Cognition and Mental Management


Dealing with an Anxiety Disorder

Anxiety can make you feel that you cannot function in everyday environments.  You may feel that you need to leave your office because of an overwhelming sense of the world is becoming smaller around you, or you may have trouble crossing a bridge driving to work with a fear you might fall off even though there are borders to protect you. You are not sure why this is happening, but you are sure that you are losing control.  You feel apprehension and uneasiness in situations that others seem to be reacting as normal. You might even feel as if you might die if you do not leave a certain area or group.


You might have a feeling of fear or it could escalate to a feeling to completely avoid an event to stay away from a group completely.  This may be something you have thought about last night, or it may just rise out of the blue.  This is anxiety. And it is real. And many people will tell you how to treat it but it may not have worked for you, especially if it is just ignoring it. 


I would like to talk to you to assist you to reduce your physical reactivity and the need to run away. These are real reactions. I know, because I have anxiety.  Your heart may beat, and you may shake.  Your mind may race, and you may feel that you are going to die.  But there are some ways to fix this.  You do not have to feel like you are going to be sick or go crazy or get out of control.  You are not crazy.  You just have anxiety.


Nutritionally, stay away from caffeine and sugars.  The night before sleep early and have a glass of chamomile tea. In fact, having a glass in the morning would be helpful as well.  Do not over eat.  Having a full belly could make you feel gaseous and that could make you nauseas.  A simple toast, or if you are gluten free have a half of a cantaloupe.  Enjoy a relaxation tape every morning.


If you can take 30 minutes at night you can help your situation.  Put your clothes out the night before so that you do not have stress prior to driving or going to your meeting so you do not have to worry about what to wear.  Shower, have your personal items set out in the morning so you do not have to look for them and get nervous and have your earrings/ cufflinks ready for the day. It will save you the stress that could trigger anxiety in the morning.


Have your directions prepared for where you need to go printed the night before, even if you know where you are going. Have your house cleaned so that you do not wake up with anxiety that you have a dirty home and you worry about it later. Do as much as possible to organize yourself prior to an event that might cause you anxiety so that you deescalate it from happening.


In the morning, some basic steps are to say, “it is okay if I go out of control”.  Now, that sounds ridiculous to you, yet most people will never notice if you are shaking nor will they notice if you look awkward. Most of those things are in our mind’s eye. Tell yourself again and again that it is okay if I shake a bit. Close your eyes prior to going into a meeting and remind yourself that you are not the focus.  You are just a person and you are loved and cared for by a higher power so you are protected already. Go into the bathroom and breathe deep breaths and think about that higher power loving you and breathe deep. Relax your shoulders. Drink a glass of water.  Stay away from bright lights prior to your meeting or your drive. This often over stimulates your brain.


The reality it to prepare yourself as much as you can to relieve yourself from any necessary stress that could meet you prior to your interactions with the world is so important. Keep water with you at all times.  I will have more tips soon, but these are great starting points.


Public speaking blues...

Most people would agree that the idea of speaking in front of large groups of people can be terrifying, and so we tend to avoid it whenever possible. There are times, however, when we are faced with the task and there's no running away: we must say a few words. The following is a template for success which you can use when it's your turn to speak, in just about any type of gathering, formal or informal.

1. The Greeting


The greeting is the easy part. You begin by simply wishing your audience a good morning, afternoon, evening, or whatever time of day it is. **Good* evening everybody...*

2. State the Event

"As we all know..."

The second part is also very easy: You simply state the obvious and remind everybody what the purpose of the event or celebration is, and what you're all doing there. **As we all know,* we're here to celebrate the marriage of John and Kate, and to show them our support as they begin their journey of love and life together...* Now you've got the ball rolling, and the words are coming out easily. You look like you know what you're doing up there, and people are listening. So now, it's time to....

3. Establish Common Ground

"We've all..."

It's important to include your audience as part of the message you're delivering. Talk about something both yourself and your audience can relate to regarding the event or celebration. **We've all* had the wonderful opportunity to get to know John and Kate and enjoy watching their love develop...*

4. State Why You're Speaking


Include a personal account, or tell a brief story to let people know why you specifically are talking. What gives you the right to be speaking..? **I've* personally been very lucky to have John as a close friend of mine, and it's been quite amazing to watch how he's grown as a person, and couldn't be more pleased for him to have found someone like Kate to go about his life with...*

5. Call for Action

"So let's all..."

Finally, close your speech with a call for action. This lets everybody know that you're finished without you having to awkwardly say "That's it!" or "I'm finished, thank you"...that is how every weak speech is concluded and makes the audience uncomfortable. You should say something like **"So let's all* raise a glass to John and Kate, and wish them well. Cheers!" or, So Let's all give a big round of applause to Mark for the outstanding job he's done while working with the company"*

Obviously, there are many different ways these leading lines can be used, but if you can commit them to memory and be prepared to use them next time you might be asked to speak, you will let go of all fear and anxiety, and people will be SO impressed with your ability to get up and give a confident, fluent speech in front of a group of people, while looking like you didn't even have to prepare! Good luck, and happy public speaking!


(I can not find the original author for parts of this). 


Culture and Communications

Culture plays role in how individuals conceptualize communications and lifestyles based upon my personal experience. Sternberg (2006) noted a specific area of language comprehension that can influence behavioral decisions.  For example, if there are cognitive gaps in speech perception using the method of decoding, which was phonemes describing subsets of language, morphemes which are distinctive lexicon’s of language, phrases, and sentences.  This has been important to me from a learning perspective for cognitive psychology because language comprehension has been something that I had taken for granted before.  The ability to comprehend speech has been demonstrated for me in which I know recognize the importance of categorical perception in language. 

I have recognized the challenges children face when they can not communicate effectively and this has encouraged me to have compassion for children that are ESL (English Second Language). I am not a teacher, just a neighbor, but I understand the speech comprehension process now. 

Sternberg, R. (2006). Cognitive psychology (4th ed.). Belmont, CA: Thomson Wadsworth.



The Function and Dysfunction of my Executive Function

Executive function is often thought to occur in the frontal lobes of the brain and it is responsible for the decision making functions and cognitive abilities that allow for us to function in changing situations and allow us to anticipate outcomes of behaviors (Stirling, 2002). Executive functions are looked at as high level abilities such as focusing attention on a specific activity or performing complex tasks. The dorsolateral area and the orbitomedial prefrontal cortex are vital to executive functioning and damage to these areas can result in significant dysfunctions (Antshel & Waisbren, 2003).

Dysfunctions in executive functioning is often caused by lesions to the prefrontal cortex and often demonstrates with a loss of organizational strategies, challenges in formulating plans, and impaired social judgment but does not necessarily mean there is a loss in overall intelligence (Andrewes, 2002). Inappropriate behaviors such as making verbal comments to a person that one would otherwise keep to himself (such as saying “hey you look fat in that dress”) or acting with urges rather than restraint are common in those with executive function disorders. There are a variety of psychological disorders that are also associated with impaired executive functions such as attention-deficit/ hyperactivity disorder (ADHD), Tourette’s syndrome, depression, schizophrenia, or obsessive compulsive disorders.

There are a variety of neuropsychological test batteries that can be used to detect executive dysfunction such as the Wisconsin Card Sorting Test, the Boston Naming Test, the Stroop Color-Word Test, the Trail Making Test-Parts A and B, Visual Spatial Learning Test, Controlled Oral Word Association subtest, California Verbal Learning Test, Visual Reproduction, and subtests from the Wechsler Adult Intelligence Scale (Busch, Booth, and McBride, 2005). These tests are useful in assessing executive tasks, global functioning, and fluid intelligence capacities ( De Frias, Dixon, & Strauss, 2006).

Andrewes, D. (2002) Neuropsychology: From theory to practice. New York: Psychology Press.

Antshel, K. & Waisbren, S. (2003). Timing is everything: Executive functions in children exposed to elevated levels of phenylalanine. Neuropsychology, 17(3), 458-468.

Busch, R. M., Booth, J. E., & McBride, A. (2005). Role of executive functioning in verbal and visual memory. Neuropsychology, 19(2), 171-180.

De Frias, C. M., Dixon, R. A., & Strauss, E. (2006). Structure of four executive functioning tests in healthy older adults. Neuropsychology, 20(2), 206-214.

Stirling, J. (2002). Introducing neuropsychology. New York: Psychology Press.


Neurology and Movement Disorders

A medical neuropsychologist has an important role in managing and assessing the etiological, psychosocial, and intervention techniques in movement disorders and medical neurological disorders such as multiple sclerosis and Parkinson disease. In the case of Multiple sclerosis, pathology occurs that results in the deterioration of the myelinated neurons and gradually deteriorates the brain and the spinal cord eventually resulting in paralysis and cognitive challenges (Stirling, 2002). Parkinson’s disease is a progressive disorder that can cause tremors, muscular rigidity, slowed movement, and speech disorders as well as other dysfunctions in the basal ganglia and dopamine distribution process. Medical neurologists work with patients and family members whom are suffering from this disease to assess neurological functioning or deterioration, manage multidisciplinary rehabilitation teams, and work to help develop behavioral programs to manage long-term illnesses by assessing the patient’s functional systems (Andrewes, 2002).

Neuropsychologists will use a battery of tests to visually look for brain lesions as well as cognitive measures to understand the implications these lesions have on rehabilitative aspects of illness such as the relapse rate of patients with multiple sclerosis ( Snyder, Cappelleri, & Archibald, 2001). Additionally, research regarding physical health, aging, and mental abilities with these relatively long-term neurological degenerative disorders are of interest to neuropsychologists (Woodruff-Pak, Jaeger& Gorman, 1999). Medical neuropsychologists should also work in a collaborative role with neurologists, rehabilitative technicians, and social workers from a managerial perspective as they have an outlook that incorporates psychological, medical, and social perspectives for these disorders.

Andrewes, D. (2002) Neuropsychology: From theory to practice. New York: Psychology Press.

Snyder, P. J., Cappelleri, J. C., & Archibald, C. J. (2001). Improved detection of differential information-processing speed deficits between two disease-course types of multiple sclerosis. Neuropsychology, 15(4), 617-625.

Stirling , J. (2002). Introducing neuropsychology. New York: Psychology Press.

Woodruff-Pak, D. S., Jaeger, M. E., & Gorman, C. (1999). Relationships among age, conditioned stimulus-unconditioned stimulus interval, and neuropsychological test performance. Neuropsychology, 13(1), 90-102.


Managing Cerebral Vascular Accidents

Main Discussion Post:

Caregivers for patients who have experienced a cerebral vascular accident, also referred to as a CVA or a stroke, have to be aware of a variety of biological and emotional information to assist them in their role as a provider and often rehabilitative assistant. A CVA can occur in the right or left cerebral hemisphere and can usually be categorized as a transient ischemia (loss of oxygen to tissue) attack, compression, cerebral ischemia, hypoxia, embolism (blood clot), or thrombosis (Andrewes, 2002; Walden University, 2008). A stroke most often occurs in the middle cerebral arteries and as these arteries cover a wide portion of the lateral brain, damage can be extensive (Andrewes, 2002).

If a patient experiences a stroke on the left side of the brain, the patient may experience paralysis on the right side of the body as well as deficiencies in areas of reasoning, organization, verbal flow (expressing thoughts verbally) comprehension, anxiety, depression, and decreased response depending upon the exact location of the lesion(s) (Andrewes, 2002; Stirling, 2002). A variety of tests will be executed to determine demonstration of aphasia, which is a degree of loss of language capability, and or apraxia, which is a degree of loss in the motor capability to verbalize (Stirling, 2002). Additionally, patients who experienced a stroke in the left hemisphere may suffer an inability to perform complex natural hand gestures and sequential hand movements although research suggests that this may not be limited to only those suffering from damage in the left hemisphere (Buxbaum, Schwartz, & Montgomer, 1998).

Most CVA patients will need to have physical therapy, occupational therapy, speech therapy, and will have a complex support team often consisting of a rehabilitation nurse, dietician, social worker, case manager, recreation therapist, and a neuropsychologist (National Stroke Association, 2008). As a caregiver, it will be important to familiarize yourself with this team. As there will be complexities with normal everyday caretaking tasks such as modifying the home to support the patient, managing health insurance bills, learning new grooming and hygiene processes, and working to prevent polypharmacology it would also be beneficial to reach out to support groups for social support (National Stroke Association, 2008; Schatzberg, Cole, & DeBattista, 2007).

Andrewes, D. (2002) Neuropsychology: From theory to practice. New York: Psychology Press.

Buxbaum, L. J., Schwartz, M. F., & Montgomery, M. W. (1998). Ideational apraxia and naturalistic action. Cognitive Neuropsychology, 15(6-8), 617-644.

National Stroke Association. (2008, April 15). Hope: The stroke recovery guide. Retrieved from:

Schatzberg, A.F., Cole, J.O., DeBattista, C. (2007). Manual of clinical

psychopharmacology (6th ed.). Washington, DC: American Psychiatric Publishing, Inc.

Stirling, J. (2002). Introducing neuropsychology. New York: Psychology Press.

Walden University. (2008, April 15). Cerebral vascular accident (cva) (stroke). Week 7 Study Notes. Retrieved from


Disorders of Perception

Disorders of perception are those that affect how senses such as smell, vision, taste, hearing, touch can be devastating to a person because humans rely significantly on our senses to function in the daily world. Imagery and perceptual disorders can vary from being able to determine what a form of an object is to being unable to recognize the use of an object (Andrewes, 2002). This perceptual analysis occurs using two systems which are the ventral and dorsal pathways. A PET scan can identify the brain activity in these areas and demonstrates that the mango layers and parvo layers are pathways that are separate and manage the interpretation of the motion and color (mango layers) as well as shape (parvo layers). The occipital lobes send outputs these two layers through fiber bundles and although their purposes are different (‘what is it’ versus ‘where is it’) they operate in conjunction to facilitate perceptive processes (Stirling, 2002).

One specific perception disorder is that of achromatopsia. Achromatopsia is a disorder that is associated with the parvo and mango pathways and those diagnosed with this perceptual disorder report seeing colors as being grey or lacking color dimension. The American Association for Pediatric Ophthalmology (2008) states that on in every 40,000 children globally are born with this disorder and the color blindness is a result of an unbalanced distribution of the function red, green, and blue cones in the retina. However, many people are not born with this perception disability; rather it occurs from brain lesions or a stroke. Although this can be very disruptive in daily activities such as reading, discriminating between colors for decision making processes, or eating, there is some evidence that partial recovery from achromatopsia for those whose onset resulted from a stroke is possible, although full recovery has not yet been noted (Spillman, Laskowski, & Lange, 2000).

Apraxia is the loss of ability to perform certain complex movement tasks and it can come in one of four forms which are ideomotor apraxia, verbal apraxia, buccofacial apraxia, or ideation apraxia (Andrewes, 2002). Ideomotor apraxia, which is the inability to make gestures, can affect daily activities such as being able to hammer a nail, making symbolic hand gestures (waving goodbye), using a toothbrush, pretending to drive a car, or combing hair (Andrewes, 2002; Kaya, Unsal-Delialioglu, Kurt, Altinok, & Ozel, 2006). Although some of these behaviors may demonstrate similarities to muscle paralysis, it is actually the loss of the ability to control basic coordinated muscle movements. This is a result of lesions in the dominant parietal lobe, damage in the supplementary motor areas, or lesions of the corpus callosum and, although patients mentally are aware of the movement that they wish to replicate, they are unable to physically demonstrate the movement (Kaya et al., 2006). Common sense recommendations that would benefit those with ideomotor apraxia include removal of any harmful (sharp) objects that could be inadvertently used from the person’s living space, write down detailed instructions how to perform a specific task, and work on repeated muscular movements in a rehabilitative setting.

American Association for Pediatric Ophthalmology. (2008, April 8). What is achromatopsia? Retrieved from:

Andrewes, D. (2002) Neuropsychology: From theory to practice. New York: Psychology Press.

Kaya, K., Unsal-Delialioglu, S., Kurt, M., Altinok, N., & Ozel, S. (2006). Evalutation of ideomotor apraxia in patients with stroke: A study of reliability and validity. Journal of Rehabilitative Medicine, 38(2), 108-12.

Spillman, L., Laskowski, W., & Lange, K. W. (2000). Stroke-blind for colors, faces, and locations: Partial recovery after three years. Restorative Neurology and Neuroscience, 17(2-3), 89-103.
Stirling, J. (2002). Introducing neuropsychology. New York: Psychology Press.


Left Brain Vs. Right Brain

The human brain is divided into left and right cerebral hemispheres that are have both differences as well as similarities in their roles and functions (Pinel, 2006). The two hemispheres are connected by cerebral commissures which allow for both hemispheres to communicate. The commissures consist of nerve fibers with millions of axons that pass information from one hemisphere to the next (Andrewes, 2002). Although the left hemisphere is often referred to as the dominant hemisphere, both the left and the right sides of the brain participate in the general functions of movement, memory, vision, and audition (Stirling, 2002). The left hemisphere has dominance in the areas of recognizing words and letters, comprehending language sounds, complex movements, having verbal memory, and the functions of speech, reading, writing, and arithmetic (Pinel, 2006). The right hemisphere has dominance in the areas of geometric patterns and emotional expressiveness, music enjoyment (not interpretation as this occurs in the left hemisphere), nonverbal memory, geometry, direction, distance, movement in special patterns, and emotional content (Pinel, 2006).

Normal individuals will demonstrate some asymmetry in the lateralization of the brain and this can be observed using dichotic listening tasks in which sounds are played in one ear and then played in the other ear to measure how they are processed (Stirling, 2002). Typically the right ear will demonstrate a small level of dominance as the left brain directly receives the input (right ear managed by left hemisphere, left ear managed by right ear, left hemisphere in charge of language functions) and it is hypothesized that this results in an decreased time for word recognition (Stirling, 2002). This is very interesting as I have a real life example of how this has affected my son. My seven year old was diagnosed as being on the autistic spectrum when he was four and shortly after his fifth birthday I placed him in a sensory learning institute for a month long session to “rewire” how his brain hemispheres communicate with each other. My son had a language delay and the professionals at the Sensory Learning Institute (2008) recommend a procedure in which auditory training is achieved by first documenting a “perception map” to find the dominant ear (which is typically the left ear for these children) and then retraining the other ear (typically the right ear) to manage sounds. The theory is that the children can improve their language capabilities by having a dominant right ear so that the sounds are delivered directly to the left brain for rapid processing. My personal experience with this program, although it was quite costly and not covered by insurance, was that it was a success.

Although the left brain is considered to be dominant, both hemispheres of the brain working together are preferable. This is not always possible due to circumstances such as brain injury, strokes, and surgeries to remove tumors or halt seizures (Stirling, 2002). Andrewes (2002) noted that the Wada technique can be used to study lateralization by anesthetizing on side of the brain to demonstrate the loss of functionality in one brain hemisphere. The Wada technique has been used to deactivate the language cortex to determine the hemisphere with language dominance before any epilepsy surgeries are performed (Abou-Khalil, 2007). This procedure is invasive and consists of an anesthetic agent being injected into the internal carotid artery so that a cerebral angiogram can be conducted. There are many variations in this procedure regarding which side receives injection first, the dosage, the type of anesthesia, and the type of tests that are administered after the injection. Additionally, noninvasive procedures that can detect the language cortex activation, such as functional MRIs or transcranial Dopplers, are becoming more popular and soon may replace the use of the Wada test.

Abou-Khalil, B. (2007). An update on determination of language dominance in screening for epilepsy surgery: The wada test and newer noninvasive alternatives. Epilepsia (Series 4), 48(3), 442-455.

Andrewes, D. (2002) Neuropsychology: From theory to practice. New York: Psychology Press.

Pinel, John P. J. (2006). Biopsychology with “beyond the brain and behavior” (6th ed.). Boston: Allyn and Bacon.

Sensory Learning Center. (2008, March 25). Frequently asked questions. Retrieved from:

Stirling , J. (2002). Introducing neuropsychology. New York: Psychology Press.


What about Neuropsychological Tests?

Historically the only way that neurologists were able to study the brain for any damage, dysfunction, or diseases was to either remove a piece of the brain (biopsy) from a live patient which was very high risk, or they could perform a detailed study of the brain during an autopsy which had the disadvantage of only demonstrating the severely diseased brain rather than the brain in a preliminary diseased state (Stirling, 2002). With the increased development of technology came advancements in brain structure measurements such as Computerized Tomography (CT) Scans which uses x-rays to view the brain structures, Magnetic Resonance Imaging (MRI) which shows brain structures by emitting hydrogen atoms in a magnetic field and measuring their density, Positron Emission Tomography (PET Scan) which measures active areas of the brain using radioactive isotope that reacts similarly to glucose by neurons, and Electorencephagram (EEG) which measures waveforms (Stirling, 2002).

 In addition to the physical brain structure observations neuropsychological assessments are equally valuable; however, they preferably should not be conducted on the same day as visualizing techniques being that the results are considered invalid if the participant is tired (Stirling, 2002). Generally, neuropsychologists use two types of assessments which are structured or unstructured tests. Structured tests consist of a standard battery of tests that are administered with an inflexible approach such as the Halstead-Reitan Neuropsychology Test Batteries. Inflexible, or structured, tests have the advantage of being very exhaustive; however, this can be a challenge when administering a test battery to a person who may be suffering from psychopathologies such as schizophrenia (Allen, Goldstein, & Aldarondo, 1999).

Unstructured tests consist of tests that are selected by the neuropsychologist based upon symptoms reported by the patient and/or the family as well as clinical observations of particular disorders. The neuropsychologist can look at the results from specific tests such as the Lezak’s flexible battery to determine what, if any, additional tests would be beneficial. Unstructured tests could include language assessments such as the Aphasia Screening Test, achievement tests such as the Wide Range Achievement Tests, or memory and learning tests which measure logical memory, paired associated learning, or visual memory scales (Loring & Meador, 2008). If a neuropsychologist prefers this stepped approach to testing the advantages are the ability to have a tailored diagnostic assessment; however, the disadvantages are that the selection of tests could be based upon the neuropsychologist’s education background or work experience and this could result in the oversight of a valuable or needed battery of tests.

Allen, D. N., Goldstein, G., & Aldarondo, F. (1999). Neurocognitive dysfunction in patients diagnosed with schizophrenia and alcoholism. Neuropsychology, 13(1), 62-68.

Loring, D. W. & Meador, K. J. (2008, March 17). Neuropsychology for neurologists. NLD on the Web. Retrieved from

Stirling , J. (2002). Introducing neuropsychology. New York: Psychology Press.


Social Implications of Dementia

Whenever a family is dealing with a loved one experiencing one of the many forms of dementia, it is important for them to be well education regarding the disease as well as understanding the challenges associated with memory loss and the need for social support networks for both the patient and the caregiver.

There are a variety of types of illnesses associated with memory loss and very often brain systems, such as the cortex and medial thalamus which supports the ability to recognize familiar faces and places or the hippocampal complex and the extended hippocampal system which supports the ability to recall stored information, can be affected (Andrewes, 20020. The short term memory (also referred to as the working memory) and long term memory are affected based upon the type of memory loss a person experiences. In the case of dementia, a person will experience memory loss in addition to symptoms such as poor judgment, mood changes, language difficulties, and personality changes (Stirling, 2002).

In addition to these changes a person suffering from dementia will experience a decrease in social communication and this loss can result in feelings of depersonalization and feeling a lack of belonging (Acton, Yauk, Hopkins, & Mayhew, 2007). Communication problems such as challenges with word retrieval or verbal production are common in the middle stages of dementia and this can be challenging for a caregiver to manage. Additionally, those suffering from dementia will start to have challenges with managing their eating behaviors and likely will not have any recall in his or her working memory regarding meals so the caregiver will have to manage a communication strategy surrounding food liquid intake (Thomas & Morley, 2002). Besides the health implications, socially it is important to ensure that regular communication occurs with a person suffering from dementia. Acton et al. (2007) stated that disruptive behaviors associated with dementia decreased by 56% when social interaction was occurring. Additionally, it was noted that questions posed by caregivers ending with a ‘yes’ or ‘no’ answer rather than having an open ended response (expected by the dementia suffer) resulted in more successful communication opportunities.

Acton, G. J., Yauk, S., Hopkins, B. A., & Mayhew, P. A. (2007). Increasing social communication in persons with dementia. Research & Theory for Nursing Practice, 21(1), 32-44.

Andrewes, D. (2002) Neuropsychology: From theory to practice. New York: Psychology Press.
Stirling, J. (2002). Introducing neuropsychology. New York: Psychology Press.

Thomas, D. R. & Morley, J. E. (2002). Nutritional considerations in older people. Topic in Clinical Chiropractic, 9(2).