B7.046 Cognition: A Clinical Perspective

Question 1

definition of dementia

Answer 1

cognitive deficits impairing social or occupational functioning

• acquired (after 18)
• persistent
• multiple cognitive domains

Question 2

primary sensory and motor cortical regions

Answer 2

frontal eye fields
motor cortex
somatosensory cortex
auditory cortex
visual cortex

Question 3

first order association cortices

Answer 3

prefrontal cortex
auditory unimodal association cortex
somatosensory unimodal association cortex
visual unimodal association cortex

Question 4

multimodal association areas

Answer 4

anterior association area

posterior association area

Question 5

functions of perceptual association areas

Answer 5

integrate sensory information from the unimodal cortices

Question 6

perceptual association areas

Answer 6

parietal association area

temporal association area

Question 7

function of anterior association area

Answer 7

executive function, planning

Question 8

perceptual pathways and their functions

Answer 8

dorsal: recognition of relationships between objects
ventral: object recognition

Question 9

function of limbic association area

Answer 9

memory (and retrieval of memories), motivation

Question 10

example pathway through the cortex

Answer 10

1. sensory information to primary sensory cortex
2. information processed in corresponding unimodal association cortex
3. information from multiple unimodal association cortices converges on multimodal association cortex and information is processed together
4. information is integrated with limbic association area to recognize the stimuli based on memories
5. sensory input feeds into anterior association cortex to begin executive planning based on the reaction to the stimuli
6. planning information sent to prefrontal cortex
7. prefrontal cortex influences primary motor cortex and corticospinal tracts descend with information about movement based on the plan made in the anterior association cortex

Question 11

anterior brain

Answer 11

executive and motor functions

Question 12

posterior brain

Answer 12

perceptual and sensory functions

Question 13

left brain

Answer 13

symbolic reasoning

-language, math, serial processing of symbols

Question 14

right brain

Answer 14

pattern reasoning

-visual and spatial processing, looking at things as a whole

Question 15

what is brain dominance?

Answer 15

the side of your brain where language processing lives (majority of people are L brain dominant)

Question 16

distribution of brain dominance in the population

Answer 16

right handed people - L brain dominant

left handed people - 70% L brain dominant, 15% R brain dominant, 15% both hemispheres

Question 17

midline brain

Answer 17

memory processing

Question 18

pattern of deficits in cortical lesions

Answer 18

diffuse vs focal
dominant vs non dominant
anterior vs posterior

Question 19

clinical evaluation of deficits with suspected cortical lesion

Answer 19

history
mental status exam
elementary neuro exam

Question 20

components of history taking in evaluation of suspected cortical lesions

Answer 20

behavioral problems
memorizing lists
balancing check books
anomia
getting lost driving (non-dominant hemisphere problem)

Question 21

most common mental status exam

Answer 21

folstein mini-mental status exam

Question 22

typical score on folstein mini-mental status exam

Answer 22

most people get 30/30

if below 28, something is wrong

Question 23

most useful way to use folstein mini-mental status exam

Answer 23

look at PATTERN of deficits, not sure score
functions tested:
memory
language
constructions

Question 24

breakdown of points in folstein mini-mental status exam

Answer 24

majority memory and language (dominant and midline brain)
1 point from constructions (non dominant brain)
dominant/memory brain biased, may need to supplement non dominant tests

Question 25

limitations of clinical mental status exam

Answer 25

``` good: -symbolic reasoning (dominant) -memory -perceptual bad: -executive (motor) -pattern reasoning (non-dominant) ```

Question 26

tests for executive function

Answer 26

``` word fluency (name >15 animals in 1 min) trails test ```

Question 27

tests for construction

Answer 27

draw a cube overlapping pentagons tiles

Question 28

cortical vs subcortical damage

Answer 28

when subcortical systems are affected, elementary neuro exam is abnormal (typically in motor findings)

Question 29

motor signs in subcortical disease

Answer 29

rigidity | weakness

Question 30

what is the elementary neuro exam

Answer 30

parts of the neuro exam that don't deal with mental status

Question 31

Alzheimer's disease

Answer 31

diffuse cortical dementia idiopathic, neurodegenerative disease pathologically characterized by plaques and tangles

Question 32

progression of alzheimer's

Answer 32

lesions begin in the medial temporal lobe (hippocampus area) lesions spread without obvious symptoms for many years mild cognitive impairment manifests once lesion has spread well into temporal and frontal lobes (first symptom is typically short term memory dysfunction) dementia manifests once a large amount of the cortex is affected motor areas typically spare until very late in disease

Question 33

incidence and prevalence of alzheimers

Answer 33

increases with age | worldwide projections increasing drastically over time (epidemic)

Question 34

centrally acting cholinesterase inhibitors in Alzheimers

Answer 34

``` targets early involvement of diffuse cholinergic projection system in the basal forebrain minor benefit (if any) drugs: tacrine, donepezil, galantamine, rivastigmine ```

Question 35

NMDA receptor antagonists in Alzheimers

Answer 35

mechanism is to inhibit glutamate receptor overactivity that could lead to an influx of Ca2+ and resulting excitotoxicity minor benefit drug: memantine

Question 36

top 3 types of dementia

Answer 36

``` ortical 1. alzheimers subcortical 2. vascular dementias 3. diffuse lewy body dementia ```

Question 37

more uncommon cortical dementia

Answer 37

frontotemporal - anterior cortex affected first - memory is ok but dysexecutive symptoms are seen (inappropriateness)

Question 38

components of language processing area of brain

Answer 38

in dominant hemisphere Wernicke's (semantic area) : multimodal center that decodes auditory input, distinguishes words Broca's (encoding and grammar area) : turns ideas into sounds repetition area: connects Wernicke's and Broca's

Question 39

pathways in language processing

Answer 39

1. auditory input goes into auditory cortex and then into Wernicke's area 2. Wernicke's area sends projections into posterior association areas 3. Wernicke's also has a connection with Broca's area, the repetition area 4. Broca's area receives input from Wernicke's and anterior association areas 5. Broca's area sends input into the motor cortex to allow a person to speak

Question 40

components of a language assessment

Answer 40

fluency comprehension repetition

Question 41

Broca's aphasia

Answer 41

non-fluent speech comprehension intact no repetition

Question 42

Wernicke's aphasia

Answer 42

``` fluent speech (but non sensical) no comprehension (can't follow commands) no repetition ```

Question 43

conduction aphasia

Answer 43

fluent speech comprehension intact no repetition

Question 44

trans-cortical sensory aphasia

Answer 44

disconnects Wernicke's area from posterior association centers fluent speech no comprehension CAN repeat

Question 45

trans-cortical motor aphasia

Answer 45

disconnects Broca's area from anterior association centers non-fluent speech comprehension intact CAN repeat

Question 46

common causes of aphasias

Answer 46

watershed strokes