Lecture 2: History of Clinical Neuropsychology

mi-am bagat picioarele in capitol

clinical neuropsychological disorder

1. Condition that arises directly from abnormalities/dysfunctions within the brain's biological structures and processes

2. Condition that is shaped and defined by social, cultural and environmental contexts

 

Clinical neuropsychology both establishes phenomena and finds mechanistic explanations for them.

Clinical neuropsychology is shaped by philosophical and scientific angles, careful observation from case studies, development of systematic assessment.

history overview

antiquity

Antiquity (500 BCE – 500 CE): philosophy and empiricism

Aristotle: highly influential thinker; "heart is the seat of intelligence", "brain cools the body", compared different animals

Hippocrates: father of modern medicine, "brain is for mental functions", pioneered lesion observations

Claudius Galen: pioneered dissection and comparative anatomy in mammals, mapped ventricular system ("animal spirits") and nerves, "morosis" (dementia)

neuropsychology before the Renaissance

gross anatomy established, some idea that the brain is important for mental function, no specific theory of brain-behaviour relationships.

Little progress because of: notion that the soul had no physical basis, forbidden to experiment on humans, scientific method not fully established, exchange of ideas limited

Renaissance

Renaissance (1400–1700): scientific method! soul gets localised!

Vesalius: founder of modern human anatomy, systematic human dissections, detailed descriptions and drawings, corrected Galen's anatomical errors

René Descartes: shaped mind-body dualism, viewed body as a machine, influenced empirical physiology

Franz Joseph Gall: shaped idea of localisation, developed phrenology.

neuropsychology before the 19th century

more knowledge about structure of brain, relationship between brain and behaviour still unclear, no conceptual framework tying both together, views heavily influenced by religion and politics

neuropsychology in the 19th century

Neuropsychology in the 19th century: brain mapping! Language areas!

Paul Broca: established methods of behavioural observation and post-mortem anatomy; identified a critical area of language production

Monsieur Leborgne: patient of Paul Broca, severely affected language production: aphasia; good language comprehension; lesion in left frontal lobe (Broca's)

Carl Wernicke: identified critical area for language comprehension (left superior temporal gyrus), established idea of disconnection aphasia.

Fransiscus Donders: Dutch ophtalmologist, simple choice and go/no go reaction time tasks, subtraction method

John Hughlings Jackson: British neurologist, studied mostly epilepsy, Jacksonian March (type of simple focal aware seizure that begins in one small part of the body—typically the hand, foot, or face—and "marches" or spreads to adjacent areas); hierarchy in nervous system; higher brain regions control and inhibit lower ones; positive and negative symptom distinction

neuropsychology in the 20th century:

20th century: development of Neuropsychology tests, guns (?), strict localisation fades away

Guns and rifles: WW1,2: large-scale Npsy assessment

• Army Alpha, Army Beta: the first widely administered group intelligence assessments, used to classify 1.5–1.75 million World War I recruits

• Trail Making Test, Wechsler IQ

WW2: high velocity weapons, better healthcare; generation of brain-injured patients, studying brain-behaviour relations

Aleksandr Luria: studied soldiers with brain injuries, pioneered systems view of brain function, developed a comprehensive assessment battery, rehabilitation protocols for brain injury

Jerry Fodor: philosopher, huge influence on cognitive science, neuroscience, AI; proposed idea of modularity of mind:

Brenda Milner: uncovered brain basis of memory through work with HM, established dissociations between different aspects of memory (STM vs LTM; procedural vs declarative)

Aleksandr Luria

Luria's functional units: see picture

Luria's hierarchical organisation: hierarchical processing within each functional unit

• Primary zone: input

• Secondary zone: processing

• Tertiary zone: integration other areas

Jerry Fodor

• Characteristics of modules:

  • Process only specific inputs

  • Operate automatically

  • Are informationally encapsulated

  • Process information quickly

  • Have fixed neural architecture

• Different systems:

  • Input systems: modular (perception, language)

  • Central systems: not modular (reasoning, decision making)

neuropsychology after the 20th century

Fodor and Luria complementary perspectives on brain function (Fodor: useful for what broke and why; Luria: what to do next) - still debated: localisation vs plasticity;

present day neuropsychology

diaschisis, compensation, individual differences, cognitive reserve

diaschisis

Diaschisis = brain injury/disease may have more widespread effects:

• Differences in organisation may influence information processing streams

• Connections may affect transfer between areas (axonal lesions)

• Differences in synchronisation may affect communication

compensation

test performance doesn't necessarily reflect disrupted processing of a damaged mechanism; tasks can be performed using different strategies; patients can learn to adapt (use diff pathways to perform the same task)

individual differences

variation in typical brain anatomy and physiology (Broca's cannot be identified on the basis of morphology in 20% of typical population, despite typical language function)

cognitive reserve

way of explaining individual differences

• Brain reserve: structural capacity

• Cognitive reserve: how flexibly and efficiently the brain is used; shaped by life experiences (education, occupation, leisure activities):

  • Neural reserve: efficiency of existing networks

  • Neural compensation: recruitment of alternative networks when primary ones fail

dark history🥀

 experimentation without consent, using experimental medical procedures, racial and class judgement, misuse of assessments

We should: informed consent, independent ethical review, monitored guidelines for introducing new treatments, more inclusive research, incorporating theories from other disciplines and cultures