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Higher Cognition. James H. Baños, Ph.D. Department of Physical Medicine and Rehabilitation. Overview. General Organization and Recurring Themes A Closer Look at Organization Principles in Action: Domains of Cognition. General Organization. Where to begin?. The “vertically organized” brain.

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Higher cognition l.jpg

Higher Cognition

James H. Baños, Ph.D.

Department of Physical Medicine and Rehabilitation


Overview l.jpg
Overview

  • General Organization and Recurring Themes

  • A Closer Look at Organization

  • Principles in Action: Domains of Cognition



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Where to begin?

  • The “vertically organized” brain


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Where to Begin?

  • Major Dimensions of Organization:

    • Left vs. Right

    • Anterior vs. Posterior

    • Cortical vs. Subcortical


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The Damaged and Undamaged Brain

  • Recurring Themes:

    • Neural processing rarely occurs in a simple linear or sequential fashion

    • Instead, it often occurs in continuous “loops”

    • Like a water faucet that is always running

    • Architecture is often hierarchical


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The Damaged and Undamaged Brain

  • Recurring Themes

    • The nervous system thrives on balance and homeostasis of neural processes within these loops

    • Damage often upsets balance/homeostasis in a process

    • A “normal” process runs unchecked or fails to run at all

    • Like other neurologic symptoms, many neurocognitive symptoms can be thought of in “hyper” and “hypo” terms

    • Ex: muscle tone, reflexes, basal ganglia





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Hemispheric Specialization

  • Don’t think in terms of hemispheric “dominance”


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Left Hemisphere

Speech

Reading/writing

Praxis

Verbal memory

Processing detail

Right Hemisphere

Arousal

Self-awareness

Spatially directed attention

Emotion/affect

Nonverbal memory

Visuospatial processing

Processing “gestalt”

Nonlanguage sound

Music

Hemispheric Specialization


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Left Hemisphere: “Classic” Clinical Presentation

Right hemiparesis

Aphasia

Apraxia

Hemispheric Specialization


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Right Hemisphere: “Classic” Clinical Presentation

Left hemiparesis

Poor arousal

Left neglect

Unawareness of deficits

Flat affect

Hemispheric Specialization




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Posterior

Processing of information about the environment

Sensory gating

Unimodal and multimodal sensory associations

Constructing a unified “representation” of the environment across sensory modalities

Anterior vs. Posterior


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Anterior vs. Posterior

  • Anterior

    • Planning and formulating cognitive and behavioral goals

    • Acting on hypothetical representations of the environment

    • Incorporating behavioral relevance, reinforcement value, and emotion into cognition and behavior



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Cortical vs. Subcortical

  • Subcortical structures

    • Initiation

    • Cessation

    • Modulation

    • Control


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Cortical vs. Subcortical

  • Thalamus

    • Not just a “sensory relay”

    • Cortico-thalamo-cortical loops modulate:

      • Consciousness

      • Arousal

      • Vigilance

    • Foundation for higher attentional processes

“Cortical tone”


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Cortical vs. Subcortical

  • Basal ganglia

    • Initiation

    • Cessation

    • Maintenance

  • Similar role in motor and cognitive function


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SMA

FEF

Putamen

Caudate

(body)

Vl-GPi

Cl-SNr

Cdm-GPi

Vl-SNr

VLo

VLm

VAmc

MDpl

Cortical vs. Subcortical

  • Cortical-Basal Ganglionic Loops

Motor

Oculomotor

Cortex

Striatum

Pallidum

s. nigra

Thalamus


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AC

DLPFC

LOFC

VS

dl-Caudate

(head)

vm-Caudate

(head)

rl-GPi, VP

rd-SNr

ldm-GPi

vl-SNr

mdm-GPi

rm-SNr

pm-MD

VAmc

MDmc

VApc

MDpc

Cortical vs. Subcortical

Anterior

Cingulate

Dorsolateral

Prefrontal

Lateral

Orbitofrontal

Cortex

Striatum

Pallidum

s. nigra

Thalamus


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Cortical vs. Subcortical

  • Basal Ganglia: Motor Symptoms

    • Hyperkinetic disorders (too much movement)

      • Slow writhing movements

      • Quick jerking movements

      • Repetitive abrupt movements

    • Hypokinetic disorder (too little movement)

      • Difficulty initiating motor movement

      • Motor impersistence

      • Rigidity

      • Reduced eyeblink


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Cortical vs. Subcortical

  • Basal Ganglia: Cognitive Symptoms

    • “hypercognitive”

      • Perseveration

      • Intrusion

    • “Hypocognitive”

      • Poor cognitive initiation

      • Poor recall (failure to initiate recall processes)

      • Loss of cognitive set (cognitive impersistence)

      • Diminished semantic search effectiveness


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Cortical vs. Subcortical

  • Basal Ganglia: Emotionally Guided Behavior

    • “hyper”

      • Obsessive-compulsive behaviors

      • Addiction, gambling

      • Mania (in some disorders such as Huntington’s Disease)

      • Affective Lability

    • “Hypo”

      • Avolition

      • Flat affect


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Feedback

Plan

Cortex

Cerebellum

“Reality”

Effectors

Cortical vs. Subcortical

  • Cerebellum

Cerebrocerebellum


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Cortical vs. Subcortical

  • Cerebellar Signs

    • Motor

      • Ataxia

      • Dysmetria

    • Cognitive

      • “Cognitive Ataxia”

      • “Dysmetria of Thought”

    • Emotionally Guided Behavior

      • Affective lability

      • Psychiatric symptoms


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Putting it Together…

Common View:

Cognition

Motor/Sensory


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Putting it Together…

Reality:

Emotionally

Guided

Behavior

Cognition

Sensorimotor

Purposeful

Effortful

Automatic


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Principles in Action:Domains of Cognition


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Domains of Cognition

  • Motor and Sensory Aspects of Cognition

  • Language

  • Attention

  • Executive Function


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Hierarchical Organization

Multimodal Association Cortex

Unimodal

Association

Primary

Sensory


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Hierarchical Organization

Multimodal Association

Somatosensory

Association

Visual

Association

Auditory

Association

Primary

Somatosensory

Primary

Visual

Primary

Auditory


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Hierarchical Organization

Somatosensory

visual

auditory


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Hierarchical Processing

Anterior

Posterior

Multimodal Association Cortex

Unimodal

Association

Unimodal

Association

Unimodal

Association

Premotor

SMA

Primary

Somatosensory

Primary

Visual

Primary

Auditory

Primary

Motor


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Multimodal Association

Cortex

Premotor

SMA

Primary

Motor

Hemiparesis

Motor and Sensory Aspects of Cognition


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Akinesia,

Bimanual dyscoordination

Motor and Sensory Aspects of Cognition

Multimodal Association

Cortex

Premotor

SMA

Primary

Motor


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Motor and Sensory Aspects of Cognition

?

Multimodal Association

Cortex

Apraxia

Premotor

SMA

Primary

Motor


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Motor and Sensory Aspects of Cognition

  • Apraxia -- Inability to correctly perform learned skilled movements, not due to impaired basic motor function, impaired cognition, or impaired comprehension

  • Lesion: Inferior parietal lobule, corpus callosum, SMA


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Multimodal Association

Cortex

Multimodal Association

Cortex

Premotor

Premotor

SMA

SMA

Primary

Motor

Primary

Motor

Motor and Sensory Aspects of Cognition

Corpus

Callosum

?

Alien Hand


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Motor and Sensory Aspects of Cognition

Multimodal Association Cortex

Visual

Association

Somatosensory

Association

Auditory

Association

Visual

Loss

Somatosensory

Loss

Auditory

Loss

Primary

Visual

Primary

Somatosensory

Primary

Auditory


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Motor and Sensory Aspects of Cognition

Multimodal Association Cortex

?

?

?

Visual

Association

Somatosensory

Association

Auditory

Association

Primary

Visual

Primary

Somatosensory

Primary

Auditory


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Motor and Sensory Aspects of Cognition

  • Agnosia -- Impairment of object recognition in the presence of relatively intact basic perception and language

    • Visual Object Agnosia

    • Prosopagnosia (agnosia for faces)

    • Tactile Agnosia

    • Auditory Agnosia


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Motor and Sensory Aspects of Cognition

?

Multimodal Association Cortex

Visual

Association

Somatosensory

Association

Auditory

Association

Primary

Visual

Primary

Somatosensory

Primary

Auditory


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Motor and Sensory Aspects of Cognition

  • Hemispatial Neglect

  • Visuospatial Integration Deficits





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Language

Association

“Pure”

Language

Expressive

(non-fluent)

Receptive

(fluent)

Language

Association

Cortex

Association

Cortex

Broca’s

Wernicke’s


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Language

Association

“Pure”

Language

Expressive

(non-fluent)

Receptive

(fluent)

Language

Association

Cortex

Association

Cortex

Broca’s

Wernicke’s


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Language

  • Wernicke’s Aphasia

    • Fluent speech (but doesn’t make sense)

    • Impaired comprehension

    • Impaired repetition

  • Linguistic analog to a primary sensory deficit

    • Can’t decode words or associate meaning


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Language

Association

“Pure”

Language

Expressive

(non-fluent)

Receptive

(fluent)

Language

Association

Cortex

Association

Cortex

Broca’s

Wernicke’s


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Language

  • Broca’s Aphasia

    • Non-fluent speech

    • Intact comprehension

    • Impaired repetition

  • Linguistic analog to a primary motor deficit

    • Can’t produce the components of language output


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Language

Association

“Pure”

Language

Expressive

(non-fluent)

Receptive

(fluent)

Language

Association

Cortex

Association

Cortex

Broca’s

Wernicke’s


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Language

  • Transcortical Sensory Aphasia

    • Fluent Speech

    • Impaired comprehension

    • Intact repetition

  • Linguistic analog to agnosia

    • Can decode the word but can’t make associations to meaning


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Language

Association

“Pure”

Language

Expressive

(non-fluent)

Receptive

(fluent)

Language

Association

Cortex

Association

Cortex

Broca’s

Wernicke’s


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Language

  • Transcortical Motor Aphasia

    • Non-fluent speech

    • Intact Comprehension

    • Intact Repetition

  • Linguistic Analog to an Apraxia

    • Broca’s area can produce speech, but lacks associations necessary to assemble the components


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Attention

  • “Attention” is a generic term

  • Refers to a family of processes

  • Attention is fluid and constantly changing


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Attention

  • Aspects of Attention

    • Arousal

      • General level of responsivity

    • Orientation

      • Realignment of sensory organs

    • Selective Attention

      • Processing of one stimulus over another

    • Divided Attention

      • Simultaneous processing of stimuli

    • Attention Span

      • Holding of information with rehearsal

    • “Working Memory”

      • Mental manipulation of information in attention span


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Attention

  • Modulation of attention is an “anterior” function

  • It is mediated by cortical basal ganglionic loops

    • Some attentional shifts are automatic

    • Some must be initiated and maintained

    • Salience and relevance must be balanced

    • Unwanted shifts must be inhibited (“stimulus pull”)


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Executive Function

  • Dorsolateral Frontal

    • Planning/goal formation

    • Organizing

    • Sequencing

    • Set shifting

    • Abstract thinking

  • Orbital Frontal

    • Inhibition

    • Behavioral modulation

    • Cognitive modulation

    • Evaluating relevance/reward


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Executive Function

  • Impaired initiation:

    • Failure to generate ideas/courses of action

  • Impaired inhibition:

    • Impulsive cognitive approach

    • You think it, you do it

    • You think it, you say it


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Executive Function

  • Impaired set-shifting

    • Perseveration/decreased mental flexibility

    • Inability to shift to a more appropriate strategy when you get feedback that the current strategy is ineffective

  • Impaired Planning

    • Difficulty sequencing multiple actions to achieve a goal

    • Difficulty seeing more than one “move” ahead in the game

    • Difficulty generating multiple “if-then” alternate courses of action

    • Difficulty assessing consequences of various choices


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Executive Function

  • Impaired Abstract Reasoning

    • Literal or “concrete” thinking style

    • More likely to think in terms of objects and actions rather than concepts


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Executive Function

  • Executive Function is also…

    • “Personality”

    • Point of convergence for cognitive, emotional, and motivational aspects of behavior