Functional Neuroanatomy & Neurological Bases of Cognition Nigel Schofield, Consultant Clinical Neuropsychologist May 2008

Evolutionary Development
If you examine the brain in an evolutionary perspective, this can help to understand the interlinks between form and function. The brain can be divided anatomically and functionally into three basic components.

Reptilian Brain
Corresponds to the brainstem Consists of the medulla, pons, midbrain and basal ganglia Not only responsible for vegetative functions but also for many volitional behaviours directed towards individual preservation and propagation such as feeding, drinking and sexual aggression.

Paleomammalian Brain
The primitive cortex of the limbic lobe Subserves primitive (but distinctly mammalian behaviours) such as hoarding and parental care of offspring.

Neomammalian Brain
The neocortex Subserves higher cognitive functioning and speech which facilitate social behaviour.

Lurias Work
Simple anatomical localisation of function does not explain cognitive and behavioural complexity. Postulated three functional units

Lurias 3 Functional Units

Motor unit regulates motor tone Sensory unit receives, processes and stores sensory information The unit for programming, regulating and verifying action

How do the units work?

Progression from sensation through to symbolic function in each unit Primary, secondary and tertiary areas

e.g. Damage to the Visual Parts of the Sensory Unit

Primary areas losses of parts of the visual field Secondary areas may lead to poor judgement of motion, poor distance judgement, impaired colour perception Tertiary areas could lead to visual object agnosia

e.g. Damage in the Speech Pathways of the Motor Unit

Primary areas dysarthria Secondary areas dysphasia Tertiary areas poor speech spontaneity

Weaknesses of Lurias Model

Does not fully explain the integration of focal brain functions because: Divisions between sensory and motor neurons sometimes not clear Some functions exist several in anatomically distinct areas of the brain There are multiple parallel functions in the brain, not simple stepwise processes

Arousal, Attention, Activation Arousal, Attention, Activation

Arousal

Major Areas of Cognition

Attention and concentration Perception Memory Language Control of motor behaviour Executive function

Attention and Concentration

Three attentional networks: Alerting achieving and maintaining an alert state in preparation for incoming stimuli Orienting selectively focusing on one or more items out of many candidate ones Executive control monitoring and resolving conflicts in planning, error detection and overcoming habitual actions All dependent on the brain being aroused

Localisation of Attentional Networks

Alerting frontal and parietal cortical regions particularly of the right hemisphere Orienting parts of the superior and inferior parietal lobe, frontal eye fields and subcortical areas such as superior colliculus of the midbrain, and pulvinar and reticulate nucleus of the thalamus Executive control includes midline frontal areas(especially anterior cingulate and lateral prefrontal cortex) and the basal ganglia

3 Compartments of Attention
Top-down modulation from prefrontal, parietal & limbic cortices

Modality & domain specific attentional modulations ( sounds, tactile stimuli, colours, motion, words, spatial targets, faces, objects, memories etc.)

Bottom-up modulation from ascending reticular activating system

Components of the ARAS

Reticulothalamic cortical pathway promotes and maintains cortical arousal by facilitating transthalamic passage of sensory material towards the cortex. Transmitter specific pathways originating in the brainstem or basal forebrain, and projecting to the cerebral cortex include dopaminergic projections from the raphe nucleus & noradrenergic projections from the locus coeruleus of the brainstem, and cholinergic & gabaminergic pathways originating in the nucelus basalis.

Limbic elements of attention

Anterior cingulate cortex plays a core pivotal role in attention bilateral damage gives rise to akinetic mutism Intralaminar nuclei of the thalamus receive inputs from the brainstem nuclei and relay info widely to the cortex, with a reciprocal feedback loop from the cortex modulating these ascending pathways via the thalamus

Cortical elements of attention

Parietal cortex involved in sustained and selective attention Dorsolateral prefrontal cortex has a key role in divided attention

Perception
How we take energy from the environment & convert it into a representation that the mind can use

Perceptual Problems
Visual field cuts Cortical blindness Achromatopsia inability to discriminate between colours (medial occipito-temporal) Hemianaesthesia Hemineglect ? an attentional problem Hemispatial neglect Hemiakinesia Agnosias Loss of taste and/ or smell

Types of Agnosia
Visual agnosias inability to recognise familiar objects e.g.
Prosopagnosia inability to recognise faces Agnostic alexia inability to read Colour agnosia inability to retrieve colour information e.g. what colour are bananas Object agnosia inability to name objects Simultiagnosia inability to recognise a whole image although individual details are recognised

 Auditory agnosia an inability to recognise auditory stimuli - Auditory/verbal information agnosia an inability to hear words - Auditory agnosia inability to hear environmental sounds e.g. car starting or dog barking - Receptive amusia inability to hear music Somatosensory agnosia (Astereognosis or tactile agnosia) - Difficulty perceiving objects by touch

Object recog, understanding & naming

Functions Discrimination of shape, colour, location Perceptual classification Object Consequence of impairment Apperceptual agnosia

Visual analysis

Object recog.

Associative agnosia (modality specific) Associative agnosia (non-modality specific) Anomia & paraphasias

Knowledge of objects

Semantic system

Store of names

Lexicon

Spoken name

Apperceptive vs Associative Agnosia

Basic High-level Naming Semantic visual perceptual & knowledge proc analysis identific. Apperc. Assoc. / / x / x x / x/

Prosopagnosia
Face
Visual analysis Expression, lip reading, Feature matching Face-recognition units ****

Semantic system

Voice, gait etc. Knowledge of person

Lexicon of names

Spoken name

Topographical Disorientation
Egocentric disorientation an inability to represent the location of objects relative to self (often seen in conjunction with features of Balints syndrome due to bilateral posterior parietal damage Landmark agnosia an inability to recognise salient environmental stimuli (buildings etc) a form of associative agnosia due to lingual gyrus (basal occipital) damage Anterograde spatial disorientation an inability to create new maps or representaions of the environment due to damage to the right parahippocampal gyrus

Memory Taxonomy

Cortical Network Memory

Basic Neuroanatomy of Memory

A) Subcortical structures Basal ganglia and cerebellum Procedural memory. Caudate nucleus involved particularly with habit formation (unconscious learning) Thalamus Temporal sequencing information. Also supplementary role to medial temporal lobes in new learning Basal forebrain The binding together of different modal components in episodic memory

B. Cortical structures Hippocampus Acquisition of new factual knowledge Primary association cortex Visual, auditory and somatosensory data Non-medial temporal Retrieval of previously learned material e.g. autobiographical info, names, faces Ventromedial frontal lobes Memory traces linking facts and emotion Dorsolateral frontal lobes Recency and frequency memory. Working memory

Limbic System Elements of Episodic Memory

Cingulate cortex Frontal Lobe Retrosplenial Cortex

Fornix

Thalamus Anterior mediodorsal

Mamillary body Basal forebrain Amygdala Hippocampus Entorhinal cortex

Semantic Memory
Pre-motor cortex Sensorimotor cortex

Action Words Semantic Representation Motion

Touch
Perisylvian cortex

Sound
Occipeto-temporal parietal junction

Middle temporal gyrus Anterior temporal cortex

Colour Shape
Posterior ventral occipetal temporal cortex

Posterior temporal/inferior parietal cortex

Language Areas of the Brain

Language Functions
Phonology production & comprehension of appropriately sequenced speech sounds (phonemes) left superior temporal lobe and anterior insula Semantics Assignment of meaning to words and production of linguistically appropriate individual words Anterior and inferior temporal lobe (semantic representations) and Wernickes area (mapping sound to underlying representations)

 Syntax Assembly of strings of words into sentences using pronouns, prepositions, tenses etc. Brocas area Prosody Fine tuning by intonation, cadence etc Left anterior hemisphere and basal ganglia & Emotional expression Right hemisphere

Characteristics of Different Types of Aphasia

Type Fluent Repetition Comprehension Naming Right-sided Sensory hemiplegia deficits no yes yes no yes no no yes poor poor poor poor good good good good good poor good poor poor good poor good poor poor poor poor poor poor poor poor yes no no yes some some some no few some some yes yes no yes no

Broca Wernicke Conduction Global Transcortical sensory Transcortical motor Transcortical mixed Anomia

Disorders of Reading
Peripheral dyslexias - Preserved oral and written spelling, and ability to identify words spelt out aloud coupled with (a) ability to write, but unable to read other than letter by letter (alexia without agraphia) left medial occipital lobe (b) errors reading left-hand or initial parts of words (neglect dyslexia) Right hemisphere lesions

Central linguistic dyslexias linguistically based, invariably affect oral spelling

(a) Breakdown of whole word (lexical) reading, difficulty with irregularly spelt words, phonologically plausible errors (surface dyslexia) left tempero-parietal damage (b) Loss of sound-based (phonological) reading, semantic errors, difficulty with function and abstract words, inability to read non-words (deep dyslexia) extensive left hemisphere damage

Disorders of Spelling
Dyspraxic dysgraphia oral spelling intact, defective copying dominant parietal or frontal lobe Neglect dyspraxia wide left margin or misspelling of initial part of words. Other neglect phenomena usually also preseent Right hemisphere lesions

 Lexical (surface) dysgraphia breakdown of lexical route for spelling, so difficulty spelling irregular words, phonologically plausible errors left temperoparietal damage Deep dysgraphia breakdown of sound route for spelling , so semantic errors, unable to spell unfamiliar or non-words, better concrete than abstract spelling extensive left hemisphere damage

Control of Movement

Apraxia
Limb kinetic apraxia breakdown of fine motor organisation of finger movements, so find it hard to copy meaningless hand movements, mimic proper gestures or use real objects flawlessly Basal ganglia damage, supplementary motor area damage Ideomotor apraxia unable to carry out motor acts to command, but often can do so spontaneously. Difficulty with selection, sequencing, spatial orientation and movements in meaningless and meaningful gestures, and demonstrating imaginary use of objects dominant lobe. Perf. improves with imitation, and real object use Inferior parietal and prefrontal damage. Callosal lesions can impair performance of one limb (usually the left)

 Ideational or conceptual apraxia inability to carry out a complex sequence of co-ordinated movements even though each separate component of the sequence can be successfully performed. Inability to mime use of objects, or to even use the real objects. Thus possibly a disorder of semantic memory. Left temporal lobe damage Orobuccal apraxia difficulty performing learned, skilled movements of face, lips, tongue, cheeks, larynx and pharynx on command Inferior frontal region and insula, so commonly seen in Brocas aphasia patinets

Frontal Executive Function

Abstract conceptual ability Set shifting/mental flexibility Inhibitory control Problem solving and strategy formulation Planning Self-monitoring Initiation Sequencing of behaviour Decision making Temporal-order judgements Personality, esp. drive, motivation & inhibition Social behaviour, incl. theory of mind

Important core functions

Controlling acquisition of new memories Divergent thinking choosing different ways of approaching a situation Environmental control of behaviour using cues and information from the environment to direct, control or change personal behaviour. Directing interpersonal behaviour

Acquisition Deficits
Impaired working memory Poor associative learning difficulty associating varying facets of memory about facts or events, thus finding it hard to make use of external cues to direct behaviour

Divergent Thinking Deficits

Loss of spontaneous behaviour e.g. speaking and verbal fluency decreased; decreased ability to produce graphic designs or doodling; reduced behavioural output shown by lethargy, inability to initiate Impaired strategy formulation and planning, especially in response to novel situations Poor abstract thinking e.g. concept formation

Deficits in Environmental Control of Behaviour

Ability to inhibit responses is impaired, so perseverative on tasks Breaking rules and taking risks Unable to follow instructions Gambling Poor error perception Amotivation and apathy

Impaired Interpersonal Behaviours

Inappropriate social and sexual behaviour, or altered behaviours in comparison to premorbid patterns. Pseudodepression Pseudopsychopathy

Brains are not absolutely hard-wired as shown by these fMRI images of regional activation in different people doing a Stroop task some overlap of dorsolateral and medial frontal lobe, inferior parietal lobule and occipital cortex plus significant other variability. There are also gender differences that can account for better gender performance on different tasks e.g. on spatial working memory tasks men have more frontal and less occipital activation, women have the opposite.