Week 6 Flashcards
What is clinical neuropsychology?
The scientific study of the relationships between brain function and behaviour.
Clinical neuropsychlogy looks at how ___, ____ ad ___ are impacted by brain function.
Cognition, emotions, behaviour.
Clinical neuropsychologists usually deal with assessment, diagnosis and treatment of people with ___ brain function.
Impaired
List the conditions that are acquired brain injuries:
-Traumatic brain injury
-Stroke
-Infection (encephalities, meningitis)
-Brain tumour
-Epilepsy
List some neurodegenerative conditions:
-Alzheimer’s disease
-Frontotemportal dementia
-Dementia with lewy bodies
-Partkinson’s disease
-Motor neuron disease
List some neurodevelopmental conditions:
-Autism spectrum disorder
-Attention deficit hyperactivity disorder
-Learning disorders
List some neuropsychoatric conditions:
-Schizophrenia
-Depression
-Post traumatic stress disorder
What approach does a clinical neurpsychological assessment follow?
Hypothesis-testing
What are the key factors of a clinical interview?
-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
What may comparing the client report to informant report tell you?
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.
What are the two main factors of behavioural observations?
- Elements of a mental status exam (speech, mood and affect, cognition, appearance and behaviour)
- How they approached and completed tasks (cooperation, effort, persistence, engagement - tasks and examiner)
What is some examples of factors that may impact on assessment?
A phone call, telehealth, fire alarm etc.
What are some things we include in formulation?
-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
What are the 4 main lobes?
Frontal lobe, parietal lobe (top). temporal lobe (side), occipital lobe (back)
What are the two main functions of the frontal lobe?
Cognitive and behavioural
What are the main features of the parietal lobe?
-Integrates sensory information
-Visuopatial navigation
-Numerical relationships
-Language processing and comprehension
What is the temporal lobe primarily involed in?
-memory creation/new learning (hippocampus)
-Auditory and visual processing
-Object recognition
-Language recognition
-Emotional processing (amygdala)
What is involved in the occipital lobe?
Visual perception
What is involved in the cerebellum?
-Coordinating movement
-maintaining balance
-Likely also involved in attention, language, and emotional control
-Implicit memory
What are the two types of cushion protecting your brain and spinal fluid?
Meninges, ventricles and cerebrospinal fluid.
What are the medulla and pons located and what are they involved in? What will happen if they get damaged?
Right in the centre, protected, basic functions such as heart rating, respiration, blood pressure, swallowing. Usually death if damaged.
What part of the brain is really involved in Parkinson’s disease?
Substantia nigra - movement, reward circuitry
In the midbrain, superior colliculi is important for:
visual function
In the midbrain, inferior colliculi is important for:
auditory function
How many nuclei does the thalamus have
20 bundles projecting to cortex
What is the thalamus for?
Relay station for sensory information
The hypothalamus is small, but __ nuclei are involved in many important behaviours. What are some of these?
22
Eating, sex, sleeping, emotions, temperature, movement. Regulates hormone release from pituitary gland.
What are the two main areas of the epithalamus and what are they involved in?
- Pineal gland (melatonin)
- Habenula (hunger, thirst)
What is involved with the limbic system involved in?
Social and emotional behaviour, memory, spatial behaviour. Includes amygdala and hippocampus.
What is involved mainly in the basal ganglia?
Voluntary control of motor function, associative learning (procedural, reward), executive function. Connects to frontal lobe, thalamus, limbic system, brain stem.
Why is premorbid IQ so important to know when doing a neuropsychological assessment?
To tell how much they’ve been impaired.
What is one way to gather where someone should be in terms of premorbid IQ?
Demographic, educational, and occupational details. We kind of have to guess, estimate.
How would we assess general intellectual functioning?
WPPSI (preschoolers) WISC (children) WAIS (adults)
What is visuo spatial skills?
A complex neural network workign together to prcess visuo spatial information.
How do we assess visuo spatial skills by looking at the brain
Look at the different pathway - where in the pathway is affect (everything after this most likely also affected).
Visuo-spatial disorders affect the ability to:
Recognise objects, drive, recognise faces, negotiate stairs, pour a drink, and draw.
We need to screen for ____ from the outset. ____ is not enough.
visuo-spatial and motor skills
asking
When assessing visuo-spatial and motor skills, what are we looking for in behavioural observation and during everyday tasks?
We are looking for avoidance and use of compensation.
Give some examples of testing visuo-spatial and motor skills:
Line bisection and orientation, bells test of neglect, left-right orientation, clock/bicycle drawing tests, construction tests
Where is language/verbal function generally dominant to?
The left hemisphere
What is Wernicke’s area typically involved in?
Language comprehension
Which gender is more likely to have language bi-laterally represented?
Females
What is Broca’s area typically involved in?
Language/speech production
If the client has no trouble producing language, but it doesn’t make much sense, is it more likely Wernick’s or Broca’s?
Wernicke’s
What type of dementia is primary progressive aphasia?
fronto-temporal dementia
What is going on biologically in primary progressive aphasia?
Neuronal loss (atrophy) in frontal and/or temporta areas
If you have primary progressive aphasia, there is progressive impairment in what?
Communication - language production and/or comprehension, almost always word finding difficulties.
What kind of function with will see on other cognitive tasks except language in primary progressive aphasia?
Good function.
What are the three main subtypes of primary progressive aphasia?
-Semantic
-Nonfluent
-Logopenic
What might we see in semantic type of primary progressive aphasia?
Not being to understand what things are - losing the meaning of things. Producing language.
What might we see in nonfluent type of primary progressive aphasia?
Bit more like Broca’s aphasia, producing language.
How can one get primary progressive aphasia?
Stroke, TBI, neurodegenerative disease.
Primary progressive aphasia issues mainly concerns:
language
What might we see in logopenic type of primary progressive aphasia?
More likely to be a working memory issue, most likely actually due to underlying Alzheimer’s disease rather than fronto-temporal.
If someone comes in to be assessed with language/verbal function, what is the assessment process?
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.
What are the two ways that we assess verbal fluency?
- Letter fluency (Give me all the words you can think of that start with F)
- Category fluency (list all animals you can think of)
What does assessing processing speed measure, and is is focally located within the brain?
Measures efficiency and organisation of neural networks.
Not something that is located focally within the brain.
The integrity of white matter tracts is related to what?
Processing speed
What are some ways that we assess processing speed?
-Processing speed index
-Speed as a component of other timed tasks
-Trail making test
The neuroanatomy of attention is very ___ and requires a lot of different ______.
Complex
Different parts of the brain.
How do we assess basic attention and alertness?
Behavioural observation (are they yawning, alert, etc)
What is sustained attention?
Ability to maintain concentration or focus towards stimuli over a given time frame. Often referred to as ‘vigilance’.
What are problems with sustained attention evident by?
Decreased alertness and responsiveness over time, losing train of thought or the focus of attention wanders.
How do we assess sustained attention?
Ability to focus on a repetitive and monotonous task over an extended period.
What is selective attention?
The ability to focus attention on a stimulus and ignore irrelevant internal or external stimuli.
What are problems with selective attention indicated by?
Distractibility or difficulty disengaging from competing environmental stimuli (auditory or visual).
How do we assess selective attention?
Behavioural observation (is the person easily distracted?) and various cognitive tests.
What is alternative attention?
The ability to shift the focus of attention from one aspect of a task to another - also related to mental flexibility.
What are some problems with alternating attention evident by?
The person getting stuck on one task and neglecting others or starting tasks, leaving the and failing to return to complete them.
How do we assess alternating attention?
Tasks which require the person to shift smoothly from one aspect of a task to another.
What is divided attention?
The ability to attend or respond simultaneously to more than one task or stimulus
What are problems with divided attention evident by?
A person saying they cannot juggle tasks and need to do one thing at a time.
How do we assess divided attention?
Measures of dual-task ability that require simultaneous responses.
What is memory model 1?
Stages of memory
How long is information in the sensory memory?
Less than 3 seconds
What is sensory memory?
-Receives information from all 5 senses
-Largely unaware
-Very brief
-Large capacity
-Lots of information at this stage.
What is stage 2 of memory, as per memory model 1?
Working memory
What progressive information from sensory memory into working memory?
Selective attention
How long is information in the working memory?
Up to 15 seconds
What are some aspects of the working memory?
-Conscious
-Needs constant rehearsal
-Temporary
-Limited capacity
-Lots of information lost at this stage
What makes information go from working memory to recently acquired memory?
Rehearsal
How long is information typically held in recently acquired memory?
Up to several months
What is involved in recently acquired memory?
-Conscious
-More enduring store
-A few minutes to a few months
-Still fragile
-Plenty of information forgotten at this stage
What makes information in recently acquired memory go to remote memory?
Consolidation
What is involved in remote memory?
-Robust store
-Episodic - events
-Semantic, knowledge and facts
-Procedural - skills and habits
What are the 3 parts of remote memory?
-Episodic
-Semantic (knowledge and facts)
-Procedural
What is thought of the main memory spot in the brain?
Medial temporal lobe, particularly the hippocampus.
How does the hippocampus create new memory?
By binding or linking together all the things that make up that memory.
Left hemisphere damage may result in issues with ___, right hemisphere damage might result with issues with _____.
verbal
visual
What are the 3 stages of memory process?
Encode
Store
Retrieve
How are the basal ganglia and cerebellum involved in memory?
Implicit (non-declarative) memory
How is the amygdala involved in memory?
Attaching emotional significance to memories.
Longer term memories stored as patterns of neural network activations throughout the ____
neocortex
Memories are not stored in the neurons themselves, but in the:
pattern of communication between neurons.
Which region is involved in memory retrieval?
Pre-frontal
memory retrieval involves the ___ of that memory.
RE-creation
Sometimes neurons from other networks might be activated, causing merging of information from different memory experiences. What can this lead to?
Memories being altered during recall.
How do we assess memory?
-Behavioural observation
-Carefully structured interview questions
-Self report and informant report questionnaires
-Standardised tests
-Remote memory
-Testing (lower limits if needed)
What memory scale provides testing coverage for all the memory indexes? (auditory, visual, working memory, cognitive status)
The Weshler memory scale.
The frontal lobes involve what percentage of the neocortex?
30-35%
Damage/dysregulation in the dorsolateral pre frontal cortex may see cognitive impairment in what “cool” executive functioning?
-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
Damage to the orbito-frontal and ventromedial prefrontal damage/dysregulation may result in what in terms of “hot” executive functioning?
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”
Impaired “hot” executive functions might mean there’s damage where?
In the orbitofrontal and ventromedial prefrontal cortex
Impaired “cold” executive functions might mean there’s damage where?
Dorsolateral prefrontal cortex damage/dysregulation
What is the most classic frontal lobe damage case?
Phineas Gage
