Brain and cognition 2 Notes

Lecture 1.

Patient HM had a lot of influence on how we think now about memory.

Luria-Nebraska introduced hypothesis testing in psychology -> had a big influence on how we think
about testing cognitive functioning nowadays. Also the way of assessment he did looks a lot like how
we do it nowadays.

The role of the neuropsychologist is to test what is left of functioning. It is not about damage of the
brain, but what is left of the brain.

Brain has become highly relevant in modern-day (mental) health care.

- Increase in people with brain damage or dysfunction

A clinical neuropsychologist is not a brain researcher but a scientist practioner whose focus lies on
behaviour and cognition.

The brain has persuasion in daily practise -> it makes you less responsible for your behaviour.

ICF = international classification of functioning (dsm of medicine)

 Description of consequences of brain disease/disorder at three different level: impairment –

limitation – restriction
 Identify moderating factors

Lecture 4. Vascular cognitive impairment

Cognitive disorders with a cerebrovascular aetiology

 Vascular Cognitive Impairment (VCI)

 All forms of cognitive disorder associated with cerebrovascular disease
 Aetiology – Large vessel disease – Small vessel disease
 VCI covers the entire spectrum from mild cognitive disorders to vascular dementia

Arteries: Carry oxygenated blood from the heart

Veins: Carry deoxygenated blood to the heart

Large versus small vessel disease

Lacunar infarcts: small vessel infarct

When we age vessels become stiffer and this process can be infected by risk-factors like diabetes and
hypertension. With aging risk-factors like high blood pressure are increasing and small deep brain
vessels infarcts become more prone.
Many of these risk-factors increase with ageing. Depression has a higher risk in younger ages for
vascular diseases.

What you do at a young age is very important for how you age when you get older. When engaging in
a lot of cognitive, physical and social activities you build a buffer for cognitive decline at an older age.
More risk-factors will make you 10 years older than people with no risk-factors when your ageing
(cognitive decline)

Global increase in unhealthy lifestyle -> more risk-factors -> vascular diseases

Modifiable risk factors of dementia

 Cardiovascular risk factors make aging-related changes more pronounced

 E.g. hypertension, alcohol usage, obesity, smoking, physical inactivity, diabetes
 Modifying these might prevent or delay up to 12% of dementias
 And generally improve healthy ageing

A lot we can do to stabilize and improve cognition by incorporating a healthy lifestyle and reduce risk-
factors.

Around 50% of people older than 85 suffer from dementia

Older adults that do a lot of exercise have more oxygen and blood flow to the brain.
Cerebrovascular accident (CVA)

 CVA = stroke
 40.000 people per year
 15% between 18 and 50 yrs

In general it effects older people -> risk-factors accumulate in your life -> we become less flexible
when we get older.

Ischemic stroke= blood clot blocks the blood flow in a artery

Haemorrhagic stroke = blood from an artery suddenly begins bleeding into the brain

Embolic stroke = clotted material that breaks off from elsewhere in the body (eg lungs)

Atherothrombosis = formation of blood clot (thrombotic stroke) in brain artery

Haemorrhagic stroke

Symptoms: dizziness, nausea and a really bad headache

Most people do not survive this type of stroke

 Intracerebral haemorrhage (within brain)

- Lobar: located in one of the cerebral lobes
- Non-lobar: located in basal ganglia, thalamus, cerebellum or brain stem
 Subarachnoid haemorrhage (not within brain)
- Bleeding in the subarachnoid space
Type of motor or cognitive dysfunction depends on location of stroke:

Supply area of anterior cerebral artery

Supplies blood to the dorsal and medial parts of the frontal and parietal lobes

Impairments are found in:

- Language
- Executive function
- Social cognition
- Behaviour and emotions

Supply area of middle cerebral artery

Supplies blood to the frontal, temporal and parietal lobes, and deep brain structures (eg thalamus).
Accounts for approximately 80% of all stroke cases.

Common consequences:

- Memory disorders
- Aphasia
- Apraxia
- Hemispatial neglect
- Extinction

Supply area of posterior cerebral artery

Supplies blood to the occipital and temporal lobes.

Common consequences:

- Hemianopsia or quadrantanopia
- Visual agnosia (e.g., object agnosia, prosopagnosia)

Transient ischaemic attack (TIA)

Recovery < 24 hours. But have a higher risk in developing a stroke. People still keep some mild
problems.

TIA:

 Brief ischaemic event

 Focal symptoms: Problem is specific to a certain area of the brain
 Abnormalities often also appear on acute brain scan
 Increased risk of having a stroke
  Many people still report cognitive problems TIA
 And impairment on neuropsychological assessment

Cognitive recovery -> 49% cognitive impairments in acute phase -> 31% at follow-up (a lot of
spontaneous recovery in a stroke after 6 months)

Cognitive recovery after stroke

 ‘Unimpaired’ patients still unimpaired after six months

 Other group generally shows progress
- Dynamic recovery and not ‘demented’
- Dependent on affected domain
- May be linked to location of recovery
 Determinants
- Schooling/age -> ‘cognitive reserve’? (Stern et al., 2003; Robertson & Murre, 1999)
- Lesion volume less important than location -> small strategic infarcts sometimes
accompanied by dementia (see Auchus et al., 2002)

Mood disorders post-stroke

 Depressive symptoms occur in one third of stroke survivors

 Frequency is highest within the first year after stroke event
 Associated with poor recovery and long-term outcomes
 Suggested underlying mechanisms: Biological hypothesis (Robinson et al.) Reactive
hypothesis (Gainotti et al.) Vascular depression hypothesis (Alexopoulus et al.)