Introduction to Neuropsychology

• Neuropsychology is the scientific study of the relationship between brain function and behavior.
• Neuropsychology is multidisciplinary, combining anatomy, biology, pharmacology, and philosophy.
• Neuropsychology helps identify impairments from brain injuries, neurological disorders, and mental health conditions.

Historical Background

• Donald Hebb coined the term "neuropsychology" in 1949.
• Hebb wrote The Organization of Behavior: A Neuropsychological Theory.
• Hebb emphasized the connection between brain structure/function and behavior.

Traumatic Brain Injury (TBI) Case Study: L.D.

• The patient fell down five flights of stairs, resulting in severe head injury.
• Patient's Glasgow Coma Scale score was 3, indicating low consciousness.
• CT Scan revealed bleeding on both sides of the brain.
• Neuropsychological testing revealed impairments in memory and attention.
• The patient had difficulty multitasking, frustration, and loss of social interest.
• Sensory Loss: loss of smell and taste.
• Symptoms included impaired, emotional, and social withdrawal.

TBI Statistics

• U.S. statistics show 1.7 million TBI cases per year.
• TBIs contribute to 30% of accidental deaths.
• TBIs are a common cause of military discharge.
• TBIs are most frequent in children (under 6), young adults, and older adults (over 65).
• Many TBI cases go unreported.
• Diffuse brain injury complicates ability/disability outcomes.

Importance of Neuropsychology

• Neuropsychology assessment helps assess brain function, identify impairments, and diagnose conditions.
• Neuropsychology prognosis predicts recovery outcomes and complications.
• Rehabilitation aids in developing treatment strategies for recovery.
• Impact statistics: 2 million patients with TBI receive medical attention in Canada and the U.S. yearly.
• 5.5 million people are affected by Alzheimer's in these countries.
• There are additional cases of Parkinson's disease, MS, and other neurodegenerative diseases.
• An estimated 20-30 million individuals need neuropsychological attention annually.

Ancient Practices: Antecedents to Neuropsychology

• Trephination is an ancient practice of drilling holes into the skull, dating back 4,000 years.
• Trephination was thought to treat brain injuries or release evil spirits.
• Evidence includes a trephined skull found in Palestine.
• Neuropsychology helps understand how the brain influences behavior.
• The field has evolved from ancient practices to modern scientific approaches.
• Neuropsychology is critical for diagnosing and treating brain injuries and disorders.
• Its relevance is growing due to the increasing number of individuals affected by brain-related conditions.

Types of Traumatic Brain Injuries

• Definition of open-head Injuries: Injuries that involve penetration of the skull.
• The neurological symptoms of Open-head Injuries are highly specific.
• Damage is usually localized to a specific brain area in Open-head Injuries.
• Localized injuries provide critical insights into brain function and organization.
• Small and specific Open-head Injuries result in rapid and spontaneous recovery.
• Long-term prognosis for Open-head Injuries is often favorable (80-90% return to employment 15-20 years post-injury).
• For example: Gabrielle Giffords demonstrated remarkable recovery after an open-head injury.
• Definition of Closed-Head Injuries: Injuries caused by blunt trauma where the skull remains intact.
• Coup Injury: Damage occurs directly at the site of the blow in Closed-Head Injuries.
• Contrecoup Injury: Damage occurs on the opposite side of the brain due to being pushed or pressed against the skull in Closed-Head Injuries.
• Additional factors in Closed-Head Injuries:
  • Twisting and shearing of major fiber tracts
  • Hematomas: Blood pooling due to bleeding.
  • Edema: Swelling in response to injury.
• Concussion is defined as a disturbance of consciousness resulting from a blow to the head, with no visible contusion.
• Concussions are distinguished from more severe closed-head injuries, but the line between them can be fine.

Effects and Outcomes of Closed-Head Injuries

• Coma: A definition of Closed-Head Injuries is a state of loss of consciousness.
• Localized behavioral impairments: Specific functions mediated by the cortex at the site of damage may be affected (e.g., motor control, speech).
• Generalized impairments: Result from widespread trauma throughout the brain, impacting multiple cognitive and behavioral systems.
• Some common complaints after Closed-Head Injuries are difficulties with concentration and reduced ability to perform tasks.
• Skilled professionals often feel the greatest impact, as subtle cognitive impairments can hinder complex tasks following Closed-Head Injuries
• Frontal and temporal lobe damage from Closed-Head Injuries can lead to changes in personality and social behavior.
• Individuals with a history of closed-head injuries are at an increased risk of sustaining future injuries.
• Effects from repeated injuries tend to be cumulative, amplifying cognitive and behavioral impairments over time.
• Key Takeaways for Open-Head Injuries: Localized damage with better long-term recovery prospects with Open-Head Injuries.
• Open-Head Injuries offer valuable insights into brain function due to specific deficits.
• Closed-Head Injuries are more common and involve complex internal damage mechanisms, including coup, contrecoup, and diffuse trauma.
• Behavioral effects of Closed-Head Injuries range from localized to generalized impairments.
• Risk future injuries and cumulative effects makes prevention critical.
• Distinctions between concussion, closed-head injury, and open-head injury is vital for clinical assessment and treatment planning.
• Traumatic brain injuries (TBIs) were focused on in this in-depth look with the two basic types of open-head injuries and closed-head injuries.
• This in-depth look went over mechanics of these injuries, their behavioral and cognitive impacts, and factors influencing recovery and long-term prognosis

Headaches and Neurological Disorders

• Headaches Associated with Neurological Disorders are caused by various factors that affect pain-sensitive structures in the dura mater.
• Common neurological causes of Headaches Associated with Neurological Disorders include:
  • Tumors
  • Head trauma
  • Infections
  • Vascular malformations
  • Hypertension
• Migraine:
  • An individualized treatment to headaches with a range of drugs.
  • Ergotamine compounds (vasoconstrictors) often combined with caffeine for acute attacks.
• Nonmigrainous Vascular Headaches:
  • Treated with over-the-counter medications such as: Ibuprofen, Acetaminophen, and Aspirin.
• Tension Headaches:
  • Managed through muscle relaxants, minor tranquilizers, and improving posture.
• Reducing stress
• Headaches Associated with Neurological Diseases focus is on treating the underlying disease rather than the symptom.

Infections and Their Effects on the Nervous System

• Definition of Infections : Involves invasion by disease-causing microorganisms and subsequent tissue reactions.
• Infections damage the nervous system by disruption of blood supply.
• Infections damage the nervous system by interference with glucose or oxygen metabolism.
• Infections damage the nervous system through alteration of cell membranes.
• Infections damage the nervous system through the formation of pus.
• Infections damage the nervous system through the induction of edema (swelling).
• Viral Infections:
  • Virus: Encapsulated aggregate of nucleic acid (DNA or RNA).
  • Categories:
• Neurotropic Viruses: Target CNS cells specifically (e.g., rabies, polio).
• Pantropic Viruses: Affect both CNS and other tissues (e.g., mumps, herpes).
• May cause encephalitis (inflammation of the brain).
• Bacterial Infections:
  • Bacterium: Microorganism that lacks chlorophyll and multiplies by division.

•  Examples include Bacterial Meningitis: Infection of the meninges causing cell necrosis and increased intracranial pressure.
  

• Brain Abscesses: Result from infections elsewhere in the body causing bacteria to multiply and destroy cells.
• Mycotic (Fungal) Infections are rare but occur when fungi invade the nervous system.
• Parasitic Infestations:
  • Amebiasis:

•  Caused by the protozoan Entamoeba histolytica, leading to encephalitis and brain abscesses.
  

  • Malaria:
• Spread by mosquito bites; causes hemorrhages and neuron degeneration.
• Treatment is challenging with Viral Infections as there are no specific antidotes, except for rabies.
• Bacterial Infections are treated through the usage of Antibiotics. -Bacterial Infections also take surgical interventions such as draining abscesses or performing a spinal tap to relieve pressure.
• Mycotic and Parasitic Infections:
  • Treatment options are limited.
  • Antibiotics may help manage secondary complications.
• Key Takeaways:
  • The cause and treatments of headaches are neurological disorders associated with headaches and central nervous system (CNS) infections.
  • Types of infectious agents covered are their mechanisms of damage, and treatment options.

Examination of the Head

• Primarily involves assessing which includes 12 Cranial Nerves:
• I: Olfactory
• II: Optic
• III: Oculomotor
• IV: Trochlear
• V: Trigeminal
• VI: Abducens
• VII: Facial
• VIII: Vestibulocochlear
• IX: Glossopharyngeal
• X: Vagus
• XI: Accessory
• XII: Hypoglossal

Examination of the Cranial Nerves

• I: Olfactory - Test sense of smell (e.g., coffee). - Clinical sign: anosmia (loss of smell).
• II: Optic - Visual fields and acuity. - Fundoscopy - Papilledema may indicate elevated brain pressure from tumors.
• III: Oculomotor - Pupil constriction - Argyll Robertson pupil - Controls eyelid elevation resulting in ptosis.
• III, IV, VI: Eye Movements - III (Oculomotor) Upward and inward movements resulting in downward and outward eyeball drifts. - IV (Trochlear): Downward movement resulting in weakness in downward gaze and upward eyeball drifts. - VI (Abducens): Lateral movement resulting in weakness in outward gaze and the eyeball drifts inward.
• V: Trigeminal - Sensory function of the face.
• VII: Facial - Controls facial muscles and contributes to hearing.
• VII, VIII: Vestibulocochlear - Hearing and balance
• VII, IX, X: Taste - Test with sugar and salt resulting in ageusia.
• IX, X: Pharyngeal Reflex - Gag reflex and pharyngeal movements.
• XI: Accessory - Controls shoulder muscles.
• XII: Hypoglossal - Tongue movements.

Motor System

• Muscle Strength is graded on MRC scale.
• Posture abnormalities may indicate underlying neurological issues.
• Abnormal resting tremors, seizures, fasciculations.
• Tone abnormalities include spasticity
• Rigidity
• Coordination
• Cerebellum
• Other signs include Nystagmus and Intention tremor and staccato speech
• Deep Tendon Reflexes are tested using a reflex hammer on the masseter and plantar.
• Findings include Brisk and Reduced reflexes
• Sensory Systems testing modalities for pain, temperature, vibration, and position
• Two-point discrimination and Sensory Systems tests are completed together.
• Romberg Test assesses balance by removing vision
• Neurological Examination Summary:
  • Neurologist documents positive and negative findings, provisional diagnosis, plan for further diagnostic tests and suggested therapies.
• Additional Clinical Tests include Electrophysiology, Cerebrospinal Fluid Studies, Imaging Techniques, neuropsychological testing.

Occipital Lobes Lec 5/ Chapter 13:Anatomy

• Lateral Surface
• No clear anatomical division exists between the occipital and temporal cortices on the lateral side.
• The occipital cortex is functionally specialized for processing visual information.
• Medial Surface:
• Calcarine Sulcus contains much of the primary visual cortex.
• Divides the upper and lower visual fields for visual processing.
• Ventral Surface:
• Lingual Gyrus Processes early-stage visual information
• Fusiform Gyrus Specializes in color perception/complex pattern recognition.

Categories of Vision

• Form/Recognizing shapes and contours
• Motion/Detecting and analyzing movement
• Color/Processing wavelengths of light
• Depth/Combining cues to judge distance and spatial relationships

Occipital Lobe Disfunction

• Damage to Dorsal Stream:
• Issues with Spatial Awareness
• Akineticopsia/Inability to Perceive Motion -Damage Ventral Stream:
• Recognizing an object or a face
• Visual Agnosia/Recognizing Objects
• Prosopagnosia/Recognizing Faces

Occipital Lobes Lec 6/ Chapter 13: Lec 6 Anatomy

• Located in the back of the brain
• Responsible for visual inputs
• Distinct regions
• Primary visual cortex V1
• Secondary visual area V2-V5

Categories of Vision

• Vision for action/ Dorsal
• Coordination
• Spatial relationship
• Real time processing
• Action For Vision
• Where eye movements
• Focus on Important Things

Occipital Lobe Disfunction Continued

• Connects the occipital lobe to the paritel lobe
• Responsible for spatial awareness/ movement of coordination damage
• Problems with object localization/visially guided movements

Parietal Lobe Lec 7/ Chapter 14: Disfunction Right Hemisphere

• Patients struggle with map reading/ navigating
• Left Hemisphere leads to patients developing difficulties to create appropriate mental image
• Right = Difficulty manipulating the generated Image

Posner Task

• Spatial attention task
• Examine how individuals shift in response to verbal cues
• Understanding:
• Role of the paraliel lobe
• Attention shifting Findings in Parliel Lobe Damaged Patients Patients exhibit impaired in disengaging attendtion

Explore neuropsychology, the study of brain-behavior relationships. It integrates diverse fields like anatomy and pharmacology. Learn about its origins with Donald Hebb and a TBI case study showcasing the impact of brain injuries on cognitive functions.