Brain & Cognition 2
Lecture 1 (H2)
Clinical neuropsychology: The clinical application of the scientific area that studies the relations
between brain and behaviour, related to assessment, treatment and care of individuals with
(presumed) cognitive (dys)function as a result of developmental disorders, brain disease or
psychiatric disorders.
Behaviour in the broad sense: this refers to cognitive functions (latent variables can be assess
through tests) and overt behaviour (“video camera”).
Neuropsychology developed in the second half of the 20 th century.
Patient Phineas Gage: had a front-lobe operation and it also changed his personality.
Patient H.M.: hippocampus was removed on both sides. He was left with amnesia. That was
important for theories regarding memory function.
Relation between structure and function is more complex: brain networks rather than strictly
localized function.
Clinical neuropsychology
Highly relevant in modern-day (mental) health care
o Increase in people with brain damage or dysfunction
Decrease in mortality rates because of medical progression more people
surviving brain damage
Aging more aging related brain diseases
Increase in the importance of quality of life not just keeping them alive,
but also giving them the best support
A clinical neuropsychologist is a scientist practitioner whose focus lies on behaviour and
cognition
A clinical neuropsychologist is not a brain researcher
Clinical neuropsychology is more than localisation of functions
It’s also about the cognitive domains (perception, memory, language, attention etc..)
For example if you have someone with Alzheimer disease, you have to look at the different
types of memory (episodic, semantic etc.)
Different cognitive domains have different brain regions.. Certain diseases effect specific parts of the
brain, for example:
Alzheimer disease medial temporal lobe
Parkison basal ganglia
Stroke temporal lobe
Psychiatric diseases often affect a certain brain network, for example:
Hyperactivity attention network
ICF model WHO
Is used to describe the consequences of a disease or disorder.
It enables us to split out the different levels that a patient has.
- Function impairment = e.g. memory problems
- Activity limitation = e.g. not able to do grocery
shopping
- Participation restriction= can we fulfil our roles in
society?
,ICF model useful in clinical neuropsychology
Description of consequences of brain disease / disorder at three different levels: impairment,
limitation, restriction (‘handicap’)
Identify moderating factors
Relevant for understanding subjective complaints and problems in daily life (school)
Identify target for treatment or optimalisation
It’s important to know at with levels the problems are, because you can target the right
problem. E.g. not improve the whole memory, but only help someone with how to write an
email.
The clinical neuropsychologists toolbox
Assessment/diagnosis: tests, questionnaires, observation scales, interview techniques
Treatment/intervention: psychotherapeutic techniques (eg CBT), cognitive training and
neuropsychological rehabilitation
Both are equally important.
Assessment and the diagnostic cycle
For assessment they use the diagnostic cycle (De Bruyn/De Groot)
o Formulate hypotheses – test them – reject them --- reformulate
Explanation model about an individual’s behaviour: B = f (I x S)
I = characteristics of an individual
S = characteristics of the situation (“fixed” = environment, or the impaired brain)
Using theoretical knowledge about cognition, neuropsychological theories, anatomy and
physiology
In accordance with the scientist-practitioner model (not a “cook book”, reflect on your own
professional acts).
Assessment is more than just test administration!
It’s a collection of a whole range of information, including:
o Clinical interview
o Medical history
o The tests
o Knowledge of the disease (etiology)
o Functional neuroanatomy knowledge of the interaction between brain and
behaviour
, Goals of neuropsychological assessment
Differential diagnosis (medical/localisation) diagnosing what is going on
o “Does the patient have ADHD or not?”
o Dementia or ‘normal ageing’?
Developmental delay is the child slow in development due to a disease?
Toxic effects influence of drugs/alcohol on brain (drugs als in drugs)
Side effects influence of perscripted drugs on brain (drugs als in medicijnen)
Functional analysis (impaired versus intact abilities or consequences) what are the
strengths in a cognitive domain? Maybe you can use the strengths to overcome the problems
in an impaired domain?
Advice on interventions or everyday function
To improve participation (societal role)
test selection
referral clinical interview with
medical history and observation interpretation reporting
question interview informant
administration
The neuropsychological method
Case: ‘Sam’
A typical guy, he only didn’t finish his school (MBO)
He had a stroke two years ago in his right hemisphere, has concentration issues and difficulty
studying.
1. Referral question: Referred for a neuropsychological assessment in relation to his poor study
result, are these due to his stroke?
2. Medical history: He had a low birth weight, he is small for his age, 2yrs ago he had a stroke.
Stroke is possible due to an underlying connective tissue disease.
o MRI scan: A structural MRI (not about function, just a picture). He has an “Ischaemia
of middle cerebral artery”. They use a radiological convention (left=right in the
picture).
3. Clinical interview: Talk with patient for about an hour about the patient. He wants to know
what his cognitive and intellectual (in)abilities are, which will help him in selecting the right
course.
4. Clinical interview with significant others. Talking with parents.
5. Test selection and administration. Test that shows scores on for example memory and
intelligence. But also questionnaires and observation scales, self-report by the patient and
rating of how friends and family rate him.
6. Observation. How does the patient take the test? Is he stressed? Does he show initiative to
the examination? What stands out?
7. Interpretation. Comparison of individual’s performance with reference group of the same
age, sex and education level: normative data. Using statical analysis (probabilities
normaalverdeling) + self-report and observant scales.
8. Reporting. In this case: not due to stroke, but due to poor speed of processing + advice, e.g.
strategies to cope with processing speed deficit (which can be caused by the stroke).
, Clinical neuropsychology is multidisciplinary, you work together with lot’s of other people.
Lecture 2
Parkinson’s disease
Myths about Parkinson’s Disease (PD)
1) PD only affects movement-related (motor) symptoms such as tremor, stiffness and slowness
“Een tremor is een voortdurende schudbeweging van één of meer lichaamsdelen en wordt
veroorzaakt door een onwillekeurige contractie van spieren.”
Many symptoms of PD are unrelated to movement. Non-motor (“invisible symptoms”) of PD
are common and may affect everyday life more than the more obvious movement difficulties,
including depression, sleep disorders and impaired smell.
2) Only older people can be diagnosed with PD
While the majority of those with Parkinson’s are over the age of 62, it is entirely possible to
be diagnosed earlier in life. Young-onset Parkinson’s occurs when an individual receives a
Parkinson’s diagnosis before they turn 50. It is believed that only 2 percent of 1 million
people with Parkinson’s are younger than 40.
3) PD is a predictable disease we know what is going to happen
If Parkinson’s were predictable, then it would likely be curable too. Similar to many other
progressive diseases, Parkinson’s varies from person to person. How fast the disease
progresses and how often symptoms are experienced are different for each individual with
Parkinson’s. Alongside this, there’s no way to predict who will receive a diagnosis.
4) Once you’re diagnosed with Parkinson’s, there’s little to no hope
Parkinson’s may be a progressive disease, and it may be incurable, but (see myth 3) also
unpredictable in progression.
What is Parkinson’s disease?
Core features:
Tremor
Slowness
Stiffness
