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Flashcards in Attention/Memory Deck (34):
1

Neuroanatomy of attention

Cortex: reticular modulation of ascending sensory info
Focusing attention requires voluntary effort (frontal)
Paralimbic: input adds emotional importance
--> selective attention
Brainstem/basal forebrain cholinergic projections: circuit-tuning
Parietal cortices: shifting from one spatial locus of attention to another

2

MOCA test

doesn't test writing/reading
limited naming
attention subtest

3

Digit span

normally can repeat 5-7 forwards

4

Divided attention

reverse digit span should be >= foward span-2
Months backwards - better screen in the elderly
Days of week backwards if unable to do months
Spelling "world" backwards (MMSE)

5

Delirium

prototypical disorder of attention
10-30% of hospitalized patients
may be a presenting feature of undiagnosed medical illness
can be life-threatening
Increased risk of complications
mortality rate of 25% within 6 months of discharge
frequently iatrogenic
under-recognized in nursing homes/hospitalized elderly

6

Delirium presentation

prominent, fluctuating disturbance of attention
arousal/hallucinations

7

Common causes of delirium

fever (children esp)
infection (pneumonia, bladder, sepsis)
R/O meningitis, encephalitis
Chemical disturbances/energy failure
withdrawa/intoxication
Drugs - esp anticholinergic
Focal/multifocal lesions
Autoimmune processes

8

Metabolic causes of delirium

hyponatremia
uremia
hypoglycemia
hypoxemia
hypercarbia
hyperammonemia due to hepatic failure
thyroid dysfunctio
thiamine deficiency

9

Drug-related causes of delirium

Withdrawal/intoxication
- alcohol
- benzo
- barbiturates
- other sedatives that increase GABA

Primary/secondary anticholinergics
opioids
lithium
anticonvulsants
antiparkisonian agents
drugs of abuse

10

Autoimmune causes of delirium

CNS lupus
paraneoplastic syndromes

11

Right hemisphere syndromes

Construction apraxia
spatial/topographical disorientation
Dressing impairment (dressing apraxia)
hemi-neglect, anosagnosia
emotional indifference
language alterations, aprosodias
alteration in "pragments" of speech

12

Hemi-spatial neglect

persistent failure to detect, respond or orient to relevant stimuli, or to initiate appropriate movemetns in a hemispace
unexplained by primary sensory/motor defects
typically L-sided neglect due to R sided lesions
often accompanied by unawareness of deficit (anosognosia)
persistent R-sided neglect is rare - suspect bilateral lesions/unilateral L-side lesion + superimposed encephalopathy

13

Semantic memory location

inferolateral temporal lobes

14

Procedural memory locations involved

basal ganglia
cerebellum
supplementary motor area

15

Working memory neuroanatomy

prefrontal cortex
Verbal/arithmetic: L>R prefrontal/parietal

Visuospatial R>L prefrontal/parietal

16

Episodic memory test

temporally specific events, personal experiences
recent event recall
word lists
paragraph recall
3 word 3 shape test
3 bedside objects/locations

17

Episodic memory locations

mesial temporal lobes (hippocampus, parahippocamapal gyrus)
fimbria/fornix
mamillary bodies
mamillothalamic tract
anterior thalamic nuclei
cingulate gyrus

18

Agnosia

impaired higher level recognition in presence of preserve elementary perception, memory and general intellect
could be considered a form of semantic memory impairment

19

Apperceptive visual agnosia

shape/visual form agnosia
shape perception abnormal
worse for geometric figures, pics
seen most often after anoxic damage (esp CO poisoning)
usually involves occipital cortices extensively

20

Associative visual agnosia

relatively intact perception, but poor recognition
unable to match/describe use by sight
can copy line drawings but not identify
bilateral posterior damage/degeneration involving ventral occipitotemporal areas, esp peri-striate region

21

Prosopagnosia

loss of facial recognition
usually associated with left hemifield defect
Localization: ventral visual associative areas (medial occipitotemporal cortex)
usually bilateral lesions, right-predominant
Right PCA territory infarct

22

Colour agnosia

visual association area
occipitotemporal

23

Tactile agnosia

Parietal sensory association

24

Auditory agnosia

auditory association cortices
post sup temporal gyrus and connections

25

Finger agnosia

dominant angular gyrus in inferior parietal lobule

26

Simultanagnosia

visual association areas
bilateral superior parietal cortex (spatial visual pathway)

27

Anagnosia

unawareness of neurological deficit/illness
common in hemispatial neglect
seen in other syndromes: fluent aphasia, dementia, cortical blindness (Anton's syndrome), schizophrenia, mania

28

Frontal lobe cognitive functions

divided/selective attn
retrieval from semantic and episodic memory
abstraction
analogical reasoning
"switching gears"
insight
judgment, assessment of reward
planning/problem solving

29

Frontal lobe behavioural function

motor activation (apathy)
aspects of personality
social judgment/demeanor
empathy and consideration of rights and feelings of others
interest in personal hygiene/grooming

30

Orbifrontal syndrome

Behavioural variant of frontotemporal dementia, head injury

Disinhibition
impulsive behaviour
distractible
emotional lability, irritable
inane euphoria
jocularity
poor judgment/insight
hyperactive/manic-like
sexual disinhibition

31

Dorsolateral frontal syndrome

FTD, frontal lobe infarcts, penetrating head injury
Reduce verbal, nonverbal fluency
perseveration
abstraction impaired
retrieval defects
poor set shifting
poor strategies on copying tasks
impaired attention
depressed mood

32

Medial frontal syndrome causes

ACA/MCA borderzone infarcts
ruptured ACA aneurysms
falx meningiomas
hydrocephalus

33

Medial frontal syndrome presentation

lack of motivation/drive
emotional emptiness/blunting
failure to implement new plans
poor performance and maintenance of output on fluency tasks
decreased motor activity
extreme form: akinetic mutism (no initiation of speech/voluntary movements)

34

Frontal lobe function tests

verbal fluency
category fluency
nonverbal (design fluency)