Neuropsychological Approach Research Articles

Bénéfices secondaires d’une réhabilitation cognitive réalisée chez un patient souffrant d’un éthylisme chronique : effets sur la conscience des troubles, la motivation, et la coopération globale aux soins

Alcoholism causes psychological, behavioral and cognitive symptoms that need to be addressed together. The neuropsychological alterations among alcohol-dependent people are considered to make the therapeutic work complex and longer. A cognitive rehabilitation program is sometimes difficult to achieve with these patients. Functional results are often difficult to anticipate. However, the consequences of this therapeutic approach are multiple and there are many interactions between psycho-affective, behavioral and cognitive components. A neuropsychological approach can be used like a tool to improve metacognition. A bad contribution to treatment programs is often secondary to the illusion of a satisfying intellectual functioning. Patients' motivation for the therapeutic work is very changeable. A complete consciousness of impairments can help them to stay involved. The following case shows the cognitive effects and secondary benefits associated with a neuropsychological work, which was carried out by a chronic ethylic patient with severe physical and cognitive symptoms. The patient aged 50, with a good qualification level (scientific section in the final year of secondary school, with no diploma, then attended a training program to become a croupier) was suffering from chronic alcoholism since his adolescence. He arrived in the closed unit after many hospitalizations in psychiatric and hepato-gastroenterology units. He had been showing mental confusion. He presented a frontal and subcortical profile of alcohol-related dementia according to Oslin's criteria. MRI revealed global cerebral atrophy, more pronounced on the fronto-parietal cortex with cerebellar leukoencephalopathy, but no pontine central myelinolysis. The neurocognitive program had two main lines: reducing attentional, executive and graphical deficits with training exercises (individual and group sessions) and compensating memory, and executive disorders with an external aid. The cognitive program had been assessed by means of repeated psychometric measures, behavior and metacognition estimated by direct clinical observations. The cognitive remediation was carried out during a 10-month hospitalization, and then in an outpatient rehabilitation setting over a 12-month period. The external individual sessions were associated with medical consultations and support for reintegration at home provided by the mobile psychiatric team. The test results showed a significant improvement in attentional processes and executive functions. On graphic level, his writing was recovered after 10 months. Impairment within episodic memory processes-encoding was observed, and prospective memory was reinforced by external aids. At the end of the program, the use of an agenda proved to be effective even if updating was difficult once back home. Although a part of these effects could be expected, their psychological influence on the patient must be underlined: his perception of the alcohol related problem had been modified with more consciousness of the neurobiological consequences and a strong desire of personal implication. He worked a lot on his own (always under supervision) on cognitive exercises and succeeded in remaining abstinent for nearly 2 years. He died of complications of acute hepatitis. All the cognitive assessments and rehabilitation results seem to have increased his participation in the global therapeutic care. Therapeutic tools used for cognitive work give a concrete picture of the consequences of alcohol consumption and the necessary time to retrieve brain capacities. Visible improvements in terms of reduction in disability-handicaps encouraged the patient, valued his efforts, and increased his determination to solve his alcohol related problem. Thus, cognitive programs can help to reduce passiveness and develop activeness. This patient regarded therapeutic difficulties as a challenge, not as an obstacle. We can reasonably assume the effect of the cognitive rehabilitation on the Persistence of the Cloninger's biosocial model. This increase in temperament corresponds to a certain form of tenacity, which would facilitate abstinence.

Abnormal Causal Attribution Leads to Advantageous Economic Decision-making: A Neuropsychological Approach

People tend to assume that outcomes are caused by dispositional factors, for example, a person's constitution or personality, even when the actual cause is due to situational factors, for example, luck or coincidence. This is known as the "correspondence bias." This tendency can lead normal, intelligent persons to make suboptimal decisions. Here, we used a neuropsychological approach to investigate the neural basis of the correspondence bias, by studying economic decision-making in patients with damage to the ventromedial pFC (vmPFC). Given the role of the vmPFC in social cognition, we predicted that vmPFC is necessary for the normal correspondence bias. In our experiment, consistent with expectations, healthy (n = 46) and brain-damaged (n = 30) comparison participants displayed the correspondence bias during economic decision-making and invested no differently when given dispositional or situational information. By contrast, vmPFC patients (n = 17) displayed a lack of correspondence bias and invested more when given dispositional than situational information. The results support the conclusion that vmPFC is critical for normal social inference and the correspondence bias. The findings help clarify the important (and sometimes disadvantageous) role of social inference in economic decision-making.

Neuroanatomical Correlates of Executive Functions: A Neuropsychological Approach Using the EXAMINER Battery

Executive functions (EF) encompass a variety of higher-order capacities such as judgment, planning, decision-making, response monitoring, insight, and self-regulation. Measuring such abilities quantitatively and establishing their neural correlates has proven to be challenging. Here, using a lesion-deficit approach, we report the neural correlates of a variety of EF tests that were developed under the auspices of the NINDS-supported EXAMINER project (Kramer, 2011; www.examiner.ucsf.edu). We administered a diverse set of EF tasks that tap three general domains--cognitive, social/emotional, and insight--to 37 patients with focal lesions to the frontal lobes, and 25 patients with lesions outside the frontal lobes. Using voxel-based lesion-symptom mapping (VLSM), we found that damage to the ventromedial prefrontal cortex (vmPFC) was predominately associated with deficits in social/emotional aspects of EF, while damage to dorsolateral prefrontal cortex (dlPFC) and anterior cingulate was predominately associated with deficits in cognitive aspects of EF. Evidence for an important role of some non-frontal regions (e.g., the temporal poles) in some aspects of EF was also found. The results provide further evidence for the neural basis of EF, and extend previous findings of the dissociation between the roles of the ventromedial and dorsolateral prefrontal sectors in organizing, implementing, and monitoring goal-directed behavior.

CONVERGENCE OF TWO INDEPENDENT ROADS LEADS TO COLLABORATION BETWEEN EDUCATION AND NEUROSCIENCE

Collaboration is the foundation for innovative discoveries, as individuals with different backgrounds come together and combine their unique expertise. In the current article, an educational researcher and two neuroscientists relate their experiences in establishing a successful collaborative effort. The marriage of neuroscientific findings with educational research has begun to further advance educational approaches. Initial functional magnetic resonance imaging (fMRI) findings indicate that direct interplay between educational interventions and brain‐based measures of sensory, motor, and cognitive processes provides an important link among cognitive processing and psychometric measures. If neuroimaging results support existing theoretical constructs of brain organization, then testable hypotheses may be designed to determine which educational interventions will be effective. The neuropsychological approach may provide school psychologists and teachers with an extensive array of fMRI‐based, developmentally appropriate instructional strategies for enhancing the functional organization of the developing brain of children. Promising suggestions and strategies for educational researchers, school psychologists, and neuroscientists are included.

Metacognição e funções executivas: relações entre os conceitos e implicações para a aprendizagem

A pesquisa sobre aprendizagem indica que as capacidades de planejamento, monitoramento e controle são centrais ao processo de aprender e que falhas ou atraso no seu desenvolvimento estão presentes nas dificuldades de aprendizagem. Tais capacidades são definidas como metacognição em uma abordagem psicológica e como funções executivas em uma abordagem neuropsicológica. Assim, deparamo-nos com dois conceitos distintos que remetem a capacidades mentais semelhantes. Neste trabalho objetivou-se, através da revisão da literatura clássica e recente, examinar os conceitos de metacognição e de funções executivas, relacionando-os entre si e com o aprender. Como resultado, evidenciou-se que os conceitos aproximam-se em alguns aspectos e divergem em outros, e que há dados empíricos iniciais confirmando a relação entre as habilidades descritas pelos dois conceitos.

Connecting Past and Present: The Vygotskian–Lurian Neuropsychological Approach and Its Relevance Today

Connecting Past and Present: The Vygotskian–Lurian Neuropsychological Approach and Its Relevance Today

Promising developments in neuropsychological approaches for the detection of preclinical Alzheimer’s disease: a selective review

Recently published guidelines suggest that the most opportune time to treat individuals with Alzheimer’s disease is during the preclinical phase of the disease. This is a phase when individuals are defined as clinically normal but exhibit evidence of amyloidosis, neurodegeneration and subtle cognitive/behavioral decline. While our standard cognitive tests are useful for detecting cognitive decline at the stage of mild cognitive impairment, they were not designed for detecting the subtle cognitive variations associated with this biomarker stage of preclinical Alzheimer’s disease. However, neuropsychologists are attempting to meet this challenge by designing newer cognitive measures and questionnaires derived from translational efforts in neuroimaging, cognitive neuroscience and clinical/experimental neuropsychology. This review is a selective summary of several novel, potentially promising, approaches that are being explored for detecting early cognitive evidence of preclinical Alzheimer’s disease in presymptomatic individuals.

A neuropsychological approach to time estimation

Time estimation, within a range of seconds, involves cognitive functions which depend on multiple brain regions. Here we report on studies investigating the reproduction and production of three durations (5, 14, and 38 seconds) in four groups of patients. The amnesic patient underproduced the length of the long durations because of episodic memory deficit following bilateral medial temporal lesions. Epileptic patients (n = 9) with right medial temporal lobe resections underproduced the three durations because of a distorted representation of time in long-term memory. Traumatic brain injury patients (n = 15) made more variable duration productions and reproductions because of working memory deficits following frontal-lobe dysfunction. Patients with Parkinson's disease (n = 18) overproduced the short duration and underproduced the long duration because of a possible increase in internal clock speed following levodopa treatment, as well as working memory deficits associated with frontal-lobe damage. Further research, in neurological and psychiatric patients, is required to better understand the underlying mechanisms of time estimation.

Cognitive neuropsychological approach to aphasia treatment: Implications for evidence-based clinical practice. Commentary on Laine and Martin, “Cognitive neuropsychology has been, is, and will be significant to aphasiology”

In their target article for this Aphasiology forum Matti Laine and Nadine Martin (2012) support the continued relevance of cognitive neuropsychology (CNP) in aphasia research and clinical aphasiolo...

Place de l’inhibition dans le trouble obsessionnel-compulsif

The nature of neuropsychological mechanisms underlying the clinical picture of obsessions and compulsions has not been clearly determined. A number of studies has emphasized the role of cognitive deficits, but diversity of methodology and overlapping of clinical sub-groups have not established a specific cognitive functioning of these patients. The studies carried out on executive functions have, however, helped to identify the important role that both inhibition and cognitive flexibility play in obsessive-compulsive (OC) symptoms. Most of them have found that a deficit of inhibition and alteration of cognitive flexibility could explain inflexibility and repetitive thoughts and actions typical of all types of OC disorders. The aim of the paper is to present the published data supporting the hypothesis of a specific role played by a deficit of inhibition and cognitive inflexibility. In the first, theoretical part, we present the neuropsychological approach emphasizing inhibition and lack of flexibility as a promising explanation of the functioning of OC disorders. In the second part, we will present studies using various measurements of inhibition and the results of which, therefore, support this hypothesis. On the theoretical level, it is the model of attention that was used in explaining the OCD hypothesis. In the model of attention control of action, described by Norman, Shallice and Burgess, three systems were emphasized: one that takes care of routine actions, and the second that takes over the first in situations where automatic activities must stop in order to establish an attention control and therefore inhibit automatic responses. When selection of everyday and automatic activities is not sufficient to accomplish a task, it is the third system, that of cognitive control, which takes over. This supervisory attentional system operates in non-routine and ambiguous activities. The cognitive control is charged with detecting potential or emitted cognitive errors and resolving ambiguous situations. Neurocognitive studies show that cingular anterior cortex and prefrontal lateral cortex are engaged in ambiguous and conflicting situations. These two regions are considered essential for inhibition of routine actions, adjustment to change and, more generally, for an efficient and flexible behaviour. Repetitive nature of verification rituals in OCD could be explained in terms of lack of relationship between two systems, leaving in action the one that regulates automatic activities. Therefore, the rituals are considered to be under particular influence of the system which, being in charge of automatic actions, has a deficit in disengagement. Another model of attention, described by Posner, gives a further explanation of OCD. Mental inhibition has the capacity to treat information, either by applying strategies to control it (i.e. trying not to remember an unpleasant event) or leaving it to automatic control (i.e. incapacity to experience an emotion in relation to a particular event). In this way, the effort to suppress an intrusive thought is considered as controlled and deliberate cognitive treatment of emotionally charged information. In OCD, in the context of heightened anxiety, the assumed negative valence of information would influence habitual suppression of thought during controlled treatment. As a result, controlled efforts to suppress obsessions in emotionally stressful situations, would lead to the production of repetitive thoughts, as controlled treatment of information has failed in this action. On a clinical and experimental level, these studies have led to a better understanding and conceptualization of OCD. In spite of some conflicting results, there are concordant data in favour of hypotheses of the role of sub-cortical and frontal regions and their function in inhibition/desinhibition implied in the onset and maintenance of OCD. Functional neuroimagery anomalies are also in favour of the role of sub-cortical-frontal region in clinical manifestations of OCD. They are often associated with low performance in cognitive tasks, especially those implying frontal functions, which are, in turn, dependent on a necessary level of attention in order to guide or inhibit motor and cognitive programs.

Conciliating cognition and consciousness: the perceptual foundations of clinical reasoning

Clinical reasoning has been defined as a form of cognition applied to evaluating and managing a patient's medical problem. As a kind of cognition, a product of the human psyche, it is logical to expect that clinical reasoning should be best understood through methods derived from psychology, neuropsychology and the cognitive sciences. However, the application of scientific methods to evaluating clinical reasoning is unable to analyse clinical reasoning in terms of first-person experience and consciousness. By reducing clinical reasoning to its cognitive components the cognitivist approach tends to ignore the larger context in which clinical reasoning occurs. By reducing its conception of clinical reasoning to its cognitive components, the neuropsychological approach fails to acknowledge clinical reasoning as a form of intentionality, a gestalt, grounded in human perception. A full epistemology of clinical reasoning requires a phenomenological analysis that can make sense of the relation between pre-reflective consciousness and explicit forms of knowing. In this paper I conciliate cognition and consciousness in medicine through analysing the phenomenology of perception in clinical reasoning. I compare the application of phenomenology to clinical reasoning with the attempt to model clinical reasoning on Aristotelian practical wisdom or phronesis. Finally, I analyse empathy as a type of perception critical for effective clinical interaction and exemplary for reflecting on perception as the intersubjective foundation of clinical reasoning.

Healing gardens: recommendations and criteria for design

The French Alzheimer plan anticipates new specialized structures for cognitive rehabilitation and psycho-behavioural therapy of Alzheimer's patients: the cognitive-behavioural units as follow-care units, the units of reinforced hospitalization inside the long term care units and the adapted activities units. this plan indicates the need to make healing gardens integral parts of these units. The benefits of green space in urban environments has been demonstrated with regards to physical, psychological and sociological effects and similarly studies in hospitals have revealed objective and measurable improvements of patients well being. Although green spaces and gardens are available in many French care units, they are rarely specifically adapted to the needs of Alzheimer's patients. For the garden "art, memory and life" a specific concept guided by a neuropsychological approach was developed, complemented by an artistic vision based on cultural invariants. It is already used in the frame of non-pharmacological therapies to improve symptoms such as deambulation, sleep disorders, apathy and aggressive behaviors. Based on the literature, and our experience and research, recommendations for the design of such gardens dedicated to Alzheimer's patients can be proposed. Beyond taking into account obvious aspects relating to security, allowing for free access, a careful design of walk-ways and a conscious choice of plants is needed. A systematic analysis of the existing green spaces or garden must be conducted in order to pinpoint the weakness of the space and identify the potential for developing it into a real healing garden. Evaluation of adapted questionnaires for users and professionals allow to establish a list of requirements combining both user requests and therapeutic needs as basis for the design of the garden as well as to evaluate during the course of the project, whether the needs of the various stakeholders have been met or if adjustments are necessary.

Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex

A considerable body of previous research on the prefrontal cortex (PFC) has helped characterize the regional specificity of various cognitive functions, such as cognitive control and decision making. Here we provide definitive findings on this topic, using a neuropsychological approach that takes advantage of a unique dataset accrued over several decades. We applied voxel-based lesion-symptom mapping in 344 individuals with focal lesions (165 involving the PFC) who had been tested on a comprehensive battery of neuropsychological tasks. Two distinct functional-anatomical networks were revealed within the PFC: one associated with cognitive control (response inhibition, conflict monitoring, and switching), which included the dorsolateral prefrontal cortex and anterior cingulate cortex and a second associated with value-based decision-making, which included the orbitofrontal, ventromedial, and frontopolar cortex. Furthermore, cognitive control tasks shared a common performance factor related to set shifting that was linked to the rostral anterior cingulate cortex. By contrast, regions in the ventral PFC were required for decision-making. These findings provide detailed causal evidence for a remarkable functional-anatomical specificity in the human PFC.

Can We Incorporate Psychosocial Treatment Interventions Into Psychopharmacology Clinical Trials?

Can We Incorporate Psychosocial Treatment Interventions Into Psychopharmacology Clinical Trials?

EVALUACIÓN DEL DESARROLLO DE LA FUNCIÓN EJECUTIVA EN ESCOLARES: USO DE LA PRUEBA DIMENSIONAL CHANGE CARD SORT (DCCS) EN UNA MUESTRA ESPAÑOLA.

Executive function (EF) has been studied from different perspectives, with the medical or neuropsychological approach has been the most deployed in the field of science, based on the effects that certain damage to the frontal lobes cause to human actions such as planning, impulse control or goal-directed action. Currently, there are studies of EF focused on defining the development and acquisition of skills relating to the components of this function. Therefore, the search for effective and simple tools that allow the detection of students who may have difficulty in control functions, planning, working memory tasks or evaluation, is a necessary resource in the work of detection and diagnosis of the school counselor. This study analyzes the development of executive function (EF) in school populations through the application of the test Dimensional Change Card Sort (DCCS). We used a sample of 82 students in kindergarten and primary (4 to 7 years) of public schools in western Andalusia. We analyzed the test results and its relationship with age and sex of subjects. The results observed showed a progressive domain, as hierarchical stages, of the EF tasks, being the most complex task, the combined use of several rules, the last to achieve. This pattern of solution of the tasks in a stepwise and hierarchical process shows that the DCCS is appropriate to observe the developmental level of EF, becoming an useful tool for early diagnosis of students with possible deficit related to self-control, mastery rules and attention problems such as attention-deficit hyperactivity or pervasive developmental disorder.

The neurocognition of alexithymia: evidence from neuropsychological and neuroimaging studies.

Alexithymia refers to an ineffective regulation and expression of emotions. It constitutes a major risk factor for a range of medical and psychiatric problems, including chronic pain, somatisation, anxiety and depression. Alexithymia is a multi-faceted concept, described in terms of cognitive and affective aspects. From a neuropsychological perspective, alexithymia can be defined as a disturbance in affective information processing and social cognition. As the growing literature on brain structures involved in alexithymia is fragmented and sometimes even contradictory, the aim of this article was to review findings on neural substrates with regard to their convergence. A narrative review was performed, including both early neuropsychological and more recent imaging studies, in order to achieve a better understanding of the aetiology of alexithymia. Corpus callosum, cingulate cortex and insula are clearly involved in alexithymia. The amygdala and the orbitofrontal part of the cortex appear to be implicated as mediators, because of their broader involvement in emotional processing and executive control. Notwithstanding the diffuse neural representation, the alexithymia construct can be usefully applied in the clinical and empirical studies of social cognition, particularly when adopting a dimensional neuropsychological approach.

A Neuropsychological Test of Belief and Doubt: Damage to Ventromedial Prefrontal Cortex Increases Credulity for Misleading Advertising

We have proposed the False Tagging Theory (FTT) as a neurobiological model of belief and doubt processes. The theory posits that the prefrontal cortex is critical for normative doubt toward properly comprehended ideas or cognitions. Such doubt is important for advantageous decisions, for example in the financial and consumer purchasing realms. Here, using a neuropsychological approach, we put the FTT to an empirical test, hypothesizing that focal damage to the ventromedial prefrontal cortex (vmPFC) would cause a “doubt deficit” that would result in higher credulity and purchase intention for consumer products featured in misleading advertisements. We presented 8 consumer ads to 18 patients with focal brain damage to the vmPFC, 21 patients with focal brain damage outside the prefrontal cortex, and 10 demographically similar healthy comparison participants. Patients with vmPFC damage were (1) more credulous to misleading ads; and (2) showed the highest intention to purchase the products in the misleading advertisements, relative to patients with brain damage outside the prefrontal cortex and healthy comparison participants. The pattern of findings was obtained even for ads in which the misleading bent was “corrected” by a disclaimer. The evidence is consistent with our proposal that damage to the vmPFC disrupts a “false tagging mechanism” which normally produces doubt and skepticism for cognitive representations. We suggest that the disruption increases credulity for misleading information, even when the misleading information is corrected for by a disclaimer. This mechanism could help explain poor financial decision-making when persons with ventromedial prefrontal dysfunction (e.g., caused by neurological injury or aging) are exposed to persuasive information.

Comparative analysis of Russian and foreign systems for the neuropsychological diagnosis of children from the standpoint of the psychometric approach

Modern approaches to the psychological diagnostics of children are based on need analysis and the systematization of existing trends in domestic and foreign children’s neuropsychological diagnoses. This article highlights the strengths and weaknesses of each approach, as well as identifying possible areas of integration. One of the most acute problems is the development of experimental psychological methods to determine the quantitative and expressed characteristics of the mental development of children by flexibly combining qualitative and quantitative approaches, with a view to putting into practice foreign neuroscience principles and standards of evidence. An analysis of contemporary publications on neuropsychological diagnosis reveals the need to consider the standardization of neuropsychological research in the context of current approaches, requirements, and psychodiagnostic criteria. In the domestic neuropsychological literature, these issues are need attention: standardized procedures for presenting stimuli are not, as a rule, described; basic psychometric assessment of the results of the tests is lacking; no investigation of their clinical and psychometric validity is carried out. An analysis was made of the nature of the psychometric approach in foreign child neuropsychology, which relies on mathematical procedures of processing qualitative (ordinal) data converted into quantitative indicators. We examined separately the mathematical software for clinical trials (based on the principles of «evidencebased medicine»), which relies on the «abnormal» nature of the distribution of clinical phenomena.

Cognitive Structure of Writing Disorders in Russian: What Would Luria Say?

Acquired disorders of writing in the Russian language have been reported for more than a century. The study of these disorders reflects the history of Russian neuropsychology and is dominated by the syndrome approach most notably by the writings of Luria. Indeed, our understanding of acquired dysgraphia in Russian speakers is conceptualized according to the classical approach in Modern Russia. In this review, we describe the classical approach and compare it to the cognitive neuropsychological models of writing disorders that are developed to explain dysgraphia in English and in other Western European languages. We argue that the basic theoretical assumptions of the two approaches – cognitive and classical or syndrome approach – share similarities. It is therefore proposed that identification of acquired cases of dysgraphia in Russian could potentially benefit from taking the cognitive neuropsychological perspective. We also conclude that adopting elements of the syndrome approach would substantially enrich the understanding of acquired dysgraphia since these offer an insight into processes not described in the cognitive neuropsychological approach.

A Neuropsychological Approach to Understanding Risk-Taking for Potential Gains and Losses

Affective neuroscience has helped guide research and theory development in judgment and decision-making by revealing the role of emotional processes in choice behavior, especially when risk is involved. Evidence is emerging that qualitatively and quantitatively different processes may be involved in risky decision-making for gains and losses. We start by reviewing behavioral work by Kahneman and Tversky (1979) and others, which shows that risk-taking differs for potential gains and potential losses. We then turn to the literature in decision neuroscience to support the gain versus loss distinction. Relying in part on data from a new task that separates risky decision-making for gains and losses, we test a neural model that assigns unique mechanisms for risky decision-making involving potential losses. Included are studies using patients with lesions to brain areas specified as important in the model and studies with healthy individuals whose brains are scanned to reveal activation in these and other areas during risky decision-making. In some cases, there is evidence that gains and losses are processed in different regions of the brain, while in other cases the same region appears to process risk in a different manner for gains and losses. At a more general level, we provide strong support for the notion that decisions involving risk-taking for gains and decisions involving risk-taking for losses represent different psychological processes. At a deeper level, we present mounting evidence that different neural structures play different roles in guiding risky choices in these different domains. Some structures are differentially activated by risky gains and risky losses while others respond uniquely in one domain or the other. Taken together, these studies support a clear functional dissociation between risk-taking for gains and risk-taking for losses, and further dissociation at the neural level.