Dela Vega, Karl Ryann B.

BSEE 2-2

NEUROPSYCHLOGY
Definition
Clinical neuropsychology is a field with historical origins in both psychology and neurology. The
primary activity of neuropsychologists is assessment of brain functioning through structured and
systematic behavioral observation. Neuropsychological tests are designed to examine a variety of
cognitive abilities, including speed of information processing, attention, memory, language, and
executive functions, which are necessary for goal-directed behavior. By testing a range of
cognitive abilities and examining patterns of performance in different cognitive areas,
neuropsychologists can make inferences about underlying brain function. Neuropsychological
testing is an important component of the assessment and treatment of traumatic brain injury,
dementia , neurological conditions, and psychiatric disorders. Neuropsychological testing is also
an important tool for examining the effects of toxic substances and medical conditions on brain
functioning.
Description

As early as the seventeenth century, scientists theorized about associations between regions of
the brain and specific functions. The French philosopher, Descartes, believed the human soul
could be localized to a specific brain structure, the pineal gland. In the eighteenth century, Franz
Gall advocated the theory that specific mental qualities such as spirituality or aggression were
governed by discrete parts of the brain. In contrast, Pierre Flourens contended that the brain was
an integrated system that governed cognitive functioning in a holistic manner. Later discoveries
indicated that brain function is both localized and integrated. Paul Broca and Karl Wernicke
furthered understanding of localization and integration of function when they reported the loss of
language abilities in patients with lesions to two regions in the left hemisphere of the brain.
The modern field of neuropsychology emerged in the twentieth century, combining theories
based on anatomical observations of neurology with the techniques of psychology, including
objective observation of behavior and the use of statistical analysis to differentiate functional
abilities and define impairment. The famous Soviet neuropsychologist Alexander Luria played a
major role in defining neuropsychology as it is practiced today. Luria formulated two principle
goals of neuropsychology: to localize brain lesions and analyze psychological activities arising
from brain function through behavioral observation. American neuropsychologist Ralph Reitan
emphasized the importance of using standardized psychometric tests to guide systematic
observations of brain-behavior relationships.
Before the introduction of neuroimaging techniques like the computed tomography (CAT scan)
and magnetic resonance imaging (MRI), the primary focus of neuropsychology was diagnosis .
Since clinicians lacked non-surgical methods for directly observing brain lesions or structural
abnormalities in living patients, neuropsychological testing was the only way to determine which
part of the brain was affected in a given patient. Neuropsychological tests can identify syndromes

Dela Vega, Karl Ryann B.

BSEE 2-2

associated with problems in a particular area of the brain. For instance, a patient who performs
well on tests of attention, memory, and language, but poorly on tests that require visual spatial
skills such as copying a complex geometric figure or making designs with colored blocks, may
have dysfunction in the right parietal lobe, the region of the brain involved in complex
processing of visual information. When a patient complains of problems with verbal
communication after a stroke , separate tests that examine production and comprehension of
language help neuropsychologists identify the location of the stroke in the left hemisphere.
Neuropsychological tests can also be used as screening tests to see if more extensive diagnostic
evaluation is appropriate. Neuropsychological screening of elderly people complaining of
memory problems can help identify those at risk for dementia versus those experiencing normal
age-related memory loss.
As neuropsychological testing came to play a less vital role in localization of brain dysfunction,
clinical neuropsychologists found new uses for their skills and knowledge. By clarifying which
cognitive abilities are impaired or preserved in patients with brain injury or illness,
neuropsychologists can predict how well individuals will respond to different forms of treatment
or rehabilitation. Although patterns of test scores illustrate profiles of cognitive strength and
weakness, neuropsychologists can also learn a great deal about patients by observing how they
approach a particular test. For example, two patients can complete a test in very different ways
yet obtain similar scores. One patient may work slowly and methodically, making no errors,
while another rushes through the test, making several errors but quickly correcting them. Some
individuals persevere despite repeated failure on a series of test items, while others refuse to
continue after a few failures. These differences might not be apparent in test scores, but can help
clinicians choose among rehabilitation and treatment approaches.
Performance on neuropsychological tests is usually evaluated through comparison to the average
performance of large samples of normal individuals. Most tests include tables of these normal
scores, often divided into groups based on demographic variables like age and education that
appear to affect cognitive functioning. This allows individuals to be compared to appropriate
peers.
The typical neuropsychological examination evaluates sensation and perception, gross and fine
motor skills, basic and complex attention, visual spatial skills, receptive and productive language
abilities, recall and recognition memory, and executive functions such as cognitive flexibility and
abstraction. Motivation and personality are often assessed as well, particularly when clients are
seeking financial compensation for injuries, or cognitive complaints are not typical of the
associated injury or illness.
Some neuropsychologists prefer to use fixed test batteries like the Halstead-Reitan Battery or
the Luria-Nebraska Battery for all patients. These batteries include tests of a wide range of
cognitive functions, and those who advocate their use believe that all functions must be assessed
in each patient in order to avoid diagnostic bias or failure to detect subtle problems. The more
common approach today, however, is to use a flexible battery based on hypotheses generated
through a clinical interview, observation of the patient, and review of medical records. While this
approach is more prone to bias, it has the advantage of preventing unnecessary testing. Since
patients often find neuropsychological testing stressful and fatiguing, and these factors can

Dela Vega, Karl Ryann B.

BSEE 2-2

negatively influence performance, advocates of the flexible battery approach argue that tailoring
test batteries to particular patients can provide more accurate information.
The nervous system is a complex collection of nerves and specialized cells known as neurons
that transmit signals between different parts of the body. It is essentially the bodys electrical
wiring.
Structurally, the nervous system has two components: the central nervous system and the
peripheral nervous system. According to the National Institutes of Health, the central nervous
system is made up of the brain, spinal cord and nerves. The peripheral nervous system consists of
sensory neurons, ganglia (clusters of neurons) and nerves that connect to one another and to the
central nervous system.
Functionally, the nervous system has two main subdivisions: the somatic, or voluntary,
component; and the autonomic, or involuntary, component. The autonomic nervous system
regulates certain body processes, such as blood pressure and the rate of breathing, that work
without conscious effort, according to Merck Manuals. The somatic system consists of nerves
that connect the brain and spinal cord with muscles and sensory receptors in the skin.
Description of the nervous system

Nerves are cylindrical bundles of fibers that start at the brain and central cord and branch out to
every other part of the body, according to the University of Michigan Medical School.
Neurons send signals to other cells through thin fibers called axons, which cause chemicals
known as neurotransmitters to be released at junctions called synapses, the NIH noted. A synapse
gives a command to the cell and the entire communication process typically takes only a fraction
of a millisecond.
Sensory neurons react to physical stimuli such as light, sound and touch and send feedback to the
central nervous system about the bodys surrounding environment, according to the American
Psychological Association. Motor neurons, located in the central nervous system or in peripheral
ganglia, transmit signals to activate the muscles or glands.
Glial cells, derived from the Greek word for "glue," are specialized cells that support, protect or
nourish nerve cells, according to the National Institute on Aging.

Dela Vega, Karl Ryann B.

BSEE 2-2

Dela Vega, Karl Ryann B.

BSEE 2-2

Find out about the workings of the brain and nerves.

Credit: Ross Toro, Livescience.com contributor
Diagnosing nervous system conditions

There are a number of tests and procedures to diagnose conditions involving the nervous system.
In addition to the traditional X-ray, a specialized X-ray called a fluoroscopy examines the body
in motion, such as blood flowing through arteries, according to the NIH.
Other standard neurological exams include an MRI (magnetic resonance imaging), CT scan, and
an electroencephalogram (EEG), which records the brain's continuous electrical activity. Positron
emission tomography (PET) is a procedure that measures cell or tissue metabolism and brain
activity to detect tumors or diseased tissue or tumors, the NIH noted.
A spinal tap places a needle into the spinal canal to drain a small amount of cerebral spinal fluid
that is tested for infection or other abnormalities, according to the NIH.
Diseases of the nervous system

Of all the diseases of the nervous system, the most common difficulty that people have is pain,
and much of that is nerve-related, according to Dr. Shai Gozani, founder and CEO of
NeuroMetrix, a medical device company. There are 100 million people who live with chronic
pain.
According to the Mayo Clinic, patients with nerve disorders experience functional difficulties,
which result in conditions such as:

Epilepsy, in which abnormal electrical discharges from brain cells cause

seizures

Parkinson's disease, which is a progressive nerve disease that affects

movement

Multiple sclerosis (MS), in which the protective lining of the nerves is attacked
by the bodys immune system

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a

motor neuron disease which weakens the muscles and progressively hampers
physical function

Huntington's disease, which is an inherited condition that cause the nerve

cells in the brain to degenerate

Dela Vega, Karl Ryann B.

BSEE 2-2

Alzheimer's disease, which covers a wide range of disorders that impacts

mental functions, particularly memory.

Mayo Clinic also noted that the nervous system can also be affected by vascular disorders such
as:

Stroke, which occurs when there is bleeding on the brain or the blow flow to
the brain is obstructed;

Transient ischemic attack (TIA), which are mini-type strokes that last a shorter
period of time but mimic stroke symptoms; and

Subarachnoid hemorrhage, which is specifically bleeding in the space

between your brain and the surrounding membrane that can be the result of
a trauma or rupturing of a weak blood vessel;

Infections such as meningitis, encephalitis, polio, and epidural abscess can also affect the
nervous system, the NIH noted.
Treatments vary from anti inflammatory medications and pain medications such as opiates , to
implanted nerve stimulators and wearable devices, Gozani said. Many people also turn to herbal
and holistic methods to reduce pain, such as acupuncture.
CENTRAL NERVOUS SYSTEM (CNS)

The nervous system consists of the brain, spinal cord, and a complex network of neurons. This
system is responsible for sending, receiving, and interpreting information from all parts of the
body. The nervous system monitors and coordinates internal organ function and responds to
changes in the external environment. This system can be divided into two parts: the central
nervous system and the peripheral nervous system.

Nervous System

Neurons

CNS Brain

Nerve

The Brain Tissue

Let's take a look at the central nervous system.

Dela Vega, Karl Ryann B.

BSEE 2-2
Central Nervous System
The central nervous system (CNS) is the processing center for the nervous system.
It receives information from and sends information to the peripheral nervous
system. The two main organs of the CNS are the brain and spinal cord. The brain
processes and interprets sensory information sent from the spinal cord. Both the
brain and spinal cord are protected by three layers of connective tissue called the
meninges.
Within the central nervous system is a system of hollow cavities called ventricles.
The network of linked cavities in the brain (cerebral ventricles) is continuous with
the central canal of the spinal cord. The ventricles are filled with cerebrospinal fluid
which is produced by specialized epithelium located within the ventricles called the
choroid plexus. Cerebrospinal fluid surrounds, cushions, and protects the brain and
spinal cord from trauma. It also assists in the circulation of nutrients to the brain.
Central Nervous System: Brain
The brain is the control center of the body. It consists of three main components:
the forebrain, the brainstem, and the hindbrain. The forebrain is responsible for a
variety of functions including receiving and processing sensory information,
thinking, perceiving, producing and understanding language, and controlling motor
function. The forebrain contains structures such as the thalamus and hypothalamus
which are responsible for such functions as motor control, relaying sensory
information, and controlling autonomic functions. It also contains the largest part of
the brain, the cerebrum. Most of the actual information processing in the brain takes
place in the cerebral cortex.
The midbrain and the hindbrain together make up the brainstem. The midbrain is
the portion of the brainstem that connects the hindbrain and the forebrain. This
region of the brain is involved in auditory and visual responses as well as motor
function.
The hindbrain extends from the spinal cord and contains structures such as the
pons and cerebellum. These regions assist in maintaining balance and equilibrium,
movement coordination, and the conduction of sensory information. The hindbrain
also contains the medulla oblongata which is responsible for controlling such
autonomic functions as breathing, heart rate, and digestion.
Central Nervous System: Spinal Cord
The spinal cord is a cylindrical shaped bundle of nerve fibers that is connected to
the brain. The spinal cord runs down the center of the protective spinal column
extending from the neck to the lower back. Spinal cord nerves transmit information
from body organs and external stimuli to the brain and send information from the
brain to other areas of the body. The nerves of the spinal cord are grouped into
bundles of nerve fibers that travel in two pathways. Ascending nerve tracts carry

Dela Vega, Karl Ryann B.

BSEE 2-2
sensory information from the body to the brain. Descending nerve tracts send
information pertaining to motor function from the brain to the rest of the body.
Central Nervous System: Neurons
Neurons are the basic unit of the nervous system. All cells of the nervous system
are comprised of neurons. Neurons contain nerve processes which are "finger-like"
projections that extend from the nerve cell body. The nerve processes consist of
axons and dendrites which are able to conduct and transmit signals. Axons typically
carry signals away from the cell body. They are long nerve processes that may
branch out to convey signals to various areas. Dendrites typically carry signals
toward the cell body. They are usually more numerous, shorter and more branched
than axons. Axons and dendrites are bundled together into what are called nerves.
These nerves send signals between the brain, spinal cord, and other body organs
via nerve impulses. Neurons are classified as either motor, sensory, or interneurons.
Motor neurons carry information from the central nervous system to organs, glands,
and muscles. Sensory neurons send information to the central nervous system from
internal organs or from external stimuli. Interneurons relay signals between motor
and sensory neurons.

The hindbrain is composed of 2 regions: the metencephalon and myelencephalon. It is the most
posterior region of the brain.
The metencephalon

Pons The part of the metencephalon located on the brain stem that forms a
bulge on the brain stems ventral surface. It is involved in motor control and
sensory analysis, acting as the sensory/motor relay center.

Dela Vega, Karl Ryann B.

BSEE 2-2

Cerebellum The cauliflower piece in the back of the brain that is

responsible for sensorimotor function (the part that helps regulate posture,
balance, and coordination). Think of the practice makes perfect theory of
sports, for example.

Reticular formation The reticular formation is comprised of 2 columns of

neuronal nuclei with ill-defined boundaries, which go up through the medulla
and into the mesencephalon. The reticular formation plays a role in arousal,
and regulates your sleep/wake cycle. It is also associated with habituation
(example able to tune out background noise), somatic motor control (tone,
balance, and posture), cardiovascular regulation and pain modulation.

The myelencephalon

Medulla oblongata Located between the pons and brain stem, the
medulla is responsible for basic life support functions like respiration and
heart rate. Therefore, you cannot have a non-functioning medulla. The
medulla oblongata also acts as a protective system that eliminates things
that dont belong (sneezing/coughing) in your body. The medulla can be
influenced/controlled through meditation

Mesencephalon:

The mesencephalon or midbrain is the portion of the brainstem that connects the hindbrain and
the forebrain. A number of nerve tracts run through the midbrain that connect the cerebrum with
the cerebellum and other hindbrain structures. A major function of the midbrain is to aid in
movement as well as visual and auditory processing. Damage to certain areas of the
mesencephalon have been linked to the development of Parkinson's disease.
Function:

Functions of the mesencephalon include:

Dela Vega, Karl Ryann B.

BSEE 2-2

Controlling Responses to Sight

Eye Movement

Pupil Dilation

Regulate Muscle Movement

Hearing

Location:

The mesencephalon is the most rostral portion of the brainstem. It is located between the
forebrain and the hindbrain.
Structures:

A number of structures are located in the mesencephalon including the tectum, tegmentum,
cerebral peduncle, substantia nigra, crus cerebri, and cranial nerves (oculomotor and trochlear).
The tectum consists of rounded bulges called colliculi that are involved in vision and hearing
processes.

The cerebral peduncle is a bundle of nerve fibers that connect the forebrain and hindbrain.
The cerebral peduncle includes the tegementum (forms the base of the midbrain) and the crus
cerebri (nerve tracts that that connect the cerebrum with the cerebellum). The substantia nigra
has nerve connections with the frontal lobes and other areas of the brain involved in motor
function. Cells in the substantia nigra also produce dopamine, a chemical messenger that helps to
coordinate muscle movement.
Disease:

Neurodegeneration of nerve cells in the substantia nigra results in a drop off of dopamine
production. Significant loss in dopamine levels (60-80%) may result in the development of
Parkinson's disease. Parkinson's disease is a nervous system disorder that results in the loss of
motor control and coordination. Symptoms include tremors, slowness of movement, muscle
stiffness, and trouble with balance.
More Mesencephalon Information:

Gray's Anatomy: Midbrain

Divisions of the Brain

Forebrain - encompasses the cerebral cortex and brain lobes.

Dela Vega, Karl Ryann B.

BSEE 2-2

Midbrain - connects the forebrain to the hindbrain.

Hindbrain - regulates autonomic functions and coordinates movement.

Diencephalon

The diencephalon, along with the telencephalon (cerebrum) comprise the two major divisions of
prosencephalon (forebrain). Main structures of the diencephalon include the hypothalamus,
thalamus, epithalamus (including the pineal gland), and subthalamus. Also located within the
diencephalon is the third ventricle, one of the four brain ventricles or cavities filled with
cerebrospinal fluid.
The diencephalon relays sensory information between brain regions and controls many
autonomic functions of the peripheral nervous system. It also connects structures of the
endocrine system with the nervous system and works in conjunction with limbic system
structures to generate and manage emotions and memories.
Function

The diencephalon is involved in several functions of the body including:

Directing Sense Impulses Throughout the Body

Autonomic Function Control

Endocrine Function Control

Motor Function Control

Homeostasis

Hearing, Vision, Smell, and Taste

Touch Perception

Structures of the Diencephalon

The various structures of the diencephalon control a number of important functions in the body.
Structures of the diencephalon include:

Thalamus - assists in sensory perception, regulation of motor functions, and

control of sleep and wake cycles.

Dela Vega, Karl Ryann B.

BSEE 2-2

Hypothalamus - control center for many autonomic functions through the

release of hormones.

Epithalumus (posterior area of the diencephalon that includes the pineal

gland) - aids in sense of smell and helps to regulate sleep-wake cycles.

Subthalamus - assists in motor control.

Location

Directionally, the diencephalon is situated between the cerebral hemispheres, superior to the
midbrain.

Telencephalon
A major component of the telencephalon is the cerebral cortex, which is further divided into four
lobes. These lobes include the frontal lobes, parietal lobes, occipital lobes, and temporal lobes.
The cerebral cortex contains folded bulges called gyri that create indentations in the brain.
Functions of the cerebral cortex include processing sensory information, controlling motor
functions, and performing higher order functions such as reasoning and problem solving.

Frontal Lobes - include the prefrontal cortex, premotor area, and motor area of the brain.
These lobes function in voluntary muscle movement, memory, thinking, decisionmaking, and planning.

Parietal Lobes - are responsible for receiving and processing sensory information. These
lobes also contain the somatosensory cortex, which is essential for processing touch
sensations.

Occipital Lobes - are responsible for receiving and processing visual information from
the retina.

Temporal Lobes - house limbic system structures including the amygdala, and
hippocampus. These lobes organize sensory input, as well as aid in auditory perception,
memory formation, and language and speech production.

Diencephalon
The diencephalon is the region of the brain that relays sensory information and connects
components of the endocrine system with the nervous system. The diencephalon regulates a
number of functions including autonomic, endocrine, and motor functions. It also plays a major
role in sensory perception. Components of the diencephalon include:

Dela Vega, Karl Ryann B.

BSEE 2-2

Thalamus - a limbic system structure that connects areas of the cerebral cortex that are
involved in sensory perception and movement with other parts of the brain and spinal
cord. The thalamus also plays a role in the control of sleep and wake cycles.

Hypothalamus - this brain structure acts as the control center for many autonomic
functions including respiration, blood pressure, and body temperature regulation. This
endocrine structure secretes hormones that act on the pituitary gland to regulate
biological processes including metabolism, growth, and the development of reproductive
system organs. As a component of the limbic system, the hypothalamus influences
various emotional responses through its influence on the pituitary gland, skeletal
muscular system, and autonomic nervous system.

Pineal Gland - this small endocrine gland produces the hormone melatonin. Melatonin
production is vital to the regulation of sleep-wake cycles and also influences sexual
development. The pineal gland converts nerve signals from the sympathetic component
of the peripheral nervous system into hormone signals, thereby linking the nervous and
endocrine systems