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INTRODUCTION
« The Brain – is wider than the Sky – For – put them side by side – The one the other will contain – With ease – and You – beside-. » Emily Dickinson (1999)
The answers to archaic questions have ebbed and flowed with the tides of changing thoughts and discoveries. The proverbial giant turtle once served as the pivot on which a flat world balanced, until a leap of faith and logic illuminated the void beneath which the giant turtle rested. Notions such as these have their parallels in the progressive history of neuroscience. Some great thinkers were wont to sharing untested and sensational theories whereby they paradoxically devolved to the brain great faculties of thought but judicious responsibility: it was Flourens who proposed that the brain secretes thought as the liver secretes bile (cited in Kandel, 2000).
It has been a long path of discovery from the early cephalocentric theories of brain function to the current day notions of functional systems, and many metaphors derived from computer science, mechanics, philosophy, and cybernetics have served as heuristics for understanding functional systems.
Alzheimer’s disease, named after Alois Alzheimer who discovered this insidious and progressive degeneration of the brain, by virtue of its neuropathological, cognitive and noncognitive manifestations encompasses the notion of dynamic interacting systems that underlie human thought, emotion, and behaviour. In terms of the neuropathological and cognitive substrates, this disease is imbued with a relative uniformity that expedites classification and diagnosis.
The noncognitive manifestations, however, hint at an intricate network of psychological and biological antecedents and disease processes that may confound the occurrence of these manifestations. The latter conjecture is strengthened by illustration; studies have found that neuropathology alone cannot account for the heterogeneous noncognitive profiles observed in Alzheimer’s disease patients. By implication, it illuminates the need to understand the ontology of the antecedents that may colour the neuropsychological profile of an Alzheimer’s patient.
In this brief chapter, the problem statement, research questions, aims, and hypotheses are described. Thereafter a chapter-by-chapter synopsis is provided.
CHAPTER 1: INTRODUCTION
1.1 Problem statement
1.2 Research questions
1.3 Research aims
1.3.1 Primary aim
1.3.2 Secondary aim
1.4 Basic hypotheses
1.5 Chapter synopsis
CHAPTER 2: THE NEUROBIOLOGY OF ALZHEIMER’S DISEASE
2.1 Dementia
2.1.1. Localisation of atrophy
2.1.2 States of decline
2.1.3 Treatment efficacy
2.2 The ageing brain
2.2.1 Consequences of disease or age? Neurons and thresholds
2.2.1.1 Cognition and ageing effects
2.2.1.2 Thresholds of structural degradation
2.2.2 Consequence of disease or age? Processing capacity
2.2.2.1 Basic principles of dynamic systems
University of Pretoria etd – Cassimjee, N (2003)
2.2.2.2 Brain processes as dynamic systems
2.2.2.3 Brain complexity: Derivative of structure and function
2.2.2.4 Quantitative indices of chaotic outcomes
2.2.3 Summary
2.3 Alzheimer’s disease
2.3.1 Subtypes of Alzheimer’s disea
2.3.1.1 The subtype hypothesis revisited
2.3.1.2 A common definition for Alzheimer’s disease
2.3.2 Theories of aetiology
2.3.2.1 Rogue genes
2.3.2.2 Miscellaneous putative risk factors
2.3.3 Biological markers
2.3.3.1 Neuropathological features
2.3.3.2 Neurochemical features
2.4 Alzheimer’s disease in perspective
CHAPTER 3.1: THE NEUROPSYCHOLOGY OF ALZHEIMER’S DISEASE:
COGNITIVE SUBSTRATES
3.1.1 Cognitive morbidity: A necessary or sufficient disease index
3.1.1.1 Emotion and intellect: Estranged bedfellows
3.1.1.2 Psychological states and parallel neural representations
3.1.1.3 A symphony of emotion and intellect: Frontal orchestration
3.1.2 Neuropsychological signs and symptoms
University of Pretoria etd – Cassimjee, N (2003
3.1.2.1 Cognitive and noncognitive morbidity
3.1.2.2 Noncognitive conceptual caveats
3.1.2.3 Noncognitive methodological caveats
3.1.3 Memory: System or process
3.1.3.1 Hippocampus
3.1.3.2 Integrated neural systems
3.1.4 Executive functions
3.1.5 Conclusion
CHAPTER 3.2: THE NEUROPSYCHOLOGY OF ALZHEIMER’S DISEASE:
NEUROPSYCHIATRIC & NEUROBEHAVIOURAL PERSPECTIVE
3.2.1 Disorders of thought and perception
3.2.1.1 Delusions
3.2.1.1.1 Prevalence of delusions
3.2.1.1.2 Co-occurrence with patient characteristics
3.2.1.1.3 Symptom comorbidity
3.2.1.1.4 Underlying substrates
3.2.1.2 Hallucinations
3.2.1.2.1 Prevalence of hallucinations
3.2.1.2.2 Co-occurrence with patient characteristics
3.2.1.2.3 Symptom comorbidity
3.2.1.2.4 Underlying substrates
3.2.1.3 Misidentification
3.2.1.3.1 Prevalence of misidentification
3.2.1.3.2 Symptom comorbidity
3.2.1.3.3 Underlying substrates
3.2.2 Disorders of mood
3.2.2.1 Depression
3.2.2.1.1 Prevalence of depression
3.2.2.1.2 Co-occurrence with patient characteristics
3.2.2.1.3 Symptom comorbidity
3.2.2.1.4 Underlying substrates
3.2.2.2 Anxiety
3.2.2.2.1 Prevalence of anxiety
3.2.2.2.2 Underlying substrat
3.2.2.3 Emotional dysregulation/affective lability
3.2.3 Summary of neuropsychiatric disturbances
3.2.4 Disorders of behaviour
CHAPTER 4: THEORETICAL FOUNDATIONS OF TEMPERAMENT
4.1 Analogues of temperament
4.2 Composition of temperament
4.3 Biological bases of temperament
4.4 Symptom profiles and premorbid temperament: A case for neurological
patient groups
4.5 Conclusion
CHAPTER 5: EMPIRICAL INVESTIGATION
CHAPTER 6: RESULTS
CHAPTER 7: DISCUSSION
REFERENCE LIST
