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Neuroscience Block > Cognition > Flashcards

Cognition Flashcards

1
Q

What is aphasia?

A

A disturbance in language as a result of brain damage

Language is produced through a number of modes; primarily speech and writing. These modes of language can be impaired without disturbances to language - e.g carpal tunnel syndrome with writing.

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2
Q

What are some causes of aphasia?

A

Acute Onset

  • Stroke
  • Penetrating head injury
  • Surgical resection

**Insidious Onset/Progressive **

  • Dementia
  • Neoplastic change

Paroxysmal-Episodic

  • Focal seizures
  • Migraine
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3
Q

What is meant by hemispheric dominance?

How does this relate to language?

A

Dominance refers to the specialisation of hemispheres for specific tasks and the associated preferenceof individuals to use a certain hemisphere.

The left hemisphere is dominant for language; whereas the right hemisphere is dominant for visuospatial function.

95% of right handers and 70% of left-handers have left lateralised language

While the left hemisphere may be dominant for language, the right hemisphere may play roles in propositional speech, prosody and paralinguistic aspects of speech that are associated with the speaking mode of language.

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4
Q

What is the relevance of the middle cerebral artery to language centers?

A

Deficits in language are commonly associated to pathology of the middle cerebral artery which supplies the varying centers of language.

Clinical symptoms vary on which division of the MCA is damaged.

Superior Division

  • Sensorimotor cortex
  • Ventrolateral prefrontal cortex

Inferior Division

  • Temporoparietal cortex
  • Visual tracts
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5
Q

What are the two broad categories of language disorders?

A

Non-Fluent Language Disorder

  • Production deficits
  • Inability to put words together in a meaningful manner
  • Difiiculties in grammar, syntax and sentence construction

Fluent Language Disorders

  • Selectiion deficits
  • Unable to select appropriate content
  • Are unable to pick the right words - e.g. naming an object a chair when it is a desk or confabulating.
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6
Q

Compare Broca’s aphasia with Wernicke’s aphasia

A

Broca’s Aphasia

  • _Non-fluent aphasia _
  • Anterior lesion of Broca’s area (lateral frontal lobe)
  • Loss of gramatical structure of language
  • Intact selection of content

Wernicke’s Aphasia

  • Fluent aphasia
  • Posterior lesion of Wernicke’s area (temporoparietal cortex)
  • Impaired selection of content
  • Intact grammatical structure
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7
Q

What signs are observed in Wernicke’s Aphasia Syndrome?

A
  • Fluent jargonistic language output
    • Neologisms
    • Paraphasic errors eg. boap for boat
  • Impaired comprehension
  • Right quadrantanopsia (loss of a quarter of visual field)
  • No motor weakness
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8
Q

What signs are observed in Broca’s Aphasia Syndrome?

A
  • Non-fluent, highly effortful language output
  • Telegrammatic
  • Preserved comprehension
  • Right face and arm weakness
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9
Q

Besides Broca’s and Wernicke’s Aphasia, describe two other types of aphasic syndromes

A

Conduction aphasia

  • Fluent aphasia, but more meaningful than Wernicke’s type
  • Relatively intact basic auditory comprehension
  • Poor repetition of words

Transcortical motor aphasia

  • Non-fluent aphasia
  • Muteness at most severe
  • Repetition is preserved
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10
Q

Compare and contrast the mechanisms of recovery from cortical brain lesions via contralateral transfer or ipsilateral re-organisation

A

Contralateral Transfer

  • The compensatory transfer of function to the corresponding area on the opposite hemisphere to the lesion
  • Better reorganisation in younger people when plasticity is greater - outcomes in adults are poor.
  • Commonly occurs in early hemispherectomy, neonatal infarctions and major development abnormalities

Ipsilateral Re-organisation

  • Reorganisation occurs in structures immediately surrounding lesions
  • Commonly occurs in focal developmental anomalies and adult-onset stroke

NOTE: Patients who have reorganisation of language into both hemispheres have better outcomes than those with reorganisation to a single lobe.

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11
Q

What is meant by the term ‘perception’ in relation to the human cognition?

A

Perception is the transformation and interpretation of information to construct meaningful percepts.

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12
Q

What is meant by the term ‘cognition’?

A

Cognition is the process of knowing

It has more specific definitions depending on the field of study and context with which it is refered to.

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13
Q

Why is it important to study cognition?

A

**To inform diagnoses - **cognitive deficits can represent key symptoms and signs in many neurological presentations.

**How to best manage/work with patients - **Ability to understand, remember, take on board and manage medical conditions or decisions. Ultimately; discovering the best approach to maximise patient outcomes.

Examples of cognition include:

Memory, speed of information processing, language, planning, problem solving and attention

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14
Q

Very broadly speaking, what are the functions of the four lobes of the brain?

A

**Frontal **

Planning, execution and regulation of behaviour

Temporal

Audition, language, music, memory and emotion

**Parietal **

Somatic and visuospatial representations

**Occipital **

Vision

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15
Q

Luria’s brain-behaviour theory states there are three basic units of the CNS. What are these areas?

A
  1. Regulation of arousal and muscle tone
    * Brainstem and associated areas
  2. Reception, integration and analysis of sensory information
    * Posterior cortical regions
  3. **Planning, executing and verifying behaviour **
    * Frontal and prefrontal lobes
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16
Q

Describe Luria’s three principles of “pluripotentiality”

A
  1. Each area of the brain operates in conjunction with other areas
  2. No area is singly responsible for voluntary human behaviour
  3. Each area may play a specific role in many behaviours
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17
Q

Describe the brain-behaviour relationship

A

Behaviour is comprised of two components:

  1. Cognition
    * What we know about the world, how we ‘think’
  2. _Emotion _
    * How we understand the world through our feelings
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18
Q

How is emotion defined?

A

Emotion is an inferred behavioural state

It is derived from conscious, subjective feelings that are internal

Emotion is inexplicably linked with a persons psychophysiological state which incorporates:

  • Conscious feelings
  • Physiological arousal
  • Cognition
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19
Q

What is the significance of the amygdala in emotions?

A

It comprises a part of the limbic system involved in emotion.

The amygdala is primarily involved in non-conscious/implicit emotional learning

Clinically:

  1. Loss of the amygdala region via lobectomy causes Kluver-Bucy Syndrome: **tameness and/or loss of fear **
  2. Amygdala dysfunction or changes in shize/shape are related to depression and anxiety in patients
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20
Q

What is the significance of the orbitofrontal cortex in emotion?

A

The orbitofrontal cortex is responsible for the identification and expression of emotion

Clinically:

  1. Lesions result in reduced facial expression and affect (right lesions worse than left)
  2. Reduced OFC volume correlated to affect disorders e.g. depression
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21
Q

What is the significance of the hippocampus in emotion?

A

Hippocampus has largely been neglected in studies of emotion until recently.

Imaging studies link reduced hippocampal volume to depression.

The hippocampus is the core structure linking serotonin abnormalities and stress hypotheses of depression - as the hippocampus is normally dense with serotonergic neurons absent in depression.

22
Q

Discuss the two theories of the interface between cognition and emotion

A

James Lange Theory

We experience emotion in response to physiological changes - we feel sad because we cry; happy because we smile

Cannon Bard Theory

People can experience emotion without expressing it physically (e.g. in spinal cord lesioned patients) - physiological changes are not unique to specific emotions

23
Q

What is cognitive appraisal?

A

Cognitive appraisal is the personal interpretation of a situation - how an individual views a situation.

It is integral to emotional states and directly impacts the physiological responses of emotion:

Having a positive outlook - people have positive perceptions of the experience and vice versa.

Addressing a patient’s cognitive appraisal is a significant part of cognitive behavioural theory

24
Q

What is nociceptive pain?

A

Nociceptive pain is an adaptive, high threshold pain that acts as an early warning system against further damage.

Nociceptors are high threshold receptors of noxious stimuli - the stimulus must be of high intensity to elicit an action potential response and transmit to the CNS.

Nociceptive pain leads to the perception of pain, autonomic response to pain and withdrawl reflexes.

25
Q

Generally, describe the frontal lobe.

What functions are characteristic of the frontal lobe?

A

The frontal lobe occupies 30% of total brain volume and is situated at the rostal aspect of the brain (most anteriorly). It is bordered by the central sulcus posteriorly.

It is characterised as an area influencing:

  • Motor control
  • Language
  • Higher level cognition / executive function

Areas of the frontal cortex can be subdivided according to cytoarchitecture, connections with the thalamus or functional properties

26
Q

Penetrating injuries to the frontal lobe are known to cause what effects?

A

Penetrating injuries to the cortex don’t normally involve loss of consciousness - if so it is only transitory - because the brainstem is unaffected; allows us to see functional changes that result.

Prefrontal cortex lacotomy/labotomy result in the calming down of patients - sedates/makes them more passive. Change in personality.

This was the case in Phineas Gage

27
Q

Where are the executive function areas located within the frontal cortex?

A

Executive function is an umbrella term that describes the inter-related processes responsible for goal directed, purposeful behaviour. It involves emotional and social behaviour; as well as cognition.

Executive function is localised to the pre-frontal cortex

The pre-frontal is located rostrally from the pre-motor and motor cortexes of the frontal lobe.

The prefrontal cortex is further divided into functional areas that are responsible for specific aspects of executive function:

  • Dorsolateral pre-frontal cortex
  • Medial pre-frontal cortex
  • Orbitofrontal pre-frontal cortex
28
Q

Describe the functions of the dorsolateral pre-frontal cortex

A

The **dorsolateral pre-frontal cortex **is responsible for traditional executive functions:

  • Working memory
  • Response selection
    • choosing correct responses
    • deficiencies lead people to continue with failing strategies / can’t identify correct pathways
  • Planning and organisation
  • Hypothesis generation
  • Flexibly maintaining/shifting set
  • Insight
    • ability to reflect on one’s self
    • deficiencies lead to inability to recognise own problems / state.
  • Moral judgement

This area is largely supplied by the middle cerebral artery

29
Q

Describe the functions of the medial pre-frontal cortex

A

The **medial pre-frontal cortex **is responsible for the emotional - motivational interface of executive functioning

  • ​Emotional intelligence
    • ability to recognise, understand and utilise emotions expressed by both others and one’s self

Deficiencies, at their most extreme, lead to akinetic mutism:

  • Apathy
  • Initiative
    • patients have the capacity to do things but aren’t compelled to do anything. They lack engagement and initiative.
  • Indifference

The area is supplied by the anterior cerebral artery

30
Q

Describe the functions of the orbitofrontal pre-frontal cortex

A

The orbitofrontal pre-frontal cortex is highly connected to limbic areas and is responsible for decision making:

  • Inhibition
    • encompassing emotional, cognitive and social inputs
  • Impulsivity
    • lesions here result in socially disinhibitive patients -> express opinions others wouldn’t

It is supplied by both the anterior cerebral artery and middle cerebral artery

31
Q

Compared to other animals, how large is the human brain (relative to body size) ;and in particular the size of the PFC

A

The human brain is the largest, relative to body size, of any animal in the animal kingdom.

The human prefrontal cortex is especially larger in humans

The PFC provides the substance of ‘who we are’ as human beings and is a significant contributing structure to our complexity.

32
Q

Explain the maturation of the frontal lobe

A

The frontal lobe is the last area of the brain to develop and mature

It also one of the first structures to degenerate as part of the aging process.

Executive functions are the last abilities to reach maturity. This is due to:

  1. Delayed development of the PFC
    * lower order functions of the brain develop first; higher order later.
  2. Genetic and environmental factors

Remember: maturity of the CNS involves both positive processes (neural proliferation) and negative processes (pruning).

33
Q

Can the terms frontal lobe dysfunction and executive dyfunction be used synonymously?

A

No

Saying somebody is ‘frontal’ implies they have pathology of the frontal lobe.

The pathology may occur in the motor regions of the frontal cortex causing particular signs/symptoms; while pathology of the PFC may result in different sign/symptoms of executive function.

If someone is demonstrating deficits in executive function - the pathology does not have to be occuring in the PFC; these signs/symptoms can be caused by pathologies elsewhere (e.g. thalamus)

34
Q

Describe the common symptoms of executive dysfunction

A

Executive dysfunction results from lesions to the **executive system ; **which includes both the PFC as a coordinator of executive function and other regions of the brain that provide executive input (e.g. thalamus)

Common symptoms include:

Positive Symptoms

  • Distractibility
  • Social disinhibition
  • Emotional instability
  • Perseveration
  • Impulsivity
  • Hypergraphia

Negative Symptoms

  • Lack of concern
  • Restricted emotion
  • Deficient empathy
  • Failure to complete tasks
  • Lack of initiation
35
Q

What are the common causes of executive dysfunction?

A
  • Closed head injuries
  • Stroke
  • Psychiatric conditions
    • Schizophrenia, mania
  • Dementias
  • Focal lesions
    • tumors, abscesses
  • Inflammation
    • MS, encephalitis
  • Developmental abnormalities
    • autism
36
Q

How sensitive are areas of the PFC to formal neuropsychological testing?

A

Medial and orbitofrontal lesions are DIFFICULT to formally assess - diagnosis on clinical judgement and history.

Formal neuropsychological testing of the dorsolateral PFC is very sensitive

Testing of dorsolateral PFC includes:

  • Tower of London task (planning)
  • Stroop Test (selective attention)
    • words of colours, words in a different colour to that written.
  • Complex figure tasks (planning)
    • recreate drawn images
37
Q

Illustrate the different memory systems

A
38
Q

What is procedural memory?

A

Procedural memory** is the long term implicit memory responsible for **skill acquisition

It is an autonomised and slow accretion of memory that it retained “forever” - i.e. riding a bicycle

Procedural memory doesn’t normally break down - even with severe pathology

39
Q

What is episodic memory?

A

Episodic memory is autobiographical memory

It involves memories assocaited to a personal event with it’s own specific temporal, spatial and emotional context.

40
Q

What is semantic memory?

A

Semantic memories are of general facts

They are not contextual and are not specific to any individual (is shared knowledge)

e.g 7 follows 6 or bannanas are yellow.

41
Q

List the strucutres important to declarative memory

A

The **hippocampal system **is the most important neural network in declarative memory formation.

The system includes the hippocampus, entorhinal cortex and perirhinal cortex.

The hippocampus is comprised of subregions: Dentate gyrus, CA-1, CA-2 CA-3 and CA-4. These areas of the hippocampus can break down independently in some conditions giving different neuological deficits.

42
Q

What is meant by the “lateralisation/material specificity of memory”?

A

It is believed that there is lateralisation of memory function between the left and right hippocampus.

Left Hippocampus - Verbal Memory

  • list learning
  • paired associate learning (remembering two things that are provided together - not necessarily related)
  • story recall

Right Hippocampus - Non-verbal memory

  • visuo-spatial associations
  • face recall
43
Q

List and discuss the common causes of memory impairment

A

Degenerative disorders

  • Alzheimers disease
    • Most common cause of dimentia (50% of cases)
  • Chronic alcoholism
    • decline due to toxicity of alcohol but mainly the malnutrition that tends to accompany it.

Cerebrovascular disease

  • Bilateral hippocampal infarction
  • Cardiogenic cerebral anoxia

Paroxysmal/transient disorders

  • _Transient global amnesia _
    • *precipitating events: *sexual intercourse, immersion in cold water or emotional stress
    • transient anterograde amnesia
    • no disruption to self identity
    • Underlying cause unknown
  • Temporal lobe epilepsy/transient epileptic amnesia
    • _​_caused by hippocampal sclerosis
      • cell loss particularly in CA-1
      • Gliosis (scar tissue)
    • present with declarative memory disturbance
  • Post-traumatic amnesia
    • _​_following traumatic brain injury
    • spontaneously resolves
    • can last a few minutes

Surgical resection

44
Q

What structures outside of the hippocampal system are important in the formation of episodic memories?

A
  • Anterior thalamus
  • Basal forebrain
  • Mesial temporal region
  • Mamillary bodies
  • Retrosplenial cortex

Memory is not relient of the hippocampus alone.

45
Q

What is mild cognitive impairment?

A

Mild cognitive impairment (MCI) is subclinical memory loss indicating the transitional phase between normal aging and dementia

In it characterised by:

  1. Self-reported memory complaints
    * history of six to twelve months
  2. Objective memory impairment (-1.5 SD of the population)
  3. Unaffected general cognitive function
  4. Normal capacity to perform activities of daily living

Early memory complaints in MCI are name-face associations and object place associations.

It is important to identify patients with MCI as they are predisposed to developing dementia/Alzheimers ; early treatment available to delay the onset of the disease

46
Q

What types of language impairments are observed in Alzheimer’s disease?

A

In AD, various language impairments are observed, including:

Dysnomia

Dysnomia is a disorder in which patients have difficulty recalling words or names. It leads people to speak with **circumlocution **where they talk in round-ways to describe the word they can’t recall.

47
Q

Where are memories stored/formed?

A

Memories are stored in the medial temporal lobe hippocampus

48
Q

How are memories stored in the short term?

A

Short term memories are formed via the:

  • insertion of NMDA glutamate receptors
  • phosphorylation of NMDA receptors
  • increased pre-synaptic NT release via retrograde signalling

NMDA receptor types are implicated in memory formation in the short term:

  • NR1
    • knockouts of these receptor types prevents the ability to form new memories in mice
  • NR2A
  • NR2B
    • are elevated during development and are specialised for plasticity
    • inserting these into adult gene expression extends the window of developmental plasticity
49
Q

How are memories formed in the long term?

A

Protein synthesis and permanent structural changes at the synapse result in **long term potentiation **that induces long term memories.

A neuron becomes potentiated (i.e. increasingly responsive to new input of the same type) for minutes, days, or weeks when it is bombarded with brief but rapid series of stimulations.

The fact that simultaneous stimulation of different synapses, or cooperativity, is required for LTP makes it a promising mechanism for associative learning at the level of a single cell

50
Q

What effects does ‘brain exercise’ have on the brain?

A

Stimulating environments and cognitive exercise are shown to:

  • release growth factors (BDNF) that generate new neurons
  • improvements in mood in memory
51
Q

What effect does early physical exercise rehabilitation have in stroke victims?

A

Very early rehabilitation (<24 hours post stroke) with an emphasis on mobilisation may contribute to improved outcomes following stroke.

50% of patients who exercise early are back on their feet within 3 days

52
Q
A

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