Lecture 13 - Neuropsychology Flashcards
STUDY: CBT reversing altered activation patterns to emotional stimuli
- People in scanner; given emotional task
- find that activation to negative stimuli was less after CBT compared to before therapy
- CBT interventions can influence brain activity in how we deal with negative information
Cognitive Symptoms in Depression
o Reduced concentration is one of the diagnostic criteria
o Reduced motor function
o Memory problems are common complaint
o Depression often goes together with neurocognitive disorders
o Many neurological disorders are risk factors for anxiety disorders and depression
o Anxiety disorders and depression increase the risk for certain neurological disorders
o Cognitive problems are common for certain neurological disorders for mental health problems (what came first?)
Neurocognitive Disorders
o Considered part of mental disorders in the DSM-5
o Core symptom: decline from a previously attained level of cognitive functioning
o Examples: delirium, major/mild cognitive disorders due to medical disorders (Ex: due to TBI, Parkinson’s, HIV infection)
o For many of these disorders, depression is VERY common; so if someone goes in for a neurocognitive test but also has depression; how does one separate that
Cognitive Impairments and Mental Health
All these have cognitive impairments:
o Psychosis, BD, Unipolar disorder, Eating disorders, Substance abuse, ADHD…
o Depression can be a confounder (Ex: ADHD can’t pay attention…but same in depression)
Cognitive alterations and physical health
All these cause cognitive alterations
o Epilepsy, MS, Stroke, Head trauma
o Depression is a common symptom in many physical health problems
Cognitive Alterations and mood disorders
o Memory impairments (episodic, explicit memory)
o Implicit memory remains well (knowing how to do things)
o Attention (selective, divided, set-shifting)
o Working memory/executive function
o Hard to compare the different studies b/c heterogeneous, and different test batteries used
Neuropsychological Impairments in Mood Disorders
o Many studies report cognitive impairments on memory, attention, executive function
o However, studies differ in results, strength of effect and methodology
o Effortful vs. automatic processing (more impairment on tasks of effortful processing) – ex: studying for exam
o More impairment on stimuli with emotional valence? Harder to remember positive words
o Overall: individuals who are depressed have cognitive difficulties in memory, attention and executive functioning; but studies aren’t conclusive BUT most studies show effortful tasks and emotional tasks more difficult
Types of neurocognitive functioning
Memory
o Short-term memory, Long-term memory, Implicit (knowing how to do something) vs. explicit (memory for facts), Episodic memory (memory of events)
Attention
o Focused attention (the spotlight- how we focus the attention), Divided attention (ability to pay attention to different things at same time; ex: driving and texting), Sustained attention (focus on something for long period of time)
o** when someone comes in complaining of not being able to remember things; could be more an attention problem**
Executive Function
o Executive function = our “navigation” system
o Higher-level cognitive processes, which control and regulate lower-level processes (Ex: perception, motor responses) to effortfully guide behaviour towards a goal, especially in non-routine situations
o Ex: planning schedule
o Allows us to respond flexibly to environment: break out of habits, make decisions and evaluate risks, plan for the future, prioritize and sequence actions, and cope with novel situations, among many other things
Impaired executive functioning
- Mood disorders
- Psychotic disorders
ex: OCD, ADHD - Linked to altered functioning of the prefrontal cortex, but not all studies consistent
- Might not see a difference b/w normal and disordered people in everyday life; but differences show up in subtle ways on tests
Impaired executive functioning in depression depends on:
o Depression severity
o Medication use (especially other types of antidepressants – TCA - tricyclic)
o Age (older age = more impaired) * but results not clear
o Motor speed (lots of tests check reaction times, but sometimes their motor speed is just naturally lower so it confounds)
o Depending on task used, effect size ranged from small to large
Issues with neuropsychological impairments with mood disorders
- Is neuropsychological impairment due to low mood/lack of motivation
- Do they exist before getting depressed?
- Are they permanent? (Trait or state)
A neuropsychological assessment in real clinical practice:
- Intake
- Neuropsychological tests
- Questionnaires (e.g. depression)
- Report & Feedback session
Why are neuropsychological tests administered?
- Future capabilities (work, study)
- Strengths and weaknesses
- Explanation of certain behaviors
- Neuropsychological exam is not done to diagnose depression, but can help in understanding cognitive problems and estimate the contribution of depression to these problems
Examples of neurocognitive tests
o Word Learning Task: California Verbal learning task
- Measures ability to store, retrieve and recognize verbal information
o Stroop Task
- Executive function or attention
o Trail Making test
- Measure ability to do this, and also motor speed
o Tower of London
- Measures planning
o Sternberg Memory Task
- Working memory task (or short-term)
o MMSE
- Mini mental state examination
- Used in older populations
- More common in older individuals
o MoCa
- Montreal Cognitive Assessment
- Brief screening tool for mild cognitive impairment
o Questionnaires:
- Depend on other problems; ex: depression scales (ex: BDI), ADHD scales…
- We don’t just take the results at face value, we check it with other information
Important considerations when doing a neuropsychological exam
- Norm scores
- Impact of cultures
- One test sometimes measures different constructs
- Always interpret a test in the context of other cognitive tests and behavioural assessment and observations
