Term
| Deficit, dysfunction, impairment, symptom, disorder |
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Definition
| used synonymously, refer to any motor, sensory, perceptual, behavioral, psychological, emotional, or cognitive abnormality |
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Definition
| group of symptoms that characteristically occur together after brain damage |
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| base word prefixed with 'a-' |
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Definition
| absence of root word function, i.e. agnosia; not always strictly adhered to, sometimes SHOULD be 'dys-' but called 'a-' anyway |
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| base word prefixed with 'dys' |
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Definition
| partial impairment of root word function, i.e. dyslexia |
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| How can you specify among broad categories like 'agnosia'? |
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| By using antecedent descriptor words, as in 'visual agnosia'--doesn't know (agnosia) what they're seeing, or 'dressing dyspraxia or apraxia' can't dress (a form of work/function) properly or at all |
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| 'achievement or performance' |
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| affecting both hemispheres |
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| contralateral/contralesional |
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Definition
| opposite side; i.e. lesion on LEFT hemisphere affecting RIGHT harm function |
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| damage in a circumscribed area of the brain, often as a result of stroke or intracerebral hematoma or neurosurgical removal of debris, tumor, or damaged brain tissue; leaves rest of brain intact and unaffected |
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| area of dead brain tissue |
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Definition
| affects many areas of brain, visible on scans and in autopsies as atrophy; happens with dementias, meningitis, etc. |
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| swelling near site of tissue damage that temporarily inflates/increases areas of dysfunction, also water/fluid in white matter; when the swelling goes down, impairments are dramatically reduced, but enough swelling can kill someone by choking their brainstem |
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| The study of diseases. That is, the structural changes in organs caused by disease |
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| A biological process causing pathology in organs and illness in individuals |
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| a disease from trauma is: |
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Definition
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| a cerebrovascular disease is caused by: |
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Definition
| loss of blood supply or bleeding from blood vessels in the brain |
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| a nutritional disease is caused by: |
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Definition
| some dietary issue, usually a vitamin deficiency |
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| a metabolic disease is caused by: |
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Definition
| altered body chemistry or metabolism, like hypothyroidism |
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Term
| a developmental brain disease is: |
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Definition
| failure of the brain to develop normally, usually in utero |
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| due to circumstances surrounding birth, such as injuries to the brain; i.e. cerebral palsy |
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| dysfunction in immune system, in brain the problem is usually inflammatory damage |
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| 'new growth'; with brain diseases this is a brain tumor |
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| An instance (or ‘case’) of a disease in a specific individual |
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| The effect of an illness as noted by the patient or clinician |
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| Complaint reported by the patient (e.g. headache, numbness) |
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| Abnormality elicited during examination (e.g. a dilated pupil or abnormal reflex) |
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| A constellation of signs and symptoms that is characteristic of a given disease or localisation of pathology. (e.g. hemispatial neglect, aphasia) |
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| An illness developing over a short period of time |
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| A gradually developing and/or long standing illness. Either progressive (e.g. dementia); or an illness that begins acutely by leaves permanent sequelae that leaves the patient with a chronic illness |
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Term
| Stages of the behavioural neurology consultation: |
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Definition
History
Neurological Examination
Mental Status Examination
Review of neurodiagnostic studies including brain scans
Diagnostic formulation
Recommendations for further studies and management |
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Definition
| What is troubling the patient, carer and referring doctor. |
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| History of Present Illness |
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Definition
| A sequential account of the symptoms. Based on reports of the patient, other informants and review of available records. |
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| Illnesses in other family members that might be relevant |
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| Education, vocational and domestic information |
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| Exam that attempts to elicit neurological signs that aid in localisation of the lesion(s) |
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| Aspects of Mental Status Examination |
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Definition
| General Presentation, Orientation, Concentration, Memory, Simple Arithmetic, Speech and Language, Visuospatial, Reasoning, Inhibitory Control |
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| Impressions of the patient’s presentation: Alertness, appropriateness, and insight into circumstances. Mood, eye contact, tone of voice. Dress and grooming. Level of cooperation social engagement. |
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| Does the patient know where he is, what day it is, why he is here? |
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| Digit span – forward and backward. (There are norms for this; but a rule of thumb – Normal adults can remember at least 6 digits forward and backward can recall no less than 3 of the forward digit span.) Recite the months of the year forward and backward. Count backward from 20 by 3s. |
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Definition
| Ask the patient to repeat 3 or 4 items and then ask the patient to remember them. At the end of the examination, ask the patient what the items were. If the patient does not recall all of them, give a list of items to choose from and see how many the patient can recognise. |
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Definition
| Have them complete simple math problems |
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| Spontaneous speech, comprehension (e.g. following simple commands), object naming, repetition, reading, writing. |
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| Drawing and copying simple shapes and pictures. e.g. Necker cube |
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Definition
| Broken Window picture. Proverb interpretation. Similarities (how are a chain and a table alike? A fly and a tree?). If you found a letter on the street that was sealed and addressed and had a stamp, what would you do with it”. (Look for the owner or give it to a policeman are not examples of good reasoning.) |
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Definition
| See if they can stop producing a response they have been giving when indicated or get stuck on recent stimuli, go-no go task i.e. I tap once, you tap twice; I tap twice, you tap once”, or ask the patient to place the hands on a clock so that the clock tells “ten minutes after eleven”. Patients with impaired inhibitory control will, after drawing the small hand pointing to the 11, may have their attention captured by the number 10 and then draw the minute hand pointing to the 10 instead of the 2. |
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Term
| What is included in diagnostic formulation? |
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Definition
| Localisation, aetiology, and functional disability |
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| What is included in the review of neurodiagnostic studies? |
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Definition
| Brain scans (MRI or CT), previous psychometric results, EEG, lab results including spinal fluid labs |
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| What is included in recommendations? |
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Definition
Further studies (scans, psychometric assessment, etc)
Capacity assessment e.g. to live independently, to manage own affairs, vocational (return to work?) or educational (retraining?), to make safe choice about where to live or the medical care they need, to answer charges and participate in their own defence.
Medication if any
Other therapies if any i.e. occupational, physical, cognitive re-training, etc. |
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Definition
| What brain areas are affected |
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| What disease process is responsible for symptoms (if any) |
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Term
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| An assessment of the specific deficits of mental function and preserved functioning |
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| Which recommendations can be deferred if more assessment is necessary? |
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Definition
| Capacity, Medication, and Other Therapies |
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Term
| Major categories of brain diseases |
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Definition
| Developmental, Congenital, Traumatic Brain Injury, Cerebrovascular Disease, Infectious, Demyelinating, Toxic/Metabolic |
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Term
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Definition
| Virus, bacteria, or fungus damaging the brain |
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Definition
| Disease, usually the result of an immune system problem, that causes inflammation that then damages the myelin surrounding axons that transmit information between nerve cells, e.g. multiple sclerosis |
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Term
| Toxic/Metabolic brain disease |
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Definition
| Brain injury as a result of nutritional deficiencies, toxins (such as alcohol), or systemic disorders of the endocrine system (e.g. thyroid), liver, or kidneys that results in accumulation of neurotoxic substances in the blood stream |
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Term
| Degenerative brain disease |
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Definition
| Diseases (some genetic but most now of unknown cause) that result in progressive death of neurons. Examples include Parkinson’s disease (degeneration of the basal ganglia) and Alzheimer’s disease (degeneration of the cerebral cortex). |
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Definition
| Abnormal electrical activity causing brain dysfunction due to seizures. These can be secondary to some other brain disease like previous stroke, trauma or brain infection. |
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Definition
| How you identify a patient's deficits, possible lesion locations, etc. with testing |
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Term
| What do clinical neuropsychologists do? |
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Definition
Assess neurological patients (assist in diagnosis and track function over time)
Design, implement, and manage rehabilitation programmes
Educate professionals, patients, and patient's families on the effects of brain damage and disease on mental apparatus |
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Term
| Clinical sciences allied to neuropsychology |
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Definition
| Neuroanatomy/neuroradiology, neuropathology, clinical neurology |
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Term
| What do clinical neuropsychologists need to know? |
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Definition
| Neuropsychological deficits, how they map onto the brain, and how to test in a way that reveals deficits |
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| How was neuropsychological assessment approached at first? |
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Definition
| Very quantitative, heavy on psychometrics with strict cutoffs that were regarded as indicating 'organic' or 'functional', psychometrician instead od neuropsychologist, no history or medical information used, no tailoring of assessments to patients, strict grouping of results into diagnoses |
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Term
| Problems with how neuropsychological assessment was initially approached |
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Definition
| The 'hit rates' that identified success or failure vary by population, hard to accurately standardise. No allowance for patient compensation for other problems. Major problems with misdiagnosis. Numerous reasons to fail a test and no consideration of HOW a person failed. Tests were supposed to map onto specific brain areas but were not effective at identifying lesion placement. Lack of attention to how or why a patient performed as they did meant that it was impossible to predict performance on a different test |
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| Why use Verbal & Performance IQ tests like in the WAIS-R? |
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Definition
| To predict the laterality of lesion |
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| What is a problem with using VIQ/PIQ performance to predict the laterality of a lesion? |
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Definition
| It is not targeted enough because it measures the brain, which can be compromised without a lesion |
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Term
| What does alcoholics' poorer performance on PIQ versus VIQ illustrate? |
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Definition
| That you can fail a test for more than the reasons expected in the construction of a test. Alcohol doesn't selectively damage the right hemisphere as would be predicted, the PIQ tests are all timed and only one VIQ is timed, and that is what causes this effect. |
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Term
| Why, other than having a unilateral lesion, would a person have a PIQ-VIQ difference? |
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Definition
| PIQ is timed and involves responding to new problems, so if you have slower psychomotor speed for any reason you'll do more poorly. The two focus on crystallized versus fluid intelligence so factors affecting these also bias the test. |
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Term
| What are the main problems of a quantitative approach? |
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Definition
Brain scans now often show the lesions of the kind that these tests try to locate.
The tests use ignore useful information like patient history and the WAY a patient fails or passes a test. |
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Term
| What is useful about quantification? |
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Definition
| It is important to know what is normal and abnormal in the population, to keep track of progress over time, and to establish pre-morbid intelligence. |
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Term
| What is pre-morbid intelligence necessary for? |
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Definition
| To contextualise ENTIRE assessment; more significant for some functions than others |
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Term
| What is a problem with many tests used to assess neurological patients? |
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Definition
| Control groups for normalisation. Many are validated against only a small control group, no neurological controls, only a few have a large sample of controls, which means that a patient who is only moderately bad may actually fall within normal range. |
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| What are some measures of 'failing' a measure? |
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Definition
More than 2 standard deviations below mean
Worse than worst control subject
Lowest 5th percentile |
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| What is the problem with a narrow pass/fail? |
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Definition
| It creates a zone of possible vs. definite failure, and reasons for failure that the test was not attempting to measure can confound the results |
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| Why can't you rely on the pass/fail indicated by the test? |
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Definition
| Because premorbid intelligence/capabilities plays a role as well. A brilliant person may still pass a test while still being very diminished in that capacity compared to before the damage. |
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| Why are there many tests that cover the same function? |
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Definition
| Because those functions work differently in different contexts, and assessing them in multiple ways both strengthens your evidence and narrows down/specifies your diagnosis. Also, one bad day/test shouldn't set the whole diagnosis and treatment. It's important to be confident that test failure is because of a deficit in the area tested. |
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| Why give parallel versions of the same test multiple times? |
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Definition
| Most people improve on retakes; if your patient isn't, that's a red flag right there. Also, it can clarify a marginal score. |
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| What is the basis of the more qualitative approach usually used now? |
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Definition
| Test->Psychological Function->Anatomy |
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| What are some of the difficulties with the newer, more qualitative approach? |
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Definition
Not all psychological functions are clearly mapped on the brain.
Understanding which tests measure which functions and how performance on those tests indicates function is complicated, especially considering that functional impairments will manifest in both testing and everyday life. |
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| What are some strengths of the more qualitative approach? |
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Definition
| It allows for hypothesis testing. When you think you know what part of the brain is damaged or what particular problem is going on, you can verify or disprove that hypothesis by administering other tests that would be related to that issue and thus confirm diagnosis or avoid wasting time and disheartening patients with incorrect diagnoses. |
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| How does one choose which tests to administer? |
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Definition
| Based on the patient's history and their presenting symptoms, and give a cursory examination of their other mental functions just to get a full picture and not miss anything obvious. You can best hone in on the problem when you start the more intensive investigation with a known complaint. Change test selection based on the implications of the tests you've already given instead of sticking to an unsupported hypothesis. |
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| Should you always give the test as written and indicated by its materials? |
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Definition
| No. Tailor a test to get the most informative results from your patient. You know more when you let a patient continue well beyond time frame than when you cut them off at the limit, i.e. CAN they do it, but just slowly? Or not at all no matter how much time they have? Are they failing because it involves drawing and their arm is paralyzed? Sometimes you need to alter a test to make sure the patient understands it. Give them every opportunity to perform or you aren't actually testing their functioning in this area. |
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Term
| Are there neuropsychological tests? |
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Definition
| No. There are only psychological tests that neuropsychologists often use. There IS a difference because failing them does not necessarily mean 'organicity'. |
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Term
| What does neuropsychological assessment involve? |
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Definition
Examining REASONS for test failure (or underperformance)
Examining the PATTERN of test performance
Considering the above in CONTEXT with THIS PATIENT |
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| What are the steps of hypothesis generation? |
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Definition
Think about the complaint (look for functional impairment)
Suggest possible lesion sites (based on functional impairment)
Consider what disease types could cause this impairment/damage to suggested sites |
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Term
| What should you look at when making a diagnosis in addition to your own results? |
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Definition
| Medical history, i.e. referral letter, medical records, surrounding circumstances, demographics, family and patient reports |
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| Why is it important to know how structures in the brain are related in space and vascularisation? |
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Definition
| Because sometimes a patient will not report all of their problems or even be aware of them, but still be affected, and you can track down these other issues when you map the geography of the damage, i.e. patient with basilar artery stroke causing occipital lesion (and thus visual field deficit) also was depressed because she was AMNESIC (posterior cerebral artery to hippocampus served by basilar artery!) but never mentioned the verbal memory impairment because the visual field deficit was more obvious and she was only ever asked about that problem. --DETAILED HISTORY is CRITICAL |
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| How do you know when your hypothesis is strong enough to be a diagnosis? |
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Definition
| When you have run tests to confirm/disprove and the pattern of test failure and success fits with your proposed model and fits with the description of everyday deficits. |
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Term
| Why might a patient with memory problems become depressed? |
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Definition
They may worry about a degenerative condition like dementia or Alzheimer's disease.
They may worry that it is the onset of aging that will prevent them from being independent.
They are likely to have experienced repeated failure due to forgetting things and repeating actions, conversations, confusion, etc. |
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Term
| Why is it important to give an accurate diagnosis? |
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Definition
| It is necessary for the patient to understand their actual deficits and prognosis, as well as to implement strategies to cope with those deficits. |
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Term
| When your hypothesis is disproved, what do you do? |
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Definition
| Backtrack, look at all the results you've gathered, and retest and rethink until you have a new testable hypothesis that fits the data you have thus far. |
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Term
| What might be going on if you are having a really difficult time localising a lesion? |
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Definition
There may be more than one lesion.
It could be pseudo-neurological (hysteria, malingering)
You may need to seek more information (people or books) for this case; it may just be something that you haven't seen before but has been noted elsewhere. |
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Term
| What is important to keep in mind regarding pseudo-neurological disorders? |
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Definition
Usually a diagnosis by exclusion; you may have missed something, especially since new neurological disorders are being discovered constantly.
'Sub-optimal' effort--but even here, be careful because many things contribute to sub-optimal effort. |
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Term
| What comes after diagnosis? |
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Definition
| Treatment plan. Sometimes the easiest diagnosis can have the most difficult treatment plans. |
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| What are some problems that can arise when formulating treatment plans? |
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Definition
| Sometimes the prognosis isn't very good and people are unlikely to get any better. Sometimes it is difficult to make patients understand their deficits. It can be a challenge to make patients and their families understand the full impact of a diagnosis and change their expectations for a difficult future without destroying their hope or leaving them depressed. |
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