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The Fragile Brain: Understanding Neurological, Neurodegenerative, and Developmental Disorders
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Publisher: Editura Universitară
Author: Maria Zivari
Edition: I
Pages: 252
Publisher year: 2026
ISBN: 978-606-28-2151-7
DOI: https://doi.org/10.5682/9786062821517
Product Code:
9786062821517
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The Fragile Brain is a book about the precarious balance between performance and vulnerability, between reason and emotion, between adaptation and failure.
Drawing on insights from neuroscience, psychology, and everyday human experience, the book explores how the brain—this extraordinarily plastic organ—can be both resilient and fragile. Stress, trauma, decision-making, error, and relationships become windows through which we understand not only how the mind works, but also why it sometimes fails.
The book emphasizes the essential role of a multidisciplinary approach to brain health, where neurology, psychiatry, psychology, sleep medicine, rehabilitation, and clinical communication come together in a common effort. Brain health is not the result of a single specialty, but of a team that learns to look at the person as a whole.
This is not a book about weakness, but about lucidity. About recognizing the limits of the brain as the first step toward protecting, understanding, and using it better.
Maria Zivari
The present work, entitled “The Fragile Brain: Understanding Neurological, Neurodegenerative and Developmental Disorders”, aims to provide an in-depth neuropsychological perspective on pathologies that profoundly affect the quality of life and autonomy of the individual. By exploring in detail the mechanisms, manifestations and interventions, this volume analyzes the three major categories of brain disorders: neurological disorders (stroke, traumatic brain injury, epilepsy), neurodegenerative disorders (dementia, Alzheimer’s disease, Parkinson’s disease) and developmental disorders (ADHD, autism, dyslexia).
Neurological pathology, such as stroke, is a major cause of morbidity and mortality worldwide. Stroke, whether ischemic or hemorrhagic, is a medical emergency whose outcome depends on rapid intervention to reduce the risk of severe brain damage. The consequences of these lesions, along with those caused by traumatic brain injury, are manifested by motor, sensory, cognitive and behavioral dysfunctions. For example, post-stroke brain lesions can affect the frontal lobe, causing difficulties with planning, decision-making, and self-control, or the temporal lobe, causing language (aphasia) and memory (amnesia) disorders. Another important neurological disorder addressed is epilepsy, one of the most widespread chronic diseases, affecting approximately 50 million people worldwide. Epilepsy, defined by recurrent epileptic seizures resulting from excessive neuronal discharges, requires a rigorous differential diagnosis, given that it can be confused with non-epileptic psychogenic disorders or other conditions.
In the field of neurodegenerative disorders, we are faced with chronic conditions that progressively affect the entire human structure: thoughts, emotions, personality, memory and motor functions. Dementia, defined as a progressive cognitive deterioration that significantly interferes with independence, is not a normal consequence of aging, but the result of neuropathological changes, such as the accumulation of abnormal proteins (beta amyloid and tau) in Alzheimer's disease. Alzheimer's disease, the most common form of dementia, predominantly affects recent episodic memory, leading to the disintegration of personal identity. Parkinson's disease is also a progressive neurodegenerative condition, clinically characterized by resting tremor, rigidity and bradykinesia, caused by a decrease in dopamine in the substantia nigra. In both dementia and Parkinson's disease, in addition to motor and cognitive deficits, affective disorders (depression and anxiety) play a major role in determining the quality of life.
A third pillar of this work is dedicated to neurodevelopmental disorders, which have an early onset and require long-term specialized intervention. Attention deficit hyperactivity disorder is defined by a persistent pattern of inattention, hyperactivity, and impulsivity. In adults, manifestations can develop into internal agitation and organizational difficulties. Autism spectrum disorders are characterized by persistent difficulties in communication and social interaction, along with repetitive behaviors, and the wide spectrum of manifestations requires a classification according to the level of support needed. Dyslexia, a specific learning disorder, involves difficulties in the acquisition and use of reading and writing, despite normal intelligence, being associated with a dysfunction of the specialized neural network for phonological processing. Early recognition of signs of ASD, ADHD, or dyslexia is crucial, as early intervention can significantly improve the developmental trajectory.
All these complex pathologies impose a unified conclusion: their management requires a multidisciplinary, personalized and integrated approach. Success in recovery and in maintaining quality of life depends on close coordination between neurologists, psychiatrists, physiotherapists, speech therapists and psychologists.
In this framework, the role of the clinical psychologist is fundamental and transversal, covering assessment, intervention and support at all levels. The psychologist is the one who carries out the detailed neuropsychological assessment of the affected cognitive functions (memory, attention, executive functions, language), using standardized instruments such as MMSE, MoCA, WCST and memory tests. Furthermore, the psychologist assesses and manages the emotional and behavioral impact, treating comorbidities such as depression and anxiety through psychotherapeutic interventions (e.g. cognitive behavioral therapy). Beyond direct intervention on the patient, the support given to the family and medical staff is offered by the clinical psychologist, who through counseling, psychoeducation and coping strategies supports them effectively, facilitating adaptation to new realities and maintaining the patient's dignity.
Essentially, this work gathers the information necessary to understand the fact that, whether we are talking about post-stroke recovery, post-TBI social reintegration, maintaining autonomy in dementia, managing non-motor symptoms in Parkinson's disease or early intervention in developmental disorders, an approach centered on the patient and his support network is the key to optimizing the prognosis and quality of life. Therefore, this material represents a valuable guide for all specialists and students interested in the complexity and fragility of the human brain and the ways in which we can support people in suffering to lead a more fulfilling life.
Neurological pathology, such as stroke, is a major cause of morbidity and mortality worldwide. Stroke, whether ischemic or hemorrhagic, is a medical emergency whose outcome depends on rapid intervention to reduce the risk of severe brain damage. The consequences of these lesions, along with those caused by traumatic brain injury, are manifested by motor, sensory, cognitive and behavioral dysfunctions. For example, post-stroke brain lesions can affect the frontal lobe, causing difficulties with planning, decision-making, and self-control, or the temporal lobe, causing language (aphasia) and memory (amnesia) disorders. Another important neurological disorder addressed is epilepsy, one of the most widespread chronic diseases, affecting approximately 50 million people worldwide. Epilepsy, defined by recurrent epileptic seizures resulting from excessive neuronal discharges, requires a rigorous differential diagnosis, given that it can be confused with non-epileptic psychogenic disorders or other conditions.
In the field of neurodegenerative disorders, we are faced with chronic conditions that progressively affect the entire human structure: thoughts, emotions, personality, memory and motor functions. Dementia, defined as a progressive cognitive deterioration that significantly interferes with independence, is not a normal consequence of aging, but the result of neuropathological changes, such as the accumulation of abnormal proteins (beta amyloid and tau) in Alzheimer's disease. Alzheimer's disease, the most common form of dementia, predominantly affects recent episodic memory, leading to the disintegration of personal identity. Parkinson's disease is also a progressive neurodegenerative condition, clinically characterized by resting tremor, rigidity and bradykinesia, caused by a decrease in dopamine in the substantia nigra. In both dementia and Parkinson's disease, in addition to motor and cognitive deficits, affective disorders (depression and anxiety) play a major role in determining the quality of life.
A third pillar of this work is dedicated to neurodevelopmental disorders, which have an early onset and require long-term specialized intervention. Attention deficit hyperactivity disorder is defined by a persistent pattern of inattention, hyperactivity, and impulsivity. In adults, manifestations can develop into internal agitation and organizational difficulties. Autism spectrum disorders are characterized by persistent difficulties in communication and social interaction, along with repetitive behaviors, and the wide spectrum of manifestations requires a classification according to the level of support needed. Dyslexia, a specific learning disorder, involves difficulties in the acquisition and use of reading and writing, despite normal intelligence, being associated with a dysfunction of the specialized neural network for phonological processing. Early recognition of signs of ASD, ADHD, or dyslexia is crucial, as early intervention can significantly improve the developmental trajectory.
All these complex pathologies impose a unified conclusion: their management requires a multidisciplinary, personalized and integrated approach. Success in recovery and in maintaining quality of life depends on close coordination between neurologists, psychiatrists, physiotherapists, speech therapists and psychologists.
In this framework, the role of the clinical psychologist is fundamental and transversal, covering assessment, intervention and support at all levels. The psychologist is the one who carries out the detailed neuropsychological assessment of the affected cognitive functions (memory, attention, executive functions, language), using standardized instruments such as MMSE, MoCA, WCST and memory tests. Furthermore, the psychologist assesses and manages the emotional and behavioral impact, treating comorbidities such as depression and anxiety through psychotherapeutic interventions (e.g. cognitive behavioral therapy). Beyond direct intervention on the patient, the support given to the family and medical staff is offered by the clinical psychologist, who through counseling, psychoeducation and coping strategies supports them effectively, facilitating adaptation to new realities and maintaining the patient's dignity.
Essentially, this work gathers the information necessary to understand the fact that, whether we are talking about post-stroke recovery, post-TBI social reintegration, maintaining autonomy in dementia, managing non-motor symptoms in Parkinson's disease or early intervention in developmental disorders, an approach centered on the patient and his support network is the key to optimizing the prognosis and quality of life. Therefore, this material represents a valuable guide for all specialists and students interested in the complexity and fragility of the human brain and the ways in which we can support people in suffering to lead a more fulfilling life.
PREFACE/11
PART I
NEUROLOGICAL DISORDERS: CERATROLE (CVA), TBI (Head Injury) AND EPILEPSY /15
CHAPTER I . STROKE/17
1. Overview/17
2. Types of stroke /17
2.1 Ischemic stroke/17
2.2 Hemorrhagic stroke/18
2.3 Transient ischemic attack (TIA)/18
3. Causes of stroke/18
4. Traumatic injuries and cerebral aneurysm/20
5. Clinical manifestations of stroke (CVA) /21
5.1 Rapid recognition of clinical manifestations/22
6. Impact of stroke on the brain/22
6.1 Local brain lesions/22
6.1.1 Frontal lobe lesions /22
6.1.2 Temporal lobe lesions/24
6.1.3 Parietal lobe lesions/25
6.1.4 Occipital lobe lesions/26
7. Psychological assessment and recovery post stroke/28
8. Treatment, recovery and long-term care after stroke/28
9. Speech therapy/29
9.1 Techniques used in speech therapy/30
9.1.1 Articulation exercises/30
9.1.2 Language comprehension exercises/30
9.1.3 Imagery technique/30
9.1.4 Memory recovery exercises/31
9.2 Benefits of speech therapy/31
10. Case studies/32
10.1 Ischemic stroke in a 65-year-old patient/32
10.2 Hemorrhagic stroke in a 72-year-old patient/35
10.3 Transient stroke in a 58-year-old patient/38
11. The role of the psychologist in post-stroke recovery/40
12. Conclusions /42
Bibliography/43
Appendices/54
CHAPTER II. BRAIN INJURIES/56
1. Introduction/56
1.1 Overview/56
1.2 Pathophysiological mechanisms/56
1.3 Severity of dysfunctions/57
1.4 Classification/57
2. Causes and risk factors of traumatic brain injuries/57
3. Clinical and neuropsychological manifestations/59
4. Clinical and imaging evaluation/60
4.1 Neurological status evaluation (Glasgow Scale)/60
4.2 Vital signs and vital functions evaluation/61
4.3 Imaging investigations/61
4.4 Differential diagnosis/61
5. Standardized cognitive tests/62
6. Psychological assessment/65
7. Cognitive recovery/66
9. Behavioral and emotional interventions in CBT/66
10. Monitoring progress, adjusting interventions and socio-professional integration/68
11. Ethical and legal aspects/68
12. Conclusions/70
Bibliography/70
CHAPTER III. PARKINSON'S DISEASE/167
1. Definition and generalities/167
2. History/167
3. Evolution and diagnosis/167
4. Studies on Parkinson's disease/167
5. Psychological assessment/172
6. Case study: psychological assessment of a patient with Parkinson's disease /173
7. The role of the psychologist in the management of Parkinson's disease/176
8. Intervention plan for the patient with Parkinson's disease/176
8.1 Cognitive level/176
8.2 Emotional level/178
8.3 Social level/178
8.4 Implementation and monitoring plan/179
9. Treatment of Parkinson's disease/179
10. Psychosocial impact/180
11. Ethical and legal aspects/180
12. Differentiating Parkinson's disease from other conditions/181
13. Conclusions /182
Annexes/182
Bibliography/185
PART III
DEVELOPMENTAL DISORDERS: ATTENTION DEFICIT HYPERACTIVITY DISORDER, AUTISM, DYSLEXIA /190
CHAPTER I. ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)/193
1. Definition and diagnostic criteria/193
2. Clinical subtypes/193
3. Characteristic symptoms/194
4. Causes and risk factors/194
5. Evaluation and diagnosis/198
6. Interventions and treatment/199
7. ADHD in children versus adults/200
8. ADHD case study/203
Bibliography/205
CHAPTER II. AUTISM SPECTRUM DISORDERS/213
1. Definition and general characteristics /213
3. Causes and risk factors/215
3.1 Genetic factors/215
3.2 Involvement of genetic factors/216
3.3 Genes and complex interactions with the environment/216
3.4 Prenatal and perinatal factors in the etiology of ASD/217
3.5 Neurological abnormalities in ASD/217
3.6 Brain connectivity and regions involved in social processing/218
3.7 Prefrontal cortex and behavioral control in ASD/218
3.8 Changes in brain connectivity and the complex etiology of ASD/219
4. Early signs and early diagnosis in ASD/219
5. Interventions and support in ASD/221
5.1 Behavioral interventions/221
5.2 Occupational and sensory therapy/223
5.3 Speech therapy/223
5.4 Family involvement/224
5.5 Drug treatment/224
6. ASD case study/225
Bibliography/227
CHAPTER III. DYSLEXIA/233
1. Definition and conceptualization/233
2. Clinical signs and manifestations of dyslexia/233
3. Diagnosis and assessment /234
4. Intervention and support in dyslexia/236
5. Dyslexia in adulthood/237
6. Case studies/238
6.1 Case study, dyslexia in children/238
6.2 Case study: dyslexia in adults /241
Appendices/243
Bibliography/250
PART I
NEUROLOGICAL DISORDERS: CERATROLE (CVA), TBI (Head Injury) AND EPILEPSY /15
CHAPTER I . STROKE/17
1. Overview/17
2. Types of stroke /17
2.1 Ischemic stroke/17
2.2 Hemorrhagic stroke/18
2.3 Transient ischemic attack (TIA)/18
3. Causes of stroke/18
4. Traumatic injuries and cerebral aneurysm/20
5. Clinical manifestations of stroke (CVA) /21
5.1 Rapid recognition of clinical manifestations/22
6. Impact of stroke on the brain/22
6.1 Local brain lesions/22
6.1.1 Frontal lobe lesions /22
6.1.2 Temporal lobe lesions/24
6.1.3 Parietal lobe lesions/25
6.1.4 Occipital lobe lesions/26
7. Psychological assessment and recovery post stroke/28
8. Treatment, recovery and long-term care after stroke/28
9. Speech therapy/29
9.1 Techniques used in speech therapy/30
9.1.1 Articulation exercises/30
9.1.2 Language comprehension exercises/30
9.1.3 Imagery technique/30
9.1.4 Memory recovery exercises/31
9.2 Benefits of speech therapy/31
10. Case studies/32
10.1 Ischemic stroke in a 65-year-old patient/32
10.2 Hemorrhagic stroke in a 72-year-old patient/35
10.3 Transient stroke in a 58-year-old patient/38
11. The role of the psychologist in post-stroke recovery/40
12. Conclusions /42
Bibliography/43
Appendices/54
CHAPTER II. BRAIN INJURIES/56
1. Introduction/56
1.1 Overview/56
1.2 Pathophysiological mechanisms/56
1.3 Severity of dysfunctions/57
1.4 Classification/57
2. Causes and risk factors of traumatic brain injuries/57
3. Clinical and neuropsychological manifestations/59
4. Clinical and imaging evaluation/60
4.1 Neurological status evaluation (Glasgow Scale)/60
4.2 Vital signs and vital functions evaluation/61
4.3 Imaging investigations/61
4.4 Differential diagnosis/61
5. Standardized cognitive tests/62
6. Psychological assessment/65
7. Cognitive recovery/66
9. Behavioral and emotional interventions in CBT/66
10. Monitoring progress, adjusting interventions and socio-professional integration/68
11. Ethical and legal aspects/68
12. Conclusions/70
Bibliography/70
CHAPTER III. PARKINSON'S DISEASE/167
1. Definition and generalities/167
2. History/167
3. Evolution and diagnosis/167
4. Studies on Parkinson's disease/167
5. Psychological assessment/172
6. Case study: psychological assessment of a patient with Parkinson's disease /173
7. The role of the psychologist in the management of Parkinson's disease/176
8. Intervention plan for the patient with Parkinson's disease/176
8.1 Cognitive level/176
8.2 Emotional level/178
8.3 Social level/178
8.4 Implementation and monitoring plan/179
9. Treatment of Parkinson's disease/179
10. Psychosocial impact/180
11. Ethical and legal aspects/180
12. Differentiating Parkinson's disease from other conditions/181
13. Conclusions /182
Annexes/182
Bibliography/185
PART III
DEVELOPMENTAL DISORDERS: ATTENTION DEFICIT HYPERACTIVITY DISORDER, AUTISM, DYSLEXIA /190
CHAPTER I. ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)/193
1. Definition and diagnostic criteria/193
2. Clinical subtypes/193
3. Characteristic symptoms/194
4. Causes and risk factors/194
5. Evaluation and diagnosis/198
6. Interventions and treatment/199
7. ADHD in children versus adults/200
8. ADHD case study/203
Bibliography/205
CHAPTER II. AUTISM SPECTRUM DISORDERS/213
1. Definition and general characteristics /213
3. Causes and risk factors/215
3.1 Genetic factors/215
3.2 Involvement of genetic factors/216
3.3 Genes and complex interactions with the environment/216
3.4 Prenatal and perinatal factors in the etiology of ASD/217
3.5 Neurological abnormalities in ASD/217
3.6 Brain connectivity and regions involved in social processing/218
3.7 Prefrontal cortex and behavioral control in ASD/218
3.8 Changes in brain connectivity and the complex etiology of ASD/219
4. Early signs and early diagnosis in ASD/219
5. Interventions and support in ASD/221
5.1 Behavioral interventions/221
5.2 Occupational and sensory therapy/223
5.3 Speech therapy/223
5.4 Family involvement/224
5.5 Drug treatment/224
6. ASD case study/225
Bibliography/227
CHAPTER III. DYSLEXIA/233
1. Definition and conceptualization/233
2. Clinical signs and manifestations of dyslexia/233
3. Diagnosis and assessment /234
4. Intervention and support in dyslexia/236
5. Dyslexia in adulthood/237
6. Case studies/238
6.1 Case study, dyslexia in children/238
6.2 Case study: dyslexia in adults /241
Appendices/243
Bibliography/250
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