Chapter 5: Domains of Neuropsych Fx & Related Neurobehavioral DOs Flashcards
Which brain area plays a key role in motivating selective attention toward a salient stimulus?
A) inferior parietal
B) basal forebrain
C) dorsolateral frontal
D) anterior cingulate
D - anterior cingulate
Motivation and saliency involve executive systems such as the anterior cingulate (limbic)
The etiology of amnesia most likely to result in confabulation is a(n) _____.
A) anoxic encephalopathy
B) anterior communicating artery (ACoA) aneurysm
C) surgical ablation of the medial temporal lobe
D) herpes encephalopathy
B - anterior communicating artery (ACoA) aneurysm
An aneurysm of the ACoA would be an example of a pathology producing diencephalic amnesia with resultant confabulation; the other three etiologies affect temporal areas.
Posner and Peterson’s attentional model would predict difficulty with ____ as a result of damage to the ascending reticular activating system (ARAS).
A) alerting
B) detection
C) orienting
D) shifting
A - Alerting
Orienting and shifting, according to Posner and Petersen’s model, involves the posterior network; alerting and arousal involve the ARAS.
Classification of aphasia is based primarily on which three parts of the language assessment?
A) fluency, repetition, prosody
B) fluency, comprehension, naming
C) fluency, comprehension, repetition
D) comprehension, naming, repetition
C - Fluency, comprehension, repetition
Fluent versus nonfluent speech localizes anterior from posterior aphasic syndromes; impairment in comprehension distinguishes Wernickes’ s from conduction aphasia, and the ability to repeat implies that perisylvian language areas are intact.
A 63-year-old right-handed woman with hypertension was talking on the phone when suddenly she had difficulty getting words our and could not answer simple questions. She was taken to the hospital; on exam, she was able to follow three-step commands, and repeated words and sentences with 100% accuracy. Reading was not assessed. Writing was sparse and telegraphic. Naming was 1 of 6. What kind of aphasic syndrome is likely present in this patient?
A) Broca’s Aphasia
B) Wernicke’s Aphasia
C) Transcortical sensory Aphasia
D) Transcortical motor Aphasia
D - transcortical motor aphasia
This aphasic syndrome resembles Broca’s aphasia, but because it involves the extrasylvian region, repetition is intact.
A 63-year-old right-handed woman with hypertension was talking on the phone when suddenly she had difficulty getting words our and could not answer simple questions. She was taken to the hospital; on exam, she was able to follow three-step commands, and repeated words and sentences with 100% accuracy. Reading was not assessed. Writing was sparse and telegraphic. Naming was 1 of 6.
Where is the patient’s lesion likely to have been?
A) extrasylvian area
B) Broca’s area
C) Wernicke’s area
D) arcuate fasciculus
A - extrasylvian area (anterior cerebral artery territory)
Which of the following is NOT a symptom of Gerstmann Syndrome?
A) agraphia
B) acalculia
C) alexia
D) finger agnosia
C - alexia
The four components of Gerstmann syndrome are finger agnosia, acalculiac right-left disorientation, and agraphia
A 16-year-old girl is evaluated in rehabilitation following a ruptured aneurysm. She is unable to follow commands, repeat, or name objects, but very matter-of-factly states, “I was ba frink clink in da damn.” The most likely diagnosis is ____.
A) Broca’s aphasia
B) conduction aphasia
C) anomic aphasia
D) Wernicke’s Aphasia
D - Wernicke’s aphasia
Although both Wernicke’s aphasia and conduction aphasia are characterized by fluent (albeit paraphasic) speech, only Wernicke’s aphasia also includes impaired comprehension.
Intact spatial abilities but disturbed recognition of objects implies disruption in the ____ pathway.
A) dorsal
B) mesial
C) ventral
D) rostral
C - Ventral
Which of the following is the loss of the ability to plan and execute complex gestures?
A) ideomotor apraxia
B) ideational apraxia
C) constructional apraxia
D) buccofacial apraxia
B - Ideational apraxia
Which of the following might you see with damage to the dorsolateral frontal lobe?
A) emotional lability
B) Witzelsucht
C) abulia
D) lack of empathy
C - abulia
emotional lability, lack of empathy, and Witzelsucht would more likely be seen with orbitofrontal damage
Memory of who you stayed with at your conference last month would be an example of ____ memory.
A) semantic
B) episodic
C) procedural
D) remote
B - episodic
Memory for temporal events
A 5 year-old boy demonstrates delayed language, parallel play, and an obsession with electrical outlets, but can recite the day of the week of any date. He most likely demonstrates ____.
A) aphasia
B) obsessive comulsive disorder
C) savantism
D) schizophrenia
C - savantism
The patient described has autistic disorder, which has some association with savantism.
You are called to evaluate an inpatient with a history of alcohol abuse who had tried to escape from his assisted living facility by climbing a tree 2 days ago. On admission, his toxicology screen was negative. Testing indicated poor orientation and attention, fair memory, and poor reasoning. Your tentative diagnosis is _____.
A) Korsakoff’s dementia
B) transient global amnesia
C) delirium
D) transient ischemic attack
C - delirium
The patient’s fair memory eliminates Korsakoff’s syndrome and TGA; their poor orientation and attention are consistent with delirium.
The inability to recall events prior to an accident/illness or event is ___ amnesia.
A) anterograde
B) retrograde
C) global
D) psychogenic
B - Retrograde
Anosodiaphoria
Disorder wherein patients are aware they have impairments (e.g., paralysis), yet show no emotional concern or distress about it; neglect also often present
Brain system damage –> Right parietal or frontal systems
Alexithymia
An inability to understand, process, or describe emotions
Brain system damage–> Right hemisphere
Emotional lability
Fluctuations of emotion and/or increased emotional reactivity
Brain system damage–> Orbitofrontal area limbic system
Pseudobulbar affect
Type of emotional lability; extreme involuntary emotional responses (i.e., tearful crying, excessive laughing) to mild stimulation
Brain system damage –> due to pseudobulbar palsy, or damage to the upper motor neuron corticobulbar tract.
Abulia
passive behavior wherein one exhibits little spontaneous activity and markedly delayed responses and tends to speak briefly or softly. In the extreme, the patient may be immobile, akinetic and mute, but will continue to appear awake, sitting with his or her eyes open.
Circumlocution
The purposeful substitution of usually many words for a word or other words a pt is unable to find that manifests as talking around word-finding difficulties rather than using specific words. These are not considered paraphasic errors, and circumlocution is not the equivalent of tangentiality.
Crystallized intelligence (Gc)
This refers to the breadth and depth of knowledge and understanding that is acquired through learning, education, experience, and acculturation; it is often resistant to the effects of aging and neurologic injury or illness.
Dysarthria
A speech disorder involving difficulty in articulation.
NOT an aphasia or language disorder, although sometimes confused with them.
Patients with dysarthria are typically able to read and write normally, which readily differentiates them from patients with expressive aphasia.
Dysphonia
A speech disorder involving difficulty in vocalization
Fluid intelligence (Gf)
This intelligence refers to the ability to reason, adapt, solve problems, form concepts, and understand relationships in unfamiliar or novel circumstances. Unlike, Gc, it is susceptible to the effects of aging.
Literal (or phonemic) paraphasias
The substitution or rearrangement of sounds or syllables in otherwise correct words.
Pragmatics
The context in which the words are used
Prosody
An element of speech that contributes to the conveyance of meaning through rhythm, stress, pitch, loudness, tempo, and intonation. It can indicate the basic structure of a sentence, the emotional content, or the main point in an utterance.
Semantics
The meanings of words and the rules governing the use of words. It is the sequencing of meaningful words and sounds to convey meaning
Semantic paraphasias
The substitution of a correct word or phrase for another semantically related word/phrase.
Note: Semantic paraphasias in the form of multiword paraphasic errors or “paragrammatism” is one feature that differentiates the syndrome of Wernicke’s aphasia from other fluent aphasic syndromes.
Syntax
The rules governing the structure of phrases and sentences
Verbal paraphasias
The substitution of one correct word for another. Some substitutions may have no obvious semantic relationship with the correct word, whereas others involve substitution of a correct word or phrase for another semantically related word or phrase.
ATTENTION:
What are some associated disorders with notable impairment in attention?
Delirium
Attention-Deficit/Hyperactivity Disorder (ADHD)
Hemispatial Inattention (A.K.A. Neglect)
Traumatic Brain Injury (TBI)
Others: depression, anxiety, fatigue, lack of sleep, environmental factors (i.e., noise), and medications
ATTENTION: What does the following relevant brain structure do with regard to attention?
Ascending Reticular Activating System (ARAS)
Arousal and attention
ATTENTION: What does the following relevant brain structure do with regard to attention?
Anterior Cingulate (and Limbic System)
Determines saliency of stimuli and associated emotion/motivation
ATTENTION: What does the following relevant brain structure do with regard to attention?
Prefrontal
Response selection, control, sustained attention, focus, switching, searching, and alternating attention
ATTENTION: What does the following relevant brain structure do with regard to attention?
Orbitofrontal
inhibition of responses
ATTENTION: What does the following relevant brain structure do with regard to attention?
Dorsolateral Frontal
Initiation of responses
ATTENTION: What does the following relevant brain structure do with regard to attention?
Superior Colliculus
Shifting attention; eye movements
ATTENTION: What does the following relevant brain structure do with regard to attention?
Lateral Pulvinar
Extracting information from the target location and filtering distractions
ATTENTION: What does the following relevant brain structure do with regard to attention?
Inferior and Posterior Parietal
underlies disengagement from a stimulus and the representation of space; its damage is associated with hemispatial inattention/neglect
ATTENTION: What does the following relevant brain structure do with regard to attention?
Right Hemisphere
Spatial attention; associated with hemispatial inattention/neglect
