Week 1. Introduction & assessment
Chapter 1. Introduction to Clinical Neuropsychology
A definition of clinical neuropsychology and its aims
The study of human behaviors, emotions, and thoughts and how they relate to the brain,
particularly the damaged brain, is the subject matter of clinical neuropsychology.
- Applied aims: learning more about neurological disorders and diseases so that we can
more accurately and usefully diagnose, treat, and rehabilitate people who suffer such
disorders and, along with other disciplines, ultimately find ways to prevent their
occurrence.
- Academic aim: to learn more about how the undamaged or “normal” human brain and
mind work by carrying out experiments, usually in the form of cognitive tests, on brain-
damaged people.
Neurology: study of medical aspects of central nervous system disorders and treatments (pay
more attention to clinical symptoms than psychological). How the brain works and the central
nervous system.
Cognitive psychology: to understand the workings of the human mind by analyzing the higher
cognitive functions and their components. Participants in experiments are unimpaired people
(usually undergraduate students).
Cognitive neuropsychology: concentrates on the detailed analysis of higher cognitive functions,
often using similar paradigms to those used in cognitive psychology but it studies brain-damaged
patients rather than ‘normal’.
Clinical neuropsychology: neurological interest in brain pathology and the resulting symptoms
and a psychological interest in the analysis of higher cognitive functions, both to understand the
workings of the normal mind and to develop better rehabilitation methods for patients.
(Neurologists specialized in clinical neuropsychology are called behavioral neurologists).
Improving the life of people with brain damage
Neuroimaging:
- EEG: measures the electrical brain waves of patients
- CT & MRI: measure structure and damage
- PET & fMRI: visualize the changing metabolism of the working brain
Neuroanatomy: Structural anatomy vs functional neuroanatomy : more about the functions of
the brain areas
,3 major divisions in the brain:
1. Cerebrum: The cerebral hemispheres: above the midbrain and the pons
- Gyri = the “hills” of the cortex
- Sulci = the “valleys” of the cortex
- Basal ganglia = paired structures of gray matter deep within the hemispheres.
- Longitudinal fissure = separate the two hemispheres. From anterior frontal lobes
to the posterior occipital lobes
- Central fissure or sulcus = separates the frontal from the parietal lobes
- Lateral fissure = separates the temporal lobe from the parietal lobes
= longitudinal fissure
2. The Cerebellum: Cerebellar hemispheres: Motor coordination, muscle tone and
balance
3. The brain stem: is an upward extension of the spinal cord, consist of 4 parts:
, 1. Medulla Oblongata
2. Pons
3. Midbrain
3. Diencephalon (thalamus + hypothalamus)
The thalamus serves as a relay center for motor pathways,
many sensory pathways and the RF (= Reticular
formation) controls the overall arousal levels of the
cortex)
Limbic system: Hippocampus + amygdala. Is involved in emotion, motivation and memory
The brain has 3 coverings:
1. Dura mater = the most thick, adheres the inner surface of the skull
2. Arachnoid mater/spider mother = middle membrane is attached to the fine
3. Pia matter/little mother = adheres closely to the cortex.
→ the subarachnoid space lies between the arachnoid and the pia matter and is filled with
cerebrospinal fluid.
Cerebral cortex: Posterior cortex + frontal cortex. Divided by the central fissure.
, Posterior cortex: parietal, temporal and occipital lobes lying behind the central sulcus. Involved
in a person’s awareness.
1. Primary zone: sensory information
- Parietal: touch, sensations, spatial relations and position sense. Left: sequential
and logical spatial abilities, calculate. Right: holistic appreciation, spatial
information and conceptualization
- Temporal: sound, auditory and olfactory and different frequencies. Left: more with
language, verbal. Right: more with nonverbal functions, such as interpretation of
voice and emotional face expressions
- Occipital: specific parts of the visual field, sight, visual perception and knowledge.
Left: visual language functions. Right: visually judging orientation lines or objects
→ damage results in highly specific deficits in sensation
2. Secondary zone: Concerned with perception and meaning of sensory info. Damage
results in an inability to perceive or comprehend what one is sensing, depending on what
lobe is damaged.
3. Tertiary zone: Specificity disappears and integration of info across sense modality occurs.
Damage can involve abnormal emotional components since the tertiary zones are linked
to the limbic system.
The frontal lobes: The left frontal lobe includes Broca’s area
1. Primary zone: parallels the sensory strip
2. Secondary zone: mediates the organization of motor patterns
3. Tertiary zone/prefrontal cortex: Is involved in executive functions. The prefrontal lobes
are involved with mood, motivation and emotion → connection with limbic system
- Frontal amnesia: patient is unable to use memory strategies (due to frontal lobe damage)
this leads to difficulty learning and recalling new information
- Personality changes are often described after frontal lobe lesions.
Functional systems:
The concept of a functional system was proposed by Luria, who further proposed that in terms
of double dissociation, damage to area A will lead to impairments in A but not in B, damage to
area B will lead to impairments in B but not A.
- Enkele dissociatie: Patiënt of groep met laesie X vertoont functiestoornis op taak A
maar niet op taak B (er is dan geen uitspraak over lokalisatie mogelijk)
