Summary
Summary Adult Neuropsychology (PSY3369/IPN3369)
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Summary of all the recommended literature + cases questions discussed in this course. I passes the exam the first time with grade 8.0
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Lecture 1 (readings + presentations itself) + tutorial 1What is neuropsychology?
Neuropsychology
Study into brain-behavior relationships.
Relation between brain functions, brain lesions, brain
areas and behavior.
Behavior = brain + person + environment
Neuropsychologcial assessment aims to clarify
functional brain disorders in relation to brain injuries
and brain diseases.
Neuropsychological treatment aims to optimize
participation in society.
Neuropsychologists are scientist practitioners.
They are clinicians with knowledge of
neuropsychological symptoms and test methods.
Diagnosis, treatment and scientific research about knowledge of functioning of the brain in relation to behavior.
Neuropsychology = brain is healthy
Clinical neuropsychology = brain is damaged
How did the field evolve?
Historical milestones
Ancient Greeks & Romans: interest in
o Neurology
o Psychiatry
o Brain-behaviour relationship
o 3 different forms of the soul: survival via
food intake (present in plants); interacting
with the environment (present in animals);
higher-order soul for morality (present in
humans.
o Cell theory: the ventricles are the site of the
mind. Mind has three functions: sensus communis, interpreting the image and memoria.
o Physiognomy (Aristotle): interpreting someone’s personality based on the shape of their face.
René Descartes
o Body & mind (res extensa & res cogitans)
o Not material
o Mind located in cavity of the brain: pineal gland
Franz Joseph Gall
o Localisation
o Phrenology
o Used experimental psychological research methods when working with patients with brain disorders to find
relationship between brain and behaviour.
o Interested in Plasticity substitution (some brain areas take over for others post lesion).
o Designed new diagnostic procedures in Handbook of Mental Examination Methods.
o Used the principles of behaviourist learning theory.
Paul Broca & Carl Wernicke
o Clinical anatomical method
o Lateralisation
John Hughlings Jackson
o Location of lesion ≠ location of function
1960: two major developments in the USA that resulted in neuropsychology as a separate scientific discipline
o Norman Geschwind: disconnection models based on lesion analysis.
o Split-brain surgery: Roger Sperry
, Kurt Golstein: holism > Brain functions as a whole
Alexander Luria & Oliver Zangwill: modern neuropsychological assessment
Test batterys
Barbara Wilson: Neuropsychological rehabilitation
Abram Grunbaum: First dutch neuropsychologist.
Brief history of neuropsychological treatment
1600-1700: language training
1865: first programme for patient with aphasia by Paul Broca
World war I: brain injury centres in Germany and Austria (Kurt Goldstein)
World war II: Alexander Luria (Russia)
Post war: More traffic accidents and scientific interest (USA,UK)
Nowadays: Many specialized programmes and centres for patients with brain damage.
Cognitive rehabilitation: any intervention strategy or technique which intends to enable clients or patients, and their
families, to live with, manage, by-pass, reduce or come to terms with cognitive deficits precipitated by injury to the
brain.
Aspect of cognitive rehabilitation: relearn old skills, learn new skills, learn to adapt to changed functions
(compensation) and learn to manage a changed life.
Neuroplasticity = capacity of the brain to reorganize by changes in structure and function in reaction to experience
or environmental stimulation throughout life.
Repeated performance of routine tasks as a result of training leads to permanent brain changes.
Short, intensive training of a new task also leads to structural and functional brain changes.
in healthy brains.
Which patient groups are of interest to a clinical neuropsychologist?
• Stroke (CVA: Cerebro Vascular Accident) (45000 a year) • Intoxications: Korsakov
• Traumatic brain injury (85000 a year) • Degenerative diseases: MS, Parkinson, Huntington
• Hypoxic brain injury • Degenerative diseases: Forms of dementia,
• Brain tumours Alzheimer (13000 a year)
• Epilepsy • Psychiatric diseases: Schizophrenia, depression
• Infections: Meningitis, encephalitis • Developmental disorders: ASD, ADHD
Consequences of brain damage
• Sensorimotor (i.e. hemiparesis) • Personality/character (i.e. neurotic, not interested)
• Cognitive (i.e. memory) • Social (i.e. isolation)
• Emotional (i.e. depression and anxiety) • Participation (i.e. employment)
• Behavioural (i.e. aggression, apathy) • System: family and friends (i.e. burden, depression)
reduced white matter integrity: slower signals
between neurons: information processed slower.
Spontaneous recovery until 6 months > than
vanishes Spontaneous recovery in first months
> 50 is normal line of functioning > thus, still slower differs between cognitive functions
, • Awareness • Executive functions (initiative, planning, organisation,
• Speed of informationprocessing inhibition)
• Attention and concentration (sustained, • Praxis (idea/concept, performance)
selective, divided) • Perception (neglect, hemianopia, agnosia)
• Memory (short and long, sorts of information) • Oriëntation in time, place and person
• Communication (language production and comprehension)
Cognitive consequences
After stroke
impairments still after 2 years in different cognitive areas
Memory: some even deteriorate over time > can also be an
indication of vascular dementia.
What are the main approaches?
What is the role of a neuropsychologist in a multidisciplinary team?
What kind of activities does a neuropsychologist undertake?
Assessment
What can a neuropsychologist do in case of brain damage?
Participation: Vocational rehabilitation, holistic rehabilitation >
reintegrate in society
Neuropsychological treatment
Focus on cognitive disorders, emotional and behaviour disorders
from brain injury.
Knowledge of psychotropic drugs are important,
neuropsychologists need to be competent in every treatment
modality.
What is a neuropsychological test?
Neuropsychological assessment
, Analysis of functions: impaired and intact
Contribution to medical diagnosis
Contribution to multidisciplinary treatment plan
Advice to patient & relatives
In science: the sky is the limit; in clinical practice: money, insurance, medial conditions.
Neuropsychological examination: the study of behavior
Examines the strength, efficiency, reactivity, and appropriateness of the patient’s responses to commands,
questions, discrete stimulation of particular neural subsystems, and challenges to specific muscle groups and
motor patterns.
Body structures, looking for evidence of brain dysfunction such as swelling of the retina or atrophied muscles.
The mental status portion of the neurological exam is specifically focused on “higher” behavioral functions such
as language, memory, attention, and praxis.
Intensive study of behavior by means of interviews and standardized tests and questionnaires that provide precise
and sensitive indices of neuropsychological functioning.
Attention, perception, memory, speech and language, building and drawing, reasoning, problem solving,
judgment, planning, and emotional processing.
Laboratory techniques for assessing brain function
Some of the earliest instruments for studying brain function that remain in
use are electrophysiological: include electroencephalography (EEG),
evoked and event-related potentials (EP, ERP), and electrodermal
activity.
o EEG: diagnosing seizure disorders and sleep disturbances and
monitoring depth of anesthesia
o EP and ERP: identifying hemispheric specialization and assessing
processing speed and efficiency.
Magnetoencephalography (MEG) records magnetic rather than electrical
fields. It can have a higher resolution than EEG and can thus more
precisely identify the source of epileptic discharges in patients with a
seizure disorder.
Electrodermal activity is measured as skin conductance response (SCR). It
reflects autonomic nervous system functioning and provides a sensitive measure of emotional responses and
feelings. This activity and other autonomic measures such as heart rate have also been used to demonstrate
nonconscious forms of brain processing.
Other methods that enable visualization of ongoing brain activity are collectively known as functional brain
imaging > useful for exploring both normal brain functioning and specific brain disorders.
o Regional cerebral blood flow (rCBF): reflects the brain’s metabolic activity indirectly as it changes the
magnitude of blood flow in different brain regions.
o Computerized tomography (CT) and magnetic resonance imaging (MRI) reconstruct different densities and
constituents of internal brain structures into clinically useful 3D pictures of intracranial anatomy. A CT might
be best suited for acute head injury when skull fracture and/or bleeding are suspected, whereas MRI, with
diffusion tensor imaging (DTI) might be chosen in the chronic stages of head injury, when the clinician is
especially concerned about white matter integrity.
o Positron emission tomography (PET): visualizes brain metabolism directly as glucose radioisotopes emit
decay signals > their quantity indicates level of brain activity in a given area > diagnosis of neurodegenerative
diseases.
o Single photon emission computed tomography (SPECT) is less expensive than PET. It involves a contrast
agent that is readily available.
o Functional magnetic resonance imaging (fMRI) is based on the fact that increasing neuronal activity requires
more oxygen. The amount of oxygen delivered by blood flow tends to exceed demand, creating a ratio of
oxygenated to deoxygenated blood known as the BOLD signal. This signal can be precisely measured and
localized (often by mapping it onto a structural MRI) > spatial resolution > permits visualization of brain areas
that are activated during various cognitive tasks.
used to study time perception, semantic processing, emotional processing, response inhibition, etc.
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