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Subcortical Structures and Cognition: Implications for Neuropsychological Assessment Review
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One of the main concepts presented within this book is that the basal ganglia play a central role in adaptation. They do this by serving as a "gate" of sorts that "decides" when to release predominantly subcortically mediated, automatic behaviors in the context of familiar and over learned situations, in which case releasing such behaviors is efficient and effective. On the other hand, they "decide" not to release such behaviors in favor of opening channels for cortically based, higher level reasoning in the context of circumstances that are novel. It is much more economical to do what is familiar, as cortical resources are at a premium and employing them requires cognitive effort. By the same token, if one employs overlearned responses in the context of a situation that is new, one may move through it with relative ease, but at the expense of accuracy and at the expense of taking advantage of the opportunity for new learning that such circumstances provide.
This framework has applications to multiple aspects of behavior and thinking. It could even be applied to some of the central tenets within the philosophy of science, and particularly Thomas Kuhn's assertion in The Structure of Scientific Revolutions, that scientific communities resist accepting new paradigms to explain phenomena that are thought to be explained adequately with existing paradigms. Existing paradigms might be considered a familiar, procedural way of doing things which, while they are economical, may function in this manner at the expense of allowing for new learning. To accept a new paradigm requires cognitive effort, and unless science can be persuaded that the new ideas are, in essence, worth the effort, there is a default to the familiar, overlearned ways of understanding.
Subcortical Structures and Cognition requires such a paradigm shift - in this case, from a predominantly cortically based way of understanding behavior in which left-right brain dichotomies and the verbal-nonverbal aspects of thinking with which they are associated, to a vertically organized way of understanding behavior in which the role of deep brain structures are highlighted, in the context of their dynamic and reciprocal relationships with cortex. The book will reward those scientists and practitioners willing to expend the cognitive effort necessary to reframe their familiar ways of thinking to accommodate these ideas.
Paradigms shift when they have to do so, on the basis of overwhelming evidence that precludes the old paradigm being considered as sufficient to explain a phenomenon. "Wild science" and assertions founded in the absence of persuasive evidence do not result in paradigm changes, but paradigms must shift when the right conditions are met - when all the evidence points to the correctness of a new way of thinking to replace that which no longer provides the best fit. Perhaps the Kuhn-ian analogy is not a perfect one, because the authors have not replaced the concept of hemispheric specialization, but they have immeasurably enriched aspects of it while they highlight its limitations and provide rich information to fill these gaps. Their ideas are far from "wild science." To the contrary, the ideas within this book are founded upon an enormous body of literature that they extensively and thoughtfully review. It is integrated elegantly within their theoretical assertions, in a manner that allows multiple aspects of thinking and behavior to be understood in ways that have not heretofore been explained in a satisfactory manner in the absence of this knowledge.
Right-left/nonverbal-verbal dichotomies and a corticocentric view made sense in the context of the information available about brains historically, which was predominately based on examining the impact of injuries to adult, fully formed brains. Since the historical limitations in imaging technology have been overcome, however, the information available about brain function has expanded exponentially. Continuing to fit our data into old ways of explaining things is no longer necessary nor is it satisfying. Just as the ability to gate the release of automatic, procedural learning in favor of higher level, cortical reasoning serves human adaptation by allowing people to take advantage of opportunities to learn about and master a broader range of demands, clinicians and practitioners who make the cognitive effort necessary to read and understand the information presented in this volume have the opportunity to gain an adaptive advantage as will the patients they serve.
How much cognitive effort is necessary to make this shift? The first several chapters can be a bit intimidating, in which the authors describe in detail the prototypical frontal-basal ganglia circuits that function interactively to subserve movement, cognition, affect, and motivation, and they explicate dynamic changes in neuroanatomy that govern tasks as they move from higher order control to being mediated more automatically. While the neuropsychologists, psychologists, psychiatrists, developmental pediatricians, and neurologists who stand to gain so much by reading this book have all been schooled in neuroanatomy, many may not have been exposed to the level of neuroanatomical detail that the first few chapters describe. And even for those who have been taught this material, it is not likely to be automated information that can be retrieved without a good deal of cognitive effort. The chapters are exceptionally well written, but the material is dense and those of us who ordinarily feel a sense of mastery within our field of practice might feel a bit unbalanced by how much these first two chapters can illustrate to us that we do not know. It may be tempting to read the chapter summaries and shelve the book as a reference. Don't make this mistake. Instead, read the first chapters to grasp the concepts that the authors are describing - which you will - and move forward. Those who may not have felt smart during the first three chapters will be rewarded by feeling very smart thereafter. For the book is exceptionally well written, theoretical concepts are presented in terms that are easily assimilated, and there are multiple real-world analogies incorporated to explicate ideas as well. As an extra treat, the authors introduce each chapter with passages from references as diverse as Mark Twain, Albert Einstein, Yogi Berra, Aristotle, Jonas Salk, and Oliver Wendell Holmes.
But move forward only if you are prepared that some sacred cows may have to be, if not sacrificed, then moved to a less prominent place in the barn. Among them is the value of composite index test scores that are calculated on the basis of multiple subtest scores each of which, itself, may rely on a variety of subcomponent functions and may represent the integration of a broad spectrum of functions that bear little relationship to one another. Lest we fret at having familiar frameworks for thinking disrupted, rest assured that in the place of the centrality of such scores, the authors provide a framework within which we can glean so much more information about the patients we see within the same data sets that we are accustomed to collect. They provide a means by which we can approach a consideration of quantitative and qualitative performance of the subtest scores contributing to the indices. They highlight the critical importance of understanding the nuanced differences in the demands made by subtests that purport to measure the same construct. They argue for the importance an ipsative consideration of the relationship between the individual scores, which, if they are considered in isolation, may obscure important information. They highlight the importance of recognizing the manner in which statistics may distort information, such as by forcing behaviors that are not normally distributed into a "bell shaped curve." They argue that this may obscure the importance of errors which appear "normal" on the basis of these statistical machinations, but which should more rightly be considered as pathognomonic signs.
Another sacred cow who needs to move aside is a collection of familiar ideas about the functions that specific, familiar tests measure. Rather than taking a test's "name" at face value and conceptualizing its demand according to that name, the authors posit that what defines a neuropsychologist is the ability to analyze the cognitive requirements of different tests and interpret findings based upon a solid grasp of underlying neuroanatomic functions that drive test performance, in consideration of important historical information about a patient and important qualitative observations of his or her behavior. Performance on tests that have long been assumed to measure frontal or temporal cortical processing can be impacted, potentially, by pathology anywhere within the circuitry that connects frontal and temporal regions with the subcortical structures and circuits that subserve them. The authors provide a compelling review of literature to support these views, and present fascinating data from a neuropsychological assessment of a patient with a hypothalamic tumor that was impinging upon basal forebrain circuitry. His neuropsychological tests results, interpreted blind, would lead to a sure conclusion of cortical impairment, but his frontal lobes were, in fact, entirely unimpacted. It is likely that the review of any of the various cases in this book will lead clinicians reading this book to consider, or reconsider, a variety of the conclusions they have reached for patients they have tested in the absence of having this framework with which to consider their findings.
The authors point out that as our knowledge of brain functioning expands, the applicability of neuropsychology and neuropsychological assessment to populations beyond brain injured...Read more›
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Posted in: brain, cognitive science, dorsolateral cortex, hippocampus, memory, mind, neurology, neuropsychology, neuroscience, orbital cortex
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