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Term 5: Neuro > 6/10- Testing of Higher Cortical Function > Flashcards

6/10- Testing of Higher Cortical Function Flashcards

1
Q

What’s on the DDx for things causing dementia?

A
  • Alzheimer’s Dz (most common)
  • FTLD (with variants: behavioral, semantic, progressive non-fluent aphasia, logopenic progressive aphasia)
  • LBD
  • PSP
  • Corticobasal degeneration
  • Parkinson’s dz demetnia
  • Vascular dementia
  • Normal pressure hydrocephalus
  • HIV dementia
  • Huntington’s dz dementia
  • Dementia due to MS
  • Post-traumatic encephalopathy including chronic traumatic encephalopathy
  • Mixed dementias
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2
Q

Purpose of cognitive testing? Types?

A

Determine the extent and profile of cognitive impairment so we are able to facilitate diagnosis of specific cognitive disorders as well as monitor disease progression and response to treatment.

Types:

  • Bedside
  • Formal neuropsychological testing
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3
Q

What is the first step of assessment?

What factors should be considered?

A

Determining if cognitive impairment is present by measuring cognitive ability and comparing result with an individual’s expected performance/baseline

Consider:

  • Years of education and occupation (allows estimate premorbid cognitive ability and baseline)
  • Age: MMSE expected test result decreases significantly with age (usually cut off is under 26, but 23 for 80)
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4
Q

What is the second step of assessment after determining if cognitive impairment is present?

A

Determine the profile of cognitive impairment in regards to basic cognitive functions:

  • Attention and concentration
  • Language
  • Executive functions
  • Memory
  • Praxis
  • Gnosis
  • VIsuospatial construction

Pattern of impairment helps clinician figure out the localization and the etiology

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5
Q

Diagnostic characteristics of the Folstein MMSE (for bedside mental status testing)

  • Sensitivity:
  • Specificity:
  • Strengths:
  • Shortcomings:
A

Sensitivity: 0.81

Specificity: 0.89

Strengths:

  • Widely used
  • Norms available

Shortcomings:

  • Does not test executive function
  • Can have some non-AD dementias and have normal or near normal MMSE

The MMSE focuses a lot on language, but not too much on things in the R hemisphere

Score is meant to be taken as a whole (although may provide hints of where problem may be)

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6
Q

Diagnostic characteristics of the Montreal Cognitive Assessment (MOCA) (for bedside mental status testing)

  • Sensitivity:
  • Specificity:
  • Strengths:
  • Shortcomings:
A

(for detecting MCI):

Sensitivity: 0.89

Specificity: 0.75

Strengths: appears to have tests of executive function

Shortcomings:

  • Cut off score is too high for non-college educated people
  • No improved sensitivity/specificity from MMSE

Score is meant to be taken as a whole (although may provide hints of where problem may be)

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7
Q

What are the broad levels of consciousness?

A
  • Clouding of consciousness
  • Confusional state
  • Lethargy
  • Obtundation
  • Stupor
  • Coma
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8
Q

What is clouding of consciousness?

A

Very mild form of altered mental status in which the pt has inattention and reduced wakefulness

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9
Q

What is confusional state?

A

More profound deficit that includes disorientation, bewilderment, and difficulty following commands

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10
Q

What is lethargy?

A

Consists of severe drowsiness in which the pt can be aroused by moderate stimuli and then drift back to sleep

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11
Q

What is obtundation?

A

State similar to lethargy in which the pt has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states

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12
Q

What is stupor?

A

Only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the pt will immediately lapse back to the unresponsive state

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13
Q

What is coma?

A

A state of unarousable unresponsiveness

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14
Q

Parts of the MOCA?

A
  • Visuospatial/executive (connecting letters/numbers, copy cube, draw clock)
  • Naming (animals)
  • Memory
  • Attention
  • Language
  • Abstraction
  • Delayed Recall
  • Orientation
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15
Q

What is the clock drawing test? What does it test?

A

(It’s part of the MOCA exam)

Ask patient to draw a clock

  • If don’t know/remember what a clock is or where to start (possible aphasia)
  • If all numbers are on right side (hemi-neglect)
  • General assessment of planning and coordination (executive function)
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16
Q

What tests can be used to test attention and concentration?

A
  • Serial 7s
  • WORLD backwards
  • Digit span forward and backwards (backwards no more than -2, normal 6-8 forward)
  • Vigilance test (“tap every time I say A”)
17
Q

What is the Wisconsin card sorting test?

A
  • Matching shape/color/number
  • Change rules and see if they adjust
18
Q

What is executive function?

A
  • Complex set of cognitive abilities that are involved in planning and multitasking.
  • These functions operate in non-routine situations and exert a top-down, volitional control over cognition and behavior
  • Also refers to the ability to be aware of environmental input and to change cognition or behavior if required
  • Preservation results from an inability to change
  • Generating thoughts and actions are also implicated in executive functioning and impairment manifests with lack of initiation or apathy
19
Q

What are some tests of executive function?

A
  • Luria hand movement tests (show, do it with them, do alone; e.g. fist -> hand -> flat -> fist…)
  • Verbal fluency tests

—- Category or semantic fluency: animal words in 1 min

—- Phonemic or lexical fluency- “f” or “s” words in 1 min

  • Go-No-Go Task: tap once if I tap once but don’t tap at all if I tap twice
  • Alternating sequence: trailmaking test (1-A-2-B-3-C etc.)
  • Months of the year backwards
  • Abstraction- similarities (e.g. fly and human;
20
Q

What are some categories/ways to test language at the bedside?

A

Fluency- ask open ended questions

Comprehension- ask to follow every more complex commands

  • Point to the ceiling
  • Point to the ceiling and then the window
  • ….. and then the floor
  • ….. and then the door

Naming (overlaps with visual agnosia)- objects or pictures of objects (use high and low frequency objects appropriate to pt’s life experience)

Repetition: “no ifs, ands, or buts”

Reading: individual words including irregulars and sentence

Writing: write a sentence

21
Q

What are the categories for selected memory systems (broad)?

Length of memory storage in each?

Types of awareness?

A

Episodic memory

  • min-yrs
  • Explicit, declarative awareness

Semantic memory

  • min-yrs
  • Explicit, declarative awareness

Procedural memory

  • min- yrs
  • Explicit or implicit; nondeclarative awareness

Working memory

  • s- min; info actively rehearsed or manipulated
  • Explicit, declarative type of awareness
22
Q

What are the major anatomical structures involved and examples of episodic memory?

A

Structures:

  • Medial or temporal lobe
  • Anterior or thalamic nucleus
  • Mammillary body
  • Fornix
  • Pre-frontal cortex

Examples:

  • Word recall (e.g. remember an address, 3 word, 10 word)
  • Remembering a short story
  • What you had for dinner last night
  • What you did on your last birthday
23
Q

What are the major anatomical structures involved and examples of semantic memory?

A

(Fund of knowledge)

Structures:

  • Inferolateral temporal lobes

Examples:

  • Knowing who the 1st president of the US was
  • Capital of the US
  • Color of a lion
  • How a fork differs from a comb
24
Q

What are the major anatomical structures involved and examples of procedural memory?

A

Structures:

  • Basal ganglia
  • Cerebellum
  • Supplementary motor area

Types of awareness:

  • Driving a car with a standard transmission (explicit)
  • Learning the sequence of numbers on a touch-tone phone without trying (implicit)
25
Q

What are the major anatomical structures involved and examples of working memory?

A

Structures (phonologic)

  • Prefrontal cortex
  • Broca’s area
  • Wernicke’s area

Structures (spatial)

  • Prefrontal cortex
  • Visual-association areas

Examples:

  • Phonologic: keeping a phone number in your head before dialing
  • Spatial: mentally following a route or rotating an object in your mind
26
Q

What is praxis?

A

The ability to translate an idea into action and to execute the action

27
Q

What is apraxia?

A

The inability to perform purposeful movements in the presence of normal elementary motor and sensory function

28
Q

What localized areas are responsible for movement planning (early and late)?

A
  • Initially done with words in the posterior aspect of the dominant hemisphere (left parietal cortex)
  • The plans are moved to the frontal cortex, supplementary motor area, and motor cortex for final movement; primary motor
29
Q

How can you assess apraxia at the bedside?

A

Ideomotor apraxia:

  • Mime a task
  • Mimic a hand motion/position

Other apraxias:

  • Ideational: complex multistep activities
  • Limb-kinetic: finely coordinated movements
  • Dressing (visuospatial dysfunction due to right parietal issue): copy cube; intersecting pentagons
  • Oral-mouth movement issues: blow out candles, lick crumbs off limps
30
Q

What is agnosia? How can it be tested?

A

Impairment of perceptual functioning due to a breakdown in higher order stimuli

Tests: naming or objects seen, heard, or touched

31
Q

Localization of agnosia?

A

Higher order sensory function is processed in the association cortices.

This involves the parietal lobes and sensory association areas of the occipital and temporal lobes

32
Q

What tests comprise Formal Neuropscyhological Testing?

A
  • Rey Osterrieth Complex Figure (picutre)
  • Stroop test (word name vs. color of words)
  • Symbol Digit test (draw particular symbol under numbers)
  • Boston Naming Test (30 in increasing difficulty)
  • California verbal learning test (two different lists with 16 words, 4 words from 4 different categories in pseudo random manner. A x 5, B x 1 immediately after; presentation recall)
  • Block Design

Term 5: Neuro (24 decks)

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