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Neuropsychology > Cognitive Disorders and Special Topics > Flashcards

Cognitive Disorders and Special Topics Flashcards

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0
Q

Broca’s Aphasia

A

Lesions to the left front lobe, specifically to the motor strip area which controls the muscles that produce speech
Severe problems with articulation (dysarthria), speech slow and effortful
MOSTLY verbal comprehension
NO repeat phrases
NO fluency

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1
Q

aphasia

A

Language disorder
Results from damage (aka lesions) in the left hemisphere
Location of lesion determines nature of language disruption

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2
Q

Wernicke’s Aphasia

A 
Lesions to left temporal lobe
NO language comprehension
NO execute verbal commands
NO repeat phrases
YES fluency, but say complete nonsense 
Unaware of problem, expect others to be able to understand them
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3
Q

Conduction Aphasia

A 
Lesions in connections between expressive and receptive speech areas
YES language comprehension
YES execute verbal commands
NO repeat phrases
YES fluency, but don't make sense
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4
Q

Global Aphasia

A 
Damage to most of cortex
Most language functions impaired
NO comprehension
NO repeat verbal phrases
NO fluency
NO naming, reading, writing
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5
Q

One-sided neglect

A

When damage occurs to one side of brain, opposite side of body frequently affected\

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6
Q

Apraxia

A

Inability to carry out purposeful motor movements (e.g. waving), despite the absence of motor or sensory deficits
Can move limbs normally, but innervates wrong muscles, puts limbs in incorrect position, omits some element of action when asked to carry out specific motor command
Believed to be caused by left brain lesions, damage to left brain produces apraxia in both limbs

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7
Q

Agraphia

A

Impairment in ability to write acquired after person has learned to write
Can involve spelling, word selection, grammar, spatial arrangement
Left hemisphere damage in variety of areas - frontal lob, temporal, parietal regions, basal ganglia

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8
Q

Alexia

A 
Acquired partial or complete inability to read
Most commonly caused by stroke to dominant (left) hemisphere
Pure alexia (without agraphia) - lesions that disconnect visual association cortex from temporoparietal cortices
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9
Q

Prosopagnosia

A

Most common of visual agnosias
Inability to recognize familiar face
Typically retrograde (can’t recognize faces of previously known individuals) AND anterograde (can’t learn new faces)
Despite normal or near normal visual perception, intact alertness, inattention, intelligence, langage
Injury to areas of visual association cortex

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10
Q

Anosagnosia

A

Lack of awareness of a disability or lack of awareness of nature of one’s illness
e.g. people with Wernicke’s typically don’t recognize they are speaking gibberish

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11
Q

Hydrocephalus

A

Accumulation of cerebrospinal fluid (CSF) in brain’s ventricles, causing increased intracranial pressure
Symptoms: dementia, urinary incontinence, unsteady gait
Can be treated with surgical procedure to increase drainage

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12
Q

Dementia

A

Impairment in memory PLUS: aphasia, apraxia, agnosia, or disturbance in executive functioning
Overall rate equal in men and women

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13
Q

Alzheimer’s Disease

-phases

A

Most common form of dementia, over half of all dementia cases
More prevalent in women
Progressive, rate of slope and decline varies
Early phase - impairments in recent memory, difficulty problem-solving, irritabilty, frustration, anger
Intermediate stage - further memory impairment, cognitive deficits (aphasia, apraxia, agnosia), confusion, socially undesirable behaviors
Late stage - gait and motor problems, may become mute or bedridden
Most rapid and relentless course occurs with early onset Alzheimer’s (before 65 years of age)

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14
Q

Genetic component of Alzheimer’s

A

First degree relatives of patients with AD carry six times greater risk of developing AD
Senile plaques, neurofibrillary tangles found throughout cortex and other brain structures (hippocampus - memory, amygdala)
Decreases in Acetylcholine, involved in memory and learning

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15
Q

Treatment of Alzheimer’s

A

Aricept (donepezil) - modest improvements in cognitive functioning (3-4 points in Folstein Mini Mental State)

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16
Q

Vascular Dementia

A

10-15% of all cases of dementia in older adults, sometimes coexists with Alzheimer’s
Twice as common in males

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17
Q

Why does Vascular Dementia occur

A

Numerous small CVAs (cerebrovascular accidents) or strokes believed to be caused by generalized cerebrovascular disease

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18
Q

Onset of Vascular Dementia

A

Typically abrupt

Course marked by rapid, step-wise changes - plateaus followed by further degeneration

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19
Q

Prognosis of Vascular Dementia, age of onset

A

Half die within two to three years of diagnosis

Age of onset usually much younger than AD

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20
Q

Prevention and treatment of Vascular Dementia

A

Primary and secondary prevention important
Lifestyle changes - reduction in smoking, weight loss, increased exercise effective in arresting progress of disease
No medications to reverse effects of stroke - but aspirin, anticoagulants, antihypertensives reduce likelihood of future stroke

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21
Q

Parkinson’s Disease - prevalence

A

Affects over a quarter of a million older adults in US

Slightly more men than women

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22
Q

What is Parkinson’s Disease

A

Movement disorder marked by tremor, rigidity, bradykinesia (slow initiation of movement) and shuffling gait
Neuropsychiatric symptoms - psychosis, dementia, depression

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23
Q

Parkinson’s dementia

A

30-50% of patients with PD have dementia

Sub-cortical dementia, affecting speed of processing and executive functions (planning, organizing, sequencing)

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PD associated with...
Degeneration of neurons in the substantia nigra, section of basal ganglia As a results, decrease in dopamine available in BG as a whole BG involved in regulating voluntary movement
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Treatment of PD
L-Dopa (Levodopa), precursor to dopamine | Does not alter progression of disease or decrease symptoms of dementia
26
Depression and PD
Occurs in 50-90% of patients with PD, may be direct effect of brain changes caused by disease Antidepressants may improve emotional and cognitive functioning
27
Huntington's Disease (Chorea)
Involves the BG NTs Acetylcholine and GABA implicated Does not become apparent until 35-45 Offspring have 50% change of being affected
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Signs of Huntington's Disease
Personality change first sign in 50% of cases Progressively deteriorating dementia Choreiform movements (frequent, discrete, brisk jerking movements of pelvis, trunk, limbs) Athetosis (slow writhing movements) Facial grimaces
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Pick's DiseaSE
Rare dementia that is clinically indistinguishable from AD Affects women twice as often as men\Onset peaks between 50s and 60s Affected neurons swell and have "Pick bodies" (irregularly shaped inclusions)
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Lobes affected by Pick's Disease
Frontal and temporal
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Signs of Pick's Disease
Decreases in initiative, episodes of tactless and inappropriate behavior, facetiousness and euphoria, explosive temper, disinhibition and poor impulse control, impaired insight --> all symptoms associated with frontal lobe dysfunction Problems with memory and language also common (but less common than in AD)
32
Pick's Disease vs. Alzheimer's
PD: Unlike with AD, deterioration not wide-spead throughout brain, no senile plaques or neurofibrillary tangles
33
AID's Dementia
AKA AIDS dementia complex (ADC) 10-15% of people with AIDS develop dementia Cognitive, motor, and behavioral symptoms
34
Cognitive Symptoms of AIDs Dementia
memory problems (LT frequently remains intact), difficulty with attention and concentration, language difficulties
35
Motor Symptoms of AIDs Dementia
Weakness, lack of coordination, unsteady gait, jerky eye movements
36
Behavioral Symptoms of AIDs Dementia
Apathy, withdrawal, lack of motivation, personality changes, inappropriate affect, mood swings, and even hallucations
37
Dementia due to Head Trauma
Impaired memory most obvious and reliable complaint of head trauma
38
Closed-headed injuries
Skull not pierced or cracked Frequently results in loss of consciousness 2 most common subtypes: concussions and contusions
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Concussions
Short term loss of consciousness Anterograde amnesia - inability to remember new information Retrograde amnesia - loss of memory for information required prior to the injury - typically right before injury and incident itself
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Postconcussion Syndrome
Constellation of somatic and psychological symptoms including headache, dizziness, fatigue, diminished memory, memory deficit, irritability, anxiety, insomnia, hypochondriacal concern, hypersensitivity to noise, and photophobia Symptoms: irritability, fatigue, headache, and dizziness
41
Contusions
More serious than concussions Coup-countrecoup injuries (bruising beneath point of impact and opposite side of brain) May lose consciousness for minute or hour If conscious, may be drowsy, confused, agitated, even violent In returning to alert state, may experience temporary aphasia, slight hemiparesis, unilateral numbness
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Discrete Impairment
Results from injury at site of coup or countrecoup, most frequently frontal and temporal lobes Frontal Lobe Syndrome- lack of foresight and concern, irresponsibility, loss of insight Temporal Lobe Syndrome - irritability, hostility
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Diffuse Impairment
General loss of complex cognitive functions
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Open-headed injuries
e.g. gunshot wounds penetration of skull most people do not lose consciousness, neurological signs highly specific
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Recovery from head trauma
Bulk of cognitive recovery occurs within first 6 to 9 months Memory for more remote events returns before memory for more recent events Frequently never regain memory for what happened immediately prior to injury
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Pseudodementia
Cognitive impairment due to depression Depressive symptoms resemble mild cognitive dysfunction: slower processing speed, difficulties concentrating, psychomotor retardation, social withdrawal, easily giving up on items when tested
47
Indications of pseudodementia
Acute onset with precise date of onset, association with personal loss or emotional distress, and rapid progression Subjective complaints of memory loss (patients with organic dementia generally lack insight regarding their deterioration)
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Delirium
Acute confusional state | Acetylcholine involved
49
Hallmarks of delirium
Disturbance of consciousness with reduced ability to focus, sustain, or shift attention Change in cognition (e.g. memory deficit, disorientation), or development of a perceptual disturbance
50
Delirium vs dementia
Delirium typically has acute onset and fluctuating course Delirium more likely to be reversible Neurological signs are frequently present e.g. dysphasia, tremor, poor coordination) as well as disturbed sleep patters
51
Common causes of delirium
infections, metabolic and endocrine disorders, postoperative states, substance intoxication (medications or illicit drugs), substance withdrawal
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Drug of choice for delirium
Ativan
53
Amnestic Disorders
Disturbance in memory related to the effects of a general medical condition or persisting effects of a substance
54
Most common causes of amnestic disorders
head trauma | alcohol abuse
55
Korsakoff's Syndrome
Caused by chronic thiamin (Vigtaming B1) deficiency associated with alcoholism Most significant problem --> Anterograde amnesia - forming new memories Also suffer from retrograde amnesia, with extensive impairment in remote memory for most of their adult lives Frequently confabulate (make up) plausible stories about past events that did not occur
56
Effects of ECT
Bilareral ECT frequently induces memory changes Most memory problems are reversible, with return to pretreatment functioning within 6 months Generally greatest memory problem considered to be retrograde amnesia, but some research reports found anterograde to be larger problem
57
Gate Control Theory
Melzak and Wall (1965) Popular theory with regard to experience of pain Sensations of pain not directly related to activation of pain receptors Rather, pain sensations mediated by neural gates in the spinal cord tha tallow these signals to continue onto the brain Pressure stimulation tends to close the gate - that's why rubbing hurt area can often relieve pai Psychological factors also effect the gate - attitudes (cognitions) and moods, may open the gate and increase experience of pain
58
Management of chronic pain
BOth narcotic and anti-narcotic medications | Best done on time-contingent (e.g. on fixed interval schedule) rather than pain-contingent schedule
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Two major phases of sleep
Non-REM (stages 1-4) and REM (rapid eye movement)
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Beta waves
predominate when person is alert and attentive
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Alpha waves
brain waves show pattern of 8 to 12 Hz per second | When person closes eyes and relaxes
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Stages of sleep
Stage 1: Predominance of theta waves of 4-8 Hz Brief transitional stage between wakefulness and sleep Stage 2: Spindles or rhythmical responses of 12 to 16 Hz Occupies greatest amount of time during sleep Stages 3 & 4: Slow waves of 1 to 2 Hz, known as delta waves Sleeper generally hard to waken REM Sleep: EEG patterns of stage 1 reappear in conjunction with rapid eye movement
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REM Sleep
newborns: 50% of time in REM by age 5: 20-25% of time in REM sleep by old age: 18% in REM sleep respiration and heart rate increase, muscles become relaxed if awoken - report bizarre and illogical dreams
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non-REM sleep
eye movements absent heart rate and respiration slowed muscles maintain tone
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Generalized Seizures
Tonic clonic seizures and petit mal seizures | Occur when electrical abnormalities exist throughout the brain
66
Tonic clonic seizures
Involve tonic stage (continuous tension or contraction) followed by clonic stage (rapid, involuntary, alternating muscle contractions, and relaxation) Occur during grand-mal seizure Seizures usually dramatic and involve convulsions throughout the body Loss of consciousness common Afterwards - headache, confusion, fatigue, and amnesia for seizure
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Petit mal seizures
aka absence seizures Occur most frequently in children, usually beginning before age 5 Last 1-30 seconds Begin with brief change in level of consciousness, followed by blinking or rolling of eyes, a blank stare, and slight mouth movements Posture is retained and pre-seizure activity is returned to without difficult
68
Partial Seizures
Simple Partial Seizures Jacksonian Seizures Complex Partial Seizures
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Simple partial seizures
electrical abnormalities in a focal area of the brain only size of affected area can be as small as a thumb and as large as half the body patient usually remains conscious during seizure and can later describe it in detail
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Jacksonian seizures
Initially localized motor seizure, with spread of abnormal activity to adjacent brain areas
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Complex Partial Seizures
Preceded by an aura and usually include purposeless behavior (e.g. aimless wandering), lip smacking, and unintelligible speech Consciousness is frequently impaired Ultimately person makes full recovery
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PET scan
Positron Emission Tomography Inject person with glucose and a small amount of radioactive substance Active neurons use up glucose and scan picks up the radioactive material - that's where brain is active Shows functional capacity of a particular brain region
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MRI
Magnetic Resonance Imaging Used for visualization of brain structure Magnets used - more detail than CAT scan
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CAT scan
Computerized Axial Tomography | X-ray like pictures of internal organs that are clearer and more accurate than normal x-rays
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fMRI
Functional Magnetic Resonance Imaging | Measures changes in oxygenated blood flow
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Synesthesia
When one type of sensory stimulation elicits another sense | e..g. seeing music, smelling colors
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General Adaptation Syndrome
Hans Selye developed a model of response to severe stress
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Three stages of General Adaptation Syndrome
Alarm Resistance Exhaustion
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Alarm stage of GAS
Body mobilizes resources to cope with stress by activating the sympathetic nervous system Body highly alert, yet in state of lowered resistance to illness Symptoms: headaches, fatigue, diarrhea
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Resistance stage of GAS
Alarm reaction subsides and the body adapts to the stressor and actually attains a level of resistance to illness above normal
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Exhaustion stage of GAS
Occurs in response to chronic, unremitting stress Body's resources are exhausted and stress hormones are depleted Unless a way of reducing stress is found, there can be significant loss of health and in extreme cases, even death
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Health belief model
Rosenstock Individuals who believe they can control their health are more likely to engage in healthy habits such as exercise and good nutrition and to decrease harmful behaviors such as overeating, smoking, etc
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Akathesia
Inability to sit or stand still | Uncomfortable sense of restlessness
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Asomatognosia
Inability to recognize parts of own body
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ataxia
slurred speech, severe tremors, incoordination, clumsiness, lack of balance
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athetosis
slow writhing movements
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chorea
irregular, involuntary, rapid jerky movements, usually in the face, limns, and trunk
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color agnosia
inability to name or discriminate between colors
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dressing apraxia
inability to dress oneself
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dyskinesia
abnormal muscle movement including twitchy, jerky, and writhing movements (chorea, tics, tremors)
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dysprosody
disturbance in the stress, pitch, and rhythm of speech
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ideational apraxia
inability to carry out a sequence of movements
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ideomotor apraxia
cannot pantomime motor movements nut usually has less trouble performing same movements with actual object; due to left posterior parietal damage
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simultagnosia
inability to see more than 1 thing or 1 aspect of an object at a time
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Tactile agnosia
inability to recognize familiar objects by touch
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tardive dyskinesia
repetitive oral and facial grimaces, tongue movements, spasms of the neck and head, jerky movements of the limbs and trunk; need to raise GABA levels to relieve
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Frontal lobe syndrome
Frontal Lobe Syndrome- lack of foresight and concern, irresponsibility, loss of insight
98
Temporal love syndrome
irritability, hostility

Neuropsychology (2 decks)

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