Sam Neuropsychology
Lecture 1 – The Neuropsychologist
What is a neuropsychologist?
A clinician and/or scientist who uses neurology, neuroscience and psychology
- to understand how behaviors correlate with brain function
- to assess ‘normal’ and ‘impaired’ cognitive, social, physical and emotional functioning
Neuropsychology is usually clinical in nature
- Neuropsychologist are not medical doctors
- Clinical task are usually diagnostic
- Referrals to specialists may be given for treatments
- Research tasks may include investigating causes of a disorder, its brain/behavioral/cognitive
processes, its diagnostic approaches, the efficacy of treatments (how well they work), etc
Donald Hebb (Considered the ‘father of neuropsychology’):
Hebbian theory: neural pathways develop based on experiences; as pathways are used
more, they become faster and stronger
Early neuropsychology was closely linked to brain injury and dementia research and diagnosis:
Relationship between loss of brain function and change in thoughts/behaviors easier to
observe Modern neuropsychology includes a variety of disorders
Neurological examination:
Patient’s history
State of awareness:
- Alert, confused etc
- Speech abnormalities, body posture, facial asymmetries,
- Emotions (agitated, anxious, depressed, apathetic, restless)
Physical examination (assess a person’s nervous-systems functioning): Blood pressure, brain
imaging, muscle movement and reflexes, smell, pain etc.
Disorders:
- Strokes, injuries, and lesions may show asymmetry, loss of function
- Parkinson’s may show loss of smell and motor changes
- Dementia may show memory loss or disorientation
Biopsychosocial model of neuropsychological assessments:
Neuropsychological assessment: Combines many tests depending on patients ‘symptoms’
(e.g. IQ, cognitive and psychometric tests)
Biopsychosocial model: Big role for the environment
- Social support networks (friends, family) influence outcomes
- Patients’ sense of wellbeing influence outcomes
- Sometimes a mismatch between the patients’ needs and their social network (e.g.,
patient wanted to stay home, family thinking they should work) this can add stress that
may impair healing
How did the biopsychosocial model change neuropsychology?
First conceptualized in 1950 by Roy Grinker applied “bio” to psychology
Proposed as a medical perspective by George L. Engel in 1977 applied the “social”
component to medicine (effect of friends and family on mental health)
, A person is not made of isolated organs, but function as a whole you need good biological,
social and psychological circumstances to have a good mental health
Example from Dementia:
Dementia: Umbrella term for impaired memory, -cognition, and -
decision-making (Common causes: Alzheimer’s, Huntington’s disease,
multiple sclerosis (MS) )
- Symptoms include: poor mood and perception (May include
depression, apathy, and hallucinations)
Neuropsychiatric Inventory (NPI): questionnaire score form used to
characterize dementia in the clinic
- Assesses frequency and severity of symptoms and assesses changes in
behavior
Biopsychosocial perspective in dementia: (Usually applied as part of treatment plan)
External triggers are assessed through history interview (e.g. one study found that 80% of
dementia symptoms had external triggers) therefore social support and environmental
well-being considered in treatment plan
Biopsychosocial perspective helped lead to other social-clinical models:
Part of our social well-being is our cultural fit
Beliefs from our community shape our experience of medicine
Not all symptoms are symptoms
Certain beliefs are cultural and sometimes hallucinations are even considered culturally
appropriate
therefore Cultural Formulation Interview (CFI): Used to determine whether something is
pathological or cultural Example from dementia:
- assess whether ‘hallucinations’ or ‘delusions’ are considered odd by family members
- How their relationship is to the healthcare system
these questions can reduce psychosocial distress for some patients
Not all clinical work Many neuropsychologists are also scientists:
Use neuroimaging to study relationship between brain and psychology
Functional neuroanatomy is crucial
Working knowledge of relevant biological and psychological theories
May study healthy and patient populations
How brain lesions led to the modern understanding of brain function and organization
Franz Josef Gall (1758–1828) and his partner Johann Gaspar Spurzheim: proposed that the cortex
and its gyri were functioning parts of the brain and not just for covering the pineal body
Phineas Gage:
in 1848 he taught us about reginal brain functions
damaged his frontal brain, and after coma he had become a different person
Example Broca’s aphasia: Brain lesion observed in frontal lobe (Broca’s area ensures the language is
produced in a fluent way)
Difficulty forming words or sentences (loss of grammatical structure)
Patients often have right-side weakness or paralysis due to the lesion’s impact on motor
function (because often not only the language part (in the left hemisphere) is damaged due
to a lesion)
Wernicke’s Aphasia: problem in understanding the meaning of words and make meaningful
sentences (make whole sentences, but there is no meaning in them = word salad), they don’t have
muscle movement problems
, - Wernicke’s area ensures that the language makes sense
- Pure word deafness: Not able to understand speech (due to damage to the connection
between the temporal primary and secondary auditory area)
Conduction Aphasia: Damage to direct connection between Wernicke and Broca (arcuate fasciculus),
the extra connection enables normal speech and repeating speech in own words
Apraxia of speech: unable to activate the muscle anymore (to say words correctly) in the primary
motor cortex
What is a brain lesion?
Brain lesion = area of brain damage
- Can result from stroke, loss of blood flow, tumor, injury, etc.
- On the MRI seen as white area = damage from reduced blood flow caused by a stroke
How brain lesions lead to the modern understanding of brain function and organization:
Localization: Damage/ Injury in a certain location of the brain leads to the same symptoms
(e.g. with Broca’s aphasia) concluded that some brain functions were anatomically located
Lateralization: Damage was on a certain side of the head concluded that some functions
were usually on a specific side of the brain (e.g. language)
Distribution of function: Lost functions are sometimes rehabilitated concluded that other
parts of the brain can sometimes compensate for the damage (so multiple brain areas share
functions) not full recovery)
Hierarchical organization: the loss of functions very depending on whether a ‘higher’ or
‘lower’ brain area is damaged Brain processes begins with lower (relevant) levels and are
processed through increasingly higher levels
- Loss of function in higher brain regions = dissolution (brain can compensate with lower
regions resulted in simplified behaviors (e.g. with Phineas Gage))
- From lowest to highest: Hindbrain – Midbrain – Forebrain
Back to the Broca’s Area Example:
Speech is hard to produce but usually not impossible
Other language functions, like understanding speech and motor movements, as well as
production of familiar songs, often remain intact
The hierarchical structure of the brain - The Triune Brain (MacLean)
eptilian Brain
Hindbrain/ Metencephalon (Probably evolved first)
Spinal cord: Send information from the body to the brain, send commands from
the brain to the body and to coordinate reflexes
Brainstem/ medulla: Controls vital functions (e.g. breathing, hart beat etc)
cerebellum: really dense structure
- Function: Motor control of muscles (timing, balance and coordination)
Pons: connects the medulla (extended marrow) with the thalamus
Midbrain/ Mesencephalon (Probably evolved second)
Colliculi: Important for locating objects and orientating to those object
- Lateral geniculate body = relays visual information
- Medial geniculate body = relays auditory information
- Superior colliculus = incorporates information
- Inferior colliculus = incorporates auditory and nonauditory information
Tegmentum: Related to motor functions
Cerebral peduncles: Vision, hearing, motor function, alertness, and temperature regulation
Lecture 1 – The Neuropsychologist
What is a neuropsychologist?
A clinician and/or scientist who uses neurology, neuroscience and psychology
- to understand how behaviors correlate with brain function
- to assess ‘normal’ and ‘impaired’ cognitive, social, physical and emotional functioning
Neuropsychology is usually clinical in nature
- Neuropsychologist are not medical doctors
- Clinical task are usually diagnostic
- Referrals to specialists may be given for treatments
- Research tasks may include investigating causes of a disorder, its brain/behavioral/cognitive
processes, its diagnostic approaches, the efficacy of treatments (how well they work), etc
Donald Hebb (Considered the ‘father of neuropsychology’):
Hebbian theory: neural pathways develop based on experiences; as pathways are used
more, they become faster and stronger
Early neuropsychology was closely linked to brain injury and dementia research and diagnosis:
Relationship between loss of brain function and change in thoughts/behaviors easier to
observe Modern neuropsychology includes a variety of disorders
Neurological examination:
Patient’s history
State of awareness:
- Alert, confused etc
- Speech abnormalities, body posture, facial asymmetries,
- Emotions (agitated, anxious, depressed, apathetic, restless)
Physical examination (assess a person’s nervous-systems functioning): Blood pressure, brain
imaging, muscle movement and reflexes, smell, pain etc.
Disorders:
- Strokes, injuries, and lesions may show asymmetry, loss of function
- Parkinson’s may show loss of smell and motor changes
- Dementia may show memory loss or disorientation
Biopsychosocial model of neuropsychological assessments:
Neuropsychological assessment: Combines many tests depending on patients ‘symptoms’
(e.g. IQ, cognitive and psychometric tests)
Biopsychosocial model: Big role for the environment
- Social support networks (friends, family) influence outcomes
- Patients’ sense of wellbeing influence outcomes
- Sometimes a mismatch between the patients’ needs and their social network (e.g.,
patient wanted to stay home, family thinking they should work) this can add stress that
may impair healing
How did the biopsychosocial model change neuropsychology?
First conceptualized in 1950 by Roy Grinker applied “bio” to psychology
Proposed as a medical perspective by George L. Engel in 1977 applied the “social”
component to medicine (effect of friends and family on mental health)
, A person is not made of isolated organs, but function as a whole you need good biological,
social and psychological circumstances to have a good mental health
Example from Dementia:
Dementia: Umbrella term for impaired memory, -cognition, and -
decision-making (Common causes: Alzheimer’s, Huntington’s disease,
multiple sclerosis (MS) )
- Symptoms include: poor mood and perception (May include
depression, apathy, and hallucinations)
Neuropsychiatric Inventory (NPI): questionnaire score form used to
characterize dementia in the clinic
- Assesses frequency and severity of symptoms and assesses changes in
behavior
Biopsychosocial perspective in dementia: (Usually applied as part of treatment plan)
External triggers are assessed through history interview (e.g. one study found that 80% of
dementia symptoms had external triggers) therefore social support and environmental
well-being considered in treatment plan
Biopsychosocial perspective helped lead to other social-clinical models:
Part of our social well-being is our cultural fit
Beliefs from our community shape our experience of medicine
Not all symptoms are symptoms
Certain beliefs are cultural and sometimes hallucinations are even considered culturally
appropriate
therefore Cultural Formulation Interview (CFI): Used to determine whether something is
pathological or cultural Example from dementia:
- assess whether ‘hallucinations’ or ‘delusions’ are considered odd by family members
- How their relationship is to the healthcare system
these questions can reduce psychosocial distress for some patients
Not all clinical work Many neuropsychologists are also scientists:
Use neuroimaging to study relationship between brain and psychology
Functional neuroanatomy is crucial
Working knowledge of relevant biological and psychological theories
May study healthy and patient populations
How brain lesions led to the modern understanding of brain function and organization
Franz Josef Gall (1758–1828) and his partner Johann Gaspar Spurzheim: proposed that the cortex
and its gyri were functioning parts of the brain and not just for covering the pineal body
Phineas Gage:
in 1848 he taught us about reginal brain functions
damaged his frontal brain, and after coma he had become a different person
Example Broca’s aphasia: Brain lesion observed in frontal lobe (Broca’s area ensures the language is
produced in a fluent way)
Difficulty forming words or sentences (loss of grammatical structure)
Patients often have right-side weakness or paralysis due to the lesion’s impact on motor
function (because often not only the language part (in the left hemisphere) is damaged due
to a lesion)
Wernicke’s Aphasia: problem in understanding the meaning of words and make meaningful
sentences (make whole sentences, but there is no meaning in them = word salad), they don’t have
muscle movement problems
, - Wernicke’s area ensures that the language makes sense
- Pure word deafness: Not able to understand speech (due to damage to the connection
between the temporal primary and secondary auditory area)
Conduction Aphasia: Damage to direct connection between Wernicke and Broca (arcuate fasciculus),
the extra connection enables normal speech and repeating speech in own words
Apraxia of speech: unable to activate the muscle anymore (to say words correctly) in the primary
motor cortex
What is a brain lesion?
Brain lesion = area of brain damage
- Can result from stroke, loss of blood flow, tumor, injury, etc.
- On the MRI seen as white area = damage from reduced blood flow caused by a stroke
How brain lesions lead to the modern understanding of brain function and organization:
Localization: Damage/ Injury in a certain location of the brain leads to the same symptoms
(e.g. with Broca’s aphasia) concluded that some brain functions were anatomically located
Lateralization: Damage was on a certain side of the head concluded that some functions
were usually on a specific side of the brain (e.g. language)
Distribution of function: Lost functions are sometimes rehabilitated concluded that other
parts of the brain can sometimes compensate for the damage (so multiple brain areas share
functions) not full recovery)
Hierarchical organization: the loss of functions very depending on whether a ‘higher’ or
‘lower’ brain area is damaged Brain processes begins with lower (relevant) levels and are
processed through increasingly higher levels
- Loss of function in higher brain regions = dissolution (brain can compensate with lower
regions resulted in simplified behaviors (e.g. with Phineas Gage))
- From lowest to highest: Hindbrain – Midbrain – Forebrain
Back to the Broca’s Area Example:
Speech is hard to produce but usually not impossible
Other language functions, like understanding speech and motor movements, as well as
production of familiar songs, often remain intact
The hierarchical structure of the brain - The Triune Brain (MacLean)
eptilian Brain
Hindbrain/ Metencephalon (Probably evolved first)
Spinal cord: Send information from the body to the brain, send commands from
the brain to the body and to coordinate reflexes
Brainstem/ medulla: Controls vital functions (e.g. breathing, hart beat etc)
cerebellum: really dense structure
- Function: Motor control of muscles (timing, balance and coordination)
Pons: connects the medulla (extended marrow) with the thalamus
Midbrain/ Mesencephalon (Probably evolved second)
Colliculi: Important for locating objects and orientating to those object
- Lateral geniculate body = relays visual information
- Medial geniculate body = relays auditory information
- Superior colliculus = incorporates information
- Inferior colliculus = incorporates auditory and nonauditory information
Tegmentum: Related to motor functions
Cerebral peduncles: Vision, hearing, motor function, alertness, and temperature regulation
