Category: Education

Brain Overview

The brain is divided into two halves, called hemispheres. Clinically, they are described as the “dominant” and “non-dominant” hemispheres. The dominant hemisphere is generally the half in which language abilities are housed, which for most people is the left (about 99% of right-handed people and 85% of left-handed people). While all aspects of thinking use both the left and right halves of your brain, certain functions are thought to be lateralized, or more strongly associated, with specific hemispheres.

Each hemisphere can be divided into specific areas called lobes (frontal, parietal, temporal, and occipital), as well as lower brain structures, the cerebellum and the brain stem. Each of these areas are generally associated with specific brain functions.

•Higher-order thinking
•Abstract reasoning
•Emotional control
•Planning and organization
•Behavioral regulation
•Motor skills
•Speech production
•Memory retrieval
•Learning and memory
•Language comprehension
•Auditory perception
•Spatial perception
•Object recognition
• Vision
•May be associated with higher-order thinking abilities
•Orientation and arousal
•Regulation of bodily functions (i.e. breathing, sleep, blood pressure)
•Movement and sensation

Author: Delia Silva, PsyD, ABPP-CN

Overview of Traumatic Brain Injuries (TBI)

What is a TBI?

A traumatic brain injury (TBI) occurs when external forces (for example, from falling, car accident, or assault) cause an injury to the brain. The injury itself can be penetration to the brain, bruising, bleeding, or stretching of the connections between the neurons (brain cells), called axons. The severity of the TBI can be graded as mild, moderate, or severe, and is determined by a number of factors from the date of injury. Sometimes, secondary injuries can result after a TBI, such as a stroke or increased intracranial pressure from swelling.

What are the symptoms of TBI? What can I expect from the recovery?

Symptoms of TBI vary greatly, depending on the parts of the brain that were affected, the severity of the TBI, and the mechanism of injury. Confusion is a common early symptom, in which the affected individual is not fully aware of the situation, and may not be oriented to the date or even aspects about themselves (for example, their age). Agitation and socially inappropriate behavior are common symptoms early on after a TBI, and are attributable to the effects of the brain injury, not necessary the patient’s personality. For moderate and severe injuries, it can take several weeks or months until the person is no longer confused and/or agitated. However, cognitive and behavioral symptoms can persist. In general, the most improvement in rehabilitation occurs in the first 6 months, but the brain can continue to recover for years after an injury. The prognosis for how much recovery a person is able to make depends on the severity of the injury.

MTBI is synonymous with “concussion.” In general, people who suffer mTBI have an excellent prognosis and are expected to make a full recovery within a month, as the brain structures are typically not permanently affected from a concussion. However, there are a minority of individuals who continue to experience symptoms beyond the period of neurological recovery, and are diagnosed as having “postconcussive syndrome.” There are a number of reasons why symptoms can persist, and a thorough neuropsychological evaluation is indicated in these cases to determine the causes and proper treatment. The neuropsychological evaluation takes into account other medical or physical conditions, side effects from medications, psychological factors, and rules out neurodegenerative conditions.

How Can a Neuropsychologist Help with TBI?iStock_000026150244_Large

A neuropsychological evaluation is a valuable tool for an individual recovering from a traumatic brain injury. It provides the patient with detailed information about their cognitive strengths and weaknesses, which includes assessment of: memory, attention, expressive and receptive language, visual/perceptual abilities, motor and sensory functioning, and executive functions (problem solving, multi-tasking, organizing, coming up with strategy, ability to self-monitor, etc.). Knowing these strengths and weaknesses can help in directing the focus of cognitive rehabilitation and developing strategies to compensate for deficits. It can also assist in determining whether a person is able to return to work, or guide the person in finding new opportunities in which their strengths will be utilized. In the case of mild TBI as described above, a neuropsychological evaluation is the gold standard for determining treatment of postconcussive syndrome. A neuropsychological evaluation can also be performed at different points in time during the recovery process to objectively measure and track changes in cognitive functioning.

A neuropsychologist or psychologist can also provide treatment for individuals with TBI. Clinicians at PNBC provide psychotherapy to individuals with TBI who may be having difficulties adjusting to the new changes in their mental and physical functioning. TBI can be devastating to a person’s sense of self. Our clinicians can help patients go through the emotional process of grieving their losses and reaching a state of acceptance in which they can realize new meaning and opportunities in their lives. Patients are provided with education regarding their brain injury and tools to help with compensating for cognitive deficits. Often times, patients receive structured cognitive rehabilitation from a speech and language pathologist or occupational therapist at a more comprehensive brain injury treatment program.

Dementia/Neurodegenerative Diseases/Major Neurocognitive Disorders

What is Dementia?

The term “dementia” refers to a group of conditions that deteriorate the brain over time, causing changes in cognition (thinking), behavior, and physical functioning. When the symptoms are severe enough to impact a person’s ability to function independently, dementia can be diagnosed. They are now more commonly referred to as “neurodegenerative diseases” or “major neurocognitive disorders (MND).”The most common form of MND is Alzheimer’s disease, which accounts for 60-80% of all cases of dementia. Behaviorally, Alzheimer’s disease characterized by symptoms of short-term memory problems, communication, reasoning, navigating the environment, and knowing how to use objects. In the end stages, physical functioning is affected, and there may be some drastic changes in personality.

The second most common form is vascular dementia, which can occur when an individual has suffered multiple strokes. Depending on what parts of the brain were affected, the symptoms can appear to be similar to Alzheimer’s disease.

Frontotemporal dementias (FTD) are another category of conditions that are neuropathologically distinct, affecting certain parts of the frontal and temporal lobes. Some individuals with FTD might exhibit early symptoms of personality change with little to no apparent change in their memory. Others might have a marked decline in their ability to express themselves.

Parkinson’s Disease (PD) is a neurological condition affecting motor functions and causes tremors. However, the neuronal pathways affected in Parkinson’s disease can also affect cognition. In some individuals, the symptoms may be severe enough to be considered a “Parkinson’s Dementia.” Additionally, there are a number of other neurological conditions that appear similar to Parkinson’s disease, but have distinct features that indicate other parts of the brain that are not typically affected with a pure Parkinson’s condition are involved.

Lewy body dementia is a condition that has similar features to both Alzheimer’s disease and Parkinson’s disease, and often includes symptoms of psychosis.

Each form of dementia has a distinct pathology, which makes proper diagnosis important when medications are being considered. Additionally, some types of dementia may have a rapid course whereas others have a much slower progression. Knowing what type of dementia one has is important for planning important issues, such as caregiving, safety implementations, and legal matters.

Senior lady and her granddaughterWhy is a Proper Diagnosis Important?

Unfortunately, there is no cure for MNDs. However, there are medications to treat specific symptoms associated with dementia. A proper diagnosis of a dementia subtype is important because some medications that may be used for one condition can actually worsen symptoms if the person actually has a different neurological condition. For example, if a person with undiagnosed Lewy body disease (LBD) who is experiencing symptoms of psychosis (delusions or hallucinations) and was misdiagnosed as schizophrenic may be given traditional antipsychotic medications, which can worsen their condition. Using the same example, this person may also have tremors and be misdiagnosed as having Parkinson’s disease, but some anticholinergic medications used to treat the tremors can worsen the symptoms of psychosis. Worsening of symptoms can lead to even more rapid decline and neurodegeneration.

A proper neuropsychological evaluation will examine the clinical history, neurologic and behavioral presentation, and use objective cognitive tests in order to arrive to the most accurate diagnosis of an MND. The neuropsychologist can then refer the patient and family members to the right doctors or organizations to help with treatment and provide support and education. Additionally, the neuropsychologist can work with caregivers to help them understand the limitations of the patient, and determine the most optimal environment to promote well-being and safety.