Flashcards in 2. Cognitive Exam Deck (101)
inability to perceive/understand the import of sensory stimuli despite intact sensory mechanisms. perception devoid of meaning.
inability to recognize own neurological deficit.
inability to perform learned actions despite intact motor functions
define receptive aphasia
inability to understand. characteristic of Wernicke's
define expressive aphasia
inability to express via speech. characteristic of Broca's
define global aphasia
inability to comprehend, produce, repeat speech.
visual agnosia. inability to read.
inability to write. Akin to expressive aphasia
frontal lobe lesion accompanied by inappropriateness, etc
anomia, difficulty naming items
well-articulated but incorrect words. includes neologisms, semantic paraphasia, phonemic paraphasia
Language: bilateral or unilateral?
attention to the non-dominant world: bilateral or unilateral?
somatic sensation: bilateral or unilateral?
vision: bilateral or unilateral?
voluntary motor function: bilateral or unilateral?
hearing: bilateral or unilateral?
bi (Heschel's gyrus)
short term memory: bilateral or unilateral?
bi (medial temopral lobe)
frontal lobe functions (mood, behavior, emotional control, motivation, exec function): bilateral or unilateral?
long-term memory: bilateral or unilateral?
visuospatial function: bilateral or unilateral?
bi. parietal lobe
aphasia is lateralized where?
to the dominant hemisphere
patients with Broca's, Wernicke's, global and conductive aphasias will be unable to do what?
repeat complex phrases
Broca's area infarction results in what?
very reduced speech, repetition and naming. intact aud and visual language comprehension (reading). frustration.
Wernicke's area infarction results in what?
output that is active but nonsensical, inability to comprehend language. inability to repeat and name things. not frustrated.
conduction aphasia is due to a lesion where?
define conduction aphasia
reasonably normal expression and comprehension, but impaired repetition of simple and complex phrases.
Inability to repeat due to interruption of the arcuate fasciculus. Fluent, but with paraphasias. Comprehension may be OK.
damage to the dominant occipital lobe and splenium of the corpus callosum yields what?
alexia without agraphia. can write but can't read what they're written
immediate recall occurs where?
short term memory occurs where?
long term memory occurs where?
diffusely. only lost if large and diffuse areas are damaged
the non-dominant parietal lobe does what?
attention to the contralateral world
lesion of the non-dominant parietal lobe yields what?
hemi-inattention/neglect of the non-dominant world. impaired recognition of self, inability to learn that deficits exist in non-dominant motor/sensory functions.
what does the frontal lobe do?
exec functions like initiative, sequencing, planning, problem solving.
lesion to the frontal lobe yields what?
personality change, failure of executive function, difficulty with activities of daily living
orbitofrontal injury can lead to what/
what can a corpus callosum transection yield?
split brain: information not transferred from side to side, R hand not knowing what L hand is doing.
what does the neurological exam include?
mental status, cranial nerves, motor systems, reflexes, sensory systems, coordination, gait
when to do the mental status exam?
known brain lesion, suspected brain lesion, psychiatric disease, behavioral complaints
what is included in the mental status exam?
LOC, attention, concentration, cognitive functions, thought processes, thought content, affect
a generalized deterioration of intellectual or cognitive function, particularly memory, without altered alertness or perception
acute thinking disorder. expected to improve.
acute thinking disorder plus altered consciousness, hyperactivity, irritability etc
Broadly, diffuse alteration in brain function generally including disordered thinking. Static.
pure loss of memory without other cognitive loss
Retrograde amnesia – loss of memory prior to a specific time
Anterograde amnesia – loss of memory after a specific time
4 levels of consciousness?
how to test attention/concentration?
digit span, spell world/backwards
loss or impairment of the use and understanding of inflection
substitute wrong word
substitute wrong sound
use of non-existent word
why is Broca's often seen with R hemipareisis?
lesion usually on L side because of L sided language dominance
what are 4 tests of language?
-pace of speech (should be 12-50 words per minute)
-naming items and parts of items
-comprehension (paper, fold, put on floor)
-repetition of phrases
where is Broca's aphasia lesion?
inferior precentral gyrus
where is Wernicke's aphasia lesion?
upper posterior temporal
where is conduction aphasia lesion?
where is global aphasia lesion?
large area in parietal and frontotemporal
where is music localized?
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?
L posterior temporal
what are the parts of memory that we test?
episodic, short term/working
where does episodic memory reside?
medial temporal (bil), hippocampus, mammillary body
where does short term memory reside?
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?
medial temporal (bil), hippocampus, mammillary body
acalculia results from a lesion where?
dominant parietal lobe
how to test calculation?
serial 7s, adding
inability to recog faces
inability to recognize items by touch
Inability to recognize objects despite normal vision.
visual agnosia: location?
Lesion is usually bilateral parieto-occipital cortex.
Lesions usually in bilateral occipital lobes.
Can see objects but cannot sort them out from one another.
Cannot see forest for trees
Lesion in L temp-parieto-occipital region
Alexia: be sure to rule out what?
Field defect - L
inability to recognize numbers traced on hand
inability to recognize and identify specific sounds despite normal hearing
auditory agnosia: location?
Lesion usually in non-dominant temporal lobe. non-dom because that's the side we process music on.
non-dominant parietal lobe
Lesion usually contralateral parietal lobe, esp R
Ventral thalamic lesions can produce neglect too
Visual neglect - parieto-occip lesions
Neglect syndrome testing?
cross all the lines in half, circle all the As: pt will only do task in right side of visual field
83 year old woman is brought to the ER from for retirement home because of confusion
On exam she is awake and neurologically intact but she seems to ignore you and does not move her left side unless coaxed. MRI reveals a stroke.
dominant posterior frontal cortex
Gerstmann's Syndrome: symptoms?
Gerstmann's Syndrome: location?
dominant angular gyrus, corpus callosum
constructional apraxia: definition
inability to copy or construct figures. disturbance in visuo-spatial abilities rather than pure apraxia
constructional apraxia: lesion?
non-dominant parietal cortex
tests of constructional ability?
clock drawing, overlapping pentagons, cube
A 57 year old man with Parkinson’s disease has a great deal of trouble performing simple actions like combing his hair.
What is a likely cause of this?
-Bradykinesia (slowness of movement)
-Procedural memory deficit
all of these
inability to perform a specific task when asked. ie, unable to show how to use a comb, use a key
ideomotor apraxia: location
usually non-localizable, but can be due to disconnection (callosal lesion preventing opp side from receiving command from Wernicke's)
gait apraxia: location
bil frontal lobes
gait: wide based, unable to tandem
gait: stooped, smalls steps, turns en bloc
gait: high knee-lift, foot slapping
gait: stiff, short steps, scissoring
gait: slow and unsteady, magnetic
social inappropriateness, disinhibition, euphoria, abnl sexual beh: where is lesion?
apathy, akinesis, abulia: where is lesion?
irritability, inflexibility, reduced sex interest, loss of exec function: where is lesion?
frontal lobe testing: observe what, and ask what?
observe for perseveration, slowness/abulia, apathy
judgment: pose a scenario
proverbs: ask to interpret
planning: how would you...