Information
Editors
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
- 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.