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Samenvatting hoorcolleges Klinische Neuropsychologie
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Samenvatting hoorcolleges Klinische Neuropsychologie
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Summary of the lectures B&C2; Samenvatting van de colleges B&C2
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Samenvatting Klinische neuropsychologie, ISBN: 9789024402830 Neuropsychology
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Samenvatting alle hoorcolleges B&C2
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Klinische neuropsychologie lecturesLecture 1a. Introduction
Neuropsychology = study of the brain/behavior relationships and impact of injury/disease on
cognitive, emotional, and general adaptive capacities of the individual
Clinical neuropsychology => focuses on patients and networks in the brain. Problems with emotion,
cognition, function. Not just about lesions, also about hybrid functions.
Characteristics of a good clinical neuropsychologist:
- Curiosity
- Flexibility; patients do not always do what you ask them to do (tests)
- Inventiveness = vindingrijk
- Patience
- Knowledge
- Empathy even in routine situations; want veel patienten hebben problemen met taal
(uitdrukken, het volgen van een gesprek etc.)
What patients do we see?
- From across the lifespan and from all socioeconomic backgrounds
- Inter-individual differences and intra-individual changes over time
o Inter => tussen 2 personen, bv person A en person B
o Intra => 1 persoon verandert door de tijd heen door gebeurtenissen, we don’t stay the
same.
- Many don’t fit into syndromes – comorbidity is typical => Alzheimer & diabetes for example
You must figure out who the person is in front of you and what you can do
Different populations:
- Children and adolescents
o Asperger, autism
o ADHD
o Childhood stroke
o Epilepsy
o Dyslexia and other language disorders
o FAS
o Down
o Tourette
- Adults
o Head injuries
o Aids
o ADHD in adults → were not diagnosed as kids
o Down → very vulnerable to Alzheimers!
o Schizophrenia and other psychiatric disorders
o Drug-induced lesions and/or diffuse damage
Keep in mind:
- Possible sex/education/cultural differences in presentation
- Site of lesion if known
- People with TBI (traumatic brain injury) are often lethargic/hard to motivate making testing
difficult
- Possible effects of any medication the client may be using and possibility of co-morbidity
- The elderly
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, o Alzheimer’s and other dementia
o Parkinson and Huntington
o Strokes: vooral bij ouderen
o Head injuries
Specific aspects to be aware of in this population:
- Hearing
- Sight
- Movement and other disabilities → they are a lot slower; 600 ms ipv 200 ms reactietijd om op
een knopje te drukken
- May get tired faster than younger clients
- Some researchers have found increased incidence of depression in elderly populations, and this
may hamper assessment
Gerontology: scientific study of aging and older adults
Geriatrics: medical specialty focused on care and treatment of older people
Typical symptoms of normal aging
- Slower RT
- Cognitive inflexible
- Harder to learn new things
- Experience of tip of the tongue
- Worse at naming tasks, verbal fluency, problems with starting and holding conversation
- Hearing and visual problems
- Sense of smell is also less
- Depression and sleeping problem may/may not be more common than they were
Not all bad news:
- Crystallized intelligence (= verbal capacity, woordenschat) tends to remain stable or even
improve with age (includes aspects of semantic memory)
- Fluid intelligence (= het vermogen om inductief te redeneren) can be improved
- Wide-spread individual differences w.r.t the cognitive abilities of elderly people
- Lifestyle changes can help reduce cognitive loss (diet, sport, use-it-or-lose-it)
Lecture 1b. Normal aging vs pathological brain changes
Advancing age causes changes in:
- Brain size – typically shrinkage (inkrimping) at all levels. This shrinkage may be especially
apparent in the frontal cortex. Grey and white matter loss results in enlarged ventricles. Meer
inkrimping bij Alzheimer…
- Neurotransmitters and hormones – dopamine and serotonin – production of both is said to
decline with age; declining sex hormones especially in women after menopause. Glucose and
oxygen uptake also tend to reduce with age (glucose is juist heel erg belangrijk voor het brein)
- Vasculature – arteries and vein-walls thin, blood can clot more easily leading to aneurisms,
blood pressure, blood pressure can increase or decrease with age
Normal aging – structure
Be critical when you look at scans
Kamers in hersenen worden groter omdat de hersenen in volume verminderen
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,A = jong persoon
B = oud persoon
Beide zijn gezond, er is geen pathologie! Dit is normale veroudering.
Meer details op fysieke breinveranderingen met leeftijd
Volume en gewicht verminderingen of the brain at a rate of around 5% per decade after the age of
40 en vooral na 70
Niet duidelijk hoe of waarom dit gebeurt
Kan door: neuronal death, shrinkage, synaptic changes. White matter can also decrease with both
thinner and less production of myelin found in both normal and pathological aging
“Aging is a multifaceted process that involves interacting brain region and neurotransmitter systems
that are not uniformly affected by aging”
Brain changes do not occur to the same extent in all brain regions:
- (1) PFC is most affected by age
- (2) Then the striatum
- (3) Temporal lobe, cerebellar vermis, cerebellar hempispheres and hippocampus
- Least affected: occipital cortex
- Men and women may also differ with frontal and temporal lobes most affected in men compared
with the hippocampus and parietal lobes in women → vaker dementie in vrouwen
gediagnosticeerd (want vrouwen leven langer)
Main brain network affected by aging
Reduced functional connectivity in:
- Executive control network (most)
- Dorsal attention network
- Default mode network
- Salience network (least)
Vooral frontal-parietal network is erg kwetsbaar voor pathologie. Maar allemaal kunnen affected
zijn door pathologie.
Vasculature of the brain
Mensen met hartproblemen hebben eerder een beroerte en andersom
Hersenen en lichaam komen altijd samen; ze voeden het brein met glucose en zuurstof
Meeste beroertes komen voor in aderen
Focus ligt vaker op arteriele systeem, maar venus systeem is net zo belangrijk (bloed gaat omhoog
maar wordt ook weer afgevoerd)
20-30% of older people have asymptomatic cerebrovascular disease (infarction, micorbleeds,
microinfarcts)
Another category of vascular pathology frequently seen on MR scans of older individuals is white
matter hyperintensities (WMH). White matter hyperintensities (= witte stof ziekte) predict an
increased risk of stroke, dementia, and death.
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, Pathological aging – structure
- White matter lesions, strokes and dementia all increase with increasing age
- Age is the number 1 risk factor for developing any form of dementia
- Vascular risk factors:
o High BP, high cholesterol, obesity, smoking, diabetes, lack of exercise
o Increase the risk of strokes and subsequent neuronal death
Signs of pathological brain aging are:
- Larger than expected volume loss in one or more regions of the brain, faster impairment
- Dysregulation of neuronal Ca2+ homeostasis
- Amyloid, tau, greatly reduced neurogenesis and plasticity – note: all of these also occur in
normal aging!
o En dat is het grootste probleem met amyloïde
➔ Huge inter-individual differences in both normal and pathological brain changes
Normal aging – functioning
- Mapping structure to function and change because of ageing is a complex task, however there
are studies that show links between volume and neuropsychological function others do not. It
depends on what is measured.
- We do see a tendency for older people to activate both hemispheres when younger people
activate unilaterally
- Hypothesis: PFC compensation for failing neural function elsewhere in the brain, such as
hippocampus
- Here we use ERP’s (electrical brain responses), but functioning can also be assessed using
neuropsychological tests
Experiment changing brains with age
Stimulus: man en vrouwen stem en erna zeggen of ze het herkennen en zo ja welke stem ze hoorden.
Old-new effect start eerder in jongeren en houdt langer aan.
Zelfs met alzheimer is het brein niet helemaal shut-off, er is nog steeds activiteit in het brein en
ze reageren hetzelfde op taken die ze moeten uitvoeren, maar het kan zijn dat ze langer de tijd
nodig hebben of dat ze de taak zijn vergeten en dus je moet herhalen. Ouderen laten ook
alsnog wel een old-new effect zien, ze herkennen wel de nieuwe en oude items, maar het houdt
niet zo lang aan als bij jongeren.
Neurotransmitter changes e.g. dopamine
- Reductions in neurotransmitters and hormones with age (especially dopamine, serotonin, sex
hormones during menopause in women)
- Parkinson’s disease – symptoms due to marked reduction in dopamine
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