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Flashcards in behavioral cortical dementia Deck (27):
1

Recent or short-term memory

ability to recall information after several minutes of retention

2

remote or long term memory

ability to recall past events hours, weeks or even years afterward

3

Memory function depends on bilateral circuits involving what?

temporal lobe and thalamus
specifically:
1. hippocampus
2. fornix
3. mamillary body
4. anterior thalamic nucleus

4

What is amnesia in Wernicke-Korsakoff syndrome caused by?

bilateral thalamic and mammillary body lesions
-thiamine deficiency

5

What causes amnesia in cardiac arrest survivors or herpes simplex encephalitis?

bilateral hippocampal lesions

(cardiac arrest survivors=anoxia)

6

Apraxia

the inability to conceptualize and perform a skilled, learned, motor act on command
unable to do action when commanded but able to do it at other times

7

What is gait apraxia and what lesion is involved?

inability to walk on command
-prefrontal lobe lesion

8

Constructional apraxia
Lesion?

patient cannot draw a house or copy a simple drawing
-parietal lobe

9

dressing apraxia

patient can not dress
-parietal

10

agnosia

impaired recognition of perceived stimuli caused by lesions of sensory association cortex

11

prefrontal or frontal lobe syndrome

1. listless, apathetic, unconcerned, with poor hygiene and incontinence, poor judgment, executive functions impaired , lacks creativity
2. motor preservation (aimless repetition of simple motor acts)
3. gegenhalten or paratonia
4. frontal lobe release signs

12

what is gegenhalten or paratonia

increased limb tone or resistance is felt as the examiner moves the patient's limb more rapidly

13

What are frontal lobe release signs

previously normal findings in infancy
-suck, snout, root, plantar grasp

14

Syndrome of temporal lobes

-amnesia-bilateral hippocampal lesions
-cortical deafness-bilateral auditory cortex lesion
-kluver-bucy-limbic
-unilateral lesion of the superior posterior dominant temporal lobe--wernicke's aphasia

15

Parietal lobe syndromes

1. sensory cortex
a. astereognosis
b. agraphesthesia
2. lesions of the nondominant parietal lobe-impairment of spatial relationship between the body and its surroundings
a. anosognosia
3. dressing apraxia or constructional apraxia
4. supramarginal or angular gyrus of the dominant parietal lobe
a. Gerstmann's syndrome

16

anosognoisa

unaware of his or her hemiparesis
-denial of half of body or "hemispatial neglect"
-may neglect to groom left side of body

17

Gerstmann's syndrome

1. agraphia
2. right-left disorientation
3. dyscalculia
4. finger agnosia

18

occipital lobe syndrome

1. bilateral visual cortex to produce cortical blindness
-sometimes accompanied by a denial or unawareness of visual loss-Anton's syndrome

2. bilateral temporo-occipital lesions
-visual agnosia (prosopagnosia )

3. dominant temporo-occipital lobe
-color anomia

19

acute confusional state or delerium

fluctuating levels of attention and motor activity
-tremulous, asterixis, myoclonus, ataxia, dysarthria
-could be from viral encephalitis or post-ictal state
-kidney failure, metabolic abnormalities, or meds or drugs
-hours to days

20

dementia

diffuse impairment of cortical function which usually evolves less abruptly or over a longer period of months to years and impedes the daily function of patients
-memory loss
-changes in judgment and intellect
-aphasia, apraxia, agnosia
-personality changes

21

What could be causing dementia?

-alcohol or drugs, taking meds incorrectly, lack of vitamins
-vascular cause-stepwise, focal neurological deficits
-depression
-hereditary
-chronic, subdural hematomas, brain tumor, abscesses, multiple infarctions, hemorrhages, hydrocephalus
-chronic meningitis-fever
-HIV-in younger patients
-thyroid
-alzheimer's

22

What is the evaluation for dementia?

standardized cognitive tests-MMSE
MRI

23

Alzheimer's disease

most common type of dementia in the US
-gradual destruction of specific types of neurons by metabolic changes
-memory loss-medial temporal lobes and hippocampi

24

What is the pathologic hallmark of alzheimer's

1. accumulation of b-amyloid in the form of extracellular amyloid or senile cortical plaques
-coded on chromosome 21

2. beta amyloid deposition leads to intraneuronal neurofibrillary tangles
-consisting microtubule-associated tau proteins

3. cell death especially cholinergic neurons

25

What are typical signs of vascular dementia? (from multiple bilateral cerebral ischemic infarcts)

focal, asymmetrical neurological deficits such as hemiparesis, hemisensory loss, hemianopia, or cerebellar signs

26

What does a PET scan utilizing Pittsburgh compound B, which selectively binds to B-amyloid show?

the typical alzheimer's disease uptake in the prefrontal, temporal and sensory association cortex
-sparing the occipital and primary sensorimotor cortex

27

What can slow down AD?

central acetylcholinesterase inhibitors
1. donepezil
2. rivastigmine
3. galantamine
later:
1. memantine-NMDA antagonist -opposes the excitotoxic effects of glutamate on the CNS

(die of aspiration pneumonia, pulmonary emboli and malnutrition)