2. Cognitive Exam Flashcards
Define agnosia
inability to perceive/understand the import of sensory stimuli despite intact sensory mechanisms. perception devoid of meaning.
define anosagnosia
inability to recognize own neurological deficit.
define apraxia
inability to perform learned actions despite intact motor functions
define receptive aphasia
inability to understand. characteristic of Wernicke’s
define expressive aphasia
inability to express via speech. characteristic of Broca’s
define global aphasia
inability to comprehend, produce, repeat speech.
define alexia
visual agnosia. inability to read.
define agraphia
inability to write. Akin to expressive aphasia
define disinhibition
frontal lobe lesion accompanied by inappropriateness, etc
define dysnomia
anomia, difficulty naming items
define paraphasia
well-articulated but incorrect words. includes neologisms, semantic paraphasia, phonemic paraphasia
Language: bilateral or unilateral?
uni.
attention to the non-dominant world: bilateral or unilateral?
uni
somatic sensation: bilateral or unilateral?
uni
vision: bilateral or unilateral?
uni
voluntary motor function: bilateral or unilateral?
uni
hearing: bilateral or unilateral?
bi (Heschel’s gyrus)
short term memory: bilateral or unilateral?
bi (medial temopral lobe)
frontal lobe functions (mood, behavior, emotional control, motivation, exec function): bilateral or unilateral?
bi
long-term memory: bilateral or unilateral?
diffuse (both)
visuospatial function: bilateral or unilateral?
bi. parietal lobe
aphasia is lateralized where?
to the dominant hemisphere
patients with Broca’s, Wernicke’s, global and conductive aphasias will be unable to do what?
repeat complex phrases
Broca’s area infarction results in what?
very reduced speech, repetition and naming. intact aud and visual language comprehension (reading). frustration.
Wernicke’s area infarction results in what?
output that is active but nonsensical, inability to comprehend language. inability to repeat and name things. not frustrated.
conduction aphasia is due to a lesion where?
arcuate fasciculus.
define conduction aphasia
reasonably normal expression and comprehension, but impaired repetition of simple and complex phrases.
Inability to repeat due to interruption of the arcuate fasciculus. Fluent, but with paraphasias. Comprehension may be OK.
damage to the dominant occipital lobe and splenium of the corpus callosum yields what?
alexia without agraphia. can write but can’t read what they’re written
immediate recall occurs where?
frontal lobe
short term memory occurs where?
hippocampus
long term memory occurs where?
diffusely. only lost if large and diffuse areas are damaged
the non-dominant parietal lobe does what?
attention to the contralateral world
lesion of the non-dominant parietal lobe yields what?
hemi-inattention/neglect of the non-dominant world. impaired recognition of self, inability to learn that deficits exist in non-dominant motor/sensory functions.
what does the frontal lobe do?
exec functions like initiative, sequencing, planning, problem solving.
lesion to the frontal lobe yields what?
personality change, failure of executive function, difficulty with activities of daily living
orbitofrontal injury can lead to what/
disinhibition, aggression
what can a corpus callosum transection yield?
split brain: information not transferred from side to side, R hand not knowing what L hand is doing.
what does the neurological exam include?
mental status, cranial nerves, motor systems, reflexes, sensory systems, coordination, gait
when to do the mental status exam?
known brain lesion, suspected brain lesion, psychiatric disease, behavioral complaints
what is included in the mental status exam?
LOC, attention, concentration, cognitive functions, thought processes, thought content, affect
define dementia
a generalized deterioration of intellectual or cognitive function, particularly memory, without altered alertness or perception
define confusion
acute thinking disorder. expected to improve.
define delirium
acute thinking disorder plus altered consciousness, hyperactivity, irritability etc
define encephalopathy
Broadly, diffuse alteration in brain function generally including disordered thinking. Static.
define amnesia/retrograde/anterograde
pure loss of memory without other cognitive loss
Retrograde amnesia – loss of memory prior to a specific time
Anterograde amnesia – loss of memory after a specific time
define aphasia
language impairment
4 levels of consciousness?
awake
somnolent
stuporous
coma
how to test attention/concentration?
digit span, spell world/backwards
define aprosody
loss or impairment of the use and understanding of inflection
semantic paraphasia
substitute wrong word
phonemic paraphasia
substitute wrong sound
neologism
use of non-existent word
why is Broca’s often seen with R hemipareisis?
lesion usually on L side because of L sided language dominance
what are 4 tests of language?
- pace of speech (should be 12-50 words per minute)
- naming items and parts of items
- comprehension (paper, fold, put on floor)
- repetition of phrases
- reading
- writing
where is Broca’s aphasia lesion?
inferior precentral gyrus
where is Wernicke’s aphasia lesion?
upper posterior temporal
where is conduction aphasia lesion?
inferior parietal
where is global aphasia lesion?
large area in parietal and frontotemporal
where is music localized?
R hemisphere
72 year old left-handed man was noted by his wife to be confused this morning. On exam he has some difficulty naming items as well as trouble following complex commands. He is noted to have atrial fibrillation on ECG. He is otherwise intact. Where might you expect a lesion?
L posterior temporal
what are the parts of memory that we test?
episodic, short term/working
where does episodic memory reside?
medial temporal (bil), hippocampus, mammillary body
where does short term memory reside?
frontoparietal regions
62 year old man was seen in the ED because of “altered mental status”. On exam he has some difficulty remembering events, and in fact seemed to make up some details to mask this problem. He was not well-oriented. Language was good. Where might you expect a lesion?
medial temporal (bil), hippocampus, mammillary body
acalculia results from a lesion where?
dominant parietal lobe
how to test calculation?
serial 7s, adding
prospagnosia
inability to recog faces
astereognosia
inability to recognize items by touch
visual agnosia
Inability to recognize objects despite normal vision.
visual agnosia: location?
Lesion is usually bilateral parieto-occipital cortex.
prospagnosia: location?
Lesions usually in bilateral occipital lobes.
simultagnosia
Can see objects but cannot sort them out from one another.
Cannot see forest for trees
alexia: location?
Lesion in L temp-parieto-occipital region
Alexia: be sure to rule out what?
Visual impairment Diplopia Field defect - L Simultanagnosia Illiteracy
Agraphesthesia
inability to recognize numbers traced on hand
auditory agnosia
inability to recognize and identify specific sounds despite normal hearing
auditory agnosia: location?
Lesion usually in non-dominant temporal lobe. non-dom because that’s the side we process music on.
anosognosia: location
non-dominant parietal lobe
neglect: location
Lesion usually contralateral parietal lobe, esp R
Ventral thalamic lesions can produce neglect too
Visual neglect - parieto-occip lesions
Neglect syndrome testing?
cross all the lines in half, circle all the As: pt will only do task in right side of visual field
83 year old woman is brought to the ER from for retirement home because of confusion
On exam she is awake and neurologically intact but she seems to ignore you and does not move her left side unless coaxed. MRI reveals a stroke.
Where?
R parietal
agraphia: location?
dominant posterior frontal cortex
Gerstmann’s Syndrome: symptoms?
agraphia
finger agnosia
L/R disorientation
acalculia
Gerstmann’s Syndrome: location?
dominant angular gyrus, corpus callosum
constructional apraxia: definition
inability to copy or construct figures. disturbance in visuo-spatial abilities rather than pure apraxia
constructional apraxia: lesion?
non-dominant parietal cortex
tests of constructional ability?
clock drawing, overlapping pentagons, cube
A 57 year old man with Parkinson’s disease has a great deal of trouble performing simple actions like combing his hair. What is a likely cause of this? -Bradykinesia (slowness of movement) -Dementia -Procedural memory deficit -Apraxia -Depression
all of these
ideomotor apraxia
inability to perform a specific task when asked. ie, unable to show how to use a comb, use a key
ideomotor apraxia: location
usually non-localizable, but can be due to disconnection (callosal lesion preventing opp side from receiving command from Wernicke’s)
gait apraxia: location
bil frontal lobes
gait: wide based, unable to tandem
ataxia
gait: stooped, smalls steps, turns en bloc
Parkinsonian
gait: high knee-lift, foot slapping
foot drop
gait: stiff, short steps, scissoring
spastic paresis
gait: slow and unsteady, magnetic
apractic
social inappropriateness, disinhibition, euphoria, abnl sexual beh: where is lesion?
orbitofrontal
apathy, akinesis, abulia: where is lesion?
medial frontal
irritability, inflexibility, reduced sex interest, loss of exec function: where is lesion?
dorsolateral
frontal lobe testing: observe what, and ask what?
observe for perseveration, slowness/abulia, apathy judgment: pose a scenario proverbs: ask to interpret planning: how would you... working memory
types of perceptual disturbances?
illusions - misinterpretation
hallucinations - sensory
depersonalization
derealization
