behavioral cortical dementia

Question 1

Recent or short-term memory

Answer 1

ability to recall information after several minutes of retention

Question 2

remote or long term memory

Answer 2

ability to recall past events hours, weeks or even years afterward

Question 3

Memory function depends on bilateral circuits involving what?

Answer 3

temporal lobe and thalamus 
specifically:
1. hippocampus
2. fornix
3. mamillary body
4. anterior thalamic nucleus

Question 4

What is amnesia in Wernicke-Korsakoff syndrome caused by?

Answer 4

bilateral thalamic and mammillary body lesions

-thiamine deficiency

Question 5

What causes amnesia in cardiac arrest survivors or herpes simplex encephalitis?

Answer 5

bilateral hippocampal lesions

cardiac arrest survivors=anoxia

Question 6

Apraxia

Answer 6

the inability to conceptualize and perform a skilled, learned, motor act on command
unable to do action when commanded but able to do it at other times

Question 7

What is gait apraxia and what lesion is involved?

Answer 7

inability to walk on command

-prefrontal lobe lesion

Question 8

Constructional apraxia

Lesion?

Answer 8

patient cannot draw a house or copy a simple drawing

-parietal lobe

Question 9

dressing apraxia

Answer 9

patient can not dress

-parietal

Question 10

agnosia

Answer 10

impaired recognition of perceived stimuli caused by lesions of sensory association cortex

Question 11

prefrontal or frontal lobe syndrome

Answer 11

1. listless, apathetic, unconcerned, with poor hygiene and incontinence, poor judgment, executive functions impaired , lacks creativity
2. motor preservation (aimless repetition of simple motor acts)
3. gegenhalten or paratonia
4. frontal lobe release signs

Question 12

what is gegenhalten or paratonia

Answer 12

increased limb tone or resistance is felt as the examiner moves the patient’s limb more rapidly

Question 13

What are frontal lobe release signs

Answer 13

previously normal findings in infancy

-suck, snout, root, plantar grasp

Question 14

Syndrome of temporal lobes

Answer 14

• amnesia-bilateral hippocampal lesions
• cortical deafness-bilateral auditory cortex lesion
• kluver-bucy-limbic
• unilateral lesion of the superior posterior dominant temporal lobe–wernicke’s aphasia

Question 15

Parietal lobe syndromes

Answer 15

1. sensory cortex
   a. astereognosis
   b. agraphesthesia
2. lesions of the nondominant parietal lobe-impairment of spatial relationship between the body and its surroundings
   a. anosognosia
3. dressing apraxia or constructional apraxia
4. supramarginal or angular gyrus of the dominant parietal lobe
   a. Gerstmann’s syndrome

Question 16

anosognoisa

Answer 16

unaware of his or her hemiparesis

• denial of half of body or “hemispatial neglect”
• may neglect to groom left side of body

Question 17

Gerstmann’s syndrome

Answer 17

1. agraphia
2. right-left disorientation
3. dyscalculia
4. finger agnosia

Question 18

occipital lobe syndrome

Answer 18

1. bilateral visual cortex to produce cortical blindness
   - sometimes accompanied by a denial or unawareness of visual loss-Anton’s syndrome
2. bilateral temporo-occipital lesions
   - visual agnosia (prosopagnosia )
3. dominant temporo-occipital lobe
   - color anomia

Question 19

acute confusional state or delerium

Answer 19

fluctuating levels of attention and motor activity

• tremulous, asterixis, myoclonus, ataxia, dysarthria
• could be from viral encephalitis or post-ictal state
• kidney failure, metabolic abnormalities, or meds or drugs
• hours to days

Question 20

dementia

Answer 20

diffuse impairment of cortical function which usually evolves less abruptly or over a longer period of months to years and impedes the daily function of patients

• memory loss
• changes in judgment and intellect
• aphasia, apraxia, agnosia
• personality changes

Question 21

What could be causing dementia?

Answer 21

• alcohol or drugs, taking meds incorrectly, lack of vitamins
• vascular cause-stepwise, focal neurological deficits
• depression
• hereditary
• chronic, subdural hematomas, brain tumor, abscesses, multiple infarctions, hemorrhages, hydrocephalus
• chronic meningitis-fever
• HIV-in younger patients
• thyroid
• alzheimer’s

Question 22

What is the evaluation for dementia?

Answer 22

standardized cognitive tests-MMSE

MRI

Question 23

Alzheimer’s disease

Answer 23

most common type of dementia in the US

• gradual destruction of specific types of neurons by metabolic changes
• memory loss-medial temporal lobes and hippocampi

Question 24

What is the pathologic hallmark of alzheimer’s

Answer 24

1. accumulation of b-amyloid in the form of extracellular amyloid or senile cortical plaques
   - coded on chromosome 21
2. beta amyloid deposition leads to intraneuronal neurofibrillary tangles
   - consisting microtubule-associated tau proteins
3. cell death especially cholinergic neurons

Question 25

What are typical signs of vascular dementia? (from multiple bilateral cerebral ischemic infarcts)

Answer 25

focal, asymmetrical neurological deficits such as hemiparesis, hemisensory loss, hemianopia, or cerebellar signs

Question 26

What does a PET scan utilizing Pittsburgh compound B, which selectively binds to B-amyloid show?

Answer 26

the typical alzheimer’s disease uptake in the prefrontal, temporal and sensory association cortex
-sparing the occipital and primary sensorimotor cortex

Question 27

What can slow down AD?

Answer 27

central acetylcholinesterase inhibitors
1. donepezil
2. rivastigmine
3. galantamine 
later:
1. memantine-NMDA antagonist -opposes the excitotoxic effects of glutamate on the CNS

(die of aspiration pneumonia, pulmonary emboli and malnutrition)