The brain is a highly complex organ with numerous anatomical structures working in sync to execute proper social, cognitive, and behavioral function. It is thus vital to understand these structures and their workings before looking at how dementia affects them.
The brain receives approximately 20 to 30% of inspired oxygen by a dense vascular network surrounding it. The brain has 2 hemispheres – the left that is responsible for language and logical processing, speech function, arithmetic ability and writing skills; the right side of the brain controls spatial perception, artistic and musical comprehension, and creativity. It is noteworthy that the left hemisphere controls the right side of the body and vice versa. The 2 hemispheres are connected by a structure called the corpus collosum. The hemispheres of the brain are asymmetrical, with the right hemisphere being slightly larger. Alongside this, there are variations in chemical concentrations on both sides of the brain alongside differences in white and grey matter distribution. The brain can be broadly categorized into 3 parts – the cerebrum, the cerebellum, and the brainstem. The cerebrum is the largest, consisting of both the hemispheres of the brain. It is responsible for execution of high order functions such as the interpretation of sensory signals, regulating speech and emotions, aid in learning and memory, as well as fine motor control. The cerebellum lays at the base of the cerebrum and is responsible for controlling balance, posture, coordination, and movement. The brainstem connects the spinal cord to the cerebrum and cerebellum, and also controls automatic homeostatic mechanisms such as breathing, digestion, heart rate, body temperature, sleep cycles, swallowing, sneezing, and coughing.
Further distinction between the parts of the brain can be seen by looking at the 4 lobes each hemisphere has – the frontal lobe, the parietal lobe, the occipital love, and the temporal lobe. Each of these lobes is localized in function, i.e., they are associated, but not causally linking, to certain functions. The lobes of the brain and their functions are listed below.
The frontal lobe – This lobe ‘is generally where higher executive functions including emotional regulation, planning, reasoning and problem solving occur;’ it is associated with judgement, problem solving, comprehension, reasoning, planning, as well as speech since Broca’s area lies in the posterior frontal gyrus, i.e., an infolding in the cortex towards the back of the frontal lobe. This lobe also aids in the mediation of emotional and behavioural responses, essentially forming the basis of one’s personality. Lastly, this lobe is known to influence intellectual capacity and self-awareness.
The parietal lobe – It holds the sensory strip, which is why the processing of ‘signals from vision, hearing, motor, sensory and memory’ occurs in the parietal lobe. It is also responsible basic visuospatial perception and for the sense of touch, pain, and temperature. The parietal lobe also plays some part in the construing and comprehension of words.
The occipital lobe – This lobe is responsible primarily for visual processing - of colour, light, and movement - as it holds the primary visual cortex. ‘The primary visual cortex, also known as V1, receives visual information from the eyes. This information is relayed to several secondary visual processing areas, which interpret depth, distance, location and the identity of seen objects.’
The temporal lobe – This lobe is known to play part in memory and recall as its medial portion is close to the hippocampus, as well as sequential organization, and lingual ability as it holds Wernicke’s area. ‘The temporal lobe contains the primary auditory cortex, which receives auditory information from the ears and secondary areas, and processes the information so we understand what we’re hearing.’ Alongside hearing, it also performs some visual functions – such recognition and differentiation.
Apart from these 4 lobes, the cortex refers to the surface of the cerebrum, and has several infoldings that make it uneven, thus increasing its surface area. A larger surface area is attributed to the capacity to perform high order functions. ‘The cortex contains neurons (grey matter), which are interconnected to other brain areas by axons (white matter). The cortex has a folded appearance. A fold is called a gyrus and the valley between is a sulcus.’
Deeper structures within the brain are – the hippocampus, the hypothalamus, the thalamus, the limbic system with the amygdala, the pituitary and pineal glands, and the basal ganglia. The anatomical structure, position, and function of these parts are explained below.
The hippocampus – It ‘is a complex brain structure embedded deep into temporal lobe. It has a major role in learning and memory.’ This also makes it highly neuroplastic as neurogenesis and synaptogenesis, i.e., the creation of new neurons and synapses, occurs at a high rate here when a particular synaptic pathway is fired regularly. The hippocampus is also known to be associated with the consolidation of long-term memory via rehearsal.