So you want to be a neuropsychologist… (Neuropsych exam, forensic neuro)
Name at least 5 common domains on a comprehensive neuropsychological exam.
Attention and concentration
Sensory/motor
Speech and language
Learning and memory (verbal and visual)
Visual-spatial
Executive functioning
Intellectual Capacity
Psychological/Emotional
Name 3 blood vessels in the human body and their general function (Can you name what test this question is on?)
Arteries- Bring oxygen rich blood, nutrients, and hormones from heart to body’s cells. High pressure
Veins - Returns deoxygenated blood from your organs back to your heart. low pressure
Capillaries - connection and buffers pressure between arteries and veins. Primary function of capillaries is the exchange of materials between the blood and tissue cells.
What is white matter?
Neuronal myelinated axons (myelin makes axon appear white, insulates fibers for quicker, more efficient communication)
What is the role of the basal ganglia?
Coordinate movement - initiate and smooth out voluntary and involuntary movement
What is the function of the hypothalamus? What are the four F’s of the hypothalamus?
Maintains homeostasis
– Feeding
– Fleeing
– Fighting
– Fornication
What are the guidelines for training in clinical neuropsychology called? What is the name of the new set of guidelines currently in progress?
Houston Conference Guidelines (1998)
Minnesota Conference Guidelines
Describe 2 different types of strokes. What kind did Dr. Jill Bolte Taylor have (Stroke of Insight)?
Ischemic - blood clot that blocks flow of oxygen-rich blood to cells beyond point of obstruction. Causes damage to neurons and they often die/loss of fx (infarct - tissue necrosis seen on imaging)--TIA
Hemorrhagic - brain bleed - blood escapes the arteries and floods into the brain. Blood is toxic to neurons. 17% of strokes
Aneurysm - weakening in the wall of a blood vessel that balloons out and ruptures
Arteriovenous Malformation (AVM) - rare form of hemorrhagic stroke. Congenital disorder with abnormal arterial formation. Artery is directly connected to vein with no buffering capillary. Over time the vein can’t handle high pressure from artery and bein breaks spilling blood into the brain. 2% of hem strokes. Most common stroke in <45 years
Name the 3 types of white matter tracts.
a) Projection fibers-connection with brainstem down through spinal cord
b) Association fibers-connect cortical areas within the same hemisphere
c) Commisual fibers-connect areas of contraleteral hemispheres
Name the key structures and functions of the Limbic System.
a)STRUCTURES
• Hippocampus
• Hypothalamus
• Amygdala
• Thalamus
• Cingulate Gyrus
• Olfactory Bulb
• Nucleus Accumbens
• Basal Ganglia
b) FUNCTIONS - HOME
• Hypothalamus - Homeostasis
• Olfactory cortex - Olfaction
• Hippocampus - Memory
• Amygdala - Emotion
Name a senior living option that provides medical support.
Nursing Homes or Skilled Nursing Facilities
- Residents receive medically supported living services
- 24 Hour nurse support
- Medical insurance will cover services for a limited period of time
- Requires a doctor’s order
Name a scenario where a neuropsychological exam would be helpful and would NOT be helpful.
Helpful: Differential diagnosis, determining strengths and weaknesses when functional level is unclear, identifying cognitive impairment and making recommendations/referrals for appropriate supports (e.g., learning disability, ID, dementia, capacity)
NOT helpful: Results will not inform/alter treatment/care plan, impairment is too severe (exam not possible), acute illness/injury (brief exam may be helpful), patient near end of life.
What is the blood brain barrier and why is it important? Name 2 pathologies with BBB dysfunction.
(BBB) is the specialized system of brain microvascular endothelial cells (BMVEC) that
shields the brain from toxic substances in the blood,
supplies brain tissues with nutrients,
filters harmful compounds from the brain back to the bloodstream
multiple sclerosis, stroke, and epilepsy, implicated in neurodegenerative diseases such as Alzheimer’s disease.
Name 4 injuries/conditions that can cause white matter disease/damage.
a) Vascular disease
b) Multiple sclerosis
c) TBI
d) Exposure to toxins
e) Hypoxia
Virus (e.g., Covid-19)
What are the 2 Basal Ganglia pathways?
1) D1 - Direct - excitatory GO pathway // Turn ON motor cortex
2)D1 - Indirect - inhibitory STOP pathway
Name 3 cerebellar disorders or symptoms
• Disruptions in balance and gait
• Uncoordinated movements (ataxia)
• Speech (dysarthria)
• Visual problems (nystagmus)
• Vertigo
What is the difference between a subpoena and a court-ordered subpoena? What should you do if you get a subpoena from a lawyer asking you to turn over test results/records of your patient?
A subpoena is a “strong suggestion. You must respond to it but don’t have to follow it. A court-ordered subpoena comes from a judge and should be followed. However, you should always do your best to protect the confidentiality of your patient.
Get an ROI!
What are the 3 arterial regions in the brain?
A stroke with primary symptoms of visual and sensory deficits is most likely associated with what cerebral artery?
MCA, ACA, PCA
PCA
Name a projection tract, whether it is afferent/efferent, and describe its path from start to finish.
Afferent: Dorsal column-medial lemniscal pathway, spinothalamic tract
Efferent: Lateral corticospinal tract, Anterior spinal tract, corticobulbar tracts
Identify at least 2 pathologies of the limbic system
a) Hypokinesia - too little movement
-Excitatory pathway pathologies
-Parkinson’s - dopamine deficiency due to a progressive loss of dopaminergic neurons innervating the basal ganglia. (not enough go too much stop)
b) Hyperkinesia - too much movement
-Inhibitory pathways pathologies
-Huntington’s - STOP neurons die selectively - fx imbalance in basal ganglia circuit (too much go, unwanted movements or commands- CHOREA)
c) Korsakoff’s - anterograde amnesia from thiamine deficiency (mammillary bodies)
d) Parkinsonism sxs - control speech, movement, posture / start, stop, sustain movement
Name 5 neurotransmitters and their functions
See table
Scenario: A lawyer calls you and says they would like you to perform a capacity evaluation on their 82-year-old client. They say the client has Medicare and ask whether insurance will cover the evaluation. What are some potential issues with this inquiry? What information would you like to know if you plan to take the case?
Capacity evaluations are often not medically necessary so cannot be billed to insurance.
Try to understand the purpose of the referral to determine whether it is medically necessary.
Capacity is not a unitary construct–what kind of capacity are they inquiring about?
Capacity can vary (e.g. with medication/lifestyle management in schizophrenia).
Label the arteries
A=Anterior communicating artery
B=Anterior cerebral artery
C=Middle Cerebral Artery
D=Interior carotid artery
E=Posterior Cerebral artery
F=Posterior communicating artery
G= Basilar artery
H= vertebral artery
What kind of tract is the superior longitudinal fasciculus? What lobes does it connect? It is made up of how many components?
a) Association tract
b) Connects all four lobes of the brain
c) 3 or 4 (SLF1-Dorsal, SLF2-major/largest tract, SLF3-Ventral, Arcuate Fasciculus)
Name the key structures in order of the Papez Circuit. What is its purpose?
a) Hippocampus
--Fornix
b) Mamillary Body
c) Thalamus- Anterior Thalamic Nucleus (through internal capsule)
d) Cingulate gyrus (parahippocampal gyrus to entorhinal cortex)
e) Hippocampus
--He-Man Ate a Cat: He – Hippocampus (limbic system) Man – Mamillary body (hypothalamus) Ate – Anterior Thalamic Nucleus (thalamus) Cat – Cingulate gyrus (limbic system)
Purpose: Learning and consolidation of memories -- during sleep
What are the two broad regions in the prefrontal cortex? Name 3 symptoms of syndromes in each region.
Dorsolateral PFC and Orbitofrontal (or ventrolateral) PFC
Dorsolateral PFC Syndrome
Dysexexutive syndrome -> poor problem solving
Poor word list generation
Impaired organization
Poor sequencing
Abulia/lack of motivation
Impaired set-shifting & perseveration
Reduced working memory, encoding/retrieval strategies, & temporal organization (order)
Orbitofrontal PFC Syndrome
Disinhibition
Emotional lability (inappropriate affect)
Impulsivity
Childishness
Tactless
Impaired judgment & insight
Social appropriateness