Attention/Memory

Question 1

Neuroanatomy of attention

Answer 1

Cortex: reticular modulation of ascending sensory info
Focusing attention requires voluntary effort (frontal)
Paralimbic: input adds emotional importance
–> selective attention
Brainstem/basal forebrain cholinergic projections: circuit-tuning
Parietal cortices: shifting from one spatial locus of attention to another

Question 2

MOCA test

Answer 2

doesn’t test writing/reading
limited naming
attention subtest

Question 3

Digit span

Answer 3

normally can repeat 5-7 forwards

Question 4

Divided attention

Answer 4

reverse digit span should be >= foward span-2
Months backwards - better screen in the elderly
Days of week backwards if unable to do months
Spelling “world” backwards (MMSE)

Question 5

Delirium

Answer 5

prototypical disorder of attention
10-30% of hospitalized patients
may be a presenting feature of undiagnosed medical illness
can be life-threatening
Increased risk of complications
mortality rate of 25% within 6 months of discharge
frequently iatrogenic
under-recognized in nursing homes/hospitalized elderly

Question 6

Delirium presentation

Answer 6

prominent, fluctuating disturbance of attention

arousal/hallucinations

Question 7

Common causes of delirium

Answer 7

fever (children esp)
infection (pneumonia, bladder, sepsis)
R/O meningitis, encephalitis
Chemical disturbances/energy failure
withdrawa/intoxication
Drugs - esp anticholinergic
Focal/multifocal lesions
Autoimmune processes

Question 8

Metabolic causes of delirium

Answer 8

hyponatremia
uremia
hypoglycemia
hypoxemia
hypercarbia
hyperammonemia due to hepatic failure
thyroid dysfunctio
thiamine deficiency

Question 9

Drug-related causes of delirium

Answer 9

Withdrawal/intoxication

• alcohol
• benzo
• barbiturates
• other sedatives that increase GABA

Primary/secondary anticholinergics
opioids
lithium
anticonvulsants
antiparkisonian agents
drugs of abuse

Question 10

Autoimmune causes of delirium

Answer 10

CNS lupus

paraneoplastic syndromes

Question 11

Right hemisphere syndromes

Answer 11

Construction apraxia
spatial/topographical disorientation
Dressing impairment (dressing apraxia)
hemi-neglect, anosagnosia
emotional indifference
language alterations, aprosodias
alteration in "pragments" of speech

Question 12

Hemi-spatial neglect

Answer 12

persistent failure to detect, respond or orient to relevant stimuli, or to initiate appropriate movemetns in a hemispace
unexplained by primary sensory/motor defects
typically L-sided neglect due to R sided lesions
often accompanied by unawareness of deficit (anosognosia)
persistent R-sided neglect is rare - suspect bilateral lesions/unilateral L-side lesion + superimposed encephalopathy

Question 13

Semantic memory location

Answer 13

inferolateral temporal lobes

Question 14

Procedural memory locations involved

Answer 14

basal ganglia
cerebellum
supplementary motor area

Question 15

Working memory neuroanatomy

Answer 15

prefrontal cortex
Verbal/arithmetic: L>R prefrontal/parietal

Visuospatial R>L prefrontal/parietal

Question 16

Episodic memory test

Answer 16

temporally specific events, personal experiences
recent event recall
word lists
paragraph recall
3 word 3 shape test
3 bedside objects/locations

Question 17

Episodic memory locations

Answer 17

mesial temporal lobes (hippocampus, parahippocamapal gyrus)
fimbria/fornix
mamillary bodies
mamillothalamic tract
anterior thalamic nuclei
cingulate gyrus

Question 18

Agnosia

Answer 18

impaired higher level recognition in presence of preserve elementary perception, memory and general intellect
could be considered a form of semantic memory impairment

Question 19

Apperceptive visual agnosia

Answer 19

shape/visual form agnosia
shape perception abnormal
worse for geometric figures, pics
seen most often after anoxic damage (esp CO poisoning)
usually involves occipital cortices extensively

Question 20

Associative visual agnosia

Answer 20

relatively intact perception, but poor recognition
unable to match/describe use by sight
can copy line drawings but not identify
bilateral posterior damage/degeneration involving ventral occipitotemporal areas, esp peri-striate region

Question 21

Prosopagnosia

Answer 21

loss of facial recognition
usually associated with left hemifield defect
Localization: ventral visual associative areas (medial occipitotemporal cortex)
usually bilateral lesions, right-predominant
Right PCA territory infarct

Question 22

Colour agnosia

Answer 22

visual association area

occipitotemporal

Question 23

Tactile agnosia

Answer 23

Parietal sensory association

Question 24

Auditory agnosia

Answer 24

auditory association cortices

post sup temporal gyrus and connections

Question 25

Finger agnosia

Answer 25

dominant angular gyrus in inferior parietal lobule

Question 26

Simultanagnosia

Answer 26

visual association areas

bilateral superior parietal cortex (spatial visual pathway)

Question 27

Anagnosia

Answer 27

unawareness of neurological deficit/illness
common in hemispatial neglect
seen in other syndromes: fluent aphasia, dementia, cortical blindness (Anton’s syndrome), schizophrenia, mania

Question 28

Frontal lobe cognitive functions

Answer 28

divided/selective attn
retrieval from semantic and episodic memory
abstraction
analogical reasoning
"switching gears"
insight
judgment, assessment of reward
planning/problem solving

Question 29

Frontal lobe behavioural function

Answer 29

motor activation (apathy)
aspects of personality
social judgment/demeanor
empathy and consideration of rights and feelings of others
interest in personal hygiene/grooming

Question 30

Orbifrontal syndrome

Answer 30

Behavioural variant of frontotemporal dementia, head injury

Disinhibition
impulsive behaviour
distractible
emotional lability, irritable
inane euphoria
jocularity
poor judgment/insight
hyperactive/manic-like
sexual disinhibition

Question 31

Dorsolateral frontal syndrome

Answer 31

FTD, frontal lobe infarcts, penetrating head injury
Reduce verbal, nonverbal fluency
perseveration
abstraction impaired
retrieval defects
poor set shifting
poor strategies on copying tasks
impaired attention
depressed mood

Question 32

Medial frontal syndrome causes

Answer 32

ACA/MCA borderzone infarcts
ruptured ACA aneurysms
falx meningiomas
hydrocephalus

Question 33

Medial frontal syndrome presentation

Answer 33

lack of motivation/drive
emotional emptiness/blunting
failure to implement new plans
poor performance and maintenance of output on fluency tasks
decreased motor activity
extreme form: akinetic mutism (no initiation of speech/voluntary movements)

Question 34

Frontal lobe function tests

Answer 34

verbal fluency
category fluency
nonverbal (design fluency)