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BMB Test 3 > B7.046 Cognition: A Clinical Perspective > Flashcards

B7.046 Cognition: A Clinical Perspective Flashcards

1
Q

definition of dementia

A

cognitive deficits impairing social or occupational functioning

  • acquired (after 18)
  • persistent
  • multiple cognitive domains
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2
Q

primary sensory and motor cortical regions

A 
frontal eye fields
motor cortex
somatosensory cortex
auditory cortex
visual cortex
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3
Q

first order association cortices

A

prefrontal cortex
auditory unimodal association cortex
somatosensory unimodal association cortex
visual unimodal association cortex

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4
Q

multimodal association areas

A

anterior association area

posterior association area

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5
Q

functions of perceptual association areas

A

integrate sensory information from the unimodal cortices

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6
Q

perceptual association areas

A

parietal association area

temporal association area

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7
Q

function of anterior association area

A

executive function, planning

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8
Q

perceptual pathways and their functions

A

dorsal: recognition of relationships between objects
ventral: object recognition

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9
Q

function of limbic association area

A

memory (and retrieval of memories), motivation

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10
Q

example pathway through the cortex

A
  1. sensory information to primary sensory cortex
  2. information processed in corresponding unimodal association cortex
  3. information from multiple unimodal association cortices converges on multimodal association cortex and information is processed together
  4. information is integrated with limbic association area to recognize the stimuli based on memories
  5. sensory input feeds into anterior association cortex to begin executive planning based on the reaction to the stimuli
  6. planning information sent to prefrontal cortex
  7. prefrontal cortex influences primary motor cortex and corticospinal tracts descend with information about movement based on the plan made in the anterior association cortex
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11
Q

anterior brain

A

executive and motor functions

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12
Q

posterior brain

A

perceptual and sensory functions

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13
Q

left brain

A

symbolic reasoning

-language, math, serial processing of symbols

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14
Q

right brain

A

pattern reasoning

-visual and spatial processing, looking at things as a whole

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15
Q

what is brain dominance?

A

the side of your brain where language processing lives (majority of people are L brain dominant)

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16
Q

distribution of brain dominance in the population

A

right handed people - L brain dominant

left handed people - 70% L brain dominant, 15% R brain dominant, 15% both hemispheres

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17
Q

midline brain

A

memory processing

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18
Q

pattern of deficits in cortical lesions

A

diffuse vs focal
dominant vs non dominant
anterior vs posterior

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19
Q

clinical evaluation of deficits with suspected cortical lesion

A

history
mental status exam
elementary neuro exam

20
Q

components of history taking in evaluation of suspected cortical lesions

A 
behavioral problems
memorizing lists
balancing check books
anomia
getting lost driving (non-dominant hemisphere problem)
21
Q

most common mental status exam

A

folstein mini-mental status exam

22
Q

typical score on folstein mini-mental status exam

A

most people get 30/30

if below 28, something is wrong

23
Q

most useful way to use folstein mini-mental status exam

A 
look at PATTERN of deficits, not sure score
functions tested:
memory
language
constructions
24
Q

breakdown of points in folstein mini-mental status exam

A

majority memory and language (dominant and midline brain)
1 point from constructions (non dominant brain)
dominant/memory brain biased, may need to supplement non dominant tests

25
Q

limitations of clinical mental status exam

A 
good:
-symbolic reasoning (dominant)
-memory
-perceptual
bad:
-executive (motor)
-pattern reasoning (non-dominant)
26
Q

tests for executive function

A 
word fluency (name >15 animals in 1 min)
trails test
27
Q

tests for construction

A

draw a cube
overlapping pentagons
tiles

28
Q

cortical vs subcortical damage

A

when subcortical systems are affected, elementary neuro exam is abnormal (typically in motor findings)

29
Q

motor signs in subcortical disease

A

rigidity

weakness

30
Q

what is the elementary neuro exam

A

parts of the neuro exam that don’t deal with mental status

31
Q

Alzheimer’s disease

A

diffuse cortical dementia
idiopathic, neurodegenerative disease
pathologically characterized by plaques and tangles

32
Q

progression of alzheimer’s

A

lesions begin in the medial temporal lobe (hippocampus area)
lesions spread without obvious symptoms for many years
mild cognitive impairment manifests once lesion has spread well into temporal and frontal lobes (first symptom is typically short term memory dysfunction)
dementia manifests once a large amount of the cortex is affected
motor areas typically spare until very late in disease

33
Q

incidence and prevalence of alzheimers

A

increases with age

worldwide projections increasing drastically over time (epidemic)

34
Q

centrally acting cholinesterase inhibitors in Alzheimers

A 
targets early involvement of diffuse cholinergic projection system in the basal forebrain
minor benefit (if any)
drugs: tacrine, donepezil, galantamine, rivastigmine
35
Q

NMDA receptor antagonists in Alzheimers

A

mechanism is to inhibit glutamate receptor overactivity that could lead to an influx of Ca2+ and resulting excitotoxicity
minor benefit
drug: memantine

36
Q

top 3 types of dementia

A 
ortical
1. alzheimers
subcortical
2. vascular dementias
3. diffuse lewy body dementia
37
Q

more uncommon cortical dementia

A

frontotemporal

  • anterior cortex affected first
  • memory is ok but dysexecutive symptoms are seen (inappropriateness)
38
Q

components of language processing area of brain

A

in dominant hemisphere
Wernicke’s (semantic area) : multimodal center that decodes auditory input, distinguishes words
Broca’s (encoding and grammar area) : turns ideas into sounds
repetition area: connects Wernicke’s and Broca’s

39
Q

pathways in language processing

A
  1. auditory input goes into auditory cortex and then into Wernicke’s area
  2. Wernicke’s area sends projections into posterior association areas
  3. Wernicke’s also has a connection with Broca’s area, the repetition area
  4. Broca’s area receives input from Wernicke’s and anterior association areas
  5. Broca’s area sends input into the motor cortex to allow a person to speak
40
Q

components of a language assessment

A

fluency
comprehension
repetition

41
Q

Broca’s aphasia

A

non-fluent speech
comprehension intact
no repetition

42
Q

Wernicke’s aphasia

A 
fluent speech (but non sensical)
no comprehension (can't follow commands)
no repetition
43
Q

conduction aphasia

A

fluent speech
comprehension intact
no repetition

44
Q

trans-cortical sensory aphasia

A

disconnects Wernicke’s area from posterior association centers
fluent speech
no comprehension
CAN repeat

45
Q

trans-cortical motor aphasia

A

disconnects Broca’s area from anterior association centers
non-fluent speech
comprehension intact
CAN repeat

46
Q

common causes of aphasias

A

watershed strokes

BMB Test 3 (21 decks)

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