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Lecture 5 – The temporal lobe

Overview
- Topic entryway: Temporal lobe epilepsy
- Anatomy
- Temporal lobe function and networks
- Disorders and symptom assessment

Topic entryway: Temporal lobe epilepsy

Temporal Lobe Epilepsy (TLE)

- Temporal lobe epilepsy → The epileptic seizures are in the temporal lobe.
- Epilepsy → A condition that causes frequent seizures.
o Seizures → Bursts of electrical activity in the brain that temporarily disrupt
functioning.
- TLE is among the most common forms of epilepsy.
o Causes → Traumatic brain injury, infections (e.g., encephalitis or meningitis), brain
tumor, stroke.
▪ When you disrupt the physical structure of the brain it can create electrical
problems.
▪ Infections can cause brain swelling or extra fluid in the brain which disrupts
the brain.
▪ However, often the cause is unknown which makes it very hard to treat the
underlining problem that causes the epilepsy.
o Age of onset → Can start at any age but usually starts in childhood or after age 60.
▪ Brain injury can happen at any age which can result in epilepsy.
▪ During childhood and after age 60 there are already a lot of changes in the
brain happening which makes it easier for a brain injury or something else to
disrupt the electrical signaling in the brain.
o Treatments → Medications, surgeries, brain stimulation.
▪ However, epilepsy often cannot completely be controlled by treatments.
o Side effects → Drowsiness, forgetfulness, anxiety, loss of creativity.
▪ A lot of patients are severely suffering from the side effects.

TLE patient experience

- https://www.youtube.com/watch?v=rp8fKX8Gsf0
- TLE can be hard to be diagnosed because symptoms are not always clear.
o This patient only got diagnosed when the symptoms became very severe.
- Temporal lobe epilepsy can cause auditory hallucinations, temperature changes, déjà vu
auras, memory problems.

TLE déjà vu auras

- https://www.youtube.com/watch?v=aUa30_msY4U
- Déjà vu → Injected into a dream → Having a really intense dream where everything feels
very familiar but foreign at the same time.
- After the seizure the person often forget the déjà vu auras.
- Déjà vu auras are the start of a seizure.

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Types of seizures
- The types of seizures are based on how severe the seizure is.
- 3 types:
o Focal onset:
▪ Most common type for epilepsy.
▪ Person remains aware during the seizure because the point of origin of the
seizure remains in one hemisphere → The other hemisphere is still
functioning correctly and is not disrupted so the patient can stay conscious.
▪ Because only half the brain is affected, the seizure is often milder.
o Generalized onset:
▪ The electrical disruption affects both hemispheres → More severe type.
▪ Person loses awareness.
o Unknown onset:
▪ This happens when the seizure isn’t witnessed by anyone, and the patient
doesn’t remember whether or not they were aware during the seizure.
• The seizures can affect memory also when it is focal so a patient
might not remember the event very well.

Tonic-clonic seizures
- This is the seizure type often depicted in movies → Jerky movements.
o If onset is unilateral, then it is focal.
o If onset is bilateral, then it is generalized.
- Tonic-clonic (grand mal) seizures → Cause a loss of consciousness and violent muscle
contractions, abnormal electrical activity throughout the brain.
o Very severe type of epilepsy.
- Phases:
o Signs of onset → A partial seizure (called an "aura") → Abnormal sensations such as
a particular smell, vertigo, nausea, or anxiety.
▪ Example → Because of the electrical disruption your brain gets stimulated as
if there is a particular smell.
o Tonic phase → Sudden stiffness or tension in the muscles of the arms, legs, or torso.
▪ If they are standing, then they may fall when it is a bilateral general seizure.
▪ Here the patient loses consciousness.
o Clonic phase → Repeated jerking movements of the arms and legs on one or both
sides of the body, sometimes with numbness or tingling (when they are conscious
during seizure).
o Postictal Period → Period after a seizure when the brain is recovering.
▪ People often are still unconscious, or they fall asleep because of the seizure
is extremely stressful and highly energy consuming.
▪ The electrical activity of the brain is no longer disrupted.

Electrical seizure activity

- Electrical seizure activity can be seen with EEG.
o Cap nomenclature key:
▪ FP = Prefrontal (frontopolar)
▪ F = Frontal
▪ C = Central
▪ T = Temporal

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▪ P = Parietal
▪ O = Occipital
▪ A = Ears
▪ Odd number → Left side of the brain.
▪ Even number → Right side of the brain.
- Because the scalp is a bad electrical conductor, we cannot talk about the exact located
where the electrical activity is happening, we can only talk about the electrical changes.
- Electrical changes can be seen on EEG when gross motor changes aren’t obscuring the
signal.
o Brain waves are very small compared to movement → Therefore it is not always a
good measure because the movements during a seizure can obscure the signal.
- In the video they use an average reference montage → The average of the scalp’s electrical
current is compared to the electrical signal individually at each measurement point.
o https://www.youtube.com/watch?v=zZLaElM5YY0
o Picture 1 → Clinical seizure → High frequency →
Visible motor movements.
▪ Clonic stage when there are jerking
movements.
o Picture 2 → Electrical seizure → Invisible/subclinical
electrical activity.
▪ Has a clear beginning and end of the activity.
▪ There is an evolution in frequency and amplitude:
• First there is delta frequency and then theta frequency → Higher
frequency.
• The amplitude will increase.
o Picture 3 → Normal brain waves.
▪ Much slower waves → Lower frequency.
▪ No rhythm in the waves → Different things are going on.

EEG measures active synapses of pyramidal neurons closest to the scalp.

- Complexity of pyramidal neurons increases from posterior to
anterior brain regions → The higher the hierarchical organization
the more complex the pyramidal neurons are.
- Degree of complexity is theorized to reflect cognitive capabilities
→ This theory echoes hierarchical organization theory.

Temporal lobe anatomy

- Temporal lobe compared to the occipital lobe:
o It is more sophisticated than the occipital lobe.
o It has more functions than the occipital lobe → Vision, emotion, memory, hearing,
smelling.
o It is more complex and movement within the temporal lobe is
more varied → It is more flexible and more adaptable to life.
- Superior temporal gyrus → Auditory processing occurs.
- Inferotemporal cortex → Visual processing occurs.
- Pyriform cortex → Olfactory processing & memory occur.
o Olfactory bulbs are close to the hippocampus.
- Fusiform gyrus → Facial recognition & processing occur.

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- Corpus callosum → Bilateral communication between the hemispheres.

- Hippocampus and hippocampal gyrus → Spatial navigation and spatial object
memory occur.
- Amygdala → Emotion processing occurs.
o Mostly fear and threat emotions but also other emotions.
- Insula → Processes subjective feelings and salience detection occurs.
o Things that are salience are easier to remember → Emotions make
things salience.
o The lateral (Sylvian) fissure contains tissue forming the insula.
- Superior temporal sulcus (STS) → Biological motion occurs.
o Separates the superior temporal gyrus
and the middle temporal gyrus.

Ventral stream anatomy → What pathway

- The temporal lobe has an important role in object recognition → The ventral
stream that comes from the occipital lobe will enter the temporal lobe → What
pathway (TE and TEO).
- We don’t know that much about these anatomical regions of the brain. What has
been determined is:
o TE → Feature analysis and category processing.
▪ The features of something are what creates a category.
o TEO → Function unclear.
- TEO and TE → Together used for object categorization.
o If TE is removed bilaterally in animals, objects can still be recognized and
categorized.
▪ We assume this is also true for humans based on brain imaging studies.
o If TEO is removed bilaterally in animals, there is mild impairment of object
recognition.
▪ So TEO has something to do with object recognition, but the exact function
remains unknown.
o If both TE and TEO are removed bilaterally in animals, object recognition becomes
severely impaired and might not rehabilitate.
▪ Neuroplasticity will not lead to rehabilitation when both TE and TEO are
removed.
- So, when you talk about the What pathway the TE and TEO are fundamental and are the
main parts that define the What pathway (object recognition).

Cortical columns in TE
- The right picture is a visual representation of the anatomical organization of the
neurons.
- Neurons that respond to similar categories of shapes form columns in the TE of
the brain.

Temporal lobe function & networks

The temporal lobe is a secondary processing area.

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Main functions of the temporal lobe → Sensory processes.

- 1. Processing auditory input.
o Helps Broca’s area (which is in the frontal lobe) → Speech & language perception,
music (right lobe = melody, left lobe = rhythm).
▪ The frontal lobe is a higher brain region → It is more sophisticated.
▪ The temporal lobe is a lower brain area and feeds in the Broca’s area.
▪ When there is damage to the Broca’s area:
• Parts of the temporal lobe might be able to assume the function of
the Broca’s area and rehabilitate this function.
• Parts of the temporal lobe might be able to provide a more basic
function of the Broca’s area that allows the person to still complete
tasks in daily life.
- 2. Visual object recognition.
o Including faces.
- 3. Long-term storage of sensory input (memory).
o Hippocampus is located in the temporal lobe.
o Hippocampus is involved in storage of all kinds of memory.
- 4. Processing olfactory input.
o Smell and memory are linked → Brain region responsible for processing olfactory
input also has olfactory memory storage and the hippocampus is located right next
to it and can convert the smell into long-term memory storage.
o Smell can also help you to remember things.
- 5. Spatial navigation.
o The hippocampus plays a role in spatial navigation.

Other functions of the temporal lobe

- Affective Responses.
o Amygdala → Emotional reactions to threats.
- Biological Motion.
o STS.
o The hippocampus helps a bit by remembering the elements of the motions.
- Learning and other memory processes.
o Hippocampus → Memory.
o Insula → Feelings, salience.
▪ How your experience emotions (affective state).

Temporal lobe networks for face recognition

- There are parts of the temporal lobe that talk to other parts of the temporal lobe.
o Core system (internal in temporal lobe) → Visual analysis.
▪ Early perception of face features → Inferior occipital gyri.
▪ Perception of unique identity of the faces → Fusiform face area.
▪ Processing changeable things of faces like eye gaze, expression,
and lip movement → Superior temporal sulcus.
- Other parts of the temporal lobe talk to other parts of the brain.
o Extended system → Further processing in concert with other neural
systems.
▪ The anterior temporal cortex, amygdala, insula, limbic system,
intraparietal sulcus, and the auditory cortex feed in the other

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brain regions a lot more but also give a lot of feedback to each other within
the temporal lobe network.

Disorders and symptom assessments

Asymmetry of function
- Damage to left temporal lobe.
o Deficits in verbal memory function.
o Deficits in processing speech sounds.
- Damage to right temporal lobe.
o Deficits in nonverbal memory function (e.g., facial memory, facial expression
recognition).
▪ Things that you can see but cannot really put into words.
o Deficits in processing nonspeech sounds (e.g., music).

Temporal lobe epilepsy

- The general clinical impression is that temporal-lobe patients may exhibit a personality
change.
o “Temporal-lobe personality” is a set of traits that may be seen in temporal lobe
epilepsy patients.
- “Temporal-lobe personality” is controversial.
o There has been a long history where clinicians noticed that having seizures on a
regular basis that it can lead to personality changes.
▪ These personality changes seemed to be most correlated with temporal
lobe seizures → Led to the temporal-lobe personality.
o However, there is a lot of research that start to doubt if temporal-lobe personality
is real.
▪ Only some of the traits emerge in some TLE patients.
▪ Usually, they are mild and not all seen in a single patient → TLP is more a
stereotype of people who have TLE, but it is not nuanced enough to describe
single patients.
▪ Theorized to be caused by neural plasticity coping with changes or damage
→ Temporal-lobe personality is a sign of rehabilitation to some degree.

Damage location by symptom

- The symptoms correspond with the anatomy of the
brain and where the damage is done.
- Example:
o Disorder of music perception → Damage in the
superior temporal gyrus.
o Disorders of auditory perception → Damage near the auditory processing areas.
- When somebody experience TLE these (see table) are all areas that can be disrupted
depending on origin of the epilepsy.

Temporal-lobe personality
- Altered sexual interest → Loss of libido and hyposexualism or hypersexual episodes,
exhibitionism, fetishism, transvestitism.
- Anger and aggression → Heightened temper, irritability, and overtly hostility.

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o This could be because the amygdala is damaged.

- Emotionality → Deepened emotion; sustained, intense bipolar disorder and exhilarated
mood.
o This could emerge because of damage to the insula or amygdala.
- Guilt → Self-scrutiny and self-recrimination.
- Hypermoralism → Scrupulous attention to rules without distinguishing significant from
minor infractions.
- Viscosity → “Stickiness”; tendency to repetition (stuck in a thought).
- Obsessiveness → Ritualism; orderliness; compulsive attention to detail.
- Humorlessness, sobriety → Overgeneralized, overbearing concern; humor lacking or
idiosyncratic.
- Hypergraphia → Extensive diary keeping, detailed note taking; writing poetry,
autobiography, or novel.
- Paranoia → Suspicious, overinterpreting motived and events; paranoid schizophrenia
diagnosis.
- Religiosity → Deep religious beliefs; often idiosyncratic multiple conversations or mystical
states.
o So, the temporal lobe might be relevant to understand religious beliefs.
- Sadness → Discouraged, fearful, self-deprecating; depression diagnosis; suicidal thought or
tendencies.
o Related to damage of the insula.

Autism (not a “temporal lobe disorder”, but...)

- Autism is very heterogeneous → Hard to diagnose/recognize sometimes because patients
can look so different.
- Autism is a developmental disorder.
- Main characteristics of autism:
o Impaired social skills → Difficulties processing social information, understanding
people’s intensions and facial expressions.
o Stereotypic motion → Hyper interest in light or objects that are physically moving or
doing repetitious motions themselves.
o Communication deficits → Difficulty with communicating with other people,
understanding own desires and intentions.
- There are three major things that are happening in the temporal lobe that are relevant to
these autism symptoms.
o Facial processing difficulties.
▪ Decreased activation of the fusiform face area (FFA) → People with autism
have difficulty with social interaction and reading facial expression.
o Biological motion detection.
▪ People with autism often prefer non-biological motion → Physics.
▪ There is a decreased perception of biological motion and STS activation
during explicit (behavioral output) tasks (e.g., indicating when biological
motion is observed).
o Affective processing differences.
▪ Decreased activation of insula.
▪ Atypical functional connectivity of insula.
▪ Sometimes there is hyperactivation of the insula.

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- The question with autism → Which came first: the autism or the difficulty in processing
things in the temporal lobe → Are the difficulties in processing things something that
emerge because of biological state of being autistic or are they the source of becoming
autistic?

Things from the book

Chapter 15, all sections

15.1 Temporal-Lobe Anatomy

The medial temporal region (limbic cortex) includes the amygdala and adjacent cortex (uncus), the
hippocampus and surrounding cortex (subiculum, entorhinal cortex, perirhinal cortex), and the
fusiform gyrus.

The fusiform gyrus and inferior temporal gyrus → Functionally part of the lateral temporal cortex.

Temporal-parietal junction (TPJ) → Cortical region lying along the boundary of the temporal and
parietal lobe → Important for attention, memory, language, and social processing (central in
decision making in a social context).

Connections of the temporal cortex → 6 distinct types of cortical-cortical connections:

- A hierarchical sensory pathway → Stimulus recognition.
- A dorsal auditory pathway → Directing movements with respect to auditory information.
o Analogous to part of the dorsal visual pathway that likely plays a role in detecting the
spatial location of auditory inputs.
- A polymodal pathway → Probably stimulus categorization.
- A medial temporal projection → Crucial to long-term memory.
o Performant pathway → Connects (“perforates”) the hippocampus to medial
temporal (limbic) regions; when disrupted, results in major
hippocampal dysfunction.
- A frontal-lobe projection → Necessary for various aspects of movement
control, short-term memory, and affect.
- Olfactory projections → Related to odor perception and memory.

Anatomy of the ventral stream → At least 6 distinct pathways.

- Occipitotemporal-neostratial network → Set of subcortical projections
from every region of the occipitotemporal pathway that extends to the
neostratium.
- From the TE to the amygdala → Processing of emotionally salient stimuli.
- From the inferotemporal cortex to the ventral striatum → Support
assignment of stimulus valence (potency).
- From the TE to the medial temporal cortex → Long-term memory.
- From the TE to the orbitofrontal cortex → Object-reward association.
- From the TE to the ventrolateral prefrontal → Object working memory.

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15.2 A Theory of Temporal-Lobe Function

The multifunctional temporal lobe houses the primary auditory cortex, secondary auditory and
visual cortex, limbic cortex, part of the primary olfactory cortex, and the amygdala and
hippocampus.

Cross-modal matching → Matching visual information with auditory information.

- Likely happens in the cortex of the superior temporal sulcus.

Biological motion
- The STS receives multimodal inputs that play a role in categorizing stimuli.
- A major category is social perception → Analyzing body movement that provide socially
relevant information.
o Important for social cognition → A theory of mind that allows us to develop
hypotheses about other people’s intentions.

Visual processing in the temporal lobe

- The temporal lobe’s role in visual processing is not determined genetically but is subject to
experience, even in adults → Allows the visual system to adapt to different demands in a
changing visual environment.

There is a clear asymmetry between the temporal lobes in the analysis of faces.
- Right-temporal lobe lesions → Greater effect on facial processing than left-temporal-lobe
lesions.
- Even in control participants you can see an asymmetry in perception:
o Participants were shown photos of faces that are a composite of
the right side of the original face or a composite of the left side of
the original face and they had to tell which one looked more like
the original → Right-handed controls consistently matched the left
side of the original photo with the composite of the left sides →
Left-visual-field bias.

Speech differs from other auditory input:

- Speech sound come largely from three restricted frequency ranges → Formants.
- The same speech sounds vary from one context in which they are heard to another, yet all
are perceived as being the same.
o Example → The sound spectrogram of the letter d in English is different in the
words deep, deck, and duke, yet a listener perceives them all as d.
o The auditory system must have a mechanism for categorizing varying sounds as
equivalent, and this mechanism must be affected by experience.
- Speech sounds change very rapidly in relation to one another, and the sequence of the
sounds is critical to understanding.
- Speech is processed both for comprehension and for directing articulatory movements in
the frontal lobe.

Language perception
- Speech → Motor ability to talk.
- Language → Symbolic, rule-based system used to convey a message.

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- Receptive language → What we can understand.

- Expressive language → Ability to communicate with others through language.

Music perception
- Musical sounds differ from one another in 3 aspects:
o Loudness → Subjective magnitude of an auditory sensation judged by a person.
o Timbre → Distinctive character of a sound → The quality that distinguishes it from
all other sounds of similar pitch and loudness.
o Pitch → Position of a sound in a musical scale as judged by the listener.
▪ Contributes to the tone of voice → Prosody.
- Frequency and pitch.
o Fundamental frequency → Lowest component of a tone.
o Overtones or partials → Frequencies above the fundamental frequency.
o Harmonics → Overtones that are multiples of the fundamental frequency.
o Periodicity pitch → If the fundamental frequency is removed from a
note by means of electronic filters, the overtones are sufficient to
determine the pitch of the fundamental frequency.
o Heschl’s gyrus right temporal lobe → Primary auditory cortex.
▪ Important in periodicity-pitch discrimination →
Determining where a tone is on a musical scale.
- Rhythm.
o Two types of time relationships are fundamental:
▪ Segmentation of sequences of pitches into groups based on the duration of
the sounds → Left temporal lobe.
▪ Identification of temporal regularity, or beat, also called meter → Right
temporal lobe.
- Music memory.
o Retention of melodies is more affected by right temporal injury.
o Right temporal lobe → Generally greater role in producing melody.
o Left temporal lobe → Generally greater role in rhythm.
o The right temporal lobe has a special function in extracting pitch from sound,
whether the sound is speech or music.
- Music and brain morphology
o Musicians’ brains are morphologically different in the area of Heschl’s gyrus →
Cells in the temporal lobe alter their perceptual functions with experience.
▪ The greater the musical aptitude, the larger the gray-matter volume.
o Musical training is a powerful instrument for inducing brain plasticity in
musicians → Therapeutic role in combating the effects of brain injury and aging.
o Music perception and performance include the inferior frontal cortex in both
hemispheres.
o There is considerable variability in the degree of pleasure that different people
experience from music → The greater the white matter connection between the
superior temporal gyrus and the nucleus accumbens that runs via the
orbitofrontal cortex, the greater the musical pleasure.
- Why do we love music?
o Music engages the reward system, especially the nucleus accumbens (NAc) and
associated regions → Caudate nucleus, prefrontal cortex, anterior cingulate cortex,
insula, and amygdala.

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Olfactory processing in the temporal lobe.

- The temporal pyriform cortex has roles in both olfactory perception and memory.

15.4 Symptoms of Temporal-Lobe Lesions

Ten principal symptoms are associated with disease of the temporal lobes:
- (1) Disturbance of auditory sensation and perception.
o Difficulty discriminating speech sounds and judging their temporal order.
o Both audio-perceptual impairments are more severe after left-temporal lobe
lesions.
- (2) Disorders of music perception.
o Damage to right posterior superior temporal gyrus → Disorder of rhythm
discrimination.
o Damage to anterior superior temporal gyrus → Disorder of meter discrimination.
o Congenital amusia → Tone deaf → Abnormality in neural networks for music.
- (3) Disorders of visual perception.
o Damage to right temporal lobe → Impairment in facial perception and recognition
and impairment in seeing facial signals.
- (4) Disturbance in the selection of visual and auditory input.
o Left-temporal-lobe lesions → Impair selective attention to auditory input.
o When two different visual stimuli are presented simultaneously, one at each visual
field:
▪ Damage left temporal lobe → Impairs recall of content of the right visual
field.
▪ Damage right temporal lobe → Impairs recall of content of both visual
fields.
- (5) Impaired organization and categorization of sensory input.
o Patients with left temporal lobectomies → Impaired in their ability to categorize
even single words or pictures of familiar objects.
o Semantic categories → Hierarchies of meaning in which a single word might belong
to several categories simultaneously.
▪ Patients with left posterior temporal lobe lesions → Able to recognize the
broader categorization but difficulty with more specific ones.
- (6) Impaired perception and memory of odors.
o Both temporal-lobe epilepsy and temporal-lobe resections to control epilepsy →
Produce deficits in olfactory discrimination and memory.
- (7) Inability to use contextual information.
o Right temporal lobectomies.
- (8) Impaired long-term memory.
o Anterograde amnesia → Amnesia for alle events after surgery of removal of the
medial temporal lobes.
o Damage to inferotemporal cortex → Interferes with conscious recall of information.
o Lesions of left temporal lobe → Impaired recall of verbal material.
o Lesions of right temporal lobe → Impaired recall of nonverbal material.
- (9) Altered personality and affective behavior.
- (10) Altered sexual behavior.
o Bilateral temporal-lobe damage that includes the amygdala → Increase in sexual
behavior.

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Lecture 6 – The parietal lobe

Overview
- Parietal lobe anatomy & function
- Disorders and symptom assessments

Parietal lobe anatomy & function

Association areas
- Association area → Any processes that aren’t vision, motor, or other basic sensory areas.
- Association areas tend to be more flexible → The anatomy is much more varied.
o The structure is based on neural connections between different regions that are
affected by experience → Here the brain becomes highly individualized.
- Areas of higher cognitive function.
o Complex processes that allow perception to translate into behaviors.
o Most of the cortex (~80%) is responsible for these intermediary connections.
o Combining sensory modalities so you can have a complex experience of something.
▪ Example → You not only see a chair, but you can also feel the chair, hear the
chair, etc.
o Attention is shifted → Being able to shift attention when you hear something loud
for example which is a very complex process.
o Planning occurs.
o Memories are stored → More sophisticated ways than just short-term memory.
- Agraphia → No longer being able to write.
o Caused by a lesion in the parietal-temporal-occipital association area.
o Writing is very complex → Language is involved, visual imagery is involved, symbolic
representations are involved, representing sounds and thoughts are involved, and
motor skills are involved.

Lobe function
- Occipital Lobe → Vision.
- Temporal → Vision, audition, smell, emotion, biological motion, memory.
- Parietal:
o Vision → The parietal lobe is part of the Where (dorsal) pathway.
o Sensory perception integration → Integrating multiple senses.
▪ For example → See the chair, feel the chair, hear the chair, etc.
o Taste and touch.
o Movement → There is a lot of body sense in parietal lobe.
o Spatial skills.
o Reading.
o Sensory aspects of episodic memory → Episodic memory is when you are thinking
about events in your life and can imagine for example the sounds (sensory aspect)
that you could hear during the event.
o Physical self → How your body feels and moves through space and your perception
of your body (personal awareness of one's body) → Body schema.
▪ It also has to do with body dysmorphia → The parietal lobe is involved in
having a poor body image.

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o Parietal lobe is also important for self identity:

▪ Episodic memory partly defines who you are.
▪ Also, the way you think about your physical self defines who you are.

Parietal function in broad terms

- Anterior zone → Somatic sensations and perceptions.
o Somatic → Bodily.
- Posterior zone → Sensory integration and whole-body movements.
- These networks connect to all other lobes and feed very much into
the frontal lobe.

Major functional regions

- Superior parietal lobe
- Inferior parietal lobe
- Somatosensory cortex
- Precuneus

Superior parietal lobe

- Spatial orientation
o Needed for visual perception → Helps you knowing where something
is.
o You need to know where something is in space in order to
understand what you see.
o Includes object manipulation → Using objects, grabbing objects.
▪ In order to grab an object, you need to have the spatial sense
of where the object is and where your body is in relation to it.

Inferior parietal lobe

- Spatial attention and multimodal sensory integration.
o Spatial attention → Not only knowing where something is but also pay your
attention to it.
▪ When you pay attention to something and hear for example a noise your
inferior parietal lobe makes it possible for you to understand where the
sound is coming from and how you can pay attention to it.
▪ Attention → In general when you are paying attention to one thing,
attention is like a spotlight.
o Needed for visual perception.
o Paying attention to movement/location.
o Produces complex sensory experiences.

Dorsal stream anatomy → Where and How pathway.

- The inferior and superior parietal lobe are where the “Where” and “How”
pathway is.
o How pathway → You need to know where something is in order to
know how you can use it.
- Dorsal stream → Spatial awareness, guidance of actions, localizing objects in space.
- The dorsal stream also includes the supramarginal gyrus → Important for tactile perception
and location of limbs.

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Somatosensory cortex
- This part of the brain is organized spatially → Based on how your body is laid
out.
- The amount of cortical space for a certain
body part corresponds with how complex the
body part is.
o Example → Your torso is not as
sophisticated as your tongue and
therefore the size of cortical area for
your torso is much smaller than for your tongue.
- Adjacent to the primary motor cortex.
o Primary motor cortex → Frontal lobe.
▪ It is organized in the same way as the somatosensory cortex.
o Somatosensory cortex → Parietal lobe.
o Divided by the central sulcus.
- In the somatosensory cortex the neurons are organized in columns.
o All the neurons in a column specialize in
similar things.
o Some of the columns are dedicated it speed
→ Fast adapting neurons.

Precuneus
- Highly complex → Important association area.
- May facilitate over 60 processes.
- Functions:
o Visuo-spatial imagery → When you are imagining in your mind what something
looks like.
o Episodic memory retrieval → Thinking about an event that happened to you.
o Self-processing → Thinking about who you are and how you physically are in space.
o First-person perspective taking → How you look into the world and have a certain
opinion about certain things.
o Experience of agency → Having the feeling of freedom and being a free being with
the ability to choose.
o Self-consciousness → Being able to look at yourself and think about who you are →
Self reflection.
o Possibly consciousness in general → The feeling that you are experiencing things.
- Default mode network (DMN) → Brain processes that are active when brain is at rest.
o Precuneus is functionally central to DMN → Major network that is active.
o There are mostly social activations during rest → When we are rest, we are
processing social information that has happened to us.
o Support → In people with autism the DMN does not show the same activation in
social brain regions because they tend to think about social things less.

Temporal-Parietal Junction (TPJ) (Temporoparietal Junction)

- Where the two lobes meet and communicate with each other.
- Forms a bridge at the inferior parietal lobe and posterior superior temporal sulcus.
- Is active all the time → Facilitates social cognition, attention, and language
processes.

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o Reorients attention (especially to novel or surprising stimuli) → When you are

paying attention to something and there is a novel or surprising stimuli you will shift
your attention to that new stimulus.
o Theory of Mind → When you are thinking about what someone else might is
thinking about.
▪ Social cognition.
o Empathy & self-awareness.
▪ Related to theory of mind → Insula is involved in feeling (temporal lobe) and
theory of mind is in the parietal lobe.
o Connects environmental information to memories, emotions, & existing knowledge
(especially when information is verbal/linguistic).
▪ This integration helps with language processes → Being able to convert the
connections into speech.

Disorders and symptom assessment

Effects of lateral parietal lesions

- Unilateral neglect → Patients most often have a right parietal lesion.
- Dressing disability → Patients most often have a right parietal lesion.
- Cube counting → Patients have a right parietal lesion.
- Paper cutting → Patients have a right parietal lesion.
- Topographical loss → Patients most often have a right parietal lesion.
- Right-left discrimination → Patients have a left parietal lesion.
- Weigl’s sorting test → Patients most often have a left parietal lesion.
o You can use it with parietal lesions but also with frontal lesions.
o You ask the participant to sort by shape or color depending on
what you are testing.
o You can also ask the participant to use different ways of sorting
(making a pile or columns) → Spatial skills.
- In the table you see that for some things there is lateralization but not for
all people → This has probably to do with neural organization related to things like
handiness.

Common symptoms of parietal lesions and their clinical assessment

- Symptoms:
o Disorders of tactile function → Not being able to feel things or have weird
sensations when you are feeling something.
o Tactile agnosia → Inability to recognize objects through feeling.
o Defects in eye movements.
▪ Two levels → Gross motor skills (looking up down, to the side) and saccades
(very small movements of the eyes).
o Mis-reaching → Not being able to reach something.
o Manipulation of objects → Not being able to use an object.
o Apraxia → Loss of ability to execute or carry out skilled movement and gestures.
o Constructional apraxia → Inability to copy drawings or three-dimensional
constructions.
o Acalculia → Loss of the ability to perform simple calculations.

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o Impaired cross-modal matching → Impairment of matching the visual information

with the right auditory information.
o Contralateral neglect → Deficit in attention paid to one side of the visual field.
o Impaired object recognition.
o Disorders of body image.
o Left-right confusion → Orientation with space is messed up.
o Disorders of spatial ability.
o Disorders of drawing.
- Different tests for testing different functions of the parietal lobe:
o Somatosensory threshold → Two-point discrimination test.
o Tactile form recognition → Seguin-Goddard Form Board (tactile patterns) test.
o Contralateral neglect → Line bisection test.
o Visual perception → Gollin incomplete figures or Mooney closure test.
o Spatial relations → Right-left differentiation test.
o Speech comprehension → Token test.
o Reading comprehension → Token test.
o Apraxia → Kimura Box test.

Asomatognosia
- A loss of knowledge of one’s body, usually considered a type of agnosia caused by parietal
lesion.
- There are several types:
o Anosognosia → Unawareness/denial of illness → Your sick and you either don’t
know it or just don’t amid it.
o Anosodiaphoria → Indifference to illness → You don’t care that you are sick and
throw up everywhere, or you are sick, but you don’t care and thus don’t take good
care of yourself.
o Autopagnosia → Inability to localize/name body parts.
▪ Finger agnosia → The most common type of autopagnosia → Unable to
identify fingers.
o Asymbolia for pain → Absence of typical pain responses.
- Asomatognosias may affect one or both sides of the body, although most commonly the left
side as a result of right parietal lobe lesion.
o Autopagnosia usually results from lesions of the left parietal cortex.

Apraxia
- Loss of movement caused by a brain lesion and not by any damage related to the muscles or
other body parts/processes.
- There are several types:
o Ideomotor apraxia → Disturbance to physical movements → Unable to copy or
make gestures.
▪ Example → When someone is waving hello you are not able to wave back,
you might respond verbally.
▪ Patient with left posterior parietal lesion often present ideomotor apraxia.
o Constructional apraxia → Disturbance to spatial processing → Unable to build a
puzzle or draw a picture.
▪ Having trouble with the Weigl’s sorting test.
▪ Often posterior parietal lesions.

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o Speech apraxia → Disturbance to speech due to brain lesion and not caused by
other types of language disorders (nothing is wrong with the muscles).
▪ There is a brain lesion in the somatosensory cortex that is affected the
ability to use your mouth and tongue in a way that allows you to articulate.
▪ Speech therapy can help a bit in rehabilitating speech.

Contralateral neglect
- Sometimes called hemispatial neglect.
- When a parietal lobe lesion causes patient to ignore stimuli on contralateral side of body.
o Contralateral side → The side opposite the brain lesion.
o Example → When you have a right parietal lobe lesion, when you are trying to do
things in the world you will not see anything that is on the left side.
▪ If you are eating, you will only eat everything on the right side of the plate.
▪ When you are drawing, you will only draw on the right side of the paper.
- Clock test is a classic clinical assessment.
o https://www.youtube.com/watch?v=VdIC-x6UZg0
o Trying to draw a clock.
o Person has trouble with drawing the clock → It looks like she is running out of space
on the page because she does not perceive the whole clock on the page → She
creates her own curvature.
- If you shift your head, then you would be able to see the other side of the visual field that
you first could not see.
o Patients are often not aware of having the impairment because this needs memory
processes and consciousness, and these are often also impaired → Denial of the
deficit.

Gerstmann’s syndrom
- Josef Gerstmann (1924) observed a patient with left parietal stroke and unusual symptoms:
o Finger agnosia → You don’t know which finger is which.
▪ Often also motor problems in moving the fingers.
o Left-right confusion → If you ask the person to touch his right shoulder, he will have
trouble to know which shoulder he has to touch.
o Agraphia → Inability to write.
▪ Relates to the finger agnosia and the motor problems of moving the fingers.
o Acalculia → Inability to perform arithmetic.

Gerstmann’s syndrome exam

- https://www.youtube.com/watch?v=GLJdcmSIoNQ
- The sound quality is bad. Key audio:
o Acalculia 0:52
▪ Doctor: Can you tell me what 4+2 is?
▪ Patient: 3.
o Agraphia 1:20
▪ Doctor: Can you write your name on there?
▪ Patient draws small doodles.
o Left-right confusion 1:56
▪ Doctor: Can you point to your left shoulder?

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▪The patient can do this → He is slow in his movements, but he is able to do it

eventually.
o Finger agnosia 2:31
▪ Doctor: Can you wiggle your index finger?
▪ Patient points to his finger first with his other hand but eventually can wiggle
his index finger.
- Not a very severe case → He is able to do half of the tests correctly but there is a mild
impairment in all tests.

Balint syndrome
- Rezsö Bálint (1909) observed a patient with bilateral parietal lesions and unusual symptoms:
o Could move his eyes but not fixate on visual stimuli → The ability to stop your eyes
from moving is hard.
▪ Most likely to result from lesions in the superior parietal region.
o Displayed simultagnosia → Can only attend to one stimulus at a time and would not
notice other stimuli at the same time.
▪ Reading is very hard because each letter is perceived separately.
o Displayed optic ataxia → A difficulty in reaching for stimuli even when guided.
▪ Most likely to result from lesions in the superior parietal region.
- Video of a patient:
o https://www.youtube.com/watch?v=ROlc68VM9_8
o When a spoon is presented, the patient can see it. When a comb is presented next to
it, the patient can either see the comb or the spoon but not both.
o Moving an object can help to perceive it.

Parietal lobe epilepsy

- A rare from of epilepsy.
- It is a focal epilepsy (otherwise you cannot characterize it because generalized epilepsies
have the same symptoms).
o So, the patient is aware during the seizures.
- Causes bodily sensations during seizures.
- Somatic illusions → A common symptom that causes misperception of real stimuli (e.g.,
feeling like body is falsely morphing, moving, or damaged).
o You are aware and you are seeing and feeling things but because your brain activity
is disrupted, it changes how you interpret the things you see and feeling.
o It often makes the patient feel afraid because it feels like there is something wrong
with his/her body.
- Inability to detect space/distance.
- Dysesthesia → Distortion to the sense of touch that causes feeling of pain without nerve
stimulation (brain itself creates pain).
- Vertigo → Sensation that you, or the environment around you, is moving or spinning.
- Disturbs other brain processes because of network connections.
o Example → Can cause loss of language processes that are in the frontal lobe.

Parietal lobe seizure

- Focal seizures cause bodily distortions.
o https://www.youtube.com/watch?v=zw9B4i7-LDw

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o Because parietal lobe networks across the brain, it is hard to identify the onset
location of focal parietal lobe seizures using brain imaging.
▪ Electrical disruptions tend to be more spread out.

Schizophrenia (not a “parietal lobe disorder”, but…)

- Abnormal parietal lobe activations can cause psychotic-like symptoms.
o Parietal dysfunction can mimic symptoms of schizophrenia.
▪ Having trouble interpreting space and your body and the where and how
pathways (vision) can really disrupt how you are interpreting the world
which can create the type of break from reality that you see in psychosis.
o But parietal lobe disruptions in schizophrenia are usually modest.
- Disruptions to frontal and temporal lobe are most pronounced in schizophrenia.
- But parietal lobe may be responsible for several symptoms.
o Gray matter volume is reduced across parietal lobe in patients with schizophrenia
→ It can affect the sophistication of your understanding or your ability to process or
perform the things that the parietal lobe is responsible for.
o During hallucinations, activity in the postcentral gyrus and the inferior parietal
lobule increases.
o Distorted sensory integration/misinterpretation → This can lead to hallucination.
o Illusions of control.
▪ One symptom of schizophrenia is mind control → The patient thinks he can
control somebody with their thoughts.
o Poor distinction between self and other → People with schizophrenia sometimes
confuse what properties others have as a person and what properties they have
themselves as a person.
o Poor social cognition related to parietal function → Empathy, theory of mind,
default mode network.

Things from the book

Chapter 14, all sections

14.1 Parietal-Lobe Anatomy

Functional regions of the parietal cortex

- Precuneus region:
o Anterior precuneus → Connected with somatosensory cortex and motor regions →
Sensomotor function.
o Central precuneus → Associated with prefrontal cortex and inferior parietal cortex
→ Cognitive function.
o Posterior precuneus → Functional connectivity with visual regions → Vision-related
functions.

Anatomy of the dorsal stream → Three pathways.

- Parieto-premotor pathway → How pathway.
- Parieto-prefrontal pathway → Visuospatial functions, especially related to working memory
for visuospatial objects.

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- Parieto-medial-temporal pathway → Flows directly to the hippocampus and

parahippocampal regions as well as indirectly via the cingulate and retosplenial cortex →
Spatial recognition and spatial navigation.

14.2 A Theory of Parietal-Lobe Function

Behavioral uses of spatial information

- We need spatial information about the locations of objects in the world both to direct
actions at those objects and to assign meaning and significance to them → Spatial
information is another property of visual information, much like form, motion, and color.
- Sensorimotor transformation → Neural calculations that integrate the movements of
different body parts (eyes, body, arm, etc.) with the sensory feedback of what movements
are actually being made (the efference copy) and the plans to make the movements.
o Depends on both movement-related and sensory-related signals produced by cells
in the posterior parietal cortex.
- Spatial navigation:
o Route knowledge → Having some type of cognitive spatial map in our brain as well
as mental list of what we do at each spatial location to travel about our environment.

The complexity of spatial information

- The ability to manipulate objects mentally by the posterior parietal lobe is likely an
extension of the ability to manipulate objects with the hands.

Other parietal-lobe functions

- Parietal lobe patients experience acalculia → Inability to perform mathematical operations.
o In this case arithmetic operations because of the task’s spatial nature.
- Language can be seen as quasi-spatial → Spatial organization of letters is different for the
words “tap” and “pat” and therefore have a very different meaning.

14.3 Somatosensory Symptoms of Parietal Lesions

Somatosensory thresholds
- Damage to the postcentral gyrus is associated with changes in somatosensory thresholds
for detecting objects via touch → Abnormal high sensory threshold, impaired position sense,
deficits in stereognosis, and afferent paresis.
o Postcentral gyrus → Primary somatosensory cortex.
o Stereognosis → Tactile perception → Recognition of objects through the sense of
touch.
o Afferent paresis → Loss of kinesthetic feedback which produces clumsy movements.

Somatoperceptual disorders
- Astereognosis → Inability tot recognize the nature of an object by touch.
- Simultaneous extinction → Inability to detect a sensory event when it is
paired with an identical one on the opposite side of the body or visual space.
o Most associated with damage to the secondary somatic cortex,
especially in the right parietal lobe.
- Numb touch → Tactile analogue of blindsight.

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o People do not feel it when something is touching them and are not aware of it, but
they can point the right location after the question where they were being touched.

14.4 Symptoms of Posterior Parietal Damage

Contralateral neglect
- Recovery of contralateral neglect → Two stages.
o Allesthesia → Person’s beginning to respond to stimuli on the neglected side as if
the stimuli were on the unlesioned side → The person responds and orients to
visual, tactile, or auditory stimuli on the left side of the body as if they were on the
right.
o Simultaneous extinction → The person responds to stimuli on the hitherto
neglected side unless both sides are stimulated simultaneously, in which case he or
she notices only the stimulation on the side ipsilateral to the lesion.
- Why does neglect arise?
o Two main theories argue that neglect is caused by either (1) defective sensation or
perception or (2) defective attention or orientation.
▪ Strong argument for (1) → Lesion to the parietal lobes, which receive input
from all the sensory regions, can disturb the integration of sensation into
perception → Amorphosynthesis.
▪ Argument for (2) → Defect in orienting to stimuli results from the disruption
of a system whose function is to arouse the person when new sensory
stimulation is present.

Object recognition
- Patients having right parietal lobe lesions can recognize objects shown in familiar views but
are unable to recognize them in unfamiliar views.

Symptoms of left parietal lesions:

- Disturbed language function → Agraphia, dyslexia, dysphasia (errors in grammar).
- Apraxia.
- Dyscalculia.
- Recall.
- Right-left discrimination.
- Right hemianopia → Visual field loss on the right side.

Disengagement → The process by which attention is shifted from one stimulus to another (parietal
lobe function).

Disorders of spatial cognition

- Spatial cognition → Broad category of abilities that require using or manipulating spatial
properties of stimuli, including the ability to manipulate images of objects and maps
mentally.
- Parietal posterior lesions produce deficits in mental-rotation and map-reading tasks.
o Left-hemisphere deficit may result from an inability to generate an appropriate
mental image.
o Right-hemisphere deficit may result from an inability to perform operations on this
mental image.

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o Deficits in using topographic information are more likely associated with damage to
the right hemisphere than to the left.

14.5 Major Symptoms and Their Assessment

Standardized clinical neuropsychological test for parietal-lobe damage.

- Somatosensory threshold → The two-point discrimination test requires a blindfolded subject
to report whether he or she felt one or two points touch the skin.
- Tactile form recognition → In the Seguin–Goddard Form Board Test, a blindfolded subject
manipulates 10 blocks of different shapes (star, triangle, and so forth) and attempts to place
them in similarly shaped holes on a form board. Afterwards the subject is asked to draw the
board from memory.
- Contralateral neglect → In the line-bisection test the subject is asked to mark the middle of
each of a set of 20 lines of different lengths and located at different positions.
o Patients fail to mark lines of the left side of the page.
- Visual perception → In the Mooney Closure Faces test and the Gollin Incomplete-Figures
test series of incomplete representations of faces or objects are presented, and the subject
must combine the elements to form a gestalt and identify the picture.
- Spatial relations → In the right–left differentiation test, a series of drawings of hands, feet,
ears, and so on is presented in different orientations (upside down, rear view, etc.), and the
subject’s task is to indicate whether the drawing is of the left or right body part.
- Language:
o Language comprehension → Twenty tokens are placed in front of a subject and then
the subject has to do first simple task and then progressively more difficult tasks.
o Reading comprehension → The token test but then the subject is reading the
instructions out loud and then carrying them out.
- Apraxia → In the Kimura Box test subjects are required to make consecutive movements,
first pushing a button with the index finger, then pulling a handle with four fingers, and
finally pressing a bar with the thumb.

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