B7-050 Delirium, Attention, and Executive Function Flashcards
contrast gaze preference and gaze palsy
preference: you could get them to have a normal VOR but they only voluntary look one direction
palsy: inability to look to one side, cannot be overcome on VOR
gaze preference indicates a lesion where?
frontal eye fields
(will look away from paralyzed limb)
gaze palsy indicates a lesion where?
PPRF
(will look toward paralyzed side)
where are the frontal eye fields?
dorsolateral prefrontal cortex
disturbance in level of awareness and reduced ability to direct, focus, sustain, and shift attention
delirium
delirium develops over […] and fluctuates in severity
short period (hours to days)
nearly always, delirium is caused by […] process
diffuse toxic metabolic process
(but not severe enough to cause stupor or coma)
which hemisphere is more important to attention?
non-dominant
a non-dominant hemisphere lesion can cause […] neglect
severe
(example where he talked about patient not recognizing own arm; dominant side lesions cause minimal neglect)
non-dominant parietal lobe lesion can cause […] from double simultaneous stimulation
extinction
(can’t recognize the bilateral stimulation)
acquired, chronic disorder affecting multiple cognitive domains
dementia
dementia generally does not affect […] or […] until late in disease course
attention
consciousness
(exception: diffuse lewy body disease)
antibiotic that can cause myoclonic jerks and delirium
cefepime
the conscious executive center of the brain
dorsolateral prefrontal cortex
non-declarative memory is unconscious motor memory that occurs in the […]
striatum and cerebellum
inability to recognize faces
still have emotional response
prosopaganosia
prosopaganoisa occurs due to a lesion where?
inferior temporal cortex (associated with Alzheimers)
has to be bilateral
able to recognize faces
but have no emotional response
capgras syndrome
(results in delusion that loved ones have been replaced by a look-alike imposter)
can be caused by lesions in non-dominant hemisphere
[…] hemisphere of the brain constructs explanations in order to make sense of the world
can even go so far as to confabulate
dominant
(left brain interpreter)
executive centers [4]
amygdala
orbitofrontal cortex
dorsolateral prefrontal cortex
anterior cingulate cortex
subconscious evaluator of the meaning of stimuli
provides emotional response to the consequences of the situation
amygdala
some innate fears (like spiders or snakes) are hardwired in the
amygdala
the […] is involved when we make decisions based on the reward value of stimuli
amygdala
most common cause of bilateral damage to the amygdala
herpes encephalitis
(develop syndrome where they have no reaction to fearful stimuli)
emotional interpretation center
orbitofrontal cortex
(example of gambling; orbitofrontal cortex recognizes better odds before the frontal cortex)
a lesion in […] causes decisions to be painfully deliberate and effortful
orbitofrontal cortex
how would an orbitofrontal lesion effect empathy?
poor empathy (no emotional interpreter)
directs working memory
dorsolateral prefrontal cortex
activated by pain, cognitive conflict, and errors in task performance
anterior cingulate cortex
ascertains whether behavior is successfully proceeding toward desired goal
anterior cingulate cortex
extremely important to learning from error
anterior cingulate cortex
flow of information in executive function
amygdala –> orbitofrontal cortex —> dorsolateral –>premotor —> motor cortex
(sensory info goes from thalamus and sensory cortex, then into this pathway)
automatic (fast) thinking is unconsciously mediated by
system 1
orbitofrontal cortex
reflective (slow) thinking is consciously mediated by
system 2
dorsolateral prefrontal cortex
which mode of thinking is more prone to error?
automatic (fast)
system 1
describe the pathway of the hyperfast system of thinking
thalamus –> amygdala –> premotor cortex –> motor cortex
the only way to get around the hyperfast thinking system is with
training
[system 1 or 2 of thinking]
when faced with a difficult question, substitutes an easier one
system 1
[system 1 or 2 of thinking]
availability bias
system 1
[system 1 or 2 of thinking]
near term outcomes are favored over long term
system 1
[system 1 or 2 of thinking]
poor grasp of probability
system 1
[system 1 or 2 of thinking]
overconfidence, this decision “feels right”
system 1
[system 1 or 2 of thinking]
anchoring, irrelevant info used to make decisions
system 1
[system 1 or 2 of thinking]
framing, influenced by presentation
system 1
[system 1 or 2 of thinking]
adjustment, discounting pre-test probability and ignoring new evidence
system 1
optimal decision making: simple decision and you have a lot of experience, trust […]
orbitofrontal cortex (if you are expert)
optimal decision making: simple decision and you have a limited experience, engage […]
DLPFC to analyze correctness of decision
optimal decision making: complex decision with many variables
use DLPFC to reject simple solution offered by OFC, learn risk/benefit benefits
do not force DLPFC to make decision
then after a period of not consciously thinking about is, use OFC to makea snap decision
[system 1 or 2 of thinking]
risk stratification
system 2
responsible for startle response
amygdala
part of the brain concerned with errors in task performance
anterior cingulate cortex
core symptom of delirium
inattention
the dorsal lateral prefrontal cortex should initially […] the solution offered by the orbital frontal cortex
reject
what is the last step of complex decision making
make a snap decision after a period of time not thinking about it
hemiparesis with gaze preference away from the side of hemiparesis indicates a lesion in
frontal eye fields
a […] lesion can cause gaze palsy with patients looking toward affected limb
pontine
attentional area of the brain
dorsal lateral prefrontal cortex
a lesion of the pons would be expected to cause […] hemiparesis and […] gaze paralysis
contralateral
ipsilateral
a lesion in the pons can cause gaze palsy due to involvement of the
PPRF
(patient looks toward paralyzed limbs)
the […] hemisphere is more important to attention
non-dominant
(right hemispheric lesions are associated with severe left neglect)
