Brain Functions & Map 1

Brain Functions and Map Online Resources: Brain Injury Resource Foundation

http://www.birf.info/home/bi-tools/brainmap/qlinks_bramap.html BBC: Science & Nature: Human Body & Mind

http://www.bbc.co.uk/science/humanbody/body/interactives/organs/brainmap/index.shtml

Brain Functions & Map 2

The brain has many parts including the cerebral cortex, brain stem, and cerebellum. By listing some of the functions of each part of the brain, we will provide an overview of what problems occur after injury to these parts. It is important to understand that the brain functions as a whole by interrelating its component parts. An injury may only disrupt a particular step of an activity that occurs in a specific part of the brain. The interruption of that activity at any particular step, or out of sequence, can reveal the problems associated with the injury. Below is a list of functions and deficits or problems revealed when injury occurs at particular locations. The terms in parenthesis are the professional terms used to describe the deficit. Please refer to the Brain Map for more details and related references

Brain Functions & Map 3

CEREBRAL CORTEX FRONTAL LOBE: Most anterior, right under the forehead Functions:

• How we know what we are doing within our environment (Consciousness) • How we initiate activity in response to our environment • Judgments we make about what occurs in our daily activities • Controls our emotional response • Controls our expressive language • Assigns meaning to the words we choose • Involves word associations • Memory for habits and motor activities

Observed Problems: • Loss of simple movement of various body parts (Paralysis) • Inability to plan a sequence of complex movements needed to complete multi-stepped

tasks, such as making coffee (Sequencing) • Loss of spontaneity in interacting with others • Loss of flexibility in thinking • Persistence of a single thought (Perseveration) • Inability to focus on task (Attending) • Mood changes (Emotionally Labile) • Changes in social behavior • Changes in personality • Difficulty with problem-solving • Inability to express language (Broca's Aphasia)

PARIETAL LOBE: near the back and top of the head Functions:

• Location for visual attention • Location for touch perception • Goal-directed voluntary movements • Manipulation of objects • Integration of different senses that allows for understanding a single concept

Observed Problems: • Inability to attend to more than one object at a time • Inability to name an object (Anomia) • Inability to locate the words for writing (Agraphia) • Problems with reading (Alexia) • Difficulty with drawing objects • Difficulty in distinguishing left from right • Difficulty with doing mathematics (Dyscalculia) • Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads

to difficulties in self-care • Inability to focus visual attention • Difficulties with eye and hand coordination

OCCIPITAL LOBES: Most posterior, at the back of the head Functions:

• Vision Observed Problems:

• Defects in vision (Visual Field Cuts) • Difficulty with locating objects in environment • Difficulty with identifying colors (Color Agnosia) • Production of hallucinations

Brain Functions & Map 4

• Visual illusions - inaccurately seeing objects • Word blindness - inability to recognize words • Difficulty in recognizing drawn objects • Inability to recognize the movement of an object (Movement Agnosia) • Difficulties with reading and writing

TEMPORAL LOBES: Side of head above ears Functions:

• Hearing ability • Memory acquisition • Some visual perceptions • Categorization of objects

Observed Problems: • Difficulty in recognizing faces (Prosopagnosia) • Difficulty in understanding spoken words (Wernicke's Aphasia) • Disturbance with selective attention to what we see and hear • Difficulty with identification of, and verbalization about objects • Short-term memory loss. Interference with long-term memory • Increased or decreased interest in sexual behavior • Inability to catagorize objects (Categorization) • Right lobe damage can cause persistant talking • Increased aggressive behavior

BRAIN STEM: Deep in Brain, leads to spinal cord Functions:

• Breathing • Heart Rate • Swallowing Reflexes to seeing and hearing (Startle Response) • Controls sweating, blood pressure, digestion, temperature (Autonomic Nervous

System) • Affects level of alertness • Ability to sleep • Sense of balance (Vestibular Function)

Observed Problems: • Decreased vital capacity in breathing, important for speech • Swallowing food and water (Dysphagia) • Difficulty with organization/perception of the environment • Problems with balance and movement. Dizziness and nausea (Vertigo) • Sleeping difficulties (Insomnia, sleep apnea)

CEREBELLUM: Located at the base of the skull Functions:

• Coordination of voluntary movement Balance and equilibrium • Some memory for reflex motor acts

Observed Problems: • Loss of ability to coordinate fine movements • Loss of ability to walk • Inability to reach out and grab objects • Tremors • Dizziness (Vertigo) • Slurred Speech (Scanning Speech) • Inability to make rapid movements

Brain Functions & Map 5

BRAIN SYSTEMS References: Amen, D. (1997). Windows into the A.D.D. mind: Understanding and treating

Attention Deficit Disorder childhood through adulthood. Fairfield, CA: MindWorks Press.

Amen, D. (1998). Firestorms in the brain: An inside look at violent behavior. Fairfield, CA: MindWorks Press.

Brain System: Limbic System

Location: center of deep brain; walnut-size Controls: • emotional tone • stores highly charged emotional memories (positive & negative) • processes social contacts (e.g., parental-child bonding) • affects motivation & drive • controls sleep & appetite cycle of the body • center for powerful pleasure (e.g., sex drive) and pain • processes sense of smell (hence, strong association of smells to emotions) Behavior Resulting from Dysfunction: • irritability • depression • increased negative thinking & hopelessness • decreased motivation & energy (“I don’t care” attitude) • sleep & appetite problems • social isolation & withdrawal • decreased or increased sexual responsiveness Factors Influencing Dysfunction: Traumatic Brain Injury Stress Drug/Alcohol abuse Toxic/Infectious Disease exposure Genetics Medications Used to Control Dysfunction: Anti-depressants: Serotenergic/SSRI/Tricyclic medications Prozac Zoloft Paxil Serzone Anafranil Effexor St. John’s Wort

Brain System: Basal Ganglia Location: Toward center of brain; surrounds the deep limbic system Controls: • Integrating feelings/thoughts/movements • Controls smooth integration of emotions, thoughts & motoric behaviors and shifts • Controls/Sets anxiety levels, motivation, feelings of pleasure/ecstasy Behavior Resulting from Dysfunction: Underactive: • deficiency in dopamine in basal ganglia is characterized by symptoms of AD/HD • individual can respond quickly &/or without fear in stressful/crisis situations (respond without

thinking of consequences) • dysgraphia; • finger agnosia – inability to commit thoughts to paper • evident in Parkinson’s & Tourette’s syndrome

Brain Functions & Map 6

Overactive: • excess of dopamine may result in individual being overwhelmed by stressful/crisis

situations: tendency to “freeze” in such situations • anxiety/stress increase Factors Influencing Dysfunction: Traumatic Brain Injury Stress Drug/Alcohol abuse (Cocaine, Ritalin enhance dopamine availability in the brain for short

periods of time and then there is a craving for more leading to more severe addiction) Genetics Toxic/Infectious Disease exposure Medications Used to Control Dysfunction: Primarily stimulants: Ritalin Adderall Dexedrine/Desoxyn Cylert L-dopa (dopamine)

Brain System: Temporal Lobes Location: Behind the eye sockets and under(neath) the temples Controls: • Storage of experiences/memory • Interprets what we hearby integrating sounds we process with memories • Controls auditory & visual processing • Processing of language, auditory learning, word retrieval, short- & long-term & complex

memory • Defines oneself/identity • Enhances motor stability Behavior Resulting from Dysfunction: • Characteristic behavior: Out-of-control Emotions • Abdominal pain without clear explanation/cause • Aggression/Violence; quick temper; rage behaviors • Amnesia/Memory problems • Feelings of déjà vu & jamais vu (not recognizing the familiar) • Panic/Anxiety/Fear/Paranoia for no compelling reason (irrational) • Difficulty in social situations • Difficulty processing sounds/speech • Visual distortions/processing problems (hallucinations) • Excessive writing • Reading difficulties • Religious/Moral preoccupation (excessive religiosity) • Seizures • Periods of spaciness & confusion • Suicidal ideation/actions • Schizophrenia • Alzheimer’s symptoms • Brain of violent individual shows abnormal activity (either increased or decreased) Factors Influencing Dysfunction: Traumatic Brain Injury Drug/Alcohol abuse Genetics Stress Toxic/Infectious Disease exposure Medications Used to Control Dysfunction: Anti-convulsants: Tegretol Depakene/Depakote Neurontin, Lamictal Dilantin

Brain Functions & Map 7

Brain System: Pre-Frontal Cortex Location: Located at the front tip of the brain directly underneath the forehead Controls: Organization/Planning of daily life • Controls emotions • Translates emotions into actions & words Behavior Resulting from Dysfunction: • Characteristic behavior: Acting without Thinking • Childish behavior • Capricious • Obstinate • Rude • Contrary • Argumentative • Conflict seeking • Poor judgment • Foul language/Swearing • Inconsiderate of others • Blurts out at inappropriate times or interrupts frequently • Impulsivity • Disorganization (in daily living) • Attentional problems: attention span, distractibility, procrastination, poor judgment • Brain of violent individual shows decreased activity (when required to concentrate) Factors Influencing Dysfunction: Traumatic Brain Injury Drug/Alcohol abuse Genetics Stress Toxic/Infectious Disease exposure Medications Used to Control Dysfunction: Primarily stimulants: Ritalin Adderall Dexedrine/Desoxyn Cylert Anti-convulsants may be helpful especially in the case of known head/brain trauma

Brain System: Cingulate System Location: Runs lengthwise through the deep part (cingulate gyrus) of the frontal lobe (interior) between the Left & Right hemispheres Controls: • Change thoughts from one to another (cognitive flexibility) • Change focus of attention from one thing to another Behavior Resulting from Dysfunction: • Characteristic behavior: Stuck on Negative Thinking Overactivity • Feelings of insecurity & pessimism about the future • Worry can lead to emotional & physical harm to oneself • Argumentative, oppositional, stubbornly resistant • Addictive behaviors: alcohol &/or drug abuse, eating disorders • Obsessive-compulsive disorder (OCD) • Perseveration • Overfocused on specific things • Decreased impulse control violent behaviors • Impaired concentration

Brain Functions & Map 8

• Thinking disorders (can’t find solutions, resolve problems) • Brain of violent individual shows increased activity Factors Influencing Dysfunction: Traumatic Brain Injury Drug/Alcohol abuse Genetics Stress Toxic/Infectious Disease exposure Medications Used to Control Dysfunction: Anti-convulsant/seizure medications: Tegretol, Depakene/Depakote Neurontin, Lamictal Dilantin Anti-depressants: Serotenergic/SSRI/Tricyclic medications Prozac Zoloft Paxil Remeron Anafranil Effexor Luvox St. John’s Wort

Mood Medications Reference: http://www.adaa.org/GettingHelp/AnxietyDisorders/chart.htm NOTE: The information in this table applies to the treatment of anxiety disorders in adults age

18 and older, not to the treatment of these conditions in children and adolescents. KEY: This chart lists the names of drugs commonly prescribed for anxiety disorders, the

disorder for which they're indicated, and how they are thought to work. GAD = Generalized anxiety disorder * = Generic commercially available OCD = Obsessive-compulsive disorder † = FDA approved for the treatment of one

or more anxiety disorders PD = Panic disorder PTSD = Posttraumatic stress disorder SAD = Social anxiety disorder

Drug Class Brand Name Generic Name Target Anxiety

Disorder How It's Thought to Work Antidepressants Selective Serotonin Reuptake Inhibitors (SSRIs)

Celexa Lexapro † Luvox † Luvox CR † Paxil * † Prozac * † Zoloft †

Citalopram Escitalopram Fluvoxamine Paroxetine Fluoxetine Sertraline

PD, OCD, SAD, GAD, PTSD

Affects the concentration and activity of the neurotransmitter serotonin, a chemical in the brain thought to be linked to anxiety disorders.

Tricyclic Antidepressants (TCAs)

Adapin * Anafranil * Aventyl * Elavil * Ludiomil * Norpramin * Pamelor * Sinequan * Surmontil * Tofranil * Vivactil *

Doxepin Clomiprimine Nortriptyline Amitriptyline Maprotiline Desipramine Nortriptyline Doxepin Trimipramine Imipramine Protriptyline

PD, PTSD, GAD OCD (Anafranil only)

Affects the concentration and activity of the neurotransmitters serotonin and norepinephrine, chemicals in the brain thought to be linked to anxiety disorders.

Monoamine Oxidase Inhibitors (MAOIs)

Marplan * Nardil * Parnate *

Isocarboxid Phenelzine Tranylcypromine

PD, SAD, PTSD Blocks the effect of an important brain enzyme, preventing the breakdown of serotonin and norepinephrine.

Other Antidepressants

Cymbalta Desyrel * Effexor † Remeron

Duloxetine Trazodone Venlafaxine MIrtazapine

PD, OCD, SAD, GAD, PTSD (sparse data for PTSD)

Affects the concentration of the neurotransmitters serotonin and/or norepinephrine, chemicals in the brain thought to be linked to anxiety disorders.

Drug Class Brand Name Generic Name Target Anxiety

Disorder How It's Thought to Work Wellbutrin Bupropion No current

indication for any anxiety disorder. Depression, possibly ADHD

Exact mechanism unknown; effects may be mediated through the neurotransmitters norepinephrine and dopamine

Anxiolytics Azapirones BuSpar * † Buspirone GAD Enhances the activity of

serotonin. Benzodiazepines Ativan *

Dalmane * Klonopin * † Halcion * Librium * Restoril * Serax * Tranxene * Valium * Xanax * †

Lorazepam Flurazepam Clonazepam Triazolam Chlordiazepoxide Temazepam Oxazepam Clorazepate Diazepam Alprazolam

GAD, SAD, PD Exact mechanism unknown; some research shown to enhance the function of gamma aminobutyric acid (GABA).

Antihistamines Atarax, Vistaril * Hydroxyzine GAD Sedative effects through blockade of histamine receptors in the brain.

Anticonvulsants Augmentation therapy

These medications may be added when symptoms respond partially to another medication to increase the overall response to treatment.

Gabitril Neurontin Tiagabine Gabapentin

Enhances the function of GABA.

Depakote * Lamictal Topimax

Valproate Lamotrigine Topiramate

Exact mechanisms unknown; possible effects include enhancing or inhibiting effects of neurotransmitters associated with anxiety and blockade of sodium channels in the brain.

Noradrenergic Agents

Beta Blockers Inderal * Tenormin *

Propranolol Atenolol Prazosin

Performance anxiety, possibly PD

Blocks receptors associated with physiologic symptoms of anxiety.

Alpha Blocker Minipress * Catapres Tenex

Prazosin Clonidine Guanfacine

PTSD (nightmares) Some evidence

Drug Class Brand Name Generic Name Target Anxiety

Disorder How It's Thought to Work in PTSD, anticipatory anxiety

Atypical Antipsychotics

Augmentation therapy

These medications may be added when symptoms respond partially to another medication to increase the overall response to treatment.

Abilify Geodon Risperdal Seroquel Zyprexa

Aripiprazole Ziprasidone Risperidone Quetiepine Olanzapine

Affects the concentration and activity of the neurotransmitter serotonin, a chemical in the brain thought to be linked to anxiety disorders.