Higher Cognition

1. Higher Cognition James H. Baños, Ph.D. Department of Physical Medicine and Rehabilitation

2. Overview • General Organization and Recurring Themes • A Closer Look at Organization • Principles in Action: Domains of Cognition

3. General Organization

4. Where to begin? • The “vertically organized” brain

5. Where to Begin? • Major Dimensions of Organization: • Left vs. Right • Anterior vs. Posterior • Cortical vs. Subcortical

6. 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

7. 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

8. A Closer Look at Organization

9. Left Vs. Right

10. Hemispheric Specialization

11. Hemispheric Specialization • Don’t think in terms of hemispheric “dominance”

12. 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

13. Left Hemisphere: “Classic” Clinical Presentation Right hemiparesis Aphasia Apraxia Hemispheric Specialization

14. Right Hemisphere: “Classic” Clinical Presentation Left hemiparesis Poor arousal Left neglect Unawareness of deficits Flat affect Hemispheric Specialization

15. Anterior vs. Posterior

16. Anterior vs. Posterior

17. 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

18. 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

19. Cortical vs. Subcortical

20. Cortical vs. Subcortical • Subcortical structures • Initiation • Cessation • Modulation • Control

21. Cortical vs. Subcortical • Thalamus • Not just a “sensory relay” • Cortico-thalamo-cortical loops modulate: • Consciousness • Arousal • Vigilance • Foundation for higher attentional processes “Cortical tone”

22. Cortical vs. Subcortical • Basal ganglia • Initiation • Cessation • Maintenance • Similar role in motor and cognitive function

23. 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

24. 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

25. 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

26. 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

27. 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

28. Feedback Plan Cortex Cerebellum “Reality” Effectors Cortical vs. Subcortical • Cerebellum Cerebrocerebellum

29. Cortical vs. Subcortical • Cerebellar Signs • Motor • Ataxia • Dysmetria • Cognitive • “Cognitive Ataxia” • “Dysmetria of Thought” • Emotionally Guided Behavior • Affective lability • Psychiatric symptoms

30. Putting it Together… Common View: Cognition Motor/Sensory

31. Putting it Together… Reality: Emotionally Guided Behavior Cognition Sensorimotor Purposeful Effortful Automatic

32. Principles in Action:Domains of Cognition

33. Domains of Cognition • Motor and Sensory Aspects of Cognition • Language • Attention • Executive Function

34. Hierarchical Organization Multimodal Association Cortex Unimodal Association Primary Sensory

35. Hierarchical Organization Multimodal Association Somatosensory Association Visual Association Auditory Association Primary Somatosensory Primary Visual Primary Auditory

36. Hierarchical Organization Somatosensory visual auditory

37. Hierarchical Processing Anterior Posterior Multimodal Association Cortex Unimodal Association Unimodal Association Unimodal Association Premotor SMA Primary Somatosensory Primary Visual Primary Auditory Primary Motor

38. Multimodal Association Cortex Premotor SMA Primary Motor Hemiparesis Motor and Sensory Aspects of Cognition

39. Akinesia, Bimanual dyscoordination Motor and Sensory Aspects of Cognition Multimodal Association Cortex Premotor SMA Primary Motor

40. Motor and Sensory Aspects of Cognition ? Multimodal Association Cortex Apraxia Premotor SMA Primary Motor

41. 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

42. Multimodal Association Cortex Multimodal Association Cortex Premotor Premotor SMA SMA Primary Motor Primary Motor Motor and Sensory Aspects of Cognition Corpus Callosum ? Alien Hand

43. 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

44. Motor and Sensory Aspects of Cognition Multimodal Association Cortex ? ? ? Visual Association Somatosensory Association Auditory Association Primary Visual Primary Somatosensory Primary Auditory

45. 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

46. Motor and Sensory Aspects of Cognition ? Multimodal Association Cortex Visual Association Somatosensory Association Auditory Association Primary Visual Primary Somatosensory Primary Auditory

47. Motor and Sensory Aspects of Cognition • Hemispatial Neglect • Visuospatial Integration Deficits

48. Motor and Sensory Aspects of Cognition

49. Language

50. Language