Approach to Cognitive Dysfunction

Question 1

Agnosia

def

Answer 1

failure to recognize or comprehend perceived stimuli

Question 2

Agraphia

def

Answer 2

inability to write

Question 3

Alexia

def

Answer 3

inability to read

Question 4

Anomia

def

Answer 4

inability to name, word finding difficulty

Question 5

Anosagnosia

def

Answer 5

failure to recognize illness, lack of awareness of deficits

Question 6

aphasia

def

Answer 6

inability to understand and use language

Question 7

apraxia

def

Answer 7

impairment of skilled movement to command or mimicry despite comprehension and normal motor function

Question 8

Neglect

def

Answer 8

inattention to stimuli from one side of the visuospatial environment

Question 9

Disconnection syndromes

def

Answer 9

a) Deficits due to inability to transmit information from one area of cortex to another
b) Callosotomy: the right hand does not know what the left is doing, or what is in the left visual field

Question 10

Language syndromes

speech/comprehension/repetition

Brocas aphasia

Answer 10

Speech:
Comprehension:
Repetition:

Poor
Intact
poor

Question 11

Language syndromes

speech/comprehension/repetition

Wernickes aphasia

Answer 11

Speech:
Comprehension:
Repetition:

Fluent
Poor
poor

Question 12

Language syndromes

speech/comprehension/repetition

Conduction aphasia

Answer 12

Speech:
Comprehension:
Repetition:

Intact
Intact
poor

Question 13

Language syndromes

speech/comprehension/repetition

Global aphasia

Answer 13

Speech:
Comprehension:
Repetition:

Poor
poor
poor

Question 14

Language syndromes

speech/comprehension/repetition

Transcortical motor aphasia

Answer 14

Speech:
Comprehension:
Repetition:

Poor
Intact
intact

Question 15

Language syndromes

speech/comprehension/repetition

Echolalia

Answer 15

Speech:
Comprehension:
Repetition:

Poor
Poor
intact

Question 16

Anomia

def

Answer 16

Difficulty naming objects, common with all aphasia and often the only sign of mild or resolving aphasia

Question 17

Aprosodia

def

Answer 17

Prosody refers to intonation and emphasis, the intonation which reflects affective or emotional content in speech

(1) Encoding and decoding of affective components of speech (and behavior) is performed in the right hemisphere
(2) A categorization aprosodias similar to that of aphasias localizes deficits around the right Sylvian fissure

Question 18

Gerstmann’s syndrome

loc

Answer 18

Dominant parietal lobe lesion

Each component of the tetrad can arise from multiple sites, but combination of all four strongly suggests a dominant parietal lobe lesion

Question 19

Gerstmann’s syndrome

tetrad

Answer 19

(a) Finger agnosia: Can not name fingers or indicate a finger named by the examiner. Extreme cases can not recognize which finger has been touched or moved by the examiner
(b) Left-right disorientation: Can not show left vs right hand or foot. Crossed pointing is more sensitive (Point to right foot with left hand)
(c) Acalculia: Inability to carry out calculations, often due to aphasic acalculia in which the patient mistakes or substitutes one number for another, but true anarithmetria can occur
(d) Agraphia: Writing impairment

Question 20

Gerstmann’s Syndrome

Non-dominant parietal lobe

Answer 20

(1) Neglect
(2) Anosagnosia
(3) Constructional apraxia
(4) Dressing apraxia

Question 21

Cortical blindness

def

Answer 21

No visual perception due to cortical deficit. Pupillary response is preserved.

Question 22

Anton’s syndrome

Answer 22

Classically defined as cortical blindness with anosagnosia. It can sometimes resolve through Balint’s syndrome, and may thus be a disconnection phenomenon where the patient has vision but can not extract any useful information from what he sees.

Question 23

Balint’s Syndrome

Answer 23

oculomotor apraxia (can’t direct gaze effectively), optic ataxia (can’t reach out to a visual target accurately), visual inattention (& sometimes aprosopagnosia: can’t recognize faces). These difficulties result from inability to extract or use visuospatial information, but color information is better preserved.

Question 24

Achromatopsia

def

Answer 24

Loss of color vision in all or part of the visual field. Inferior parietal occipital lobe lesions.

Question 25

Alexia and agraphia Chars Lesion location/associated deficits

Answer 25

Alexia without agraphia Lesion: Posterior dominant hemisphere, occipital lobe and splenium of the corpus callosum Associated deficits: Right homonymous hemianopia, color anomia or achromatopsia Alexia with agraphia Lesion: Dominant hemisphere parietal lobe Associated deficits: Variable components of right hemisensory deficit, hemiparesis, and aphasia

Question 26

Alexia and agraphia Chars Reading/ writing, dictation

Answer 26

Alexia without agraphia Reading: Very poor Writing, dictation: No agraphia Alexia with agraphia Reading: Very poor Writing, dictation: Severe agraphia

Question 27

Alexia and agraphia Chars Copying/comprehension of spelled words

Answer 27

Alexia without agraphia Copying: Slavish (drawing a picture of the writing) Comprehension of spelled words: Good Alexia with agraphia Copying: Slavish (drawing a picture of the writing) Comprehension of spelled words: Very poor

Question 28

Alexia and agraphia Chars Spelling aloud/verbal output

Answer 28

Alexia without agraphia Spelling aloud: Good Verbal output: Normal Alexia with agraphia Spelling aloud: Very poor Verbal output: Normal to anomic

Question 29

Alexia and agraphia Chars Letter naming/paralexia

Answer 29

Alexia without agraphia Letter naming: Usually good, quite variable Paralexia: Occasional semantic paralexia (synonym substitutions) Alexia with agraphia Letter naming: Severe letter anomia Paralexia: Frequent semantic paralexia

Question 30

Prosopagnosia chars

Answer 30

i) Literally, inability to recognize faces, but more generally, refers to difficulty recognizing specific members of a general class of objects, on the basis minor visual feature variations ii) Patients can distinguish people by voice and stance iii) Patients can recognize a face and distinguish parts (eyes, ears, nose, mouth) iv) A problem of visual cueing of memories: patients can select pictures of the same person from a group of pictures v) Prosopagnosia can apply to other categories: (1) Farmer can't distinguish his cows (2) Inability to distinguish makes of cars, species of birds

Question 31

Visual agnosia def

Answer 31

i) Ability to see and describe an object while unable to recognize it ii) Should be able to draw the object or match it to a drawing or picture iii) Must be unaware of the nature or use of an object, not just its name iv) The man who mistook his wife for a hat

Question 32

Types of memory list

Answer 32

Registration (attention span) Short-term memory (recall) Long-term memory (public events) Motor skills and conditioned reflexes

Question 33

Amnesia def

Answer 33

Anterograde: Inability to form new memories (1) Korsakoff's syndrome Retrograde: premorbid memories Ribot's law: more recent memories are most affected

Question 34

Amnestic syndrome chars

Answer 34

i) Bilateral limbic system lesions (1) Medial temporal lobes (2) Medial thalamic nuclei ii) Usually a mixture of anterograde and retrograde amnesia iii) Both improve as the lesion resolves

Question 35

Transient Global amnesia chars

Answer 35

Acute onset transient anterograde amnesia Benign usually (migraine, seizure, TIA) Leaves a permanent memory gap Full recovery of anterograde memory

Question 36

Psychogenic amnesia (psychogenic fugue) def

Answer 36

Loss of personal identity and past Intact memory for recent events Occurs most often in fiction

Question 37

Dementia DSM-def

Answer 37

Loss of multiple cognitive abilities in a person with a clear sensorium (no delirium) DSMIV-R requires memory impairment plus impairment in one of: (1) language (2) judgement (3) abstract thinking (4) praxis (5) constructional abilities (6) visual recognition

Question 38

MCI criteria

Answer 38

``` Memory complaint, preferably corroborated by an informant Objective memory impairment Normal general cognitive function Intact activities of daily living Not demented ```

Question 39

Vascular dementia Modified hachinski ischemic score Pg. 206

Answer 39

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