Lecture 1 Introduction to clinical neuropsychology
Clinical neuropsychology
“Scientific area that studies the relations between brain and behaviour especially the clinical
applicability of assessment, treatment, and care of individuals with (presumed) cognitive
(dys)function as a result of developmental disorders, neurological disorders (brain diseases or
damage), or psychiatric disorders.”
Behaviour in a broad sense; a Bio-Psycho-Social model
In clinical psychology it is not only “bio”, we are very concentrated on is the brain dysfunctioning, is
there an impairment. That is not our job, behaviour is the question for a psychologist.
Behavioural symptoms …
- …Latent variables that objectively can be assessed through tests
- …That subjectively can be observed by the patient and significant others
There is a difference between objective diagnosed symptoms and subjective complaints
Bio perspective of assessment is objective testing. The problem of psychology is that we don’t have a
laboratory way of assessment
Objective… testing in clinical neuropsychology
Inferences about:
- Behavioural (abnormalities)
- Cognitive functions related to brain diseases, damage
A gold standard is the method that can diagnose a particular condition with the greatest certainty, or
a test that can best distinguish between patients with and without a disease. Psychology does not
have a golden standard, we cannot diagnose.
Neuropsychological testing: Before and after neuroimaging
- They researched the organicity of the brain and thought the brain existed of a lot of dents
and bumps and thought you could research if there is a hole in the brain (phrenology)
- The brain consists of multiple “organs” and they all have a different function
- Development of theories on brain-behaviour relationships
- Organicity: is there a hole in the brain?
- Hypothesis → testing theories about cognitive functioning
- It’s not about the damage of the brain, it’s about assessment, treatment and care of
individuals with cognitive (dys)functions, as a result of brain disorders
- The most important discovery was that many of our colleagues observed very well, case
studies were the most valuable in psychology
1
, Credited for establishing what we call clinical neuropsychology:
- Interested
- Definite ideas
- She listened and observed
- Quiet your mouth and listen to patients
- Hypotheses
- Methodological persistent
- …single patient by asking the right questions… tease out the fundamentals of memory…
- …I believe my observations…
- Clear thinking, pervasive convinced, argues very effectively, clean observer → that
combination makes a formidable scientist
Clinical neuropsychology
- Has become highly relevant in modern-day (mental) health care
• Increase in people with brain damage or dysfunction
1. Decrease in mortality rates because of improvements in medical care
2. Aging
3. More interest in quality of life
• A clinical neuropsychologist is a scientist practitioner whose focus lies on behaviour
and cognitions
• A clinical neuropsychologist is not a brain researcher, but makes inferences with
knowledge about the brain
- The brain has persuasion
Costs of brain diseases
Brain disorders but also mental disorders become more prevalent nowadays. In the past there was a
problem with education so nowadays they are way better hypothesized.
Neuropsychology and the brain are “fancy”… now
Clinical neuropsychology in a wide range of clinical settings
- General hospitals
- University hospitals
- Specialized neurologic clinics
• Dementias like Alzheimer disease
• Epilepsy
• Sleep etc.
- Mental health care
- Specialized psychiatric clinics
- Rehabilitation centres
- Private practices
- Schools
- Etc.
2
,Multidisciplinary
- DSM-5 - ICF
• Health psychologist • Neurologist
• Clinical psychologist • Neurophysiologist
• Psychological technician • Neurosurgeon
• Nurse • Neuroradiologist
• Speech therapist • Rehabilitation physician
• Physiotherapist • Psychiatrist
• Teacher
Clinical neuropsychology
“Applied science that studies the relationship between brain (dys)functions and behaviour in patients
and the application in assessment and treatment
- Brain (dys)functioning / damage
- Contextual factors: psychosocial, developmental, somatic (pain), performance validity
- Everyday functioning: home, social, work/study, family, etc.
The International Classification of Functioning (ICF)
ICF is a classification system but than from the
medical point of view
ICF is useful in clinical neuropsychology
- Description of consequences of brain disease / disorder at three different levels: impairment
– limitation – restriction (“handicap”)
- Identify moderating factors
- Relevant for understanding subjective complaints and problems in daily life (school – work –
social functioning)
- Identify target for treatment or optimalisation
3
, Lecture 2 Korsakoff’s syndrome and alcohol-related
cognitive disorders
Alcohol-related cognitive disorders
- Terminology
- Wernicke’s encephalopathy (WE) and Korsakoff’s syndrome (KS)
• Definition of KS
• Definition of WE
• Cognitive profile (memory and beyond)
• Confabulations
• Apathy
• Brain abnormalities
- Ethanol neurotoxicity
• The “continuity hypothesis”
- Alcohol and the adolescent brain: the facts (and the fiction)
- Care for patients with alcohol-related cognitive disorders
Terminology
- Problematic alcohol use (“alcohol misuse”): drinking pattern resulting in physical complains
and or psychological or social problems. The amount of alcohol units consumed is not leading
for the diagnosis
- Alcohol Use Disorder (AUD): problematic alcohol use meeting the DSM-5-TR criteria for this
classification
- Binge drinking: consumption of large amounts of alcohol (men ≥ 5 AU, women ≥ 4 AU) in a
short time period, with periods of full abstinence
- Alcohol intoxication: result of excessive alcohol use in a short period of time, with dose
related symptoms (disorientation, sexual/aggressive disinhibition, inability to make
judgements) and a (risk of) severe complications, e.g. loss of consciousness, shock, breathing
problems, hypothermia and hypoglycaemia
- Alcohol withdrawal syndrome: result of sudden withdrawal after long-term excessive alcohol
use
4
Clinical neuropsychology
“Scientific area that studies the relations between brain and behaviour especially the clinical
applicability of assessment, treatment, and care of individuals with (presumed) cognitive
(dys)function as a result of developmental disorders, neurological disorders (brain diseases or
damage), or psychiatric disorders.”
Behaviour in a broad sense; a Bio-Psycho-Social model
In clinical psychology it is not only “bio”, we are very concentrated on is the brain dysfunctioning, is
there an impairment. That is not our job, behaviour is the question for a psychologist.
Behavioural symptoms …
- …Latent variables that objectively can be assessed through tests
- …That subjectively can be observed by the patient and significant others
There is a difference between objective diagnosed symptoms and subjective complaints
Bio perspective of assessment is objective testing. The problem of psychology is that we don’t have a
laboratory way of assessment
Objective… testing in clinical neuropsychology
Inferences about:
- Behavioural (abnormalities)
- Cognitive functions related to brain diseases, damage
A gold standard is the method that can diagnose a particular condition with the greatest certainty, or
a test that can best distinguish between patients with and without a disease. Psychology does not
have a golden standard, we cannot diagnose.
Neuropsychological testing: Before and after neuroimaging
- They researched the organicity of the brain and thought the brain existed of a lot of dents
and bumps and thought you could research if there is a hole in the brain (phrenology)
- The brain consists of multiple “organs” and they all have a different function
- Development of theories on brain-behaviour relationships
- Organicity: is there a hole in the brain?
- Hypothesis → testing theories about cognitive functioning
- It’s not about the damage of the brain, it’s about assessment, treatment and care of
individuals with cognitive (dys)functions, as a result of brain disorders
- The most important discovery was that many of our colleagues observed very well, case
studies were the most valuable in psychology
1
, Credited for establishing what we call clinical neuropsychology:
- Interested
- Definite ideas
- She listened and observed
- Quiet your mouth and listen to patients
- Hypotheses
- Methodological persistent
- …single patient by asking the right questions… tease out the fundamentals of memory…
- …I believe my observations…
- Clear thinking, pervasive convinced, argues very effectively, clean observer → that
combination makes a formidable scientist
Clinical neuropsychology
- Has become highly relevant in modern-day (mental) health care
• Increase in people with brain damage or dysfunction
1. Decrease in mortality rates because of improvements in medical care
2. Aging
3. More interest in quality of life
• A clinical neuropsychologist is a scientist practitioner whose focus lies on behaviour
and cognitions
• A clinical neuropsychologist is not a brain researcher, but makes inferences with
knowledge about the brain
- The brain has persuasion
Costs of brain diseases
Brain disorders but also mental disorders become more prevalent nowadays. In the past there was a
problem with education so nowadays they are way better hypothesized.
Neuropsychology and the brain are “fancy”… now
Clinical neuropsychology in a wide range of clinical settings
- General hospitals
- University hospitals
- Specialized neurologic clinics
• Dementias like Alzheimer disease
• Epilepsy
• Sleep etc.
- Mental health care
- Specialized psychiatric clinics
- Rehabilitation centres
- Private practices
- Schools
- Etc.
2
,Multidisciplinary
- DSM-5 - ICF
• Health psychologist • Neurologist
• Clinical psychologist • Neurophysiologist
• Psychological technician • Neurosurgeon
• Nurse • Neuroradiologist
• Speech therapist • Rehabilitation physician
• Physiotherapist • Psychiatrist
• Teacher
Clinical neuropsychology
“Applied science that studies the relationship between brain (dys)functions and behaviour in patients
and the application in assessment and treatment
- Brain (dys)functioning / damage
- Contextual factors: psychosocial, developmental, somatic (pain), performance validity
- Everyday functioning: home, social, work/study, family, etc.
The International Classification of Functioning (ICF)
ICF is a classification system but than from the
medical point of view
ICF is useful in clinical neuropsychology
- Description of consequences of brain disease / disorder at three different levels: impairment
– limitation – restriction (“handicap”)
- Identify moderating factors
- Relevant for understanding subjective complaints and problems in daily life (school – work –
social functioning)
- Identify target for treatment or optimalisation
3
, Lecture 2 Korsakoff’s syndrome and alcohol-related
cognitive disorders
Alcohol-related cognitive disorders
- Terminology
- Wernicke’s encephalopathy (WE) and Korsakoff’s syndrome (KS)
• Definition of KS
• Definition of WE
• Cognitive profile (memory and beyond)
• Confabulations
• Apathy
• Brain abnormalities
- Ethanol neurotoxicity
• The “continuity hypothesis”
- Alcohol and the adolescent brain: the facts (and the fiction)
- Care for patients with alcohol-related cognitive disorders
Terminology
- Problematic alcohol use (“alcohol misuse”): drinking pattern resulting in physical complains
and or psychological or social problems. The amount of alcohol units consumed is not leading
for the diagnosis
- Alcohol Use Disorder (AUD): problematic alcohol use meeting the DSM-5-TR criteria for this
classification
- Binge drinking: consumption of large amounts of alcohol (men ≥ 5 AU, women ≥ 4 AU) in a
short time period, with periods of full abstinence
- Alcohol intoxication: result of excessive alcohol use in a short period of time, with dose
related symptoms (disorientation, sexual/aggressive disinhibition, inability to make
judgements) and a (risk of) severe complications, e.g. loss of consciousness, shock, breathing
problems, hypothermia and hypoglycaemia
- Alcohol withdrawal syndrome: result of sudden withdrawal after long-term excessive alcohol
use
4
