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Summary neuropsychology course
- Instelling
- Vrije Universiteit Amsterdam (VU)
This document is a summary from the course Neuropsychology given in the minor Psychology and the brain on the VU.
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Voorbeeld 4 van de 64 pagina's
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Lecture 1: The neuropsychologistA neuropsychologist is a clinician and/or scientist who..
- Uses neurology, neuroscience and psychology
- To understand how behaviors correlate with brain function
- To assess ‘normal’ and ‘impaired’ cognitive, social, physical and emotional functioning
Neuropsychology is usually clinical in nature
- Neuropsychologists are not medical doctors
- Clinical tasks are usually diagnostic
- Referrals to specialists may be given for treatments
- Research tasks may include investigating causes of a disorder, its brain/behavioral/cognitive
processes, its diagnostic approaches, the efficacy of treatments etc..
Donald Hebb
- Considered the father of neuropsychology
o Hebbian theory = neural pathways develop based on experiences: as pathways are
used more, they become faster and stronger
- Early neuropsychology was closely linked to brain injury and dementia research and
diagnostics
o Relationship between loss of brain function and change in thoughts/behaviors easier
to observe (what ability changes based on what brain part is damaged) -> brain and
behavior are related
o Modern neuropsychology includes a variety of disorders (used to be only dementia
research, now almost everything)
Neurological examination (to get a picture of the whole patient)
- Patient’s history (social history (family life, support network), medical history, trauma etc..)
- State of awareness
o Alert, drowsy, stupor, confused
o Speech abnormalities, facial asymmetries, body posture
o Emotions (agitated, anxious, apathetic, restless)
- Physical examination
o Blood pressure, brain imaging, reflexes, pain, muscle movement, smell etc..
- Disorders
o Strokes, injuries and lesions may show asymmetry, loss of function
o Parkinson’s may show loss of smell and motor changes
o Dementia may show memory loss, disorientation or agitation
In research you think the same but in groups of people
Biopsychological model of neuropsychological assessment
- Neuropsychological assessment
o Combines many tests depending on patients’ symptoms
o May include IQ, cognitive and psychomentric tests
- Biopsychosocial model (Not only looking at biology but also how social world influences a
person)
o Social support networks (friends, family) influence outcomes
o Patients’ sense of wellbeing influence outcomes
, o Sometimes a mismatch between the patients’ needs an their social network (e.g.
patient wanted to stay at home, family thinking they should work) or environment
(e.g. needing a quit place to sleep but living somewhere noisy can add stress that
may impair healing)
How did the biopsychosocial model change neuropsychology
- First conceptualized in 1950 by Roy Grinker -> applied ‘bio’ to psychology -> that biology
affects your psychology
- Proposed as a medical perspective by George L.
Engel 1977 -> applied ‘social’ to medicine -> your
social life can influence you
Premise
- A person is not made of isolated organs, but
functions as a whole
You need good biological, social and psychological
circumstances to have good mental health
- So need to understand a person in these three
ways to study mental health
Dementia is not a disorder itself it is a symptom
- Umbrella term for impaired memory, cognition and decision making
o Common causes: Alzeihmer’s disease, Huntington’s disease, MS -> all have dementia
as a symptom
- Symptoms related to dementia include poor mood and perception
o May include depression, apathy and hallucinations
Neuropsychiatric Inventory (NPI) -> classic way of see if someone has dementia
- Used to characterize dementia in clinic
- Assesses frequency and severity of symptoms
- Assesses changes in behavior
In research: in average for a group
Biopsychosocial perspective in dementia
- Usually applied as part of treatment plan
- External triggers are assessed through history interview
o For example, one study found that 80% of dementia symptoms had external triggers
- Social support and environmental well-being considered in treatment plan
Biopsychosocial perspective helped lead to other social-clinical models
- Culture is important, because in different countries people might show symptoms
differently.
o For example, in some countries people with anxiety have sweaty palms or some are
moving around a lot. -> Important to know as a clinician
- Part of our social well-being is our cultural fit
o Beliefs from community shape our experience of medicine
- Not all symptoms are symptoms
o Certain beliefs are cultural
, o Sometimes hallucinations are even considered culturally appropriate (when they
moved somewhere else people thought they had schizophrenia, and thus learned
that we need to know more background from people)
- Cultural Formulation interview (CFI)
o Used to determine whether something is pathological (so is something sign of
distress or as normal)
o Looks at things like: how would you describe your problem to your friends, why do
you think it happens to you, could you explain it with religion or anything -> relate
what patient is reporting to what community is reporting
Example from dementia
- Might assess whether apparent ‘hallucinations’ or ‘delusions’ are considered odd by family
members
o Do the experiences described have a cultural place?
- Might assess relationship to healthcare system
o Do they believe that western biomedicine is a valid approach
o Do they feel safe?
- Asking these questions can reduce psychosocial distress for some patients
Many neuropsychologists are also scientists (on average)
- Use neuroimaging to study relationship between brain and psychology
- Functional neuroanatomy is crucial
- Working knowledge of relevant biological and psychological theories
- May study healthy and patient populations
How brain lesions led to the modern understanding of brain function and organization
Phineas Gage
- In 1848, he taught us about regional brain functions -> had a pole through his head during an
accident. Brain was noticeably affected, had personality changes but he recovered over time.
As he healed, people realized the brain changes all the time.
Topic entryway: Broca’s aphasia
- Knowledge of neuroanatomy and brain function are fundamental aspects of
neuropsychology
Broca’s aphasia
- Loss of grammatical structure
- Difficulty forming words or sentences
Noticed in clinic
- Brain lesion observed in frontal lobe
- Patients often have right-side weakness or paralysis due to lesion’s impact on motor function
What is a brain lesion?
- The lesion causes a loss of structure of the brain. Part of the brain collapses
Brain lesion = area of brain damage caused by something
Can result from stroke, loss of blood flow, tumor, injury etc..
This is what it looks like in an MRI scan
- White = damage from reduced blood flow caused by a stroke
Clinical cases (like Broca’s aphasia) led to discovery that certain types of damage was consistent with
certain types of symptoms
, - Localization: the fact that the brain is organized:
o damage was in a certain part of the brain -> concluded that some brain functions
were anatomically located: more to the front, most complex, least organized?
o Injury in a certain anatomical location leads to the same symptoms
- Lateralization: some functions are on only one side of the brain, when other side is damaged
no loss of function seen.
o Damage was on a certain side of the head -> concluded that some functions were
usually on a specific side of the brain
- Distribution of function: if something is damaged doesn’t mean you can’t do it at all, so
Broca’s aphasia can still speak a bit because also other brain regions process language.
o Lost functions are sometimes rehabilitated -> concluded that other parts of the brain
can compensate
- Hierarchical organization: Some area’s are more sophisticated than others. Some brain areas
processes more simple/complex things. First simple than complex things processed. Damage
in higher area’s means you can still do simple tasks for example
o Sophistication of functions very depending on whether a ‘higher’ or ‘lower’ brain
area is damage -> brain processes start with lower levels and are processed through
increasingly higher levels
Hierarchical organization
- Hindbrain (really important for survival) -> lowest brain region
o Spinal cord, brain stem, cerebellum
o Controls vital functions
o Probably evolved first
- Midbrain
o Colliculi, tegmentum and cerebral peduncles
o Vision, hearing, motor function, alertness and temperature regulation
o Probably evolved second
- Forebrain (for more complex things, and thus not per se needed to survive) -> highest brain
region!
o Telencephalon (includes the cerebral hemispheres) and diencephalon (includes the
thalamus, hypothalamus, epithalamus and subthalamus)
o Complex cognitive, sensory and motor activities
o Probably evolved last
Processing begins with lower (relevant) brain regions then moves to higher brain regions
dissolution
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