NeuNeuropsychological Assessment and Associated Fields – I
Orientation of time and space is associated with temporal and frontal lobes. When inquiring the individual’s orientation, the functionality of “fusiform gyrus” (occipitotemporal gyrus) located in the temporal lobe and playing a part in distinguishing people’s faces.
When instantaneous remembering that occurs in seconds is tested; Wernicke area located in the temporal lobe, and Broca area located in the frontal lobe, and the arcuate fasciculus functions linking both areas are assessed. The Wernicke and Broca areas can be respectively named the understanding and speaking centers in the brain, and these areas play a part in a person repeating the word that is said.
Hippocampus and medial temporal lobe are assessed by means of the questions measuring the belated remembering that occurs in 2-3 minutes.
The function of the frontal lobe is inquired through the questions assessing the different components of attention. By asking questions that will require the person to make calculations, the activities of the dorsolateral prefrontal cortex (DLPFC), inferior parietal lobule and cingulate gyrus are assessed.
When we ask a person to tell the name of an object being shown, we inquire the functions of the left temporal and parietal lob of that person. The premotor cortex located in the temporal lobe and frontal lobe take part in the execution of the three-phased commands (e.g. the paper folding question in MMT).
The functions of the left parietal and temporal lobes are assessed through the questions on reading and understanding. The left parietal area takes part in the act of writing. In the figure copying, however, basal ganglia take part, along with the right parietal area, and its projections on the prefrontal cortex (PFC).
It is believed that the symptoms of psychosis in dementia patients (delirium and hallucinations) arise from the degeneration that occurs in the mesiotemporal (mesial temporal) and frontal brain areas.
Amygdala, PFC, thalamus and hippocampus are the brain areas being accused the most for the increase of anxiety. Amygdala is a brain area that is in charge of fear conditioning and euphoria.
Agitation/aggression are observed due to the hyperfunction of the serotonergic and cholinergic systems caused by neuropathologic changes, along with the relative hyperfunction of the dopaminergic and noradrenergic systems.
The pathology causing motor agitation is located in the brain area named “striatum”.
Disinhibition is observed in orbitofrontal cortex (OFC) lesions.
The brain areas in charge of irritability/lability are amygdala and PFC.
Apathy is caused by the degeneration that occurs in the parahippocampal gyrus, frontal and parietal neocortex, hippocampus and Meynert’s basal nucleus.
Hypothalamus and thalamus are assessed by inquiring the changes in sleep and appetite.
It is possible to assess frontal lobe behaviors through the Frontal Behavior Inventory. While it is possible to demonstrate the DLPFC damage through the inquiry of the items of negative behavior and lack of specific normal behaviors, the deviations in the ventromedial prefrontal cortex (VMPFC) and OFC functions can be determined through the assessment of the items of disinhibited, excessive or abnormal behavior. DLPFC is in charge of the executive functions such as planning, judging, motivation, motives and behavior.
Amygdala, thalamus and hippocampus are the brain areas taking part in depression. Amygdala and hippocampus are the parts of the limbic system; they constantly interact and are associated respectively with emotions and memory.
The affective symptoms observed in depression are associated with the VMPFC; while inactivity, striyatum, withdrawal from life are linked with brain area named nucleus accumbens.
The VMPFC is the emotion-oriented part of the PFC. Striyatum is a basal ganglion nucleus, works in collaboration with other brain areas and regulates the movements of a person. Nucleus accumbens is the target of the dopamine excreted from the neurotransmitter center in the brain stem and is the brain part concerning pleasure and addiction.