Clinical Neuropsychology (PSB3E-CN01): Summary Fractured Minds, ISBN: 1365
All chapters for the 2022/23 exam, including Cases.
All chapters for the test 2022/23, Including Cases
Clinical Neuropsychology Summary
Clinical Neuropsychology Summary.......................................................................................1
Clinical Neuropsychology Summary.......................................................................................1
Chapter 1 Introduction to Clinical Neuropsychology...........................................................3
Chapter 1 Introduction to Clinical Neuropsychology...........................................................3
Chapter 2 Neuropsychological Assessment.......................................................................8
Chapter 2 Neuropsychological Assessment.......................................................................8
Chapter 3 Global Amnesia...............................................................................................12
Chapter 3 Global Amnesia...............................................................................................12
Chapter 4 The consequences and Treatment of Epilepsy................................................16
Chapter 4 The consequences and Treatment of Epilepsy................................................16
Chapter 5 The Breakdown of Language..........................................................................19
Chapter 5 The Breakdown of Language..........................................................................19
Chapter 7 Out of Mind, Out of Sight.................................................................................22
Chapter 7 Out of Mind, Out of Sight.................................................................................22
Chapter 8 Visual Object agnosia & Prosopagnosia..........................................................28
Chapter 8 Visual Object agnosia & Prosopagnosia..........................................................28
Chapter 9 The Impaired Executive...................................................................................32
Chapter 9 The Impaired Executive...................................................................................32
Chapter 10 Severe TBI and Rehabilitation.......................................................................35
Chapter 10 Severe TBI and Rehabilitation.......................................................................35
Chapter 11 Mild Traumatic Brain.....................................................................................39
Chapter 11 Mild Traumatic Brain.....................................................................................39
Chapter 12 Subarachnoid Hemorrhage...........................................................................41
Chapter 12 Subarachnoid Hemorrhage...........................................................................41
Chapter 13 Organic Solvent Neurotoxicity.......................................................................44
Chapter 13 Organic Solvent Neurotoxicity.......................................................................44
Chapter 14 Multiple Sclerosis..........................................................................................47
Chapter 14 Multiple Sclerosis..........................................................................................47
Chapter 15 Parkinson’s Disease......................................................................................51
Chapter 15 Parkinson’s Disease......................................................................................51
Chapter 17 Dementia.......................................................................................................54
Chapter 17 Dementia.......................................................................................................54
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Chapter 1 Introduction to Clinical Neuropsychology
Related disciplines:
- Neurology (more brain focused)
- clinical symptoms and signs as indications of underlying neuropathology, less
concerned with the details of the higher behaviors and cognitions.
- Cognitive psychology (more focused on the mind)
- Aims to understand the human mind by analyzing the higher cognitive
functions and their components.
(Lecture 1: psychiatry added to this continuum.)
Gross Structure of the Brain
Three major divisions:
1. cerebral hemispheres (most concerned in neuropsychology)
Paired structures above the midbrain and pons.
Covered by a highly convoluted layer of nerve cells called the cerebral cortex (Grey matter).
- ‘hills’ of the cortex are called gyri (gyrus) and the ‘valleys’ are called sulci (sulcus).
2. Cerebellum
3. Brain stem, upward extension of the spinal cord, consists of 4 parts
a. medulla oblongata
b. pons
c. midbrain
d. diencephalon
The brainstem is the ‘life-support’ part of the brain: controls respiration, cardiovascular
function, gastrointestinal function.
System called the Reticular Formation (RF) controls the overall arousal level of the cortex.
Within the brain lies the limbic system, including the hippocampus and amygdala. Involved in
emotion, motivation and memory.
The brain has three coverings (meninges) The dura mater (tough mother), is the outermost
thick and tough cover.
The arachnoid mater (spider mother) is the delicate middle membrane.
The pia mater (little mother) is closest to the cortex.
The subarachnoid space lies between the arachnoid and pia mater and is filled with
cerebrospinal fluid (CSF)
The cerebrovascular system involves two pairs of
cerebral arteries:
- The internal carotid arteries, supply the anterior
parts of the brain
- The vertebral arteries supply the posterior parts
of the brain.
They form the anterior cerebral arteries and middle
cerebral arteries in each hemisphere.
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Cerebral cortex
The parietal, temporal and occipital lobes lying behind the central sulcus constitute the
posterior cortex and are involved mainly in a person’s awareness of what is happening in the
world. Can be divided into three zones:
1. The primary zones, primary projection areas in which incoming sensory information is
projected to sense-modality-specific neurons.
Each side of the body is mapped onto the primary sensory strip of the opposite
(contralateral) hemisphere.
2. The secondary zones lie adjacent (aangrenzend) to the primary zones. neurons in
these zones do not have direct topographic relationship with sensory information
relayed from a particular body part or sense organ. They receive modality-specific
information from their primary cortex
and integrate it into a meaningful
whole.
→ Concerned with perception and
meaning within a single-sense modality.
Damage in the secondary cortex can
result in an inability to perceive or
comprehend what one is touching,
hearing or seeing.
3. The tertiary zones lie at the inner
borders of each lobe, so that the
parietal, temporal, and occipital tertiary
zones overlap. Damage to these zones
can lead to complex higher cognitive
disorders that involve transmodal
integration (e.g. writing to dictation).
Also links with the limbic system,
involved in emotion and memory,
disorder in this area can involve
abnormal emotional components.
The Frontal lobes lie anterior to the central sulcus and are concerned mainly with acting on
knowledge relayed to the posterior part of the cerebral cortex from the outside world. Can be
divided into three zones:
1. Primary zone / motor strip: on the precentral gyrus
2. secondary zone / premotor cortex (association cortex): mediates the organization of
motor patterns. e.g. riding a bicycle.
3. Tertiary zone: prefrontal cortex. Large area situated at the anterior pole of
the brain. Involved in executive functions (planning ,organization, abstract
thinking). Rich connections with the limbic system → intimately involved
with mood, motivation & emotion. Damage to them can result in many
and varied impairments involving the interactions of motivational and
emotional states and executive functions.\
Cortical Lobes
The division of the cortex into four lobes is a useful concept in clinical neuropsychology,
although the lobes are not true anatomic divisions but rather divisions of convenience. The
three posterior lobes, parietal, temporal, and occipital, are involved in awareness,
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perception, and integration of information from the outside world, with the parietal lobe
involved in tactile sensations and spatial relations. The temporal lobe is involved in auditory
and olfactory abilities, while the occipital lobe mediates sight, visual perception, and visual
knowledge. The frontal lobes are responsible for motor functions and executive functions,
including forming abstract concepts and planning and executing actions. While the functional
verbal-nonverbal division between the left and right prefrontal lobes is less marked than in
the posterior lobes, some neuropsychological tasks can demonstrate the difference. Lesions
in these areas can result in various deficits, including visual agnosia and visual-field defects.
Functional Systems
The concept of a functional system was proposed by Luria (1973), who further proposed that
in terms of double dissociation, damage to area A will result in the impairment of a factor or
subcomponent a, and all functional systems that include this factor will suffer. Likewise,
when area B is damaged, all functional systems that include subcomponent b will suffer.
Simple motor and sensory functions are mediated by a specific group of neurons, and
damage to these neurons results in an unambiguous deficit. On the other hand, higher
cognitive functions, such as reading or memory, are the result of complex functional systems
composed of different brain areas working together, and damage to one area can disrupt
many functional systems. The concept of functional systems suggests that if a patient can
find a new way to reach the same endpoint while avoiding the impaired subcomponent,
recovery of function is possible. In some cases of spontaneous recovery of function, nearby
undamaged neurons can sprout new dendrites that "fill the gap" left by the damaged
neurons and connect with the dendritic trees of undamaged neurons in other cortical areas.
Disconnection Syndrome
Disorders resulting from anatomic disconnection between cortical areas can be within one
hemisphere or between hemispheres. Examples include ideomotor apraxia, which is caused
by damage to the fiber connection between the language comprehension area and the
motor association cortex, and disconnection of the verbal comprehension area in the left
hemisphere and the motor strip in the right hemisphere due to damage to the anterior
section of the corpus callosum.
Neuropsychological Terminology
Neurology and neuropsychology have their own jargon that is necessary to understand their
literature. Terms like deficit, dysfunction, symptom, impairment, and disorder are used
interchangeably and can refer to various abnormalities. Syndrome refers to a group of
symptoms that usually occur together after brain damage. The base word of a label can
indicate the type of disorder, e.g., phasia for speech disorder and graphia for writing. A prefix
of "a" means the function is absent, while "dys" means partial impairment. Unilateral and
bilateral refer to damage in one or both hemispheres respectively, while contralesional and
contralateral refer to impairments or lesions that are opposite each other
Assumptions that Underlie Clinical Neuropsychology
Cognitive and clinical neuropsychology rely on two assumptions: that the brain of a patient
was normal before damage and that we can generalize brain-behavior relationships from
one "normal" human to another. However, these assumptions can be challenged when using
patients with long-term neurological conditions. Studies of brain-damaged patients can help
understand the workings of the normal brain and mind, but experiments with brain-damaged
children require different tests and clinical methods. While there are criticisms of these
assumptions, it is generally accepted that making broad generalizations about brain-
behavior relationships from one human to another is valid.
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