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Cheng-Ching > Cognitive > Flashcards

Cognitive Flashcards

1
Q

Dementia screening

A

CBC, glucose, TSH, BMP with Cr/BUN, LFTs

-no VDRL/RPR or HIV screening anymore or LP

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2
Q

AD genes

A

ALL Autosomal dominant

Late onset AD - APOE4 increases risk -chr 19
(ApoE4 homozygous is a susceptibility gene not genetic mutation)

(apo E2 protective)

Early - APP- amyloid precursor - chr 21
presenilin 1 (most common) -chr 14
presenilin 2 -chr 1

TREM2 gene increase risk AD

-beta-amyloid plaques, tau fibrillary tangles

lecanemab - decreased B amyloid plaques, moderate effect on disease -
Risk: ARIA - rash, encephalopathy, superficial siderosis

Risk factors: FEMALE gender, low level education, repeated head trauma

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3
Q

IgLON5 Ab

A

Abnormal sleep movements, obstructive sleep apnea, bulbar Sx, central hypo ventilation, tauopathy

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4
Q

FDG PET patterns

A

AD dementia- low posterior temporoparietal activity (post cingulate low first)
-decreased glucose metabolism

LBD - lateral occipital cortex low, cingulate island sign = post cingulate preserved > temporoparietal hypometabolism

FTD - low frontal lobe, anterior temporal lobe

HD - low caudate, putamen

vascular dementia - scattered areas low update corresponding to infarcts

PSP - decreased glucose metabolism BG, thalamus, upper brainstem, ant cingulate

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5
Q

atypical AD

A
  1. parietaloccipital - Gerstmann
  2. logopenic - L temporoparietal function - repetition impaired
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6
Q

FTDegeneration

A

Pathology:
FT lobar degeneration

Primary progressive aphasias - semantic variant- FTD 43-

non fluent agrammatic variant - then hand involved (fine finger movements) -apraxia

-bvFTD - like a kid - loss empathy, apathy; FTD/ALS - C9orf72 TDP 43
-picks disease repeat expansion

-motor FTD - PSP - hummingbird
-motor FTD - CBD

tpd43 semantic variant
focal anterior temporal lobe atrophy - start asymmetric on left then right then orbitofrontal

Progranulin - TPD 43
MAPT - chr 17
3R repeats - Pick’s
4R - CBD and PSP

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7
Q

AD CSF

A

CSF pattern consistent with high risk of progression from MCI to Alzheimer’s:
High Tau, LOW beta-amyloid
-beta-amyloid plaques accumulate so low beta amyloid in CSF

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8
Q

minor cognitive impairment

A

1 or more domains
-doesn’t interfere with iADLs
-amnestic MCI->early AD
vs nonamnestic - language/executive/attn/visuospatial fxn

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9
Q

papez circuit, memory formation

A

entorhinal cortex->hippocampus->fornix->mamillary bodies->Anterior Nuc thalamus ->cingulate gyrus->entorhinal cortex

medial temp lobe: storage, retrieval (3 word recall first impairment ; episodic memory impaired vs immediate/remote memory; semantic spared until laterAD)

-BL medial temp lobe lesions - loss declarative/explicit memory

no specific lesions leading to loss of nondeclarative memory

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10
Q

AD histopathology, pathophys

A
  1. early before Sx: amyloid deposition-cortex, leptomeningeal vessels**
    neuritic plaques piles of sprinkles, neurofibrillary tangles-most specific -

-granulovacuolar degneration, Hirano bodies-less specific

(*Alzheimer’s type II astrocytes - hepatic encephalopathy)

-loss cholinergic neurons-nucleus basalis of Meynert
-loss AChtransferase acitivty-correlates with memory loss

MRI: hippocampal lumpy bumpy sign

Amyloid scan: grey + white matter light up, normal = just white matter lights up

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11
Q

Huntington’s disease

A

chromosome 4

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12
Q

FTD

A

inherited - chromosome 17 (backwards F)
tauopathy -histo: pick bodies (clumps of tau)

-behavioral variant FTD - Pick’s disease - least likely to be depressed vs HD- apathy, abulia, poor judgement, personality change, hyperphagia, OCD

-progresive nonfluent aphasia - preserve comprehension

-semantic dementia/progressive fluent aphasia - ~transcortical sensory aphasia, BL temp

Kluver-Bucy - BL anterior temporal lobe/amygdala - hyperphagia, hyperorality, and hypersexual, visual agnosia- HSV encephalitis

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13
Q

thalamic nuclei

A

anterior nuclei - Papez circuit memory formation

Dorsomedial nuc - abulia, anterograde amnesia, social disinhibition

pulvinar - visual, sensory integration
VPM-face
VPL-body

reticular nuc - sleep spindles

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14
Q

akinetic mutism

A

BL GPi
-BL ACA infarcts
-medial frontal lobe

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15
Q

TBI

A

altered personality interferes most with rehab

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16
Q

AD drugs

A

memantine - NMDA antagonist (+5HT3 antagonist)

Donepezil - pure ACHE antagonist

Rivastigmine ACHE + butyrylcholinesterase antagonist “reverse the stigma” double punch to raise ACHE

Galantamine - ACHE antagonist + allosteric nicotinic modulator “Alzheimer’s Gala”

17
Q

Histopathology

A

LBD - halo around Lewy body

Pick bodies - off center inclusion, fat (hyperphagia in FTD) - tau aggregates-silver staining

AD - 1st - amyloid angiopathy
neuritic plaques piles of sprinkles- like plaque psoriasis-Beta-amyloid
(B-secretase)

  1. neurofibrillary tangles - matted densehelix -hyperphosphylated tau
  2. granulovacuolar degeneration - vaculoles with intracytoplasmic granules- open spaces around cells

CJD - spongiform vacuoles - blank white spaces

PSP - tufted astrocytes (tufted eyebrows)

MSA - glial cytoplasmic inclusions

CBD - coiled bodies, ballooned neurons

Negri bodies - Rabies-little black dot (negro) perfect circle

ALS - Bunina bodies - buried dots at perimeter motor cell

18
Q

Wernicke, Korsakoff vs psychogenic

A

psychogenic: lose autobiographical memory, +/- can learn new things
Wernicke - confusion, ataxia, ophthalmoplegia

19
Q

CJD

A

familial - susceptibility-PRNP-Chr 20

PrP alpha helix converts to B-pleted sheet
cortical ribbon
-increase T2 caudate, putamen, pulvinar

20
Q

balint syndrome

A

Where disorders - dorsal stream (donde)
-simultanagnosia (can’t see more than one thing at one time)+ ocular apraxia + optic ataxia
BL parieto-occipital

21
Q

agnosia types

A

prosopagnosia - BL fusiform gyri (temporo-occipital); +/- achromatopsia

topographagnosia - can’t navigate, read/draw maps - R posterior parahippocamcal/infracalcarine cortex

asomatognosia - can’t recognize body part - R superior parietal, supramarginal (somato = body)
-somatoparaphrenia - deny ownership of body parts + think they are stolen

misoplegia - severe hatred of limb

22
Q

aphasias

A

pure word deafness/verbal auditory agnosia - can’t understand other people speaking but otherwise intact language; normal writing
-BL middle superior temporal gyri - disrupt connection to Heschl’s gyrus
-amusia - agnosia to music

nonverbal auditory agnosia - agnosia to sounds - BL anterior temporal lesions/R temporal lobe

anomia - recognize but can’t name - angular gyrus syndrome (finger agnosia-Gerstmann)

aphemia - pure word mutism - productive aphasia but can write, cannot repeat - dominant frontal operculum

conduction aphasia - cannot repeat, otherwise intact - internal arcuate fasciculus

amelodia/affective motor aprosodia - nondom posterior inferior frontal gyrus (R analog of Broca/s)

sensory/receptive aprosodia - inability to percieve/understand emotional contents of speech - R superior temp gyrus (R analog of Wernicke)

23
Q

Foix-Chavany-Marie - anterior opercular syndrome

A

severe dysarthria, BL voluntary paralysis; preserved social smile/emotional innervation

BL anterior operculum

24
Q

operculum

A

cover of insula - frontal, temp, parietal

25
Q

pseudobulbar palsy

A

BL corticoBULBar pathways
Tx: dextromethorphan-quinidine

26
Q

Lesions to OFC vs DLPFC vs DMPFC vs anterior cingulate

A

OFC -disinhibited, pressured speech, inappropriate jocularity (witzelsucht), echopraxia-imitate behavior
-Dorsomedial nuc thalamus- abulia, anterograde amnesia, social disinhibition

DMPFC - motor initiation, goal directed behavior, motivation

If severe->akinetic mutism + incontinence (paracentral lobule)
-BL DMPFC/anterior cingulate (ACA/pericallosal infarcts)
- BL GPi

DLPFC - disorganized, no multitasking, lose interest in hobbies, executive dysfunction

27
Q

cognitive tests

A

pegboard test - finger texterity
trail making - processing, visual search, attention, WM, task set switching NOT visuospatial

random cancellation test - attention, processing

clock drawing - visuospatial

Wisconsin card sorting - prefrontal cortical function

28
Q

delusional misidentification

A

Fregoli’s - same person exists in several disguises

intermetamorphosis - swap identity while maintaining appearance

reduplicate paramnesia - identical places/objects

Capgras - identical imposter

pseudocyesis - delusion that person is pregnant

Cheng-Ching (13 decks)

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