NEUROPSYCHOLOGY NEUROPSYCHOLOGY PERSPECTIVES AND PERSPECTIVES AND

HISTORYHISTORY

Lecture 41Lecture 41

Very important growth area in clinical Very important growth area in clinical psychology.psychology.

Increased professional membership.Increased professional membership. A number of training programs.A number of training programs. The increase in many journals and books.The increase in many journals and books. The primary challenge of it appears to be health The primary challenge of it appears to be health

care reform.care reform.

PERSPECTIVES AND HISTORYPERSPECTIVES AND HISTORY Neuropsychologist have a foot in both the Neuropsychologist have a foot in both the

psychological and neurological domains.psychological and neurological domains. DEFINITIONS:-DEFINITIONS:-Most simply, it can be defined Most simply, it can be defined

as the study of the relation between brain as the study of the relation between brain function and behavior. It deals with the function and behavior. It deals with the understanding assessment, and treatment of understanding assessment, and treatment of behaviors directly related to the functioning of behaviors directly related to the functioning of the brain (Golden, 1984).the brain (Golden, 1984).

Neuropsychological evaluations have also Neuropsychological evaluations have also provided useful information about the impact of provided useful information about the impact of a patient's limitations on many areas of brain a patient's limitations on many areas of brain functioning.functioning.

ROLES OF NEUROPSYCHOLOGISTSROLES OF NEUROPSYCHOLOGISTS

Neuropsychologists function in a number of Neuropsychologists function in a number of different roles.different roles.

To help establish or rule out particular To help establish or rule out particular diagnoses.diagnoses.

Neuropsychologists can often make predictions Neuropsychologists can often make predictions regarding the prognosis for recovery.regarding the prognosis for recovery.

A third major role involves intervention and A third major role involves intervention and rehabilitation.rehabilitation.

HISTORY OF NEUROPSYCHOLOGYHISTORY OF NEUROPSYCHOLOGY

Theories of Theories of Brain Functioning.Brain Functioning.

Others suggest that it all began when Others suggest that it all began when Pythagoras said that human reasoning occurs Pythagoras said that human reasoning occurs in the brain.in the brain.

Others are partial to the second century A.D.Others are partial to the second century A.D.

the most significant early base for the most significant early base for neuropsychology seems to have been laid in neuropsychology seems to have been laid in the nineteenth centurythe nineteenth century..

The earliest signs of this understanding The earliest signs of this understanding came with Franz Gall and his now came with Franz Gall and his now discredited phrenology.discredited phrenology.

notion of notion of localization of function.localization of function.

Observations from two autopsies of Observations from two autopsies of patientspatients

Concept of Concept of EQUIPOTENTIALITYEQUIPOTENTIALITY

Although there certainly is localization of brain Although there certainly is localization of brain function, the cortex really functions as a whole function, the cortex really functions as a whole rather than as isolated units. rather than as isolated units.

In particular, higher intellectual functioning is In particular, higher intellectual functioning is mediated by the brain as a whole, and any mediated by the brain as a whole, and any brain injury will impair these higher functions. brain injury will impair these higher functions.

Yet there is the ability of one area of the cortex Yet there is the ability of one area of the cortex to substitute for the damaged area.to substitute for the damaged area.

Both the localization and equipotentiality Both the localization and equipotentiality theories presented some problemstheories presented some problems

Localizationalists could not explain why lesions Localizationalists could not explain why lesions in very different parts of the brain produced the in very different parts of the brain produced the same deficit or impairment, whereas those same deficit or impairment, whereas those adhering to the equipotentiality theory could not adhering to the equipotentiality theory could not account for the observation that some patients account for the observation that some patients with very small lesions manifested marked, with very small lesions manifested marked, specific behavioral deficits.specific behavioral deficits.

An alternative theory that integrates these two An alternative theory that integrates these two perspectives is the perspectives is the FUNCTIONAL MODELFUNCTIONAL MODEL..

NEUROPSYCHOLOGICAL ASSESSMENT:NEUROPSYCHOLOGICAL ASSESSMENT:

Notions of mass action of brain functioning.Notions of mass action of brain functioning.

The psychological tests were used for simple The psychological tests were used for simple assessment.assessment.

for example, the Benton Visual Retention Test for example, the Benton Visual Retention Test and the Graham-Kendall Memory-for-Designs and the Graham-Kendall Memory-for-Designs Test.Test.

Information about specific test correlates of Information about specific test correlates of specific brain lesions was not collected very specific brain lesions was not collected very efficiently.efficiently.

The Beginning Of NeuropsychologyThe Beginning Of Neuropsychology.. Work of Ward Halstead.Work of Ward Halstead. Halstead was able to identify certain specific Halstead was able to identify certain specific

characteristics of their behavior. Next, he tried to characteristics of their behavior. Next, he tried to assess these characteristics by administering a variety assess these characteristics by administering a variety of psy chological tests to these patients. Through factor of psy chological tests to these patients. Through factor analysis, he settled on ten measures that ulti mately analysis, he settled on ten measures that ulti mately comprised his test battery.comprised his test battery.

Work of Ralph Reitan, a graduate student of Work of Ralph Reitan, a graduate student of Haistead's. This work culminated in the Halstead Haistead's. This work culminated in the Halstead Reitan Neuropsychological Test Battery. Reitan Neuropsychological Test Battery.

Flexible battery approach to assessment. Flexible Flexible battery approach to assessment. Flexible batteries allow each assessment to be tailored to the batteries allow each assessment to be tailored to the individual, based on the clinical presen tation and on individual, based on the clinical presen tation and on the hypotheses of the neuro psychologist. the hypotheses of the neuro psychologist.

THE BRAIN STRUCTURE, FUNCTION, AND THE BRAIN STRUCTURE, FUNCTION, AND IMPAIRMENTIMPAIRMENT

STRUCTURE AND FUCNTIONSTRUCTURE AND FUCNTION

Two Hemispheres Left Hemisphere and Right Two Hemispheres Left Hemisphere and Right Hemisphe.Both controls the opposite sides.Hemisphe.Both controls the opposite sides.

Two hemispheres communicate via corpus Two hemispheres communicate via corpus callosum.callosum.

Corpus callosum helps to coordinate and Corpus callosum helps to coordinate and integrate complex behavior.integrate complex behavior.

Each cerebral hemisphere has four lobes.Each cerebral hemisphere has four lobes.

The The frontal lobes frontal lobes are the most recently developed are the most recently developed parts of the brain. parts of the brain.

They enable us to observe and compare our behavior They enable us to observe and compare our behavior and the reactions of others to it in order to obtain the and the reactions of others to it in order to obtain the feedback necessary to alter our behavior to achieve feedback necessary to alter our behavior to achieve valued goals. valued goals.

Also associated with the frontal lobes are executive Also associated with the frontal lobes are executive functions-formulating, planning, and carrying out goal-functions-formulating, planning, and carrying out goal-directed initiatives. directed initiatives.

Finally, emotional modulation the ability to monitor and Finally, emotional modulation the ability to monitor and control one's emotional state-is also associated with control one's emotional state-is also associated with frontal lobe functioning.frontal lobe functioning.

The The temporal lobes temporal lobes mediate linguistic expres sion, mediate linguistic expres sion, reception, and analysis. They are also involved in reception, and analysis. They are also involved in auditory processing of tones, sounds, rhythms, and auditory processing of tones, sounds, rhythms, and meanings that are non language in nature.meanings that are non language in nature.

The The parietal lobes parietal lobes are related to tactile and kinesthetic are related to tactile and kinesthetic perception, understanding, spatial perception, and perception, understanding, spatial perception, and some language understanding and processing. They some language understanding and processing. They are also involved in body awareness. are also involved in body awareness.

The The occipital lobes occipital lobes are mainly oriented toward visual are mainly oriented toward visual processing and some aspects of visually mediated processing and some aspects of visually mediated memory. Motor coordination, as well as the control of memory. Motor coordination, as well as the control of equilibrium and muscle tone, is associated with the equilibrium and muscle tone, is associated with the cerebellum.cerebellum.

ANTECEDENTS OR CAUSES OF BRAIN ANTECEDENTS OR CAUSES OF BRAIN DAMAGEDAMAGE

TRAUMATRAUMA The occurrence of head injuries.The occurrence of head injuries. The outcomes are wide-rangingThe outcomes are wide-ranging.. The major effects of head trauma can be categorized The major effects of head trauma can be categorized

as as Concussions Concussions Contusions Contusions LaceraLacerations tions

Concussions Concussions (jarring of the brain) usually result in (jarring of the brain) usually result in momentary disruptions of brain function although momentary disruptions of brain function although permanent damage is uncommon (unless there are permanent damage is uncommon (unless there are repeated concussions, as might b the case in football, repeated concussions, as might b the case in football, soccer, or boxing, for example). soccer, or boxing, for example).

Contusions refer to cases in which the brain has been Contusions refer to cases in which the brain has been shifted from its normal position and pressed against shifted from its normal position and pressed against the skull. As a result, brain tissue is bruised. the skull. As a result, brain tissue is bruised. Outcomes can often be severe and may be followed Outcomes can often be severe and may be followed by comas and deliriums. by comas and deliriums.

LaceraLacerations involve actual ruptures and destruction of tions involve actual ruptures and destruction of brain tissue. They can be caused by bullets or flying brain tissue. They can be caused by bullets or flying objects, for example. These lacerations are of course, objects, for example. These lacerations are of course, exceedingly serious forms of damage.exceedingly serious forms of damage.

CEREBROVASCULAR ACCIDENTSCEREBROVASCULAR ACCIDENTS The blockage a rupture of cerebral blood vessels is often The blockage a rupture of cerebral blood vessels is often

termed "stroke. “This is a very common cause of brain damage termed "stroke. “This is a very common cause of brain damage in adults, and stroke is one of the leading causes of death in the in adults, and stroke is one of the leading causes of death in the United States (and other countries). United States (and other countries).

Occlusions and its effects. In Occlusions and its effects. In occlusions occlusions blood clot blocks the blood clot blocks the vessel that feeds a particular area of the brain. This can result vessel that feeds a particular area of the brain. This can result in aphasia (language impairment), apraxia (inability to perform in aphasia (language impairment), apraxia (inability to perform certain voluntary movements), or agnosia (disturbed sensory certain voluntary movements), or agnosia (disturbed sensory perception).perception).

Cerebral Hemorrhage and its effects. In the case of Cerebral Hemorrhage and its effects. In the case of a cerebral a cerebral hemorrhage, hemorrhage, the blood vessel ruptures and the blood escapes the blood vessel ruptures and the blood escapes onto brain tissue and either damages or destroys it. The exact onto brain tissue and either damages or destroys it. The exact symptoms that ensue depend on the site of the accident and its symptoms that ensue depend on the site of the accident and its severity. In very severe cases, death is the outcome. Those severity. In very severe cases, death is the outcome. Those who survive often show paralysis, speech problems, memory who survive often show paralysis, speech problems, memory and judgment difficulties, and so on.and judgment difficulties, and so on.

TUMORS:TUMORS: The reason of brain tumors. Brain The reason of brain tumors. Brain tumors tumors may grow may grow

outside the brain, within the brain, or result from outside the brain, within the brain, or result from metastatic cells spread by body fluids from some other metastatic cells spread by body fluids from some other organ of the body, such as the lung or the breast organ of the body, such as the lung or the breast

Initial signs of brain tumors are often quite subtle and Initial signs of brain tumors are often quite subtle and can include head aches, vision problems, gradually can include head aches, vision problems, gradually developing problems in judgment, and so on. As the developing problems in judgment, and so on. As the tumor grows, so does the variety of other symptoms tumor grows, so does the variety of other symptoms (such as poor memory, affect problems, or motor (such as poor memory, affect problems, or motor coordination). coordination).

Treatment of tumors: Tumors can be removed Treatment of tumors: Tumors can be removed surgically, but the surgery itself can result in more surgically, but the surgery itself can result in more brain damage. Some tumors are inoperable or lo cated brain damage. Some tumors are inoperable or lo cated in areas too dangerous to operate on. In such cases, in areas too dangerous to operate on. In such cases, radiation treatments are often used.radiation treatments are often used.

DEGENERATIVE DISEASESDEGENERATIVE DISEASES Characterized by a degeneration of Characterized by a degeneration of

neurons in the central nervous system.neurons in the central nervous system. Huntington's chorea, Parkinson's disease, Huntington's chorea, Parkinson's disease,

and Alzheimer's disease and other and Alzheimer's disease and other dementia.dementia.

Alzheimer's disease is the most common Alzheimer's disease is the most common followed by Parkinson's disease (age of followed by Parkinson's disease (age of onset 50 to 60 years old), and finally onset 50 to 60 years old), and finally Huntington's chorea (age of on set 30 to 50 Huntington's chorea (age of on set 30 to 50 years old).years old).

The effect of these diseases.The effect of these diseases.

NUTRITIONAL DEFECIENCIESNUTRITIONAL DEFECIENCIES Malnutrition can ultimately produce neurological and Malnutrition can ultimately produce neurological and

psychological disorders. psychological disorders. They are most often observed in cases of Korsakoff's They are most often observed in cases of Korsakoff's

psychosis (resulting from nutritional problems brought psychosis (resulting from nutritional problems brought about by poor eating habits common in longtime about by poor eating habits common in longtime alcoholics), pellagra (niacin/vitamin B-3 deficiency), alcoholics), pellagra (niacin/vitamin B-3 deficiency), and beriberi (thiamin/vitamin B-1 deficiency).and beriberi (thiamin/vitamin B-1 deficiency).

TOXIC DISORDERSTOXIC DISORDERS A variety of metals, toxins, gases, and even plants can A variety of metals, toxins, gases, and even plants can

be absorbed through the skin. In some instances, the be absorbed through the skin. In some instances, the result is a toxic or poisonous effect that produces brain result is a toxic or poisonous effect that produces brain damage. A very common symptom associated with damage. A very common symptom associated with these disorders is these disorders is deliriumdelirium (disruption of (disruption of consciousness).consciousness).

CHRONIC ALCOHOL ABUSECHRONIC ALCOHOL ABUSE

Chronic exposure to alcohol have neurological Chronic exposure to alcohol have neurological effects. For example, changes in neurotrans effects. For example, changes in neurotrans mitter sensitivity and shrinkage in brain tissue.mitter sensitivity and shrinkage in brain tissue.

Some regions of brain are more vulnerable.Some regions of brain are more vulnerable.

Effect on Limbic system:Effect on Limbic system:The limbic system is a network of structures The limbic system is a network of structures within the brain associated with memory within the brain associated with memory formation, emo tional regulation, and sensory formation, emo tional regulation, and sensory integration. Studies of alcoholics have indicated integration. Studies of alcoholics have indicated deficits in these areas of functioning.deficits in these areas of functioning.

Effect on diencephalons: The diencephalon is a Effect on diencephalons: The diencephalon is a region near the center of the brain that includes region near the center of the brain that includes the mammillary bodies of the hypothalamus. the mammillary bodies of the hypothalamus. Studies suggest shrinkage or lesions in these Studies suggest shrinkage or lesions in these areas as a result of chronic alcohol exposure, and areas as a result of chronic alcohol exposure, and memory deficits in alcoholics are consistent with memory deficits in alcoholics are consistent with these findings. Several studies have also reported these findings. Several studies have also reported findings that suggest alcoholics evidence atrophy findings that suggest alcoholics evidence atrophy of the cerebral cortex. of the cerebral cortex.

Damage to Cerebellum: damage to the cerebellum, Damage to Cerebellum: damage to the cerebellum, responsible for motor coordination, is also well responsible for motor coordination, is also well documented. A history of accidental falls or documented. A history of accidental falls or automobile accidents may suggest neurological automobile accidents may suggest neurological damage resulting from alcohol abuse/dependence. damage resulting from alcohol abuse/dependence.

CONSEQUENCES AND SYMPTOMS OF CONSEQUENCES AND SYMPTOMS OF BRAIN DAMAGEBRAIN DAMAGE

Brain injury or trauma can produce a variety of Brain injury or trauma can produce a variety of cognitive and behavioral symptoms.cognitive and behavioral symptoms.

Impaired orientationImpaired orientation.. Impaired memory.Impaired memory. Impaired intellectual functionsImpaired intellectual functions.. Impaired judgment.Impaired judgment. Shallow and labile affect.Shallow and labile affect. Loss of emotional and mental resilienceLoss of emotional and mental resilience Frontal lobe syndromeFrontal lobe syndrome

BRAIN-BEHAVIOR RELATIONSHIPSBRAIN-BEHAVIOR RELATIONSHIPS

The popular view of localization of functions,The popular view of localization of functions, same sized tumors in different parts of brain same sized tumors in different parts of brain

can cause different type of deficits.can cause different type of deficits. According to equipotential theory, all areas of According to equipotential theory, all areas of

the brain contribute equally to overall the brain contribute equally to overall intellectual functioning.intellectual functioning.

Emphasis of Equipotentialists. Emphasis of Equipotentialists. Many investigators have been unable to accept Many investigators have been unable to accept

either localization or equipotentiality completelyeither localization or equipotentiality completely

Thus, alternatives such as the one pro posed by Thus, alternatives such as the one pro posed by Hughlings Jackson (Luria, 1973) have become Hughlings Jackson (Luria, 1973) have become prominent.prominent.

The functional model of brain.The functional model of brain. The effect of brain damage. Often clinicians are The effect of brain damage. Often clinicians are

called upon to determine the presence of called upon to determine the presence of intellectual deterioration.intellectual deterioration.

(1)a decline resulting from psychological (1)a decline resulting from psychological factors psychosis, lack of motivation, emotional factors psychosis, lack of motivation, emotional problems, the wish to defraud an insurance problems, the wish to defraud an insurance company, and so on);company, and so on);

(2)a decline stemming from brain injury.(2)a decline stemming from brain injury. Advantages of premorbid data.Advantages of premorbid data.

INTERVENTION AND REHABILITATIONINTERVENTION AND REHABILITATION Two principal questions of issues of Two principal questions of issues of

neurological impairment.neurological impairment.

First, what is the nature of the First, what is the nature of the deterioration or damage?deterioration or damage?

Second, is there any real brain damage Second, is there any real brain damage that can account in some way for the that can account in some way for the patient's behavior?patient's behavior?

Diffused or Focal damage.Diffused or Focal damage.

RehabilitationRehabilitation is is becoming one of the major becoming one of the major functions of neuropsychologists.functions of neuropsychologists.

First, a thorough assessment of the First, a thorough assessment of the patient's strengths and deficits is patient's strengths and deficits is conducted.conducted.

A program of rehabilitation is then A program of rehabilitation is then developed that will be maximally beneficial developed that will be maximally beneficial to the patient, given her or his deficits, as to the patient, given her or his deficits, as well as one that will be efficient in the well as one that will be efficient in the sense of requiring a minimum amount of sense of requiring a minimum amount of staff time and supervision.staff time and supervision.

Rehabilitation through spontaneous recovery or Rehabilitation through spontaneous recovery or through functional system.through functional system.