BIOLOGICAL BASIS OF BEHAVIOR
Psychology 321
Spring, 2005 HGH 225
Dr. John M. Morgan MWF, 8am to 9:00
Neurosurgeon/ Patient
By Kristy Gauthier
Brain injury is an unexpected and complex disability. The
brain can be damaged in many ways: as a result of an accident, a
stroke, alcohol or drug abuse, tumors, poisoning, infection and
disease, hemorrhage, near drowning, AIDS, and a number of other
things such as Parkinson’s disease, Multiple Sclerosis, and
Alzheimer’s disease. The human brain is one of the most vital
and complex organs in the human body. It is where we store our
thoughts, feelings and all of our learned behavior.
The parietal lobe is the lobe of the cerebral cortex that
is at the top of the brain, which processes information in
reference to touch, taste, pressure, pain, and heat and cold.
The parietal lobes can be divided into two functional regions.
One involves sensation and perception and the other is concerned
with integrating sensory input, primarily with the visual
system. The first function integrates sensory information to
form a single precept (cognition). The second function
constructs a spatial coordinate system to represent the world
around us.
Individuals with damage to the parietal lobes often show
striking deficits, such as abnormalities in body image and
spatial relations (Kandel, Schwartz & Jessel, 1991).Damage to
the left parietal lobe can result in what is known as
"Gerstmann's Syndrome." This syndrome’s effects include right-
left confusion, difficulty with writing (agraphia) and
difficulty with mathematics (acalculia). It can also yield
disorders of language (aphasia) and the inability to perceive
objects normally (agnosia). Damage to the right parietal lobe
can result in neglecting part of the body or space
(contralateral neglect), which can impair many self-care skills
such as dressing and washing. Right side damage can also cause
difficulty in making things (constructional apraxia), denial of
deficits (anosagnosia) and drawing ability. (Kimura,D.1977) Bi-
lateral damage (large lesions to both sides) can cause "Balint's
Syndrome," a visual attention and motor syndrome. This is
characterized by the inability to voluntarily control the gaze
(ocular apraxia), inability to integrate components of a visual
scene (simultanagnosia), and the inability to accurately reach
for an object with visual guidance (optic ataxia). Special
deficits (primarily to memory and personality) can occur if
there is damage to the area between the parietal and temporal
lobes. Left parietal-temporal lesions can effect verbal memory
and the ability to recall strings of digits (Warrington &
Weiskrantz, 1977reland et al., 1994).
The job of the neurosurgeon is to operate on the lesions in
order to somewhat repair some of the damage that is caused by
lesions and brain tumors. If the surgery is successful, some of
the behavior of the individual is restored or repaired. If the
surgery is not successful, the individual will have problems
with the function of his/her behavior for the rest of their
life. So the surgeon must be well aware of the operation they
are performing and have spoken in detail with the patient about
all the possible side effects. You can expect the neurosurgeon
to review the risks and benefits of the surgery. From the
patient’s point of view, the idea of brain surgery can be
frightening. Our personalities, intelligence, instincts,
capabilities, memories, and notions of "who we are" are located
in the area about to be assaulted. How will it affect me? Based
on expertise and experience doctors can only predict what you
can realistically expect. Each patient and their situation is
individual, and therefore the results will be
individual.(Rueffer,K. 2003)
Often times, lesions can be corrected by certain types of
surgery which will help change the behavior to a livable
position for the patient. Preparing for surgery can be a tough
factor to deal with, which has many steps involved for the
patient. If the patient is not already in the hospital for
medical treatment before the day of surgery, they will be given
instructions on the location and time of the surgery (usually at
least one day prior to surgery). When you are admitted into the
hospital, the patient will be under the care of their
neurosurgeon, residents, and nurses. All of these professions
are highly trained health care professionals, who will provide
the patient with the best possible care. In preparation for
surgery, the patient will undergo a few routine tests that
include blood tests, an electrocardiogram, and an X-ray.
Additionally, the patient’s neurosurgeon will need the
information provided by CT and/or MRI scans of the patient’s
brain and an angiogram of their brain's blood supply. These
tests may have been done prior to the patient’s hospital
arrival. The doctor will talk with the patient before the day of
their surgery. He or she will explain the operation in detail
and review the benefits and risks of the surgery. An
anesthesiologist who will be working with the neurosurgeon
during the operation will also visit the patient before their
surgery in order to ask questions about medical history,
medication the patient may be taking, allergies acquired, and
any previous operations they may have undergone. Hospitals like
the patient to be well informed about their surgery, so there
are many meetings when necessary with all health professionals.
There are many questions that came up for patients who are
undergoing an operation. The most common question asked by
patients scheduled for brain surgery is, “What will I be like
after my surgery?” Skill, knowledge and experience of the
neurosurgeon will minimize the risks of surgery, it always
involves some risk. Each patient's surgery is unique and no
single answer can be provided. There are many side effects
associated with brain surgery including increased weakness,
visual problems, severe headaches, fever, vomiting, seizures,
and swelling or drainage of fluid to name a few. After the
patient is taken to the operating room, the anesthesiologist
will give the patient anesthetic drugs in the form of an
intravenous (IV) catheter. An anesthesiologist will also attach
monitoring equipment to the patient. This will enable the
surgical team to closely watch the patient’s progress throughout
the operation. A general anesthetic, that will keep the patient
from awakening during the operation, is primarily given before
brain surgery. In some cases, the neurosurgeon may choose to
perform the surgery under local anesthesia and keep the patient
awake. The operation is frequently performed with the patient
lying on his or her back. Depending on the surgery and surgeon,
the patient may be asked to be on their stomach or sitting up
during surgery. The hair over the incision area, where the
surgery is performed, is cut away and shaved. The scalp is then
cleansed to a great extent. This operation is known as a
craniotomy, which means skull (crani-) cutting (-otomy). First,
the surgeon makes an incision in the scalp skin. Then a surgical
saw is used to make an opening in the skull and the piece of
skull bone is removed and kept sterile (it is replaced at the
end of the operation). The doctor then makes an incision into
the membrane covering the brain and exposes the area of the
brain upon which the surgeon will operate. When the surgery is
complete, the membrane, skull, and scalp are replaced and
stitched closed. Patients are then usually transferred directly
into the neurosurgical intensive care unit to begin their
recovery.
When the patient awakens after surgery, the head will be
wrapped in bandages which often lead to a panicked feeling for
the patient. The bandages will be checked and changed
periodically. The doctors may also insert one or more tubes
coming from the head incision, which drain blood and other
fluids from the incision area and help it to heal quicker. Other
pieces of equipment that may be attached to the patient, by the
medical staff, are multiple IVs, a urinary catheter, and
stockings to promote blood circulation while the patient is
resting. All of this equipment is necessary for a fast and
uncomplicated recovery and is slowly removed as it is no longer
of use. When the patient’s condition stabilizes, they will be
transferred to a neurosurgical nursing unit where they will do
the rest of their recovery. After the patient leaves the
hospital, there will be many other visits for follow ups to make
sure the progress is going well.
Neurologist & the Patient
By Julia Rose
Jan is a 55 year old female that is employed as an
architect with a reputable firm. She uses both computer programs
and her own skill to draw plans for structures such as bridges
or buildings. One afternoon as Jan began work on a draft of a
museum she noticed something strange. For some reason her
drawings were not coming out as her originals had. Her windows
were not symmetrical; her walls did not meet at the right angle,
etc. This puzzled her because she wasn’t doing anything any
different than she would on any other day. She began doing the
measurements for the materials and found she had difficulty with
simple arithmetic. Now she was really concerned, what could
possibly be wrong? A co-worker passed by and asked her to hand
him a pencil, but when she reached for the utensil on her desk
her hand closed before it was anywhere near it. That was the
final straw. Jan went immediately to her boss’s office and asked
to leave early in order to see her doctor.
Jan’s symptoms concern her doctor very much. He sends her
to a neurologist for testing, though he tells her his suspicion
that she might have suffered damage to her nervous system,
judging from her symptoms, the left side of her brain. By the
time Jan reaches my office, she is beside herself. As a doctor,
it is my job to calm her and alleviate some of her stress. As a
neurologist, it is my job to perform diagnostic tests such as a
CAT scan, an MRI/MRA, or an EEG, as well as perform a
neurological examination to ascertain the source of Jan’s
difficulties.
The neurological examination is a doctor patient
interaction in which the doctor tests mental status, cranial
nerves, the motor system, the sensory system, deep tendon
reflexes, coordination, and gait. The examination can be key in
diagnosing and treating problems like Jan’s. “Sophisticated
imaging and laboratory tests do not always provide sufficient
information about how the nerves are functioning or not
functioning, as the case may be. The neurological examination is
a series of simple questions and tests that provide crucial
information about the nervous system” (neurological exam).
My first task is to test Jan’s mental status. These are
questions that help me determine her cognitive ability,
including her state of consciousness and her intellectual
resources (neurological exam). Some questions I might ask Jan
include simple math problems, repeating movements I demonstrate,
or remembering sequences of words or objects. While I ask these
questions, I listen to Jan’s speech. If her auditory functioning
was affected, I would be able to tell by the way she spoke. She
appears to have difficulty with speech, which suggests aphasia.
“Aphasia is a defect or loss of language function in which
comprehension or expression of words (or nonverbal equivalent of
words) is impaired as a result of injury to or degeneration of
the language centers in the cerebral cortex” (Aphasia).She
understands the commands I give, such as to lift one arm
followed by the other and make a fist. This means that her
comprehension is not an issue, and she possibly has expressive
aphasia, the forming of words is difficult for her. Her problem
lies in the execution of the movement, which indicates a motor
cortex problem. She can not complete even basic subtraction
problems, which suggests acalculia or dyscalculia, so damage to
her parietal lobe is a possibility.
Next I test Jan’s cranial nerves; “The cranial nerve exam
involves testing the function of all 12 sets of cranial nerves”
(neurological exam). This means testing all of Jan’s 5 senses as
well as things such as eyelid movement and gag reflex. This does
not give me much information, except to further rule out other
possible causes for Jan’s symptoms. I then test her motor system
by having her undress and examining her body’s muscle tone. I
can then test her strength in various muscles and evaluate
babinski response. “The neurologist strokes or scratches, heel
to toe, the outer side of the sole of the foot and in patients
over the age of 2, the toes normally curl downward in response.
If the toes fan upward, a brain or spinal cord injury is
indicated” (neurological exam). Jan’s babinski response
indicates brain damage, which concerns me, but I move on to
testing her sensory system.
To test Jan’s perception of different types of sensation,
including pain and temperature, I use a variety of objects. I
use pin pricks to see if her response to them is appropriate. I
also place hot and cold objects against Jan’s skin in a variety
of spots to test her reactions. Jan does not appear to have
sensation on her left side; she does not notice though that she
is not using that side of her body. This is another clue to her
condition. I repeat the tests to ensure accuracy, and then I
move on to testing Jan’s reflexes. These are involuntary
reactions to stimuli, in this case, the reactions of the tendons
to stimuli such as a rubber hammer. At this point Jan’s muscles
should contract in response to being hit, and any other response
would indicate a problem with the area that I am testing. When I
hit Jan’s left knee I get no response. This reinforces the
result of earlier tests such as the babinski response.
To conclude the examination, I test Jan’s coordination and
ask to walk and run at a variety of paces to examine her gait.
To test her coordination I ask her to touch her finger to her
nose and then my finger repeatedly. She does this but frequently
in the wrong order, sometimes with the wrong finger, and
sometimes with the wrong movement altogether. This reflects her
story of reaching for the pencil at work, and is a significant
problem.
From my examination of Jan I have ascertained that all of
the symptoms she mentioned are readily apparent, and she seems
to have a loss of sensation to her left side as well. This
causes me to suspect she has suffered a stroke and has brain
damage. To find out how much brain damage and which areas are
affected I perform a CAT scan on Jan. Computerized axial
tomography (CAT scan) is an x ray of the head that basically
provides a picture of the landscape of the brain. To perform
this test I inject dye into Jan’s bloodstream and have her lie
down with only her head placed in a tubular machine. The machine
then sends x rays through her head and takes pictures on the
other side. “The CT scanner is rotated slowly until a
measurement has been taken at each angle of 180 degrees” (Kalat
74). All of these views give me a complete picture of Jan’s
brain. By analyzing the data I have collected from my
neurological examination and diagnostic/ imaging tests of Jan’s
brain I conclude that Jan has indeed suffered a stroke and has a
lesion on her parietal lobe. The lesion has impaired her
cognitive and motor skills, and some form of rehabilitation will
be necessary for her to maintain her quality of life.
Jan has a rare illness called Gerstmann syndrome, caused by
lesion(s) to the left hemisphere, the left parietal lobe in
particular. Gerstmann syndrome is actually a combination of
several other problems: finger agnosia, right-left confusion,
acalculia, and agraphia. In a 2002 study by E.M. Wingard, et. al
which looked at Gerstmann syndrome in Alzheimer’s patients, the
correlation between symptoms of the syndrome was measured.
Results of the study suggest the relationship between symptoms
to be the result of anatomical proximity and not a common
neuronal network affected by the lesion(s).
Her inability to imitate movements indicates limb apraxia,
also caused by a lesion to the left side of her brain (The
Apraxias). “Using information received from the right parietal
association cortex about the spatial location of the object,
neural circuits in the left parietal association cortex assess
the relative location of the person’s hand and the object and
send information about the starting and ending coordinates to
the left premotor cortex” (The Apraxias). It is in the sending
of information that there is a breakdown which causes the
disorder. The Apraxia also seems to be responsible for Jan being
unaware of elements of her left side.
Since Jan seems to suffer from Gerstmann syndrome, which is
caused by a lesion to the left parietal lobe, and apraxia, which
is related to damage to the right parietal lobe, the lesion
seems to have caused bi lateral damage. This is the information
I present to Jan when I receive the results of her CAT scan. She
is quick to ask what treatment is available for these problems,
and I inform her that there is no cure for her impairments, but
with therapy her symptoms will most likely diminish over time
(Gerstmann syndrome). I then refer her to a physical therapist
and send my results and recommendations to her regular doctor,
wishing her success in the future.
Upon hearing she has suffered damage to her parietal lobe,
Jan has to make some adjustments to her routine and changes in
her work. For the present she can no longer drive and she must
see a speech therapist for her expressive aphasia. Fortunately,
she is still alert and aware, and she feels she is still able to
perform her duties at work after a short leave of absence. She
informs her employer of her situation, and also my
recommendations. She wants to continue her employment with the
firm even though she is nearing retirement, because she still
feels she can contribute to the workplace.
At this point her employer must make accommodations for Jan
in order for her to be successful in her job. Her employer is
very understanding, and does not wish to lose such a loyal and
talented part of the team. Jan’s difficulty with mathematics is
dealt with by using a calculator, and to compensate for her
inability to draw at the same competency as she had previously
done, she supplements increased use of the computer. She works
shorter days so as not to become overwhelmed, and goes to
physical therapy five days a week. In this way Jan is able to
maintain her former activeness and vitality, which is a key
component in her sense of self.
Jan’s story is just one example of the many people who
suffer damage of one sort or another to their parietal lobes.
Since these areas of the brain are obviously important in many
ways, this can be devastating for those who suffer and everyone
around them. Health professionals, support systems in the form
of family and friends, protection from termination by disability
laws, and the patient’s own optimism are the ingredients that
create a successful recovery. How these various aspects combine
can change an outcome just as surely as the severity of the
damage to the brain.
Neuropsychology & Spouse/Family Members
By Kelsey Maffei
I intend to explore the effects of a parietal brain injury
from the perspective of a neuropsychologist; ranging from types
of tests that are employed when trying to determine the extent
of the damage, to gaining an understanding of how this damage
will affect the rest of the brain and/or the body. I will also
explore the effects of a brain injury from the perspective of
the family members, and their experiences with the changes that
occur during the rehabilitation process.
According to The Neuropsychology Center,
“neuropsychological assessment is a systematic clinical
diagnostic procedure used to determine the extent of any
possible behavioral deficits following diagnosed or suspected
brain injury”(www.neuropsych.com). As mentioned previously, a
brain injury can be the result of many types of injuries or
disorders, thus a broad range of assessment procedures have been
developed to encompass these possibilities. Two types of
assessment procedures that are currently being used are the
Luria-Nebraska Neuropsychological Battery (LNNB), and the
Halstead Russell Neuropsychological Evaluation System (HRNES-R).
The LNNB is used to diagnose cognitive deficits, while the
HRNES-R indicates both the presence and degree of impairment.
Both procedures involve tasks that require the patient to
complete a series of functions that test abilities and/or
perceptions. Such tasks would include, but are not limited to,
problem solving, memory, sensorimotor functioning, and
psychological/emotional status.
Other testing procedures that are commonly employed, in
order to gain a better visual image of the excitatory activity
in the brain are the PET scan and the MRI. According to Kalat
(2004), these methods are non-invasive, meaning that they don’t
require the insertion of objects into the brain, yet they yield
results that allow researchers to record brain activity. The
PET scan (positron emission tomography) involves the researcher
injecting a radioactive chemical into the patient’s body, which
is then absorbed mainly by the brain’s most active cells. With
the use of radioactive detectors, placed around the patient’s
head, a map is produced that shows which areas of the brain are
most active. The MRI, on the other hand is less expensive and
much safer (as it doesn’t expose the patient to potentially
harmful radioactive chemicals). The MRI or magnetic resonance
imaging device, as an safer alternative, applies a powerful
magnetic field around the head of the patient. With the
patient’s head in the MRI machine, the magnetic field slowly
circles around their head. As it does this, the device detects
changes in the blood’s hemoglobin molecules as they release
oxygen. When the magnetic (radio frequency) field is turned
off, the atomic nuclei release electromagnetic energy as they
relax and return to their original state. This energy is
measured and recorded in order to create an image of the brain.
To illuminate these assessment procedures in a way that
promotes a more comprehensive understanding, I will attempt to
elucidate the effects of a lesion to the parietal lobe. My main
focus will be on the spatial attentiveness of the parietal
cortex and how deficits in these abilities can affect other
areas/functions within the body. “Anatomical and physiological
data indicate that the parietal cortex is formed by several
regions, and that a combination of visual, attentional, memory,
and planning neuronal signals can be recorded in those regions”
(Parasuraman, 1998).
Due to the ability of the superior parietal cortex to
process a specific stimulus, in relation to the sensorimotor
cortex, it’s important to note that the inputs of many stimuli
are required in spatial tasks. This variety of inputs would
include depth perception, visual acuity, peripheral vision,
along with touch and auditory inputs. Although the parietal
cortex doesn’t specifically control or mediate the touch or
auditory inputs, they are still considered a factor in
influencing the reactions and/or perceptions that a person has
in conjunction with the visual inputs. One such spatial task
would include the location of a particular object on a table or
in a room. Specification of the object by color, shape, and
size would determine whether or not the patient was able to
differentiate between other objects in the room. If the patient
were unable to either find the object in relation to other
objects, for instance, it would suggest that the patient had
some level of deficit in that region.
Part of this deficit in object location can better be
understood by the explanation of how this part of the brain
corresponds with the visual system. “The occipitoparietal
pathway, or dorsal stream, which extends to posterior parietal
regions, is critical for the analysis of spatial relations among
objects and for guidance of eye and hand movements toward
objects (Parasuraman, 1998). In other words, if the were to be
a lesion anywhere along this dorsal stream, the parietal
functioning would be undermined. Another area of the brain may
try to compensate for the damaged area, but it would not likely
produce the same behavior that was typical prior to the lesion.
This compensation often occurs after the axons of a neuron are
damaged, thus not allowing the previous connections to be made.
Via sprouting, a neighboring axon will send dendrites to the
synaptic area that was once occupied by another dendritic spine.
In an attempt to ensure that all possible connections have an
input that is filled, the new connection may not have the same
resulting behavior as before. This suggests that guidance of
the hand toward an object can be altered or hampered if the
connections that were previously used in that process are
damaged. Even if the connections are reestablished through
sprouting, it also suggests that they may not be accurate for
the intents and purposes that they were accustomed to performing
before the lesion/damage occurred.
Due to the difficulties for the patient, which would come
as a result of such a parietal lesion, it’s easy to see that
these difficulties would be shared by those around the
individual. Just as the effects of a brain injury can be
numerous and diverse on the patient’s behaviors that result, so
too can be the effects of these changes on the family or spouse
of that individual. Throughout the course of rehabilitation,
which for most is a never ending process, these changes can be
very difficult to live with. The most obvious reasoning being
that it’s difficult to see a loved one change in such a dramatic
way. It makes it worse at times, like with Jan when she didn’t
realize the effects that the stroke had on the movement of the
left side of her body, when the patient doesn’t recognize the
extent to which the behaviors have been altered.
One case that was mentioned by Parasuraman (pg 269-275)
involved a patient by the name of RM. Due to two strokes that
he suffered at seven months apart, “RM was left with a
neuropsychological syndrome known as Balint’s syndrome
(sometimes called simultanagosia). This is a very rare disorder
in which nearly symmetrical lesions occur in both sides of the
occipitoparietal regions. RM had severe deficits in spatial
representations, and was unable to see more than one object in
his environment at a given time. RM would get frustrated with
the tests that researchers were performing on/with him, and at
times wouldn’t realize that he had the deficits that were
presenting. If this were a person’s son, for example, the
difficulty coming to terms with such a situation would be
immensely tiresome and frustrating.
Coming to terms with the devastation of an accident, and
how the lives of both the patient and the family would be
changed forever, is just what is portrayed in the biography that
was written and documented by Ruthann Johansen. Her son, Erik,
suffered a brain injury, as a result of a terrible car accident.
In her biography, which chronicles the time leading up to the
accident, throughout the time he was in the hospital, and
throughout rehab, excerpts from personal journals that she and
her daughter Sonia wrote help to illuminate the struggle that a
family goes through when trying to piece together life after a
brain injury. In one of the diary entries, written by Sonia who
was twelve years old at the time of the accident, stated that,
“Tonight Mom and Dad said the doctor put a bolt in Erik’s head.
Gruesome. Where? Did they drill a hole?...Can Erik feel this?
I just wish he’d wake up. Will he remember any of this when he
wakes up?” (Johansen pg 33). This entry hints at the struggle
to gain some sort of understanding for what has happened. The
separation caused by such an accident, makes this family feel
lost and helpless in the situation. Being a religious family,
the story goes on to describe the way that they rely on their
faith and the strength of their community support to see Erik
through this rough time in his life. The story talks about how
Erik can’t understand what’s happened and why they are in the
situation they are in. As the family pulls together and
provides strength and the will to carry on, Erik slowly gets
better and life moves on yet again. The example of Erik and the
struggles that he and his family have endured may be a bit more
severe than many people have to endure, yet it goes to show that
life does go on.
Bibliography
Aphasia. In The Merck Manual of Diagnosis and Therapy. Retrieved
April 20, 2005 from
http://www.merck.com/mrkshared/mmanual/section14/chapter169/169b
.jsp.
Apraxia. In The Merck Manual of Diagnosis and Therapy. Retrieved
April 20, 2005 from
http://www.merck.com/mrkshared/mmanual/section14/chapter169/169b
.jsp.
Filley, C.M. (2001) Neurobehavioral Anatomy. University Press of
Colorado, Boulder, CO. pg 97-100.
Johansen, R.K. (2002) Listening in the silence, seeing in the
dark. University of California Press, Berkeley and Los Angeles,
CA, pg 1-145.
Kalat, J. (2004) Biological Psychology, 8th edition.
Wadsworth/Thomson Learning, Belmont, CA. pg 76-77 & 112.
Kandel, J., Schwartz, J., & Jessell, T. Principles of Neural
Science. 3rd edition. Elsevier. New York: NY, 1991.
Kimura, D. (1977) Acquisition of motor skill after left
hemisphere damage. Brain, 100:527-542.
NINDS Gerstmann’s Syndrome Information Page. (2005). National
Institute of Neurological Disorders and Syndromes. Retrieved
April 20, 2005 from
http://www.ninds.nih.gov/disorders/gerstmanns/gerstmanns_pr.htm.
Parasuraman, R. (1998) The Attentive Brain. The MIT Press,
Cambridge, MA, pg 57-274.
Schapiro, J. (2004) The University of Chicago Department of
Surgery
Springer, S., & Deutsch, G. (1998). Left Brain Right Brain:
Perspectives from Cognitive Neuroscience. W.H. Freeman and
Company, NY, pg 188-198.
Warrington, E., & Weiskrantz, L. An analysis of short-term and
long-term memory defects in man. In J.A. Deutsch, ed. The
Physiological Basis of Memory. New York: Academic Press, 1973.
Westmoreland et al. Medical Neurosciences: An Approach to
Anatomy, Pathology, and Physiology by Systems and Levels.
Little, Brown and Company. New York: NY, 1994. You’re Brain
Surgery
Wingard, E.M., Barrett, A.M., Crucian, G.P., Doty, L., &
Heilman, K.M. (2002). The Gerstmann syndrome in Alzheimer’s
disease. J Neurol Neurosurg Psychiatry, 72, 403-405.
What is a Neurological Exam? (1998). Retrieved April 21, 2005
http://www.neurologychannel.com/common/PrintPage.php.
What is Neuropsychological Assessment?
http://www.neuropsych.com/
Go back to the beginning
Copyright © 2005, Dr. John M. Morgan, All rights
reserved -
This page last edited 1-3, 2005
If you have any feedback for the author, E-mail me
