Methodological issues and controversies in research on cognitive disorders

Damasceno, Benito Pereira

doi:10.1590/S1980-57642010DN40400004

Abstract

Research on cognitive disorders is challenging due to the complexity of functions studied and to the numerous variables involved. First, the concept of cognition as a mediated (semiotic) and systemic activity is reviewed. According to this concept, the result of a local lesion is not an isolated symptom but a syndrome, and the best neuropsychological approach is an analysis based on appropriate tests to disclose double dissociations and thereby provide clues to brain-behavior relationships. This approach takes into account the influence of task-relevant variables (confounders) related to the patient (e.g., age, education), to the lesion (size, etiology), and to the tests and testing conditions (ecological validity, examiner's experience), which need to be controlled and analyzed in multivariate statistical analyses, as illustrated in research on medial temporal lobe epilepsy. Other controversial issues such as single and double dissociations, single-case versus group studies, and the lesion method are also examined.

Key words:
cognition; neuropsychological tests; double dissociation; lesion localization; cognitive disorder research; epilepsy

Resumo

O estudo das desordens cognitivas é tarefa dificil devido à complexidade das funções estudadas e às numerosas variáveis implicadas. Neste artigo, nós primeiro revisitamos o conceito de cognição como atividade sistêmica e mediada (semiótica), de acordo com o qual a consequência de uma lesão focal não é um sintoma isolado mas uma syndrome, e a melhor abordagem neuropsicológica é uma análise baseada em testes apropriados para detectar dissociações duplas e, assim, fornecer pistas para relações cerebro-comportamentais. Esta abordagem leva em conta a influência de variáveis que podem influenciar o desempenho nos testes, as quais podem estar relacionadas ao paciente (idade, educação, etc.), à lesão (tamanho, etiologia), aos testes ou condições da testagem (validação ecológica, experiência do examinador), as quais precisam ser controladas e incluídas em análises estatísticas multivariadas, tal como fazemos em estudos de epilepsia de lobo temporal medial. Outras questões controversas, tais como dissociações simples e duplas, estudos de casos isolados versus estudos de grupos, bem como o método lesional são também examinados.

Palavras-chave:
cognição; testes neuropsicológicos; dissociação dupla; localização de lesão; pesquisa em transtornos cognitivos; epilepsia

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References

Vygotsky LS. Psychology and the theory of localization of psychic functions. In: Vygotsky LS, editor. Sobranie sochinenij. Tom 1. Voprosy teorii i istorii psikhologii. Moscow: Pedagogika; 1934/1982; 168-174. (in Russian)
Luria AR. Higher cortical functions in man. 2nd edition. New York, NY: Basic Books; 1966/1980.
Damasceno BP. Research on cognition disorder: methodological issues. In: J.P. Tsai (editor), Leading-edge cognitive disorders research. New York: Nova Science Publishers, Inc.; 2008:131-154.
Vygotsky LS. Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard University Press; 1978.
Leontiev AN. Problems of the development of the mind. Moscow: Progress Publishers; 1981.
Leontiev AN. The problem of activity in psychology. In: Wertsch JV, editor. The concept of activity in soviet psychology. New York, NY: M. E. Sharpe; 1981:38-71.
Tomasello M, Kruger AC, Ratner HH. Cultural learning. Behav Brain Sci 1993;16:495-552.
Galperin PY. An introduction to psychology. Moscow: Moscow University Press; 1976 (in Russian).
Wertsch JV. Mind as action. New York, NY: Oxford University Press; 1998.
Igliori GC, Damasceno BP. Theory of mind and the frontal lobes. Arq Neuropsiquiatr 2006;64:202-206.
Damasceno BP. Mente, cérebro e atividade: abordagem neuropsicológica. Rev Bras Neurol 2004;40:5-13.
Anokhin PK. Problems of center and periphery in the physiology of nervous activity. Gorki: Gozizdat; 1935 (in Russian).
Mesulam M-M. Large-scale neurocognitive networks and distributed processing for attention, language, and memory. Ann Neurol 1990;28:597-613.
Rummelhart DE, McClelland JL. Parallel distributed processing: explorations in the microstructure of cognition. Cambridge, MA: MIT Press; 1986.
Dennet DC. Consciousness explained. Boston: Little, Brown & Co.; 1991.
Jackson JH. On the nature of the duality of the brain. In: selected writings of John Hughlings Jackson. New York, NY: Basic Books ; 1958.
Gazzaniga MS, Ivry RB, Mangun GR. Cognitive neuroscience: the biology of the mind. New York, NY: W.W. Norton & Co.; 1998.
Luria AR. The working brain: an introduction to neuropsychology. New York, NY: Basic Books ; 1973.
Wechsler D. Wechsler Adult Intelligence Scale-Revised. New York, NY: The Psychological Corporation; 1981.
Lezak MD. Neuropsychological assessment. 3rd edition. New York, NY: Oxford University Press ; 1995.
Hooper HE. Hooper visual organization test (VOT). Los Angeles: Western Psychological Services; 1983.
Benton AL, Hamsher KS, Varne NR, Spreen O. Contributions to neuropsychological assessment. New York, NY: Oxford University Press ; 1983.
Beck AT. Beck Depression Inventory. San Antonio, TX: The Psychological Corporation; 1987.
Shallice T. From neuropsychology to mental structure. Cambridge: Cambridge University Press; 1988.
Teuber HL. Physiological psychology. Annu Rev Psychol 1955; 9:267-296.
Weiskrantz L. Some traps and pontifications. In: Weiskrantz L, editor. Analysis of behavioral change. New York, NY: Harper & Row; 1968.
Kinsbourne M. Cognitive deficit: experimental analysis. In: McGaugh JL, editor. Psychobiology. New York, NY: Academic Press; 1971.
Huettel SA, Song AW, McCarthy G. Functional magnetic resonance imaging. Sunderland, MA: Sinauer Associates, Inc.; 2004.
Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345:311-318.
Tellez-Zenteno JF, Dhar R, Hernandez-Ronquillo L, Wiebe S. Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 2007;130:334-345.
Milner B. Interhemispheric differences in the localization of psychological processes in man. Br Med Bull 1971;27:272-277.
Jones-Gotman M. Psychological evaluation for epilepsy surgery. In: Shorvon S, Dreifuss F, Fish D, Thomas D, editors. The treatment of epilepsy. Oxford: Blackwell Science; 1996: 621-630.
Caramazza A. Is cognitive neuropsychology possible? J Cogn Neurosci 1992;4:80-95.
Damasio H, Damasio AR. Lesion analysis in neuropsychology. New York, NY: Oxford University Press ; 1989.
Gazzaniga MS, Ivry RB, Mangun GR. Cognitive neuroscience: the biology of the Mind. 2nd edition. New York, NY: W.W. Norton & Co .; 2002.
Hart J, Berndt RS, Caramazza A. Category-specific naming deficit following cerebral infarction. Nature 1985;316:439-440.
Crick F. The recent excitement about neural networks. Nature 1989;337:129-132.
Crawford JR, Garthwaite PH. Detecting dissociations in single-case studies: Type I errors, statistical power and the classical versus strong distinction. Neuropspychologia 2006;44: 2249-2258.
Leischner A. Über den Verlauf und die Einteilung der aphasischen Syndrome. Arch Psychiatr Nervenkr 1972;216:219-231.
Sbordone RJ, Long CJ. Ecological validity of neuropsychological testing. Delray Beach, FL: GR Press / St. Lucie Press; 1996.
Von Monakow C. Über Lokalisation der Hirnfunktionen. Wiesbaden: Von Bergmann; 1910.
Fuster JM. The prefrontal cortex: anatomy, physiology, and neuropsychology of the frontal lobe. 2nd edition. New York, NY: Raven Press; 1989.
Damasio H, Damasio AR. The lesion method in behavioral neurology and neuropsychology. In: Feinberg TE, Farah MJ, editors. Behavioral neurology and neuropsychology. New York, NY: McGraw-Hill Co.; 1997:69-82.
Rorden C, Karnath HO. Using human brain lesions to infer function: a relic from a past era in the fMRI age? Nat Rev Neurosci 2004;5:813-819.
Frank RJ, Damasio H, Grabowski TJ. Brainvox: an interactive, multimodal visualization and analysis system for neuroanatomical imaging. Neuroimage 1997;5:13-30.
Rorden C, Brett M. Stereotaxic display of brain lesions. Behav Neurol 2000;12:191-200.
Rorden C, Karnath HO, Bonilha L. Improving lesion-symptom mapping. J Cogn Neurosci 2007;19:1081-1088.
Kinkingnéhun S, Volle E, Pélégrini-Issac M, et al. A novel approach to clinical-radiological correlations: Anatomo-Clinical Overlapping Maps (AnaCOM): method and validation. Neuroimage 2007;37:1237-1249.
Balthazar ML, Cendes F, Damasceno BP. Semantic error patterns on the Boston Naming Test in normal aging, amnestic mild cognitive impairment, and mild Alzheimer's disease: is there semantic disruption? Neuropsychology 2008;22:703-709.
Balthazar ML, Yasuda CL, Pereira FR, Pedro T, Damasceno BP, Cendes F. Differences in grey and white matter atrophy in amnestic mild cognitive impairment and mild Alzheimer's disease. Eur J Neurol 2009;16:468-474.
Balthazar ML, Yasuda CL, Cendes F, Damasceno BP. Learning, retrieval, and recognition are compromised in aMCI and mild AD: are distinct episodic memory processes mediated by the same anatomical structures? J Int Neuropsychol Soc 2010;16:205-209.
Raineteau O, Schwab ME. Plasticity of motor systems after incomplete spinal cord injury. Nat Rev Neurosci 2001;2:263-273.
Jezzard P; Matthews PM; Smith, SM editors. Functional MRI: an introduction to methods. Oxford: Oxford University Press; 2001.
Rorden C, Fridriksson J, Karnath HO. An evaluation of traditional and novel tools for lesion behavior mapping. Neuroimage 2009;44:1355-1362.

Publication Dates

Publication in this collection
Oct-Dec 2010

History

Received
06 Sept 2010
Accepted
11 Nov 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Vygotsky LS. Psychology and the theory of localization of psychic functions. In: Vygotsky LS, editor. Sobranie sochinenij. Tom 1. Voprosy teorii i istorii psikhologii. Moscow: Pedagogika; 1934/1982; 168-174. (in Russian)

[2] Luria AR. Higher cortical functions in man. 2nd edition. New York, NY: Basic Books; 1966/1980.

[3] Damasceno BP. Research on cognition disorder: methodological issues. In: J.P. Tsai (editor), Leading-edge cognitive disorders research. New York: Nova Science Publishers, Inc.; 2008:131-154.

[4] Vygotsky LS. Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard University Press; 1978.

[5] Leontiev AN. Problems of the development of the mind. Moscow: Progress Publishers; 1981.

[6] Leontiev AN. The problem of activity in psychology. In: Wertsch JV, editor. The concept of activity in soviet psychology. New York, NY: M. E. Sharpe; 1981:38-71.

[7] Tomasello M, Kruger AC, Ratner HH. Cultural learning. Behav Brain Sci 1993;16:495-552.

[8] Galperin PY. An introduction to psychology. Moscow: Moscow University Press; 1976 (in Russian).

[9] Wertsch JV. Mind as action. New York, NY: Oxford University Press; 1998.

[10] Igliori GC, Damasceno BP. Theory of mind and the frontal lobes. Arq Neuropsiquiatr 2006;64:202-206.

[11] Damasceno BP. Mente, cérebro e atividade: abordagem neuropsicológica. Rev Bras Neurol 2004;40:5-13.

[12] Anokhin PK. Problems of center and periphery in the physiology of nervous activity. Gorki: Gozizdat; 1935 (in Russian).

[13] Mesulam M-M. Large-scale neurocognitive networks and distributed processing for attention, language, and memory. Ann Neurol 1990;28:597-613.

[14] Rummelhart DE, McClelland JL. Parallel distributed processing: explorations in the microstructure of cognition. Cambridge, MA: MIT Press; 1986.

[15] Dennet DC. Consciousness explained. Boston: Little, Brown & Co.; 1991.

[16] Jackson JH. On the nature of the duality of the brain. In: selected writings of John Hughlings Jackson. New York, NY: Basic Books ; 1958.

[17] Gazzaniga MS, Ivry RB, Mangun GR. Cognitive neuroscience: the biology of the mind. New York, NY: W.W. Norton & Co.; 1998.

[18] Luria AR. The working brain: an introduction to neuropsychology. New York, NY: Basic Books ; 1973.

[19] Wechsler D. Wechsler Adult Intelligence Scale-Revised. New York, NY: The Psychological Corporation; 1981.

[20] Lezak MD. Neuropsychological assessment. 3rd edition. New York, NY: Oxford University Press ; 1995.

[21] Hooper HE. Hooper visual organization test (VOT). Los Angeles: Western Psychological Services; 1983.

[22] Benton AL, Hamsher KS, Varne NR, Spreen O. Contributions to neuropsychological assessment. New York, NY: Oxford University Press ; 1983.

[23] Beck AT. Beck Depression Inventory. San Antonio, TX: The Psychological Corporation; 1987.

[24] Shallice T. From neuropsychology to mental structure. Cambridge: Cambridge University Press; 1988.

[25] Teuber HL. Physiological psychology. Annu Rev Psychol 1955; 9:267-296.

[26] Weiskrantz L. Some traps and pontifications. In: Weiskrantz L, editor. Analysis of behavioral change. New York, NY: Harper & Row; 1968.

[27] Kinsbourne M. Cognitive deficit: experimental analysis. In: McGaugh JL, editor. Psychobiology. New York, NY: Academic Press; 1971.

[28] Huettel SA, Song AW, McCarthy G. Functional magnetic resonance imaging. Sunderland, MA: Sinauer Associates, Inc.; 2004.

[29] Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345:311-318.

[30] Tellez-Zenteno JF, Dhar R, Hernandez-Ronquillo L, Wiebe S. Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 2007;130:334-345.

[31] Milner B. Interhemispheric differences in the localization of psychological processes in man. Br Med Bull 1971;27:272-277.

[32] Jones-Gotman M. Psychological evaluation for epilepsy surgery. In: Shorvon S, Dreifuss F, Fish D, Thomas D, editors. The treatment of epilepsy. Oxford: Blackwell Science; 1996: 621-630.

[33] Caramazza A. Is cognitive neuropsychology possible? J Cogn Neurosci 1992;4:80-95.

[34] Damasio H, Damasio AR. Lesion analysis in neuropsychology. New York, NY: Oxford University Press ; 1989.

[35] Gazzaniga MS, Ivry RB, Mangun GR. Cognitive neuroscience: the biology of the Mind. 2nd edition. New York, NY: W.W. Norton & Co .; 2002.

[36] Hart J, Berndt RS, Caramazza A. Category-specific naming deficit following cerebral infarction. Nature 1985;316:439-440.

[37] Crick F. The recent excitement about neural networks. Nature 1989;337:129-132.

[38] Crawford JR, Garthwaite PH. Detecting dissociations in single-case studies: Type I errors, statistical power and the classical versus strong distinction. Neuropspychologia 2006;44: 2249-2258.

[39] Leischner A. Über den Verlauf und die Einteilung der aphasischen Syndrome. Arch Psychiatr Nervenkr 1972;216:219-231.

[40] Sbordone RJ, Long CJ. Ecological validity of neuropsychological testing. Delray Beach, FL: GR Press / St. Lucie Press; 1996.

[41] Von Monakow C. Über Lokalisation der Hirnfunktionen. Wiesbaden: Von Bergmann; 1910.

[42] Fuster JM. The prefrontal cortex: anatomy, physiology, and neuropsychology of the frontal lobe. 2nd edition. New York, NY: Raven Press; 1989.

[43] Damasio H, Damasio AR. The lesion method in behavioral neurology and neuropsychology. In: Feinberg TE, Farah MJ, editors. Behavioral neurology and neuropsychology. New York, NY: McGraw-Hill Co.; 1997:69-82.

[44] Rorden C, Karnath HO. Using human brain lesions to infer function: a relic from a past era in the fMRI age? Nat Rev Neurosci 2004;5:813-819.

[45] Frank RJ, Damasio H, Grabowski TJ. Brainvox: an interactive, multimodal visualization and analysis system for neuroanatomical imaging. Neuroimage 1997;5:13-30.

[46] Rorden C, Brett M. Stereotaxic display of brain lesions. Behav Neurol 2000;12:191-200.

[47] Rorden C, Karnath HO, Bonilha L. Improving lesion-symptom mapping. J Cogn Neurosci 2007;19:1081-1088.

[48] Kinkingnéhun S, Volle E, Pélégrini-Issac M, et al. A novel approach to clinical-radiological correlations: Anatomo-Clinical Overlapping Maps (AnaCOM): method and validation. Neuroimage 2007;37:1237-1249.

[49] Balthazar ML, Cendes F, Damasceno BP. Semantic error patterns on the Boston Naming Test in normal aging, amnestic mild cognitive impairment, and mild Alzheimer's disease: is there semantic disruption? Neuropsychology 2008;22:703-709.

[50] Balthazar ML, Yasuda CL, Pereira FR, Pedro T, Damasceno BP, Cendes F. Differences in grey and white matter atrophy in amnestic mild cognitive impairment and mild Alzheimer's disease. Eur J Neurol 2009;16:468-474.

[51] Balthazar ML, Yasuda CL, Cendes F, Damasceno BP. Learning, retrieval, and recognition are compromised in aMCI and mild AD: are distinct episodic memory processes mediated by the same anatomical structures? J Int Neuropsychol Soc 2010;16:205-209.

[52] Raineteau O, Schwab ME. Plasticity of motor systems after incomplete spinal cord injury. Nat Rev Neurosci 2001;2:263-273.

[53] Jezzard P; Matthews PM; Smith, SM editors. Functional MRI: an introduction to methods. Oxford: Oxford University Press; 2001.

[54] Rorden C, Fridriksson J, Karnath HO. An evaluation of traditional and novel tools for lesion behavior mapping. Neuroimage 2009;44:1355-1362.

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