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Clinical Neuropsychology > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What is clinical neuropsychology?

A

The scientific study of the relationships between brain function and behaviour.

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2
Q

Clinical neuropsychlogy looks at how ___, ____ ad ___ are impacted by brain function.

A

Cognition, emotions, behaviour.

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3
Q

Clinical neuropsychologists usually deal with assessment, diagnosis and treatment of people with ___ brain function.

A

Impaired

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4
Q

List the conditions that are acquired brain injuries:

A

-Traumatic brain injury
-Stroke
-Infection (encephalities, meningitis)
-Brain tumour
-Epilepsy

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5
Q

List some neurodegenerative conditions:
-Alzheimer’s disease
-Frontotemportal dementia
-Dementia with lewy bodies
-Partkinson’s disease
-Motor neuron disease

A

List some neurodevelopmental conditions:
-Autism spectrum disorder
-Attention deficit hyperactivity disorder
-Learning disorders

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6
Q

List some neuropsychoatric conditions:

A

-Schizophrenia
-Depression
-Post traumatic stress disorder

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7
Q

What approach does a clinical neurpsychological assessment follow?

A

Hypothesis-testing

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8
Q

What are the key factors of a clinical interview?

A

-Develop rapport
-Presenting problem
-Cognitive and behavioural issues
-Impact on everyday life/function
-Medical history
-Psychiatric history and current mood
-Developmental history
-Educational and occupational history
-Family history
-Current living situation/supports
-Coping and adjustment

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9
Q

What may comparing the client report to informant report tell you?

A

If they have insight, perhaps more depression or anxiety. If they don’t and informant reporting terrible memory problems that the client isn’t aware of, perhaps a dementia or something else.

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10
Q

What are the two main factors of behavioural observations?

A
  1. Elements of a mental status exam (speech, mood and affect, cognition, appearance and behaviour)
  2. How they approached and completed tasks (cooperation, effort, persistence, engagement - tasks and examiner)
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11
Q

What is some examples of factors that may impact on assessment?

A

A phone call, telehealth, fire alarm etc.

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12
Q

What are some things we include in formulation?

A

-answer referral question
-consistent with particular diagnosis
-cognitive/behavioural strengths and weaknesses
-management and treatment recommendations
-design and implement neuropsychological interventions
-feedback to client? family, referrer

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13
Q

What are the 4 main lobes?

A

Frontal lobe, parietal lobe (top). temporal lobe (side), occipital lobe (back)

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14
Q

What are the two main functions of the frontal lobe?

A

Cognitive and behavioural

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15
Q

What are the main features of the parietal lobe?

A

-Integrates sensory information
-Visuopatial navigation
-Numerical relationships
-Language processing and comprehension

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16
Q

What is the temporal lobe primarily involed in?

A

-memory creation/new learning (hippocampus)
-Auditory and visual processing
-Object recognition
-Language recognition
-Emotional processing (amygdala)

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17
Q

What is involved in the occipital lobe?

A

Visual perception

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18
Q

What is involved in the cerebellum?

A

-Coordinating movement
-maintaining balance
-Likely also involved in attention, language, and emotional control
-Implicit memory

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19
Q

What are the two types of cushion protecting your brain and spinal fluid?

A

Meninges, ventricles and cerebrospinal fluid.

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20
Q

What are the medulla and pons located and what are they involved in? What will happen if they get damaged?

A

Right in the centre, protected, basic functions such as heart rating, respiration, blood pressure, swallowing. Usually death if damaged.

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21
Q

What part of the brain is really involved in Parkinson’s disease?

A

Substantia nigra - movement, reward circuitry

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22
Q

In the midbrain, superior colliculi is important for:

A

visual function

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23
Q

In the midbrain, inferior colliculi is important for:

A

auditory function

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24
Q

How many nuclei does the thalamus have

A

20 bundles projecting to cortex

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25
Q

What is the thalamus for?

A

Relay station for sensory information

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26
Q

The hypothalamus is small, but __ nuclei are involved in many important behaviours. What are some of these?

A

22
Eating, sex, sleeping, emotions, temperature, movement. Regulates hormone release from pituitary gland.

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27
Q

What are the two main areas of the epithalamus and what are they involved in?

A
  1. Pineal gland (melatonin)
  2. Habenula (hunger, thirst)
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28
Q

What is involved with the limbic system involved in?

A

Social and emotional behaviour, memory, spatial behaviour. Includes amygdala and hippocampus.

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29
Q

What is involved mainly in the basal ganglia?

A

Voluntary control of motor function, associative learning (procedural, reward), executive function. Connects to frontal lobe, thalamus, limbic system, brain stem.

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30
Q

Why is premorbid IQ so important to know when doing a neuropsychological assessment?

A

To tell how much they’ve been impaired.

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31
Q

What is one way to gather where someone should be in terms of premorbid IQ?

A

Demographic, educational, and occupational details. We kind of have to guess, estimate.

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32
Q

How would we assess general intellectual functioning?

A

WPPSI (preschoolers) WISC (children) WAIS (adults)

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33
Q

What is visuo spatial skills?

A

A complex neural network workign together to prcess visuo spatial information.

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34
Q

How do we assess visuo spatial skills by looking at the brain

A

Look at the different pathway - where in the pathway is affect (everything after this most likely also affected).

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35
Q

Visuo-spatial disorders affect the ability to:

A

Recognise objects, drive, recognise faces, negotiate stairs, pour a drink, and draw.

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36
Q

We need to screen for ____ from the outset. ____ is not enough.

A

visuo-spatial and motor skills
asking

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37
Q

When assessing visuo-spatial and motor skills, what are we looking for in behavioural observation and during everyday tasks?

A

We are looking for avoidance and use of compensation.

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38
Q

Give some examples of testing visuo-spatial and motor skills:

A

Line bisection and orientation, bells test of neglect, left-right orientation, clock/bicycle drawing tests, construction tests

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39
Q

Where is language/verbal function generally dominant to?

A

The left hemisphere

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40
Q

What is Wernicke’s area typically involved in?

A

Language comprehension

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41
Q

Which gender is more likely to have language bi-laterally represented?

A

Females

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42
Q

What is Broca’s area typically involved in?

A

Language/speech production

43
Q

If the client has no trouble producing language, but it doesn’t make much sense, is it more likely Wernick’s or Broca’s?

A

Wernicke’s

44
Q

What type of dementia is primary progressive aphasia?

A

fronto-temporal dementia

45
Q

What is going on biologically in primary progressive aphasia?

A

Neuronal loss (atrophy) in frontal and/or temporta areas

46
Q

If you have primary progressive aphasia, there is progressive impairment in what?

A

Communication - language production and/or comprehension, almost always word finding difficulties.

47
Q

What kind of function with will see on other cognitive tasks except language in primary progressive aphasia?

A

Good function.

48
Q

What are the three main subtypes of primary progressive aphasia?

A

-Semantic
-Nonfluent
-Logopenic

49
Q

What might we see in semantic type of primary progressive aphasia?

A

Not being to understand what things are - losing the meaning of things. Producing language.

50
Q

What might we see in nonfluent type of primary progressive aphasia?

A

Bit more like Broca’s aphasia, producing language.

51
Q

How can one get primary progressive aphasia?

A

Stroke, TBI, neurodegenerative disease.

52
Q

Primary progressive aphasia issues mainly concerns:

A

language

53
Q

What might we see in logopenic type of primary progressive aphasia?

A

More likely to be a working memory issue, most likely actually due to underlying Alzheimer’s disease rather than fronto-temporal.

54
Q

If someone comes in to be assessed with language/verbal function, what is the assessment process?

A

referral, behavioural observations, performance on WAIS and WISC subtests, basic screening, production, reception/comprehension, spoken vs. written, areas to consider: naming, repetition, fluency, abstract reasoning, vocab, comprehension etc.

55
Q

What are the two ways that we assess verbal fluency?

A
  1. Letter fluency (Give me all the words you can think of that start with F)
  2. Category fluency (list all animals you can think of)
56
Q

What does assessing processing speed measure, and is is focally located within the brain?

A

Measures efficiency and organisation of neural networks.
Not something that is located focally within the brain.

57
Q

The integrity of white matter tracts is related to what?

A

Processing speed

58
Q

What are some ways that we assess processing speed?

A

-Processing speed index
-Speed as a component of other timed tasks
-Trail making test

59
Q

The neuroanatomy of attention is very ___ and requires a lot of different ______.

A

Complex
Different parts of the brain.

60
Q

How do we assess basic attention and alertness?

A

Behavioural observation (are they yawning, alert, etc)

61
Q

What is sustained attention?

A

Ability to maintain concentration or focus towards stimuli over a given time frame. Often referred to as ‘vigilance’.

62
Q

What are problems with sustained attention evident by?

A

Decreased alertness and responsiveness over time, losing train of thought or the focus of attention wanders.

63
Q

How do we assess sustained attention?

A

Ability to focus on a repetitive and monotonous task over an extended period.

64
Q

What is selective attention?

A

The ability to focus attention on a stimulus and ignore irrelevant internal or external stimuli.

65
Q

What are problems with selective attention indicated by?

A

Distractibility or difficulty disengaging from competing environmental stimuli (auditory or visual).

66
Q

How do we assess selective attention?

A

Behavioural observation (is the person easily distracted?) and various cognitive tests.

67
Q

What is alternative attention?

A

The ability to shift the focus of attention from one aspect of a task to another - also related to mental flexibility.

68
Q

What are some problems with alternating attention evident by?

A

The person getting stuck on one task and neglecting others or starting tasks, leaving the and failing to return to complete them.

69
Q

How do we assess alternating attention?

A

Tasks which require the person to shift smoothly from one aspect of a task to another.

70
Q

What is divided attention?

A

The ability to attend or respond simultaneously to more than one task or stimulus

71
Q

What are problems with divided attention evident by?

A

A person saying they cannot juggle tasks and need to do one thing at a time.

72
Q

How do we assess divided attention?

A

Measures of dual-task ability that require simultaneous responses.

73
Q

What is memory model 1?

A

Stages of memory

74
Q

How long is information in the sensory memory?

A

Less than 3 seconds

75
Q

What is sensory memory?

A

-Receives information from all 5 senses
-Largely unaware
-Very brief
-Large capacity
-Lots of information at this stage.

76
Q

What is stage 2 of memory, as per memory model 1?

A

Working memory

77
Q

What progressive information from sensory memory into working memory?

A

Selective attention

78
Q

How long is information in the working memory?

A

Up to 15 seconds

79
Q

What are some aspects of the working memory?

A

-Conscious
-Needs constant rehearsal
-Temporary
-Limited capacity
-Lots of information lost at this stage

80
Q

What makes information go from working memory to recently acquired memory?

A

Rehearsal

81
Q

How long is information typically held in recently acquired memory?

A

Up to several months

82
Q

What is involved in recently acquired memory?

A

-Conscious
-More enduring store
-A few minutes to a few months
-Still fragile
-Plenty of information forgotten at this stage

83
Q

What makes information in recently acquired memory go to remote memory?

A

Consolidation

84
Q

What is involved in remote memory?

A

-Robust store
-Episodic - events
-Semantic, knowledge and facts
-Procedural - skills and habits

85
Q

What are the 3 parts of remote memory?

A

-Episodic
-Semantic (knowledge and facts)
-Procedural

86
Q

What is thought of the main memory spot in the brain?

A

Medial temporal lobe, particularly the hippocampus.

87
Q

How does the hippocampus create new memory?

A

By binding or linking together all the things that make up that memory.

88
Q

Left hemisphere damage may result in issues with ___, right hemisphere damage might result with issues with _____.

A

verbal
visual

89
Q

What are the 3 stages of memory process?

A

Encode
Store
Retrieve

90
Q

How are the basal ganglia and cerebellum involved in memory?

A

Implicit (non-declarative) memory

91
Q

How is the amygdala involved in memory?

A

Attaching emotional significance to memories.

92
Q

Longer term memories stored as patterns of neural network activations throughout the ____

A

neocortex

93
Q

Memories are not stored in the neurons themselves, but in the:

A

pattern of communication between neurons.

94
Q

Which region is involved in memory retrieval?

A

Pre-frontal

95
Q

memory retrieval involves the ___ of that memory.

A

RE-creation

96
Q

Sometimes neurons from other networks might be activated, causing merging of information from different memory experiences. What can this lead to?

A

Memories being altered during recall.

97
Q

How do we assess memory?

A

-Behavioural observation
-Carefully structured interview questions
-Self report and informant report questionnaires
-Standardised tests
-Remote memory
-Testing (lower limits if needed)

98
Q

What memory scale provides testing coverage for all the memory indexes? (auditory, visual, working memory, cognitive status)

A

The Weshler memory scale.

99
Q

The frontal lobes involve what percentage of the neocortex?

A

30-35%

100
Q

Damage/dysregulation in the dorsolateral pre frontal cortex may see cognitive impairment in what “cool” executive functioning?

A

-Planning and organisation
-Problem solving (novel)
-Alternating and divided attention
-Mental flexibility
-Sequencing
-Rule following and strategy formation
-Working memory and online monitoring
-Response suppression/inhibition

101
Q

Damage to the orbito-frontal and ventromedial prefrontal damage/dysregulation may result in what in terms of “hot” executive functioning?

A

Behavioural dysregulation
-impulsivity and disinibition
-Lack of spontaneity and stimulus bound behaviour
-Reduced social skills (reading and responding to social skills)
Personality
-lack of empathy and poor mentalising ability
-Increased or decreased emotional responsivity
-After brain injury relatives may perceive the person as “no longer him/herself”

102
Q

Impaired “hot” executive functions might mean there’s damage where?

A

In the orbitofrontal and ventromedial prefrontal cortex

103
Q

Impaired “cold” executive functions might mean there’s damage where?

A

Dorsolateral prefrontal cortex damage/dysregulation

104
Q

What is the most classic frontal lobe damage case?

A

Phineas Gage

Clinical Neuropsychology (6 decks)

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