1.6 Problem 5
Lost in the Labyrinth
Neurocognitive disease originate from damage/abnormalities in biological substrates
linked with thinking/behaving
Causes are biological, usually identified as biochemical imbalances in the
brain/CSN or direct/indirect damage to brain tissue
Caused by disease, physical trauma, or genetic predispositions
Can affect:
Cognitive functioning
Disposition
Personality
Can use Rehabilitation Programmes, aims:
1. Restoring previously affected cognitive/behavioural functions
2. Helping clients to develop new skills to replace those lost from tissue damage
3. Provide therapy for concurrent depression, anxiety or anger problems
4. Provide clients/carers with skills and advice to help them structure their living
environment in way that helps accommodate cognitive and behavioural ability
changes
Cognitive Deficits Commonly Found in NCD
Learning and memory
o Amnesia- inability to learn new information, failure to recall past events or
failure to recall events in most recent past
o Anterograde amnesia (anterograde memory dysfunction)- memory loss
for information acquired after onset of amnesia
Attention and arousal
o Often some of first indications of NC problems
- lack of attention
- easily distracting
- performing well-learnt activities slower than before
- difficulty focussing/keeping up with conversations
- more time need to make simple decisions
Language
- difficulty focussing/keeping up with conversations more
- ramble during conversation
- difficulty conveying what they have to say coherently
- difficultly reading and understanding others speech
o known as aphasias
o many forms:
1. inability to comprehend/understand speech or repeat speech
accurately/correctly
2. fluent aphasia- production of incoherent, jumbled speech
3. non-fluent aphasia- inability to initiate speech or respond to
speech with anything but simple words
Broca’s aphasia- disruption of ability to speak consisting of difficulties
with word ordering, finding correct word, and articulation
damage to left frontal lobe
Wernicke’s aphasia- deficit in comprehension of speech involving
difficulties in recognising spoken words and converting thoughts into
words
damage to area behind frontal lobes
Visual-perceptual functioning
- Agnosia- unable to recognise everyday objects/name them
Can affect functional skills
Motor skills
- Apraxia- loss of ability to execute/carry out familiar movements,
despite desire and physical ability to perform them
Executive functioning
, - Inability to problem-solve, plan, initiate, organise, monitor and inhibit
complex behaviours
- Normally associated with prefrontal cortex
Test using Wisconsin card sorting task- individuals sort cards for
number of trials using one role, then sort cards using different rule
Higher Order Intellectual Functioning
- Impairment in abstract mental tasks
Assessment in Clinical Neuropsychology
Assessment important for:
1. Determining nature of deficits & location of related tissue
damage in brain
2. Providing info about onset, type, severity, symptom progression
3. Help discriminate between neurological deficits with organic
basis and psychiatric symptoms that don’t
4. Help identify focus for rehab programmes and assess progress
on these programmes
Assessment:
Usually on neuropsychological tests
EEG analyses, brain scans, blood tests, chemical analyses of cerebrospinal fluids
Behavioural information
Info from clients and families about onset, type, severity, symptoms progression
History of education, occupational, psychosocial, demographic, and medical
factors
Common test: WAIS-IV
Short test: Mini Mental State Examination (many tests very extensive and take too
long)
Difficulties of Diagnosis
Symptoms/deficits resemble other psychopathologies:
o Cognitive deficits= dissociative disorders and schizophrenia
o Motor-coordinate deficits, paralysis, impairments of sensory input=
somatic symptom disorders
Early stages of degenerative neurological disorder, experience cognitive
impairments affecting daily life- often cause development of psychological
problems
Means psychological problems misdiagnosed as neurological ones and vice versa
Symptoms of neurological disorders have much overlap
Types of NCD (DSM-5)
2 types: Delirium, Major/Mild Cognitive Disorders
1. Delirium
Delirium- disturbance of consciousness that develops over a short time period
Often occurs from other NCDs
Symptoms
Can develop rapidly (hours/days)
May begin abruptly after specific trauma
o Disturbance in attention
o Disruption in cognition
o Disorganised thinking, incoherent speech, hallucinations, delusions
o Sleep-wake cycle disturbances
o Emotional disturbances (Eg. fear, euphoria, apathy) with
rapid/unpredictable emotional state shifts
May also have memory/learning deficits, disorientation and perceptual
disturbances
Cause
May be result of physiological consequences of medical condition, substance
intoxication/withdrawal
Lost in the Labyrinth
Neurocognitive disease originate from damage/abnormalities in biological substrates
linked with thinking/behaving
Causes are biological, usually identified as biochemical imbalances in the
brain/CSN or direct/indirect damage to brain tissue
Caused by disease, physical trauma, or genetic predispositions
Can affect:
Cognitive functioning
Disposition
Personality
Can use Rehabilitation Programmes, aims:
1. Restoring previously affected cognitive/behavioural functions
2. Helping clients to develop new skills to replace those lost from tissue damage
3. Provide therapy for concurrent depression, anxiety or anger problems
4. Provide clients/carers with skills and advice to help them structure their living
environment in way that helps accommodate cognitive and behavioural ability
changes
Cognitive Deficits Commonly Found in NCD
Learning and memory
o Amnesia- inability to learn new information, failure to recall past events or
failure to recall events in most recent past
o Anterograde amnesia (anterograde memory dysfunction)- memory loss
for information acquired after onset of amnesia
Attention and arousal
o Often some of first indications of NC problems
- lack of attention
- easily distracting
- performing well-learnt activities slower than before
- difficulty focussing/keeping up with conversations
- more time need to make simple decisions
Language
- difficulty focussing/keeping up with conversations more
- ramble during conversation
- difficulty conveying what they have to say coherently
- difficultly reading and understanding others speech
o known as aphasias
o many forms:
1. inability to comprehend/understand speech or repeat speech
accurately/correctly
2. fluent aphasia- production of incoherent, jumbled speech
3. non-fluent aphasia- inability to initiate speech or respond to
speech with anything but simple words
Broca’s aphasia- disruption of ability to speak consisting of difficulties
with word ordering, finding correct word, and articulation
damage to left frontal lobe
Wernicke’s aphasia- deficit in comprehension of speech involving
difficulties in recognising spoken words and converting thoughts into
words
damage to area behind frontal lobes
Visual-perceptual functioning
- Agnosia- unable to recognise everyday objects/name them
Can affect functional skills
Motor skills
- Apraxia- loss of ability to execute/carry out familiar movements,
despite desire and physical ability to perform them
Executive functioning
, - Inability to problem-solve, plan, initiate, organise, monitor and inhibit
complex behaviours
- Normally associated with prefrontal cortex
Test using Wisconsin card sorting task- individuals sort cards for
number of trials using one role, then sort cards using different rule
Higher Order Intellectual Functioning
- Impairment in abstract mental tasks
Assessment in Clinical Neuropsychology
Assessment important for:
1. Determining nature of deficits & location of related tissue
damage in brain
2. Providing info about onset, type, severity, symptom progression
3. Help discriminate between neurological deficits with organic
basis and psychiatric symptoms that don’t
4. Help identify focus for rehab programmes and assess progress
on these programmes
Assessment:
Usually on neuropsychological tests
EEG analyses, brain scans, blood tests, chemical analyses of cerebrospinal fluids
Behavioural information
Info from clients and families about onset, type, severity, symptoms progression
History of education, occupational, psychosocial, demographic, and medical
factors
Common test: WAIS-IV
Short test: Mini Mental State Examination (many tests very extensive and take too
long)
Difficulties of Diagnosis
Symptoms/deficits resemble other psychopathologies:
o Cognitive deficits= dissociative disorders and schizophrenia
o Motor-coordinate deficits, paralysis, impairments of sensory input=
somatic symptom disorders
Early stages of degenerative neurological disorder, experience cognitive
impairments affecting daily life- often cause development of psychological
problems
Means psychological problems misdiagnosed as neurological ones and vice versa
Symptoms of neurological disorders have much overlap
Types of NCD (DSM-5)
2 types: Delirium, Major/Mild Cognitive Disorders
1. Delirium
Delirium- disturbance of consciousness that develops over a short time period
Often occurs from other NCDs
Symptoms
Can develop rapidly (hours/days)
May begin abruptly after specific trauma
o Disturbance in attention
o Disruption in cognition
o Disorganised thinking, incoherent speech, hallucinations, delusions
o Sleep-wake cycle disturbances
o Emotional disturbances (Eg. fear, euphoria, apathy) with
rapid/unpredictable emotional state shifts
May also have memory/learning deficits, disorientation and perceptual
disturbances
Cause
May be result of physiological consequences of medical condition, substance
intoxication/withdrawal
