L1 Neuropsychology

• Lecture 1 - Summary

  • Types of Neurological Disorders
  • The Diagnosis & Assessment of Neurological Disorders
  • Treatment & Rehabilitation of Neurological Disorders
• Neurological Disorders


  Have their origins in damage or abnormalities in the biological substrates that underlie thinking and behaviour
• Causes of neurological disorders

  • Disease
  • Physical trauma (such as brain injury)
  • Genetic predispositions causing irreversible changes in the brain and central nervous system (CNS)
• The Cerebral Cortex


  • Gyri (raised bulges)
  • Sulci (deep grooves)
  • All normal human brains usually have the same major gyri and sulci, but there are substantial differences across individuals in the precise sizes and shapes of those structures, due in large part to genetic influences
• Types of Neurological Disorder

  • Cerebral Infection
  • Traumatic Brain Injury (TBI)
  • Cerebrovascular Accidents (CVA)
  • Brain Tumours
  • Degenerative Disorders (Dementia)
• Encephalitis


  Viral infection causing brain inflammation (HSE)
• Meningitis


  Infection to the meniges (membranous covering of brain/spinal cord)
• Cerebral Abscess


  Localised inflammation of the brain (linked to physical trauma)
• HIV Infection

  Progressive cortical atrophy
• Variant Creutzfeldt-Jakob Disease (vCJD)

  Spongiform encephalopathy (CNS) – incubation 10/15 years – mood changes & cognitive loss
• Traumatic Brain Injury


  • One of the most common causes of neurological impairment
  • Caused by road traffic accidents (50%), domestic & industrial accidents (20-30%), and sports and recreational activities (10%)
  • Most victims will show a steady improvement over time (usually in the first 6 months)
  • Permanent cognitive deficits can be associated with emotional sequelae (e.g., depression)
• Closed head TBI


  A person sustains a sudden blow to the head that damages the brain while leaving the skull intact (e.g., car accident or sporting accident)
• Open head TBI


  Both the brain and the skull are penetrated by an object such as a bullet or a piece of shrapnel (e.g., Gabby Giffords)
• Penetrating Head Injury


  Damage to skull and outer layer of meninges breached
• Types of Traumatic Brain Injury

  • Concussion – head impact, jars brain, temporary
  • Closed Head Injury – head trauma, loss of consciousness, impaired vision/STM –which perseverates
  • Contusion – severe jarring and bruising of brain
  • Dementia Pugilistica – sporting syndrome (boxing/jockeys) – also known as Chronic Traumatic Encephaolpathy
• Phineas P. Gage: A victim of a penetrating head injury, one of the first examples to indicate that brain damage could cause radical changes to personality and affect socially appropriate interaction
• Cerebrovascular Accidents (CVA)


  Damage to brain tissue can occur as a result of cardiovascular accidents, also known as strokes
• Causes of Cerebrovascular Accidents (CVA)

  • Occlusion – blood vessel blockage – leading to ischaemia (blood/oxygen shortage) – can be short duration (TIA – transient ischaemic attack)
  • Haemorrhage – blood vessel bursts causing tissue damage
  • Infarction – area of dead tissue
• Strokes


  • Thrombotic: A clot forms within the blood vessel and eventually clogs it
  • Embolic: A clot forms in some other part of the circulatory system, and when it travels up into the brain it eventually gets stuck in an artery
  • If blood flow is not restored quickly, the tissue will die, leaving a cavity that gets filled with cerebrospinal fluid
  • The effects of such focal lesions depend on the functions that are normally subserved by the affected regions
• Strokes are the third most common cause of death in UK
• The severity of symptoms depend on brain areas affected
• Most common long-term symptoms of strokes

  • Aphasia (33%)
  • Agnosia
  • Apraxia
  • Paralysis (hemiplegia)
• Sufferers also exhibit emotional as well as cognitive disturbance
• Between 14-19% meet DSM criteria for major depression (Robinson, 2003)
• Vascular Dementia


  • Patients present with impairments of attention, executive function, speed of processing
  • Cognitive impairment due to CV disease linked to small vessel ischemic disease, multiple cortical strokes, strategic infarcts
  • Aprox. 5-10% of dementia patients have pure vascular dementia
  • Aprox. 10-15% of dementia patients have a mixed dementia including CV disease issues
  • Depression in such cases often evident (likely due to insight)
  • "Pseudobulbar" affect presentation (uncontrollable laughing or crying) – medication treatment effective (Nuedexta)
• Brain Tumours are caused by abnormal and uncontrolled cell division either in the brain or in the meninges
• Primary brain tumours are those that originate and grow in the brain
• Depression is both a common precursor and consequence of brain tumours
• Some individuals with brain tumours begin to exhibit acquired sociopathy
• Gliomas


  The most common type of brain tumour, originating in the white matter and expanding outward at variable rates, destroying or displacing neurons
• Most common causes of degenerative dementia

  • Alzheimer's Disease – Other cortical dementias
  • Vascular Dementia
  • Parkinson's Disease – Sub-cortical dementia
  • Huntington's Disease – Sub-cortical dementia
  • Multiple Sclerosis
• Difficulties in the diagnosis of degenerative disorders include distinguishing from normal ageing, distinguishing between different disorders, comorbidities in the elderly, individual variation, and other medical causes
• Alzheimer's Disease


  • Most common form of dementia
  • Manifests as progressive impairments in short-term memory, aphasia, apraxia, and agnosia
  • Many sufferers may exhibit irritability and paranoid behaviour
  • Average duration of the disease from onset of symptoms is 9-10 years
• Risk factors for Alzheimer's Disease

  • Age
  • Sex: Prevalence is higher in women
  • Genetics: Having a first degree relative with the disease increases risk
  • Family history of dementia
  • A history of head injury
  • Low educational status (aka "cognitive reserve")
• Aetiology of Alzheimer's Disease

  • Beta Amyloid Plaques – linked to Neurofibrillary tangles
  • Faulty production of the brain neurotransmitter acetylcholine
• AD can be preceded by an intermediate impaired state (MCI) - 5-20% in over 65s – amnestic MCI being most common – diagnosis of the condition raises probability of AD presentation eventually – probability increases with age
• Mini-mental state exam


  Scores of 25-30 considered normal; Scores of 21-24 as mild, Scores of 10-20 as moderate and <10 as severe impairment
• Limitation of MMSE: Well educated/High IQ patients, patients with learning, linguistic/communication difficulties
• Mild Cognitive Impairment (MCI) is a pre-clinical period during which biomarkers are abnormal – but people are still cognitively normal
• Faulty production of the brain neurotransmitter acetylcholine


  Linked to Alzheimer's disease