Ch-15 Alteration in Cognitive Systems, Cerebral Hemodynamics and Motor Function Flashcards
1
Q
What does cognitive behavior functional competence mean?
A
integrated process of cognitive, sensory and motor systems
2
Q
What is full consciousness?
A
state of awareness of oneself and appropriate responses to environment
3
Q
What are the 2 components of consciousness?
A
arousal (state of awakeness) & awareness (content of thought)
4
Q
What is structural alterations?
A
divided according to their location of dysfunction.
5
Q
What are the disorders of structural alterations?
A
supratentorial disorders & infratentorial disorders
6
Q
Where is supratentorial disorders located and how does this affect our body?
A
located above tentorium cerebelli; produces changes in arousal
7
Q
Where does infratentorial disorders located and how does this affect the body?
A
located below tentorium cerebelli; produce decline in arousal by dysfuntion of reticular activating system or brainstem
8
Q
What is metabolic alterations?
A
disorders produce a decline in arousal by alteration in delivery of energy substrates
9
Q
What are the 5 patterns of neurological functions for alterations in arousal?
A
(1) level of consciousness
(2) pattern of breathing
(3) pupillary reaction
(4) oculomotor responses
(5) motor responses
10
Q
Which of the 5 patterns is the most critical index of NS function?
A
level of consciousness
11
Q
Highest level of consciousness = person _____/oriented to oneself, others, place & time.
A
alert
12
Q
T or F: For level of consciousness, the changes indicate improvement or deterioration.
A
True
13
Q
What is apneusis?
A
prolonged inspiratory time and a pause before expiration.
14
Q
What is ataxic breathing?
A
complete irregularity of breathing with increasing periods of apnea
15
Q
T or F: For pattern of breathing, normal breathing = rhythmic pattern.
A
True
16
Q
As consciousness diminishes, breathing responds to changes in ______ levels.
A
PaCO2
17
Q
Cheynes-Stokes is directly related to _____
A
PaCO2
18
Q
What is the altered period of tachypnea & apnea?
A
Cheyne-Stokes
19
Q
Pupillary reaction indicate the presence/level of ______ dysfuntion.
A
brainstem
20
Q
What causes pinpoint pupils?
A
hypothermia/opiates
21
Q
What is the pupil rxn for when ischemia occurs?
A
dilated/fixated pupils
22
Q
Oculomotor responses is when resting, spontaneous and reflexive ______ movements change at various levels of brain dysfunction.
A
eye
23
Q
What is the normal response for oculomotor responses.
A
eyes move together to side opposite from turn of head
24
Q
What is an abnormal response for oculomotor responses?
A
eyes do not turn together
25
What is an absent response for oculomotor responses?
eyes move in direction of head movement
26
What is an example to test oculomotor responses?
Caloric Ice Water Test - injected into ear canal
27
What is the normal response for caloric ice water test?
eyes turn together to side of head where ice injected
28
What is the abnormal response for caloric ice water test?
eyes do not move together
29
What is an absent response for caloric ice water test?
no eye movement
30
What does motor responses determine?
it determines brain dysfunction & indicate most severely damaged side of brain.
31
What are some pattern of response for motor responses?
- purposeful
- inappropriate, generalized movement
- not present
32
Motor signs indicate loss of _______ _______
cortical inhibition
33
Loss of cortical inhibition = decreased ______ which is associated with performance of ______ reflexes and rigidity.
consciousness; primitive
34
What disorder is associated with rigidity?
paratonia
35
T or F: Grasp reflex is an example of primitive reflexes
True
36
What are some complex reflex-like motor responses? Where does this integrated in?
vomiting, yawning & hiccups; brainstem
37
Dysfunction of what brain area results in compulsive/repetitive production of vomiting, yawning and hiccups
medulla oblongata
38
What are the two forms of neurological death?
brain death (1) & cerebral death (2)
39
What are the two categories of outcomes of alterations in arousal?
disability (morbidity) & mortality
40
What is brain death?
- brain damaged; irreversible; cannot maintain homeostasis.
- aka total brain death
41
What form is neurological death is neurological determination of death (NDD) associated with?
brain death
42
What are the three Canadian criteria for NDD
unresponsive coma (1), no brainstem functions (2) & no spontaneous respiration (e.g., apnea) (3)
43
What is cerebral death?
- aka irreversible coma
- death of cerebral hemispheres except brainstem and cerebellum
- brain continue to maintain homeostasis.
44
T or F: Brain death means there is a permanent brain damage.
FALSE; cerebral death
45
What areas of brain are not affected by cerebral death?
brainstem & cerebellum
46
What are the three types of cerebral death?
persistent vegetive state (1), minimally conscious state (2) & locked-in syndrome (3)
47
Which type of cerebral death is associated with blinking as means of communication?
locked in syndrome
48
What type of cerebral death is associated with complete paralysis of voluntary muscles except for eye movement?
locked in syndrome
49
In locked in syndrome, content of thought and level of arousal are intact, meaning they are fully ______
conscious
50
What type of cerebral death is associated with following simple commands, manipulate objects and give yes/no responses?
minimally conscious state (MCS)
51
What type of cerebral death is responsbile for complete unawareness of self or environment, does not speak, sleep-wake cycles present and cerebral function is absent.
persistent vegetative state
52
T or F: Minimally conscious state (MCS) is associated with the presence of sleep wake cycles.
False; persistent vegetative state
53
T or F: Minimally conscious state has something to so with complete unawareness of self or environment.
FALSE; persistent vegetative state
54
T or F: In persistent vegetative state. the cerebral function is present.
False; absent
55
T or F: Minimally conscious state includes giving yes/no responses, manipulate objects and follow simple commands.
TRUE
56
T or F: Arousal encompasses all cognitive function.
FALSE; awareness
57
What is awareness mediated by?
Executive Attention Networks (EAN)
58
The EAN, includes selective _____ and _____ and involve abstract reasoning, planning, decision making, judgement and self-control.
attention; memory
59
What is selective attention?
ability to select information and focus on related specific task
60
T or F: Selective attention includes selective visual and auditory attention.
True
61
What are the 3 types of executive attention deficits?
initial detection, mild deficit & severe deficit
62
Which executive attention deficits is associated with a person failure to stay alert & orientate to stimuli?
initial detection
63
What is the mild deficit of executive attention deficits?
grooming and social graces are lacking.
64
Which type of executive attention deficits is associated with motionless, lack of response and doesn't react with surroundings?
severe deficit
65
The characteristics of executive attention deficits is the inability to maintain sustained _____ and inability to set _____ and ____ when goal is achieved.
attention; goals; recognize
66
What is memory?
recording, retention and retrieval of ifo
67
What is amnesia?
loss of memory
68
T or F: Retrograde amnesia is the inability to form new memories.
FALSE; anterograde amnesia
69
T or F: Anterograde amnesia is the difficulty retrieving past memories.
FALSE; Retrograde amnesia
70
What are the 5 data processing deficits?
1. Agnosia
2. Dysphasia
3. Acute Confusional State & Delirium
4. Dementia (Alzeheimer's)
5. frontotemporal dementia
71
What does data-processing deficits mean?
problems associated with recognizing & processing sensory information
72
T or F: Agnosia affects more than one sense.
FALSE; affects only one.
73
T or F: Agnosia is associated with cerebrovascular accidents to specific brain areas.
True
74
What is agnosia?
-defect of pattern recognition
- failure to recognized form and nature of objects.
75
What is dysphasia?
impairment of comprehension or production of language
76
Name the 2 types of dysphasia?
expressive dysphasia & receptive dysphasia
77
What is another term for expressive dysphasia?
Broca's dysphasia
78
What is expressive dysphasia?
loss of ability to produce spoken or writing language
79
T or F: In expressive dysphasia, verbal comprehension is usually present.
True
80
What is another term for receptive dysphasia?
Wernicke dysphasia
81
What is receptive dysphasia?
inability to understand written or spoken language.
82
T or F: Expressive dysphasia is associated with speech being fluent but words and phrases have no meaning.
False; Receptive dysphasia
83
The pathology of dysphasia is due to occlusion of middle ____ _____
cerebral artery
84
One of the ____ major middle cerebral arteries supplies blood to brain
three
85
What are the causes of acute confusional states and delirium?
drug intoxication, alcohol withdrawal, post anethesia and electrolyte imbalance
86
Acute confusional states and delirium are the _____ disorders of awareness and may have sudden or ____ onset.
transient; gradual
87
Where does delirium most commonly occurs?
in critical care unit over 2-3 days
88
What are the neurotransmitters involved in delirium?
dysfuntion of acetylcholine & dopamine
89
Another name for delirium?
Hyperactive acute confusional state
90
Another name of excited delirium syndrome?
agitated delirium
91
How do you evaluate acute confusional state & delirium?
CAM-ICU: Confusion Assessment Method for Intensive Care Unit
92
When the person acquires acute confusional states and delirium, there is a disruption of _______ system, thalamus, cortex and _____ system
reticular; limbic
93
What are some manifestations for acute confusional states and delirium?
terrifying dream, hallucinations, gross alteration of perception, individual cannot sleep
94
What are some signs for excited delirium syndrome?
rapid breathing, high tolerance to pain and superhuman strenght
95
T or F: Hyperkinetic delirium is an excited delirium syndrome that can lead to sudden death.
True
96
What is dementia?
deterioration/progressive failure of many cerebral functions
97
What causes dementia?
cerebral neuron degeneration, atherosclerosis & genetics
98
What are some manifestations for dementia?
no specific cure exists, maximizing remaining capacities & helping family to understand
99
What disease is the leading cause of severe cognitive dsyfunction in older adults/ exact cause is unknown?
Alzheimer's disease
100
What are the three forms of Alzheimer's disease?
(1) Nonhereditary sporadic late-onset AD
(2) Early-onset familial AD
(3) Early-onset AD
101
T or F: Early-onset AD is very rare.
true
102
T or F: Early-onset familial AD is the most common form of AD.
False; Nonhereditary sporadic late-onset AD
103
T or F: Nonhereditary sporadic late-onset has no specific genetic association.
True
104
What % of Nonhereditary sporadic late-onset AD are there?
70-90%
105
Which form of AD is linked to chromosomal 21 mutations?
Early-onset familial AD
106
Which form of AD is linked to chromosomal 19 mutations?
Early-onset AD
107
T or F: The pathological alterations of all types of Alzheimer's are different.
FALSE; all pathological alteration of all types of AD are same
108
The key components of AD are the accumulation of ____ fragments of ______ plaques (1),
loss of _____ in forebrain cholinergic neurons = _____ of neurons, (2)
____ proteins (microtubule) form neurofibrillary tangles within the neuron = _____ neural death (3),
neurofibrillary tangle are concentrated in ______ cortex (4)
Brain atrophy via widening of ____ (grooves) and ____ of gyrus (5)
toxic; acetylcholine, death; tau, increased; cerebral; sulcus, shrinking
109
T or F: Sulcus are grooves.
True
110
What are the first symptoms of AD?
memory loss & impaired learning
111
What are the continuation of symptoms of AD?
- language
- reasoning
- social behavior
- dyspraxia
112
What is dyspraxia?
loss of movement and co-ordination
113
T or F: When person has AD, the progression from STM loss to total loss of cognitive function.
true
114
T or F: The pathophysiological changes of AD can occur decades before dementia syndrome.
true
115
Which data-processing deficits is previously known as 'pick disease'?
frontotemporal deficits
116
T or F: Frontotemporal dementia is the second most know form of dementia.
true
117
The frontotemporal dementia is an umbrella term for disorders that affect _____ and _____ regions of brain.
frontal; temporal
118
What are the first symptom of frontotemporal dementia?
apathy, poor judgement/ reasoning, break laws
119
T or F: Frontotemporal dementia involves mutation of tau encoding genes.
true
120
Frontotemporal dementia has ____ component with onset at less than _____ years old.
genetic; 60
121
Seizures represent a _____ of disease, not a specific disease entity.
manifestation
122
What is seizure?
sudden disruption in brain electrical function caused by ab excessive discharge of cortical neurons (interneurons)
123
What is epilepsy?
recurrence of seizures where no known cause for seizures can be found.
124
What are convulsions?
jerky, contact-relax movements associated with seizures.
125
What are some probable causes of seizures for older adults?
alcohol, drug withdrawal; metabolic disorders; CNS degeneration
126
What are some probable causes of seizures for young adults?
alcohol, drug withdrawal; brain tumour; peri-natal insults
127
When does peri-natal insults occur?
between 28 weeks of gestation to 28 days after birth
128
What are the three anatomy of a seizures?
(1) epileptogenic focus
(2) tonic phase
(3) clonic phase
129
Which anatomy of seizures involves muscles contraction with increased muscle tone, thus associated with loss of consciousness?
tonic phase
130
What happens to the brain during clonic phase?
there is reduced in O2, leading to the switch to anaerobic metabolism, thus there is an accumulation of lactic acid
131
What is the cause of the seizure cessation during clonic phase?
due to epileptogenic neurons being exhauted
132
T or F: Increase in number of seizures = decrease in brain damage.
FALSE; increase in brain damage
133
What is the result of clonic phase?
seizure discharge is interrupted, thus intermittent contractions diminish and cease
134
Which anatomy of seizures involves alternative contraction and relaxation of muscles.
clonic phase
135
Clonic phase begins when _____ neurons in thalamus and basal ganglia react to cortical excitation.
inhibitory
136
Where is the focus of epileptogenic seizures?
brain site where seizure originates; aka epileptogenic zone
137
Neurons in epileptogenic focus are ______ and activated by numerus stimuli
hypersensitive
138
What is SPECT?
test that detects blood flow changes in brain
139
T or F: During seizure focus can be determined by activated SPECT.
true
140
The cerebral blood flow (CBF) related to _____ injury states.
three
141
What are the three injury states of CBF?
(1) inadequate cerebral perfusion
(2) normal perfusion but with elevated intracranial pressure (ICP)
(3)Excessive blood volume (CBV)
142
What is the normal ICP?
1-15 mmHg
143
ICP results from _____ in intracranial content due to tumour, edema, hemorrhage, etc
increase
144
What is the first thing to be removed in order to increase content?
displacement of cerebral spinal fluid (CSF)
145
What is the result of continued high ICP?
alterations in cerebral blood volume and blood flow.
146
What is the result of alterations of cerebral blood volume and blood flow?
four stages of ICP that lead to death
147
Which stages of ICP is associated with the cranial vasoconstriction and systemic adjustments?
Stage 1
148
During stage 1 of ICP, the cranial ______ and systemic _____ result in a ______ in ICP.
vasoconstriction; adjustments decrease
149
T or F: There are no detectable symptoms of ICP during stage 1.
True
150
During stage 2 of ICP, the pressure begins to affect neuron _____
oxygenation
151
With the continual expansion of intracranial contents during stage 2, the ICP ______ compensatory mechanisms
exceeds
152
What are some manifestations during stage 2 of ICP?
confusion, restlessness and lethargy
153
The pupils and breathing during stage 2 of ICP remain ______
normal
154
What is best intervention for stage 2 of ICP?
surgical intevention
155
What is autoregulation?
mechanism to alter diameter of intracranial blood vessels to maintain a constant blood flow during changes in ICP
156
T or F: Autoregulation is lost in stage 4.
False; lost in stage 3
157
When autoregulation is loss, ICP approaches _____ pressure.
arterial
158
During stage 3 of ICP, severe ______, hypercapnia, and _____ occur.
hypoxia; acidosis
159
What are some manifestations for stage 3 of ICP?
loss of peripheral vision, blindness and tinnitus
160
During stage 3 of ICP, ______ intervention is ______ here.
surgical; needed
161
What is the condition of pupils during stage 3 of ICP?
small & sluggish
162
During stage 3 of ICP, there is ______ of pulse pressure.
widening
163
Herniated brain tissue in stage 4 of ICP, means there is ______ in blood supply
reduction
164
During stage 4 of ICP, the brain tissue shifts or _____ from greater pressure to lesser pressure
herniates
165
T or F: Herniations rapidly increases ICP.
true
166
What are the conditions of pupils during stage 4 of ICP?
bilateral dilation and fixation
167
The breathing during stage 4 of ICP is ______
Cheyne-Stokes breathing
168
The mental status during stage 4 of ICP?
progresses to deep coma
169
During stage 4 of ICP, surgical intervention is _____ here. Thus ______ occur
futile; death
170
What are the three types of cerebral edema?
vasogenic edema (1), cytotoxic edema (2) & interstitial edema (3)
171
What is the most important type of cerebral edema?
vasogenic edema
172
What causes vasogenic edema?
increased capillary permeability/disruption of BBB
173
What are some manifestations of vasogenic edema?
consciousness disturbances and increases in ICP
174
What is the resolution for vasogenic edema?
slow diffusion
175
During vasogenic edema, the plasma proteins and fluid leak into cranial _____. So the fluid accumulates in _____ matter which leads to ______ of myelinated fibers.
ECF; white; separation
176
During brain edema, the lateral ventricles are ______ and the _____ flattened
compressed; gyri
177
In cytotoxic edema the loss of ____ and gain large amounts of of ____ = change in intracellular osmolarity thus the cells _____
K+; Na+; swell
178
Which type of cerebral edema is associated with toxic factors that affects neural, glial, and endothelial cells which results in loss of active transport mechanisms?
cytotoxic (metabolic) edema
179
Which type of cerebral edema is associated with the movement of cerebral spinal fluid from ventricles into interstitial space?
interstitial edema
180
What is the result of interstitial edema?
disappearance of myelination
181
With interstitial edema, as fluid volume increases around ventricles, there is an increased pressure within ______ matters, which results in disappearance of _______.
white; myelination
182
What is the condition in which there is an excess of cerebral spinal fluid (CSF) in ventricles or subarachnoid space?
hydroencephalus
183
What is the cause of hydroencephalus?
- increased CSF production --> obstruction in ventricles --> defective reabsorption of CSF fluid into systemic blood.
184
What are the 2 types of hydroencephalus?
communicating hydrocephalus & noncommunicating hydrocephalus
185
T or F: The cause of noncommunicating hydrocephalus is infection.
False; congenital
186
T or F: Communicating hydrocephalus only occurs in adults.
FALSE; noncommunicating hydroencephalus
187
T or F: Communicating hydrocephalus is the impairment absorption of CSF from subarachnoid space
True.
188
What causes communicating hydrocephalus?
infection
189
T or F: Noncommunicating hydrocephalus is present from birth (congenital)
true
190
What is noncommunicating hydrocephalus?
obstruction of CSF between ventricles
191
The word "communicating" refers to fact the _____ can still flow ____ the ventricles.
CSF; between
192
Hydrocephalus is due to the _____ of CSF flow which increase pressure and ____ of ventricles. Leads to ______ of cerebral cortex and _______ of ______ matter
obstruction; dilation; atrophy; degeneration; white
193
The manifestations for acute hydrocephalus is the ____ developing of ICP, which leads to deep _____
rapidly; coma
194
T or F: Hydrocephalus develops slowly for normal pressure hydrocephalus.
true
195
In normal pressure hydrocephalus, there the dilation of ventricles _____ increased pressure
without
195
In normal pressure hydrocephalus, the family notices declines in _____.
memory
196
What are the triad symptoms for normal pressure hydrocephalus?
broad-base gait, falling & incontinence.
197
What is the tx for hydrocephalus?
shunt procedure
198
T or F: Shunt procedure is one of the three most common neurosurgical procedures.
true
199
T or F: Hypertonia is the decreased in muscle tone.
false; hypotonia
200
People with hypotonia have joints that are _____ which can acquire positions requiring extreme joint mobility
hyperflexible
201
What are some characteristics of hypotonia?
tire easily (1)
difficulty rising from sitting position (2)
muscle mass atrophy (3)
muscles appear flabby and flat (4)
202
T or F: Hypotonia is the increased in muscle tone.
FALSE; hypertonia
203
What are the symptoms of hypertonia?
enlargement of muscle mass, dev of firm muscles and muscle spasms
204
Which muscle tone is associated with passive movement the occurs with increased resistance?
hypertonia
205
What are the causes of alterations in muscle movement?
neurotransmitter dopamine involved in several disorders (1) & other disorders are neurological disorder (2)
206
What is hyperkinesia?
excessive, purposeless movement
207
What are the 3 types of hyperkinesia?
1. Paroxysmal dyskinesias
2. Tardive dyskinesias
3. Ballism
208
Which type of hyperkinesia is associated with the muscle disorder with wild flinging movement of limbs?
ballism
209
What are some characteristics of tardive dyskinesias?
rapid repetitive stereotypical movements like continually chewing or tongue protrusions.
210
A disorder that involves tardive dyskinesias is _____ syndrome
tourette
211
Tardive dyskinesias involves _______ movement of face, lips, tongue and extremeties.
involuntary
212
what often caused tardive dyskinesia?
prolonged antipsychotic meds
213
Which type of hyperkinesia is associated with involuntary movements that occur as spasms
paroxysmal dyskinesias
214
What is huntington's disease known as?
chorea
215
T or F: Huntington's disease symptoms are hallmark of hyperkinesia.
true
216
What is the onset for HD?
25-45 years old
217
What brain areas involved in HD?
basal ganglia and cerebral cortex
218
HD is relatively rare degrative _______ disorder
hyperkinetic
219
What are some manifestations for HD?
- begins in face & arms --> eventually the whole body
- thinking is slow
- alterations in euphoria and depression are common
- involuntary fragmented movements.
220
HD is an inherited disease, _______ dominant trait
autosomal
221
T or F: The age of disease onset for HD is determined by number of repeated amino acid chains.
true
222
HD: increase amino acid chains = _____ toxicity of protein = _______ age of onset
increased; earlier
223
How many does healthy gene repeats?
10-26
224
In HD, altered amino acids chain = _____ toxic to neurons
protein
225
There is a mutation in chromosome ____ for HD that result in _____ long protein caused by cytosine-adenine-guanine (____) trinucleotide.
4; abnormally; CAG
226
Hypokinesia means there is a _____ in movement
decreased
227
What is hypokinesia?
loss of voluntary movement despite preserved consciousness.
228
What are the two types of hypokinesia?
akinesia (1) & bradykinesia (2)
229
T or F: Bradykinesia is the lack of spontaneous movement or associated movements.
FALSE; akinesia
230
What is bradykinesia?
slowing of performed movements
231
What is akinesia?
lack of movement
232
What is Parkinson's disease (PD)?
complex motor disorder accompanied by systemic nonmotor and neurological symptoms
233
When does primary PD begin?
after 40 years old with increased incident after 60 years old
234
T or F: Secondary PD is the leading cause of neurological disability in people over 60 years old.
FALSE; primary PD
235
________ intoxication PD is the most common secondary form and most often reversible.
medication
236
What are the causes of medication intoxication PD?
- neuroleptics --> antipsychotics (treat hallucinations, delusion)
- antiemetics --> prescribed to address nausea and vomiting
- anti-hypersentives
237
Secondary PD is caused by ______ other than PD (e.g., head trauma, infections, toxins and meds intoxication).
disorder
238
T or F: PD involves single gene mutations.
FALSE; several gene mutations
239
What is the pathology for PD?
basal ganglia dysfunction due to misfolded proteins
240
Symptoms like muscle tremor and rigidity produce _____ movement called _____'s
abnormal; Parkinson
241
PD: Because of the basal ganglia dysfunction due to misfolded proteins, there is a loss of _____-producing neuorns in ______ ____
dopamine; substantia nigra
242
What are some manifestations for PD?
- resting tremor, rigidity, bradykinesia, dysarthria
- loss of smell can be an early symptom
243
Dysarthria = _____ ____
slurring speech
244
What is the result of disorders of equilibrium?
falls like a post
245
T or F: PD can make appropriate postural adjustments to tilting
FALSE; can't make appropriate postural adjustments to tilting
246
What is the principle feature of Lou Gehrig's disease?
degeneration of both lower and upper motor neurons
247
How does Lou Gehrig's disease affect lower motor neurons?
denervation of motor units
248
How does Lou Gehrig's disease affect upper motor neurons?
- decrease in large motor neurons in CNS
- motor neurons death results in demyelination and glia proliferation and sclerosis (scarring)
249
What are some manifestations for Lou Gehrig's disease?
- muscle weakness starting in arms and legs, progressing to difficulty speaking and swallowing.
- no associated mental or sensory symptoms.
250
T or F: There is an associated mental or sensory symptoms in Lou Gehrig's disease
FALSE; no associated mental or sensory symptoms
251
What is the tx for Lou Gehrig's disease?
meds: rilutek extends time before ventilatory assistance is required
252
