Module PPP-4003:
Clinical Neuropsychology II

Module Facts

Run by School of Psychology

20 Credits or 10 ECTS Credits

Semester 2

Organiser: Dr Giovanni d'Avossa

Overall aims and purpose

The main aim of the class is to overview a number of neurological disorders, resulting in cognitive and psychiatric comorbidities, which are likely to be encountered in the office by practicing clinical neuropsychologists. The focus of the course is on disorders affecting adult populations, although one lecture will examine developmental disorder affecting social cognition. Finally, basic findings relevant to understanding neural plasticity and brain remodelling in the injured brain are overviewed and discussed in relation to their implication for recovery and neurorehabilitation. The class addresses most, but not all, of the disorders that the BPS expects psychologists with qualifications in Clinical Neuropsychology to be knowledgeable about (please see: https://www.bps.org.uk/sites/bps.org.uk/files/Qualifications/QICN%20Candidate%20Handbook%202018.pdf). It is expected that familiarity with how to approach the study of disorders of neuropsychological relevance will allow interested students to independently acquire the relevant knowledge, a lifelong ability expected from qualified clinicians

Course content

Most of the course is focused mainly on neurological and psychiatric disorders affecting adult populations. The list of disorders reviewed include: 1. Dementia, including Alzheimer's Disease, Lewy Body Dementia, Vascular Dementia, Fronto-Temporal Dementias. 2. Traumatic Brain Injury. 3. Epilepsy. 4. Stroke 5. Autism Spectrum Disorders. 6. Neurorehabilitation

Additional two lectures are specifically dedicated to the discussion of principles of Neurorehabilitation.

Assessment Criteria

excellent

The student will demonstrate the ability to summarise and critically appraise the rationale, findings and conclusions of studies published in the peer-reviewed literature concerning the consequences of brain disorders on cognitive, physical and emotional function, their treatment and assessment. The student will demonstrate full grasp of research criteria used in the differential diagnosis of major neurocognitive disorders and their use in specific cases. The student will demonstrate detailed knowledge of the epidemiology, pathology and network anatomy pertinent to different brain disorders. The student will demonstrate a good understanding of how neuropsychological assessments can be used to determine the integrity, or lack thereof, of different cognitive and emotional domains. The student will understand and be able to relate major neurocognitive disorders to their most frequently encountered neuropsychological sequelae.

threshold

The student will be able to summarise the main point of a published clinical papers published in the peer-reviewed literature. The student will know the main epidemiological features of common disorders. The student will be able to detail the causes of various neurocognitive disorders. The student will be able to report the major diagnostic criteria of various neurocognitive disorders. The student will be able to differentiate among main cognitive disturbances of memory, attentional and language. The student will have general understanding of the main pathays to recovery in brain injured patients.

good

The student will demonstrate the ability to summarise the main rationale, findings and conclusions of studies published in the peer-reviewed literature concerning the consequences of brain disorders on cognitive, physical and emotional function, their treatment and assessment. The student will recognize common major confounds in clinical studies. The student will demonstrate understanding of the research criteria used in the differential diagnosis of major neurocognitive disorders. The student will demonstrate knowledge of the epidemiology, pathology and anatomy pertinent to different brain disorders. The student will demonstrate a good grasp of the main neuropsychological assessments available to determine the integrity of different cognitive and emotional domains. The student will understand and be able to relate major neurocognitive disorders to their most frequently encountered neuropsychological sequelae.

Learning outcomes

  1. Understand the role of diagnostic criteria in clinical assessments. All major neurological disorders have had diagnostic criteria drawn up, to help clinicians reach consistent diagnosis. Students are familiarised with a number of such criteria and their evolution over time.

  2. Understand the principles underlying functional recovery from CNS injury. Neural recovery and adaptation to brain injury is a universal aspect of the natural course of disorders such as TBI< stroke and focal epilepsy. Students need to be aware of general principles of neural plasticity and their implication for neural recovery.

  3. Demonstrate knowledge of the basic facts concerning the epidemiology of major neuro-behavioral disorders. Epidemiological concepts such as incidence, prevalence etc are explained and used throughout the course. Similarly, indexes of diagnostic quality such as sensitivity, specificity, negative and positive predictive value are used to define the quality of diagnostic criteria and tools.

  4. Demonstrate knowledge of the common cognitive and psychiatric consequence of major neurological disorders. Major neurological disorders are commonly associated with a number of cognitive and psychological abnormalities, including mood disorders, psychosis anxiety etc. Studnets are introduced to the diagnostic criteria used in identifying these conditions and recognising their features.

  5. Understand the natural history of neurological disorders. Most neurological disorders change over time, either because of progression of the underlying pathology or neural plasticity.

  6. Be able to search the published medical literature for evidence relevant to clinical practice and assess it critically.

Assessment Methods

Type Name Description Weight
INDIVIDUAL PRESENTATION In Class Presentation

A paper, which appeared in the peer reviewed literature, is assigned by the Instructor a week before presentation. The student has to present the paper in class or write a brief, critical synopsis of the paper that is graded by the MO.

25
GROUP PRESENTATION Literature Review - Group Assignment

A topic is assigned by the MO. Groups made of two students each have to summarise the relevant literature in a written essay. The assignment involves searching, reading and summarising coherently a corpus of published literature in way which demonstrates the relevance of the reviewed studies to issue highlighted in the assignment.

25
EXAM Final Exam

Multiple Choice Questions exam includes 66 questions assessing the students' knowledge of the material covered in class, both student' lead presentation as well as the lecture content.

50

Teaching and Learning Strategy

Hours
Lecture

The class periods include both student lead presentations as well as a formal lectures delivered by one of the Instructors. The topics included in the lectures include dementia (AD, LBD, VaD & FTD), Parkinson's Disease and deep Brain Stimulation, Epilepsy, Autism, Traumatic Brain Injury, Neurorehabilitation. Each lecture is delivered using a power point presentation and is captured on Panopto. Particular emphasis is paid to the anatomical, physiological underpinnings of the neuropsychological and emotional consequences of these disorders.

20
Private study

Students are expected to read two papers each week, which are then presented in class. This takes about six hours (x10). Additionally they will need to review the lecture form the previous week for 2 hours (X11). Preparing a summary of a paper takes about 12 hours. The group project is about 30 hours of work. Preparing for the final exam takes between 40 to 50 hours.

166
Seminar

Classes include both student lead presentations as well as a formal lectures delivered by one of the Instructors. The student lead presentations overview a single published study. The paper is assigned to the students presenting a week before the scheduled presentation. The students presenting have to generate a summary of the paper that they will overview in class in a power point file. Thus, students have the opportunity to hear a summaries of recently published papers concerning the epidemiology, pathology, clinical presentation and treatment of a number of neurological disorders that are commonly seen by clinical neuropsychologists and this become familiarised with the format and methodologies used in clinical studies

10
One-to-one supervision

Students received one on one teaching during the preparation of the presentation. The Instructor helps the students come to grips with the study design, the findings and their implications. The instructor also provides explicitly advice regarding the structure of the presentation.

1
Laboratory

Three-four patients are invited to the lectures to provide first person account of the consequences of neurological disorders on a person's life. These visits also provide the opportunity to demonstrate some of the neuropsychological impairments overviewed in class and are generally warmly received by students.

3

Transferable skills

  • Literacy - Proficiency in reading and writing through a variety of media
  • Self-Management - Able to work unsupervised in an efficient, punctual and structured manner. To examine the outcomes of tasks and events, and judge levels of quality and importance
  • Exploring - Able to investigate, research and consider alternatives
  • Information retrieval - Able to access different and multiple sources of information
  • Inter-personal - Able to question, actively listen, examine given answers and interact sensitevely with others
  • Critical analysis & Problem Solving - Able to deconstruct and analyse problems or complex situations. To find solutions to problems through analyses and exploration of all possibilities using appropriate methods, rescources and creativity.
  • Presentation - Able to clearly present information and explanations to an audience. Through the written or oral mode of communication accurately and concisely.
  • Teamwork - Able to constructively cooperate with others on a common task, and/or be part of a day-to-day working team
  • Argument - Able to put forward, debate and justify an opinion or a course of action, with an individual or in a wider group setting
  • Self-awareness & Reflectivity - Having an awareness of your own strengths, weaknesses, aims and objectives. Able to regularly review, evaluate and reflect upon the performance of yourself and others

Subject specific skills

  1. Collect the published evidence concerning a specific clinical topic.
  2. Summarise and evaluate critically primary sources.
  3. Appreciate the role of epidemiological, biological and psychological factors in neuropsychological disorders.
  4. Understand the role of neuropsychological assessment in the care of neurological and psychiatric patients.

Resources

Talis Reading list

http://readinglists.bangor.ac.uk/modules/ppp-4003.html

Reading list

Lecture 1 – Dementia Diagnostic Criteria & Epidemiology 1. Langa, Kenneth M., et al. "A comparison of the prevalence of dementia in the United States in 2000 and 2012." JAMA Internal Medicine 177.1 (2017): 51-58. 2. Satizabal, Claudia L., et al. "Incidence of dementia over three decades in the Framingham Heart Study." New England Journal of Medicine 374.6 (2016): 523-532. 3. Matthews, F. E., et al. "A two decade dementia incidence comparison from the Cognitive Function and Ageing Studies I and II." Nature communications 7 (2016): 11398.

Lecture 2 – Alzheimer’s Disease and MCI - Diagnostic Criteria & Biomarkers 4. Bateman, Randall J., et al. "Clinical and biomarker changes in dominantly inherited Alzheimer's disease." New England Journal of Medicine 367.9 (2012): 795-804. 5. Morris, John C. "Revised criteria for mild cognitive impairment may compromise the diagnosis of Alzheimer disease dementia." Archives of Neurology 69.6 (2012): 700-708. 6. Wadley, Virginia G., et al. "Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study." Journal of the American Geriatrics Society 55.8 (2007): 1192-1198.

Lecture 3 – Lewy Body Dementia & REM Sleep Behaviour Disorder 7. Gnanalingham, Kanna K., et al. "Motor and cognitive function in Lewy body dementia: comparison with Alzheimer's and Parkinson's diseases." Journal of Neurology, Neurosurgery & Psychiatry 62.3 (1997): 243-252. 8. Ferman, Tanis J., et al. "Neuropsychological differentiation of dementia with Lewy bodies from normal aging and Alzheimer's disease." The Clinical Neuropsychologist 20.4 (2006): 623-636. 9. Iranzo, Alex, et al. "Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study." The Lancet Neurology 5.7 (2006): 572-577.

Lecture 4 – Vascular Dementia 10. Vermeer, Sarah E., et al. "Silent brain infarcts and the risk of dementia and cognitive decline." New England Journal of Medicine 348.13 (2003): 1215-1222. 11. Graham, N. L., T. Emery, and J. R. Hodges. "Distinctive cognitive profiles in Alzheimer’s disease and subcortical vascular dementia." Journal of Neurology, Neurosurgery & Psychiatry 75.1 (2004): 61-71. 12. Wallin, Anders, et al. "Alzheimer’s disease—subcortical vascular disease spectrum in a hospital-based setting: Overview of results from the Gothenburg MCI and dementia studies." Journal of Cerebral Blood Flow & Metabolism 36.1 (2016): 95-113. . Lecture 5 – Parkinson’s Disease 13. Lees, A. J., and Eileen Smith. "Cognitive deficits in the early stages of Parkinson's disease." Brain 106.2 (1983): 257-270. 14. Owen, A. M., et al. "Fronto-striatal cognitive deficits at different stages of Parkinson's disease." Brain 115.6 (1992): 1727-1751. 15. Schrag, Anette, et al. "Clinical variables and biomarkers in prediction of cognitive impairment in patients with newly diagnosed Parkinson's disease: a cohort study." The Lancet Neurology 16.1 (2017): 66-75.

Lecture 6 – PD & Deep brain Stimulation 16. Combs, Hannah L., et al. "Cognition and depression following deep brain stimulation of the subthalamic nucleus and globus pallidus pars internus in Parkinson’s disease: a meta-analysis." Neuropsychology Review 25.4 (2015): 439-454. 17. Lim, Shen-Yang, et al. "Dopamine dysregulation syndrome, impulse control disorders and punding after deep brain stimulation surgery for Parkinson’s disease." Journal of Clinical Neuroscience 16.9 (2009): 1148-1152. 18. Owen, A. M., et al. "Fronto-striatal cognitive deficits at different stages of Parkinson's disease." Brain 115.6 (1992): 1727-1751.

Lecture 7 – Epilepsy 19. Lencz, Todd, et al. "Quantitative magnetic resonance imaging in temporal lobe epilepsy: relationship to neuropathology and neuropsychological function." Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 31.6 (1992): 629-637. 20. Williamson, P. D., et al. "Characteristics of medial temporal lobe epilepsy: II. Interictal and ictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results, and pathology." Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 34.6 (1993): 781-787. 21. Hernandez, Maria Teresa, et al. "Deficits in executive functions and motor coordination in children with frontal lobe epilepsy." Neuropsychologia 40.4 (2002): 384-400.

Lecture 8 – Neurorehabilitation & Plasticity 22. Nardo, Davide, et al. "Less is more: neural mechanisms underlying anomia treatment in chronic aphasic patients." Brain 140.11 (2017): 3039-3054. 23. Farne, A., et al. "Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients." Journal of Neurology, Neurosurgery & Psychiatry75.10 (2004): 1401-1410. 24. Zhang, X., et al. "Natural history of homonymous hemianopia." Neurology 66.6 (2006): 901-905.

Lecture 9 – Autism 25. Lyall, Kristen, et al. "The changing epidemiology of autism spectrum disorders." Annual review of public health 38 (2017): 81-102. 26. Jones, Catherine RG, et al. "The association between theory of mind, executive function, and the symptoms of autism spectrum disorder." Autism Research 11.1 (2018): 95-109. 27. Castelli, Fulvia, et al. "Autism, Asperger syndrome and brain mechanisms for the attribution of mental states to animated shapes." Brain 125.8 (2002): 1839-1849.

Lecture 10- Traumatic Brain Injury 28. Koenigs, Michael, et al. "Focal brain damage protects against post-traumatic stress disorder in combat veterans." Nature Neuroscience 11.2 (2008): 232. 29. Hoge, Charles W., et al. "Mild traumatic brain injury in US soldiers returning from Iraq." New England Journal of Medicine 358.5 (2008): 453-463. 30. Mac Donald, Christine L., et al. "Detection of blast-related traumatic brain injury in US military personnel." New England journal of medicine 364.22 (2011): 2091-2100.

Courses including this module

Compulsory in courses:

Optional in courses: