Neuropsychology

Block-1 Neuropsychology [4]

Unit-1 Neuropsychology Methods

Unit-2 Neuropsychological Assessment and Screening

Unit-3 Neuropsychology Test Batteries

Unit-4 Behavioural Neuropsychology, Brain Fitness and Activities that Promote

Brain Fitness

Block-2 Brain Behaviour Inter-Relationship [4]

Unit-1 Neuropsychology Methods

Unit-2 Neuropsychological Assessment and Screening

Unit-3 Neuropsychology Test Batteries

Unit-4 Behavioural Neuropsychology, Brain Fitness and Activities that Promote

Brain Fitness

Block-3 Basics of the Central Nervous System [4]

Unit-1 Brain Size and Devaluation, Genes, Brain and Behaviour

Unit-2 The Brain

Unit-3 The Cerebrum and the Cerebral Hemispheres and their Functions

Unit-4 Cerebral Lobes and the Limbic System

Block-4 Neurobiology and Behaviour [4]

Unit-1 Brain Behaviour Relationship, Consiousness and Mind Brain Relationship

Unit-2 Consciousness and Neuro Chemical Process and Higher Cerebral Functions

Unit-3 Neurobiological and Neuropsychological Aspects in the Development of

Memory, Emotion and Consciousness

Unit-4 Nervous System Diseases

 Introduction, Definiton and
UNIT 1 INTRODUCTION, DEFINITION AND Description of
Neuropsychology
DESCRIPTION OF
NEUROPSYCHOLOGY

Structure
1.0 Introduction
1.1 Objectives
1.2 Introduction to Neuropsychology
1.2.1 Historical Perspective of Neuropsychology
1.2.2 Clinical Neuropsychology
1.2.3 Central Nervous System
1.2.4 Functioning of the Nervous System
1.3 Definition and Concept of Neuropsychology
1.4 Neuropsychology and other Disciplines
1.5 Functions of Neuropsychologists
1.6 Major Domains of Neuropsychological Functioning
1.6.1 Referrals to Neuropsychologists for Neuropsychological Examination
1.6.2 Information Obtained from Neuropsychological Reports
1.6.3 Applications of Neuropsychological Examinations
1.6.4 Technical Limitations and Issues in Neuropsychological Evaluation
1.7 Neuropsychological Test Selection
1.7.1 Problems in Assessing Executive Functions
1.8 Let Us Sum Up
1.9 Unit End Questions
1.10 Suggested Readings

1.0 INTRODUCTION
This unit deals with neuropsychology, its definition and descriptions. It starts
with introduction to neuropsychology, followed by historical perspectives of
neuropsychology, clinical neuropsychology, what it is and a description of theme,
followed by a description of the central nervous system and its functioning. Then
we move on to definitions of neuropsychology and its concepts. Then we
differentiate it from other related disciplines, followed by the functions of
neuropsychologists. Then we deal with the domains of neuropsychological
functioning and the reasons for referrals to neuropsychologists for
neuropsychological examination. Then we describe what the reports contain based
on the neuropsychological examination, what are the applications of
neuropsychological examination and the various limitations to neuropsychological
test applications. Then we move on to neuropsychological test selection and the
problems one faces in assessing executive functions and how to overcome the
same.
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Neuropsychology
1.1 OBJECTIVES
After completing this unit, you will be able to:
• Define neuropsychology;
• Conceptualise neuropsychology;
• Describe the various aspects related to neuropsychology;
• Explain historically how neuropsychology came about;
• Describe the central nervous system and its functioning;
• Explain the functions of neuropsychologists;
• Elucidate the major domains of neuropsychological functioning;
• Describe when a person is to be referred to neuropsychologist for testing;
and
• Analyse the application of neuropsychology examination to different areas.

1.2 INTRODUCTION TO NEUROPSYCHOLOGY

A field that combines neurology and psychology and studies the relationship
between brain and behaviour is called the field of neuropsychology. The
behavioural neurobiology, neuropsychology, neurology and psychology are all
combined together to study how brain functions and in what ways the various
systems and organs work together to produce different types of behaviours. It
studies the cognitive processes and tries to understand which part of the brain is
associated with which type of cognitive processes etc. It aims to understand how
the structure and function of the brain relates to specific psychological processes.

Neuropsychology is a structured, objective, and scientific discipline which delves

into the brain and tries to associate various behaviours of the individuals to the
changes that come about in the brain. The ultimate aim is to understand the
individual mind and brain.

The methods that neuropsychology uses to study many of these aspects include
both experimental and objective scientific methods. Neuropsychology compares
the performance among persons with known differences in their biological brain
structures and attempts to find out the various sources that cause the variations
in the brain which all produce differences in individual behaviours. These sources
include the following:
1) biological factors (e.g., genetic, diseases, and injuries)
2) psychological factors (e.g., learned behaviours and personality) and
3) social factors (e.g., economics, family structure, and cultural values).
Most persons may have come across people who are very old having tremors in
their hands and unable to have proper motor coordination, and many would have
also come across persons having tics and speech problems and quite a few would
have come across persons lying in coma for days on in the hospital bed. All these
conditions are related to neurological pathology. In other words these are related
to certain neurological problems or brain related dysfunctions. At the same time
6
there are also many behavioural aspects related to these dysfunctions. Many Introduction, Definiton and
Description of
behaviours can be traced to certain areas of the brain and if those areas of the Neuropsychology
brain are attended to, then probably the person’s behaviour could also be changed.
However whether they will become normal or not depends on a large number of
factors. All that one could state is that there would be a change and that too more
towards the positive direction.

Thus one may state that Neuropsychology is the study of brain behaviour
relationships. It makes assessment, understands the problem and suggests
modifications to certain aspects, like for instance memory areas. Neuropsychology
seeks to understand how the brain, through structure and neural networks,
produces and controls behaviours and mental processes, including emotions,
personality, thinking, learning and remembering, problem solving, and
consciousness. The field is also concerned with how behaviour may influence
the brain and related physiological processes, as in the emerging field of psycho
neuro immunology (the study that seeks to understand the complex interactions
between brain and immune systems, and the implications for physical health).

Neuropsychology is that branch of psychology which deals with the relationship

between the nervous system, especially the brain, and the cerebral or mental
functions such as language, memory, and perception. Neuropsychology as a
science is concerned with the integration of psychological observations on
behaviour with neurological observations on the central nervous system (CNS),
including the brain.

Neuropsychology seeks to gain knowledge about brain and behaviour

relationships through the study of both healthy and damaged brain systems. It
seeks to identify the underlying biological causes of behaviours, from creative
genius to mental illness, that account for intellectual processes and personality.

1.2.1 Historical Perspective of Neuropsychology

The First Anatomical Studies
Vesalius (1514-1564) was the first to conduct careful observations of brain
anatomy and qualify the teachings of the cell doctrine in which he was trained.
He represents the beginning of a period in which careful observations and
empirical science began to triumph over the ideas that had been handed down
since the time of Aristotle and Galen. Vesalius introduced the anatomical theater
in which students and doctors could watch dissections from above. Vealius made
careful diagrams of human anatomy.

Mind-Body Dualism
Descartes (1596-1650) introduced the concept of a separate mind and body. He
believed that all mental functions were located in the pineal gland, a small centrally
located brain structure which is now believed to play a role in sleep wake and
dark light cycles. The dualist philosophy suggested a complete split between
mental and bodily processes, and explained automatic bodily reflexes (body)
while purposeful behaviours were a product of free will (mind).

Descartes subscribed to some of Galen’s theories (that the brain was a reservoir
of fluid, in which the fire displaces the skin, which pulls a tiny thread, which
opens a pore in the ventricle allowing the “animal spirit” to flow through a hollow
7
Neuropsychology tube, which inflates the muscle of the leg, causing the foot to withdraw. This
would now be described as a reflex, for which Descartes is credited.

Phrenology
Gall (1758-1828) introduced the idea that the brain was comprised of separate
organs, each localised and responsible for a basic psychological trait. These traits
controlled complex mental faculties, such as Cautiousness, Combativeness and
Agreeableness, and simpler functions, such as Memory, Calculation Ability and
Color Perception. Phrenology correlated the mental faculties described by
philosophers with the development of specific brain areas. The development of
these brain areas, called cerebral organs, resulted in skull prominences. These
bumps could be analysed and a Phrenology practitioner could determine the
subject’s personality and intelligence from analysis of the skull, called
cranioscopy.
Followers of phrenology categorised individuals on the basis of skull, and brain
size. Men were believed to have larger “social regions” with more “pride, energy,
and self-reliance”, as compared to female skulls which were thought to possess
more inhabitivness, that is love of home, a lack of firmness and self esteem.
However research has shown that there is no relationship between the bumps on
the skull and the underlying brain tissue, nor is there a relationship between the
size of an area of brain and the size of the function that it supports. Although he
was almost completely incorrect, Gall’s Phrenology represents the beginning of
the strong modern day localisationist doctrine.

19th Century Localisation

Broca (1824-1880) described most famous case, “Tan”, a patient who suffered a
stroke of the left hemisphere who could only utter the phrase “Tan”. The patient
could accurately comprehend language. Broca then used this case and a number
of others to show that the expression of language was localised to the left frontal
lobe. If you look carefully at the brain, you can detect a soft, fluid filled area in
the frontal lobe. This represents the empty space, or infarction that is caused by
the drop in blood supply to that brain area (stroke). The third convolution of the
inferior posterior frontal lobe has since become known as “Broca’s area”, and
patients with damage to Broca’s area are referred to as having Broca’s aphasia.
Several years after Broca presented his cases of frontal lobe lesions, Wernicke
(1848-1904) presented cases in which patients had lesions of the superior posterior
part of the left hemisphere and had trouble comprehending language. This resulted
in the idea that component processes of language were localised. On the basis of
Wernicke’s observations, the modern doctrine of component process localisation
and disconnection syndromes began. This doctrine states that complex mental
functions, such as language, represent the combined processing of a number of
subcomponent processes represented in widely different areas of the brain. A
mental faculty like “Combativeness” described by the Phrenologists was not
discreetly localised in the brain. Such faculties, if they have validity at all, are
the result of a number of primary cognitive operations.

1.2.2 Clinical Neuropsychology

Clinical neuropsychology seeks such understanding, particularly, in the case of
how damaged or diseased brain structures alter behaviours and interfere with
8 mental and cognitive functions.
To understand fully the functions of neuropsychology it is imperative to have an Introduction, Definiton and
Description of
idea of the structure and functions of the brain and the nervous system. Neuropsychology

1.2.3 Central Nervous System (CNS)

The central nervous system is that part of the nervous system that consists of the
brain and spinal cord. It is one of the two major divisions of the nervous system.
The other is the peripheral nervous system (PNS) which is outside the brain and
spinal cord.

The peripheral nervous system (PNS) connects the central nervous system (CNS)
to sensory organs such as the eye and ear, other organs of the body, muscles,
blood vessels and glands. The peripheral nerves include the 12 cranial nerves,
the spinal nerves and roots, and what are called the autonomic nerves that are
concerned specifically with the regulation of the heart muscle, the muscles in
blood vessel walls, and glands.

We can consider the brain as a central computer that controls all bodily functions.
The nervous system can be likened to a network that relays messages back and
forth from the brain to different parts of the body. It does this via the spinal cord.
The spinal cord runs through the back and has threadlike nerves which branch
out to every organ and body part. These transmit all messages to the body from
the brain and vice versa.

Imagine yourself touching a hot iron, immediately you wince and pull your hand
back.

What happened, let us see. The moment you touched the hot iron, the nerves in
your skin sent a message of pain to the brain. The brain immediately sends back
a message asking the muscles in your hands to pull back. All this happens in a
split second before you even realise what is going on.

Though so much of work is accomplished the human brain is only 3 pounds in

weight. It has many folds and grooves which can store a large amount of
information received by the brain. This brain is protected by the bones of the
skull. The brain is made up of 3 parts, namely forebrain, midbrain and the
hindbrain.

The forebrain is the largest and contains the cerebrum that is the area with folds
and grooves and a certain other structures beneath it.

The spinal cord, on the other hand, is a long bundle of nerve tissue about 18
inches long and ¾ inch thick. It extends from the lower part of the brain down
through spine. Along the way, various nerves branch out to the entire body. These
are called the peripheral nervous system.

Both the brain and the spinal cord are protected by bone: the brain by the bones
of the skull, and the spinal cord by a set of ring-shaped bones called vertebrae.
They’re both cushioned by layers of membranes called meninges as well as a
special fluid called cerebrospinal fluid. This fluid helps protect the nerve tissue,
keep it healthy, and remove waste products.

The brain is made up of three main sections: the forebrain, the midbrain, and the
hindbrain.
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Neuropsychology The cerebrum contains all information about us, that is our intelligence, memory,
personality, emotion, speech, and ability to feel and move.

The cerebrum also contains four lobes, that is frontal, parietal, temporal and
occipital lobes. The cerebrum is also divided into two halves, the right and the
left hemispheres. These hemispheres are connected by a band of nerve fibres,
called as corpus collosum. This helps in the two hemispheres communicating
with each other.
It must be kept in mind that the two hemispheres have different functions to
perform, that is while the left hemisphere is considered to be logical, analytical
and objective, the right side is considered to be more intuitive, creative and
subjective. For example, when you are doing maths, you are using your left
hemisphere, and when you listen to music you are using the right hemisphere.
Until now we were discussing the inner parts of the cerebrum. Now let us see
what its outer parts are like. The outer layer of the cerebrum is called the cortex.
You know we have five senses, vision, hearing, touch, taste and smell. Information
collected by these 5 senses are sent by the spinal cord to the cortex. Cortex is
also known as the gray matter. The information then is directed to other parts of
the nervous system for further processing. For example in the case of touching
the hot iron, not only the hand is withdrawn, but the information is sent to the
memory to make sure that you don’t do it again.
The messages received from the sensory organs like eyes, nose, tongue, skin and
ears are carried to the cortex by the thalamus which is in the inner part of the
forebrain.
Another organ within the forebrain is called the hypothalamus which controls
the pulse, thirst, appetite and sleep which are automatic processes. It also controls
the pituitary gland associated with growth of the body, metabolism etc.
The midbrain is located underneath the middle of the forebrain, acts as a master
coordinator for all the messages going in and out of the brain to the spinal cord.
The hindbrain sits underneath the back end of the cerebrum, and it consists of
the cerebellum, pons, and medulla.
The cerebellum is also called as the “little brain” because it looks like a small
version of the cerebrum. The cerebellum is responsible for balance, movement,
and coordination.
The pons and the medulla, along with the midbrain, are often called the brainstem.
The brainstem takes in, sends out, and coordinates all of the brain’s messages. It
also controls many of the body’s automatic functions, like breathing, heart rate,
blood pressure, swallowing, digestion, and blinking.

1.2.4 Functioning of the Nervous System

The basic functioning of the nervous system depends a lot on tiny cells called
neurons. The brain has billions of them, and they have many specialised jobs.
For example, sensory neurons take information from the eyes, ears, nose, tongue,
and skin to the brain. Motor neurons carry messages away from the brain and
back to the rest of the body.
10
The nervous system is the System of specialised cells (neurons, or nerve cells) Introduction, Definiton and
Description of
which conduct stimuli from a sensory receptor through a network to the site. A Neuropsychology
neuron consists of many of the impulse-conducting cells that constitute the
brain, spinal column, and nerves. It consists of a nucleated cell body with one or
more dendrites and a single axon.

It is also called as the nerve cell. (e.g., a gland or muscle) where the response
occurs. The cranial nerves handle head and neck sensory and motor activities,
except the vagus nerve, which conducts signals to visceral organs. Each spinal
nerve is attached to the spinal cord by a sensory and a motor root.

All neurons, however, relay information to each other through a complex

electrochemical process, making connections that affect the way we think, learn,
move, and behave.

At birth, the nervous system contains all the neurons you will ever have, but
many of them are not connected to each other. As you grow and learn, messages
travel from one neuron to another over and over, creating connections, or
pathways, in the brain.

To take an example, when you learnt to drive the cycle it was so difficult and
took time but once you leant you do not have to think to cycle, but cycling comes
automatically to you. That means a pathway has been established.

In young children, the brain is highly adaptable; in fact, when one part of a
young child’s brain is injured, another part can often learn to take over some of
the lost function. But as we age, the brain has to work harder to make new neural
pathways, making it more difficult to master new tasks or change established
behaviour patterns. That’s why many scientists believe it’s important to keep
challenging your brain to learn new things and make new connections. It helps
keep the brain active over the course of a lifetime.

Memory is another complex function of the brain. The things we have learned,
seen are first processed in the cortex, and then, if we sense that this information
is important enough to remember permanently, it is passed inward to other regions
of the brain (such as the hippocampus and amygdala) for long-term storage and
retrieval. As these messages travel through the brain, they too create pathways
that serve as the basis of our memory.

Different parts of the cerebrum are responsible for moving different body parts.
The left side of the brain controls the movements of the right side of the body,
and the right side of the brain controls the movements of the left side of the
body. When you press the accelerator with your right foot, for example, it’s the
left side of your brain that sends the message allowing you to do it.

A part of the peripheral nervous system called the autonomic nervous system is
responsible for controlling many of the body processes we almost never need to
think about, like breathing, digestion, sweating, and shivering. The autonomic
nervous system has two parts: the sympathetic and the parasympathetic nervous
systems.

The sympathetic nervous system prepares the body for sudden stress, like if you
see a robbery taking place. When something frightening happens, the sympathetic
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Neuropsychology nervous system makes the heart beat faster so that it sends blood more quickly to
the different body parts that might need it. It also causes the adrenal glands at the
top of the kidneys to release adrenaline, a hormone that helps give extra power
to the muscles for a quick getaway. This process is known as the body’s “fight or
flight” response.

The parasympathetic nervous system does the exact opposite: It prepares the
body for rest. It also helps the digestive tract move along so our bodies can
efficiently take in nutrients from the food we eat.

Because the brain controls just about everything, when something goes wrong
with it, it is often serious and can affect many different parts of the body. Inherited
diseases, brain disorders associated with mental illness, and head injuries can all
affect the way the brain works and upset the daily activities of the rest of the
body.

Problems that can affect the brain include brain tumours, cerebral palsy, epilepsy
meningitis and encephalitis, migraine headaches, and mental illnesses. Another
important problem is head injury which may be caused by many factors including
accidents.
Self Assessment Questions
1) Define Neuropsychology and state its characteristic features.
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2) Trace the history of neuropsychology.
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3) What is clinical neuropsychology? Discuss
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4) Describe the Central nervous system and elucidate its functions.
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 Introduction, Definiton and
1.3 DEFINITION AND CONCEPT OF Description of
Neuropsychology
NEUROPSYCHOLOGY
Neuropsychology, as mentioned earlier is the study of (and the assessment,
understanding, and modification of) brain-behaviour relationships.
Neuropsychology seeks to understand how the brain, through structure and neural
networks, produces and controls behaviour and mental processes, including
emotions, personality, thinking, learning and remembering, problem solving,
and consciousness. The field is also concerned with how behaviour may influence
the brain and related physiological processes, as in the emerging field of
psychoneuroimmunology (the study that seeks to understand the complex
interactions between brain and immune systems, and the implications for physical
health).

The neuropsychologist uses objective tools, such as the neuropsychological tests

to find out the association between biological and behavioural aspects together.
Through the use of tests, the clinical neuropsychologist is able to differentiate
whether or not a behavioural abnormality is more likely caused by a biological
abnormality in the brain or by an emotional or learned process.

1.4 NEUROPSYCHOLOGY AND OTHER

DISCIPLINES
If we presume that the brain is the starting point for why and how we process all
mental information and not just cognitive, but interpersonal communications,
self-concept, emotional reactivity, personality, learned responses, etc., then in
some aspect, all psychology is neuropsychology. Neurolinguistics, for example,
is the study of how language shapes our self concepts and our interpersonal
communications.

Neurodevelopmental psychology is the study of how behavioural and mental

characteristics change with nervous system growth. Even psychological concepts
of dreaming (and dream content), level of attention, and conscious experience
are subserved by brain processes.

Neuropsychology is the basic scientific discipline that studies the structure and
function of the brain related to specific psychological processes and overt
behaviours. The term neuropsychology has been applied to lesion studies in
humans and animals.

It has also been applied to efforts to record electrical activity from individual
cells (or groups of cells) in higher primates (including some studies of human
patients).
Neuropsychology is scientific in its approach.
• It is closely related to cognitive psychology in that it also considers the
mind as information processing system
• It is closely related to cognitive science.
• It is considered eclectic
• It overlaps with some areas of neuroscience
13
Neuropsychology • It is also closely associated to philosophy of mind
• It ofcourse is associated closely with neurology
• Psychiatry draws a lot from neurology
• By using artificial neural networks it is considered close to computer science
also.
Neuropsychology seeks to gain knowledge about brain and behaviour
relationships through the study of both healthy and damaged brain systems. It
seeks to identify the underlying biological causes of behaviours, from creative
genius to mental illness, that account for intellectual processes and personality.
Clinical neuropsychology seeks such understanding, particularly, in the case of
how damaged or diseased brain structures alter behaviours and interfere with
mental and cognitive functions.

Cognitive Neuropsychology aims to promote the investigation of human cognition

that is based on neuropsychological methods including brain pathology, recording,
stimulation or imaging. The research can involve brain lesioned or neurologically
intact adults, children or non human animals as long as it makes an explicit
contribution to our understanding of normal human cognitive processes and
representations. Cognition is understood broadly to include the domains of
perception, attention, planning, language, thinking, memory and action.

1.5 FUNCTIONS OF NEUROPSYCHOLOGISTS

Neuropsychologists are not medical doctors, but doctors of psychology whose
field of study is concentrated on the brain and its functions. Neuropsychological
testing is designed to determine the brain’s capacity with respect to short and
long term memory, abstract reasoning, attention, concentration, executive
functioning, motor skills and other cognitive and psychological factors. By
comparing the pattern of these results, against the patients pre-morbid capabilities,
and correlating these results with the nature of the trauma suffered by the patient,
neuropsychologists can, to a reasonable degree of certainty, opine that individuals
without an acute diagnosis of brain injury, have permanent deficits as a result of
brain trauma.

Neuropsychologists use batteries of tests to triangulate the brain’s functioning

and through that triangulation, determine whether the brain is functioning as it
should. Just like tapping a knee to check the reflexes is an objective test of how
the nervous system operates, neuropsychological tests are an objective measure
of how the brain is functioning.

If a neuropsychologist is using what is called a “fixed battery” they will be using

one of two such batteries, the Halstead-Reitan or the Luria-Nebraska battery.
The advantage of using such batteries is that decades of study and thousands of
test results have created an accurate profile of the pattern of deficits which correlate
to specific types of brain injury.

The Halstead-Reitan Battery consists of the Category Test, Tactual Performance

Test, Seashore Rhythm Tests, Speech Sounds Perception Tests, Finger Tapping
Test, and Trail Making. Neuropsychologists often administer Full Scale IQ, Verbal
IQ, and Performance IQ.
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The most commonly employed intelligence test is the Wechsler Adult Intelligence Introduction, Definiton and
Description of
Scale-Revised (WAIS-R). The three summary IQ measures are derived from Neuropsychology
averaging individual subtest scores.

An Aphasia Screening Test, a Sensory-Perceptual Examination, are also typically

administered, and many neuropsychologists will also administer the MMPI as
well.

A normal IQ score, or even high test scores in specific areas, do not rule out
brain injury. First, if a person has a 130 IQ before the injury and a 100 IQ after,
this would clearly establish injury. More significantly, many profoundly brain
injured survivors, maintain an average IQ near their pre-morbid levels. It is not
their average scores that are significant, but the pattern of such scores. The IQ
only measures certain brain functions, those primarily cognitive in nature. The
neuropsychological examination is designed to evaluate a comprehensive cross
section of brain function.

Self Assessment Questions

1) Define Neuropsychology.
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2) How would you conceptualise neuropsychology?
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3) How is neuropsychology related to other disciplines? Explain
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4) What are the functions of neuropsychologists? Elucidate.
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Neuropsychology
1.6 MAJOR DOMAINS OF
NEUROPSYCHOLOGICAL FUNCTIONING
Neuropsychological examination is useful in measuring many categories of
functioning, including the following:
• Intellectual functioning
• Academic achievement
• Language processing
• Visuospatial processing
• Attention/concentration
• Verbal learning and memory
• Visual learning and memory
• Executive functions
• Speed of processing
• Sensory-perceptual functions
• Motor speed and strength
• Motivation/symptom validity
• Personality assessment

1.6.1 Referrals to Neuropsychologists for Neuropsychological

Examination
Neuropsychological testing provides diagnostic clarification and grading of
clinical severity for patients with obvious or supposed cognitive deficits. Often
these include patients with a history of any of the following problems:
• Head injury
• Failure to achieve developmental milestones
• Learning or attention deficits
• Exposure to drugs, alcohol, or maternal illness in utero
• Exposure to chemicals, toxins, or heavy metals
• Parkinson’s disease
• Seizure disorders
• Substance abuse
• Strokes
• Dementia
• Psychiatric Disorders

1.6.2 Information Obtained From Neuropsychological Reports

Neuropsychological tests are a series of measures that identify cognitive
impairment and functioning in individuals. They provide quantifiable data about
the following aspects of cognition:
• Reasoning and problem solving ability
• Ability to understand and express language
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• Working memory and attention Introduction, Definiton and
Description of
• Short-term and long-term memory Neuropsychology

• Processing speed
• Visual-spatial organisation
• Visual-motor coordination
• Planning, synthesising, and organising abilities

1.6.3 Applications of Neuropsychological Examinations

This includes the following:
• Differential diagnosis of organic and functional pathologies
• Assessment for dementia versus pseudodementia.
• Determination of the presence of epilepsy versus somatoform disorder (that
is, nonepileptic seizures or pseudoseizures)
• Determination of the presence of traumatic brain injury (TBI) versus
malingering or
– unconscious highlighting
• Guidance for rehabilitation programs and monitor patient progress
• Guidance for referring to specialists
• Providing of data to guide decisions about the patient’s condition, such as
the following:
– Competency to manage legal and financial affairs
– Capacity to participate in medical and legal decision making
– Ability to live independently or with supervision
– Ability to return to work and school affairs
– Candidacy for transplants
• Providing data to guide the following assessments and procedures:
– Evaluation of the cognitive effects of various medical disorders and
associated interventions
– Assessment of tests for diabetes mellitus, chronic obstructive pulmonary
disease (COPD), hypertension, human immunodeficiency virus (HIV)
infection, coronary artery bypass graft (CABG), and clinical drug trials
– Assessment of CNS lesions and/or seizure disorders before and after
surgical interventions, including corpus callosotomy, focal resection
(e.g., topectomy, lobectomy), and multiple subpial transection
• Monitoring the effects of pharmacologic interventions
• Documentation of the cognitive effects of exposure to neurotoxins
• Documentation of the adverse effects of whole brain irradiation in children
• Issuance of Standard protocols for assessment of specific disorders, such as
dementia (e.g. Alzhimer Disease)
In addition to the above, developmental disorders (e.g. specific learning
disabilities) require detailed assessment of cognition, academic achievement, 17
Neuropsychology and psychosocial adjustment for proper identification and neuropsychological
tests help in these assessments. It acts as a guide to their management including
academic placement in special education and resource classrooms.
Neuropsychological examination is however of limited value in the following
areas and these are given below.
• In cases where the patient is severely compromised, as in the case of advanced
dementia
• Where patient is suffering from serious brain injury (e.g., TBI, stroke, anoxia,
infection),
• Where the patient has other serious medical complications or psychiatric
disorders.

1.6.4 Technical Limitations and Issues in Neuropsychological

Evaluation
Results of an NPE must be considered in the context of the patient’s age,
education, sex, and cultural background. These factors can affect test performance
and limit the conclusions that can be drawn from the evaluation. In addition,
issues such as reliability, validity, sensitivity, and specificity need to be considered.
• Large, population based norms are available for relatively fewer measures.
• Those measures that do boast such norms, such as major intellectual and
academic instruments, are of limited usefulness within a neuropsychological
test battery.
• Ideally, patients should be compared with population based norms, as well
as with local norms and subgroup norms so as to examine strengths and
weaknesses in the individual who is being tested.
• Significant gaps can be found in the normative data for all age, educational,
and intellectual ranges.
• Also there are major deficiencies in the development of appropriate measures
and norms for minority populations.

Self Assessment Questions

1) What are the major domains of neuropsychological functioning?
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2) When and whom we refer to neuropsychologists for examinations?
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 Introduction, Definiton and
3) Describe the information available in a neuropsychological report. Description of
Neuropsychology
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4) Discuss the application of neuropsychological examination to different
areas.
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5) What are the limitations to neuropsychological test examination?
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1.7 NEUROPSYCHOLOGICAL TEST SELECTION

1) Reliability, Validity, Sensitivity and Specificity
Generally, findings suggest that performance on tests of motor functioning, speed
of cognitive processing, cognitive flexibility, complex attention, and memory
are related positively to real-world success. The amount of variance accounted
for by cognitive factors alone, however, is typically quite small. Exceptions occur
when comparisons made between results of formal Neuropsychological
examination and real world criteria are limited to very simple, very circumscribed,
and very well defined functions.

Consequently, situational assessment is seen as a critical adjunct to

neuropsychological assessment, especially at higher levels of cognitive functioning.

Neuropsychological tests, with very few exceptions, were not developed with an
eye toward ecologic validity. They were developed as indicators of brain function
or dysfunction and generally were validated against neurosurgical, neurologic,
and neuroradiologic data. Nevertheless, many tests have proven to be good
predictors of future behaviour and, therefore, have demonstrated ecologic validity.
19
Neuropsychology A qualitative process approach may improve the ecologic validity of the
neuropsychological test battery. For example, testing the limits with measures of
memory and executive functioning allows the examiner to understand better
what a person can do under relatively ideal circumstances. The test itself may
have little demonstrable ecologic validity, but an accurate analysis and insightful
interpretation of findings can be highly valid from an ecologic perspective.

2) Sensitivity and Specificity

Sensitivity refers to a test’s ability to detect the slightest abnormalities in CNS
function and is a reflection of the test’s true positive rate, that is, its ability to
identify persons with a disorder. Specificity refers to the ability to
differentiate patients with a certain abnormality from those with other
abnormalities or with no abnormality, as indicated by the true negative rate.

A score on any test can be a true positive, false positive, true negative, or false
negative.

True positive means it rquires high sensitivity to dysfunction, allowing

dysfunctions to be detected.

False positive means it indicates sensitivity to dysfunction, though lacks specificity

to a particular dysfunction.

True negative refers to the high specificity, allowing negative to be distinguished

from others.

False negative on the other hand refers to the lack of sensitivity, without regard
to specificity of the test.

Therefore for any evaluation, it is important to understand the rates of each of

the above aspects in the results.

The Stroop Test, for example, shows a relatively high level of specificity, with a
high true negative rate (95.7%) and low false positive rate (4.3%). However, its
sensitivity is questionable, as it has a relatively low true positive rate (30.8%)
and high false negative rate (69.2%).

It must be kept in mind that each test has strengths and weaknesses in its ability
to detect a minimal CNS dysfunction (sensitivity) while being able to indicate a
specific CNS dysfunction (specificity).

Timed measures of cognitive and/or motor processing are generally sensitive to

diffuse cerebral dysfunctions, although the specificity of these tests is generally
poor to moderate.

Measures of cognitive and motor processing that are not timed are generally less
sensitive to diffuse dysfunctions but are very useful in identifying specific brain
lesions.

1.7.1 Problems in Assessing Executive Functions

One of the major drawbacks of the neuropsychological tests can be stated to be
the lack of ecologic validity when assessing executive functioning.

20
As is known, the neuropsychological examination is generally conducted within Introduction, Definiton and
Description of
calm and quiet testing rooms where the subject is clearly presented with the task Neuropsychology
to be completed, is informed of time restrictions, and is prompted to start and
stop behaviours. Under these conditions, a subject may achieve a score that
indicates no executive dysfunctions, although the individual may be particularly
drained from the mental exertion.

Completing tasks in the real world, however, requires several executive functions
that are not tested in traditional neuropsychological examination, including
recognising that a task must be completed, starting the task, switching tasks,
adapting to changes, and stopping a task.

However, changes in executive tests have dramatically increased the

environmental validity of executive neuropsychological examination. These
changes include a growing emphasis on subject self reporting of premorbid and
postmorbid functioning, as well as premorbid and postmorbid reports from
relatives and significant others in the subject’s life. Oftentimes, the self report is
not sufficient, for executive dysfunctions may be unknown to the subject, or else
they may be ego syntonic.

A dramatic approach to overcoming the problem of ecologic validity appears in

the Multiple Errands Test (MET). The test takes place in a shopping mall and
requires the subject to conduct 3 tasks simultaneously, such as buying an item,
meeting at a certain location at a certain time, and acquiring available information
(such as a foreign currency exchange rate). This evaluation tests the subject’s
abilities in planning, task initiation, and task switching, and even requires the
subject to interact with other individuals in an effective manner. The test has
shown considerable sensitivity and specificity, and subjects with neurologic
deficits have performed considerably worse than controls. A version of this test
has also been created for the hospital setting.

1.8 LET US SUM UP

Neuropsychology is that branch of psychology which deals with the relationship
between the nervous system, especially the brain, and the cerebral or mental
functions such as language, memory, and perception.

The field emerged through the work of Paul Broca and Carl Wernicke , both of
whom identified sites on the cerebral cortex involved in the production or
comprehension of language.

The nervous system is the System of specialised cells (neurons, or nerve cells)
which conduct stimuli from a sensory receptor through a network to the site. A
neuron consists of any of the impulse-conducting cells that constitute the brain,
spinal column, and nerves, consisting of a nucleated cell body with one or more
dendrites and a single axon.

The field is also concerned with how behaviour may influence the brain and
related physiological processes, as in the emerging field of psychoneuro-
immunology (the study that seeks to understand the complex interactions between
brain and immune systems, and the implications for physical health).

21
Neuropsychology The neuropsychologist uses objective tools -neuropsychological tests to tie the
biological and behavioural aspects together. Through the use of tests, the clinical
neuropsychologist is able to differentiate whether or not a behavioural abnormality
is more likely caused by a biological abnormality in the brain or by an emotional
or learned process.

Cognitive Neuropsychology aims to promote the investigation of human cognition

that is based on neuropsychological methods including brain pathology, recording,
stimulation or imaging.

Neuropsychological examination is used to quantitatively measure the cognitive

and behavioural capabilities of a patient. The data from neuropsychological tests
can then be compared to normative data based on a number of different
demographic criteria, including (but not limited to) age, race, gender, and socio-
economic status. NPE can include testing of intelligence, attention, memory,
and personality, as well as of problem solving, language, perceptual, motor,
academic, and learning abilities.

1.9 UNIT END QUESTIONS

1) Discuss the functions of neuropsychologists.
2) Define Neuropsychology and bring out its characteristic features.
3) Discuss the important aspects related to the major domain of
neuropsychological functioning
4) What are the important aspects to be kept in mind in applying
neuropsychological battery to patients? (discuss the reliability, validity,
specificity etc.).
5) What are the various problems encountered in testing executive functions
with neuropsychological test?

1.10 SUGGESTED READINGS

John A.Kiernan (2008). 9th edition. Barr’s The Human Nervous System: An
Anatomical Viewpoint, Lippincott Williams Wilkins.

Kolb Bryan and Ian Q.Whishaw (2008). Fundamental of Human

Neuropsychology. Worth publishers, NY

Todd E. Feinberg and Martha J.Farah (2003). (2nd edition). Behavioural Neurology
and Neuropsychology. McGraw Hill Medical Publishing Division, New York.

Warren H Lewis (editor) (2000). (2oth edition) Gray’s Anatomy of the Human
Body Anatomy of the Human Body New York: Bartleby.com

22
 Introduction, Definiton and
UNIT 2 NEUROPSYCHOLOGY AND OTHER Description of
Neuropsychology
DISCIPLINES

Structure
2.0 Introduction
2.1 Objectives
2.2 Concept and Definition of Neuropsychology
2.2.1 Historical Perspective
2.2.2 Approaches to Neuropsychology
2.3 Neuropsychology and Neuroscience
2.4 Cognitive Neuropsychology and Neuroscience
2.5 Biological Psychology and Neuropsychology
2.6 Cognitive Psychology and Neuropsychology
2.7 Neurobiology and Neuropsychology
2.8 Neuropsychology and Neurophysiology
2.9 Neurology and Neuropsychology
2.10 Comparative Neuropsychology and Neuropsychology
2.11 Scientific Study of the Nervous System
2.12 Cognitive Neuroscience and Neuropsychology
2.13 Behavioural Neurology
2.14 Behavioural Neuroscience
2.14.1 Broca’s and Wernicke’s Areas
2.15 Let Us Sum Up
2.16 Unit End Questions
2.17 Suggested Readings

2.0 INTRODUCTION
In this unit we are going to deal with neuropsychology as related to other
disciplines like neurosciences, neurobiology and so on. We start with concept
and definition of neuropsychology providing certain historical aspects as to how
neuropsychology came about. Then we deal with the various approaches to
neuropsychology. We then present the relationship of neuropsychology to various
other disciplines. In this we start with neuroscience as related to neuropsychology,
followed by cognitive neuropsychology, and then cognitive psychology as related
to neuropsychology. Then we turn on to biological psychology, neurobiology,
neurology etc. and bring their relatedness to neuropsychology. Then we take up
behavioural neuroscience and point out how neuropsychology explains behaviour
in terms of the various parts of the brain and its functions.

2.1 OBJECTIVES
After completing this unit, you will be able to:
• Define neuropsychology;
23
Neuropsychology • Describe neuropsychology in terms of its characteristic features;
• Explain historically the emergence of neuropsychology;
• Describe the methods used in neuropsychology; and
• Elucidate the relationship between neuropsychology and other disciplines.

2.2 CONCEPT AND DEFINITION OF

NEUROPSYCHOLOGY
Neuropsychology is that branch of psychology that deals with the relationship
between the nervous system, especially the brain, and cerebral or mental functions
such as language, memory, and perception. It is a science concerned with the
integration of psychological observations on behaviour with neurological
observations on the Central Nervous System including the brain. The two areas
in the brain identified by Paul Broca and Carl Wernicke, involved in the production
or comprehension of language. Actually set the tone for neuropsychology research
and practice. Since then much work has been carried out in describing the
neuroanatomical systems and their relation to higher mental processes. The
developments which led up to the emergence of an autonomous discipline of
neuropsychology have a long and chequered history and provide insights into
the perennial issues which still occupy neuropsychologists.

2.2.1 Historical Perspective

The study of the nervous system dates back to ancient Egypt. Evidence of
trepanation, the surgical practice of either drilling or scraping a hole into the
skull with the aim of curing headaches or mental disorders or relieving cranial
pressure, being performed on patients dates back to Neolithic times and has
been found in various cultures throughout the world. Manuscripts dating back to
1700BC indicated that the Egyptians had some knowledge about symptoms of
brain damage.

In parallel with this research, work with brain damaged patients by Paul Broca
suggested that certain regions of the brain were responsible for certain functions.
At the time Broca’s findings were seen as a confirmation of Franz Joseph Gall’s
theory that language was localised and certain psychological functions were
localised in the cerebral cortex. The localisation of function hypothesis was
supported by observations of epileptic patients conducted by John Hughlings
Jackson, who correctly deduced the organisation of motor cortex by watching
the progression of seizures through the body.

Wernicke further developed the theory of the specialisation of specific brain

structures in language comprehension and production. Modern research still uses
the Brodmann cytoarchitectonic (referring to study of cell structure) anatomical
definitions from this era in continuing to show that distinct areas of the cortex
are activated in the execution of specific tasks.

2.2.2 Approaches to Neuropsychology

Today there are several different approaches to the study of the brain behaviour
relationships. It is important to note that the results of carefully controlled animal
studies have been very important in the development of neuropsychology. While
24
one cannot study the brain behaviour relationships in the humans with the same Neuropsychology and other
Disciplines
precision one could use in animal studies, yet with the neuroimaging techniques
etc., presently much breakthrough in understanding the brain behaviour
relationship has come about in regard to humans too. In human studies,
experimental psychologists have contributed significantly by devising ingenious
techniques to be used under controlled conditions and by proposing theoretical
concepts to account for the deficits in behaviour observed in brain damaged
patients the distinction between short-term memory and long-term memory and
models of their interrelationships. Neuropsychologists study our awareness of
the world in which we move. What we see, hear, and touch are dependent upon
the proper functioning of the intact central nervous system. Likewise, how we
respond by taking action is dependent on the intactness of those parts of the
nervous system concerned with initiating and sustaining coordinated motor
activity. But it is not only sensory and motor processes that may be altered by
changes in the nervous system but the higher functions such as language, thought,
and memory may also be changed.

To state briefly neuropsychology studies the structure and function of the brain
related to specific psychological processes and behaviours. The term
neuropsychology has been applied to lesion studies in humans and animals. It is
scientific in its approach and like cognitive psychology and cognitive science
considers the mind from a information sharing point of view.

In practice neuropsychologists tend to work in clinical settings (involved in

assessing or treating patients with neuropsychological problems in forensic
settings or industry as consultants where neuropsychological knowledge is
applied. It is also interdisciplinary in nature to an extent and has in someway or
the other related to certain other fields. These are being discussed below.

Self Assessment Questions

1) Define neuropsychology.
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2) Trace historically the emergence of neuropsychology.
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Neuropsychology
3) What are the various functions of neuropsychologists?
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4) Describe Broaca’s and Wernicke’s work on the brain that led to the
emergence of neuropsychology.
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2.3 NEUROPSYCHOLOGY AND NEUROSCIENCE

Rapid advances in technology combined with knowledge about how the brain
and nervous system work have ushered in progress once considered purely science
fiction, but today falling under a growing area of scientific study called
“neuroscience.”
Take, for example, the case of implanting a sensor into a paralysed individual’s
brain. The sensor detects thoughts that the individual has about moving an arm,
for example. These “thoughts” are then sent to a plug on the individual’s scalp,
which sends signals to a computer that translates the signals into motor
movements.
The field of Neuroscience, an area of specialty that was not formalised into its
own field until 1971. Since then, the amount of investigation and research
completed by those working in the field has grown faster than most other scientific
areas of thought and empirical study.
Individuals with devastating brain and spinal cord injuries, brain diseases and
disorders, are the main beneficiaries of these once unimaginable scientific
advancements.
Neuroscience is a field that studies of the nervous system, including the brain,
spinal cord, and networks of sensory nerve cells called neurons. It is an
interdisciplinary field, meaning that it integrates several disciplines, including
psychology, biology, chemistry, and physics.
In studying the nervous system, the field adds to a body of knowledge about
human thought, emotion, and behaviour that is the main area of expertise for
those working in psychology, especially the field of Neuropsychology
Both neuropsychologists and neuroscientists focus their research on the
understanding of “brain” disorders, injuries, and deficits. For this reason, these
26
scientists must have a solid understanding of how psychological processes relate Neuropsychology and other
Disciplines
to the brain’s structures and systems, or on the interrelated and inseparable
connections between cognition and brain physiology.

2.4 COGNITIVE NEUROPSYCHOLOGY AND

NEUROSCIENCE
Cognitive neuropsychology and neuroscience methods are used to elucidate the
nature of mental representation and processing and its neural substrates. Specific
methods include the analysis of the performance of adults who have suffered
neural injury (as a result or stroke, trauma, degenerative disease), the study of
individuals who suffer from developmental deficits including developmental
dyslexia , dysgraphia etc., through functional magnetic resonance imaging (fMRI),
eye tracking and cortical stimulation. These methods are used to investigate,
among others, topics such as: the relationship between language and spatial
processes, the neural substrates that support recovery of function in acquired
language deficits, the relationship between and among language processes etc.

2.5 BIOLOGICAL PSYCHOLOGY AND

NEUROPSYCHOLOGY
Biological psychology, also called physiological psychology or behavioural
neuroscience, is the study of the physiological bases of behaviour. Biological
psychology is concerned primarily with the relationship between psychological
processes and the underlying physiological events. In other words, the mind
body phenomenon. Its focus is the function of the brain and the rest of the nervous
system in activities (e.g., thinking, learning, feeling, sensing, and perceiving)
recognised as characteristic of humans and other animals. Biological psychology
has continually been involved in studying the physical basis for the reception of
internal and external stimuli by the nervous system, particularly the visual and
the auditory system.

2.6 COGNITIVE PSYCHOLOGY AND

NEUROPSYCHOLOGY
Cognitive psychology is the branch of psychology that studies mental processes
including how people think, perceive, remember and learn. As part of the larger
field of cognitive science, this branch of psychology is related to other disciplines
including neuroscience, philosophy, and linguistics.
The core focus of cognitive psychology is on how people acquire, process and
store information. There are numerous practical applications for cognitive
research, such as ways to improve memory, how to increase decision making
accuracy, and how to structure educational curricula to enhance learning.
Self Assessment Questions
1) Discuss the relationship between neuropsychology and neuroscience.
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27
Neuropsychology
2) Describe cognitive neuropsychology and bring out the relationship
between neuropsychology and cognitive neuropsychology.
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3) Describe the field of biological psychology. How do we use this
knowledge in neuropsychology?
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4) What close relationship Cognitive psychology and neuropsychology
have? Elucidate.
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2.7 NEUROBIOLOGY AND NEUROPSYCHOLOGY

Neurobiology brings together persons who do research and instruction with the
mission of understanding how nervous systems work. This task requires scientific
approaches on different physical scales, from the level of single molecules to the
level of the entire nervous system, and of different temporal scales from fractions
of a millisecond to years. There is an analysis of the brain circuits and neural
networks. The researchers use genetics to understand sensory receptor function.
They sort out the molecular mechanisms of neurotransmitter release and
neurotransmitter receptor regulation. They make computational models of
processes from the movement of molecules in membranes to the control of
behaviours.

They use Molecular and cell biological techniques and use biophysical recordings
using a variety of electrophysiological and optical techniques. Computerised
analysis are providing great insights into the functioning of single nerve cells, as
well as complicated networks of neurons. This multidisciplinary approach is
yielding insights into the rich complexity of mechanisms that influence how we
think, feel, and act.
28
Research also focuses on information processing in vertebrate retina; structure, Neuropsychology and other
Disciplines
function, and development of auditory and visual systems; development and
regeneration in the central and peripheral nervous system; neural mechanisms
mediating higher nervous system functions, including perception, learning,
attention and decision making.

2.8 NEUROPSYCHOLOGY AND

NEUROPHYSIOLOGY
Neuropsychology is that branch of psychology which deals with the relationship
between the nervous system, especially the brain, and the cerebral or mental
functions such as language, memory, and perception. The nervous system is
composed of a network of neurons and other supportive cells (such as glial cells).
Neurons form functional circuits, each responsible for specific tasks to the
behaviours at the organism level. While neurophysiology is the study of the
chemical and physical changes which take place in the nervous system,
Neuroscience is the study of all aspects of nerves and the nervous system, in
health and in disease. It includes the anatomy, physiology, chemistry,
pharmacology, and pathology of nerve cells; the behavioural and psychological
features that depend on the function of the nervous system; and the clinical
disciplines that deal with them, such as neurology, neurosurgery, and psychiatry

The term neurobiology is usually used interchangeably with neuroscience,

although the former refers specifically to the biology of the nervous system, the
latter refers to the entire science of the nervous system.

2.9 NEUROOLOGY AND NEUROPSYCHOLOGY

Neurology deals with diseases of the central and peripheral nervous systems
such as amyotrophic lateral sclerosis (ALS) and stroke, while psychiatry focuses
on behavioural, cognitive, and emotional disorders. It uses neuropsychology for
understanding the disorders in terms of the brain dysfunctions. It uses
neuropsychology for testing and other purposes including rehabilitation of the
patients suffering from neurological disorders.

Neurology is part of medical science that deals with the nervous system and
disorders affecting it. It is a Medical specialty concerned with nervous system
function and disorders.

Clinical neurology began in the mid-19th century, when mapping of the functional
areas of the brain first began and understanding of the causes of conditions such
as epilepsy improved.

Neuropsychiatry is the medical study of disorders with both neurological and

psychiatric features. It is the branch of medicine dealing with mental disorders
attributable to diseases of the nervous system. It preceded the current disciplines
of psychiatry and neurology. However, neurology and psychiatry subsequently
split apart and are typically practiced separately.

Mind/brain monism: Neurologists have focused objectively on organic nervous

system pathology, especially of the brain, whereas psychiatrists have laid claim
29
Neuropsychology to illnesses of the mind. This antipodal distinction between brain and mind as
two different entities has characterised many of the differences between the two
specialties. However, it is argued that this division is simply not veridical; a
plethora of evidence from the last century of research has shown that our mental
life has its roots in the brain and that the brain and mind are not discrete entities
but function differently and look at the same phenomenon from a different
perspective.

It has been argued that embracing this mind/brain monism is important for several
reasons. Firstly, rejecting dualism logically implies that all mental activities are
biological and so immediately there is a common research framework in which
understanding of and the treatment of mental suffering can be advanced. Secondly,
it removes the widespread confusion about the legitimacy of mental illness: all
disorders should have a footprint in the brain-mind system.

In sum, one reason for the division between psychiatry and neurology was the
difference between mind or first-person experience and brain. That this difference
is artificial is taken as good support for a merge between these specialties.

Neuropathology focuses upon the classification and underlying pathogenic

mechanisms of central and peripheral nervous system and muscle diseases, with
an emphasis on morphologic, microscopic and chemically observable alterations.

Behavioural neurology is a subspecialty of neurology that studies the neurological

basis of behaviour, memory, and cognition, the impact of neurological damage
and disease upon these functions, and the treatment thereof.

Causal pluralism
Another broad reason for the divide is that neurology traditionally looks at the
causes of disorders from an ‘inside-the-skin’ perspective (neuropathology,
genetics) whereas psychiatry looks at ‘outside-the-skin’ causation (personal,
interpersonal, cultural). This dichotomy is argued not to be instructive and authors
have argued that it is better conceptualised as two ends of a causal continuum.

The benefits of this position are:

1) Firstly, understanding of etiology will be enriched, in particular between
brain and environment. One example is eating disorders, which have been
found to have some neuropathology, but also show increased incidence in
rural Fijian school girls after exposure to television. Another example is
schizophrenia, the risk for which may be considerably reduced in a healthy
family environment.
2) Secondly, it is argued that this augmented understanding of aetiology will
lead to better remediation and rehabilitation strategies through an
understanding of the different levels in the causal process where one can
intervene. Indeed, it may be that non-organic interventions, like cognitive
behavioural therapy (CBT), soothe disorders alone or in conjunction with
drugs.
To sum up, the argument is that an understanding of the mental disorders must
not only have a specific knowledge of brain constituents and genetics but also
the context in which these parts operate. Only by joining neurology and psychiatry,
30
it is argued, can this combination or interaction be used to reduce human suffering.
 Neuropsychology and other
2.10 COMPARATIVE NEUROPSYCHOLOGY AND Disciplines

NEUROPSYCHOLOGY
Comparative neuropsychology refers to an approach used for understanding
human brain functions. It involves the direct evaluation of clinical neurological
populations by employing experimental methods originally developed for use
with nonhuman animals.

The principles of cognitive neuropsychology have recently been applied to mental

illness, with a view to understanding, for example, what the study of delusions
indicate about the function of normal belief. This relatively young field known
as cognitive neuropsychiatry refers to an approach used for understanding human
brain functions. It involves the direct evaluation of clinical neurological
populations by employing experimental methods originally developed for use
with nonhuman animals.

Over many decades of animal research, methods were perfected to study the
effects of well-defined brain lesions on specific behaviours, and later the tasks
were modified for human use. Generally the modifications involve changing the
reward from food to money, but standard administration of the tasks in humans
still involves minimal instructions, thus necessitating a degree of procedural
learning in human and nonhuman animals alike.

Currently, comparative neuropsychology is used with neurological patients to

link specific deficits with localised areas of the brain. This approach employs
simple tasks that can be mastered without relying upon language skills. Precisely
because these simple paradigms do not require linguistic strategies for solution,
they are especially useful for working with patients whose language skills are
compromised, or whose cognitive skills may be minimal.

Comparative neuropsychology contrasts with the traditional approach of using

tasks that rely upon linguistic skills, and that were designed to study human
cognition. Because important ambiguities about its heuristic value had not been
addressed empirically, only recently has comparative neuropsychology become
popular for implementation with brain-damaged patients.

Within the past decade, comparative neuropsychology has had prevalent use as a
framework for comparing and contrasting the performances of disparate
neurobehavioural populations on similar tasks.

Self Assessment Questions

1) What are the characteristic features of neurobiology? How is it related
to neuropsychology?
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31
Neuropsychology
2) Describe molecular and cellular technology in the functions of
neuropsychology.
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3) What is neurobiology? How is it different from neuroscience?
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4) Describe Clinical neuropsychology and its functions.
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5) What is neuropathology?
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6) What is meant by causal pluralism? What are its benefits?
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7) How is the experiments conducted on animal brains are of use in the
understading of human brain functioning?
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 Neuropsychology and other
2.11 SCIENTIFIC STUDY OF NERVOUS SYSTEM Disciplines

The scientific study of the nervous systems underwent a significant increase in

the second half of the twentieth century, principally due to revolutions in molecular
biology, electrophysiology, and computational neuroscience. It has become
possible to understand, in much detail, the complex processes occurring within
a single neuron. However, to understand as to how the networks of neurons
produce intellectual behaviour, cognition, emotion, and physiological responses
is rather difficult even today.

The task of neural science is to explain behaviour in terms of the activities of the
brain. It is indeed a marvel to find that the brain controls and manipulates millions
of individual nerve cells to bring about a behaviour. These cells are also influenced
by the environment and it is important to know how this happens. It is important
to understand the biological basis of consciousness and the mental processes by
which we perceive, act, learn and remember Neuroscience can be studied at
different levels from molecular to cellular level to systems level to cognitive
level.

The nervous system is composed of a network of neurons and other supportive

cells (such as glial cells).

Neurons form functional circuits, each responsible for specific tasks to the
behaviours at the organism level.

At the molecular level, the basic questions addressed in molecular neuroscience

include the mechanisms by which neurons express and respond to molecular
signals and how axons form complex connectivity patterns.

At this level, tools from molecular biology and genetics are used to understand
how neurons develop and die, and how genetic changes affect biological functions.

The morphology, molecular identity and physiological characteristics of neurons

and how they relate to different types of behaviour are also of considerable interest.
(The ways in which neurons and their connections are modified by experience
are addressed at the physiological and cognitive levels.)

At the cellular level, the fundamental questions addressed in cellular neuroscience

are the mechanisms of how neurons process signals physiologically and
electrochemically. They address how signals are processed by the dendrites, somas
and axons, and how neurotransmitters and electrical signals are used to process
signals in a neuron.

Another major area of neuroscience is directed at investigations of the

development of the nervous system. These questions of neural development
include the patterning and regionalisation of the nervous system, neural stem
cells, differentiation of neurons and glia, neuronal migration, axonal and dendritic
development, trophic interactions, and synapse formation.

At the systems level, the questions addressed in systems neuroscience include

how the circuits are formed and used anatomically and physiologically to produce
the physiological functions, such as reflexes, sensory integration, motor
coordination, circadian rhythms, emotional responses, learning and memory.
33
Neuropsychology In other words, they address how these neural circuits function and the
mechanisms through which behaviours are generated.

For example, systems level analysis addresses questions concerning specific

sensory and motor modalities: how does vision work? How do songbirds learn
new songs and bats localise with ultrasound? How does the somatosensory system
process tactile information? The related field of neuroethology, in particular,
addresses the complex question of how neural substrates underlie specific animal
behaviour.

2.12 COGNITIVE NEUROSCIENCE AND

NEUROPSYCHOLOGY
At the cognitive level, cognitive neuroscience addresses the questions of how
psychological/cognitive functions are produced by the neural circuitry. The
emergence of powerful new measurement techniques such as neuroimaging (e.g.,
fMRI, PET, SPECT), electrophysiology and human genetic analysis combined
with sophisticated experimental techniques from cognitive psychology allows
neuroscientists and psychologists to address abstract questions such as how human
cognition and emotion are mapped to specific neural circuitries.

Neurocognitive is a term used to describe cognitive functions closely linked to

the function of particular areas, neural pathways, or cortical networks in the
brain.

Neuroscience is the scientific study of the nervous system. Traditionally,

neuroscience has been seen as a branch of biology. Nevertheless, it is currently
an interdisciplinary science that involves other disciplines such as cognitive and
neuro-psychology, computer science, statistics, physics, philosophy, and medicine.
As a result, the scope of neuroscience has broadened to include different
approaches used to study the structure, function, evolutionary history,
development, genetics, biochemistry, physiology, pharmacology, informatics,
computational neuroscience and pathology of the nervous system.

The techniques used by neuroscientists have also expanded enormously, from

biophysical and molecular studies of individual nerve cells to imaging of
perceptual and motor tasks in the brain. Recent theoretical advances in
neuroscience have also been aided by the use of computational modeling of
neural networks.

Given the ever increasing number of neuroscientists that study the nervous system,
several prominent neuroscience organisations have been formed to provide a
forum to all neuroscientists and educators. For example, the International Brain
Research Organisation was founded in 1960, the European Brain and Behaviour
Society in 1968, and the Society for Neuroscience in 1969.

Neuroscience is also beginning to become allied with social sciences, and

burgeoning interdisciplinary fields of neuroeconomics, decision theory, social
neuroscience are starting to address some of the most complex questions involving
interactions of brain with environment. Neuroscience generally includes all
scientific studies involving the nervous system.

34
Psychology, as the scientific study of mental processes, is closely related to Neuropsychology and other
Disciplines
neuroscience, although the two disciplines are distinct, with such subjects as
behaviourism and traditional cognitive psychology studied independently of the
underlying neural processes.

The term neurobiology is usually used interchangeably with neuroscience,

although the former refers specifically to the biology of the nervous system, the
latter refers to the entire science of the nervous system.

Neurology, psychiatry, and neuropathology are medical specialties that specifically

address the diseases of the nervous system. These terms also refer to clinical
disciplines involving diagnosis and treatment of these diseases.

Neurology deals with diseases of the central and peripheral nervous systems
such as amyotrophic lateral sclerosis (ALS) and stroke, while psychiatry focuses
on behavioural, cognitive, and emotional disorders.

Neuropathology focuses upon the classification and underlying pathogenic

mechanisms of central and peripheral nervous system and muscle diseases, with
an emphasis on morphologic, microscopic and chemically observable alterations.
The boundaries between these specialties have been blurring recently, and they
are all influenced by basic research in neuroscience.

Integrative neuroscience makes connections across these specialised areas of

focus.

Current neuroscience education and research activities can be very roughly

categorised into the following major branches, based on the subject and scale of
the system in examination as well as distinct experimental or curricular
approaches. Individual neuroscientists, however, often work on questions that
span several distinct subfields.

Self Assessment Questions

1) Describe the central nervous system and its functioning briefly.
...............................................................................................................
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...............................................................................................................
...............................................................................................................
2) What is meant by cognitive neuroscience? How is it related to
neuropsychology?
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...............................................................................................................
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...............................................................................................................
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35
Neuropsychology
3) Describe neuropathology, neurology and psychiatry and their relationship.
...............................................................................................................
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...............................................................................................................
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2.13 BEHAVIOURAL NEUROLOGY

Behavioural neurology is a subspecialty of neurology that studies the neurological
basis of behaviour, memory, and cognition, the impact of neurological damage
and disease upon these functions, and the treatment thereof. Two fields associated
with behavioural neurology are neuropsychiatry and neuropsychology.

Behavioural neurology is that speciality which deals with the study of neurological
basis of behaviour, memory, and cognition, and their impact of damage and disease
and treatment.

Syndromes and diseases commonly studied by behavioural neurology include

but are not limited to:
Agraphia Aprosodias
Agnosias Dementias
Agraphesthesia Dyslexias
Alexia_(disorder) Epilepsy
Amnesias Hemispatial Neglect
Anosognosia Stroke
Aphasias Traumatic Brain Injury
Apraxias
Relationship behavioural neuroscience to other fields of psychology and biology.
In many cases, humans may serve as experimental subjects in behavioural
neuroscience experiments; however, a great deal of the experimental literature
in behavioural neuroscience comes from the study of non-human species, most
frequently rats, mice, and monkeys. As a result, a critical assumption in
behavioural neuroscience is that organisms share biological and behavioural
similarities, enough to permit extrapolations across species. This links behavioural
neuroscience closely with comparative psychology, evolutionary psychology,
evolutionary biology, and neurobiology.

Behavioural neuroscience also has paradigmatic and methodological similarities

to neuropsychology, which relies heavily on the study of the behaviour of humans
with nervous system dysfunction.

Synonyms for behavioural neuroscience include biopsychology, behavioural

neuroscience, and psychobiology. Physiological psychology is another term often
used synonymously with behavioural neuroscience, though some authors would
36
make physiological psychology a subfield of behavioural neuroscience, with an Neuropsychology and other
Disciplines
appropriately more narrow definition.

The distinguishing characteristic of a behavioural neuroscience experiment is

that either the independent variable of the experiment is biological, or some
dependent variable is biological. In other words, the nervous system of the
organism under study is permanently or temporarily altered, or some aspect of
the nervous system is measured (usually to be related to a behavioural variable).

Disabling or decreasing neural function. These include the following, viz., lesions,
electrolytic lesions, chemical lesions, temporary lesions, transcranial magnetic
stimulation, psychopharmacological manipulations, etc.

Areas in behavioural neuroscience

In general, behavioural neuroscientists study similar themes and issues as
academic psychologists, though limited by the need to use nonhuman animals.
As a result, the bulk of literature in behavioural neuroscience deals with mental
processes and behaviours that are shared across different animal models such as:
• Sensation and perception
• Motivated behaviour (hunger, thirst, sex)
• Control of movement
• Learning and memory
• Sleep and biological rhythms
• Emotion
However, with increasing technical sophistication and with the development of
more precise noninvasive methods that can be applied to human subjects,
behavioural neuroscientists are beginning to contribute to other classical topic
areas of psychology, philosophy, and linguistics, such as:
• Language
• Reasoning and decision making
• Consciousness
Behavioural neuroscience has also had a strong history of contributing to the
understanding of medical disorders, including those that fall under the purview
of clinical psychology and biological psychopathology (also known as abnormal
psychology).

Although animal models for all mental illnesses do not exist, the field has
contributed important therapeutic data on a variety of conditions, including the
following:

• Parkinson’s disease, a degenerative disorder of the central nervous system

that often impairs the sufferer’s motor skills and speech.

• Huntington’s disease, a rare inherited neurological disorder whose most

obvious symptoms are abnormal body movements and a lack of coordination.
It also affects a number of mental abilities and some aspects of personality.

37
Neuropsychology • Alzheimer’s Disease, a neurodegenerative disease that, in its most common
form, is found in people over the age of 65 and is characterised by progressive
cognitive deterioration, together with declining activities of daily living and
by neuropsychiatric symptoms or behavioural changes.
• Clinical depression, a common psychiatric disorder, characterised by a
persistent lowering of mood, loss of interest in usual activities and diminished
ability to experience pleasure.
• Schizophrenia, a psychiatric diagnosis that describes a mental illness
characterised by impairments in the perception or expression of reality, most
commonly manifesting as auditory hallucinations, paranoid or bizarre
delusions or disorganised speech and thinking in the context of significant
social or occupational dysfunction.
• Autism, a brain development disorder that impairs social interaction and
communication, and causes restricted and repetitive behaviour, all starting
before a child is three years old.
• Anxiety, a physiological state characterised by cognitive, somatic, emotional,
and behavioural components. These components combine to create the
feelings that are typically recognised as fear, apprehension, or worry.

2.14 BEHAVIOURAL NEUROSCIENCE

Behavioural neuroscience is also known as biological psychology, biopsychology,
or psychobiology. It is the application of the principles of biology, in particular
neurobiology, to the study of mental processes and behaviour in human and non-
human animals.

A psycho-biologist, for instance, may compare the unfamiliar imprinting

behaviour in goslings to the early attachment behaviour in human infants and
construct theory around these two phenomena. Behavioural Neuroscientists may
often be interested in measuring some biological variable, e.g. an anatomical,
physiological, or genetic variable, in an attempt to relate it quantitatively or
qualitatively to a psychological or behavioural variable, and thus contribute to
evidence based practice.

2.14.1 Broca’s Area and Wernicke’s Area

Similarly, Paul Broca’s 1861 post mortem study of an aphasic patient, known as
‘Tan’ after the only word which he could speak, showed that an area of the left
frontal lobe (now known as Broca’s area) was damaged. As Tan was unable to
produce speech but could still understand it, Broca argued that this area might be
specialised for speech production and that language skills might be localised to
this cortical area.

Clues about the role of the occipital lobes in the visual system were provided by
soldiers returning from World War I. The small bore ammunition often used in
this conflict occasionally caused focal brain injuries. Studies of soldiers with
such wounds to the back of their head showed that areas of blindness in the
visual field were dependent on which part of the occipital lobe had been damaged,
suggesting that specific areas of the brain were responsible for sensation in specific
visual areas, known as retinotopy.
38
Studies on Patient HM are commonly cited as some of the precursors, if not the Neuropsychology and other
Disciplines
beginning of modern cognitive neuropsychology. Henry Gustav Molaison
(February 26, 1926 – December 2, 2008), famously known as HM or H.M., was
an American memory disorder patient who was widely studied from late 1957
until his death. His case played a very important role in the development of
theories that explain the link between brain function and memory, and in the
development of cognitive neuropsychology, a branch of psychology that aims to
understand how the structure and function of the brain relates to specific
psychological processes. Before his death, he resided in a care institute located
in Windsor Locks, Connecticut, where he was the subject of ongoing investigation.

His brain now resides at UC San Diego where it was sliced into histological
sections on December 4, 2009. HM had parts of his medial temporal lobes
surgically removed to treat intractable epilepsy in 1953. The treatment proved
successful in reducing his dangerous seizures, but left him with a profound but
selective amnesia.

Because HM’s impairment was caused by surgery, the damaged parts of his brain
were precisely known, information which was usually not possible to know in a
time before accurate neuroimaging became widespread. This allowed detailed
connections to be made between theories of memory formation and the brain
structures removed in HM.

These and similar studies had a number of important implications.

1) The first is that certain cognitive processes (such as language) could be
damaged separately from others, and so might be handled by distinct and
independent cognitive and neural processes.
2) The second is that such processes might be localised to specific areas of the
brain. Whilst both of these claims are still controversial to some degree,
3) The influence led to a focus on brain injury as a potentially fruitful way of
understanding the relationship between psychology and neuroscience.
During the 1960s, information processing became the dominant model in
psychology for understanding mental processes. This provided an important
theoretical basis for cognitive neuropsychology, as it allowed an explanation of
what areas of the brain might be doing and also allowed brain injury to be
understood in abstract terms as impairment in the information processing abilities
of larger cognitive system.

Self Assessment Questions

1) Discuss behavioural neurology. What are the syndrome and diseases
seen in behavioural neurology?
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39
Neuropsychology
2) Discuss the relationship of behavioural neuroscience with the field of
psychology and biology.
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...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
3) Enumerate the areas of behaviour neuroscience.
...............................................................................................................
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4) What do you understand by Broca’s and Wernicke’s area?
...............................................................................................................
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...............................................................................................................
...............................................................................................................

Neurocognitive is a term used to describe cognitive functions closely linked to

the function of particular areas, neural pathways, or cortical networks in the
brain. Therefore, their understanding is closely linked to the practice of
neuropsychology and cognitive neuroscience, two disciplines that broadly seek
to understand how the structure and function of the brain relates to thought and
behaviour.

A neurocognitive deficit is a reduction or impairment of cognitive function in

one of these areas, but particularly when physical changes can be seen to have
occurred in the brain, such as after neurological illness, mental illness, drug use,
or brain injury.

2.15 LET US SUM UP

Neuropsychology is that branch of psychology which deals with the relationship
between the nervous system, especially the brain, and the cerebral or mental
functions such as language, memory, and perception.

While neurophysiology is the study of the chemical and physical changes which
take place in the nervous system, Neuroscience is the study of all aspects of
nerves and the nervous system, in health and in disease. It includes the anatomy,
physiology, chemistry, pharmacology, and pathology of nerve cells; the
40
behavioural and psychological features that depend on the function of the nervous Neuropsychology and other
Disciplines
system; and the clinical disciplines that deal with them, such as neurology,
neurosurgery, and psychiatry. Neuroscience is the scientific study of the nervous
system. Traditionally, neuroscience has been seen as a branch of biology.

The nervous system is composed of a network of neurons and other supportive

cells (such as glial cells). Neurons form functional circuits, each responsible for
specific tasks to the behaviours at the organism level.

The term neurobiology is usually used interchangeably with neuroscience,

although the former refers specifically to the biology of the nervous system, the
latter refers to the entire science of the nervous system.

Neurology, psychiatry, and neuropathology are medical specialties that specifically

address the diseases of the nervous system. These terms also refer to clinical
disciplines involving diagnosis and treatment of these diseases.

Neurology deals with diseases of the central and peripheral nervous systems
such as amyotrophic lateral sclerosis (ALS) and stroke, while psychiatry focuses
on behavioural, cognitive, and emotional disorders.

Neuropathology focuses upon the classification and underlying pathogenic

mechanisms of central and peripheral nervous system and muscle diseases, with
an emphasis on morphologic, microscopic and chemically observable alterations.

Behavioural neurology is a subspecialty of neurology that studies the neurological

basis of behaviour, memory, and cognition, the impact of neurological damage
and disease upon these functions, and the treatment thereof.

Behavioural neuroscience also has paradigmatic and methodological similarities

to neuropsychology, which relies heavily on the study of the behaviour of humans
with nervous system dysfunction.

Behavioural neuroscience is also known as biological psychology, biopsychology,

or psychobiology. It is the application of the principles of biology, in particular
neurobiology, to the study of mental processes and behaviour in human and non-
human animals.

Comparative neuropsychology refers to an approach used for understanding

human brain functions. It involves the direct evaluation of clinical neurological
populations by employing experimental methods originally developed for use
with nonhuman animals.

Neurocognitive is a term used to describe cognitive functions closely linked to

the function of particular areas, neural pathways, or cortical networks in the
brain.

2.16 UNIT END QUESTIONS

1) Define neuropsychology and bring out its features.
2) Trace historically the emergence of neuropsychology discipline
3) Why is it neuropsychology called an interdisciplinary approach?
41
Neuropsychology 4) Bring out the relationship between neuropsychology and all other disciplines
and related fields.
5) Describe the scientific study of nervous system. How is it helpful to
neuropsychiology?
6) What is neuropathology? Describe some of the pathological syndromes
related to the brain.
7) What are the functions of neuropsychologist?

2.17 SUGGESTED READINGS

M. W. Eysenck, and M. T. Keane (2005). Cognitive Psychology: A Student’s
Handbook (5th ed.). Hove, UK: Psychology Press.

E. E. Smith and S. M. Kosslyn (2007). Cognitive Psychology: Mind and Brain

(1st ed.). Upper Saddle River, NJ: Pearson/Prentice Hall.

B. Kolb and I. Q. Whishaw, I. Q. (1996). Fundamentals of Human

Neuropsychology (4th ed.). New York, NY: W. H. Freeman.

42
 Neuropsychology and other
UNIT 3 HISTORICAL PERSPECTIVE OF Disciplines

NEUROPSYCHOLOGY

Structure
3.0 Introduction
3.1 Objectives
3.2 History of Neuropsychology
3.2.1 Trephanation
3.2.2 Ancient Egyptian
3.2.3 Ancient Greek
3.2.4 The Cell Doctrine
3.2.5 Phrenology
3.2.6 Localisation
3.3 Brain and Behaviour
3.4 Let Us Sum Up
3.5 Unit End Questions
3.6 Suggested Readings

3.0 INTRODUCTION
In this unit we will be discussing the historical perspective of neuropsychology.
We start with history of neuropsychology within which we will be presenting
trephanation, ancient Egyptian methods, Ancient Greek methods and then follow
it up with cell doctrine. We then discuss phrenology and how this helped in
understanding the functions of the brain. Then we take up localisation in which
we present some of the disorders arising due to pathology in certain localised
areas. Then we have a discussion about the relationship between brain and
behaviour.

3.1 OBJECTIVES
After going through this unit, you will be able to:
• understand the evidence of neuropsychology;
• know various studies which got neuropsychology into existence;
• discuss the relation between the brain and behaviour; and
• understand the current developments in neuropsychology.

3.2 HISTORY OF NEUROPSYCHOLOGY

Neuropsychology is the basic scientific discipline that studies the structure and
function of the brain related to specific psychological processes and overt
behaviours. The term neuropsychology has been applied to studying lesions in
humans and animals. It has also been applied to efforts to record electrical activity
from individual cells (or groups of cells) in higher primates (including some
studies of human patients).
43
Neuropsychology Neuropsychology and neuroscience in general have a history that is quite a bit
older than one would think. Written records of the nervous system date back as
far as 1700 B.C. But the bulk of knowledge about the brain and its functions did
not become known until the 17th century. This is when men like Rene Descartes
and Thomas Willis began studying the human nervous system and how it worked.
The brain has really only recently been linked to the behaviours of individuals.
This was begun in the 1900’s when scientists started to look at how the mind
affected people’s behaviours.

Neuropsychology is the study of the relationships between brain function and

behaviour. It observes changes in thoughts and behaviours that relate to the
structural or cognitive integrity of the brain. It is a method of studying the brain
by examining its behavioural product.

The developments which led up to the emergence of an autonomous discipline

of neuropsychology have a long and chequered history and provide insights into
the perennial issues which still occupy neuropsychologists.

3.2.1 Trephanation
Trephanation is the ancient surgical procedure of operating on the human skull
by scraping, chiseling, or cutting bone from the skull. This method was discovered
by archaeologists. It is reported that at that time when this method was used
many who underwent trephanations survived which showed that this method
was very effective in healing some of the brain disorders. Those disorders for
which trephanation was used included Traumatic Brain disorders, psychiatric
disorders etc. This method was rather a crude method and many also died and
never got alright. Some even underwent multiple trephanations. Many had their
skulls damaged due to trephanation. Trephanation was also carried out for
religious purposes that is to release and drive away the evil spirits etc. perhaps a
religious rite - to release evil spirits.
In a study conducted by Verona & Williams (1992), they examined 750 skulls
from Peru and measured trephinated skulls for technique, location, size, healing,
and presence of fractures. Results suggest that most trephinations were performed
in the frontal and upper parietal regions following injury to the skull from clubs
and other weapons of the pre-Columbian era. Scraping and circular grooving
had the highest success rates as opposed to straight cutting and drilling. Techniques
used were similar to modern day methods of drilling burr holes to relieve pressure
and release trapped blood.
In one process, the practitioner had even produced ring of small holes. The next
step in the procedure is to cut the bone between each hole and pry off the bone
piece in the center. The patient probably would die before the trephination is
completed. There is no evidence of healing. There is also a large linear skull
fracture besides the trephination opening. It is clear that this trephination was
used to treat the associated skull fracture. Perhaps the practitioner believed that
a blood clot was underneath the skull, near the fracture. Such blood clots are a
frequent result of this type of traumatic skull injury.
This skull on the right shows evidence of multiple head injuries and trephinations.
There is a well-healed trephination and a fresh one. The patient probably died
soon after receiving this recent head injury and fresh trephination. This one
demonstrates the great survival rate associated with the procedure. This person
44
lived for many years after the first trephination. There is considerable healing. Historical Perspective of
Neuropsychology
This trephination was done with the scraping method.

In another process, the practitioner begins with cuts that surround the central
area. They began cutting the outer perimeter in order to create a larger opening.
This trephination shows no signs of healing because the patient dies.

3.2.3 Ancient Greek

The knowledge of brain function at that time was limited by the strong aversion
to dissecting the brain. They had a number of mistaken beliefs, including
Aristotle’s localisation of mental functions in the heart. This theory explained
that people with heavy upper bodies were intellectually dull due to the extra
weight bearing on the heart. The view that the heart is the organ of the human
mind or consciousness is called the “cardiac or cardio centric hypothesis”.
Aristotle identified the heart as “the most important organ of the body,” and the
first to form according to his observations of chick embryos. It was the seat of
intelligence, motion, and sensation - a hot, dry organ. Aristotle described it as a
three-chambered organ that was the center of vitality in the body. Other organs
surrounding it (e.g. brain and lungs) simply existed to cool the heart.

Why? After death, the heart was weighed to see if one would enter into eternal
afterlife, but the brain was usually discarded. Aristotle believed in “dualism”
which divides the world into two spheres: mind and matter. The mind (or soul)
is a nonphysical entity, which somehow interacts with the material body. In
particular, mind-body dualism claims that neither the mind nor matter can be
reduced to each other in any way, and is sometimes referred to as “mind and
body” and stands in contrast to philosophical monism, which views mind and
matter as being ultimately the same kind of thing. According to Aristotle, the
mind and body interacted through a “point of interaction” which he identified as
the heart. To this day, we continue to perpetuate this belief by giving cards with
hearts on Valentine’s day, and by using terms such as “heartbroken” or “cold-
blooded.”

Pythagoras (circa 550 BC, best known for the Pythagorean theorem) was one of
the first to propose that the thought processes and the soul were located in the
brain and not the heart. This belief is the “brain or cephalocentric hypothesis”,
stating that the brain is the source of reasoning and all human behaviour.
Pytharoras also claimed to have lived four lives that he could remember in detail,
and heard the cry of his dead friend in the bark of a dog.

Hippocrates (circa 400 BC, influenced by Socrates) was considered one of the
most outstanding figures in the history of medicine, is referred to as the “father
of medicine”, and was the founder of the Hippocratic school of medicine. The
Hippocratic school held that all illness was the result of an imbalance in the
body of the four humours, fluids which in health were naturally equal in proportion
(pepsis). When the four humours, blood, black bile, yellow bile and phlegm,
were not in balance (dyscrasia, meaning “bad mixture”), a person would become
sick and remain that way until the balance was somehow restored. Hippocratic
therapy was directed towards restoring this balance.

However, Hippocrates also believed the brain to be the seat of intelligence, and
the controller of the senses, emotions, and movement, and was the first to
45
Neuropsychology recognise that paralysis occurred on the side of the body opposite the side of a
head injury.

History of cognitive neuropsychology

Cognitive neuropsychology first began to flourish in the second half of the
Nineteenth Century, initially in relation to disorders in the comprehension and
production of spoken language (aphasia). Continental neurologists such as Broca
(1861), Lichtheim (1873) and Wernicke (1874) studied patients with aphasia
and inferred information-processing models of the normal language-processing
system from the patterns of preserved and impaired language abilities they saw
in their patients. They even expressed these models as box-and-arrow flowcharts
of information processing, which is the universal notation in modern cognitive
neuropsychology. This cognitive-neuropsychological approach was also applied
to the understanding of disorders of written language, both reading and spelling
(Bastian, 1869; Dejerine, 1891), and soon spread to other cognitive domains
such as object recognition (Lissauer, 1890), calculation (Lewandowsky &
Stadelmann, 1908) and many others.
Cognitive neuropsychology was thus flourishing by the early Twentieth Century.
But then it rapidly lost favour. This happened for two reasons, one to do with
psychology and the other to do with neurology.
Re psychology: the whole idea that it is possible to study the structure and nature
of mental information processing systems that is, the idea that it is possible to do
cognitive psychology was directly attacked by John B Watson in 1913 argued
that mental processes were not directly observable and therefore could not be
studied scientifically. All that should be studied by psychologists is what could
be objectively observed. Stimuli and an organism’s responses to them. This
doctrine is known as behaviourism. It became very strong in the psychology of
the first half of the twentieth century, and since it was completely incompatible
with an interest in developing models of mental processing systems, it provided
a hostile climate for cognitive psychology and hence for cognitive
neuropsychology.
Regarding neurology, the nineteenth century cognitive neuropsychologists were
also neurologists. So they were not satisfied just with developing modular models
of cognitive processes. They also wanted to localise these modules in the brain.
This was a hopelessly premature endeavour which was bound to fail, and when
it failed this left them highly vulnerable to criticism.
The endeavour was premature for two reasons. Firstly, the only way they could
acquire information about the location in the brain of any patient’s lesion was
extremely crude by autopsy after the patient’s death. Secondly, even if the
information about lesion location could have been obtained by less crude methods,
the models themselves were not sufficiently detailed for questions to be sensibly
asked about where the modules were located in the brain. That may even still be
true even today; cognitive neuroscientists believe that it isn’t.
Early in the twentieth century, a number of anti modular and anti localisationist
neurologists attacked the work of Broca, Wernicke and others, and their attacks
made highly effective use of the unconvincingness of the attempts by the
nineteenth century cognitive neuropsychologists to demonstrate relationships
between particular lesion sites and particular cognitive impairments.
46
Particularly effective were the attack on Broca by Pierre Marie in 1906 and, Historical Perspective of
Neuropsychology
especially, the attack on the whole field of cognitive neuropsychology by Henry
Head in 1926, which was expressed in the most brutal of terms: “Wernicke failed
to recognise the wide-spread nature of the difficulty owing to the preconceptions
with which it was approached: in the solemn discussion which follows that report
we can only wonder at his clinical obtuseness and want of clinical insight . . We
are astonished at the serene dogmatism with which the writers assume a
knowledge of the working of the mind and its dependence on hypothetical groups
of cells and fibres. Most of the observers mentioned in this chapter failed to
contribute anything of permanent value to the solution of the problem.”

The “Cognitive Revolution” the abandonment of behaviourism and the

acknowledgement that there are scientifically acceptable ways of investigating
the structure and nature of mental information-processing systems even if these
are no more directly observable than neutrons and electrons - occurred in Britain
and North America in the mid-1950s. New and more detailed modular models
of various forms of cognitive processing, initially language and also selective
attention, were developed and applied to the explanation of data collected from
experiments on normal subjects.

Then there developed certain research collaborations between cognitive

psychologists who had been doing this kind of work and clinical
neuropsychologists who saw in the clinic various kinds of breakdowns of
cognition caused by brain damage. The clinicians were interested in understanding
these breakdowns in more detail. The cognitive psychologists were interested in
learning more about normal systems by studying how they could break down.

The 1960s saw two such seminal collaborative papers, which marked the rebirth
of cognitive neuropsychology: Marshall and Newcombe (1966) on reading and
Warrington & Shallice (1969) on memory. A decade later, cognitive
neuropsychology had been fully reestablished, according to Selnes (2001), who
notes that in 1977 “a meeting to discuss deep dyslexia was convened in Oxford,
and this is often considered by many to be a convenient marker for the early
beginnings of cognitive neuropsychology (E. Saffran, personal communication,
2000). The book Deep Dyslexia (Coltheart, Patterson & Marshall, 1980) which
resulted from the conference is considered by many to be the first major book
that deals with the cognitive approach to neuropsychology. The journal Cognitive
Neuropsychology was first published in 1984.” (Selnes, 2001, p. 38). Not long
afterwards, in 1988, the field’s first textbook, Human Cognitive Neuropsychology,
was published (Ellis & Young, 1988), and so was the first book critically reviewing
the field (Shallice, 1988).

Cognitive neuropsychology has two major domains of application: assessment

and rehabilitation.

Cognitive-neuropsychological assessment is assessment that is based on an

explicit modular information-processing model of the relevant cognitive domain.
The existence of the model permits the construction of tests specific to the
individual modules of the model, so that a comprehensive analysis can be made
of which of these cognitive modules is operating normally and which have been
perturbed by brain damage (in the case of acquired disorders of cognition) or
have not been acquired to age-appropriate levels (in the case of developmental
47
Neuropsychology disorders of cognition). The best-developed cognitive-neuropsychological
assessment batteries are the PALPA battery for the assessment of disorders of
spoken and written language (Kay, Lesser & Coltheart, 1992) and the BORB
battery for the assessment of disorders of visual perception and visual object
recognition (Riddoch and Humphreys, 1993).

Cognitive-neuropsychological rehabilitation (Coltheart, Brunsdon & Nickels,

2005) is similarly model-based: it is treatment that is specifically directed at
improving the functioning of the particular cognitive modules or pathways that
have been identified, via cognitive-neuropsychological assessment methods, as
specifically impaired. Other approaches to neuropsychological rehabilitation differ
from this in typically being rather generally aimed at the entire cognitive domain
within which the patient shows some or other symptoms. Numerous examples
of the cognitive-neuropsychological approach to rehabilitation can be found in
Humphreys & Riddoch (1994) and Whitworth, Webster & Howard (2005).

The volume by Coltheart and Caramazza (2006) is a recent review of the field
which contains state-of-the-art accounts of contributions of cognitive
neuropsychology to our understanding of a variety of domains of cognition,
showcasing in particular what we have learned so far from cognitive
neuropsychology about conceptual representation, speech production, sentence
comprehension, reading and spelling, short-term memory, visual object
recognition, spatial attention and skilled action.

Self Assessment Questions

1) Match the Following:
1) Trephenation a) Aristolte
2) Ancient Egyptian b) Vermona & Williams
3) Localisation c) Edwin Smith
2) Give one word for each of the following statement:
a) Relationship between brain function and behaviour. .....................
b) Ancient surgical procedure of operating on the human skull is ....
.......................................................
c) Weaknmess on the one side of the body is ....................................
d) Thought processes and soul were located in the brain and not the
heart ..............................................
e) The brain is the seat of intelligence, and the controller of senses,
emotion and movement. ........................................

3.2.4 The Cell Doctrine

This theory postulated that mental and spiritual processes/functions were localised
in the ventricles (called Cells) of the brain. The theory was proposed by Nemesius
and Saint Augustine in approximately 130-200 A.D. It was strongly influenced
by the anatomical studies of Galen in the second century, in which he described
the ventricles in detail and developed his own theory of “psychic gases and
humours” that flowed through the body and ventricles (thus, the ventricular
localisation hypothesis”), giving rise to mental functions. (He also characterised
48 the brain as a “large clot of phlegm”.)
The idea that the ventricles were merely a sewer system through which passed Historical Perspective of
Neuropsychology
bodily fluids, led to the theory of the importance of “humors” which has persisted
for 1000 years. Mental functions derived from the descriptions of Aristotle, such
as memory, attention, fantasy and reason, were assigned locations within the
ventricles. These images depict the connections between the senses (vision,
hearing etc.) and the “Common Sense”, located in the first ventricle. Cognitive
functions were then arrayed from front to back in the ventricles. This Doctrine
was proven to be totally false, as we now know that the ventricles are the site
through which cerebrospinal fluid passes.

From this period, many important discoveries and theories were noted. Dissections
of condemned criminals (who, at that time, were at the disposal of scientists and
physicians) led to the knowledge that specific parts of the brain control specific
behaviours (discussed later as localisation). As well, the discovery of ascending
(sensory) and descending (motor) nerves occurred.

Galen (circa 200 BC) was a prominent ancient Greek physician, who also served
as a physician in a gladiator school. During this time he gained much experience
with treating trauma and especially wounds, which he later called “windows
into the body”. He performed many operations, including brain and eye surgeries,
and also “vivisections” of numerous animals to study the function of the kidneys
and the spinal cord. From these studies, Galen hypothesised that the mind
controlled fluids known as pneuma (animal spirits): the brain was the reservoir
of pneuma, which were stored in the ventricles.

Pneuma traveled through nerves, which Galen believed were tubes, throughout
the body - sent out from the brain to the muscles (i.e., controlled by the mind,
causing the body to move) and sent back to the brain due to sensory stimulation.
Physical functioning was dictated by the balance of four bodily fluids or humors:
Blood, Mucus, Yellow bile, Black bile, which were related to the four elements
- air, water, fire, and earth. Galen also showed that pressing on the heart in human
subjects did not lead to loss of consciousness or loss of sensation but severing
the spinal cord in animals abolished sensory responses after brain stimulation.

The First Anatomical Studies: Vesalius (1514-1564) was the first to conduct
careful observations of brain anatomy and qualify the teachings of the cell doctrine
in which he was trained. He represents the beginning of a period in which careful
observations and empirical science began to triumph over the ideas that had
been handed down since the time of Aristotle and Galen. Vesalius introduced the
anatomical theater in which students and doctors could watch dissections from
above. Vesalius made careful diagrams of human anatomy.

Mind-Body Dualism: Descartes (1596-1650) introduced the concept of a

separate mind and body. He believed that all mental functions were located in
the pineal gland, a small centrally-located brain structure which is now believed
to play a role in sleep/wake and dark/light cycles. The dualist philosophy suggested
a complete split between mental and bodily processed, and explained automatic
bodily reflexes (body) while purposeful behaviours were a product of free-will
(mind).

Descartes did subscribe to some of Galen’s theories (that the brain was a reservoir
of fluid), as demonstrated by one of his illustrations, in which the fire displaces
49
Neuropsychology the skin, which pulls a tiny thread, which opens a pore in the ventricle (F) allowing
the “animal spirit” to flow through a hollow tube, which inflates the muscle of
the leg, causing the foot to withdraw. This would now be described as a reflex,
for which Descartes is credited. Popular culture has many references to dualism.

3.2.5 Phrenology
Phrenology is a hypothesis stating that the personality traits of a person can be
derived from the shape of the skull. It is now considered a pseudoscience.
Developed by German physician Franz Joseph Gall in 1796, the discipline was
very popular in the 19th century.
Phrenology is based on the concept that the brain is the organ of the mind, and
that certain brain areas have localised, specific functions or modules.
Phrenologists believed that the mind has a set of different mental faculties, with
each particular faculty represented in a different area of the brain.
These areas were said to be proportional to a person’s propensities, and the
importance of the given mental faculty. It was believed that the cranial bone
conformed in order to accommodate the different sizes of these particular areas
of the brain in different individuals, so that a person’s capacity for a given
personality trait could be determined simply by measuring the area of the skull
that overlies the corresponding area of the brain.
Gall (1758-1828) introduced the idea that the brain was comprised of separate
organs, each localised and responsible for a basic psychological trait. These traits
controlled complex mental faculties, such as Cautiousness, Combativeness and
Agreeableness, and simpler functions, such as Memory, Calculation Ability and
Color Perception. Phrenology correlated the mental faculties described by
philosophers with the development of specific brain areas. The development of
these brain areas, called cerebral organs, resulted in skull prominences. These
bumps could be analysed and a Phrenology practitioner could determine the
subject’s personality and intelligence from analysis of the skull, called
cranioscopy.
Followers of phrenology categorised individuals on the basis of skull, and thus,
brain size. Men were believed to have larger “social regions” with more “pride,
energy, and self-reliance”, as compared to female skulls which were thought to
possess more “inhabitivness (love of home), a lack of firmness and self esteem.”
Many studies have refuted the notion that skulls of different races reflect
superiority, and it is impossible to distinguish between murders and geniuses on
the basis of skull size or shape.
Phrenology was a complex process that involved feeling the bumps in the skull
to determine an individual’s psychological attributes. Franz Joseph Gall first
believed that the brain was made up of 27 individual ‘organs’ that created one’s
personality, with the first 19 of these ‘organs’ believed to exist in other animal
species.
Phrenologists would run their fingertips and palms over the skulls of their patients
to feel for enlargements or indentations. The phrenologist would usually take
measurements of the overall head size using a caliper. With this information, the
phrenologist would assess the character and temperament of the patient and
address each of the 27 “brain organs”.
50
Gall’s list of the “brain organs” was lengthy and specific, as he believed that Historical Perspective of
Neuropsychology
each bump or indentation in a patient’s skull corresponded to his “brain map”.
An enlarged bump meant that the patient utilised that particular organ extensively.
The 27 areas were varied in function, from sense of colour, to the likelihood of
religiosity, to the potential to commit murder.
Each of the 27 “brain organs” was located in a specific area of the skull. As a
phrenologist felt the skull, he could refer to a numbered diagram showing where
each functional area was believed to be located.
There is no relationship between the bumps on the skull and the underlying
brain tissue, nor is there a relationship between the size of an area of brain and
the size of the function that it supports (skulls are hard, brains are not). Although
he was almost completely incorrect, Gall’s Phrenology represents the beginning
of the strong modern day localisationist doctrine.

3.2.6 Localisation
Broca (1824-1880) described most famous case, “Tan”, and a patient who suffered
a stroke of the left hemisphere who could only utter the phrase “Tan”. The patient
could accurately comprehend language. Broca then used this case and a number
of others to show that the expression of language was localised to the left frontal
lobe. If you look carefully at the brain, you can detect a soft, fluid-filled area in
the frontal lobe. This represents the empty space, or infarction that is caused by
the drop in blood supply to that brain area (stroke). The third convolution of the
inferior posterior frontal lobe has since become known as “Broca’s area”, and
patients with damage to Broca’s area are referred to as having “Broca’s aphasia”.
Several years after Broca presented his cases of frontal lobe lesions, Wernicke
(1848-1904) presented cases in which patients had lesions of the superior posterior
part of the left hemisphere and had trouble comprehending language. This resulted
in the idea that component processes of language were localised. On the basis of
Wernicke’s observations, the modern doctrine of component process localisation
and disconnection syndromes was begun. This doctrine states that complex mental
functions, such as language, represent the combined processing of a number of
subcomponent processes represented in widely different areas of the brain. A
mental faculty like “Combativeness” described by the Phrenologists was not
discreetly localised in the brain. Such faculties, if they have validity at all, are
the result of a number of primary cognitive operations.
Responses to Localisation: Freud described several types of language disorders
wich could not be explained by lesions to Broca’s or Wernike’s areas. He
postulated that lesions in the subcortical areas would produce similar behavioural
disorders. Similar anti-localisation concepts were presented by Flourens (1794-
1867). He asserted that while sensory input was localised, to an extent, at an
elementary level, the more compels process of perception was dependent on the
entire brain (Luria later explained this in terms of primary, secondary and tertiary
zones). Based on ablation studies of hens and pigeons, he concluded that loss of
function is more a product of the amount of damage rather than the location of
that damage. Flourens also offered the notion of equipotentiality of brain tissue,
or that if there is enough intact tissue following brain damage, the remaining
tissue will compensate and take over the function of the missing area. By utilising
dependent measures such as wing-flapping and eating behaviours in pigeons,
Flourens erroneously suggested that only 10 percent of brain tissue of used.
51
Neuropsychology Munk (1839-1912) produced temporary “mind-blindness” in dogs following
lesions in their association cortex. This notion that an animal will recognise an
object (i.e., see the object) but fail to recall the conditioned significance is similar
to the concept of “anosognosia.” Following lesions to the association cortex of
the right hemisphere, Babinski (1857-1932) described a similar unawareness of
deficit.

Lashley supported Flourens’ notion of equipotentiality based on his own research

on rats. While the specific area of the lesion had no effect on subsequent
performance, Lashley found that the amount of brain tissue removed from rat
brains effected the ability to negotiate previously learned mazes. From his studies,
Lashley offered the theories of “mass action” and “multipotentiality”; the amount
of damaged brain tissue influences subsequent behaviour and each part of the
brain participates in multiple functions.

3.3 BRAIN AND BEHAVIOUR

Brain and behaviour is concerned with determining the neural and chemical
correlates of motivation, development, and cognition. This includes reward,
feeding, maternal behaviour, biological rhythms, drugs, and psychiatric disorders;
the anatomy, physiology, and chemistry of brain change associated with learning,
aging, retardation, and epilepsy; and cognitive changes in brain-injured human
patients.
The brain has really only recently been linked to the behaviours of individuals,
this was begun in the 1900’s when scientists started to look at how the mind
affected people’s behaviours.
1913 John Watson presented his theory that human behaviour is based upon
conditioned responses to stimuli. His theory was somewhat against the eugenics
theory which had reached its height at this time. This marked the beginning of
the behaviour of the behaviourist school of psychology.
Eugenics According to this, human behaviour is said to be an inherited trait. In
1930’s scientists try to affect the workings of the brain in order to treat mental
illnesses such as anxiety, depression and schizophrenia.
Lobotomy This method was developed by Monis,. This involved was the surgical
sieving of connections in the frontal lobe of the patients. This actually resulted
in adverse side effects such as mood problems and changes in personality.
Electric Shock Therapy. This was developed by Cerletti and Boni. Used electric
shocks to induce positive chemical changes in the brain. This like lobotomy had
detrimental side effects.
The use of both these techniques declined in the 1950’s after the development of
the medicine Thorazine.
1950’s and 60’s. Wilder Penfield identified specific areas of the brain that control
motor impulses, sensory inputs and memories.
1970’s and 80’s. New scanning devices like the CT scanner and MRI allow for
detailed mapping of the brains functions.
1975 The roles of brain chemicals such as endorphins are discovered. Behaviour
52 is now thought of as biochemical events.
1990. With new knowledge more effective drugs are developed for the treatment Historical Perspective of
Neuropsychology
of mental illnesses.
Genes also are beginning to be studied in order to see if there are ties to behaviours.
This could lead to evidence supporting eugenics or knowledge that could link
eugenics and behaviourism together.
Today there are several different approaches to the study of the brain behaviour
relationships, but the method which has figured most prominently is the one that
is the natural successor or complement to the work of the early neurologists,
namely study of the effects of lesions in specific areas of the brain by carefully
observing associated changes in behaviour.

Self Assessment Questions

1) What do you understand by cell doctrine?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
2) Discuss phrenology and localisation.
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
3) Discuss the relation between the brain and behaviour.
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

3.4 LET US SUM UP

The developments which led up to the emergence of an autonomous discipline
of neuropsychology have a long and chequered history
Attempts to localise mental processes to particular bodily structures can be traced
back at least to the 5th century BC, when Hippocrates identified the brain as the
organ of intellect, and the heart as the organ of the senses.
53
Neuropsychology Recent research (Bruce 1985) suggests that the term ‘neuropsychology’ was first
used in 1913 by Sir William Osler in an address he gave at the opening of the
Phipps Clinic at the Johns Hopkins Hospital.
Hans-Lukas Teuber, one of the early pioneers in neuropsychology, argued that
the task of neuropsychology is twofold.
To help the patient with the damaged brain to understand his disease and to
provide essential insights into the physiological basis of normal brain function.
Today there are several different approaches to the study of the brain–behaviour
relationships, but the method which has figured most prominently is the one that
is the natural successor or complement to the work of the early neurologists,
namely study of the effects of lesions in specific areas of the brain by carefully
observing associated changes in behaviour.
Neuropsychologists study the individual’s awareness of the world in which one
moves. But it is not only sensory and motor processes that may be altered by
changes in the nervous system: higher functions such as language, thought, and
memory may also be changed.
Another approach to the study of brain function arises at times in the course of
major brain surgery when a neurosurgeon may briefly stimulate the exposed
surface of the brain electrically in order to ascertain which part of the brain he is
treating, and also to establish with as much certainty as possible on which side
of the brain speech is lateralised.
The flow of blood to the neocortex increases in areas where the neurons are
particularly active. In some cases batteries of tests have been applied to large
groups of patients in an attempt to analyse quantitatively the patterns of deficits
that emerge between the different brain-damaged groups.
Each of these distinctive approaches to neuropsychology has contributed
significantly to its development and will continue to do so.

3.5 UNIT END QUESTIONS

1) Trace the history of Neuropsychology.
2) What is meant by localisation?
3) Discuss the relationship between brain and behaviour.

3.6 SUGGESTED READINGS

Kolb, B.& Wishaw,I.Q. (1990). Fundamentals of Human Neuropsychology.
W.H.Freeman and Company. New York
Rao,S.L.,Subbakrishna,D.K.,Gopukumar,K.(2004). Nimhans Neuropsychology
Battery. Nimhans Publication. Bangalore.
Snyder,P.J.,Nussbaum,P.D.,Robins,D.L.(2006). Clinical Neuropsychology A
Pocket Handbook for Assessment. American Psychological Association ,
Washington.
Spreen,O. & Strauss,E.(1991). A Compendium of Neuropsychological Tests.
Oxford University Press. New York.
54
 Historical Perspective of
UNIT 4 DOMAINS OF NEUROPSYCHOLOGY Neuropsychology

Structure
4.0 Introduction
4.1 Objectives
4.2 Areas of Neuropsychology
4.2.1 Clinical Neuropsychology
4.2.2 Expérimental Neuropsychology
4.3 Cognitive Functions
4.3.1 Attention
4.3.2 Motor Function
4.3.3 Language
4.3.4 Learning and Memory
4.3.5 Visual Perception and Constructional Ability
4.3.6 Executive Functions
4.4 Neuropsychological Assessment
4.5 Approaches of Neuropsychological Assessment
4.5.1 Fixed Battery Approach
4.5.2 Flexible Battery Approach
4.6 Goals of Neuropsychological Assessment
4.7 Assessment Process
4.8 Other Assessments
4.9 Let Us Sum Up
4.10 Unit End Questions
4.11 Suggested Readings

4.0 INTRODUCTION
The brain is a fascinating and enigmatic machine. It has the ability to monitor
and control our basic life support systems, to maintain our posture and direct our
movements, to receive and interpret information about the world around us, and
to store information in a readily accessible form throughout our lives. It allows
us to solve problems which range from the strictly practical to the highly abstract,
to communicate with our fellows through language, to create new ideas and
imagine things that have never existed, to feel love and happiness and
disappointment and to experience an awareness of ourselves as individuals.
Neuropsychology as one of the neurosciences has grown to be a separate field of
specialisation within psychology. Neuropsychology seeks to understand the
relationship between the brain and behaviour i.e. it attempts to explain the way
in which the activity of the brain is expressed in observable behaviour.

4.1 OBJECTIVES
After completing this unit, you will be able to:
• Define neuropsychology;
55
Neuropsychology • Describe neuropsychological functions;
• Explain the different neuropsychological functions;
• Explain the different approaches to neuropsychological assessment;
• Elucidate the goals of neuropsychological assessment; and
• Describe the various tests used for assessment.

4.2 AREAS OF NEUROPSYCHOLOGY

Neuropsychology is often divided into two main areas: clinical neuropsychology
and experimental neuropsychology.

4.2.1 Clinical Neuropsychology

This deals with patients who have lesions of the brain. These lesions may be the
effect of disease or tumours, may result from damage or trauma (such as accident)
to the brain, or be the result of some biochemical changes caused by toxic
substances.

4.2.2 Experimental Neuropsychology

The experimental neuropsychologist works with normal subjects with intact
brains. A variety of techniques are employed in the laboratory to study higher
functions in the brain. Subjects are generally required to undertake performance
tasks while their accuracy or speed of response is recorded, from which inferences
about brain organisation are made.

4.3 COGNITIVE FUNCTIONS

Neuropsychological functioning covers a wide variety of cognitive domains
subserved by different parts of the brain. In order to establish the relationship
between brain and behaviour a neuropsychologist should have a thorough
knowledge of these cognitive functions and the brain Ares responsible for these
functions. The following section briefly describes the cognitive domains.

4.3.1 Attention
Attention can be defined as “the concentration of mental effort on sensory or
mental events. Attentional processes facilitate, enhance, or inhibit other cognitive
processes. Attentional problems may manifest as either distractibility or difficulty
remaining focused on a task. Individuals with attentional dysfunction are usually
unable to allocate cognitive resources effectively to the task at hand and fails to
perform at optimal levels even though primary cognitive resources, such as
sensory registration, perception, memory, and associative functions, are intact.

There are three subsystems of attention – selective attention, sustained attention

and divided attention.

Selective or Focussed attention

This requires a capacity to focus and ‘close’ on one stimulus stream or feature,
while attenuating the distracting effect of competing information. Orbitofrontol
area (OFC) in the prefrontal cortex mediates the capacity to inhibit responding
56
to stimuli irrelevant to the task at hand. Lesion studies have shown that damage Domains of
Neuropsychology
to this area results in distractibility.

Sustained attention
This requires ‘holding’ attention over relatively long periods of time and has
features of vigilance. Right fronto parietal network mediates sustained attention.
Imaging studies have depicted that vigilance tasks that require sustained attention
activate a network of structures in the right frontal and parietal cortices.

Divided attention
This refers to the ability to perform two or more tasks simultaneously and may
be considered as requiring the opposite operations to selective attention. For
example a subject may be presented with stimuli which vary with respect to
colour, motion and shape and monitor changes in all three dimensions.
Dorsolateral prefrontal cortex is implicated in divided attention. Overall it can
be said that frontal lobe plays an important role in all aspects of attention.

4.3.2 Motor Function

Motor function requires integration among multiple structures. The prefrontal
cortex mediates motor planning, the supplementary motor area mediates initiation
of motor acts while the premotor cortex , basal ganglia and cerebellum mediate
fine motor control

4.3.3 Language
Language functions include expressive language (e.g. naming, vocabulary,
storytelling), verbal fluency (fluency of speech, writing, reading), and receptive
language (following directions, attending to spoken language, comprehension
of information). Disorder of language occurs as aphasia.
Aphasia is a primary disturbance in the comprehension or production of speech
caused by brain damage. Mainly there are two types of aphasia:
Expressive aphasia characterised by difficulty in producing words. Patients has
difficulty using grammatical constructions, a nomia (word finding difficulty)
and articulation difficulty (mispronounce words).It is caused by lesion in the left
frontal lobe.
Receptive Aphasia is characterised by poor speech comprehension and production
of meaningless speech.

4.3.4 Learning and Memory

These are the capacities by which an individual gains experience and retain it.
Learning is the means of acquisition of new information about the environment
and memory refers to the processes that are used to acquire, store, retain and
later retrieve information. There are three major processes involved in memory:
encoding, storage and retrieval. Both are interdependent processes. Memory can
be broadly divided into explicit memory and implicit memory.

Explicit memory
This is the conscious recollection of information such as specific facts or events
and at least in humans that can be verbally communicated. There are two subtypes
of explicit memory. 57
Neuropsychology Episodic memory
It is the retention of information about the where and when of life’s happening.

Semantic Memory
Semantic means meanings. It is a person’s knowledge about the world. It includes
general knowledge, knowledge about meanings of words famous individuals,
important places etc.

Procedural memory
It is related to unconsciously remembering skills and perceptions rather than
consciously remembering facts. Examples include skills of driving a car or typing.
Once learnt the individuals do not have to remember consciously how to drive a
car or type. The subsystems of implicit memory are:

Studies have shown the acquisition of new information is meditated by a wide

network of structures including anterior temporal cortex amygdala hippocampus
prefrontal cortex.

The left prefrontal cortex is involved in encoding episodic memory and retrieval
for semantic memory.

The right prefrontal lobe is implicated in retrieval from episodic memory. Left
temporal lobe mediates verbal memory and of the right temporal lobe mediates
visuo- spatial memory.

Memory deficits may take the form of amnesia in which there is a partial or total
loss of memory. Amnesic patients are unable to encode and consolidate verbal
and nonverbal information regardless of the modality of presentation (auditory
or visual) or the nature of the material (verbal or nonverbal). In contrast, attention
span, language functions, and reasoning are relatively preserved. Amnesic patients
show the greatest deficits on tasks of declarative memory in that they are unable
to demonstrate awareness of prior learning experiences, whereas procedural
memory (skills, habits, and classically conditioned responses) remains intact.
Amnesia may be of two types.

Anterograde amnesia (AA) refers to an inability to learn new information after

the onset of amnesia. AA is present inmost cases of amnesia. Retrograde amnesia
(RA) refers to deficient recall of events preceding the onset of amnesia.

4.3.5 Visual Perception and Constructional Ability

The evaluation of visual perception and constructional ability is a necessary
component of the comprehensive neuropsychological examination. A focal lesion
or incipient dementia may cause a profound deficit of visuoperceptual
discrimination, visuospatia judgment, or constructional ability in an otherwise
articulate patient with normal verbal functioning and normal visual acuity.

Visual perception
It is the process through which sensory information derived from light is
interpreted for object recognition or spatial orientation. Visual perception consists
of visuoperceptual and visuospatial ability, two functionally independent
processes that have separate neuroanatomical substrates.This functional
58
distinction is commonly referred to as “what” (visuoperceptual) verses “where” Domains of
Neuropsychology
(visuospatial).

Visuoperceptual ability
This subsumes form or pattern discrimination. Colour, shape, and other intrinsic
features are processed by the visuoperceptual system, regardless of the spatial
dimensions of an object or environment. Visuo-perceptual deficit may manifest
in the form of

a) Visual agnosia I
It is a deficit in recognition of common objects or familiar faces. Bilateral temporo-
occipital lesions damaging the visual association cortices of both hemispheres
usually leads to the manifestation of visual agnosia.

b) Deficits of form discrimination

This may be found on a variety of tasks, including the following:
i) discrimination of unfamiliar human faces;
ii) visual analysis, which involves the identification of overlapping or hidden
figures;
iii) visual synthesis, which involves the ability to mentally combine disparate
parts into an integrated whole; and
iv) identification or matching of objects obscured by excessive shadowing or
by presentation at unusual angles.
The typical neuroanatomical substrate for these deficits is a lesion in the right
temporo-occipital area. .

Visuospatial ability
It is the processing of visual orientation or location in space, regardless of the
intrinsic features of that object or environment. Depth and motion are subsumed
by this system. Visuospatial deficit may appear as

a) Balint-Holmes syndrome in which the spatial disturbance is so severe that

despite adequate visual acuity, the patients may collide with large objects in
their path and may be unable to grasp objects placed within their reach.
Balint-Holmes syndrome is associated with bilateral lesions of the superior
parietal lobule.

b) Visual neglect is pathological inattention to objects or events in the visual

space contralateral to a brain lesion. Visual neglect is due to unilateral lesions
of the parietal lobe, dorsolateral frontal lobe, putamen, cingulate gyrus and
thalamus.

c) Deficit in visuospatial judgment – In this there is deficits in judging the

position and orientation of objects due to posterior right-hemisphere disease.

Constructional ability
Constructional ability is the capacity to draw or assemble an object from
component parts, either on command or to copy a model. The concept measures
the integrative aspect of construction. Visuo constructive ability requires attention,
59
Neuropsychology visuo spatial perception, visuomotor coordination, planning and error correction
abilities. It is mediated by bilateral parietal structures predominantly right parietal
structure. The prefrontal structures mediate the planning and error correction
capacity.

4.3.6 Executive Functions

Executive functions are the capacities that enable a person to control their
behaviour and engage successfully in independent, purposive, goal-directed
activities. (Lezak, 1995). Lezak describes four components of executive functions,
each of which relies on its own set of behaviours:
a) volitional activity, which relies on self-awareness, initiation, and motivation;
b) planning and organisation;
c) carrying out purposive action; and
d) self-regulation, which relies on monitoring, shifting, inhibiting; and
selfcorrecting.
Executive functions include: planning, set shifting and response inhibition

Planning
It is the ability to set goals, to monitor performance so as to reach the goals and
to make corrections in the steps adopted, in order to ensure that the goal is attained.
Goal setting involves identification of both final goals and intermediate goals
that needs to be achieved in order to attain the final goal. Left frontal lobe is
associated with planning ability.

Cognitive flexibility/ Set Shifting

It refers to a person’s ability to switch from one topic to another. In this an
individual needs to inhibit or curtail the current behaviour and spontaneously
commence another. Test that measure these characteristics typically set up an
automatic expectancy or routine of behaviour in the patient and then require the
patient to shift from that expectancy or routine in an independent manner. It
requires strategic planning, organised searching utilising environmental feedback
to shift cognitive set directing behaviour towards the goal and modulating
impulsive response. Lesions of the dorsolateral prefrontal cortex impair set
shifting ability and increases perseverative responses.

Response inhibition
The concept refers to the suppression of actions that are inappropriate in a given
context and that interfere with goal-driven behaviour. Prefrontal areas are essential
for response inhibition.

Problems with executive function may present in many ways, such as impulsivity,
disorganisation, poor judgment, dysregulated behaviour, and amotivation.

4.4 NEUROPSYCHOLOGICAL ASSESSMENT

A neuropsychological assessment is the systematic administration of clearly
defined procedures (i.e., “tests”) to assess the neurocognitive, behavioural, and
emotional functioning of an individual in order to form hypotheses regarding
60
his/her central nervous system functioning. Neuropsychological assessment Domains of
Neuropsychology
precisely identifies which functional system is impaired or to what extent it is
impaired.

4.5 APPROACHES OF NEUROPSYCHOLOGICAL

ASSESSMENT
Despite shared goals, neuropsychologists differ widely with respect to their
approach to assessment. There are two different approaches (i) Fixed battery
approach and (ii) Flexible battery approach. These two approaches are discussed
below.

4.5.1 Fixed Battery Approach

Proponents of this approach typically recommend the use of a standard or fixed
battery of tests, in which the same set of instruments is used for each individual
tested, regardless of the referral question. These batteries include tests of a wide
range of cognitive functions by utilising a standard test battery, practitioners
ensure that all significant domains are addressed, thus avoiding the possibility
of overlooking deficits that may better account for or contribute to the patient’s
presenting problem. The disadvantages of battery approach are: 1) excessive
time (fatigues patient, requires several visits); 2) include assessment measures
that might not be necessary for a given patient.

4.5.2 Flexible Battery Approach

On the other hand flexible approach emphasises the need to tailor the assessment
to the nature of particular patient’s difficulties. In this approach tests are chosen
depending on the presenting issues or suspected pathologies and are sometimes
based on a short screening battery. The disadvantages of this approach are that it
relies heavily on the skills and insights of the individual clinician. There is a risk
that certain areas of function might get neglected or that complex patterns of
functional interaction may be missed.

4.6 GOALS OF NEUROPSYCHOLOGICAL

ASSESSMENT
Neuropsychological assessment can be useful in achieving several clinical goals
with a variety of patient populations.
First the neuropsychological assessment aims to diagnose the presence of cortical
damage or dysfunction and localise (which part of the brain is damaged) it.
Second neuropsychological assessment helps to conceptualise an individual’s
overall functional abilities and his/her specific cognitive strengths and
weaknesses.
Third Neuropsychological assessment can identify the presence of mild
disturbances in cases in which other diagnostic studies have produced equivocal
results.
Fourth, it determines the baseline functioning of the individual following
traumatic exposure which serves as a means of devising a rehabilitation
61
Neuropsychology programme or offering advice as to an individual’s ability to carry out certain
tasks (for example, fitness to drive, or returning to work).

Finally serial assessments over time helps to monitor treatment effects and provide
information regarding the rate of recovery and the potential for resuming previous
lifestyle.

4.7 ASSESSMENT PROCESS

Neuropsychological assessment usually starts with a detailed history of the
pateient followed by the evaluation of general intellectual functioning as
intelligence test provide an overview of cognitive function integrity. Thereafter
assessment of specific cognitive domains is done by either using fixed of flexible
battery approach.

Intelligence Tests
Usually Wechsler Tests of Intelligence is administered.WAIS-IV, (current version)
is composed of 10 core subtests and five supplemental subtests, with the 10 core
subtests comprising the Full Scale IQ. It provides four index scores representing
major components of intelligence:
Verbal Comprehension Index (VCI)
Perceptual Reasoning Index (PRI)
Working Memory Index (WMI)
Processing Speed Index (PSI)
Subtests
The Verbal Comprehension Index includes four tests:
i) Similarities: Abstract verbal reasoning (e.g., “In what way are an apple and
a pear alike?”)
ii) Vocabulary: The degree to which one has learned, been able to comprehend
and verbally express vocabulary (e.g., “What is a guitar?”)
iii) Information : Degree of general information acquired from culture (e.g.,
“Who is the president of Russia?”)
iv) Comprehension [Supplemental]: Ability to deal with abstract social
conventions, rules and expressions (e.g., “What does Kill 2 birds with 1
stone metaphorically mean?”)
The Perceptual Reasoning Index comprises five tests:
i) Block Design: Spatial perception, visual abstract processing and problem
solving.
ii) Matrix Reasoning: Nonverbal abstract problem solving, inductive reasoning,
spatial reasoning.
iii) Visual Puzzles: non-verbal reasoning.
iv) Picture Completion [Supplemental]: Ability to quickly perceive visual details.
v) Figure Weights [Supplemental]: quantitative and analogical reasoning.

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The Working Memory Index is obtained from three tests: Domains of
Neuropsychology
i) Digit span: attention, concentration, mental control (e.g., Repeat the numbers
1-2-3 in reverse sequence)
ii) Arithmetic: Concentration while manipulating mental mathematical
problems (e.g., “How many 45-cent stamps can you buy for a dollar?”)
iii) Letter-Number Sequencing [Supplemental]: attention and working memory
(e.g., Repeat the sequence Q-1-B-3-J-2, but place the numbers in numerical
order and then the letters in alphabetical order)
The Processing Speed Index includes three tests:
i) Symbol Search: Visual perception, speed
ii) Coding: Visual-motor coordination, motor and mental speed
iii) Cancellation [Supplemental]: visual-perceptual speed
Two broad scores are also generated, which can be used to summarise general
intellectual abilities:

Full Scale IQ (FSIQ), is obtained from the combined performance of the VCI,
PRI, WMI, and PSI

General Ability Index (GAI), based only on the six subtests that comprise the
VCI and PRI

The WAIS-IV measure is appropriate for use with individuals aged 16–90 years.
For individuals under 16 years, the Wechsler Intelligence Scale for Children
(WISC, 6-16 years) and the Wechsler Preschool and Primary Scale of Intelligence
(WPPSI, 2½–7 years, 3 months) are used.

Fixed Approach of Assessment

The two most widely known batteries are Halstead-Reitan Battery and Luria
Nebraska Neuropsychological Battery.

The Halstead-Reitan Battery includes:

Trails A and B (which see how quickly a patient can connect a sequence of
numbers (trail A) or numbers and letters (trail B).

Controlled Oral Word Association Test (COWAT, or Verbal Fluency) - a measure

of a person’s ability to make verbal associations to specified letters.

Halstead Category Test is a measure of abstract ability, including seven subtests

which form three factors:
i) a Counting factor (subtests I and II),
ii) a Spatial Positional Reasoning factor (subtests III, IV, and VII), and
iii) a Proportional Reasoning factor (subtests V, VI, and VII).)
Tactual Performance Test A form board containing ten cut-out shapes, and ten
wooden blocks matching those shapes are placed in front of a blindfolded
individual. Individuals are then instructed to use only their dominant hand to
place the blocks in their appropriate space on the form board. The same procedure
is repeated using only the non-dominant hand, and then using both hands.
63
Neuropsychology Rhythm Test: discrimination of like and unlike pairs of musical beats is required.
Speech Sounds Perception Test: It is a test of auditory acuity.
Finger Oscillation Test. In this, the subjects finger tapping speed is measured.
Luria-Nebraska Neuropsychological Battery
The Luria-Nebraska is a standardised test appropriate for people aged 13 and
older and takes between 90 and 150 minutes to complete. It consists of 269
items in the following 11 clinical scales:

Reading, writing, arithmetic, visual memory, expressive language, receptive

language, motor function, rhythm, tactile, intellectual.

Scores for three summary scales can also be calculated: pathognomonic, right
hemisphere, and left hemisphere.

A children’s version of the battery, called the Luria- Nebraska Neuropsychological

Battery for Children (LNNB-C), appropriate for children aged eight to 12, is
also available.

Flexible Approach of Assessment

As already stated in flexible approach of assessment neuropsychologist uses
pertinent patient information to guide test selection and chooses tests (either
from existing batteries or tests designed to assess specific deficits) that assess
cognitive functions relevant to a given patient. More than 700 tests of cognitive
functioning are available. A brief overview of few of the tests assessing various
cognitive functions is described below:

Tests for Attention

Measures of Sustained Attention
i) Colour Cancellation Test: This test Comprises of a sheet having 150 circles
in five different colours i.e. red, yellow, blue, black and gray. Subject is
required to cancel only red and yellow circles as quickly as possible. Time
taken to complete the test is recorded and error of commission (circles other
than red and yellow cancelled) and error of omission (red and yellow circles
not cancelled) is noted.
ii) Digit Span Test: Subject listen to random sequences of numbers presented
in increasing length, and immediately repeat each sequence (two trials at
each span length are presented) - maximum span is number of digits patient
can correctly repeat on at least one trial (normal 5-9 digits).
iii) Corsi Block Test: Subject is presented with nine blocks array arranged in
random order; examiner touches blocks in sequences of increasing length;
patient is required to reproduce sequence at each length.
iv) Paced Auditory Serial Addition Test (PASAT): Extremely sensitive measure
of vigilance patient listens to tape recording of digits presented one at time;
patient must add each number to one immediately preceding it (e.g. recording
presents numbers 1, 7, 5, 4 - patient adds first two numbers (1 + 7) and
responds with number 8; patient then adds second two numbers (7 + 5) and
responds with number 12; patient then adds third two numbers (5 + 4) and
responds Tests assess attention and vigilance (span tests also require working
64 memory).
Measures of Selective Attention Domains of
Neuropsychology
i) Conners’ Continuous Performance Task/Test (CPT) (Computerised version)
In CPT the respondents are required to press the space bar or click the mouse
whenever any letter except the letter ‘X’ appears on the computer screen. The
person must refrain from clicking if they see any other letter presented. The
inter-stimulus intervals (ISIs) are 1, 2 and 4 seconds with a display time of 250
milliseconds.

Four types of scores are obtained

Corrects Detection: This indicates the number of times the client responded to
the target stimulus. Higher rates of correct detections indicate better attentional
capacity.

Reaction Times: This measures the amount of time between the presentation of
the stimulus and the client’s response.

Omission errors: This indicates the number of times the target was presented,
but the subject did not respond/click the mouse. High omission rates indicate
that the subject is either not paying attention (distractibility) to stimuli or has a
sluggish response.

Commission errors: This score indicates the number of times the client responded
but no target was presented. A fast reaction time and high commission error rate
points to difficulties with impulsivity.

Measures of Divided Attention

Triads Test: It consists of verbal triads task with a actual number identification
task. The two tasks differ with reference to the stimulus modality and the nature
of stimulus processing. Both the tasks require verbal response. The verbal triads
task consists of 48 nouns grouped into 16 word triads. In each triad two words
belong to same category while the third one does not. The subject names the odd
word. In the tactual number identification task an Arabic numeral is written on
the right hand and the subject identifies it by calling it out. The subject performs
the tasks blindfolded. Number of errors committed on each task is counted.

Learning and Memory

Assessment of Various forms of declarative memory, forms a core part of memory
examination in both forms of amnesia.

Assessment of Anterograde Amnesia

The Wechsler Memory Scale (WMS) is designed to measure different memory
functions in a person. It can be used with people from age 16 through 90. The
current version is the fourth edition (WMS-IV) which was published in 2009.
WMS-IV is made up of seven subtests:
• Spatial Addition,
• Symbol Span,
• Design Memory,
• General Cognitive Screener,
65
Neuropsychology • Logical Memory,
• Verbal Paired Associates, and
• Visual Reproduction.
A person’s performance is reported as five Index Scores:
• Auditory Memory,
• Visual Memory,
• Visual Working Memory,
• Immediate Memory, and
• Delayed Memory.
Rey Auditory Learning Test (RAVLT)
RAVLT involves presentation of a list of 15 words(List A), which an examiner
reads aloud at the rate of one per second. The patient’s task is to repeat all the
words he or she can remember, in any order. This procedure is carried for five
trials. Thereafter an interference list (List b) of 15 words is presented followed
by an immediate recall of List B. After this the subject is asked to recall List A.
Immediate recall of List B and then List A provides measure of proactive/
retroactive interference. A delayed recall of List A is taken after 30 minutes delay
period.

Rey-Osterrieth Complex Figure Test (ROCF)

This is a test of complex visual organisation and visual memory. Individuals are
asked to reproduce a two dimensional figure without time restrictions, first by
copying and then from memory. Scoring focuses on the accuracy of details
rendered. Initial copying is done without the knowledge that memory will be
examined. Hence initial recall is a measure of incidental learning. Delayed recall
performance is examined relevant to rate of forgetting.

• •
•

Fig.: The Rey-Osterrieth Complex (Osterrieth, 1946)

66
Warrington Recognition Memory Test Domains of
Neuropsychology
The Warrington Recognition Memory Test (Warrington,1984) involves
recognition of 50 verbal stimuli (words) and 50 nonverbal stimuli (faces). In the
first subtest, patients are shown 50 words (one at a time) at a rate of 3 seconds
per stimulus.

They are then asked to select the previously viewed words that are presented -in
a forced-choice list (one foil paired with each target). In the second subtest, 50
black-and-white photographs of male faces are presented. The patient is then
shown two faces (one previously seen and one distractor) and asked to point
tothe target stimulus. The Warrington Recognition Memory Test provides useful
information regarding material-specific aspects of memory.

The Brief Visuospatial Memory Test—Revised

This is a measure of visual learning and memory. Participants are asked to study
a sheet with six figures on it for 10 s, and then draw from memory all the figures
accurately and in their correct location. This is repeated for a total of three trials.
Following a 25 min delay, participants are asked to freely recall and again draw
the six figures.

Assessment of Retrograde Amnesia

There are many factors that make formal assessment of RA difficult. Personal
memories from the remote past are difficult to verify, and it is not possible to
determine whether errors are due to inadequate storage at the time of initial
exposure or disruption of the retrieval process. One method of assessing RA
involves recall of public events. The problem with this approach is that there is
a great deal of variability in individuals’ premorbid fund of knowledge; variations
in performance may be due to differences in baseline intelligence or interest in
world events. With these caveats in mind, it is recommended that the assessment
of RA should encompass different types and classes of memories (i.e., personal
history, world history, and popular culture) that may be disrupted differentially
in the context of neurological disease.

Autobiographical Memory Interview

The Autobiographical Memory Interview is a semistructured interview that
focuses on events from three time periods throughout the life span. Both semantic
and episodic aspects of events are probed. Each memory is scored according to
the amount of detail and vividness of the recollection. Any assessment of
autobiographical memory should be accompanied by an interview with someone
who can provide a collateral source of information.

The Famous Face Test

The Famous Faces Test requires the individual to identify photographs of famous
individuals from the 1920s through the 1990s. The FFT provides useful
information regarding the individual’s knowledge and recall of public figures.

Visual perception and constructional ability

Visual neglect
The presence of hemispatial neglect is easily assessed by cancellation tasks,
which demand that the patient visually scan an array and cross-out designated
67
Neuropsychology targets. Line bisection tasks, in which patients are asked to, draw a mark through
the midpoint of a horisontal line, may also be used. The patient with neglect will
fail to cross out target stimuli on one side of the cancellation task, and on line
bisection tasks his or her center mark will grossly deviate from the actual midpoint
of the line.

Visuoperceptual discrimination
Benton Test of Facial Recognition (BFRT)is a clinically useful test of
visuoperceptual discrimination. In BFRT subjects are presented with a target
face and several test faces, and they are asked to indicate which of the images
match the target face. Male and female faces are used, and the faces are
closelycropped so that no clothing and little hair are visible.

Visuospatial Judgment
Benton et al.’s (1994) Judgment of Line Orientation task is a clinically useful
test of visuospatial judgment. It consists 30 stimuli with one page with two lines
and a second page with 11 lines. Participants are asked to compare the two pages
and report which two lines on the second page point in the same direction and
are in the same location as the two lines on the first page. This measure has high
split-half reliability for adults.

Constructional Ability
The Benton Visual Retention Test (or simply Benton Test) is an individually
administered test for ages 8-adult The individual is shown 10 designs, one at a
time, and asked to reproduce each one as exactly as possible on plain paper from
memory. The test is untimed, and the results are professionally scored by form,
shape, pattern, and arrangement on the paper.

Rey-Osterreith Complex Figure (already discussed)

Block Design or Object Assembly of Weschler Adult Intelligence Scale also
provides measure of constructional ability.

Executive functions
Planning is assessed using
Tower of London. This test evaluates the subjects’ ability to plan and anticipate
the results of their actions to achieve a predetermined goal. The test consists of
two identical wooden boards with three round pegs of different sizes and two
sets of three balls painted red, green, and blue respectively. The examiner arranges
the balls in a predetermined manner (goal state) on one of the wooden boards
and instructs the subjects to move the balls on the wooden board placed before
him so that he/she achieves that goal state. Tower of London comprises of
problems with 2 moves, 3 moves 4 moves and 5 moves. Scoring yields standard
scores for the total number of moves, total initiation time, total problem-solving
time, total execution time, and the number of correct solutions (i.e., items solved
in minimum number of moves), total time violations, and total rule violations.

The Porteus Maze Test is a graded set of paper forms on which the subject traces
the way from a starting point to an exit; the subject must avoid blind alleys along
the way. There are no time limits. The mazes vary in complexity from simple
diamond shape for the average three-year-old to intricate labyrinths for adults.
68
Set Shifting Domains of
Neuropsychology
Wisconsin Card Sorting Test (WCST)
The test uses stimulus and response cards that show different forms in various
colours and numbers. Individually administered, it requires the client to sort the
cards according to different principles (i.e., by colour, form, or number). As the
test progresses, there are unannounced shifts in the sorting principle which require
the client to alter his or her approach: however, the subject is given the feedback
whether a particular match is right or wrong. Time taken for the participant to
learn the new rules, and the mistakes made during this learning process are
analysed to arrive at a score.

Trail Making Test

This comprises two parts and consists of 25 circles distributed over a sheet of
paper. In Part A, the circles are numbered 1 – 25, and the patient should draw
lines to connect the numbers in ascending order. In Part B, the circles include
both numbers (1 – 13) and letters (A – L) and as in Part A, the patient draws lines
to connect the circles in an ascending pattern, but with the added task of alternating
between the numbers and letters (i.e., 1-A-2-B-3-C, etc.). The patient should be
instructed to connect the circles as quickly as possible, without lifting the pen or
pencil from the paper. Time taken is noted down.

Response inhibition
Stroop Test-
It comprises of three cards (D,W & C).Card D consists of 24 dots printed in
blue, green, red and yellow. Each color is used six times and arranged in a order
so that each color appear once in a row. Subjects are instructed to read the color
of the dots. Card W is similar to card D except dots are replaced by the words
and subjects are instructed to name the colour of the word in which it is printed.
In Card stimuli is the name of the colours and the instruction is to read the colour
in which the word is printed. Scoring is done in the form of the time taken and
the number of errors committed.
Language
Measure of Aphasia
Boston Diagnostic Aphasia Examination:
The tests are organised into five major sections as given below:
i) Conservational and Expossitory Speech
ii) Auditiory Comprehension
iii) Oral Expression
iv) Understanding Written Language
v) Writing
Token Test
Token Test: This test is designed to assess verbal comprehension of commands
of increasing complexity. The test employs a set of 20 plastic tokens consisting
of 5 colours, two shapes and two sizes. The test sees if an individual can follow
orally presented instructions. For example, the examiner may say, “Touch the
69
Neuropsychology red square” and then the behaviour or lack of behaviour in the individual is
observed and noted.

The Boston Naming Test

(BNT) represents a measure of object naming from line drawings that patients
with often have greater difficulties with the naming of objects. Thus, instead of
there being a simple category of anomia, naming difficulties may be rank ordered
along a continuum. It contains 60 items..

Motor Function
Motor Speed
Finger Tapping Test In Finger Tapping Test (FTT) also referred as the Finger
Oscillation Test the client is asked to initially tap his or her dominant index
finger as fast as possible for five consecutive 10- second trials. The procedure is
then repeated for the nondominant index finger. Performances are measured on
a recording device . The score is simply the average number of taps in a 10-
second interval. The two average scores (for dominant and nondominant fingers/
hands) are compared with each other to see if there are wide discrepancies.

Dexterity
It is measured by Purdue Pegboard Test. The test board consists of two parallel
rows of 25 holes each. Pins, collars and washers are located at the extreme right
hand and left hand cups at the top of the board. The procedure for administration
and scoring is as follows. Performance of the RH and LH subtests require
participants to first use their right hand (dominant) then left hand (nondominant)
to place as many pins as possible down the respective row within 30 sec. The
score for each of these subtests is the total number of pins placed by each hand in
the time allowed. The BH subtest is a bimanual test where the participants use
their right and left hand simultaneously to place as many pins as possible down
both rows in 30 sec. The score for this subtest is the total number of pairs of pins
placed in 30 sec. The assembly subtest requires that both hands work
simultaneously while performing different tasks for 60 sec. The score for this
subtest is the total number of pins, washers, and collars placed in 60 sec. It can
be administered to individuals or groups.

Strength
In order to assess the strength of the voluntary movements of the hands Hand
Dynamometer is used. The subject is required to hold the upper part of the
dynamometer in the palm of the hand and squeeze the stirrup with the fingers as
hard as possible. It is conducted on each hand respectively.

4.8 OTHER ASSESSMENTS

Along with the assessment of cognitive functions academic achievement also
needs to be assessed
Measures of Academic Achievement – assess standard academic skills (reading,
writing, arithmetic skills, spelling, etc.
The Wide Range Achievement Test
This is a test of basic academic skills for ages 5-adult, covering reading (word
70 recognition and pronunciation), written spelling, and arithmetic. The test is given
at two levels: Level I (ages 5-11) and Level II (12-adult). It consists of three Domains of
Neuropsychology
paper-and-pencil subtests with 50-100 items each, arranged in order of increasing
difficulty. The Reading subtest consists of recognising and naming letters and
pronouncing printed words. The Spelling subtest includes copying marks
resembling letters, writing one’s name, and printing words, and the Arithmetic
section involves counting, reading number symbols, and oral and written
computation.
Peabody Individual Achievement Test-Revised-
This is an individual measure of academic achievement. Reading, mathematics,
and spelling are assessed in a multiple-choice format. It comprises of six subtests:
• General Information—100 verbal items assess general knowledge.
• Reading Recognition—100 items measure recognition of printed letters and
the ability to read words aloud.
• Reading Comprehension—82 items measure reading comprehension.
• Written Expression—assesses written language skills.
• Mathematics—100 multiple choice items test knowledge and application
of math concepts and facts.
• Spelling—100 multiple choice items measure recognition of correct word
spelling.
PIAT-R also provides a Written Language Composite, obtained by combining
scores on the Spelling and Written Expression subtests, and a Total Reading
score, a combination of scores from the Reading Recognition and Reading
Comprehension subtests for overall indexes for written expression.

Emotional Status and Level of Adaptive Behaviour

While measures of cognitive and behavioural abilities are important, a client’s
emotional status and relative level of adaptive behaviour are also of considerable
relevance. This information is useful for at least three types of situations. First,
clinicians might try to decide whether abnormal cognitive test results are primarily
from CNS (central nervous system) involvement or emotional factors. If emotional
functioning is relatively normal, but the individual still has cognitive deficits,
this would strongly implicate CNS involvement. Second, a clinician might need
to know the extent to which emotional reactions are complicating organic
impairment. A client with organically based confusion is likely to have this further
exacerbated by reactions such as depression.

Third, predictions often need to be made related to a person’s overall level of

functioning. While level of cognitive deficit is useful, personality and emotional
factors have often been found to be better predictors of psychosocial adjustment
and rehabilitation outcome.

The assessment of personality and adaptive behaviour can be accomplished

through a variety of tests.

Measure of Personality
Minnesota Multiphasic Personality Inventory (MMPI) It is a self administered
measure of personality. The revised version MMPI-2 contains 567 test items and
71
Neuropsychology takes approximately 60 to 90 minutes to complete. It comprises of following
clinical scales that are used to indicate different conditions.

Hs Hypochondriasis Concern with bodily symptoms

D Depression Depressive Symptoms
Hy Hysteria Awareness of problems and
vulnerabilities
Pd Psychopathic Deviate Conflict, struggle, anger, respect for
society’s rules
MF Masculinity/Femininity Stereotypical masculine or feminine
interests/behaviours
Pa Paranoia Level of trust, suspiciousness, sensitivity
Pt Psychasthenia Worry, Anxiety, tension, doubts,
obsessiveness
Sc Schizophrenia Odd thinking and social alienation
Ma Hypomania Level of excitability
Si Social Introversion People orientation
Thematic Apperception Test
The Thematic Apperception Test, or TAT, is a projective measure intended to
evaluate a person’s patterns of thought, attitudes, observational capacity, and
emotional responses to ambiguous test materials. In the case of the TAT, the
ambiguous materials consist of a set of cards that portray human figures in a
variety of settings and situations. The subject is asked to tell the examiner a story
about each card that includes the following elements: the event shown in the
picture; what has led up to it; what the characters in the picture are feeling and
thinking; and the outcome of the event.

Measure of Adaptive Behaviour

Vineland Adaptive Behaviour Scale (VABS)
VABS assesses the social abilities of an individual, whose age ranges from
preschool to 18 years old.
Since adaptive behaviour is a composite of various dimensions, the test measures
five domains– Communication, Daily Living Skills, Socialisation, Motor Skills,
and Maladaptive Behaviour domains.
The Communication Domain evaluates the receptive, expressive, and written
communication skills of the child.
The Daily Living Skills Domain measures personal behaviour as well as domestic
and community interaction skills.
The Socialisation Domain covers play and leisure time, interpersonal
relationships, and various coping skills.
The Motor Skills Domain measures both gross and fine motor skills.
Maladaptive Behaviour is an optional part of the assessment test. It is used to
72 measure obvious undesirable behaviours.
 Domains of
4.9 LET US SUM UP Neuropsychology

In this unit you have read

Neuropsychology is the “applied science of brain behaviour relationships”.
There are two areas of neuropsychology: Clinical and experimental
Neurppsychological functioning covers cognitive domains of – attention, motor
function, visuoperceptual and constructional ability, language, memroy, and
executive functions.

There are two approaches of Neuropsychological assessment: Fixed and Flexible.

Goals of neuropsychological assessment is to diagnose,assess strengths and
deficits and monitor recovery process.

Any neuropsychological assessment should assess the general intellectual

functioning, academic achievement and emotional and adaptive behaviour of an
individual in addition to core cognitive domains.

4.10 UNIT END QUESTIONS

1) Define Neuropsychology. Briefly explain the various domains of
neuropsychology.
2) What are the goals of neuropsychological assessment?
3) Briefly discuss the various tests used to assess the different domains of
cognitive function.
4) Why it is necessary to assess the emotional and adaptive functioning as a
part of neuropsychological assessment. Briefly describe the test used for
the assessment of emotional and adaptive behaviour.
5) What is fixed battery approach. Discuss the salient points of any one battery.

4.11 SUGGESTED READINGS

Kolb, B.& Wishaw,I.Q. (1990). Fundamentals of Human Neuropsychology.
W.H.Freeman and Company. New York

Rao,S.L.,Subbakrishna,D.K.,Gopukumar,K.(2004). Nimhans Neuropsychology

Battery. Nimhans Publication. Bangalore.

Snyder,P.J.,Nussbaum,P.D.,Robins,D.L.(2006). Clinical Neuropsychology A

Pocket Handbook for Assessment. American Psychological Association ,
Washington.

Spreen,O. & Strauss,E.(1991). A Compendium of Neuropsychological Tests.

Oxford University Press. New York.

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 Neuropsychology Methods
UNIT 1 NEUROPSYCHOLOGY METHODS

Structure
1.0 Introduction
1.1 Objectives
1.2 Techniques for Measuring Brain Structure and Functions
1.2.1 Examining Tissue
1.2.2 Lesions and Ablation
1.2.3 Electrical Stimulation
1.2.4 Neurochemical Manipulations
1.2.5 Electrical Recording
1.2.6 In-Vivo Imaging
1.3 Neuropsychological Assessment
1.4 Dissociation and Double Dissociations
1.5 In Vivo Imaging in Psychiatry
1.6 Let Us Sum Up
1.7 Unit End Questions
1.8 Suggested Readings

1.0 INTRODUCTION
In this unit, you will be introduced to some of the methods that researchers use
to explore the relationships between brain structure and function.
Neuropsychology is a bridging discipline that draws on material from neurology,
experimental psychology and even psychiatry; and the area is served by a diverse
collection of investigative measures ranging from neuroanatomical procedures
at one end of the spectrum to assessments from experimental psychology at the
other.

A particularly exciting development over the last 30 years has been the
introduction of invivo imaging techniques. The rapid spread in availability of
scanning and imaging hardware (particularly during ’the decade of the brain’ in
1990s) has provided neuroscientists with research opportunities that were, until
recently, unthinkable. In vivo imaging has provided independent confirmation
of the suspected role(s) of particular brain regions in psychological processing
(for example, the role of the anterior cingulate in attention). In other instances,
in-vivo techniques have revealed the true complexity of processes that other
procedures had tended to oversimplify.

The application of imaging techniques to language to find out the different areas
involved in different processing of language is an example of the same.

Informative though the various procedures can be, it is also important to realise
that most neuropsychological techniques (including in vivo scanning) have their
limitations. So, although the demise of older procedures has frequently been
predicted as imminent, many still have important role to play. In fact, the
combination of imaging with traditional techniques can turn out to be a particularly
fruitful and informative collaboration. In simple terms using a combination of
5
Brain Behaviour methods is the best way to follow when studying a phenomenon in
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neuropsychology.

The unit starts with a brief review of classical techniques that are, for the most
part, neuroanatomical in origin. Next, the use of electrical stimulation and
electrical recording of the brain is discussed and elaborated. Then some of the
in-vivo techniques are identified that allows researchers to visualise the structure
and/or function of the ‘living’ brain. Neuropsychological procedures are
elaborated towards the end, some of which can be used in conjunction with in-
vivo imaging to provide better insight and understanding of the functioning of
the brain. It is tried to keep the information simple and brief, but at the same
time pertinent information is not omitted. The unit concludes with an illustration
of an exciting application of in-vivo imaging in psychiatry.

1.1 OBJECTIVES
After completing this unit, you will be able to:
• Define and describe neuropsychological assessment;
• Describe the techniques for measuring brain structures and functions;
• Describe the tests and subtests underlying neuropsychological assessment
battery;
• Differentiate between dissociation and double dissociation; and
• Elucidate the in vivo imaging in psychiatry.

1.2 TECHNIQUES FOR MEASURING BRAIN

STRUCTURE AND FUNCTIONS
The brain is the control center of the human body. It sends and receives millions
of signals every second, day and night, in the form of hormones, nerve impulses,
and chemical messengers. This exchange of information make us move, eat,
sleep and think.

Obstructions such as tumors can interrupt normal brain activity, leading to deficits
of normal reasoning, motor control, or consciousness. Many of the signs of neural
damage are easily recognisable by an outside observer, but since the actual cause
of these problems are internal, the symptoms can be vague. The real deficits can
affect the brain’s anatomy, or the way signals are processed. A physician can
only determine the real cause by examining the brain internally to find
irregularities, either in structure or in functioning. Since the brain is extremely
fragile and difficult to access without risking further damage, imaging techniques
are used frequently as a noninvasive method of visualising the brain’s structure
and activity.

Today’s technology provides many useful tools for studying the brain, and this
website will try to briefly describe the most important ones. Some have their
most important applications in medical diagnosis, and some are used more for
research. The latter are often too expensive or limited for cost-efficient medical
use, but can prove valuable and necessary in the future through development
and further advances.
6
There are two main groups of procedures. Structural analysis is used to analyse Neuropsychology Methods
the anatomy of the brain, in order to find structural deviations. These could be
tumors, hemorrhages, blood clots and lesions, or even deficits present at birth.
Functional analysis tries to measure and locate brain activity. This is useful for
investigating the functioning of special structures, and to diagnose epileptic
seizures or diseases affecting brain activity. Functional imaging is also used to
aid surgical treatment of brain lesions when it becomes necessary to determine
the locality of essential functional cortex to help guide the best surgical approach.
Many times a structural and functional method will be used in conjunction to
better assess how the activity and region are related.

1.2.1 Examining Tissue

Until quite recently, the options for measurement of brain structure were,
effectively, limited to post-mortem, and on very rare occasions, biopsy. The latter
is a drastic technique involving the removal and analysis of small (but
irreplaceable) samples of brain tissue from the ‘appropriate’ area of brain. A
combination of the ‘hit and miss’ nature of biopsy and the inevitable damage it
causes mean that it is hardly ever used on human. Post-mortem on the other
hand, as a long and fairly ‘single colourful’ history in medicine, but requires the
person to be dead! Thus, early signs of disease are likely to be masked by changes
that occur as the disease progresses. Sometimes, there are obvious signs of damage
in end-stage illness that may nevertheless be of interest: Broca only conducted a
superficial post-mortem investigation of Tan’s brain but damage to the left frontal
region was clear to see.

The brain of a person who has died as a result of Huntington’s disease or

Alzheimer’s disease will look abnormal even to the naked eyes. It will appear
shrunken inwards from the skull; gyri (surface bumps) will look ‘deflated’ and
the sulci (surface grooves) will be wider. Usually, however, researchers are less
interested in the outward appearance of the brain at death than in the subtle
changes that occur during, or even before, the development of overt signs and
symptoms. In any case, the external appearance of the brain at post-mortem may
be entirely normal, with damage or disease only apparent on closure inspection
of internal structures of tissues.

Brain tissue looks solid to the naked eye (it has a consistency of stiff jelly), so
‘finger-grain’ investigations had to await two technological developments. The
first was the gradual refinement over many years of the light microscope, and
second was the discovery of tissue staining techniques that had the effect of
‘highlighting’ particular component structures of tissue. The combinations of
these developments enable researchers to identify small groups of neurons, or
even individual neurons, using a microscope. Thanks to technological
improvements in lens manufacture, microscopy has developed considerably since
its first reported use to examine biological tissues (of a cow) by Van Leeuwenhoek
in1674. Light microscope can now reliably magnify by a factor of several hundred,
but electron microscope can magnify by a factor of several thousands. They can
produce images of images of individual synapses (junctions between neurons),
or even of receptor sites for neurotransmitters on the surface of neurons.

New staining techniques have also been developed since the pioneering work of
Golgi in the late 19th century, although his silver-staining method (which makes
7
Brain Behaviour stained material appear dark) is still used to produce images of neurons. Other,
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staining techniques, such as horseradish peroxidise (HRP), have been developed
to enable the tracing of connections between neurons. This stain gets absorbed
by distal (remote) regions of neuron, but is carried back to the cell body (by
retrograde transport within the neuron) to reveal the pathway that the neuron’s
axon takes. A combination of silver and HRP techniques can be used to establish
functional connectivity between the brain regions, such as the innervations of
the striatum by the substantia nigra.

Early last century the neuroanatomists Broadmann used a combination of staining

and microscopy to map the cytoarcitecture (cell structure\type) of human cerebral
cortex. His research lead him to the realisation that different cortical locations
comprised structurally distinct types, and his map identified 52 numbered regions,
many of which are still used for identification purposes today (Broadmann, 1909).
The primary visual cortex is, for example, also known as area 17, and Broca’s
area straddles Brodmann’s areas 44 and 45 in the left hemisphere.

1.2.2 Lesions and Ablation

A long-standing technique in neurology has been observed the effects on
behaviour of lesions (cutting) or ablation (removal) of nerve tissue. Karl Lashley
used brain lesions and worked exclusively with animals. Many of his studies
measured the effects of lesions (removal of brain tissue) in maze learning in
rodents. Initially, there would be a period of orientation during which time an
animal learned its way around a maze to locate a food pellet. Then he would
remove a small region of cortex, and, following a period of recovery, see how
many trials it took the animal to relearn the maze and find the food pellet. On the
basis of many such trials, Lashley concluded that the amount of lesioned brain
tissue rather than its location best predicted how long it would take the rat to
learn the maze, supporting his idea of mass action (that the entire cortex is involved
in all functions).

For obvious reasons these procedures are not used experimentally on humans,
but sometimes brain tissue is ablated for medical reasons such as the excision of
tumour. Occasionally, surgical lesioning is also undertaken. Taylor’s (1969) study
of the effects of lesions to the left and right sides of the cortex in two patients is
an example of the former. The surgical procedure of lesioning the corpus callosum
as a treatment for epilepsy is an example of the latter. Sometimes, accidents
cause lesions (or ablations). The case of Phineas Gage is one celebrated case in
point. The case of NA, who developed amnesia following an accident with a
fencing foil, is less well known but equally interesting.

It is also possible to induce lesions by the application of chemicals/drugs. The

Wada test (Wada and Rasmussen, 1960) involves administering a fast acting
barbiturate to one hemisphere at a time, via the left or right carotid artery, to
introduce a temporary lesion lasting a matter of minutes. Other drugs may induce
permanent lesions through their toxic influence. The substance MPTP, a toxin
which was inadvertently mixed with synthetic heroin by recreational drug users
in California in the mid-1980s, irreversibly destroys dopamine neurons in the
substantia nigra, bringing about a very ‘pure’ form of induced Parkinson’s disease
in humans and animals.

8
 Neuropsychology Methods
Self Assessment Questions
1) Discuss the techniques for measuring brain structures and functions.
...............................................................................................................
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2) What is meant by lesions and ablations? Discuss their role in measuring
brain structure.
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3) Discuss Taylor’s study of the effects of lesions to the left and right sides
of the cortex.
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1.2.3 Electrical Stimulation

Brain stimulation has been used to map connections in the brain and to elicit
changes in behaviour. Much of the pioneering work on mapping out the primary
somatosensory and motor cortex was done by neurosurgeon Wilder Penfield in
1958. His participants were his patients, many of whom required surgery for life
threatening conditions such as removal of brain tumours or blood clots. He asked
them whether, in the course of surgery, they would mind if he applied a mild
stimulating electrode to the surface of their brains. Partly thanks to the brain’s
lack of pain receptors and resultant insensitivity to pain, brain surgery is sometimes
conducted with the patient awake, so Penfield could talk to his patients as he
stimulated different parts of their exposed brains. Using this technique, Penfield
was the first researcher to discover the amazing topographic representation of
body areas in the primary motor and somatosensory cortex.

1.2.4 Neurochemical Manipulations

Neurochemical and immunological methods have been used to identify groups
of neurons in the central nervous system that use specific neurotransmitters. The
number of neurotransmitters identified continues to increase, and one neuron
9
Brain Behaviour may express more than one neurotransmitter. The anatomy of major
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neurotransmitter pathways has been elucidated, and the molecular mechanisms
by which some neurotransmitters function is now known in some detail. Drugs
given systematically or applied to specific anatomic areas may stimulate or block
specific neurotransmitter receptors. There are also drugs that will selectively
destroy neurons containing specific neurotransmitters, and genetic methods are
available to produce animals that lack specific enzymes. Through PET studies,
specific neurotransmitters such as dopamine can be imaged in humans. Using
these and other techniques, it is possible to correlate the behavioural effects of
pharmacological agents with dysfunction in anatomical areas defined by chemical
criteria.

1.2.5 Electrical Recording

We can also learn about brain function by recording its electrical activity. In
electroencephalography (EEG) and the closely-related potential (ERP) recording,
electrodes are attached to the scalp and the amplified electrical activity detected
by them is displayed on chart recorder or computer screen. Surface recording is
possible because the electrochemical activity of the brain is conducted passively
through the meninges (protective membranes surrounding the brain), and the
skull to scalp. The recorded voltages represent the summed activity of millions
of neurons in the area of brain closest to the recording electrode so, in order to
get an idea about the spatial distribution of activity, several separate channels of
EEG corresponding to electrodes in different positions on the head can be recorded
simultaneously. This procedure has proved invaluable in the diagnosis of epilepsy
and in the identification of sleep-related disorders.

In order to record ERPs a series of stimuli such as tones or light flashes are
presented to the participant, and the raw EEG for a precise one or two second
period following each stimulus is recorded and fed into a computer where it is
summed and averaged. This will be a response (or ‘event-related potential’) in
the brain to each separate stimulus but this will be small (millionths of a volt) in
comparison with the background EEG (thousandths of a volt). By summing all
EEGs together and averaging them, the more-or-less random EEG averages to
zero, to leave an ERP that has a characteristic waveform when shown on the
computer screen. Various abnormalities in this waveform have been linked to
predisposition to alcoholism and schizophrenia. The ERP technique has also
been useful as a tool to explore the mechanism of attention.

Recently, a variant ERP known as magnetoencephalography (MEG) has been

developed. MEG, which is still in its infancy, requires upward of 60 electrodes to
be attached to the participant’s scalp, and takes advantage of the fact that when
neurons are active they generate tiny magnetic fields. Event-related fields (ERFs)
can be detected by an MEG analyser in much the same way as ERPs, but they
provide a more accurate means of identifying the origin of particular signals.
MEG can locate the source of maximum magnetic field activity in response to
stimuli, and, if required, map these areas three dimensionally and in real time.
This technique has been of use in identifying the precise focal origins of epileptic
seizures, and, as I hinted as above, it has also been used to map areas of the
somatosensory cortex.

10
 Neuropsychology Methods
Self Assessment Questions
1) What is the contribution/discovery of Penfield?
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2) How will you correlate the behavioural effects of pharmacological agents
with dysfunction in anatomical areas ?
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3) Discuss the ERP.
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1.2.6 In-Vivo Imaging

The first of the in-vivo imaging techniques, computer tomography (CT) scanning,
came on stream in the early 1970s. As technologies developed, and the value of
scanning became clearer, it was soon followed by other procedures including
PET (positron emission tomography), rCBF (regional cerebral blood flow) and
MRI (magnetic resonance imaging). The common feature of these procedures is
that researchers can produce images of the structure or functional activity of the
brains of living people.
Computerised tomography (CT, but also known as computerised axial
tomography, or CAT) provides structural images. To generate brain scans, low
levels of X radiation are passed through an individual’s head at a series of different
angles (through 180 degree). A computer analyses each ‘image’ and generates
what is effectively, a compound X-ray. It can provide a ‘slice-by-slice’ picture of
entire brain, or other parts of the nervous system such as the spinal cord, if
required. A drawback of CT scanning is that the contrast between more or dense
tissue is not particularly good, although it can be improved by the administration
of a dye (injected into the blood stream just before the scan is taken). CT scans
cannot measure functional activity but they have provided valuable information
about structural changes seen in the brains of some people with dementia, and
about the effects and location of brain damage in general. 11
Brain Behaviour MRI is a more recent development that was initially introduced as a rival to CT.
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The technique itself is complex, relying on measurement of the response of
hydrogen atoms to radio waves in very strong magnetic field. The MRI scanner
measures the tiny magnetic fields that the spinning hydrogen atoms produce,
and since the density of hydrogen varies in different types of tissue, the scan data
can be computer-processed to generate images. The entire brain can be imaged
in successive slices, which can be produced in saggital (side), coronal (front) or
horisontal transverse planes. The high resolution of MR images (in comparison
with CT images) is a major plus point. A second advantage is that participants
are not exposed to radiation sources.

STANDARD MRI MACHINE

Patient RF Coil Superconducting

Table magnet rings
MRI scan
result

Source: www.mirium-english.org

PET scans provide colour-coded images of person’s brain as they undertake

different sorts of task, such as reading words, solving mental arithmetic and
listening to music. The technique relies on the fact that active neurons use more
glucose (fuel), so, shortly before the scan; a small amount of radioactively labelled
glucose is given to the participant by injection, some of which will be taken up
by active neurons. Several different radioactive markers are now available; some
have longer or shorter half-lives; others may have specific targets in the brain. A
commonly used isotope is oxygen 15, which has a half-life of about 2 minutes.
This means it can only be used for relatively brief scanning periods so repeated
administration will be necessary in complex or lengthy studies. As it decays it
gives off gamma rays that are detected by the PET scanner, and activity level of
different regions of the brain can be assessed.

PET is powerful means of assessing functional brain activity, although it does

not directly measures neuronal events. Rather it indicates levels of (or change
in) activity under different conditions. To do this ‘image subtraction’ is often
employed, meaning that activity during a control condition is (literally) subtracted
by computer from activity during the active test condition, and the remaining
PET activity taken as the index of the activation specific to the test condition.

12
Other in vivo imaging procedures that you may read about include regional Neuropsychology Methods
cerebral flow (rCBF) and single photon emission computerised tomography
(SPECT). Both are variants of PET technology.

In rCBF, the participant inhales a small amount of a radioactive gas such as

xenon, which is absorbed into the bloodstream and thus transported around the
body. The participant sits in a piece of apparatus that looks a little like dryer seen
in hair-saloons! This has a series of sensors that detect the radioactivity from the
transported xenon, and because more blood is required by ‘active’ brain regions,
a computer can built up an image of areas of greater (and lesser) activity based
on the detection rates.

SPECT differs from PET in certain technical respects, the upshot of which is
that the clarity of the scans is less precise because they take longer to generate.

Functional magnetic resonance imaging (fMRI) is a recent development that

permits simultaneous measurements of the brain structure and function. The
technique relies on the same principles and the hardware as (structural) MRI
described earlier. However, it takes advantage of the fact that active neurons
require higher levels of oxygenated haemoglobin.

The MRI scanner can be ‘tuned’ to detect the very subtle disturbances to the
magnetic field induced by the different proportions of oxygenated and
deoxygenated blood in active and inactive regions. The so-called BOLD (blood
oxygenated level dependent) signal can be further improved by the use of more
powerful magnets in the scanner, and the spatial resolution (which generates the
structural scans) is barely compromised.

Although fMRI has only been available for a few years, it has been adopted
enthusiastically by researchers because, like MRI, fMRI scanning does not expose
participants to radiation. Among many of its applications, it has recently been
used to identify functional changes in frontal brain regions as participants
undertake tests of working memory.

Self Assessment Questions

1) Describe Invivo imaging.
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2) What is rCBF?
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13
Brain Behaviour
Inter-relationship 3) What is MRI? Describe
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4) What is the function of PET scan?
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5) Differentiate between SPECT and PET.
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1.3 NEUROPSYCHOLOGICAL ASSESSMENT

The neuropsychological approach relies on the use of tests in which poor
performance may indicate either focal (localised) or diffuse (widespread) brain
damage. A neuropsychological assessment serves several purposes. First, it can
give a ‘neuro-cognitive’ profile of an individual, identifying both strengths and
weaknesses. For example, an individual’s initial assessment may highlight a
specific problem with spatial memory set against a background of above average
IQ. Since many tests are ’standardised’, a person’s performance can be readily
compared with scores generated by other age and\or sex matched respondents (a
process known as norm referencing). A second advantage is that repeating testing
over time can give an insight into changes in cognitive functioning that may
relate either to recovery after accident injury or the progression of neurological
illness.

Usually, a series of tests (called a test battery) will be given. One widely used
battery is Halstead Reitan, which includes measures of verbal and nonverbal
intelligence, language, tactile and manipulative skills, auditory sensitivity, and
so on (Reitan & Wolfson, 1993). Some of the tests are very straightforward: The
tapping test, which assesses motor function, requires nothing more than for the
respondent to tap as quickly as possible with each of his\her fingers for a fixed
time period on a touch sensitive pad. The Corsi block-tapping test measures
14 spatial memory using a series of strategically placed wooden blocks on a tray. A
third test measures memory span for sets of digits. The Luria Nebraska test battery Neuropsychology Methods
(Luria, 1966) is even more exhaustive procedure taking about two to three hours
to administer, including over 250 test items.

Luria-Nebraska Neuropsychological Battery (LNNB)

Source: portal.wpspublish.com

The lengthy administration of test battery may be unsuitable for some individuals
(such as demented or psychiatric patients) who simply do not have the requisite
attention span. In such instances a customised battery may be more appropriate.
Such assessments typically still include some overall index of intelligence: the
comprehensively norm-referenced WAIS-R (the revised Wechsler Adult
Intelligence Scale; Wechsler, 1981) is commonly used. In addition, specific
measures may be adopted to test particular hypotheses about an individual.

For example, if the person has received brain damage to the frontal lobes, tests
might be selected that are known to be especially sensitive to frontal damage.
The Wisconsin card sort test, the trails test (in which respondents have to join
numbered doted on a page according to particular rules) and verbal fluency
(generating words starting with particular letter on belonging to a specific
category) are cases in point.

Poor performance on one particular test may signal possible localised damage or
dysfunction, while poor across the board performance may indicate generalised
damage. For example, inability to recognise objects by touch (astereognosis)
may be a sign of damage to the parietal lobes.

A poor verbal test score (compared with normal non-verbal test score) may
indicate generalised left hemisphere damage.

The WAIS-R is particularly useful in this respect because the eleven components
tests segregate into six verbal and five performance sub tests, from which it is
possible to derive separate verbal and non verbal estimates of IQ.
15
Brain Behaviour The National Adult Reading Test (NART; Nelson, 1982) allows the researcher
Inter-relationship
to obtain an estimate of an individual’s IQ prior to damage or disease onset. This
may be useful if a neuropsychologist is making an initial assessment of a person
who has been brain damaged or ill for some time. The NART comprises 50
words that sound different to their spelling (such as yacht, ache and thought).
The respondent reads through the list until they begin to make pronunciation
errors. Such words were almost certainly learned before the onset of illness or
brain damage, and because this test has been referenced against the WAIS, the
cut off point can be used to estimate IQ prior to illness, disease or accident.
Self Assessment Questions
1) Discuss in detail the neuropsychological assessment.
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2) Describe the tests and subtests.
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3) What is the implication of applying these tests.
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1.4 DISSOCIATION AND DOUBLE

DISSOCIATIONS
Neuropsychologists typically try to design studies that provide evidence of the
differential performance of brain damaged and control subjects because such
studies can inform structure function relationships. Consider the following
example: The right frontal lobe is thought to be important for memorising designs.
To test this hypothesis, a researcher assesses memory for designs (MemD) and
memory for words (memW) in group of people with known right frontal damage
and a second group of non brain damaged controls.

16
 Table 1.1: Groups and tasks % correct Neuropsychology Methods

GROUP TASK (% CORRECT)

MemD MemW
A Single dissociation experiment
Right frontal 70% 90%
Control 90% 95%
B A double dissociation experiment.
Right frontal 66% 93%
Left frontal 95% 90%
Control 60% 95%

Hypothetical results from this study are shown in the above table. At first glance
they seem to support the hypothesis because the right frontal subjects appear to
be selectively impaired on the MemD condition. Many neuropsychological
investigations employ this sort of design, and use the evidence of dissociation
between groups in the MemD but not the MemW as support for the hypothesis.
There is, however design problem with single dissociation studies stemming
from the assumption that the two conditions are equally ‘sensitive’ to differences
between the two groups of participants (which may or may not be the case). For
example, it could be that right frontal subjects have poor attention, which happens
to affect the memD task more than the MemW task.

A much ‘stronger’ design is one with the potential to show a double dissociation.
For example, if we also thought that left frontal damage impaired MemW but
not MemD, we could recruit two groups of patients that is (i) one group with left
and (ii) the other with right frontal damage, plus (iii) a control group. Then test
all participants on both measures. Hypothetical results from this design are shown
in the table. They indicate that one group of patients is good at one test but not
the other, and the reverse pattern is true for the second group of patients. In other
words, we have evidence of a double dissociation, which suggests to
neuropsychologists that the two tasks involve non overlapping component
operations that may be anatomically separable too.

1.5 IN VIVO IMAGING IN PSYCHIATRY

To illustrate the ingenious applications to which in vivo imaging can be put,
consider the use of PET in the study of hallucinations by Frith and Colleagues in
London, and a similar application of fMRI by woodruff’s group. Silbersweig
and Colleagues used PET to measure brain activity in a group of mentally ill
patients who were experiencing hallucinations at the time of scanning. Preliminary
results indicated that auditory hallucinations were linked to cortical activation in
the left temporal lobe and parts of the left orbital region of the frontal lobe.

Woodruff et al. (1997) examined seven schizophrenic subjects on two occasions.

First, during a period of severe ongoing auditory hallucinations and secondly
after these had diminished. External speech was found to activate the temporal
cortex significantly more powerfully and extensively in the hallucinations present
17
Brain Behaviour conditions. The greatest difference was found in the right mid temporal gyrus
Inter-relationship
(MTG). This finding suggests that auditory hallucinations compete with external
stimulation for temporal cortex processing capacity.

A recent update of Woodruff’s study has been reported by Shergill et al. (2000).
The researchers recorded fMRI activity in six regularly hallucinating
schizophrenic patients. Approximately every 60 seconds respondents had to
indicate whether (or not) they had ‘experienced’ an auditory hallucination during
the last time epoch.

In comparison with non-hallucinating epochs, the presence of hallucinations was

associated with widespread activation, which was especially pronounced in
bilateral inferior frontal and temporal regions, the left hippocampus and adjacent
cortex (para-hippocampal gyrus). Although it is still too early to say precisely
where, or why hallucinations form, the use of ‘in vivo’ imaging shows beyond
doubt that the experience of hallucinations is related to changes in activity in
various regions of cortex.

1.6 LET US SUM UP

Researchers interested in understanding brain function and its relationship to
psychological function can now draw on a wide range of investigative techniques.
In this unit, you were introduced to lesion and ablation, electrical stimulation
and recording, and the structural and functional in vivo imaging procedures.
Consideration is also given to the burgeoning use of neuropsychological testing.
Researchers have moved rapidly from an era in which analysis of brain structure
could usually only be assessed after the person has died to an era in which the
various in-vivo imaging techniques are quickly becoming almost common place
as a particularly promising research area. Although we have not yet reached the
point where invivo imaging can be used to establish what people are thinking,
the applications of PET and fMRI to psychiatry are bringing us close to identifying
brain areas that may contribute to the types of disordered thinking so characteristic
of mental illness.

1.7 UNIT END QUESTIONS

1) Describe major methods of study in neuropsychology.
2) What is the difference between MRI and fMRI?
3) What do you understand by neuropsychological assessment as a method?
4) Describe in detail, the early methods of neuropsychology.
5) What is meant by dissociation and double dissociation? Describe
6) What are main in-vivo imaging methods in neuropsychology?

1.8 SUGGESTED READINGS

Cullum.C.M (1998). Neuropsychological Assessment of Adults. Bellack A.S,
Herson M, Reynolds. C.R (eds) Comprehensive Clinical Psychology: 4 328-
333.
18
Davis, K. (1983). Potential neurochemical and neuroendocrine validators of Neuropsychology Methods
assessment instruments. Paper presented at conference on clinical memory
Assessment of older adults, Wakefield, M.A.

Filskov, S. B., & Bold, T. J (1981). Handbook of Clinical Neuropsychology.

New York: Wiley-Interscience.

Kapur. M, Hinsave. U, Oommen A (2002). Psychological Assessment of Children

in the Clinical Setting. NIMHANS publications Bangalore

Kolb B, Whishaw I.Q (1990). Fundamentals of Human Neuropsychology (3rd

ed). W.H Freeman and company New York.

Lezak, M.(1976). Neuropsychological Assessment (Ist ed.). New York: Oxford

university press.

Walsh K.(1994). Neuropsychology: A Clinical Approach (3rd ed). B.I Churchill

Livingstone Pvt. Ltd. New Delhi.

19
Brain Behaviour
Inter-relationship UNIT 2 NEUROPSYCHOLOGICAL
ASSESSMENT AND SCREENING

Structure
2.0 Introduction
2.1 Objectives
2.2 Neuropsychological Assessment of Infants and Young Children
2.2.1 Localisation of Functions in the Brain
2.2.2 Categorisation of Neuropsychological Assessment
2.2.3 Categorisation of Major Brain Functions
2.2.4 Approaches to Neuropsychological Assessment
2.2.5 Functional Domains in Children
2.2.6 Developmental Concepts Unique to Infants and Young Children
2.2.7 Nonhuman Experimental Studies
2.3 Advances in Neurodiagnostic Techniques
2.3.1 Clinical Studies
2.3.2 Nature and Degree of Abnormality
2.3.3 Social Attention and Environmental Influences
2.3.4 Clinical Evaluation of Infants and Young Children
2.4 Neuropsychological Assessment of Older Children
2.4.1 General Principles
2.4.2 Methods of Assessment
2.5 Neuropsychological Assessment of Adults
2.6 Validity and Reliability
2.7 Neuropsychological Screening of Adults
2.8 Let Us Sum Up
2.9 Unit End Questions
2.10 Suggested Readings

2.0 INTRODUCTION
The clinical practice of neuropsychology involves an integration of knowledge
bases from the disciplines of psychology, psychometrics, neuroscience, clinical
neuropsychology and psychiatry. In this unit you will be presented with an
introduction to how neuropsychologists assess brain function. First we will look
at the area from a developmental perspective illustrating how neuropsychologists
evaluate young preschool children, older children, youngster adults, and elderly
adults. The brain is an evolving organ and functions very differently at different
stages of life span. Assessment issue are different during these stages, as are the
prevalence and characteristics of the various brain disorders. Obviously, the
behavioural evaluation of a 3-years-old child cannot use the same materials and
methods as the evaluation of a 40-year-old adult. It has therefore has been
necessary to develop different tests and methods for neuropsychological
evaluations across the life span, and consequently we have now tests and test
batteries specifically designed for infants and young children, older children,
adults, and the elderly.
20
Neuropsychological assessment provides information concerning the status of Neuropsychological
Assessment and Screening
brain function across the life span. It does so primarily by testing those functions
and abilities may be evaluated in a comprehensive, specialised, or combined
manner. The areas typically assessed in a neuropsychological evaluation include
the ability to reason and conceptualise; to remember; to speak and understand
spoken and written language; to attend to and perceive the environment accurately
through the senses of vision, hearing, touch, and smell; to construct objects in
two- or three-dimensional space; and to perform skilled, purposive movements.
Clinical neuropsychology in particular has the task of identifying in individual
patients the level and pattern of disruption of these abilities as a result of brain
dysfunction.

The present unit starts with Neuropsychological Assessment of Infants and Young
Children followed by the developmental Concepts Unique to Infants and Young
Children. Then we deal with the various experimental studies especially the non
human ones. We then discuss the advances that have taken place in the
neurodiagnostic techniques and how one could accurately measure and assess
the neurological damages in the brain. These are substantiated by clinical studies.
This is followed by social attention and environmental influences. We then take
up the clinical evaluation of infants and young children. This is followed by
neuropsychological assessment of older children, the general principles associated
with the same, the methods of assessment etc. Finally we take up
neuropsychological assessment of adults and discuss the validity and reliability
associated with these assessments. Then we describe the neuropsychological
screening.

2.1 OBJECTIVES
After completing this unit, you will be able to:
• Define and describe neuropsychological assessment;
• Elucidate the neuropsychological methodology for assessing infants and
young children;
• Explain the developmental concepts unique to infants and young children;
• Describe the advances in the neurodiagnostic techniques;
• Delineate the methods for neuropsychological assessment of older children;
• Describe the neuropsychological assessment with adults;
• Analyse the validity and reliability of these tests; and
• Explain Neuropsychological Screening.

2.2 NEUROPSYCHOLOGICAL ASSESSMENT OF

INFANTS AND YOUNG CHILDREN
Neuropsychological assessment is the clinical practise of using tests and other
behavioural evaluation instruments to determine the status of brain function. It
is based on the assumption that the brain is the organ of behaviour, and so the
status of the brain can be evaluated through the use of behavioural measures.
Over many years of research, particular procedures have been found to have
21
Brain Behaviour particular sensitivities to alteration on brain function, and these procedures have
Inter-relationship
come to be known as psychological tests.

A neuropsychological test therefore is defined as behavioural procedure that is

particularly sensitive to the condition of the brain. While any purposeful behaviour
involves the brain, neuropsychological tests provide the clearest demonstrations
of behaviour that indicate that the brain is functioning normally, or that something
is wrong with it. There are many factors that can produce brain dysfunction
including genetic endowment, developmental abnormalities, physical injury,
exposure to toxic or infectious agents, systemic diseases (e.g. vascular disorders,
cancer, metabolic disorders), and progressive disorders that specifically affect
central nervous system tissue, such as multiple sclerosis.

2.2.1 Localisation of Functions in the Brain

Neuropsychologists and neurologists studying behaviour have been greatly
concerned with localisation of function in the brain. The first great discovery of
neuropsychology is thought to be Paul Broca’s identification of the relationship
between language and left hemisphere of brain. Neuropsychological tests are
often used to assist in determining localisation of brain damage, and that practise
continues even after the development of the relatively new neuroimaging
procedures. However, contemporary views of brain function tend to conceptualise
localisation in interaction with a number of developmental and pathological
considerations. Localisation of function in the brain of an infant is not the same
as it is in adult. Localisation in women is not same as it is in men. Furthermore,
the neurobehavioural characteristics of disease or destruction of the very same
brain regions may vary substantially with the particular pathological process.
We have therefore chosen to introduce neuropsychological assessment on the
basis of these different processes, with localisation treated within the contexts of
those processes.

2.2.2 Categorisation of Neuropsychological Assessment

One can divide neuropsychological assessment into two areas:
i) comprehensive and
ii) specialised assessment.
Comprehensive assessment generally employs standard test batteries, notably
the Halstesd Reitan or Luria Nebraska batteries. A comprehensive assessment
typically evaluates all of the areas evaluated by specialised assessments, or may
do only specialised assessments in response to the referral question. This matter
is controversial in the field, but the more productive approach is probably highly
related to the setting in which one works, and the nature of its patient population.

2.2.3 Categorisation of Major Brain Functions

As a framework, the major brain functions typically divided into modalities and
domains. The major modalities are motor function and the senses of vision,
hearing, touch, and rarely, smell. The major domains are the cognitive abilities
and include abstract reasoning and intellectual function, memory, language, spatial
abilities and motor skills. We will also discuss how assessments are conducted
by behavioural neurologists. Behavioural neurologists typically do specialised
evaluations based on their initial examination and review of the history, but they
22
use a somewhat different conceptual framework and methodological approach Neuropsychological
Assessment and Screening
from clinical neuropsychologists, providing an interesting and important contrast.

Domain Syndrome
Abstraction\intellectual function Dementia
Memory Amnesia
Language Aphasia, Alexia, Acalculia
Spatial abilities Constructional apraxia, visuospatial defects
Motor skills Apraxia

The aim of specialised assessment is often to identify a syndrome and specify its
probable basis in abnormal brain function. The basic purpose for identifying a
syndrome is to characterise the deficit and make a formulation concerning possible
neurological correlates. For example, in the case of memory, the diagnostic
question often involves whether the patient has amnesia, and if so, what type.
Thus, there is an association between the domain and a class of abnormal
syndromes, illustrated in the table above. This table is gross oversimplification,
but is only meant to suggest the association of certain cognitive domains to
different non behavioural syndromes.

The neuropsychology of the various modalities and domains involves applications

from the knowledge base concerning the domain or modality itself, its
neurobiological substratum, and the functional changes that take place as a result
of brain damage or injury. Thus, neuropsychology of memory involves application
of the experimental psychology of memory. Also, our knowledge of memory is
represented in the brain, and the changes that take place in the memory as a
consequence of brain damage. These changes are characterised as the amnesic
syndromes. Similarly, disorders of speech, language, reading, writing, and
mathematical abilities are understood in terms of linguistics and the psychology
of language and of what is known about the relationship between the brain and
language. Lacking definitive knowledge of how the brain really works,
neuropsychologists have constructed an elegant conceptual model of how the
brain processes information within and across modalities and domains.

2.2.4 Approaches to Neuropsychological Assessment

Probably the most useful model of neuropsychological interpretation is described
in Reitan and Wolfson’s (1993) four approaches to assessment which are given
below:
i) level of performance,
ii) pathognomonic signs,
iii) pattern of performance, and
iv) comparison of the left and right sides of the body.
The last approach can also include comparisons between the anterior and posterior
parts of the brain, or between cortical and sub cortical structures, but our
knowledge base remains strongest for right versus left comparisons.

23
Brain Behaviour A comprehensive assessment ideally uses all four approaches. Some forms of
Inter-relationship
specialised assessment rely heavily on pathognomic signs, behaviours that are
almost exclusively seen in brain damaged patient and that have some specific,
often localising significance. Other forms of specialised evaluations rarely use
the general level of performance approach, which is generally reflected in some
kind of summary index of impairment based on tests of varying domains and
modalities. While all these approaches are important, relative emphases on any
of them may relate to setting in which one practises and the clinical characteristics
of the clientele in that practice. In the light of contemporary patterns of health
care provision, the distinction between being in a primary care, “first-line” setting
and a specialised tertiary care practise is very important.

2.2.5 Functional Domains in Children

There are three functional domains of particular interest in this age range:
• attention,
• memory, and
• executive function.
The goal of neuropsychologist is to challenge clinicians to develop concepts
about brain behaviour relationships in this group, and to provide a basis from
which the clinicians could generate hypotheses in their own clinical evaluations
and effect appropriate interventions. The objective is not to provide an exhaustive
listing of tests and measures, but instead to consider the functional domains for
which a judicious selection of tests can be made.

Whether one should refer to “neuropsychology” of infants and young children is

perhaps controversial. The questions that need to be answered include the
following:

• How does one reliably assess and evaluate brain behaviour relationships in
the newborn, neonate or very young child?
• If this is even possible, how practical would such evaluation be?
• Is the methodology used by paediatric neuropsychologists applicable to the
youngest ages? and
• If so, with what degree of reliability or validity?
• Which variables are traceable to the very youngest ages?
• Which will result in long lasting (i.e., adult) cognitive compromise?
• What interventions can be applied in these very early years to lessen the
impact of early insults?
Since these and other related questions remain largely unanswered, many
practitioners are naturally reluctant to endorse terminology that may be misleading
or inappropriate.

What is not controversial is the fact that paediatric and psychological specialists
frequently encounter infants and young children whose developmental delays or
cognitive deficiencies are attributable to underlying neurodevelopmental
24
abnormality or to documented neurological disease or disorder that occurred in Neuropsychological
Assessment and Screening
the earliest stages of growth and development. The increased recognition that
these etiological factors exist and have an important influence on the child’s
later cognitive outcome is a result of a number of converging developments.
These include:
1) a better definition of the unique developmental concepts that are applicable
to infants and young children,
2) finely detailed analyses of normal and abnormal brain development from
experimental studies of nonhumans,
3) major advances in neurodiagnostic techniques,
4) an expanding clinical and research literature on human developmental
studies, and
5) an increase in societal attention to the needs of infants and young children,
in part emphasised by preschool screening and intervention programs.

2.2.6 Developmental Concepts Unique to Infants and Young

Children
The cognitive and social emotional development of infants and very young
children has unique features. This age range is associated with less differentiation
of some functional areas, the presence of early developmental constructs that are
less dominant than in older children, and an increased variability of performance
compared to older children. Understanding the critical precursor behaviours
during these early years allows the neuropsychologist to generate early predictions
about later patterns of strength and weakness, for example, in attention, memory,
and executive function domains.

Two concepts that are especially critical to understanding brain development in

the very young child are:
• symbolic representation and
• imitation in learning.
Knowing these concepts helps us better understand developmental progress and
provide a stronger foundation for understanding cognitive and social development.
The social environment also has a special role.

Symbolic representation is the representation of both the external and internal

world through symbols and has been discussed in relation to important
neuropsychological domains, including executive self-regulation and memory.

The concept of imitation in the learning process is also a key developmental

concept for infants and young children.

Although the social learning theory has long posited that behaviour is an important
element in learning, imitation behaviours etc., they are significantly more
pronounced and overt in infants and young children. From a neuropsychological
perspective, imitation can be an adaptive form of stimulus bound behaviour,
which can be considered pathological at older ages.

25
Brain Behaviour 2.2.7 Nonhuman Experimental Studies
Inter-relationship
How normal brain development proceeds is essential knowledge for professionals
concerned with understanding infant and young child development. Laboratory
studies of nonhumans have contributed substantially to our knowledge about
normal and abnormal human brain function. Our understanding of the
abnormalities that can occur and that may explain and individual’s
neurobehavioural dysfunctioning has broadened considerably as a result of these
studies.

Self Assessment Questions

1) Discuss the neuropsychological assessment of infants and young children.
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2) Delineate the localisation functions in the brain.
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3) What are the categories of neuropsychological assessment and main
brain functions.
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4) Discuss the approaches to neuropsychological assessment.
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5) What are the developmental concepts that are unique to infants and
young children?
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 Neuropsychological
2.3 ADVANCES IN NEURODIAGNOSTIC Assessment and Screening

TECHNIQUES
Major scientific and technology advances have made it easier to correlate
behaviours suspected as having a neurological basis with actual neuroanatomical
(structural) and neurophysiological abnormalities. Many of these advances have
been applied to the study of infants and young children, such as techniques to
examine the foetus in utero and to monitor development in the perinatal period.
For example, real time ultrasonography is useful for determining the presence,
timing, and course of intraventicular behaviour in a preterm infant.

Some techniques visualise anatomy, provide objective confirmation of structural

abnormality. These include neuroradiological imaging procedures such as
computed tomography (CT) and magnetic resonance imaging (MRI). However,
gross brain structure may appear normal despite functional behavioural
abnormality that suggests to the clinician that there is an underlying neurological
etiology. This may be particularly perplexing when a formal neuropsychological
evaluation has documented dysfunction.

2.3.1 Clinical Studies

The opportunity to investigate the conditions that influence stages of growth and
development from gestation to infancy to early childhood and their impact on
eventual neurobehavioural outcome is especially challenging. It is precisely these
investigations that are being addressed now by researchers in neuroscience,
psychology, and related fields concerned with neurodevelopment. Empirical data
have only recently been more widely collected to verify or negate claims of clear
casual connections between certain medical conditions and later cognitive
functioning.

The paediatric clinical literature has expanded greatly in its coverage of the wide
variety of medical circumstances that can negatively affect the developing human
brain. As a consequence, populations of children who are at risk for cognitive
impairment have been identified, and formal investigations have provided insight
into the influence of the many factors that influence the success or failure of
cognitive development. That infants at risk are more likely to have learning
difficulties than infants not at risk is well established.

The link between structural abnormality and unique behavioural aberration has
become clearer as technological advances have allowed for even more finely
tuned discrimination than that obtained from study of gross structural anatomy.
This was made dramatically apparent by several early neuropathological studies
of dyslexia. The classic diagnosis of dyslexia was based on psychoeducational
features until advances in neurological diagnosis enabled identification of
associated neuropathological mechanisms and anatomic abnormalities.

2.3.2 Nature and Degree of Abnormality

The nature and degree of abnormality will effect normal neural growth and
maturational outcome. For example, in an adult damage to the developing brain
may be the result of toxic exposure (e.g., alcohol abuse, lead exposure, and
maternal drug use), nutritional deprivation, trauma, or environmental
27
Brain Behaviour circumstances. Early birth and very low birth weight have received much attention
Inter-relationship
and are often accompanied by a number of neonatal complications that may
contribute to eventual cognitive compromise, including intraventricular
behavioural (IVH), hyaline membrane disease and associated respiratory distress
syndrome, hyperbilirubinemia, asphyxia, bronchopulmonary dysplasia, and
apnea. The effects of prenatal or perinatal oxygen deprivation are perhaps most
commonly cited as a main pathogenetic factor in neurodevelopmental problems.

Temporal Factors: Given the on going schedule of postnatal neurodevelopment,

the age of the child at the time of exposure and the behaviour can have a significant
effect on the type of neuropsychological damage and dysfunction. Given the
ongoing development of brain connectivity and the progressively greater reliance
on the more complex cognitive and behavioural functions during school age,
adolescence, and young adulthood, the actual damage or dysfunction resulting
from brain injury or disorder may not be fully realised until years after the child’s
exposure.

Plasticity: The notion of brain plasticity has been of interest to researchers and
clinicians alike for decades. The outcome of injury is the result of the underlying
plastic potential of the brain and varies with the neurodevelopmental stage at the
time of insult, the type of lesion, the severity of the lesion, the behaviour being
measured, the range of the scores of the individual at assessment, and other
factors. It has been proposed that the brain modifies itself through change at the
synapse, that is, by alterations in the axon terminal, spine density, dendritic
behavioural, or structure of the existing synapse. The neural process occurring
in the recovery from brain injury are thought to be similar to the processes involved
in learning from experience, which result in the production of new synapse, the
loss of old synapses (pruning), and the modification of existing synapses.
Adaptation in response to insult is also an impressive finding.

Early therapeutic Intervention: Since outcome may be ameliorated by well

timed and appropriate treatment, the prevailing belief is that dysfunction should
be identified early to allow for optimal outcome. There is great interest in
examining which early intervention strategies will result in a significantly
improved neurobehavioural outcome.

2.3.3 Social Attention and Environmental Influences

The importance of social environment and early experiences in neurodevelopment
is increasingly recognised. Due to developmentally adaptive aspects of imitation,
that is behaviour boundendness, infants and young children rely on the
environmental context for the appropriate acquisition of knowledge and cognitive
stimulation. Children’s cognitive function may be more strongly influenced by
social and environmental factors than that of adults. The brain may be thought of
as a “dependant variable” that is shaped in part by the facilitative stimulation
that is experienced. Further, whether a young child will respond and demonstrate
knowledge acquisition is often dependent on “optimal” environmental conditions.
Thus, this context must be taken into account when considering a child’s
demonstrated strengths and weakness and their generalisability from the
evaluation setting to the real world. Assessment of the sequel of brain insult may
be confounded by these important factors, and consideration of these influences
is needed to avoid simplistic hypotheses about brain behaviour functioning.
28
2.3.4 Clinical Evaluation of Infants and Young Children Neuropsychological
Assessment and Screening
Approaches to clinical practice advanced in recent year are mostly directed at
older children and adolescents. There has not been a similar focus on the infant
and young child. To date, theoretical models developed for older children and
adults have had little impact on clinical practice with young children. The absence
of a model of neuropsychological development that spans the entire age range is
limiting and in part responsible for the relative lack of attention directed to the
very youngest children.
A comprehensive model would
1) provide continuity in understanding developmental progress, or lack thereof,
in those disorders that affect neurological development;
2) encourage a broader consideration of function and a more diverse selection
of methodologies, that is, not restricting assessment to general cognitive
development alone;
3) allow for earlier definition and differentiation of functions during an active
stage of developmental gain or delay;
4) encourage early and specific recommendations that can directly influence
the developmental course and reduce the impact of and obstacle to
development;
5) provide a basis for measurement of the effectiveness of treatment
recommendations;
6) encourage the elaboration of existing knowledge about the natural history
of normal and abnormal brain behaviour relationships in the early years;
and
7) stimulate the development of innovations and techniques that can lead to
better science and practice. For example, to evaluate etiological factors more
precisely or to increase understanding of later concomitants of early injury
or illness. The power that such a model would offer explains why the focus
should be increasingly on the very youngest children and on a comprehensive
understanding of the full life span.

In the evaluation of infants and young children, all sources of reliable and valid
data available to the paediatric neuropsychologist must be used, including the
history, direct and indirect observations of behaviour, and performance on selected
tests. Although the evaluation of an individual at any age should never rest solely
upon test performance, work with infants and young children demands an even
greater degree the use of multiple sources of data. Some of the sources of data
are given below.

a) Child History Questionnaire: A clinical investigation begins with a careful

history taking. One must consider the many factors that may alone, or in
combination, affect behaviour and outcome. A thorough history taking
includes an exploration of events that precede birth, factor that surrounded
the time of birth, and developmentally relevant issues that extend from
delivery up to the present time. An outline of the types of questions that are
generally asked in clinical history interview is presented in the box below.
29
Brain Behaviour
Inter-relationship Sample Outline of Child History Questionnaire
Basic identifying data:
• Child’s name
• Date of birth
• Date of evaluation
• Person referring for evaluation
• Person filling out the questionnaire
• Child’s behavioural problems for which being referred to
Referral information:
• Reason for referral
• Circumstances/factor judged responsible for this problem
• Child’s strength
• Child’s weakness
• Do parents agree about the nature and causes of the problem?
Family information:
• Address
• Telephone
• Parents (name, age, education, marital status)
• Child’s natural, adopted, or fosters status
• Siblings (name, age)
• Other’s living in home
• Approximate family income
• Father’s occupation
• Mother’s occupation
• Significant family or marital conflict
Pregnancy, birth history, neonatal period:
• Age of mother at delivery
• Health problems of mother during pregnancy
• Length of labour and any complications
• Delivery type (vaginal, Caesarean) and any complications
• Term length (full, premature, number of week’s gestation)
• Birth weight and height
• Condition of baby (e.g., baby breathed spontaneously, Apgar scores)
• Type of nursery (e.g. normal new-born, paediatric intensive care)
• Days until discharge from the hospital after birth
• Medical problems after discharge (e.g., jaundice, fever)
• Any problems in the first few months
30
 Neuropsychological
Developmental history Assessment and Screening

• Motor development
• Age at first accomplishment (e.g., sat alone, crawled, walked alone)
• Was child slow to develop motor skills or awkward compared to sibling/
friends (e.g., running skipping, climbing, biking, playing ball)?
• Handedness (right, left, both); history of left – handedness
• Need for physical therapy or occupational therapy

Language
• Age at first accomplishment (e.g., first word, put two or three words
together)
• Speech/language delays/problems (e.g., stutters, difficult to understand,
poor comprehension)
• Oral motor problems (e.g., the alphabet, name colours, count)
• Language spoken in home
• Provision of speech/language therapy

Toileting
• Age when toilet trained
• Associated problems (e.g., bedwetting, urine accidents, soiling)

Social behaviour
• Relationships with other children; with adults
• Ability to begin and maintain friendships
• Understanding of gestures, nonverbal stimuli, social cues
• Appropriateness of sense of humour

Medical history
• Results of vision check
• Results of hearing check
• Serious illness/injuries/hospitalisations/surgeries
• Head injuries (e.g., date, type, loss of consciousness?, changes in
behaviour)
• Current medications and reasons

Personal history
• Febrile seizures
• Epilepsy
31
Brain Behaviour
Inter-relationship • Lead poisoning/toxic ingestion
• Asthma or allergies
• Loss of consciousness
• Abdominal pains/vomiting, and when they occur
• Headaches, and when they occur
• Frequent ear infections
• Sleep difficulties
• Eating difficulties
• Tics/twitching
• Repetitive/stereotyped movements
• Impulsivity
• Temper tantrums
• Nail biting
• Clumsiness
• Head banging
• Self-injuries behaviour

Family history
Learning difficulty
Neurological illness
Seizures
Psychiatric disorder
Instances of similar problem in any family member

Education history
Current school and address
Grade and type of placement (e.g., regular, resource, special education,
emotionally disturbed)
Grades skipped or repeated
Teachers reported problems areas (e.g., reading, spelling, arithmetic, writing,
attention/concentration
Problems with hyperactivity or inattention in the classroom

Prior psychological history

Previous contact with a social agency, psychologist, clinic, or private agency

Although it was once thought that the capacities of the very young child were
quite limited, it is now well understood that the infant has cognitive abilities that
can be demonstrated with appropriate techniques. An examination of the literature
on three domains, namely attention, memory, and executive function, provides
data that support this idea.

b) Psychological tests
Attention

32
The construct of attention has been found to comprise several interrelated elements Neuropsychological
Assessment and Screening
that the paediatric neuropsychologist can consider in the clinical evaluation. For
example, attention may be conceptualised as involving more specific components,
such as the ability to initiate, sustain, inhabit, and shift, or the ability to focus /
execute (scan the stimulus field and respond), sustain (be vigilant, attend for a
time interval), encode (sequential registration, recall and mental manipulation
of information), and shift. The ability to focus and sustain attention is especially
relevant to the study of attention in the infant and the preschool child. The shift
dimension of attention is related to executive function.

Fig.2.1: Letter cancellation test Fig.2.2: Stoop test

Begin

Trail making text. Part B

Fig.2.3: Trail making test

33
Brain Behaviour Memory: The acquisition, reaction, and retrieval of new information is a domain
Inter-relationship
of much importance in infants and young children at risk, for neuropsychological
dysfunction (e.g., those with acquired brain injuries, neurotoxic exposure,
developmental language disorders, hydrocephalus, or a history of hypoxia).
Memory research with young children has provided some examples of functioning
analogous to that described for older children and adults and has resulted in a
new appreciation for the capacity of the very young child. For example, in their
first year, children can retain information about object location.
Event recall has been shown to be possible in the months following the event.
Accurate long term recall over a 1 week delay was found in 13 month olds.
Children ages 21 to 29 months were tested for information presented when they
were 8 months younger, and novel events were recalled over the long delay,
even by the youngest children. Children aged 3 years were found to have well
organised representation of familiar events. Young children can recall events
from when they were 2 years old although adults cannot remember events
occurring before 3 or 4 years of age. Further, the complexity of children’s event
representation increases with age. It is suggested that what determines event
recall is what the child is asked to remember, the number of exposures to the
event, and the availability of cues and reminders of the event, much as in the
older child and adult.
Specifically, tasks of infant habituation/recognition memory, immediate memory
span, and verbal learning/memory list, story passage, names) are available (see
Table below).
Table 2.1: Assessment Tools: Memory
Test name Age Type of measure
Bayley scales of infant Habituation Novelty preference stimuli
Development – 1-3 months (Selected tests)
Recognition & memory
DAS Number Recall Immediate Digit Span (forward)
Memory Span
2 years
SB4 Sentence Memory 2 years Sentence Span
DAS Picture 2½ years Picture (object) recognition
Recognition of increasing number of stimuli
MSCA Picture Memory 5 years Picture name recall, six –item
card
K-ABC Spatial memory 2 years Recall of picture location of
on matrix; simultaneous
presentation of x-y items
SB4 Bead Memory Active learning Memory for picture of beads,
and Memory task of increasing quantity
DAS Object Recall 4 years Three-trial verbal recall of 20
picture names; immediate
learning trial; delayed recall
MSCA Story Memory 21/2 years Immediate verbal recall of
story passage
34
Executive Functions: Executive functions are those involved in the planning, Neuropsychological
Assessment and Screening
organisation, regulation and monitoring of goal directed behaviour. In the past,
the assessment of those skills and related abilities, such as problem solving and
abstract reasoning, has often been conducted informally, often by examining the
quality of performance on tests falling within other measurement domains.
Recently however, a wider variety of tests has been employed to assess executive
functions, including measures such as Wisconsin Card Sorting Test, the Tower
of London, and the Children’s Category Test. Executive Function would appear
to play a critical role in determining a child’s adaptive functioning.

Fig.2.4: Tower of London

Self Assessment Questions

1) Discuss the advances in neurodiagnostic techniques.
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2) How are clinical studies considered important in neurodiagnostics?
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3) Discuss the nature and degree of abnormality that are encountered during
neuropsychological testing.
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35
Brain Behaviour
Inter-relationship 4) How are social attention assessed? How do environmental influences
affect the neuropsychological assessment?
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5) Discuss all aspects related to clinical evaluation of infants and children.
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2.4 NEUROPSYCHOLOGICAL ASSESSMNET OF

OLDER CHILDREN
In the recent years, the field of child neuropsychology has undergone tremendous
growth. There has been a burgeoning interest in the neuropsychological
assessment of children with disorders of the central nervous system, systematic
medical illnesses, neurodevelopmental and related learning disabilities, and
psychiatric disorders. Recent surveys indicate that a significant proportion of
neuropsychologists now devote most of their clinical services to children and
adolescents.

We will discuss a set of general principles that help to conceptualise

neuropsychological assessment. The principles acknowledge that child
development is driven by a complex interplay of multiple forces, including, but
not limited to, brain function. We then describe more concretely the methods
and procedures of neuropsychological assessment. We briefly examine some of
the recent clinical and scientific applications of child neuropsychological
assessment.

2.4.1 General Principles

The neuropsychological assessment of school age of children and adolescents is
not primarily a technological enterprise. That is, it is not defined on the basis of
specific interview procedures or test instruments because the latter methods are
subject to substantial change and refinement over time. Instead, child
neuropsychological assessment is based on a conceptual foundation and knowledge
base, the application of which is grounded in an interest in understanding brain-
behaviour relationships for the purpose of enhancing children’s adaptation. Thus,
recent models of child neuropsychological assessment, whether characterised as
behavioural or systemic neurodevelopmental, have shared several general
principles. These include the following.
36
1) Principle of Adaptation Neuropsychological
Assessment and Screening
The first principle is that the central goal of assessment is to promote the
adaptation of the child, rather than simply to document the presence or
location of brain damage or dysfunction. Adaptation can be understood as
resulting from the interactions between children and the contexts within
which they develop, or as reflecting the functional relationship between
children and their environments.

Failures in adaptation, such as poor school performance or unsatisfactory

peer relationships are usually problems that bring children to the attention
of clinical neuropsychologist. Neuropsychological assessment is useful
largely to the extent that it helps explain those failures and facilitates more
successful future outcomes. Indeed, the broader goal of assessment extends
beyond the facilitation of learning and behaviour in the immediate context
of school and home to include the promotion of long term adaptation to the
demand of adult life.

2) Principle of Brain and Behaviour

A second principle is that insight into children’s adaptation can be gained
through an analysis of brain behaviour relationships. Advances in
neurosciences over the past two decades have begun to yield a clearer
appreciation of the relationship between the brain and behaviour. Old notions
of localisation have been replaced by more dynamic models involving the
interaction of multiple brain regions. The assessment of brain behaviour
relationships in children is quite complex and clearly depends upon factors
such as the age of the child, the specific cognitive skills and behaviours
assessed, the type of disorder under consideration and the nature of the
documented or hypothesized brain impairment.

3) Principle of Context
A third principle guiding the neuropsychological assessment of children is
that environment contexts help to constraint and determine behaviour. Thus,
the ability of neuropsychological assessment to determine whether brain
impairment contributes to failures of adaptation or of adaption rests on a
careful examination of the influences of environmental or contextual
variables that also influence behaviour. The reasons for examining these
influences are to rule out alternative explanations for a child’s adaptive
difficulties and to assess the nature of the child’s environment and as the
situational demands being placed on the child. In this regard,
neuropsychological assessment is designed not so much to measure a child’s
specific cognitive skills, but to determine how a child applies thesse skills
in the environment.

4) Principle of Development
The final guiding principle is that assessment involves the measure of change,
or development, across multiple levels of analysis. Developmental
neuroscience has highlighted the multiple processes that characterise brain
development. For example the cell differentiation and migration, the dendritic
behavioural and pruning as well as the timing of these processes. Although
less research has been conducted concerning developmental changes in
37
Brain Behaviour children’s environment, there is nevertheless a natural history of environment
Inter-relationship
that is characteristic of most children in a culture. Behavioural development
in turn can be conceptualised as the result of the joint interplay of these
biological and environmental time tables and is characterised by the
emergence, stabilisation and maintenance of new scales as well as the loss
of earlier ones. The neuropsychological assessment therefore requires
appreciation for the developmental changes that occur in brain, behaviour
and context because the interplay between these levels of analysis determines
adaptation outcomes.

Self Assessment Questions

1) Discuss the neuropsychological assessment of older children. What are
all the aspects to be considered?
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2) Elucidate the general principles of neuropsychological assessment of
older children.
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2.4.2 Methods of Assessment

The four general principles outlined above, that is, adaptation, brain and
behaviour, context, and development serve as the foundation for the specific
methods of assessment used by child neuropsychologists.

Although neuropsychological assessment is equated with the administration of a

battery of tests designed to assess various cognitive skills, the most typical
combination of methods involves the collection of historical information,
behavioural observations and psychological investigations which together permit
a border and a detailed characterisation of neuropsychological functioning.

1) History taking
The careful collection of historical information is accomplished by a combination
of questionnaires and parent interviews which are essential in neuropsychological
assessments. Thorough history not only clarifies the nature of a child’s presenting
problems but also assists in determination of its source. A careful history can
help to determine a child’s present problems have a neuropsychological basis or
may be related primarily to psychological or environmental factors.
38
a) Birth and Developmental History: Collection of information regarding a Neuropsychological
Assessment and Screening
child’s early development usually begins with the mother’s pregnancy, labour
and delivery, and extends to the acquisitions of developmental milestones.
Information about such issues and events is useful in identifying early risk
factors, as well as these are early indicators of anomalous development.
The presence of early risk factors or developmental anomalies makes a
stronger case for a constitutional or neuropsychological basis for a child’s
failures in adaptation.

The early development of the child also warrants study, including interactions
with parents, socialisation with peers, gross and motor skills, receptive and
expressive language skills, constructional skills (i.e., block/puzzle/picture
play), attention disabilities, feeding and sleeping patterns and development
of hand preference/ delays or anomalies in these domains are often early
precursors of later learning problems.

b) Medical History: A child’s medical history often contains predictors of

neuropsychological functioning. Perhaps the most obvious predictor is the
presence of some documented brain abnormality or insult. For instance,
closed head injuries during childhood can clearly compromise cognitive
and behavioural function. Similarly seizure disorders are frequently
associated with neuropsychological deficits.

c) Family and Social History: Recent studies suggest that genetic variation
plays an important role in etiology of learning problems. Hence, the collection
of information regarding a family’s history of academic difficulties is often
relevant in establishing a possible familial basis for learning problems.
Family History should also be collected regarding psychiatric disturbances,
language disorders, and neurological illnesses, each of which can also signal
a biological foundation for later neuropsychological deficits.

d) Educational History: A complete school history includes information

regarding a child’s current grade placement, any grade repetitions or
specialisation programs, and changes in school placement. Information about
school history is usually available from parents. School personnel also can
be contacted to obtain additional descriptions of a child’s academic and
behavioural difficulties at school. The value of school reports is that teachers
and other school personnel are aware of the child’s ability to meet educational
demands and of how the child compares to peers. School reports often
corroborate parental information, but can frequently add new or even
contradictory impressions.

2) Behavioural Observations
Behavioural observations of the child are the second critical source of
information available to the neuropsychologist. Qualitative observations
are extremely important, not only in interpreting the results of
neuropsychological testing, but also in judging the adequacy of social,
communicative, problem solving, and sensorimotor skills that may not be
amenable to standardised testing.

Behavioural observations are often noteworthy to the extent that they involve
alterations in the examiner’s usual responses to a child. That is, changes in
39
Brain Behaviour the examiner’s usual style of interaction may signal anomalies in a child’s
Inter-relationship
functioning. For instance, the need for the clinician to modify his or her
utterances may signal a language disorder.

Similarly, if the clinician must use verbal prompts more frequently than
usual in order to keep the child on task, then the child may be considered to
have attention problems. Rigorous observation, though, must be referenced
to certain basic domains of functioning to which neuropsychologists routinely
attend.
A typical list of domains would include the following:
• Mood and affect
• Motivation and cooperation
• Social interaction
• Attention and activity level
• Response style
• Speech, language and communication
• Sensory and motor skills
• Physical appearance
3) Psychological Testing
Psychological testing is the third source of information about the child, and
the source most often equated with neuropsychological assessment. The
findings obtained from formal testing allow for normative comparisons.
The findings obtained from formal testing allow for normative comparisons.
Formal testing also provides a context for making qualitative observations
of response styles and problem-solving strategies under standardised test
batteries, such as Halstead-Reitan Neuropsychological Test Battery, as
opposed to more flexible approaches to assessment. In general, however,
most child neuropsychologists administer a variety of tests that sample from
a broad range of behavioural domains. The administration of a comprehensive
battery provides converging evidence for specific deficits or problems and
ensures an accurate portrayal of a child’s overall profile of functioning.
Test batteries typically assess the following domains:
• General cognitive ability
• Language ability
• Visuoperceptual and constructional abilities
• Attention
• Learning and memory
• Executive functions
• Corticosensory and motor capacities
• Academic skills
• Emotional status, behavioural adjustment and adaptive behaviours
Let us deal with each of them above domains
40
a) General Cognitive Ability: General cognitive ability is usually assessed Neuropsychological
Assessment and Screening
using standardised intelligence tests, such as Wechsler Intelligence Scale
for Children Third Edition (WISC-III), the Stanford Binet Intelligence Scale
Fourth Edition, and the Kauffman Assessment Battery for Children.

b) Language Abilities: The study of aphasia and acquired language disorders

was one of the driving forces in the growth of neuropsychology in this
century. Thus, when using batteries, such as the Neurosensory Center
Comprehensive Examination of Aphasia, they also make use of tests used
by speech pathologists and other psychologists, such a Peabody Picture
Vocabulary Test Revised.

c) Attention: From a neuropsychological perspective, attention is a

multidimensional construct that overlaps with the domain of “executive”
functions discussed below. Neuropsychological assessment therefore usually
involves tests that assess various aspects of attention, such as vigilance.
Exemplary procedures include the Gordon Diagnostic System, which is one
of the several continuous performance tests, The Contingency Naming Test,
and the Arithmetic, Digit Span, Coding and Symbol Search subtests from
the WISC-III.

d) Executive Functions: Executive functions are those involved in the

planning, organisation, regulation and monitoring of goal-directed behaviour.
In the past, the assessment of those skills and related abilities, such as
problem-solving and abstract reasoning, has often been conducted informally,
often by examining the quality of performance on tests failing within other
measurement domains. recently however, a wider variety of tests has been
employed to assess executive functions, including measures such as
Wisconsin Card Sorting Test, the Tower of London, and the Children’s
Category Test. Executive Function would appear to play a critical role in
determining a child’s adaptive functioning.

e) Corticosensory and Motor Capacities: Tests of corticosensory and motor

capacities usually involve standardised versions of various components of
the traditional neurological examination. Relevant corticosensory skills
include finger localisation, sereogenesis, graphesthesia, sensory extinction,
and left right orientation, for which a variety of standardised assessment
procedures are available.

f) Academic skills: These are tested for reading, writing and mathematics by
giving achievement tests etc. appropriate to the age and class levels of the
students.

g) Emotional status etc. These are tested with personality tests such as the
personality trait questionnaires, sentence completion tests etc.
Self Assessment Questions
1) Discuss the methods of assessment.
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41
Brain Behaviour
Inter-relationship 2) What are all the aspects to be covered in history taking?
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3) What is meant by behavioural observations? What aspects need to be
covered here?
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4) What are the various psychological tests to be used in assessment?
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2.5 NEUROPSYCHOLOGICAL ASSESSMENT OF

ADULTS
This section provides a general introduction of the field of neuropsychological
assessment and deals specifically with the extensive standard test batteries and
individual tests used with adults. The focus of neuropsychological assessment
has traditionally been in the brain damaged patient, but there have been major
extensions of the field to psychiatric disorders, functioning of normal individuals,
and normal aging.

Perhaps the best definition of a neuropsychological test has been offered by Ralph
Reitan, who described it as a test that is sensitive to the condition of the brain. If
performance on a test changes with a change in brain function, then the test is a
neuropsychological test. However, neuropsychological assessment is not restricted
to the use of only neuropsychological tests. It should also contain some tests that
are often useful for providing a baseline against which the extent of impairment
associated with acquired brain damage can be measured.

The practise in neuropsychology is roughly divided into two approaches. Some

practitioners use standard comprehensive neuropsychological test batteries, while
others use individual tests that do not constitute a formal battery. Sometimes the
42 tests used vary from patient to patient depending on referral and diagnostic
considerations, and sometimes essentially the same tests are always used by the Neuropsychological
Assessment and Screening
practitioner, but the collection of tests does not constitute a standard battery.

A great standard comprehensive battery is a procedure that assesses all of the

major functional areas by structural brain damage. We use the term an ideal
because none of the standard, commonly available procedures entirely achieves
full comprehensiveness. Since brain damage most radically affects cognitive
processes, most neuropsychological tests assesses various areas of cognition,
but perception and motor skills also are frequently evaluated.

Thus, neuropsychological tests are generally thought of as assessment instruments

for a variety of cognitive, perceptual, and motor skills. While the emphasis is on
cognitive function, neuropsychologists in general practice, typically add brief
personality assessments using the Minnessota multiphasic personality Inventory
(MMPI) or similar procedure, and some measure of academic achievement, such
as the Revised Wide Range Achievement Test.

Neuropsychological assessment typically involves the functional areas of general

intellectual capacities; memory; speed and accuracy of psychomotor activity;
visual-spatial skills; visual, auditory, and tactile perception; language; and
attention. Thus, a comprehensive neuropsychological assessment may be defined
as a procedure that at least surveys all of these areas.

Neuropsychological tests have the same standardisation requirements as all

psychological tests. That is, there is the need for appropriate qualification, norms,
and related test construction considerations, as well as the need to deal with
issues related to validity and reliability. However, there are some special
considerations regarding neuropsychological tests. Neuropsychological test
batteries must be administered to brain damaged patients who may have
substantial cognitive impairment and severe physical disability.

Thus, stimulus and response characteristics of the tests themselves, as well as of

the test instructions, become exceedingly important considerations. In general,
the test material should consist of salient stimuli that the patient can readily see
or hear and understand. Instructions should not be unduly complex, and if the
patient has a sensory deficit, it should be possible to give the instructions in an
intact modality, without jeopardising the use of established test norms. The
opportunity should be available to repeat and paraphrase instructions until it is
clear that they are understood. Similarly, the manner of responding to the test
material (e.g. pressing a lever or writing on a multiple choice form) should be
within the patient’s capabilities.

Neuropsychological assessments aim at specifying in as much detail as possible

the functional deficits that exists in a manner that allows for mapping of these
deficits onto known systems in the brain. There are several methods of achieving
these goals, and not all neuropsychologists agree as to the most productive route.
In general, some prefer to examine patients in what may be described as a liner
manner, with a series of interlocking component abilities, while others prefer
using more complex tasks in the form of standard, extensive batteries and
interpretation through examination of performance configurations.

The linear approach is best exemplified in the work of A.R. Luria and various
collaborators, while the configurational approach is seen in the work of Ward
43
Brain Behaviour Halstead and collaborators. In either case, however, the aim of the assessment is
Inter-relationship
to determine the pattern of the patient’s preserved and impaired functions and
infer from this pattern the nature of the disturbed brain function. Individual tests
and test batteries are really only of neuropsychological value if they can be
analysed by one of these two methods.

2.6 VALIDITY AND RELIABILITY

With regard to concurrent validity, the criterion used in most cases is the objective
identification of some central nervous system lesion arrived at independently of
the neuropsychological test results. Therefore, validation is generally provided
by neurologists or neurosurgeons. Historically, identification of lesions of the
brain has been problematic because, unlike many organs of the body, the brain
cannot usually be visualised directly in the living individual. The major exception
occurs when the patient undergoes brain surgery or a brain biopsy. In the absence
of these procedures, validation has been dependent on autopsy data or the various
brain imaging techniques.

Autopsy data are not always entirely usable for validation purposes, in that
numerous changes may have taken place in the patient’s brain between the time
of testing and time of examination of the brain. Currently, the new neuroimaging
procedures and the very extensive research associated with them have made
substantial progress towards resolution of this problem. Of the various imaging
techniques, magnetic resonance imaging (MRI) is currently the most widely used.

Cooperation among neuroraudiologists, neurologists, and neuropsychologists has

already led to the accomplishment of several important studies correlating MRI
data with neuropsychological test results. Most of the neropsychological tests
and batteries used today have proven reliability and validity.

In the next section, we will discuss neuropsychological batteries for adults in

detail that form a large part of adult neuropsychological assessment.

2.7 NEUROPSYCHOLOGICAL SCREENING OF

ADULTS
Normally, a neuropsychological examination explores in depth an individual’s
performance in a wide range of functional domains. There are instances, however,
in the early phases of diagnostic exploration when the presence of a brain injury
or disease is not compelling but when a suspicion reasonably might be considered.
In such cases, along with other diagnostic procedures, a neuropsychological
screening examination may be employed.

A neuropsychological screening examination is a considerably abbreviated version

of a full neuropsychological assessment, looking only at key sensitive areas of
function.

The purpose of a neuropsychological screening examination is to determine if

there is reasonable evidence, beyond initial clinical impression, for a diagnosis
of brain injury or brain disease. Even though it is “screening,” the examination
must be definitive in this regard.
44
To miss a neurological diagnosis on the basis of a screening examination could Neuropsychological
Assessment and Screening
be quite unfortunate. Once a screening points to reasonable probability that a
neurological condition exists, a full neuropsychological examination would be
indicated to attain further diagnostic, prognostic, and treatment planning
information. A referral for neurological examination would also be appropriate
at this point.

Both screening and full neuropsychological examinations offer the opportunity

for diagnosis of probability of brain dysfunction (as opposed to diagnosis of
psychodynamic, personality, and/or emotional disorder not associated with
neurological causes).

For a screening examination, assessing probability of brain dysfunction is about

as far as the diagnosis goes. A full neuropsychological examination, on the other
hand, is necessary to delineate the wide variety of functional manifestations of
brain damage or disease. Such detail is necessary to understand the life
consequences of functional impairment (e.g., work, school, relationships, driving
potentials, competency, and so forth).

Indications for neuropsychological screening

• Nature of referral question warrants it.
• Situational explanation for changes in emotions or cognitive functioning
cannot be readily identified;
• A medical or injury condition is suspected to have impacted brain health
(for example, compromised circulation, chronically poor nutrition, or drug
toxicity);
• Any relatively sudden, unexpected, and unaccounted for changes appear in
mental or cognitive performance that impacts work or daily functioning;
• Gradual or sudden onset of unusual physical, sensory, or motor changes (an
examination by a physician is always indicated in these instances, as well);
• An individual fails to improve with special educational or therapeutic
interventions designed to address a specific mental or cognitive problem.
• Feasibility issue (e.g. time, cost, etc.)
Strengths of Brief Screening Measures
1) Inexpensive, rapid, portable
2) Needs less training in administration and interpretation
3) Differentiating between dementia and pseudo-dementia
Weaknesses of Brief Screening Measures
1) High rate of false negatives in early stage of disease

Strengths of Full Battery Measures

1) Wide range of scores allow differential diagnosis in various cognitive
disorders
2) More reliable, and sensitive
3) Breadth of domains covered help in treatment planning
45
Brain Behaviour Weakness of Full Battery Measures
Inter-relationship
1) Expensive and time consuming.

2.8 LET US SUM UP

A neuropsychological test is defined as behavioural procedure that is particularly
sensitive to the condition of the brain. While any purposeful behaviour involves
the brain, neuropsychological tests provide the clearest demonstrations of
behaviour that indicate that the brain is functioning normally, or that something
is wrong with it. The general format of assessment essentially includes detailed
case history, behavioural observation, interview and information from various
sources and use of neuropsychological assessment tools.

The cognitive and social emotional development of infants and very young
children has unique features. This age range is associated with less differentiation
of some functional areas, the presence of early developmental constructs that are
less dominant than in older children, and an increased variability of performance
compared to older children. While the approach to the neuropsychological
examination of infants and young children is similar in its general form to that
used in the evolution of older individuals, there are differences in terms of the
existence of a body of knowledge regarding the cognitive and social emotional
development process in this age group and brain behaviour relationships in normal
and abnormal developmental condition; and there is relatively less reliance on
standardised test measures to assess all desired functional areas.

There is a set of general principles that help to conceptualise neuropsychological

assessment of older children and adolescents. The principles acknowledge that
child development is driven by a complex interplay of multiple forces, including,
but not limited to, brain function in this age range as it is a transitional stage.

In adults neuropsychological assessment typically involves the functional areas

of general intellectual capacities; memory; speed and accuracy of psychomotor
activity; visual spatial skills; visual, auditory, and tactile perception; language;
and attention. Thus, a comprehensive neuropsychological assessment may be
defined as a procedure that at least surveys all of these areas.

2.9 UNIT END QUESTIONS

1) How non-human experiments and clinical studies contributed in the
development and understanding of neuropsychological assessment.

2) Explain the concept of plasticity and its significance in neuropsychological

assessment.

3) What are the main domains need to be evaluated in developmental history.

4) Give examples and explain tests of attention and memory in children.

5) Discuss the reliability and validity of neuropsychological assessment.

46
 Neuropsychological
2.10 SUGGESTED READINGS Assessment and Screening

Filskov, S. B., & Bold, T. J (1981). Handbook of Clinical Neuropsychology.

New York: Wiley-Interscience.

G. Golstein & T. M. Incagnoli (Eds) (1974). Contemporary Approaches to

Neuropsychological Assessments. ,New York: Plenum Press.

Lezak, M. (1976). Neuropsychological Assessment (Ist ed.). New York: Oxford

university press.

References
Christensen, A.L. (1975a). Luria’s neuropsychological investigation. New York
spectrum.
Christensen, A.L. (1975b). Luria’s neuropsychological investigation: manual.
New York spectrum.
Davis, K.(1983,october). Potential neurochemical and neuroendocrine validators
of assessment instruments. paper presented at conference on clinical memory
Assessment of older adults, Wakefield, M.A.
Golden, C. J(1981). A standardised version of Luria’s neuropsychological tests;a
quantitative and qualitative approach to neuropsychological evaluation. In Filskov,
S. B., & Bold, T. J (Eds.),handbook of clinical neuropsychology(pp.608 to 642).
New York: Wiley-Interscience.
Golden, C. J., Hemmeke, T. & Purisch, A. (1980). The Luria-Nebraska battery
manual, Los Angeles: Western psychological services.
Golden, C. J., Hemmeke, T. & Purisch, A(1985) Luria-Nebraska
neuropsychological battery manual form I & II. Los Angeles: Western
psychological services.
Goldstein, G. (1982). Overview: clinical application of Halstead-Reitan and Luria-
nebraska batteries. Paper presented at NE-RMEC conference, Northport, NY.
Goldstein, G., & Watson, J. R (1989). Test-retest reliability of the Halstead-Reitan
battery and the WAIS in a neuropsychiatric population. The clinical
neuropsychologist,3,265-273.
Heaton, R. K, Grant, I., & Matthews, C. G.(1991).comprehensive norms for an
expanded Halstead-Reitan battery. Odessa, FL: psychological assessment
resources.
Heaton, R. K, Pendleton, M. G. (1981). Use of neuropsychological test to predict
adult patients everyday functioning. Journal of consulting and clinical
psychology,49, 807-821.
Jastak, S.,& Wilkinson, G. S (1984).wide range achievement test-revised.
Wilmington, DE: Jastak Associates, Inc.
Levin, H. S., Benton, A. L., & Grossman, R. G. (1982).neurobehavioural
consequences of closed head injury. New York Oxford university press.

Luria, A. R.(1973).the working brain. New York basic books.

47
Brain Behaviour Meier, M.J.(1974).some challenges for clinical neuropsychology. In R. M. Reitan
Inter-relationship
& L. A. Davison(Eds), clinical neuropsychology. Reed, J.C, & H.B.C(1997),
Halstead-Reitan neuropsychological battery. In G. Golstein & T. M. Incagnoli
(Eds) ,Contemporary approaches to neuropsychological assessments(pp.93-
129),New York: Plenum Press.

Reitan, R. M (1958).Qualitative versus quantitative mental changes following

brain damage. journal of psychology,46,339-346.

Reitan, R. M (1964). Psychological deficits resulting from cerebral lesion in

man. In J. M. Warren & K. Akert (Eds.), the frontal granular cortex and behaviour
(pp.295-312). New York: McGraw Hill.

Reitan, R. M., & Wolfson, D. (1993). The Halstead-Reitan neuropsychological

test battery: theory and clinical interpretation (2 nd ed.).Tucson, AZ:
Neuropsychology Press.

Russell, E. W., & Starkey, R. I (1993). Halstead-Russell neuropsychological

evaluation system: manual and computer program. Los Angeles; Western
Psychological Services.

Selz, M., & Reitan, R. M. (1979).Rules for neuropsychological diagnosis:

classification of brain function in older children. Journal of consulting and clinical
psychology,47 ,258-264.

Shelly, C., & Goldstein, G. (1983). Discrimination of chronic schizophrenia

and brain damage with the Luria-Nebraska battery: A partially successful
replication. clinical neuropsychology,5,82-85

Sherrill, R. E. jr. (1987). options for shortening Halstead’s category test for adults.
I Archives of clinical neuropsychology,2,343-352.

Wechsler, D. (1955). Wechsler adult intelligence scale manual. San Antonio,

TX: The psychological corporation.

References (for pictures)

brainfitnessresources.com
en.wikipedia.org/wiki/Brain_fitness
assessmenttoolshop.com

48
 Neuropsychological
UNIT 3 NEUROPSYCHOLOGY TEST Assessment and Screening

BATTERIES

Structure
3.0 Introduction
3.1 Objectives
3.2 Neuropsychological Assessment
3.2.1 The Nervous System and Behaviour
3.2.2 Neuropsychological Examination
3.3 Neuropsychological Understanding of Behavioural Deficits
3.4 Goals of Neuropsychological Assessment
3.5 Nature of Neuropsychological Tests
3.6 Identifications of a Deficit by Neuropsychological Tests
3.7 The Luria-Nebraska Neuropsychological Battery
3.7.1 History
3.7.2 Structure and Content
3.7.3 Theoretical Foundations
3.7.4 Standardisation Research
3.8 The Halstead-Reitan Neuropsychological Battery
3.8.1 History
3.8.2 Structure and Content
3.8.3 Theoretical Foundations of Component Tests
3.8.4 Standardisation Research
3.8.5 The NIMHANS Neuropsychological Battery
3.9 Let Us Sum Up
3.10 Unit End Questions
3.11 Suggested Readings

3.0 INTRODUCTION
In this unit we are dealing with neuropsychological batteries and tests. We start
with the definition of neuropsychological assessment and present the various
aspects related to the same. Then we discuss how Neuropsychological Assessment
would also lead to obtaining information regarding the neurological deficits
resulting in behavioural deficiencies. Then we take up Goals of
Neuropsychological Assessment and discuss the various factors and clues that
may be obtained in regard to the neurological problems within the individual.
This is followed by a discussion on the nature of neuropsychological tests and
how to identify a deficit with the help of neuropsychological test battery. Two
major batteries, the Luria Nebraska and the Halstead Reitan Neuropsychological
batteries are presented with their history, structure and content within the tests,
the theoretical foundations underlying these tests and the validity and reliability
of these tests. Then we deal with the NIMHANS Neuropsychological battery
and give a description of the various tests within the same.

49
Brain Behaviour
Inter-relationship 3.1 OBJECTIVES
After completing this unit, you will be able to:
• Define and describe Neuropsychological;
• Explain how neuropsychological tests can be used for understanding of
behavioural deficits;
• Elucidate the goals of neuropsychological assessment;
• Describe the nature of neuropsychological tests;
• Explain how to identify a deficit through neuropsychological tests;
• Describe the various aspects of the Luria-Nebraska Neuropsychological
Battery;
• Delineate how the test was evolved and devised;
• Describe the Halstead-Reitan battery and its contents, tests and subtests;
and
• Explain the NIMHANS Neuropsychological Battery.

3.2 NEUROPSYCHOLOGICAL ASSESSMENT

Neuropsychological assessment has its roots in neurology, the branch of medicine
that focuses on the nervous system and its disorders. It focuses on the relationship
between brain functioning and behaviour. It used to be a specialty area within
clinical psychology. In neuropyshcological assessment the psychologists screen
for signs and symptoms of a neurological deficit during:
• History Taking
• Interviewing
• Test-taking
• Intelligence Tests
• Other Tests.

3.2.1 The Nervous System and Behaviour

Damage to certain parts of the brain will be reflected as behaviour deficits. For
example, damage to the temporal lobe may affect: sound discrimination, sound
recognition, voice recognition, visual memory storage.Tests and procedures
employed in a neuropsychological examination vary as a function of: Purpose of
examination, Neurological intactness of the examinee, Thoroughness of the
examination.

3.2.2 Neuropsychological Examination

For a neuropsychological examination a battery of tests administered should
include, at a minimum:
• Intelligence Tests
• Personality Tests
• Perceptual-Motor / Memory Tests
50
If impairment is discovered, the examinee will be referred for further and more Neuropsychology Test
Batteries
detailed tests.

The typical neuropsychological exam begins with a careful history taking. Areas
of interest include:
• Medical history of patient.
• Medical history of patient’s family.
• Presence of absence of developmental milestones.
• Psychosocial history.
• Character, severity, and progress of any history of complaints.
The MSE deals with questions concerning the addressee’s Consciousness,
Emotional State, Thought Content and Clarity, Memory, Sensory Perception,
Performance of Action, Language, Speech, Handwriting, Handedness.Tests and
assessment procedures assess various aspects of functioning including aspects
of:
• Perceptual functioning
• Motor functioning
• Verbal functioning
• Memory Functioning
• Cognitive Functioning
These tests are also used in screening for deficits and in adjunct to medical
examinations.
The tests can be helpful in the assessment of:
• Change in mental status
• Abnormalities in function before abnormalities in structure can be detected.
• Strengths and weaknesses of patient.
• Ability of individual to stand trial.
• Changes in disease process over time.
The Wechsler Scales are often used as a diagnostic tool for intellectual ability
testing.
Formal testing for memory may involve the use of instruments such as the
Wechsler Memory Scale-Revised:
• The task is to recall stories and other verbal stimuli.
• The test is appropriate for people within the ages of 16-74.
Verbal memory, non verbal memory etc. are tested through the presentation of
stimuli such as verbal learning test, selective reminding test Benton test of visual
retention etc. As for tests of cognitive functioning, difficulty in thinking abstractly
is a relatively common consequence of brain injury. One popular measure of
verbal abstraction ability is the Wechsler Similarities Subtest in which the task is
to identify how two objects are alike. Proverb interpretation is another way to
assess ability to think abstractly. Nonverbal tests of abstraction include sorting
tests such as the Wisconsin Card Sorting Test. 51
Brain Behaviour A neuropsychological assessment is a clinical examination of both the working
Inter-relationship
brain and dysfunctional brain. Neuropsychological tests are an aid in this
examination. The objective of neuropsychological assessment is to chart the
deficits and adequacies in the behaviour of patients. The behavioural deficits are
explained by underlying cognitive, emotional, and volitional deficits as well as
changes in the patient’s behaviour. The outcome of a neuropsychological
assessment is a profile of the patient’s deficits and adequacies.

Fig.3.1: Structural and functional brain

3.3 NEUROPSYCHOLOGICAL UNDERSTANDING

OF BEHAVIOURAL DEFICITS
Behaviour is an outcome of the interaction of the brain with the environment. A
composite of multiple psychological processes shape behaviour. The chief
domains of the psychological processes are cognition, emotion and volition. Each
of these three cardinal domains has specialised processes and each of the
specialised process has components, which constitute the sub process. Nuances
in behaviour arise because of the nuances of the domains/ process/ components.
The objective of neuropsychological assessment is to identify the disturbed
psychological domain/process/ component, which could be giving rise to the
behavioural disruption.

3.4 GOALS OF NEUROPSYCHOLOGICAL

ASSESSMENT
The psychological domains/processes/ components are mediated by specific brain
structures and connected brain structures forming functional networks.
Identification of disruptions in specified psychological components/processes/
domains indicate damage to the brain structures/networks, which mediate these
processes.

52
Neuropsychological assessment therefore has twin goals. Neuropsychology Test
Batteries
i) The first goal is to identify the disrupted psychological components/
processes/domains in an individual patient and arrive at a profile of
adequacies and deficits of psychological functions.
ii) The second goal is to identify the brain structures/ functional networks, which
are dysfunctional or damaged using the neuropsychological profile that has
previously been derived. Finally, this information is used to lateralise and
localise the bran lesion.

3.5 NATURE OF NEUROPSYCHOLOGICAL TESTS

Neuropsychological tests are aids in the neuropsychological examination. The
tests measure specified psychological processes including the constituent
components of the process. The level of difficulty is not high, as the goal of the
testing is to identify a deficit in functioning and not to test the limits of the top
end of performance. These are that the test should have adequate reliability and
validity, the scoring should be objective, and the test should have adequate
normative data.

3.6 IDENTIFICATIONS OF A DEFICIT BY

NEUROPSYCHOLOGICAL TESTS
Ideometric approach and psychometric approach are the two methods that are
used in the identification of deficits through neuropsychological tests. Ideometric
approach is suitable for clinical examinations of individual patients. Psychometric
approach is suitable for the assessment of abilities/ aptitudes using quantitative
scores. While the first is used in a clinical examination that takes into account
the background of the patient, the second is used in an examination of abilities
and aptitudes of the patient irrespective of his or her background.

Ideometric approach in the context of neuropsychological assessment emphasises

the patient’s premorbid functioning with reference to education, occupation, social
and occupational functioning as well as performance on other neuropsychological
tests. Factors such as the patient’s currents sensory/motor deficiencies,
motivational deficits and fatigue level are noted. These are taken into account in
interpreting the neuropsychological examination. Because the complete
background of the patient and his/her current level of functioning are obtained,
the diametric is well suited for clinical examination.

On the other hand, the psychometric approach takes a ‘here and now’ view. It
interprets objective scores with reference to normative data, without taking into
account previous history or current functioning in other areas.

Comprehensive neuropsychology testing requires a combination of Context

related ideometric and quantitative psychometric approaches. While the patient
is undergoing the test the neuropsychologists must observe the factors which
may contribute to the failure of the patient in performance of a given task.
Examples of such factors include unfamiliarity with timed tests, inability to pay
attention for the required length of time, inability to modulate the mental effort
required by a task, poor motivation, poor insight, premorbid characteristics such
53
Brain Behaviour as impulsivity, unwillingness to try out new things, etc. Another set of factors
Inter-relationship
that affects patients level of functioning is deficits in specific areas, which can
hamper the patients’ performance in a specific test.

Example of these include deficits of visuo-spatial perception hampering

performance on construction tasks, poor comprehension hampering performance
on verbal memory tests, and visual difficulties impairing performance on visual
memory tests. A comprehensive account of the patients’ premorbid functioning
and current performance is essential to understand the performance on a
neuropsychological test.

At the same time, it is essential to have objective scores, in order to identify and
classify deficits in psychological components and processes. The need for
objective scores becomes greater when the deficits are mild or when minimal
levels of temporal improvement or deterioration are being tracked. Objective
scores can be obtained if the tests are constructed according to the psychometric
approach.

Normative data, which take into account the effects of socio-demographic

variables such as age, education and gender, are also used in such an approach.

Thus, while neuropsychological tests have to be constructed using the

psychometric approach the interpretation of test performance would require a
blend of both ideometric and psychometric approaches. The scores would then
be compared with normative data. Finally, interpretation of the results would
again require a blend of ideometric and psychometric approaches.

Self Assessment Questions

1) What is neuropsychological assessment?
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2) Discuss the relationship between the nervous system and behaviour.
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54
 Neuropsychology Test
3) In what way neuropsychology helps in understanding the behvarioural Batteries
deficits?
...............................................................................................................
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...............................................................................................................
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4) What are the goals of neuropsychological assessment?
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5) Discuss the nature of neuropsychological tests.
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6) How would neuropsychological test identify a deficit?
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3.7 THE LURIA-NEBRASKA

NEUROPSYCHOLOGICAL BATTERY
3.7.1 History
This procedure was first reported in 1978 in the form of two initial validity
studies. Historically, Chirstensen, a student of the prominent Russian neurologist
and neuropsychologist, A. R. Luria, published a book called Luria’s
neuropsychological investigation. The book was accompanied by a manual and
a kit containing test materials used by Luria and his co-workers. Although some
of Luria’s procedures had previously appeared in English, they had never been
presented in a manner that encouraged direct administration of the test items to
55
Brain Behaviour the patients. The material published initially did not contain information relevant
Inter-relationship
to standardisation of these items. There was no scoring system, norms, data
regarding validity and reliability, or review of research accomplished with the
procedure as a standard battery.

This work was taken on by a group of investigators under the leadership of

Charles J. Golden. Thus, in historical sequence, Luria adopted or developed
these items over the course of many years, Christensen published them in English
but without standardisation data, and finally Golden and collaborators provided
quantification and standardisation. Since that time, Golden’s group as well as
other investigators have produced a massive amount of studies with what is now
known as the Luria Nebraska Neuropsychological Battery.

The battery was published in 1980 by Western Psychological Services and is

now extensively used in clinical and research applications. An alternate form of
the battery is now available, as is a children’s version.

3.7.2 Structure and Content

The battery contains 269 items, each of which may be scored on a 2- or 3- point
scale. A score of 0 indicates normal performance. Some items may receive a
score of 1, indicating borderline performance. A score of 2 indicates clearly
abnormal performance. The items are organised into the categories provided in
the Christensen kit, but while Christensen organised the items primarily to suggest
how they were used by Luria, the Luria-Nebraska version is presented as a set of
quantitative scales.

The raw score for each scale is the sum of the 0, 1 and 2 item scores. Thus, the
higher the score, the poorer the performance. The scores for the individual items
may be based on speed, accuracy, or quality of response. In some cases, two
scores may be assigned to the same task, one for speed and the other for accuracy.
These two scores are counted as individual items. For example, one of the items
is a block counting task, with separate scores assigned for number of errors and
time to completion of the task. In case of time scores, blocks of seconds are
associated with the 0, 1 and 2 scores. When quality of response is scored, the
manual provides both rules for scoring and, in the case of copying tasks,
illustrations of figures representing 0, 1 and 2 scores.

The 269 items are divided into 11 content scales, each of which may be
administered individually. Since these scales contain varying number of items,
raw scale scores are converted to T score with a mean of 50 and a standard
deviation of 10. These T scores are displayed as a profile on a form prepared for
that purpose. In the alternate form of the battery, the names of the content scales
have been replaced by abbreviations. Thus, we have Motor, Rhythm, Tactile,
Visual, Receptive Speech, Expressive Speech, Writing, Reading, Arithmetic,
Memory, and Intellectual Processes scales, which are referred to as the C1 through
C11 scales in the alternate form.

In addition to these 11 content scales, there are three derived scales that appear
on the standard profile form: the Pathognomonic, Left Hemisphere scales. The
Pathognomonic scale contains from throughout the battery found to be particularly
sensitive to the presence or absence of brain damage. The left and right hemisphere
scales are derived from the Motor and Tactile scale items that involve comparisons
56
between the left and right sides of the body. They therefore reflect sensorimotor Neuropsychology Test
Batteries
asymmetries in the two sides of the body.

Several other scales have been developed by Golden and various collaborators,
all of which are based on different ways of scoring the same 269 items. These
special scales include new (empirically derived) right and left hemisphere scales,
a series of localisation scales a series of factor scales and double discrimination
scales. The new right and left hemisphere scales contain items from throughout
the battery and are based on actual comparisons among patients with right
hemisphere, left hemisphere, and diffuse brain damage.

The localisation scales are also empirically derived, being based on studies of
patients with localised brain lesions. There are frontal, sensorimotor, temporal,
and parieto-occipital scales for each hemisphere. The factor scales are based on
extensive factor analytical studies of the major content scales. The new right and
left hemisphere scales contain items from throughout the battery and are based
on actual comparisons among patients with right hemisphere, left hemisphere
and diffuse brain damage. The new right and left hemisphere, localisation factor
scales may all be expressed in T scores with a mean of 50. There are also two
scales that provide global indices of dysfunctions, and are meant as equivalents
to the Halstead impairment index. They are called the Profile Elevation and
Impairment Scales.

The Luria Nebraska procedure involves an age and education correction. It is

accomplished through computation of a cutoff score for abnormal performance
based on an equation that takes into consideration both age and education. The
computed score is called the critical level and is equal to .214(Age) + 1.47
(Education) + 68.8 (Constant). Typically, a horisontal is drawn across the profile
at the computed critical level point. The test user has the option of considering
scores above the critical level, which may be higher or lower than 60, as abnormal.

As indicated above, extensive factor analytic studies have been accomplished,

and the factor structure of each of the major scales has been identified. These
analyses were based on item intercorrelations, rather than on correlations among
the scales. It is important to note that most items on any particular scale correlate
better with other items on that scale than they do with items on other scales
(Golden, 1981). This finding lends credence to the view that the scales are at
least somewhat homogeneous, and thus that the organisation of the 269 items
into those scales can be justified.

3.7.3 Theoretical Foundations

As in the case of the Halstead- Reitan battery, one could present two theoretical
bases for the Luria- Nebraska, one revolving around the use of Luria’s name and
the other around the Nebraska group, namely, Golden and his collaborators. This
view is elaborated upon in by Goldestein. Luria himself had nothing to do with
the development of the Luria Nebraska battery, nor did any of the co workers.
The use of his name in the title of battery is, in fact, somewhat controversial and
seems to have been essentially honorific in intent, recognising his involvement
in development of items and the underlying theory for their application. Indeed,
Luria died some time before publication of battery but was involved in the
preparation of the Christensen materials, which he endorsed. Furthermore, the
method of testing employed by the Luria- Nebraska was not Luria’s method, and
57
Brain Behaviour the research done to establish the validity, reliability, and clinical relevance of
Inter-relationship
the Luria- Nebraska was not done by Luria and his collaborators.

Therefore, our discussion of the theory underlying the Luria Nebraska battery
will be based on the assumption that the only connecting link between Luria and
that procedure is the set of Christensen items. In doing so, it becomes clear that
the basic theory underlying the development of Luria- Nebraska is based on a
philosophy of science that stresses empirical validity, quantification and
application of established psychometric procedures. Indeed, as pointed out
elsewhere, it is essentially the same epistemology that characterises the work of
the Reitan group.
Thus, research done with the Luria Nebraska battery determined
1) whether it discriminates between brain damaged patients in general and
normal controls;
2) whether it discriminates between patients with structural brain damage and
those with schizophrenia;
3) whether the procedure has the capacity to lateralise and regionally localise
brain damage; and
4) whether there are performance patterns specific to particular neurological
disorders, such as alcoholic dementia or multiple sclerosis.
Since this research was accomplished in recent years, it was able to benefit from
the new brain imaging technology, notably the CT scan, and the application of
high speed computer technologies, allowing for extensive use of powerful
multivariate statistical methods. With regard to methods of clinical inference,
the same method suggested by Reitan that is level of performance, pattern of
performance, pathognomonic signs, and right left comparisons etc., are used
with the Luria Nebraska battery.

Adhering to our assumption that the Luria Nebraska bears little resemblance to
Luria’s methods and theories, there seems little point in examining the theoretical
basis for the substance of the Luria Nebraska battery. For example, there is little
point in examining the theory of language that underlies the Receptive Speech
and Expressive Speech scales or the theory of memory that provides the basis
for the Memory scale. We believe that the Luria Nebraska battery is not a means
of using Luria’s theory and methods in English speaking countries, but rather a
standardised psychometric instrument with established validity for certain
purposes and reliability.

The choice of using items selected by Christensen to illustrate Luria’s testing

methods was, in retrospect, probably less crucial than the research methods chosen
to investigate the capabilities of this item set. Indeed, it is somewhat misleading
to characterise these items as “Luria’s tests,” since many of them are standard
items used by neurologists throughout the world. Surely, one cannot describe
asking a patient to interpret proverbs or determine 2 point thresholds as being
exclusively “Luria’s tests”. They are, in fact, venerable, widely used procedures.

3.7.4 Standardisation Research

There are published manuals for the Luria Nebraska that describe the battery in
detail and provide information pertinent to validity, reliability, and norms. There
58
are also several reviews articles that comprehensively describe the research done Neuropsychology Test
Batteries
with the battery. Very briefly reviewing this material, satisfactory discriminative
validity has been reported in studies directed toward differentiating miscellaneous
brain damaged patients from normal controls and from chronic schizophrenics.
Cross validations were generally successful, but Shelly and Goldstein (1983)
could not fully replicate the studies involved with discriminating between brain-
damaged and schizophrenic patients.

Discriminative validity studies involving lateralisation and localisation achieved

satisfactory results, but the localisation studies were based on small samples.
Quantitative indices from the Luria-Nebraska were found to correlate significantly
with CT scan quantitative indices in alcoholic and schizophrenic samples. There
have been several studies of specific neurological disorders including multiple
sclerosis, alcoholism, Huntington’s disease, and learning disability, all with
satisfactory results in terms of discrimination.

The test manual reports reliability data. Test-retest reliabilities for the 13 major
scales range from .78 to .96. The problem of interjudge reliability is generally
not a major one for neuropsychological assessment, since most of the test used is
quite objective and have quantitative scoring systems. However, there could be
a problem with the Luria-Nebraska, since the assignment of 0, 1, and 2 scores
sometimes requires a judgement by the examiner.

During the preliminary screening stage in the development of the battery, items
in the original pool that did not attain satisfactory interjudge reliability were
dropped. A 95% inter-rater agreement level was reported by the test constructors
for the 282 items used in an early version of the battery developed after dropping
those items. The manual contains means and standard deviations for each item
based on samples of control, neurologically impaired, and schizophrenic subjects.
An alternate form of the battery is available. To the best of our knowledge, there
have been no predictive validity studies. It is unclear whether or not there have
been studies that address the issue of construct validity.

Self Assessment Questions

1) Discuss in detail the Luria Nebraska Neuropsychological battery.
...............................................................................................................
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2) Trace the history of how the Luria Nebraska battery was devised.
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59
Brain Behaviour
Inter-relationship 3) What are the structure and content in the Luria Nebrasks
Neuropsychological battery?
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4) Discuss the theoretical foundation on which Luria Nebraska battery is
devised.
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5) What are the validity and reliability of this test battery?
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3.8 THE HALSTEAD-REITAN

NEUROPSYCHOLOGICAL BATTERY
3.8.1 History
The beginnings of the battery can be traced to the special laboratory established
by Halstead in 1935 for the study of neurosurgical patients. The first major report
on the findings of this laboratory appeared in a book called Brain and intelligence:
A Quantitative study of the frontal lobes), suggesting that the original intent of
Halstead’s test was describing frontal lobe function. In this book, Halstead
proposed his theory of “biological intelligence” and presented what probably
the first factor analysis that was done with neuropsychological test data. Perhaps
more significantly, however, the book contains descriptions of many of the tests
now contained in the Halstead Reitan battery. In historical perspective, Halstead’s
major contributions to neuropsychological assessment, in addition to his very
useful tests, include the concept of the neuropsychological laboratory in which
objective tests are administered in standard fashion and quantitatively scored,
and the concept of impairment index, a global rating of severity of impairment
and probability of the presence of structural brain damage.

60
Reitan adopted Halstead’s methods and various test procedures and with them Neuropsychology Test
Batteries
established a laboratory at the University of Indiana. He supplemented these
tests with a number of additional procedures in order to obtain greater
comprehensiveness and initiated a clinical research program that is ongoing.
The program began with cross validation of the battery and expanded into
numerous areas, including validation of new tests added to the battery (e.g. the
Trail Marking Test), lateralisation and localisation of function, aging, and
neuropsychological aspects of a wide variety of disorders such as alcoholism,
hypertension, disorders of children, and mental retardation.

Theoretical matters were also considered. Some of the major contributions

included the concept of type locus interaction, the analysis of quantitative as
opposed to qualitative deficits associated with brain dysfunction, the concept of
the brain age quotient, and the scheme for levels and types of inference in
interpretation of neuropsychological test data. In addition to the published
research, Reitan and his collaborators developed a highly sophisticated method
of blind clinical interpretation of the Halstead Reitan battery that continues to be
taught at workshops conducted by Dr. Reitan and associates.

The Halsted Reitan battery, as the procedure came to be known over the years,
also has a history. It has been described as a fixed battery, but the sets of tests are
grown by accretion and revision and continues to be revised. The tests that
survived a long research history include the Category Test, The Tactual
Performance Test, The Speech Perception Test, The Seashore Rhythm Test, and
Finger Tapping.

There have been numerous additions, including the various Wechsler Intelligence
scales, the Trail Making test, a sub-battery of perceptual tests the Reitan aphasia
Screening Test, the Klove Grooved Pegboard, and other tests that are used in
some laboratories but not in others.

Most recently, a procedure described as an “expanded Halsted Reitan battery”

has appeared that includes the original tests plus several additional ones, listed
below. Three major new methods have also been developed for scoring the battery
and computing the impairment index.

The Halstead Reitan battery continues to be widely used as a clinical and research
procedure. Numerous investigators use it in their research, and there have been
several successful cross validations done in settings other than Reitan’s laboratory.
In addition to the continuation of factor analytic work with the battery, several
investigators have applied other forms of multivariate analysis to it in various
research applications.

Some of this research has been conducted relative to objectifying and even
computerising interpretation of the battery; the most well-known efforts are the
Selz Reitan rules for classification of brain function in older children and the
Russel, Neuringer, and Goldstein “neurological keys”.

The issue of reliability of the battery has been addressed, with reasonably
successful results. Clinical interpretation of the battery continues to be taught at
workshops and in numerous programs engaged in the training of professional
psychologists.
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Brain Behaviour 3.8.2 Structure and Content
Inter-relationship
Although there are several versions of the Halsted Reitan battery, the differences
tend to be minor, and there appears to be a core set procedures that essentially all
versions of the battery must be administered in a laboratory containing specific
equipment. It is probably best to plan on about 6 to 8 hours of patient time. Each
test of the battery is independent and may be administered separately from the
other tests. However, it is generally assumed that a certain number of the tests
must be administered in order to compute an impairment index.

Scoring for the Halsted Reitan varies with the particular test, such that individual
scores may be expressed in time to completion, errors, number correct, or some
form of derived score. These scores are often converted to standard scores or
ratings so that they may be profiled. All of the tests contributing to the impairment
index on a 6-point scale, the data being displayed as a profile of the ratings. They
have also provided quantitative scoring systems for the Reitan Aphasia Test and
for the drawing of a Greek cross that is part of that test. However, some clinicians
do not quantify those procedures, except in the form of counting the number of
Aphasic symptoms elicited.

Theoretical Foundation: There are really two theoretical bases for the Halsted
Reitan battery, one contained in brain and intelligence and related writings of
Halstead. The other are found in numerous papers and chapters written by Reitan
and various collaborators. Halstead was really the first to establish a human
neuropsychology laboratory in which patients were administered objective tests,
some of which are semi automated, utilising standard procedures and sets of
instructions. His Chicago laboratory may have been the stimulus for the now
common practice of administration of neuropsychological tests by trained
technicians. Halstead was also the first to use sophisticated, multivariate statistics
in the analysis of neuropsychological test data.

Reitan’s program can be conceptualised as an effort to demonstrate the usefulness

nad accuracy of Halstead’s tests and related procedures in clinical assessment of
brain damaged patients. Halstead’s of a standard neuropsychological battery
administered under laboratory conditions and consisting of objective, quantifiable
procedure was maintained and expanded by Reitan. Both Halsted and Reitan
shared what might be described as a Drawinian approach to neuropsychology.

Halstead’s discriminating tests are viewed as a measure of adaptive abilities, of

skills that ensured man’s survival on the planet. Many neuropsychologists are
now greatly concerned with the relevance of their test procedures to adaptation,
that is the capacity to carry on functional activities of daily living and to live
independently (Heaton & Pendleton, 1981). This general philosophy is somewhat
different from the more traditional models emanating from behavioural neurology,
in which there is a much greater emphasis on the more medical-pathological
implications of behavioural test findings.

One could say that Reitan’s great concern has always been with the empirical
validity of test procedures. Such validity can only be established through the
collection of large amounts of data obtained from patients with reasonably
complete documentation of their medical\neurological conditions. Both presence
and absence of brain damage had to be well documented, and if present, findings
related to site and type of lesion had to be established. He described his work
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informally as one large experiment, necessitating maximal consistency in the Neuropsychology Test
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procedures used, and to some extent, in the methods of analysing the data. Reitan
and his various collaborators represent the group that was primarily responsible
for the introduction of standard battery approach to clinical neuropsychology. It
is clear from reviewing the Reitan group’s work that there is substantial emphasis
on performing controlled studies with samples sufficiently large to allow for the
application of conventional statistical procedures.

It would probably be fair to say that the major thrust of Reitan’s research and
writings has not been espousal of some particular theory of brain function, but
rather an extended examination of the inferences that can be made from
behavioural indices relative to the condition of the brain. There is a great emphasis
on methods of drawing such inferences in case of the individual patient. Thus,
this group’s work has always involved empirical research and clinical
interpretation, with one feeding into the other. In this regard, there has been a
formulation of inferential methods used in neuropsychology that provides a
framework for clinical interpretation. Four methods are outlined: level of
performance, pattern of performance, specific behavioural deficits
(pathognomonic signs), and right-left comparisons. In other words, one examines
whether the patient’s general level of adaptive function is comparable to that of
normal individuals, whether there is some characteristics performance profile
that suggests impairment even though the average score may be within normal
limits, whether there are unequivocal individual signs of deficits, and whether
there is a marked discrepancy in functioning between the two sides of the body.

3.8.3 Theoretical Foundations of Component Tests

Some form of lateral dominance examination administered, generally including
tests for hand, foot, and eye dominance

Halstead’s Biological Intelligence Tests: There are five subtests in this section
of Halsted-Reitan battery developed by Halstead.

The Halstead Category Test: This test is a concept identification procedure in

which the subject must discover the concept or principle that governs various
series of geometric forms and verbal and numerical material. The apparatus for
the test includes a display screen with four horisontally arranged numbered
switches placed beneath it. The stimuli on slides and the examiner use a control
console to administer the procedure. The subject is asked to press the switch that
the picture reminds him or her of, and is provided with additional instructions.

The point of the test is to see how well the subject can learn the concept, idea, or
principle that connects the pictures. If the correct switch is pressed, the subject
will hear a pleasant chime, while wrong answers are associated with a rasping
buzzer. The conventionally used score is the total number of errors for the seven
groups of stimuli that forms the test. Booklet forms (Adams & Trenton, 1981;
DeFillippis, McCampbell & Rogers, 1979) and abbreviated forms (Calsyn,
O’Leary, & Chaney, 1980; Russel & Levy, 1987; Sherril, 1987) of this test have
been developed.

The Halstead Tactual Performance Test: This procedure used a version of the
Seguin-Goddard Form board, but it is done blindfold. The subject’s task is to
place all the 10 blocks into the board, using only the sense of touch. The task is
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Brain Behaviour repeated three times, once with the preferred hand, once with the non preferred
Inter-relationship
hand, and once with both hands, after which the board is removed. After removing
the blindfold, the subject is asked to draw a picture of the board, filling in all of
the blocks he or she remembers in their proper locations on the board. Scores
from this test include time to complete the task for each of the three trials, total
time, number of blocks correctly drawn, and number of blocks correctly drawn
in their proper locations on the board.

The Speech Perception Test: The subject is asked to listen to a series of 60

sounds, each of which consists of a double e digraph with varying prefixes and
suffixes. The test is given in a four-alternative multiple-choice format, the task
being to underline on an answer sheet the sound heard, the score is the number
of errors.

The Seashore Rhythm Test: This test consists of 30 pairs of rhythmic patterns.
The task is to judge whether the two members of each pair are the same or
different and to record the response by writing an S or a D on an answer sheet.
The score is either the number correct or the number of errors.

Finger Tapping: The subject is asked to tap his or her extended index finger on
a typewriter key attached to a mechanical counter. Several series of 10-second
trials are run, with both the right and the left hand. The scores are the average
number of taps, generally over five trials, for the right and left hand.

Tests added to the battery by Reitan. Reitan added four components to the battery
and these are given below:

The Wechsler Intelligence Scales: This test is given according to manual

instructions and is not modified in any way. Most clinicians use the most current
revision of these scales, although much of the early research was done with the
Wechsler-Bellevue and the Wechsler Adult Intelligence scale (WAIS).

The Trail Making Test: In part A of this procedure the subject must connect in
order a series of circled numbers randomly scattered over a sheet of 81\2 X 11
paper. In part B, there are circled numbers and letters and the subject’s task
involves alternating between numbers and letters in serial order. The score is
time to completion expressed in seconds for each part.
The Reitan Aphasia Screening Test: This test serves two purposes in that it
contains both copying and language-related tasks. As an Aphasia screening
procedure, it provides a brief survey of the major language functions: naming,
repetition, spelling, reading, writing, calculation, narrative speech, and right-left
orientation. The copying task involves having the subject copy a square, Greek
cross, triangle, and key. The first three items must each be drawn in one continuous
line. The language section may be scored by listing the number of aphasic
symptoms or by using the quantitative system developed by Russel and co-
workers. The drawings are either not formally scored are rated through a matching
to model system also provided by Russel and Colleagues.
Perceptual Disorders: The procedure actually constitute a sub-battery and
include tests of the subject’s ability to recognise shapes by touch and identifies
numbers written on the fingertips, as well as tests of finger discrimination and
visual, auditory, and tactile neglect. The number of errors is the score for all
64 these procedures.
Other Tests: The Halsted Reitan battery was expanded further by other Neuropsychology Test
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researchers to include more tests.
The Klove Grooved Pegboard Test: The subject must place pegs shaped like
keys into a board containing recesses that are oriented in randomly varying
directions. The test is administered twice, once with the right and once with the
left hand. Sores are the time to completion in seconds in each hand and errors for
each hand, defined as the number of pegs dropped during performance of the
task.
The Klove roughness Discrimination Test: The subject must order four blocks
covered with varying grades of sandpaper presented behind a blind with regards
to degree of roughness. Time and error scores are recorded for each hand.
Visual Field Examination: Russel et. al include a formal visual field examination
using a parameter as part of their assessment procedure.
Tests in the expanded version include the Wisconnin card Sorting, Thurstone
word Fluency, Story Memory, Figural Memory, Seashore Tonal Memory, Digit
Vigilance, Peabody Individual Achievement, and Boston naming Tests, plus a
part of Boston Diagnostic Aphasia Examination.

3.8.4 Standardisation Research

The Halsted Reitan battery, as a whole, meets rigorous validity requirements.
Following Halstead’s initial validation it was cross-validated by Reitan and in
several laboratories. Validity, in this sense, means that all component tests of the
battery that contribute to the impairment index, discriminate at levels satisfactory
for producing usable cut off scores for distinguishing between brain-damaged
and non brain-damaged patients. The major expectations, the time sense and
Flicker Fusion Tests, have been dropped from the battery by most of its users. In
general, the validation criteria for these studies consisted of neurological and
other definitive neurological data. It may be mentioned, however, that most of
these studies were accomplished before the advent of computed tomography
(CT) scan, and it would probably now be possible to do more sophisticated validity
studies, perhaps through correlating the extent of impairment with quantitative
measures of brain damage (e.g. CT scan or MRI measures). Validity studies were
also accomplished with tests added to the battery such as the Wechsler scales,
the Trail Making Test, and the Reitan Aphasia Screening Test, with generally
satisfactory results.

By virtue of the level of inferences made by clinicians from Halsted-Reitan battery

data, validity studies must obviously go beyond the question of presence or
absence of brain-damage. The first issue raised related to discriminative validity
between patients with left hemisphere and right hemisphere brain-damage such
measures as Finger Tapping, the Tactual Performance, the Perceptual disorders
sub-battery, and the Reitan Aphasia Screening test all were reported to have
adequate discriminative validity in this regard. There have been very few studies,
however, that goes further and provides validity data related to more specific
criteria such as localisation and type of lesion.

It would appear from one impressive study that valid inferences concerning
prediction at this level must be clinically, and one cannot call upon the standard
univariate statistical procedures to make the necessary discriminations. The study
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Brain Behaviour provides the major impetus for Russel and co-workers’ neuropsychological key
Inter-relationship
approach, which was an essence an attempt to objectify higher-order inferences.

The discriminative validity of Halsted-Reitan battery in the field of

psychopathology, mainly regarding schizophrenia, has been widely studied, and
has been substantially reconceptualised since the discovery of numerous
neurobiological abnormalities in schizophrenia. What we have now is really a
neuropsychology of schizophrenia, to which the Halsted-Reitan battery has
contributed.

Although there have been several studies of the predictive validity of

neuropsychological tests with children and other studies with adults that does
not use the full Halsted-Reitan battery no major formal assessment of the
predictive validity of Halsted-Reitan battery has been accomplished with adults.
Within neuropsychology, predictive validity has two aspects:

Predicting everyday academic, vocational, and social functioning and Predicting

course of illness.

With regard to the first aspect, Heaton and Pendleton (1981) document lack of
predictive validity studies using extensive batteries of the Halsted Reitan type.
However they do not report one study in which Halsted Reitan successfully
predicted employment status on 6-month follow-up. With regard to prediction
of course of illness, there appears to be a good deal of clinical expertise, but no
major formal studies in which the battery’s capacity to predict whether the patient
will get better, worse, or stay the same is evaluated. This matter is of particular
significance in such conditions as head injury and stroke, since outcome tends to
be quite variable in these conditions. The changes that occur during the early
stages of these disorders are often the most significant ones related to prognosis.

In general, there has not been a great deal of emphasis on studies involving the
reliability of the Halsted Reitan battery, probably because of nature of the tests
themselves, particularly with regard to the practice effect problem, and because
of the changing nature of those patients from whom the battery was developed.
Golstein and Watson (1989) provided a review of Halsted Reitan battery reliability
studies, as well as a test-retest study of their own, concluding that reliability
levels were satisfactory in a number of different clinical groups.

The category test can have its reliability assessed through the split-half method.
Self Assessment Questions
1) Discuss in detail the Halstead-Reitan Neuropsychological battery.
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 Neuropsychology Test
2) Trace the history of how the Halstead-Reitan battery was devised. Batteries
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3) What are the structure and content in the Halstead Reitan
Neuropsychological battery?
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4) Discuss the theoretical foundation on which Halstead Reitan battery is
devised.
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5) What are the validity and reliability of this test battery?
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3.8.5 The NIMHANS Neuropsychological Battery

There are two approaches of NIMHANS Neuropsychological Battery
I) The first approach was proposed by Dr. C.R Mukundan. The battery
constitutes tests, some of which are adapted for the local patient population
and some developed on the basis of principles of cerebral localisation and
lateralisation of higher mental functions. This is a loosely packed battery
from which appropriate tests can be chosen according to diagnostic needs
and used along with other tests to form an integrated interpretation. The
various tests included are: 67
Brain Behaviour Tests for Eliciting Frontal Lobe Dysfunction
Inter-relationship
1) Attention
– Spontaneous arousal of attention
– Distraction
– Excessive broadening/ narrowing of attention

2) Tests of visual search

– Visual scanning of numbers
– Visual scanning of pictures
– Visual exploration test

3) Mental set- Psychomotor perseveration

4) Psychomotor deficits
– Test of Optic-kinaesthetic organisation
– Test of optic-spatial organisation
– Kinetic melody disturbance

5) Deficits in working memory

– Test of mental control
– Delayed response tests

6) Deficits of ideational and design fluency test

7) Deficits in visuospatial planning tasks

– Bender gestalt test
– Alexander passalong test
– Object assembly test
– Maze tests
8) Frontal Amnesia
9) Expressive speech disturbances
10) Changes in voluntary activity, personality and affect
Tests for Eliciting Temporal Lobe Dysfunction
1) Deficits of visual integration
– Block design test
– Object assembly test
2) Verbal and Visual learning and memory functions test
– The verbal learning and memory functions test
– Visual learning and memory functions test
3) Benton’s visual retention test
4) Test of comprehension
5) Presence of nominal aphasia
6) Presence of conduction aphasia
– Sentence repetition test
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7) Recent history of cognitive, emotional and personality changes Neuropsychology Test
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Tests for Eliciting Parietal Lobe Dysfunction
1) Tests for visuospatial perception
– Bender gestalt test

– Block design test

– Spatial comparison test

– Spatial comparison using verbal report of differences
2) Presence of
– Apraxia (ideomotor, ideational and constructional)
– Agnosia (Visual object agnosia, prospagnosia, finger agnosia,
autotopagnosia, hemisomatagnosia, simultagnosia, visual inattention,
astereognosia and left-right disorientation)
II) The second approach was developed by Dr. Shobhani Rao et.al in 2004:
This approach is more quantitative and the tests are organised on the basis
of various neuropsychological functions. Performance on neuropsychological
tests is influenced by socio-demographic variables such as age, education,
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Brain Behaviour and the test-taking attitude of the population. For example, the Indian
Inter-relationship
population has wide variation with reference to education hence normative
data collected elsewhere will be invalid in an Indian context, has seen the
development of many tests in the recent past, these tests may have to be
changed, as they may not have carry meaning to our population. For the
above two reasons, we need to collect normative data for our population.
The present study is the outcome of an endeavour to collect normative data
for 18 widely used tests, which assess various domains and are in current
international usage. The various tests included are:
Tests of Speed: can be categorised into
1) Motor speed - Finger tapping tests and
2) Mental speed -Digit Symbol Substitution Test

Tests of Attention:
3) Focused attention-Colour trails test
4) Sustained attention- digit vigilance test
5) Divided attention- the triads test

Tests of executive functions:

6) Phonemic fluency-controlled oral word association test (COWA)
7) Category Fluency-Animal names test
8) Design fluency-design fluency test

Working memory:
9) N back test (Verbal working memory and Visual working memory)
10) Self ordered pointing test

Planning
11) Tower of London test

Set shifting
12) Wisconsin card sorting test (WCST)
Response inhibition
13. Stroop test-NIMHANS version
Verbal comprehension
14) Token test
Tests of verbal Learning and memory:
15) Rey’s Auditory verbal learning test
16) Logical memory test

Visuo constructive ability

17) Complex figure test

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 Neuropsychology Test
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18) Design learning test

3.9 LET US SUM UP

In the first part of this chapter, general problems in the area of standardisation of
comprehensive neuropsychological test batteries were discussed, while the second
part contained brief reviews of the two most widely used procedures, the Halstead
Reitan and the Luria Nebraska Neuropsychological batteries. These batteries
have their advantages and disadvantages. The Halstead-Reitan is well established
and detailed but is lengthy, cumbersome, and neglects certain areas, notably
memory. The Luria Nabraska is also fairly comprehensive and briefer than the
Halstead Reitan but is currently quite controversial and is thought to have major
deficiencies in standardisation and rationale, at least by some observers. We
have taken the view that all of these standard batteries are screening instruments,
but not in the sense of screening for presence or absence of brain damage. Rather,
they may be productively used to screen a number of functional areas, such as
memory, language, or visual-spatial skills that may be affected by brain damage.
With the development of the new imaging techniques in particular, it is important
that the neuropsychologist not simply tally the referring agent what he or she
already knows. The unique contribution of standard neuropsychological
assessment is the ability to describe functioning in many crucial areas on a
quantitative basis. The extent to which one procedure can perform this type of
task more accurately and efficiently than other procedures will no doubt greatly
influence the relative acceptability of these batteries by the professional
community.

3.10 UNIT END QUESTIONS

1) Discuss the goals of neuropsychological assessment.
2) Describe structure and content of Luria-Nebraska neuropsychological test
battery.
3) Mention the major contents of Halstead- Reitan battery of neuropsychological
assessment. 71
Brain Behaviour 4) Discuss the need and benefits of Indian standardisation of neuropsychological
Inter-relationship
test batteries.
5) Explain the tests of executive functioning and working memory tests of
NIMHANS neuropsychological battery.

3.11 SUGGESTED READINGS

Filskov, S. B., & Bold, T. J (1981). Handbook of Clinical Neuropsychology.
New York: Wiley-Interscience.

G. Golstein & T. M. Incagnoli (Eds), Contemporary Approaches to

Neuropsychological Assessments (pp.93-129),New York: Plenum Press.

Lezak, M. (1976). Neuropsychological Assessment (Ist ed.). New York: Oxford

university press.

References

Christensen, A.L. (1975a). Luria’s neuropsychological investigation. New York

spectrum.

Christensen, A.L. (1975b). Luria’s neuropsychological investigation: manual.

New York spectrum.

Davis, K.(1983,october). Potential neurochemical and neuroendocrine validators

of assessment instruments. paper presented at conference on clinical memory
Assessment of older adults, Wakefield, M.A.

Golden, C. J(1981). A standardised version of Luria’s neuropsychological tests;a

quantitative and qualitative approach to neuropsychological evaluation. In Filskov,
S. B., & Bold, T. J (Eds.),handbook of clinical neuropsychology(pp.608 to 642).
New York: Wiley-Interscience.

Golden, C. J., Hemmeke, T. & Purisch, A. (1980). The Luria-Nebraska battery

manual, Los Angeles: Western psychological services.

Golden, C. J., Hemmeke, T. & Purisch, A(1985) Luria-Nebraska

neuropsychological battery manual form I & II. Los Angeles: Western
psychological services.

Goldstein, G. (1982). Overview: clinical application of Halstead-Reitan and Luria-

nebraska batteries. Paper presented at NE-RMEC conference, Northport, NY.

Goldstein, G., & Watson, J. R (1989). Test-retest reliability of the Halstead-Reitan

battery and the WAIS in a neuropsychiatric population. The clinical
neuropsychologist,3,265-273.

Heaton, R. K, Grant, I., & Matthews, C. G.(1991).comprehensive norms for an

expanded Halstead-Reitan battery. Odessa, FL: psychological assessment
resources.

Heaton, R. K, Pendleton, M. G. (1981). Use of neuropsychological test to predict

adult patients everyday functioning. Journal of consulting and clinical
psychology,49, 807-821.
72
Jastak, S.,& Wilkinson, G. S (1984).wide range achievement test-revised. Neuropsychology Test
Batteries
Wilmington, DE: Jastak Associates, Inc.

Levin, H. S., Benton, A. L., & Grossman, R. G. (1982).neurobehavioural

consequences of closed head injury. New York Oxford University Press.

Luria, A. R.(1973).the working brain. New York basic books.

Meier, M.J.(1974).some challenges for clinical neuropsychology. In R. M. Reitan

& L. A. Davison(Eds), clinical neuropsychology. Reed, J.C, & H.B.C(1997),
Halstead-Reitan neuropsychological battery. In G. Golstein & T. M. Incagnoli
(Eds) ,Contemporary approaches to neuropsychological assessments(pp.93-
129),New York: Plenum Press.

Reitan, R. M (1958).Qualitative versus quantitative mental changes following

brain damage. journal of psychology,46,339-346.

Reitan, R. M (1964). Psychological deficits resulting from cerebral lesion in

man. In J. M. Warren & K. Akert (Eds.), the frontal granular cortex and behaviour
(pp.295-312). New York: McGraw Hill.

Reitan, R. M., & Wolfson, D. (1993). The Halstead-Reitan neuropsychological

test battery: theory and clinical interpretation (2 nd ed.).Tucson, AZ:
neuropsychology press.

Russell, E. W., & Starkey, R. I (1993). Halstead-Russell neuropsychological

evaluation system: manual and computer program. Los Angeles; Western
psychological services.

Selz, M., & Reitan, R. M. (1979).Rules for neuropsychological diagnosis:

classification of brain function in older children. Journal of consulting and clinical
psychology,47 ,258-264.

Shelly, C., & Goldstein, G. (1983). Discrimination of chronic schizophrenia

and brain damage with the Luria-Nebraska battery: A partially successful
replication. clinical neuropsychology,5,82-85

Sherrill, R. E. jr. (1987). options for shortening Halstead’s category test for adults.
I Archives of clinical neuropsychology,2,343-352.

Wechsler, D. (1955). Wechsler adult intelligence scale manual. San Antonio,

TX: The psychological corporation.

References (for pictures)

brainfitnessresources.com
en.wikipedia.org/wiki/Brain_fitness
assessmenttoolshop.com

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Brain Behaviour
Inter-relationship UNIT 4 BEHAVIOURAL
NEUROPSYCHOLOGY, BRAIN
FITNESS AND ACTIVITIES THAT
PROMOTE BRAIN FITNESS

Structure
4.0 Introduction
4.1 Objectives
4.2 Neuropsychology
4.2.1 Definition of Neuropsychology
4.2.2 Brief History of Neuropsychology
4.2.3 Neuropsychology and Related Fields
4.3 Behavioural Neuropsychology
4.3.1 Introduction
4.3.2 Techniques Used in the Cognitive Retraining
4.4 Brain and Behaviour
4.5 Brain Fitness
4.6 Brain Training
4.6.1 General Activities that Promote Brain Fitness
4.6.2 Activities for Improving Specific Cognitive Domains
4.7 Let Us Sum Up
4.8 Unit End Questions
4.9 Suggested Readings

4.0 INTRODUCTION
This unit is about neuro bio behavioural psychology. It starts with the definition
of Neuropsychology and continues on to discuss the evolution of
neuropsychology. The historical aspects are covered in detail in tis section. This
is followed by a detailed discussion of the relationship of neuropsychology to
other scientific and related fields such as experimental neuropsychology, cognitive
neuropsychology etc. Then a definition of behavioural neuropsychology will be
presented followed by the various techniques used in cognitive training. The
next section deals with brain behaviour relationship and the various aspects related
to the same. This is followed by a section on brain fitness and how to retain such
fitness and the exercises needed for the same. Then the section presents measures
to be used to improve specific cognitive domains.

4.1 OBJECTIVES
After completing this unit, you will be able to:
• Define Neuropsychology;
• Trace historically the development of neuropsychology;
• Describe the relationship of neuropsychology to other related fields;
74
• Define behavioural neuropsychology; Behavioural
Neuropsychology, Brain
• Elucidate the technbiques used in cognitive retraining; Fitness and Activities that
Promote Brain Fitness
• Delineate the relationship between brain and behaviour;
• Explain what is brain fitness;
• Explain the various methods used to retain the fitness of the brain; and
• Analyse the various activities related to mental stimulation.

4.2 NEUROPSYCHOLOGY
4.2.1 Definition of Neuropsychology
According to Bruce, the term neuropsychology was first used by Williams Osler.
It was then used by D.O. Hebb, in a subtitle in his 1949 book The Organisation
of behaviour: A Neuropsychological Theory. Although neither defined nor used
in the text itself, the term was probably intended to represent a study that combined
the neurologist’s and physiological psychologist’s common interest in brain
function. Traditionally defined, neuropsychology is the study of (and the
assessment, understanding, and modification of) brain-behaviour relationships.
The contemporary definition is strongly influenced by two traditional foci for
experimental and theoretical investigations in brain research: the brain hypothesis,
the idea that the brain is the source of behaviour; and the neuron hypothesis, the
idea that the unit of brain structure and function is the neuron.

Neuropsychology seeks to understand how the brain, through structure and neural
networks, produces and controls behaviour and mental processes, including
emotions, personality, thinking, learning and remembering, problem solving,
and consciousness. The field is also concerned with how behaviour may influence
the brain and related physiological processes, as in the emerging field of
psychoneuroimmunology (the study that seeks to understand the complex
interactions between brain and immune systems, and the implications for physical
health). Neuropsychology seeks to gain knowledge about brain and behaviour
relationships through the study of both healthy and damaged brain systems. It
seeks to identify the underlying biological causes of behaviours, from creative
genius to mental illness, that account for intellectual processes and personality

Neuropsychology is a multidisciplinary science. It draws information from many

different areas of study across many different scientific disciplines. The areas of
study which contribute to neuropsychology include: anatomy, animal biology,
biophysics, ethology, human experimental psychology, human clinical
psychology, psychiatry, medicine, neurology, chemistry, physiology, physiological
psychology, philosophy and physics.

The neuropsychologist uses objective tools, that is neuropsychological tests to

tie the biological and behavioural aspects together. Through the use of tests, the
clinical neuropsychologist is able to differentiate whether or not a behavioural
abnormality is more likely caused by a biological abnormality in the brain or by
an emotional or learned process.

Neuropsychological understanding is achieved through a comprehensive

exploration of the neurophysiological foundation of behaviour and seemingly
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Brain Behaviour infinite potential contributing factors. Everyone’s brain is wired differently, a
Inter-relationship
product of native biological structure, past experiences, physical health, learned
responses and personality, injuries and diseases, and a host of other factors.
Clinically, it is the role of the neuropsychologist to sort out the factors that
influence how the brain is working in order to understand disease expression,
progress, and recovery.

4.2.2 Brief History of Neuropsychology

Greek and Roman Period
This period shows a great advancement in thinking: Medicine begins to be seen
as a science, and philosophers/physicians begin to study the relationship between
the body and behaviour.

One important question is debated: What structure in the body is the “seat of
intellect”?

Hippocrates: argued that disease was a result of an unhealthy brain or body,

rather than the result of more mystical influences such as demons, gods, or evil
spirits. He was a critical force in developing his Humoral Theory. According to
the humoral theory, disease is owing to imbalance among the four humors.
Plato: argued for a tripartite theory of behaviour, according to which:
• head is the seat of intellect;
• heart is the seat of anger, fear, pride and courage;
• liver is the seat of lust, greed, and desire.
Galen, the most influential physician in the Roman Empire, also has great impact
on western ideas regarding the mind and brain. This physician to four Roman
emperors wrote between five hundred and six hundred treatises.
• focused again on the brain as the location of cognitive function in the body.
• argued that the brain transforms “vital spirits” to “animal spirits”; this idea
was basically a variation on the older humoral theories of Hippocrates.
• believed animal spirits are then stored in the ventricles, and the function of
the neurons was to carry the spirits throughout the body and thus control
behaviour.
Middle Ages
The Middle Ages was a period of little significant advancement in understanding
the brain or behaviour. In particular, the accepted understanding of brain
physiology and function came from Galen, and the church argued that the most
important parts of the brain were the ventricles:
• Anterior ventricle controls perception.
• Middle ventricle controls cognition.
• Posterior ventricle controls memory.
The Renaissance-Important philosophical advances: DaVinci showed that
the ventricles in higher animals such as humans looked very different than
previously believed (though he still believed in the humoral theory).
76
Andreas Vesalius: In “On the Workings of the Human Body,” he made several Behavioural
Neuropsychology, Brain
important observations: human ventricles and the ventricles of other mammals Fitness and Activities that
are very similar; yet, other mammals are not able to show similar “reasoning.” In Promote Brain Fitness
fact, relatively stupid animals like cows had larger ventricles than humans. It
became obvious that large ventricles were not the key to intelligence.

Descartes thought of the body as an automaton. The nerves and brain control the
reflexive actions of the automaton. Also believed that at the pineal gland in the
brain. And concluded that there is a spiritual soul and the physical brain, and the
soul and brain interact to generate human behaviour.

Gall theorised (correctly) that different parts of the brain carried out different
cognitive and behavioural functions.

Flourens argued that neuroscience had to be empirical. He developed the theory

of cortical equipotentiation:
• Cerebellum: important for movement (correct)
• Medulla: important for vital functions (correct)
• Cerebral cortex: completely undifferentiated (incorrect).
Broca: studied the functional localisation of human speech in patients with
cortical brain damage. Broca’s work did not conclude the debate about localisation
of function, in part because replicating clinical patient studies is difficult. Thus,
the debate between localisation and holism continued.

Fritsch and Hitzig supported the theory of functional localisation via their
discovery of the motor cortex. Unlike Broca’s work, which depended on the use
of clinical patients (hence, it’s imprecision), Fritsch and Hitzig did electrical
stimulation and lesion work with dogs. These tools and methods allowed more
precise replication.

The Neuron Debate

During this same period in which clinical patient data and comparative
physiological studies were helping advance the field of neuropsychology, new
tools played an important role in the study of the brain. The development of
more powerful microscopes and new staining techniques that allowed researchers
to see the structure of the neuron.

• Neuron doctrine: By arguing that neurons are individual units or cells that
are physically isolated from each other, this theory was preferred for most
in the functional localisation school.

• Nerve nets theory: This theory proposed that neurons grow together to
form interconnected nets that are physiologically inseparable in adult animals,
more consistent with the theory of holism.

This debate was eventually resolved because of research carried out by Camillo
Golgi; she developed an important staining technique that allowed scientists to
see the neuron cell structure much more clearly. Using Golgi’s new staining
technique, Santiago Ramon y Cajal was able to show that neurons were in fact
separate individual cells. These findings also provided additional support for the
more general theory of localisation of function.
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Brain Behaviour 4.2.3 Neuropsychology and Related Fields
Inter-relationship
1) Clinical Neuropsychology: Clinical neuropsychology is the application of
neuropsychological knowledge to the assessment, management and
rehabilitation of people who have suffered illness or injury (particularly to
the brain) which has caused neurocognitive problems. In particular they
bring a psychological viewpoint to treatment, to understand how such illness
and injury may affect and be affected by psychological factors. They also
can offer an opinion as to whether a person is demonstrating difficulties due
to brain pathology or as a consequence of emotional or other (potentially)
reversible cause.

Clinical neuropsychology seeks such understanding, particularly, in the case

of how damaged or diseased brain structures alter behaviours and interfere
with mental and cognitive functions.

In the application of clinical neuropsychology, understanding the biological

sources of individual differences, particularly, helps identify brain-based
disorders in memory, personality, self-awareness (conscious experience),
cognition, and emotional expression. Working backwards, then, from a look
at abnormal behaviour obtained using formal tests, reasonable inferences
about brain disorders can be reached. Understanding these neurofunctional
changes (i.e., abnormalities) as a result of brain changes (i.e., injury) defines
parameters for current and future behavioural expectations in the lifestyle
of the individual.

Combined with additional understanding of biopsychosocial factors that

coalesce into behavioural expression, the neuropsychologist can gain a
comprehensive impression of what is normal or abnormal behaviour. As
our knowledge of recovery from brain injury improves, such understanding
provides realistic expectations for remediation (restoration or adjustment)
of disordered behaviour.

2) Experimental neuropsychology: This is an approach which uses methods

from experimental psychology to uncover the relationship between the
nervous system and cognitive function. The majority of work involves
studying healthy humans in a laboratory setting, although a minority of
researchers may conduct animal experiments. Human work in this area often
takes advantage of specific features of our nervous system (for example
that visual information presented to a specific visual field is preferentially
processed by the cortical hemisphere on the opposite side) to make links
between neuroanatomy and psychological function.

3) Cognitive neuropsychology: is a relatively new development and has

emerged as a distillation of the complementary approaches of both
experimental and clinical neuropsychology. It seeks to understand the mind
and brain by studying people who have suffered brain injury or neurological
illness. One model of neuropsychological functioning is known as functional
localisation. This is based on the principle that if a specific cognitive problem
can be found after an injury to a specific area of the brain, it is possible that
this part of the brain is in some way involved.

78
 However, there may be reason to believe that the link between mental Behavioural
Neuropsychology, Brain
functions and neural regions is not so simple. An alternative model of the Fitness and Activities that
link between mind and brain, such as parallel processing, may have more Promote Brain Fitness
explanatory power for the workings and dysfunction of the human brain.
Yet another approach investigates how the pattern of errors produced by
brain-damaged individuals can constrain our understanding of mental
representations and processes without reference to the underlying neural
structure. A more recent but related approach is cognitive neuropsychiatry
which seeks to understand the normal function of mind and brain by studying
psychiatric or mental illness.

4) Neuroscience generally refers to the study of neurons and the way they
work in either animals or humans.

5) Psychophysiology : This refers to the study of psychological theories using

physiological measures. In other words, psycho-physiologists normally try
to understand some kind of behaviour or cognitive process. Their data
generally includes some kind of physiological response, such as heart rate.

6) Functional neuroanatomy focuses on the study of anatomy using

psychological measures. One application of this kind of research is to help
medical professionals anticipate the possible problems a patient might
experience following brain injury.

7) Clinical neuroscience concerns the study of clinical populations both to

better understand neuroanatomy and to test psychological theories. A clinical
neuroscientist often works in a hospital setting.

8) Behavioural neurology includes the study of disorders of mood, personality,

intelligence, perception and arousal and is concerned with the structural
basis of normal and abnormal behaviour.

9) Neuropsychiatry includes the study of organic basis of psychiatric illnesses.

Self Assessment Questions

1) Define Neuropsychology.
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2) Give a historical account of the development of neuropsychology.
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Brain Behaviour
Inter-relationship 3) Elucidate the neuron debate.
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4) Discuss the relationship between neuropsychology and related fields.
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5) What is the difference between neuropsychology and experimental
neuropsychology?
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4.3 BEHAVIOURAL NEUROPSYCHOLOGY

4.3.1 Introduction
Behavioural neuropsychology has been defined as ‘the application of behaviour
therapy techniques to problems of organically impaired individuals while applying
a neuro-psychologically based assessment and treatment perspectives.’ Essentially
it is a meeting ground between clinical neuropsychology and behaviour therapy.
In recent years, numerous important efforts have been made to apply behaviour
therapy techniques to the rehabilitation and management of individuals with
brain damage.

Behavioural neuropsychology approaches are based on the principles of learning

theory and behavioural modification. Behavioural psychology principles are
applicable in the following areas.

Visuoperceptive disorders
It relates to the way in which brain damage impairs people’s ability to adapt to
the visual world and the methods used to treat these disabilities which consist of
• Restoration of memory
• Cognitive retraining of attention and concentration
80
• Cognitive retraining of Language and communication Behavioural
Neuropsychology, Brain
• Management of effects of brain damage on affect and mood Fitness and Activities that
Promote Brain Fitness
• Restoration of Executive functioning
• Management of impairments in the Activities of daily living

4.3.2 Techniques Used in the Cognitive Retraining

The techniques of behaviour therapy which are used in the cognitive retraining
of various brain functions are the following.

Antecedent and consequence control

Therapy and consultation cannot be effective unless the behaviours to be changed
are understood within a specific context. The process of understanding behaviour
in context is called functional behavioural assessment. Therefore, a functional
behavioural assessment is needed before performing behaviour modification.
One of the simplest yet effective methods of functional behavioural assessment
is called the “ABC” approach, where observations are made on Antecedents,
Behaviours, and Consequences. In other words, “What comes directly before
the behaviour?”, “What does the behaviour look like?”, and “What comes directly
after the behaviour?” Once enough observations are made, the data are analysed
and patterns are identified. If there are consistent antecedents and/or consequences,
an intervention should target those to increase or decrease the target behaviour.

Environmental control
Restructuring and adaptations are set up to cue appropriate behaviours.

Response cost
This is a type of punishment in which the subject has to return back the token
(positive reinforcement) earned earlier if the subject displays undesirable or
maladaptive behaviour like anger, distraction etc.

Differential reinforcement (Training of incompatible behaviour)-

Differential reinforcement of incompatible behaviour (DRI) is used to reduce a
frequent behaviour without punishing it by reinforcing an incompatible response.
An example would be reinforcing clapping to reduce nose picking.

Differential reinforcement of other behaviour (DRO)

This is used to reduce a frequent behaviour by reinforcing any behaviour other
than the undesired one. An example would be reinforcing any hand action other
than nose picking.

Differential reinforcement of low response rate (DRL)

This is used to encourage low rates of responding.example: “If you ask me for a
potato chip no more than once every 10 minutes, I will give it to you. If you ask
more often, I will give you none.”

Differential reinforcement of high rate (DRH)

This is used to increase high rates of responding. It is like an interval schedule,
except that a minimum number of responses are required in the interval in order
to receive reinforcement.
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Brain Behaviour Contingency management
Inter-relationship
Here the use of positive and negative reinforcement schedules for discouraging
distractions and maintaining goal directed behaviours.

Chaining
Chaining involves reinforcing individual responses occurring in a sequence to
form a complex behaviour. It is frequently used for training behavioural sequences
(or “chains”) that are beyond the current repertoire of the learner. The chain of
responses is broken down into small steps using task analysis. Parts of a chain
are referred to as links. The learner’s skill level is assessed by an appropriate
professional and is then either taught one step at a time while being assisted
through the other steps forward or backwards or if the learner already can complete
a certain percentage of the steps independently, the remaining steps are all worked
on during each trial total task. A verbal stimulus or prompt is used at the beginning
of the teaching trial. The stimulus change that occurs between each response
becomes the reinforcer for that response as well as the prompt/stimulus for the
next response without requiring assistance from the teacher.

As small chains become mastered, i.e. are performed consistently following the
initial discriminative stimulus prompt, they may be used as links in larger chains.
(Ex. teach hand washing, tooth brushing, and showering until mastered and then
teach morning hygiene routine which includes the mastered skills). Chaining
requires that the teachers present the training skill in the same order each time
and is most effective when teachers are delivering the same prompts to the learner.
The most common forms of chaining are backward chaining, forward chaining,
and total task presentation.

Shaping
The differential reinforcement of successive approximations, or more commonly,
shaping is a conditioning procedure used primarily in the experimental analysis
of behaviour. In shaping, the form of an existing response is gradually changed
across successive trials towards a desired target behaviour by rewarding exact
segments of behaviour.

Relaxation exercises
A relaxation technique (also known as relaxation training) is any method, process,
procedure, or activity that helps a person to relax, to attain a state of increased
calmness, or otherwise reduce levels of anxiety, stress or anger. Relaxation
techniques are often employed as one element of a wider stress management
program and can decrease muscle tension, lower the blood pressure and slow
heart and breath rates, among other health benefits. Examples are- Jacobson’s
Progressive muscular relaxation technique, deep breathing exercise and pranayam.

Neurobiofeedback
Neurofeedback (NFB), also called neurotherapy, or EEG biofeedback, is a type
of biofeedback that uses real time displays of electroencephalography to illustrate
brain activity, often with a goal of controlling central nervous system activity.
Sensors are placed on the scalp to measure activity, with measurements displayed
using video displays or sound.

Neurofeedback is a type of biofeedback that uses electroencephalography to

82
 Behavioural
provide a signal that can be used by a person to receive feedback about brain Neuropsychology, Brain
activity. Fitness and Activities that
Promote Brain Fitness
Token economy
A token economy is a system of behaviour modification based on the principles
of operant conditioning. Specifically, the original proposal for such a system
emphasised reinforcing positive behaviour by awarding “tokens” for meeting
positive behavioural goals. Ayllon’s study included only adolescent males.
Ayllon’s tokens were secondary reinforcers, a secondary reinforcer is something
that has no use to the individual in itself, but can be exchanged for a primary
reinforcer. Secondary reinforcers include money, tokens or vouchers. A primary
reinforcer is something that fulfills out needs directly, e.g. food, warmth or
cigarettes satisfy a craving.

Observational learning
This is also known as vicarious learning, social learning, or modelling. This is a
type of learning that occurs as a function of observing, retaining and replicating
novel behaviour executed by others. It is argued that reinforcement has the effect
of influencing which responses one will partake in, more than it influences the
actual acquisition of the new response.

Prompting
A prompt is a cue or assistance to encourage the desired response from an
individual. Types of prompts:
Verbal prompts: Utilising a vocalisation to indicate the desired response.
Visual Prompts: a visual cue or picture.
Gestural prompts: Utilising a physical gesture to indicate the desired response.
Positional prompt: The target item is placed closer to the individual.
Modeling: Modeling the desired response for the student. This type of prompt is
best suited for individuals who learn through imitation and can attend to a model.
Physical prompts: Physically manipulating the individual to produce the desired
response. There are many degrees of physical prompts. The most intrusive being
hand-over-hand, and the least intrusive being a slight tap to initiate movement.

Self Assessment Questions

1) What do you understand by behavioural neuropsychology?
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83
Brain Behaviour 2) Describe visuoperceptual disorders.
Inter-relationship
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3) What are the techniques used in cognitive retraining?
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4) Discuss chaining and shaping and neurobiofeedback.
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5) Describe token economy and observational learning.
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4.4 BRAIN AND BEHAVIOUR

84
Four pounds and several thousand miles of interconnected nerve cells (about Behavioural
Neuropsychology, Brain
100 billion) control every movement, thought, sensation, and emotion that Fitness and Activities that
comprises the human experience. Within the brain and spinal cord there are ten Promote Brain Fitness
thousand distinct varieties of neurons, trillions of supportive cells, a few more
trillion synaptic connections, a hundred known chemical regulating agents, miles
of minuscule blood vessels, axons ranging from a few microns to well over a
foot and a half in length, and untold mysteries of how almost flawlessly all these
components work together. This is the amazing brain.

The brain behaviour relationships, namely the functional system, were developed
in the many works of Luria. A preferred term might be the ‘distributed anatomical
system’. The term emphasise that every complex psychological process has as
its underpinning collections of nerve cells, both in the cerebral cortex and sub
cortex, linked together through fibre pathways usually of greater complexity.
Each of these anatomical systems has extensive connections with numerous other
systems. Mesulam (1981) has expressed the major features clearly as follows:
• Components of a single complex function are represented within distinct
but interconnected sites which collectively constitute an integrated network
for that function.
• Individual cortical areas contain the neural substrate for components of
several complex functions and may therefore belong to several partially
overlapping networks.
• Lesions confined to a single cortical region are likely to result in multiple
deficits.
• Severe and lasting impairments of an individual complex function usually
involve the simultaneous involvement of several components in the relevant
network and
• The same complex function may be impaired as a consequence of a lesion
in one of several cortical areas, each of which is a component of an integrated
network for that function.

4.5 BRAIN FITNESS

The term brain fitness reflects a hypothesis that cognitive abilities can be
maintained or improved by exercising the brain, in analogy to the way physical
fitness is improved by exercising the body. Although there is strong evidence
that aspects of brain structure remain plastic throughout life, and that high levels
of mental activity are associated with reduced risks of age-related dementia,
scientific support for the concept of “brain fitness” is limited. The term is virtually
never used in the scientific literature, but is commonly used in the context of
self-help books and commercial products.

Brain fitness is the capacity of a person to meet the various cognitive demands
of life. It is evident in an ability to assimilate information, comprehend
relationships, and develop reasonable conclusions and plans. Brain fitness can
be developed by formal education, being actively mentally engaged in life,
continuing to learn, and exercises designed to challenge cognitive skills. Healthy
lifestyle habits including mental stimulation, physical exercise, good nutrition,
stress management, and sleep can improve brain fitness. On the other hand,
85
Brain Behaviour chronic stress, anxiety, depression, aging, decreasing estrogen, excess oxytocin,
Inter-relationship
and prolonged cortisol can decrease brain fitness as well as general health.

Brain fitness can be measured physically at the cellular level by neurogenesis. It

can also be evaluated by behavioural performance as seen in cognitive reserve,
improved memory, attention, concentration, executive functions, decision-
making, mental flexibility, and other core capabilities. Neurogenesis is the creation
of new neurons. The more active a particular brain cell is, the more connections
it develops with its neighbouring neurons through a process called dendritic
sprouting. A single neuron can have up to thirty thousand such connections,
creating a dense web of interconnected activity throughout the brain. Each neuron
can then be stimulated directly through experience (real or imagined) or indirectly
through these connections from its neighbours, which saves the cell from cell
death.

Consistent mental challenge by novel stimuli increases production and

interconnectivity of neurons and nerve growth factor, as well as prevents loss of
connections and cell death. The Advanced Cognitive Training for Independent
and Vital Elderly (ACTIVE) nationwide (America) clinical trial is so far the
nation’s largest study of cognitive training. Researchers found that improvements
in cognitive ability roughly counteract the degree of long-term cognitive decline
typical among older people without dementia. The results, published in the Journal
of the American Medical Association in 2002, showed significant percentages
of the 2,802 participants age 65 and older who trained for five weeks for about
2½ hours per week improved their memory, reasoning and information-processing
speed.

Joe Verghese, M.D. found that people with higher activity score had lower risks
of Alzheimer’s and dementia. An open question in the field is whether people
who will later develop Alzheimer’s are naturally less active, or whether
intervening to raise an activity score will delay or prevent Alzheimer’s. If the
latter hypothesis were true, people could lower their dementia risk by 7% simply
by adding one activity per week (such as doing a crossword puzzle or playing a
board game) to their schedule. According to the findings of that same study,
subjects who did crossword puzzles four days a week had a 47% lower risk of
dementia than subjects who did a crossword puzzle just once a week.

Brain fitness is a national health priority, as positive adaptation and healthy living
clearly improves brain function. The good news is that the brain is adaptable and
able to grow new brain cells with our experiences and new learning. We should
examine the relationship between our lifestyle and our brain fitness. From before
birth, through childhood, adolescence, and through adulthood and beyond we
can optimize brain fitness. Continuing education about brain fitness is needed to
maximize our potential.

Recent studies have culminated in an appreciation of importance of brain health

and brain fitness, whether related to learning in school, participating in sports,
work productivity, memory enhancement or mind-body health.

Brain health is a national priority. What is good for the heart is good for the
brain. Lifestyle and brain fitness go hand-in-and Brain fitness programs should
begin early in life and continue across the life span that involve positive adaptation
86 and brain health.
Neuroplasticity and neurogenesis have fuelled the imagination toward increasing Behavioural
Neuropsychology, Brain
the brain’s connectivity and improve speed of transmission which are based on Fitness and Activities that
your experiences and health. Promote Brain Fitness

4.6 BRAIN TRAINING

Exercise Map for the Mind

MOTIVATION
PERCEPTION

Accuracy METACOGNITION
Noticing
& spted
Utilising
Strategies Self reflection
REASONING
MEMORY
Logical
Thinking Systomatic
Thought Retriewal
MENTAL FITNESS Information
Processing

USING NUMBERS
FLEXIBLE
Mathmatical Practical
THINKING
Reasoning Arithmatic

Divergent
Opening New Thinking SPATIAL RELATIONSHIPS
Pathways

LANGUAGE Shap Direction and

Recognition Location
Verbal Fluency
Enlarged
Alternate Vocabulary COMMUNICATION
meanings of
words Listening Giving and Following
Directions

4.6.1 General Activities that Promote Brain Fitness

Physical fitness
It is an old saying that ‘sound mind lies in sound body’. So the first and most
important step towards the brain fitness is to be physically fit. Maintain physical
health by monitoring blood pressure, blood sugar, cholesterol levels and calorie
intake; immobilisation and physical inactivity are to be avoided at all costs.
Physical exercise boosts the brain’s rate of neurogenesis throughout life. Both
physical exercise and the challenge from mental exercise increase the secretion
of nerve growth factor, which helps neurons grow and stay healthy. For example

Dancing regularly
practicing yoga
Aerobic exercise 3 hours per week for 3 months helped healthy seniors grow
new brain cells in their frontal lobes (increased attention and memory) and corpus
callosum (speed of processing)
87
Brain Behaviour Stretching exercises and supervised weight-bearing exercises are recommended.
Inter-relationship
The best single exercise done without equipment is standing on one foot for as
long as possible and then switching to the other foot and doing the same thing.
This combines muscle strengthening, balance, and coordination;

Walk at least four hours a week

Learn the art of napping for short periods during the day. These provide a
temporary respite from the day’s activity and lead to improvements in energy,
alertness and mood; Melatonin may make sense for night-time sleep disturbances,
but no convincing research exists that it exerts any positive effect on longevity.

Adopt a brain healthy diet

Research suggests that high cholesterol may contribute to stroke and brain cell
damage. A low fat, low cholesterol diet is advisable. And there is growing evidence
that a diet rich in dark vegetables and fruits, which contain antioxidants, may
help protect brain cells.

Remain socially active

Social activity not only makes physical and mental activity more enjoyable, it
can reduce stress levels, which helps maintain healthy connections among brain
cells.

Mental Health: Positive mental health is very necessary for happiness and good
functioning of the body and the brain. It can be attained through the following
measures:
• Work as long as possible in a career
• Retain consistent level of physical activity
• Find opportunities to converse
• Avoid excessive use of alcohol and other drugs
• Active group activities – tennis, dancing
• Passive group activities – volunteering, art class
• Active individual activities – walking, swimming
• Passive individual activities – cooking, word puzzle
Try to retain a sense of humor and do everything you can to keep up your present
friendships and strike up new ones.

Try cultivating a few with the younger generation, loneliness is the greatest
challenge to overcome as you advance toward the mature years.

Build up your tolerance for being alone; find pleasure in your own company;
consider a pet.

Reduce stress: Mentally reformulate everyday frustrations and problems into

challenges.

When facing mental challenges, go slowly, check your work, draw on your years
of experience, and rely less on your speed of response. Reaction time lengthens
with age. Compensate by using your wisdom and accumulated life experience.
88
Mental stimulation: Activities of mental stimulation directly contributes for Behavioural
Neuropsychology, Brain
improving the brain fitness. Some research shows that brain stimulation can Fitness and Activities that
help prevent age-related cognitive decline, reverse behavioural assessment Promote Brain Fitness
declines in dementia and Alzheimer’s and can also improve normally functioning
minds. Brain fitness can be improved by various challenging activities such as
playing chess or bridge.

Structured computer based workouts: This is not a substitute for a social life,
but a place to be stimulated with new information, find others who share common
interests, and engage in activities (internet bridge groups) that you may not be
able to attend outside the home; games like bingo, bridge, and chess help maintain
sharpness in different mental domains.

Stay curious and involved commit to lifelong learning

Read, write, work crossword or other puzzles. Activities that involve ahead
planning, like chess or crossword puzzle, stimulate the Frontal lobe area of the
brain

Attend lectures and plays

Enroll in courses at your local adult education center, community college or
other community group
Activities like learning a new language or painting require the coordinating of
multiple regions of the brain.

Self Assessment Questions

1) Discuss brain behaviour relationship.
...............................................................................................................
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...............................................................................................................
...............................................................................................................
2) What is meant by brain fitness?
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3) What are the activities that will promote brain fitness?
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89
Brain Behaviour
Inter-relationship 4) Describe positive mental health and how to ensure the same?
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5) How do you reduce stress? Give the methods to reduce stress.
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6) What is meant by mental stimulation?
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4.6.2 Activities for Improving Specific Cognitive Domains

• Attention and Concentration
• Letter cancellation
• Word cancellation
• Grain sorting
• Stringing work
• Matching
• Dot joining
• Spot the difference
• Finger dexterity games
• Scissor work
• Computer games

Reasoning, Planning and Problem Solving

• Mazes
• Games on computer like minesweeper and solitaire
• Soduku
• Puzzles
• Tower games
• Chinese checker
• Matrices
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Memory Behavioural
Neuropsychology, Brain
1) Talk to yourself, either aloud or to yourself about tasks you are performing Fitness and Activities that
Promote Brain Fitness
to keep your mind on the task and help you recall whether the job has been
accomplished.

2) Paraphrase and repeat back what you have said as a way to focus on the
conversation and recall the important details.

3) Control the rate at which information is presented to you by taking small

breaks and rest between tasks.

4) Reduce interference by limiting distractions by turning off the television or

radio when having a conversation.

5) When shopping, group items into categories that can later act as reminders.
Group grocery store items into fruits, meats and canned goods to assist in
recalling the items as you go through the store.

7) Connect new information with old information. When meeting a new person
named “Brenda”, compare and contrast her characteristics with those of
another person named “Brenda”.

8) Rhyme new information with old.

9) Practice a new task in shorter, more frequent intervals rather than longer
and less frequent sessions.

10) To reduce the anxiety of retrieving information, try deep breathing or other
relaxation techniques.

11) Caregivers can help out a forgetful loved one by cuing them with the first
letter of the word they are looking for or by saying the category of the lost
word, like hardware, clothing or food.

Memory enhancing devices to consider:

1) Written Reminders: Write yourself a note about a certain task and put it
where you will easily see it. Remember to write it down, and always write it
down in one place.

2) Timers: To provide an auditory cue for tasks in the future, set a watch alarm,
alarm clock or cooking timer to go off when a task needs to be performed.

3) Computerised Paging System: Set your paging system to vibrate or produce

a tone to display a message about the event or task you need to be reminded
of.

4) Electronic Organiser: Besides personal information, you can enter the task
you need to perform and the time you need to begin.

5) Digital Voice Recorder: These can store simple information to be used

throughout the day to effectively remind you of things to do or even where
your car is parked at the mall.

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Brain Behaviour
Inter-relationship Self Assessment Questions
1) What are the activities to improve the cognitive domains?
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...............................................................................................................
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2) How do we help a person to improve reasoning, planning etc abilitieis?
...............................................................................................................
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3) How do we help improve memory in a person?
...............................................................................................................
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4) What are the various memory enhancing devices?
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Language and Communication

1) The direct stimulation technique: In this technique, repetitive verbal
exercises are given to the patient to stimulate language.

2) PACE (Promoting Aphasics Communicative Effectiveness) Therapy:

Davis and Wilcox (1981) proposed promoting aphasics communication
effectiveness technique. In it the patient and therapist exchange the functions
of transmitter and receiver in such a way that during the treatment, real
situations of communication are produced. In a natural situation of
communication, the adequate use of language requires constructing a scheme
of mental representation. PACE uses graphic representations of objects
unseen by receiver as message.
92
 This focuses the patient to use different strategies of communication and Behavioural
Neuropsychology, Brain
introduce new elements into the message with the aim of facilitating Fitness and Activities that
comprehension. Thus the patient achieves a more integrated development Promote Brain Fitness
of language whether acting as a transmitter or receiver. The technique thus
allows the use of different forms of communication fulfilling its aim of
increasing communication skills. Finally patient must receive adequate
feedback of his communication efficiency.
3) Compensatory approach: Bliss symbols are flash cards which contain
symbols instead of words as means of communication. Communication
boards, picture charts and electrical scanning units can also be used for
facilitating communication.
4) Behavioural rehearsal through Role playing: In the patients whose
communication problem like stuttering increases in a particular social
situation, role-playing can be used for rehearsal of desired communication
pattern, reducing anxiety associated with the situation and building up self-
confidence.
5) Tea party technique: In this technique language is taught in a meaningful
setting like tea party, dinner situation etc. The idea is that the client learns
how a tea party runs in terms of using different material, associated actions
and comprehending and communicating various aspects of language.
6) Joint action routines: In it a situation or series of situations such as bus
travel, lunch period etc., with a unifying theme are selected and the expected
words, sentences, gestures, or signs are carefully selected so that the roles
can be assigned. While the situation is carried out the following techniques
can be used to vary the use of different utterances
Sabotage- Deliberately modifying equipment so as to lead an unpredictable
event
Omission- not doing something expected
Error- doing something incorrectly
Events- doing new things in routine contexts and
Choice-Offering alternatives e.g. two kinds of food offered in a lunch break
setting.
7) Management for reading and writing problem

Step I
Error analysis: This involves identification and analysis of the types of errors
the patient does. It involves knowledge of basic sight words, configuration cues
(like word lengths, capital letters, double letters and letter height), context cues
(like pictures and words), phonetic analysis of consonents, phonetic analysis of
vowels, prefixes, suffixes and dictionary skills etc. Once the error analysis is
done following techniques can be used to develop reading and writing skills.
a) For improving basic sight words: Flash cards can be used and making the
patient familiar with 4 to 5 words
b) Multisensory method or Fernald method: In it a written word on flash
card is presented in front of the patient. Then the patient has to trace the
word with finger and saying it aloud while tracing. Then the patient writes 93
Brain Behaviour the word without tracing, patient recognise the word with memory and then
Inter-relationship
each word is filed in alphabetic order and used in stories.
c) Gillingham method or Phonetic method: A small card with one letter
printed on it is exposed to the patient and the name spoken by therapist. The
name is then repeated by patient.
As soon as the name is mastered, its sound is made by the therapist and
repeated by patient. The original card is then exposed and the therapist asks
what this letter says. The patient is expected to give the sound.
Without the card exposed, the therapist makes the sound represented by
letter and says, “tell me the name of the letter that has this sound. The Patient
is expected to give the name of the letter. The letter then written by the
therapist and its form is explained to the patient. Then letter is traced, copied,
written from memory and then written again by looking at it.
Finally, the therapist makes the sound and instructs the patient to write the
letter that has this sound.
d) For writing: For improving writing skills, regular practise of writing is
required. After each practise session adequate feedback should be given
with reinforcements.
Visuospatial Functions
1) Computerised tasks involving visual scanning and reaction time: The
program uses a light board with 20 coloured lights and a target can be moved
around the board at different speeds. With this device the patient can be
systematically trained to attend to the neglected visual field. This procedure
with addition of other tasks e.g. size estimation and body awareness task
improves visual perceptual functioning. In left unilateral neglect syndrome,
patients may be made to actively scan left hemisphere by implanting left
visual field anchor like bright red light stimulus, response pacing, immediate
feedback etc.

2) Multi-sensory cuing strategy: It consists of copying sentences using left

visual field, auditory cuing to scan left hemi-space and auditory nonverbal
stimuli, may be successfully used to direct and orient patients to left hemi-
space.
3) Puzzles and Mazes: It can be used for improving visuo-spatial planning.
4) Manipulation of Blocks: It can be used for visuospatial perception.
5) Figures, diagrams and matrices: These are used and practiced for
enhancing visuo-spatial skills.

Self Assessment Questions

1) How to improve language and communication?
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94
 Behavioural
2) What are the measures used in the management of reading and writing Neuropsychology, Brain
problems? Fitness and Activities that
Promote Brain Fitness
...............................................................................................................
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3) How to enhance visuo spatial functions?
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4.7 LET US SUM UP

In this unit we defined neuropsychology. Presented an account of historical review
of the development of neuropsychology over the centuries. We then discussed
the relationship of neuropsychology to various related fields. Then we had a
discussion on the neurons and their functions and roles and this was related to
neuropsychology. This was followed by a definition of behavioural
neuropsychology. We described the visuo perceptual disorders. Then we put across
the many remedial measures to overcome these disorders. We discussed the
techniques used in cognitive retraining. Then we dealt in detail the brain behaviour
relationship. We defined brain fitness and the various activities one should take
up in order to enhance and retain the brain fitness. Following this we defined
positive mental health and discussed the ways and means to reduce stress. The
next section was on mental stimulation and the various measures used to stimulate
the mind and the brain. We put forward the various activities to improve the
cognitive domains, and presented measures to improve one’s reasoning and
planning capabilities. Then a section was devoted to memory and how to enhance
the same.

4.8 UNIT END QUESTIONS

1) What is neuropsychology and how it is different from behavioural
neuroscience? Discuss the idea of multidisciplinary approach in dealing
behavioural problems related to brain impairment.
2) What is behavioural neuropsychology? Describe any five techniques of
behavioural neuropsychology for the restoration of memory and language
functions.
3) How much is the concept of brain fitness relevant in the present era? What
sorts of life style changes are required for achieving brain fitness?
95
Brain Behaviour 4) Write short notes on the following topics:
Inter-relationship
a) Brain behaviour relationship
b) Improving attention and concentration
c) Phonetic method
d) Cognitive neuropsychology
e) Biofeedback

4.9 SUGGESTED READINGS

Alderman N and Ward A. Behavioural treatment of the dysexecutive syndrome:
Reduction of repetitive speech using response cost and cognitive over learning.
Neuropsychological Rehabilitation. 1991;3:63-76. As in : Hanlon R.
Neuropsychological rehabilitation. In: Zaidel DW (ed). Neuropsychology.
Academic Press: New York; 1994: 317-333.

brainfitnessresources.com

Kapur. M, Hinsave. U, Oommen A (2002). Psychological Assessment of Children

in the Clinical Setting. NIMHANS publications Bangalore.

Kolb B, Whishaw I.Q (1990). Fundamentals of Human Neuropsychology (3rd

ed). W.H Freeman and company New York.

Walsh K.(1994). Neuropsychology: A Clinical Approach (3rd ed). B.I Churchill

Livingstone Pvt. Ltd. New Delhi.

References
Cullum.C.M (1998). Neuropsychological assessment of adults. In Bellack A.S,
Herson M, Reynolds. C.R (eds) Comprehensive clinical psychology: 4 328-333.
en.wikipedia.org/wiki/Brain_fitness
en.wikipedia.org/wiki/Behaviour_modification

Hanlon RE, Clontz B et al. Management of severe behavioural dyscontrol

following subarachnoid haemorrhage. Neuropsychological Rehabilitation.
1993;3:63-76. As in : Hanlon R. Neuropsychological rehabilitation. In: Zaidel
DW (ed). Neuropsychology. Academic Press: New York; 1994: 317-333.

Rao.T.A.S (1992); Manual on developing communication skills in mentally

retarded persons, Shree Ramana Process, Secundrabad.

Woods RL. Rehabilitation of patients with disorders of attention. Journal of head

trauma rehabilitation; 1986; 43-53. As cited in : Hanlon R. Neuropsychological
rehabilitation. In: Zaidel DW (ed). Neuropsychology. Academic Press: New York;
1994: 317-333.

96
 Brain Size and Devaluation,
UNIT 1 BRAIN SIZE AND DEVALUATION, Genes, Brain and
Behaviour
GENES, BRAIN AND BEHAVIOUR

Structure
1.0 Introduction
1.1 Objectives
1.2 Brain Size
1.2.1 Male Female Brain Differences
1.3 Indicators of Biological Basis of Behaviour
1.3.1 Behaviour often is Species Specific
1.3.2 Behaviour often Breed True
1.3.3 Behaviours Change in Response to Alterations in Biological Structures
1.3.4 Behaviour has an Evolutionary History
1.4 Human Brain and Human Behaviour
1.5 Genes, Brain and Behaviour
1.5.1 Definition of Behavioural Genetics
1.5.2 Definition of a Gene
1.5.3 Description of DNA
1.5.4 Definition of Chromosome
1.6 Genes Influence Behaviour and Attitudes
1.7 Let Us Sum Up
1.8 Unit End Questions
1.9 Suggested Readings

1.0 INTRODUCTION
The brain is the organ that sets us apart from any other species. It is not the
strength of our muscles or of our bones that makes us different, it is our brain.—
Pasko T. Rakic
Brain is an important part of our various organs. Without brain humans do not
exist. In this unit we will be dealing with brain, brain size and how this varies in
humans and especially between males and females. Then we discuss the biological
indicators of behaviour of humans within which we will show how behaviour is
species specific, and how behaviour keeps occurring and how behaviours change
in response to alternations in biological structures and processes. Then we trace
the evolutionary history of behaviour. This is followed by brain and behaviour
and how they are interrelated. What all aspects of behaviours are produced by
the activities within the brain etc. Then we deal with genes, brain and behaviour
within we will be discussing the definition of behavioural genetics and then we
give the definition of gene, DNA and chromosomes. Then we delineate how
behaviour and attitudes are influenced by genes.

1.1 OBJECTIVES
After completing this unit, you will be able to:
• Elucidate brain and brain size;
5
Basics of the Central • Differentiate between male and female brain size;
Nervous System
• Elucidate the indicators of biological basis of behaviour;
• Explain how behaviour change in response to alternations in biological
structures;
• Describe the relationship between brain and behaviour;
• Define genes, behavioural genetics;
• Describe DNA and Chromosomes; and
• Explain how genes influence behaviour and attitudes.

1.2 BRAIN SIZE

The brain is one of the most important organs because it controls so many of the
body’s functions. The brain makes up only 2% of the total body weight. The
volume of a human brain, otherwise known as cranial capacity, varies depending
on several factors, such as age, environment, and body size.

Throughout the history of neuroscience certain presumptions have been made.

One of these is that the development of increased cognitive capacity is related to
increased brain size over evolutionary time. This was the view held by Charles
Darwin, who wrote “the difference between man and the higher animals, great
as it is, is certainly one of degree and not of kind”

Approx Human brain length=15cm

Approx brain weight=1400g

Brain injury could result in permanent damage or even death. Therefore, it is

very important for the brain to be protected.
The brain and spinal cord make up the central nervous system. The skull
(cranium), made of bone, protects the brain. The three major sections of the
brain are:
i) the forebrain,
ii) the midbrain, and
iii) the hindbrain.
6
The forebrain Brain Size and Devaluation,
Genes, Brain and
The forebrain includes the cerebrum, the largest part of the brain that takes up Behaviour
about two thirds of the brain.

• The cerebrum is divided into two hemispheres that is the left and the right
hemispheres. It controls the interpretation of impulses from sense receptors,
memory, learning, and emotions.

The midbrain
• The midbrain carries messages between the forebrain and hindbrain.

The hindbrain
The hindbrain is composed of the cerebellum and the medulla oblongata.
• The cerebellum controls all voluntary and some involuntary movements.
• It maintains balance and coordination.
The medulla oblongata
• This controls many involuntary functions such as breathing and heartbeat.
• If the medulla is destroyed, a person will die.
• The medulla is connected to the spinal cord, which connects the peripheral
nervous system with the brain and controls reflexes (automatic responses).
Early humans are known as hominids. Australopithecus was the first human like
creature, that lived in Africa about 5 million years ago. Their brains were 350 to
450 cubic centimeters, the size of a gorilla. Homo habilis, which was more human
like, lived two million years ago and was the first to use stone tools. Their brain
volume was about 700 cubic centimeter. The Neanderthals, which are more
modern humans, are classified in the same species (Homo sapiens) as today’s
humans. However, living humans belong to a different subspecies, Homo sapiens.
Although the Neanderthal brain was larger than that of humans today, it does not
mean that the Neanderthals were more intelligent, because brain size is related
to body size and the temperature of the environment.

The volume of a human brain, otherwise known as cranial capacity, varies

depending on several factors, such as age, environment, and body size. The
volume is usually measured in cubic centimeters (cm3 or cc). Modern humans
have cranial capacities from 950 cm3 to 1800 cm3, but the average volume of a
modern human brain is 1300 cm3 to 1500 cm3.

The brain is a three-dimensional form, weighing about 3 pounds in adults less

than a pound in newborns. Each of the 100 billion cells, called “neurons”, in our
brain connects with thousands of other neurons. There are also another 900 billion
or so “supporting cells” in the brain. It is believed that there are around 1
quadrillion (1015) connections between neurons, called “synapses”, in the entire
brain, where activity happens to create the mind.

So the development of the brain is largely a problem of how to connect 100

billion neurons using 1 quadrillion synapses, so that the brain can operate, signals
can be processed, memories can form, and responses can be effected.

7
Basics of the Central About 6,000 of our genes seem to be active only in the brain; gene-produced
Nervous System
proteins, which induce neurons to grow in specific directions inside the skull,
and others that allow them to recognise friendly neurons and cling to them and
make a synapse, and then allow signals to be transmitted across those synapses
together.

Once neurons have made their specific connections together in the course of
their development, those same synapses can be used to send signals from one
neuron to other.

Synapses are not truly connections but gaps between neurons into which signaling
chemicals are injected. Usually, those chemicals are neurotransmitters, like
serotonin, which are used to send signals from one neuron to the next across the
synaptic gap. But hormones and other compounds, like anti-depressants, in the
bloodstream are also able to influence the signal of many synapses and other
receptors at a global level.

The adult human brain weighs on average about 3 lb (1.5 kg) with a size (volume)
of around 1130 cubic centimeters (cm3) in women and 1260 cm3 in men, although
there is substantial individual variation. Men with the same body height and
body surface area as women have on average 100g heavier brains, although these
differences do not correlate in any simple way with gray matter neuron counts or
with overall measures of cognitive performance. The volume is usually measured
in cubic centimeters (cm3 or cc). Modern humans have cranial capacities from
950 cm3 to 1800 cm3, but the average volume of a modern human brain is
1300 cm3 to 1500 cm3.

1.2.1 Male Female Brain Differences

Studies that have looked at differences in the brains of males and females have
focused on (i) Total brain size, (ii) Cell number (iii) Cellular connections (iv)
corpus callosum (v) hypothalamus (vi) Language etc. These are discussed below:
i) Total brain size: In adults, the average brain weight in men is about 11-
12% more than the average brain weight in women. Men’s heads are also
about 2% bigger than women’s. This is due to the larger physical stature of
men. Male’s larger muscle mass, and larger body size require more neurons
to control them. This does not suggest that due to the larger brain, males are
smarter than females.
ii) Cell number: Men have 4% more brain cells than women , and about 100
grams more of brain tissue. This may explain why women are more prone
to dementia (such as Alzheimer’s disease) than men, because although both
may lose the same number of neurons due to the disease, in males, the
functional reserve may be greater as a larger number of nerve cells are present,
which could prevent some of the functional losses.
iii) Cellular connections: While men have more neurons in the cerebral cortex,
women have a more developed neuropil, or the space between cell bodies,
which contains synapses, dendrites and axons, and allows for communication
among neurons .
iv) Corpus callosum: It is reported that a woman’s brain has a larger corpus
callosum which means women can transfer data between the right and left
8
 hemisphere faster than men. Men tend to be more left brained, while women Brain Size and Devaluation,
Genes, Brain and
have greater access to both sides. Given below is the picture of brain showing Behaviour
corpus callosum

v) Hypothalamus: LeVay discovered that the volume of a specific nucleus in

the hypothalamus (third cell group of the interstitial nuclei of the anterior
hypothalamus) is twice as large in heterosexual men than in women and
homosexual men, which may indicate a biological basis for homosexuality.

vi) Language: Two areas in the frontal and temporal lobes related to language
(the areas of Broca and Wernicke) were significantly larger in women, thus
providing a biological reason for women’s notorious superiority in language
associated thoughts. For men, language is most often just in the dominant
hemisphere (usually the left side), but a larger number of women seem to be
able to use both sides for language. This gives them a distinct advantage. If
a woman has a stroke in the left front side of the brain, she may still retain
some language from the right front side. Men who have the same left sided
damage are less likely to recover as fully.

vii) Inferior parietal lobule (IPL) It is a brain region in the cortex, which is
significantly larger in men than in women. This area is bilateral and is located
just above the level of the ears (parietal cortex). Furthermore, the left side
IPL is larger in men than the right side. In women, this asymmetry is reversed,
although the difference between left and right sides is not so large as in
men. This is the same area which was shown to be larger in the brain of
Albert Einstein, as well as in other physicists and mathematicians. So, it
seems that IPL’s size correlates highly with mental mathematical abilities.
Studies have linked the right IPL with the memory involved in understanding
and manipulating spatial relationships and the ability to sense relationships
between body parts. It is also related to the perception of our own affects or
feelings. The left IPL is involved with perception of time and speed, and the
ability to mentally rotate 3-D figures .

viii) Orbitofrontal to amygdale ratio (OAR): In one project, they measured

the size of the orbitofrontal cortex, a region involved in regulating emotions,
and compared it with the size of the amygdala, implicated more in producing
emotional reactions. The investigators found that women possess a
significantly larger orbitofrontal to amygdala ratio (OAR) than men do.
9
Basics of the Central One can speculate from these findings that women might on average prove
Nervous System
more capable of controlling their emotional reactions.

ix) Limbic size: Females, on average, have a larger deep limbic system than
males. This gives females several advantages and disadvantages. Due to the
larger deep limbic brain women are more in touch with their feelings, they
are generally better able to express their feelings than men. They have an
increased ability to bond and be connected to others. Females have a more
acute sense of smell, which is likely to have developed from an evolutionary
need for the mother to recognise her young. Having a larger deep limbic
system leaves a female somewhat more susceptible to depression, especially
at times of significant hormonal changes such as the onset of puberty, before
menses, after the birth of a child and at menopause. Women attempt suicide
three times more than men. Yet, men kill themselves three times more than
women, in part, because they use more violent means of killing themselves.
Men are generally less connected to others than are women. Disconnection
from others increases the risk of completed suicides.

The average human brain weighs three pounds (1.36 kilograms). The average
female brain capacity is 79.3 cubic inches, slightly smaller than the male brain
of 88.5 cubic inches. The largest human brains may be twice those of average
size, but size has no relevance to brain performance.

Man has been a tribal animal since he first walked erect, more than four million
years ago. With the impediment of being bipedal, he could not out climb or
outrun his predators. Only through tribal cooperation could he hold his predators
at bay.

For two million years, the early hominid was a herd/tribal animal, primarily a
herd herbivore. During the next two million years the human was a tribal hunter/
warrior. He still is. All of the human’s social drives developed long before he
developed intellectually. They are, therefore, instinctive. Such instincts as mother-
love, compassion, cooperation, curiosity, inventiveness and competitiveness are
ancient and embedded in the human. They were all necessary for the survival of
the human and pre human. Since human social drives are instinctive (not
intellectual), they can not be modified through education. As with all other higher
order animals, however, proper behaviour may be obtained through training.

The intellect, the magnitude of which separates the human from all other animals,
developed slowly over the entire four million years or more of the human
development. The intellect is not unique to the human, it is quite well developed
in a number of the other higher animals. The intellect developed as a control
over instincts to provide adaptable behaviour. The human is designed by nature
(evolution) to modify any behaviour that would normally be instinctive to one
that would provide optimum benefit (survivability). This process is called self-
control or self-discipline, and is the major difference between the human and the
lower order animals, those that apply only instinct to their behavioural decisions.
Self-discipline, therefore, is the measuring stick of the human. The more
disciplined behaviour (behaviour determined by intellect) displayed by the
individual, the more human he becomes. The less disciplined behaviour
(behaviour in response to instinct) displayed by an individual, the more he
becomes like the lower order animals that are lacking in intellect and are driven
10 by their instincts.
 Brain Size and Devaluation,
Self Assessment Questions Genes, Brain and
Behaviour
1) Describe different parts of the brain.
...............................................................................................................
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2) Differentiate between the brain size of male and female humans.
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3) In what way corpus callosum differs in females?
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4) Discuss inferior parietal lobe and its significance.
...............................................................................................................
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5) What is meant by OAR?
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6) How does limbic size vary between males and females?
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11
Basics of the Central
Nervous System 1.3 INDICATORS OF BIOLOGICAL BASIS OF
BEHAVIOUR
1.3.1 Behaviour often is Species Specific
A chickadee, for example, carries one sunflower seed at a time from a feeder to
a nearby branch, secures the seed to the branch between its feet, pecks it open,
eats the contents, and repeats the process. Finches, in contrast, stay at the feeder
for long periods, opening large numbers of seeds with their thick beaks. Some
mating behaviours also are species specific. Prairie chickens, native to the upper
Midwest, conduct an elaborate mating ritual, a sort of line dance for birds, with
spread wings and synchronised group movements. Some behaviours are so
characteristic that biologists use them to help differentiate between closely related
species.

1.3.2 Behaviours Often Breed True

We can reproduce behaviours in successive generations of organisms. Consider
the instinctive retrieval behaviour of a yellow Labrador or the herding posture of
a border collie.

1.3.3 Behaviours Change in Response to Alterations in

Biological Structures
For example, a brain injury can turn a polite, mild-mannered person into a foul-
mouthed, aggressive boor, and we routinely modify the behavioural manifestations
of mental illnesses with drugs that alter brain chemistry. More recently, geneticists
have created or extinguished specific mouse behaviours—ranging from nurturing
of pups to continuous circling in a strain called “twirler”— by inserting or
disabling specific genes. In humans, some behaviours run in families. For
example, there is a clear familial aggregation of mental illness.

1.3.4 Behaviour Has an Evolutionary History

Chimpanzees are our closest relatives, separated from us by a mere 2 percent
difference in DNA sequence. We and they share behaviours that are characteristic
of highly social primates, including nurturing, cooperation, altruism, and even
some facial expressions. Genes are evolutionary glue, binding all of life in a
single history that dates back some 3.5 billion years. Conserved behaviours are
part of that history, which is written in the language of nature’s universal
information molecule called the DNA.

Self Assessment Questions

1) What are the indicators of biological basis of behaviour?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
12
 Brain Size and Devaluation,
2) Describe how behaviour is species specific. Genes, Brain and
Behaviour
...............................................................................................................
...............................................................................................................
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...............................................................................................................
...............................................................................................................
3) Indicate how behaviour often breeds.
...............................................................................................................
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...............................................................................................................
4) Trace the evolutionary history of behaviour.
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1.4 HUMAN BRAIN AND HUMAN BEHAVIOUR

Human behaviour is influenced both by the genes that we inherit and the
environment in which we live. All behaviour is the joint product of heredity and
environment, but differences in behaviour can be apportioned between hereditary
and environment. The Canadian psychologist Donald Hebb has likened the nature
nurture controversy to an argument about whether the area of a rectangle depends
more importantly on its width or length. For any given rectangle the area is
always a joint product of the two dimensions. However, when comparing two
rectangles having different areas, it is meaningful to ask to what extent the different
areas can be attributed to differences in either of the dimensions. (Note the
corollary: two rectangles can have the same area but different dimensions).
Substituting, we can see that any behaviour is always the joint product of heredity
and environment, but differences in behaviour can be apportioned between
differences in heredity and in environment.

The feeling that brain size or surface complexity is of crucial importance in

terms of intelligence or mental capacity and that man excels in both, has plagued
anthropological research for almost a hundred years. The actual significance of
brain size is being called into question, and so also is its structural form or surface
complexity.

13
Basics of the Central Consider these facts. Julian Huxley was satisfied that the evidence demonstrates
Nervous System
that a larger brain is a better learning organ than a smaller one, though the learning
process may take longer. In a nutshell, his argument is that an absolutely larger
brain (i.e., not larger relative to the body itself) will have a relatively as well as
an absolutely larger number of cells in its cortex. A larger number of cortical
cells make more elaborate learning possible. The experiments upon which Huxley
based this were conducted by the German biologist, Rensch.

1.5 GENES, BRAIN AND BEHAVIOUR

Basically, genes although rarely would directly affect our conscious and
subconscious processes of evaluating information and thus determine our
behaviour. However, they control the creation of our bodies, including our brains,
and thus predetermine how our brains will respond to various stimuli that come
to them through our senses.

The traditional differentiation of nature vs. nurture is thus, basically, artificial,

that is the behaviour of people is mostly determined by what they learn from
their culture. However, what we learn is predetermined by our genes. No single
gene determines a particular behaviour. Behaviours are complex traits involving
multiple genes that are affected by a variety of other factors a few days in some
cases.

About 6,000 of our genes seem to be active only in the brain. Genes (or gene-
produced proteins) like Robo which induce neurons to grow in specific directions
inside the skull, and others that allow them to recognise friendly neurons and
cling to them (making a synapse), and then allow signals to be transmitted across
those synapses. Many specialised proteins, such as Reelin, help in the formation
of synapses once two neurons find each other and “dock” together. Reelin also
helps the brain develop its characteristic six layer structure.

Cadherins are sticky molecules that guide neurons as they migrate inside the
skull, to find their permanent position. Think of them like Spiderman climbing
a building, using a sticky substance to cling and move against gravity and friction,
propelling against other neurons until the right one is found with which to form
a more permanent synaptic connection.

The Emx family of genes is involved in establishing the identity of certain regions
in the brain. The brain is full of specialised areas such as vision, speech, planning,
etc., which are set up in the course of development.

The Eph family of genes helps in lay out of the basic topography map of the
brain, by setting up a chemical gradient, which allows migrating neurons to find
their homes.

The Hox genes also help to establish basic layouts of the brain and body.

Other examples of “brain genes” include Pax6, important for the formation of
the eye, and NMDA receptors which seem to play an important role in establishing
memories when the activity of two neurons coincides closely in time.

Since genes largely function to create proteins, genes and proteins can be used
interchangeably. However, some genes can code for multiple proteins depending
14
on the context, so it is not as simple as one gene = one protein. Brain Size and Devaluation,
Genes, Brain and
Behaviour
The FGF8 gene (fibroblast growth factor 8), for example, can be sliced and
diced in different ways, leading to the production of different proteins , depending
on the context. Those proteins are also responsible for laying out some of the
gross anatomy of the brain.

Once neurons have made their specific connections together in the course of
their development, those same synapses can be used to send signals from one
neuron to another. Synapses are not truly connections that is, gaps between
neurons into which signaling chemicals are injected. Usually, those chemicals
are neurotransmitters such as the serotonin which are used to send signals from
one neuron to the next across the synaptic gap. But hormones and other
compounds such as the anti depressants in the bloodstream are also able to
influence the signal of many synapses at a global level.

Some researchers are attempting to locate specific genes or groups of genes,

associated with behavioural traits and to understand the complex relationship
between genes and the environment. This is called research in behavioural
genetics. In contrast to research into the genetic basis of diseases and disorders,
researchers in behavioural genetics investigate aspects of our personalities such
as intelligence, sexual orientation, susceptibility to aggression and other anti
social conduct, and tendencies towards extraversion and novelty-seeking. If genes
that influence particular behavioural traits are identified, it could become possible
to test for the presence of variations in these genes in individual people.

Now let us examine what is behavioural genetics.

1.5.1 Definition of Behavioural Genetics

Sir Francis Galton (1822-1911) was the first scientist to study heredity and human
behaviour systematically. The term “genetics” did not even appear until 1909,
only 2 years before Galton’s death. Human behavioural genetics, a relatively
new field, seeks to understand both the genetic and environmental contributions
to individual variations in human behaviour. Research in the field of behavioural
genetics aims to find out how genes influence our behaviour. Researchers are
trying to identify particular genes, or groups of genes, that are associated with
behavioural traits, and investigating the role of environmental factors. This is
not an easy task, for the following reasons.

It often is difficult to define the behaviour in question. Intelligence is a classic

example. Is intelligence the ability to solve a certain type of problem? The ability
to make one’s way successfully in the world? The ability to score well on an IQ
test? During the late summer of 1999, a Princeton molecular biologist published
the results of impressive research in which he enhanced the ability of mice to
learn by inserting a gene that codes for a protein in brain cells known to be
associated with memory. Because the experimental animals performed better
than controls on a series of traditional tests of learning, the press dubbed this
gene “the smart gene” and the “IQ gene,” as if improved memory were the central,
or even sole, criterion for defining intelligence. In reality, there is no universal
agreement on the definition of intelligence, even among those who study it for a
living.

15
Basics of the Central Having established a definition for research purposes, the investigator still must
Nervous System
measure the behaviour with acceptable degrees of validity and reliability. That is
especially difficult for basic personality traits such as shyness or assertiveness,
which are the subject of much current research. Sometimes there is an interesting
conflation of definition and measurement, as in the case of IQ tests, where the
test scores itself has come to define the trait it measures. This is a bit like using
batting averages to define hitting prowess in cricket. A high average may indicate
ability, but it does not define the essence of the trait. Behaviours, like all complex
traits, involve multiple genes, a reality that complicates the search for genetic
contributions.

As with much other research in genetics, studies of genes and behaviour require
analysis of families and populations for comparison of those who have the trait
in question with those who do not. The result often is a statement of “heritability,”
a statistical construct that estimates the amount of variation in a population that
is attributable to genetic factors. The explanatory power of heritability figures is
limited, however, applying only to the population studied and only to the
environment in place at the time the study was conducted. If the population or
the environment changes, the heritability most likely will change as well. Most
important, heritability statements provide no basis for predictions about the
expression of the trait in question in any given individual.

1.5.2 Definition of a Gene

Genes are sections or segments of DNA that form the individual units of heredity.
They are carried on the chromosomes and contain instructions for making
molecules called proteins. Each protein enables a cell to perform its own special
function. The hemoglobin in red blood cells, for example, is responsible for
transporting oxygen throughout your body. Another protein, insulin, helps you
metabolise your food. The keratin protein is what helps your hair and nails to grow.
If you look at DNA as a recipe for creating a living thing, then genes and proteins are
the ingredients which work together to build, repair, and run your body.

The traits which make us each unique are also inherited from our ancestors.
Physical characteristics such as curly hair, blue eyes, and a tendency for acne are
all determined by our genes. Scientists also believe that many emotional and
behavioural traits, at least in part, are influenced by an individual’s genetic
makeup. Eating habits, intelligence, a penchant for aggressiveness, and even
sleeping patterns all have their roots in our DNA.

Because genes are carried on the chromosomes, humans have two copies of each
gene, one inherited from the mother and one from the father. The two copies are
not necessarily the same, however. Just like snowflakes, genes come in variant
forms. These variations are known as alleles. Different alleles are what produce
variations in inherited traits. This is why your individual traits such as hair colour
or blood type may not match those traits in either of your parents.

1.5.3 Description of DNA

DNA is made up of four chemical bases: Adenine (A), Cytosine (C), Thymine
(T), and Guanine (G). These bases are combined into pairs that is adenine with
thymine and cytosine with guanine. These make up the “rungs” of the DNA
ladder. Each “rung,” more accurately called a base pair, is one of three billion
16 such pairs which work together to provide the instructions for building and
maintaining a human being, called as the human genome. The exact order in Brain Size and Devaluation,
Genes, Brain and
which these base pairs are combined is called the DNA sequence. Much in the Behaviour
way letters of the alphabet are combined to form words and sentences, the
sequence of these bases are the “letters” which spell out the genetic code.

DNA, which stands for DeoxyriboNucleic Acid is an extremely (by cellular

standards) long macromolecule which forms the main component of
chromosomes (a basic component in the genetic determination and development
of all known life forms).

DNA, structurally, is composed of two nucleotide ‘strands’, which coil around

each other like a set of spiraling stair cases. It is constructed of two main chains
of alternating phosphate and deoxyribose units, bound together chemically with
purine and pyrimidine bases (known as adenine, guanine, cytosine and thymine)

DNA is a chemical polymer and is found in the nucleus of the cell. The specific
ordering of the chemical bases (mentioned earlier) found within DNA allow it to
store and maintain the biological characteristics of all living things. The Laws
by which the DNA sequences govern our biological traits are known as the laws
of genetics.

DNA is physically capable of self replicating, as well as chemically capable of

synthesizing the creation of RNA, a cellular messenger which distributes genetic
and cellular information within the cells. This distribution of information
facilitates protein synthesis as well as the functionality of genetic determination.

1.5.4 Definition of Chromosome

A chromosome is an organised structure of DNA and protein that is found in
cells. It is a single piece of coiled DNA containing many genes, regulatory
elements and other nucleotide sequences. Chromosomes also contain DNA bound
proteins, which serve to package the DNA and control its functions. Chromosomes
are the packaging for our genetic material, or DNA (deoxyribonucleic acid).
DNA carries a specific code that gives instructions to our body on how to grow,
develop and function. The instructions are organised into units called genes. There
are 46 chromosomes in most cells of the human body. The body is made up of
many different cells that are the building blocks for the various tissues and organ
systems in our body. If we were able to look inside most cells in a person’s body
we would expect to see 46 chromosomes in each cell.

Self Assessment Questions

1) Discuss the relationship between brain and behaviour of humans.
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17
Basics of the Central
Nervous System 2) Define behavioural genetics and bring out the characteristic features.
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3) Define gene. What are their importances?
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4) Describe DNA. How is it important for growth and development of
behaviour.
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5) Define chromosome and state its importance.
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18
 Brain Size and Devaluation,
1.6 GENES INFLUENCE BEHAVIOUR AND Genes, Brain and
Behaviour
ATTITUDES
Studies of families and twins strongly suggest genetic influences on the
development and expression of specific behaviours, but there is no conclusive
research demonstrating that genes determine behaviours. In “The Interplay of
Nature, Nurture, and Developmental Influences: The Challenge Ahead for Mental
Health” (Archives of General Psychiatry, vol. 59, no. 11, November 2002),
psychiatrist Michael Rutter observed that a range of mental health disorders from
autism and schizophrenia to attention deficit hyperactivity disorder (ADHD)
involve at least indirect genetic effects, with heritability ranging from 20 to 50%.
He further asserted that genetically influenced behaviours also bring about gene-
environment correlations.

Genetics influence the environment experienced by individuals, which explains

how, for example, children growing up in the same family often experience and
interpret their environments differently. This also explains why individuals who
share the same genes though living apart show some concordance in selecting or
creating similar experiences.

Traditional psychological theory holds that attitudes are learned and most strongly
influenced by environment. In “The Heritability of Attitudes: A Study of Twins”
(Journal of Personality and Social Psychology, vol. 80, no. 6, June 2001), James
Olson et al. examined whether there is a genetic basis for attitudes by reviewing
earlier studies and conducting original research on monozygotic and dizygotic
twins. Olson and his colleagues argued that the premise that attitudes are learned
is not incompatible with the idea that biological and genetic factors also influence
attitudes. They hypothesized that genes probably influence predispositions or
natural inclinations, which then shape environmental experiences in ways that
increase the likelihood of the individual developing specific traits and attitudes.
For example, children who are small for their age might be teased or taunted by
other children more than their larger peers. As a result, these children might
develop anxieties about social interaction, with consequences for their
personalities such as shyness or low self-esteem discomfort with large groups.

It has been shown in research as mentioned above, that behavioural traits such as
intelligence, personality including anxiety, novelty seeking and shyness, antisocial
behaviour including aggression and violent behaviour and sexual orientation are
all determined to a great extent by genes. It has been also shown that some
diseases are caused by changes to a single gene, such as cystic fibrosis and
Huntington’s disease. In the case of heart disease and diabetes it has been stated
that they are likely to be affected by many genes, and the environment may also
play a role. The relationship between genes and behaviour is even more complex.
It is widely agreed that genes do have some influence on behaviour but it is
likely that many genes are involved in influencing behaviours. Environmental
factors will also have an effect.

Psychiatrist Michael Rutter explained the mechanism of genetic influence on

behaviour—genes affect proteins, and through the effects of these proteins on
the functioning of the brain there are resultant effects on behaviour. Rutter viewed
environmental influences as comparable to genetic influences in that they are
19
Basics of the Central strong and pervasive but do not determine behaviours, and studies of
Nervous System
environmental effects show that there are individual differences in response.

There are several reasons as to why it is so difficult to find which genes have an
effect on behavioural traits. The following section gives the details.

• More than one gene may contribute to a trait, with many genes each having
a small effect;
• A gene may affect more than one trait.
• The action of a gene depends on the presence of other genes.
• Environmental factors may contribute to a trait.
• Genes and the environment interact together in different ways and
• Genes do not have a continuous effect throughout our bodies or for all of
our lives.
• The effects of genes are not inevitable.
• Genes, like environmental factors, probably just make a behaviour more or
less likely to occur. They are part of the cause, but not the only cause.
One single gene has major consequences for behaviour
A single gene usually makes a single protein or sometimes only a part of a protein
as for example, it takes the products of 4 different genes to produce a single
acetylcholine receptor/channel. A typical cell expresses 10,000 different gene
products. Therefore, if the product of a single gene differs from the prototype
for that gene because of a heritable change in the gene, we would expect the
following:
• Many cells will be affected, sometimes all the cells in the body.
• Some cells will be affected more than others.
• Consequences for the organism can range from lethality to slightly altered
performance.
• Altered performance may at times include an improvement in performance

1.7 LET US SUM UP

We have read till now that everything one does, and experiences is a function of
the brain. The brain makes up only 2% of the total body weight. The brain is a
three-dimensional form, weighing about 3 pounds in adults less than a pound in
newborns. The adult human brain weighs on average about 3 lb (1.5 kg) with a
size (volume) of around 1130 cubic centimeters (cm3) in women and 1260 cm3
in men, although there is substantial individual variation. Human behaviour is
influenced both by the genes that we inherit and the environment in which we
live. All behaviour is the joint product of heredity and environment. Basically,
genes –although rarely- in that they would directly affect our conscious and
subconscious processes of evaluating information and thus determine our
behaviour. However, they controlled the creation of our bodies, including our
brains, and thus predetermined how our brains will respond to various stimuli
that come to them through our senses.
20
 Brain Size and Devaluation,
1.8 UNIT END QUESTIONS Genes, Brain and
Behaviour
1) Describe different parts of the brain and state their importance.
2) Discuss the various indicators of biological basis of behaviour.
3) Elucidate the relationship between human brain and behaviour.
4) How are genes, brain and behaviour inter related? Discuss in detail.
5) How do genes influence behaviour and attitudes of humans?

1.9 SUGGESTED READINGS

Neil R. Carlson (1995). Foundations of Physiological Psychology (6th edition).
Allyn and Bacon, NY

Levinthal, C.F. (1990). Introduction ot Physiological Psychology (3rd edition).

Prentice Hall of India, New Delhi.

Thompson, R.E. (1975). Introduction to Physiological Psychology. Harper and

Row Publishers, NY.

Morgan, C.T. and King, R.A. (2010). (11th edition). Introduction to Psychology.
McGraw Hill Book Company, New Delhi.

21
Basics of the Central
Nervous System UNIT 2 THE BRAIN

Structure
2.0 Introduction
2.1 Objectives
2.2 The Brain
2.2.1 The Cerebrum
2.2.2 The Cerebellum
2.2.3 The Pituitary Gland
2.2.4 The Hypothalamus
2.2.5 The Brain Stem
2.3 The Forebrain
2.3.1 The Cerebral Cortex
2.3.2 The Lobes
2.3.3 The Limbic System
2.3.4 Basal Ganglia
2.3.5 Thalamus
2.4 The Midbrain
2.4.1 The Brain Stem
2.4.2 Colliculi
2.5 The Hindbrain
2.5.1 Cerebellum
2.5.2 The Pons
2.5.3 Medulla
2.6 The Neurons or the Brain Cells
2.6.1 Different Types of Neurons
2.6.2 The Lifespan of Neurons
2.6.3 Protection of the Brain
2.7 Functions of the Brain
2.8 Let Us Sum Up
2.9 Unit End Questions
2.10 Suggested Readings

2.0 INTRODUCTION
In this unit we give a very elaborate description of the brain and its various parts.
We start with the brain itself and its parts briefly with the cerebrum, cerebellum,
pituitary gland, the hypothalamus and the brain stem. Then we move on to the
forebrain and the cerebral cortex followed by the four lobes, that is the frontal,
temporal, occipital and the parietal lobe and their functions. This is followed by
the description of the limbic system, the basal gangliaand the thalamus. Then we
discuss the parts of the midbrain in which we discuss in detail the brain stem and
the colliculi. The hindbrain is the last part which we discuss in which we describe
the cerebellum, the pons and the medulla. Then we take on the very important
brain nerve cells called the neurons and discuss their different types, the lifespan
of the neurons and how the brain as a whole is protected. Then we present the
22 functions of the brain.
 The Brain
2.1 OBJECTIVES
After completing this unit, you will be able to:
• Define and describe brain and its five different parts;
• Describe the forebrain and the cerebral cortex and their functions;
• Explain the four different lobes and their functions;
• Describe the limbic system and the basal ganglia;
• Explain the parts of the midbrain;
• Describe the brain stem and its functions;
• Explain the hindbrain and its parts;
• Define neurons and their functions;
• Analyse the different types of neurons; and
• Elucidate the functions of the brain.

2.2 THE BRAIN

The brain is probably the most complex structure in the known universe. The
human brain is the center of the human nervous system and is a highly complex
organ. This nervous system is composed of billions of cells, the most essential
being the nerve cells or neurons. There are estimated to be as many as 100
billion neurons in our nervous system. Enclosed in the cranium, brain has the
same general structure as the brains of other mammals, but is over three times as
large as the brain of a typical mammal with an equivalent body size (Johanson,
D. C.1996). The human brain is an organ that controls an individual’s ability to
breathe, think, move and interact with the world around the individual. This
organ consists of more than 15 billion cells used to receive, interpret and transmit
information throughout the body. These cells, which are known as neurons, form
a series of parts that each control a different set of body functions. It continuously
receives sensory information, and rapidly analyses this data and then responds,
control bodily actions and functions.

In humans, the brain weighs about 3 pounds. Differences in weight and size do
not correlate with differences in mental ability. The brain is the control center for
movement, sleep, hunger, thirst, and virtually every other vital activity necessary
to survive. It is a pinkish gray mass that is composed of about 10 billion nerve
cells. The nerve cells, called neurons, are linked to each other and together are
responsible for the control of all mental functions.

The nervous system consists of the brain, the spinal cord and the network of
nerves that extend to every part of the body. The brain weighs about three pounds;
there are about 45 miles of nerves in the human body. It has right and left
hemispheres. (See figure below)

The brain has five major parts:

1) the cerebrum,
2) cerebellum,
23
Basics of the Central 3) brain stem,
Nervous System
4) pituitary gland and
5) the hypothalamus.
The two halves of the brain (Cerebrum)

2.2.1 The Cerebrum (See Sigure Below)

The cerebrum has two halves, the right and left, and is the largest part. It is
responsible for thinking, reasoning, both short and long term memory, and for
voluntary muscle movement. The right side of the cerebrum controls the left
side of the body and is related to abstract thought, colours, shapes, music and
creative endeavors. The left side of the cerebrum controls the right side of the
body and is associated with logical, analytical and mathematical thought, and
speech. The cerebrum contains the information that essentially makes us who
we are: our intelligence, memory, personality, emotion, speech, and ability to
feel and move. Specific areas of the cerebrum are in charge of processing these
different types of information. These are called lobes, and there are four of them:
the frontal, parietal, temporal, and occipital.

The cerebrum has right and left halves, called hemispheres, which are connected
in the middle by a band of nerve fibers (the corpus collosum) that enables the
24
two sides to communicate. Though these halves may look like mirror images of The Brain
each other, many scientists believe they have different functions. The left side is
considered the logical, analytical, objective side. The right side is thought to be
more intuitive, creative, and subjective. So when you’re balancing the checkbook,
you’re using the left side; when you’re listening to music, you’re using the right
side. It’s believed that some people are more “right-brained” or “left-brained”
while others are more “whole-brained,” meaning they use both halves of their
brain to the same degree.

2.2.2 The Cerebellum

The cerebellum controls and coordinates movements of the muscles, like walking
or swinging the arms. This means that the movement is smooth and controlled
and you do not fall over when you turn around

2.2.3 The Pituitary Gland

The pituitary gland is a pea size structure in the center of the brain under the
cerebrum which controls hormone production, metabolism and growth. It is in
many ways the extension of the hypothalamus. The posterior part of the pituitary
gland contains hormone-secreting terminal buttons of axons whose cell bodies
lie within the hypothalamus.

2.2.4 The Hypothalamus

This is a very small structure also under the cerebrum, which controls the body’s
temperature and helps it respond to the environment by shivering or sweating in
order to maintain a steady body temperature. It is a part of the diencephalon,
ventral to the thalamus. The structure is involved in functions including
homeostasis, emotion, thirst, hunger, circadian rhythms, and control of the
autonomic nervous system. The hypothalamus controls the pulse, thirst, appetite,
sleep patterns, and other processes in our bodies that happen automatically. It
also controls the pituitary gland, which makes the hormones that control our
growth, metabolism, digestion, sexual maturity, and response to stress.

The cerebellum is smaller than the cerebrum and located below it at the back of
the brain. It controls balance, movement and coordination. We could not move
around without it.

2.2.5 The Brain Stem

The brain stem is at the back of the brain and connects the brain to the spinal
cord. It regulates involuntary movement such as breathing, digestion, and blood
circulation. It also sorts out millions of messages going back and forth to the rest
of the body.

The spinal cord is about 18 inches long and three-quarters of an inch wide and
acts as a conduit for all impulses to and from every body part and the brain. It is
protected from harm by the bones of the spinal column.

Our nerves are intimately linked with our senses and our emotions, which are
also seated in the brain. They relay information to and from the brain so that it
can function as “executive”, controlling responses to stimuli and keeping things
going.
25
Basics of the Central Damage to the brain can result in altered functioning. Because the brain is so
Nervous System
complex, it is sometimes impossible to determine cause and effect accurately.
Human traits like mood, preferences, and character are somewhat of a mystery,
probably due to the relationship of our spiritual selves with the physical, social
and emotional.

The brain is wrapped in 3 layers of tissue and floats in a special shock proof fluid
to stop it from getting bumped on the inside of your skull as your body moves
around.

Parts of the Brain

The brain is made of three main parts: the forebrain, midbrain, and hindbrain.
The forebrain consists of the cerebrum, thalamus, and hypothalamus (part of the
limbic system). The midbrain consists of the tectum and tegmentum. The
hindbrain is made of the cerebellum, pons and medulla. Often the midbrain,
pons, and medulla are referred to together as the brainstem.

The Forebrain ———- The Midbrain ———— The Hindbrain

Self Assessment Questions

1) What are the parts of the brain?
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2) Describe the cerebrum and the cerebellum.
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26 ...............................................................................................................
 The Brain
4) What is the role of hypothalamus?
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2.3 THE FOREBRAIN

The forebrain is the largest and most complex part of the brain. It surrounds the
rostal end of the neural tube. Its two major components are the Telencephalon
and the Diencephalon.

Telencephalon: It includes most of the two symmetrical cerebral hemispheres

that make up the cerebrum. The cerebral hemispheres are covered by the cerebral
cortex and contain the limbic system and the basal ganglia. The latter two set of
structures are primarily in the subcortical regions of the brain.

2.3.1 The Cerebral Cortex

The outer layer of the cerebrum is called the cortex (also known as “gray matter”).
It encompasses about two-thirds of the brain mass and lies over and around most
of the structures of the brain. It is the most highly developed part of the human
brain and is responsible for thinking, perceiving, producing and understanding
language. It is also the most recent structure in the history of brain evolution.
Most of the actual information processing in the brain takes place in the cerebral
cortex. Information collected by the five senses comes into the brain from the
spinal cord to the cortex. This information is then directed to other parts of the
nervous system for further processing. For example, when you touch the hot
stove, not only does a message go out to move your hand but one also goes to
another part of the brain to help.

The cerebral cortex is divided into four sections, called “lobes”: the frontal lobe,
parietal lobe, occipital lobe, and temporal lobe. Each has a specific function. For
example, there are specific areas involved in vision, hearing, touch, movement,
and smell. Other areas are critical for thinking and reasoning. Although many
functions, such as touch, are found in both the right and left cerebral hemispheres,
some functions are found in only one cerebral hemisphere. For example, in most
people, language abilities are found in the left hemisphere. 27
Basics of the Central 2.3.2 The Lobes: (see picture below)
Nervous System

i) Frontal Lobe: This Lobe is located deep to the Frontal Bone of the skull. It
plays an integral role in the following functions/actions such as reasoning,
planning, parts of speech, movement, emotions, and problem solving.
ii) Parietal Lobe: This Lobe is located deep to the Parietal Bone of the skull. It
is associated with movement, orientation, recognition, perception of stimuli.
iii) Occipital Lobe: The Occipital Lobe is located deep to the Occipital Bone
of the Skull. Its primary function is the processing, integration, interpretation,
etc. of vision and visual stimuli.
iv) Temporal Lobe: These Lobes are located on the sides of the brain, deep to
the temporal Bones of the skull and associated with perception and
recognition of auditory stimuli, memory, and speech.

2.3.3 The Limbic System

A group of brain regions including the anterior thalamic nuclei, amygdala,
hippocampus, limbic cortex, and parts of the hypothalamus as well as their
interconnecting fibre bundles is called limbic system. Hippocampus is a structure
of the temporal lobe, includes the hippocampus proper, dentate gyrus and
subiculum. Amygdala is located in the temporal lobe is involved in memory,
emotion, and fear. The amygdala is just beneath the surface of the front, medial
part of the temporal lobe where it causes the bulge on the surface called the
uncus. (See picture of limbic system below)

28
2.3.4 Basal Ganglia The Brain

The basal ganglia are a collection of subcortical nuclei in the forebrain that lie
beneath the anterior portion of the lateral ventrical. Nuclei are group of neurons
of the same shape.

Diencephalon: The diencephalon, the inner part of the forebrain, consists of the
thalamus, hypothalamus, and pituitary gland.

2.3.5 Thalamus
A large mass of gray matter deeply situated in the forebrain at the topmost portion
of the diencephalon. The structure has sensory and motor functions. Almost all
sensory information enters this structure where neurons send that information to
the overlying cortex. Axons from every sensory system (except olfaction) synapse
here as the last relay site before the information reaches the cerebral cortex. The
thalamus carries messages from the sensory organs like the eyes, ears, nose, and
fingers to the cortex.

Self Assessment Questions

1) Describe the forebrain and its functions.
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2) Discuss the role of cerebral cortex.
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Basics of the Central
Nervous System 4) What are the functions of the limbic system?
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2.4 THE MIDBRAIN (MESENCEPHALON)

The midbrain is located between the two developmental regions of the brain
known as the forebrain and hindbrain. It acts as a master coordinator for all the
messages going in and out of the brain to the spinal cord. The midbrain and the
hindbrain together make up the brainstem.

2.4.1 The Brain Stem

This is the lower extension of the brain where it connects to the spinal cord.
Neurological functions located in the brainstem include those necessary for
survival (breathing, digestion, heart rate, blood pressure) and for arousal (being
awake and alert).

It consists of two major parts: (i) Tectum and (ii) Tegmentum. Tectum is the
dorsal part of the midbrain and includes the inferior colliculi and the superior
colliculi. Tegmentum is the ventral part of the midbrain which includes the
periacquductal grey matter, reticular formation, red nuclei and substantia nigra.

Most of the cranial nerves come from the brainstem. The brainstem is the pathway
for all fiber tracts passing up and down from peripheral nerves and spinal cord to
the highest parts of the brain.

This region of the brain is involved in auditory and visual responses as well as
motor function. The reticular formation influences motor functions. The
tegmentum is a general area within the brainstem. It is located between the
30
ventricular system and distinctive basal or ventral structures at each level. It The Brain
forms the floor of the midbrain whereas the tectum forms the ceiling. It is a
multisynaptic network of neurons that is involved in many unconscious
homeostatic and reflective pathways. The tectum (Latin: roof) is a region of the
brain, specifically the dorsal part of the mesencephalon (midbrain). This is
contrasted with the tegmentum, which refers to the region ventral to the ventricular
system. It is responsible for auditory and visual reflexes.

The midbrain also contains the crus cerebri, which is made up of nerve fibres
connecting the cerebral hemispheres to the cerebellum, and a large pigmented
nucleus called the substantia nigra. The substantia nigra consists of two parts,
the pars reticulata and the pars compacta. Cells of the pars compacta contain the
dark pigment melanin; these cells synthesize dopamine and project to either the
caudate nucleus or the putamen, both of which are structures of the basal ganglia
and are involved in mediating movement and coordination. The roof plate of the
midbrain is formed by two paired rounded swellings, the superior and inferior
colliculi.

2.4.2 Colliculi
In adult humans it is present only in the mesencephalon as the inferior and the
superior colliculi.

The superior colliculus is involved in preliminary visual processing and control

of eye movements. In non-mammalian vertebrates it serves as the main visual
area of the brain, functionally analogous to the visual areas of the cerebral cortex
in mammals.

The inferior colliculus is involved in auditory processing. It receives input from

various brain stem nuclei and projects to the medical geniculate nucleus of the
thalamus, which relays auditory information to the primary auditory cortex.

Both colliculi also have descending projections to the paramedian pontine reticular
formation and spinal cord, and thus can be involved in responses to stimuli faster
than cortical processing would allow. Collectively the colliculi are referred to as
the corpora quadrigemina.

At the caudal (rear) midbrain, crossed fibres of the superior cerebellar peduncle
(the major output system of the cerebellum) surround and partially terminate in
a large centrally located structure known as the red nucleus. Most crossed
ascending fibres of this bundle project to thalamic nuclei, which have access to
the primary motor cortex. A smaller number of fibres synapse on large cells in
caudal regions of the red nucleus; these give rise to the crossed fibres of the
rubrospinal tract, which runs to the spinal cord and is influenced by the motor
cortex.

The second segment appears as a slight swelling in lower vertebrates and enlarges
in the higher primates and ourselves into the midbrain. The structures contained
here link the lower brain stem to the thalamus (for information relay) and to the
hypothalamus (which is instrumental in regulating drives and actions). The latter
is part of the limbic system.

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Basics of the Central
Nervous System 2. 5 THE HINDBRAIN
The hindbrain sits underneath the back end of the cerebrum, and it consists of
the cerebellum, pons, and medulla. (Picture of cerebellum. The small portion
indicated is cerebellum)

2.5.1 Cerebellum
It is also called the “little brain” because it looks like a small version of the
cerebrum — is responsible for balance, movement, and coordination. The
cerebellum, or “little brain”, is similar to the cerebrum in that it has two
hemispheres and has a highly folded surface or cortex. This structure is associated
with regulation and coordination of movement, posture, and balance. The
cerebellum is assumed to be much older than the cerebrum, evolutionarily. The
pons and the medulla, along with the midbrain, are often called the brainstem.

2.5.2 The Pons

The pons (Latin for “bridge”) is a structure located on the brain stem. It is superior
to (up from) the medulla oblongata, inferior, to (down from) the midbrain, and
rostral to (in front of) the cerebellum. The pons (see the picture below)

32
The pons measures about 2.5 cm in length. It contains nuclei that relay signals The Brain
from the cerebrum to the cerebellum, along with nuclei that deal primarily with
sleep, respiration, swallowing, bladder control, hearing, equilibrium, taste, eye
movement, facial expressions, facial sensation, and posture. It is a part of the
metencephalon in the hindbrain. It is involved in motor control and sensory
analysis, for example, information from the ear first enters the brain in the pons.
It has parts that are important for the level of consciousness and for sleep. Some
structures within the pons are linked to the cerebellum, thus are involved in
movement and posture.

2.5.3 Medulla
This structure is the caudal-most part of the brain stem, between the pons and
spinal cord. It is responsible for maintaining vital body functions, such as breathing
and heart rate. The brainstem takes in, sends out, and coordinates all of the brain’s
messages. It also controls many of the body’s automatic functions, like breathing,
heart rate, blood pressure, swallowing, digestion, and blinking.

Self Assessment Questions

1) Describe the parts of the midbrain and the hindbrain.
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Basics of the Central
Nervous System 4) Where are the Pons located and what are their functions?
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Overview of Anatomical Sub-divisions of Brain

Part Location Functions Other Facts
The Cere- This newspaper The cerebral cortex In higher mammals
bral Cortex sized “white matter” controls your the cortex looks like it
is the 1/4" outside thinking, voluntary has lots of wrinkles,
covering of both movements, grooves and bumps.
brain hemispheres. l a n g u a g e , Grooves and bumps
reasoning, and are also called “gyros.”
perception. Cortex is the Latin
word for “bark.”
Cerebellum The cerebellum is a The cerebellum The very word
cauliflower-shaped controls your cerebellum comes
structure located in movement, from the Latin word
the lower part of the balance, posture, “little brain.”
brain next to the and coordination.
occipital area and New research has
the brain stem. also linked it to
thinking, novelty,
and emotions.
Hypothala- The hypothalamus The hypothalamus The hypothalamus is
mus is part of the limbic controls your body composed of several
system. It is located temperature, different areas and is
in the internal emotions, hunger, located at the base of the
portion of the brain thirst, appetite, brain. It is only the size
under the thalamus. digestion and of a pea (about 1/300 of
sleep. the total brain weight),
but is responsible for
some very important
behaviours.

34
 The Brain
Thalamus The thalamus is part The thalamus The thalamus recieves
of the limbic system controls your sensory information
so it is located in the s e n s o r y and relays it to the
internal portion of integration and cerebral cortex. The
the brain or the motor integration. cerebral cortex also
center of the brain. sends information to
the thalamus which
then transmits this
information to other
parts of the brain and
the brain stem.

Pituitary The pituitary gland The pituitary Without your pituitary

Gland is part of the limbic gland controls gland, you could eat
system although it your hormones but you wouldn’t get
hangs below the rest and it helps to turn any energy from the
of the limbic system. food to energy. food.
Pineal The pineal gland is The pineal gland I bet you didn’t know
Gland part of the limbic controls your that your pineal gland
system so it is located growing and is activated by light
in the internal maturing. so if you were born
portion of the brain. and lived all your life
in a place without a
trace of light your
pineal gland would
never start to work.
Amygdala The almond shaped The amygdala Your amygdala is
amygdala is part of (there are two of very important.
the limbic system so them) control your Without it you could
it is located in the emotions such as win the lottery and
internal portion of regulating when feel nothing. You
the brain. you’re happy or wouldn’t be happy.
mad.
Hippocam- The crescent shaped The hippocampas Your hippocampus is
pus hippocampus is forms and stores one of the most
found deep in the your memories important parts of your
temporal lobe, in the (scientists think brain. If you didn’t
front of the limbic there are other have it, you wouldn’t
system. things unknown be able to remember
about the hippo- anything. People with
campus) and is Alzheimer’s Disease
involved in loose the functioning
learning. of their hippocampus.
Mid-brain The mid-brain is an The mid-brain The mid-brain
area located in the controls your includes the thalamus,
middle of the brain breathing, hippocampus, and
behind the frontal reflexes, and your amygdala. Every
lobes. swallowing living thing has to
reflexes. have a mid-brain.
35
Basics of the Central
Nervous System 2.6 THE NEURONS OR THE BRAIN CELLS
The brain cells are called the neurons
(Source:http://www.enchantedlearning.com/subjects/anatomy/brain/Neuron.shtml)
The word “neuron” was coined by the German scientist Heinrich Wilhelm
Gottfried von Waldeyer-Hartz in 1891 (he also coined the term “chromosome”).
There is much type of neurons. They vary in size from 4 microns (.004 mm) to
100 microns (.1 mm) in diameter. Their length varies from a fraction of an inch
to several feet.

Neurons are nerve cells that transmit nerve signals to and from the brain at up to
200 miles per hour. A typical neuron has about 1,000 to 10,000 synapses

i) a cell body (or soma) . The cell body (soma) contains the neuron’s nucleus
(with DNA and typical nuclear organelles). Dendrites branch from the cell
body and receive messages.
ii) Dendrites branch from the cell body. They are the signal receivers. Dendrites
bring information to the cell body.
iii) A projection called an axon, which conduct the nerve signal. Axon is a long
extension of a nerve cell which take information away from the cell body.
Bundles of axons are known as nerves. Within the Central Nervous System
these are known as nerve tracts or pathways.
At the other end of the axon, the axon terminals transmit the electro-chemical
signal across a synapse (the gap between the axon terminal and the receiving
cell).

The axons are protected by myelin coats and insulates the axon, increasing
transmission speed along the axon. Myelin is manufactured by Schwann’s cells,
and consists of 70-80% lipids (fat) and 20-30% protein.

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2.6.1 Different Types of Neurons The Brain

There are different types of neurons. They all carry electro chemical nerve signals,
but differ in structure (the number of processes, or axons, emanating from the
cell body) and are found in different parts of the body.

Sensory neurons or Bipolar neurons carry messages from the body’s sense
receptors (eyes, ears, etc.) to the CNS. These neurons have two processes. Sensory
neuron account for 0.9% of all neurons. (Examples are retinal cells, olfactory
epithelium cells.). are sensitive to various non-neural stimuli. There are sensory
neurons in the skin, muscles, joints, and organs that indicate pressure, temperature,
and pain. There are more specialised neurons in the nose and tongue that are
sensitive to the molecular shapes we perceive as tastes and smells. Neurons in
the inner ear are sensitive to vibration, and provide us with information about
sound. And the rods and cones of the retina are sensitive to light, and allow us to
see.

Motor neurons or Multipolar neurons carry signals from the CNS to the
muscles and glands. These neurons have many processes originating from the
cell body. Motoneurons account for 9% of all neurons. (Examples are spinal
motor neurons, pyramidal neurons, Purkinje cells.). are able to stimulate muscle
cells throughout the body, including the muscles of the heart, diaphragm,
intestines, bladder, and glands.

Inter neurons or Pseudopolare (Spelling) cells form all the neural wiring within
the CNS. These have two axons (instead of an axon and a dendrite). One axon
communicates with the spinal cord; one with either the skin or muscle. These
neurons have two processes (Examples are dorsal root ganglia cells.) are the
neurons that provide connections between sensory and motor neurons, as well
as between themselves. The neurons of the central nervous system, including
the brain, are all inter-neurons.

2.6.2 The Life Span of Neurons

Unlike most other cells, neurons cannot regrow after damage (except neurons
from the hippocampus). Fortunately, there are about 100 billion neurons in the
brain.

2.6.3 Protection of the Brain

As mentioned earlier, the entire brain is enveloped in three protective sheets
known as the meninges, continuations of the membranes that wrap the spinal
cord. The two inner sheets enclose a shock-absorbing cushion of cerebrospinal
fluid. Nerve fibers in the brain are covered in a near-white substance called myelin
and form the white matter of the brain. Nerve cell bodies, which are not covered
by myelin sheaths, form the gray matter. The cerebral cortex is the layer of the
brain often referred to as gray matter. The cortex (thin layer of tissue) is gray
because nerves in this area lack the insulation that makes most other parts of the
brain appear to be white. The cortex covers the outer portion (1.5mm to 5mm) of
the cerebrum and cerbellum. The portion of the cortex that covers the cerebrum
is called the cerebral cortex. The cerebral cortex consists of folded bulges called
gyri that create deep furrows or fissures called sulci. The folds in the brain add to
its surface area and therefore increase the amount of gray matter and the quantity
of information that can be processed.
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Basics of the Central Most of the actual information processing in the brain takes place in the cerebral
Nervous System
cortex. The cerebral cortex is divided into lobes that each has a specific function.
For example, there are specific areas involved in vision, hearing, touch,
movement, and smell. Other areas are critical for thinking and reasoning. Although
many functions, such as touch, are found in both the right and left cerebral
hemispheres, some functions are found in only one cerebral hemisphere. For
example, in most people, language abilities are found in the left hemisphere.

Self Assessment Questions

1) Define Neurons.
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 The Brain
2.7 FUNCTIONS OF THE BRAIN
Human brain is more powerful, more complex and more clever than any computer
ever built.
It is constantly dealing with hundreds of messages from the world around , and
from the individual’s body, and telling the body what to do.
It gets the messages from the person’s senses that is seeing, hearing, tasting,
smelling, touching and moving. The messages travel from nerve cells all over
the body. They travel along nerve fibres to nerve cells in the brain.
Cranial nerves carry messages to and from the ears, eyes, throat, tongue and skin
on one’s face and scalp.
The spinal cord carries messages from and to the arms, legs and trunk of the
body.
Sensory nerves collect the information and send it to the brain along one network.
Then the motor nerves take the brain’s orders back along another network.
As for the control centers of the brain, the different parts of the brain are in
charge of different things. Look at the diagram for an easy way to understand.

The outside layer of the cerebrum has special areas which receive messages
about sight, touch, hearing and taste. Other areas control movement, speech,
learning, intelligence and personality.

The brain stem is in charge of keeping the automatic systems of the body working,
such as breathing,

The human brain has 100 billion nerve cells. It also has 1000 billion other cells,
which cover the nerve cells and the parts of the nerve cells which form the links
between one cell and another, feed them and keep them healthy.

The left side of the brain is better at problem solving, maths and writing.

The right side of the brain is creative and helps the person to be good at art and
music.

39
Basics of the Central The brain stores in memory facts and figures and all the smells, tastes and things
Nervous System
the person has seen, heard or touched.

The brain can also find things that one has remembered such as how to spell a
word etc.

Each area of the brain has an associated function, although many functions may
involve a number of different areas.

The cerebellum is the hind part of the brain. It is made up of gray, unmyelinated
cells on the exterior and white, myelinated cells in the interior. The cerebellum
coordinates muscular movements and, along with the midbrain, monitors posture.
It is essential to the control of movement of the human body in space. The brain
stem, which incorporates the medulla and the pons, monitors involuntary activities
such as breathing and vomiting.

The thalamus, which forms the major part of the diencephalon, receives incoming
sensory impulses and routes them to the appropriate higher centers. The
hypothalamus, occupying the rest of the diencephalon, regulates heartbeat, body
temperature, and fluid balance. Above the thalamus extends the corpus callosum,
a neuron-rich membrane connecting the two hemispheres of the cerebrum.

The cerebrum occupies the topmost portion of the skull. It is by far the largest
part of the brain. It makes up about 85% of the brain’s weight. The cerebrum is
split vertically into left and right hemispheres. it appears deeply fissured and
grooved. Its upper surface, the cerebral cortex, contains most of the master controls
of the body. In the cerebral cortex ultimate analysis of sensory data occurs, and
motor impulses originate that initiate, reinforce, or inhibit the entire spectrum of
muscle and gland activity. The left half of the cerebrum controls the right side of
the body; the right half controls the left side.

Other important parts of the brain are the pituitary gland, the basal ganglia, and
the reticular activating system (RAS). The pituitary participates in growth
regulation. The basal ganglia, located just above the diencephalon in each cerebral
hemisphere, handle coordination and habitual but acquired skills like chewing
and playing the piano. The RAS forms a special system of nerve cells linking the
medulla, pons, midbrain, and cerebral cortex. The RAS functions as a sentry. In
a noisy crowd, for example, the RAS alerts a person when a friend speaks and
enables that person to ignore other sounds.

2.8 LET US SUM UP

Brain, a part of the central nervous system, is located in the skull. It controls
mental and physical actions of the organism. The brain, with the spinal cord and
network of nerves, controls information flow throughout the body, voluntary
actions. The human nervous system, with its billions of nerve cells, is often
described as “the most complex system in the known universe.” It starts as a
tube of cells in the embryo, rapidly developing three distinct parts called the
forebrain, midbrain, and hindbrain. As the forebrain develops, it folds into
wrinkles called convolutions. This allows a great surface area to be packed into
the limited space of the skull. Human brains have noticeably more convolutions
than brains of other species.
40
The cerebrum is the large, topmost part of the brain. The cerebral cortex is the The Brain
outer layer of the cerebrum, where most of the cell bodies are packed. This layer
is visible as a dark layer of gray matter when a preserved brain is sliced. Deep
folds in the cerebral cortex, called fissures, are found in the same location on
each brain. They can be used to define major areas on the cerebral cortex called
lobes. The temporal lobe is at the side of the brain, below the lateral fissure. The
parietal lobe is above the lateral fissure. The frontal lobe is farthest forward in
the brain. It is more developed in humans than in other animals. It contains the
prefrontal areas, farthest in front, which are involved in complex mental processes
such as planning and creativity.

The two hemispheres of the brain are somewhat specialised for different activities,
with language depending upon areas on the left, spatial processing upon areas
on the right. Emotional processing is also lateralised. However, expert
neuroscientists feel that the idea of “right brain thinking” and “left brain thinking”
has been overdone, and most complex mental activity involves a mix of areas on
the two sides.

2.9 UNIT END QUESTIONS

1) Describe the brain and its parts briefly. Why is brain so important for humans?
2) Describe the lobes highlighting the functions of each lobe.
3) Describe with a diagram the forebrain, the midbrain and the hind brain.
What are their parts? Describe the functions of each part.
4) Describe the neurons and their functions and their importance for the brain.
5) What are the functions of the brain? Give in detail.

2.10 SUGGESTED READINGS

Singh, Inderbir (2008) (2nd edition). Anatomy and Physiology for Nurses. Anshan
Ltd., New Delhi

Pearce, Evelyn (2008)(16th edition). Anatomy and Physiology for Nurses. Faber
Publications, London.

41
Basics of the Central
Nervous System UNIT 3 THE CEREBRUM AND THE
CEREBRAL HEMISPHERES AND
THEIR FUNCTIONS

Structure
3.0 Introduction
3.1 Objectives
3.2 The Cerebrum and the Cerebellum
3.3 The Brain Stem
3.4 The Diencephalon
3.5 The Cerebrum
3.5.1 The Cerebral Cortex
3.5.2 Functional Areas of the Cerebral Cortex
3.6 The Cerebellum
3.6.1 Difference between Cerebrum and Cerebellum
3.7 Study of the Brain
3.8 Cerebral Hemisphreres
3.8.1 Left Brain and Right Brain
3.8.2 The Hands and the Two Hemispheres
3.8.3 Cerebral Dominance
3.8.4 Functions of the Left Hemisphere
3.8.5 Functions of the Right Hemisphere
3.8.6 Hemispheric Lobe Functions
3.8.7 Lateralisation or Plasticity of Hemispheric Function
3.9 The Limbic System
3.10 The Forebrain
3.11 Lobes of the Brain
3.11.1 Frontal Lobe
3.11.2 Parietal Lobe
3.11.3 Temporal Lobe
3.11.4 Occipital Lobe
3.12 Let Us Sum Up
3.13 Unit End Questions
3.14 Suggested Readings

3.0 INTRODUCTION
This unit discusses the two main aspects of the brain namely the cerebrum and
the cerebral hemispheres and their functions. The first section starts with the
cerebrum and the cerebellum followed by a discussion on the brain stem and its
various functions. This is followed by a description of the diencephalon and its
functions. The next topic to be taken up is the cerebrum within which we discuss
the cerebral cortex and the functional areas of the cerebral cortex. We then take
up the description of the cerebellum and bring out the differences between the
42
cerebrum and the cerebellum. How to learn about the brain and what are the The Cerebrum and the
Cerebral Hemispheres and
various methods available to us to learn about the brain is discussed next which their Functions
includes the MRI, PET and other such equipments which help to understand
what goes on within the brain. Then the two hemispheres are discussed of the
brain and we take up the description of the left and the right brain followed by
the how the two hands are controlled and managed by the two hemispheres.
Then we discuss about the cerebral dominance and the functions of the right and
left hemispheres. Then we discuss the limbic system, the forebrain and the four
lobes of the brain.

3.1 OBJECTIVES
After completing this unit, you will be able to:
• Define and describe cerebrum and the cerebellum;
• Differentiate between the cerebrum and the cerebellum;
• Describe the diencephalon, and the brain stem;
• Explain the cerebral cortex and its functions;
• Describe the two hemispheres of the brain;
• Explain how the right and left hands are controlled by the two sides of the
brain;
• Define the limbic system and its functions;
• Eklucidate the role of the forebrain; and
• Analyse the functions of the four lobes of the brain.

3.2 THE CEREBRUM AND THE CEREBELLUM

The brain, with the spinal cord and network of nerves, controls information flow
throughout the body, voluntary actions, such as walking, reading, and talking,
and involuntary reactions, such as breathing and heartbeat.

The human brain is a soft, shiny, grayish white, mushroom shaped structure.
Encased within the skull, the brain of an average adult weighs about 3 lb
(1.4 kg).

At birth, the average human infant’s brain weighs 13.7 oz (390 g); by age 15, the
brain has nearly reached full adult size. The brain is protected by the skull and by
a three layer membrane called the meninges.

Many bright red arteries and bluish veins on the surface of the brain penetrate
inward. Glucose, oxygen, and certain ions pass easily from the blood into the
brain, whereas other substances, such as antibiotics, do not.
The four principal sections of the human brain are:
• the brain stem,
• the diencephalon,
• the cerebrum, and
• the cerebellum.
43
Basics of the Central
Nervous System 3.3 THE BRAIN STEM
Underneath the limbic system is the brain stem. This structure is responsible for
basic vital life functions such as breathing, heartbeat, and blood pressure.
Scientists say that this is the “simplest” part of human brains because animals’
entire brains, such as reptiles (who appear early on the evolutionary scale)
resemble our brain stem.

The brain stem connects the brain with the spinal cord. All the messages that are
transmitted between the brain and spinal cord pass through the medulla, which
is a part of the brain stem. This it does through fibers. The fibers on the right side
of the medulla cross to the left and those on the left cross to the right.

As a result, each side of the brain controls the opposite side of the body. The
medulla also controls the heartbeat, the rate of breathing, and the diameter of the
blood vessels and helps to coordinate swallowing, vomiting, hiccupping,
coughing, and sneezing.

Another component of the brain stem is the pons (meaning bridge). The pons
conducts messages between the spinal cord and the rest of the brain, and between
the different parts of the brain. They convey impulses between the cerebral cortex.
The pons, and the spinal cord is a section of the brain stem known as the midbrain,
which also contains visual and audio reflex centers involving the movement of
the eyeballs and head.

The brain stem is made of the midbrain, pons, and medulla. Let us see what
these structures do:
i) Midbrain: The midbrain is the smallest region of the brain that acts as a
sort of relay station for auditory and visual information.
The midbrain controls many important functions such as the visual and
auditory systems as well as eye movement. Portions of the midbrain called
the red nucleus and the substantia nigra are involved in the control of body
movement. The darkly pigmented substantia nigra contains a large number
of dopamine-producing neurons are located. The degeneration of neurons
in the substantia nigra is associated with Parkinson’s disease.
ii) Pons: In Latin, the word pons literally means bridge. The pons is a portion
of the hindbrain that connects the cerebral cortex with the medulla oblongata.
It also serves as a communications and coordination center between the two
hemispheres of the brain. As a part of the brainstem, the pons helps in the
transferring of messages between various parts of the brain and the spinal
cord.
iii) Medulla: This structure is the caudal most part of the brain stem, between
the pons and spinal cord. It is responsible for maintaining vital body
functions, such as breathing and heartrate
iv) Cranial nerves: Twelve pairs of cranial nerves originate in the underside of
the brain, mostly from the brain stem. They leave the skull through openings
and extend as peripheral nerves to their destinations. Among these cranial
nerves are the olfactory nerves that bring messages about smell and the
optic nerves that conduct visual information.
44
 The Cerebrum and the
3.4 THE DIENCEPHALON Cerebral Hemispheres and
their Functions
The diencephalon lies above the brain stem and embodies the thalamus and
hypothalamus. The thalamus is an important relay station for sensory information,
interpreting sensations of sound, smell, taste, pain, pressure, temperature, and
touch.
The thalamus also regulates some emotions and memory.
The hypothalamus controls a number of body functions, such as heartbeat rate
and digestion, and helps regulate the endocrine system and normal body
temperature. The hypothalamus interprets hunger and thirst, and it helps regulate
sleep, anger, and aggression.

3.5 THE CEREBRUM

The cerebrum constitutes nearly 90% of the brain’s weight. Specific areas of the
cerebrum interpret sensory impulses. For example, spoken and written language
are transmitted to a part of the cerebrum called Wernicke’s area.

Wernicke’s area is the region of the brain that is important in language

development. The Wernicke’s Area is located on the temporal lobe on the left
side of the brain and is responsible for the comprehension of speech (Broca’s
area is related to the production of speech). Language development or usage can
be seriously impaired by damage to the Wernicke’s Area.

Broca studied patients with language deficits. Later after their death when he
autopsied, he found a sizable lesion in the left inferior frontal cortex. Subsequently,
Broca studied eight other patients, all of whom had similar language deficits
along with lesions in their left frontal hemisphere. This led him to make his
famous statement that “we speak with the left hemisphere” and to identify, for
the first time, the existence of a “language centre” in the posterior portion of the
frontal lobe of this hemisphere. Now known as Broca’s area, this was in fact the
first area of the brain to be associated with a specific function that is in this case
language.

Ten years later, Carl Wernicke, a German neurologist, discovered another part of
the brain, this one involved in understanding language, in the posterior portion
45
Basics of the Central of the left temporal lobe. People who had a lesion at this location, could speak,
Nervous System
but their speech was often incoherent and made no sense.

Wernicke’s observations have been confirmed many times since. Neuroscientists

now agree that there is a sort of neural loop that is involved both in understanding
and in producing spoken language. At the frontal end of this loop lies Broca’s
area, which is usually associated with the production of language, or language
outputs . At the other end (more specifically, in the superior posterior temporal
lobe), lies Wernicke’s area, which is associated with the processing of words
that we hear being spoken, or language inputs. Broca’s area and Wernicke’s area
are connected by a large bundle of nerve fibres called the arcuate fasciculus.

Broca’s area translates thoughts into speech, and coordinates the muscles needed
for speaking. Impulses from other motor areas direct hand muscles for writing
and eye muscles for physical movement necessary for reading.
The cerebrum is divided into two hemispheres, that is, left and right.
In general, the left half of the brain controls the right side of the body, and vice
versa.
For most right-handed people (and many left-handed people as well), the left
half of the brain is dominant.
By studying patients whose corpus callosum had been destroyed, scientists
realised that differences existed between the left and right sides of the cerebral
cortex.
The left side of the brain functions mainly in speech, logic, writing, and arithmetic.
The right side of the brain, on the other hand, is more concerned with imagination,
art, symbols, and spatial relations.

3.5.1 The Cerebral Cortex

The cerebrum’s outer layer, the cerebral cortex, is composed of gray matter made
up of nerve cell bodies.
The cerebral cortex is about 0.08 in (2 mm) thick and its surface area is about 5
sq ft (0.5 sq m)—around half the size of an office desk.
White matter, composed of nerve fibers covered with myelin sheaths, lies beneath
the gray matter.
During embryonic development, the gray matter grows faster than the white
matter and folds on itself, giving the brain its characteristic wrinkly appearance.
The folds are called convolutions or gyri, and the grooves between them are
known as sulci.
A deep fissure separates the cerebrum into a left and right hemisphere, with the
corpus callosum, a large bundle of fibers, connecting the two.

3.5.2 Functional Areas of the Cerebral Cortex

Considerable knowledge of cortical function has come from patients with damage
to specific cortical areas, and from electrical stimulation and recording from the
46
cortex, often as a necessary prelude to neurosurgery. Imaging procedures The Cerebrum and the
Cerebral Hemispheres and
developed in the 1980s and 1990s, such as positron emission tomography (PET), their Functions
enable neuroscientists to follow changes in cortical activity over time. PET scans
can show sequential changes in brain activity during such tasks as planning and
executing movement and learning and storing information.

Motor Areas: Four motor areas collectively occupy almost half of the frontal
lobe. One of these, the primary motor cortex, is the precentral gyrus just anterior
to the central sulcus. The motor areas are extensively connected to the basal
ganglia and cerebellum. Working together in complex feedback loops, these areas
are essential for motor coordination, postural stability and balance, learned
movements, and the planning and execution of voluntary movement.

Sensory Areas: Primary sensory areas receive incoming sensory information.

One of these, the primary somatosensory cortex, receives input for pain,
temperature, touch, and pressure. It is located in the postcentral gyrus, the first
gyrus of the parietal lobe posterior to the central sulcus. The primary auditory
cortex, for hearing, is on the super (upper) margin of the temporal lobe, deep in
the lateral fissure. The primary visual cortex, for sight, is in the occipital lobe,
especially the medial surface.

Primary sensory areas are organised into precise sensory maps of the body. The
primary somatosensory cortex, for example, has a point-for-point correspondence
with the opposite (contralateral) side of the body, so that, for instance, the first
and second fingers of the left hand send sensory information to adjacent areas of
the right primary somatosensory cortex. Similarly, the primary visual cortex has
a point-for-point map of the contralateral visual field. The primary auditory cortex
has a tonotopic map of the cochlea of the inner ear, with different points in the
cortex representing different sound frequencies.

Association Areas: Once received by a primary sensory area, information is

sorted and relayed to adjacent sensory association areas for processing.
Association areas identify specific qualities of a stimulus and integrate stimulus
information with memory and other input. To hear a piece of music, for example,
involves the primary auditory cortex, but to recognise that music as Mozart or
Elvis Presley involves the auditory association area just below the primary
auditory cortex.

The human brain differs from that of other primates in its large amount of
association cortex. Association areas not only integrate immediate sensory data
with other information, but are also responsible for human ingenuity, personality,
judgment, and decision making.

Self Assessment Questions

1) Describe cerebrum and cerebellum and bring out the differences.
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

47
Basics of the Central
Nervous System 2) Define brain stem and states its functions.
...............................................................................................................
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3) What is Diencephalon and what role does it play?
...............................................................................................................
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...............................................................................................................
...............................................................................................................
...............................................................................................................
4) Describe the cerebral cortex and indicate the functional areas of the
cerebral cortex.
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

3.6 THE CEREBELLUM

The cerebellum is located below the cerebrum and behind the brain stem. It is
butterfly-shaped, with the “wings” known as the cerebellar hemispheres. The
cerebellum controls many subconscious activities, such as balance and muscular
coordination.

Disorders related to damage of the cerebellum are ataxia (problems with

coordination), dysarthria (unclear speech resulting from problems controlling
the muscles used in speaking), and nystagmus (uncontrollable jerking of the
eyeballs). A brain tumor that is relatively common in children known as
medullablastoma grows in the cerebellum.

3.6.1 Difference between Cerebrum and Cerebellum

• One of the basic anatomical difference between these two structures is in
there numbers of layers of grey matter. cerebrum has 6 layers of distinct
cells in its cortex where as cerebellum has only 3 layers of neuronal cells in
its cortex.

• Other difference is that they both have difference in their vasculature.

cerebellum has a very high vasculature as compared to cerebrum.
48
• The next difference is that Cerebrum has sensory areas that interpret sensory The Cerebrum and the
Cerebral Hemispheres and
activities, association areas that are concerned with emotional and intellectual their Functions
processes like will, judgement, memory etc. It controls all voluntary
activities. Cerebellum coordinates muscular activities and maintains body
posture and balance.

3.7 STUDY OF THE BRAIN

Researchers have discovered that neurons carry information through the nervous
system in the form of brief electrical impulses called action potentials. When an
impulse reaches the end of an axon, neurotransmitters are released at junctions
called synapses. The neurotransmitters are chemicals that bind to receptors on
the receiving neurons, triggering the continuation of the impulse.

Fifty different neurotransmitters have been discovered since the first one was
identified in 1920. By studying the chemical effects of neurotransmitters in the
brain, scientists are developing treatments for mental disorders and are learning
more about how drugs affect the brain.

Scientists once believed that brain cells do not regenerate, thereby making brain
injuries and brain diseases untreatable. Since the late 1990s, researchers have
been testing treatment for such patients with neuron transplants, introducing
nerve tissue into the brain. They have also been studying substances, such as
nerve growth factor (NGF), that someday could be used to help regrow nerve
tissue.

Technology provides useful tools for researching the brain and helping patients
with brain disorders. An electroencephalogram (EEG) is a record of brain waves,
electrical activity generated in the brain. An EEG is obtained by positioning
electrodes on the head and amplifying the waves with an electroencephalograph
and is valuable in diagnosing brain diseases such as epilepsy and tumors.

Scientists use three other techniques to study and understand the brain and
diagnose disorders:

1) Magnetic resonance imaging (MRI) uses a magnetic field to display the

living brain at various depths as if in slices.

2) Positron emission tomography (PET) results in color images of the brain

displayed on the screen of a monitor. During this test, a technician injects a
small amount of a substance, such as glucose, that is marked with a
radioactive tag. The marked substance shows where glucose is consumed
in the brain. PET is used to study the chemistry and activity of the normal
brain and to diagnose abnormalities such as tumors.

3) Magnetoencephalography (MEG) measures the electromagnetic fields

created between neurons as electrochemical information is passed along.
When under the machine, if the subject is told, “wiggle your toes,” the
readout is an instant picture of the brain at work. Concentric colored rings
appear on the computer screen that pinpoint the brain signals even before
the toes are actually wiggled.

49
Basics of the Central Using an MRI along with MEG, physicians and scientists can look into the brain
Nervous System
without using surgery. They foresee that these techniques could help paralysis
victims move by supplying information on how to stimulate their muscles or
indicating the signals needed to control an artificial limb.

Self Assessment Questions

1) Define and describe cerebellum.
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
2) What are the various parts of the cerebellum?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
3) What are the importances of studying the brain?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
4) What are the various methods available to scientists to study the brain?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

3.8 CEREBRAL HEMISPHERES

By means of a prominent groove, called the longitudinal fissure, the brain is
divided into two halves called hemispheres. At the base of this fissure lies a
thick bundle of nerve fibers, called the corpus callosum, which provides a
communication link between the hemispheres. The left hemisphere controls the
right half of the body, and the right hemisphere controls the left half of the body,
because of a crossing of the nerve fibers in the medulla.

A cerebral hemisphere (hemispherium cerebrale) is one of the two regions of the

eutherian brain that are delineated by the median plane, (medial longitudinal
fissure). The brain can thus be described as being divided into left and right
cerebral hemispheres. Each of these hemispheres has an outer layer of grey matter
50
called the cerebral cortex that is supported by an inner layer of white matter. The The Cerebrum and the
Cerebral Hemispheres and
hemispheres are linked by the corpus callosum, a very large bundle of nerve their Functions
fibers, and also by other smaller commissures, including the anterior commissure,
posterior commissure, and hippocampal commissure.

These commissures transfer information between the two hemispheres to

coordinate localised functions. The architecture, types of cells, types of
neurotransmitters and receptor subtypes are all distributed among the two
hemispheres in a markedly asymmetric fashion. However, while some of these
hemispheric distribution differences are consistent across human beings, or even
across some species, many observable distribution differences vary from
individual to individual within a given species.

Although the right and left hemispheres seem to be a mirror image of one another,
there are important functional distinctions. In most people, for example, the areas
that control speech are located in the left hemisphere, while areas that govern
spatial perceptions reside in the right hemisphere.

3.8.1 Left Brain and Right Brain

The two cerebral hemispheres are neither anatomically nor functionally identical.
Cortical functions are said to be lateralised when one hemisphere is dominant
over the other for a particular function. The side containing the speech centers is
called the dominant hemisphere, and is usually the left hemisphere. Most people
are highly lateralised for language skills, and lesions in the dominant cortex can
cause complete loss of specific language functions. The posterior, superior part
of the dominant temporal lobe is important for understanding spoken and written
language. Lesions in the language centers produce various forms of aphasia,
difficulty understanding or using written or spoken language. The language-
dominant hemisphere is also a site of mathematical skills, and intellectual decision
making and problem solving using rational, symbolic thought processes.

The non-dominant hemisphere is more adept at recognition of complex, three-

dimensional structures and patterns of both visual and tactile kinds. It is also the
site for recognition of faces and other images, and for non-verbal, intuitive thought
processes. Creative and artistic abilities reside in the non-dominant hemisphere.
Thus, the dominant hemisphere tends to be the more analytical one, and the non-
dominant hemisphere more intuitive. (See the figure below)

51
Basics of the Central Left and Right Hemispheres
Nervous System
Left Hemisphere Functions Right Hemisphere Functions

numerical computation (exact numerical computation (approximate

calculation, numerical comparison, calculation, numerical comparison,
estimation) left hemisphere only: estimation) (Dehaene, et.al 1999)
direct fact retrieval (Dehaene, et.
al.1999)

language: grammar/vocabulary, language: intonation/accentuation,

literal(Taylor,1990) prosody, pragmatic, contextual
(Taylor,1990)

3.8.2 The Hands and Two Hemispheres

The advantage of the popular right and left-brain speculations is that most people
know they have two cerebral hemispheres. The left hemisphere controls the right
half of the body and visa versa. The crossed innervation of the body is one of
those curious facts that has no particular explanation. It just happens to be the case.

Damage or disease in the left hemisphere shows up in the right side of the body
and visa versa. The left hemisphere tends to be dominant in terms of hand use
and language storage in about 92% of humans. You determine dominance by
watching which hand holds a pen and does more of the fine motor skills. The
dominant side of the body also tends to be larger than the non-dominant side.
About 4% of humans have right hemisphere dominance and another 4% are in
the middle with more or less symmetrical hemispheric function.

The human hand is remarkably adaptable and the brain systems that control
hand movements are more remarkable. Human hands hold tools, gesture, express
feelings and meanings. Two hands work together in most tasks. This means that
the two hemispheres work together by sending signals back and forth through a
massive bundle of wires, the corpus callosum. In normal people, the left and
right hemispheres form integrated operating systems that are often tightly
coordinated as in walking, running, and tool use. Clumsy people are less
coordinated and some have distinct difficulty achieving left and right cooperation.

The dominant hand leads the nondominant hand by 15 to 30 milli-seconds when

coordinated movements are performed. This suggests that the left hemisphere
initiates the movement and sends signals to the right. This asymmetric activation
of the hemispheres may come from below the cerebral cortex (from the thalamus,
for example) and may have implications about how all volitional activity is
organised.

A popular notion, that the dominant left hemisphere is “analytic” and the right
hemisphere is “synthetic or artistic,” makes little sense and is not a good way to
try to understand how the human brain works. Roger Sperry and other surgeons
launched the right-left theories by cutting the corpus callosum in patients with
epilepsy. Studies of cognitive function revealed some interesting features of these
“split-brain” patients who could not send signals back and forth between their
hemispheres. These were distinctly abnormal people and their peculiarities did
not reveal how normal people work.
52
As one would expect, the split-brain patients had disconnected cognitive functions The Cerebrum and the
Cerebral Hemispheres and
because their hemispheres could not share information. In contrived experiments, their Functions
information could be supplied to only one hemisphere and would not be available
to the other. Each hemisphere revealed a separate consciousness in terms of
responses to stimuli and reportable contents. Usually, only the left hemisphere
could speak and could only report on information received on the left. The right
hemisphere could not speak, but communicated with nonverbal vocalisations
and in other ways.

The coordination of left and right hand and arm movements is critically important
to human survival. Both hands are needed to perform most tasks and although
the hands may do different tasks, both hands cooperate and work toward the
same goal. The right-left linkage shows up clearly whenever you try to perform
distinctly different tasks with each hand. Even with sustained practice, the hands
want to do similar things or perform linked movements as you do when you play
the bongo drums or knit sweaters.

The central sulcus and the lateral sulcus, divide each cerebral hemisphere into
four sections, called lobes (see Division of the Cortex Into Lobes). The central
sulcus, also called fissure of Rolando, also separates the cortical motor area (which
is anterior to the fissure).

Central Sulcus is an important landmark because it forms the boundary between

the frontal and parietal lobes and also separates the primary sensory cortex
(posterior) from the primary motor cortex (anterior).

Starting from the top of the hemisphere, the upper regions of the motor and
sensory areas control the lower parts of the body.

3.8.3 Cerebral Dominance

This term refers to the fact that one of the cerebral hemispheres is “leading” the
other one in certain functions. The difference is most realised in language and
manual skills. Although there is an individual and cultural variability, language
is mostly represented on the left hemisphere, while non-verbal skills tend to be
represented on the right hemisphere. Broca’s area and Wernick’s area refers to
language function and lie on the left hemisphere.

The advantage of the popular right and left-brain speculations is that most people
know they have two cerebral hemispheres. The left hemisphere controls the right
half of the body and visa versa. The crossed innervation of the body is one of
those curious facts that has no particular explanation. It just happens to be the
case.

Damage or disease in the left hemisphere shows up in the right side of the body
and visa versa. The left hemisphere tends to be dominant in terms of hand use
and language storage in about 92% of humans. You determine dominance by
watching which hand holds a pen and does more of the fine motor skills. The
dominant side of the body also tends to be larger than the non-dominant side.
About 4% of humans have right hemisphere dominance and another 4% are in
the middle with more or less symmetrical hemispheric function.

53
Basics of the Central The human hand is remarkably adaptable and the brain systems that control
Nervous System
hand movements are more remarkable. Human hands hold tools, gesture, express
feelings and meanings. Two hands work together in most tasks. This means that
the two hemispheres work together by sending signals back and forth through a
massive bundle of wires, the corpus callosum. In normal people, the left and
right hemispheres form integrated operating systems that are often tightly
coordinated as in walking, running, and tool use. Clumsy people are less
coordinated and some have distinct difficulty achieving left and right cooperation.

The dominant hand leads the non dominant hand by 15 to 30 milli-seconds when
coordinated movements are performed. This suggests that the left hemisphere
initiates the movement and sends signals to the right. This asymmetric activation
of the hemispheres may come from below the cerebral cortex (from the thalamus,
for example) and may have implications about how all volitional activity is
organised.

A popular notion, that the dominant left hemisphere is “analytic” and the right
hemisphere is “synthetic or artistic,” makes little sense and is not a good way to
try to understand how the human brain works. Roger Sperry and other surgeons
launched the right-left theories by cutting the corpus callosum in patients with
epilepsy. Studies of cognitive function revealed some interesting features of these
“split-brain” patients who could not send signals back and forth between their
hemispheres. These were distinctly abnormal people and their peculiarities did
not reveal how normal people work.

As one would expect, the split-brain patients had disconnected cognitive functions
because their hemispheres could not share information. In contrived experiments,
information could be supplied to only one hemisphere and would not be available
to the other. Each hemisphere revealed a separate consciousness in terms of
responses to stimuli and reportable contents. Usually, only the left hemisphere
could speak and could only report on information received on the left. The right
hemisphere could not speak, but communicated with nonverbal vocalisations
and in other ways.

The coordination of left and right hand and arm movements is critically important
to human survival. Both hands are needed to perform most tasks and although
the hands may do different tasks, both hands cooperate and work toward the
same goal. The right-left linkage shows up clearly whenever you try to perform
distinctly different tasks with each hand. Even with sustained practice, the hands
want to do similar things or perform linked movements as you do when you play
the bongo drums or knit sweaters.

This term refers to the fact that one of the cerebral hemispheres is “leading” the
other one in certain functions. The difference is most realised in language and
manual skills. Although there is an individual and cultural variability, language
is mostly represented on the left hemisphere, while non-verbal skills tend to be
represented on the right hemisphere.

Broca’s area and Wernick’s area refer to language function and lie on the left
hemisphere.

54
3.8.4 Functions of the Left Hemisphere The Cerebrum and the
Cerebral Hemispheres and
Considered the “dominant half of the brain” in most people due to the verbal and their Functions
analytical skills contained, the left hemisphere is the logical, rational hemisphere
of the brain, as Enspire Press states. It controls all communication such as talking,
reading and verbal awareness. The processing of information in logic and spatial
perceptions—such as multiplying, using reason, typing and analysing situations
is made possible within the left hemisphere. The left hemisphere also controls
the right half of the body.

3.8.5 Functions of the Right Hemisphere

The right hemisphere, explains Alz Online, “is associated with ‘unconscious’
awareness (in the sense it is not linguistically based).” Recognition of faces,
understanding of social interaction, artistic creativity, intuition and emotion are
controlled by your brain’s right hemisphere. However, although either hemisphere
has its own specialty, communication between both occurs across the corpus
callosum—the dividing matter. But, “this is not an equal partnership ... one
hemisphere usually dominates over the other,” as Bryn Mawr explains. Evidence
of this is in people who are either left or right handed. Additionally, women have
a thicker corpus callosum, explains Enspire Press, “likely giving rise to women’s
intuition.” Even the differences between men’s and women’s thoughts and
emotions are thought to arise from differences in the right and left hemispheres.

3.8.6 Hemispheric Lobe Functions

Both of the hemispheres, right and left, contain specialised areas called lobes.
The lobes are named to correspond to the section of skull plate protecting them:
frontal, parietal, temporal, and occipital. Most important of these, the frontal
lobe, contained in both left and right hemispheres, is associated “with what it
means to be human,” as Enspire Press explains. Whether in the right or left
hemisphere, any damage results “in a person who is deemed emotionally shallow,
listless, apathetic, and insensitive to social norms,” Enspire continues. In contrast,
the parietal, temporal and occipital lobes within the hemispheres regulate
perception. The parietal regulates touch, pressure, pain, even temperature. The
occipital processes visual information, and hearing is controlled by the temporal
lobe. Thus, it is not the hemispheres at all that control emotional and physical
function—but the lobes located in the hemispheres.

3.8.7 Lateralisation or Plasticity of Hemispheric Function

It can prove unclear which predominates, that is the specialisation of a hemisphere
and its lobes, called lateralisation or the interaction and cooperation of hemispheric
regions. In the early years of psychology, the discovery of Broca’s area a small
region of the right hemisphere without which speech is impossible led
psychologists to speculate that hemispheric power is all or nothing. Each
hemisphere has localised function, they believed, which led to a very stereotyped
understanding of the two hemispheres. In reality in most instances, hemispheres
do not work alone. The functions of the major cerebral hemispheres and their
lobes work together, and for function to be completely lost, both hemispheres
must be damaged.

55
Basics of the Central
Nervous System Self Assessment Questions
1) With the help of a diagram show the two hemispheres of the brain and
discuss their functions.
...............................................................................................................
...............................................................................................................
...............................................................................................................
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...............................................................................................................
2) Discuss the role of right and left hemispheres in regard to hand
dominance.
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
3) What is meant by cerebral dominance?
...............................................................................................................
...............................................................................................................
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...............................................................................................................
...............................................................................................................
4) What are the functions of left and right hemispheres?
...............................................................................................................
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...............................................................................................................
...............................................................................................................
...............................................................................................................
5) What do you understand by lateralisation or plasticity of hemispheric
function?
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56
 The Cerebrum and the
3.9 THE LIMBIC SYSTEM Cerebral Hemispheres and
their Functions
The limbic system is a ring of tissue on the medial surface of each hemisphere,
surrounding the corpus callosum and diencephalon and incorporating parts of
the frontal, parietal, and temporal lobes. Corpus callosum is the main “bridge”
between the left and right cerebral hemispheres; a broad bundle of myelinated
fibers (white matter) carrying information from regions in one lobe to similarly
placed regions in the opposing lobe. There are some 300 million fibers in the
average corpus callosum. Cutting the corpus callosum prevents communication
between the hemispheres (creating the well-known “split-brain” cases), and is
used in severe cases of epilepsy. A major component of this system is the
hippocampal formation, deep in the temporal lobe.

This is often referred to as the “emotional brain”, and is found buried within the
cerebrum. Like the cerebellum, evolutionarily the structure is rather old.

This system contains the thalamus, hypothalamus, amygdala, and hippocampus.

Here is a visual representation of this system.

1) Thalamus
2) Hypothalamus
3) Amygdala
4) Hippocampus
Let us see what these structures do.
1) The thalamus: The thalamus is part of the limbic system so it is located in
the internal portion of the brain or the center of the brain. The thalamus
controls your sensory integration and motor integration. The thalamus
recieves sensory information and relays it to the cerebral cortex. The cerebral
cortex also sends information to the thalamus which then transmits this
information to other parts of the brain and the brain stem.
57
Basics of the Central 2) The Hypothalamus: The hypothalamus is part of the limbic system. It is
Nervous System
located in the internal portion of the brain under the thalamus. The
hypothalamus controls your body temperature, emotions, hunger, thirst,
appetite, digestion and sleep. The hypothalamus is composed of several
different areas and is located at the base of the brain. It is only the size of a
pea (about 1/300 of the total brain weight), but is responsible for some very
important behaviours.

3) Amygdala: The almond shaped amygdala is part of the limbic system so it

is located in the internal portion of the brain. The amygdala (there are two
of them) control your emotions such as regulating when you’re happy or
mad. Your amygdala is very important. Without it you could win the lottery
and feel nothing. You wouldn’t be happy.

4) Hyppocampus: The crescent shaped hippocampus is found deep in the

temporal lobe, in the front of the limbic system. The hippocampas forms
and stores your memories (scientists think there are other things unknown
about the hippocampas) and is involved in learning. Your hippocampus is
one of the most important parts of your brain. If you didn’t have it, you
wouldn’t be able to remember anything. People with Alzheimer’s Disease
loose the functioning of their hippocampus

3.10 THE FOREBRAIN

The cerebrum or telencephalon, the largest subdivision of the human brain,
together with the diencephalon, constitutes the forebrain. It is the most anterior
or, especially in humans, most superior region of the vertebrate central nervous
system.
“Telencephalon” refers to the embryonic structure, from which the mature
“cerebrum” develops. It consists of a pair of cerebral hemispheres.
The dorsal telencephalon, or pallium, develops into the cerebral cortex, and the
ventral telencephalon, or subpallium, becomes the basal ganglia.
Each hemisphere consists of an outer mantle of gray matter (the cerebral cortex),
an extensive underlying of white matter, and deep aggregations of gray matter,
the basal nuclei, or ganglia.
It, with the assistance of the cerebellum, controls all voluntary actions in the
body.
Basal ganglia are large “knots” (ganglion means knot) of nerve cells deep in the
cerebrum. They are thought to be involved in various aspects of motor behaviour
(Parkinson’s disease, for example, is an affliction of the basal ganglia).
Structures contained in the basal ganglia include the amygdala, globus pallidus,
and striatum (containing the caudate nucleus and the putamen).
As the cortex continues to grow, it is thrown into folds called gyri (singular,
gyrus), separated by shallow grooves called sulci (singular, sulcus).
Sulcus is a cleft or fissure in the cerebrum. A few especially prominent sulci
appear early in development and are consistent from brain to brain. They serve
as landmarks to divide the cortex into areas called lobes.
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 The Cerebrum and the
Self Assessment Questions Cerebral Hemispheres and
their Functions
1) Describe the limbic system.
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3) Where is forebrain located and what is its importance?
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4) What are the parts of the forebrain? Discuss each of them in detail.
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3.11 LOBES OF THE BRAIN

The frontal, parietal, temporal, and occipital lobes

The frontal, parietal, temporal, and occipital lobes are visible on the surface of
the brain. The frontal lobe extends from the region of the forehead to a groove
called the central sulcus at the top of the head.

The parietal lobe begins there and progresses posteriorly as far as the parieto-
occipital sulcus, which is visible only on the medial surface of the brain.

The occipital lobe extends from there to the rear of the head.
59
Basics of the Central A conspicuous lateral fissure separates the temporal lobe, in the region of the
Nervous System
ear, from the frontal and parietal lobes above it.

The insula is a fifth lobe of the cerebrum not visible from the surface. It lies deep
to the lateral fissure between portions of the frontal, parietal, and temporal lobes.

Let us study these lobes in detail.

3.11.1 Frontal Lobe

The frontal lobes are anterior to the central sulcus. They are essential for planning
and executing learned and purposeful behaviours; they are also the site of many
inhibitory functions. There are several functionally distinct areas in the frontal
lobes:

The primary motor cortex is the most posterior part of the precentral gyrus. The
primary motor cortex on one side controls all moving parts on the contralateral
side of the body. 90% of motor fibers from each hemisphere cross the midline in
the brain stem. Thus, damage to the motor cortex of one hemisphere causes
weakness or paralysis mainly on the contralateral side of the body.

The medial frontal cortex (sometimes called the medial prefrontal area) is
important in arousal and motivation. If lesions in this area are large and extend
to the most anterior part of the cortex (frontal pole), patients sometimes become
abulic (apathetic, inattentive, and markedly slow to respond).

The orbital frontal cortex (sometimes called the orbital prefrontal area, helps
modulate social behaviours. Patients with orbital frontal lesions can become
emotionally labile, indifferent to the implications of their actions, or both. They
may be alternately euphoric, facetious, vulgar, and indifferent to social nuances.
Bilateral acute trauma to this area may make patients boisterously talkative,
restless, and socially intrusive. With aging and in many types of dementia,
disinhibition and abnormal behaviours can develop; these changes probably result
from degeneration of the frontal lobe, particularly the orbital frontal cortex.

The left posteroinferior frontal cortex (sometimes called Broca’s area or the
posteroinferior prefrontal area controls expressive language function. Lesions in
this area cause expressive aphasia (impaired expression of words).

The dorsolateral frontal cortex (sometimes called the dorsolateral prefrontal area)
manipulates very recently acquired information—a function called working
memory. Lesions in this area can impair the ability to retain information and
process it in real time (e.g, to spell words backwards or to alternate between
letters and numbers sequentially).

3.11.2 Parietal Lobe

Several areas in the parietal lobes have specific functions.
The primary somatosensory cortex, located in the postrolandic area (postcentral
gyrus) in the anterior parietal lobes, integrates somesthetic stimuli for recognition
and recall of form, texture, and weight. The primary somatosensory cortex on
one side receives all somatosensory input from the contralateral side of the body.
Lesions of the anterior parietal lobe can cause difficulty recognising objects by
60 touch (astereognosis).
Areas posterolateral to the postcentral gyrus generate visual-spatial relationships The Cerebrum and the
Cerebral Hemispheres and
and integrate these perceptions with other sensations to create awareness of their Functions
trajectories of moving objects. These areas also mediate proprioception
(awareness of the position of body parts in space).

Parts of the midparietal lobe of the dominant hemisphere are involved in abilities
such as calculation, writing, left-right orientation, and finger recognition. Lesions
in the angular gyrus can cause deficits in writing, calculating, left-right
disorientation, and finger-naming (Gerstmann’s syndrome).

The nondominant parietal lobe integrates the contralateral side of the body with
its environment, enabling people to be aware of this environmental space, and is
important for abilities such as drawing. Acute injury to the nondominant parietal
lobe may cause neglect of the contralateral side (usually the left), resulting in
decreased awareness of that part of the body, its environment, and any associated
injury to that side (anosognosia). For example, patients with large right parietal
lesions may deny the existence of left-sided paralysis. Patients with smaller lesions
may lose the ability to do learned motor tasks (e.g, dressing, other well-learned
activities)—a spatial-manual deficit called apraxia.

3.11.3 Temporal Lobe

The temporal lobes are integral to auditory perception, receptive components of
language, visual memory, declarative (factual) memory, and emotion. Patients
with right temporal lobe lesions commonly lose the ability to interpret nonverbal
auditory stimuli (eg, music). Left temporal lobe lesions interfere greatly with the
recognition, memory, and formation of language.

Patients with epileptogenic foci in the medial limbic-emotional parts of the

temporal lobe commonly have complex partial seizures, characterised by
uncontrollable feelings and autonomic, cognitive, or emotional dysfunction.
Occasionally, such patients have personality changes, characterised by
humorlessness, philosophic religiosity, and obsessiveness.

3.11.4 Occipital Lobe

The occipital lobes contain the primary visual cortex and visual association areas.
Lesions in the primary visual cortex lead to a form of central blindness called
Anton’s syndrome; patients become unable to recognise objects by sight and are
generally unaware of their deficits. Seizures in the occipital lobe can cause visual
hallucinations, often consisting of lines or meshes of color superimposed on the
contralateral visual field.

3.12 LET US SUM UP

The cerebral cortex is the layer of the brain often referred to as gray matter. The
cortex (thin layer of tissue) is gray because nerves in this area lack the insulation
that makes most other parts of the brain appear to be white. The cortex covers
the outer portion of the cerebrum and cerebellum. The portion of the cortex that
covers the cerebrum is called the cerebral cortex. The cerebral cortex consists of
folded bulges called gyri that create deep furrows or fissures called sulci. The
folds in the brain add to its surface area and therefore increase the amount of
gray matter and the quantity of information that can be processed.
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Basics of the Central The cerebral cortex is divided into right and left hemispheres. It encompasses
Nervous System
about two-thirds of the brain mass and lies over and around most of the structures
of the brain. It is the most highly developed part of the human brain and is
responsible for thinking, perceiving, producing and understanding language. It
is also the most recent structure in the history of brain evolution. Most of the
actual information processing in the brain takes place in the cerebral cortex.

The cerebral cortex is divided into lobes that each has a specific function. For
example, there are specific areas involved in vision, hearing, touch, movement,
and smell. Other areas are critical for thinking and reasoning. Although many
functions, such as touch, are found in both the right and left cerebral hemispheres,
some functions are found in only one cerebral hemisphere. For example, in most
people, language abilities are found in the left hemisphere. The cerebral cortex
is responsible for sensing and interpreting input from various sources and
maintaining cognitive function. Sensory functions interpreted by the cerebral
cortex include hearing, touch, and vision. Cognitive functions include thinking,
perceiving, and understanding language.

3.13 UNIT END QUESTIONS

1) Discuss the cerebrum and cerebellum in detail.
2) Discuss in detail all aspects related to the two hemispheres of the brain.
3) What is the importance of the forebrain? Discuss its parts and their functions.
4) Discuss the temporal lobe and the occipital lobe in terms of their location
and their functions.
5) Discuss the functions of the frontal and parietal lobes of the brain.

3.14 SUGGESTED READINGS

Mark E. Bear, Barry W. Connors & Michael A.Paradiso (2001) (2nd edition).
Neuroscience. Exploring the Brain. Lippincott Williams & Wilkins, New York.

Restack, Richard (19096). Brainscapes: An Introduction to what neuroscience

has Learned about the Structure, Function and Abilities of the Brain. Discover
books, NY.

62
 The Cerebrum and the
UNIT 4 CEREBRAL LOBES AND THE Cerebral Hemispheres and
their Functions
LIMBIC SYSTEM

Structure
4.0 Introduction
4.1 Objectives
4.2 The Lobes of the Brain
4.3 The Frontal Lobe
4.3.1 The Location of the Frontal Lobe
4.3.2 Anatomy of Frontal Lobe
4.3.3 Different Functions of Frontal Lobes
4.3.4 Frontal Lobe Damage
4.4 The Occipital Lobe
4.4.1 Occipital Lobe Anatomy
4.4.2 Location of the Occipital Lobe
4.4.3 Functions of the Occipital Lobe
4.4.4 Occipital Lobe Damage and Its Effects
4.5 The Parietal Lobe
4.5.1 Location of Parietal Lobe
4.5.2 Anatomy of Parietal Lobe
4.5.3 Functions of Parietal Lobe
4.5.4 Damage to Parietal Lobe and Its Effects
4.6 The Temporal Lobe
4.6.1 Location of Temporal Lobe
4.6.2 Anatomy of Temporal Lobe
4.6.3 The Functions of Temporal Lobe
4.6.4 Temporal Lobe Damage and Its Effects
4.7 The Limbic System
4.8 The Amygdala
4.9 Let Us Sum Up
4.10 Unit End Questions
4.11 Suggested Readings

4.0 INTRODUCTION
In this unit we will be dealing with the lobes of the brain. This consists of the
frontal, occipital, parietal and temporal lobes. Then we take up in detail the
frontal lobe and discuss its anatomy, location and functions. Then we deal with
the damage caused to the frontal lobe and what are the effects of the same. This
section is followed by the section on Occipital lobe. We take up the anatomy,
location and functions of occipital lobe, and discuss the consequences of any
damage to any part of the occipital lobe. Then we take up the issue of parietal
lobe and discuss its location, anatomy and functions. We also mention about the
damages caused to the parietal lobe and the consequences of the same. This is
followed by a section on temporal lobe in which we discuss then location, anatomy
63
Basics of the Central and functions of the temporal lobe and point out how damage to this lobe ma
Nervous System
cause myriads of problems. Then we present the limbic system and amygdala
and their effects on behaviour.

4.1 OBJECTIVES
After completing this unit, you will be able to:
• Define lobes of the brain;
• Categorize the structural divisions of the brain;
• Describe the general structure of the frontal lobe;
• Describe the primary functions of the frontal lobe;
• Explain what would happen if the frontal lobe is damaged;
• Describe the location, anatomy and functions of the occipital lobe;
• Analyse the problems that may arise as a result of damage to the occipital
lob;
• Elucidate the functions, location and anatomy of temporal lobe; and
• Explain the behaviours that may be affected as a result of damage to the
lobe.

4.2 THE LOBES OF THE BRAIN

The human brain is not only one of the most important organs in the human
body but it is also the most complex. In the following sections, We will discuss
the basic structures that make up the brain as well as how the brain works.

The cerebral cortex is a part of the brain that functions to make human beings
unique. Distinctly human traits including higher thought, language, human
consciousness, as well as the ability to think, reason, and imagine all originate in
the cerebral cortex.
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The cerebral cortex is what we see when we look at the brain. It is the outermost Cerebral Lobes and the
Limbic System
portion that can be divided into the four lobes of the brain. Each bump on the
surface of the brain is known as a gyrus, while each groove is known as a sulcus.

The Four Lobes (Source: Kendra Van Wagner)

The cerebral cortex can be divided into four sections, which are known as lobes
(see figure above). The frontal lobe, parietal lobe, occipital lobe and temporal
lobe. These lobes have been associated with different functions ranging from
reasoning to auditory perception.
The frontal lobe is located at the front of the cerebrum. This section reaches
maturity when a person is about 25 years old. It handles the functions of planning,
emotions, and parts of speech. It is associated with reasoning, motor skills, higher
lever cognition, and expressive language. It is also where most of the personality
is based. This means that it controls a lot of a person’s behaviour and expressions.
Because this lobe is so large and located in the front of the skull, the majority of
injuries to the brain occur to this lobe. At the back of the frontal lobe, near the
central sulcus, lies the motor cortex. This area of the brain receives information
from various lobes of the brain and utilises this information to carry out body
movements.
The parietal lobe above the occipital lobe and behind the frontal lobe. It is
located in the middle section of the brain and is associated with processing tactile
sensory information This part of the cerebellum handles information related to
touch, temperature, pain and pressure. This lobe coordinates sensory information
and enables the person to correctly perceive their environment as one complete
whole. If this area is damaged, a person may have difficulty with coordination,
movement or recognition that his or her body is in pain. A portion of the brain
known as the somatosensory cortex is located in this lobe and is essential to the
processing of the body’s senses.
The temporal lobe is located on the side of the cerebrum and at the bottom
section of the brain. This lobe is also the location of the primary auditory cortex,
which is important for interpreting sounds and the language we hear. The
hippocampus is also located in the temporal lobe, which is why this portion of
the brain is also heavily associated with the formation of memories. The main
purpose of this lobe is to interpret auditory data. This means that it processes
information that a person receives through their sense of hearing. This lobe also
plays a role in both speech and memory. It is believed that the temporal lobe
helps when the brain is transferring memories from short term to long term.
65
Basics of the Central The occipital lobe is the part of the brain that manages data received through
Nervous System
the sense of vision. This lobe is located behind and below the parietal and temporal
lobes. It is located at the back portion of the brain and is associated with
interpreting visual stimuli and information. This part of the brain allows us to
distinguish shapes and colours and to process what our eyes see. The primary
visual cortex, which receives and interprets information from the retinas of the
eyes, is located in the occipital lobe.

Let us now take each of the lobes and discuss them in detail. Let us start with
frontal lobe.

4.3 THE FRONTAL LOBE (FIGURE BELOW)

The frontal lobes are considered our emotional control center and home to our
personality. There is no other part of the brain where lesions can cause such a
wide variety of symptoms (Kolb & Wishaw, 1990). The frontal lobes are involved
in motor function, problem solving, spontaneity, memory, language, initiation,
judgement, impulse control, and social and sexual behaviour. The frontal lobes
are extremely vulnerable to injury due to their location at the front of the cranium,
proximity to the sphenoid wing and their large size. MRI studies have shown
that the frontal area is the most common region of injury following mild to
moderate traumatic brain injury.
There are important asymmetrical differences in the frontal lobes. The left frontal
lobe is involved in controlling language related movement, whereas the right
frontal lobe plays a role in non verbal abilities. Some researchers emphasise that
this rule is not absolute and that with many people, both lobes are involved in
nearly all behaviour.
Disturbance of motor function is typically characterised by loss of fine movements
and strength of the arms, hands and fingers. Complex chains of motor movement
also seem to be controlled by the frontal lobes.
66
Patients with frontal lobe damage exhibit little spontaneous facial expression, Cerebral Lobes and the
Limbic System
which points to the role of the frontal lobes in facial expression. Broca’s Aphasia,
or difficulty in speaking, has been associated with frontal lobe damage.

An interesting phenomenon of frontal lobe damage is the insignificant effect it

can have on traditional IQ testing. Researchers believe that this may have to do
with IQ tests typically assessing convergent rather than divergent thinking. Frontal
lobe damage seems to have an impact on divergent thinking, or flexibility and
problem solving ability. There is also evidence showing lingering interference
with attention and memory even after good recovery from a TBI(Traumatic Brain
Injury).
Another area often associated with frontal damage is that of “behavioural
sponteneity.” It has been noted that individual with frontal lobe damage displayed
fewer spontaneous facial movements, spoke fewer words (left frontal lesions) or
excessively (right frontal lesions).
One of the most common characteristics of frontal lobe damage is difficulty in
interpreting feedback from the environment. Perseverating on a response, risk
taking, and non compliance with rules, and impaired associated learning using
external cues to help guide behaviour are a few examples of this type of deficit.
The frontal lobes are also thought to play a part in our spatial orientation, including
our body’s orientation in space.
One of the most common effects of frontal lobe damage can be a dramatic change
in social behaviour. A person’s personality can undergo significant changes after
an injury to the frontal lobes, especially when both lobes are involved. There are
some differences in the left versus right frontal lobes in this area. Left frontal
damage usually manifests as pseudodepression and right frontal damage as
pseudopsychopathic.
Sexual behaviour can also be effected by frontal lesions. Orbital frontal damage
can introduce abnormal sexual behaviour, while dorolateral lesions may reduce
sexual interest (Walker and Blummer, 1975).
Some common tests for frontal lobe function are: Wisconsin Card Sorting
(response inhibition); Finger Tapping (motor skills); Token Test (language skills).

4.3.1 The Location of the Frontal Lobe

The frontal lobe is an area in the brain of humans and other mammals, located at
the front of each cerebral hemisphere and positioned anterior to (in front of) the
parietal lobes and above and anterior to the temporal lobes (i.e. directly behind
the forehead or “temple”).

It is separated from the parietal lobe by the post-central gyrus primary motor
cortex, which controls voluntary movements of specific body parts associated
with the precentral gyrus posteriorly.

It is associated inferiorly by lateral sulcus which separates it from the temporal

lobe.

It is associated superiorly by the superior margin of the hemisphere and anteriorly

by the frontal pole.
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Basics of the Central 4.3.2 Anatomy of Frontal Lobe
Nervous System

Frontal Lobe: Front part of the brain; involved in planning, organising, problem
solving, selective attention, personality and a variety of “higher cognitive
functions” including behaviour and emotions.

The anterior (front) portion of the frontal lobe is called the prefrontal cortex. It is
very important for the “higher cognitive functions” and the determination of the
personality.

The posterior (back) of the frontal lobe consists of the premotor and motor areas.
Nerve cells that produce movement are located in the motor areas. The premotor
areas serve to modify movements.

Ventral View (From Bottom)

Side View (Cognition and memory)

68
On the lateral surface of the human brain, the central sulcus separates the frontal Cerebral Lobes and the
Limbic System
lobe from the parietal lobe.

The lateral sulcus separates the frontal lobe from the temporal lobe.
The frontal lobe can be divided into the following:
• a lateral part
• a polar (front almost) part
• an orbital (also called basal or ventra) part
• a medial part.
Each of these parts consists of particular gyri:
i) Lateral part: Precentralgyrus, lateral part of the superior frontal gyrus,
middle frontal gyrus, inferior frontal gyrus.
ii) Polar part: Transverse frontopolar gyri, frontomarginal gyrus.
iii) Orbital part: Lateral orbital gyrus, anterior orbital gyrus, posterior orbital
gyrus, medial orbital gyrus, gyrus rectus.
iv) Medial part: Medial part of the superior frontal gyrus, cingulate gyrus.

The gyri are separated by sulci. E.g., the precentral gyrus is in front of the central
sulcus, and behind the precentral sulcus.

The superior and middle frontal gyri are divided by the superior frontal sulcus.

The middle and inferior frontal gyri are divided by the inferior frontal sulcus.

In humans, the frontal lobe reaches full maturity around only after the 20s marking
the cognitive maturity associated with adulthood.

4.3.3 Different Functions of Frontal Lobes

The frontal lobes are considered our emotional control center and home to our
personality. There is no other part of the brain where lesions can cause such a
wide variety of symptoms.
Prefrontal area is involved in the following:
• The ability to concentrate and attend, elaboration of thought.
• The “Gatekeeper”; (judgment, inhibition).
• Personality and emotional traits.
• Deals with Movement.
• Motor Cortex (Brodman’s): voluntary motor activity.
• Premotor Cortex: storage of motor patterns and voluntary activities.
Language problems and motor speech problems include the following:
• Impairment of recent memory, inattentiveness, inability to concentrate,
behaviour disorders, difficulty in learning new information. Lack of
inhibition (inappropriate social and/or sexual behaviour). Emotional lability.
“Flat” affect.
69
Basics of the Central • Contralateral plegia, paresis.
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• Expressive/motor aphasia.
The frontal lobes are involved in motor function, problem solving, spontaneity,
memory, language, initiation, judgment, impulse control, and social and sexual
behaviour.

There are important asymmetrical differences in the frontal lobes. The left frontal
lobe is involved in controlling language related movement, whereas the right
frontal lobe plays a role in non verbal abilities. Some researchers emphasise that
this rule is not absolute and that with many people, both lobes are involved in
nearly all behaviour.

The executive functions of the frontal lobes involve the ability to recognise future
consequences resulting from current actions, to choose between good and bad
actions, override and suppress unacceptable social responses, and determine
similarities and differences between things or events. Therefore, it is involved in
higher mental functions.

The frontal lobes also play an important part in retaining longer term memories
which are not task-based. These are often memories associated with emotions
derived from input from the brain’s limbic system.

The frontal lobe modifies those emotions to generally fit socially acceptable
norms.

Psychological tests that measure frontal lobe function include finger tapping,
Wisconsin Card Sorting Task, and measures of verbal and figural fluency.

4.3.4 Frontal Lobe Damage

The frontal lobes are extremely vulnerable to injury due to their location at the
front of the cranium, proximity to the sphenoid wing and their large size. MRI
studies have shown that the frontal area is the most common region of injury
following mild to moderate traumatic brain injury (Levin et al., 1987).
The frontal lobe contains most of the dopamine-sensitive neurons in the cerebral
cortex. The dopamine system is associated with reward, attention, long-term
memory, planning, and drive. Dopamine tends to limit and select sensory
information arriving from the thalamus to the fore-brain. A report from the
National Institute of Mental Health says a gene variant that reduces dopamine
activity in the prefrontal cortex is related to poorer performance and inefficient
functioning of that brain region during working memory tasks, and to slightly
increased risk for schizophrenia.
A new study has found the strongest evidence regarding what sets humans apart
from other primates. This is found in the brain’s frontal lobes, particularly in an
area the size of a “billiard ball” called the right prefrontal cortex.
Understanding the mental processes of others, that is mentalising is the basis of
our socialisation and what makes us human. It gives rise to our capacity to feel
empathy, sympathy, understand humor and when others are being ironic, sarcastic
or even deceptive. It’s a “theory of mind” that has been associated with the frontal
lobes, but until now scientists have had difficulty demonstrating this ability to
70 specific regions of the brain.
What is exciting about this study, according to Dr. Timothy Shallice of the Institute Cerebral Lobes and the
Limbic System
of Cognitive Neuroscience at University College London, is that the Rotman
study came at this challenge with two different testing methods and both generated
similar compelling evidence to show that these higher cognitive functions in
humans are “localisable” to a specific region within the frontal lobes. Dr. Shallice
wrote the lead editorial in BRAIN.

Dr. Stuss and his research colleagues tested patients who had damage to various
parts of the frontal lobes, and other areas of the brain as well. The selective
impairment in only some patients provided the ability to precisely localise those
regions that are necessary when specific mentalising tasks are performed.
Dr Strauss and his colleagues reported that in their study, the frontal lobes were
the most critical region for visual perspective taking, and the inferior medial
prefrontal region, particularly for the right, for detecting deception. Visual
perspective taking is the ability to empathise or identify with the experience of
another person.

It has long been known that some patients with frontal lobe damage have
significantly changed personalities. What is important about the study is that it
helps families, friends and caregivers of the patient to appreciate and understand
a very important reason why this occurs. This deficit in mentalising can affect
social cognition which is important in everyday human interactions. For example,
patients with damage in the specific frontal area are often less empathetic and
sympathetic, and they miss social cues which lead to inappropriate judgements.

In a study conducted by Strauss, 32 adults with lesions in frontal and non-frontal

brain regions, most commonly as a result of stroke, and a control group of 14
healthy adults, underwent two seemingly very simple tests. Both tasks required
participants to guess in which coffee cup a ball was hidden under. Participants
sat across a table from the experimenter and a table curtain was used on some
occasions to conceal which cup the experimenter hid the ball under. The
participant was asked to point to the correct cup.

The first test was on visual perspective taking. In this the participants had to
reflect on their own experience to understand and interpret the experience of
others. For example, the participants either saw the ball being hidden under a
particular cup with the curtain open, or were told that the ball was being hidden
when the curtain was closed and they could not see anything.

Then two assistants joined the task. One sat beside the experimenter, and one
beside the participant. The table curtain was drawn this time, concealing which
cup the ball was placed under. When the participant had to guess where the ball
was hidden, the assistants ‘helped’ by moving beside the examiner and each
pointed to a different cup.

Participants needed to realise that one of the assistants had not been in a position
to see where the ball was hidden (because they were sitting beside the participant
who themselves could not see where the ball was hidden).

The results of this experiment showed that the Frontal lesion subjects had a
much higher error rate on the task and it appeared that the ‘right’ frontal lobe
was most critical. While the small number of right frontal subjects (4) makes
this only a suggestion, it is still a striking finding, says Dr. Strauss.
71
Basics of the Central In the second test on deception, an assistant sat at the table beside the experimenter
Nervous System
and always pointed to a cup where the ball was NOT hidden. Participants had to
infer that the assistant was trying to deceive them. Those with right inferior
medial prefrontal damage had difficulty catching on to the ruse and were the
most frequently deceived.

A team of brain scientists at Carnegie Mellon University and the University of

Pittsburgh has found spontaneous reorganisation of cognitive function
immediately following brain damage caused by stroke.

The findings are based on functional magnetic resonance imaging (FMRI) scans
showing that brain function associated with language shifted away from the stroke-
damaged area of the adult brain to the corresponding area on the undamaged
side of the brain. The findings show the “healing” that happens after a stroke
occurs at a high level of organisation, demonstrating the plasticity of the human
brain long into adulthood. Such plasticity was routinely credited to the brain in
the first few years of life.

The results also indicate the organisational flexibility of the cortical systems that
underlie higher level thinking processes. The researchers say this knowledge
may be useful in designing future rehabilitation strategies that can exploit the
flexibility.

Using non-invasive FMRI, the team looked at the brains of two stroke patients,
34 and 45 years old, as they read and indicated their comprehension of normal
English sentences. Very soon after stroke, the cortical areas on the right sides of
their brains, the right-hand homologues of Broca’s area or of Wernick’s area,
showed increasing activation during the sentence comprehension, at about the
same time as the patients’ ability to process language was coming back to them.

In healthy brains, language functions are carried out by a network of mirror

image brain areas in the left and right side of the brain, with one side, usually the
left, being dominant. The subordinate side, usually the right, may spend most of
its lifetime playing an understudy role, as well as developing its own
specialisations.

But if a stroke or some other neurological damage disables one of the network
components on the dominant side, the corresponding left side component rapidly
and spontaneously emerges from its understudy role, and starts to activate to a
normally high level during language processing.

The rapid recovery of the ability to use language after stroke damage to the
language network was previously attributed to tissue healing functions, like
reduction of swelling in the brain.

Researchers say the new results show that part of the recovery is due to the brain
function reorganisation, a re-balancing of the network, like the cast of a play
adjusting to the loss of a key actor. The adjustment can begin within a day or two
after the stroke, and can continue for many months.
Damage to the frontal lobes can lead to a variety of results:
• Mental flexibility and spontaneity will be impaired, but IQ is not reduced.
72
• Talking may increase or decrease dramatically. Cerebral Lobes and the
Limbic System
• Perceptions regarding risk-taking and rule abiding are impaired.
• Socialisation can diminish or increase.
• Orbital frontal lobe damage can result in peculiar sexual habits.
• Dorsolateral frontal lobe damage reduces sexual interest.
• Creativity is diminished or increased as well as problem solving skills.
• Distraction occurs more frequently.
• Loss of smell and/or taste.
• One of the most common characteristics of frontal lobe damage is difficulty
in interpreting feedback from the environment.
• Perseverating on a response, risk taking, and non compliance with rules
• Impaired associated learning
• The effects of frontal damage can lead to a dramatic change in social
behaviour.
• A person’s personality can undergo significant changes after an injury to the
frontal lobes, especially when both lobes are involved.
• There are some differences in the left versus right frontal lobes in this area.
Left frontal damage usually manifests as pseudo depression and right frontal
damage as pseudo psychopathic.
• An interesting phenomenon of frontal lobe damage is the insignificant effect
it can have on traditional IQ testing. Researchers believe that this may have
to do with IQ tests typically assessing convergent rather than divergent
thinking.
• Frontal lobe damage seems to have an impact on divergent thinking, or
flexibility and problem solving ability.
• There is also evidence showing lingering interference with attention and
memory even after good recovery from a Traumatic Brain Injury (TBI).
• Disturbance of motor function is typically characterised by loss of fine
movements and strength of the arms, hands and fingers.
• Complex chains of motor movement also seem to be controlled by the frontal
lobes.
• Patients with frontal lobe damage exhibit little spontaneous facial expression,
which points to the role of the frontal lobes in facial expression.
• Broca’s Aphasia, or difficulty in speaking, has been associated with frontal
damage by Brown.

• Another area often associated with frontal damage is that of “behavioural

spontaneity.”

73
Basics of the Central Kolb & Milner (1981) found that individual with frontal damage displayed
Nervous System
fewer spontaneous facial movements, spoke fewer words (left frontal lesions)
or excessively (right frontal lesions).

• The frontal lobes are also thought to play a part in our spatial orientation,
including our body’s orientation in space.

• One of the most common Sexual behaviours can also be affected by frontal
lesions. Orbital frontal damage can introduce abnormal sexual behaviour,
while dorolateral lesions may reduce sexual interest.

Self Assessment Questions

1) Discuss with a diagram the lobes of the brain.
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2) Describe the frontal lobe, its location and anatomy.
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3) What are the functions of the different frontal lobes?
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4) What all would happen if the frontal lobe is damaged?
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74
 Cerebral Lobes and the
4.4 THE OCCIPITAL LOBES Limbic System

The occipital lobes are the center of our visual perception system.

The Per striate region of the occipital lobe is involved in visuospatial processing,
discrimination of movement and color discrimination.

The primary visual cortex is called the Brodmann area 17, commonly called V1
(visual one). Human V1 is located on the medial side of the occipital lobe within
the calcarine sulcus.

The full extent of V1 often continues onto the posterior pole of the occipital
lobe.

V1 that is Visual one is often also called striate cortex because it can be identified
by a large stripe of myelin, the Stria of Gennari.

Visually driven regions outside V1 are called extrastriate cortex.

There are many extrastriate regions, and these are specialised for different visual
tasks, such as visuospatial processing, color discrimination and motion perception.

4.4.1 Occipital Lobe Anatomy

The occipital lobes are one of the four main lobes or regions of the cerebral
cortex. They are positioned at the back region of the cerebral cortex and are the
main centers for visual processing. In addition to the occipital lobes, posterior
portions of the parietal lobes and temporal lobes are also involved in visual
perception. Located within the occipital lobes is the primary visual cortex. This
region of the brain receives visual input from the retina. These visual signals are
interpreted in the occipital lobes.

4.4.2 Location of the Occipital Lobe

The occipital lobes are the smallest of four lobes in the human cerebral cortex.
Located in the rearmost portion of the skull, the occipital lobes are part of the
forebrain. It should be noted that the cortical lobes are not defined by any internal
75
Basics of the Central structural features, but rather by the bones of the skull that overlie them. Thus,
Nervous System
the occipital lobe is defined as the part of the cerebral cortex that lies underneath
the occipital bone.

The lobes rest on the tentorium cerebelli, a process of dura mater that separates
the cerebrum from the cerebellum. They are structurally isolated in their respective
cerebral hemispheres by the separation of the cerebral fissure.

At the front edge of the occipital are several lateral occipital gyri, which are
separated by lateral occipital sulcus.

The occipital aspects along the inside face of each hemisphere are divided by the
calcarine sulcus.

Above the medial, Y-shaped sulcus lies the cuneus, This cuneus is also called the
Brodman’s area 17 and the area below the sulcus is the lingual gyrus.

4.4.3 Functions of the Occipital Lobe

The most important functional aspect of the occipital lobe is that it contains the
primary visual cortex.

Retinal sensors convey stimuli through the optic tracts to the lateral geniculate
bodies, where optic radiations continue to the visual cortex.

Each visual cortex receives raw sensory information from the outside half of the
retina on the same side of the head and from the inside half of the retina on the
other side of the head.

The cuneus (Brodman’s area 17) receives visual information from the contralateral
superior retina representing the inferior visual field.

The lingula receives information from the contralateral inferior retina representing
the superior visual field.

The retinal inputs pass through a “way station” in the lateral geniculate nucleus
of the thalamus before projecting to the cortex.

Cells on the posterior aspect of the occipital lobes’ gray matter are arranged as a
spatial map of the retinal field. Functional neuroimaging reveals similar patterns
of response in cortical tissue of the lobes when the retinal fields are exposed to a
strong pattern.

If one occipital lobe is damaged, the result can be homonomous vision loss from
similarly positioned “field cuts” in each eye.

4.4.4 Occipital Lobe Damage and Its Effects

They are not particularly vulnerable to injury because of their location at the
back of the brain, although any significant trauma to the brain could produce
subtle changes to our visual perceptual system, such as visual field defects and
scotomas.

Damage to one side of the occipital lobe causes homonomous loss of vision with
exactly the same “field cut” in both eyes.
76
Disorders of the occipital lobe can cause visual hallucinations and illusions. Cerebral Lobes and the
Limbic System
Lesions in the parietal temporal occipital association area are associated with
color agnosia, movement agnosia, and agraphia.

Visual hallucinations (visual images with no external stimuli) can be caused by

lesions to the occipital region or temporal lobe seizures.

Visual illusions (distorted perceptions) can take the form of objects appearing
larger or smaller than they actually are, objects lacking color or objects having
abnormal coloring.

Lesions in the parietal temporal occipital association area can cause word
blindness with writing impairments (alexia and agraphia).

Self Assessment Questions

1) Describe the occipital lobe and its importance.
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2) Where is occipital lobe located?
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3) Describe the anatomy of the occipital lobe and its functions.
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4) If there is damage to the occipital lobe what functions are affected?
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77
Basics of the Central
Nervous System 4.5 THE PARIETAL LOBE

THE MEDICAL DETAILS

Senator Edward M. kennedy has been diagnosed with a malignant
glioma in his left parietal lobe.
Malignant:
Relatively fast-growing
tumor.

Glioma:
Tumor originating in the
brain. It can spread within
the nervous system, but
not outside.
Left Parietal Lobe:
Region of the brain
registering sensory
perception; involved in
understanding written and
spoken words.
Treatment:
Kennedy’s doctors say that
chemotherapy and radiation are
usual in similar cases, but that the best
options for Kennedy have not yet been
determined. The doctors did not mention surgery.
Some tumor locations preclude surgery.
SOURCES: Mayo Clinic; neurskills.com: Massachusetts General Hospital DAVID BUTLER/GLORE STAFF

4.5.1 Location of Parietal Lobe

The parietal lobes are positioned above (superior to) the occipital lobe and behind
(posterior to) the frontal lobe.
This lobe is divided into two hemispheres left and right.
The left hemisphere plays a more prominent role for right handers and is involved
in symbolic functions in language and maths.
The right hemisphere plays a more prominent role for left handers and is
specialised to carry out images and understanding of maps i.e. spatial relationships.

4.5.2 Anatomy of Parietal Lobe

The parietal lobe is defined by four anatomical boundaries: the central sulcus
separates the parietal lobe from the frontal lobe.
The parieto occipital sulcus separates the parietal and occipital lobes.
The lateral sulcus is the most lateral boundary separating it from the temporal
lobe.
The medial longitudinal fissure divides the two hemispheres.
Immediately posterior to the central sulcus, and the most anterior part of the
parietal lobe, is the postcentral gyrus the primary somatosensory cortical area.
Dividing this and the posterior parietal cortex is the postcentral sulcus.
78
The posterior parietal cortex can be subdivided into the superior parietal lobule Cerebral Lobes and the
Limbic System
and the inferior parietal lobule separated by the intraparietal sulcus (IP).
The intraparietal sulcus (IP) and adjacent gyri are essential in guidance of limb
and eye movement, and based on cytoarchitectural and functional differences is
further divided into medial (MIP), lateral (LIP), ventral (VIP), and anterior (AIP)
areas.

4.5.3 Functions of Parietal Lobe

The parietal lobe can be divided into two functional regions.
• One involves sensation and perception and the other is concerned with
integrating sensory input, primarily with the visual system.
• The first function integrates sensory information to form a single perception
(cognition).
• The parietal lobe plays important roles in integrating sensory information
from various parts of the body, knowledge of numbers and their relations
(Blakemore & Frith (2005) and in the manipulation of objects.
• The second function constructs a spatial coordinate system to represent the
world around us.
• Individuals with damage to the parietal lobes often show striking deficits,
such as abnormalities in body image and spatial relations (Kandel, Schwartz
& Jessel, 1991).
• Portions of the parietal lobe are involved with visuospatial processing.
• Although multisensory in nature, the posterior parietal cortex is often referred
to by vision scientists as the dorsal stream of vision (as opposed to the
ventral stream in the temporal lobe).
• Various studies in the 1990s found that different regions of the posterior
parietal cortex in Macaques represent different parts of space.
• The lateral intraparietal (LIP) contains a map of neurons (retinotopically-
coded when the eyes are fixed representing the saliency of spatial locations,
and attention to these spatial locations.
• It can be used by the oculomotor system for targeting eye movements, when
appropriate.
• The ventral intraparietal (VIP) area receives input from a number of senses
(visual, somatosensory, auditory, and vestibular).
• Neurons with tactile receptive fields represented space in a head-centered
reference frame. The cells with visual receptive fields also fire with head-
centered reference frame but possibly also with eye-centered coordinate.
• The medial intraparietal (MIP) area neurons encode the location of a reach
target in eye-centered coordinates.
• The anterior intraparietal (AIP) area contains neurons responsive to shape,
size, and orientation of objects to be grasped as well as for manipulation of
hands themselves, both to viewed and remembered stimuli.
79
Basics of the Central 4.5.4 Damage to Parietal Lobe and Its Effects
Nervous System
Damage to the left parietal lobe can result in what is called “Gerstmann’s
Syndrome.”
It includes right-left confusion,
difficulty with writing (agraphia) and
difficulty with mathematics (acalculia).
It can also produce disorders of language (aphasia) and the inability to perceive
objects normally (agnosia).

Damage to the right parietal lobe can result in neglecting part of the body or
space (contralateral neglect), which can impair many self-care skills such as
dressing and washing.

Right side damage can also cause difficulty in making things (constructional
apraxia), denial of deficits (anosagnosia) and drawing ability.

Bi lateral damage (large lesions to both sides) can cause “Balint’s Syndrome,” a
visual attention and motor syndrome.

This is characterised by the inability to voluntarily control the gaze (ocular

apraxia), inability to integrate components of a visual scene (simultanagnosia),
and the inability to accurately reach for an object with visual guidance (optic
ataxia) (Westmoreland et al., 1994).

Special deficits (primarily to memory and personality) can occur if there is damage
to the area between the parietal and temporal lobes.

Left parietal temporal lesions can effect verbal memory and the ability to recall
strings of digits (Warrington & Weiskrantz, 1977).

The right parietal-temporal lobe is concerned with non-verbal memory. Right

parietal-temporal lesions can produce significant changes in personality.

Self Assessment Questions

1) Discuss the importance of the parietal lobe.
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2) Where is parietal lobe located?
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 Cerebral Lobes and the
3) Describe the anatomy of the parietal lobe. Limbic System
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4) What are the functions of parietal lobe?
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5) If damage occurs to parietal lobe which behaviours are affected?
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4.6 THE TEMPORAL LOBES

Temporal lobe (pink portion)

4.6.1 Location of Temporal Lobe

The temporal lobes are anterior to the occipital lobes and lateral to the Fissure of
Sylvius.

The temporal lobe is a region of the cerebral cortex that is located beneath the
Sylvian fissure on both cerebral hemispheres of the mammalian brain. 81
Basics of the Central There are two temporal lobes, one on each side of the brain located at about the
Nervous System
level of the ears. These lobes allow a person to tell one smell from another and
one sound from another. They also help in sorting new information and are
believed to be responsible for short-term memory.
Right Lobe - Mainly involved in visual memory (i.e., memory for pictures and
faces).
Left Lobe - Mainly involved in verbal memory (i.e., memory for words and
names).

4.6.2 Anatomy of Temporal Lobe

The superior temporal gyrus includes an area (within the Sylvian fissure) where
auditory signals from the cochlea (relayed via several subcortical nuclei) first
reach the cerebral cortex.
This part of the cortex (primary auditory cortex) is involved in hearing.
Adjacent areas in the superior, posterior and lateral parts of the temporal lobes
are involved in high level auditory processing.
In humans this includes speech, for which the left temporal lobe in particular
seems to be specialised.
Wernicke’s area, which spans the region between temporal and parietal lobes,
plays a key role (in tandem with Broca’s area, which is in the frontal lobe).
The temporal lobe is involved in auditory perception and is home to the primary
auditory cortex.
It is also important for the processing of semantics in both speech and vision.
The temporal lobe contains the hippocampus and plays a key role in the formation
of long-term memory.

4.6.3 The Functions of Temporal Lobe

The left temporal lobe is not limited to low level perception but extend to
comprehension, naming, verbal memory and other language functions.

Blunt trauma to the temporal lobe can result in hair-trigger violent reactions and
increased aggressive responses.

The underside (ventral) part of the temporal cortices appear to be involved in

high-level visual processing of complex stimuli such as faces (fusiform gyrus)
and scenes (parahippocampal gyrus).

Anterior parts of this ventral stream for visual processing are involved in object
perception and recognition.

The medial temporal lobes (near the Sagittal plane that divides left and right
cerebral hemispheres) are thought to be involved in episodic/declarative memory.

Deep inside the medial temporal lobes lie the hippocampi, which are essential
for memory function that is particularly the transference from short to long term
memory and control of spatial memory and behaviour.
82
4.6.4 Temporal Lobe Damage and Its Effects Cerebral Lobes and the
Limbic System
Damage to this area typically results in anterograde amnesia.

Kolb & Wishaw (1990) have identified eight main symptoms of temporal lobe
damage:
1) Disturbance of auditory sensation and perception,
2) Disturbance of selective attention of auditory and visual input,
3) Disorders of visual perception,
4) Impaired organisation and categorisation of verbal material,
5) Disturbance of language comprehension,
6) Impaired long-term memory,
7) Altered personality and affective behaviour,
8) Altered sexual behaviour.
Selective attention to visual or auditory input is common with damage to the
temporal lobes.

Left side lesions result in decreased recall of verbal and visual content, including
speech perception.

Right side lesions result in decreased recognition of tonal sequences and many
musical abilities.

Right side lesions can also effect recognition of visual content (e.g. recall of
faces).

The temporal lobes are involved in the primary organisation of sensory input.

Individuals with temporal lobes lesions have difficulty placing words or pictures
into categories.

Language can be affected by temporal lobe damage. Left temporal lesions disturb
recognition of words.

Right temporal damage can cause a loss of inhibition of talking.

The temporal lobes are highly associated with memory skills.

Left temporal lesions result in impaired memory for verbal material.

Right side lesions result in recall of non-verbal material, such as music and
drawings.

Seizures of the temporal lobe can have dramatic effects on an individual’s

personality.

Temporal lobe epilepsy can cause perseverative speech, paranoia and aggressive
rages (Blumer and Benson, 1975).

Severe damage to the temporal lobes can also alter sexual behaviour (e.g. increase
in activity) (Blumer and Walker, 1975).
83
Basics of the Central
Nervous System Self Assessment Questions
1) Discuss the importance of temporal lobe.
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2) Where is temporal lobe located?
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3) Describe the anatomy of temporal lobe.
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4) What are the functions of temporal lobe?
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84
 Cerebral Lobes and the
4.7 THE LIMBIC SYSTEM Limbic System

The limbic system, essentially alike in all mammals, lies above the brain stem
and under the cortex and consists of a number of interconnected structures. The
limbic system, often referred to as the “emotional brain”, is found buried within
the cerebrum. Like the cerebellum, evolutionarily the structure is rather old.
This system contains the thalamus, hypothalamus, amygdala, and hippocampus.

1) The Thalamus
A large mass of gray matter deeply situated in the forebrain at the topmost
portion of the diencephalon. The structure has sensory and motor functions.
Almost all sensory information enters this structure where neurons send
that information to the overlying cortex. Axons from every sensory system
(except olfaction) synapse here as the last relay site before the information
reaches the cerebral cortex. The thalamus carries messages from the sensory
organs like the eyes, ears, nose, and fingers to the cortex.
2) Hypothalamus
It is a part of the diencephalon, ventral to the thalamus. The structure is
involved in functions including homeostasis, emotion, thirst, hunger,
circadian rhythms, and control of the autonomic nervous system. The
hypothalamus controls the pulse, thirst, appetite, sleep patterns, and other
processes in our bodies that happen automatically. It also controls the pituitary
gland, which makes the hormones that control our growth, metabolism,
digestion, sexual maturity, and response to stress.

3) Hippocampus
It is the portion of the cerebral hemispheres in basal medial part of the
temporal lobe. This part of the brain is important for learning and memory,
for converting short term memory to more permanent memory, and for
recalling spatial relationships in the world about us.

4.8 THE AMYGDALA

Amygdala is located in the temporal lobe is involved in memory, emotion, and
fear. The amygdala is just beneath the surface of the front, medial part of the
temporal lobe where it causes the bulge on the surface called the uncus.
Researchers have linked these structures to hormones, drives, temperature control,
emotion, and one part, the hippocampus to memory formation.
Neurons affecting heart rate and respiration appear concentrated in the
hypothalamus and direct most of the physiological changes that accompany strong
emotion.
Aggressive behaviour is linked to the action of the amygdala, which lies next to
the hippocampus.
The latter plays a crucial role in processing various forms of information as part
of our long term memory.
Damage to the hippocampus will produce global retrograde amnesia, or the
inability to lay down new stores of information. 85
Basics of the Central
Nervous System 4.9 LET US SUM UP
The occipital lobe is the visual processing center of the mammalian brain
containing most of the anatomical region of the visual cortex. The parietal lobe
is a lobe in the brain. It is positioned above (superior to) the occipital lobe and
behind (posterior to) the frontal lobe. The parietal lobe integrates sensory
information from different modalities. The temporal lobe is a region of the cerebral
cortex that is located beneath the Sylvian fissure on both cerebral hemispheres
of the mammalian brain. The temporal lobe is involved in auditory perception
and is home to the primary auditory cortex. The limbic system structures control
behaviour-related signals as well, such as satiety and tranquility (ventromedial
nucleus), fear, punishment (thin zone of the periventricular nuclei and central
gray area of the mesencephalon), and sexual drive (hypothalamus). Some other
limbic areas also control reward and punishment sensations.

4.10 UNIT END QUESTIONS

1) Discuss briefly the structure and anatomy of frontal lobe.
2) Describe the anatomy and functions of occipital lobe.
3) Explain the effects of parietal lobe damage.
4) What is limbic system?
5) Differentiate between thalamus and hypothalamus.
6) Discuss the role of amygdala and hippocampus in human behaviour.

4.11 SUGGESTED READINGS

Mark E. Bear, Barry W. Connors & Michael A.Paradiso (2001) (2nd edition).
Neuroscience. Exploring the Brain. Lippincott Williams & Wilkins, New York.

Restack, Richard (19096). Brainscapes: An Introduction to what Neuroscience

has Learned about the Structure, Function and Abilities of the Brain. Discover
books, NY.

86
 Brain Behaviour
UNIT 1 BRAIN BEHAVIOUR RELATIONSHIP, Relationship, Consiousness
and Mind Brain
CONSCIOUSNESS AND MIND BRAIN Relationship

RELATIONSHIP

Structure
1.0 Introduction
1.1 Objectives
1.2 Brain-Behaviour Relationship
1.2.1 The Brain, Master Organ of the Body
1.2.2 Divisions of the Brain
1.2.3 Brain Structure
1.3 Mind-Brain Relationship
1.3.1 The Relationship between Mind and Brain: The Main Positions
1.3.2 Behaviourism
1.3.3 Identity Theory
1.3.4 Functionalism
1.3.5 Eliminative Instrumentalism
1.3.6 Consciousness and the Brain Process
1.3.7 Selection of Behaviours
1.4 Consciousness
1.4.1 The Neural Basis of Consciousness
1.5 Let Us Sum Up
1.6 Unit End Questions
1.7 Suggested Readings
1.8 Answers to Self Assessment Questions
“From the brain and the brain alone arise our pleasures, joys, laughter and jests,
as well as our sorrows, pains and grief’s” -Hippocrates

1.0 INTRODUCTION
In this unit we will be dealing with the brain behaviour relationship, the
consciousness and the mind brain relationship. Then we present brain behaviour
relationship in which we describe the brain as the master organ of the body.
Provide the divisions of the brain and present the brain structure. Then we discuss
the mind and brain relationship within which we deal with the relationship
between mind and body, behaviourism, identity theory, functionalism and
eliminative instrumentalism. We then deal with consciousness and the brain
processes. The next section deals with consciousness as such and presents the
neural basis of consciousness.

1.1 OBJECTIVES
After completing this unit, you will be able to:
• Explain the relationship between brain and behaviour;
5
Neurobiology and • Describe the different parts of the brain and the divisions of the brain;
Behaviour
• Explain the relationship between brain and behaviour;
• Elucidate the mind brain relationship;
• Analyse the relationship between mind and body;
• Explain how behaviourism is able to deal with mind brain relationship;
• Elucidate the identity theory and functionalism from the mind brain
relationship point of view;
• Describe eliminative instrumentalism; and
• Define consciousness and explain the neural basis of consciousness.

1.2 BRAIN-BEHAVIOUR RELATIONSHIP

Brain is a thinking organ that learns and grows by interacting with the world
through perception and action. Mental stimulation improves brain function and
actually protects against cognitive decline.

Step back a half-billion years ago, to when the first nerve cells developed. The
original need for a nervous system was to coordinate movement, so an organism
could go find food, instead of waiting for the food to come to it. Jellyfish and sea
anemone, the first animals to create nerve cells, had a tremendous advantage
over the sponges that waited brainlessly for dinner to arrive.

After millions of generations of experimentation, nervous systems evolved some

amazing ways of going out to eat. But behind all the myriad forms of life today,
the primary directive remains. In fact, a diminished ability to move is a good
measure of aging. Inflexibility heralds death, while a flexible body and fluid
mind are the hallmarks of youth.
Elastic comes from the Greek word for “drive” or “propulsion.” It is the tendency
of a material to return to its original shape after being stretched. Elasticity is the
basic animal drive that powers your muscles, giving you strength and balance –
flexibility, mobility, and grace.
Plastic derives from the Greek word meaning “molded” or “formed.” It is the
tendency of the brain to shape itself according to experience. Plasticity is the
basic mental drive that networks your brain, giving you cognition and memory,
fluidity, versatility, and adaptability.
Before birth you created neurons, the brain cells that communicate with each
other, at the rate of 15 million per hour! When you emerged into the world, your
100 billion neurons were primed to organise themselves in response to your new
environment, no matter what your culture, climate, language, or lifestyle was.
During infancy, billions of these extraordinary cells intertwined into the vast
networks that integrated your nervous system. By the time you were four or five
years old, your fundamental cerebral architecture was complete.
Until your early teens, various windows of opportunity opened when you could
most easily learn language and writing, math and music, as well as the coordinated
movements used in sports and dance. But, at any age you can and should continue
to build your brain and expand your mind.
6
Throughout life, your neural networks reorganise and reinforce themselves in Brain Behaviour
Relationship, Consiousness
response to new stimuli and learning experiences. This body mind interaction is and Mind Brain
what stimulates brain cells to grow and connect with each other in complex Relationship
ways. They do so by extending branches of intricate nerve fibers called dendrites
(from the Latin word for “tree”). These are the antennas through which neurons
receive communication from each other.

A healthy, well-functioning neuron can be directly linked to tens of thousands of

other neurons, creating a totality of more than a hundred trillion connections,
each capable of performing 200 calculations per second! This is the structural
basis of your brain’s memory capacity and thinking ability.

As a product of its environment, your “three pound universe” is essentially an

internal map that reflects your external world. The human brain is able to
continually adapt and rewire itself and is responsible for all our behaviours,
from breathing to eating to being conscious to being alive. If it ceases to exist we
will cease to exist.

1.2.1 The Brain, Master Organ of the Body

The brain is the master organ of the body. From our eyes, ears, nose, and skin,
the brain receives messages that tell us what is going on in the world about us.
The brain also receives a steady stream of signals from other body organs that
enables it to control the life processes.

The brain stores information from past experiences. This is why we can learn,
remember, and think. The brain selects and combines messages from the senses
with memories and emotions to form various thoughts and reactions.

The brain is a greatly expanded bulb at the upper end of the spinal cord. It consists
mainly of neurons, or nerve cells; supporting cells, and blood vessels. The nerve
cells carry out the brain’s functions. Each of the billions of tiny neurons consists
of a cell body and a number of fibers. These fibers connect the cell body with
other cell bodies. The brain is not a single organ; it has many parts with special
functions, though they are all connected.

Messages to the brain all pass through the brain stem. From the brain stem, they
go to different parts of the brain for ‘processing.’ Messages go out through the
grain stem to control the muscles and glands of the body.

The brain is vital to our existence. It controls our voluntary movements, and it
regulates involuntary activities such as breathing and heartbeat. The brain serves
as the seat of human consciousness: it stores our memories, enables us to feel
emotions, and gives us our personalities. In short, the brain dictates the behaviours
that allow us to survive and makes us who we are. Scientists have worked for
many years to unravel the complex workings of the brain. Their research efforts
have greatly improved our understanding of brain function.

1.2.2 Divisions of the Brain

The brain has three main divisions: (1) the forebrain, (2) the midbrain, and (3)
the hindbrain. Each division has many parts with special functions.

7
Neurobiology and
Behaviour Central Nervous
System

Brain Spinal Cord

Forebrain Midbrain Hindbrain

Telencephalon Diencephalon Mesencephalon Metencephalon Myelencephalon

Cerebral Cerebellum Medulla

Thalamus Tectum
Cortex

Basal Hypothalamus Tegmentum Pons

Ganqlia

Amygdala

Hippocampus

1.2.3 Brain Structure

The human brain consists of three major divisions; hindbrain, midbrain, and
forebrain
Hindbrain – structures in the top part of the spinal cord, controls basic biological
functions that keep us alive.
Midbrain – between the hind and forebrain, coordinates simple movements with
sensory information.
Forebrain – controls what we think of as thought and reason.
Major Division Subdivision Structures
Prosencephalon Telencephalon Neocortex; Basal Ganglia; Amygdala;
(Forebrain) Hippocampus; Lateral Ventricles
Diencephalon Thalamus; Hypothalamus;
Epithalamus; Third Ventricle
Mesencephalon Mesencephalon Tectum; Tegmentum; Cerebral
(Midbrain) Aqueduct
Rhombencephalon Metencephalon Cerebellum; Pons; Fourth Ventricle
(Hindbrain) Myelencephalon Medulla Oblongata; Fourth Ventricle
8
Diagram showing major divisions of the Brain Brain Behaviour
Relationship, Consiousness
and Mind Brain
Relationship

Telencephalon Diencephalon Mesencephalon

Metencephalon Myelencephalon

Forebrain: Found in the area of the forehead, this part of the brain is concerned
with all the emotions, planning, organising, reasoning, memory, movement,
speech, recognition of auditory stimuli, visual processing, etc. It also deals with
our imaginative abilities, creativity, judgments, opinions, etc. The forebrain can
be again divided into three parts called the cerebrum, thalamus, and hypothalamus
(part of the limbic system).

Cerebral Cortex/Cerebrum: The cerebrum or the cortex is the large part of the
brain and is associated with the cognitive functions of the brain, such as thinking
and action. So next time you find people moving into doldrums, ask them to get
their cerebrum moving. This cerebrum can again be divided into four sections or
lobes called:

Lobes of the cortex

The frontal lobe is located at the front of the brain and is associated with
reasoning, motor skills, higher level cognition, and expressive language. At the
back of the frontal lobe, near the central sulcus, lies the motor cortex. This area
of the brain receives information from various lobes of the brain and utilises this
information to carry out body movements.

The parietal lobe is located in the middle section of the brain and is associated
with processing tactile sensory information such as pressure, touch, and pain. A
portion of the brain known as the somatosensory cortex is located in this lobe
and is essential to the processing of the body’s senses.

The temporal lobe is located on the bottom section of the brain. This lobe is
also the location of the primary auditory cortex, which is important for interpreting
sounds and the language we hear. The hippocampus is also located in the temporal
9
Neurobiology and lobe, which is why this portion of the brain is also heavily associated with the
Behaviour
formation of memories.
The occipital lobe is located at the back portion of the brain and is associated
with interpreting visual stimuli and information. The primary visual cortex, which
receives and interprets information from the retinas of the eyes, is located in the
occipital lobe.
These four units together form the cerebrum. Now, a deep furrow is present
which divides the brain into two symmetrical halves, called the left and right
hemispheres or brain. These two hemispheres are connected and their functions
differ slightly. The right hemisphere is seen to be associated with creativity, while
the left brain is seen to deal with logical thinking. We often end up using our
logical thinking side of the brain, however, fail to use the creative part of the
brain as we grow into adults.
Thalamus and Hypothalamus: The thalamus is situated in the forebrain at the
uppermost part of the diencephalon (posterior part of the forebrain). It’s an
important part of the brain as all the sensory information we gather enters into
this part, which is then sent via neurons into the cortex. All sensory inputs to the
brain, except that of the sense of smell, are through the thalamus. The
hypothalamus lies ventral to the thalamus and is a part of the diencephalon. It
deals with the function of homeostasis (metabolic equilibrium), thirst, hunger,
emotions, control of autonomic nervous system and the pituitary gland. The
hypothalamus is involved with the body’s vital drives and activities, such as
eating, drinking, temperature regulation, sleep, emotional behaviour, and sexual
activity. It controls the functions of many internal body organs and helps
coordinate activities of the brain stem.
Midbrain: Also known as the mesencephalon, this part is located behind the
frontal lobes and in the center of the entire brain. It deals with functions such as
hearing, vision, body and eye movements. The midbrain can be divided into
three parts called the tectum, tegmentum and cerebral peduncles. The midbrain
is the smallest region of the brain that acts as a sort of relay station for auditory
and visual information. The midbrain controls many important functions such
as the visual and auditory systems as well as eye movement. Portions of the
midbrain called the red nucleus and the substantia nigra are involved in the
control of body movement. The darkly pigmented substantia nigra contains a
large number of dopamine-producing neurons. The degeneration of neurons in
the substantia nigra is associated with Parkinson’s disease.
Hindbrain: This is the posterior part of the brain, and is composed of cerebellum,
pons and medulla. Often the midbrain, pons and medullas are together referred
to as brain stem. The hindbrain is located toward the rear and lower portion of a
person’s brain. It is responsible for controlling a number of important body
functions and process, including respiration and heart rate. The brain stem is an
important part of the hindbrain, controlling functions that are critical to life,
such as breathing and swallowing. The cerebellum is also part of the hindbrain,
playing a role in physical ability.
Cerebellum: The cerebellum forms the posterior part of the brain, just below
the cerebrum. However, as compared to the cerebrum, its far smaller; 1/8 the
size of the cerebellum. Small as it may seem, it performs crucial functions like
balance, movement, co-ordinating muscle movements, etc. It’s the cerebellum
10
that helps us maintain our balance, move around. The very fact that we can enjoy Brain Behaviour
Relationship, Consiousness
all kinds of sport like surfing, skiing, etc. we realise how important this part is. and Mind Brain
Without the cerebellum, we can say goodbye to even walking. Relationship

Pons and Medulla: Pons and medulla along with the midbrain form the brain
stem. This partnering act takes control of involuntary muscle movements in the
body. For example, muscles of the heart and stomach work irrespective of our
desire for them to function. Their movement is not in our control, but is controlled
by the brain stem. While running or performing vigorous exercises, it’s the brain
stem that directs the heart to pump more blood. After a meal, it’s the brain stem
that directs the stomach to digest the food. The pons and medulla also perform
the crucial role of connecting the brain to the spinal cord, thus transform thoughts
into actions.
Self Assessment Questions
1) Fill in the blanks:
Mental stimulation .................. brain function and actually ................
against cognitive decline.
The brain cells that communicate with each other, at the rate of ................
per hour.
Brain is also known as ................................. Pound Universe.
The brain is ............................... to our existence.
The brain has three main divisions: (1) .............., (2) .......................,
and (3) ..........................................
The cerebellum forms the ............................. part of the brain, just below
the cerebrum.
Cerebral Cortex is divided into ............................., ..........................,
........................................ and ............................................
Midbrain is also known as ................................................................
Hindbrain is composed of .................................., ............................, and
........................................................................
Brain stem is responsible for .........................................................
2) “The brain is the master organ of the body” Justify this statement
3) Match the following
i) Frontal lobe a) Pons and cerebellum
ii) Cerebellum b) Connects both hemisphere
iii) Thalamus c) Balance and body control
iv) Hypothalamus d) Reasoning and judgement
v) Temporal lobe e) Controls basic biological functions
vi) Corpus callosum f) Gathers sensory information
vii) Hind brain g) Maintains Homeostasis
viii) Occipital lobe h) Creativity
ix) Metecephalon i) Visual processing
x) Right Brain j) Memory
11
Neurobiology and
Behaviour 1.3 MIND-BRAIN RELATIONSHIP
1.3.1 The Relationship between Mind and Brain: The Main
Positions
In modern times, before the 20th century, the most popular interpretation of the
mind-brain relationship was some version of dualism. It claims that mind is
essentially non-physical. The brain is the place where this nonphysical reality
interacts with physical reality. The reason why you cannot “see” the mind when
you inspect the brain is that the methods of inspection are adapted to the
observation of material phenomena, and not to the observation of immaterial
phenomena like e.g. thoughts. So what you can inspect using the methods of the
natural sciences, is at most the correlates of consciousness, not the conscious
itself.

In the 20th century, a series of materialist, or physicalist, alternatives to dualism

have been developed. The main positions are (philosophical) behaviourism, the
identity theory, functionalism and eliminativism.

1.3.2 Behaviourism
According to (philosophical) behaviourism the mind is simply the behaviour, or
dispositions for behaviour, that an organism exhibits. The brain is not the mind,
but the mechanism that enables mind – i.e. the underlying mechanism that enables
the complex behaviour which is the mind. And the reason why you cannot observe
mind by simply observing the brain is not that mind is something immaterial.
The reason is that you are so to speak looking in the wrong place – at the
mechanism that makes mind possible, not at mind (the behaviour) itself.

1.3.3 Identity Theory

A frequent objection to behaviourism is that we think of mind not as the behaviour
itself but as what causes and regulates behaviour. And what causes and regulates
behaviour are brain states; so mental states are brain states according to the (neural)
identity theory. This mind-brain identity must be accepted as a kind of scientific
truth, comparable to e.g. the identity of light and electromagnetic waves. So the
states that you inspect when you inspect the brain are (some of them) mental
states – it is only that you will not recognise them as mental states until you have
developed the right ‘theoretical spectacles’.

1.3.4 Functionalism
An objection to the identity theory is that mental phenomena, e.g. pain, can be
realised in the brain in many different ways, depending on what kind of organism
we are talking bout. According to functionalism, mind is not brain states, but
something more abstract – namely the functional states the brain can be in.
Anything (e.g. a complex robot, or an extraterrestrial being) with inner states
that performed the right functions would have a mind, even if it did not have a
biological brain. In functionalism the relationship between brain and mind is
often compared to the relationship between hardware and software. And the
reasons why you cannot observe mind by just observing brain processes, is that
you are not focusing on a sufficiently abstract level – you are like an engineer
who does not understand a computer because he only sees the electronic hardware
12
and not the software (i.e. the set of programmed functions) that runs on this Brain Behaviour
Relationship, Consiousness
hardware. and Mind Brain
Relationship
1.3.5 Eliminative Instrumentalism
What is common to behaviourism, identity-theory and functionalism is a belief
that mental phenomena are real phenomena that can, in the end, be described in
terms taken from the natural sciences (including biology) – either as behaviour,
or neural states, or functional states. Eliminativism maintains that this is not the
case – our common sense conception of mind is a theory of mind (“folk
psychology”) that is basically wrong, so that nothing corresponds to mental
phenomena “in the real world”. A correct theory will only refer to brain states
and behaviour, not mind. Mind is at most a useful fiction (instrumentalism); and
the reasons why you cannot observe the mind by observing the brain, are simply
that the mind does not exist – there is no mind to observe.

None of the theories mentioned above have been generally accepted among
philosophers working on the mind-brain relationship. Many look on themselves
as some kind of materialists (or “physicalists”). Few are fully-fledged dualists,
but elements of such a position can also be found in contemporary philosophy –
notably the following two points:

1.3.6 Consciousness and the Brain Process

Consciousness cannot be completely reduced to brain processes, and the study
of it requires (in addition to methods found in the natural sciences) some special
methods – a special kind of self-observation (introspection, or “phenomenological
descriptions”) and perhaps some kind of interpretation of behaviour (similar to
the interpretation of texts).

The answer may also depend on how we conceive the relationship between mind
and brain.

Traditionally philosophers have thought of the relationship between mind and

matter either in terms of identity (‘the mind is nothing but brain states and/or
behaviour’) or in terms of causality (‘mind is different from brain states, but
somehow caused by brain states’). Lately it has been proposed that it would be
better to think of the relationship as a kind of supervenience-relationship. Mental
states supervene on brain states if it is impossible to have a change of mental
states without some change in brain states. Or conversely: Complete similarity
in brain states entails complete similarity in mental states. Such a relationship
implies that the mental is a kind of function of the brain even if it should prove
impossible to formulate exact causal laws for how mind depends on the brain.

It has also been pointed out that individual mental events (e.g. the pain that I feel
just now) can be identical with individual brain events (e.g. the firing in C-fibres
going on just now) without the properties of mental events necessarily being
identical with neurological properties. The first type of identity is called “token
identity” while the latter is called “type identity”. If this view is accepted one can
for example say that the pain I feel is in fact token-identical with some brain
event, while it has properties (e.g. ‘being a throbbing pain’) which cannot be
identified with neurological properties (though they probably supervene on such
properties). Such a view often called non-reductive physicalism, and may be
considered a kind of compromise between a physicalist and a dualist position. 13
Neurobiology and Donald Hebb and others have argued that the central question in neuropsychology
Behaviour
is the relation between the mind and the brain. The question is easy to ask, yet it
is not so easy to grasp what it is that we need to explain. One needed explanation
is how we select information on which to act.

1.3.7 Selection of Behaviours

Animals such as simple worms have a limited sensory capacity and an equally
limited repertoire of behaviours. Animals such as dogs have a much more
sophisticated sensory capacity and a corresponding increase in behavioural
options. Primates, including humans, have even further developed sensory
capacity and behavioural complexity.

Thus, as sensory and motor capacities increase, so does the problem of selection
both of information and of behaviour. Furthermore, as the brain expands, memory
increases, providing an internal variable in both stimulus interpretation and
response selection. Finally, as the number of sensory channels increases, the
need to correlate the different inputs to produce a single “reality” arises.

One way to consider these evolutionary changes is to posit that, as the brain
expands to increase sensorimotor capacity, so does some other process (or
processes) having a role in sensory and motor selection. One proposed process
for selective awareness and response to stimuli is attention.

The concept of attention implies that somehow we focus a “mental spotlight” on

certain sensory inputs, motor programs, memories, or internal representations.
This spotlight might be unconscious, in that we are not aware of the process, or
it might be conscious, such as when we scan our memories for someone’s name.
The development of language should increase the likelihood of conscious
attention, but it is unlikely that all conscious processing is verbal. One can
speculate, for example, that the “Eureka” insight of Archimedes entailed conscious
processing that was more than just verbal.

The point is that, as sensorimotor capacities expand, so do the processes of

attention and consciousness. In broad terms, consciousness is, at a primary level,
synonymous with awareness and, at a secondary level, with awareness of
awareness. The clear implication is that consciousness is not a dichotomous
phenomenon; rather, a gradual evolutionary increase in consciousness is correlated
with the ability to organise sensory and motor capacities. The most evolved
organiser is language, which implies an increased capacity for the processes of
attention.

1.4 CONSCIOUSNESS
Conscious experience is probably the most familiar mental process that we know,
yet its workings remain mysterious. Everyone has a vague idea of what is meant
by being conscious, but consciousness is easier to identify than to define.

Definitions of consciousness range from the view that it merely refers to complex
thought processes to the more slippery implication that it is the subjective
experience of awareness or of “inner self.” Nonetheless, there is general agreement
that whatever conscious experience is, it is a process.
14
One of the first modern theories of consciousness was proposed by Descartes. Brain Behaviour
Relationship, Consiousness
He proposed that being able to remember past events and being able to speak and Mind Brain
were the primary abilities that enabled consciousness. But think if we encounter Relationship
people who have lost the ability to remember and have lost the ability to speak.
We may not describe them as no longer being conscious. In fact, consciousness
is probably not a single process but a collection of many processes, such as those
associated with seeing, talking, thinking, emotion, and so on.

Consciousness is also not always the same. A person at different ages of life is
not thought to be equally conscious at each age; young children and demented
adults are usually not considered to experience the same type of consciousness
as healthy adults do. Indeed, part of the process of maturation is becoming fully
conscious. And consciousness varies across the span of a day as we pass through
various states of sleep and waking.

Most definitions of consciousness exclude the conditions of simply being

responsive to sensory stimulation or simply being able to produce movement.

Thus, animals whose behaviour is simply reflexive are not conscious. Similarly,
the isolated spinal cord, although a repository for many reflexes, is not conscious.

Machines that are responsive to sensory events and are capable of complex
movements are not conscious. Many of the functions of normal humans, such as
the beating of the heart, are not conscious processes. Similarly, many processes
of the nervous system, including simple sensory processes and motor actions,
are not conscious. Consciousness requires processes that differ from all of the
aforementioned.

Some people have argued that certain processes are much more important for
consciousness than others. Language is often argued to be essential to
consciousness because language makes a fundamental change in the nature of
human consciousness. Gazzaniga (2004) suggest that language acts as an
interpreter, which he felt led to an important difference between the functions of
the hemispheres. People who are aphasic are not considered to have lost conscious
awareness, however; nor are people who have their right hemispheres removed.
Famous patient H. M., has a dense amnesia, yet he is quite conscious and can
engage in intelligent conversations. In sum, although language may alter the
nature of our conscious experience, it seems unlikely that any one brain structure
can be equated with consciousness. Rather, it makes more sense to view
consciousness as a product of all cortical areas, their connections, and their
cognitive operations.

1.4.1 The Neural Basis of Consciousness

As stated earlier, consciousness must be a function of numerous interacting
systems, presumably including sensory areas, memory structures, and perhaps
structures underlying other processes such as emotion and executive functions.
The problem for a theory of the neural basis of consciousness is to explain how
all these systems can be integrated.
Most investigators agree that at least four processes must take part:
1) Arousal, the waking up of the brain by nonspecific modulatory systems
2) Perception, the detection and binding of sensory features
15
Neurobiology and 3) Attention, the selection of a restricted sample of all available information
Behaviour
4) Working memory, the short-term storage of ongoing events
Engel and Singer (2001) propose that all these processes either require or modify
the operation of an overall binding process and that binding is implemented by
the transient and precise synchronisation of neural discharges in diffuse neural
networks. The general idea is that neurons that represent the same object or
event fire their action potentials in a temporal synchrony with a precision of
milliseconds. No such synchronisation should take place between cells that are
part of different cellular networks. Recall that the idea of synchrony was proposed
earlier as a mechanism of attention. Taken further, it is proposed that without
attention to an input there is no awareness of it.

Consciousness, a property of complex brains, binds diverse aspects of sensory

information into a single event that we experience as reality.

Self Assessment Questions

1) Fill in the blanks:
i) According to ............................. the mind is simply the behaviour,
or dispositions for behaviour, that an organism exhibits.
ii) Mental states are brain states according to the .................... theory.
iii) According to .................................., mind is not brain states, but
something more abstract – namely the functional states the brain
can be in.
iv) ................................. says that the mind does not exist – there is no
mind to observe.
2) Give details of the four processes must take part in consciousness
process:
i) Arousal, .......................................................................................
ii) Perception, ..................................................................................
iii) Attention, ....................................................................................
iv) Working memory, ........................................................................
3) Explain how would you conceptualise mind brain relationship?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

1.5 LET US SUM UP

Brain, Mind and Consciousness, the connection between these three still eludes
most researchers. The researches are contributing heavily to make some more
sense out of these connections. Though, these researches are at its infancy stage.
There is still requirement of more information in these areas to come to a concrete
16
conclusion as to how these connections can be best explained. But that certainty Brain Behaviour
Relationship, Consiousness
is possible only in future with wider information bank. and Mind Brain
Relationship
1.6 UNIT END QUESTIONS
1) Why is our brain also known as “three pound universe”?
2) Give major subdivision of brain with the help of a diagram?
3) “Brain is vital to our existence” justify this statement.
4) Cerebral Cortex is divided into 4 lobes, name these lobes and give their
functions?
5) How and why hypothalamus is responsible for our functioning?
6) What is forebrain and what are its functions?
7) What are the sub parts of brain stem and what is the function of brain stem?
8) Explain all the four main positions of mind-brain relationship?
9) Explain the processes that contribute to consciousness.
10) Explain briefly the neural connection of consciousness.

1.7 SUGGESTED READINGS

Block, N. 2002. Concepts of Consciousness. In Chalmers 2002
Carlson, N.R. 6th ed., 2005. Foundations of Physiological Psychology, Pearson
Education Inc: India
Gazzaniga, M.S. ed. 2004. The Cognitive Neurosciences III. Cambridge, Mass.:
MIT Press.
References
Chalmers, D.J. (ed.) 2002. Philosophy of Mind. Oxford: Oxford University Press
Chalmers, D. J. 1996. The Conscious Mind. Oxford: Oxford University Press.
Descartes, R. 1641/1996. Meditations on First Philosophy. J. Cottingham, trans.-
ed. Cambridge, England: Cambridge University Press.
Engel, A., and Singer, W. 2001. Temporal binding and the neural correlates of
sensory awareness. Trends Cogn. Sci. 5, 16–25.
Gazaaniga, M. S. 1984. Handbook of Cognitive Neuroscience, Plenum Press:
NY

1.8 ANSWERS TO SELF ASSESSMENT

QUESTIONS
1) Fill in the blanks
Improves, protect against
15 millions
17
Neurobiology and Three
Behaviour
Vital
The forebrain, the midbrain, the hindbrain
Posterior
Frontal lobe, Parietal lobe, Occipital lobe, and Temporal lobe
Mesencephalon
Cerebellum, pons and medulla
Control of involuntary muscle movements in the body
2) Match the Following
1) d, 2)C, 3) f, 4) g, 5) j, 6) b, 7) e, 8) i, 9) a, 10) h.
3) Fill in the blanks
i) (philosophical) behaviourism
ii) (neural) identity
iii) functionalism
iv) Eliminativism
4) Give details of the four processes must take part in consciousness process:
i) Arousal, the waking up of the brain by nonspecific modulatory systems
ii) Perception, the detection and binding of sensory features
iii) Attention, the selection of a restricted sample of all available information
iv) Working memory, the short-term storage of ongoing events

18
 Brain Behaviour
UNIT 2 CONSCIOUSNESS AND NEURO Relationship, Consiousness
and Mind Brain
CHEMICAL PROCESS AND HIGHER Relationship

CEREBRAL FUNCTIONS

Structure
2.0 Introduction
2.1 Objectives
2.2 Consciousness
2.2.1 Definition of Consciousness
2.2.2 Types of Consciousness
2.2.3 Functions of Consciousness
2.2.4 Neurochemistry of Consciousness
2.2.5 Sleep
2.3 Neurochemical Process
2.3.1 Acetylcholine
2.3.2 Noradrenaline
2.3.3 Serotonin
2.3.4 Dopamine
2.3.5 Histamine
2.3.6 Adenosine
2.3.7 Neurotensin
2.4 Neurons
2.4.1 Neurotransmission
2.4.2 Neurotransmitters
2.4.3 Biogenic Amines
2.4.4 Amino Acids
2.4.5 Peptide
2.5 Neurochemical Process and Higher Cerebral Functions
2.5.1 Attention
2.5.2 Neurochemistry of Attention
2.5.3 Memory
2.5.4 Long term Potentiation (LTP)
2.6 Let Us Sum Up
2.7 Unit End Questions
2.8 Suggested Readings
2.9 Answers to Self Assessment Questions

2.0 INTRODUCTION
This unit deals with consciousness, neurochemical process and higher mental
functions. We start with Consciousness, define consciousness, types of consciousness
and functions of consciousness. Then we take up the neurochemistry of
consciousness, followed by sleep and its effect on the consciousness. Then we
deal with the neurochemical processes in which we consider acetylcholine,
noradrenalin, serotonin etc. This is followed by a discussion on neurons and
19
Neurobiology and how these connect to each other through synapse. We then present the
Behaviour
neurotransmitters, biogenic amines, amino acides and peptides. Then we discuss
the neurochemical process and higher cerebral functions which takes into account
attention, neurochemistry of attention, memory and long term potentiation.

2.1 OBJECTIVES
After completing this unit, you will be able to:
• Define Consciousness;
• Elucidate the types of consciousness;
• Explain the functions of consciousness;
• Analyse the Neurochemical processes;
• Explain the structure and functions of neurons;
• Describe the role of neurotransmitters, biogenic amines and peptides;
• Relate neurochemical process with higher cerebral functions; and
• Neurochemical process and higher cerebral functions such as attention,
memory etc.

2.2 CONSCIOUSNESS
The importance of the brain in our everyday lives can never be underestimated.
The brain has physical properties that are in a constant state of flux. The brain
never rests totally but is always teeming with electrochemical activity. All
cognitive functions such as consciousness, attention, memory, thinking, the use
of language and many more are reflection of the modulated pattern of chemical
activity among specialised cells i.e. neuron , that are mostly concentrated in the
brain’s cerebral cortex. We owe our entire cognitive universe to the functioning
of these neurons which transmits information in the form of electrical waves.

2.2.1 Definition of Consciousness

Consciousness is a phenomenon that is shared by nearly all people. It cannot be
directly seen or touched. Yet it is real enough to most people. It is the fundamental
state that denotes the being as alive and gives the body the necessary information
about the world outside it and about the body itself. It covers cognitive functions
such as attention, sensory experiences, memory and states such as being awake
or dreaming.
Several definitions of Consciousness have been proposed by different authors:
Consciousness consists of all the sensations, perceptions, memories and feelings
you are aware of at any instance (Farthing, 1992).
Consciousness is the awareness of environmental and cognitive events such as
sights and sounds of the world as well as of one’s memories, thoughts, feelings
and bodily sensations. By this definition consciousness has two sides:
Consciousness includes a realisation of environmental stimuli. For example one
might become mindful of an old tune, a headache, or visual recognition of an old
friend.
20
Consciousness also includes once cognisance of mental events – thoughts that Consciousness and Neuro
Chemical Process and
results from memories Higher Cerebral Functions

Consciousness is a psychological construct – a concept i.e. devised to help us

understand our observations or behaviours. The construct of consciousness has
several meanings.
Consciousness as sensory awareness: our sense organs (Eyes, ears, nose etc.)
enable us become aware of the environment.
Consciousness as inner state: We are conscious of thoughts, images, emotions
and memories within ourselves though they may not have physical occurrence
of these aspects.
Consciousness as the waking state: consciousness is also referred to as the waking
state as opposed for example to sleep.
All the above definitions highlight that Consciousness overall constitutes
subjective experience i.e. awareness, the ability to experience feelings and
wakefulness means having a sense of selfhood.
Consciousness can be defined as the immediate knowledge or perception of the
presence of any object, state, or sensation. It is the feeling, persuasion, or
expectation, especially inward sense of guilt or innocence. It actually refers to
the state of being conscious. It is the knowledge of one’s own existence, condition,
sensations, mental operations, acts, etc.

2.2.2 Types of Consciousness

There are two types of consciousness, (i) Individual consciousness (ii) Collective
or Universal consciousness. Let us take up the individual consciousness. Every
individual human being needs consciousness for a happy life. Clear consciousness
forms as a power of consciousness and it can do everything.

The physical brain is not a source of experience as some current neuroscientists

now mistakenly believe. While areas of the brain are associated with different
consciousness functions, many neuroscientists do admit that they cannot locate
emotions, mind, and soul in the brain. They cannot also fully explain the human
psyche with neuroanatomy. The physical brain is a relay station, translating
emotional, mental, and spiritual events and information into neuro electrochemical
events and information.

Neurochemicals and associated brain processes are simply channel selectors for
various states of consciousness. All states of consciousness exist independent of
the physical body. This relay station works in both directions, that is spiritual,
mental, or emotional states trigger neuro electrochemical events in the brain
(physical consciousness) and neurochemical stimulation, for example through
drugs etc., open access to specific states of emotion, thought, or spiritual
awareness. Contemporary physics has proven very clearly that solid physical
matter is an illusion and that all is energy only. Therefore, to say that the solid
physical brain is the mind, is a mistake. While the brain appears to be solid, it is
not. Actually it is the energy appearing solid, but is not solid. It is energy, only.
The mind is also energy, an energy that interacts with the energy that creates the
appearance of a brain.
21
Neurobiology and The physical body is composed of the energy states of solids, liquids, and gases
Behaviour
and is dependent upon the etheric body for its vitality, life, organisation, and
many processes that result in health.

2.2.3 Functions of Consciousness

Consciousness allows individuals to be aware of his/her surrounding, thereby
defining the context and removing ambiguities. There are quite a few functions
of consciousness and these are given below:
1) Simplification and Selection of information: There is much “editing” that
goes on in the mind—from the first cuts as the senses to those of perception,
memory, and thinking—but still there is far too much information available
at once, so there needs to be a choice in what the organism does at any
moment. It is in consciousness that the choice is made.
2) Guiding and overseeing actions: Consciousness connects brain and body
states with external occurrences. In order to function in a complex
environment, actions must be planned, guided and organised: We must know
when and where to walk; when to speak and what to say; when to eat, drink,
eliminate, and sleep. These actions must be coordinated with events in the
outside world. At any moment the content of consciousness is what we are
prepared to act on next.
3) Setting priorities for action: It is not enough for our actions to be
coordinated with events in the outside world; they must reflect our internal
needs. Pain can flood consciousness in the same way that an emergency
fills the front page of a newspaper. The priority system gives certain events,
those affecting survival, fast access or a controlling influence on
consciousness. Survival and safety come first; while hunger will not intrude
as dramatically as does pain, the need will be felt if left unattended.
4) Detecting and resolving discrepancies: Since the information selected to
enter consciousness is usually about changes in the external and internal
worlds, when there is a discrepancy between our stored knowledge about
the world and an event, it is more likely to come to consciousness. For
instance, a woman in a bikini would probably not attract too much attention
on the beach, but if she wore the same outfit to a formal dinner it would
certainly be noticed. Discrepancies may arise internally as well. For instance,
you are usually not conscious of your breathing. However, when you have a
cold your breathing may enter your consciousness, and this may tell you to
slow down or to see a doctor. Consciousness involves actions to reduce the
discrepancy, as when you straighten out a crooked painting on the wall
because it does not fit with the other paintings.
Other functions include the following:
5) Adaptation and learning function: Adaptation to novel experiences
requires more conscious involvement, for successful learning and problem
solving.
6) Reflective and Self Monitoring Function: Through conscious inner speech
and imagery one can reflect upon and to some extent control one self’s
conscious and unconscious functioning.
22
7) Error Detection and Editing Function: Consciousness helps us avoid Consciousness and Neuro
Chemical Process and
acting solely through habit. It allows us to make novel responses to familiar Higher Cerebral Functions
situations and to use prior knowledge to respond appropriately to novel
situations.
8) Decision-making: Consciousness helps us to make rational decisions instead
of relying on emotional responses.

2.2.4 Neurochemistry of Consciousness

Conscious experience is probably the most familiar mental process that we know,
yet its workings remain mysterious. Consciousness is not directly accessible for
study. Hence the neurochemistry of consciousness is studied by examining the
neurochemical correlates of well recognised natural states and alterations of
consciousness. These include natural functions such as sleep and dreaming,
attention, memory, etc. Altered states constitutes changes induced by drugs and
by pathological states such as dementia, psychotic states etc.

In the present context neuro chemical process of consciousness will be explained

by examining the neurotransmitters involved in waking state through various
stages of sleep.

2.2.5 Sleep
Sleep involves a global alteration of brain functioning, and occupies one third
of our lives, The transition from waking to sleep is one of the most dramatic
natural alterations in consciousness. Sleep is differentiated from waking state by
reduction in neuronal responsiveness, inattention to sensory stimuli, and loss of
consciousness. These two states differ fundamentally in most physiological
parameters including the activity of a variety of key neurotransmitter systems.

Sleep Structure: Electroencephalogram (EEG) recordings reveal the two most

basic states of sleep - REM (Rapid Eye Movement) sleep and NREM sleep.
NREM comprises of four stages (Stages1 to 4). EEG pattern of wakeful state
and different stages of sleep is explained further.

Active wakefulness: It is accompanied by low amplitude, high frequency beta

waves. In relaxed wakefulness with eyes closed, the brain emits alpha waves.
Alpha waves are low amplitude brain waves of about 8 to 13 cycles per second.

NREM (non-rapid-eye-movement) SLEEP

Stage 1 sleep: As an individual becomes drowsy, and enters stage 1, alpha wave
decreases and theta waves appear. Theta waves with a frequency of about 6 to 8
cycles per second are accompanied by slow rolling eye movements. Stage 1 is
the lightest stage of sleep. After 30 to 40 minutes of stage 1 sleep one undergoes
a rather steep descent into stages 2, 3 and 4.
Stage 2 sleep: In stage 2 sleep is composed of largely theta background, and is
characterised by:
Sleep spindles: regular spindle shaped waves of 13-15 cycles/sec with waxing
and waning amplitude
K-complexes- high voltage spikes present intermittently. Stage 2 occupies about
50% of sleep.
23
Neurobiology and Stages 3 and 4, Slow wave sleep (SWS): During deep sleep stages 3 and 4,
Behaviour
brain produces slow delta waves. In stage 3 delta waves have a frequency of 1 to
3 cycles per second.

Stage 4 sleep: The deepest stage of sleep, shows predominant delta activity with
frequency of 0.5 to 2 cycles per second and highest amplitude. Slow wave sleep
usually lasts for 70–90 minutes and takes place during the first hours of sleep.

REM (rapid-eye-movement) SLEEP

After deep stage 4 sleep, comes REM sleep. It derives its name from the rapid
eye movements; observable beneath the closed eyelids.REM sleep is characterised
by rapid, low amplitude brain waves similar to that of light stage 1 sleep. REM
sleep is associated with dream.

2.3 NEUROCHEMICAL PROCESS

Alertness and sleep are dependent on the activity of the brain as a whole, although
different levels of consciousness are determined primarily by areas of the brain
stem. A key anatomical structure in the regulation of waking and sleeping, (and
thus consciousness), is the reticular formation, located in the brain stem. It is a
highly complex interlacing network of fiber bundles.
Neuro chemically, there is a great diversity of neurotransmitters present: serotonin,
mainly from the mid-line raphe nuclei; noradrenaline from the locus coeruleus;
acetylcholine from pedunculopontine nuclei with also peptidergic and
dopaminergic components.
The alterations in the activity of these neurotransmitters either triggers or
accompany the onset of natural sleep and distinguish slow wave or non-REM
from REM sleep thus providing one of the most compelling arguments in favour
of chemical neurotransmission being specifically involved in mechanisms of
conscious awareness.
Pharmacological manipulations of these neurotransmitters provide evidence for
the role of neuro chemical processes in consciousness. In this context it is
important to understand that there are two categories of drugs used to vary the
level of neurotransmitters.

Antagonist (drugs that decreases the level of neurotransmitters)

Agonist (drugs that increases the level of neurotransmitters)

2.3.1 Acetylcholine (Ach)

Cholinergic mechanisms are important in wakefulness and cortical activation.
In general, increased acetylcholine is associated with wakefulness and REM sleep
and decreased level of acetylcholine promotes sleep and non-REM sleep
phenomena.

2.3.2 Noradrenaline
Increased level of noradrenalin is implicated in wakefulness. Locus coeruleus
noradrenergic neurons decrease their rate of firing at sleep onset. Drugs that
diminish noradrenergic neurotransmission tend to cause sedation, while the
reverse is the case for drugs that potentiate noradrenergic function.
24
2.3.3 Serotonin Consciousness and Neuro
Chemical Process and
Serotonin complements the action of noradrenalin and acetylcholine in promoting Higher Cerebral Functions
wakefulness and cortical responsiveness. Experiments provide evidence that the
level of serotonin during waking is higher in most cortical and subcortical areas
than during sleep.

The seretonergic neurons in the raphe nuclei show the highest firing rate during
waking decrease their firing rate during slow wave sleep.

2.3.4 Dopamine
An increase in dopamine activity produces an increase in wakefulness.
Dopaminergic neurons in the ventral tegmental areas are constantly active
throughout the various stages of sleep, including SWS or non-REM.
D-amphetamine, methylphenidate, high doses of L-dopa and cocaine, which
predominantly enhance dopamine activity, induce arousal and decrease REM
sleep.

2.3.5 Histamine
Histamine is involved in controlling the level of consciousness during waking.
The level of histamine diminishes during sleep and its antagonists induce sleep
and impair daytime vigilance

2.3.6 Adenosine
The adenosine plays a major role in inducing sleep. Injections of adenosine
promote sleep and decrease wakefulness. Conversely, adenosine receptor
antagonists’ caffeine and theophylline are widely used as stimulants to induce
vigilance and promote wakefulness.

During wakefulness adenosine accumulates in the extracellular space of the basal

forebrain. The increase in extracellular adenosine concentration decreases the
activity of the wakefulness-promoting cholinergic neurons in the basal forebrain.
When the activity of the wakefulness-active cells decreases sufficiently sleep is
initiated. During sleep the extracellular adenosine concentrations decrease, and
thus the inhibition of the wakefulness-active cells also decreases allowing the
initiation of a new wakefulness period.

2.3.7 Neurotensin
Although little is known about the role of this peptide during the sleep-wake
cycle, it has recently been shown that neurotensin injections in the basal forebrain
decreases slow wave sleep and increases REM sleep.

Therefore it can be concluded that several neurotransmitters are involved in the

modulation of the sleep-wake cycle. In particular the elevation in adenosine levels
and concomitant reduction in cholinergic, serotonergic, noradrenergic and
histaminergic neurotransmission appear to be specifically related to the sudden
loss or major reduction in conscious awareness that occurs at the onset of sleep.

25
Neurobiology and
Behaviour Self Assessment Questions
Match the Following:
1) Neurotensin a) Beta waves
2) Stage 1sleep b) Promotes wakefulness
3) Altered states of consciousness c) Sensations, perceptions,
memories and feelings you are
aware of at any instance
4) Increased level of acetylcholine d) Theta waves
5) Awake e) Dreaming
6) Consciousness f) Increases REM sleep
7) Decreased Histamine g) Pathological states such as
dementia, psychotic states
8) REM sleep h) Induces sleep

2.4 NEURONS
Information is constantly exchanged between the brain and other parts of the
body through both electrical and chemical impulses. Cells called neurons are
responsible for carrying these impulses. A neuron has three main parts. The cell
body directs all the neuron’s activities. Dendrites, short branches that extend out
from the cell body, receive messages from other neurons and pass them on to the
cell body. An axon is a long fibre that transmits messages from the cell body to
the dendrites of other neurons or to other tissues in the body, such as muscles. A
protective covering, called the myelin sheath, covers the axons of many neurons.
Myelin insulates the axons and helps messages from nerve signals travel faster,
farther, and more efficiently.

2.4.1 Neurotransmission
The exchange of information between the axon of one neuron and the dendrites
of another neuron is called neurotransmission. Neurotransmission takes place
26 through the release of chemicals into the space between the axon of the first
neuron and the dendrites of the second neuron. These chemicals are called Consciousness and Neuro
Chemical Process and
neurotransmitters. The space between the axon and the dendrite is called a Higher Cerebral Functions
synapse.

When neurons communicate, an electrical impulse travels down the axon and
causes neurotransmitters to be released from the end of the axon into the synapse.
The neurotransmitters cross the synapse and bind to special molecules, called
receptors, on the dendrite of the second neuron. Receptors are found on the
dendrites and cell bodies of all neurons. The neurotransmitters bind to receptors
in the same way as a key fits into a lock i.e. a specific neurotransmitter binds
only to its corresponding receptor. The receptors convert the information into
chemical or electrical signals which are then transmitted to the cell body and
eventually to the axon. The axon then carries the signal to another neuron or to
body tissues such as muscles.

Once a neurotransmitter binds to a receptor, a series of events follow. First, the

message carried by the neurotransmitter is passed on to the receiving neuron.
Second, the neurotransmitter is inactivated. It is either broken down by an enzyme
or reabsorbed by the axon from which it was released. Other molecules, called
transporter molecules, complete this reabsorption process. These molecules are
located in the cell membranes of the axon that releases the neurotransmitters.
They pick up specific neurotransmitters from the synapse and carry them back
across the cell membrane and into the axon, where they are recycled for use at a
later time.

2.4.2 Neurotransmitters
There are different types of neurotransmitters found in brain. Each
neurotransmitter has a specific role to play in the functioning of the brain.
Cognitive functions rely on neurotransmitter processes to coordinate what signals
are sent between the different areas of the brain. As already discussed above
neurotransmitters are chemicals manufactured by nerve cells and are released
whenever a nerve cell is stimulated. Neurotransmitter messages can be generalised
as either excitatory or inhibitory messages. An excitatory neurotransmitter is
one that increases the activity of neurons, and an inhibitory neurotransmitter
decreases the activity of neurons.
27
Neurobiology and The three principal neurotransmitters systems found in the brain are:
Behaviour
Biogenic amines
The biogenic amines are the best understood neurotransmitters because they were
the first to be discovered and constitute the neurotransmitter substance in only a
small percentage of neurons. Biogenic amines include dopamine, epinephrine,
norepinephrine, serotonin, acetylcholine, and Histamine

Amino acids
Amino acids were discovered later and are present in 70% of neurons.
Gamaaminobutyric acid (GABA) and Glutamate are examples of aminoacids.

Peptides
The peptide neurotransmitters are intermediate in terms of the percentage of
neurons that contain such neurotransmitter.
Brief description of each neurotransmitter is given below:

2.4.3 Biogenic Amines

Acetylcholine
Acetylcholine is found in many parts of the brain having particularly high
concentrations in the cerebral cortex, limbic system, basal, forebrain,
hypothalamus and thalamus.

Receptors
The two major types of cholinergic receptors are muscarinic and nicotinic.

Dopamine
Dopaminergic neurons occur in two closely connected groups: Ventral tegmental
area (VTA) of the midbrain and Substantia nigra,(in medial region of the
midbrain). While substantia nigra neurons project to the striatum, VTA neurons
serves to most areas of cerebral cortex and limbic system.

Receptors
At least five types of Dopamine receptors, D1 to D5 are known to exist. D1 and
D2 are evenly distributed in the straitum. D2 receptors also occur throughout
the cerebral cortex particularly temporal lobe. D3 receptors are concentrated in
the limbic portion, and in hippocampus.

Norepinephrine and Epinephrine

The major concentration of noradrenergic (and adrenergic) cell bodies is found
in locus ceruleus a nucleus in the reticular formation. The axons of these neurons
project through the medial forebrain to the cerebral cortex, the limbic system the
thalamus and the hypothalamus.

Receptors
The two broad groups of adrenergic and noradrenergic receptors are á-adrenergic
receptors and â-adrenergic receptors. The á-adrenergic receptors are further
subdivided into two types á1, á 2 and â-adrenergic receptors are subdivided into
â1 â2 and â3 . The â1 subtype predominates in the cerebral cortex and â2 in the
28 cerebellum.
Serotonin Consciousness and Neuro
Chemical Process and
The major site of serotonergic cell bodies is in upper pons and the midbrain, Higher Cerebral Functions
specifically the median and dorsal raphe nuclei and to a lesser extent in caudal
locus ceruleus . These neurons serve to the basal ganglia, limbic system and
cerebral cortex.

Receptors
Seven types of serotonin receptors have been recognised: 5-HT1 through 5-HT7
receptors with numerous subtypes, totaling 14 distinct receptors. 5HT1A receptors
are widely distributed, concentrated in limbic areas (e.g., hippocampus and
amygdala), in the cerebral cortex and also in raphé nuclei. Basal ganglia and
hippocampus have 5HT1B receptors, and the 5HT1D receptor subtype is also
evident in basal ganglia. 5HT2 or 5HT2A receptors are concentrated in cerebral
cortex. 5HT3 receptors are present at low densities in cortex with highest densities
in medulla and spinal cord.

Histamine
A fifth member of the monoamine transmitter group is histamine. That release
histamine as their neurotransmitter is located in the hypothalamus and project
to cerebral cortex, limbic system and thalamus.

Receptors
There are three types of histamine receptors. H1 receptors occur throughout the
CNS with particularly high densities in the thalamus and hippocampus H2
receptors are concentrated in the striatum, hippocampus and thalamus and H3
receptors in cortex, hippocampus and amygdala.

2.4.4 Amino Acids

GABA (Gamaaminobutyric acid)
GABA is the principal inhibitory transmitter in the brain. The concentration of
GABA is up to 1000 times greater than that of other transmitters like acetylcholine
or dopamine. Neurons containing GABA are relatively small, and widely
distributed, especially in regions—cerebral cortex, striatum, hypothalamus,
septum and thalamus.

Receptors
There are two types of GABA receptors: GABAA and GABAB.

Glutamate
It is the principal excitatory transmitter in the brain and is found throughout the
central nervous system.

Receptors
Glutamate receptors include NMDA (N-methyl-D-aspartate) and AMPA
(amino3hydroxy-5-methyl-4-isoxazole proprionic acid) subtypes which are
concentrated in cortex and striatum, and the kainate subtype.

29
Neurobiology and 2.4.5 Peptide
Behaviour
There are as many as 300 peptide neurotransmitters found in the brain. Peptide
is a short protein consisting of fewer than 100 amino acids. Examples of peptides
are somatostatin, neuropeptide Y, galanin, substance P, neurotensin, vasopressin
adenosine etc. Peptide implicated in consciousness is discussed below.

Adenosine
Adenosine has four different receptor subtypes (A1, A2A, A2B and A3).
Adenosine A2A receptors are concentrated in striatum. Adenosine receptor
modulation is one of the most important modulatory mechanisms of altering the
level of consciousness.

Neurotensin
Neurons containing neurotensin (NT) are concentrated in the hypothalamus,
striatum, amygdala. Receptors are localised in basal forebrain cholinergic neurons,
dopaminergic nuclei and hypothalamus.

Self Assessment Questions

1) An excitatory neurotransmitter ......................... the activity of neurons.
2) The space between the axon and the dendrites is called ....................
3) ........................... is the principal inhibitory transmitter in the brain.
4) The three parts of a neuron are ...................., ........................, and
................................................................
5) The two receptors of Acetylcholine neurotransmitter is .......................,
....................................................................
6) The axon of a neuron is covered by ...................................................
7) The two amino acids are ...........................and,....................................

2.5 NEUROCHEMICAL PROCESS AND HIGHER

CEREBRAL FUNCTIONS
As discussed above consciousness is a combination of multiple higher cerebral
functions. The knowledge of the neuro chemical processes involved in these
functions also contributes to the understanding of consciousness. Two of the
most important higher cerebral activities i.e. attention and memory is discussed
below.

2.5.1 Attention
Attention can be defined as “the concentration of mental effort on sensory or
mental events.

There are three types of attention selective attention, sustained attention and
divided attention.

Selective or Focused attention refers to the capacity to perform a task in the

presence of distracting stimuli. The capacity to listen to conversation at a railway
station, identify a friend in crowd.
30
Sustained attention requires ‘holding’ attention over relatively long periods of Consciousness and Neuro
Chemical Process and
time. The capacity to study or the capacity to listen to a lecture for an extended Higher Cerebral Functions
length of time is an example of sustained attention.

Divided attention refers to the ability to perform or attend to two or more tasks
simultaneously. The concept of divided attention explains dual tasking, wherein
two tasks require effort and attention. For example a subject may be presented
with stimuli which vary with respect to color and motion and monitor changes
in both the dimensions.

2.5.2 Neurochemistry of Attention

Different neurotransmitters systems are implicated in attention. Cholinergic,
dopaminergic and serotonergic systems play major roles in neurochemical
machinery of attention.

Acetylcholine: More than any other neurotransmitter, acetylcholine has been

implicated in attentional processes. Blockage of Muscarinic receptors by a drug
scopolamine (antagonist) results in impaired performance on a number of task
measuring sustained attention. On the other hand Nicotine (agonist) administration
improves task performance on the measures of sustained attention. Lesions of
the basal forebrain cholinergic system result in impaired attentional function in
rats and monkeys. Therefore it seems that increased level of acetylcholine is
important for sustained attention.

Dopamine: Dopamine plays a pivotal role in aspects of shifting attention.

Administration of D1/D2 receptor antagonist haloperidol impairs the ability to
shift attention from one aspect to another aspect of a task. Thus increased level
of dopamine is required to enhance the ability of shifting attention.

Seretonin: Low level of serotonin is implicated in the improved performance

on tasks assessing focussed attention.

2.5.3 Memory
Memory is the retention of information over time.
Stages or Process of Memory: There are three stages of memory
Encoding process: It is the process of receiving sensory input and transforming
it into a form or code, which can be stored.
Storage: It is the process of actually putting coded information into memory.
There are three systems of memory storage
Sensory memory: It holds information from the external world in its original
sensory form for fraction of a second to few seconds. Information is quickly lost
if not transferred into short term or long term memory.
Short-term memory: It is a limited capacity memory system in which
information is retained for only as long as 30 seconds unless strategies are used
to retain it longer.
Long-term memory: It is a relatively permanent type of memory that stores
huge amount of information for a long time. Long-term memory is further divided
into explicit and implicit memory.
31
Neurobiology and Explicit memory: This is the conscious recollection of information such as
Behaviour
specific facts or events and at least in humans that can be verbally communicated.
There are two subtypes of explicit memory.
Episodic memory: It is the retention of information about the where and when
of life’s happening.
Semantic Memory: Semantic means meanings. It is a person’s knowledge about
the world. It includes general knowledge, knowledge about meanings of words
famous individuals, important places etc.
Implicit memory: It is related to unconsciously remembering skills and
perceptions rather than consciously remembering facts. Examples include skills
of driving a car or typing. Once learnt the individuals do not have to remember
consciously how to drive a car or type. The subsystems of implicit memory are:
Procedural memory involves memory for skills.
Classical conditioning: It implies automatic learning of associations between
stimuli. A small child may develop fear of dogs if the dog approaches the child
and barks on him repeatedly.
Working Memory: It has often been suggested that memory does not always
work in three stage sequence and the model of memory system comprising of
sensory, short-term and long-term memory is too simplistic.
Therefore another concept has been introduced by Alan Baddeley i.e. Working
Memory.
It is a system that temporarily holds information as people perform cognitive
tasks. It is a kind of mental workbench on which information in manipulated and
assembled to help us comprehend language, make decisions and solve problems.
It is an active memory system.
Retrieval: This is the process of gaining access to stored, coded information
when it is needed.
Neurochemistry of Memory: Memory is the result of certain neural mechanism
and biochemical responses in the brain following sensory input. First the neural
mechanism will be discussed followed with the role of various neurotransmitters.

2.5.4 Long Term Potentiation (LTP)

It is a neural mechanism that plays a role in encoding of new information.
Encoding takes place as a result of changes in the strength of synapses among
neurons in neuronal networks that process and store information. This change
occurs when one or more axons connected to some dendrite bombard it with a
brief but rapid series of stimuli-such as 100 synaptic excitations per second for
1to 4 seconds. The burst of intense stimulation leaves the synapses potentiated
(more responsive to new input of the same type) for minutes, days or weeks.
This phenomenon is termed as long term potentiation. It occurs in many brain
areas and is particularly prominent in hippocampus.

The chemicals involved in LTP are glutamate and its receptors – NMDA and
AMPA. A wide variety of drugs that interfere with LTP also blocks encoding
process whereas drugs that facilitate LTP enhance the process.
32
Acetylcholine Consciousness and Neuro
Chemical Process and
Acetylcholine, a well known neurotransmitter, plays a critical synaptic role in Higher Cerebral Functions
the initial formation of memory. Chemical blockage of the acetylcholine receptors
makes it harder to learn and remember even in healthy young people. Evidence
for it comes from pharmacological studies conducted on human subjects wherein
blockage of muscarinic cholinergic receptors by drugs such as scopolamine
impaired the encoding of new memories. Conversely, drugs which activated
nicotinic receptors enhanced the encoding of new information.

Similarly administration of scopolamine into the hippocampus impaired encoding

of spatial memory. It has also been found that administration of drug that increases
the level of acetylcholine in Alzheimer’s disease (characterised of memory
problems) improves memory by inhibiting the action of acetyl cholinesterase, an
enzyme that breaks down acetylcholine and reduces its amount.

Overall it can be said that decreased acetylcholine in the brain cause problems
with memory function.

Serotonin
Increased level of serotonin is implicated in the enhancement of memory. It plays
a significant role in classical conditioning wherein stimuli are paired repeatedly,
by increasing the efficiency of neural transmission at certain synapses. It has
been also found that a chemical lesion in the raphe nuclei containing large
concentration of serotonin leads to memory problem.

Adrenaline and Noradrenaline

Both these neurotransmitter strengthen memory when they are released into the
blood stream following learning. Stressful events stimulate release of stress
hormones from the adrenal glands-adrenaline and steroids-which in turn stimulate
amygdala (a structure in limbic system) to release noradrenaline. These hormones
and neurotransmitters acting together heighten memory for stressful events.

Dopamine
Dopamine is important for working memory and drug that increases the level of
dopamine in the brain or facilities the action of dopamine, enhances working
memory capabilities.Dopamine helps to maintain the ongoing information in
the face of interference by signaling when the information in working memory
should be updated. It is suggested that anatomy of the dopamine system is such
that dopamine-producing cells have a strong connection to the prefrontal cortex–
the brain region that is considered most important for protecting maintained
information from distraction.

Self Assessment Questions

Put True or False to the following statements:
1) Decreased acetylcholine improves memory functioning. ( )
2) Noradrenalin plays role in emotional memory. ( )
3) Scopolamine is a drug that increases acetylcholine. ( )
4) Increased level of Serotonin enhances focused attention. ( )

33
Neurobiology and
Behaviour 5) Nicotinic receptor improves memory. ( )
6) In long-term potentiation axons bombard dendrite with a
brief but rapid series of stimuli. ( )
7) Implicit memory involves unconscious processing. ( )
8) Glutamate is involved in Long term potentiation of synapses. ( )
9) Selective attention requires holding of attention over relatively
long periods of time. ( )
10) Working memory is a permanent storage of information. ( )

2.6 LET US SUM UP

In this unit you have read all about the Cells called neurons that are responsible
for carrying electrochemical impulses. A neuron comprises of a cell body,
dendrites, and axon. The exchange of information between the axon of one neuron
and the dendrites of another neuronon is called neurotransmission and it takes
place through the release of chemicals called neurotransmitters.

Neurotransmitters cross the synapse and bind to special molecules, called

receptors and thereafter they are inactivated.

The three principal neurotransmitters systems found in the brain are biogenic
amines, amino acids and peptides.

Consciousness overall constitutes subjective experience i.e. awareness, the ability

to experience feelings and wakefulness means having a sense of selfhood.

Functions of Consciousness includes defining context, adaptation and learning

function, reflective and self monitoring function, error detection and editing
function, decision-making.

Since consciousness is not directly accessible for study, the neurochemistry of

consciousness is studied by examining the neurochemical correlates of its natural
and altered states.

In the present context neurochemical process of consciousness has been explained

by examining the neurotransmitters involved in waking state through various
stages of sleep.

Neurotransmitters implicated are elevated levels of cholinergic, serotonergic,

noradrenergic, dopaminergic and histaminergic neurotransmission contribute to
waking state and increased adenosine induces sleep.

Since consciousness covers multiple higher cerebral function. The two most
important discussed here are attentional process and memory.

Attention is “the concentration of mental effort on sensory or mental events and

its subtypes are selective attention, sustained attention and divided attention.

Increased level of acetylcholine and dopamine is implicated in sustained attention

and shifting of attention whereas low level of serotonin is implicated in focused
attention.
34
Memory is the retention of information over time and comprises of three stages Consciousness and Neuro
Chemical Process and
encoding process, storage and retrieval. Subtypes of memory include sensory Higher Cerebral Functions
memory, short-term memory and long-term memory.

In biochemical process of memory glutamate is implicated in long term

potentiation (LTP), increased levels of acetylcholine and plays a critical synaptic
role in the encoding of memory.

Increased level of serotonin is implicated in classical conditioning. Adrenaline

and Noradrenaline plays role in memory for stressful events whereas increased
level of Dopamine is important for working memory.

2.7 UNIT END QUESTIONS

1) What is a neuron? Explain with the help of a diagram the different parts of
a neuron.
2) What are different types of biogenic amines? Briefly describe the areas in
the brain where the amino acids are mainly found along with the receptors.
3) Define consciousness and its functions.
4) Briefly describe the biochemical mechanism of consciousness.
5) Define attention and its subtypes. Briefly discuss the neurochemicals
implicated in attentional processes.

2.8 SUGGESTED READINGS

Kalat, J.W. (2001). Biological Psychology. Thomson Learning. Canada.

Levinthal, C.F. (1990). Introduction to Physiological Psychology. Pearson

Education. New jersy, U.S.A.

Perry, E., Ashton. H., & Young, A. (2001) Neurochemistry of Consciousness

John Benjamins Publishing Company, Amsterdam, Philadelphia

Santrock, J.W. (2006). Psychology Essentials. Tata McGraw Hill, New Delhi

Solso, R. L. (2001). Cognitive Psychology. Dorling Kindersley Pvt. Ltd. India

2.9 ANSWERS TO SELF ASSESSMENT

QUESTIONS
Fill in the Blanks

1) Increase, 2) Synapse, 3) GABA, 4) Cell body, axon, and dendrites.

5) Muscarinic and Nicotinic, 6) Myelin seath, 7) GABA andGlutamate.

Match the Following: 1f, 2d, 3g, 4b,5a, 6c, 7h, 8e.

True or False

1) F, 2) T, 3) F, 4) F ,5) T, 6) T , 7) T, 8) T, 9) F, 10) F.

35
Neurobiology and
Behaviour UNIT 3 NEUROBIOLOGICAL AND
NEUROPSYCHOLOGICAL
ASPECTS IN THE DEVELOPMENT
OF MEMORY, EMOTION AND
CONSCIOUSNESS

Structure
3.0 Introduction
3.1 Objectives
3.2 Memory
3.3 Neurobiological and Neuropsychological Aspects of Memory
3.3.1 Neurobiology of Short Term Memory
3.3.2 Neurobiology of Long Term Memory
3.3.3 Neural Substrates of Implicit Memory
3.3.4 Neural Substrates of Explicit Memory
3.3.5 Neural Substrates of Emotional Memory
3.4 Anatomy of the Hippocampus
3.4.1 The Perirhinal Cortex
3.4.2 The Temporal Cortex
3.4.3 Parietal and Occipital Cortex
3.4.4 Frontal Cortex
3.5 Emotion
3.5.1 Nature of Emotions
3.5.2 Anatomy of Emotion
3.5.3 Cortical Connections of Emotion
3.5.4 Frontal Lesions and Emotion
3.5.5 Brain Circuits for Emotion
3.6 Neuropsychological Theories of Emotion
3.6.1 Somatic Marker Hypothesis
3.6.2 Cognitive Emotion Interaction
3.6.3 Cognitive Asymmetry and Emotion
3.6.4 Cognitive Control of Emotion
3.7 Consciousness
3.7.1 Neurobiology and Neuropsychology of Consciousness
3.7.2 Involvement of Cerebral Regions in Consciousness
3.8 Let Us Sum Up
3.9 Unit End Questions
3.10 Suggested Readings

3.0 INTRODUCTION
Memory is generally defined as the processes of encoding, storing and retrieving
information. During the 1960’s, a number of models that attempted to explain
the workings and interactions of memory processes and systems were proposed
36 by experts in the field. One model proposed by Atkinson and Shiffrin (1968) has
been nicknamed the “Modal Memory Model” because it was typical of others Neurobiological and
Neuropsychological Aspects
and was probably one of the most influential (Baddeley, 1998). Memory is thought in the Development of
to begin with the encoding or converting of information into a form that can be Memory, Emotion and
stored by the brain. However, the term emotion refers to positive or negative Consciousness
feelings that are produced by particular situations. For example being treated
unfairly makes us unhappy, seeing someone suffer makes us sad, and being closed
to loved one make us feel happy. This further raise the question that does emotion
help us in remembering? How are our emotions connected to our thoughts?
How is our brain connected to our mind, our body, and ultimately, our
consciousness? These are the some question we will be discussing in this section
and will be attempting to explain the neurobiological association of different
parts of the brain in over all functioning of memory, emotion and consciousness.

3.1 OBJECTIVES
After completing this unit, you will be able to:
• Define the concept and meaning of memory, emotion and consciousness;
• Describe nature and associated features of memory, emotion and
consciousness; and
• Differentiate the neurobiological and neuropsychological aspects of memory,
emotion and consciousness.

3.2 MEMORY
Memory is the process by which we encode, store and retrieve the information.
The information is initially recorded in a form usable to memory is known as
encoding. The maintenance of material saved in the memory system is storage,
and the material in memory storage is located, brought in to awareness, and used
is known as retrieval.

The processes of encoding, storing and retrieving the information are necessary
for memory to operate successfully. Many psychologists studying memory suggest
that there are different systems or stages through which information must travel
if it is to be remembered. According to enduring theories, the two major
classification of memory are the short term memory and the long term memory.
Refer to the diagram below.

Memory

Short-Term (Working) Memory Long-Term Memory

Explicit Implicit
(Consicous) (Unconsicous)

Priming Procedural Memory

Episodic Memory Semantic Memory
(specific personal events (General knowledge
and their context) about the world)
37
Neurobiology and i) Short-term memory: Short-term memory is the work bench of our
Behaviour
consciousness, and includes our awareness of the sensations, feelings and
thoughts that are experienced. Closely related to “working memory”, short
term memory is like a receptionist for the brain. As one of two main memory
types, short-term memory is responsible for storing information temporarily
and determining if it will be dismissed or transferred on to long-term memory.
Although it sounds complicated, this process takes for short-term memory
less than a minute to complete.

ii) Long -term memory systems: Long-term memory refers to the continuing
storage of information. It may last from a minute or so to weeks or even
years. From long term memory you can recall general information about the
world that you learned on previous occasions, memory for specific past
experiences, specific rules previously learned, and the like. In Freudian
psychology, long-term memory would be to recall the preconscious and
unconscious material within the mind. This information is largely outside
of our awareness, but can be called into working memory to be used when
needed. Long term memory has no limit to capacity and can store vast
amounts of information.
Long term memories are of three types:
i) implicit memory
ii) explicit memory and
iii) emotional memory
These are supported by three pathways in the brain. We recall implicit memories
of skills, conditioned reactions and events unconsciously or on prompting.
However, we can spontaneously and consciously recall explicit memories for
events and facts. Emotional memory refers to the affective properties of stimuli
or events and is generally vivid. It has aspects of both conscious and unconscious
long term memory. All these three memories are distinguished by differences in
the way in which the information is processed.

Implicit memory is unconscious, non intentional memory. Your abilities to use

language and to perform motor skills such as riding a bicycle or playing a sport
are implicit memories. It depends simply on receiving the sensory information
and does not require any manipulation by higher level.

Explicit memory is the conscious intentional remembering of fact based on

semantic memories (2+2 = 4) and personal experiences, or episodic memories
(What you did last night).

Explicit memory depends on conceptually driven, or top down, processing, in

which a subject reorganises the data to store it.

Emotional Memory is arousing, vivid, and available on prompting. Thus, like

implicit memory, it relies on bottom up processing.

Emotional memory likewise has the intentional, top down element of explicit
memory in that the internal cues that we use in processing emotional events and
it can also be used to initiate their spontaneous recall.

38
 Neurobiological and
Self Assessment Questions Neuropsychological Aspects
in the Development of
1) Discuss the neurobiological and neuropsychological aspects of memory. Memory, Emotion and
Consciousness
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2) What are the neurobiological aspects of short term memory?
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3) Elucidate the neurobiology of long term memory.
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4) What are the three types of long term memory? Discuss the three
pathways.
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5) Discuss the neural Substrates of Implicit Memory. Explicit memory
and emotional memory.
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39
Neurobiology and
Behaviour 3.3 NEUROBIOLOGICAL AND
NEUROPSYCHOLOGICAL ASPECTS OF
MEMORY
The first evidence that the temporal lobe might play a role in human memory
came to light by the case of H. M. in 1900, when Vladimir Bekhterev autopsied
the brain of a patient who had shown severe memory impairment. He discovered
the impact of bilateral softening in the region of the medial temporal cortex on
human behaviours. Brenda Milner and her coworkers in the 1950s not only
confirmed the role of the temporal lobe in memory but also indicated the special
contribution of different structures within the temporal lobes to different kinds
of memory.

Temporal Lobe

Brainstem

3.3.1 Neurobiology of Short Term Memory

In 1890, William James drew a distinction between memories that endure for a
very brief time and for longer term. Not until 1958, however, there was any
separate short term and long term memories. In 1958, this was specifically
postulated by Donald Broadbent. According to Broadbent, Short term memory,
sometimes also called the working memory or temporal memory refers to a neural
record for recent events and their order. It is the system that we use for holding
sensory events, movements, and cognitive information such as digits, words,
names or other items for a brief period. Short term memory is mediated by different
regions in the cerebral cortex such as temporal lobe, some specific areas of frontal
lobe, and motor cortex. The detail discussions of these are given below.

i) Short Term Memory and Temporal Lobe: Warrington and her colleagues
describe a patient, who received a left posterior temporal lesion. The lesion
resulted in an almost total inability to repeat verbal stimuli such as digits,
letters, words and sentences. In contrast, his long term recall of paired
associates words or short stories was nearly normal. Warrington and her
40
 colleagues also found that some patients apparently have defects in short Neurobiological and
Neuropsychological Aspects
term recall of the same stimuli presented auditorily. Short term memory in the Development of
deficits can also result from damage to the polymodal sensory areas of the Memory, Emotion and
posterior parietal cortex and the posterior temporal cortex. Consciousness

ii) Short Term Memory and Frontal Lobe: Damage to the frontal cortex is
the recognised cause of many impairments of short term memory for tasks
in which subjects must remember the temporary location of stimuli. The
tasks themselves may be rather simple given this cue, make that response
after a delay. But as one trial follows another, both animals and people with
frontal lobe lesions start to mix up the previously presented stimuli.

L. Prisko devised a “compound stimulus” task in which two stimuli in the same
sensory modality are presented in succession, separated by a short interval. A
subjects’ task is to report whether the second stimulus of the pair is identical
with the first. In half the trials, the stimuli were the same in the other trials, they
were different. Thus, the task required the subject to remember the first stimulus
of a pair in order to compare it with the second while suppressing the stimuli that
had been presented in previous trials.

3.3.2 Neurobiology of Long Term Memory

There is no single entity in the mind called memory and no single brain structure
or process which can be labeled the seat of memory (Squire & Kandel, 1998).
Instead, research posits several memory systems with discrete interacting
anatomical substrates sub served by long evolved molecular components. Long
term memory is subdivided into explicit (declarative) and implicit (procedural)
memory.

Explicit memory provides factual knowledge of the world (semantic) and personal
past (episodic).

Explicit memories are recollected in consciousness, with long-term encoding

dependent on the hippocampus (Squire & Kandel, 1998).

Implicit memory stores our skills, tasks, habits and emotional reflexes; however,
their expression does not necessitate immediate transfer into the consciousness
or require the hippocampus for long-term encoding, but is likely to be mediated
through the cerebellum, basal ganglia and amygdala (Squire & Kandel, 1998).

The different parts of cerebral cortex involved in Implicit and explicit memory
have been discussed in detail as below.

3.3.3 Neural Substrates of Implicit Memory

Petri and Mishkin suggest a brain circuit for implicit memory. The key structures
in this proposed circuit are the neocortex and basal ganglia (the caudate nucleus
and putamen) The basal ganglia receives projections from all regions of the
neocortex and send projections through the globus pallidus and ventral thalamus
to the premotor cortex. The basal ganglia also receives projection from cells in
the substantia nigra. The motor cortex shares connections with the cerebellum,
and it in turn also contributes to implicit memory.

41
Neurobiology and
Behaviour

i) The Basal Ganglia: Evidence from other clinical and experimental studies
supports a formative role for the basal ganglia circuitry in implicit memory.
In a study of patients with Huntington’s chorea, a disorder characterised by
the degeneration of cells in the basal ganglia, were impaired in the mirror
drawing task, on which patients with temporal lobe lesions are unimpaired
(Martone et al., 1984). Conversely, the patients with Huntington’s chorea
were unimpaired on a verbal recognition task.

ii) The Motor Cortex: Positron emission tomography was used to record
regional cerebral blood flow as normal subjects learned to perform a motor
task (Grafton et al., 1992). In this Pursuit Rotor Task, a subject attempts to
keep a stylus in particular location on a rotating turntable that is about the
size of a vinyl record album. The task draws on skills that are very much
like the skills needed in mirror drawing. The researchers found that
performance of this motor task is associated with increases in regional
cerebral blood flow in the motor cortex, basal ganglia and cerebellum.
Acquisition of the skill was associated with a subset of these structures,
including the primary motor cortex, the supplementary motor cortex, and
the pulvinar nucleus of the thalamus.

A more dramatic demonstration of the role of the motor cortex in implicit

learning comes from a study by Alvaro Pascual Leone and his colleagues.
In this study, subjects were required to press one of the four numbered buttons
by using a correspondingly numbered finger in response to numbered cues
provided on a television monitor.

For example, when number 1 appears on the screen, push button 1 with
finger 1 . The measure of learning was the decrease in reaction time between
the appearance of the cue and the pushing of the button on successive trials.

iii) The Cerebellum: The motor regions of the cortex also receive projections
through the thalamus from the cerebellum. Kyu Lee and Richard Thompson
presented evidence that the cerebellum occupies an important position in
the brain circuits taking part in motor learning. They suggested that the
cerebellum plays an important role in a form of learning called classical
conditioning.

42
In their model, a puff of air is administered to the eyelid of a rabbit, paired with Neurobiological and
Neuropsychological Aspects
a stimulus such as a tone. Eventually, the rabbit becomes “conditioned” to blink in the Development of
in expectation of the air puff whenever the tone is sounded. Lesions to pathways Memory, Emotion and
from the cerebellum abolish this conditioned response but do stop the rabbit Consciousness
from blinking in response to an actual air puff, the unconditioned response.

3.3.4 Neural Substrates of Explicit Memory

Evidence is growing that neural system, each consisting of a number of structures,
support different kinds of memory. On the basis of animal and human studies,
Herbert Petri and Mortimer Mishkin propose a largely temporal frontal lobe
neural basis for explicit memory. Most are in the temporal lobe or closely related
to it, such as the hippocampus, the rhinal cortices in the temporal lobe, and the
prefrontal cortex.

Nuclei in the thalamus also are included, in as much as many connections between
the prefrontal cortex and the temporal cortex are made through the thalamus.
The regions that make up the explicit memory circuit receive input from the
neocortex and from the ascending systems in the brainstem, including the
acetylcholine, serotonin, and noradrenalin systems. Explicit memory function
and contribution of different brain regions are described in the following section:

3.3.5 Neural Substrates of Emotional Memory

In fear conditioning, a noxious stimulus is used to elicit fear, an emotional
response. A rat or other animal is placed in a box that has a grid floor through
which a mild but noxious electrical current can be passed (This shock is roughly
equivalent to the static electrical shock that we get when we rub our feet on a
carpet and then touch a metal object or another person).

When the tone is later presented without the sock, the animal will act afraid. It
may become motionless and may urinate in expectation of the shock. The
presentation of a novel stimulus, such as a light in the same environment has
little effect on the animal. Thus, the animal tells us that it has learned the
association between the tone and the shock.

Because the conditioned response is emotional, circuits of the amygdala, rather

than the cerebellum, mediate fear conditioning. Although both eye blink and
fear conditioning are pavlovian and different parts of the brain mediate the
learning. Whether emotional memories are implicit or explicit is not altogether
clear; in fact, they could be both.

Self Assessment Questions

1) Discuss the neurobiology of Short term memory.
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43
Neurobiology and
Behaviour 2) Elucidate the relationship between short term memory, temporal and
frontal lobes.
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3) Describe the neurobiology of long term memory.
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4) What are the neural substrates of implicit memory.
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5) Discuss the neural substrates of explicit memory.
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3.4 ANATOMY OF THE HIPPOCAMPUS

Because the hippocampus figures prominently in discussions of memory, we
describe its anatomy in some detail, both in reference to its position as a way
station between the posterior sensory cortex and the frontal cortex and in reference
to its intrinsic complexity. In the 1960s, anatomist H. Chandler Elliott described
the hippocampus as “quite archaic and vestigial, possibly concerned with primitive
feeding reflexes no longer emergent in man.” This structure, small in comparison
with the rest of the human forebrain, plays a dominant role in the discussion of
memory.
44
 Neurobiological and
Neuropsychological Aspects
in the Development of
Memory, Emotion and
Consciousness

The hippocampus extends in a curve from the lateral neocortex of the medial
temporal lobe toward the midline of the brain and has a tube like appearance. It
consists of two gyri, Ammon’s horn and the Dentate gyrus. If you imagine cutting
a tube length wise and placing one half on top of the other so that their edges
overlapped, the upper half would represent Ammon’s horn and the lower one the
Dentate gyrus. (See the picture below)

The hippocampus is reciprocally concerned with the rest of the brain through
two major pathways.

i) The perforant pathway (because it perforates the hippocampus) consents

the hippocampus to the posterior neocortex and

ii) The fimbria-fornix (arch-fringe, because it arches along the edge of the
hippocampus),

These connect the hippocampus to the thalamus and frontal cortex, the basal
ganglia, and the hypothalamus.
45
Neurobiology and Through its connection to these two pathways, the hippocampus can be envisioned
Behaviour
as a way station between the posterior neocortex on one end of the journey and
the frontal cortex, basal ganglia, and brainstem on the other.

Within the hippocampus, input from the neocortex goes to the dentate gyrus,
and the dentate gyrus projects to Ammon’s horn. (as is seen in the above picture).

Thus, the granule cells are the “sensory” cells of the hippocampus, and the
pyramidal cells are its motor” cells that facilitate this processing and memory
function.

3.4.1 The Perirhinal Cortex

When Corkin and her colleagues used MRI to reexamine the temporal lobe
removal, they found that the resection removed most of the entorhinal cortex.
The rhinal cortex that is the cortex surrounding the rhinal fissure, including the
entorhinal cortex and the perirhinal cortex, is often damaged in patients with
medial temporal lobe lesions.

These lesions and the damage are relevant for amnesia.

Elisabeth Murray and her colleague have used neurotoxic lesion techniques to
selectively damage the cells of either the hippocampus or the rhinal cortex in
monkeys and then examined the specific contributions of each structure to
amnesia. In Murray’s studies, monkeys reach through the bars of their cage to
displace objects under which a reward may be located. To find the reward, the
animals must make use of their abilities to (1) recognise objects or (2) recognise
a given object in a given context.

In these studies of memory for objects and contexts, animals with selective
hippocampal removal displayed no impairments on the object recognition test
but were impaired when the test included context. In contrast, animals with rhinal
cortex lesions displayed severe anterograde and retrograde impairments on the
object recognition tests. Thus the conclusion from the results of these studies is
that objects recognition (factual, or semantic, knowledge) depends on the rhinal
cortex, whereas contextual knowledge (autobiographic, or episodic, knowledge)
depends on the hippocampus.

3.4.2 The Temporal Cortex

Because one treatment for epilepsy is the removal of the affected temporal lobe,
including both neocortical and limbic systems a large number of patients have
undergone such surgery and have subsequently undergone neuropsychological
study. The results of these studies suggest significant differences in the memory
impairments stemming from damage to the left and right hemispheres.

They also show that the temporal neocortex makes a significant contribution to
these functional impairments. After right temporal lobe removal, patients are
impaired on face recognition spatial position and maze learning tests. Left
temporal lobe lesions are followed by functional impairments in the recall of
word lists, the recall of consonant trigrams, and non-spatial associations.

Milner and her colleagues concluded that the lesions of the right temporal lobe
result in impaired memory of nonverbal material. Lesions of the left temporal
46
lobe, on the other hand, have little effect on the nonverbal tests but produce Neurobiological and
Neuropsychological Aspects
deficits on verbal tests such as the recall of previously presented stories and in the Development of
word pairs, as well as the recognition of words or numbers and recurring nonsense Memory, Emotion and
syllables. Consciousness

3.4.3 Parietal and Occipital Cortex

Cortical injuries in the parietal, posterior temporal and possibly, occipital cortices
sometimes produces specific long term memory difficulties. Examples include
color amnesia, prosopagnosia, object anomia (Inability to recall the names of
objects), and topographic amnesia (inability to recall the location of an object in
the environment). Many of these deficits appear to develop in the presence of
bilateral lesions only.

3.4.4 Frontal Cortex (Hemispheric Encoding and Retrieval

Asymmetry)
The frontal cortex also participates in memory. An interesting pattern of
hemispheric asymmetry is seen in comparisons between the encoding of memory
and its retrieval. The pattern is usually referred to as HERA, for hemispheric
encoding and retrieval asymmetry. HERA makes three predictions:
1) The left prefrontal cortex is differentially more engaged in encoding semantic
information than in retrieving it.
2) The left prefrontal cortex is differentially more engaged in encoding episodic
information than in retrieving it.
3) The right prefrontal cortex is differentially more engaged in episodic memory
retrieval than is the left prefrontal cortex.

Self Assessment Questions

1) With the help of a diagram describe the anatomy of the hippocampus.
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2) Describe the perihinal cortex and indicate its functions.
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47
Neurobiology and
Behaviour 3) How does memory retrival etc. take place in the temporal cortex?
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4) Discuss the role of parietal and occipital lobes in memory retrieval etc.
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5) How does frontal cortex participate in memory.
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3.5 EMOTION
Emotion, like memory, entails cognitive processes that may either be conscious
or lie outside our awareness. We begin this topic by exploring the nature of
emotion and how neuroscientists have studied emotion and developed theories
over the past century.

3.5.1 Nature of Emotions

To neurophysiologists, impairments of movement, perception, language, or
memory affect not only how a person expresses and reacts to emotion but also
how others perceive that person’s emotions. Indeed, some view emotion as an
inconvenient remnant of our evolutionary past, a nonconscious time when humans
literally were driven by “instincts” such as emotion.
An emotional experience may include all sorts of thoughts or plans about who
said or did what or what will be done in the future. Your heart may pound, your
throat tighten; you may sweat, tremble, or flush. Strong emotional feelings (rage
or elation) are not always verbalised. Marked changes in facial expression, tone
of voice or vole posture-even tears of sadness or joy-are sufficient to convey
emotion to others.
Neurophysiologists view emotion not as a thing but rather as an inferred
behavioural state called affect, a conscious, subjective feeling about a stimulus
48 independent of where or what it is. Affective behaviour is internal and subjective.
As observers, we can infer emotion in others only from their behaviour (what Neurobiological and
Neuropsychological Aspects
they say and do) and by measuring physiological changes associated with in the Development of
emotional processes. Emotion includes at least four principal behavioural Memory, Emotion and
components: Consciousness

Physiological Behaviour: Physiological components include central and

autonomic nervous system activity and the resulting changes in neuro hormonal
and visceral activity. Emotion produces changes in heart rate, blood pressure,
the distribution of blood flow, perspiration, and the digestive system, among
others, as well as the release of hormones that may affect the brain or the ANS.
Distinctive motor behaviour: Facial expression, tone of voice, and posture
express emotional states. These motor behaviours are especially important to
observing emotions because they convey overt action that can differ from observed
verbal behaviour.
Self-reported cognition: Cognitive processes are inferred from self reported
rankings. Cognition operates in the ream of subjective emotional feelings (feeling
love or hate, feeling loved or hated) and other cognitive processes (plans,
memories, or ideas).
Unconscious behaviour: This component incorporates unconscious inference-
cognitive processes that influence behaviour of which we are not aware. We
may make decisions on the basis of “intuition” or a hunch or on other apparently
unfounded bases.

3.5.2 Anatomy of Emotion

Psychologists began to speculate about emotions at the turn of the twentieth
century, but they had little knowledge about the neural; basis of emotional
behaviour. By the late 1920s, physiologists began to examine the relation between
autonomic, endocrine and neuro-hormonal factors and inferred emotional states,
with particular emphasis on measuring indices such as heart rate, blood pressure,
and skin temperature.

Philip Bard made one of the first major anatomical discoveries about emotion
while working in Walter Cannon’s laboratory in the late 1920s. Working with
cats, Bard showed that emotional response depends on the diencephalon, which
includes the thalamus and hypothalamus.

He found that, if the diencephalon was intact, animals showed strong “emotional”
responses, but if the animals were decerebrate, leaving the diencephalon
disconnected from the midbrain, they were unemotional.

The lesion and stimulation studies on the diencephalon were important, because
they led to the idea that the thalamus and hypothalamus contain the neural circuits
for the overt expression of emotion and for autonomic responses such as changes
in blood pressure heart rate, and respiration.

3.5.3 Cortical Connections of Emotion

Two contributions in the 1930s shed light on the nature of the cortical structures
and connections implicated in emotion. In both cases, investigators were studying
something other than emotion and made serendipitous findings that fundamentally
changed our thinking about the emotional brain.
49
Neurobiology and i) Kluver-Bucy Syndrome: A major finding came in 1939, when Heinrich
Behaviour
Kluver and Paul Bucy announced the rediscovery of an extraordinary
behavioural syndrome that had first been noted by Sanger Brown and Edward
Schaefer in1888. An obvious aspect of this extraordinary set of behaviours
is lack of affect. For example, animals displaying Kluver-Bucy syndrome
show no fear whatsoever to threatening stimuli such as snakes or to “threat”
signals from humans or other animals, situations in which normal animals
show strong aversion.

Wendy Marlowe and colleagues reported on a patient with Kluver-Bucy

symptoms that resulted from meningoencephalitis (inflammation of the brain
and the meninges).

Behavioural patterns were distinctly abnormal. He exhibited a flat affect,

and, although originally restless, ultimately became remarkably placid. He
appeared indifferent to people or situations.

He spent much time gazing at the television but never learned to turn it on;
when the set was off, he tended to watch reflections of others in the room
on the glass screen. On occasion became facetious, smiling inappropriately
and mimicking the gestures and actions of others. Once initiating an imitative
series, he would perseverate copying all movements made by another for
extended period of time.

In addition, he commonly generated a series of idiosyncratic, stereotyped

gestures employing primarily his two little fingers which he would raise
and tough end- to–end in repetitive fashion. The patient’s sexual behaviour
was a particular source of concern while in hospital. Although vigorously
heterosexual prior to his illness, he was observed in hospital to make
advances toward other male patients by stroking their legs and inviting
fellatio by gesture; at times he attempted to kiss them. Although on a sexually
mixed floor during a portion of his recovery, he never made advances towards
women, and, in fact, his apparent reversal of sexual polarity prompted his
fiancée to sever their relationship. (Marlowe et. al., 1975, pp.55-56)

ii) Psychsurgery: At about the time of kluver and Bucy’s discovery, a less
dramatic, but in many ways more important discovery was made. Carlyle
Jacobsen studied the behaviour of chimpanzee in a variety of learning tasks
subsequent to frontal lobe removals. In 1935, he reported his findings on
the effects of the lesions at the Second International Neurology Congress in
London. He casually noted that after the surgery similar lesions in people
might relieve various behavioural problems.

Thus was born psychosurgery and the frontal lobotomy. Unbelievably, fontal
lobotomies were performed on humans without an empirical basis. Not until the
late 1960s was any systematic research done on the effects of frontal lobe lesions
on the affective behaviour of nonhuman animals. Experimental findings by several
laboratories clearly confirm the results of frontal lobotomies on humans. Frontal
lobe lesion in rats, cats and monkeys have severe effects on social and affective
behaviour across the board.

50
3.5.4 Frontal Lesions and Emotion Neurobiological and
Neuropsychological Aspects
Spouses or relatives often complain of personality changes in brain damaged in the Development of
Memory, Emotion and
patients, but the parameters of these changes have been poorly specified in human Consciousness
subjects. The results of research on animals, particularly nonhuman primates,
make possible the identification of six behavioural changes associated with
emotional process after frontal lesions.

Reduced social interaction: This was noted especially after orbito-frontal and
anterior cingulate lesions, monkeys become socially withdrawn and even fail to
re establish close preoperative relations with family members. The animals sit
alone; seldom if ever engage in social grooming or contact with other monkeys
and in a free ranging natural environment, become solitary leaving the troop
together.

Loss of Social dominance: This happened after orbito-frontal lesions, monkeys

that were formerly dominant in a group do not maintain their dominance, although
the fall from power may take week to complete, depending on the aggressiveness
of other monkeys in the group.

Inappropriate social interaction: Monkeys with orbito-frontal lesions fail to

exhibit the appropriate gestures of submission to dominant animals and may
approach any other animal without hesitation, irrespective of that animals social
dominance. This behaviour often results in retaliatory aggression from the
dominant, intact animals.

Altered social preference: Although normal animals prefer to sit beside intact
monkeys of the opposite sex, monkeys with large frontal lesions prefer to sit
with other frontal lesion monkeys of the same sex, presumably because they are
less threatening.

Reduced affect: Monkeys with frontal lesions largely abandon facial expressions,
posturing, and gesturing in social situations. Thus, monkeys with frontal lesions
show a drastic drop in the frequency and variability of facial expression and are
described as poker faced.

Reduced Vocalisation: Lesions of the frontal cortex reduce spontaneous social

vocalisation. Indeed, after anterior cingulate lesions, rhesus monkeys effectively
make no normal vocalisations at all.

In general then, lesions of the monkey orbito-frontal cortex produce marked

changes in social behaviour. In particular lesion monkeys become less socially
responsive and fail to produce or respond to species typical stimuli.

3.5.5 Brain Circuits for Emotion

In the early 1930s, the limbic lobe including the amygdala and prefrontal cortex
were identified as brain regions implicated in emotion. Although the original
limbic structures identified by Papez in the late 1930s focused on the hippocampus
and its connections with the hypothalamus, modern views of the limbic system
include the amygdala and prefrontal cortex. The hippocampus, amygdala, and
prefrontal cortex all connect with the hypothalamus. The mammillary nucleus
of the hypothalamus connects to the anterior thalamus, with in turn connects to
the cingulate cortex. Connections from the cingulate cortex complete the circuit
51
Neurobiology and by connecting to the hippocampus, amygdala, and prefrontal cortex. Although
Behaviour
the entire circuit is important for emotional behaviour, the amygdala and prefrontal
cortex hold the key to understanding the nature of emotional experience.

Like the prefrontal cortex, the amygdala receives inputs from all sensory systems
to be excited; the cells of the amygdala, like those of the prefrontal cortex require
complex stimuli. Many cells in the amygdala are multimodal, in fact some respond
to visual, auditory, somatic, gustatory and olfactory stimuli just as prefrontal
cells do.

3.6 NEUROPSYCHOLOGICAL THEORIES OF

EMOTION
One theme runs through all modern theories of emotion: emotion and cognition
are intimately related and likely entail overlapping neural system. It therefore
follows that changes in cognitive abilities will be related to changes in emotion
and vice versa. Here, we outline three current theories that represent the major
lines of thinking in cognitive neuroscience regarding emotion:

3.6.1 Somatic Marker Hypothesis

The core of Damasio’s somatic marker hypothesis which states that when a person
is confronted with a stimulus of biological importance, the brain and the body
change as a result. This has its origin in William James ideas. In the late nineteenth
century James began to argue that an emotion consists of a change in body and
brain states in response to the evaluation of a particular event. For example, if
you encounter a poisonous snake as you walk along a path your somatic markers
including heart rate, respiration and sweating, increase. You interpret these
physiological changes as fear.

Whereas James was really talking about intense emotions such as fear or anger.
Damasio’s theory encompasses a much broader range of bodily changes. For
example, there may be a change in motor behaviour, facial expression, autonomic
arousal, or endocrine changes as well as neuromodulatory changes in the brain.
Hence, for Damasio, emotions engage those neural structures that represent body
states and those structures that somehow link the perception of external stimuli
to body states. The somatic markers are thus linked to external events and
influence cognitive processing.

3.6.2 Cognitive Emotional Interaction

Ledoux’s Theory is evolutionary in nature. The general idea is that emotions
evolved to enhance the survival of animals and, as the brain evolved, cognitive
and emotional processes grew more and more interrelated. In contrast with
Damasio, LeDoux has not tried to account for all emotions rather has chosen
one emotion namely; fear-as an exemplar of how to study brain behaviour relations
in emotion.

In LeDoux’s view, all animals inherently detect and respond to danger, and the
related neural activities eventually evolve to produce a feeling. In this case, it
produced fear. When a mouse detects a cat, fear is obviously related to predation,
and, in most situations, animals such as mice have fear related either to predation
or to danger from other mice who may take exception to their presence in a
52
particular place. For humans, however, fear is a much broader emotion that today Neurobiological and
Neuropsychological Aspects
is only rarely of predation but routinely includes stress-situations in which we in the Development of
must “defend” ourselves on short notice. Memory, Emotion and
Consciousness
The key brain structure in the development of conditioned fear is the amygdala,
which sends outputs to stimulate hormone release and activate the ANS and thus
generates emotion, which we interpret in this case as fear. Physiological measures
of fear conditioning can rank autonomic functioning (for example, heart rate or
respiration), and quantitative measures can rank behaviour (for example, standing
motionless) after the tone is heard.

Damage to the amygdala interferes with fear conditioning, regardless of how it

is measured. People with damage to the temporal lobe that includes the amygdala
are impaired at fear conditioning, yet imaging studies show activation of the
amygdala during fear conditioning (LaBar et al., 1998). How does the amygdala
“know” that a stimulus is dangerous? LeDoux proposes two possibilities. Both
implicate neural networks, one genetically evolved and one shaped by learning.

3.6.3 Cognitive Asymmetry and Emotion

We have seen in both Damasio’s and LeDoux’s theories that emotion entails
cognitive appraisals. Because significant asymmetries exist in a variety of
cognitive functions, it follows that related emotional systems also must be
lateralised. This idea is not new and can be traced to at least the 1930s, when
clinicians reported detailed observations of patients with large unilateral lesions,
noting an apparent asymmetry in the effects of left- and right-hemisphere lesions
on emotional behaviour.

Kurt Goldstein suggested that left-hemisphere lesions produce “catastrophic”

reactions characterised by fearfulness and depression. However, right hemisphere
lesions produce “indifference.” The results of the first systematic study of these
contrasting behavioural effects, by Gainotti in 1969, showed that catastrophic
reactions were found in 62% of his left hemisphere sample compared with only
10% of his right hemisphere cases. In contrast, indifference was common in the
right hemisphere patients, found in 38% compared with only 11 % of the left
hemisphere cases. A key point to remember in regard to Goldstein’s and Gainotti’s
observations is that, if the left hemisphere is damaged extensively, then the
behaviour that we observe is in large part a function of what the right hemisphere
can do. Thus, if we observe a catastrophic reaction after a left hemisphere injury,
one conclusion is that this behaviour is coming from the right hemisphere. This
conclusion leads directly to the idea that the right hemisphere normally plays a
major role in the production of strong emotions, especially in emotions regarded
as negative, such as fear and anger.

3.6.4 Cognitive Control of Emotion

Humans produce an amazing range of emotions, but we also have the cognitive
capacity to control them. For example, we may have expectations about how a
stimulus might feel (e.g., a syringe injection of penicillin) and our expectations
can alter the actual feeling when we experience the event. Nobukatsu Sawamoto
and colleagues found that non painful stimuli are perceived as painful when
participants expect pain, and this is correlated with activation of the cingulate
cortex, a region associated with pain perception.
53
Neurobiology and The use of cognitive processes to change an existing emotional response has
Behaviour
also recently been studied using noninvasive imaging. Kevin Ochsner and James
Gross reviewed such studies and conclude that when subjects reappraise self-
emotions there is concurrent activation of the prefrontal and cingulate cortex.

Self Assessment Questions

1) Define emotion and describe the nature of emotion.
...............................................................................................................
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2) Delineate the anatomy of emotions.
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3) What are the cortical connections of emotions?
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4) Discuss Kluver Bucy syndrome.
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5) What do you understand by psychosurgery? When is it needed?
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54
 Neurobiological and
6) What happens to emotions when there is frontal lesions? Neuropsychological Aspects
in the Development of
............................................................................................................... Memory, Emotion and
Consciousness
...............................................................................................................
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7) Describe the brain circuits of emotions.
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8) Elucidate the neuropsychologial theories of emotions.
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9) Discuss the Somatic Parker hypothesis and congnitive emotional
interaction.
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10) Describe cognitive control of emotions.
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55
Neurobiology and
Behaviour 3.7 CONSCIOUSNESS
Conscious experience is probably the most familiar mental process that we know,
yet its workings remain mysterious. Everyone has a vague idea of what is meant
by being conscious, but consciousness is easier to identify than to define.

Definitions of consciousness, which we define as the level of responsiveness of

the mind to impressions made by the senses, range from the view that it merely
refers to complex thought processes to the more slippery implication that it is
the subjective experience of awareness or of “inner self.” Nonetheless, there is
general agreement that, whatever conscious experience is, it is a process. Descartes
proposed one of the first modern theories of consciousness. He proposed that
being able to remember past events and being able to speak were the primary
abilities that enable consciousness.
In fact, consciousness is probably not a single process but a collection of many
processes, such as those associated with seeing, talking, thinking, emotion, and
so on.
Consciousness is also not always the same. A person at different ages of life is
not thought to be equally conscious at each age; young children and demented
adults are usually not considered to experience the same type of consciousness
as healthy adults do. Indeed, part of the process of maturation is becoming fully
conscious and consciousness varies across the span of a day as we pass through
various states of sleep and waking.
Most definitions of consciousness exclude the conditions of simply being
responsive to sensory stimulation or simply being able to produce movement.
Thus, animals whose behaviour is simply reflexive are not conscious. Similarly,
the isolated spinal cord, although a repository for many reflexes, is not conscious.
Machines that are responsive to sensory events and are capable of complex
movements are not conscious. Many of the physiological functions of normal
humans, such as the beating of the heart, are not conscious processes. Similarly,
many processes of the nervous system, including simple sensory processes and
motor actions, are not conscious. Consciousness requires processes that differ
from all the aforementioned.

3.7.1 Neurobiology and Neuropsychology of Consciousness

Consciousness allows us to select behaviours that correspond to an understanding
of the nuances of sensory inputs. As stated earlier, consciousness must be a
function of numerous interacting systems, presumably including sensory areas,
memory structures, and perhaps the structures underlying other processes such
as emotion and executive functions.
The theory of the neural basis of consciousness explains how all these systems
can be integrated. Before examining this idea more closely, we need to examine
processes that are believed to be prerequisites of consciousness. Most investigators
agree that at least four processes must take part:
• Arousal, the waking up of the brain by nonspecific modulatory systems
• Perception, the detection and binding of sensory features
• Attention, the selection of a restricted sample of all available information
56 • Working memory, the short-term storage of ongoing events
Andreas Engel and Wolf Singer proposed that all these processes either require Neurobiological and
Neuropsychological Aspects
or modify the operation of an overall binding process and that binding is in the Development of
implemented by the transient and precise synchronisation of neural discharges Memory, Emotion and
in diffuse neural networks. The general idea is that neurons that represent the Consciousness
same object or event fire their action potentials in a temporal synchrony with a
precision of milliseconds.

No such synchronisation should take place among cells that are part of different
neural networks. Recall that the idea of synchrony was proposed earlier as a
mechanism of attention. Taken further, without attention to an input, there is no
awareness of it. But what produces the synchrony? Neuronal groups exhibit a
wide range of synchronous oscillations (6-80 Hz) and can shift from a
desynchronised state to a rhythmic state in milliseconds. Thus, we can predict
that, when we become consciously aware of some event, there should be evidence
of synchronous activity among widely separated brain regions.

A review of the evidence on synchrony and consciousness concludes that phase

synchrony acts not only to bind the sensory attributes but also to bind all
dimensions of the cognitive act, including associative memory, emotional tone,
and motor planning (Thompson and Varella, 2001). The problem, however, is
that all studies to date are correlative. There is no direct evidence that changes in
synchrony lead to changes in either behaviour or consciousness. A search for
such evidence is the likely direction of studies on consciousness in both laboratory
animals and human subjects in the coming decade.

3.7.2 Involvement of Cerebral Regions in Consciousness

Little is known about the essential cerebral regions for consciousness. One way
to investigate this matter is to identify which structures in the brain are inactive
when we are unconscious and active when we are conscious. Notice that, in all
cases, there is inactivation of the dorso-lateral prefrontal cortex, the medial frontal
cortex, the posterior parietal cortex and the posterior cingulate cortex. The brain
activation in a quiet resting state identifies two distinct neural networks of
structures that are either correlated or anti-correlated. Again, there is evidence of
a general fronto-parietal network.

A second way to look for cerebral substrates is to look for structures that might
synchronise activity. Crick and Koch introduced the novel idea that a little-studied
brain region may play central role in the processes that bind diverse sensory
attributes. The claustrum, meaning “hidden away,” is a thin sheet of gray matter
that, in the human brain, lies below the general region of the insula. Its connectivity
is unique in that it receives input from virtually all regions of the cortex and
projects back to almost all regions of the cortex.

Virtually nothing is known about the functions of the claustrum in any mammalian
species, in large part because it is almost impossible to damage selectively; Crick
and Koch proposed that this unique anatomy is compatible with a global role in
integrating information to provide the gist of sensory input on a fast time scale.
They provocatively state: “This should be further experimentally investigated,
in particular if this structure plays a key role in consciousness (Crick and Koch,
2005).

57
Neurobiology and In summary, the emerging field of cognitive social neuroscience is radically
Behaviour
changing our understanding of how the brain participates in the complex social
behaviour of humans such as different types of memory function, emotional
behaviours and consciousness. The literature comprising of lesion studies tended
to focus on the perception and production of social behaviour. The new perspective
is allowing insights into the very nature of how the brain allows humans to think
about themselves and one another.
Self Assessment Questions
1) Define consciousness and delineate the nature of consciousness.
...............................................................................................................
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...............................................................................................................
...............................................................................................................
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2) Discuss the neurobiological aspects of consciousness.
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3) Discuss the neuropsychological aspects of Consciousness.
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4) Elucidate the involvement of cerebral regions for consciousness.
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58
 Neurobiological and
3.8 LET US SUM UP Neuropsychological Aspects
in the Development of
Memory, Emotion and
Memory is generally defined as the processes of encoding, storing and retrieving Consciousness
information. Memory is thought to begin with the encoding or converting of
information into a form that can be stored by the brain. However, the term emotion
refers to positive or negative feelings that are produced by particular situations.
Memory is the process by which we encode, store and retrieve the information.
The information is initially recorded in a form usable to memory is known as
encoding. The maintenance of material saved in the memory system is storage,
and the material in memory storage is located, brought in to awareness, and used
is known as retrieval.

The processes of encoding, storing and retrieving the information are necessary
for memory to operate successfully. Many psychologists studying memory suggest
that there are different systems or stages through which information must travel
if it is to be remembered. According to enduring theories, the two major
classification of memory are the short term memory and the long term memory.
Long term memories are of three types:
i) implicit memory,
ii) explicit memory and
iii) emotional memory
These are supported by three pathways in the brain.
The first evidence that the temporal lobe might play a role in human memory
came to light by the case of H. M. in 1900, when Vladimir Bekhterev autopsied
the brain of a patient who had shown severe memory impairment. In 1890, William
James drew a distinction between memories that endure for a very brief time and
for longer term. Not until 1958, however, there was any separate short term and
long term memories. In 1958, this was specifically postulated by Donald
Broadbent. According to Broadbent, Short term memory, sometimes also called
the working memory or temporal memory refers to a neural record for recent
events and their order. It is the system that we use for holding sensory events,
movements, and cognitive information such as digits, words, names or other
items for a brief period. Short term memory is mediated by different regions in
the cerebral cortex such as temporal lobe, some specific areas of frontal lobe,
and motor cortex. Long term memory is subdivided into explicit (declarative)
and implicit (procedural) memory.

The different parts of cerebral cortex involved in Implicit and explicit memory
include the basal ganglia, the motor cortex and the cerebellum.

Then we discussed the anatomy of the hippocampus. We showed how these are
related to memory. Then we showd how the frontal coretex and occipital cortex
function in regard to memory and related factors. Then we took up temporal
cortex and dealt with it in terms of memory. Then we discussed the neural
substrates of emotional memory. The next section was on emotion. We discussed
the nature of emotion and anatomy of emotions. Then we pointed out how the
frontal lesions affect the emotion. This was followed by brain ciorcuits of emotion.
We then discussed the different theories of emotion. We then took up discussion
on The consciousness and related the same to the neurobiology and
59
Neurobiology and neuropsychology of consciousness. Then we discussed about the involvement
Behaviour
of cerebral regions in consciousness.

3.9 UNIT END QUESTIONS

1) Define Memory and discuss the neurobiological and Neuropsychological
aspects of Memory.
2) What are the Neurobiology of Short Term and long term Memory?
3) Discuss the neural substrates of Explicit Memory and emotional memory.
4) Define emotion and state its nature.
5) Discuss the anatomy of emotions and present the cortical connections of
emotion.
6) Discuss the brain circuits of emotion.
7) Elucidate the Neuropsychological Theories of Emotion and discuss the
Neurobiology and Neuropsychology of Consciousness.
8) How are cerebral regions involved in consciousness.

3.10 SUGGESTED READINGS

Levinthal Charles F (2007). Introduction to Physiological Psychology. PHI
Learning Private Limited, India.

Neil R.Carlson (2007). Foundation of Physiological Psychology. Pearson

Education, Inc., India.

Robert S. Feldman (2004). Understanding Psychology. Tata McGraw Hill

Education Private Limited, New Delhi, India-110008.

60
 Neurobiological and
UNIT 4 NERVOUS SYSTEM DISEASES Neuropsychological Aspects
in the Development of
Memory, Emotion and
Consciousness
Structure
4.0 Introduction
4.1 Objectives
4.2 Nervous System Diseases
4.3 Causal Factors
4.4 Classification
4.5 Vascular Disorders
4.5.1 Cerebral Ischemia
4.5.2 Migraine Stroke
4.5.3 Cerebral Hemorrhage
4.5.4 Angiomas and Aneurysms
4.6 Traumatic Brain Injuries
4.6.1 Open-Head Injuries
4.6.2 Closed-Head Injuries
4.7 Epilepsy
4.7.1 Focal Seizures
4.7.2 Generalised Seizures
4.7.3 Akinetic and Myoclonic Seizures
4.7.4 Tumor
4.8 Headaches
4.8.1 Migraine
4.8.2 Headache Associated with Neurological Diseases
4.8.3 Muscle Contraction Headache
4.8.4 Non Migrainous Vascular Headaches
4.9 Infections
4.9.1 Viral Infections
4.9.2 Bacterial Infections
4.9.3 Mycotic Infections
4.10 Disorders of Motor Neurons and the Spinal Cord
4.10.1 Myasthenia Gravis
4.10.2 Poliomyelitis
4.10.3 Multiple Sclerosis
4.10.4 Paraplegia
4.10.5 Brown-Sequard Syndrome
4.10.6 Hemiplegia
4.11 Disorders of Sleep
4.11.1 Narcolepsy
4.11.2 Insomnia
4.12 Let Us Sum Up
4.13 Unit End Questions
4.14 Suggested Readings 61
Neurobiology and
Behaviour 4.0 INTRODUCTION
This unit deals with the various nervous system disorders. We start with defining
what is nervous system disorders and then move on to different types of disorders
based on certain standard classification. We start with vascular disorders in which
we discuss cerebral ischemia, migraine stroke, cerebral hemorrhage, and angiomas
and aneurysms. This is followed by another group of nervous system disorders
called the Traumatic brain injuries. Then we take up epilepsy and discuss under
it the focal seizures, generalised seizures, akinetic and myoclonic seizures and
the tumors. In the following section we describe the different types of headaches
such as the migraines, and headaches associated with neurological diseases. Then
we discuss the diseases caused by infections under which we describe the disorders
caused by viral infections, bacterial infections and mycoctic infections. This is
followed by a description of the disorders due to motor neurons and the spinal
cord. This includes myasthenia gravis, poliomyelitis, paraplegia, hemiplegia and
Brown Sequard syndrome. Following this we present sleep disorderssuch as
narcolepsy etc.

4.1 OBJECTIVES
After reading this unit, the students will be able to:
• Define the concept and meaning of nervous system diseases;
• Describe nature and associated features of different nervous system diseases;
• Explain the involvement of different parts of nervous system in the
manifestation of symptoms; and
• Understand and differentiate the neurobiological and neuropsychological
aspects of nervous system diseases.

4.2 NERVOUS SYSTEM DISEASES

The nervous system consists of the brain, the spinal cord, and the network of
nerves throughout the rest of the body. It is sometimes called the master system,
since it regulates and coordinates every other body system. The nervous system
provides a rapid means for the various parts of the body to communicate with
each other. It allows us to adjust to the world around us and cope with the
challenges of life. It influences how we act or react to specific situation. The
nervous system is composed of two major parts; the central nervous system
(CNS) and the peripheral nervous system (PNS). The central nervous system is
the brain and spinal cord, where most information is processed. The peripheral
system is the network of nerves throughout the rest of the body. The peripheral
nervous system allows signals to travel between the central nervous system and
the body’s sensory receptors and motor effectors. Besides these, a functional
division also exists: the somatic nervous system and the autonomic nervous system
where the autonomic nervous system is further divided in sympathetic and
parasympathetic nervous system.
Nervous system diseases are the disorders of the body caused by structuctural,
biochemical or electrical abnormalities in the brain or spinal cord, or in the nerves
leading to or from them. The symptoms can be manifested in the form of paralysis,
62
muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain
and altered levels of consciousness. The identification of symptoms and diagnoses Nervous System Diseases
are done on the basis of neurological examination and neuropsychological
assessments and studied and treated within the specialties of neurology and clinical
neuropsychology. The World Health Organisation estimated that neurological
disorders and their sequel affect as many as one billion people worldwide, and
identified health inequalities and social stigma/discrimination as major factors
contributing to the associated disability and suffering (WHO, 2006).

4.3 CAUSAL FACTORS

Although, the brain and spinal cord are surrounded by tough membranes, enclosed
in the bones of the skull and spinal vertebrae, and chemically isolated by the
so-called blood-brain barrier, they are very susceptible if compromised. An
individual’s neurons, the building blocks of the nervous system, and the neural
networks into which they form, are susceptible to electrochemical and structural
disruption. While neuro-regeneration may occur in the peripheral nervous system,
it is thought to be rare in the brain and spinal cord and therefore results in different
form of neural diseases. The genetic and congenital abnormalities, infections,
malnutrition, brain injury, spinal cord injury and nerve injury are some of the
very important contributory factors for the development of nervous system
diseases.

4.4 CLASSIFICATION
Neurological disorders can be categorised according to the primary location
affected, the primary type of dysfunction involved, or the primary type of cause.
The broadest division is between central nervous system (CNS) disorders and
peripheral nervous system (PNS) disorders. Here in this section we have discussed
various nervous system diseases under the section of Vascular Disorders,
Traumatic Brain Injuries, Epilepsy, Tumors, Headaches, Infections, Disorders
of Motor Neurons and Disorders of Sleep.

4.5 VASCULAR DISORDERS

Normal central nervous system functioning can be affected by a number of
vascular problems, because blood-vessel disease or damage can greatly-even
totally-reduce the flow of oxygen and glucose to a brain region. If such interference
lasts longer than 10 minutes, all cells in the affected region die. The common
term used in the discussion of this cerebral vascular disorder is stroke, also known
as cerebral vascular accident. Thus, a stroke is the sudden appearance of
neurological symptoms as a result of the interruption of blood flow. If the flow
through small blood vessels, such as capillaries, is interrupted, the effects are
more limited than the often-devastating consequences of damage to large vessels.
If a stroke or other cerebral vascular disorder is in one restricted part of a vessel
(and other parts of the system are relatively healthy), the prognosis can be rather
good, because vessels in the surrounding areas can often supply blood to at least
some of the deprived area. On the other hand, if a stroke affects a region supplied
largely by weak or diseased vessels, the effects can be much more serious, because
there is no possibility of compensation. Of the numerous vascular disorders that
affect the central nervous system, the most common are ischemia, migraine stroke,
cerebral hemorrhage, angiomas, and arteriovenous aneurysms. 63
Neurobiology and 4.5.1 Cerebral Ischemia
Behaviour
Ischemia refers to any of a group of disorders in which the symptoms are caused
by vessel blockage preventing a sufficient supply of blood to the brain. In
thrombosis, for example, some of the blood in a vessel has coagulated to form a
plug or clot that has remained at the place of its formation. This is known as
embolism. An embolism can be a blood clot, a bubble of air, a deposit of oil or
fat, or a small mass of cells detached from a tumor. Reduction in blood flow can
also result from other factors that narrow the vessel. The most common example
of such narrowing is a condition marked by thickening and hardening of the
arteries, called cerebral arteriosclerosis. When ischemia is temporary, it may be
termed cerebral vascular insufficiency or transient ischemia, indicating the
variable nature of the disorder with the passage of time. The onset of transient
attacks is often abrupt; in many cases, they are experienced as fleeting sensations
of giddiness or impaired consciousness.

4.5.2 Migraine Stroke

Since the late 1800s, physicians have recognised that migraine attacks may lead
to infarcts and permanent neurological deficits. Such migraine strokes are
relatively rare compared with other types, but they are believed to account for a
significant proportion of strokes in young people (under 40 years of age),
especially women. The immediate cause of these strokes is probably some form
of vasospasm-constriction of blood vessels-but the underlying cause of the
vasospasm remains a mystery. The classic migraine stroke is experienced with a
variety of neurological symptoms, including impaired sensory function (especially
vision), numbness of the skin (especially in the arms), difficulties in moving,
and aphasia.

4.5.3 Cerebral Hemorrhage

Cerebral hemorrhage is a massive bleeding into the substance of the brain. The
most frequent cause is high blood pressure, or hypertension. Other causes include
congenital defects in cerebral arteries, blood disorders such as leukemia, and
toxic chemicals. The onset of cerebral hemorrhage is abrupt, and the bleeding
may quickly prove fatal. It usually occurs when a person is awake, presumably
because the person is more active and thus has higher blood pressure.

4.5.4 Angiomas and Aneurysms

Angiomas are congenital collections of abnormal vessels that divert the normal
flow of blood. These capillaries, venous, or arteriovenous (A-V) malformations
are masses of enlarged and tortuous cortical vessels that are supplied by one or
more large arteries and are drained by one or more large veins, most often in the
field of the middle cerebral artery. However, aneurysms are vascular dilations
resulting from localised defects in the elasticity of a vessel. They can be visualised
as balloon like expansions of vessels that are usually weak and prone to rupture.
Although, aneurysms are usually due to congenital defects, they may also develop
from hypertension, arteriosclerosis, embolisms, or infections. A characteristic
symptom of an aneurysm is severe headache, which may be present for years,
because the aneurysm is exerting pressure on the dura mater, which is richly
endowed with pain receptors.

64
 Nervous System Diseases
4.6 TRAUMATIC BRAIN INJURIES
Brain injury is a common result of automobile and industrial accidents and of
war injuries. Brain injury can affect brain function by causing direct damage to
brain by disrupting blood supply; by inducing bleeding, leading to increased
intracranial pressures, by causing swelling, by opening the brain to infections
and by producing the scarring of brain tissue. There are two main types of brain
trauma: open head injury and closed head injury.

4.6.1 Open Head Injuries

Open head injuries are TBIs in which the skull is penetrated, as in gun shot or
missile wounds, or in which fragment of bone penetrate the brain substance.
Open head injuries tend to produce distinctive symptoms that may undergo rapid
and spontaneous recovery. The neurological sign may be highly specific, and
many of the effects of the injuries closely resemble those of the surgical excision
of small area of cortex.

4.6.2 Close Head Injuries

Closed-head injuries result from a blow to the head, which can subject the brain
to a variety of mechanical forces:

• Damage at the site of the blow, a bruise (contusion) called a coup, is incurred
where the rain has been compacted by the bone’s pushing inward, even
when the skull is not fractured.

• The pressure that produces the coup may push the brain against the opposite
side or end of the skull, producing an additional bruise, known as a
countercoup.

• The movement of the brain may cause a twisting or shearing of nerve fibers,
producing microscopic lesions. In addition, twisting and shearing may
damage the major fiber tracts of the brain, especially those crossing the
midline, such as the corpus callosum and anterior commissure. As a result,
connection between the two sides of the brain may be disrupted, leading to
a disconnection syndrome.

• Bruises and strains caused by the impact may produce bleeding (hemorrhage).
Because the blood is trapped within the skull, it acts as a growing mass
(hematoma), exerting pressure on surrounding structures.

• As with blows to other parts of the body, blows to the brain produce edema,
another source of pressure on the brain tissue.

Closed-head injuries are commonly accompanied by coma. According to Muriel

Lezak, the duration of unconsciousness can serve as a measure of the severity of
damage, because it correlates directly with mortality, intellectual impairment,
and deficits in social skills. The longer a coma lasts, the greater the possibility of
serious impairment and death.

Often, the chronic effects of closed head injuries are not accompanied by any
obvious neurological signs, and the patients may therefore be referred for
psychiatric evaluation. Thorough psychological assessments are especially useful
65
Neurobiology and in these cases for uncovering seriously handicapping cognitive deficits that have
Behaviour
not yet become apparent. Although, the prognosis for significant recovery of
cognitive functions is good, there is less optimism about the recovery of social
skills or normal personality, areas that often change significantly.

Self Assessment Questions

1) Discuss the Nervous System Diseases and put forward the causative
factors.
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2) Classify the nervous system diseases.
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3) Describe cerebral Ischemia.
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4) Give an account of Migraine stroke.
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5) What do you understand by cerebral hemorrhage?
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66
 Nervous System Diseases
6) Discuss traumatic brain injuries. What do you understand by open closed
head injuries?
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4.7 EPILEPSY
In epilepsy, a person suffers from recurrent seizures of various types that register
on an electroencephalogram and are associated with disturbances of
consciousness. Epileptic episodes have been called convulsions, seizures, fits,
and attacks, but none of these terms on its own is entirely satisfactory, because
the character of the episodes can vary greatly.
Epileptic seizures are classified as symptomatic seizures if they can be identified
with a specific cause, such as infection, trauma, tumor, vascular malformation,
toxic chemicals, very high fever, or other neurological disorders.
They are called idiopathic seizures if they appear to arise spontaneously and in
the absence of other diseases of the central nervous system. The most remarkable
clinical feature of epileptic disorders is the widely varying length of intervals
between attacks , that is from minutes to hours to weeks or even years. In fact, it
is almost impossible to describe a basic set of symptoms to be expected in all or
even most people with the disorder. At the same time, three particular symptoms
are found in many types of epilepsy:
1) An aura, or warning, of impending seizure: This aura may take the form
of a sensation-an odor or a noise-or it may simply be a “feeling” that the
seizure is going to take place.
2) Loss of consciousness: Ranging from complete collapse in some people to
simply staring off into space in others, loss of consciousness is often
accompanied by amnesia in which the victim forgets the seizure itself and
the period of lost consciousness.
3) Movement: Seizures commonly have a motor component, although the
characteristics vary considerably. Some people shake during an attack; others
exhibit automatic movements, such as rubbing the hands or chewing.
A diagnosis of epilepsy is usually confirmed by an EEG. In some epileptics,
however, seizures are difficult to demonstrate in this way, except under special
circumstances (for example, in an EEG recorded during sleep). Several schemes
for classifying epilepsy have been published through the years. Four commonly
recognised types of seizures are:
i) focal seizures,
ii) generalised seizures, and
iii) akinetic and
iv) myoclonic seizures.
These are being discussed in the following section. 67
Neurobiology and 4.7.1 Focal Seizures
Behaviour
A focal seizure begins in one place and then spreads. As for example in a
Jacksonian focal seizure, the attack begins with jerking movements in one part
of the body (for example, a finger, a toe, or the mouth) and then spreads to
adjacent parts. John Hughlings-Jackson hypothesized in 1870 that such seizures
probably originate from the point (focus) in the neocortex representing the region
of the body where the movement is first seen.

However, Complex partial seizures, another type of focal seizure, originate

most commonly in the temporal lobe. Complex partial seizures are characterised
by three common manifestations:
1) subjective experiences that presage the attack such as forced, repetitive
thoughts, sudden alterations in mood, feelings of deja vu, or hallucinations;
2) automatisms, which are repetitive stereotyped movements such as lip
smacking or chewing or activities such as undoing buttons; and
3) postural changes, such as when the person assumes a catatonic, or frozen,
posture.

4.7.2 Generalised Seizures

Generalised seizures are bilaterally symmetrical without focal onset. One subtype,
the grand mal attack, is characterised by loss of consciousness and by stereotyped
motor activity. This kind of seizure typically comprises three stages:
1) a tonic stage, in which the body stiffens and breathing stops;
2) a clonic stage, in which there is rhythmic shaking; and
3) a postseizure, also called postictal depression, during which the patient is
confused. About 50% of these seizures are preceded by an aura.
The other subtype, petit mal attack is a loss of awareness during which there is
no motor activity except for blinking, turning the head, or rolling the eyes.

4.7.3 Akinetic and Myoclonic Seizures

Akinetic seizures are ordinarily seen only in children. Usually, an affected child
collapses suddenly and without warning. These seizures are often of very short
duration, and the child may get up after only a few seconds. The fall can be
dangerous, however, and a common recommendation is to have the children
wear football helmets until the seizures can be controlled by medication.

Myoclonic seizures are massive seizures that basically consist of a sudden flexion
or extension of the body and often begin with a cry.

4.7.4 Tumor
Tumor, or neoplasm, is a mass of new tissue that persists and grows independently
of its surrounding structures and has no physiological use. Brain tumors grow
from glia or other support cells rather than from neurons. Tumors account for a
relatively high proportion of neurological disease compared with other causes.
After the uterus, the brain is the most common site for them.

68
Tumors that are not likely to recur after removal are called benign, and tumors Nervous System Diseases
that are likely to recur after removal, that is often progressing and becoming a
threat to life are called malignant. The brain is affected by many types of tumors,
and no region of the brain is immune to tumor formation.
A tumor may develop as a distinct entity in the brain, a so-called encapsulated
tumor, and put pressure on the other parts of the brain. Some encapsulated tumors
are also cystic, which means that they produce a fluid filled cavity in the brain,
usually lined with the tumor cells.
Because the skull is of fixed size, any increase in its contents compresses the
brain, resulting in dysfunctions.
In contrast with encapsulating tumors, so called infiltrating tumors are not clearly
marked off from the surrounding tissue. They may either destroy normal cells
and occupy their place or surround existing cells (both neurons and glia) and
interfere with their normal functioning.
The general symptoms of brain tumors, which result from increased intracranial
pressure, include headache, vomiting, swelling of the optic disc (papilledema),
slowing of the heart rate (bradycardia), mental dullness, double vision (diplopia),
and, finally, convulsions, as well as functional impairments due to damage to the
brain where the tumor is located.

4.8 HEADACHES
Headache is so common among the general population that rare indeed is the
person who has never suffered one. Headache may constitute a neurological
disorder in itself as in migraine; it may be secondary to neurological diseases
such as tumor or infection; or it may result from psychological factors, especially
stress as in tension headache. There are different kinds of headaches such as
migraine and headache associated with neurological disease etc.

4.8.1 Migraine
Perhaps the most common neurological disorder, migraine afflicts some 5% to
20% of the population at some time in their lives. The World Federation of
Neurology defines migraine as a “Familial disorder characterised by recurrent
attacks of headache widely variable in intensity, frequency and duration. Attacks
are commonly unilateral and are usually associated with anorexia, nausea, and
vomiting. In some cases they are preceded by or associated with neurological
and mood disturbances”. There are several types of migraine, including classic
migraine, common migraine, cluster headache, and hemiplegic and
ophthalmologic migraine.

i) Classic migraine: This is probably the most interesting form, occurring in

about 12% of migraine sufferers, because it begins with an aura, which
usually lasts for 20 to 40 minutes. The aura is thought to occur because
constriction of one or more cerebral arteries has produced ischemia of the
occipital cortex.

The results of PET studies have shown that, during the aura, there is a
reduction in blood flow in the posterior cortex, and this reduction spreads at
the rate of about 2 millimeters per minute, without regard to its location.
69
Neurobiology and The headache is experienced as an intense pain localised in one side of the
Behaviour
head, although it often spreads on that side and sometimes extends to the
opposite side as well.
A severe headache can be accompanied by nausea and vomiting, and it may
last for hours or even days.
ii) Common migraine: This is the most frequent type, occurring in more than
80% of migraine sufferers. There is no clear aura as there is in classic
migraine, but there may be a gastrointestinal or other “signal” that an attack
is pending.
iii) Cluster headache: This is a unilateral pain in the head or face that rarely
lasts longer than 2 hours but recurs repeatedly for a period of weeks or even
months before disappearing. Sometimes long periods pass between one series
of cluster headaches and the next.

The remaining two types of migraine,

iv) Hemiplegic migraine and ophthalmologic migraine: These are relatively
rare and include loss of movement of the limbs and eyes, respectively.

4.8.2 Headache Associated with Neurological Diseases

Headache is a symptom of many nervous system disorders, usually resulting
from the distortion of pain sensitive structures. Common disorders producing
headache include tumor, head trauma, infection, vascular malformations, and
severe hypertension (high blood pressure). The characteristics and locations of
these headaches vary according to the underlying cause.

4.8.3 Muscle Contraction Headache

This is one of the most common headaches. It is also known as tension or nervous
headaches. They result from sustained contraction of the muscles of the scalp
and neck caused by constant stress and tension, especially if poor posture is
maintained for any length of time.
Patients describe their pain as steady, nonpulsing, tight, squeezing, or pressing
or as the feeling of having the head in a vise.
Some patients complain of a crawling sensation.
The headaches may be accompanied by anxiety, dizziness, and bright spots in
front of the eyes.
In some people, caffeine may exacerbate the headaches, presumably because it
exacerbates anxiety.

4.8.4 Non Migrainous Vascular Headaches

This headache associated with dilation of the cranial arteries and can be induced
by a wide variety of diseases and conditions. The most common causes are fever,
anoxia (lack of oxygen), anemia, high altitude, physical effort, hypoglycemia
(low blood sugar), foods, and chemical agents.
In addition, this headache may result from congestion and edema of the nasal
membranes, often termed vasomotor rhinitis, which is assumed to be a localised
vascular reaction to stress.
70
 Nervous System Diseases
Self Assessment Questions
1) Discuss the symptoms and nature and course of epilepsy.
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2) What are focl seizures?
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3) Describe generalised seizures.
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4) Differentiate between akinetic and myoclonic seizures.
...............................................................................................................
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5) What are the effects of tumors on the nervous system? Whjat diseases
emerge as a result of tumor?
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6) Describe and classify headaches.
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71
Neurobiology and
Behaviour 4.9 INFECTIONS
Infection is the invasion of the body by disease-producing (pathogenic)
microorganisms and the reaction of the tissues to their presence and to the toxins
generated by them. Because the central nervous system can be invaded by a wide
variety of infectious agents-including viruses, bacteria, fungi, and metazoan
parasites-the diagnosis and treatment of infection are important components of
clinical neurology. Infections of the nervous system are particularly serious
because the affected neurons and glia usually die, leaving permanent lesions.

4.9.1 Viral Infections

A virus is an encapsulated aggregate of nucleic acid that may be made of either
DNA or RNA. Some viruses, such as those causing poliomyelitis and rabies, are
called neurotropic viruses, because they have a special affinity for cells of the
central nervous system. In contrast, pantropic viruses (such as those that cause
mumps and herpes simplex) attack other body tissues in addition to the CNS.
Most viral infections of the nervous system produce nonspecific lesions affecting
widespread regions of the brain, such as lesions due to St. Louis encephalitis,
rabies, and poliomyelitis.

4.9.2 Bacterial Infections

Bacterium is a loose generic name for any microorganism (typically one celled)
that has no chlorophyll and multiplies by simple division. Bacterial infections of
the central nervous system result from an infestation of these organisms, usually
through the bloodstream. The most common neurological disorders resulting
from bacterial infection are meningitis and brain abscess. In meningitis, the
meninges are infected by any of a variety of bacteria. Brain abscesses also are
produced by a variety of bacteria, secondary to infection elsewhere in the body.

4.9.3 Mycotic Infections

Invasion of the nervous system by a fungus is known as a mycotic infection. A
fungus is any member of a large group of lower plants (in some taxonomic
schemes) that lack chlorophyll and subsist on living or dead organic matter; the
fungi include yeasts, molds, and mushrooms. Ordinarily, the central nervous
system is highly resistant to mycotic infections, but fungi may invade a brain
whose resistance has been reduced by diseases such as cancer or tuberculosis.

4.10 DISORDERS OF MOTOR NEURONS AND

THE SPINAL CORD
A number of movement disorders are produced by damage either to the spinal
cord or to cortical projections to the spinal cord. These disorders include
myasthenia gravis, a disorder of the muscle receptors; poliomyelitis, a disorder
of the motor-neuron cell bodies; multiple sclerosis, a disorder of myelinated
motor fibers; paraplegia and Brown-Sequard syndrome, caused by complete
transection or hemitransection of the spinal cord, respectively; and hemiplegia,
caused by cortical damage.

72
4.10.1 Myasthenia Gravis Nervous System Diseases

Myasthenia gravis (severe muscle weakness) is characterised by muscular fatigue

in the wake of very little exercise. It may be apparent after a short period of
exercise or work, toward the end of a long conversation, or sometimes even after
a few repetitions of a movement. Rest brings a feeling of recovery. The rapid
onset of weakness after exercise distinguishes myasthenia gravis from other
disorders such as depression or general fatigue. There are no visible signs of
muscle pathology.

Although myasthenia can affect people of any age, it is most likely to begin in
the third decade of life and is more common in women than in men. The muscular
weakness is caused by a failure of normal neuromuscular transmission due to a
paucity of muscle receptors for acetylcholine. These receptors may have been
attacked by antibodies from the patient’s own immune system.

4.10.2 Poliomyelitis
Poliomyelitis is an acute infectious disease caused by a virus that has a special
affinity for the motor neurons of the spinal cord and sometimes for the motor
neurons of the cranial nerves. The loss of these motor neurons causes paralysis
and wasting of the muscles. If the motor neurons of the respiratory centers are
attacked, death can result from asphyxia. The occurrence of the disease was
sporadic and sometimes epidemic until the Salk and Sabin vaccines were
developed in the 1950s and 1960s. Since then, poliomyelitis has been well
controlled.

4.10.3 Multiple Sclerosis (MS; Sclerosis, from Greek, Meaning

“Hardness”)
This is a disease characterised by the loss of myelin, largely in motor tracts but
also in sensory tracts. The loss of myelin is not uniform, rather, it is lost in
patches-small, hard, circumscribed scars, called sclerotic plaques in which the
myelin sheath and sometimes the axons are destroyed.

Multiple sclerosis produces strange symptoms that usually appear first in

adulthood. The initial symptoms may be loss of sensation in the face, limbs, or
body, blurring of vision; or loss of sensation and control in one or more limbs.

Often, these early symptoms go into remission, after which they may not appear
again for years. In some forms, however, the disease may progress rapidly in just
a few years until an affected person is limited to bed care. The cause of MS is
still not known. Proposed causes include bacterial infection, a virus,
environmental factors, and an immune response of the central nervous system.

4.10.4 Paraplegia
Paraplegia (from the Greek para, “alongside of,” and plegia, “stroke”) is a
condition in which both lower limbs are paralyzed (quadriplegia is the paralysis
of all four extremities). Paraplegia results when an injury to the spinal cord is
below the first thoracic spinal nerve. This results in the loss of feeling and
movement, to some degree, of the legs. Paraplegics can experience anything
from impairment of leg movement to complete loss of leg movement all the way
up to the chest. Paraplegics are able to move their arms and hands. The degree of
73
Neurobiology and function that a person with paraplegia will experience depends upon the level of
Behaviour
injury, type of injury, and whether the injury was complete or incomplete. The
complications of paraplegia include (i) Skin care issues (ii) Loss of bladder control
(iii) Loss of bowel control (iv) Loss of sensory function (v) Loss of motor
function. Treatment during the acute phase will focus on returning as much
function as possible. Long term treatment will focus on learning to compensate
with disabilities, and keeping complications at bay.

4.10.5 Brown-Sequard Syndrome

Brown-Sequard syndrome is a rare spinal disorder that results from an injury to
one side of the spinal cord in which the spinal cord is damaged but is not severed
completely. It is usually caused by an injury to the spine in the region of the neck
or back. In many cases, affected individuals have received some type of puncture
wound in the neck or in the back that damages the spine and causes symptoms to
appear.

Characteristically, the affected person loses the sense of touch, vibrations and/or
position in three dimensions below the level of the injury (hemiparalysis or
asymmetric paresis). The sensory loss is particularly strong on the same side
(ipsilateral) as the injury to the spine. These sensations are accompanied by a
loss of the sense of pain and of temperature (hypalgesia) on the side of the body
opposite (contralateral) to the side at which the injury was sustained.

Symptoms of Brown-Sequard syndrome usually appear after an affected

individual experiences a trauma to the neck or back. First symptoms are usually
loss of the sensations of pain and temperature, often below the area of the trauma.
There may also be loss of bladder and bowel control. Weakness and degeneration
(atrophy) of muscles in the affected area may occur. Paralysis on the same side
as that of the wound often occurs. Paralysis may be permanent if diagnosis is
delayed.

Individuals with this syndrome have a good chance of recovering a large measure
of function. More than 90% of affected individuals recover bladder and bowel
control, and the ability to walk. Most affected individuals regain some strength
in their legs and most will regain functional walking ability.

This syndrome is often a consequence of a traumatic injury by a knife or gunshot

to the spine or neck. In many cases, however, it is caused by, or is the result of,
other spinal disorders such as cervical spondylosis, arachnoid cyst or epidural
hematomas. BrownSequard syndrome may also accompany bacterial or viral
infections. Blunt traumas, such as occur in a fall or automobile accident, on rare
occasions may be the cause of the Brown-Sequard syndrome.

There is no specific treatment for individuals with Brown-Sequard syndrome. In

most instances, treatment focuses on the underlying cause of the disorder.
Treatment may involve drugs that control muscle symptoms, and there is some
dispute as to whether high-dose steroid administration is effective.

Devices that help an affected individual continue daily activities such as braces,
hand splits, limb supports, or a wheelchair are important. Various other aids may
be necessary if the patient has difficulty breathing or swallowing. Other treatment
is symptomatic and supportive.
74
4.10.6 Hemiplegia Nervous System Diseases

The characteristics of hemiplegia (again, hemi means “half”) are loss of voluntary
movements on one side of the body, changes in postural tone, and changes in the
status of various reflexes. Hemiplegia results from damage to the neocortex and
basal ganglia contralateral to the motor symptoms. In infancy, such damage may
result from birth injury, epilepsy, or fever. In young adults, hemiplegia is usually
caused by rupture of a congenital aneurysm or by an embolism, a tumor, or a
head injury. Most cases of hemiplegia, however, are found in middle-aged to
elderly people and are usually due to hemorrhaging as a consequence of high
blood pressure and degeneration of the blood vessels.

Self Assessment Questions

1) What are the nervous system diseases caused by infection?
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2) What are the types of infections one comes across?
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3) Discuss mycotic infections.
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4) Discuss the nervous system diseases caused by disorders of motor
neurons and the spinal cord.
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75
Neurobiology and
Behaviour 5) Give a description of Myasthenia gravis.
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6) What do you understand by Brown sequard syndrome.
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4.11 DISORDERS OF SLEEP

The need for sleep varies considerably from one person to another, as well as in
the same person at different stages of life. We have all been told that we need
eight hours of sleep each night for good health. In fact, there are both long and
short sleepers. Some people can stay healthy on as little as an hour of sleep per
day, whereas others may need to sleep as much as 10 to 12 hours. The definition
of what constitutes adequate sleep must be decided within the context of a person’s
sleep history. People who suffer from disorders related to sleep are usually
examined in a sleep laboratory for 1 to 2 days. A polygraph (Poly meaning “many”)
records their brain waves, or EEG; an electromyogram, or EMG, records muscle
activity; an electro oculogram, or EOG, records eye movements; and a
thermometer measures body temperature during sleep. Together, these recordings
provide a comprehensive and reliable description of sleep waking behaviour.

Sleep disorders are generally divided into two major groups:

1) narcolepsy, which is characterised by excessive sleep or brief inappropriate
episodes of sleep, often associated with other symptoms; and
2) insomnia, which is characterised by an inadequate amount of sleep, an
inability to fall asleep, or frequent inconvenient arousals from sleep. These
two are dealt with in detail below.

4.11.1 Narcolepsy
This is an inappropriate attack of sleep, the affected person has an overwhelming
impulse to fall asleep or simply collapses into sleep at inconvenient times. Attacks
may be infrequent or may occur many times a day. Narcolepsy disorders are
surprisingly common. The estimates suggest that as much as 0.02% of the
population may suffer from them. Males and females seem equally affected. The
narcolepsies include
1) sleep attacks,
76
2) cataplexy, Nervous System Diseases

3) sleep paralysis, and

4) hypnagogic hallucinations.
Although all these disorders do not generally exist at the same time or in the
same person, they are present together often enough to be considered interrelated.

i) Sleep attacks: These are brief, often irresistible, episodes of sleep, probably
slow wave, NREM, naplike sleep that last about 15 minutes and can occur
at any time. Their approach is sometimes recognisable, but they can also
occur without warning. Episodes are most apt to occur in times of boredom
or after meals, but they can also occur during such activities as sexual
intercourse, scuba diving, or baseball games. After a brief sleep attack, the
affected person may awaken completely alert and remain attack free for a
number of hours.

ii) Cataplexy: Catalepsy (Greek, ‘cata’ meaning “down,” and ‘plexy’ meaning
“strike”) is a complete loss of muscle tone or a sudden paralysis that results
in “buckling” of the knees or complete collapse. The attack may be so sudden
that the fall results in injury, particularly because the loss of muscle tone
and reflexes prevents an affected person from making any motion that would
break the fall. During the attack, the person remains conscious and, if the
eyelids stay open or are opened, can recall seeing events that took place
during the attack. In contrast with sleep attacks, cataplexic attacks usually
occur at times of emotional excitement, such as when a person is laughing
or angry.

iii) Sleep paralysis: This is an episode of paralysis in the transition between

wakefulness and sleep. The period of paralysis is usually brief but can last
as long as 20 minutes. Sleep paralysis has been experienced by half of all
people, if classroom surveys are a true indication of its frequency. In contrast
with cataplexy, the paralysed person can be easily aroused by being touched
or called by name and, if experienced with the attacks, can terminate them
by grunting or using some other strategy that shakes off the sleep. What
appears to happen in sleep paralysis is that the person wakes up but is still
in the state of paralysis associated with dream sleep.

iv) Hypnagogic hallucinations: Hypnagogic hallucinations (Greek, ‘hypnos’

meaning “sleep,” and ‘gogic’ meaning “enter into”) are episodes of auditory,
visual, or tactile hallucination during sleep paralysis as an affected person
is falling asleep or waking up. The hallucinations are generally frightening;
the person may feel that a monster or something equally terrifying is lurking
nearby. A curious feature of the hallucinations is that the person is conscious
and often aware of things that are actually happening. These hallucinations
may actually be dreams that a person is having while still conscious.

4.11.2 Insomnia
The results from studies of people, who claim that they do not sleep, or wake up
frequently from sleep show that their insomnia can have many causes.
Nevertheless, systematic recordings of EEGs from poor sleepers before and during
sleep show that the sleepers exaggerated the length of time that it took them to
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Neurobiology and get to sleep. But poor sleepers do have decreased dream sleep, move more during
Behaviour
sleep, and go through more transitions between sleep stages than normal people
do. Moreover, when awakened from slow-wave sleep, they claim that they have
not been sleeping. Insomnia may be associated with nightmares and night terrors,
sleep apnea (arrested breathing during sleep), restless legs syndrome (RLS,
described in the Snapshot below), myoclonus (involuntary muscle contraction),
the use of certain kinds of drugs, and certain kinds of brain damage.

i) Nightmares: Nightmares are intense, frightening dreams that lead to waking.

Less common are night terrors, attempts to fight or flee accompanied by
panic and screams or similar utterances. Nightmares occur during dream
sleep, but night terrors occur during NREM sleep. Night terrors are usually
brief (1 or 2 minutes) and are usually forgotten on waking.

ii) Sleep apnea: Sleep apnea (from the Greek for “not breathing”), a periodic
cessation of respiration in sleep that ranges in length from about 10 seconds
to 3 minutes, is of two types.
i) Obstructive sleep apnea
ii) Central sleep apnea

The obstructive sleep apnea occurs mainly in the course of dream sleep and
seems to be caused by a collapse of the oropharynx during the paralysis of dream
sleep. Patients with this problem invariably have a history of loud snoring sounds
produced as a consequence of the difficulty of breathing through the constricted
air passage. The obstruction can be reduced through surgical intervention.

The Central sleep apnea stems from a central nervous system disorder. It primarily
affects males and is characterised by a failure of the diaphragm and accessory
muscles to move.

Sleep apnea can be caused or aggravated by obesity, which contributes to

narrowing of the air passage. According to Caterina Tonon, oxygen deprivation
incurred in sleep apnea can lead to neuronal loss in the brain.

Self Assessment Questions

1) Discuss the various disorders of sleep.
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2) Describe cataplexy.
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 Nervous System Diseases
3) What is narcolepsy and how does it differ from insomnia.
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4) What are Hypnogogic hallucinations?
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5) What is sleep apnea.
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4.12 LET US SUM UP

The nervous system consists of the brain, the spinal cord, and the network of
nerves throughout the rest of the body. The nervous system provides a rapid
means for the various parts of the body to communicate with each other. The
nervous system is composed of two major parts; the central nervous system
(CNS) and the peripheral nervous system (PNS. Besides these, a functional
division also exists: the somatic nervous system and the autonomic nervous system
where the autonomic nervous system is further divided in sympathetic and
parasympathetic nervous system.

Nervous system diseases are the disorders of the body caused by structuctural,
biochemical or electrical abnormalities in the brain or spinal cord, or in the nerves
leading to or from them. The symptoms can be manifested in the form of paralysis,
muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain
and altered levels of consciousness. The identification of symptoms and diagnoses
are done on the basis of neurological examination and neuropsychological
assessments and studied and treated within the specialties of neurology and clinical
neuropsychology. An individual’s neurons, the building blocks of the nervous
system, and the neural networks into which they form, are susceptible to
electrochemical and structural disruption. While neuro-regeneration may occur
in the peripheral nervous system, it is thought to be rare in the brain and spinal
cord and therefore results in different form of neural diseases. 79
Neurobiology and Neurological disorders can be categorised according to the primary location
Behaviour
affected, the primary type of dysfunction involved, or the primary type of cause.
The broadest division is between central nervous system (CNS) disorders and
peripheral nervous system (PNS) disorders. Vascular disorders include Cerebral
Ischemia, Migraine stroke, Cerebral Hemorrhage, Angiomas and Aneurysms.

Brain injury is a common result of automobile and industrial accidents and of

war injuriesTraumatic Brain Injury include Open head injury, Close head injuries,
etc. Then we dealt with epilepsy in which we described the different types of
epilepsy and their symptopms. The we took up tumor for discussion followed by
headaches. We discussed under headaches migraines, and their types, headaches
associated with neurological diseases, Muscle Contraction Headache, Non
migrainous vascular headaches. Then we dwealt with infections and the various
types of infections that could cause neurological disorders. This was followed
by a discussion on disorders of the motor neurons and the spinal cord under
which we discussed myasthenia gravis and other related disorders. Then we
presented multiple sclerosis, paraplegia, Brown-Sequard syndrome , Hemiplegia,
etc. Then we moved on to sleep disorders that included narcolepsy, insomnia,
sleep apnea etc.

4.13 UNIT END QUESTIONS

1) Discuss the nervous system diseases and their causes in general.
2) How are the nervous system diseases classified? Give the classification in
your own words.
3) What are the vascular disorders under the nervous system diseases? Give a
brief description.
4) What are traumatic brain injuries? How are they caused.
5) Describe epilepsy.
6) What are the various types of headaches ounder the nervous system diseases?
Give a description of migraine.
7) How do infections cause nervous system diseases?
8) Discuss the disorders of motor neurons and pinal cord.
9) What are the various types of sleep disorders ? Describe.

4.14 SUGGESTED READINGS

WHO (2007). WHO Neurological Disorders: Public Health Challenges. WHO
Press, 1211 Geneva 27, Switzerland.

Merck Veterinary Manual (2008). Nervous System. Merck & Co., Inc. Whitehouse
Station, NJ USA.

Jeffrey L. Cummings and Michael S. Mega, (2003). Neuropsychiatry and

Behavioral Neuroscience, Oxford University Press.

Levinthal Charles F (2007). Introduction to Physiological Psychology. PHI

Learning Private Limited, India.

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