Chapter 15 - Cognitive Systems and Motor Function Flashcards
Cognitive behavioural functional competence
integrated processes of cognitive, sensory, and motor systems
What systems get manifested through the motor network?
behaviours that appropriate to human activity
Full Consciousness
state of awareness of oneself and appropriate responses to environment
What are the two components of consciousness?
arousal and awareness
Arousal
state of awakeness
Awareness
content of thought
How are structural alterations divided?
by their location of dysfunction
Where do supratentorial disorders affect?
above the tentorium cerebelli
What do supratentorial disorders produce change in?
arousal
Where do infratentorial disorders affect?
below the tentorium cerebelli
What do infrantentorial disorders do?
produce decline of arousal by RAS dysfunction
Metabolic alterations produce a ________ in arousal by altering…
decline; delivery of energy substrates
How many patterns of neurological functions are critical to evaluation process?
5
Which function is the most critical index of nervous system function?
level of consciousness
Changes in level of consciousness indicate _________ or _________
improvement or deterioration
What are characteristics of highest level of consciousness?
when the person is alert and orientated to oneself, others, place, time
What does level of consciousness diminish to?
confusion, then disorientation, then coma
Normal breathing is a __________ pattern
rhythmic
Diminished consciousness leaves breathing responding to changes in _________ levels
PaCO₂
Cheyne-Stokes Respirations
altered period of tachypnea and apnea related directly to PaCO₂
Apneusis
prolonged inspiratory time and a pause before expiration
Ataxic Breathing
complete irregularity of breathing with increased periods of apnea
What does pupillary reaction indicate?
presence and level of brainstem dysfunction
Where is the brainstem area that controls pupils?
adjacent to the areas controlling arousal
How does ischemia affect the pupils?
makes them dilated/fixed
What causes pinpoint pupils?
hypothermia or opiates
Oculomotor Responses
resting, spontaneous, and reflexive eye movements
Normal Oculomotor Response
eyes move together to side opposite from turn of head
Abnormal Oculomotor Response
eyes do not turn together
Absent Oculomotor Response
eyes move in the direction of head movement
What is the caloric ice water test used to measure
oculomotor response
How does the caloric ice water test work?
ice water is injected into the ear canal
Normal Caloric Ice Water Test Response
eyes turn together to side of head where ice injected
Abnormal Caloric Ice Water Test Response
eyes do not move together
Absent Caloric Ice Water Test Response
no eye movement
What do motor responses tell us about brain dysfunction?
severity and which side of the brain is damaged
Motor response patterns may be ________, __________, or _____________
- purposeful
- inappropriate
- not present
Paratonia
form of hypertonia with an involuntary variable resistance during passive movement
Slide 13 - § Motor signs indicating loss of cortical inhibition
= decreased consciousness / associated with the
performance of primitive reflexes and rigidity
(paratonia)????
Dysfunction of the medulla oblongata may manifest as?
compulsive/repetitive vomiting, yawning, hiccups
Alterations in arousal may result in ________ (morbidity) or _______
disability or mortality
Outcomes of arousal alterations depend on the ________, _________, ________ of the coma
cause, damage, duration
What are the two forms of neurological death?
brain death and cerebral death
Brain Death = ________ brain death
total
NDD
neurological determination of death
Brain death is _______
irreversible
Brain death occurs when the brain cannot maintain __________
homeostasis
What is the criteria for NDD in Canada?
- unresponsive coma
- no brainstem functions
- no spontaneous respiration (apnea)
Cerebral death = ___________ coma
irreversible
Which part of the cerebral hemisphere is not involved in cerebral death?
brainstem and cerebellum
With cerebral death it is possible for the brain to continue __________ maintenance
homeostasis
With a persistent vegetative state the person is completely _________ of their self or environment.
unaware
What are 3 factors in a persistent vegetative state?
-no speech
-no cerebral function
-yes sleep-wake cycles
3 factors of a minimally conscious state (MSC)
-follow simple commands
-manipulate objects
-give yes/no responses
Locked in syndrome involves the complete paralysis of voluntary muscles except for…
eye movement
With locked in system the person is fully ________
conscious
How do people with locked in syndrome communicate?
blinking
Awareness encompasses all _________ function
cognitive
What mediates awareness?
executive attention networks (EAN)
Executive Attention Networks (EAN)
selective attention and memory involving abstract reasoning, planning, decision making, judgement, self-control
Selective Attention
ability to select specific information and focus on related task
Initial Executive Attention Deficit Detection
person fails to stay alert and orientate to stimuli
Mild Executive Attention Deficit Detection
grooming and social graces are lacking
Severe Executive Attention Deficit Detection
motionless, no response, no reaction to surroundings
Attention Deficits are characterized by an inability to maintain __________ attention and set ________
sustained; goals
Memory
recording, retention, retrieval of information
Amnesia
loss of memory
Retrograde Amnesia
difficulty retrieving past memories
Anterograde Amnesia
inability to form new memories
Data-Processing Deficits
problems associated with recognizing and processing sensory information
Agnosia is a defect of _________ recognition
pattern
Agnosia is characterized by the failure to recognize ______ and ______ of objects
form and nature
Agnosia only affects _____ sense most times
one
Agnosia Example
can’t identify a safety pin by touching it but can name it when looking at it
Agnosia is associated with _______________ accidents
cerebrovascular
Dysphasia
impairment of comprehension or production of language
Expressive Dysphasia aka _____ dysphasia
Broca
Expressive dysphasia results in the lost ability to…
produce spoken or written language
With expressive dysphasia, ________ comprehension is usually present
verbal
Receptive dysphasia aka ___________ dysphasia
wernicke
Receptive dysphasia results in the inability to…
understand written or spoken language
People with receptive dysphasia are fluent with speech but the words have no __________
meaning
Which artery is responsible for the pathology of dysphasia?
middle cerebral artery
How many major arteries supply blood to the brain?
3
Transient (acute) disorders of awareness have _______ or _______ onset
sudden or gradual
What causes transient awareness disorders?
-drug intoxication
-alcohol withdrawal
-post anesthesia
-electrolyte imbalance
Acute Confusion and Delirium result from disruption of the _____, ________, ________, and _________
thalamus, cortex, RAS, limbic system
Delirium aka ___________ Acute Confusional State
Hyperactive
Where does delirium most commonly occur?
critical care units over 2-3 days
Hyperactive Delirium results from a disruption of which neurotransmitters?
acetylcholine and dopamine
Excited Delirium Syndrome aka _________ delirium
agitated
Agitated delirium is hyperkinetic and can lead to…
sudden death
How does excited (agitated) delirium syndrome manifest?
-rapid breathing
-high pain tolerance
-superhuman strength
Acute Confusional States and Delirium Manifest as:
-terrifying dreams
-hallucinations
-gross alteration of perception
-insomnia
How is delirium evaluated?
CAM-ICU - Confusion Assessment Method for Intensive Care Unit
Dementia
the deterioration or progressive failure of many cerebral functions
What are some possible causes of dementia?
-cerebral neuron degeneration
-atherosclerosis
-genetics
Is there a cure for dementia?
no
With dementia it is important to maximize ____________ capacities
remaining
What is the leading cause of severe cognitive dysfunction is older adults?
Alzheimer’s Disease
What causes Alzheimers disease?
unknown
How many forms of Alzheimers disease exist?
3
What is the most common form of Alzheimer’s?
Nonhereditary sporadic late-onset AD
Which form of Alzheimer’s has no genetic association?
Nonhereditary sporadic late-onset
Early-onset familial AD is associated with a mutation on chromosome ___
21
Early-onset AD is linked to a mutation on chromosome ___
19
How common is early-onset AD?
not
The pathology of the 3 different types of Alzheimer’s is _______
the same
4 Key Pathophysiological Components of Alzheimer’s Disease
- accumulation of toxic amyloid plague fragments
- loss of ACh in the forebrain cholinergic neurons (neuronal death)
- Tau Proteins form neurofibrillary tangles in neuron (=death)
- Brain atrophy
Amyloid Plagues
aggregates of misfolded proteins
Where are neurofibrillary tangle concentrated?
cerebral cortex
With brain atrophy, the sulci _________ and the gyri _________
widen; shrink
What is the first symptoms of Alzheimer’s?
memory loss and impaired learning
What continuation of symptoms result from Alzheimer’s?
loss of language, reasoning, social behaviour, dyspraxia
Dyspraxia
loss of movement and co-ordination
Alzheimer’s progresses from _____-term memory loss to ____ loss of cognitive function
short-term; total
Do pathophysiological changes occur before or after dementia syndrome?
decades before usually
What is the second most common form of dementia?
Frontotemporal Dementia
Frontotemporal Dementia was previously known as…
Pick Disease
Frontotemporal Dementia is an umbrella term for disorders that…
affect the frontal and temporal brain regions
What is the first symptoms of Frontotemporal Dementia
apathy, poor judgement and reasoning, breaking laws
The genetic component of frontotemporal dementia is associated with onset at less than ____ years of age
60
Frontotemporal dementia involves a mutation of which encoding genes?
Tau
Seizures are a _________ of disease, not a disease themselves
manifestation
What is a seizure?
a sudden disruption in brain electrical function caused by abnormal excessive discharges of cortical neurons
Cortical neurons = ____neurons
inter
What is epilepsy?
a disorder characterized by the recurrence of seizure where no known cause for the seizures is found
What are convulsions?
jerky, contact-relax movements associated with seizures
What are 4 probable causes of seizure in young adults?
- alcohol withdrawal
- drug withdrawal
- brain tumour
- peri-natal insults
Peri-natal insults
insults occurring between 28 weeks of gestation to 28 days after birth
What are 4 probable causes of seizures in older adults?
- alcohol withdrawal
- drug withdrawal
- metabolic disorders
- CNS degeneration
Epileptogenic Focus (zone)
brain site where seizure originates
Neurons in the epileptogenic focus are ____sensitive and activated by numerous stimuli
hyper
epileptogenic focus neurons fire ______ frequently and with ______ amplitude
more; greater
How is the epileptogenic focus determined during seizures?
activated SPECT - test that detects blood flow changes in the brain
What is the tonic phase of a seizure?
muscle contraction with increased muscle tone
The tonic phase is associated with loss of _____________
consciousness
What is the clonic phase of a seizure?
alternating contraction and relaxation of muscles
The clonic phase begins when _______ neurons in the ________ and _________ react to cortical excitation
inhibitory; thalamus and basal ganglia
The clonic phase results in the seizure discharge being ________ with intermittent ________ that diminish
interrupted; contractions
Increase in the number of seizure = increase in ____________
brain damage
What causes seizure cessation?
epileptogenic neurons becoming exhausted
During a seizure, reduced oxygen to the brain forces cells to switch to __________ metabolism which causes a _____ ______ accumulation
anaerobic; lactic acid
Cerebral blood flow (CBF) is related to 3 injury states: 1) inadequate cerebral p________ 2) normal perfusion but with elevated _______ ______ (ICP) 3) excessive ________ volume (CBV)
perfusion; intracranial pressure (ICP); blood volume (CBV)
What is a normal ICP?
1-15 mmHg
ICP results from an increase in intracranial _____ (ie. due to tumour, edema, hemorrhage)
content
With increased content, something must be _________. First it is _______.
removed; CSF
Continued high ICP results in cerebral blood _____ and _____ alterations
volume and flow
Increased ICP results in the ______ stages of ____ that lead to death
4 stages of ICP
Stage 1 ICP is characterized by cranial ______ and systemic adjustments to decrease ICP
vasoconstriction
Stage 1 involves no detectable _____ of ICP
symptoms (person is awake, alert, with equal and reactive pupils, normal breathing, with normal pulse and BP)
In Stage 2 ICP, intracranial contents continue to ______ and the ICP has _______ compensatory mechanisms (stage 1)
expand; exceeded
With stage 2 ICP: pressure begins to affect neuron __________
oxygenation
What are the manifestations of stage 2 ICP?
-confusion
-restlessness
-lethargy
In stage 2 ICP, pupils and breathing are…
normal
Surgical intervention is best during stage ___
2
Autoregulation
mechanism to alter diameter of intracranial blood vessels to maintain a constant blood flow during ICP changes
Autoregulation is lost in stage ____
3
In stage 3, ICP approaches _______ pressure
arterial
In stage 3, _______, ________, and acidosis occur which deteriorate the condition
hypoxia; hypercapnia
In stage 3 the pupils are…
small and sluggish
During stage 3, pulse pressure ________
widens
Manifestations of stage 3 ICP:
-loss of peripheral vision/blindness
-tinnitus
Surgical intervention is ________ in stage 3
needed
During stage 4, brain tissue ______ from greater pressure to lesser pressure
herniates
Herniated brain tissue results in a _______ of blood supply
reduction
What do herniations rapidly increase?
ICP
During stage 4, the pupils have progressed to…
bilateral dilation and fixation
What is the breathing pattern during stage 4?
Cheyne-stokes
During stage 4, mental status progresses to…
a deep coma
Surgical intervention during stage 4 is _______
futile (pointless)
_______ results from stage 4
death
What are the 3 types of cerebral edema?
- vasogenic
- cytotoxic
- interstitial
Which type of cerebral edema is the most important?
vasogenic
What causes vasogenic edema?
-increased capillary permeability
-BBB disruption
During vasogenic edema, _____ ______ leak into the cranial ECF
plasma proteins
During vasogenic edema, fluid accumulates in the ______ matter which leads to the separation of __________ fibers
white; myelinated
What are the manifestations of vasogenic edema?
-consciousness disturbances
-ICP increase
How is vasogenic edema resolved?
slow diffusion
During cerebral edema the lateral ventricles are ______ and the gyri are ______
compressed; flattened
Cytotoxic edema aka ______ edema
metabolic
During cytotoxic edema, toxic factors affect neural, glial, and endothelial cells which results in the loss of ______ transport mechanisms
active
Cytotoxic edema results from a loss of ____ and a gain of ____ which cause the cells to _____
K+, Na+, swell
Interstitial edema results from the movement of ____ from ventricles into the interstitial space
CSF
Interstitial edema causes a fluid increas around the ventricles which increases pressure in the _____ matter, causing ________ to disappear
white; myelination
What is hydrocephalus?
condition of excess CSF into the ventricles or subarachnoid space
What are 3 things that can cause hydrocephalus?
- Increased CSF production
- Obstruction in ventricles
- Defective reabsorption of CSF into systemic blood
Hydrocephalus can be ___________ or __________
communicating or non-communicating
What is “communicating” hydrocephalus?
when CSF can still flow between the ventricles
Communicating hydrocephalus is caused by ________
infection
Communicating hydrocephalus can occur anytime from ___________ to adulthood
infancy
Communicating hydrocephalus is caused by impaired ___________ of CSF from the ______________ space
absorption; subarachnoid
Non-communicating hydrocephalus only occurs in ________
adults
Non-communicating hydrocephalus is caused by ___________ of CSF between ventricles
obstruction
Non-communicating hydrocephalus is congenital meaning…
it is present from birth
What does an obstruction of CSF do when it increases pressure in the brain?
causes dilation of the ventircles and atrophy of the cerebral cortx
Hydrocephalus causes the degeneration of ________ matter
white
Acute hydrocephalus results in a rapidly increasing _____ and places the person in a deep _____
ICP; coma
Normal pressure hydrocephalus involves the dilation of ventricles without increased __________
pressure
Normal pressure hydrocephalus develops _______
slowly
What symptoms does the family notice with normal pressure hydrocephalus?
decline in memory
Normal pressure hydrocephalus appears as a triad of symptoms that are: ______-_____ gate, f_______, in____________
broad-based gate, falling, incontinence
How is hydrocephalus treated?
shunting - bypasses CSF into normal channels where it can be absorbed
Shunt placement for hydrocephalus is one of ______ most common neurosurgical procedures
three
Normal muscle tone has a slight ________ to passive movement, is smooth, constant, and even
resistance
What is hypotonia?
decreased muscle tone
People with hypotonia get _____ easily and have difficulty rising from a _______ position
tired; sitting
Hypotonia causes muscle atrophy and muscles appear ________ and flat
flabby
People with hypotonia have _____________ joints
hyperflexible
What is hypertonia?
increased muscle tone
Hypertonia causes increased _______ with passive movement
resistance
What are the symptoms of hypertonia?
-enlarged muscle mass
-firm muscles
-muscle spasms
___________ is a neurotransmitter that in high or low amounts can cause alterations in muscle movement
dopamine
Some muscle disorders are ___________
neurological
What is hyperkinesia?
excessive, purposeless muscle movement
What are the 3 types of hyperkinesia?
- paroxysmal dyskinesia
- tardive dyskinesia
- ballism
With paroxysmal dyskinesia, muscle movement occurs as _________
spasms
Tardive dyskinesia occurs as involuntary movement of the _____, lips, tongue, and __________
face, lips, tongue, extremities
________ dyskinesia is often caused by prolonged antipsychotic medication
Tardive
Tardive dyskinesia appears as rapid repetitive ___________ movements like continually _______ or tongue protrusions
stereotypical; chewing
Tourette syndrome is a type of _______ dyskinesia
tardive
What is Ballism?
a muscle disorder with wild flinging movements of the limbs
What is another name for Huntington’s disease?
chorea
Huntington’s disease symptoms are a hallmark of ____________
hyperkinesia
Huntington’s disease involves which areas of the brain?
basal ganglia and cerebral cortex
What age does the onset of Huntington’s disease occur?
25-45 years
Huntington’s disease involves involuntary fragmented movements of the _____ and ____ (eventually whole body), slowed ______, and alterations in euphoria and ________.
face and arms; thinking; depression
Huntington’s disease is inherited by an autosomal _________ trait
dominant
With HD, there is a mutation on chromosome ___ that results in an abnormally ______ protein caused by a cytosine-adenine-guanine (CAG) trinucleotide.
4; long
The altered protein chain created by the HD mutation is ______ to neurons
toxic
What determines the onset age of HD?
the number of repeated amino acid chains (increased chains = increased protein toxicity = earlier onset)
A heathy gene repeats ____-____ times.
10-26
Hypokinesia is…
loss of voluntary movement despite perceived consciousness (↓ amplitude of movement)
What are the two types of hypokinesia?
akinesia and bradykinesia
Akinesia is a _____ of spontaneous movement (facial expressions) or associated movements (_________ while walking)
lack; arm swinging
Bradykinesia is the slowing of ________ movements
performed
What are the manifestations of Parkinson’s disease?
-resting tremor
-rigidity
-bradykinesia
-dysarthria (difficulty speaking)
Dysarthria
slurred speech due to lost control of speech muscles
What is an early symptom of Parkinson’s disease?
loss of smell
When tilting, people with PD often fall like a post because they can’t make proper _________ adjustments.
postural
Amyotrophic Lateral Sclerosis (ALS) aka ______________ disease
Lou Gehrig’s
ALS involves degeneration of which type of neurons?
upper and lower motor neurons
How does ALS affect upper motor neurons?
-decrease in large motor CNS neurons
-demyelination, glia proliferations, sclerosis of neurons
Sclerosis = _______
scarring
How does ALS affect lower motor neurons?
denervation of motor units
Symptoms of ALS:
-muscle weakness starting in arms and legs
-difficulty speaking and swallowing
Does ALS involve mental or sensory symptoms?
no
How is ALS treated?
Rilutek medication
What is the purpose of Rilutek for ALS?
extend the time before ventilatory support is needed
