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• Clinical neuropsychology focuses on behaviors, emotions, and thinking affected by brain disorders/damage.
• It studies how human behaviors, emotions, and thoughts relate to the brain, especially the damaged brain.
• The discipline has applied and academic goals.
• Applied aims involve improving the diagnosis, treatment, rehabilitation, and prevention of neurological disorders.
• The primary academic aim involves studying the workings of the "normal" brain through experiments on brain-damaged individuals.
• Chapter introduces clinical neuropsychology, functional neuroanatomy, neuropsychological terms/concepts, clinical practice/research, roles of neuropsychologists, and cross-cultural issues.
• Chapter 2 explains neuropsychological assessment.
• Chapters 3-19 present case studies of neuropsychological disorders like aphasia, visual agnosia, and dementia.
• Other important clinical neuropsychology issues are cited throughout the case studies.
• The intro chapter concludes with a list of topics keyed to chapters with more detail.

Relationship of Clinical Neuropsychology to other Disciplines

• Clinical neuropsychology relates to neurology (brain) and cognitive psychology (mind).
• Neurology studies the medical aspects and treatments of central nervous system disorders.
• Neurologists focus on clinical symptoms/signs and underlying neuropathology in the brain, spinal cord, and peripheral nervous system.
• Cognitive psychology aims to understand the mind by analyzing higher cognitive functions.
• Cognitive psychology experiments use unimpaired participants (often students).
• Cognitive neuropsychology blends cognitive psychology and clinical neuropsychology by analyzing higher cognitive functions in brain-damaged patients.
• Cognitive neuropsychology uses similar paradigms as cognitive psychology to study brain-damaged patients, analyzing deficits and implications for normal brain functioning.
• Clinical neuropsychology bridges neurology and cognitive neuropsychology; balancing neurological interests in brain pathology with psychological interest in higher cognitive functions.
• Clinical neuropsychology aims to understand the normal mind and improve rehabilitation methods.
• Disciplines overlap, and some neurologists specialize in clinical neuropsychology, known as behavioral neurologists.
• Clinical neuropsychologists in university psychology departments often research cognitive neuropsychology.
• Other important areas that contribute to clinical neuropsychology include animal psychology, neuroscience, neuropharmacology, and human neurophysiology.
• Human neurophysiology measures electrical brain waves using electroencephalographs (EEG) and evoked potentials.
• Neuroimaging tech like CT scans, MRI, PET scans, and functional MRI, have revolutionized neuroscience and clinical neuropsychology.
• CT and MRI visualize anatomical structures and damage in the living brain.
• Cerebral blood flow techniques, PET, and fMRI visualize the working brain's changing metabolism.
• These imaging techniques confirm/extend hypotheses about brain-behavior relations.
• Neuropsychologists require clinical skills for rapport, assessment, and discussing sensitive information.
• Clinical neuropsychologists should respond professionally and sensitively to patient emotions.
• Research subjects are entitled to sensitive treatment without exploitation.

Functional Neuroanatomy

• The human brain section provides a basic overview of cortical areas/neuroanatomical structures related to higher cortical functioning.
• More detailed descriptions of neuroanatomy can be found in texts by Lezak (1995), Walsh (1994), and Mesulam (1985).

Gross Structure of the Brain

• The brain's three major divisions include the cerebral hemispheres, cerebellum, and brain stem.
• Neuropsychology focuses on the cerebral hemispheres.
• The brain stem links the spinal cord to the medulla oblongata, pons, midbrain, and diencephalon.
• It supports life by controlling respiration, cardiovascular function, and gastrointestinal function.
• It contains cranial nerve nuclei for special senses but not higher cognitive function.
• The cerebellar hemispheres are positioned at the base of the cerebral hemispheres, focus on coordination, muscle tone, and balance
• The cerebral hemispheres are paired above the midbrain and pons and consist of a cerebral cortex or grey matter
• Gyri (hills) and sulci (valleys) consist of folded tissue on the cortex
• Axons or fiber tracts form a layer directly below the cortex called white matter, and connect the nerve cells to the rest of the brain
• Deep within the hemispheres are paired structures of grey matter known as basal ganglia which are more deeply outlined in Chapter 15 regarding Parkinson's disease
• The cerebral hemispheres are split by the longitudinal fissure runs down from the anterior frontal lobes to the posterior occipital lobes
• Other main fissures include the central/rolandic fissure (separates frontal/parietal lobes) and lateral/sylvian fissure (separates temporal lobe from frontal/parietal lobes).
• The corpus callosum is the tough band of interhemispheric fibers that connects the two brain hemispheres.
• The ascending reticular formation (RF) controls the cerebral cortex arousal level
• RF is a multisynaptic neuron chain traveling up through the brain stem
• Sensory pathways send impulses to the RF, which relays them to the thalamus (a paired grey structure on either side of the midline).
• The thalamus relays motor, sensory, and RF and influences mental alertness/sleep
• The limbic system (hippocampus, amygdala, cingulate gyrus, mamillary bodies) involves emotion, motivation, and memory and lies within the brain
• The brain, covered by the meninges has three coverings, called the meninges
  • The outermost is the dura mater (tough outer layer)
  • The middle layer called is the arachnoid mater ("spider mother")
  • The fine pia mater ("little mother") adheres to the cortex.
• The subarachnoid space lies between the arachnoid and pia mater, that is filled with cerebrospinal fluid (CSF).
• Meningitis is an inflammation of the meninges, causes a stiff neck
• Ventricles deep within the hemispheres, consist of CSF that are continually formed by the choroid plexus and circulates through the ventricles.
• The cerebrovascular system involves two pairs of cerebral arteries: internal carotid arteries (supply anterior brain) and vertebral arteries (supply posterior brain)
• The anterior cerebral arteries (ACA) supply medial/inferior surfaces of the frontal lobes, medial surfaces of the parietal lobes, and corpus callosum.
• The middle cerebral arteries (MCA) supply the lateral surfaces of the frontal, temporal, and parietal lobes, as well as parts of the inferior surfaces of the frontal lobes and medial surfaces of the temporal lobes.
• The vertebral arteries form the posterior cerebral arteries, which supply the occipital lobes and parts of the medial/inferior/temporal lobe surfaces (including the hippocampus)
• The internal carotid and vertebral arterial systems link at the brain's base via the Circle of Willis, for blood to flow around circle when the artery is blocked
• If one of the major cerebral arteries is blocked, the blood can pass around the Circle of Willis to reach the deprived area
• A part from the circle of Willis weakens on the artery wall, called aneurysms, it expels blood around the brain in the subarachnoid space
• A blockage away from the Circle of Willis cuts off oxygen which is called a stroke (brain death)
• Cerebral veins are divided into superficial (drains lateral/lower surfaces) and deep veins (drain inner brain).
• Brain veins empty into venous sinuses located in the dura mater, which in turn, empty into the large internal jugular vein.

Cerebral Cortex

• Brain cortex is divided into primary, secondary, and tertiary cortical zones relate anatomical-functional areas.
• Parietal, temporal, and occipital lobes (posterior cortex) are mainly aware of what is happening
• Primary zones are main projecting areas for incoming sensory information
• The body is mapped to each zone on the appropriate side known as the contralateral hemisphere Each body map is projected to sense-modality-specific neurons.
• Secondary zones (association cortex) integrate modality-specific input from primary cortex.
• They handle perception and meaning within a sense modality.
• Damage results in inability to perceive/comprehend touch, hearing, or sight.
• Tertiary zones integrate information across sense modalities located at the border of each lobe
• Damage results in complex higher cognitive disorders/abnormal emotional components.
• Frontal lobes handle acting with relays posterior knowledge from cerebral cortex
• Frontal lobes, located with the zone running parallel to the sensory strip, that links topographic layout(hangs the body onto the opposite contralateral hemisphere).
• The premotor cortex associates the location with secondary location helps in organization motor patterns.
• The prefrontal cortex, tertiary of the frontal lobe for anterior pole includes the basomedial(orbitomedial) cortex that connect the two lobes.
• The prefrontal cortex is involved in executive functions (planning, organization, abstract thinking), mood, motivation, and emotion can result executive impairments.
• The cortex/hemisphere is divided into four lobes
• Parietal , temporal, and occipital lobes helps the individual's mood, motivation, and experiences.
  • The parietal lobes are involved in tactile sensations, position sense, and spatial relations.
  • Left has to work with sequential, logical spatial abilities for detail and right is more work with spatial knowledge.
    • The left calculate, which makes the relationship with spatial concepts
    • Right makes the relationship with patterns together
• The temporal lobes are involved in auditory olfactory abilities
• The Temporal Lobe is interconnected with the hippocampus related to emotional states, especially with verbal
• The right temporal works with nonverbal voice tone and facial expressions.
• The Occipital Lobes have the visual input relating visual loss based on which side is damage
  • The visual-field defects happen when damage happens in occipital cortex, otherwise it causes cortical blindness
  • Lesions in the secondary or association cortex can lead to an increase in disorders
  • The functional between hemisphere with language function in left and visually judging the object in right The Frormal Lobe concerns actions and functions while abstract concepts and plan on info received
• Motor function are primary and premotor frontal cortex
• Speech Area Broca's Area with medial parts of Frontal lobes are related to motivation
• The verbal right from left isn't marked than frontal lobes , frequently results with the nonverbal sides

Functional Systems

• Some highers cognitive functions that are the result of number one brain areas composed with behavior
• Damage relates to double dissociation to area A, resulting the loss of functions which suffers factor
• Functional systems finds a way to find a new means to the same ending that aids is impairment.
• The system of the functional will restructure the by damaged neruron by making a connection wit other critical areas the function remains
• This helps aids in practicing impairments

Disconnection Syndrome

• Disorder results for some function by the disconnect of critical areas
  • Apraxia where the movement can still happen without verbal instruction
• Lesions can only happen to the above in one cerebral cortex, as a result of the corpus allosum
• In conclusion, verbal instructions cannot correlate movements when disconnected

Neuropsychological Terminology

• Neurology and Neuropsychology have specific jargons
• Understanding those terms are necessary motor, sensory, perceptual, behavioral, psychological, emotional
• Syndrome is a set of symptoms together in Chapter 6 and the understanding is vital
• Phasia refers disorder graphia is refers to writing, and lexia to reading. Praxia refers actions, gnosia refers to actions
  • An= absent, dys= partial impairment, dyslexia= difficulties
• Many terminologies should be explained depending on the circumstances

Assumptions that Underlie Clinical Neuropsychology

• Normal, functional, mind is needed to relate brain damage to specific disorders
• Patients needs to be normalized before undergoing brain damage for normalization
• However, the generalization is applicable for most as long as children are concerned to adapt those abilities

Focal Lesions and Diffuse Brain Damage

• Focal lesions is when the damage is limited to a specific spot in which a stroke occurs and the area dies as a result
• Open Head Injury where skull is struck and damages can break through to the brain.
• Neurosurgeons typically clean and remove damaged to make sure doesn't come in contact with the brain, but however penetrating objects can damage a lot related to the specific damages.
• Viruses tend to attack the cerebral cortex and destroy neurons
  • Edema where the areas that swell which has the affect of dysfunctional, however once the area recovers damages subside

Cerebral Dominance, Lateralization of Function, and Specialization

• Language in the left hemisphere and speech in the right hemisphere discovered by the Broca's area, the abilities were from skilled acts on verbal command
• Hemisphere has functions but can be understood from nonverbal information

Functional Plasticity

• Ability for the cortex to take function for things which can result due specific circumstances.
• Damage to the one has potential for the other hemisphere has potential for the intact one during children when they are in need to adapt.
• Function only established for certain years or in children but not the adults.

Double Dissociation of Function

• If brain is damaged it impair by one test.

Neuropsychological Research and Clinical Practice

• Clinical neuropsychology is linked between each other to stimulate various ways to address each problems.

Roles of a Clinical Neuropsychologist

• Works in an out patient, rehabilatative to act in various ways of what the patient needs.
• Works a therapist, and rehabilitation coordinator
• Can act as expert with how the patient acts as an opinion with the established knowledge

Understanding Neuropsychology through Case Studies

The case studies were presented to allow both descriptions and range of the disorders with victims for brain damage to explain functions