Approach to Cognitive Dysfunction Flashcards Preview

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Flashcards in Approach to Cognitive Dysfunction Deck (39):
1

Agnosia

def

failure to recognize or comprehend perceived stimuli

2

Agraphia

def

inability to write

3

Alexia

def

inability to read

4

Anomia

def

inability to name, word finding difficulty

5

Anosagnosia

def

failure to recognize illness, lack of awareness of deficits

6

aphasia

def

inability to understand and use language

7

apraxia

def

impairment of skilled movement to command or mimicry despite comprehension and normal motor function

8

Neglect

def

inattention to stimuli from one side of the visuospatial environment

9

Disconnection syndromes

def

a) Deficits due to inability to transmit information from one area of cortex to another

b) Callosotomy: the right hand does not know what the left is doing, or what is in the left visual field

10

Language syndromes

speech/comprehension/repetition

Brocas aphasia

Speech:
Comprehension:
Repetition:

Poor
Intact
poor

11

Language syndromes

speech/comprehension/repetition

Wernickes aphasia

Speech:
Comprehension:
Repetition:

Fluent
Poor
poor

12

Language syndromes

speech/comprehension/repetition

Conduction aphasia

Speech:
Comprehension:
Repetition:

Intact
Intact
poor

13

Language syndromes

speech/comprehension/repetition

Global aphasia

Speech:
Comprehension:
Repetition:

Poor
poor
poor

14

Language syndromes

speech/comprehension/repetition

Transcortical motor aphasia

Speech:
Comprehension:
Repetition:

Poor
Intact
intact

15

Language syndromes

speech/comprehension/repetition

Echolalia

Speech:
Comprehension:
Repetition:

Poor
Poor
intact

16

Anomia

def

Difficulty naming objects, common with all aphasia and often the only sign of mild or resolving aphasia

17

Aprosodia

def

Prosody refers to intonation and emphasis, the intonation which reflects affective or emotional content in speech

(1) Encoding and decoding of affective components of speech (and behavior) is performed in the right hemisphere
(2) A categorization aprosodias similar to that of aphasias localizes deficits around the right Sylvian fissure

18

Gerstmann’s syndrome

loc

Dominant parietal lobe lesion

Each component of the tetrad can arise from multiple sites, but combination of all four strongly suggests a dominant parietal lobe lesion

19

Gerstmann’s syndrome

tetrad

(a) Finger agnosia: Can not name fingers or indicate a finger named by the examiner. Extreme cases can not recognize which finger has been touched or moved by the examiner
(b) Left-right disorientation: Can not show left vs right hand or foot. Crossed pointing is more sensitive (Point to right foot with left hand)
(c) Acalculia: Inability to carry out calculations, often due to aphasic acalculia in which the patient mistakes or substitutes one number for another, but true anarithmetria can occur
(d) Agraphia: Writing impairment

20

Gerstmann’s Syndrome

Non-dominant parietal lobe

(1) Neglect
(2) Anosagnosia
(3) Constructional apraxia
(4) Dressing apraxia

21

Cortical blindness

def

No visual perception due to cortical deficit. Pupillary response is preserved.

22

Anton’s syndrome

Classically defined as cortical blindness with anosagnosia. It can sometimes resolve through Balint’s syndrome, and may thus be a disconnection phenomenon where the patient has vision but can not extract any useful information from what he sees.

23

Balint’s Syndrome

oculomotor apraxia (can’t direct gaze effectively), optic ataxia (can’t reach out to a visual target accurately), visual inattention (& sometimes aprosopagnosia: can’t recognize faces). These difficulties result from inability to extract or use visuospatial information, but color information is better preserved.

24

Achromatopsia

def

Loss of color vision in all or part of the visual field. Inferior parietal occipital lobe lesions.

25

Alexia and agraphia

Chars

Lesion location/associated deficits


Alexia without agraphia
Lesion: Posterior dominant hemisphere, occipital lobe and splenium of the corpus callosum
Associated deficits: Right homonymous hemianopia, color anomia or achromatopsia

Alexia with agraphia
Lesion: Dominant hemisphere parietal lobe
Associated deficits: Variable components of right hemisensory deficit, hemiparesis, and aphasia

26

Alexia and agraphia

Chars

Reading/ writing, dictation


Alexia without agraphia
Reading: Very poor
Writing, dictation: No agraphia

Alexia with agraphia
Reading: Very poor
Writing, dictation: Severe agraphia

27

Alexia and agraphia

Chars

Copying/comprehension of spelled words


Alexia without agraphia
Copying: Slavish (drawing a picture of the writing)
Comprehension of spelled words: Good

Alexia with agraphia
Copying: Slavish (drawing a picture of the writing)
Comprehension of spelled words: Very poor

28

Alexia and agraphia

Chars

Spelling aloud/verbal output


Alexia without agraphia
Spelling aloud: Good
Verbal output: Normal

Alexia with agraphia
Spelling aloud: Very poor
Verbal output: Normal to anomic

29

Alexia and agraphia

Chars

Letter naming/paralexia


Alexia without agraphia
Letter naming: Usually good, quite variable
Paralexia: Occasional semantic paralexia (synonym substitutions)

Alexia with agraphia
Letter naming: Severe letter anomia
Paralexia: Frequent semantic paralexia

30

Prosopagnosia

chars

i) Literally, inability to recognize faces, but more generally, refers to difficulty recognizing specific members of a general class of objects, on the basis minor visual feature variations
ii) Patients can distinguish people by voice and stance
iii) Patients can recognize a face and distinguish parts (eyes, ears, nose, mouth)
iv) A problem of visual cueing of memories: patients can select pictures of the same person from a group of pictures
v) Prosopagnosia can apply to other categories:
(1) Farmer can't distinguish his cows (2) Inability to distinguish makes of cars, species of birds

31

Visual agnosia

def

i) Ability to see and describe an object while unable to recognize it
ii) Should be able to draw the object or match it to a drawing or picture
iii) Must be unaware of the nature or use of an object, not just its name
iv) The man who mistook his wife for a hat

32

Types of memory

list

Registration (attention span)
Short-term memory (recall)
Long-term memory (public events)
Motor skills and conditioned reflexes

33

Amnesia

def

Anterograde: Inability to form new memories
(1) Korsakoff's syndrome

Retrograde: premorbid memories

Ribot's law: more recent memories are most affected

34

Amnestic syndrome

chars

i) Bilateral limbic system lesions
(1) Medial temporal lobes
(2) Medial thalamic nuclei

ii) Usually a mixture of anterograde and retrograde amnesia

iii) Both improve as the lesion resolves

35

Transient Global amnesia

chars




Acute onset transient anterograde amnesia
Benign usually (migraine, seizure, TIA)
Leaves a permanent memory gap
Full recovery of anterograde memory

36

Psychogenic amnesia (psychogenic fugue)

def

Loss of personal identity and past

Intact memory for recent events

Occurs most often in fiction

37

Dementia

DSM-def

Loss of multiple cognitive abilities in a person with a clear sensorium (no delirium)

DSMIV-R requires memory impairment plus impairment in one of:
(1) language
(2) judgement
(3) abstract thinking
(4) praxis
(5) constructional abilities
(6) visual recognition

38

MCI

criteria




Memory complaint, preferably corroborated by an informant
Objective memory impairment
Normal general cognitive function
Intact activities of daily living
Not demented

39

Vascular dementia

Modified hachinski ischemic score

Pg. 206

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