NEUROBEHAVIOR

DISORDER

Miranti Florencia Iswari,S.Kep,.Ns

Introduction
Brain – Behavior relationship

Specific Localization / longitudinal

specific function has specific localization
(lobe syndrome)

Lateralization
some function are predominantly
mediated by one hemisphere or the other
Specific localization (lobe syndrome)
Lateralization
Parallel Distributed Processing
Integrated neuronal circuits that are widely
distributed in the brain and have the capacity
to change their response bias with learning
Any point in the circuit may interconnect with
other circuits
There can be multiple potential effects
from a single lesion
Similar effects could emerge from lesions
in different parts of the same circuit
Terminology
Organic (??) and Functional (??)
“Organic” illnesses
ex: Epilepsy functional alterations with or
without structural abnormalities
“Functional” illnesses
ex: Psychosis and Depression are products of
neurologic disorders (tumor, stroke)
Idiopathic
Psychiatric disorders whose etiologies and
pathophysiology have yet to be revealed
Neurologic and Toxic-Metabolic
Specifics types of brain disorders have been
identified that account for behavioral changes
Neurobehavior
Non Cognitive
Cognitive Function Function
Attention Neuropsychiatric
Language symptoms
Depression
Memory
Delusion
Visuospatial Hallucination
Executive Function Apathy
Mania
Dysinhibition
Psychomotor
Behavior,etc
Sleep, Eating, sexual
disorder
ATTENTION
 ATTENTION/CONCENTRATION

Attention is the ability to focus on a

particular sensory stimulus to the
exclusion of others.
Concentration is ability to sustain
attention over an extended period.
Alertness is respond to any stimulus in the
environment

•Focus attention
•Sustain attention
•Shifting attention
Attention

Cortical areas

Thalamus - Limbic

ARAS (Brain Stem)

Simplication of Brainstem, Thalamic, and Cortical Circuits
Important for Mintaining Conciousness.
Hemispheric asymmetry in attention
The most common cause of decreased
attention :
Diffuse brain dysfunction
• Metabolic disturbance
• Drug intoxication
• Systemic infection
Extensive bilateral cortical damage
• Atrophy
• Multiple infarcts
• Encephalitis
• Head trauma
Right hemisphere lesions unilateral neglect
Mood alterations
• Anxiety
• depression
Attention (Examination)
Observation
Serial 7 substraction
Digit reversal (20 – 1)
Month in reverse order (Dec - Jan)
Digit span
LANGUAGE
Language
The essential elements of language
are:
Fluency
Comprehension
Repetition
Naming
Reading
Writting
Speech is the motor activity that is
final step in the expression of
language
Language
Process of language
 Process of Language
Site Function Abnormality
1. Ear and auditory Hearing deafness
nerve
2.Wernicke’s area Understanding Fluent aphasia
3.Arcuate fasciculus Repetition Loss of repetition (
Conduction aphasia)
4.Broca’s area Language Non-fluent aphasia
production
5.Motoroutput,central: Articulation of Dysarthria
cerebellum, corticobulbar speech
tracts

6.Motor output peripheral: Articulation of Dysarthria

facial,hypoglossal,, face and speech
tongue
7.Larynx, vagus nerves Voice production Dysphonia
Case 1
A 74 year old right handed woman
was brought to the emergency room
because of sudden inability to speak
and right sided weakness.
Good comprehension at bedside
testing, only a few words and
numbers in production, could not
repeat “wati”, “beruang”, named no
objects, unable to read.
Broca’s Aphasia
Case 2
An 57 year old right handed woman with
a history of hypertension, suddenly
“unable to communicate properly”,
speaking with words and sentences that
did not make any sense.
On exam:
spontaneous speech was fluent but
meaningless
normal prosody
could not repeat even single words
could not naming object
Wernicke’s Aphasia
A 64 years-old woman, suddenly
had difficulties with reading
At the clinic, she was completely
unable to read, but was able to write
normally. She wrote “it is a rainy
day in Jakarta”, but she was unable
to read her own writing a few
minutes later
MEMORY
Memory Structure (Squire & Knowlton,
1994)
Memory is the ability to register, store,
and ultimately retrieve information
Hippocampus
This structure was once thought to
be the most essential structure for
memory
Removal of one doesn’t do much but
removal of both disrupts the ability
to form new memories
No disruption of old memories
HM
HM – severe anterograde amnesia
HM
HM working memory
HM Procedural Memory
Case
Normal Brain AD
Memori
Klinik
Lama rentang waktu antara
stimulus dan recall
Immediate memory (detik)
Recent memory (menit, jam ,hari,
bulan, tahun)
Remote memory (tahun, seumur
hidup)
Memori
Stimulus
detik atensi
Immediate memory
menit, jam, konsolidasi, ulang,
hari, bln, thn simpan

Recent memory
thn, seumur hidup konsolidasi lebih
kuat
Remote memory
Memori
Amnesia
● Ketidak mampuan untuk mempelajari
informasi baru (Recent memory terganggu)
● Atensi / immediate memory, remote memory,
dan fungsi kognitif lain masih baik
● Recall terganggu
● Rekognisi terganggu
● Sindroma klinik :
▪ Sindroma Korsakof (diencephalic amnesia)
▪ Amnesia Pasca Trauma
▪ Transient Global Amnesia
▪ Ensefalitis Herpes Simpleks
▪ Anoksia dan Hipoglikemia
Memori
Retrieval Deficit Syndrome
▪ Recall terganggu
▪ Immediate memory, remote memory
masih baik
▪ Rekognisi baik
▪ Area : Frontal – Subkortikal
 Memori
Perbedaan Amnesia dan
Retrieval Deficit Syndrome
Amnesia RDS
Registrasi intak intak

Recall terganggu terganggu

Rekognisi /
Response Clues terganggu intak

Anatomi Hipokampus- Frontal-

bdn mamilaris- subkortikal
talamus
Memori (Evaluasi)
Immediate memory
● Rentang Digit (Repetisi Digit)
● Rentang Digit backward (Working memory)
Recent memory
● Verbal :Recall 5 objek (mis : pisang, meja,
biru, kucing, kantor) setelah 1 menit
● Visual : Recall 3 gambar geometrik setelah 1
menit
Remote memory
● Autobiografi, kejadian publik (?)
Semantic memory
● Pengetahuan (jml hari dalam 1 bulan, dll)
VISUOSPASIAL
Visuospatial
Sensory integration function from parietal
lobe.
The disorders are usually the result of
damage to the nondominant (right)
hemisphere.
Neglect is manifested by misperception of
or inattention to sensory stimuli on the
contralateral side of the body.
Constructional apraxia, are difficulties to
fill in the numbers on a clock face, copy
geometric figures, or build figures with
bloc
Skill and abilities mediated
asymmetrically by the two hemispheres
Left hemisphere Right hemisphere
Propositional speech Facial discrimination
Language Facial recognition
comprehension Depth perception
Repetition Receptive affective
Naming prosody
Reading Executive affective
Writing prosody
Praxis (skilled Music
movement) Constructional ability
Calculation Mental rotation of
shapes
Visuospasial
Agnosia
Sindroma klinis, dengan gangguan
pengenalan objek,namun dapat
menangkap stimulus sensorik dengan
normal
● Prosopagnosia
` Ketidakmampuan mengenal wajah yang
sudah dikenal
● Agnosia jari, lingkungan, warna,
simultanagnosia
Visual object Agnosia
Hemispatial Neglect
Visuospatial (evaluation)
Clock Drawing Test
● Visuospatial
● Executive Function (planning,
abstracts)
Visuospatial tested and brain damage
Parietal lobe → affect copying
Frontal lobe → affect spontaneous
drawing more than
copying
Sub cortical → draw in a piece meal
segmented fraction
without formulation of
and overall
EXECUTIVE FUNCTION
Fungsi Eksekutif

Frontal (terutama korteks

prefrontal) – subkortikal
Fungsi :
● Inisiasi
● Problem solving
● Planning
● Perseverasi (shifting of idea)
● Abstraksi
Fungsi Eksekutif
Verbal Fluency (menyebutkan
nama binatang dalam 1 menit)
Set Shifting
Oral trail making test (a-1-b-2-c-3-
dst)
Abstraksi (peribahasa)
Similarities
Luria 3 step
Perseverasi
Figure 1. Rey-Osterrieth Figure (complex construction) drawn by a patient with a
frontal lobe syndrome (model left, copy right). The figure was drawn in a
segmented fashion and exaggerates areas with high stimulus value.
Luria 3 step
Perseverasi (shifting of idea)