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Introduction to Neuropsychology

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Introduction to Neuropsychology For Psychiatry Residents Vaughan Bell Brain story 3 31:16 Rodrigo S, Naggara O, Oppenheim C, Golestani N, Poupon C, Cointepas Y ... – PowerPoint PPT presentation

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Title: Introduction to Neuropsychology


1
Introduction to Neuropsychology For Psychiatry
Residents
Vaughan Bell
2
Course Outline
  • Introduction to neuropsychology
  • Introduction to neuropsychological evaluation
  • Referrals, reports and interpretation
  • Evaluation of psychiatric patients

3
What is Neuropsychology
  • Neuropsychology is the science of how the
    structure and function of the brain relates to
    psychological processes.
  • As a basic science it tries to understand these
    links experimentally.
  • As a clinical science it aims to understand how
    specific impairments relate to impaired brain
    mechanisms, or vice versa.
  • In neuropsychology, these two aims are strongly
    linked.

4
Phineas Gage
  • A railroad worker in Vermont, known for his good
    character and responsible attitude.
  • Suffered an injury in 1848 where a tamping iron
    was shot through his head when setting gunpowder
    to break rocks.
  • He did not lose consciousness and he walked home.
  • He was later seen by Dr Harlow who wrote up his
    case.

5
Skull and Life Mask
6
Damasio et al (1994) Reconstruction
7
Effect on Gage
Dr Harlow reported He is fitful, irreverent,
indulging at times in the grossest profanity
capricious and vacillating, devising many plans
of future operation, which are no sooner arranged
than they are abandoned.
8
Link to Function
  • This was some of the first evidence that damage
    to specific areas of the brain could affect
    personality and behaviour.
  • Later Paul Brocas autopsy on a patient with
    expressive aphasia found a specific lesion in the
    left frontal lobe, now known as Brocas area.
  • This suggested language was not single function
    and could be linked to certain brain circuits.

9
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10
Trench Warfare and Scotoma
11
Holmes (1916) Scotoma Lesion Map
12
Modern Neuropsychology
  • Contemporary neuropsychology uses a variety of
    techniques to understand mind brain links.
  • Neuroimaging
  • Computational modelling
  • Experiments on healthy participants
  • Lesions studies
  • Studies on psychiatric disorders

13
Lesion Studies
  • Understanding how brain damage affects human
    abilities is still the most powerful tool in
    neuropsychology.
  • One of the key techniques in both research and
    clinical work is the dissociation - a difference,
    break or uneven performance on tasks.
  • A dissociation between patients suggests that the
    task is not controlled by a single cognitive
    process.
  • A dissociation within a patient suggests
    difficulties in specific abilities.

14
Video Segment
15
Dissociations
  • In this example each patient had a single
    dissociation between one ability object
    perception and another face perception.
  • Considering both patients, there is a double
    dissociation so we know they rely on different
    brain processes.

Objects Faces
Patient 1 ? ?
Patient 2 ? ?
16
Dissociations
  • The double dissociation is a scientific tool that
    helps us understand mind and brain function.
  • In a clinical patient, we can link deficits to
    what we know about neuropsychology
  • to understand what has gone wrong.

17
A Rough and Incomplete Guide to the Brain
18
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19
Early Visual Perception Deficits
  • Damage to the early visual system will produce
    things such as
  • Visual field deficits
  • Orienting difficulties
  • Impairments in shape, form or size
    discrimination.
  • Colour blindness
  • Motion blindness

20
Efrons (1968) Shape Task
21
Dorsal Stream
The where or how stream
Ventral Stream
The what stream
22
Associative Agnosia
Associative Patient HJA (Riddoch and Humphreys,
1987) Copying without Naming
23
Apperceptive Agnosia
Original
Patient Copy
Apperceptive Patient HC (Sparr et al., 1991)
Impaired Copying of Simple Shapes
24
High Level Vis Perception Deficits
  • Prosopagnosia selective impairment in
    perceiving faces.
  • Simultanagnosia difficulty perceiving more than
    one object.
  • Dorsal type can identify an object but cant
    locate them in space.
  • Ventral type can perceive more than one object,
    but can only identify one at a time.

25
Some Memory Systems
  • Working memory less than 30s, manipulated by
    executive system.
  • Long-term memory
  • Semantic memory facts
  • Episodic memory events
  • Alternative long-term memory classification
  • Declarative memory consciously describable
    information
  • Implicit unconscious skill learning,
    conditioning etc

26
Memory Functions
  • Encoding perception, selection and transfer of
    information into memory.
  • Storage maintenance of information in a
    retrievable state.
  • Retrieval reactivating stored information for
    conscious retrieval or unconscious use during
    task performance.

27
Key Memory Circuits
Hippocampi
HM (1926 2008)
Including a circuit with the fornix, mamillary
bodies and septal nuclei.
28
Key Memory Circuits
29
Working Memory Problems
  • Can be caused by damage to visual or auditory
    storage.
  • But more usually due to executive system damage
    which affects how well we use these stores.
  • Double dissociation between storage and
    manipulation of information I working memory
    (Mintzer and Griffiths, 2007)
  • Lorazepam manipulation impairment
  • Scopolamine storage impairment

30
Long-term Memory Problems
  • Amnesia for episodic memories
  • Antereograde inability to encode new
    information
  • Retrograde loss of pre-injury information, most
    recent memories most likely to be affected.
  • Semantic memory impairments
  • Semantic dementia loss of words and meaning.
  • Selective impairments e.g. living vs non-living
    things.

31
Video Segment
32
Long-term Memory Problems
  • Transient amnesias
  • Post-traumatic amnesia correlates with extent
    of injury
  • Transient global amnesia sudden, dense amnesia
    that resolves within hours.
  • Transient epileptic amnesia similar, shorter
    duration and associated with clear seizure
    activity.
  • Psychogenic amnesia syndrome of hysteria,
    often pure retrograde amnesia, and can include
    loss of identity and wandering (fugue state).

33
What is the Executive System?
  • Mainly concerned with the co-ordination of other
    cognitive resources.
  • e.g. the use of attention, organisation of
    actions, inhibition of responses, monitoring
    (metacognition).
  • It is a dynamic, online system, that may only
    fully engage some aspects in real world
    situations.
  • e.g. Saver and Damasios (1991) patient EVR
    displayed severe day-to-day executive problems
    but passed standard tests of executive function.

34
What is the Executive System?
  • So it is particularly involved in handling new,
    novel or potentially risky situations.
  • Norman and Shallice (1980) outline five types of
    situation where routine activation would not be
    sufficient.

35
Norman and Shallice (1980)
  • Those that involve planning or decision making.
  • Those that involve error correction or
    troubleshooting.
  • Situations where responses are not well-learned
    or contain novel action sequences.
  • Dangerous or difficult situations.
  • Situations which require the overcoming of strong
    habitual response or resisting temptation.

36
Neuroanatomy
  • Most associated with the prefrontal cortex
    although there is increasing evidence that
    parietal interactions are important (Collette et
    al., 2006)

37
Dysexecutive Syndrome
  • Damage can result in
  • Problems with memory (e.g. working or episodic
    memory)
  • Problems with affect and social judgment
    (inappropriateness, emotional lability /
    blunting, social perception, theory of mind)
  • Problems with abstract thinking and intentions
    (planning, understanding rules, cognitive
    flexibility, inhibition)

38
Video Segment
39
Attention
  • Typically divided into three main types (Posner
    and Petersen, 1990)
  • Spatial attention distinguish and detect
    sources of information in space
  • Selective or focused attention focus in / block
    out certain sources.
  • Arousal / sustained attention maintain focus

40
Neglect
  • Hemi-spatial neglect is one such disorder which
    particularly occurs after right parietal damage.

Severe neglect
Mild neglect
From Vallar (1993)
41
Copied Drawings
42
Copied Drawings
43
Copied Drawings
44
Line Bisection
  • When asked to mark the centre point of a line,
    patients mark to the right.

45
Video Segment
46
Language
  • Language involves
  • Production (e.g. speaking, writing, syntax,
    articulation)
  • Comprehension (e.g. reading, listening, syntax)
  • Knowledge (e.g. names, words)

47
Wernickes area
Brocas area
48
Arcuate fascilulus
From Rodrido et al. (2007)
49
Speech Problems
  • A few of the many aphasias
  • Brocas aphasia (normal comprehension, non-fluent
    speech).
  • Wernickes aphasia (impaired comprehension,
    fluent but meaningless)
  • Conduction aphasia (normal comprehension, fluent
    speech, wrong words and poor repetition)
  • and many others.

50
Reading / Writing Problems
  • Dyslexias and agraphias are broken down into two
    main types
  • Peripheral dyslexia problems with word or
    letter perception.
  • Central dyslexia problems with the semantics or
    syntax of language
  • Peripheral agraphia problems with motor
    control.
  • Central agraphia - problems with the semantics or
    syntax of language
  • and various combinations.
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