Neuropsychological disorders

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					Neuropsychological disorders
• Disorders of the nervous system • 2 main causes
– Progressive neurological illness – Head injury
• Closed vs. open

• In most cases damage is permanent

Testing for neurological damage
• Neuropsyche tests
– Test for functional ability

• Psychomotor tests
– Fingertapping, pegboard

• Memory tests
– WMS – California Verbal Learning Test

• Visual/Spatial Tests
– Bender-Gestalt

• Executive Functioning
– Stroop – Wisconsin Card Sort Test – Trailmaking A&B

• Language
– Boston Naming Test

Stroop
•

Uses of neuropsychological testing
• Comparison with norm • Comparison with general cognitive ability
– Memory vs. IQ

• Comparison with self across time
– Base rate…see progression of illness

Common problem symptoms
• Memory loss (particularly anterograde) • Speech disturbances
– Aphasia

• Motor symptoms
– Ataxia/apraxia – dyskinesia

• • • • •

Hemispheral neglect Planning/executive functioning disturbances Agnosia/prosopagnosia Mood disturbances Paranoia in some cases

Closed head injuries
• • • • • Blunt force trauma injury Coup/contra coup injuries Hematoma Microshear Mixed with alcohol

Open (Piercing) Head Injuries
• More immediate structural damage
– Partial ablation of brain

• Less risk of hematoma

Toxin Exposure
• EtOH
– Karsikoff’s syndrome
• • • • Anterograde anmesia/confabulation Fine motor tremors/apraxia Dyskinesia Confusion

• Lead, mercury, other heavy metals, some pesticides linked with dementia

Diseases and brain damage
• Diseases that cause permanent brain damage include
– – – – – – – – Encephalitis Rubella (in mother) CMV (in mother) HIV Syphilis (untreated) Polio (almost non-existent in US) PKU (and other inherited metabolic diseases) Pertussis, measles, mumps, chicken pox carry small risks of permanent brain damage – Any infection resulting in sustained high fever

Dementia
• Progressive cognitive decline
– Memory deficit – Aphasia – Apraxia – Paranoia – Loss of executive functioning – Progressive drop in IQ

Alzheimer’s Disease
• May be cluster of related illnesses
– Causes progressive brain tissue damage – Most common cause of dementia – 5-10 year illness span – Neurofibrillary tangles – Amyloid plaques – Cell death in cortex and hippocampus

Alzheimer’s Etiology
• High heritability index
– Probably related to problems controlling amyloid proteins in brain – The “Nun Study” and chromosome 19

• Treatments (no cure)
– Cholinesterase inhibitors
• Prevent breakdown of Acetylcholine • Aricept, Exelon, liver damage is a risk

– Memantine (Namenda)
• Affects glutamate • Recently declined by FDA for “mild” Alzheimer’s

– Vitamin E

Vascular Dementia
• CVA/aneurysm
– Sudden onset – Hemispheric weakness – Sudden confusion, numbness, dizziness vision problems (1 or both eyes) – Sudden onset severe headache – Seizure

• Immediate treatment is key
– Tissue Plasminogen Activator “clotbuster”

• Prevention = anticoagulants
– Warfarin, Heparin common – Cause birth defects (including MR) – If hemorrhagic stroke occurs, can make it worse

• Symptoms recovery in short term

Carotid Occlusion
• Stenosis of internal carotid arteries • Waxing and waning periods of dementia • More treatable than other dementias
– Intracranial bypass Surgery

Parkinson’s Disease
• Progressive decline of dopamineurgic centers
– Gait problems – Initiation of movement – Dementia in some cases – L-Dopa

Multiple Sclerosis
• Cluster of illnesses…all involve demyelization
– Genetic, autoimmune, toxin exposure – Measles, herpes, chlamydia

• Symptoms: weakness, confusion, memory loss, numbness, pain, dizziness, fatigue
– Relapsing-remitting type

• Treatment: no sure. Common treatments include interferon-based agents (Avonex, Betaserone)
– Viral replication interference agents – Can cause depression, anemia, liver damage, heart problems, thyroid damage