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SBM Neuro > 10-14 Intro to Neuro; Cognitive Exam > Flashcards

10-14 Intro to Neuro; Cognitive Exam Flashcards

1
Q

dementia

A

a generalized deterioration of intellectual or cognitive function, particularly
memory, without altered alertness or perception

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2
Q

amnesia

A

pure loss of memory without other cognitive loss

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3
Q

retrograde amnesia

A

loss of memory of events prior to a specific time

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4
Q

anterograde amnesia

A

loss of memory of events after a specific time

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5
Q

aphasia/dysphasia

A

language impairment

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6
Q

dysprosody/aprosody

A

loss or impairment of the use and understanding of inflection (impairment in aspects of non-verbal communication)

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7
Q

agnosia

A

inability to perceive/understand the import of sensory stimuli despite intact sensory
mechanisms

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8
Q

apraxia

A

inability to perform learned actions despite intact motor function

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9
Q

Components of the mental status exam?

A

A. Level of consciousness

B. Attention and concentration

C. Cognitive functions

  • -C1. Language, Memory, Construction, Calculation
  • -C2. Interpretation of sensory input
  • -C3. Performance of complex learned activities
  • -C4. Executive function

D. Thought processes

E. Thought content

F. Affect

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10
Q

confusion

A

acute thinking disorder

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11
Q

delirium

A

acute thinking disorder, with altered consciousness,

hyperactivity, irritability, etc.

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12
Q

encephalopathy

A

diffuse alteration in brain function generally including disordered thinking

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13
Q

Testing B. Attention and Concentration

A

digit span - give phone number and have them repeat it back

Spell WORLD forwards and backwards

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14
Q

Testing C1. Cognitive functions of: Language, Memory, Construction and Calculation

A

Language
Memory
Construction
Calculation

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15
Q

What are the different paraphasias one could see in while testing cognitive function C1 (language component)?

A

Paraphasia – production of well articulated, but incorrect, words
Semantic (verbal) paraphasia – substitute wrong word
Phonemic (literal) paraphasia – substitute wrong
sound Neologism – non-existent word

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16
Q

C1 language: Broca’s and Wernicke’s areas:

  • -location?
  • -function?
  • -connection betwixt?
A

Broca’s: inferior precentral gyrus of the frontal lobe; MOTOR
Wernicke’s: superior temporal gyrus at the posterior end of the temporal lobe; COMPREHENSION
Connection: arcuate fasiculus = white matter tract in deep anterior-inferior parietal lobe

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17
Q

C1 language: Broca’s aphasia + localization?

A

~MOTOR PROBLEM: Dysfluent (<10 words/min), few connecting words, agrammatism (inability to speak in a grammatically correct fashion), phonemic mistakes, poor repetition, +/- naming, usually seen in the setting of R hemiparesis. Usually pt is very frustrated.

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18
Q

C1 language: Aphemia + localization?

A

a.k.a. “cortical dumbness”
Inability to produce speech despite intact comprehension, reading, writing

Localization = Broca’s area or prefrontal cortex

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19
Q

C1 language - types of aphasia: Wernicke’s aphasia + localization?

A

~WORD SALAD: (a.k.a.”receptive”, “jargon”, “fluent”)
Poor comprehension, poor repetition, poor naming, neologisms, paraphasias.
Often in the setting of R superior quadrantanopsia. Patient is often not concerned (vs. frustration seen in Broca’s).
–music therapy can help

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20
Q

C1 language - types of aphasia: Word deafness

A

Inability to comprehend words. Poor repetition, but normal fluency, naming, reading and writing.

localization - superior temporal gyrif

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21
Q

C1 language - types of aphasia: Conduction aphasia + localization?

A

Inability to repeat due to interruption of the arcuate fasciculus. Fluent, but with paraphasias. Comprehension may be OK.

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22
Q

C1 language - types of aphasia: Global aphasia + localization?

A

Inability to comprehend, produce, or repeat speech.

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23
Q

C1 language - types of aphasia: Transcortical aphasia + localization?

A

Difficulty with comprehension or fluency or both, with spared repetition

SEE Slide 18 for map of aphasias
transcort. sensory aphasia local - temporal
transcortical mixed aphasia localization - anterior and posterior border zones

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24
Q

QUESTION 1: 72 year old left-handed man was noted by his wife to be confused this morning. On exam he has some difficulty naming items as well as trouble following complex commands. He is noted to have atrial fibrillation on ECG. He is otherwise intact.

Where might you expect a lesion?

  1. L prefrontal cortex
  2. R prefrontal cortex
  3. L posterior temporal
  4. R posterior temporal
  5. Hippocampus
A

3

notes: even though left-handed, still likely L lang dominant; difficulty name = anomia; trouble following complex commands = impaired comprehension

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25
Q

C1 Memory - Define the components of memory

–which do we test?

A

Declarative (conscious, factual)

  • -Episodic** – memory of events – med temporal (bilateral) – hippocampus, mammillary body
  • -Semantic – knowledge of concepts – cortical association areas

Non-declarative (skills, habits)

  • -Procedural – basal ganglia
  • -Conditioning, priming – amygdala

Working memory** (“short-term” memory)
– several seconds of storage – frontoparietal regions

**Commonly tested portions

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26
Q

C1 Memory - How do you test for declarative episodic memory?

A

IR - repeat 3 items FRONTAL

STM - recall those items in 5 minutes MEDIOTEMP

LTM - breakfast, for dinner last night, news, progress more distantly MEDIOTEMP

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27
Q

C1 Calculation - Testing for acalculia?

A

serial 7s? (guessing go back and look-up)

28
Q

C1 Memory - How do you test for semantic declarative memory?

A

more difficult to test (i.e. not commonly tested) – can ask pt to list items in a category

29
Q

C2 Sensory Input - General definition of agnosia

A

dunno!

30
Q

C1 Memory - Testing for procedural memory?

A

not commonly done - can assess learned abilities (see “apraxia”)

31
Q

62 year old man was seen in the ED because of “altered mental status”. On exam he has some difficulty remembering events, and in fact seemed to make up some details to mask this problem. He was not well-oriented. Language was good. Where might you expect a lesion?

  1. Hippocampi
  2. Mamillary bodies
  3. L temporal
  4. R temporal
  5. Bitemporal
A

2 and 5

Korsakoff’s

32
Q

C1 Calulation - Where is lesion in acalculia?

A

generally a dominant parietal lobe function, but can be seen in patients with frontal lesions

33
Q

C2 Sensory Input - Anton’s Syndrome

A

Blindness without realizing it

34
Q

C2 Sensory Input - Visual Agnosia

A

Definition: Inability to recognize objects despite normal vision.
Objects usually can be recognized by touch or sound
Lesion is usually bilateral parieto-occipital cortex. Patients usually not aphasic (but receptive aphasia is possible)

35
Q

C2 Sensory Input - Prosopagnosia

A

Definition - (a visual agnosia) – inability to recognize faces

Also includes difficulty recognizing individual items in a class (bird, but not robin)

Lesions usually in bilateral occipital lobes.

36
Q

C2 Sensory Input - Simultanagnosia

A

Patients can recognize objects or details in their visual field but only one at a time. They cannot make out the full scene.

They literally cannot see the forest out of the trees.

Ask pt to name all the items in a scene:
“What objects do you see?” Pt will only see a few

37
Q

C2 Sensory Input - Alexia: what sx accompany? DDx?

A

Definition - (a visual agnosia) – inability to read
Often accompanied by R hemianopsia, agraphia* and/or aphasia

Lesion in L temp-parieto-occipital region

DDx: •Visual impairment •Diplopia •Field defect - L •Simultanagnosia •Illiteracy

*Agraphia can actually be cured by closing your eyes

38
Q

C2 Sensory Input - Alexia w/o agraphia

A

pure word blindness Lesion in anterior L occip, disconnecting Wernicke’s from both occip cortices

39
Q

C2 Sensory Input - Astereognosia

A

Definition - inability to recognize objects by feel

Test - coins, pen

Lesion in contralateral parietal

40
Q

C2 Sensory Input - Agraphesthesia

A

Definition - inability to recognize numbers traced on hand

Lesion in contralateral parietal

41
Q

C2 Sensory Input - Auditory Agnosia

A

Definition: inability to recognize and identify specific sounds despite normal hearing

Examples – amusia**, cortical deafness

Lesion usually in non-dominant temporal lobe (side we do music on)

**total inabability to perceive music; can’t tell one tune from another

42
Q

C2 Sensory Input - Anosognosia

A

Definition: Inability to understand the significance of one’s illness

Example: Lack of insight into hemiparesis, leading to falls

Lesion usually non-dom parietal lobe

::::Case – 82 y/o woman unaware of her L sided weakness or even that it is her left arm::::

43
Q

C2 Sensory Input - Neglect syndromes: definition? types? and localization?

A

Definition: Inattention to or underuse of body part or surrounding space

Types: 1) Sensory neglect 2) Motor neglect 3) Visual neglect
–Lesion usually contralateral parietal lobe, esp R —Ventral thalamic lesions can produce neglect too –Visual neglect - parieto-occip lesions

44
Q

C2 Sensory Input - Neglect syndromes:

A

Clock-drawing; cross out all the lines on a sheet of paper; circle all the A’s on this sheet

45
Q

–C3. Performance of complex learned activities - constructional apraxia: definition, localization and testing

A

n/a

46
Q

–C3. Performance of complex learned activities - ideomotor apraxia; def, example, local, seen usually with?

A

n/a

47
Q

–C3. Performance of complex learned activities - Gait apraxia

A

n/a

48
Q

–C3. Performance of complex learned activities - Apraxia, generally

A

Definition
Inability to carry out a motor task despite intact motor pathways; tested by having the pt do a task they were taught to do earlier in life

Types include: constructional, agraphia, Gerstmann’s Syndrome, Ideomotor Apraxia, Gait “Apraxia”

Location: (see slide 53) superoposterior to Wernicke’s area: post-central gyrus looping into angular gyrus

49
Q

–C3. Performance of complex learned activities - Apgraphia: definition and location

A

Definition: inability to write

50
Q

–C3. Performance of complex learned activities - Gerstmann’s Syndrome: sx and local

A

1) Agraphia
2) Finger agnosia
3) L/R disorientation
4) Acalculia

51
Q

–C3. Performance of complex learned activities - abnormal gaits: Ataxia

A

Wide-based, unable to tandem

52
Q

–C3. Performance of complex learned activities - abnormal gaits: Parkinsonian

A

Stooped, small steps, turns en bloc

53
Q

–C3. Performance of complex learned activities - abnormal gaits: Foot drop

A

High knee-lift with foot slapping on affected side

54
Q

–C3. Performance of complex learned activities - abnormal gaits: Spastic paresis

A

Stiff, short steps, scissoring

55
Q

–C3. Performance of complex learned activities - abnormal gaits: Apractic

A

Slow and unsteady, magnetic

56
Q

–C3. Performance of complex learned activities - abnormal gaits: Astasia-abasia

A

Wildly careening w/o falling

57
Q

–C4. Executive function - Frontal “Release” signs/reflexes

A

[just guessing here; swearing loss of socially appropriate responses, etc.]

58
Q

–C4. Executive function - general info

A

Executive functions include:

59
Q

–C4. Executive function - Localization of frontal syndrome with sx: Social Inappropriateness,
disinhibition, euphoria, jocularity, abnormal sexual behavior

A

orbitofrontal

60
Q

E. Thought content - Perceptual disturbances

A

Illusion, could also be full-blown hallucination

61
Q

–C4. Executive function - Localization of frontal syndrome with sx: Apathy, akinetic, abulic

A

medial frontal

62
Q

–C4. Executive function - Localization of frontal syndrome with sx: Irritability, inflexibility, reduced sexual interest,
loss of exec function

A

dorsolateral

63
Q

–C4. Executive function - Front lobe testing

A

ASK PT’S FAMILY

64
Q

D. Thought processes - possible abnormalities

A 
Loose associations
Tangentiality
Flight of ideas
Blocking
Perseveration
Word salad
65
Q

E. Thought content - Abnormal findings

A
  • -Delusions (Persecutory (paranoid), Somatic, Grandiose, Nihilistic, Jealous, Guilty)
  • -Thought insertion/broadcasting
  • -Suicidal or Homicidal Ideation
  • -Obsessions
66
Q

F. Affect - Mood vs. Affect?

A

Mood is like climate (What is happening) Affect is like weather (What we see)

67
Q

F. Affect - Possible affect disturbances you could see

A 
Blunted
Restricted
Labile
Inappropriate affect
Pathologic weeping, laughing

SBM Neuro (29 decks)

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