B7-050 Delirium, Attention, and Executive Function

Question 1

contrast gaze preference and gaze palsy

Answer 1

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

Question 2

gaze preference indicates a lesion where?

Answer 2

frontal eye fields

(will look away from paralyzed limb)

Question 3

gaze palsy indicates a lesion where?

Answer 3

PPRF

(will look toward paralyzed side)

Question 4

where are the frontal eye fields?

Answer 4

dorsolateral prefrontal cortex

Question 5

disturbance in level of awareness and reduced ability to direct, focus, sustain, and shift attention

Answer 5

delirium

Question 6

delirium develops over […] and fluctuates in severity

Answer 6

short period (hours to days)

Question 7

nearly always, delirium is caused by […] process

Answer 7

diffuse toxic metabolic process

(but not severe enough to cause stupor or coma)

Question 8

which hemisphere is more important to attention?

Answer 8

non-dominant

Question 9

a non-dominant hemisphere lesion can cause […] neglect

Answer 9

severe

(example where he talked about patient not recognizing own arm; dominant side lesions cause minimal neglect)

Question 10

non-dominant parietal lobe lesion can cause […] from double simultaneous stimulation

Answer 10

extinction

(can’t recognize the bilateral stimulation)

Question 11

acquired, chronic disorder affecting multiple cognitive domains

Answer 11

dementia

Question 12

dementia generally does not affect […] or […] until late in disease course

Answer 12

attention
consciousness

(exception: diffuse lewy body disease)

Question 13

antibiotic that can cause myoclonic jerks and delirium

Answer 13

cefepime

Question 14

the conscious executive center of the brain

Answer 14

dorsolateral prefrontal cortex

Question 15

non-declarative memory is unconscious motor memory that occurs in the […]

Answer 15

striatum and cerebellum

Question 16

inability to recognize faces
still have emotional response

Answer 16

prosopaganosia

Question 17

prosopaganoisa occurs due to a lesion where?

Answer 17

inferior temporal cortex (associated with Alzheimers)

has to be bilateral

Question 18

able to recognize faces
but have no emotional response

Answer 18

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(results in delusion that loved ones have been replaced by a look-alike imposter)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

Question 19

[…] hemisphere of the brain constructs explanations in order to make sense of the world

can even go so far as to confabulate

Answer 19

dominant

(left brain interpreter)

Question 20

executive centers [4]

Answer 20

amygdala
orbitofrontal cortex
dorsolateral prefrontal cortex
anterior cingulate cortex

Question 21

subconscious evaluator of the meaning of stimuli

provides emotional response to the consequences of the situation

Answer 21

amygdala

Question 22

some innate fears (like spiders or snakes) are hardwired in the

Answer 22

amygdala

Question 23

the […] is involved when we make decisions based on the reward value of stimuli

Answer 23

amygdala

Question 24

most common cause of bilateral damage to the amygdala

Answer 24

herpes encephalitis

(develop syndrome where they have no reaction to fearful stimuli)

Question 25

emotional interpretation center

Answer 25

orbitofrontal cortex (example of gambling; orbitofrontal cortex recognizes better odds before the frontal cortex)

Question 26

a lesion in [...] causes decisions to be painfully deliberate and effortful

Answer 26

orbitofrontal cortex

Question 27

how would an orbitofrontal lesion effect empathy?

Answer 27

poor empathy (no emotional interpreter)

Question 28

directs working memory

Answer 28

dorsolateral prefrontal cortex

Question 29

activated by pain, cognitive conflict, and errors in task performance

Answer 29

anterior cingulate cortex

Question 30

ascertains whether behavior is successfully proceeding toward desired goal

Answer 30

anterior cingulate cortex

Question 31

extremely important to learning from error

Answer 31

anterior cingulate cortex

Question 32

flow of information in executive function

Answer 32

amygdala --> orbitofrontal cortex ---> dorsolateral -->premotor ---> motor cortex (sensory info goes from thalamus and sensory cortex, then into this pathway)

Question 33

automatic (fast) thinking is unconsciously mediated by **system 1**

Answer 33

orbitofrontal cortex

Question 34

reflective (slow) thinking is consciously mediated by **system 2**

Answer 34

dorsolateral prefrontal cortex

Question 35

which mode of thinking is more prone to error?

Answer 35

automatic (fast) **system 1**

Question 36

describe the pathway of the hyperfast system of thinking

Answer 36

thalamus --> amygdala --> premotor cortex --> motor cortex

Question 37

the only way to get around the hyperfast thinking system is with

Answer 37

training

Question 38

[system 1 or 2 of thinking] when faced with a difficult question, substitutes an easier one

Answer 38

system 1

Question 39

[system 1 or 2 of thinking] availability bias

Answer 39

system 1

Question 40

[system 1 or 2 of thinking] near term outcomes are favored over long term

Answer 40

system 1

Question 41

[system 1 or 2 of thinking] poor grasp of probability

Answer 41

system 1

Question 42

[system 1 or 2 of thinking] overconfidence, this decision "feels right"

Answer 42

system 1

Question 43

[system 1 or 2 of thinking] anchoring, irrelevant info used to make decisions

Answer 43

system 1

Question 44

[system 1 or 2 of thinking] framing, influenced by presentation

Answer 44

system 1

Question 45

[system 1 or 2 of thinking] adjustment, discounting pre-test probability and ignoring new evidence

Answer 45

system 1

Question 46

optimal decision making: simple decision and you have a lot of experience, trust [...]

Answer 46

orbitofrontal cortex (if you are expert)

Question 47

optimal decision making: simple decision and you have a limited experience, engage [...]

Answer 47

DLPFC to analyze correctness of decision

Question 48

optimal decision making: complex decision with many variables

Answer 48

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

Question 49

[system 1 or 2 of thinking] risk stratification

Answer 49

system 2

Question 50

responsible for startle response

Answer 50

amygdala

Question 51

part of the brain concerned with errors in task performance

Answer 51

anterior cingulate cortex

Question 52

core symptom of delirium

Answer 52

inattention

Question 53

the dorsal lateral prefrontal cortex should initially [...] the solution offered by the orbital frontal cortex

Answer 53

reject

Question 54

what is the last step of complex decision making

Answer 54

make a snap decision after a period of time not thinking about it

Question 55

hemiparesis with gaze preference away from the side of hemiparesis indicates a lesion in

Answer 55

frontal eye fields

Question 56

a [...] lesion can cause gaze palsy with patients looking toward affected limb

Answer 56

pontine

Question 57

attentional area of the brain

Answer 57

dorsal lateral prefrontal cortex

Question 58

a lesion of the pons would be expected to cause [...] hemiparesis and [...] gaze paralysis

Answer 58

contralateral ipsilateral

Question 59

a lesion in the pons can cause gaze palsy due to involvement of the

Answer 59

PPRF (patient looks toward paralyzed limbs)

Question 60

the [...] hemisphere is more important to attention

Answer 60

non-dominant (right hemispheric lesions are associated with severe left neglect)