Approach to Cognitive Dysfunction Flashcards
Agnosia
def
failure to recognize or comprehend perceived stimuli
Agraphia
def
inability to write
Alexia
def
inability to read
Anomia
def
inability to name, word finding difficulty
Anosagnosia
def
failure to recognize illness, lack of awareness of deficits
aphasia
def
inability to understand and use language
apraxia
def
impairment of skilled movement to command or mimicry despite comprehension and normal motor function
Neglect
def
inattention to stimuli from one side of the visuospatial environment
Disconnection syndromes
def
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
Language syndromes
speech/comprehension/repetition
Brocas aphasia
Speech:
Comprehension:
Repetition:
Poor
Intact
poor
Language syndromes
speech/comprehension/repetition
Wernickes aphasia
Speech:
Comprehension:
Repetition:
Fluent
Poor
poor
Language syndromes
speech/comprehension/repetition
Conduction aphasia
Speech:
Comprehension:
Repetition:
Intact
Intact
poor
Language syndromes
speech/comprehension/repetition
Global aphasia
Speech:
Comprehension:
Repetition:
Poor
poor
poor
Language syndromes
speech/comprehension/repetition
Transcortical motor aphasia
Speech:
Comprehension:
Repetition:
Poor
Intact
intact
Language syndromes
speech/comprehension/repetition
Echolalia
Speech:
Comprehension:
Repetition:
Poor
Poor
intact
Anomia
def
Difficulty naming objects, common with all aphasia and often the only sign of mild or resolving aphasia
Aprosodia
def
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
Gerstmann’s syndrome
loc
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
Gerstmann’s syndrome
tetrad
(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
Gerstmann’s Syndrome
Non-dominant parietal lobe
(1) Neglect
(2) Anosagnosia
(3) Constructional apraxia
(4) Dressing apraxia
Cortical blindness
def
No visual perception due to cortical deficit. Pupillary response is preserved.
Anton’s syndrome
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.
Balint’s Syndrome
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.
Achromatopsia
def
Loss of color vision in all or part of the visual field. Inferior parietal occipital lobe lesions.
Alexia and agraphia
Chars
Lesion location/associated deficits
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
Alexia and agraphia
Chars
Reading/ writing, dictation
Alexia without agraphia
Reading: Very poor
Writing, dictation: No agraphia
Alexia with agraphia
Reading: Very poor
Writing, dictation: Severe agraphia
Alexia and agraphia
Chars
Copying/comprehension of spelled words
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
Alexia and agraphia
Chars
Spelling aloud/verbal output
Alexia without agraphia
Spelling aloud: Good
Verbal output: Normal
Alexia with agraphia
Spelling aloud: Very poor
Verbal output: Normal to anomic
Alexia and agraphia
Chars
Letter naming/paralexia
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
Prosopagnosia
chars
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
Visual agnosia
def
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
Types of memory
list
Registration (attention span)
Short-term memory (recall)
Long-term memory (public events)
Motor skills and conditioned reflexes
Amnesia
def
Anterograde: Inability to form new memories
(1) Korsakoff’s syndrome
Retrograde: premorbid memories
Ribot’s law: more recent memories are most affected
Amnestic syndrome
chars
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
Transient Global amnesia
chars
Acute onset transient anterograde amnesia
Benign usually (migraine, seizure, TIA)
Leaves a permanent memory gap
Full recovery of anterograde memory
Psychogenic amnesia (psychogenic fugue)
def
Loss of personal identity and past
Intact memory for recent events
Occurs most often in fiction
Dementia
DSM-def
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
MCI
criteria
Memory complaint, preferably corroborated by an informant Objective memory impairment Normal general cognitive function Intact activities of daily living Not demented
Vascular dementia
Modified hachinski ischemic score
Pg. 206
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