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Lecture

11-12 Attention Deficit Disorder and Spatial Neglect.pdf

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Department
Psychology
Course
PSYC 330
Professor
Richard Wright
Semester
Winter

Description
11 - Attention Deficit and Disorders April-02-13 8:23 AM I. Attention Deficit Assessment • Paper and pencil tests (bedsidetests, easyto administer) ○ Trail making test (TMT)  Pagewith numbers and letters. Goal is to draw a linefrom 1-20 (in order)  Version 2 includes A-Z and you alternate between the two sets  Limitation: performance may reflect some form of attention deficit, but doesn't say beyond that (i.e., what kind, how severe) ○ Pace auditory serial addition test (PASAT)  Hold the last two digitsthat they hear in memoryand add them □ 7, 3, 6 ( = 9 ) □ 7, 3, 6, 1 ( = 7) □ 7, 3, 6, 1, 5 ( = 6) □ 7, 3, 6, 1, 5, 2 ( = 7)  Limitation: also only indicates some type of deficit but not specific ○ Test of attention performance(TAP)  Different from the previousones b/c it has different subtests: □ Alertness(respond to tone, reaction time ) □ Attention shifting (symboliclocation cue) □ Dividedattention (4 crosses on screen that move around, when they lineup to form a square, press button whiledoing auditory task where you press button when the auditory pattern changes) □ Express saccades (attentional disengagement;e.g., quicker saccades when fixation cross disappearsbefore the target shows up) □ Flexibility(switching between target types)  Alternate between trialsthat involvemaking a decisionon letters and trails that involvemakingdecisions on shapes □ Go-nogo (to measure response suppression)  Trials whereyou don't respond to target and trials where you respond to target  Lack of inhibitory response → respond anyway  e.g.,those with ADHD have difficultynot responding □ Incompatibility(resistance to interference)  Respond when arrow on right side pointing to the right, but not when it points to the left; & vice versawith the left side  Similarto Stroop tasks □ Cross-modal integration (visual-auditory)  Arrow pointing up/down whilehigh/lowtone plays  Respond when {up arrow, high tone} or {down arrow, low tone} □ Visual field/neglect  See visual stimuli on left/rightside, response speed may be slower/non- existent depending □ Visual search (with hard-to-find targets)  4x4 gridwith boxes, with a gap in each box. Target box has gap on the top. Or there are no target boxes.  Different subtests helps narrow down which functions are performing belownormal level → moreinformative ○ Test of Everyday Attention (TEA)  P are asked questions that solve problems  e.g.,Sara isdriving at 60km/h to Calgary,how long will it take to get there?  e.g.,Sara isdriving at 60km/h to Calgary,how long will it take to get there?  Limitation: doesn't narrow down what kind of deficit there is II. Traumatic BrainInjuries (TBI) • P with mildforms of concussion also show attention deficits • Previously,it was treated as a mildthing (oh you just had your bell rung. Go home and rest). Even doctors thought so • A littleknown fact ○ The first testicular guard cup was used in hockey in 1874 and the first helmetwas used in 1974 ○ It took 100 years for men to realizethat the brain is important too • TBI is much (almost 10x) more common than MS, spinal cord injuries, HIV/AIDS,breast cancer ○ Graph only shows recorded injuries. Peopletend not to go to hospital for concussions • 85% of head injuries are concussions ○ Tend to be mild.Tend to fullyrecover from them. • Before 1970's,concussions were not taken seriously • Most common causes for… ○ Children:fall ○ Teenagers/Young adults: sports/recreation ○ Middle agedadults: transportation accidents ○ Elderlyadults: falls • Concussion results when our brain rocks in our cranial cavity ○ Doesn’t even have to be an impact, can be just a whiplash ○ Contrecoup injury  The "rebound' injury. Injury viarocking back and forth → front/back of brain gets injured ○ There will never be a perfect helmet! b/c it won't stop the brain from moving on the inside of your skull • WHAT ABOUTWOODPECKERS?! ○ Unlikeour brain, their brainsare a tight fit inside their skull→ no rocking back and forth ○ Their cranium is also nice and smooth on the inside → even if brain does move, there's little friction to hurt the brain • The two brain hemispheresare very separated → the Corpus callosum is insanelyimportant for communication between the hemispheres ○ Concussions where one hemispheremoves forward and the other moves backwards → shearing of corpus callosum ○ More severe form of concussion ○ e.g.,hit whileyou turned your head sideways • Do helmetsprevent concussion? ○ No. There will alwaysbe rocking insidethe head ○ Unlessyou fill in the space in your head with… foam… (ugh) • Diagnosing concussions ○ Earliertests were for more severe cases  Classificationsystem for severehead injuries have limitedusefulness or concussions  GlasgowComa Scale □ Eye Opening Response  Spontaneous--open with blinking at baseline4 points  To verbal stimuli, command, speech 3 points  To pain only (not appliedto face) 2 points  No response 1 point □ Verbal Response Oriented 5 points  Oriented 5 points  Confused conversation, but ableto answer questions 4 points  Inappropriate words 3 points  Incomprehensiblespeech 2 points  No response 1 point □ Motor Response  Obeys commands for movement6 points  Purposeful movementto painful stimulus5 points  Withdraws in response to pain 4 points  Flexionin response to pain (decorticate posturing) 3 points  Extension response in response to pain (decerebrate posturing) 2 points  No response 1 point □ A lot of it are likebeing comatose □ Almostall people with concussions obtain a maximumscore of 15 on the scale  But concussions are a big problem! □ Not sensitiveto headache, dizziness, nausea, sensitivityto light/sound, confusion, disorientation, amnesia, poor concentration □ Not useful for sport concussions, which tend to be minimal  Glasgowbetter for mildto moderate to severe injuries ○ Early signsof concussion  Headache  Confusion and disorientation  Retrograde & anterograde amnesia  Nausea & vomiting  Motor problems and incoordination (bambi legs) ○ Graded Symptom Checklist(GSC)  Symptoms go from 0-6 ○ Concussion can be associated with impairedeyemovements  Tracking moving blue dot → smooth eye movements are all messedup in those with concussions ○ Even if an athlete feelsfine immediatelyafter a big hit, they may still have a concussion, and may still be traumatized later that day  Hockey has protocols for when to put playersback into play or sit them out, but it's up to the team doctor or playerthemselves→ slipperyslope  How do you justify it when fighting is the norm in hockey? ○ SCAT2 pocket guidecreated for refereesand lay people  Little card for people to refer to; there's an app for it too ($2.99)  Includes listof symptoms, questions to test memoryfunction, tasks to test balance  But people can cheat by dogging baselineimpact test (which willbe used to compare with score during concussion) ○ Sex difference for concussion susceptibility?  Femalesget more concussion than males  Because of structural differences(e.g., stabilityin neck?) □ Because less macho and more likelyto report concussions ○ Genetic differences in brain shaking tolerability ○ Concussion can be associated with damageto white matter (associated with shearing of axons) ○ Diffuse axonal injuryis difficult to study with CTI/MRI because axons are typically only1 micrometer in width (1000x smallerthan MRI resolution)  However, diffusiontensor imaging(DTI) may catch this shearing b/c it shows white matter tracts Brain activation immediatelyfollowing injuryis lower than normal, but after several weeks, ○ Brain activation immediatelyfollowing injuryis lower than normal, but after several weeks, it may be higher than normal  Trying harder to concentrate on tasks that used to be easier  Acute injury: 0-20 days from injury □ Decrease in fMRI activation  Recovery/rehabilitation:20-40 days □ Higherthan normal fMRI activation  Some symptoms persists, and seem to overlap with depression • [Video] Reed ○ After mildconcussion at skiing competition, found it hard to concentrate and maintaina train of thought ○ No matter how mild,a concussion is a traumatic brain injury ○ Hard to diagnoseb/c they don't show up on standard MRI scans  White matter requires DTI  Concussion → Disruptions in white matter (likea dropped call) • Despite intense therapy, Ann Schnepf had difficulty painting (can't rememberwhat to do with it, hard to name familiarobjects) ○ When tracking dot, eyedoesn't make circular pattern, even though dot was moving in predictable pattern. Have to constantly restart. • Reed can't do math in that following week→ looks likethey can perform well when they can't. Worst ifyou let them back into the field(having one concussion increasestheir risk of getting another concussion) ○ Full recoveryafter 6 weeks • Eye movements impairment≠ concussion → the glassestool is useful but not 100% accurate • Effects of TBI on attention ○ Poor concentration and lack of "mental energy"  LIKE A REALLY BAD HANGOVER ○ Increased interference by distractors  e.g.,restaurant's background noises becomes overwhelming ○ Slower detection of targets during search ○ Dividedattention capacity impaired ○ Increased Stroop interference ○ Higherfrequency of action slips ○ Reduced activation of executive attention areas ○ Mental "slowing"  = "fewer attentional resources?" • Significantassociation between multipleconcussions and cognitive impairmentlater in life ○ Deteriation earlierin life ○ e.g.,atheletes' brain may resemblea late-stage Alzheimer'spatient • Chronic traumatic encephalopathy (CTE) ○ Brain autopsy shows depletionof white matter • Animal studies: repeated concussions accelerate deposition of beta amyloidplaques ○ Which are associated brain deterioration in Alzheimer'sdisease ○ Lots of plaqueand neurofibrillarytangles ○ Lots of tau distribution • When white matter shears, neurotransmitters start to spill into synapse (which can be toxic) ○ Decrease in abilityto offset them ○ Action potential gets messedup too → brain could be in trauma with neurotransmitter spillinginto synapse ○ Playersmay say "I'm fine" b/c they don't know their brain is in earlystages of trauma → people should be allowedto self diagnose III. Brain Diseases • Pretty much all are related to it • Alzheimer'sDisease ○ Beta amyloidplaques and tanglesin brain  Similarto athletes with pronounced CTE ○ At advanced stages of Alzhimer's,brain is greatlydeteriorated (decreased volumes) ○ Cognitiveskillswe associate with frontal cortex and executive functionare disrupted in earlystages ○ Impairedfrontal cortical function → more action slips • Parkinson's disease ○ Disruption in substantia nigra(brain stem) → drop in dopamine ○ Reduced activation in basal gangliaduring complex planning task among Parkinson patients • Huntington's disease ○ Brain degenerationin caudate nucleus ○ Difficultiesin concentration focus, interference • Schizophrenia ○ More susceptible to interference, difficultyin dividedattention ○ Less frontal activation in vigilancetask • Attention and depression ○ Reduced attention function, concentration, focus, resistence to interference (associated with frontal processing) ○ Restored after you recover from depression IV. Frontal Cortex Dysfunction V. Attention Deficit Disorder (ADD) • Those with ADD tends to be more creative • Symptoms: ○ Lack of inhibition (mayinterrupt b/c they're afraidof forgetting what they're thinking) ○ Unevenattention span (under/overfocusing) ○ Can be transmitted genetically ○ Varies from under-focusing to hyper-focusing ○ Often treated with stimulants  Stimulant medication increaseslevelsof dopamineand norepinephrinein prefrontal cortex  ADD drugs used by pro athletes as performance enhancers ○ Current debate about over-diagnosis  "ADHD Fraud" -- peoplethink ADHDis not a thing!  Tends to be teachers who diagnosechildren with ADD  There isn't a reallygood system for diagnosing ADD (DSM)  Pseudo-ADD (e.g.,sound bites, additives in fast food) • ADD computerized assessment ○ Andy has ADD, mother has to be with him every waking moment • Treating ADD with marijuana ○ May be more effective with fewer side effects ○ Perhaps if dosage based, and enough to keep them concentrating but not to get high • Other tips for coping with ADD ○ Embrace strength based approach that emphasizes the positive ○ (1) Understand ADD (2) fit the world to you ○ (2) fit the world to you  Know what you do well and stick to i
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