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

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

3. General Organization

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

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

6. The Damaged and Undamaged Brain Recurring Themes:Recurring Themes: Neural processing rarely occurs in a simple linear or sequential fashionNeural processing rarely occurs in a simple linear or sequential fashion Instead, it often occurs in continuous “loops”Instead, it often occurs in continuous “loops” Like a water faucet that is always runningLike a water faucet that is always running Architecture is often hierarchicalArchitecture is often hierarchical

7. The Damaged and Undamaged Brain Recurring ThemesRecurring Themes The nervous system thrives on balance and homeostasis of neural processes within these loopsThe nervous system thrives on balance and homeostasis of neural processes within these loops Damage often upsets balance/homeostasis in a processDamage often upsets balance/homeostasis in a process A “normal” process runs unchecked or fails to run at allA “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” termsLike other neurologic symptoms, many neurocognitive symptoms can be thought of in “hyper” and “hypo” terms Ex: muscle tone, reflexes, basal gangliaEx: muscle tone, reflexes, basal ganglia

8. A Closer Look at Organization

9. Left Vs. Right

10. Hemispheric Specialization

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

12. Hemispheric Specialization Left HemisphereLeft Hemisphere SpeechSpeech Reading/writingReading/writing PraxisPraxis Verbal memoryVerbal memory Processing detailProcessing detail Right HemisphereRight Hemisphere ArousalArousal Self-awarenessSelf-awareness Spatially directed attentionSpatially directed attention Emotion/affectEmotion/affect Nonverbal memoryNonverbal memory Visuospatial processingVisuospatial processing Processing “gestalt”Processing “gestalt” Nonlanguage soundNonlanguage sound MusicMusic

13. Hemispheric Specialization Left Hemisphere: “Classic” Clinical PresentationLeft Hemisphere: “Classic” Clinical Presentation Right hemiparesisRight hemiparesis AphasiaAphasia ApraxiaApraxia

14. Hemispheric Specialization Right Hemisphere: “Classic” Clinical PresentationRight Hemisphere: “Classic” Clinical Presentation Left hemiparesisLeft hemiparesis Poor arousalPoor arousal Left neglectLeft neglect Unawareness of deficitsUnawareness of deficits Flat affectFlat affect

15. Anterior vs. Posterior

17. PosteriorPosterior Processing of information about the environmentProcessing of information about the environment Sensory gatingSensory gating Unimodal and multimodal sensory associationsUnimodal and multimodal sensory associations Constructing a unified “representation” of the environment across sensory modalitiesConstructing a unified “representation” of the environment across sensory modalities

18. Anterior vs. Posterior AnteriorAnterior Planning and formulating cognitive and behavioral goalsPlanning and formulating cognitive and behavioral goals Acting on hypothetical representations of the environmentActing on hypothetical representations of the environment Incorporating behavioral relevance, reinforcement value, and emotion into cognition and behaviorIncorporating behavioral relevance, reinforcement value, and emotion into cognition and behavior

19. Cortical vs. Subcortical

20. Subcortical structuresSubcortical structures InitiationInitiation CessationCessation ModulationModulation ControlControl

21. Cortical vs. Subcortical ThalamusThalamus Not just a “sensory relay”Not just a “sensory relay” Cortico-thalamo-cortical loops modulate:Cortico-thalamo-cortical loops modulate: ConsciousnessConsciousness ArousalArousal VigilanceVigilance Foundation for higher attentional processesFoundation for higher attentional processes “Cortical tone”

22. Cortical vs. Subcortical Basal gangliaBasal ganglia InitiationInitiation CessationCessation MaintenanceMaintenance Similar role in motor and cognitive functionSimilar role in motor and cognitive function

23. Cortical vs. Subcortical Cortical-Basal Ganglionic LoopsCortical-Basal Ganglionic Loops Cortex Striatum Pallidum s. nigra Thalamus SMA Putamen Vl-GPiCl-SNr VLoVLm Motor FEF Caudate(body) Cdm-GPiVl-SNr VAmcMDpl Oculomotor

24. Cortical vs. Subcortical Cortex Striatum Pallidum s. nigra Thalamus DLPFC dl-Caudate(head) ldm-GPivl-SNr VApcMDpc DorsolateralPrefrontal LOFC vm-Caudate(head) mdm-GPirm-SNr VAmcMDmc LateralOrbitofrontal AC VS rl-GPi, VP rd-SNr pm-MD AnteriorCingulate

25. Cortical vs. Subcortical Basal Ganglia: Motor SymptomsBasal Ganglia: Motor Symptoms Hyperkinetic disorders (too much movement)Hyperkinetic disorders (too much movement) Slow writhing movementsSlow writhing movements Quick jerking movementsQuick jerking movements Repetitive abrupt movementsRepetitive abrupt movements Hypokinetic disorder (too little movement)Hypokinetic disorder (too little movement) Difficulty initiating motor movementDifficulty initiating motor movement Motor impersistenceMotor impersistence RigidityRigidity Reduced eyeblinkReduced eyeblink

26. Cortical vs. Subcortical Basal Ganglia: Cognitive SymptomsBasal Ganglia: Cognitive Symptoms “hypercognitive”“hypercognitive” PerseverationPerseveration IntrusionIntrusion “Hypocognitive”“Hypocognitive” Poor cognitive initiationPoor cognitive initiation Poor recall (failure to initiate recall processes)Poor recall (failure to initiate recall processes) Loss of cognitive set (cognitive impersistence)Loss of cognitive set (cognitive impersistence) Diminished semantic search effectivenessDiminished semantic search effectiveness

27. Cortical vs. Subcortical Basal Ganglia: Emotionally Guided BehaviorBasal Ganglia: Emotionally Guided Behavior “hyper”“hyper” Obsessive-compulsive behaviorsObsessive-compulsive behaviors Addiction, gamblingAddiction, gambling Mania (in some disorders such as Huntington’s Disease)Mania (in some disorders such as Huntington’s Disease) Affective LabilityAffective Lability “Hypo”“Hypo” AvolitionAvolition Flat affectFlat affect

28. Cortical vs. Subcortical CerebellumCerebellum Cerebrocerebellum CortexPlanEffectors “Reality” Cerebellum Feedback

29. Cortical vs. Subcortical Cerebellar SignsCerebellar Signs MotorMotor AtaxiaAtaxia DysmetriaDysmetria CognitiveCognitive “Cognitive Ataxia”“Cognitive Ataxia” “Dysmetria of Thought”“Dysmetria of Thought” Emotionally Guided BehaviorEmotionally Guided Behavior Affective labilityAffective lability Psychiatric symptomsPsychiatric symptoms

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

31. Putting it Together… Sensorimotor Cognition EmotionallyGuidedBehavior Reality: PurposefulEffortful Automatic

32. Principles in Action: Domains of Cognition

33. Domains of Cognition Motor and Sensory Aspects of CognitionMotor and Sensory Aspects of Cognition LanguageLanguage AttentionAttention Executive FunctionExecutive Function

34. Hierarchical Organization PrimarySensory Multimodal Association Cortex UnimodalAssociation

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

36. Hierarchical Organization Somatosensory visualauditory

37. Hierarchical Processing SMAPremotor PrimaryMotor PrimarySomatosensory UnimodalAssociation Multimodal Association Cortex PrimaryVisual UnimodalAssociation PrimaryAuditory UnimodalAssociation AnteriorPosterior

38. Motor and Sensory Aspects of Cognition SMAPremotor PrimaryMotor Multimodal Association Cortex Hemiparesis

39. Motor and Sensory Aspects of Cognition SMAPremotor PrimaryMotor Multimodal Association Cortex Akinesia, Bimanual dyscoordination

40. Motor and Sensory Aspects of Cognition SMAPremotor PrimaryMotor Multimodal Association Cortex ? Apraxia

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 comprehensionApraxia -- 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, SMALesion: Inferior parietal lobule, corpus callosum, SMA

42. Motor and Sensory Aspects of Cognition SMAPremotor PrimaryMotor Multimodal Association Cortex SMAPremotor PrimaryMotor Cortex CorpusCallosum ? Alien Hand

43. Motor and Sensory Aspects of Cognition PrimaryVisual VisualAssociation Multimodal Association Cortex PrimarySomatosensory SomatosensoryAssociation PrimaryAuditory AuditoryAssociation VisualLossSomatosensoryLossAuditoryLoss

44. Motor and Sensory Aspects of Cognition PrimaryVisual VisualAssociation Multimodal Association Cortex PrimarySomatosensory SomatosensoryAssociation PrimaryAuditory AuditoryAssociation ? ??

45. Motor and Sensory Aspects of Cognition Agnosia -- Impairment of object recognition in the presence of relatively intact basic perception and languageAgnosia -- Impairment of object recognition in the presence of relatively intact basic perception and language Visual Object AgnosiaVisual Object Agnosia Prosopagnosia (agnosia for faces)Prosopagnosia (agnosia for faces) Tactile AgnosiaTactile Agnosia Auditory AgnosiaAuditory Agnosia

46. Motor and Sensory Aspects of Cognition PrimaryVisual VisualAssociation Multimodal Association Cortex PrimarySomatosensory SomatosensoryAssociation PrimaryAuditory AuditoryAssociation ?

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

48. Motor and Sensory Aspects of Cognition

49. Language

51. Broca’sWernicke’s AssociationCortexAssociationCortex Expressive(non-fluent)Receptive(fluent) LanguageAssociation“Pure”Language

52. Broca’sWernicke’s AssociationCortexAssociationCortex Expressive(non-fluent)Receptive(fluent) LanguageAssociation“Pure”Language

53. Wernicke’s AphasiaWernicke’s Aphasia Fluent speech (but doesn’t make sense)Fluent speech (but doesn’t make sense) Impaired comprehensionImpaired comprehension Impaired repetitionImpaired repetition Linguistic analog to a primary sensory deficitLinguistic analog to a primary sensory deficit Can’t decode words or associate meaningCan’t decode words or associate meaning

54. Language Broca’sWernicke’s AssociationCortexAssociationCortex Expressive(non-fluent)Receptive(fluent) LanguageAssociation“Pure”Language

55. Broca’s AphasiaBroca’s Aphasia Non-fluent speechNon-fluent speech Intact comprehensionIntact comprehension Impaired repetitionImpaired repetition Linguistic analog to a primary motor deficitLinguistic analog to a primary motor deficit Can’t produce the components of language outputCan’t produce the components of language output

56. Language Broca’sWernicke’s AssociationCortexAssociationCortex Expressive(non-fluent)Receptive(fluent) LanguageAssociation“Pure”Language

57. Transcortical Sensory AphasiaTranscortical Sensory Aphasia Fluent SpeechFluent Speech Impaired comprehensionImpaired comprehension Intact repetitionIntact repetition Linguistic analog to agnosiaLinguistic analog to agnosia Can decode the word but can’t make associations to meaningCan decode the word but can’t make associations to meaning

58. Language Broca’sWernicke’s AssociationCortexAssociationCortex Expressive(non-fluent)Receptive(fluent) LanguageAssociation“Pure”Language

59. Transcortical Motor AphasiaTranscortical Motor Aphasia Non-fluent speechNon-fluent speech Intact ComprehensionIntact Comprehension Intact RepetitionIntact Repetition Linguistic Analog to an ApraxiaLinguistic Analog to an Apraxia Broca’s area can produce speech, but lacks associations necessary to assemble the componentsBroca’s area can produce speech, but lacks associations necessary to assemble the components

60. Attention “Attention” is a generic term“Attention” is a generic term Refers to a family of processesRefers to a family of processes Attention is fluid and constantly changingAttention is fluid and constantly changing

61. Attention Aspects of AttentionAspects of Attention ArousalArousal General level of responsivityGeneral level of responsivity OrientationOrientation Realignment of sensory organsRealignment of sensory organs Selective AttentionSelective Attention Processing of one stimulus over anotherProcessing of one stimulus over another Divided AttentionDivided Attention Simultaneous processing of stimuliSimultaneous processing of stimuli Attention SpanAttention Span Holding of information with rehearsalHolding of information with rehearsal “Working Memory”“Working Memory” Mental manipulation of information in attention spanMental manipulation of information in attention span

62. Attention Modulation of attention is an “anterior” functionModulation of attention is an “anterior” function It is mediated by cortical basal ganglionic loopsIt is mediated by cortical basal ganglionic loops Some attentional shifts are automaticSome attentional shifts are automatic Some must be initiated and maintainedSome must be initiated and maintained Salience and relevance must be balancedSalience and relevance must be balanced Unwanted shifts must be inhibited (“stimulus pull”)Unwanted shifts must be inhibited (“stimulus pull”)

63. Executive Function Dorsolateral FrontalDorsolateral Frontal Planning/goal formationPlanning/goal formation OrganizingOrganizing SequencingSequencing Set shiftingSet shifting Abstract thinkingAbstract thinking Orbital FrontalOrbital Frontal InhibitionInhibition Behavioral modulationBehavioral modulation Cognitive modulationCognitive modulation Evaluating relevance/rewardEvaluating relevance/reward

64. Executive Function Impaired initiation:Impaired initiation: Failure to generate ideas/courses of actionFailure to generate ideas/courses of action Impaired inhibition:Impaired inhibition: Impulsive cognitive approachImpulsive cognitive approach You think it, you do itYou think it, you do it You think it, you say itYou think it, you say it

65. Executive Function Impaired set-shiftingImpaired set-shifting Perseveration/decreased mental flexibilityPerseveration/decreased mental flexibility Inability to shift to a more appropriate strategy when you get feedback that the current strategy is ineffectiveInability to shift to a more appropriate strategy when you get feedback that the current strategy is ineffective Impaired PlanningImpaired Planning Difficulty sequencing multiple actions to achieve a goalDifficulty sequencing multiple actions to achieve a goal Difficulty seeing more than one “move” ahead in the gameDifficulty seeing more than one “move” ahead in the game Difficulty generating multiple “if-then” alternate courses of actionDifficulty generating multiple “if-then” alternate courses of action Difficulty assessing consequences of various choicesDifficulty assessing consequences of various choices

66. Executive Function Impaired Abstract ReasoningImpaired Abstract Reasoning Literal or “concrete” thinking styleLiteral or “concrete” thinking style More likely to think in terms of objects and actions rather than conceptsMore likely to think in terms of objects and actions rather than concepts

67. Executive Function Executive Function is also…Executive Function is also… “Personality”“Personality” Point of convergence for cognitive, emotional, and motivational aspects of behaviorPoint of convergence for cognitive, emotional, and motivational aspects of behavior