Higher Cortical Functions & Cognitive / Behavioral Manifestations of Brain Disorders, Part 1

Question 1

Primary Areas: Project to ____________________________________________________________________

Answer 1

Spinal motor systems or receive sensory input (via thalamus)

Question 2

Describe Secondary Areas. (3)

Answer 2

Adjacent to primary areas
Sensory: Primary to Secondary
Motor: Secondary to Primary

Question 3

Describe Tertiary Areas: (4)

Answer 3

• Aka Association Cx
• Located between secondary areas
• Not specific to sensory or motor information
• Perform “higher-order” functions

Question 4

Give 7 examples of ‘‘Higher-Order’’ functions.

Answer 4

• Language
• Memory
• Executive Functions
• Perception
• Spatial Behaviour
• Attention
• Skilled Movement

Question 5

What are the main anatomical (perisylvian) areas associated with language? (2)

Answer 5

1. Broca’s area (green)
2. Wernicke’s area (yellow)
   (in the left Hemisphere)

Question 6

What are the Brodmann’s numbers for Broca’s and Wernicke’s areas?

Answer 6

Broca’s area (areas 44 & 45)
Wernicke’s area (area 22)

Question 7

Draw the Wernicke-Geschwind Model of comprehension (4 levels) and speech (6 Levels)

Answer 7

Question 8

What is the name of the pathway that links Wernicke’s area and Broca’s area?

Answer 8

Arcuate Fasciculus

Question 9

Explain the revisions to the Wernicke-Geschwind Model

Answer 9

• Original model is conceptually useful but details have been substantially revised by improved lesion analysis and neuroimaging
• Current models adopt network approach (not linear)
• Functions may be represented diffusely, e.g., semantics is not just in Wernicke’s area
• Broca’s area contains mental representations of language (not just motor programs)

Question 10

What is Aphasia? (2)

Answer 10

Aphasia is an acquired disorder of language apparent in speech (production &/or comprehension), reading (i.e., dyslexia/alexia) &/or writing (i.e., dysgraphia/agraphia)

Question 11

Aphasia often results from which neurological disorder?

Answer 11

Often results from stroke (> 80% of cases) but also from brain injuries, tumors, infections, dementias, etc.

Question 12

Aphasia can be broadly classified into: (2)

Answer 12

Disorders of Comprehension (i.e., fluent types)

Disorders of Production (i.e., nonfluent types)

Question 13

What are summary symptoms of disorders of comprehension? (2)

Answer 13

Question 14

What are summary symptoms of disorders of production? (8)

Answer 14

Question 15

Define aphasic syndromes of fluent aphasias (4) and nonaffluent aphasias (4)

Answer 15

Question 16

Describe Wernicke’s Aphasia. (3)

Answer 16

• Difficulty in comprehending or repeating speech produced by other people or oneself
• Language production is generally fluent (i.e., no articulation problems) but jargon-like and may include neologisms, paraphasias, and word retrieval deficits
• Often unaware of language processing problems (i.e., anosoagnosia)

Question 16

Describe Wernicke’s Aphasia. (3)

Answer 16

• Difficulty in comprehending or repeating speech produced by other people or oneself
• Language production is generally fluent (i.e., no articulation problems) but jargon-like and may include neologisms, paraphasias, and word retrieval deficits
• Often unaware of language processing problems (i.e., anosoagnosia)

Question 17

What is anomic aphasia? (3)

Answer 17

• Isolated difficulty in finding names of specific objects
• Speech comprehension, production and repetition are relatively intact
• Circumlocutions are common
  Q: What is this? (picture of igloo)
  A: I know what it is, it’s made of snow. People in the Arctic live in them or use them as shelter…

Question 18

Anomic Aphasia results from _____________________________________________________________

Answer 18

variable lesion sites (often in left temporal and/or frontal lobes)

Question 19

What is the most common aphasia seen clinically?

Answer 19

Brocas aphasia

Question 20

What is the mildest form of aphasia.

Answer 20

Anomic aphasia and is often is a residual deficit after recovery.

Question 20

What is the mildest form of aphasia.

Answer 20

Anomic aphasia and is often is a residual deficit after recovery.

Question 21

What occurs in Broca’s Aphasia? (2)

Answer 21

• Difficulty in the production of language (i.e., mental representations, not motor). Speech (when produced) is slow, labored and telegraphic.
• Comprehension is relatively good but may have difficulty with syntactically-complex phrases

Question 22

What usually preserved in Broca’s aphasia?

Answer 22

Insight into linguistic abilities

Question 23

Which type of aphasia is occurring in this example:

'’Q: Why did you come to the hospital?
A: Ah…Monday…ah Dad and Paul…and Dad…hospital. Two…ah doctors…and ah…thirty minutes…and yes…ah hospital. And er Wednesday…nine o’clock…doctors. Two doctors…and ah…teeth. Yeah…fine.”

Answer 23

Broca’s Aphasia

Question 24

Which type of aphasia is occurring in this example:

'’Q: What kind of work did you do before you came into hospital?
A: Never, now mista oyge I wanna tell you this happened when happened when he rent. His – his kell come down here and is – he got ren something. It happened. In these ropiers were with him for hi – is friend – like was. And it just happened so I don’t know, he did not bring around anything. And he did not pay it. And he roden all o these arranjen from the pedis on from iss pescid. In these floors now and so. He hadn’t had em around here.’’

Answer 24

Wernicke’s Aphasia

Question 25

What are the primary, secondary and tertiary areas that are affected in Wernicke’s aphasia?

Answer 25

Question 26

What are the primary, secondary and tertiary areas that are affected in Wernicke’s aphasia?

Answer 26

Question 27

What is global aphasia? (2)

Answer 27

Generalized difficulty in comprehending, producing or repeating speech (some automatic phrases may be spared)
Usually results from extensive left-hemisphere lesions

Question 28

What is dysarthria?

Answer 28

• Distinct from aphasia and is not a language disorder
• Refers to speech disorders that result from neuromuscular dysfunction

Question 29

The nature of motor-speech deficits in dysarthria depend on what part of system the dysfunction arises in. Give 5 examples.

Answer 29

Upper motor neurons
Lower motor neurons (ie., cranial nerves)
Basal Ganglia
Cerebellum

Question 30

Describe and draw the classification of memory systems. E.g., LTM STM

Answer 30

Different memory systems have different neural substrates

Question 31

What are the main anatomical Areas associated with LT Explicit Memory? (3)

Answer 31

Temporal lobe and proximal areas
Prefrontal cortex
Medial thalamus

Question 32

What are the main anatomical areas associated with Explicit Memory? (6)

Answer 32

Question 33

Briefly give the main anatomical areas associated with explicit and implicit LTM:

Answer 33

LTM Explicit:
- Prefrontal cortex
- temporal lobe structures
- medial thalamus circuit

LTM Implicit:
- Basal ganglia &/or cerebellum
- neocortex circuit

Question 34

What is the difference between Anterograde vs. Retrograde amnesia?

Answer 34

Question 35

What is amnesia?

Answer 35

Loss of memory

Question 36

What happened in HM case?

Answer 36

He suffered severe anterograde amnesia following bilateral medial temporal lobe resection

Question 37

In material specific amnesias, left and right hemispheres are involved in _____________________________________________________________

Lesions in LEFT hemisphere can _________________________________________________________

Answer 37

encoding and retrieving different types of material

impair memory for verbal material (i.e., language-based)

Question 38

In material specific amnesias, left and right hemispheres are involved in _____________________________________________________________

Lesions in RIGHT hemisphere can _________________________________________________________

Answer 38

Lesions in right hemisphere can impair memory for visual material

Example from patient with tumor in right temporal lobe: