1
Samenvatting Clinical Neuropsychology
Week 1:………………………………………………………………………………………………………………………..…………..2
Chapter 1: Introduction to Clinical Neuropsychology
Chapter 2: The neuropsychological assessment
Chapter 3: Marooned in the moment
Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of
Patient Experiences in Qualitative Studies – Breeksema (2020)
Week 2:…..……………………………………………………………………………………………………………………………….23
Chapter 7: Out of mind, out of sight
Chapter 8: Vision without knowledge
Monitoring cognition during awake brain surgery in adults: A systematic review – Carla Ruis (2018)
Week 3:..………………………………………………………………………………………………………………………………….41
Chapter 14: Tomorrow is another day – living with multiple sclerosis
Chapter 13: Twenty years too late – organic solvent neurotoxicity
Week 4: :………………………………………………………………………………………………………………………………….54
Chapter 12: Explosions in the mind – a case of subarachnoid hemorrhage
Chapter 15: Mind over matter – Coping with Parkinson’s disease
Chapter 17: Dementia – a family tragedy
Week 5:…………………………………………………………………………………………………………………………………….72
The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology
Chapter 10: Beating the odds: severe traumatic brain injury and the importance of ongoing
rehabilitation
Chapter 11: the unseen injury: mild traumatic brain injury
Week 6:..…………………………………………………………………………………………………………..………………………87
Chapter 5: The breakdown of language: case studies of aphasia
Chapter 4: Out of control: The consequences and treatment of epilepsy
Week 7: :………………………………………………………………………………………………………………………….……….99
Chapter 9: the impaired executive: a case of frontal-lobe dysfunction
Psychological, neuropsychological, and medical consideration in assessment and management of
pain – Martelli, Zasler, Bender & Nicholson (2004)
,2
Week 1
Chapter 1: Introduction to Clinical Neuropsychology
A definition of clinical neuropsychology and its aims
The study of human behaviors, emotions, and thoughts and how they relate to the brain, particularly
the damaged brain, is the subject matter of clinical neuropsychology.
Applied aims: learning more about neurological disorders and diseases so that we can more
accurately and usefully diagnose, treat, and rehabilitate people who suffer such disorders
and, along with other disciplines, ultimately find ways to prevent their occurrence.
Academic aim: to learn more about how the undamaged or “normal” human brain and mind
work by carrying out experiments, usually in the form of cognitive tests, on brain-damaged
people.
Relationships of clinical neuropsychology to other disciplines
A number of disciplines are closely related to clinical neuropsychology and overlap with it.
Neurology: study of medical aspects of central nervous
system disorders and treatments (pay more attention
to clinical symptoms than psychological).
Cognitive psychology: to understand the workings of
the human mind by analyzing the higher cognitive
functions and their components. Participants in
experiments are unimpaired people (usually
undergraduate students).
Cognitive neuropsychology: concentrates on the detailed analysis of higher cognitive
functions, often using similar paradigms to those used in cognitive psychology but it studies
brain-damaged patients rather than ‘normal’.
Clinical neuropsychology: neurological interest in brain pathology and the resulting
symptoms and a psychological interest in the analysis of higher cognitive functions, both to
understand the workings of the normal mind and to develop better rehabilitation methods
for patients. (Neurologists specialized in clinical neuropsychology are called behavioral
neurologists).
Neuroimaging:
- EEG: measures the electrical brain waves of patients
- CT & MRI: measure structure and damage
- PET & fMRI: visualize the changing metabolism of the working brain
A clinical neuropsychologist should first be an accomplished clinical psychologist. Because, patients
often express strong emotions about their illness and their wider situation during their assessment,
especially during the initial interview, and the clinical neuropsychologist should be able to respond
professionally and sensitively.
Functional Neuroanatomy
The human brain is the most complex system in the animal kingdom, and it is well beyond the scope
of this book to cover neuroanatomy in any detail. This section provides a brief, simplistic overview of
the cortical areas and other neuroanatomical structures that are most closely related to the disorders
of higher cortical functioning covered in this book.
Gross structure of the brain
The brain has 3 major divisions:
The cerebral hemispheres
The cerebellum
,3
The brain stem
The brain stem is an upward extension of the spinal cord, consists of four parts:
Medulla oblongata
Pons
Midbrain
Diencephalon (thalamus + hypothalamus)
It’s the life-support part of the brain as it controls: respiration, cardiovascular function,
gastrointestinal function.
It also contains the nuclei (kernen) for the cranial nerves (hersenzenuwen) connected with the
special senses, but it is not directly concerned with higher cognitive function.
Cerebellar hemispheres are paired structures at the base of the cerebral hemisphere and are
concerned mainly with motor coordination, muscle tone and balance.
Cerebral hemispheres are paired structures above the Midbrain and Pons. They are covered by a
highly convoluted layer of nerve cells called the cerebral cortex or grey matter.
- Gyri: the ‘hills’ of the cortex (heuvels)
- Sulci: the ‘valleys’ of the cortex (dal)
- White matter: the axons or fiber (vezel) tracts that connect the nerve cells (zenuwcellen) to
the rest of the brain form a layer directly below the cortex; this layer is the white matter
- Basal ganglia: further paired structures of grey matter deep within the hemispheres (zie
chapter 15 over parkinson).
- Longitudinal fissure (spleet): separates the two hemispheres, runs from the anterior frontal
lobes to the posterior occipital lobes.
- Central (or rolandic) fissure or sulcus: separates the frontal from the parietal lobes
- Lateral (sylvian) fissure or sulcus: separates the temporal lobe from the frontal and parietal
lobes.
Corpus callosum: a tough band of interhemispheric fibers (vezels) that forms a major functional
connection between the two hemispheres. (Binnen elk halfrond verbinden vezelbanen verschillende
delen van het halfrond met elkaar).
The ascending reticulat formation (RF) controls the overall arousal level of the cortex. The RF is a
diffuse system of multisynaptic neuron chains traveling up through the brain stem. Sensory pathways
send impulses via collateral axons to the RF, which relays them to a group of nuclei (kernen) in the
thalamus. The thalamus serves as a relay center for motor pathways, many sensory pathways and
the RF. On reaching (bij het bereiken van) the thalamus, the impulses are relayed (doorgegeven) to
the cerebral cortex, where they influence the level of mental alertness or sleep.
, 4
The limbic system (or paleomammilian brain) includes the hippocampus and amygdala (many more).
The limbic system is involved in emotion, motivation and memory.
The brain has 3 coverings (dekkingen) (meninges) the outermost thick, tough covering is the Dura
mater (tough mother) which adheres to the inner surface (binnenoppervlak) of the skull. The
delicate, middle membrane the arachnoid mater (spider mother) is attached by cobweb-like
(spinnenwebachtige) strans of tissue (stukjes weefsel) to the fine Pia mater (little mother) which
adheres closely to the cortex. The subarachnoid space lies between the arachnoid mater and the pia
mater and is filled with cerebrospinal fluid (CSF) (hersenvocht). Blood vessels (aderen) also lie within
the subarachnoid space and dip down (duiken naar beneden) in the sulci to supply deeper parts of
the brain. Meningitis is an inflammation (ontsteking) of the meninges (hersenvliezen). One symptom
is a stiff neck.
Ventricles are lakes of CSF located deep within the hemispheres. CSF is formed in the choroid plexus
within the ventricles and circulates through the ventricles and around the outside of the brain and
spinal cord (ruggenmerg) within the subarachnoid space. Excess (overtollig) CSF drains (wordt
afgevoerd) into the venous system of the subarachnoid space. Hydrocephalus: one of the small
apertures (openingen) between the ventricles is blocked this increases the intercranial pressure. It
can be corrected by placing a shunt or valve (klep) into the blocked ventricle.
The cerebrovascular system involves two parts of the brain:
Anterior cerebral arteries (ACA) – medial and lower surfaces of the frontal lobes, medial
suraces of the partietal lobes, and the corpus callosum.
Middle cerebral arteries (MCA) – surfaces of the frontal, temporal, and parietal lobes.
One set in each hemisphere.
The MCA also branches (vertakken) to form the striate arteries which supply the deeply situated
internal capsule, the main passageway for the fiber (vezel) tracts between the motor cortex and the
spine (corticospinal tract / pyramidal tract). Striate arteries are vulnerable to blockage. MCA supplies
75% or more of the blood supply to the cerebral hemispheres (hersenhelften).
The paired vertebral arteries (slagaders) enter the skull at the point where the spinal cord becomes
continuous with the brain stem and join to form the basilar artery. This artery then divides to form
the paired posterior cerebral arteries. The posterior cerebral arteries supply the occipital lobes part
of the medial and inferior surfaces of the temporal lobes including the hippocampus.
Circle of willis: a ring of vessels lying in the subarachnoid space formed by a single anterior
communicating artery and two posterior communicating arteries. A blockage in a vessel away from
the circle of willis can result in a stroke. If one of the main arteries becomes blocked the blood can
pass around the circle to reach the deprived area. The circle of willis is a frequent site (plaats) of
weakening (verzwakking) on the artery wall (slagaderwand) called aneurysms, if an aneurysm bursts
(barst) it expels (verdrijft) blood around in the subarachnoid space causing a subarachnoid
hemorrhage (bloeding). The cerebral veins (hersenaders) empty (lopen leeg) into channels within the
dura mater called venous sinuses which in turn (die op hun beurt) empty into the larger internal
jugular vein (grotere interne halsader).
Cerebral cortex
Cortical zones
Posterior cortex: the parietal, temporal and occipital lobes lying behind the central sulcus. The
posterior cortex is mainly involved in a person’s awareness. Each of these lobes can be divided into
three zones:
Samenvatting Clinical Neuropsychology
Week 1:………………………………………………………………………………………………………………………..…………..2
Chapter 1: Introduction to Clinical Neuropsychology
Chapter 2: The neuropsychological assessment
Chapter 3: Marooned in the moment
Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of
Patient Experiences in Qualitative Studies – Breeksema (2020)
Week 2:…..……………………………………………………………………………………………………………………………….23
Chapter 7: Out of mind, out of sight
Chapter 8: Vision without knowledge
Monitoring cognition during awake brain surgery in adults: A systematic review – Carla Ruis (2018)
Week 3:..………………………………………………………………………………………………………………………………….41
Chapter 14: Tomorrow is another day – living with multiple sclerosis
Chapter 13: Twenty years too late – organic solvent neurotoxicity
Week 4: :………………………………………………………………………………………………………………………………….54
Chapter 12: Explosions in the mind – a case of subarachnoid hemorrhage
Chapter 15: Mind over matter – Coping with Parkinson’s disease
Chapter 17: Dementia – a family tragedy
Week 5:…………………………………………………………………………………………………………………………………….72
The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology
Chapter 10: Beating the odds: severe traumatic brain injury and the importance of ongoing
rehabilitation
Chapter 11: the unseen injury: mild traumatic brain injury
Week 6:..…………………………………………………………………………………………………………..………………………87
Chapter 5: The breakdown of language: case studies of aphasia
Chapter 4: Out of control: The consequences and treatment of epilepsy
Week 7: :………………………………………………………………………………………………………………………….……….99
Chapter 9: the impaired executive: a case of frontal-lobe dysfunction
Psychological, neuropsychological, and medical consideration in assessment and management of
pain – Martelli, Zasler, Bender & Nicholson (2004)
,2
Week 1
Chapter 1: Introduction to Clinical Neuropsychology
A definition of clinical neuropsychology and its aims
The study of human behaviors, emotions, and thoughts and how they relate to the brain, particularly
the damaged brain, is the subject matter of clinical neuropsychology.
Applied aims: learning more about neurological disorders and diseases so that we can more
accurately and usefully diagnose, treat, and rehabilitate people who suffer such disorders
and, along with other disciplines, ultimately find ways to prevent their occurrence.
Academic aim: to learn more about how the undamaged or “normal” human brain and mind
work by carrying out experiments, usually in the form of cognitive tests, on brain-damaged
people.
Relationships of clinical neuropsychology to other disciplines
A number of disciplines are closely related to clinical neuropsychology and overlap with it.
Neurology: study of medical aspects of central nervous
system disorders and treatments (pay more attention
to clinical symptoms than psychological).
Cognitive psychology: to understand the workings of
the human mind by analyzing the higher cognitive
functions and their components. Participants in
experiments are unimpaired people (usually
undergraduate students).
Cognitive neuropsychology: concentrates on the detailed analysis of higher cognitive
functions, often using similar paradigms to those used in cognitive psychology but it studies
brain-damaged patients rather than ‘normal’.
Clinical neuropsychology: neurological interest in brain pathology and the resulting
symptoms and a psychological interest in the analysis of higher cognitive functions, both to
understand the workings of the normal mind and to develop better rehabilitation methods
for patients. (Neurologists specialized in clinical neuropsychology are called behavioral
neurologists).
Neuroimaging:
- EEG: measures the electrical brain waves of patients
- CT & MRI: measure structure and damage
- PET & fMRI: visualize the changing metabolism of the working brain
A clinical neuropsychologist should first be an accomplished clinical psychologist. Because, patients
often express strong emotions about their illness and their wider situation during their assessment,
especially during the initial interview, and the clinical neuropsychologist should be able to respond
professionally and sensitively.
Functional Neuroanatomy
The human brain is the most complex system in the animal kingdom, and it is well beyond the scope
of this book to cover neuroanatomy in any detail. This section provides a brief, simplistic overview of
the cortical areas and other neuroanatomical structures that are most closely related to the disorders
of higher cortical functioning covered in this book.
Gross structure of the brain
The brain has 3 major divisions:
The cerebral hemispheres
The cerebellum
,3
The brain stem
The brain stem is an upward extension of the spinal cord, consists of four parts:
Medulla oblongata
Pons
Midbrain
Diencephalon (thalamus + hypothalamus)
It’s the life-support part of the brain as it controls: respiration, cardiovascular function,
gastrointestinal function.
It also contains the nuclei (kernen) for the cranial nerves (hersenzenuwen) connected with the
special senses, but it is not directly concerned with higher cognitive function.
Cerebellar hemispheres are paired structures at the base of the cerebral hemisphere and are
concerned mainly with motor coordination, muscle tone and balance.
Cerebral hemispheres are paired structures above the Midbrain and Pons. They are covered by a
highly convoluted layer of nerve cells called the cerebral cortex or grey matter.
- Gyri: the ‘hills’ of the cortex (heuvels)
- Sulci: the ‘valleys’ of the cortex (dal)
- White matter: the axons or fiber (vezel) tracts that connect the nerve cells (zenuwcellen) to
the rest of the brain form a layer directly below the cortex; this layer is the white matter
- Basal ganglia: further paired structures of grey matter deep within the hemispheres (zie
chapter 15 over parkinson).
- Longitudinal fissure (spleet): separates the two hemispheres, runs from the anterior frontal
lobes to the posterior occipital lobes.
- Central (or rolandic) fissure or sulcus: separates the frontal from the parietal lobes
- Lateral (sylvian) fissure or sulcus: separates the temporal lobe from the frontal and parietal
lobes.
Corpus callosum: a tough band of interhemispheric fibers (vezels) that forms a major functional
connection between the two hemispheres. (Binnen elk halfrond verbinden vezelbanen verschillende
delen van het halfrond met elkaar).
The ascending reticulat formation (RF) controls the overall arousal level of the cortex. The RF is a
diffuse system of multisynaptic neuron chains traveling up through the brain stem. Sensory pathways
send impulses via collateral axons to the RF, which relays them to a group of nuclei (kernen) in the
thalamus. The thalamus serves as a relay center for motor pathways, many sensory pathways and
the RF. On reaching (bij het bereiken van) the thalamus, the impulses are relayed (doorgegeven) to
the cerebral cortex, where they influence the level of mental alertness or sleep.
, 4
The limbic system (or paleomammilian brain) includes the hippocampus and amygdala (many more).
The limbic system is involved in emotion, motivation and memory.
The brain has 3 coverings (dekkingen) (meninges) the outermost thick, tough covering is the Dura
mater (tough mother) which adheres to the inner surface (binnenoppervlak) of the skull. The
delicate, middle membrane the arachnoid mater (spider mother) is attached by cobweb-like
(spinnenwebachtige) strans of tissue (stukjes weefsel) to the fine Pia mater (little mother) which
adheres closely to the cortex. The subarachnoid space lies between the arachnoid mater and the pia
mater and is filled with cerebrospinal fluid (CSF) (hersenvocht). Blood vessels (aderen) also lie within
the subarachnoid space and dip down (duiken naar beneden) in the sulci to supply deeper parts of
the brain. Meningitis is an inflammation (ontsteking) of the meninges (hersenvliezen). One symptom
is a stiff neck.
Ventricles are lakes of CSF located deep within the hemispheres. CSF is formed in the choroid plexus
within the ventricles and circulates through the ventricles and around the outside of the brain and
spinal cord (ruggenmerg) within the subarachnoid space. Excess (overtollig) CSF drains (wordt
afgevoerd) into the venous system of the subarachnoid space. Hydrocephalus: one of the small
apertures (openingen) between the ventricles is blocked this increases the intercranial pressure. It
can be corrected by placing a shunt or valve (klep) into the blocked ventricle.
The cerebrovascular system involves two parts of the brain:
Anterior cerebral arteries (ACA) – medial and lower surfaces of the frontal lobes, medial
suraces of the partietal lobes, and the corpus callosum.
Middle cerebral arteries (MCA) – surfaces of the frontal, temporal, and parietal lobes.
One set in each hemisphere.
The MCA also branches (vertakken) to form the striate arteries which supply the deeply situated
internal capsule, the main passageway for the fiber (vezel) tracts between the motor cortex and the
spine (corticospinal tract / pyramidal tract). Striate arteries are vulnerable to blockage. MCA supplies
75% or more of the blood supply to the cerebral hemispheres (hersenhelften).
The paired vertebral arteries (slagaders) enter the skull at the point where the spinal cord becomes
continuous with the brain stem and join to form the basilar artery. This artery then divides to form
the paired posterior cerebral arteries. The posterior cerebral arteries supply the occipital lobes part
of the medial and inferior surfaces of the temporal lobes including the hippocampus.
Circle of willis: a ring of vessels lying in the subarachnoid space formed by a single anterior
communicating artery and two posterior communicating arteries. A blockage in a vessel away from
the circle of willis can result in a stroke. If one of the main arteries becomes blocked the blood can
pass around the circle to reach the deprived area. The circle of willis is a frequent site (plaats) of
weakening (verzwakking) on the artery wall (slagaderwand) called aneurysms, if an aneurysm bursts
(barst) it expels (verdrijft) blood around in the subarachnoid space causing a subarachnoid
hemorrhage (bloeding). The cerebral veins (hersenaders) empty (lopen leeg) into channels within the
dura mater called venous sinuses which in turn (die op hun beurt) empty into the larger internal
jugular vein (grotere interne halsader).
Cerebral cortex
Cortical zones
Posterior cortex: the parietal, temporal and occipital lobes lying behind the central sulcus. The
posterior cortex is mainly involved in a person’s awareness. Each of these lobes can be divided into
three zones:
