Clinical Neuro Psychology
Week 1 introduction
Chapter 1: Introduction to Clinical Neuropsychology
Neuropsychology = the scientific field that studies brain-behavior
relationships, cognitive funtioning based on brain dysfunction. Clinical
neuropsychologists have knowledge about the relationship between brain
disorders and behavior, and apply this in neuropsychological assessment,
counselling and treatment. They work based on the premise that lesions
in specific brain areas lead to specific dysfunctions
Localization and functional differentiation
- Franz Joseph Gall
o Proposed that different mental functions are controlled by
specific brain regions
o Believed these functions could be identified by examining
skull bumps (phrenology)
- Broca’s area (speech production)
o Damage to the left frontal lobe; inferieur frontal gyrus.
- Wernicke’s area (language comprehension)
o Damage to the superior temporal gyrus
o Patients can speak fluently, but they do not comprehend the
words
- Lissauer's visual agnosia theory
o Appercepion – recognizing features of an object
Damage: apperceptive agnosia (cannot recognize or
copy objects)
o Association – linking features to previous knowledge
Damage: associative agnosia (can copy objects but
cannot recognise them)
Development of experimental psychology
Franciscus Donders developed several reaction time tasks:
- Simple reaction time tasks: press the button at the appearance
of a stimulus – for detection
- Choice reaction time tasks: press button 1 at stimulus A and
button 2 at stimulus B – for discrimination
- Go/no-go reaction time: press the button at stimulus A, but not at
another stimulus – for inhibition
,The differences in reaction time between different tasks conditions
provided information about cognitive functions = subtraction method
Luria’s functional theory
Luria’s functional theory integrates holistic and localization theories into
one global functional theory. According to the theory, all brain areas are
involved in three functional units, which interact to contribute to
information-processing.
1. The subcortical brain areas; regulates arousal and attention
processes (activation)
2. The posterior brain areas; processes sensory information (input)
3. The anterior brain areas: plans and organizes actions (output)
Information within each unit is processed in the brain in three
hierarchically organized zones: primary, secondary, and tertiary.
^Luria’s ideas were not supported by later research. But it did emphasize
that the brain works as a whole to produce behavior, while specific
functions can still be linked to certain areas.
Geschwind’s behavioral neurology
He examined brain functions in patients with brain injury; focus on
language function and aphasia. Assumption; disconnection between
functional centres in the brain lead to specific deficits -> he used the
principles of dissociation
Dissociation is the finding that brain damage affects one ability but
leaves another ability intact.
Double dissociation is when two abilities/mental functions rely of
different brain areas
Neuroimaging techniques
In recent years. Neuroimaging techniques emerges that can map white
matter tracts in the brain (the structural connection), such as diffusion
tensor imaging (DTI), and functional neuroimaging methods (fMRI),
which are able to map connectivity between brain regions (the functional
connections).
Chapter 2: Scientific Methods in Neuropsychology
Scientific research in neuropsychology is mostly based on observation; the
emperical cycle goes as follows >>
There are two types of research questions;
, 1. Fundamental questions: aims to increase knowledge without
direct social benefit; often explore behaviour after brain damage
using cognitive models and experiments
2. Applied questions: have a direct practical use
After experimental or neuropsychological tasks have been done, it is
important to have a measurable, concern outcome measure. The outcome
measure has to be chosen in a way that the results will be applicable in
practice. Outcome measures can be classified at different levels, such as
- The level of functions; eg measure that will give information about
which functions are impaired. Ex. memory tests to check
hippocampal damage
- The level of activities; eg a measure that will give information
about what activities they can/can’t perform ex. can a patient cook
a meal or usa a phone?
- The level of participation; eg a measure that will give information
about how much the patient can participate independently in
society/traffic/specific activities, based on the research question. Ex.
can patient drive safely?
Remote Outcome Measurement (ROM)
Outcome measurements ususally take place in a laboratory, under the
supervision of a researcher, or remotly, by completing questionnaires and
computer tasks online
Advantages Disadvantages
Participants dont need to travel Less control over testing
Can reach more people, even conditions; participants may not
internationally perform their best
Data collection can happen in real- People with cognitive impairments
life settings, making it more may need help
representative Not everyone has access to or
Multiple measurements per day knows how to use a computer
are possible, increasing reliability
Types of research
The types of research that can be used in neuropsychology
- Descriptive/observational: observing a population’s/single
participant's behaviour. No manipulation of variables
- Correlational: investigates relationships between factors. No
variables are manipulated. And no casual relationships can be
concluded
, - Experimental: an independent variable is manipulated to measure
differences in dependent variable. Causal relationships can be
concluded. Advantage over quasi experimental: more control over
external influences
- Quasi-experimental: an experimental study, but in the field, and
not in the laboratory. Advantage over experimental: more
generalizable
Qualitative data are about non-numerical data and can be expressed in
words. Quantative data are about numerical data
Research designs
- Randomized controlled trial (RCT): participants are randomly
assigned to one of the intervention groups. One group receives
experimental treatment, the other placebo.
- Crossover designs: participants reveice several interventions, and
the effect of the intervenstions is compard within participants
- Multiple baseline measurements: several baseline measurements
are taken before starting the treatment
- Longitudinal: this is used to examine behaviors during repeated
measures over period of time
- Cross-sectional studies: measurements are made at one point in
time
- Case control; a group of people with a certain condition is compared
with a group of controls
- Case studies: one person or several people are thoroughly studied.
Chapter 3: Neuropsychology in Clinical Practice
Areas of expertise
- Hospital; neuropsychologists can work in
o Categorical hospitals: focused on one patient group. E.g.,
cancer
o University hospitals: combined with research
o General hospitals
- Mental health care: several psychiatric disorders are known to
have an effect on cognitive functioning, or cognitive impairments
are associated with the disorder itself. These dysfunctions can also
explain the more specific problems (e.g. negative bias in
depression). It also happens that behavioural disturbances only
develop after brain damage
- Neuropsychiatric model: focuses on the relationship between
brain, cognition, emotion, and behaviour.
Week 1 introduction
Chapter 1: Introduction to Clinical Neuropsychology
Neuropsychology = the scientific field that studies brain-behavior
relationships, cognitive funtioning based on brain dysfunction. Clinical
neuropsychologists have knowledge about the relationship between brain
disorders and behavior, and apply this in neuropsychological assessment,
counselling and treatment. They work based on the premise that lesions
in specific brain areas lead to specific dysfunctions
Localization and functional differentiation
- Franz Joseph Gall
o Proposed that different mental functions are controlled by
specific brain regions
o Believed these functions could be identified by examining
skull bumps (phrenology)
- Broca’s area (speech production)
o Damage to the left frontal lobe; inferieur frontal gyrus.
- Wernicke’s area (language comprehension)
o Damage to the superior temporal gyrus
o Patients can speak fluently, but they do not comprehend the
words
- Lissauer's visual agnosia theory
o Appercepion – recognizing features of an object
Damage: apperceptive agnosia (cannot recognize or
copy objects)
o Association – linking features to previous knowledge
Damage: associative agnosia (can copy objects but
cannot recognise them)
Development of experimental psychology
Franciscus Donders developed several reaction time tasks:
- Simple reaction time tasks: press the button at the appearance
of a stimulus – for detection
- Choice reaction time tasks: press button 1 at stimulus A and
button 2 at stimulus B – for discrimination
- Go/no-go reaction time: press the button at stimulus A, but not at
another stimulus – for inhibition
,The differences in reaction time between different tasks conditions
provided information about cognitive functions = subtraction method
Luria’s functional theory
Luria’s functional theory integrates holistic and localization theories into
one global functional theory. According to the theory, all brain areas are
involved in three functional units, which interact to contribute to
information-processing.
1. The subcortical brain areas; regulates arousal and attention
processes (activation)
2. The posterior brain areas; processes sensory information (input)
3. The anterior brain areas: plans and organizes actions (output)
Information within each unit is processed in the brain in three
hierarchically organized zones: primary, secondary, and tertiary.
^Luria’s ideas were not supported by later research. But it did emphasize
that the brain works as a whole to produce behavior, while specific
functions can still be linked to certain areas.
Geschwind’s behavioral neurology
He examined brain functions in patients with brain injury; focus on
language function and aphasia. Assumption; disconnection between
functional centres in the brain lead to specific deficits -> he used the
principles of dissociation
Dissociation is the finding that brain damage affects one ability but
leaves another ability intact.
Double dissociation is when two abilities/mental functions rely of
different brain areas
Neuroimaging techniques
In recent years. Neuroimaging techniques emerges that can map white
matter tracts in the brain (the structural connection), such as diffusion
tensor imaging (DTI), and functional neuroimaging methods (fMRI),
which are able to map connectivity between brain regions (the functional
connections).
Chapter 2: Scientific Methods in Neuropsychology
Scientific research in neuropsychology is mostly based on observation; the
emperical cycle goes as follows >>
There are two types of research questions;
, 1. Fundamental questions: aims to increase knowledge without
direct social benefit; often explore behaviour after brain damage
using cognitive models and experiments
2. Applied questions: have a direct practical use
After experimental or neuropsychological tasks have been done, it is
important to have a measurable, concern outcome measure. The outcome
measure has to be chosen in a way that the results will be applicable in
practice. Outcome measures can be classified at different levels, such as
- The level of functions; eg measure that will give information about
which functions are impaired. Ex. memory tests to check
hippocampal damage
- The level of activities; eg a measure that will give information
about what activities they can/can’t perform ex. can a patient cook
a meal or usa a phone?
- The level of participation; eg a measure that will give information
about how much the patient can participate independently in
society/traffic/specific activities, based on the research question. Ex.
can patient drive safely?
Remote Outcome Measurement (ROM)
Outcome measurements ususally take place in a laboratory, under the
supervision of a researcher, or remotly, by completing questionnaires and
computer tasks online
Advantages Disadvantages
Participants dont need to travel Less control over testing
Can reach more people, even conditions; participants may not
internationally perform their best
Data collection can happen in real- People with cognitive impairments
life settings, making it more may need help
representative Not everyone has access to or
Multiple measurements per day knows how to use a computer
are possible, increasing reliability
Types of research
The types of research that can be used in neuropsychology
- Descriptive/observational: observing a population’s/single
participant's behaviour. No manipulation of variables
- Correlational: investigates relationships between factors. No
variables are manipulated. And no casual relationships can be
concluded
, - Experimental: an independent variable is manipulated to measure
differences in dependent variable. Causal relationships can be
concluded. Advantage over quasi experimental: more control over
external influences
- Quasi-experimental: an experimental study, but in the field, and
not in the laboratory. Advantage over experimental: more
generalizable
Qualitative data are about non-numerical data and can be expressed in
words. Quantative data are about numerical data
Research designs
- Randomized controlled trial (RCT): participants are randomly
assigned to one of the intervention groups. One group receives
experimental treatment, the other placebo.
- Crossover designs: participants reveice several interventions, and
the effect of the intervenstions is compard within participants
- Multiple baseline measurements: several baseline measurements
are taken before starting the treatment
- Longitudinal: this is used to examine behaviors during repeated
measures over period of time
- Cross-sectional studies: measurements are made at one point in
time
- Case control; a group of people with a certain condition is compared
with a group of controls
- Case studies: one person or several people are thoroughly studied.
Chapter 3: Neuropsychology in Clinical Practice
Areas of expertise
- Hospital; neuropsychologists can work in
o Categorical hospitals: focused on one patient group. E.g.,
cancer
o University hospitals: combined with research
o General hospitals
- Mental health care: several psychiatric disorders are known to
have an effect on cognitive functioning, or cognitive impairments
are associated with the disorder itself. These dysfunctions can also
explain the more specific problems (e.g. negative bias in
depression). It also happens that behavioural disturbances only
develop after brain damage
- Neuropsychiatric model: focuses on the relationship between
brain, cognition, emotion, and behaviour.
