Psy3241 - User contributions [en]

Mini mental state exam

Hkirkland — Mon, 05 May 2008 02:07:21 GMT

Hkirkland:

[[Category:Neuropsychological methods]]
The''' Mini Mental State Exam''' is a tool used to systematically asses mental status. It is based on 11 questions that test five areas of cognitive function. The five sections of the test are divided as follows: orientation, registration, attention and calculation. The maximum score is 30 and a score if 23 and lower indicates cognitive impairment. The test usually 5-10 minutes to administer, making it practical to use repeatedly.

[[Image:Elderly-fig1.jpg]]
----
== Target Population ==
The '''Mini mental state exam''' is used as a screening tool for cognitive impairment in the older community of hospitalized adults such as nursing homes. The assessment of older adults’ cognitive function is believed to have better results if it is done routinely and thoroughly.

----
== Strenghts and Limitations ==
The '''MMSE''' is an effective instrument to separate patients with cognitive deterioration from those without it. When used repeatedly the instrument is able to measure changes in cognitive status. It is important to note, that the tool is not able to diagnose the case for changes in cognitive function. As well, the instrument relies heavily on verbal responses, such as reading and writing. Consequently, patients that have a hearing or visual impairment may have low literacy when cognitively they might be intact.
----
== References ==
Kurlowicz, L, & Wallace, M (1999). The Mini Mental Examination (MME). Try this: from the Hartford Institute for Geriatric Nursing, 1, Retrieved April 21, 2008, from http://www.chcr.brown.edu/MMSE.PDF

Mini-Mental State Examination. Psychological Assessment Resources, Inc. Retrieved April 20, 2008 from http://www.minimental.com/

Event related potentials

Hkirkland — Sun, 27 Apr 2008 22:56:40 GMT

Hkirkland: /* Picture */

[[Category:Neuropsychological methods]]

== Definition ==
'''Event related potentials''' are electrical properties of biological cells and tissues reacting to an internal or external stimulus. Electrodes are attached to the scalp and the electrical activity is the amplified and deteced on a computer screen. The activity of neurons closest to the electrodes are being recorded in order to record the effect of the ERP (could be a tone or light flash). strong responses in the Visual cortex may indicate of a person with healthy a visual system. The ERP recordings show the timing it takes for the brain to communicate the information being process in this case the stimuli. ERP techniques have been found useful in finding information on attention.
----
== Case ==
In a case testing split-brain patients, they had to decide whether pairs of pictures showed briefly and at the same time to right and left visual field represented same or different people. ERP's showed that inter-hemispheric transfer takes no more than 20 miliseconds.
----
== Picture ==
[[http://www.nature.com/nrn/journal/v8/n8/images/nrn2195-f3.jpg]]

[[Image:images-3.jpg]]

File:Images-3.jpg

Hkirkland — Sun, 27 Apr 2008 22:55:28 GMT

Hkirkland:

Elliot (frontal patient)

Hkirkland — Sun, 27 Apr 2008 22:53:37 GMT

Hkirkland: /* Elliot’s Medical Symptoms Pre-Surgery: */

[[Category:Neuropsychological profiles]]
'''Elliot (Frontal Patient):
'''

== Elliot’s Lifestyle Prior to Brain Damage:==
Elliot was a good father and husband who held a good job with a business firm. He was smart and had many skills. According to the author, Elliot “had attained an enviable personal, professional, and social status.” (A Modern Phineas Gage, 35) He was in his 30’s.
----
== Elliot’s Medical Symptoms Pre-Surgery: ==

Elliots symptoms first presented as trouble concentrating and headaches. He was diagnosed with a benign brain tumor called a Meningioma, which began growing in the midline area above his nasal passages and eye sockets. “As the tumor grew bigger, it compressed the frontal lobes upward from below.” (35) Although the tumor was benign, it could still have proven fatal if it was not removed because of the increasing compression on the brain. When Elliot was first diagnosed, the tumor was already the size of a small orange. Doctors decided to surgically remove the tumor, but because some of the tissue around the tumor was damaged, they had to remove part of his frontal lobe.

[[Image:190px-Contrast_enhanced_meningioma.jpg]]
----

== Elliot’s Neurological Symptoms and Lifestyle Post-Surgery: ==

During Elliot’s physical recovery, he and his family noticed drastic personality changes. Although his intellect, motor skills, and language use remained intact, Elliot had clearly changed since the surgery.

Elliot had trouble getting started in the morning and preparing for work. He had trouble managing his time while at work and could not operate on a schedule. While at work, Elliot had trouble reaching his main goals because he would get caught up in a single task for an unnecessary amount of time. He continually lost sight of his main priorities because of his irrational amount of detail on subsidiary tasks. One could say Elliot had trouble “shifting gears” despite advice and warnings from his employer. He was, expectedly, fired from his job at the business firm and was unable to hold other jobs. Despite Elliot’s intelligence, business background, and warnings from friends and family, he began risky business ventures and ended up in bankruptcy.

He began a collecting habit—but it was a collection of junk. Elliot’s wife divorced him for his foolish decision-making, and he had a brief marriage with another woman (who his family disliked), who also divorced him.

Overall, “his ability to reach decisions was impaired, as was his ability to make an effective plan for the hours ahead of him, let alone plan for the months and years of his future.” (37) Normal people make bad decisions, but Elliot’s behavior was clearly a sign of disease. He could no longer operate as a normal social being, and could no longer live an independent existence.

After surgery, Elliot became emotionally blunted. When one would typically expect an emotional response, he showed none.
----
== Location of Damage (as shown in computerized tomography and magnetic resonance imaging): ==

o Prefrontal damage due to removal of tissue in his frontal lobe

o Damage was more extensive on his right side than left

o Damage on the left side was within the orbital and medial sectors of the frontal lobe

o Damage on the right side was in the same areas, but the white matter (the core of the lobe) on the right side was “destroyed”

o The motor and premotor regions were not damaged

o Language related cortices (Broca’s areas) were not damaged

o Basal forebrain was intact (necessary for learning and memory)

o Temporal, occipital, and parietal regions in both hemispheres were intact
----
== Results of Neuropsychological Tests: ==

IQ was superior

Wechsler Adult Intelligence Scale: no abnormality

Immediate memory of digits was superior

Short-term verbal memory was superior

Visual memory of geometric designs was superior

Rey’s word list (delayed recall) and complex figures were normal

Multilingual Aphasia Examination (assesses language comprehension and production) were normal

Benton’s tests (facial discrimination, line orientation, geographic orientation, 2 &
3-dimensional block construction) were normal

Rey-Osterrieth complex figure-copying task was normal
memory tests with interference procedures were normal (which is interesting because most patients with frontal lobe damage do not perform at that level)

Attention and working memory were intact

Wisconsin Card Sorting Task was normal, even though most patients with similar damage would fail. Elliot was able to “shift gears” in the sorting task even though he could not shift gears in real life.

Making estimates based on incomplete knowledge (using inference) and conjuring up connections unconnected facts using logic were normal. These tasks require normal logical competence, working memory, and attention.

MMPI (personality) generated a valid profile

Answers to ethical dilemmas (social conventions) followed the same principles as examiners

Solutions to hypothetical social predicaments (as well as offering alternative solutions) elicited answers showing no deficit

Task assessing awareness of consequences (of situations where there is temptation to transgress social conventions) was superior

Means-Ends Problem-Solving Procedure (suggesting means to achieve a social goal by offering a series of effective acts leading to the outcome) was superior
Ability to predict social consequences of interpersonal situations was normal

Standard Issue Moral Judgment Interview (developmental stage of moral reasoning) was excellent
----
== Conclusions: ==

“There may be brain disease, but laboratory tests fail to measure significant impairments. The problem here lies with the tests, not with the patients.” (40) Laboratory tests are not representative of real-life series of in-the-moment decisions.

“Elliot’s impeccable performances meant that the usual suspects could not be blamed.” (43)

“Elliot was able to recount the tragedy of his life with a detachment that was out of step with the magnitude of the events.” (44)

'''Reduced emotional affect might play a role in the decision making process.'''
----
== Source: ==

Descarte’s Error, ''A Modern Phinneas Gage''.

File:190px-Contrast enhanced meningioma.jpg

Hkirkland — Sun, 27 Apr 2008 22:52:05 GMT

Hkirkland:

Controlled oral word association task

Hkirkland — Sun, 27 Apr 2008 20:45:36 GMT

Hkirkland: /* COWAT’s Applications and Research: */

[[Category:Neuropsychological methods]]
'''Controlled Oral Word Association Task (COWAT):'''

== COWAT Overview: ==

The COWAT (Benton, 1967) is a cognitive test of verbal processing ability used to assess brain impairment. Verbal processing ability and verbal fluency are considered executive functions. The emphasis on these tests focuses on the degree of discrepancy (as opposed to consistency) between current functioning and an estimated pre-impairment functioning. The COWAT assesses the subject’s ability to spontaneously produce words that begin with specific letters within a certain time limit. In particular, the test uses the letters F, A, and S. Before the test begins, the patient is given a practice trial with a different letter. Other letters may be added to the tests for comparison.
----
== COWAT’s Applications and Research: ==

The COWAT has been used to research the process of cognitive aging in accordance with the Frontal Aging Hypothesis (Dempster, 1992). This theory is based on the assumption that deterioration of the frontal lobes during the normal aging process leads to cognitive impairment similar to patients who have lesions in their frontal lobes. Since the frontal lobes are involved in executive functioning, the COWAT has been used as one measure of this functioning in the elderly. Research has shown that one should take caution when administering the COWAT to evaluate older people’s level of executive functioning for the Frontal Aging Hypothesis. This caution is due to arguments that executive functioning might not be one single mechanism; rather, it is possible that there are independent executive abilities. As a result, the COWAT alone as an assessment of executive functioning may not be an accurate representation of executive decline.

The COWAT has been used in searches for differential diagnoses for dementia. The COWAT has been used to collect normative data from a range of subjects to establish norms for age, gender, education level, etc. Normative data allows for comparison with other neuropsychological tests that evaluate word knowledge and speed of verbal processing to examine the interrelationship between the instruments. Other applications include measuring cognitive impairment due to Wilson’s Disease, HIV, drug addiction.

[[Image:en_a07tab01.gif]]
----

== Sources: ==

http://usq.edu.au/users/senior/Posters/JCordellPoster.htm

Rodrigues-Aranda, C., & Sundet, K. (2006) The Frontal Hypothesis of Cognitive Aging: Factor structure and age effects on four frontal tests among healthy individuals. The Journal of Genetic Psychology, 167(3), 269-288.

Corsi's block tapping task

Hkirkland — Sun, 27 Apr 2008 20:43:42 GMT

Hkirkland:

[[Category:Neuropsychological methods]]
[[Image:images-2.jpg]]

Corsi’s block tapping test is a neuropsychological assessment that measures spatial memory. It is composed of a set of wooden blocks that are numbered on only one side, so that the experimenter is the only one to see them. The subject remains seated at a table as the experimenter taps out a sequence of blocks, which the subject must immediately replicate. Because the subject is unable to see the numbers, they are forced to memorize the correct sequence, thus engaging their spatial memory abilities. Clasically, the experimenter will increases the length of the sequence in order to establish a spatial memory span (Sterling, 2002). DeRenzi and Nichelli (1975) found a reduced spatial memory span in patients with bilateral posterior damage. Because spatial memory appears to be localized to the right hemisphere, this test becomes particularly difficult for respondents with right frontal damage. Both hemispheres, however, do contribute to spatial processing. Sterling (2002) suggests that the right hemisphere may be specialized for processing “coordinate” spatial relations, and the left hemisphere may be specialized for “categorical” spatial locations. The Corsi tapping test has also been adapted for electronic touch screen use.

File:Images-2.jpg

Hkirkland — Sun, 27 Apr 2008 20:42:19 GMT

Hkirkland:

File:En a07tab01.gif

Hkirkland — Sun, 27 Apr 2008 20:41:50 GMT

Hkirkland:

Controlled oral word association task

Hkirkland — Sun, 27 Apr 2008 20:40:11 GMT

Hkirkland:

[[Category:Neuropsychological methods]]
'''Controlled Oral Word Association Task (COWAT):'''

== COWAT Overview: ==

The COWAT (Benton, 1967) is a cognitive test of verbal processing ability used to assess brain impairment. Verbal processing ability and verbal fluency are considered executive functions. The emphasis on these tests focuses on the degree of discrepancy (as opposed to consistency) between current functioning and an estimated pre-impairment functioning. The COWAT assesses the subject’s ability to spontaneously produce words that begin with specific letters within a certain time limit. In particular, the test uses the letters F, A, and S. Before the test begins, the patient is given a practice trial with a different letter. Other letters may be added to the tests for comparison.
----
== COWAT’s Applications and Research: ==

The COWAT has been used to research the process of cognitive aging in accordance with the Frontal Aging Hypothesis (Dempster, 1992). This theory is based on the assumption that deterioration of the frontal lobes during the normal aging process leads to cognitive impairment similar to patients who have lesions in their frontal lobes. Since the frontal lobes are involved in executive functioning, the COWAT has been used as one measure of this functioning in the elderly. Research has shown that one should take caution when administering the COWAT to evaluate older people’s level of executive functioning for the Frontal Aging Hypothesis. This caution is due to arguments that executive functioning might not be one single mechanism; rather, it is possible that there are independent executive abilities. As a result, the COWAT alone as an assessment of executive functioning may not be an accurate representation of executive decline.

The COWAT has been used in searches for differential diagnoses for dementia. The COWAT has been used to collect normative data from a range of subjects to establish norms for age, gender, education level, etc. Normative data allows for comparison with other neuropsychological tests that evaluate word knowledge and speed of verbal processing to examine the interrelationship between the instruments. Other applications include measuring cognitive impairment due to Wilson’s Disease, HIV, drug addiction.

----
== Sources: ==

http://usq.edu.au/users/senior/Posters/JCordellPoster.htm

Rodrigues-Aranda, C., & Sundet, K. (2006) The Frontal Hypothesis of Cognitive Aging: Factor structure and age effects on four frontal tests among healthy individuals. The Journal of Genetic Psychology, 167(3), 269-288.

Event related potentials

Hkirkland — Sun, 27 Apr 2008 20:33:47 GMT

Hkirkland:

Balint's syndrome

Hkirkland — Sun, 27 Apr 2008 20:23:18 GMT

Hkirkland: /* Characteristics of Balint's Syndrome */

[[Category:Neuropsychological syndromes]]

== What is Balint’s Syndrome? ==

Rezso (Rudolf) Balint identified Balint’s syndrome in 1909 as a disjointed and paralysis

of gazing ability with haphazard scanning skills. Balint’s syndrome is characterized by

optic ataxia (uncoordinated hand and eye movement) and optic apraxia (inability to

voluntarily guide eye movements and change locations of visual fixations). Due to the

combination of optic ataxia and optic apraxia, patients with Balint’s syndrome also

display simultanagnosia or the inability to perceive more then one object at a time even

when the objects are taking up the same area of the visual field. In some cases, the patient

may behave as if they are blind.

== Characteristics of Balint's Syndrome ==

Interestingly, the simultanagnosia involved with Balint’s syndrome is not specific to one object

or spatial location. For example, the tester could hold up two objects that intersect each other

on the patient’s visual field and ask the patient what he sees. The patient is just as likely to

pick one item over the other, while being completely blind to the second object.

Jackson et al (2006) conducted [[perceptual priming tasks]] with a Balint's patient where 2

pictures were shown (either the same or different semantic categories), and the participant was

asked to either classify one of the pictures or name both pictures. The results indicate that

there was a significant decrease in classification performance when the 2 pictures were different

in semantic category. The surprising aspect of this result is that the patient rarely indicated

that he saw more than one object. Thus, Jackson et al (2006) found results pointing to a

theory that Balint’s patients do not have a difficulty in seeing more than one item at a

time, but they have a deficit in explicitly identifying one item at any given time.

They suggest that this could be from an inability to disengage attention from one object once

that object catches the patient's attention. When given more time, the patient with Balint’s

syndrome can sometimes identify more than one stimulus when asked.

A patient with Balint’s Syndrome, J.J., made significantly more classification errors when items

were presented sequentially in time instead of at the same time. This indicates that the priming

stimulus could have less of an influence when it is presented simultaneously with the probe item

than when it comes before the probe item. (Jackson et al, 2006)

It could be that there is a reduced amount of competition between items on a sequential

presentation in patients with Balint’s syndrome simply because when the stimuli are presented

simultaneously, the patient only consciously perceives one item instead of two, eliminating

competition between stimuli. (Jackson et al, 2006)

== Brain Areas Involved ==

Balint’s syndrome has been associated with bilateral damage to the posterior parietal

cortex with a primary cause of the syndrome being multiple strokes, Alzheimer’s,

intracranial tumors or brain injury. Only recently has Balint’s syndrome been associated

with damage to the parietal-occipital vascular boarder zone and in children.

== Refrences ==

Gillen, J.A. and Dutton, G.N. (2003). Balint's syndrome in a 10-year-old male. Developmental Medicine & Child Neurology, 45, (349-32).

'''From class discussions:'''

Jackson et al. (2006).dorsal simultanagnosia: An impairment of visual processing or visual awareness. Cortex. 42, 740-749.

Newport et al. (2006). The role of the posterior parietal lobe in prism adaptation: Failure to adapt to optical prisms in a patient with bilateral damage to posterior parietal cortex. Cortex. (2006) 42, 720-729.

Balint's syndrome

Hkirkland — Sun, 27 Apr 2008 20:22:07 GMT

Hkirkland: /* Characteristics of Balint's Syndrome */

[[Category:Neuropsychological syndromes]]

== What is Balint’s Syndrome? ==

Rezso (Rudolf) Balint identified Balint’s syndrome in 1909 as a disjointed and paralysis

of gazing ability with haphazard scanning skills. Balint’s syndrome is characterized by

optic ataxia (uncoordinated hand and eye movement) and optic apraxia (inability to

voluntarily guide eye movements and change locations of visual fixations). Due to the

combination of optic ataxia and optic apraxia, patients with Balint’s syndrome also

display simultanagnosia or the inability to perceive more then one object at a time even

when the objects are taking up the same area of the visual field. In some cases, the patient

may behave as if they are blind.

== Characteristics of Balint's Syndrome ==

Interestingly, the simultanagnosia involved

with Balint’s syndrome is not specific to one object or spatial location. For example, the

tester could hold up two objects that intersect each other on the patient’s visual field and

ask the patient what he sees. The patient is just as likely to pick one item over the other,

while being completely blind to the second object.

Jackson et al (2006) conducted [[perceptual priming tasks]] with a Balint's patient where 2

pictures were shown (either the same or different semantic categories), and the participant was

asked to either classify one of the pictures or name both pictures. The results indicate that

there was a significant decrease in classification performance when the 2 pictures were different

in semantic category. The surprising aspect of this result is that the patient rarely indicated

that he saw more than one object. Thus, Jackson et al (2006) found results pointing to a

theory that Balint’s patients do not have a difficulty in seeing more than one item at a

time, but they have a deficit in explicitly identifying one item at any given time.

They suggest that this could be from an inability to disengage attention from one object once

that object catches the patient's attention. When given more time, the patient with Balint’s

syndrome can sometimes identify more than one stimulus when asked.

A patient with Balint’s Syndrome, J.J., made significantly more classification errors when items

were presented sequentially in time instead of at the same time. This indicates that the priming

stimulus could have less of an influence when it is presented simultaneously with the probe item

than when it comes before the probe item. (Jackson et al, 2006)

It could be that there is a reduced amount of competition between items on a sequential

presentation in patients with Balint’s syndrome simply because when the stimuli are presented

simultaneously, the patient only consciously perceives one item instead of two, eliminating

competition between stimuli. (Jackson et al, 2006)

== Brain Areas Involved ==

Balint’s syndrome has been associated with bilateral damage to the posterior parietal

cortex with a primary cause of the syndrome being multiple strokes, Alzheimer’s,

intracranial tumors or brain injury. Only recently has Balint’s syndrome been associated

with damage to the parietal-occipital vascular boarder zone and in children.

== Refrences ==

Gillen, J.A. and Dutton, G.N. (2003). Balint's syndrome in a 10-year-old male. Developmental Medicine & Child Neurology, 45, (349-32).

'''From class discussions:'''

Jackson et al. (2006).dorsal simultanagnosia: An impairment of visual processing or visual awareness. Cortex. 42, 740-749.

Newport et al. (2006). The role of the posterior parietal lobe in prism adaptation: Failure to adapt to optical prisms in a patient with bilateral damage to posterior parietal cortex. Cortex. (2006) 42, 720-729.

Kluver-Bucy syndrome

Hkirkland — Sun, 27 Apr 2008 20:17:49 GMT

Hkirkland:

[[Category:Neuropsychological syndromes]]

'''[[Kluver-Bucy Syndrome]]'''
----
== Overview:==
A rare neurological disorder occurring in humans and Rhesus monkeys (much more common in animal subjects). The full syndrome is rarely found in humans. Individuals put objects into their mouths and engage in inappropriate sexual behavior.
----
== Other symptoms may include: ==

[[Visual agnosia]] (inability to visually recognize objects), loss of normal fear or anger responses, distractibility, memory loss, dementia, seizures, hypersexuality, hyperorality, altered emotional behavior, or “psychic blindness.�? (is this the same as visual agnosia??)
----
== Possible causes: ==

Head trauma and herpes encephalitis are the most common causes of the condition.
----
== History: ==

In 1937, Heinrich Kluver and Paul Bucy performed surgery on Rhesus monkeys, removing the temporal lobe on both sides to determine its function. The monkeys immediately developed altered sexual behavior (dramatic increase of overt behavior), emotional changes, and visual agnosia. Oral tendencies (hyperphagia) and hypermetamorphosis (desire to explore everything in their surroundings) were also present. The monkeys were more likely to examine the world with their mouths instead of their eyes, perhaps because the visual agnosia caused familiar objects and their uses to be unrecognizable. The monkeys lost fear when it would normally be acceptable and expected (known as placidity). In humans, the hypersexuality is not as intense as seen in animals.
----
== Etiology: ==

Kluver-Bucy Syndrome is considered a direct consequence of bilateral anterior temporal lobe damage resulting from either injury or disease. However, lesions of the amygdala have elicited similar symptoms. Clinicians are required to document the clinical features mentioned above, as well as to prove that a bilateral lesion exists in the anterior temporal lobe or the amygdala. However, lesions are not necessary in the amygdala for KBS symptoms to exist. There have been 2 cases where neither of these regions showed damage in brain images, suggesting that KBS may involve some disruption of circuitry in the limbic areas, where mediodorsal thalamic relay occurs. All of the cases involving children were due to herpes encephalitis
----
== Research: ==

KBS may resopond to carbamazepine treatment (antipsychotic pharmaceuticals), but management is challenging. In some cases, research has shown antipsychotics resulted in clinical improvement. The cases of KBS that do not have apparent brain lesions could help develop a better functional understanding of the condition.
----
== Case Study available at: ==

http://images.google.com/imgres?imgurl=http://www.medscape.com/content/2002/00/44/43/444337/art-444337.fig.jpg&imgrefurl=http://www.medscape.com/viewarticle/444337_2&h=408&w=400&sz=40&hl=en&start=1&sig2=DaCfl40R9mMD-1fL3oLxDg&um=1&tbnid=VDs1UTzJ0b-NHM:&tbnh=125&tbnw=123&ei=9CrxR6P3MaWkgQLA-4iPDA&prev=/images%3Fq%3Dkluver-bucy%26um%3D1%26hl%3Den%26safe%3Doff%26client%3Dsafari%26rls%3Den%26sa%3DN
----
== Sources: ==

http://images.google.com/imgres?imgurl=http://www.medscape.com/content/2002/00/44/43/444337/art-444337.fig.jpg&imgrefurl=http://www.medscape.com/viewarticle/444337_2&h=408&w=400&sz=40&hl=en&start=1&sig2=DaCfl40R9mMD-1fL3oLxDg&um=1&tbnid=VDs1UTzJ0b-NHM:&tbnh=125&tbnw=123&ei=9CrxR6P3MaWkgQLA-4iPDA&prev=/images%3Fq%3Dkluver-bucy%26um%3D1%26hl%3Den%26safe%3Doff%26client%3Dsafari%26rls%3Den%26sa%3DN

http://ninds.nih.gov/disorders/kluver_bucy.htm
----
== Organizations: ==

National Organization for Rare Disorders (NORD)

http://www.rarediseases.org

Kluver-Bucy syndrome

Hkirkland — Sun, 27 Apr 2008 20:17:28 GMT

Hkirkland:

[[Category:Neuropsychological syndromes]]

'''[[Kluver-Bucy Syndrome]]'''
----
== Overview:
==
A rare neurological disorder occurring in humans and Rhesus monkeys (much more common in animal subjects). The full syndrome is rarely found in humans. Individuals put objects into their mouths and engage in inappropriate sexual behavior.
----
== Other symptoms may include: ==

[[Visual agnosia]] (inability to visually recognize objects), loss of normal fear or anger responses, distractibility, memory loss, dementia, seizures, hypersexuality, hyperorality, altered emotional behavior, or “psychic blindness.�? (is this the same as visual agnosia??)
----
== Possible causes: ==

Head trauma and herpes encephalitis are the most common causes of the condition.
----
== History: ==

In 1937, Heinrich Kluver and Paul Bucy performed surgery on Rhesus monkeys, removing the temporal lobe on both sides to determine its function. The monkeys immediately developed altered sexual behavior (dramatic increase of overt behavior), emotional changes, and visual agnosia. Oral tendencies (hyperphagia) and hypermetamorphosis (desire to explore everything in their surroundings) were also present. The monkeys were more likely to examine the world with their mouths instead of their eyes, perhaps because the visual agnosia caused familiar objects and their uses to be unrecognizable. The monkeys lost fear when it would normally be acceptable and expected (known as placidity). In humans, the hypersexuality is not as intense as seen in animals.
----
== Etiology: ==

Kluver-Bucy Syndrome is considered a direct consequence of bilateral anterior temporal lobe damage resulting from either injury or disease. However, lesions of the amygdala have elicited similar symptoms. Clinicians are required to document the clinical features mentioned above, as well as to prove that a bilateral lesion exists in the anterior temporal lobe or the amygdala. However, lesions are not necessary in the amygdala for KBS symptoms to exist. There have been 2 cases where neither of these regions showed damage in brain images, suggesting that KBS may involve some disruption of circuitry in the limbic areas, where mediodorsal thalamic relay occurs. All of the cases involving children were due to herpes encephalitis
----
== Research: ==

KBS may resopond to carbamazepine treatment (antipsychotic pharmaceuticals), but management is challenging. In some cases, research has shown antipsychotics resulted in clinical improvement. The cases of KBS that do not have apparent brain lesions could help develop a better functional understanding of the condition.
----
== Case Study available at: ==

http://images.google.com/imgres?imgurl=http://www.medscape.com/content/2002/00/44/43/444337/art-444337.fig.jpg&imgrefurl=http://www.medscape.com/viewarticle/444337_2&h=408&w=400&sz=40&hl=en&start=1&sig2=DaCfl40R9mMD-1fL3oLxDg&um=1&tbnid=VDs1UTzJ0b-NHM:&tbnh=125&tbnw=123&ei=9CrxR6P3MaWkgQLA-4iPDA&prev=/images%3Fq%3Dkluver-bucy%26um%3D1%26hl%3Den%26safe%3Doff%26client%3Dsafari%26rls%3Den%26sa%3DN
----
== Sources: ==

http://images.google.com/imgres?imgurl=http://www.medscape.com/content/2002/00/44/43/444337/art-444337.fig.jpg&imgrefurl=http://www.medscape.com/viewarticle/444337_2&h=408&w=400&sz=40&hl=en&start=1&sig2=DaCfl40R9mMD-1fL3oLxDg&um=1&tbnid=VDs1UTzJ0b-NHM:&tbnh=125&tbnw=123&ei=9CrxR6P3MaWkgQLA-4iPDA&prev=/images%3Fq%3Dkluver-bucy%26um%3D1%26hl%3Den%26safe%3Doff%26client%3Dsafari%26rls%3Den%26sa%3DN

http://ninds.nih.gov/disorders/kluver_bucy.htm
----
== Organizations: ==

National Organization for Rare Disorders (NORD)

http://www.rarediseases.org

Controlled oral word association task

Hkirkland — Sun, 27 Apr 2008 20:16:16 GMT

Hkirkland:

[[Category:Neuropsychological methods]]
'''Controlled Oral Word Association Task (COWAT):'''

== COWAT Overview: ==

The COWAT (Benton, 1967) is a cognitive test of verbal processing ability used to assess brain impairment. Verbal processing ability and verbal fluency are considered executive functions. The emphasis on these tests focuses on the degree of discrepancy (as opposed to consistency) between current functioning and an estimated pre-impairment functioning. The COWAT assesses the subject’s ability to spontaneously produce words that begin with specific letters within a certain time limit. In particular, the test uses the letters F, A, and S. Before the test begins, the patient is given a practice trial with a different letter. Other letters may be added to the tests for comparison.
----
== COWAT’s Applications and Research: ==

The COWAT has been used to research the process of cognitive aging in accordance with the Frontal Aging Hypothesis (Dempster, 1992). This theory is based on the assumption that deterioration of the frontal lobes during the normal aging process leads to cognitive impairment similar to patients who have lesions in their frontal lobes. Since the frontal lobes are involved in executive functioning, the COWAT has been used as one measure of this functioning in the elderly. Research has shown that one should take caution when administering the COWAT to evaluate older people’s level of executive functioning for the Frontal Aging Hypothesis. This caution is due to arguments that executive functioning might not be one single mechanism; rather, it is possible that there are independent executive abilities. As a result, the COWAT alone as an assessment of executive functioning may not be an accurate representation of executive decline.

The COWAT has been used in searches for differential diagnoses for dementia. The COWAT has been used to collect normative data from a range of subjects to establish norms for age, gender, education level, etc. Normative data allows for comparison with other neuropsychological tests that evaluate word knowledge and speed of verbal processing to examine the interrelationship between the instruments. Other applications include measuring cognitive impairment due to Wilson’s Disease, HIV, drug addiction.
----
== Sources: ==

http://usq.edu.au/users/senior/Posters/JCordellPoster.htm

Rodrigues-Aranda, C., & Sundet, K. (2006) The Frontal Hypothesis of Cognitive Aging: Factor structure and age effects on four frontal tests among healthy individuals. The Journal of Genetic Psychology, 167(3), 269-288.

Primary somatosensory cortex

Hkirkland — Sun, 27 Apr 2008 20:15:39 GMT

Hkirkland:

[[Image:somatosensory.jpg]][[Category:Brain areas]]
----
'''The Primary Somatosensory Cortex (S1''')

== Purpose: ==

The areas involved are related to touch. Neurons are activated when the skin is stimulated. The somatosensory cortex acts as the end of the sensory pathway.
----
== Location: ==

The cerebral cortex in the parietal lobe houses the primary somatosensory cortex (S1). S1 is located behind central sulcus in postcentral gyrus.
----
== History and Basic Anatomy: ==

Dr. Wilder Penfield was able to construct a map of the human somatosensory cortex in the 1950’s. His strategy was to find a group of patients undergoing brain surgery for epilepsy, stimulate their cortices, and ask the patients what they felt. Through these stimulations, Dr. Penfield was able to observe the parts of the brain that caused the patients to feel sensations on different regions of their bodies. Penfield found that even though one’s arms and trunk make up a lot of the body’s surface area (and, therefore, skin area), not a lot of the primary somatosensory neurons are devoted to these areas. Conversely, the face and hands take up most of the primary somatosensory cortex. This fact makes sense because the amount of cortex devoted to each area is directly proportionate to the density of nerve receptors in those areas. For example, think about how much more sensitive your fingertips are than parts of your legs.
----
== Organization: ==

The thalamus projects sensory information first to the most rostral part of the S1 (the areas situated more toward the nasal region, known as Brodmann’s areas 3a and 3b). 3a and 3b then relay information and exchange information with Brodmann’s areas 1 and 2.

Brodmann’s area 3b senses primarily texture, size, and shape, Brodmann’s area 1 receives information about texture, and Brodmann’s area 2 receives information about size and shape.

There is a topographical organization (as Penfield found) to the projection of information from the thalamus to the primary somatosensory cortex. A large region close to the base of the postcentral gyrus is devoted to sensations from the tongue, mouth, and lips. Information from the lower limbs and genitals are arranged along the midline. The fingers, lips, and tongue are well represented within the primary somatosensory cortex.
----
== Sources: ==

http://faculty.washington.edu/chudler/brainsize.html

http://www.neurosci.pharm.utoledo.edu/MBC4420/sensory.htm

http://thalamus.wustl.edu/course/bassens.html

http://encyclopedia.com/doc/1O78-somatosensorycortex.html

Elliot (frontal patient)

Hkirkland — Sun, 27 Apr 2008 20:14:33 GMT

Hkirkland:

[[Category:Neuropsychological profiles]]
'''Elliot (Frontal Patient):
'''

== Elliot’s Lifestyle Prior to Brain Damage:==
Elliot was a good father and husband who held a good job with a business firm. He was smart and had many skills. According to the author, Elliot “had attained an enviable personal, professional, and social status.” (A Modern Phineas Gage, 35) He was in his 30’s.
----
== Elliot’s Medical Symptoms Pre-Surgery: ==

Elliots symptoms first presented as trouble concentrating and headaches. He was diagnosed with a benign brain tumor called a Meningioma, which began growing in the midline area above his nasal passages and eye sockets. “As the tumor grew bigger, it compressed the frontal lobes upward from below.” (35) Although the tumor was benign, it could still have proven fatal if it was not removed because of the increasing compression on the brain. When Elliot was first diagnosed, the tumor was already the size of a small orange. Doctors decided to surgically remove the tumor, but because some of the tissue around the tumor was damaged, they had to remove part of his frontal lobe.
----
== Elliot’s Neurological Symptoms and Lifestyle Post-Surgery: ==

During Elliot’s physical recovery, he and his family noticed drastic personality changes. Although his intellect, motor skills, and language use remained intact, Elliot had clearly changed since the surgery.

Elliot had trouble getting started in the morning and preparing for work. He had trouble managing his time while at work and could not operate on a schedule. While at work, Elliot had trouble reaching his main goals because he would get caught up in a single task for an unnecessary amount of time. He continually lost sight of his main priorities because of his irrational amount of detail on subsidiary tasks. One could say Elliot had trouble “shifting gears” despite advice and warnings from his employer. He was, expectedly, fired from his job at the business firm and was unable to hold other jobs. Despite Elliot’s intelligence, business background, and warnings from friends and family, he began risky business ventures and ended up in bankruptcy.

He began a collecting habit—but it was a collection of junk. Elliot’s wife divorced him for his foolish decision-making, and he had a brief marriage with another woman (who his family disliked), who also divorced him.

Overall, “his ability to reach decisions was impaired, as was his ability to make an effective plan for the hours ahead of him, let alone plan for the months and years of his future.” (37) Normal people make bad decisions, but Elliot’s behavior was clearly a sign of disease. He could no longer operate as a normal social being, and could no longer live an independent existence.

After surgery, Elliot became emotionally blunted. When one would typically expect an emotional response, he showed none.
----
== Location of Damage (as shown in computerized tomography and magnetic resonance imaging): ==

o Prefrontal damage due to removal of tissue in his frontal lobe

o Damage was more extensive on his right side than left

o Damage on the left side was within the orbital and medial sectors of the frontal lobe

o Damage on the right side was in the same areas, but the white matter (the core of the lobe) on the right side was “destroyed”

o The motor and premotor regions were not damaged

o Language related cortices (Broca’s areas) were not damaged

o Basal forebrain was intact (necessary for learning and memory)

o Temporal, occipital, and parietal regions in both hemispheres were intact
----
== Results of Neuropsychological Tests: ==

IQ was superior

Wechsler Adult Intelligence Scale: no abnormality

Immediate memory of digits was superior

Short-term verbal memory was superior

Visual memory of geometric designs was superior

Rey’s word list (delayed recall) and complex figures were normal

Multilingual Aphasia Examination (assesses language comprehension and production) were normal

Benton’s tests (facial discrimination, line orientation, geographic orientation, 2 &
3-dimensional block construction) were normal

Rey-Osterrieth complex figure-copying task was normal
memory tests with interference procedures were normal (which is interesting because most patients with frontal lobe damage do not perform at that level)

Attention and working memory were intact

Wisconsin Card Sorting Task was normal, even though most patients with similar damage would fail. Elliot was able to “shift gears” in the sorting task even though he could not shift gears in real life.

Making estimates based on incomplete knowledge (using inference) and conjuring up connections unconnected facts using logic were normal. These tasks require normal logical competence, working memory, and attention.

MMPI (personality) generated a valid profile

Answers to ethical dilemmas (social conventions) followed the same principles as examiners

Solutions to hypothetical social predicaments (as well as offering alternative solutions) elicited answers showing no deficit

Task assessing awareness of consequences (of situations where there is temptation to transgress social conventions) was superior

Means-Ends Problem-Solving Procedure (suggesting means to achieve a social goal by offering a series of effective acts leading to the outcome) was superior
Ability to predict social consequences of interpersonal situations was normal

Standard Issue Moral Judgment Interview (developmental stage of moral reasoning) was excellent
----
== Conclusions: ==

“There may be brain disease, but laboratory tests fail to measure significant impairments. The problem here lies with the tests, not with the patients.” (40) Laboratory tests are not representative of real-life series of in-the-moment decisions.

“Elliot’s impeccable performances meant that the usual suspects could not be blamed.” (43)

“Elliot was able to recount the tragedy of his life with a detachment that was out of step with the magnitude of the events.” (44)

'''Reduced emotional affect might play a role in the decision making process.'''
----
== Source: ==

Descarte’s Error, ''A Modern Phinneas Gage''.

Elliot (frontal patient)

Hkirkland — Sun, 27 Apr 2008 20:12:37 GMT

Hkirkland:

[[Category:Neuropsychological profiles]]
'''Elliot (Frontal Patient):
'''

== Elliot’s Lifestyle Prior to Brain Damage:==
Elliot was a good father and husband who held a good job with a business firm. He was smart and had many skills. According to the author, Elliot “had attained an enviable personal, professional, and social status.” (A Modern Phineas Gage, 35) He was in his 30’s.
----
== Elliot’s Medical Symptoms Pre-Surgery: ==

Elliots symptoms first presented as trouble concentrating and headaches. He was diagnosed with a benign brain tumor called a Meningioma, which began growing in the midline area above his nasal passages and eye sockets. “As the tumor grew bigger, it compressed the frontal lobes upward from below.” (35) Although the tumor was benign, it could still have proven fatal if it was not removed because of the increasing compression on the brain. When Elliot was first diagnosed, the tumor was already the size of a small orange. Doctors decided to surgically remove the tumor, but because some of the tissue around the tumor was damaged, they had to remove part of his frontal lobe.
----
== Elliot’s Neurological Symptoms and Lifestyle Post-Surgery: ==

During Elliot’s physical recovery, he and his family noticed drastic personality changes. Although his intellect, motor skills, and language use remained intact, Elliot had clearly changed since the surgery.

Elliot had trouble getting started in the morning and preparing for work. He had trouble managing his time while at work and could not operate on a schedule. While at work, Elliot had trouble reaching his main goals because he would get caught up in a single task for an unnecessary amount of time. He continually lost sight of his main priorities because of his irrational amount of detail on subsidiary tasks. One could say Elliot had trouble “shifting gears” despite advice and warnings from his employer. He was, expectedly, fired from his job at the business firm and was unable to hold other jobs. Despite Elliot’s intelligence, business background, and warnings from friends and family, he began risky business ventures and ended up in bankruptcy.

He began a collecting habit—but it was a collection of junk. Elliot’s wife divorced him for his foolish decision-making, and he had a brief marriage with another woman (who his family disliked), who also divorced him.

Overall, “his ability to reach decisions was impaired, as was his ability to make an effective plan for the hours ahead of him, let alone plan for the months and years of his future.” (37) Normal people make bad decisions, but Elliot’s behavior was clearly a sign of disease. He could no longer operate as a normal social being, and could no longer live an independent existence.

After surgery, Elliot became emotionally blunted. When one would typically expect an emotional response, he showed none.
----
== Location of Damage (as shown in computerized tomography and magnetic resonance imaging): ==

o Prefrontal damage due to removal of tissue in his frontal lobe

o Damage was more extensive on his right side than left

o Damage on the left side was within the orbital and medial sectors of the frontal lobe

o Damage on the right side was in the same areas, but the white matter (the core of the lobe) on the right side was “destroyed”

o The motor and premotor regions were not damaged

o Language related cortices (Broca’s areas) were not damaged

o Basal forebrain was intact (necessary for learning and memory)

o Temporal, occipital, and parietal regions in both hemispheres were intact
----
== Results of Neuropsychological Tests: ==

IQ was superior

[[Wechsler Adult Intelligence Scale]]: no abnormality

Immediate memory of digits was superior

Short-term verbal memory was superior

Visual memory of geometric designs was superior

[[Rey’s word list]] (delayed recall) and complex figures were normal

[[Multilingual Aphasia Examination]] (assesses language comprehension and production) were normal

Benton’s tests (facial discrimination, line orientation, geographic orientation, 2 &
3-dimensional block construction) were normal

Rey-Osterrieth complex figure-copying task was normal
memory tests with interference procedures were normal (which is interesting because most patients with frontal lobe damage do not perform at that level)

Attention and working memory were intact

[[Wisconsin Card Sorting Task]] was normal, even though most patients with similar damage would fail. Elliot was able to “shift gears” in the sorting task even though he could not shift gears in real life.

Making estimates based on incomplete knowledge (using inference) and conjuring up connections unconnected facts using logic were normal. These tasks require normal logical competence, working memory, and attention.

MMPI (personality) generated a valid profile

Answers to ethical dilemmas (social conventions) followed the same principles as examiners

Solutions to hypothetical social predicaments (as well as offering alternative solutions) elicited answers showing no deficit

Task assessing awareness of consequences (of situations where there is temptation to transgress social conventions) was superior

Means-Ends Problem-Solving Procedure (suggesting means to achieve a social goal by offering a series of effective acts leading to the outcome) was superior
Ability to predict social consequences of interpersonal situations was normal

Standard Issue Moral Judgment Interview (developmental stage of moral reasoning) was excellent
----
== Conclusions: ==

“There may be brain disease, but laboratory tests fail to measure significant impairments. The problem here lies with the tests, not with the patients.” (40) Laboratory tests are not representative of real-life series of in-the-moment decisions.

“Elliot’s impeccable performances meant that the usual suspects could not be blamed.” (43)

“Elliot was able to recount the tragedy of his life with a detachment that was out of step with the magnitude of the events.” (44)

'''Reduced emotional affect might play a role in the decision making process.'''
----
== Source: ==

Descarte’s Error, ''A Modern Phinneas Gage''.

Elliot (frontal patient)

Hkirkland — Sun, 27 Apr 2008 20:12:02 GMT

Hkirkland:

[[Category:Neuropsychological profiles]]
'''Elliot (Prefrontal Patient):
'''

== Elliot’s Lifestyle Prior to Brain Damage:
==
Elliot was a good father and husband who held a good job with a business firm. He was smart and had many skills. According to the author, Elliot “had attained an enviable personal, professional, and social status.” (A Modern Phineas Gage, 35) He was in his 30’s.
----
== Elliot’s Medical Symptoms Pre-Surgery: ==

Elliots symptoms first presented as trouble concentrating and headaches. He was diagnosed with a benign brain tumor called a Meningioma, which began growing in the midline area above his nasal passages and eye sockets. “As the tumor grew bigger, it compressed the frontal lobes upward from below.” (35) Although the tumor was benign, it could still have proven fatal if it was not removed because of the increasing compression on the brain. When Elliot was first diagnosed, the tumor was already the size of a small orange. Doctors decided to surgically remove the tumor, but because some of the tissue around the tumor was damaged, they had to remove part of his frontal lobe.
----
== Elliot’s Neurological Symptoms and Lifestyle Post-Surgery: ==

During Elliot’s physical recovery, he and his family noticed drastic personality changes. Although his intellect, motor skills, and language use remained intact, Elliot had clearly changed since the surgery.

Elliot had trouble getting started in the morning and preparing for work. He had trouble managing his time while at work and could not operate on a schedule. While at work, Elliot had trouble reaching his main goals because he would get caught up in a single task for an unnecessary amount of time. He continually lost sight of his main priorities because of his irrational amount of detail on subsidiary tasks. One could say Elliot had trouble “shifting gears” despite advice and warnings from his employer. He was, expectedly, fired from his job at the business firm and was unable to hold other jobs. Despite Elliot’s intelligence, business background, and warnings from friends and family, he began risky business ventures and ended up in bankruptcy.

He began a collecting habit—but it was a collection of junk. Elliot’s wife divorced him for his foolish decision-making, and he had a brief marriage with another woman (who his family disliked), who also divorced him.

Overall, “his ability to reach decisions was impaired, as was his ability to make an effective plan for the hours ahead of him, let alone plan for the months and years of his future.” (37) Normal people make bad decisions, but Elliot’s behavior was clearly a sign of disease. He could no longer operate as a normal social being, and could no longer live an independent existence.

After surgery, Elliot became emotionally blunted. When one would typically expect an emotional response, he showed none.
----
== Location of Damage (as shown in computerized tomography and magnetic resonance imaging): ==

o Prefrontal damage due to removal of tissue in his frontal lobe

o Damage was more extensive on his right side than left

o Damage on the left side was within the orbital and medial sectors of the frontal lobe

o Damage on the right side was in the same areas, but the white matter (the core of the lobe) on the right side was “destroyed”

o The motor and premotor regions were not damaged

o Language related cortices (Broca’s areas) were not damaged

o Basal forebrain was intact (necessary for learning and memory)

o Temporal, occipital, and parietal regions in both hemispheres were intact
----
== Results of Neuropsychological Tests: ==

IQ was superior

[[Wechsler Adult Intelligence Scale]]: no abnormality

Immediate memory of digits was superior

Short-term verbal memory was superior

Visual memory of geometric designs was superior

[[Rey’s word list]] (delayed recall) and complex figures were normal

[[Multilingual Aphasia Examination]] (assesses language comprehension and production) were normal

Benton’s tests (facial discrimination, line orientation, geographic orientation, 2 &
3-dimensional block construction) were normal

Rey-Osterrieth complex figure-copying task was normal
memory tests with interference procedures were normal (which is interesting because most patients with frontal lobe damage do not perform at that level)

Attention and working memory were intact

[[Wisconsin Card Sorting Task]] was normal, even though most patients with similar damage would fail. Elliot was able to “shift gears” in the sorting task even though he could not shift gears in real life.

Making estimates based on incomplete knowledge (using inference) and conjuring up connections unconnected facts using logic were normal. These tasks require normal logical competence, working memory, and attention.

MMPI (personality) generated a valid profile

Answers to ethical dilemmas (social conventions) followed the same principles as examiners

Solutions to hypothetical social predicaments (as well as offering alternative solutions) elicited answers showing no deficit

Task assessing awareness of consequences (of situations where there is temptation to transgress social conventions) was superior

Means-Ends Problem-Solving Procedure (suggesting means to achieve a social goal by offering a series of effective acts leading to the outcome) was superior
Ability to predict social consequences of interpersonal situations was normal

Standard Issue Moral Judgment Interview (developmental stage of moral reasoning) was excellent
----
== Conclusions: ==

“There may be brain disease, but laboratory tests fail to measure significant impairments. The problem here lies with the tests, not with the patients.” (40) Laboratory tests are not representative of real-life series of in-the-moment decisions.

“Elliot’s impeccable performances meant that the usual suspects could not be blamed.” (43)

“Elliot was able to recount the tragedy of his life with a detachment that was out of step with the magnitude of the events.” (44)

'''Reduced emotional affect might play a role in the decision making process.'''
----
== Source: ==

Descarte’s Error, ''A Modern Phinneas Gage''.

Elliot (frontal patient)

Hkirkland — Sun, 27 Apr 2008 20:09:40 GMT

Hkirkland:

[[Category:Neuropsychological profiles]]
'''Elliot (Prefrontal Patient):
'''

Elliot’s Lifestyle Prior to Brain Damage:

Elliot was a good father and husband who held a good job with a business firm. He was smart and had many skills. According to the author, Elliot “had attained an enviable personal, professional, and social status.” (A Modern Phineas Gage, 35) He was in his 30’s.
----
Elliot’s Medical Symptoms Pre-Surgery:

Elliots symptoms first presented as trouble concentrating and headaches. He was diagnosed with a benign brain tumor called a Meningioma, which began growing in the midline area above his nasal passages and eye sockets. “As the tumor grew bigger, it compressed the frontal lobes upward from below.” (35) Although the tumor was benign, it could still have proven fatal if it was not removed because of the increasing compression on the brain. When Elliot was first diagnosed, the tumor was already the size of a small orange. Doctors decided to surgically remove the tumor, but because some of the tissue around the tumor was damaged, they had to remove part of his frontal lobe.
----
Elliot’s Neurological Symptoms and Lifestyle Post-Surgery:

During Elliot’s physical recovery, he and his family noticed drastic personality changes. Although his intellect, motor skills, and language use remained intact, Elliot had clearly changed since the surgery.

Elliot had trouble getting started in the morning and preparing for work. He had trouble managing his time while at work and could not operate on a schedule. While at work, Elliot had trouble reaching his main goals because he would get caught up in a single task for an unnecessary amount of time. He continually lost sight of his main priorities because of his irrational amount of detail on subsidiary tasks. One could say Elliot had trouble “shifting gears” despite advice and warnings from his employer. He was, expectedly, fired from his job at the business firm and was unable to hold other jobs. Despite Elliot’s intelligence, business background, and warnings from friends and family, he began risky business ventures and ended up in bankruptcy.

He began a collecting habit—but it was a collection of junk. Elliot’s wife divorced him for his foolish decision-making, and he had a brief marriage with another woman (who his family disliked), who also divorced him.

Overall, “his ability to reach decisions was impaired, as was his ability to make an effective plan for the hours ahead of him, let alone plan for the months and years of his future.” (37) Normal people make bad decisions, but Elliot’s behavior was clearly a sign of disease. He could no longer operate as a normal social being, and could no longer live an independent existence.

After surgery, Elliot became emotionally blunted. When one would typically expect an emotional response, he showed none.
----
Location of Damage (as shown in computerized tomography and magnetic resonance imaging):

o Prefrontal damage due to removal of tissue in his frontal lobe

o Damage was more extensive on his right side than left

o Damage on the left side was within the orbital and medial sectors of the frontal lobe

o Damage on the right side was in the same areas, but the white matter (the core of the lobe) on the right side was “destroyed”

o The motor and premotor regions were not damaged

o Language related cortices (Broca’s areas) were not damaged

o Basal forebrain was intact (necessary for learning and memory)

o Temporal, occipital, and parietal regions in both hemispheres were intact
----
Results of Neuropsychological Tests:

IQ was superior

[[Wechsler Adult Intelligence Scale]]: no abnormality

Immediate memory of digits was superior

Short-term verbal memory was superior

Visual memory of geometric designs was superior

[[Rey’s word list]] (delayed recall) and complex figures were normal

[[Multilingual Aphasia Examination]] (assesses language comprehension and production) were normal

Benton’s tests (facial discrimination, line orientation, geographic orientation, 2 &
3-dimensional block construction) were normal

Rey-Osterrieth complex figure-copying task was normal
memory tests with interference procedures were normal (which is interesting because most patients with frontal lobe damage do not perform at that level)

Attention and working memory were intact

[[Wisconsin Card Sorting Task]] was normal, even though most patients with similar damage would fail. Elliot was able to “shift gears” in the sorting task even though he could not shift gears in real life.

Making estimates based on incomplete knowledge (using inference) and conjuring up connections unconnected facts using logic were normal. These tasks require normal logical competence, working memory, and attention.

MMPI (personality) generated a valid profile

Answers to ethical dilemmas (social conventions) followed the same principles as examiners

Solutions to hypothetical social predicaments (as well as offering alternative solutions) elicited answers showing no deficit

Task assessing awareness of consequences (of situations where there is temptation to transgress social conventions) was superior

Means-Ends Problem-Solving Procedure (suggesting means to achieve a social goal by offering a series of effective acts leading to the outcome) was superior
Ability to predict social consequences of interpersonal situations was normal

Standard Issue Moral Judgment Interview (developmental stage of moral reasoning) was excellent
----
Conclusions:

“There may be brain disease, but laboratory tests fail to measure significant impairments. The problem here lies with the tests, not with the patients.” (40) Laboratory tests are not representative of real-life series of in-the-moment decisions.

“Elliot’s impeccable performances meant that the usual suspects could not be blamed.” (43)

“Elliot was able to recount the tragedy of his life with a detachment that was out of step with the magnitude of the events.” (44)

'''Reduced emotional affect might play a role in the decision making process.'''
----
Source:

Descarte’s Error, ''A Modern Phinneas Gage''.

Elliot (frontal patient)

Hkirkland — Sun, 27 Apr 2008 20:09:20 GMT

Hkirkland:

[[Category:Neuropsychological profiles]]
'''Elliot (Prefrontal Patient):
'''
Elliot’s Lifestyle Prior to Brain Damage:

Elliot was a good father and husband who held a good job with a business firm. He was smart and had many skills. According to the author, Elliot “had attained an enviable personal, professional, and social status.” (A Modern Phineas Gage, 35) He was in his 30’s.
----
Elliot’s Medical Symptoms Pre-Surgery:

Elliots symptoms first presented as trouble concentrating and headaches. He was diagnosed with a benign brain tumor called a Meningioma, which began growing in the midline area above his nasal passages and eye sockets. “As the tumor grew bigger, it compressed the frontal lobes upward from below.” (35) Although the tumor was benign, it could still have proven fatal if it was not removed because of the increasing compression on the brain. When Elliot was first diagnosed, the tumor was already the size of a small orange. Doctors decided to surgically remove the tumor, but because some of the tissue around the tumor was damaged, they had to remove part of his frontal lobe.
----
Elliot’s Neurological Symptoms and Lifestyle Post-Surgery:

During Elliot’s physical recovery, he and his family noticed drastic personality changes. Although his intellect, motor skills, and language use remained intact, Elliot had clearly changed since the surgery.

Elliot had trouble getting started in the morning and preparing for work. He had trouble managing his time while at work and could not operate on a schedule. While at work, Elliot had trouble reaching his main goals because he would get caught up in a single task for an unnecessary amount of time. He continually lost sight of his main priorities because of his irrational amount of detail on subsidiary tasks. One could say Elliot had trouble “shifting gears” despite advice and warnings from his employer. He was, expectedly, fired from his job at the business firm and was unable to hold other jobs. Despite Elliot’s intelligence, business background, and warnings from friends and family, he began risky business ventures and ended up in bankruptcy.

He began a collecting habit—but it was a collection of junk. Elliot’s wife divorced him for his foolish decision-making, and he had a brief marriage with another woman (who his family disliked), who also divorced him.

Overall, “his ability to reach decisions was impaired, as was his ability to make an effective plan for the hours ahead of him, let alone plan for the months and years of his future.” (37) Normal people make bad decisions, but Elliot’s behavior was clearly a sign of disease. He could no longer operate as a normal social being, and could no longer live an independent existence.

After surgery, Elliot became emotionally blunted. When one would typically expect an emotional response, he showed none.
----
Location of Damage (as shown in computerized tomography and magnetic resonance imaging):

o Prefrontal damage due to removal of tissue in his frontal lobe

o Damage was more extensive on his right side than left

o Damage on the left side was within the orbital and medial sectors of the frontal lobe

o Damage on the right side was in the same areas, but the white matter (the core of the lobe) on the right side was “destroyed”

o The motor and premotor regions were not damaged

o Language related cortices (Broca’s areas) were not damaged

o Basal forebrain was intact (necessary for learning and memory)

o Temporal, occipital, and parietal regions in both hemispheres were intact
----
Results of Neuropsychological Tests:

IQ was superior

[[Wechsler Adult Intelligence Scale]]: no abnormality

Immediate memory of digits was superior

Short-term verbal memory was superior

Visual memory of geometric designs was superior

[[Rey’s word list]] (delayed recall) and complex figures were normal

[[Multilingual Aphasia Examination]] (assesses language comprehension and production) were normal

Benton’s tests (facial discrimination, line orientation, geographic orientation, 2 &
3-dimensional block construction) were normal

Rey-Osterrieth complex figure-copying task was normal
memory tests with interference procedures were normal (which is interesting because most patients with frontal lobe damage do not perform at that level)

Attention and working memory were intact

[[Wisconsin Card Sorting Task]] was normal, even though most patients with similar damage would fail. Elliot was able to “shift gears” in the sorting task even though he could not shift gears in real life.

Making estimates based on incomplete knowledge (using inference) and conjuring up connections unconnected facts using logic were normal. These tasks require normal logical competence, working memory, and attention.

MMPI (personality) generated a valid profile

Answers to ethical dilemmas (social conventions) followed the same principles as examiners

Solutions to hypothetical social predicaments (as well as offering alternative solutions) elicited answers showing no deficit

Task assessing awareness of consequences (of situations where there is temptation to transgress social conventions) was superior

Means-Ends Problem-Solving Procedure (suggesting means to achieve a social goal by offering a series of effective acts leading to the outcome) was superior
Ability to predict social consequences of interpersonal situations was normal

Standard Issue Moral Judgment Interview (developmental stage of moral reasoning) was excellent
----
Conclusions:

“There may be brain disease, but laboratory tests fail to measure significant impairments. The problem here lies with the tests, not with the patients.” (40) Laboratory tests are not representative of real-life series of in-the-moment decisions.

“Elliot’s impeccable performances meant that the usual suspects could not be blamed.” (43)

“Elliot was able to recount the tragedy of his life with a detachment that was out of step with the magnitude of the events.” (44)

'''Reduced emotional affect might play a role in the decision making process.'''
----
Source:

Descarte’s Error, ''A Modern Phinneas Gage''.

Primary somatosensory cortex

Hkirkland — Sun, 27 Apr 2008 19:58:57 GMT

Hkirkland:

[[Image:somatosensory.jpg]][[Category:Brain areas]]
----
'''The Primary Somatosensory Cortex (S1''')

Purpose:

The areas involved are related to touch. Neurons are activated when the skin is stimulated. The somatosensory cortex acts as the end of the sensory pathway.
----
Location:

The cerebral cortex in the parietal lobe houses the primary somatosensory cortex (S1). S1 is located behind central sulcus in postcentral gyrus.
----
History and Basic Anatomy:

Dr. Wilder Penfield was able to construct a map of the human somatosensory cortex in the 1950’s. His strategy was to find a group of patients undergoing brain surgery for epilepsy, stimulate their cortices, and ask the patients what they felt. Through these stimulations, Dr. Penfield was able to observe the parts of the brain that caused the patients to feel sensations on different regions of their bodies. Penfield found that even though one’s arms and trunk make up a lot of the body’s surface area (and, therefore, skin area), not a lot of the primary somatosensory neurons are devoted to these areas. Conversely, the face and hands take up most of the primary somatosensory cortex. This fact makes sense because the amount of cortex devoted to each area is directly proportionate to the density of nerve receptors in those areas. For example, think about how much more sensitive your fingertips are than parts of your legs.
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Organization:

The thalamus projects sensory information first to the most rostral part of the S1 (the areas situated more toward the nasal region, known as Brodmann’s areas 3a and 3b). 3a and 3b then relay information and exchange information with Brodmann’s areas 1 and 2.

Brodmann’s area 3b senses primarily texture, size, and shape, Brodmann’s area 1 receives information about texture, and Brodmann’s area 2 receives information about size and shape.

There is a topographical organization (as Penfield found) to the projection of information from the thalamus to the primary somatosensory cortex. A large region close to the base of the postcentral gyrus is devoted to sensations from the tongue, mouth, and lips. Information from the lower limbs and genitals are arranged along the midline. The fingers, lips, and tongue are well represented within the primary somatosensory cortex.
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Sources:

http://faculty.washington.edu/chudler/brainsize.html

http://www.neurosci.pharm.utoledo.edu/MBC4420/sensory.htm

http://thalamus.wustl.edu/course/bassens.html

http://encyclopedia.com/doc/1O78-somatosensorycortex.html

Controlled oral word association task

Hkirkland — Sun, 27 Apr 2008 19:52:04 GMT

Hkirkland:

[[Category:Neuropsychological methods]]
'''Controlled Oral Word Association Task (COWAT):'''

COWAT Overview:

The COWAT (Benton, 1967) is a cognitive test of verbal processing ability used to assess brain impairment. Verbal processing ability and verbal fluency are considered executive functions. The emphasis on these tests focuses on the degree of discrepancy (as opposed to consistency) between current functioning and an estimated pre-impairment functioning. The COWAT assesses the subject’s ability to spontaneously produce words that begin with specific letters within a certain time limit. In particular, the test uses the letters F, A, and S. Before the test begins, the patient is given a practice trial with a different letter. Other letters may be added to the tests for comparison.
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COWAT’s Applications and Research:

The COWAT has been used to research the process of cognitive aging in accordance with the Frontal Aging Hypothesis (Dempster, 1992). This theory is based on the assumption that deterioration of the frontal lobes during the normal aging process leads to cognitive impairment similar to patients who have lesions in their frontal lobes. Since the frontal lobes are involved in executive functioning, the COWAT has been used as one measure of this functioning in the elderly. Research has shown that one should take caution when administering the COWAT to evaluate older people’s level of executive functioning for the Frontal Aging Hypothesis. This caution is due to arguments that executive functioning might not be one single mechanism; rather, it is possible that there are independent executive abilities. As a result, the COWAT alone as an assessment of executive functioning may not be an accurate representation of executive decline.

The COWAT has been used in searches for differential diagnoses for dementia. The COWAT has been used to collect normative data from a range of subjects to establish norms for age, gender, education level, etc. Normative data allows for comparison with other neuropsychological tests that evaluate word knowledge and speed of verbal processing to examine the interrelationship between the instruments. Other applications include measuring cognitive impairment due to Wilson’s Disease, HIV, drug addiction.
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Sources:

http://usq.edu.au/users/senior/Posters/JCordellPoster.htm

Rodrigues-Aranda, C., & Sundet, K. (2006) The Frontal Hypothesis of Cognitive Aging: Factor structure and age effects on four frontal tests among healthy individuals. The Journal of Genetic Psychology, 167(3), 269-288.

Kluver-Bucy syndrome

Hkirkland — Sun, 27 Apr 2008 19:46:36 GMT

Hkirkland:

[[Category:Neuropsychological syndromes]]

'''[[Kluver-Bucy Syndrome]]'''
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Overview:

A rare neurological disorder occurring in humans and Rhesus monkeys (much more common in animal subjects). The full syndrome is rarely found in humans. Individuals put objects into their mouths and engage in inappropriate sexual behavior.
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Other symptoms may include:

[[Visual agnosia]] (inability to visually recognize objects), loss of normal fear or anger responses, distractibility, memory loss, dementia, seizures, hypersexuality, hyperorality, altered emotional behavior, or “psychic blindness.�? (is this the same as visual agnosia??)
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Possible causes:

Head trauma and herpes encephalitis are the most common causes of the condition.
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History:

In 1937, Heinrich Kluver and Paul Bucy performed surgery on Rhesus monkeys, removing the temporal lobe on both sides to determine its function. The monkeys immediately developed altered sexual behavior (dramatic increase of overt behavior), emotional changes, and visual agnosia. Oral tendencies (hyperphagia) and hypermetamorphosis (desire to explore everything in their surroundings) were also present. The monkeys were more likely to examine the world with their mouths instead of their eyes, perhaps because the visual agnosia caused familiar objects and their uses to be unrecognizable. The monkeys lost fear when it would normally be acceptable and expected (known as placidity). In humans, the hypersexuality is not as intense as seen in animals.
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Etiology:

Kluver-Bucy Syndrome is considered a direct consequence of bilateral anterior temporal lobe damage resulting from either injury or disease. However, lesions of the amygdala have elicited similar symptoms. Clinicians are required to document the clinical features mentioned above, as well as to prove that a bilateral lesion exists in the anterior temporal lobe or the amygdala. However, lesions are not necessary in the amygdala for KBS symptoms to exist. There have been 2 cases where neither of these regions showed damage in brain images, suggesting that KBS may involve some disruption of circuitry in the limbic areas, where mediodorsal thalamic relay occurs. All of the cases involving children were due to herpes encephalitis
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Research:

KBS may resopond to carbamazepine treatment (antipsychotic pharmaceuticals), but management is challenging. In some cases, research has shown antipsychotics resulted in clinical improvement. The cases of KBS that do not have apparent brain lesions could help develop a better functional understanding of the condition.
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Case Study available at:

http://images.google.com/imgres?imgurl=http://www.medscape.com/content/2002/00/44/43/444337/art-444337.fig.jpg&imgrefurl=http://www.medscape.com/viewarticle/444337_2&h=408&w=400&sz=40&hl=en&start=1&sig2=DaCfl40R9mMD-1fL3oLxDg&um=1&tbnid=VDs1UTzJ0b-NHM:&tbnh=125&tbnw=123&ei=9CrxR6P3MaWkgQLA-4iPDA&prev=/images%3Fq%3Dkluver-bucy%26um%3D1%26hl%3Den%26safe%3Doff%26client%3Dsafari%26rls%3Den%26sa%3DN
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Sources:

http://images.google.com/imgres?imgurl=http://www.medscape.com/content/2002/00/44/43/444337/art-444337.fig.jpg&imgrefurl=http://www.medscape.com/viewarticle/444337_2&h=408&w=400&sz=40&hl=en&start=1&sig2=DaCfl40R9mMD-1fL3oLxDg&um=1&tbnid=VDs1UTzJ0b-NHM:&tbnh=125&tbnw=123&ei=9CrxR6P3MaWkgQLA-4iPDA&prev=/images%3Fq%3Dkluver-bucy%26um%3D1%26hl%3Den%26safe%3Doff%26client%3Dsafari%26rls%3Den%26sa%3DN

http://ninds.nih.gov/disorders/kluver_bucy.htm
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Organizations:
National Organization for Rare Disorders (NORD)

http://www.rarediseases.org

Primary somatosensory cortex

Hkirkland — Sun, 30 Mar 2008 23:46:56 GMT

Hkirkland:

[[Image:somatosensory.jpg]][[Category:Brain areas]]

File:Somatosensory.jpg

Hkirkland — Sun, 30 Mar 2008 23:44:55 GMT

Hkirkland: Cartoon illustration of Primary Somatosensory Cortex locations and functions

Cartoon illustration of Primary Somatosensory Cortex locations and functions