Lecture 1

Question 1

The 6 neuro-cognitive domains (SAMPLE)

Answer 1

1. Social cognition
2. Attention (complex attention)
3. Memory and learning
4. Perceptual and motor functions
5. Language
6. Executive functions

Question 2

Multiple Sclerosis (MS)

Answer 2

Damage to the myelin sheets in the CNS, which causes the information stream to slow down. Eventually an axon without myeline will die.
People with MS have damage to the white and grey matter, mostly in the thalamus and hippocampal area.

Question 3

Relapse and remission phase in MS

Answer 3

In the relapse phase people start to show symptoms because of demyelization and in the remission phase myelin is build up again and symptoms mostly disappear.

Question 4

Prevalence and onset of MS

Answer 4

The age of onset is between 20 and 40 years old. MS mostly affects information processing speed and memory. A larger maximal lifetime brain volume protects against cognitive decline for a while. Having enriching experiences also protects for a while.

Question 5

Diagnosis of MS

Answer 5

1. Dissemination in time: at least 2 periods of relapses, seperated in time with clinical symptoms.
2. Dissemination in space: the relapse should have different types of symptoms and originate from different regions.

Question 6

Cognitive symptoms in MS (occurs in 43-65% of patients)

Answer 6

• Information processing speeds and memory is most commonly affected.
• Mostly subtle, considerable variation.
• Heavy impact on daily life, work, social contacts etc.
• Related to atrophy of the cortex, thalamus and hippocampus (not so much to the white matter damage).

Question 7

Brain reserve hypothesis

Answer 7

The larger your maximal lifetime brain volume is, the better you are protected against cognitive decline.

! Doesn’t prevent the brain disease from happening, but it lowers the impact of the disease.

Question 8

Cognitive reserve hypothesis

Answer 8

Enriching experiences (eduction, exercise etc.) protect against cognitive decline.

! Doesn’t prevent the brain disease from happening, but it lowers the impact of the disease.

Question 9

Parkinson’s disease

Answer 9

Degeneration of dopaminergic cells (substantia nigra) and changes in noradrenergic, serotonergic and cholinergic systems. Symptoms are bradykinesia (slowness of movement) combined with one of the following:
- Rigidity
- Rest tremor
- Postural instability

Other symptoms can be:
- Fatigue
- Disturbed sense of smell
- Autonomic disorders
- Sleep disorders
- Neuropsychiatry
- Cognitive impairment

Onset: very subtle between 50 and 70

Question 10

Cognitive problems in Parkinsons disease

Answer 10

Patients do have the information stored, but sometimes can’t get to it spontaneously. They have no trouble remembering something form an hour ago, but have trouble remembering what they are talking about now.

This can be tested by repeating a short list of words, they will recognise it in a while but can’t repeat it immediately.

It starts with executive impairment, but most people develop dementia eventually.

In addition they have impairments in attention, mental speed, memory and deficits in processing visuospatial and emotional information.

Question 11

Treatment of Parkinson’s

Answer 11

There is only symptomatic treatment, this works for a while but then wears off. After this, deep brain stimulation can be administered to decrease the tremor. There is also a lot of paramedical and psychological help.

Question 12

Treatment of MS

Answer 12

There is no cure for MS, so treatment is only based on tempering the inflammation:
- Disease modifying treatment: to be able to live/work with the disease.
- Treatment for symptoms management: for pain, fatigue etc.
- Ocrelizumab, siponimod (medication) for progressive MS