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Editors

MarjaHietanen

Neuropsychological Disorders

Essentials

  • The regulation of cognitive functions, i.e. information processing functions and behaviour, is based on the activity of extensive, constantly changing neural networks.
  • A neuropsychological disorder means a change in an individual's cognitive performance, i.e. information processing, behaviour and emotion regulation.
  • The nature of the disturbance depends on where in the regulatory network the damage or weakness in brain function is situated.
  • Neuropsychological disturbances may appear as changes varying in severity, be transient or stable in a certain restricted function or wide in scope, covering several cognitive functional areas.

General neuropsychological symptoms

  • Often appear in the acute phase of disease.
  • Affect cognitive performance generally.
    • Fatigability
    • Changes in concentration
    • Slow processing

Specific neuropsychological disorders

Verbal dysfunction or aphasia

Disorders of reading, writing and arithmetic

  • Various degrees of dysfunction in skills that were already learned, not resulting from factors such as decline in visual acuity, impaired motor control or limited education
  • Reading and writing difficulties often appear in association with other verbal disorders (such as aphasia) but they may also be associated with nonverbal neuropsychological symptoms.
  • In addition, they may appear as what are called primary specific learning disorders.

Disorders of visual perception

Visual agnosia

  • Difficulty recognizing and interpreting visual information
  • May appear as a general disturbance in observing objects or be restricted to the observation of certain objects, such as faces, letters or colours.

Disorders of spatial perception

  • Difficulty in (relative) spatial perception
  • May appear as difficulty in
    • determination of position, estimation of direction and distance
    • perceiving the environment.

Visuoconstructive disorders

  • Difficulty in combining parts into an entity, which requires several cognitive functions, such as spatial perception, planning skills / executive functions and motor functions.
  • May appear as a result of several different disturbances in cognitive function and disturbances in several brain areas.

Disorders of voluntary movements, apraxia

  • Apraxia is a disorder of voluntary movement not explained by difficulties in motor or sensory functions or problems associated with the general cognitive state.
  • The most common disorder is apraxia of the arms or facial area.
  • Appear in areas such as the use of objects and production of movements/postures.

Memory disorders

  • See Memory Complaints, Mild Cognitive Impairment and Dementia.
  • Memory problems are among the most common cognitive symptoms in neurological patients.
  • Memory function may be disturbed by many reasons, including non-neurological ones.
  • Memory consists of many partial systems working together in parallel. Memory processing proceeds in stages.
  • Memory may be lost specifically in various parts of the memory system or at various stages of the memory process.
  • The type and severity of the memory disorder depend on what area of the brain is damaged.
  • Memory disorders may vary from slight problems with memorizing to considerable disturbance of episodic memory.
    • Amnesic syndrome represents extensive anterograde loss of episodic memory that may be either partial or complete, transient or permanent, stable or progressive.

Disorders of attention

  • Attention depends on many factors, such as alertness, motivation, mood, legal and illegal drugs, strain, age and skill level.
  • Disorders of attention are common in patients with neurological diseases and injuries.
  • They may become manifest in the direction, maintenance or sharing of attention or in selective attention.

Stimulus neglect

  • Difficulty noticing and reacting to stimuli in the field of function and perception opposite to the brain damage
  • More common in patients with lesions in the right hemisphere
  • Most common in the area of visual perception (visual neglect)
  • May also affect the perception of auditory (auditory neglect) or tactile (tactile neglect) stimuli.
  • In addition, there may be personal neglect of one's own body.
  • The symptoms often include other neuropsychological disturbances, such as visual memory problems, visuospatial or visuoconstructive problems or deficient awareness of symptoms or executive functions.

Disorders of executive functions

  • Executive functions are processes connecting single events in information processing into complex, target-oriented action, and flexible regulation and change of such action depending on the circumstances and feedback.
  • The anterior frontal lobe with its subcortical pathway connections is essential.
  • Disorders of executive functions may appear in the areas of
    • initiative and motivation
    • control of behaviour
    • controlling information processing.
  • Disorders of executive functions emerge more clearly in unusual and new situations than in routine tasks, and they may affect other cognitive functions secondarily.

Damage to the left hemisphere

  • In right-handed individuals and in many left-handed ones, the left hemisphere of the brain is dominant.
  • Disorders of verbal function
    • Difficulties in speech production, repetition or reception
  • Disorders of verbal conceptional skills
    • Difficulties in conceptual thinking
    • Difficulties in naming
  • Disorders of reading, writing and arithmetic
  • Difficulties in verbal memory
  • Difficulties in voluntary control of the arms, or apraxia
  • Difficulties in visuoconstructive functions

Damage to the right hemisphere

  • Difficulties in visual perception
    • Visuoconstructive difficulties
  • Difficulties in spatial perception
  • Neglect of the left perception field
  • Difficulties in visual attention
  • Difficulties in non-verbal memory
  • Deficient awareness of symptoms
  • Changes in emotions

Damage to posterior brain regions

  • Disorders of visual perception
    • Difficulties in pattern recognition, or agnosia
  • Memory disorders

Damage to frontal brain regions

  • Disorders of executive functions
    • Disorders of information processing
    • Behavioural control
    • Initiative and motivation
  • Difficulties in regulating attention
  • Disorders of working memory
  • Changes to emotions and personality

Diseases often accompanied by neuropsychological symptoms

  • Cerebrovascular disorders
  • Brain trauma
  • Progressive brain diseases
  • MS
  • Parkinson's disease
  • Brain tumours
  • Epilepsy
  • Inflammatory brain diseases
  • States of anoxia
  • Substance use disorders
  • Psychiatric diseases
  • Cardiac diseases
  • Sleep disorders

Neuropsychological examination

  • May be indicated
    • to make a differential diagnosis
    • to describe the patient's performance with regard to his/her situation and needs
      • Assessment of working ability and performance capacity
      • Assessment and planning related to the prerequisites and need for rehabilitation
      • Vocational or educational planning
    • to address special issues.
      • Assessment of driving ability
      • Assessment of legal competency
  • Assessment of cognitive functions, i.e. functions related to information processing, any changes to them and preserved functions.
    • Variation in performance in examinations does not always indicate any disorder in brain function.
  • Assessment of factors affecting mental performance, such as mood or fatigue.
  • Neuropsychological examination is based on the available history, an interview, observation, and qualitative and normative interpretation of examination and assessment results.
  • Usually done on referral by the patient's physician.

Neuropsychological rehabilitation

  • Part of medical rehabilitation, based on neuropsychological examination
  • Aims at decreasing any harm from changes to information processing, behaviour and emotion regulation due to the brain injury.
  • May form a part of multidisciplinary rehabilitation or be the only form of rehabilitation required.
  • Always based on a comprehensive neuropsychological examination and provided by a neuropsychologist.
  • May be provided as individual rehabilitation, brief neuropsychological guidance or neuropsychological group rehabilitation, and be carried out in a rehabilitation institution or in an outpatient clinic.
  • Neuropsychological rehabilitation includes various methods of cognitive rehabilitation, psychoeducation and mental and psychosocial support, depending on the time from diagnosis, the neuropsychological symptoms and the patient's overall situation.
  • In neuropsychological rehabilitation, electronic services and applications of technology, such as neuropsychological online rehabilitation as well as telerehabilitation, may be used.
  • New, developing possibilities are offered by methods based on virtual technology as well.