Clinical Neuropsychology Notes:
Lecture 1: Intro to Clinical Neuropsych
Ch 1, 2, 3
Working Field:
• Interested in diagnosing and treating brain disorders
- Genetic and neurodevelopmental disorders
- Cerebrovasculopathy
- Neurointoxication
- Psychiatric disorders
- Headache Disorders
- Neurodegeneration
• Through looking at the behavioral consequences:
- Neurocognitive function- memory, attention, language, etc.
- Mood- depression and anxiety
- Behavior- agitation, irritability, pathological laughing/crying
• Use of DSM-5- ch 17- neurocognitive disorders chapter
6 neurocognitive domains in DSM-5
• Complex Attention→ sustained attention, divided attention, selective attention,
processing speed
• Perceptual Motor Function→ visual perception, visuoconstructional reasoning,
perceptual motor coordination
• Language→ object naming, word finding, fluency, grammar and syntax, receptive
language
• Executive functioning→ planning, decision making, working memory, responding to
feedback, inhibition, flexibility
• Learning/Memory→ free recall, cued recall, recognition, semantic and autobiographical
long term memory, implicit learning
• Social cognition, recognition of emotions, theory of mind, insight
• Always consider mood and behavioral disorders too
• Must be able to distinguish between symptopm, disorder and the limitation/level of
disability:
Symptom Disorder in/of Limitation/Level of Disability
Attention Complex attention Easily distracted, doesn’t finish anything
Deficit
Amnesia Memory and learning Forgets appointments, gets lost, repeats the
same thing, wordfinding problems
Aphasia Language/reading/writing/ Unable to understand others, reading
arithmetic difficulties, writing difficulties, counting change
Agnosia Perception Faces, objects, car ignition, retrieve smth
Neglect Attention to one side Accidents, unable to find things
Apraxia Motor planning Washing, dressing, making coffee
Executive Executive functions Bad planning and anticipation
dysfunction
, • Indications for neuropsychological assessment
- Patient and/or those close to patient complain about neuropsychological functioning
- Questionable age related forgetfulness
- Normal or pathological neuropsychological 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 indications and goals for neuropsychological rehabilitation
- Forensic and insurance issues
Alzheimer’s disease
• Neurodegenerative disorder- plaques and tangles hinder communication between
neurons
• Gradual deterioration- starting with memory problems
• Treated with cholinesterase inhibitors in mild-moderate Alzheimer’s disease and NMDA
receptor antagonist in moderate-severe cases
• Neuropsychological symptoms:
- Gradual memory impairment starts with anterograde memory loss and later
retrograde amnesia
- Disorientation in time and place and later people
- Gradual deterioration in all cognitive domains
- Neuropsychiatric problems including depression
- Heavy impact on daily life, social contacts, work
- Related to brain damage- atrophy in the medial temporal lobe and later global brain
atrophy
• Brain reserve hypothesis→ larger maximal lifetime brain volume protects against
cognitive decline
• Cognitive reserve hypothesis→ enriching experiences protect against cognitive decline
Parkinson’s Disease
• Degeneration of dopaminergic cells (substantia nigra) and changes in the noradrenergic,
serotonergic and cholinergic systems
• Diagnosis is made with bradykinesia combined with rigidity, rest tremor and or postural
instability
• Other symptoms include fatigue, disturbed sense of smell, autonomic disorders. Sleep
disorders, neuropsychiatry and cognitive impairment
• Treated with levodopa and dopamine antagonist, DBS
• Cognitive impairments- eventually patients develop dementia
• Executive impairments as well as impairments in attention, mental speed, memory and
visuospatial deficits and processing of emotional info