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Neuropsychology > Cognitive Disorders and Special Topics > Flashcards

Cognitive Disorders and Special Topics Flashcards

0
Q

Broca’s Aphasia

A

Lesions to the left front lobe, specifically to the motor strip area which controls the muscles that produce speech
Severe problems with articulation (dysarthria), speech slow and effortful
MOSTLY verbal comprehension
NO repeat phrases
NO fluency

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1
Q

aphasia

A

Language disorder
Results from damage (aka lesions) in the left hemisphere
Location of lesion determines nature of language disruption

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2
Q

Wernicke’s Aphasia

A 
Lesions to left temporal lobe
NO language comprehension
NO execute verbal commands
NO repeat phrases
YES fluency, but say complete nonsense 
Unaware of problem, expect others to be able to understand them
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3
Q

Conduction Aphasia

A 
Lesions in connections between expressive and receptive speech areas
YES language comprehension
YES execute verbal commands
NO repeat phrases
YES fluency, but don't make sense
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4
Q

Global Aphasia

A 
Damage to most of cortex
Most language functions impaired
NO comprehension
NO repeat verbal phrases
NO fluency
NO naming, reading, writing
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5
Q

One-sided neglect

A

When damage occurs to one side of brain, opposite side of body frequently affected\

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6
Q

Apraxia

A

Inability to carry out purposeful motor movements (e.g. waving), despite the absence of motor or sensory deficits
Can move limbs normally, but innervates wrong muscles, puts limbs in incorrect position, omits some element of action when asked to carry out specific motor command
Believed to be caused by left brain lesions, damage to left brain produces apraxia in both limbs

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7
Q

Agraphia

A

Impairment in ability to write acquired after person has learned to write
Can involve spelling, word selection, grammar, spatial arrangement
Left hemisphere damage in variety of areas - frontal lob, temporal, parietal regions, basal ganglia

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8
Q

Alexia

A 
Acquired partial or complete inability to read
Most commonly caused by stroke to dominant (left) hemisphere
Pure alexia (without agraphia) - lesions that disconnect visual association cortex from temporoparietal cortices
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9
Q

Prosopagnosia

A

Most common of visual agnosias
Inability to recognize familiar face
Typically retrograde (can’t recognize faces of previously known individuals) AND anterograde (can’t learn new faces)
Despite normal or near normal visual perception, intact alertness, inattention, intelligence, langage
Injury to areas of visual association cortex

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10
Q

Anosagnosia

A

Lack of awareness of a disability or lack of awareness of nature of one’s illness
e.g. people with Wernicke’s typically don’t recognize they are speaking gibberish

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11
Q

Hydrocephalus

A

Accumulation of cerebrospinal fluid (CSF) in brain’s ventricles, causing increased intracranial pressure
Symptoms: dementia, urinary incontinence, unsteady gait
Can be treated with surgical procedure to increase drainage

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12
Q

Dementia

A

Impairment in memory PLUS: aphasia, apraxia, agnosia, or disturbance in executive functioning
Overall rate equal in men and women

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13
Q

Alzheimer’s Disease

-phases

A

Most common form of dementia, over half of all dementia cases
More prevalent in women
Progressive, rate of slope and decline varies
Early phase - impairments in recent memory, difficulty problem-solving, irritabilty, frustration, anger
Intermediate stage - further memory impairment, cognitive deficits (aphasia, apraxia, agnosia), confusion, socially undesirable behaviors
Late stage - gait and motor problems, may become mute or bedridden
Most rapid and relentless course occurs with early onset Alzheimer’s (before 65 years of age)

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14
Q

Genetic component of Alzheimer’s

A

First degree relatives of patients with AD carry six times greater risk of developing AD
Senile plaques, neurofibrillary tangles found throughout cortex and other brain structures (hippocampus - memory, amygdala)
Decreases in Acetylcholine, involved in memory and learning

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15
Q

Treatment of Alzheimer’s

A

Aricept (donepezil) - modest improvements in cognitive functioning (3-4 points in Folstein Mini Mental State)

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16
Q

Vascular Dementia

A

10-15% of all cases of dementia in older adults, sometimes coexists with Alzheimer’s
Twice as common in males

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17
Q

Why does Vascular Dementia occur

A

Numerous small CVAs (cerebrovascular accidents) or strokes believed to be caused by generalized cerebrovascular disease

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18
Q

Onset of Vascular Dementia

A

Typically abrupt

Course marked by rapid, step-wise changes - plateaus followed by further degeneration

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19
Q

Prognosis of Vascular Dementia, age of onset

A

Half die within two to three years of diagnosis

Age of onset usually much younger than AD

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20
Q

Prevention and treatment of Vascular Dementia

A

Primary and secondary prevention important
Lifestyle changes - reduction in smoking, weight loss, increased exercise effective in arresting progress of disease
No medications to reverse effects of stroke - but aspirin, anticoagulants, antihypertensives reduce likelihood of future stroke

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21
Q

Parkinson’s Disease - prevalence

A

Affects over a quarter of a million older adults in US

Slightly more men than women

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22
Q

What is Parkinson’s Disease

A

Movement disorder marked by tremor, rigidity, bradykinesia (slow initiation of movement) and shuffling gait
Neuropsychiatric symptoms - psychosis, dementia, depression

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23
Q

Parkinson’s dementia

A

30-50% of patients with PD have dementia

Sub-cortical dementia, affecting speed of processing and executive functions (planning, organizing, sequencing)

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24
Q

PD associated with…

A

Degeneration of neurons in the substantia nigra, section of basal ganglia
As a results, decrease in dopamine available in BG as a whole
BG involved in regulating voluntary movement

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25
Q

Treatment of PD

A

L-Dopa (Levodopa), precursor to dopamine

Does not alter progression of disease or decrease symptoms of dementia

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26
Q

Depression and PD

A

Occurs in 50-90% of patients with PD, may be direct effect of brain changes caused by disease
Antidepressants may improve emotional and cognitive functioning

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27
Q

Huntington’s Disease (Chorea)

A

Involves the BG
NTs Acetylcholine and GABA implicated
Does not become apparent until 35-45
Offspring have 50% change of being affected

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28
Q

Signs of Huntington’s Disease

A

Personality change first sign in 50% of cases
Progressively deteriorating dementia
Choreiform movements (frequent, discrete, brisk jerking movements of pelvis, trunk, limbs)
Athetosis (slow writhing movements)
Facial grimaces

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29
Q

Pick’s DiseaSE

A

Rare dementia that is clinically indistinguishable from AD
Affects women twice as often as men\Onset peaks between 50s and 60s
Affected neurons swell and have “Pick bodies” (irregularly shaped inclusions)

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30
Q

Lobes affected by Pick’s Disease

A

Frontal and temporal

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31
Q

Signs of Pick’s Disease

A

Decreases in initiative, episodes of tactless and inappropriate behavior, facetiousness and euphoria, explosive temper, disinhibition and poor impulse control, impaired insight –> all symptoms associated with frontal lobe dysfunction
Problems with memory and language also common (but less common than in AD)

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32
Q

Pick’s Disease vs. Alzheimer’s

A

PD: Unlike with AD, deterioration not wide-spead throughout brain, no senile plaques or neurofibrillary tangles

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33
Q

AID’s Dementia

A

AKA AIDS dementia complex (ADC)
10-15% of people with AIDS develop dementia
Cognitive, motor, and behavioral symptoms

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34
Q

Cognitive Symptoms of AIDs Dementia

A

memory problems (LT frequently remains intact), difficulty with attention and concentration, language difficulties

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35
Q

Motor Symptoms of AIDs Dementia

A

Weakness, lack of coordination, unsteady gait, jerky eye movements

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36
Q

Behavioral Symptoms of AIDs Dementia

A

Apathy, withdrawal, lack of motivation, personality changes, inappropriate affect, mood swings, and even hallucations

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37
Q

Dementia due to Head Trauma

A

Impaired memory most obvious and reliable complaint of head trauma

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38
Q

Closed-headed injuries

A

Skull not pierced or cracked
Frequently results in loss of consciousness
2 most common subtypes: concussions and contusions

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39
Q

Concussions

A

Short term loss of consciousness
Anterograde amnesia - inability to remember new information
Retrograde amnesia - loss of memory for information required prior to the injury - typically right before injury and incident itself

40
Q

Postconcussion Syndrome

A

Constellation of somatic and psychological symptoms including headache, dizziness, fatigue, diminished memory, memory deficit, irritability, anxiety, insomnia, hypochondriacal concern, hypersensitivity to noise, and photophobia
Symptoms: irritability, fatigue, headache, and dizziness

41
Q

Contusions

A

More serious than concussions
Coup-countrecoup injuries (bruising beneath point of impact and opposite side of brain)
May lose consciousness for minute or hour
If conscious, may be drowsy, confused, agitated, even violent
In returning to alert state, may experience temporary aphasia, slight hemiparesis, unilateral numbness

42
Q

Discrete Impairment

A

Results from injury at site of coup or countrecoup, most frequently frontal and temporal lobes
Frontal Lobe Syndrome- lack of foresight and concern, irresponsibility, loss of insight
Temporal Lobe Syndrome - irritability, hostility

43
Q

Diffuse Impairment

A

General loss of complex cognitive functions

44
Q

Open-headed injuries

A

e.g. gunshot wounds
penetration of skull
most people do not lose consciousness, neurological signs highly specific

45
Q

Recovery from head trauma

A

Bulk of cognitive recovery occurs within first 6 to 9 months
Memory for more remote events returns before memory for more recent events
Frequently never regain memory for what happened immediately prior to injury

46
Q

Pseudodementia

A

Cognitive impairment due to depression
Depressive symptoms resemble mild cognitive dysfunction: slower processing speed, difficulties concentrating, psychomotor retardation, social withdrawal, easily giving up on items when tested

47
Q

Indications of pseudodementia

A

Acute onset with precise date of onset, association with personal loss or emotional distress, and rapid progression
Subjective complaints of memory loss (patients with organic dementia generally lack insight regarding their deterioration)

48
Q

Delirium

A

Acute confusional state

Acetylcholine involved

49
Q

Hallmarks of delirium

A

Disturbance of consciousness with reduced ability to focus, sustain, or shift attention
Change in cognition (e.g. memory deficit, disorientation), or development of a perceptual disturbance

50
Q

Delirium vs dementia

A

Delirium typically has acute onset and fluctuating course
Delirium more likely to be reversible
Neurological signs are frequently present e.g. dysphasia, tremor, poor coordination) as well as disturbed sleep patters

51
Q

Common causes of delirium

A

infections, metabolic and endocrine disorders, postoperative states, substance intoxication (medications or illicit drugs), substance withdrawal

52
Q

Drug of choice for delirium

A

Ativan

53
Q

Amnestic Disorders

A

Disturbance in memory related to the effects of a general medical condition or persisting effects of a substance

54
Q

Most common causes of amnestic disorders

A

head trauma

alcohol abuse

55
Q

Korsakoff’s Syndrome

A

Caused by chronic thiamin (Vigtaming B1) deficiency associated with alcoholism
Most significant problem –> Anterograde amnesia - forming new memories
Also suffer from retrograde amnesia, with extensive impairment in remote memory for most of their adult lives
Frequently confabulate (make up) plausible stories about past events that did not occur

56
Q

Effects of ECT

A

Bilareral ECT frequently induces memory changes
Most memory problems are reversible, with return to pretreatment functioning within 6 months
Generally greatest memory problem considered to be retrograde amnesia, but some research reports found anterograde to be larger problem

57
Q

Gate Control Theory

A

Melzak and Wall (1965)
Popular theory with regard to experience of pain
Sensations of pain not directly related to activation of pain receptors
Rather, pain sensations mediated by neural gates in the spinal cord tha tallow these signals to continue onto the brain
Pressure stimulation tends to close the gate - that’s why rubbing hurt area can often relieve pai
Psychological factors also effect the gate - attitudes (cognitions) and moods, may open the gate and increase experience of pain

58
Q

Management of chronic pain

A

BOth narcotic and anti-narcotic medications

Best done on time-contingent (e.g. on fixed interval schedule) rather than pain-contingent schedule

59
Q

Two major phases of sleep

A

Non-REM (stages 1-4) and REM (rapid eye movement)

60
Q

Beta waves

A

predominate when person is alert and attentive

61
Q

Alpha waves

A

brain waves show pattern of 8 to 12 Hz per second

When person closes eyes and relaxes

62
Q

Stages of sleep

A

Stage 1: Predominance of theta waves of 4-8 Hz
Brief transitional stage between wakefulness and sleep
Stage 2: Spindles or rhythmical responses of 12 to 16 Hz
Occupies greatest amount of time during sleep
Stages 3 & 4: Slow waves of 1 to 2 Hz, known as delta waves
Sleeper generally hard to waken
REM Sleep: EEG patterns of stage 1 reappear in conjunction with rapid eye movement

63
Q

REM Sleep

A

newborns: 50% of time in REM
by age 5: 20-25% of time in REM sleep
by old age: 18% in REM sleep
respiration and heart rate increase, muscles become relaxed
if awoken - report bizarre and illogical dreams

64
Q

non-REM sleep

A

eye movements absent
heart rate and respiration slowed
muscles maintain tone

65
Q

Generalized Seizures

A

Tonic clonic seizures and petit mal seizures

Occur when electrical abnormalities exist throughout the brain

66
Q

Tonic clonic seizures

A

Involve tonic stage (continuous tension or contraction) followed by clonic stage (rapid, involuntary, alternating muscle contractions, and relaxation)
Occur during grand-mal seizure
Seizures usually dramatic and involve convulsions throughout the body
Loss of consciousness common
Afterwards - headache, confusion, fatigue, and amnesia for seizure

67
Q

Petit mal seizures

A

aka absence seizures
Occur most frequently in children, usually beginning before age 5
Last 1-30 seconds
Begin with brief change in level of consciousness, followed by blinking or rolling of eyes, a blank stare, and slight mouth movements
Posture is retained and pre-seizure activity is returned to without difficult

68
Q

Partial Seizures

A

Simple Partial Seizures
Jacksonian Seizures
Complex Partial Seizures

69
Q

Simple partial seizures

A

electrical abnormalities in a focal area of the brain only
size of affected area can be as small as a thumb and as large as half the body
patient usually remains conscious during seizure and can later describe it in detail

70
Q

Jacksonian seizures

A

Initially localized motor seizure, with spread of abnormal activity to adjacent brain areas

71
Q

Complex Partial Seizures

A

Preceded by an aura and usually include purposeless behavior (e.g. aimless wandering), lip smacking, and unintelligible speech
Consciousness is frequently impaired
Ultimately person makes full recovery

72
Q

PET scan

A

Positron Emission Tomography
Inject person with glucose and a small amount of radioactive substance
Active neurons use up glucose and scan picks up the radioactive material - that’s where brain is active
Shows functional capacity of a particular brain region

73
Q

MRI

A

Magnetic Resonance Imaging
Used for visualization of brain structure
Magnets used - more detail than CAT scan

74
Q

CAT scan

A

Computerized Axial Tomography

X-ray like pictures of internal organs that are clearer and more accurate than normal x-rays

75
Q

fMRI

A

Functional Magnetic Resonance Imaging

Measures changes in oxygenated blood flow

76
Q

Synesthesia

A

When one type of sensory stimulation elicits another sense

e..g. seeing music, smelling colors

77
Q

General Adaptation Syndrome

A

Hans Selye developed a model of response to severe stress

78
Q

Three stages of General Adaptation Syndrome

A

Alarm
Resistance
Exhaustion

79
Q

Alarm stage of GAS

A

Body mobilizes resources to cope with stress by activating the sympathetic nervous system
Body highly alert, yet in state of lowered resistance to illness
Symptoms: headaches, fatigue, diarrhea

80
Q

Resistance stage of GAS

A

Alarm reaction subsides and the body adapts to the stressor and actually attains a level of resistance to illness above normal

81
Q

Exhaustion stage of GAS

A

Occurs in response to chronic, unremitting stress
Body’s resources are exhausted and stress hormones are depleted
Unless a way of reducing stress is found, there can be significant loss of health and in extreme cases, even death

82
Q

Health belief model

A

Rosenstock
Individuals who believe they can control their health are more likely to engage in healthy habits such as exercise and good nutrition and to decrease harmful behaviors such as overeating, smoking, etc

83
Q

Akathesia

A

Inability to sit or stand still

Uncomfortable sense of restlessness

84
Q

Asomatognosia

A

Inability to recognize parts of own body

85
Q

ataxia

A

slurred speech, severe tremors, incoordination, clumsiness, lack of balance

86
Q

athetosis

A

slow writhing movements

87
Q

chorea

A

irregular, involuntary, rapid jerky movements, usually in the face, limns, and trunk

88
Q

color agnosia

A

inability to name or discriminate between colors

89
Q

dressing apraxia

A

inability to dress oneself

90
Q

dyskinesia

A

abnormal muscle movement including twitchy, jerky, and writhing movements (chorea, tics, tremors)

91
Q

dysprosody

A

disturbance in the stress, pitch, and rhythm of speech

92
Q

ideational apraxia

A

inability to carry out a sequence of movements

93
Q

ideomotor apraxia

A

cannot pantomime motor movements nut usually has less trouble performing same movements with actual object; due to left posterior parietal damage

94
Q

simultagnosia

A

inability to see more than 1 thing or 1 aspect of an object at a time

95
Q

Tactile agnosia

A

inability to recognize familiar objects by touch

96
Q

tardive dyskinesia

A

repetitive oral and facial grimaces, tongue movements, spasms of the neck and head, jerky movements of the limbs and trunk; need to raise GABA levels to relieve

97
Q

Frontal lobe syndrome

A

Frontal Lobe Syndrome- lack of foresight and concern, irresponsibility, loss of insight

98
Q

Temporal love syndrome

A

irritability, hostility

Neuropsychology (2 decks)

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