Steven P. Broglio
The acute evaluation and management of concussion are among the most complex and challenging injuries medical practitioners face. The variability in clinical presentation necessitates a systematic approach to the injury evaluation. The evaluation should include a thorough injury history and clinical examination that is supported by objective measures of mental status and motor control. The integration of all information should be used in making the clinical diagnosis.
Beth Krone, Amanda Kirschenbaum, Thomas Yang, Amy Glick, Alexander Newcorn, and Jeffrey H. Newcorn
Attention-deficit/hyperactivity disorder (ADHD) is a common, symptomatically heterogeneous, neurodevelopmental disorder. It’s symptoms first appear early in life and evolve as the brain matures and reorganizes over the lifespan. Cognitive dysfunction is a key feature of adult ADHD and typically manifests as a dysregulation of executive control of attention, working memory, inhibitory control, and emotion regulation rather than as a defining deficit in a specific cognitive domain. The heterogeneity of presentation, changing clinical manifestations across development, and variability in functional impairment associated with ADHD contribute to the difficulty of obtaining a “snapshot” diagnosis using a single assessment or representative battery. Careful history-taking of information across raters and settings generally reveals a pattern of symptoms beginning in childhood. Manifested impairment required for diagnosis depends on a variety of supportive or mitigating versus contributory factors. In adulthood, persisted or untreated ADHD may predispose to a variety of other conditions, including low educational and/or academic attainment, decreased earning potential, substance use or abuse, parenting and marital problems, poor health practices, a variety of risky behaviors, and a variety of comorbid Axis I and Axis II psychiatric disorders. High-functioning adults who have not previously come to clinical attention may present for care because of academic underattainment, suboptimal performance in the workplace, or behavioral or mood dysregulation. In addition, ADHD may be discovered as part of a more comprehensive workup of other disorders. A range of psychosocial and psychopharmacological treatments are available; response is often good to excellent once the disorder is properly identified.
Tracey E. Rizzuto, Katie E. Cherry, and Jared A. LeDoux
Aging trends worldwide raise awareness for the need to understand the impact of cognitive aging on the work lives and productivity of older adults. By confronting actual and perceptual challenges associated with cognitive aging, organizations can better support this vital workforce segment. This chapter describes the effects of aging on select aspects of cognitive functioning, and reviews research from laboratory and on-the-job studies to address how the performance of job tasks and other life activities may be affected. Various cognitive aging dimensions and their implications for job performance are discussed. In addition, methodological concerns and challenges associated with cognitive aging research are described, along with new directions for successful aging among late-career workers.
Adam T. Gerstenecker and Benjamin T. Mast
This chapter examines the role of psychologists in the rehabilitation of older adults. The chapter begins with a review of the changes expected to take place in the population demographics of the United States and its impact on geriatric rehabilitation. The next section highlights core concepts in geriatric rehabilitation, as well as predictors of successful outcome. In the final sections of the chapter, psychologists’ roles within geriatric rehabilitation will be examined, with particular emphasis placed upon assessing cognitive impairment and depression, and specific interventions for treating depression in geriatric rehabilitation patients.
Marlene Oscar-Berman, and Nasim Maleki
Chronic alcohol consumption has direct effects on the central nervous system and is among the leading causes of cognitive impairment and dementia. Alcohol-related dementia, Wernicke’s encephalopathy, and Korsakoff’s syndrome are among the most common forms of severe alcoholism-related neurological complications that are associated with widespread abnormalities in the brain, as well as impairments of multiple mental and emotional processes. Abnormalities have been consistently reported in association with Wernicke’s encephalopathy and Korsakoff’s syndrome, but alcohol-related dementia remains less well characterized. This chapter reviews the neurological and neuropsychological characteristics of these conditions, associated changes in the brain, potential molecular mechanisms involved, and some of the treatment or rehabilitation options. Future use of evidence-based diagnostic test-selection is advised to assist in refining differential diagnoses.
Anne-Pascale Le Berre, Alice Laniepce, Shailendra Segobin, Anne-Lise Pitel, and Edith V. Sullivan
Alcohol is a psychoactive substance consumed worldwide and directly responsible or at least contributing to the development of diseases such as alcohol use disorder (AUD), cirrhosis, fetal alcohol syndrome, cancer, and cardiovascular diseases. The past decades of research have revealed brain structural and functional abnormalities associated with mild to moderate cognitive impairment in recently detoxified AUD patients. Such functional compromise can be detectable even before the development of more chronic and severe neurological complications such as Korsakoff’s syndrome (KS) and alcohol-related dementia (ARD). Excessive alcohol consumption results in impairment in attention, executive functions, memory, visuospatial and motor skills, as well as deficits in metamemory processes, emotion recognition, and theory of mind abilities. As a consequence, early in abstinence, some AUD patients may not be cognitively able to benefit from therapies and could be at risk to relapse because cognitive impairment hampers efficient decision-making, motivation to change, and learning skills, in addition to challenging emotional and interpersonal interactions. This chapter describes the alcohol-related cognitive impairment observed in recently detoxified AUD patients. It then discusses potential cognitive recovery or persistence of these deficits with prolonged abstinence and their clinical implications in terms of treatment and abstinence or relapse. The specificity of the AUD cognitive and motor profile is contrasted with alcohol-related neurological complications (i.e., KS and ARD) and other neurocognitive disorders (i.e., Alzheimer’s disease and frontotemporal dementia). Finally, structural and functional brain abnormalities as well as their relationship with neuropsychological impairments are presented.
Dorene M. Rentz, Irina Orlovsky, Emily Kilpatrick, and Kathryn V. Papp
Recent research has defined Alzheimer’s disease (AD) as a multidimensional process that moves along a continuum from a preclinical, asymptomatic phase in which the pathophysiology of AD begins many years prior to the emergence of the clinical dementia syndrome. This chapter discusses the preclinical phase of AD, in which biomarkers of the disease are emerging, as well as the symptoms associated with the subsequent progression to AD dementia. It addresses the epidemiology of AD and discusses the diagnostic criteria and the clinical evaluation, as well as the cognitive and behavioral changes associated with AD dementia. Current treatments and future directions are also discussed.
Mark R. Wilson
In sport psychology, the relationship between competitive anxiety and performance has been one of the most debated and researched topics of enquiry. However, the mechanisms underlying this relationship are still unclear, as are the reasons why performance can sometimes be optimal (“clutch” performance) and sometimes far below what should be achieved (“choking”). The current chapter integrates research findings and models from the neuroscience, cognitive psychology, human movement science, and sport performance literature to offer a potential explanatory framework, especially with respect to self-paced, visually guided skills. The mediating role of visual attention is implicated, as it has been proposed to be central to both the top-down control of motor planning and the effects of anxiety on cognitive performance. Contemporary research testing the effects of anxiety on visual attention (particularly the quiet eye) in performance environments, and the efficacy of attentional training programs, are discussed.
Thor D. Stei, Victor E. Alvarez, and Bertrand R. Huber
Neuropathological examination is a key component in determining accurate diagnoses in both the postmortem and surgical settings. Postmortem analyses are necessary for clinicopathological correlation and for determination of frequent comorbid and subclinical pathologies, and neurosurgical specimens are increasingly important for molecular analysis and diagnosis of tumors, which inform treatment choices and prognosis. Neurodegenerative pathologies involve multiple and distinct brain regions, are age-dependent, and frequently co-occur. Well-developed staging systems have been developed for tau, β-amyloid, and Lewy pathologies and are used to establish threshold criteria for pathological diagnoses. The precise role of a given pathology on cognitive impairment will vary depending on pathological stage, comorbid pathology, and other factors such as cognitive reserve. A complete neuropathological workup for neurodegenerative disease requires the examination of multiple well-preserved regions with histochemical and immunohistochemical techniques optimized for paraffin embedded tissue. On the other hand, modern molecular techniques often require fresh or frozen tissue for accurate quantification of genetic and protein alterations. Overall, performing a complete neuropathological workup for accurate diagnoses and maintaining research quality tissue can be mutually beneficial and complementary processes.
Charlotte M. Pretzsch, James L. Findon, and Declan G. Murphy
Autism spectrum disorder (ASD) is a common, pervasive neurodevelopmental condition characterized by social impairments and restricted and repetitive behaviors and interests. Furthermore, frequently co-occurring physical and mental health conditions, including depression, anxiety, and epilepsy, contribute to the substantial burden on affected individuals, their family, and society. Consequently, the cost of ASD to society is greater than that of cancer, stroke, and heart disease combined. The cause of ASD is poorly understood, and there are currently no effective pharmacological treatments for its core symptoms. However, significant progress has been made in elucidating the molecular, genetic, neuroanatomical, and neurochemical associates of ASD, potentially paving the way for new treatment approaches.
Daniel A. Briley
As a field, behavior genetics has a long and often underappreciated focus on environmental and situational factors. This chapter describes the methodological details and empirical findings of this line of work, as well as what situation research can gain from behavior genetics and vice versa. Genetically informative designs offer tools to quantify the extent to which people actively create their situational experiences as opposed to randomly encountering them, and novel advances in situation research have the potential to clarify the scattered history of environmental variables in behavioral genetics. Current progress in personality psychology will be highlighted. Parallels between behavior genetics and personality work can be found both in terms of mechanisms (e.g., gene-environment correlation and gene × environment interaction contrasting with selection effects and person × situation effects) and explanatory pitfalls. Researchers interested in delineating the pathways from situations to behavior would do well to draw from and build upon work in behavior genetics.
Lance M. Rappaport, Sage E. Hawn, Cassie Overstreet, and Ananda B. Amstadter
Given the critical role that emotion dysregulation plays in many psychiatric disorders, there is a need to understand the biological underpinnings of emotion regulation deficits. This chapter opens with a brief overview of emotion regulation and constructs that fall under its broad umbrella. Next, it provides a brief primer of behavioral genetic research methods, summarizes existing literature regarding the heritability of emotional dysregulation, provides an overview of molecular genetic research methods, and reviews extant molecular genetic literature on emotion regulation. Finally, the chapter reviews the limitations of existing research and identifies promising areas of future inquiry that may clarify the underlying structure of emotion dysregulation and identify the role of common genetic loci in associations between emotion dysregulation and psychopathology.
Matt McGue and Brian M. Hicks
We review behavioral and biometrical genetic research aimed at characterizing the nature of the familial aggregation of adolescent substance use and abuse. Twin and adoption studies have shown that genetic factors contribute to individual differences in adolescent substance use phenotypes. These studies have also documented the importance of the shared environment. Biometrical analyses of large samples of twins show that the contributions of genetic and shared environmental factors to substance use phenotypes change markedly between adolescence and early adulthood. The importance of genetic influence increases with age as the importance of shared environmental influences declines. Although only a small number of relevant genetic variants have been identified at this time, they show a similar pattern of increasing association with substance use behavior with age. A major question continues to be how genetic and environmental factors operate jointly to influence the development of complex behavioral phenotypes such as substance use.
David Alais and Randolph Blake
Many important aspects of objects and scenes are fundamentally ambiguous in the retinal images. This ambiguity at the input stage to vision poses a fundamental challenge in perceptual organization as the competing interpretations invariably give rise to a bistable behavior in which the two competing percepts alternate over time. The most common approach to studying visual ambiguity is binocular rivalry, in which two different images are presented, one to each eye. Here we review the basic properties of binocular rivalry and discuss its links with perceptual organization. We also address the role of attention and top-down influences on the interpretation of visual ambiguity, as well as recent work highlighting the moderating influence of multisensory context on binocular rivalry.
Mary Fristad and Elizabeth Nick
This chapter reviews bipolar spectrum disorders (bipolar I, bipolar II, bipolar disorder not otherwise specified, and cyclothymic disorder) in childhood and adolescence. The history of the diagnosis in youth, including recent increased public and professional interest, and surrounding controversy is reviewed. Attention is given to prevalence, incidence, similarities and differences in presentation, course, and comorbidities among child, adolescent, and adult bipolar spectrum disorders. Assessment issues are reviewed, including longitudinal and multiinformant perspectives, instruments, strategies, tools, and assessment challenges with youth. Examples of symptom manifestation in youth are provided. Genetic, cognitive, neuroanatomical, psychosocial, and environmental risks for youth bipolar spectrum disorders are discussed. Evidence-based treatments reviewed include commonly prescribed mood stabilizers and atypical antipsychotics, alternative biological treatments, adjunctive psychotherapies, and complementary and alternative treatments. Finally, future directions for the study, assessment, monitoring, and treatment of youth bipolar spectrum disorders are discussed.
Steven W. Zucker
Border ownership seems instantaneous and automatic, emerging as rapidly as figure separates from background. But this apparent immediacy hides an extremely subtle problem that lies at an intermediate level of visual processing. Somehow border ownership (the process) must integrate upward-flowing image-derived information about boundaries with downward-flowing figural information derived from boundary arrangement. It is related to Gestalt notions of closure. To appreciate border ownership as a process, we contrast it with a more traditional pathway to surface inferences, from boundaries to stereo and, finally, to shape from shading. In the end border ownership emerges as a rather different concept from these more geometric visual computations, thus establishing two poles to perceptual organization. The challenge is integrating the geometric content of borders with the topological content of figures within standard modeling formalisms. We suggest an expanded framework based on mathematical and physiological ideas, perhaps involving local field potentials.
Friedhelm C. Hummel and Leonardo G. Cohen
This article explains the role of brain stimulation in neurorehabilitation. The outline of this article is formed by the characterization of some of the problems faced in the field of nuerorehabilitation. Furthermore, it describes results of studies conducted to understand the functional changes in the motor cortices of hemispheres after stroke. This article finally discusses some of the interventional approaches proposed to improve motor function. Stroke is the main cause of long-term disability among adults. The disability resulting from stroke impairs the quality of life. Post-stroke recovery remains an important clinical focus. Various modalities of brain have been proposed as strategies to enhance motor function when combined with conventional neurorehabilitative interventions after a stroke. Before these approaches can reach the clinic, their results need to be replicated in larger samples and controlled conditions to determine their value.
Kenneth M. Heilman
To successfully interact with the environment, goal-oriented movements made by human limbs must be guided by instructions from the brain. Loss of the ability to program purposeful skilled movements, in the absence of any motor, sensory, or cognitive deficit that could fully account for this disability, is called apraxia. Several types of apraxia were described by Hugo Liepmann in the beginning of the 20th century: ideomotor apraxia, where patients make spatial movement and postural errors as well as temporal errors, limb-kinetic apraxia, where patients are unable to perform precise independend and coordinated finger movements and ideational apraxia, where patients fail to correctly sequence a series of action. More recently, three other types of apraxia have been described: conceptual apraxia, where patients have a loss of mechanical knowledge; dissociation apraxia, where patients are impaired at performing a skilled act in response to stimuli in one modality but can perform normally when the stimulus is given in another modality; and conduction apraxia, where patients are impaired at action imitation. This chapter, using an historical approach, reviews the signs associated with each of these forms of apraxia, as well as their pathophysiology.
Lynn M. Maher
Broca’s aphasia serves as a platform for discussions of the cognitive and neural mechanisms of sentence production and how those systems break down in individuals with damage in left inferior frontal regions beyond Broca’s area, suggesting a role for such regions in syntactic processing. Standardized and nonstandardized diagnostic tools facilitate assessment of comprehension and production of grammatical functions that can be impaired in Broca’s aphasia. Several treatment approaches address impairment in sentence production that emanates across various processes in sentence formulation. The nomenclature surrounding Broca’s aphasia provides a launching pad to guide analysis and intervention for the communication impairments experienced by these individuals.
James C. Root, Elizabeth Ryan, and Tim A. Ahles
As the population of cancer survivors has grown into the millions, there is increasing emphasis on understanding how late effects of treatment impact survivors’ ability return to work/school, ability to function and live independently, and overall quality of life. Cognitive changes are one of the most feared problems among cancer survivors. This chapter describes the growing literature examining cognitive changes associated with non-central nervous system cancer and cancer treatment. Typical elements of cancer treatment are discussed, followed by a description of clinical presentation, self-reported and objectively assessed cognitive findings, and results of structural and functional neuroimaging research. Genetic and other risk factors for cognitive decline following treatment are identified and discussed, together with biomarkers and animal models of treatment-related effects. This is followed by a discussion of behavioral and pharmacologic treatments. Finally, challenges and recommendations for future research are provided to help guide subsequent research and theoretical models.