Cognitive and Behavioral Neurology Flashcards
Risk factors for Alzheimer’s disease
Female sex, age, black race, Hispanic ethnicity, and apolipoprotein e4 status
Routine screening for dementia
B12, CBC, electrolytes, glucose, BUN, creatinine, LFTs, TFTs and depression screening
Which chromosome is Presenilin-2 located in?
Chromosome 1, early onset familial AD
Which chromosome is Presenilin-1 located in?
Chromosome 14, aggressive early-onset familial AD
Which chromosome is Apolipoprotein E4 located in?
Chromosome 19, triples risk of AD
Which chromosome is Amyloid precursor protein located in?
Chromosome 21
Definition of immediate memory
amount of information someone can keep in conscious awareness without active memorization
test with forward digit span
Working memory
tested by manipulation of information retained in immediate memory
Recent memory
requires hippocampus, parahippocampal areas of medial temporal lobe
test with recall
Remote memory
historical life events and long-known information
Declarative memory (explicit memory)
Divided into episodic or semantic
Pathology caused by lesions to bilateral medial temporal lobes
Nondeclarative memory (implicit memory or procedural)
memory of skills and other acquired behaviors
FDG PET in Alzheimer’s disease
bilateral parietotemporal hypo metabolism
FDG PET in FTD
frontal and anterior temporal hypo metabolism
FDG PET in Huntington’s
head of caudate hypo metabolism
FDG PET in LBD
occipital region hypo metabolism
FDG PET in PSP
shows global metabolic reduction in regions including anterior cingulate, basal ganglia, thalamus and upper brainstem
Alzheimer’s type II astrocytes
hepatic encephalopathy
Neurons in locus coeruleus
noradrenergic neurons
Neurons in medial and dorsal raphe nuclei
serotonergic neurons
Neurons in nucleus accumbent and ventral tegmental area
dopaminergic neurons
Neurons in substantia nigra pars reticulata
GABAnergic neurons
Neurons in substantia nigra pars compacta
dopaminergic neurons
Lewy body disease
Parkinsonism, fluctuating cognitive impairment, visual hallucinations, dysautonomia, REM sleep behavior and neuroleptic sensitivity
chromosome in familial FTD
chromosome 17
Kluver-Bucy syndrome
lesions to bilateral anterior temporal lobes/amygdala
hyperorality, hyper metamorphosis, blunted emotional affect, hyper sexuality, visual agnosia
Behavioral variant FTD
abulia, apathy, social withdrawal, social disinhibition, impulsivity, lack of insight, poor personal hygiene, sterotyped or ritual behavior, hyperphagia, sudden new artistic abilities, emotional blunting, loss of empathy, mental rigidity, distractibility, impersistence, perseveration behavior, impaired organizational and executive skills
Progressive nonfluent aphasia
anomia, word finding difficulty, impaired object naming and effortful speech with preserved cognition
Progressive fluent aphasia
progressive speech disturbance with normal fluency impaired comprehension, anomia and semantic paraphasia
Damage to bilateral globus pallidus interna
akinetic mutism
Psychogenic amnesia
loss of autobiographical memory, sometimes with ability for new learning
Wernicke’s encephalopathy
B1 deficiency; confusion, ataxia and ophthalmoplegia
Korsakoff’s disease
chronic phase of B1 deficiency, anterograde and retrograde amnesia, confabulation
Transient global amnesia
Functional alterations in bilateral medial temporal lobes
impaired recent memory with preserved immediate and remote memory
Memantine (Namenda)
low to moderate affinity noncompetitive NMDA receptor antagonist
Donepezil (Aricept)
pure acetylcholinesterase inhibitor
Rivastigmine (Exelon)
combined acetylcholinesterase and butylrylcholinesterase antagonist
Galantamine (Razadyne)
combined acetylcholinesterase inhibitor and allosteric nicotinic modulator
Synucleinopathies
Parkinson’s
MSA
DLB
Neuro-axonal dystrophies
neuropathology of CJD
neuronal loss, glial cell proliferation, absent inflammatory response, and vacuolization of the neuropil
Balint’s syndrome
optic ataxia, oculomotor apraxia and simultagnosia
due to damage to bilateral parieto-occipital regions
Anton’s syndrome
visual anosagnosia leads to cortical blindness
due to damage to bilateral medial occipital lobes
Charles Bonnet syndrome
release hallucination marked by vivid hallucinations that occur in people with severe visual impairment
Alexia without agraphia
loss of reading comprehension despite normal visual acuity; can read individual letters, written and language comprehension normal
lesions in the dominant PCA territory in the medial and inferior occipitotemporal region and splenium of corpus callosum
Verbal auditory agnosia
impaired auditory comprehension of language with intact hearing, normal comprehension of written language
due to lesion in middle portion of superior temporal gyri
Aphemia
inability to speak fluently, impaired repetition, intact auditory comprehension, retained ability to write and comprehend written language
due to lesion in dominant frontal operculum
Foix-Chavary-Marie Syndrome
severe dysarthria, bilateral voluntary paralysis of the lower cranial nerves with preserved involuntary and emotional innervation
due to lesion in bilateral anterior operculum
Transcortical sensory aphasia
Wernicke’s aphasia + intact repetition
Transcortical motor aphasia
Brock’s aphasia + intact repetition
Orbitofrontal prefrontal cortex lesion
changes in personality, social disinhibition, facetiousness, inappropriate jocularity, echopraxia and utilization behavior
Dorsomedial prefrontal cortex lesion
apathy, indifference, loss of initiative, motivation, abulia, and reduction in movement
Dorsolateral prefrontal cortex lesion
loss of executive function, judgement and problem solving, disorganization
Gertsmann’s syndrome
finger agnosia + left-right confusion + dyscalculia + dysgraphia
lesion to dominant inferior parietal lobule
