Week 9

Question 1

Learning definition

Answer 1

Acquisition of experience

Question 2

Memory definition

Answer 2

Retention of experience

Question 3

Learning and memory

Answer 3

Work together to adapt behaviour
Versus stereotypical reflexes

Question 4

Memory classification

Answer 4

Nature of memory
Duration

Question 5

Nature-declarative

Answer 5

‘Explicit’
Consciously aware
Able to describe in words
Fades with time
Types:
-semantic :facts
-episodic: events

Question 6

Nature- non declarative

Answer 6

‘Implicit’ the how
Skills, habits, behaviours less likely to fade over time
Types:
-procedural memory: skills and habits, eg motor tasks
Conditioned responses
-associative reflexes
Emotional responses
-How we feel in a particular environment in particular circumstance based on prior experience

Question 7

Duration

Answer 7

Sensory memory
-fractions of a second
-function= sensory processing
Short term memory:
-approx 30 seconds
-7+/- items
Working memory- combining new things with stored things
Input-> sensory memory -> short term memory—consolidation—> long term memory

Question 8

Memory deficit

Answer 8

Forgetting is necessary
Increased age?
-difficulty in acquisition or storage?
—all types of memory?
-lost or difficult to retrieve ?
-synapses not neurones
Amnesia- secondary to pathology: traumatic brain injury, infection, neurodegeneration, resection, stroke
Types of amnesia
-retrograde amnesia: events before trauma. Declarative memory
—usually not complete may be reversible in recovery
-ribots law: recent memories are more likely to be lost than older ones
-anterograde amnesia: inability to form new memories
-A&R may occur independently

Question 9

Anatomical location of memory

Answer 9

Evidence
-humans with brain injury
-lashley 1920s: experimental lesions= large areas of cortex involved . Wrong
Lettvin 1960s; the grandmother cell hypothesis, every neurone was responsible for a memory. Wrong
Currently: fMRI/lesions-> network involving multiple regions

Question 10

Anatomical location of memory declarative

Answer 10

Declarative memory
-medial temporal lobes
—lesion
—AD pathology episodic then semantic
Sensory info-> hippocampus (and rhinal cortices) (particularly important for episodic)—consolidation—> neocortex
Can map time of info shifting with location in brain
Korsahoffs syndrome -episodic
Diencephalon
-intact pathways between hippocampus and neocortex important for conversions of short term memory into long term memory
Hippocampus-> hypothalamus-> thalamus-> neocortex
Fornix

Question 11

Anatomical location memory non-declarative

Answer 11

Non declarative
-procedural
—cerebellum
—supplementary motor area and basal ganglia
-emotional
—amygdala
-working memory
—prefrontal cortex

Question 12

Case study: HM

Answer 12

Bilateral temporal lobectomy
-severe anterograde amnesia for declarative memories
-childhood memories intact
—TL required for new declarative but not for very old memory
Procedural memory- cerebellum and supplementary motor area and basal ganglia not medial temporal lobe
-so no problem
Working memory: pre frontal cortex and others. Evidence: ADHD, schizophrenia

Question 13

How do neurones store memories

Answer 13

Neuroplasticity
-change in neurotransmission
-change in synaptic structure
Change in neurotransmission:
-long term potentiation LTP (long term depression)
—declarative
-LTP-> NMDA receptor activation
—calcium entry
-> immediately
->altered kinase activity esp CAMKII eg enhanced AMPA function
> persistence
->changed gene expression
-> more AMPA receptors
activation of NMDA receptors elevates activity of neurones and allows storage info

Question 14

What’s happening at the synapses

Answer 14

Change physical structure
Axon sprout growth cone
Infinite storage capacity
Synaptic Neuroplasticity
Bad news: plasticity-> maladaptive, increase vulnerability

Question 15

Memory manipulation

Answer 15

Health and recreational
Pharmacological
-enhancement
-suppressors
—NMDA antagonists eg ketamine
Non pharmacological
-EG CBT?

Question 16

Language definition

Answer 16

Is a systemic means of communication using conventionalised sounds, gestures, and marks

There are 7139 languages in the world
40% of languages are now endangered often with less than 1000 speakers remaining
23 languages account for more than half of the worlds population

Question 17

Speech

Answer 17

Is expression of thoughts in spoken words. Speech is the final motor step in oral expression of language

Question 18

Anatomy of language

Answer 18

Motor/sensory cortex
Inferior frontal gyrus (Brocas area)
Superior temporal gyrus (wernickes area)
Corticobulbar tract
Approximately 90% of people are right handed and approx 95% of them process language in the left cerebral hemisphere (left cerebral dominance)
Of the 10% of people who are left handed approx 60% have left cerebral dominance for language

Question 19

Anatomy of speech

Answer 19

Speech generating cortex
Modulatory input from corticobulbar pathway, basal ganglia and cerebellum
Modulatory unput from auditory recognition areas of brain
Cranial nerves input- 10th nerve (supplies the larynx), 12th nerve (supplies the tongue)
Tongue and other muscles
Larynx - a voice generator
Oropharynx- a voice modulator

Question 20

The language/speech components and disorders terminology

Answer 20

Phonation (sound and volume)-> dysphonia (aphonia)
Articulation of the speech-> dysarthria (anarthria)
Comprehension of the language production of language-> aphasia (dysphasia)

Question 21

Language

Answer 21

The key elements of language are comprehension, repetition, fluency, naming, reading, writing
All elements of language should be tested when a language disorder is suspected
There are several dysphasia/aphasia syndromes etc characterised by a specific form of language impairment
A language impairment pattern correlates anatomically with a specific site

Question 22

Expressive aphasia (dysphasia)

Answer 22

Motor/non fluent/Brocas/anterior
Paucity of spontaneous speech
Non fluent agrammatical, telegraphic nature of the speech
Language comprehension is intact “close your eyes” he/she can do it
Patients are unable to write normally or to repeat (tested with a content poor phase such as “no ifs ands, or buts)
The patient is typically aware of the disorder and frustrated by it
Lesion in the inferior frontal gyrus in the (usually left) hemisphere

Question 23

Receptive aphasia (dysphasia)

Answer 23

(Sensory/fluent/Wernicke’s/posterior)
Patients comprehension and retention are impaired
Speech is very fluent but does not make any sense (unintelligible)
A large volume of language is produced but lacks meaning may include paraphasic errors (words that sound similar to the correct word) and neoplasms (made up words)
Comprehension of written language is impaired
The patient cannot follow oral or written commands but can imitate the examiners action when promoted by a gesture
The patients are usually unaware of and therefore not disturbed by their aphasia
Patient could be mislabelled as confuised
Lesion in the superior temporal gyrus in the dominant (left) hemisphere

Question 24

Other types of aphasia

Answer 24

Global aphasia:
-combines features of expressive and receptive aphasia. Patients can neither express, comprehend, nor repeat spoken or written language
Conduction aphasia:
-repetition is impaired, expression and comprehension are intact
Transcortcial aphasia:
-expressive, receptive or global aphasia occurs with intact repetition
Anomic aphasia:
-a selective disorder of naming
Differential diagnosis:
-dysarthria- a speech disorder may be difficult to distinguish from aphasia
-dysarthria always spares oral and written language comprehension and written expression

Question 25

Dysphonia/aphonia

Answer 25

a disorder of the voice
Dysphonia- it’s an inability to produce sounds (phonation) properly using the vocal cords. Voice is either hoarse, rough, or soft, breathy voice
Aphonia- phonation is not possible

Question 26

Causes dysphonia/aphonia

Answer 26

Structural/neoplastic: cysts, polyps, nodules, carcinoma
Inflammatory: allergy, infections, reflux, smoking
Neuromuscular: multiple sclerosis, myasthenia gravis, Parkinson’s disease, spasmodic dysphonia, nerve injury
Systemic disease: acromegaly, amyloidosis, hypothyroidism, sarcoidosis
Other: psychogenic, stress, vocal strain

Question 27

Dysarthria/anarthria

Answer 27

Failure of articulation and difficulties to pronounce words secondary to weakness of the muscles that help produce speech
Multiple causes:
-bulbar palsy, pseudobulbar palsy, cerebellar ataxia, Parkinsonism, chorea, myoclonus, Tourette’s etc

Question 28

Clinical examination

Answer 28

The 2 most important aspects in examination of speech are comprehension (understanding) and fluency(spontaneous speech)
-asking questions: what is your address, what do you do for a living, etc. ask the patient to describe their job or what they have eaten in some detail to help assess the speech
Giving commands: start with simple command and increase the complexity as appropriate. Close eyes show me right hand, close right eye and touch left ear with your right hand
Assessing repetition: ask patient to repeat a simple word, try a full sentence, try a phrase