative disorders
Distinguishing from ageing.
distinguishing from other degenerative disorders
found in elderly (compounded with psychological problems associated with ageing, (depression)
Individual differences in cognitive reserves (buffer to impairments of ageing)
What can cause rapid cognitive deterioration?
Acute medical problems like UTI/delirium.
Neurological causes (stroke, seizure)
Medication (over medication)
sleep disorders
Diet (VB12 Deficiency, vegetarians) (high alcohol consumption and not eating (Korsakoff syndrome)
What are the characteristics of Alzheimer’s
Cognitive impairments in short term memory, aphasia, apraxia, agnosia
irritability and paranoid behaviour
Average duration 9-10 years however it is difficult to ask someone how long problems have been going due to tendency to remember catastrophic events
Risk factors of Alzheimer’s
Age (old), gender (f), genetics (58-76% heritability, Gatz et al, 2006)
family history of dementia
history of head injury
Low educational status (SES) . speaking 1 language
What is longitudinal assessment and why?
Assess someone every 6 months. comparing their performance with themselves (best form of control) Shows if things are getting worse and how quickly condition worsening. Decline is non linear can see improvements and worsening. (do something on a Monday but cant on a Tuesday)
Aetiology of Alzheimer’s
Beta Amyloid Plaques- nun study
Mild cognitive impairments
Patients think they’re experiencing cognitive decline but scores low but not super low. can eventually lead into Alzheimer’s
MMSE
Assessment tool for measuring cognitive decline. An issue is that already smart people may not show up as cognitively declined as higher baseline.
Parkinson’s diseases characteristics
White matter disease affecting movement. main symptoms are tremors, slowness of movements, stiffness or rigidity of muscles. Occurs as a result of damage dopaminergic neurons in substantia nigra area of basal ganglia
Huntingtons disease
Inherited degenerative disorder of the CNS (50%). Movement disorder however cognitive ability declines as disease progresses. causes cell death in basal ganglia.
What is the basal ganglia?
Interconnected nuclei beneath frontal and temporal lobes. receive input from cortex. two parallel pathways (go/no go). Contributes to acquisition, selection, inhibition and cessation of rewarding vs non rewarding behaviour.
Cortico basal degeneration
Motor control issues, limb apraxia. cognitive dysfunction in frontal and parietal cognitive problems.
Multiple sclerosis
Hyperactive, maladaptive autoimmune system. Mylein sheath (protector of nerve cells) breaks. can impact teenagers. Maladaptive impact dependant on variant of MS
What are the main forms of neurological disease?
Alzheimer’s
Parkinson’s
Huntington’s
cortico basal degeneration
Multiple sclerosis
Posterior cortical atrophy
Affects back of brain (visual processes). lose ability to read, recognise colours, faces. Often dissmessed as problem with eyesight.
Tang Wei (2004)
Why is assessment important?
Determining nature and profile of any defecits.
Provide information about onset, severity, prognosis, and progression of symptoms
Helping to discriminate between neurological and psychopathological symptoms
Helping to identify focus for rehabilitation programs.
Can understand which area of the brain is damaged
people find comfort in knowing what is happening to them.
Experiencing something without explanation can be difficult on patient and family
What are the categories of impairments of neurological disorders?
A attentions and arousal
M memory and learning (Amnesia)
P Perceptual visual functioning
L Language ( Aphasia)
E Executive functioning
Motor deficits (Apraxia)
Difficulty in determining type of impairment?
Often not obvious what the deficit is as the neurological impairments can combine. Often the case that we mistake an attention problem for a memory problem.
Assessment for deficit in attention
Trial making task- (dot to dot with numbers and letter)
Tests planning, focused attention, memory, visual neglect.
performing the test with a stop watch can highlight where the deficit is and how bad it is. Also if there are other impairments.
Deficits in attention or arousal example
Easily distracted in conversation. Perform learned activities slower than before ( using DVD)
Deficits in visual- perceptual functioning (agnosia) meaning
loss of ability to recognise objects, people, sounds, shapes, smells. Specific sense not faulty and no significant memory loss.
Key modality of information not providing enough information for person to recognise what they’re looking at.
Assessment of visual perceptual functioning
Visual object and space perception test
(Motor skills) apraxia definition
loss of ability to make familiar movements despite wanting to
Executive functioning defecits
inability to complete higher order processes. (cant plan, problem solve, initiate or inhibit complex behaviour). Associated with prefrontal cortex.
Assessment of executive functioning defecits
Category fluency task. look at nature of errors to determine problem in functioning and extent of issue. Whiteside 2015 (category fluency task associated with language function more than Executive functioning
What is a test battery?
cluster of cognitive assessments which cover various bits of AMPLE. generates a single cognitive score
Difficulties of diagnosing neurodegenerative disorders?
Symptoms of neurological deficits resemble those of psychopathologies (E.G. non epileptic seizures)
Neurological deficits associated with development of things like depression and anxiety
Other issues may play a part. e,g substance abuse
Rehabilitation procedures
Exercises to improve impaired function (re-training)
Training in the use of cognitive and behavioural aids (substitution)
Assistive technology (compensation)
Basic drug treatment and psychotherapy to help deal with related mood disorders.
Biological treatment types
Drug treatments (cholinesterase for Alzheimer’s) Levodpa (dopamine ) parkinsons.
Thrombolytic therapy dissolve blood clots
Deep brain stimulation (sending electrical impulses to certain parts of brain, used in Parkisnons
Surgery. chemotherapy, radiation (tumours. epilipsey)
Cognitive rehabilitation
Basic training in areas of deficit
cognitive rehabilitation for apraxia
Gestural training (Smania et al 2000).
replace tool with another tool. Visual feedback for monitoring
Cognitive rehabilitation using virtual environment
Allows for a safe and controlled environment to help coordinate actions.
Cognitive rehabilitation for executive functioning
Goal management training (GMT) break down components of task to small chunks. patient can slow down and check completion of each chunk separately.
Self instruction training (SIT) Ask patient to talk themselves through the problem (identify what point of task there on)
General cognitive rehabilitation techniques
Emotional management, relaxation,
Caregiver support programmes
Context of environment and stress of individual and collective individuals around them.
can be a cultural phenomenon (Muslims)
Caregiver support programmes 2
- Provide skills to help the carer with day-to-day living
- Advice on how to modify the home environment (Gitlin et al., 2005)
- How to control aggression and wandering (Pinkston et al., 1988)
- Peer support groups are also an important means of maintaining Quality of life
- Help caregivers and friends understand and respect individuals with neurological disorder.
Alzheimer’s society advice for caregivers
- sufficient support
- Make time of day for themselves
- Understand their rights to local services
- Try to involve other family members in caregiving
- Look after their health
- Check whether entitled to financial benefits
- Confront and deal with feelings of guilt
- Take regular breaks
Tips for making dementia sufferers feel better (INSIGHT)
- Avoid situations they are bound to fail (humiliating), look for enjoyable easy tasks
- Give plenty of encouragement (own pace, own way)
- Do things with them not for them (independence)
- Break activities into small steps so they feel a sense of achievement
- Take pride in their appearance and compliment how they look. (self-respect)
Important to note that the rehabilitation strategies are not independent and can be used in combination
Important to note that the rehabilitation strategies are not independent and can be used in combination
Co production!!
- is important to ensure a collaborative approach to individualise treatment to what best suits the patient.
- More likely to use a compensatory system because he has had direct impact on its creation.
- Psychosocial benefits (positive affirmation from friends/family due to creating a useful device for their needs) (Empowering patient) (similar to collaboration in CBT)
- Important to consider what the patient values (Do they value one skill e.g. speech over another) It is important to consider what deficit to target. (similar to ABA)
