Neuropsychological Impairments

Question 1

What is Optic Ataxia?

Answer 1

The inability to point to and/or reach for objects that are reportedly seen. (Differs from visual disorientation). People with Optic Ataxia have no problem locating parts of their own bodies.

Question 2

What is visual disorientation?

Answer 2

When patients are unable to localize single objects and act as if blind.

They have difficulty directing voluntary eye movement towards and object.

Have problems in reaching for or pointing to an object.
Attentional processes also typically impaired.

Question 3

Brain damage related to visual orientation deficits.

Answer 3

Usually in the dorsal, occipitoparietal projections. The “where” pathways. In gen. bilateral. Rare, and in the most severe form found in Balint’s syndrome.

Question 4

Diagnosis of visual disorientation?

Answer 4

Applies to patients who beside normal visual acuity is able to lacalize external sounds and tactile stimulation on her own body. (Rules out motor deficits and demonstrate accurate body sensation and body parts)

Question 5

Assessment of visual disorientation?

Answer 5

Should only be done in patients who have completed an ophthalmological examination.

Test simple localisation. Like a dot on a paper.

Assess depth discrimination. Estimate distance of objects in the natural environment, or two objects on either the same or different horizontal plane. Tactile test, move the patients finger from one object to the other

Test size discrimination.

Optic ataxia have further two conditions to fulfill.

Test spatial scan and single-point localisation using a dot-counting task.

Question 6

Two condition test for discriminating Optic Ataxia?

Answer 6

First, ask the patient to reach out and grasp an object that she is looking at.

Second, repeat the manoeuvre with a screen placed between the patient’s head and her arm (prevent her from seeing the hand movement)

Optic Ataxia will only fail at the second condition.

Question 7

Recovery of visual disorientation ?

Answer 7

Has been observed in unilateral right hemisphere spontaneously.

Some improvement have been observed after non-specific training programs.

See p. 223.

Question 8

What are the two divisions of complex visuospatial processing?

Answer 8

1. Topographical disorientation

2. Spatial analysis deficits.

Question 9

Topographical disorientation.

Answer 9

Characteristically difficulty in finding their way from one location to another (despite basic visual processing).

May have preserved topographical visual recognition and memory = they get lost even though they recognise the area.

The opposite, loss of topographical recognition, yet preserved spatial knowledge = inability to recognise buildings etc, yet accurate accounts of journeys.

Question 10

Lesions associated with topographical disorientation?

Answer 10

Predominantly right pariétal damage.

Question 11

Diagnosis of topographical disorientation?

Answer 11

Interview with patient/carer.

Questions relating to:

Does the patient get lost in familiar surroundings?

Is she unable to learn new simple routes?

Was her way-finding good before the illness?

Question 12

Assessment of topographical disorientation?

Answer 12

Ask the patient questions such as:

How did you get here?
Can you tell me how to get from A to B. (Familiar places)
How do you go from this room to the ward?
Can you describe your home?
Etc

Question 13

Recovery and rehabilitation of topographical disorientation?

Answer 13

Difficulties locating objects benefit from written lists, contents of cupboard.

Getting lost on familiar routes - photos of prominent environmental cues to use as landmarks.

Written instructions can be useful.

Simple mnemonics combining names and streets and they location can be used to make meaningful associations with daily journeys.

Walking with the patient in familiar surroundings and then asking the patient to return to the starting point. Length and nr of changes in direction are gradually increased. Finally the patient can draw a map.

Question 14

What is spatial analysis deficits?

Answer 14

Have difficulty in position discrimination and/or line orientation discrimination.

Detection requires fairly elaborate tasks.

Question 15

What lesions are associated with spatial analysis deficits?

Answer 15

Predominantly right parietal damage.

Question 16

Diagnosis of spatial analysis deficits?

Answer 16

Based on quantitative results in a series of specially constructed tests.

Question 17

How do you assess spatial analysis deficits?

Answer 17

There is a number of tests that assess this.

Position Discrimination
Number location
Cube analysis
Discrimination of line orientation

Question 18

How is recovery and rehabilitation of spatial analysis deficits?

Answer 18

The earlier assesssment may help the prognosis.

Treatment could be attempted using a tactile version of the cube analysis subtext of the line orientation test. Only for patients presenting spatial analysis deficits in the visual modality only.

Treatment using tactile and visual modalities consists different shapes into the correct holes in a board, timed.

Computer-generated virtual environment that can be explored in real time could be used to treat acquired visuospatial deficits.

Patients with musical abilities could benefit from a rehabilitation programme combining increasing levels of difficulty, figures of cubes and musical isomers. (See p 226)

Question 19

What is deficit of imaginal processes?

Answer 19

Includes two types of deficits.

A visual imagery deficit.
A spatial imagery deficit.

Question 20

What is visual imagery deficit?

Answer 20

Part of a deficit group of imagery processes.

The conscious reproduction of previously experienced events and object. Their shape, colour, size, etc.

Question 21

What is the clinical presentation of Visual imagery deficits?

Answer 21

Patients might not realise that they have this deficit.

Loss of visual imagery may be observed together with visual agnostic, or preserved visual recognition. Also frequently with right homonymous hemianopsia. Right hemiplegia and/or language disturbances can also be present.

Question 22

What brain damage is associated with visual imagery deficit?

Answer 22

Left posterior lesion.

Question 23

What is hemianopsia?

Answer 23

It is a decrease or blindness in half of the visual field.

It can be either be homonymous. Meaning the same side of the visual field on both eyes is lost.

Heteronymous is the loss on different sides in both eyes. This is further divided into two. Binasal (visual field around the nose) and bitemporal (closest to the temples).

Superior/inferior means the upper half or lower half respectively.

Quadrantanopia. Is decrease in one quarter of the visual field.

Question 24

What is the diagnosis criteria of visual imagery deficit?

Answer 24

Can only be diagnosed if the capacity to copy models and describe their visual characteristic is preserved.

Question 25

How do you assess a visual imagery deficit?

Answer 25

Ask patients to draw from memory. Then to copy from canonical models, objects like a cube, flower, etc. Ask the patient questions in rich visual attributes (what is the name of the bird [insert full visual description]). Questions about function (the bird that flies, is awake all night long, hoots). Patients with no aphasia symptoms, and impaired visual imagery will only fail the first question. Present the patient with coloured line drawings of canonical views of animals. Ask the patient to indicate whether the tail is the animal is long or short relative to its body. Has three conditions, that differentiates the ability to conjure imagery from incomplete visual items and auditory input. See p. 228. For test of visual imagery of colour see p. 228.

Question 26

How is recovery and rehabilitation of visual imagery deficits?

Answer 26

Using non visual information: a series of familiar and less familiar objects to be tactilely explored. Objects surfaces or parts are covered with fabrics of different textures, which are associated with colours. The patients must describe the shape, imagine the colour, imagine the object on a table, in a bag, near the window etc. Image rehabilitation is crucial for artistic people.

Question 27

What is spatial imagery deficit?

Answer 27

The ability (or inability) to conjure images of the location or structure of objects in three dimensions.

Question 28

What are the clinical presentation of spatial imagery deficits?

Answer 28

Not unusual for patients to say that they have more difficulty "working things out".

Question 29

What is the typical beak damage associated with spatial imagery deficit?

Answer 29

Left posterior lesions.

Question 30

What is the diagnosis criteria for spatial imagery deficits?

Answer 30

This is diagnosed it the patient fails tests of mental transformations. Regardless of his or her inability to conjure up visual images.

Question 31

How do you assess spatial imagery deficits?

Answer 31

Present the patient with a sheet of paper containing capital letters in random order, half of them upside down. Ask the patient to indicate which letters are the right way up. Ask the patient to imagine a capital letter and to count the corners. This is sensitive enough to indicate whether extended testing is needed. Give orally a series of letters with or without curves. Ask the patient to imagine them in the upper case form and to indicate whether or not they have curves. Present a series of drawings of a man holding a black disc sometimes in his right and sometimes in his left hand. The figure should be shown upside down and dark. The front or from behind. Ask to indicate in which hand the manikin is holding the black discs.

Question 32

How is recovery and rehabilitation in spatial imagery?

Answer 32

A tactile training device using a board with rotated, mad fast letters.

Question 33

What defines deficits of constructional processes?

Answer 33

Involve the ability to produce properly organised constructions such as drawings and building tasks. To assemble patterns of simple arrangements made up of blocks, tokens, sticks. Involve normal visual and motor systems to execute visuomotor tasks. Clinicians use the term constructional apraxia for convenience.

Question 34

What are the clinical presentations of constructional process deficits?

Answer 34

Patients are unable to grasp the way in which component elements relate to the final model to (re-) produced, and then to fit the components together in the correct spatial organisation.

Question 35

Brain localisation of constructional process deficits?

Answer 35

Either right or left parietal lesions. Right:left ratio is 3:1. More severe in right and bilateral lesioned cases. Independent of side, significant correlations between damaged neural substrate of Brodmann's area 18 with constructional ability. Left lesions result in oversimplification of the model within the context of a relatively preserved spatial relation. Cause is failure in the organisation of actions necessary for construction tasks Right lesion patients produce overelaborate, often irrelevant fragments showing spatial disorganisation. Cause, failure in the organisation of space.

Question 36

How do you diagnose deficits in constructional processes?

Answer 36

If the patients inability to perform drawing and construction tasks occur in the context of the following preserved functions: Visual form perception. Spatial localization Ideomotor praxis Pure constructional apraxia is rare. However there should be a relative preservation of above functions. Note complex tasks demands attention and therefore deficits in this area can affect test results. Base it then on easier tasks.

Question 37

What does the extinction of contralesional stimuli on bilateral stimulation (or double simultaneous stimulation) refer to?

Answer 37

It's a related disorder to personal neglect or hemiasomatagnosia. It occurs both in tactile, auditory, visual, and olfactory modalities. It describes cases of alienation from ones own body parts. Suggests that there is a system in the brain that tells us "this is your body, it's part of you".

Question 38

How do you assess personal neglect Or hemiasomatagnosia?

Answer 38

Depends on the severity. Mild cases: may be assessed by asking patients to touch contralesional body part or similarly trying to engage the ipsilateral side to engage with the contralateral side. Motor neglect can be examined by making the patient extend their hand or squeeze the examiners finger etc. The Fluff test, Cocchini et al (2001) can systematically assess personal neglect. It requires patients to remove white cardboard circles attached to their clothes. Blindfolded while they are attached, then asked to remove them without the blindfold. Self report measures can also be used to determine the level of dissociation

Question 39

How do you assess construction process deficits?

Answer 39

Ask the patient to carry out a spontaneous drawing. Note that these can be hard to score if produed by verbal command. If this is the case, ask her to draw a bicycle and to coomment on as many details as possible about the way in which the different parts relate to each other. Ask patient to copy a line drawing, an abstract design such as the Rey Complex Figure. Scoring procedues for this and some other copying tasks are reliable and norms exists for different groups of brain-damaged patients and normal individuals. Assessing greater demands on spatial component of perception can be done with block construction tests. Tests 3D processes, and call upon particular functions as they elicit deficits not caught by 2D tests . (Benton Constructional Test and Stanford-Binet battery, Tower and the Bridge test). The Block Design test (WAIS subtest) is the most frequently used. When used to assess constructional processes, no timelimits should be imposed. Constructing stick patterns, and copying from them are not as demanding a taks, however there is little normative data.

Question 40

How is recovery and rehabilitation in deficits of constructional processes?

Answer 40

Spontaneous recovery has been observed in two-thirds of patients. Size of lesions is not related to the rate of recovery. Differnce in average recovery depending on the side of brain injury. Left-hemisphere damage show better recovery. Very little litterature to cover this, and also rare to have 'pure' cases.

Question 41

What are the divisions made in The Handbook of Clinical Neuropsychology of pathologies of awareness and representation?

Answer 41

- Autotopagnosia - Somatosensory Hallucinations and illusions - Hemisomatagnosia (personal neglect) and related disorders - Distal extinction on unilateral double stimulation - Altered musvular proprioception - Alien hand syndrome (including Anarchic Hand) - Phantom limb and related disorders - Body-specific cognitive biases in eating disorders

Question 42

What is autotopagnosia?

Answer 42

A disorder within awareness and representation deficits. The clearest example of body-specifc representation disorder. A rare condition where the patient cannot locate body parts on verbal command.

Question 43

What is hemisomatopagnosia or personal neglect?

Answer 43

A disorder within awareness and representation deficits. It is a disorder of malfunctioning body awareness. It is related to allochiria and extinction of contralesional stimuli to bilateral tactile stimulation.

Question 44

What is alien hand syndrome?

Answer 44

A disorder within awareness and representation deficits. It is an uncommon cluster of symptoms wherin involuntary limb movements are coupled with a sense of enstrangement from or of personification of limb. Often overlaps with hemisomatoagnosia.

Question 45

What involves somatosensory hallucinations and illusions?

Answer 45

A disorder within awareness and representation deficits. The experience of a larger, smaller or even duplicated body. In some cases reports of an inability to recognize the bodies boundaries or posture.

Question 46

What are some important considerations of Autotopagnosia?

Answer 46

It should be the primary deficit, and should not result from other cognitive disorders. As with any case of agnosia. Make sure that aphasia, attentional deficits, visual or tactile agnosia, apraxia or reaching disturbances, or more peripheral motor and sensory disorders cannot explain the deficit. In the strict sense, pure autotopagnosia has not been observed, as the deficits observed are never isolated to one's own body.

Question 47

Describe the pointing tasks related to Autotopagnosia.

Answer 47

A simple test of pointing to body parts. It should be assessed in at least two conditions, verbal and non-verbal. Subtests should be used to ascertain whether the symptom converns parts of one's own and also those of other's bodies. And to be reasonably sure that the problem is not of isolating one part within the whole.

Question 48

What are the divisions of errors within autotopagnosia proposed by Semenza and Goodglass (1985)?

Answer 48

Contiguity (spatial) errors. This also includees errors that reflect misreaching. Conceptual errors. (Joint for joint, eye-ear-nose substitutions and contiguity errors where alternative response choices are presented as cut-out parts in a multiple choice display. Random errors. Includes all remaining errors. Prevaling contiguity and conceptual errors may indicate the type of autotopagnosia.

Question 49

Describe the verification tasks related to autotopagnosia.

Answer 49

Where you ask questions, such as, 'am I touching the ear?'. Published cases of autotopagnosia have reported patients who perform flawlessly here. Thus, they recognize body parts.

Question 50

Describe the construction task related to autotopagnosia.

Answer 50

The subject must build up a two- or three-dmensional body from separate pieces. Often the recognition of body parts is intact, and the knowledge of their function less so.

Question 51

Describe the description task related to autotopaginosia.

Answer 51

ARe meant to tap knowledge of body parts as stored in the semantic system. Requires two different kinds of description: that of structural attributes and that of functional attribtues. Can both be caterogical uestions and more open questions with varying levels of difficulty.

Question 52

Describe control tasks related to autotopagnosia.

Answer 52

Body specificity should be the only defining feature of autotopagnosia - therefore necessary to collect evidence of the patient's ability to locate parts of other complex objects. Can be asked to locate verbally structural points of a bike, shoe, glasses etc. Also non-verbal tests, where they are indicated physically instead. Should also be devised for construction and description tasks.

Question 53

What is personal neglect and the related disorders?

Answer 53

A disorder within awareness and representation deficits.

Question 54

What is the most common lesion related to unilateral spatial neglect and associated disorders?

Answer 54

Right hemisphere lesions, and in particular stroke.

Question 55

What is personal neglect or hemisomatagnosia?

Answer 55

It is an extention of unliateral spatial neglect, where in addition to extrapersonal space and peripersonal space, it also affects one-hald of the patient's body.

Question 56

What lesion is mostly associated with selective personal neglect?

Answer 56

Right-sided lesions. However right-sided neglect of personal space may also be consequence of early phases of disease, or of a left-sided lesion. It often occurs as paroxysmal symptomatology, frequently of epilepsy or migraine.

Question 57

What is Allochiria?

Answer 57

A related disorder to personal neglect or hemisomatagnosia. A disorder within awareness and representation deficits. Often associated with unilateral visual neglect, where tactile stimuli delivered to the contralesional side of somatic/extrasomatic space are referred to the symmetrical location on the ipsilateral side.

Question 58

What is Anton-Babinski's syndrome?

Answer 58

A related disorder to personal neglect or hemisomatagnosia. A disorder within awareness and representation deficits. Anosognosia to deficits contralateral to the lesion. Babinski recognized it as resulting from focal cortical lesion.

Question 59

What is the most common disruption of the optic radiation/geniculo-calcarine tract?

Answer 59

Vascular disorders and brain tumors.

Question 60

What caracterized early visual processing disorders?

Answer 60

They are organized modularly. Involve specialised areas in the occipital lobe coding for properties such as colour, size, movement etc. May be selectively impaired. No asymmetry at this level.

Question 61

What is anatomical correlate for visual acuity?

Answer 61

Damage to the occipital lobe as well as disorders of the eye and Optic nerve.

Question 62

What are some characteristics of deficits of visual acuity?

Answer 62

Effects on the ability to detect light, differences in contrast, targets varying in size.

Question 63

What are some possible assessment methods of visual acuity?

Answer 63

Snellen charts and other opthalmological instruments. It is however important to consider whether deficits within visual disorientation, visuospatial neglect or simultanagnosia may influence the ability to perform these tasks.

Question 64

What characterises associative visual agnosia?

Answer 64

Patients with these types of disorders perform fairly on early visual processing and perceptual test. They can copy objects and pictures, but cannot understand what they are. They may be able to recognize it from touch. These do not necessarilu affect all types of stimuli, faces might for example be spared.

Question 65

What are anatomical relation of the early visual deficits Visual disorientation and Optic Ataxia?

Answer 65

The occipital-parietal boundaries.

Question 66

What is the lesion related to false recognition of faces?

Answer 66

Frontal lesions.

Question 67

What is akinetopsia?

Answer 67

A selective early visual processing disorder that impairs the perception of movement.

Question 68

What is the anatomical relation to akinetopsia?

Answer 68

Lateral occipitotemporal lesions. (Movement)

Question 69

What are the anatomical relation to form perception deficits?

Answer 69

Bilateral occipital lesions.

Question 70

What is figure-ground discrimination?

Answer 70

It enables the viewer to analyse the defining outlines of a stimulus and its background separately. It may dissociate from form perception deficist.

Question 71

What is achromatopsia?

Answer 71

It is an impairment of colour perception. One may be unable to see colour at all or perceive colours as lacking in intensiy. Patients with left posterior lesions may have normal colour vision but are impaired in naming/comprehending colour names. Different from colour agnosia, the knowledge of colour.

Question 72

What do you need to be aware of when assessing colour perception?

Answer 72

To exclude congenital abnormalities. Ask patient to name, match colour patches, or arange them in a serios according to brightness or saturation.

Question 73

What defines higher visual recognition disorders?

Answer 73

They are visual agnosias for objects or faces (prosopagnosia). It pressuposes a well preserved primary processing, however failures with structural perception or semantic processing.

Question 74

What does object constancy and aperceptive agnosia refer to?

Answer 74

The ability to see and recognize the same object within a variety of different settings and light. It may be impaired with right-post-Rolandic/Central lesions.

Question 75

What characterises associative visual agnosia?

Answer 75

Patients with these types of disorders perform fairly on early visual processing and perceptual test.

Question 76

What are the two major divisions of prosopagnosia?

Answer 76

Structural and semantic processing deficits. Structural processing of faces can be assessed by using photographs of faces differing in sex and age, faces from different viewpoints, or with same/different expressions. Semantic processing deficits will pass these tests, but unable to recognize familiar faces.

Question 77

What is the lesion related to false recognition of faces?

Answer 77

Frontal lesions.

Question 78

What is Global Aphasia?

Answer 78

Aphasia where all language processes are severely affected. Propositional language is either absent or reduced to single words or phrase fragments, and takes effort. Few stereotyped phrases may be preserved. Few can reproduce overlearned stuff like prayers, songs etc.

Question 79

What is Broca's aphasia?

Answer 79

Principal features are reduction of linguistic proficiency on the phonologcal, lexical, and syntactic levels. They exhibit deficits of lexical retrieval with time-consuming, laborious attempts at word finding. Phonological assembly and articulation is slowed. Speech apraxia is common.

Question 80

What are the typical physical reason for Broca's aphasia?

Answer 80

Typically younger (than 60) patients who suffer large infarction/tissue death in the area of the left middle cerebral artery.

Question 81

What is paraphasia?

Answer 81

The unintentional production of syllables, words or sentences when producing speech.

Question 82

What characterises Wernicke's aphasia?

Answer 82

Speech production is usually fluent, but with phonemic and semantic paraphasia, neologisms or jargon, and paragrammatism.

Question 83

What is the most common cause of Wernicke's aphasia?

Answer 83

Posterior cerebral infartion/tissue death in patients who are either elderly or have diffuse or multifocal brain patholody in addition.

Question 84

What is anomic aphasia?

Answer 84

Core symptom is deficiten lexical access/retrieval. Phonology and syntaxtt is hardly affected. Causes pauses, circumlocutions, closely related semantic paraphasias, evasion of the target word by empty phrases or fillers,

Question 85

What is the arcuate fascicle?

Answer 85

The anatomical "bow" between the anterior Broca's area and posterior Wernicke's area. Lesion to this area is often associated with conduction aphasia.

Question 86

What defines conduction aphasia?

Answer 86

It is a disconnection between the sensory and motor language cetnters. There are two different types: Those with prominent repetition deficit due to an impairment of phonological short-term memory. Those with an impairment of phonological output programming for single words. Together with relatively preserved monitoring results in frequent attempts at correction.

Question 87

What defines transcortical aphasia?

Answer 87

Reduced language production, except for repetition, and rather preserved comprehension.

Question 88

What lesion is related to transcortical aphasia?

Answer 88

Lesion to the left frontal lobe oustide Broca's area - especially close to the supplementary motor area on the medial surface, and lesions to left basal ganglia.

Question 89

What is the overall meaning of Apraxia?

Answer 89

Apraxia refers to the inability to mimic or or perform learned motor skills at command

Question 90

What is hemiplegia?

Answer 90

A weakening or paralysis unilaterally of the body.