Chapter 1: Introduction to Clinical Neuropsychology
Neuropsychology = the study of brain-behavior relationships for both over behavior as well as
mental processes (cognitive functions)
The development of theoretical models on cognitive functioning based on brain disease
and/or dysfunction
Brain damage can be detected
Brain dysfunction cannot be detected
o Neuropsychological assessment, NPA = standardised procedures to measure
cognitive impairments
Mechanistic explanation refers to explaining how something works (e.g. causal mechanisms
in the brain)
Phenomenological description refers to observering and categorising behavior
o Neuropsychology both studies patterns (symptoms) and explains mechanisms (brain
processes)
History of neuropsychology
Hippocrates argued the brain is responsible for the intellect, senses, knowledge, and
emotions
o He used lesion observations to study the effects of brain damage
Aristotle argued that the heart is the seat of intelligence and the brain is a cooling system
Herophilus invented the cell (ventricular) theory = perception, understanding, and memory
resides within ventricles of the brain, called cells
o Imagination, cognition, and memory are located in the three fluid-filled cavities of
the brain, rather than in the brain tissue itself
Galen studied animal disssections to describe nerves and brain anatomy
Vesalius is the founder of modern anatomy and performed systematic human dissections
o Through his work he corrected earlier anatomical errors leading to more accurate
brain structure knowledge
Descartes argued the mind and body are separate entities
o The mind is located in a the pineal gland (epiphysis) according to Descartes
Gall argued that humans possess autonomous mental functions that are represented by
independently functioning parts located in the cortex
o Phrenology = the idea that mental abilities are located in specific brain areas and can
be inferred from skull shape
This is an incorrect method though it introduced the idea that functions are
localized in the brain
Broca predicted that his patient's brain injury was located in the frontal brain regions which
was confirmed by post-mortem examination
o Leborgne 'tan' patient could only utter the word 'tan' though all his other functions
were normal
o Broca's area = region responsible for speech production in the left frontal lobe
Broca's aphasia = impaired speech production though speech
comprehension is intact
o Wernicke's area = region responsible for speech comprehension in the left temporal
lobe
Wernicke's aphasia = impaired speech comprehension though speech
production is intact
o Conduction aphasia = impaired ability to repeat words though speech production
and speech comprehension is intact due to damage in the pathways between Broca's
area and Wernicke's area
Disconnection syndrome = impairment caused by disrupted communication
between brain regions, which shows that the brain works as a network
, Lissauer developed a theoretical model for investigating object perception
o Apperception = the first stage in object recognition where the structure and
characteristics of an object are perceived and its features are recorded
Apperceptive agnosia = impaired ability to combine individual features into
the concept as a whole
o Association = the second stage in object recognition where the features are linked to
knowledge or conceptual information stored in the brain's semantic system
Associative ( visual) agnosia = impaired ability to recognise objects though
perception is intact
Jackson argued that damage to a brain region may lead to functional impairment though that
does not mean that the function itself is located in that area
o Also argued that the brain was organised hierarchically: higher areas control lower
ones
o Positive symptoms = behaviors that are added to a person's experience
(hallucinations)
o Negative symptoms = behaviors that are removed from a person's experience (loss
of functions)
Donders invented the subtraction method = estimating time of mental processes by
subtracting reaction times
o The first to measure mental processes experimentally
o Simple RT: respond to stimulus
o Choice RT: choose between responses
o Go/No-go: respond or inhibit
Galton used norms to assess test performance of individuals and his work originated the
development of psychometric tests to objectively measure differences between individuals
Luria developed the theory of functional systems = cognitive functions arise from interacting
brain regions, not one location
o Explains how systems interact
o Three functional units that interact with each other
Subcortical brain areas including the brainstem
Regulation of arousal and attentional processes
Activation unit
Posterior brain areas for processing (posterior cortex)
Processing information entering the brain through the senses
Input unit
Anterior brain areas (frontal lobe)
Planning and organising actions
Output unit
Information within each functional unit is processed in
three hierarchically organised zones: primary, secondary,
and tertiary zones
Behavior can be modulated by linguistic processes in the
left-hemisphere or by non-linguistic processes in the right
hemispheres
Fodor invented the theory of modularity of mind = the human mind is composed of
specialized, distinct, and autonomous subsystems designed to perform specific cognitive
functions
o Modules are specialized systems which are domain specific, have fast operation,
fixed neural structure, and automatic processing
Language and vision are modular
Reasoning is non-modular
o Explains what broke
, Geschwind used the principles of single and double dissociation
Benton developed several standardised methods to measure motor, sensory, visuospatial,
language, and memory impairments in brain-injured patients which was also used to localise
brain damage
Milner studied patient H. M. who had bilateral temporal lobectomy (hippocampal removal)
after which he could not form new memories
Kaplan and Goodglass developed the Boston Process Approach, BPA = qualitative
neuropsychological assessment method to analyze how patients perform tasks
Stuss showed that patients with frontal lobe lesions often performed well on psychometric
tests though they showed great difficulty in everyday planning and goal setting
Modern concepts in neuropsychology
Diaschisis = brain damage affects distant but connected areas
Compensation = brain adapts by using alternative strategies or pathways (e.g. solving math
via memory vs. counting)
Individual differences = brain structures/functions vary across individuals, meaning that the
same lesions do not equal the same symptoms
Cognitive reserve = brain's ability to cope with damage
o Brain reserve refers to using physical capacity
o Cognitive reserve refers to flexible usage of the brain
o Neural compensation refers to the formation of new pathways
o Influenced by education and lifestyle
Neuropsychology = the study of brain-behavior relationships for both over behavior as well as
mental processes (cognitive functions)
The development of theoretical models on cognitive functioning based on brain disease
and/or dysfunction
Brain damage can be detected
Brain dysfunction cannot be detected
o Neuropsychological assessment, NPA = standardised procedures to measure
cognitive impairments
Mechanistic explanation refers to explaining how something works (e.g. causal mechanisms
in the brain)
Phenomenological description refers to observering and categorising behavior
o Neuropsychology both studies patterns (symptoms) and explains mechanisms (brain
processes)
History of neuropsychology
Hippocrates argued the brain is responsible for the intellect, senses, knowledge, and
emotions
o He used lesion observations to study the effects of brain damage
Aristotle argued that the heart is the seat of intelligence and the brain is a cooling system
Herophilus invented the cell (ventricular) theory = perception, understanding, and memory
resides within ventricles of the brain, called cells
o Imagination, cognition, and memory are located in the three fluid-filled cavities of
the brain, rather than in the brain tissue itself
Galen studied animal disssections to describe nerves and brain anatomy
Vesalius is the founder of modern anatomy and performed systematic human dissections
o Through his work he corrected earlier anatomical errors leading to more accurate
brain structure knowledge
Descartes argued the mind and body are separate entities
o The mind is located in a the pineal gland (epiphysis) according to Descartes
Gall argued that humans possess autonomous mental functions that are represented by
independently functioning parts located in the cortex
o Phrenology = the idea that mental abilities are located in specific brain areas and can
be inferred from skull shape
This is an incorrect method though it introduced the idea that functions are
localized in the brain
Broca predicted that his patient's brain injury was located in the frontal brain regions which
was confirmed by post-mortem examination
o Leborgne 'tan' patient could only utter the word 'tan' though all his other functions
were normal
o Broca's area = region responsible for speech production in the left frontal lobe
Broca's aphasia = impaired speech production though speech
comprehension is intact
o Wernicke's area = region responsible for speech comprehension in the left temporal
lobe
Wernicke's aphasia = impaired speech comprehension though speech
production is intact
o Conduction aphasia = impaired ability to repeat words though speech production
and speech comprehension is intact due to damage in the pathways between Broca's
area and Wernicke's area
Disconnection syndrome = impairment caused by disrupted communication
between brain regions, which shows that the brain works as a network
, Lissauer developed a theoretical model for investigating object perception
o Apperception = the first stage in object recognition where the structure and
characteristics of an object are perceived and its features are recorded
Apperceptive agnosia = impaired ability to combine individual features into
the concept as a whole
o Association = the second stage in object recognition where the features are linked to
knowledge or conceptual information stored in the brain's semantic system
Associative ( visual) agnosia = impaired ability to recognise objects though
perception is intact
Jackson argued that damage to a brain region may lead to functional impairment though that
does not mean that the function itself is located in that area
o Also argued that the brain was organised hierarchically: higher areas control lower
ones
o Positive symptoms = behaviors that are added to a person's experience
(hallucinations)
o Negative symptoms = behaviors that are removed from a person's experience (loss
of functions)
Donders invented the subtraction method = estimating time of mental processes by
subtracting reaction times
o The first to measure mental processes experimentally
o Simple RT: respond to stimulus
o Choice RT: choose between responses
o Go/No-go: respond or inhibit
Galton used norms to assess test performance of individuals and his work originated the
development of psychometric tests to objectively measure differences between individuals
Luria developed the theory of functional systems = cognitive functions arise from interacting
brain regions, not one location
o Explains how systems interact
o Three functional units that interact with each other
Subcortical brain areas including the brainstem
Regulation of arousal and attentional processes
Activation unit
Posterior brain areas for processing (posterior cortex)
Processing information entering the brain through the senses
Input unit
Anterior brain areas (frontal lobe)
Planning and organising actions
Output unit
Information within each functional unit is processed in
three hierarchically organised zones: primary, secondary,
and tertiary zones
Behavior can be modulated by linguistic processes in the
left-hemisphere or by non-linguistic processes in the right
hemispheres
Fodor invented the theory of modularity of mind = the human mind is composed of
specialized, distinct, and autonomous subsystems designed to perform specific cognitive
functions
o Modules are specialized systems which are domain specific, have fast operation,
fixed neural structure, and automatic processing
Language and vision are modular
Reasoning is non-modular
o Explains what broke
, Geschwind used the principles of single and double dissociation
Benton developed several standardised methods to measure motor, sensory, visuospatial,
language, and memory impairments in brain-injured patients which was also used to localise
brain damage
Milner studied patient H. M. who had bilateral temporal lobectomy (hippocampal removal)
after which he could not form new memories
Kaplan and Goodglass developed the Boston Process Approach, BPA = qualitative
neuropsychological assessment method to analyze how patients perform tasks
Stuss showed that patients with frontal lobe lesions often performed well on psychometric
tests though they showed great difficulty in everyday planning and goal setting
Modern concepts in neuropsychology
Diaschisis = brain damage affects distant but connected areas
Compensation = brain adapts by using alternative strategies or pathways (e.g. solving math
via memory vs. counting)
Individual differences = brain structures/functions vary across individuals, meaning that the
same lesions do not equal the same symptoms
Cognitive reserve = brain's ability to cope with damage
o Brain reserve refers to using physical capacity
o Cognitive reserve refers to flexible usage of the brain
o Neural compensation refers to the formation of new pathways
o Influenced by education and lifestyle
