NEURODEVELOPMENTAL

DISORDER
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Neurodevelopmental "disorders" are characterized according to developmental
deficits or delays that usually show up early in a child’s development, many times
before the child enters elementary school, and can persist throughout the individual’s
lifetime.
These brain functioning challenges can affect a person’s emotions, behaviors,
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memory, attention, ability to learn, ability to socialize, and ability maintain self-control.
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They can be limited, for instance, to focus only or the deficits can be global and affect
intelligence, learning, or social functioning.
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CONT........
Neurodevelopmental disorders, as defined in the
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DSM-5, include:
attention deficit hyperactivity disorder (ADHD),
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autism spectrum disorder (ASD),

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communication disorders,
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intellectual developmental disorder,
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Attention Deficit Hyperactivity
Disorder (ADHD)
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The front of the brain behind the forehead is the
frontal lobe. The frontal lobe is the part of the
brain that helps people to organize, plan, pay
attention, and make decisions. Parts of the frontal
lobe may mature a few years later in people with
ADHD
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ADHD is one of the most common
neurodevelopmental disorders of childhood. It is 3
TYPE OF ADHD

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Predominantly Inattentive Presentation: It is hard
for the individual to organize or finish a task, to
pay attention to details, or to follow instructions or
conversations. The person is easily distracted or
forgets details of daily routines.
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Predominantly Hyperactive-Impulsive
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TYPE OF ADHD

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Predominantly Inattentive Presentation: It is hard
for the individual to organize or finish a task, to
pay attention to details, or to follow instructions or
conversations. The person is easily distracted or
forgets details of daily routines.
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Predominantly Hyperactive-Impulsive
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CAUSES OF ADHD
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The cause(s) and risk factors for ADHD are
unknown, but current research shows that
genetics plays an important role
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In addition to genetics, scientists are studying
other possible causes and risk factors including:
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Brain injury
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Exposure to environmental risks (e.g., lead) 6
Diagnosis
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Deciding if a child has ADHD is a process with
several steps.
There is no single test to diagnose ADHD
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One step of the process involves having a
medical exam, including hearing and vision tests,
to rule out other problems with symptoms like
ADHD.
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A utism Spectrum Disorder
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It refers to a host of complex neurodevelopment
disorders, all of which are characterized by
repetitive patterns of behavior and difficulties with
social connection and interaction.
These symptoms, such as
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the inability to make eye contact or to talk about
feelings,
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Cont...............
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When comparing the functional connectivity of
ASD brains and unaffected brains, researchers
see that there are some networks with lower
connectivity, especially in patterns where the
distance between brain regions is greater.
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In autism there’s short-range over-connectivity
and long-range under-connectivity,” “So, for tasks
that require us to combine or assimilate 9
Cont........
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Children and adolescents with autism often have
an enlarged hippocampus, the area of the brain
responsible for forming and storing memories,
several studies suggest, but it is unclear if that
difference persists into adolescence and
adulthood1,2.
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Autistic people have decreased amounts of brain
tissue in parts of the cerebellum, the brain 10
DIAGNOSIS
Developmental Monitoring and Screening
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Developmental milestones (how a child plays,
learns, speaks, acts, or moves) are things most
children can do by a certain age.
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All young children need both developmental
monitoring and developmental screening to help
diagnose if your child’s development is on track.
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 TRAUTIC BRAIN INJURY
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Traumatic brain injury (TBI) generally refers to
injury involving the brain resulting from some type
of impact and/or acceleration/deceleration of the
brain.
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TBI is defined as an alteration in brain function,
or other evidence of brain pathology, caused by
an external force”(p. 1637) (D.K. Menon et al.,
2010). 12
TBI classification and severity
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Head injury is still synonymously with TBI, but in
some cases it refers to injury of other head
structures such as the face or jaw. Most TBIs are
closed in that the skull remains intact and the
brain is not exposed.
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Closed head injury (CHI) is referred to as blunt
head trauma or blunt injury as well.
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Symptoms
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Traumatic brain injury can have wide-ranging
physical and psychological effects. Some signs or
symptoms may appear immediately after the
traumatic event, while others may appear days or
weeks later.
Mild traumatic brain injury
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The signs and symptoms of mild traumatic brain

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Cont......
Cognitive, behavioral or mental symptoms
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Loss of consciousness for a few seconds to a
few minutes
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No loss of consciousness, but a state of being
dazed, confused or disoriented
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Cont.....

Moderate to severe traumatic brain injuries

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Moderate to severe traumatic brain injuries can
include any of the signs and symptoms of mild
injury, as well as these symptoms that may appear
within the first hours to days after a head injury: 16
Cont....
Cognitive or mental symptoms
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Profound confusion
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Agitation, combativeness or other unusual
behavior
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Slurred speech
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Children's symptoms
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Infants and young children with brain injuries
might not be able to communicate headaches,
sensory problems, confusion and similar
symptoms. In a child with traumatic brain injury,
you may observe:

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Change in eating or nursing habits
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DIAGNOSIS
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Neurological evaluation: A neurologist (specialist
in the brain) checks your memory, thinking, motor
function (balance, reflexes and coordination) and
sensory functions (hearing and vision).
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Imaging tests: A CT scan or MRI checks for brain
bleeding and swelling.
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Blood test: The Banyan Brain Trauma
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Cerebrovascular disorder
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Cerebrovascular disease refers to a group of
conditions that affect blood flow and the blood
vessels in the brain.
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Problems with blood flow may occur from blood
vessels narrowing (stenosis), clot formation
(thrombosis), artery blockage (embolism), or
blood vessel rupture (hemorrhage).
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Cont.....
Diagram
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If a blockage, malformation, or hemorrhage
prevents the brain cells from getting enough
oxygen, brain damage can result
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Cerebrovascular disease can develop from a
variety of causes, including:
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atherosclerosis, where the arteries become
narrow
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Symptoms
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The symptoms of cerebrovascular disease
depend on the location of the blockage and its
impact on brain tissue.
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Different events may have different effects, but
common symptoms include:
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a severe and sudden headache
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paralysis of one side of the body, or hemiplegia 23
Types of cerebrovascular disease
Ischemic stroke
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These occur when a blood clot or atherosclerotic
plaque blocks a blood vessel that supplies blood
to the brain. A clot, or thrombus, may form in an
artery that is already narrow.
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A stroke occurs when the lack of blood supply
results in the death of brain cells.
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CONT......
Embolism
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An embolic stroke is the most common type of
ischemic stroke. An embolism occurs when a clot
breaks off from elsewhere in the body and travels
to the brain to block a smaller artery.
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People who have arrhythmias, which are
conditions that cause an irregular heart rhythm,
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Cont......
Hemorrhagic stroke
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This occurs when a blood vessel in part of the
brain weakens and bursts open, causing blood to
leak into the brain.
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The leaking blood puts pressure on the brain
tissue, leading to edema, which damages brain
tissue. The hemorrhage can also cause nearby
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CAUSES
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Cerebrovascular disease develops for a variety of
reasons.
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If damage occurs to a blood vessel in the brain, it
will not be able to deliver enough or any blood to
the area of the brain that it serves. The lack of
blood interferes with the delivery of adequate
oxygen, and without oxygen, brain cells will start
to die. 27
Tests for Cerebrovascular Disease
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Electroencephalogram (EEG): A diagnostic
procedure that involves placing small metal discs
(electrodes) on a person's head to detect
electrical impulses. As brain waves, these
electrical signals are printed out
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Magnetic Resonance Angiogram (MRA): This is a
non-invasive investigation that takes place in a
Magnetic Resonance Imager (MRI). A computer 28
Vascular Disorders
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The vascular system refers to the system of
blood vessels that transport blood throughout the
body.
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Vascular diseases are diseases that affect the
vascular system. They can interfere with blood
flow to or from the body’s organs.
Arteries are the blood vessels that carry blood to
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Types of vascular diseases
Peripheral vascular disease
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Peripheral vascular disease (PVD) refers to
diseases of the blood vessels outside the heart
and brain.
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In PVD, a fatty deposit called plaque
accumulates on the inner walls of blood vessels,
causing the vessels to narrow. This narrowing
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Limb-threatening ischemia
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Limb-threatening ischemia (LTI) is an advanced
stage of PAD that involves a decrease in blood
flow to the limbs.
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Over time, decreased blood flow to the affected
limbs can cause nerve damage, leg ulcers, and
infections.
Symptoms
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Carotid artery disease

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Carotid artery disease is the medical term for an
accumulation of plaque in the carotid arteries,
which are large arteries on either side of the neck.
The carotid arteries deliver blood to the brain and
head.
Symptoms
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Chronic venous insufficiency
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Healthy veins have valves that counteract the
effects of gravity to prevent blood from pooling in
the lower portions of the veins. Damage to these
valves can cause the blood to pool in the lower
part of the body, including the legs and feet. The
medical term for this is chronic venous
insufficiency (CVI).
Symptoms
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Tests
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A vascular ultrasound
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is a painless, noninvasive test that uses high-
frequency sound waves to produce images of the
blood vessels. In a vascular ultrasound, sound
waves bounce off of the blood cells as they travel
through the blood vessels. This allows physicians
to calculate the speed of blood flow and identify
narrowed arteries 34
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Dementing Disorders
- Mild cognitive impairment

The term cognitive impairment(MCI) is a diagnosis given to individuals who are thought to have cognitiv
greater than expected for age and education without an obvious etiology but not sufficiently severe to w
diagnosis of dementia (Petersen,Smith,etal.,1999;Winbladetal)

As evidence of cognitive decline, the criteria suggests that the person reports decline and there is impai
objective cognitive tasks.

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Continued
Not all MCI patients ended up with dementia but it surely increased over time.

It involves disturbance in Executive function, memory and all main cognitive domains

Patients who carry an MCI diagnosis may have functional impairment that is not severe enough to
“cause significant impairment in social or occupational functioning
(AmericanPsychiatricAssociation,2000).

Various computerized tests can be used to assess MCI including the Computer Assessment of Mild
cognitive impairment ( CAMCI)

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Treatment
The goal for many of the pharmacologic and behavioral treatments for MCI has been to reduce the
risk of or slow progression to dementia.

Cognitive training has been effective in improving functioning just as useful as it has been with
people with normal cognitive functioning

Also a healthy diet, exercise, smoking cessations have been greatly useful in reducing progression
of this problem.

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Degenerative Disorders

-Degeneration refers to the process by which tissue deteriorates and loses its functional ability
due to traumatic injury, aging and wear and tear.

-The term dementia applies to a condition of cognitive decline and functional impairment.

-A degenerative disease is a type of a medical condition that causes a tissue or organ to
deteriorate over time.

- There are quite a number of degenerative diseases and many of them are associated with
aging, or gets worse during the aging process

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Dementia
-Although some accounts describe “reversible dementias,” common dementia refers to
Irreversible cognitive declineb resulting from biological mechanisms that damage brain
cells.
-Different types of dementia are associated with distinctive brain abnormalities and
relatively differentiable commonly dementia refer to an irreversible cognitive decline
resulting from symptom patterns.

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 Cortical Dementias
-Cortical dementia is the name given to the types of dementia caused by
disorders that affect the brain's cerebral cortex.

- The cerebral cortex is the brain's outermost layer, which is involved in a range
of important functions, including memory, language, abstraction, creativity,
judgment, emotion, and attention.

-Cortical dementias happen because of problems in the cerebral cortex, the

outer layer of the brain.
-People with these types of dementia usually have severe memory loss and
can't remember words or understand language

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1. Alzheimer’s Disease
- It is a progressive disease that destroys
memory and other important mental function .
- Brain cell connections and the cells themselves
degenerate and die, eventually destroying
memory and other important mental functions.

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Continued.
-Alzheimer's disease is thought to be caused by the abnormal build-
up of proteins in and around brain cells. One of the proteins involved
is called amyloid, deposits of which form plaques around brain cells.
The other protein is called tau, deposits of which form tangles within
brain cells.
-AD is characterized by inexorably progressive degenerative nerve
cell changes within the cerebral hemispheres with concomitant
progressive global deterioration of intellect and personality.

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Risk factors of Alzheimer’s Disease
1.Demographic factors
-mostly affects people over 60
-Woman are at greater risk
-low education and occupational levels

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Cont.
2.Genetic predispositions
-gene of protein(apolipoprotein)ApoE is associated with development of AD
3.Vascular Disease
4.Traumatic Brain Injury

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Possible prevention
1. Physical activities
2. Moderate alcohol consumption
3. Antioxidantslike red wine

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Progression
-Proggression is usually slow, (onset to death may be 15to 20years)

-Symptoms most evident at work, confusion, disorientation

-Language , sensori and motor ficbtions are unaffected during early stage

--The sequence in which cognitive functions first show deterioration generally begins with episodic memory but also with complex
mental tracking(e.g.,TrailMakingTest-B)and verbal fluency(M.S.Albert,Moss,Tanzi,andJones,2001).
- During midstage, cognitive impairment worsens
- Aphasia , Apraxia, agnosias
- Later stage have symptoms difficult to record because of mutism.
- Patients regress to early child development stage

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Affected Areas
-Cognition- Patients at severe stage will show impairment in all cognitive test
-Predominant Episodic memory disorder
-serious problems with language fluency, attention, complex reasoning,
psychomotor
- Verbal function and academic skills –Arithmetoc skills, degerative process is
thike that of a normal child
- -Visuospatial Functions , constructions and praxis-

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Frontotemporal lobar Degeneration
-Frontotemporal lobar degeneration is a general term
that describes a group of disorders based on their
neuropathology that cause damage and dysfunction of
the frontal and temporal lobes of the brain.
-It is also known as frontotemporal dementia.
-The other lobes remain unaffected.

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Diagnosis
-Early in the course of the disorder, people with the behavioral variant of
frontotemporal degeneration tend to score very well on
neuropsychological testing.
- Molecular genetic testing can confirm a diagnosis of frontotemporal
degeneration in certain people.
- It has symptoms similar to Alzheimer’s, so the diagnosis Should be
made after localization of the disorder to the frontal and temporal lobes.

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Proggression
-The initial stages- silliness ,socially disinhibited
behavior ,and poor judgment predominate.
-Middle stages- apathy, blunted effect, cognitive disorder.
-Later stage- mutism, motor rigidity, ending in vegetative
state
- Progression is from 2-17years.

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Affected Areas
1.Cognition-Alterations in cognitive abilities
-Difficult to assess, and do badly in the verbal fluency test
2.Executive functions, reasoning and problem solving(Wisconsin CardSorting
Test,the Stroop technique,and tests that assess decision making and risk taking
are useful)
3.Personality and psychosocial behavior – blandly inappropriate, eating sweets,
stereotypical ritualized behaviors

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Semantic Dementia
-Neuroimaging and autopsy show prominent bilateral involvemen of the anterior temporal
lobes.
-The amygdala is affected and hippocampal atrophy may be present

Rare condition in which words , meaning, concepts become impaired

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Semantic dementia (SD) designates a progressive cognitive and language deficit,
primarily involving comprehension of words and related semantic processing. These
patients lose the meaning of words, usually nouns, but retain fluency, phonology, and
syntax.
-This is so because some patients have more temporal than frontal involvent
-

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Primary progressive aphasia
- This is a variation where people remain dementia free for a long time but leading up
to the final stage
The disorder often starts as anomia and and progresses to impaired grammatical and
language impairment .
- Initially, patients are often fluent and progressively become
nonfluent(M.Blairetal.,2007).
- Nonfluent patients have slowed speech, sequencing errors, slowed speech rate
- The left temporal lobe is the site of degeneration.

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3. Dementia with Lewey Bodies
-Lewy body dementia (LBD) is a disease associated with abnormal deposits of a protein
called alpha-synuclein in the brain.
-These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in
turn, can lead to problems with thinking, movement, behavior, and mood.
-Symptoms include , visuoperceptual deficits, it follows alzheimwes vwrbal function
deterioration
-Half of the patients experience depression

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Subcortical Dementias
-Subcortical dementia is a clinical syndrome characterized by slowness of mental
processing, forgetfulness, impaired cognition, apathy, and depression.
-A result of degeration in subcortical brain region like substantia nigra.
-It is typically seen in vascular, infectious, autoimmune, inflammatory, and movement
disorders
- Major difference between the cortical and subcortical dementia is that subcortical is
behavioural

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Types
1. Movement Disorders – chqracterised by
involuntary quick or slow motor movement-
-The biggest group of patients has this disorder as
the disease has exrapyramidial motor system
which controls

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Conti.
2. Parkinson Disease or Parkinsonism
-Parkinson's disease (PD) is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain
called the basal ganglia and the substantia nigra.
- Stages involved include stage 1, mild , when impression is affected by the one side of face affected, rigidity, clumsy
leg, tremor on hand.
- Second stage- mild stage in which there is speech disorientation, loss of facial expression, decreased blinking,
- -Stage 3- moderate , characterised by loss of balance and slow movements
- -Stage 4-severe, inability to walk without assistance
- Stage 5- severe, patients may fall when standing, hallucinations and delusions

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3. Huntington’s Disease
-It is caused by a defective gene

-Motor disturbance, cognitive impairment, and psychiatric disorders together form the symptom triad.

-The parts of the brain affected include the areas called the basal ganglia and cerebral cortex. These
inter-connected areas are associated with different types of activity including movement, learning,
thinking, planning, motivation and emotion.

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4.Proggressive supranuclear palsy
-PSP is a progressive degenerative disease that erodes subcortical structures and alters cortical—
primarily prefrontal—functioning as subcortical-cortical interconnections breakdown.

-The degenerative process appears to disconnect ascending pathways from these subcortical
structures to the prefrontal cortex

-This disease often coexists with other neurodegenerative disorders .

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Brain Tumors
A cancerous or non-cancerous mass or growth of
abnormal cells in the brain.
Tumours can start in the brain, or cancer
elsewhere in the body can spread to the brain.

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Types
1. Primary brain tumors
-Primary brain tumors include tumors that originate from the tissues of the brain or the brain's
immediate surroundings. Primary tumors are categorized as glial (composed of glial cells) or
non-glial (developed on or in the structures of the brain, including nerves, blood vessels and
glands) and benign or malignant.
A) Meningioma -A usually non-cancerous tumour that arises from the membranes surrounding
the brain and spinal cord
B) CNS lympoma-Primary central nervous system (CNS) lymphoma is a disease in which
malignant (cancer) cells form in the lymph tissue of the brain and/or spinal cord.

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Secondary Brian Tumors
-Metastatic brain cancer (also called secondary brain tumors) is caused by cancer cells spreading
(metastasizing) to the brain from a different part of the body.

-The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin
(melanoma), colon, kidney and thyroid gland.

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Central nervous system symptoms
arising from brain tumors
-Brain tumors can compromise brain functioning by
1) )by producing generalized symptoms associated with increased ICP—such as headache (which occurs
in about half of all patients and is typically diffuse and most pronounced on wakening),occasionally
nausea and vomiting,and sixth nerve palsy(paralysis of lateral eye movements)

2) By inducing seizures, which are typically focal or secondarily generalized

3) By producing focal symptoms—such as hemiparesis and aphasia—that reflect progressive invasion or

displacement of brain tissue and can suggest tumor location

4) By secreting hormones or altering endocrine patterns involving a variety of body

functions(DeAngelis,2001).

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