Cognitive Neuroscience

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Sirel KARAKAŞ
Doğuş Üniversitesi Fen-Edebiyat Fakültesi, Psikoloji Bölümü, İstanbul, Türkiye
Article Language: TR
Doğada karmaşıklık düzeyi en yüksek iki nesne kuşkusuz ki insanın zihni ve beynidir. Daha da karmaşık olanı bu ikisinin ilişkisidir. Bu ilişki insanlığı her zaman meşgul etmiş; yüzyıllar boyunca felsefede 'Zihin-Beden Sorunu' olarak irdelenmiş, Aydınlanma Çağı ile de bilimin konusu olmuştur. İlerleyen zamanda bilim, bu sorunu, önce iki ayrı bilim dalının (örn. nöroloji ve psikoloji) birleşmesinden oluşan disiplinler-arası dallarda (örnekte nöropsikoloji) ele almıştır. Ancak bu karmaşık ilişkiyi anlamada iki dalın birleşik bilgi ve teknolojisi yeterli olmamıştır. Bu ilişkiyi anlayabilmek için temel ve uygulamalı biyolojik bilimler (örn., tıp), teknik bilimler (örn., elektrik ve elektronik, bilgisayar ve sinyal işleme mühendisliği), formel bilimler (örn., istatistik ve matematik) ve hatta, bilimin hâlâ cevaplayamadığı soruların var olduğu günümüzde, felsefenin (nörofelsefe) seçici bir şekilde bir araya gelmesi gerektiği anlaşılmıştır. Böylece ortaya hem multi-disipliner hem de multi-teknolojik olan 'Bilişsel Sinirbilim' çıkmıştır. Yüzyılların konusu olan 'Zihin-Beden Sorunu'nu ele almadaki çağdaş bilimsel yaklaşım olan bilişsel sinirbilimin önde gelen konularından bazıları, Türkiye Klinikleri'nin 'Bilişsel Sinirbilim' konusundaki kitabında ele alınmaktadır.

Bilişsel sinirbilim yaklaşımının oluşmasına yol açan gelişme ve aşamalar Bölüm 1'de irdelenmektedir. Bu bölümde, Prof. Dr. Sirel Karakaş, felsefenin ve daha sonra da psikolojinin konusu olan zihin ile temel ve uygulamalı biyolojik bilimlerin konusu olan beden (özelde beyin) arasındaki olası ilişki türlerini açıklamakta, bu ilişkiyi incelemede yaygın olarak kullanılan elektroensefalografi (EEG) konusunda bilgi vermektedir. Kitabın aşağıda özetlenen bölümlerinde ise, bilişsel sinirbilimin yüksek etkinlikli araştırma alanları sunulmaktadır.

Prof. Dr. Hakkı Muammer Karakaş ve Uzm. Dr. Gülşah Yıldırım bilişsel süreçlerin beyindeki yansımalarını belirlemede kullanılan nörogörüntüleme tekniklerini Bölüm 2'de açıklamakta; fonksiyonel manyetik rezonans görüntüleme ve traktografi ile elde edilen bulgular sunmaktadır. Bölümde nörogörüntüleme tekniklerinin avantaj ve kısıtlılıkları örneklerle tartışılmakta, bunların multi-teknolojik bir yaklaşımla dengelenmesinin önemi üzerinde durulmaktadır.

Zihnin beyindeki yansımalarını incelemede kullanılan en erken teknik EEG'dir. Prof. Dr. Canan Başar Eroğlu çeşitli biliş türleri altında kaydedilen dinlenme EEG'si, olay-ilişkili potansiyeller (OİPler) ve özelde olay-ilişkili salınımları (OİSler) Bölüm 3'te açıklamakta; beynin salınımsal dinamiği konusunda Erol Başar tarafından geliştirilmiş olan Bütün Beyin Ağı Kuramı üzerinde durmaktadır. Bölümde delta, teta, alfa, beta ve gamma salınımlarının nöropsikiyatrik yansımaları ele alınmakta, bunların bir biyobelirteç olma potansiyeli göz önüne serilmektedir. Aynı yaklaşım, Bölüm 4'te, Prof. Dr. Görsev G. Yener ve Prof. Dr. Bahar Güntekin tarafından, özelde Alzheimer Hastalığı ve Parkinson Hastalığı'nda karşılaştırmalı olarak ele alınmaktadır. Bu iki hastalığın örneğin teta ve gamma frekans bantlarında değişime yol açtığı açıklanmakta; olay-ilişkili salınımların nöropsikiyatrik tanı grupları için bir biyo-belirteç olabileceği gösterilmektedir.

EEG'nin kuşkusuz en çok çalışılan mikrografo-elementi uyku iğcikleridir. Dr. Öğr. Üyesi Nakşıdil Torun Yazıhan iğciklerin yapısal ve işlevsel özelliklerini Bölüm 5'te açıklamakta; bunların nöropsikiyatrik tanı gruplarındaki durumlarına ilişkin bulgular sunmaktadır. Otizm açılımı kapsamındaki bozuklukta uyku iğcik yoğunluğunun azaldığı, belirti şiddeti ile iğcik aktivitesi arasında ilişki olduğu ve iğciğin genetik temeli üzerinde durulmakta; şizofrenideki iğcik yoğunluğu azalmasının temelinde yatan nöral sistem ve işleyişler, iğciklerin duyusal kapılamadaki rolü açıklanmakta; iğcik yoğunluğunun insomniayı, tedavi öncesi iğcik yoğunluğunun ise tedavinin etkililiğini yordadığı ortaya konmaktadır

Kitabın son bölümünde, bilişsel sinirbilimin diğer çok yaygın metodolojisini oluşturan nöropsikolojik testler ve nöropsikolojik değerlendirme üzerinde durulmaktadır. Nöropsikolojik değerlendirmedeki en kritik unsur, testlerin, kullanılacağı ülke ya da topluma standardizasyonunun bulunmasıdır. Bu psikometrik işlem, testin güvenilirlik durumunun ve ölçmeyi amaçladığı özelliği ölçme derecesi olan geçerliğin ortaya konmasını ve testin normalizasyonunun yapılmasını içerir. Doç. Dr. Elvin Doğutepe, ülkemizde söz konusu psikometrik özelliklere sahip yegâne nöropsikolojik testler topluluğu olan BİLNOT Bataryası'nı Bölüm 6'da ele almaktadır. Bölümde, bataryayı oluşturan sekiz test tanıtılmakta, test malzemeleri ve testlerin psikometrik özellikleri açıklanmakta, onların hangi özellikleri ölçmede kullanılabileceği gösterilmektedir. Prof. Dr. Emel Erdoğan Bakar ise nöropsikolojik testler kullanılarak yapılan değerlendirmenin gözlem ve görüşme, uygun test ya da test bataryasının seçilip uygulanması ve raporlama şeklindeki aşamalarını Bölüm 7'de açıklamaktadır. Değerlendirmenin tanılama, tedavinin etkililiğini değerlendirme ve rehabilitasyon planı yapmadaki rolü anlatılmaktadır. Bütün bu açıklamalar, Özgül Öğrenme Bozukluğu ve/veya Dikkat Eksikliği Hiperaktivite Bozukluğu üzerinden yapılmaktadır.

Doç. Dr. Handan Can'ın Bölüm 8'deki derleme makalesinde, nöropsikolojik yaklaşımın farklı demans türlerini (Alzheimer, vasküler, Lewy cisimciği ve frontotemporal demans) ayırt etmeye katkısı ortaya konmakta; türlere özgü profiller açıklanmakta; demans türlerinde benzeşen ve ayrılan profillere işaret edilmektedir. Nöropsikolojik değerlendirmenin ek tanı ölçütü olma durumu irdelenerek bunların ayırıcı tanıya katkıları açıklanmaktadır.

Bilişsel sinirbilim, günümüzde, dünyada olduğu gibi ülkemizde de çok revaçtadır. Bu durum, konuyla ilgili araştırma ve yayınların, aynı şekilde, lisansüstü programların giderek artan sayılarında da kendisini göstermektedir. Ancak söz konusu yayınların büyük çoğunluğu uluslararası alan yazınında yer almakta olup Türkçe yayın hâlen çok azdır. Türkiye Klinikleri'nin bu kitabının, bilişsel sinirbilimdeki açığı kapatmaya ve ulusal alan yazınımızın tatminkâr düzeylere ulaşmasına katkıda bulunacağı düşünülmektedir.

Prof. Dr. Sirel KARAKAŞ
Editör
Undoubtedly, the two most complex phenomena in the universe is the human mind and the human brain. The relationship between these two phenomena is even more complex. This relationship, which has always attracted the attention of humanity, had been discussed in philosophy as the 'Mind-Body Problem'. With the advent of the Age of Enlightenment, the issue became a topic for positive sciences. In the following decades, this problem was first treated in interdisciplinary sciences that are formed by the union of two disciplines (e.g., neurology and psychology). However, time showed that a combination of the knowledge and the technology of two disciplines (in the example, neuropsychology), is not sufficient. It was realized that a comprehensive understanding of the mind-body relationship would require a selective union of applied biological sciences (e.g. medicine), technical sciences (e.g., electric and electronic engineering, signal processing, computer sciences), formal sciences (e.g., statistics, mathematics) and even philosophy, since some of the questions pertaining to the mind-body problem is presently not attainable or solvable. Thus came the multi-disciplinary and multi-technological 'Cognitive Neuroscience', the contemporary approach to the 'Mind-Body Problem'. The present book of Türkiye Klinikleri addresses this everlasting problem, and it discusses some of the prominent issues of cognitive neuroscience.

Chapter 1 treats the development and the stages through which cognitive neuroscience came into being. Prof. Dr. Sirel Karakaş explains the relationship between the mind (the subject matter of philosophy and, later, of the science of psychology) and the brain (the subject matter of basic and applied biological sciences). The chapter includes a section on electroencephalography (EEG), the technology that studies on the mind and body relationship prominently employ. The ensuing chapters in the book treat some of the research areas that cognitive neuroscience is presently focused on.

Prof. Dr. Hakkı Muammer Karakaş and Dr. Gülşah Yıldırım introduces the neuroimaging techniques that are used in studying the brain correlates of cognitive processes, and it present findings on tractography and functional magnetic resonance imaging. Chapter 2 discusses and demonstrates the advantages and disadvantages of the various neuroimaging techniques. The importance of using a multi-technological approach whereby the disadvantages of one technique would be offset by the advantages of another is emphasized.

The earliest technique for studying the brain correlates of the mind is EEG. In Chapter 3, Prof. Dr. Canan Başar Eroğlu presents the findings on EEG, event-related potentials (ERPs) and event-related oscillations (EROs) and discusses the cognitive correlates of these neuroelectric potentials. The chapter introduces Erol Başar's Whole Brain Network where oscillatory dynamics of the brain is explained. The chapter discusses the delta, theta, alpha, beta and gamma oscillations and lays out their potential for serving as bio-markers for neuropsychiatric disorders. This general approach is used by Prof. Dr. Görsev G. Yener and Prof. Dr. Bahar Güntekin in Chapter 4, and findings on Alzheimer's disease and Parkinson's disease is comparatively discussed. The authors demonstrate the effect of these disorders on particularly the theta and gamma oscillations, and show that these oscillations can be used as bio-markers for Alzheimer's and Parkinson's disease.

One of the most frequently studied micro graphical elements in EEG is undoubtedly the sleep spindles. In Chapter 5, Assist. Prof. Dr. Nakşıdil Torun Yazıhan introduces the structural and functional characteristics of the sleep spindles, and she presents the effect of neuropsychiatric disorders on the spindles. Autism spectrum disorder is characterized by a decrease in the intensity of the spindles, and there is a correlation between spindle activity and symptom severity. Genetic basis of the spindles is discussed. Another disorder characterized by intensity decrease is schizophrenia; this section discusses the neural systems and the processes that are responsible for the reduced intensity, and it outlines the role that spindles play on sensory gating. The chapter shows that insomnia can be predicted from spindle intensity, and treatment outcome can be predicted from pre-treatment spindle intensity.

The last part of the book treats another very frequently used methodology in cognitive neuroscience: neuropsychological tests and assessment. A requirement of this methodology is standardization, which is a multi-step psychometric methodology that enables the usage of the test in a culture other than the one for which it had originally been developed. The stages of this psychometric approach includes assessment of the reliability and the validity of the test followed by the normalization of the test on a sample that is representative of the participants to whom the test will be administered. Assoc. Prof. Dr. Elvin Doğutepe presents the tests in the BILNOT battery, the only neuropsychological test battery that has been standardized to the Turkish culture. Chapter 6 introduces the BILNOT tests and the test materials, discusses the psychometric properties of these tests and explains the cognitive processes that each of the tests measure. In Chapter 7, Prof. Dr. Emel Erdoğan Bakar explains the following stages of neuropsychological evaluation: observation, interview, selection of an appropriate test or battery, and a formal report of the test results and their assessment. The contribution of the neuropsychological tests to diagnosis, evaluation of treatment outcome and to rehabilitation plans is outlined. The information in Chapter 7 is provided particularly in reference to Specific Learning Disability and/or Attention Deficit Hyperactivity Disorderb

The review article of Assoc. Prof. Dr. Handan Can discusses the contribution of the neuropsychological tests to the differential diagnosis of Alzheimer's, vascular, Lewy body and frontotemporal dementias. Chapter 8 discusses the neuropsychological profiles that characterize the different types of dementia, and it points out the similarities and differences between these profiles. The capacity of the neuropsychological tests for serving as auxiliary criteria is discussed and the contribution to differential diagnosis is explained.

Presently, cognitive neuroscience is a very popular scientific area, both in the world and in Turkey. The interest shows itself in the steadily increasing research activity, publications and postgraduate programs. There is, however, a scarcity of national publications, since most of the studies are published abroad. The present book of Türkiye Klinikleri, which is an attempt to alleviate this deficit, will hopefully contribute to the attainment of a satisfactory level in the national literature on cognitive neuroscience.

Prof. Dr. Sirel KARAKAŞ
Editor

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