Chapter 15 - Cognitive Systems and Motor Function Flashcards
1
Q
Cognitive behavioural functional competence
A
integrated processes of cognitive, sensory, and motor systems
2
Q
What systems get manifested through the motor network?
A
behaviours that appropriate to human activity
3
Q
Full Consciousness
A
state of awareness of oneself and appropriate responses to environment
4
Q
What are the two components of consciousness?
A
arousal and awareness
5
Q
Arousal
A
state of awakeness
6
Q
Awareness
A
content of thought
7
Q
How are structural alterations divided?
A
by their location of dysfunction
8
Q
Where do supratentorial disorders affect?
A
above the tentorium cerebelli
9
Q
What do supratentorial disorders produce change in?
A
arousal
10
Q
Where do infratentorial disorders affect?
A
below the tentorium cerebelli
11
Q
What do infrantentorial disorders do?
A
produce decline of arousal by RAS dysfunction
12
Q
Metabolic alterations produce a ________ in arousal by altering…
A
decline; delivery of energy substrates
13
Q
How many patterns of neurological functions are critical to evaluation process?
A
5
14
Q
Which function is the most critical index of nervous system function?
A
level of consciousness
15
Q
Changes in level of consciousness indicate _________ or _________
A
improvement or deterioration
16
Q
What are characteristics of highest level of consciousness?
A
when the person is alert and orientated to oneself, others, place, time
17
Q
What does level of consciousness diminish to?
A
confusion, then disorientation, then coma
18
Q
Normal breathing is a __________ pattern
A
rhythmic
19
Q
Diminished consciousness leaves breathing responding to changes in _________ levels
A
PaCO₂
20
Q
Cheyne-Stokes Respirations
A
altered period of tachypnea and apnea related directly to PaCO₂
21
Q
Apneusis
A
prolonged inspiratory time and a pause before expiration
22
Q
Ataxic Breathing
A
complete irregularity of breathing with increased periods of apnea
23
Q
What does pupillary reaction indicate?
A
presence and level of brainstem dysfunction
24
Q
Where is the brainstem area that controls pupils?
A
adjacent to the areas controlling arousal
25
How does ischemia affect the pupils?
makes them dilated/fixed
26
What causes pinpoint pupils?
hypothermia or opiates
27
Oculomotor Responses
resting, spontaneous, and reflexive eye movements
28
Normal Oculomotor Response
eyes move together to side opposite from turn of head
29
Abnormal Oculomotor Response
eyes do not turn together
30
Absent Oculomotor Response
eyes move in the direction of head movement
31
What is the caloric ice water test used to measure
oculomotor response
32
How does the caloric ice water test work?
ice water is injected into the ear canal
33
Normal Caloric Ice Water Test Response
eyes turn together to side of head where ice injected
34
Abnormal Caloric Ice Water Test Response
eyes do not move together
35
Absent Caloric Ice Water Test Response
no eye movement
36
What do motor responses tell us about brain dysfunction?
severity and which side of the brain is damaged
37
Motor response patterns may be ________, __________, or _____________
1. purposeful
2. inappropriate
3. not present
38
Paratonia
form of hypertonia with an involuntary variable resistance during passive movement
39
Slide 13 - § Motor signs indicating loss of cortical inhibition
= decreased consciousness / associated with the
performance of primitive reflexes and rigidity
(paratonia)????
40
Dysfunction of the medulla oblongata may manifest as?
compulsive/repetitive vomiting, yawning, hiccups
41
Alterations in arousal may result in ________ (morbidity) or _______
disability or mortality
42
Outcomes of arousal alterations depend on the ________, _________, ________ of the coma
cause, damage, duration
43
What are the two forms of neurological death?
brain death and cerebral death
44
Brain Death = ________ brain death
total
45
NDD
neurological determination of death
46
Brain death is _______
irreversible
47
Brain death occurs when the brain cannot maintain __________
homeostasis
48
What is the criteria for NDD in Canada?
1. unresponsive coma
2. no brainstem functions
3. no spontaneous respiration (apnea)
49
Cerebral death = ___________ coma
irreversible
50
Which part of the cerebral hemisphere is not involved in cerebral death?
brainstem and cerebellum
51
With cerebral death it is possible for the brain to continue __________ maintenance
homeostasis
52
With a persistent vegetative state the person is completely _________ of their self or environment.
unaware
53
What are 3 factors in a persistent vegetative state?
-no speech
-no cerebral function
-yes sleep-wake cycles
54
3 factors of a minimally conscious state (MSC)
-follow simple commands
-manipulate objects
-give yes/no responses
55
Locked in syndrome involves the complete paralysis of voluntary muscles except for...
eye movement
56
With locked in system the person is fully ________
conscious
57
How do people with locked in syndrome communicate?
blinking
58
Awareness encompasses all _________ function
cognitive
59
What mediates awareness?
executive attention networks (EAN)
60
Executive Attention Networks (EAN)
selective attention and memory involving abstract reasoning, planning, decision making, judgement, self-control
61
Selective Attention
ability to select specific information and focus on related task
62
Initial Executive Attention Deficit Detection
person fails to stay alert and orientate to stimuli
63
Mild Executive Attention Deficit Detection
grooming and social graces are lacking
64
Severe Executive Attention Deficit Detection
motionless, no response, no reaction to surroundings
65
Attention Deficits are characterized by an inability to maintain __________ attention and set ________
sustained; goals
66
Memory
recording, retention, retrieval of information
67
Amnesia
loss of memory
68
Retrograde Amnesia
difficulty retrieving past memories
69
Anterograde Amnesia
inability to form new memories
70
Data-Processing Deficits
problems associated with recognizing and processing sensory information
71
Agnosia is a defect of _________ recognition
pattern
72
Agnosia is characterized by the failure to recognize ______ and ______ of objects
form and nature
73
Agnosia only affects _____ sense most times
one
74
Agnosia Example
can't identify a safety pin by touching it but can name it when looking at it
75
Agnosia is associated with _______________ accidents
cerebrovascular
76
Dysphasia
impairment of comprehension or production of language
77
Expressive Dysphasia aka _____ dysphasia
Broca
78
Expressive dysphasia results in the lost ability to...
produce spoken or written language
79
With expressive dysphasia, ________ comprehension is usually present
verbal
80
Receptive dysphasia aka ___________ dysphasia
wernicke
81
Receptive dysphasia results in the inability to...
understand written or spoken language
82
People with receptive dysphasia are fluent with speech but the words have no __________
meaning
83
Which artery is responsible for the pathology of dysphasia?
middle cerebral artery
84
How many major arteries supply blood to the brain?
3
85
Transient (acute) disorders of awareness have _______ or _______ onset
sudden or gradual
86
What causes transient awareness disorders?
-drug intoxication
-alcohol withdrawal
-post anesthesia
-electrolyte imbalance
87
Acute Confusion and Delirium result from disruption of the _____, ________, ________, and _________
thalamus, cortex, RAS, limbic system
88
Delirium aka ___________ Acute Confusional State
Hyperactive
89
Where does delirium most commonly occur?
critical care units over 2-3 days
90
Hyperactive Delirium results from a disruption of which neurotransmitters?
acetylcholine and dopamine
91
Excited Delirium Syndrome aka _________ delirium
agitated
92
Agitated delirium is hyperkinetic and can lead to...
sudden death
93
How does excited (agitated) delirium syndrome manifest?
-rapid breathing
-high pain tolerance
-superhuman strength
94
Acute Confusional States and Delirium Manifest as:
-terrifying dreams
-hallucinations
-gross alteration of perception
-insomnia
95
How is delirium evaluated?
CAM-ICU - Confusion Assessment Method for Intensive Care Unit
96
Dementia
the deterioration or progressive failure of many cerebral functions
97
What are some possible causes of dementia?
-cerebral neuron degeneration
-atherosclerosis
-genetics
98
Is there a cure for dementia?
no
99
With dementia it is important to maximize ____________ capacities
remaining
100
What is the leading cause of severe cognitive dysfunction is older adults?
Alzheimer's Disease
101
What causes Alzheimers disease?
unknown
102
How many forms of Alzheimers disease exist?
3
103
What is the most common form of Alzheimer's?
Nonhereditary sporadic late-onset AD
104
Which form of Alzheimer's has no genetic association?
Nonhereditary sporadic late-onset
105
Early-onset familial AD is associated with a mutation on chromosome ___
21
106
Early-onset AD is linked to a mutation on chromosome ___
19
107
How common is early-onset AD?
not
108
The pathology of the 3 different types of Alzheimer's is _______
the same
109
4 Key Pathophysiological Components of Alzheimer's Disease
1. accumulation of toxic amyloid plague fragments
2. loss of ACh in the forebrain cholinergic neurons (neuronal death)
3. Tau Proteins form neurofibrillary tangles in neuron (=death)
4. Brain atrophy
110
Amyloid Plagues
aggregates of misfolded proteins
111
Where are neurofibrillary tangle concentrated?
cerebral cortex
112
With brain atrophy, the sulci _________ and the gyri _________
widen; shrink
113
What is the first symptoms of Alzheimer's?
memory loss and impaired learning
114
What continuation of symptoms result from Alzheimer's?
loss of language, reasoning, social behaviour, dyspraxia
115
Dyspraxia
loss of movement and co-ordination
116
Alzheimer's progresses from _____-term memory loss to ____ loss of cognitive function
short-term; total
117
Do pathophysiological changes occur before or after dementia syndrome?
decades before usually
118
What is the second most common form of dementia?
Frontotemporal Dementia
119
Frontotemporal Dementia was previously known as...
Pick Disease
120
Frontotemporal Dementia is an umbrella term for disorders that...
affect the frontal and temporal brain regions
121
What is the first symptoms of Frontotemporal Dementia
apathy, poor judgement and reasoning, breaking laws
122
The genetic component of frontotemporal dementia is associated with onset at less than ____ years of age
60
123
Frontotemporal dementia involves a mutation of which encoding genes?
Tau
124
Seizures are a _________ of disease, not a disease themselves
manifestation
125
What is a seizure?
a sudden disruption in brain electrical function caused by abnormal excessive discharges of cortical neurons
126
Cortical neurons = ____neurons
inter
127
What is epilepsy?
a disorder characterized by the recurrence of seizure where no known cause for the seizures is found
128
What are convulsions?
jerky, contact-relax movements associated with seizures
129
What are 4 probable causes of seizure in young adults?
1. alcohol withdrawal
2. drug withdrawal
3. brain tumour
4. peri-natal insults
130
Peri-natal insults
insults occurring between 28 weeks of gestation to 28 days after birth
131
What are 4 probable causes of seizures in older adults?
1. alcohol withdrawal
2. drug withdrawal
3. metabolic disorders
4. CNS degeneration
132
Epileptogenic Focus (zone)
brain site where seizure originates
133
Neurons in the epileptogenic focus are ____sensitive and activated by numerous stimuli
hyper
134
epileptogenic focus neurons fire ______ frequently and with ______ amplitude
more; greater
135
How is the epileptogenic focus determined during seizures?
activated SPECT - test that detects blood flow changes in the brain
136
What is the tonic phase of a seizure?
muscle contraction with increased muscle tone
137
The tonic phase is associated with loss of _____________
consciousness
138
What is the clonic phase of a seizure?
alternating contraction and relaxation of muscles
139
The clonic phase begins when _______ neurons in the ________ and _________ react to cortical excitation
inhibitory; thalamus and basal ganglia
140
The clonic phase results in the seizure discharge being ________ with intermittent ________ that diminish
interrupted; contractions
141
Increase in the number of seizure = increase in ____________
brain damage
142
What causes seizure cessation?
epileptogenic neurons becoming exhausted
143
During a seizure, reduced oxygen to the brain forces cells to switch to __________ metabolism which causes a _____ ______ accumulation
anaerobic; lactic acid
144
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)
145
What is a normal ICP?
1-15 mmHg
146
ICP results from an increase in intracranial _____ (ie. due to tumour, edema, hemorrhage)
content
147
With increased content, something must be _________. First it is _______.
removed; CSF
148
Continued high ICP results in cerebral blood _____ and _____ alterations
volume and flow
149
Increased ICP results in the ______ stages of ____ that lead to death
4 stages of ICP
150
Stage 1 ICP is characterized by cranial ______ and systemic adjustments to decrease ICP
vasoconstriction
151
Stage 1 involves no detectable _____ of ICP
symptoms (person is awake, alert, with equal and reactive pupils, normal breathing, with normal pulse and BP)
152
In Stage 2 ICP, intracranial contents continue to ______ and the ICP has _______ compensatory mechanisms (stage 1)
expand; exceeded
153
With stage 2 ICP: pressure begins to affect neuron __________
oxygenation
154
What are the manifestations of stage 2 ICP?
-confusion
-restlessness
-lethargy
155
In stage 2 ICP, pupils and breathing are...
normal
156
Surgical intervention is best during stage ___
2
157
Autoregulation
mechanism to alter diameter of intracranial blood vessels to maintain a constant blood flow during ICP changes
158
Autoregulation is lost in stage ____
3
159
In stage 3, ICP approaches _______ pressure
arterial
160
In stage 3, _______, ________, and acidosis occur which deteriorate the condition
hypoxia; hypercapnia
161
In stage 3 the pupils are...
small and sluggish
162
During stage 3, pulse pressure ________
widens
163
Manifestations of stage 3 ICP:
-loss of peripheral vision/blindness
-tinnitus
164
Surgical intervention is ________ in stage 3
needed
165
During stage 4, brain tissue ______ from greater pressure to lesser pressure
herniates
166
Herniated brain tissue results in a _______ of blood supply
reduction
167
What do herniations rapidly increase?
ICP
168
During stage 4, the pupils have progressed to...
bilateral dilation and fixation
169
What is the breathing pattern during stage 4?
Cheyne-stokes
170
During stage 4, mental status progresses to...
a deep coma
171
Surgical intervention during stage 4 is _______
futile (pointless)
172
_______ results from stage 4
death
173
What are the 3 types of cerebral edema?
1. vasogenic
2. cytotoxic
3. interstitial
174
Which type of cerebral edema is the most important?
vasogenic
175
What causes vasogenic edema?
-increased capillary permeability
-BBB disruption
176
During vasogenic edema, _____ ______ leak into the cranial ECF
plasma proteins
177
During vasogenic edema, fluid accumulates in the ______ matter which leads to the separation of __________ fibers
white; myelinated
178
What are the manifestations of vasogenic edema?
-consciousness disturbances
-ICP increase
179
How is vasogenic edema resolved?
slow diffusion
180
During cerebral edema the lateral ventricles are ______ and the gyri are ______
compressed; flattened
181
Cytotoxic edema aka ______ edema
metabolic
182
During cytotoxic edema, toxic factors affect neural, glial, and endothelial cells which results in the loss of ______ transport mechanisms
active
183
Cytotoxic edema results from a loss of ____ and a gain of ____ which cause the cells to _____
K+, Na+, swell
184
Interstitial edema results from the movement of ____ from ventricles into the interstitial space
CSF
185
Interstitial edema causes a fluid increas around the ventricles which increases pressure in the _____ matter, causing ________ to disappear
white; myelination
186
What is hydrocephalus?
condition of excess CSF into the ventricles or subarachnoid space
187
What are 3 things that can cause hydrocephalus?
1. Increased CSF production
2. Obstruction in ventricles
3. Defective reabsorption of CSF into systemic blood
188
Hydrocephalus can be ___________ or __________
communicating or non-communicating
189
What is "communicating" hydrocephalus?
when CSF can still flow between the ventricles
190
Communicating hydrocephalus is caused by ________
infection
191
Communicating hydrocephalus can occur anytime from ___________ to adulthood
infancy
192
Communicating hydrocephalus is caused by impaired ___________ of CSF from the ______________ space
absorption; subarachnoid
193
Non-communicating hydrocephalus only occurs in ________
adults
194
Non-communicating hydrocephalus is caused by ___________ of CSF between ventricles
obstruction
195
Non-communicating hydrocephalus is congenital meaning...
it is present from birth
196
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
197
Hydrocephalus causes the degeneration of ________ matter
white
198
Acute hydrocephalus results in a rapidly increasing _____ and places the person in a deep _____
ICP; coma
199
Normal pressure hydrocephalus involves the dilation of ventricles without increased __________
pressure
200
Normal pressure hydrocephalus develops _______
slowly
201
What symptoms does the family notice with normal pressure hydrocephalus?
decline in memory
202
Normal pressure hydrocephalus appears as a triad of symptoms that are: ______-_____ gate, f_______, in____________
broad-based gate, falling, incontinence
203
How is hydrocephalus treated?
shunting - bypasses CSF into normal channels where it can be absorbed
204
Shunt placement for hydrocephalus is one of ______ most common neurosurgical procedures
three
205
Normal muscle tone has a slight ________ to passive movement, is smooth, constant, and even
resistance
206
What is hypotonia?
decreased muscle tone
207
People with hypotonia get _____ easily and have difficulty rising from a _______ position
tired; sitting
208
Hypotonia causes muscle atrophy and muscles appear ________ and flat
flabby
209
People with hypotonia have _____________ joints
hyperflexible
210
What is hypertonia?
increased muscle tone
211
Hypertonia causes increased _______ with passive movement
resistance
212
What are the symptoms of hypertonia?
-enlarged muscle mass
-firm muscles
-muscle spasms
213
___________ is a neurotransmitter that in high or low amounts can cause alterations in muscle movement
dopamine
214
Some muscle disorders are ___________
neurological
215
What is hyperkinesia?
excessive, purposeless muscle movement
216
What are the 3 types of hyperkinesia?
1. paroxysmal dyskinesia
2. tardive dyskinesia
3. ballism
217
With paroxysmal dyskinesia, muscle movement occurs as _________
spasms
218
Tardive dyskinesia occurs as involuntary movement of the _____, lips, tongue, and __________
face, lips, tongue, extremities
219
________ dyskinesia is often caused by prolonged antipsychotic medication
Tardive
220
Tardive dyskinesia appears as rapid repetitive ___________ movements like continually _______ or tongue protrusions
stereotypical; chewing
221
Tourette syndrome is a type of _______ dyskinesia
tardive
222
What is Ballism?
a muscle disorder with wild flinging movements of the limbs
223
What is another name for Huntington's disease?
chorea
224
Huntington's disease symptoms are a hallmark of ____________
hyperkinesia
225
Huntington's disease involves which areas of the brain?
basal ganglia and cerebral cortex
226
What age does the onset of Huntington's disease occur?
25-45 years
227
Huntington's disease involves involuntary fragmented movements of the _____ and ____ (eventually whole body), slowed ______, and alterations in euphoria and ________.
face and arms; thinking; depression
228
Huntington's disease is inherited by an autosomal _________ trait
dominant
229
With HD, there is a mutation on chromosome ___ that results in an abnormally ______ protein caused by a cytosine-adenine-guanine (CAG) trinucleotide.
4; long
230
The altered protein chain created by the HD mutation is ______ to neurons
toxic
231
What determines the onset age of HD?
the number of repeated amino acid chains (increased chains = increased protein toxicity = earlier onset)
232
A heathy gene repeats ____-____ times.
10-26
233
Hypokinesia is...
loss of voluntary movement despite perceived consciousness (↓ amplitude of movement)
234
What are the two types of hypokinesia?
akinesia and bradykinesia
235
Akinesia is a _____ of spontaneous movement (facial expressions) or associated movements (_________ while walking)
lack; arm swinging
236
Bradykinesia is the slowing of ________ movements
performed
237
What are the manifestations of Parkinson's disease?
-resting tremor
-rigidity
-bradykinesia
-dysarthria (difficulty speaking)
238
Dysarthria
slurred speech due to lost control of speech muscles
239
What is an early symptom of Parkinson's disease?
loss of smell
240
When tilting, people with PD often fall like a post because they can't make proper _________ adjustments.
postural
241
Amyotrophic Lateral Sclerosis (ALS) aka ______________ disease
Lou Gehrig's
242
ALS involves degeneration of which type of neurons?
upper and lower motor neurons
243
How does ALS affect upper motor neurons?
-decrease in large motor CNS neurons
-demyelination, glia proliferations, sclerosis of neurons
244
Sclerosis = _______
scarring
245
How does ALS affect lower motor neurons?
denervation of motor units
246
Symptoms of ALS:
-muscle weakness starting in arms and legs
-difficulty speaking and swallowing
247
Does ALS involve mental or sensory symptoms?
no
248
How is ALS treated?
Rilutek medication
249
What is the purpose of Rilutek for ALS?
extend the time before ventilatory support is needed
