Lectures on Neuropsychology PDF

+1 Learning objectives Specific learning objectives: ▪ You will ▪ Acquire knowledge regarding the profession of a neuropsychologist ▪ Be able to place this in the larger context of psychology ▪ Learn the definitions of relevant concepts within the context of neuropsychology ▪ Describe several neuro...

+1 Learning objectives Specific learning objectives: ▪ You will ▪ Acquire knowledge regarding the profession of a neuropsychologist ▪ Be able to place this in the larger context of psychology ▪ Learn the definitions of relevant concepts within the context of neuropsychology ▪ Describe several neuropsychological disorders and reasons why these disorders are neuropsychological in nature ▪ Describe where certain brain areas/structures are located in relation to other areas Recap if i was a fish my dorsal fin would be here Brain location Why are there different nomenclatures? Important for describing where lesions are in the brain Nomenclature = naming system For example, frontal, rostral, and anterior mean similar things... How brain lesions led to the modern understanding of brain function and organization Topic Entryway: Phineas Gage In 1848, he taught us about regional brain functions What is a brain lesion? Brain lesion = area of brain damage 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 Principles of organization How brain lesions lead to the modern understanding of brain function and organization Clinical cases (like Broca’s aphasia) led to discovery that certain types of damage was consistent with certain types of symptoms ▪ Localization: Damage was in a certain part of the brain -> concluded that some brain functions were anatomically located ▪ Lateralization: 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: Lost functions are sometimes rehabilitated -> concluded that other parts of the brain can compensate ▪ Hierarchical organization: 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 This one is trickier... ▪ Hindbrain Spinal cord, brain stem, cerebellum Controls vital functions Probably evolved first ▪ Midbrain Colliculi, tegmentum, and cerebral peduncles Vision, hearing, motor function, alertness, and temperature regulation Probably evolved second ▪ Forebrain Telencephalon (includes the cerebral hemispheres) and diencephalon (includes the thalamus, hypothalamus, epithalamus, and subthalamus) Complex cognitive, sensory, and motor activities Probably evolved last Hierarchical organization Processing begins with lower (relevant) brain regions then moves to higher brain regions Loss of function in higher brain regions = dissolution (brain can compensate with lower regions, simplified behaviors) Lower brain areas can sometimes compensate but output is simpler A brief history of neuropsychology Donald Hebb Considered the ‘father of neuropsychology’ ▪ 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 diagnosis ▪ Relationship between loss of brain function and change in thoughts/behaviors easier to observe ▪ Modern neuropsychology includes a variety of disorders The Hebbian assumption of change Environment, culture, customs, family history, lifestyle, and more shape who we are ▪ In neuropsychology, we focus a lot on thoughts, behaviors, and their relationship to the brain ▪ However, much relevant information is found outside the brain and psychology that influence both ▪ For example, these mice... Clones, but not identical Plasticity, flexibility, and adaptability are fundamental properties of the brain ▪ Neuropsychology is founded upon the assumption of change There is no rehabilitation unless the brain can change Therapies would not work unless psychologies can change Hebbian plasticity is the foundation of neuropsychology Bio, psycho, and social factors can change This changes the brain and the person Has consequences for mental health Understanding change is necessary for understanding neuropsychology Neurological examination Patient’s history State of awareness ▪ Alert, drowsy, stupor, confused ▪ Speech abnormalities, facial asymmetries, body posture ▪ Emotions (agitated, anxious, depressed, apathetic, restless) Physical examination ▪ Blood pressure, brain imaging, reflexes, pain, muscle movement, smell, etc Disorders ▪ Strokes, injuries, and lesions may show asymmetry, loss of function ▪ Parkinson’s may show loss of smell and motor changes ▪ Dementia may show memory loss, disorientation, or agitation Biopsychosocial model of neuropsychological assessments Neuropsychological assessment ▪ Combines many tests depending on patients’ symptoms ▪ May include IQ, cognitive, and psychometric tests Biopsychosocial model ▪ Social support networks (friends, family) influence outcomes ▪ Patients’ sense of wellbeing influence outcomes ▪ Sometimes a mismatch between the patients’ needs and their social network (e.g., patient wanted to stay home, family thinking they should work) or environment (e.g., needing a quiet place to sleep but living somewhere noisy) can add stress that may impair healing How did the biopsychosocial model change neuropsychology? Example from Dementia dementia is a symptom not a Dementia desiase itself ▪ Umbrella term for impaired memory, cognition, and decision-making Common causes: Alzheimer’s, Huntington’s disease, multiple sclerosis (MS) ▪ Symptoms include poor mood and perception May include depression, apathy, and hallucinations Neuropsychiatric Inventory (NPI) ▪ Used to characterize dementia in the clinic ▪ Assesses frequency and severity of symptoms ▪ Assesses changes in behavior Is it getting worse? Biopsychosocial perspective in dementia Usually applied as part of treatment plan External triggers are assessed through history interview ▪ 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 Example from Dementia Might assess whether apparent ‘hallucinations’ or ‘delusions’ are considered odd by family members ▪ Do the experiences described have a cultural place? Might assess relationship to healthcare system ▪ Do they believe that Western biomedicine is a valid approach? ▪ Do they feel safe? Asking these questions can reduce psychosocial distress for some patients Genetics and the brain Stress and Epigenetics Stress (and distress) have larger biological consequence than originally thought ▪ Lamarckian theory (discussed in section 1.2) Stress can influence epigenetic changes and mental health ▪ Within lifespan ▪ Across generations Underscores importance of psychosocial model Genetic Theories Mendel – Classic genetics Lamarck – Epigenetic code and phenotypic plasticity A Case of Inheriting Experience Applications to neuropsychology Behavior is caused by genetics, epigenetics, and experience-based learning Influences on cardiovascular health can also be derived from genetics, epigenetics, or experience (e.g., diet) Cardiovascular health directly affects brain function The job of a modern neuropsychologist What is a neuropsychologist? 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 (how well they work), etc. Not all clinical work Many neuropsychologists are also scientists ▪ 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 The Hebbian Assumption of Change in research and practice Some examples: ▪ Learning and skill development across the lifespan summary slide ▪ Healing after a brain injury (physical) ▪ Treating a disorder (psychological) ▪ Heritable traits passed down across generations key points - her priorities, what should you be studying Key points Phineas Gage and other medical cases taught us about regional brain functions Lesions can be caused by any types of damage to the brain, such as injury, blood flow problems, or cellular problems Localization: Damage was in a certain part of the brain -> concluded that some brain functions were anatomically located Lateralization: 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: Lost functions are sometimes rehabilitated -> concluded that other parts of the brain can compensate Hierarchical organization: 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 Directional terms and anatomical planes are necessary to memorize, because they help us to describe and discuss location of lesions (you should learn them) Donald Hebb formed neuropsychology Hebbian theory = neural pathways develop based on experiences; as pathways are used more, they become faster and stronger Hebbian assumption of change is based on experience-dependent plasticity The biopsychosocial model describes factors to consider when understanding and treating a patient Epigenetics describes how experiences can influence heritable traits A neuropsychologist can have many different jobs, including clinical and research positions How to use key points slides These slides are meant to help you identify the key points that we have discussed Study the information from the book and other slides that is related to the point on the slide For example, “Phineas Gage and other medical cases taught us about regional brain functions” ▪ Consider what happened to Phineas Gage and what it taught us about brain function. Sh Recap The Neuron Topic entryway multiple sclerosis (MS) Why start with neurons? Neuropsychologists rely on primarily information about larger brain structures and functions ▪ Global functions appear state-based (i.e., fixed, unchanging) ▪ Neuropsychology relies on change, which is not always big enough to be observed on this level of organization Understanding nerve cells is crucial ▪ Principles of change are observed through understanding cellular processes ▪ Many disorders have cellular causes Multiple Sclerosis (MS) ▪ MS is caused by damaged myelin ▪ Cumulative damage produces brain lesions ▪ MS is a heterogeneous disorder = patients have different symptoms & experiences depending on how lesion size and location, and how their individual brain is functionally organized Common symptoms of MS Affects brain and spinal cord Common symptoms: ▪ muscle spasms, stiffness, weakness, or paralysis ▪ mobility problems ▪ numbness/tingling sensations ▪ pain ▪ speech and swallowing difficulties ▪ vision problems ▪ sexual problems ▪ bladder or bowel problems ▪ fatigue ▪ difficulties thinking, learning, and/or planning ▪ depression and anxiety Most people with MS only have a few of these symptoms Average lifespan is 7 years shorter than general population Types of MS ▪ Primary progressive (PPMS) Symptoms onset and progressively get worse No history of remission ▪ Relapsing remitting (RRMS) Relapse = active symptoms/myelin damage Remission = no current symptoms/myelin damage Symptoms disappear and reappear across time ▪ Progressive relapsing (PRMS) Similar to RRMS but symptoms become increasingly disabling with each relapse Very rare, severely disabling ▪ Secondary progressive (SPMS) Occurs after patient previous had RRMS Remissions stop, symptoms get steadily worse