Higher Cognition

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

2. Overview • The Damaged and Undamaged Brain • Principles of Organization • Principles in Action: Domains of Cognition

3. The Damaged and Undamaged Brain

4. The Damaged and Undamaged Brain “The deficits observed after a brain lesion don’t tell you what the lesioned portion of the brain did. They tell you what the rest of the brain is still capable of doing.” - John Gabrieli

5. The Damaged and Undamaged Brain • 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.

6. The Damaged and Undamaged Brain • 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

7. Principles of Organization

8. Where to Begin? • Left vs. Right • Anterior vs. Posterior • Hierarchical Processing • Cortical vs. Subcortical

9. Hemispheric Specialization

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

11. 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

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

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

14. Anterior vs. Posterior

15. 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

16. 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

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

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

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

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

21. 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

22. 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

23. 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

24. 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

25. 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

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

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

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

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

30. Principles in Action:Domains of Cognition

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

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

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

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

35. 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

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

37. 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

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

39. 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

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

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

42. Motor and Sensory Aspects of Cognition

43. Language

44. Language Association “Pure” Language Expressive (non-fluent) Receptive (fluent) Language Association Cortex Association Cortex Broca’s Wernicke’s

45. Language Association “Pure” Language Expressive (non-fluent) Receptive (fluent) Language Association Cortex Association Cortex Broca’s Wernicke’s

46. 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

47. Language Association “Pure” Language Expressive (non-fluent) Receptive (fluent) Language Association Cortex Association Cortex Broca’s Wernicke’s

48. 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

49. Language Association “Pure” Language Expressive (non-fluent) Receptive (fluent) Language Association Cortex Association Cortex Broca’s Wernicke’s

50. 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