Clinical Neuropsychology
Lecture 1 Introduction to clinical neuropsychology (H1,2,3)
Brain – behavior
Neurocognitive domains
1. Complex attention
Sustained, divided and selective attention
Processing speed
2. Perceptual-motor function
Visual perception, visuoconstructional reasoning, perceptual-motor coordination
3. Language
Objective naming, word finding, fluency, grammar and syntax, receptive language
4. Executive functioning
Planning, decision making, working memory, responding to feedback, inhibition,
flexibility
5. Learning/memory
Free recall, cued recall, recognition, semantic & autobiographical long-term memory,
implicit learning
6. Social cognition
Recognition of emotions, theory of mind, insight
Symptom Disorder of/in Limitation/level of
disability
Attentional deficit Complex attention Easily distracted, doesn’t
finish anything
Amnesia Memory and learning Forgets appointments, gets
, lost, repeats same thing
Aphasia Language Unable to understand
another person, speaking
Alexia/agraphia Reading/writing Reading newspaper
Acalculia Arithmetic Tax form, change from
purchases
Agnosia Perception (visual, acoustic, Faces, objects; car ignition;
tactile) retrieve something from bag
Neglect Attention to one side Accidents, unable to find
things
Apraxia Motor planning Washing, dressing, making
coffee
Executive disfunctioning Executive functions Bad planning and
anticipation
Neuropsychological assessment: indications
- Patient and/or those close to the patient complain about (neuro)psychological
functioning
- Gradual or sudden change in neuropsychological functioning with known or unknown
somatic disorder(s)
- Questionable age-related forgetfulness
- Normal or pathological (neuro)psychological development
- Neuropsychological profiling in case of (possible) brain damage, determine remaining
capacity
- Monitor neuropsychological progress before and after intervention
- Determine relative role of neurological vs. psychological factors
- Formulate neuropsychological care indications
Complaints of patients with a (suspected) brain disorders
Diagnostics
Clinical neuropsychologists provide specialist diagnostic assessment of patients presenting
with cognitive or behavioral change in the context of actual or suspected neurological illness
or injury. They report on the indications that a given disorder is present, the degree to which
cognitive functions have been affected and the likely course of the disorder. On the basis of
,neuropsychological assessment, a diagnosis, prognosis and recommendations for treatment
and support will be given.
Methods: behavioral observation, anamnesis, and neuropsychological
tests/questionnaires
Treatment
Clinical neuropsychologists provide treatment for the cognitive, mood and behavioral
problems resulting from the actual or suspected neurological illness or injury
Methods: psychoeducation, function training, strategy training, cognitive behavioral
therapy, system therapy, lifestyle adjustment
Benefits of clinical neuropsychologists in healthcare
Alzheimer’s disease
Pathophysiology
- Neurodegenerative disorder
- Plaques and tangles
Alzheimer’s disease
- Gradual cognitive deterioration (starting with memory problems)
- Diagnosis is made if two or more cognitive domains are affected
- Worldwide: over 46 million people
- Age of onset: mostly >60
Treatment:
- Cholinesterase inhibitors in mild to moderate Alzheimer’s disease
- NMDA receptor antagonist in moderate to severe cases
Neuropsychological symptoms
- Gradual increase in memory impairment starting with anterograde loss op episodic
memory and later also retrograde amnesia
- Disorientation in time and place, and later in person
, - Gradual deterioration in various cognitive domains: language, executive functions
and attention, apraxia, deficits in visual perception
- Neuropsychiatric problems, including depression, …
- Heavy impact on daily life, work, social contacts
- Related to brain damage (atrophy in the medial temporal lobe, later global brain
atrophy, also damage to smaller blood vessels)
Brain reserve
The brain reserve hypothesis posits that larger maximal lifetime brain volume (estimated
with head size of intercranial volume) protects against cognitive decline
Cognitive reserve
The cognitive reserve hypothesis posits that enriching experiences (e.g., education, cognitive
leisure) protect against cognitive decline
Parkinson’s disease
Pathophysiology
- Degeneration of dopaminergic cells (substantia nigra) and changes in the
noradrenergic, serotonergic, and cholinergic systems
Parkinson’s disease
- Diagnosis (1) bradykinesia combined with one of the following: (2) rigidity, (3) rest
tremor and/or (4) postural instability
- Other symptoms: fatigue, disturbed sense of smell, autonomic disorders, sleep
disorders, neuropsychiatric (depression, hallucinations) and cognitive impairment
- Subtle onset
- NL: 33.000-61.000 patients (2007)
- Average age of onset: 62 years
- Mean disease duration: 8 years (range: 1-30)
Treatment
- Medication: levodopa and dopamine agonists
- DBS
- Paramedical and psychosocial treatment
Cognitive problems
- Around 24% recently diagnosed patients have cognitive impairments
- Most patients eventually develop dementia
- Executive impairments (degeneration frontostriatal circuit)
- In addition, impairments in attention, mental speed, memory, and visuospatial
deficits
- Impairments in processing of emotional information
Cognitive reserve in Parkinson’s disease
Aim: how do four lifelong factors of cognitive reserve contribute to late cognition in normal
aging and Parkinson’s disease
Methods: 47 healthy elderly and 49 patients with PD
- Cognitive reserve during lifetime: level of education, decision latitude at work, leisure
activities and physical activities
- Cognitive functioning (visuospatial perception, episodic memory, processing speed
and attention/perceptual speed)
Lecture 1 Introduction to clinical neuropsychology (H1,2,3)
Brain – behavior
Neurocognitive domains
1. Complex attention
Sustained, divided and selective attention
Processing speed
2. Perceptual-motor function
Visual perception, visuoconstructional reasoning, perceptual-motor coordination
3. Language
Objective naming, word finding, fluency, grammar and syntax, receptive language
4. Executive functioning
Planning, decision making, working memory, responding to feedback, inhibition,
flexibility
5. Learning/memory
Free recall, cued recall, recognition, semantic & autobiographical long-term memory,
implicit learning
6. Social cognition
Recognition of emotions, theory of mind, insight
Symptom Disorder of/in Limitation/level of
disability
Attentional deficit Complex attention Easily distracted, doesn’t
finish anything
Amnesia Memory and learning Forgets appointments, gets
, lost, repeats same thing
Aphasia Language Unable to understand
another person, speaking
Alexia/agraphia Reading/writing Reading newspaper
Acalculia Arithmetic Tax form, change from
purchases
Agnosia Perception (visual, acoustic, Faces, objects; car ignition;
tactile) retrieve something from bag
Neglect Attention to one side Accidents, unable to find
things
Apraxia Motor planning Washing, dressing, making
coffee
Executive disfunctioning Executive functions Bad planning and
anticipation
Neuropsychological assessment: indications
- Patient and/or those close to the patient complain about (neuro)psychological
functioning
- Gradual or sudden change in neuropsychological functioning with known or unknown
somatic disorder(s)
- Questionable age-related forgetfulness
- Normal or pathological (neuro)psychological development
- Neuropsychological profiling in case of (possible) brain damage, determine remaining
capacity
- Monitor neuropsychological progress before and after intervention
- Determine relative role of neurological vs. psychological factors
- Formulate neuropsychological care indications
Complaints of patients with a (suspected) brain disorders
Diagnostics
Clinical neuropsychologists provide specialist diagnostic assessment of patients presenting
with cognitive or behavioral change in the context of actual or suspected neurological illness
or injury. They report on the indications that a given disorder is present, the degree to which
cognitive functions have been affected and the likely course of the disorder. On the basis of
,neuropsychological assessment, a diagnosis, prognosis and recommendations for treatment
and support will be given.
Methods: behavioral observation, anamnesis, and neuropsychological
tests/questionnaires
Treatment
Clinical neuropsychologists provide treatment for the cognitive, mood and behavioral
problems resulting from the actual or suspected neurological illness or injury
Methods: psychoeducation, function training, strategy training, cognitive behavioral
therapy, system therapy, lifestyle adjustment
Benefits of clinical neuropsychologists in healthcare
Alzheimer’s disease
Pathophysiology
- Neurodegenerative disorder
- Plaques and tangles
Alzheimer’s disease
- Gradual cognitive deterioration (starting with memory problems)
- Diagnosis is made if two or more cognitive domains are affected
- Worldwide: over 46 million people
- Age of onset: mostly >60
Treatment:
- Cholinesterase inhibitors in mild to moderate Alzheimer’s disease
- NMDA receptor antagonist in moderate to severe cases
Neuropsychological symptoms
- Gradual increase in memory impairment starting with anterograde loss op episodic
memory and later also retrograde amnesia
- Disorientation in time and place, and later in person
, - Gradual deterioration in various cognitive domains: language, executive functions
and attention, apraxia, deficits in visual perception
- Neuropsychiatric problems, including depression, …
- Heavy impact on daily life, work, social contacts
- Related to brain damage (atrophy in the medial temporal lobe, later global brain
atrophy, also damage to smaller blood vessels)
Brain reserve
The brain reserve hypothesis posits that larger maximal lifetime brain volume (estimated
with head size of intercranial volume) protects against cognitive decline
Cognitive reserve
The cognitive reserve hypothesis posits that enriching experiences (e.g., education, cognitive
leisure) protect against cognitive decline
Parkinson’s disease
Pathophysiology
- Degeneration of dopaminergic cells (substantia nigra) and changes in the
noradrenergic, serotonergic, and cholinergic systems
Parkinson’s disease
- Diagnosis (1) bradykinesia combined with one of the following: (2) rigidity, (3) rest
tremor and/or (4) postural instability
- Other symptoms: fatigue, disturbed sense of smell, autonomic disorders, sleep
disorders, neuropsychiatric (depression, hallucinations) and cognitive impairment
- Subtle onset
- NL: 33.000-61.000 patients (2007)
- Average age of onset: 62 years
- Mean disease duration: 8 years (range: 1-30)
Treatment
- Medication: levodopa and dopamine agonists
- DBS
- Paramedical and psychosocial treatment
Cognitive problems
- Around 24% recently diagnosed patients have cognitive impairments
- Most patients eventually develop dementia
- Executive impairments (degeneration frontostriatal circuit)
- In addition, impairments in attention, mental speed, memory, and visuospatial
deficits
- Impairments in processing of emotional information
Cognitive reserve in Parkinson’s disease
Aim: how do four lifelong factors of cognitive reserve contribute to late cognition in normal
aging and Parkinson’s disease
Methods: 47 healthy elderly and 49 patients with PD
- Cognitive reserve during lifetime: level of education, decision latitude at work, leisure
activities and physical activities
- Cognitive functioning (visuospatial perception, episodic memory, processing speed
and attention/perceptual speed)
