Exam 2 Flashcards
Basal ganglia
caudate, putamen, globus pallidus
procedural learning, non declarative memories
basal ganglia
deficit in retrieval rather than encoding
basal ganglia
lateral inferotemporal cortices - non- MTL memory
long term storage for episodic & semantic information
what does the lateral inferotemporal cortices cause?
disease or damage produces retrograde amnesia
frontal lobes - Non- MTL memory
What is the left & right responsible for?
involved in active learning and active retrieval processes
The left prefrontal = encoding (images of normal)
Right prefrontal = active retrieval (images of normal)
Frontal lobes
-working memory
dorsolateral prefrontal
who had surgical damage to hippocampus?
HM
who had Viral encephalitis?
clive wearing
Neuro disorders & MTL
- surgical damage to hippocampus (HM)
- viral encephalitis (clive wearing)
- brain injury
- alzheimer’s disease
MTL Lesions
memory deficits in Encoding (transfer) of new information
Neuro disorders & basal ganglia
- retrieval rather than encoding
- non-declarative
- procedural learning
- priming
- Parkinson’s Disease
- Huntingtons Disease
- Fahr’s disease (“idiopathic calcification of Basal Ganglia”)
examples: teaching someone a list to remember, testing them over & over, & then giving them a random list & then they cannot remember the information from the previous list.
where are the memory deficits in the basal ganglia lesions:
memory deficits are in retrieval
HM
1953
Henry - a 27 year old man underwent an operation in which the bilateral medical temporal lobes, including the hippocampus formations & parahippocampal gyri, were resected in an attempt to control his medical-refractory epileptic seizures
HM’s neuropsychological profile
could recall new info
able to recall memories from childhood
couldn’t recall anything from 11 years leading up to surgery
unable to learn new facts or recall new experiences (given a list of 3-4 words to remember, able to correctly recite them; however, after 5 minutes unable to recall any of the words (even with cues), & no recollection of having been asked to remember words)
able to recall events from childhood & up two several years prior to surgery (LTM)
Unable to recall events in approximately 11 year span leading up to surgery
age 16 - missing 11 years - age 27 - surgery
HM’s neuropsychological profile continued
Personality and general intelligence were normal.
FSIQ = 110
Able to learn certain tasks that did not require conscious (explicit) recall • e.g., performance improvement on mirror-drawing on successive days equivalent to normal individuals, despite no recollection of having done the task before • e.g., when “primed” by exposure to a word (PROTRACTER) and then asked to complete the stem PRO-, he chose the word he had previously seen at higher than chance levels, despite no recollection of having seen the task before
H.M.’s memory led to intensive investigations on
medial temporal lobes (MTL) role in human memory
______________ resection not performed after H.M.
bilateral MTL
breakthrough discovery
initial attempt were made to produce amnesic syndrome in monkeys
discovery of multiple memory systems
MTL responsible for rapidly acquired knowledge about recent events (declarative), but not responsible for acquisition of habits (procedural)
procedural characterized by slow accumulation of response biases or motor skills
The previous matching to sample task tapped into procedural learning • New version of task for monkeys - “non-matching to sample:” reward for selecting the novel object on each trial: MTL monkeys demonstrated amnesic syndrome
STM
recall of info immediately after presentation or during uninterrupted rehearsal
limited capacity
LTM
recall of info after delay interval during which attention is focused away from target items
large capacity
why are these terms avoided in clinical practice?
they are avoided given that one person’s temporal definition of STM is another criterion for LTM; best to use descriptive terms`
problem for HM
deficit in the TRANSFER of information from STM to LTM
declarative (explicit)
directly accessible to conscious recollection
- Facts, data, knowledge, meaning of words
- retrieval is goethe intentional
non declarative (implicit)
learning demonstrated through performance; several different memory systems distinct from declarative
- procedural (skills leaning)
- priming
episodic
memory for specific events, episodes in one’s life, info assigned to particular point in time
semantic
knowledge of general info, not temporally coded, not dependent on particular time or place
(knowing what a sandwich is)
anterograde
memory for events occurring after specified point in time (onset of injury); refers to new leaning
-dory
retrograde
memory for events predating a specified pointing time (onset of injury)
learning (encoding)
process of acquiring new information, or process that modifies subsequent
memory (recall)
the “record” left by a learning process, measured as amount of information retained on recall
free recall
spontaneous recall of info without cues or aids
CUED recall
retrieval of info with help of cue
recongition
target from memory is among array of options; maximally aids retrieval by providing info
_____________ help specify the source of the “memory” problem.
retrieval formats
if recognition > Free recall
problem is in retrieval process
Parkinsons, Huntington’s
if Recall = recognition (equally poor)
problem is in encoding processes
Alzheimer’s, Korsakoff’s, “MTL” memory problem
key structure in memory
hippocampus
other structures: Perirhinal, Parahippocampal, Entorhinal, Amygdala
visual memory
Perirhinal
spatial memory
Parahippocampal
unclear functions for memory
entohinal
emotion-mediated memories
amygdala
damage to MTL disrupts the process of encoding
(I.e., transfer from attentional stores to long-term storage) still unclear whether affects the process of retrieval
bilateral damage
global amnesic syndrome
marked anterograde memory deficit (global) for declarative info
graded retorgrade deficit
immediate recall (uninterrupted rehearsal) intact
Bilateral MTL or bilateral Paper circuit lesions required for global anterograde deficits. the greater the bilateral damage, the greater the severity
unilateral damage
less severe deficits that tend to be material-specific
left MTL = verbal
Right MTL = nonverbal, topographic
unilateral MTL will result in lateral-specific anterograde deficits
Papez Circuit
hippocampus: lesions alone produce amnesia
projects via the Fornix
Mammillary bodies in hypothalamus
Then to anterior thalamic nuclei via mammillothalamic tract then to cingulate cortex downtown to entorhinal cortex & back to hippocampus
how the Papez circuit functions
- Acquisition & rapid consolidation of particular kinds of associations
- several passes of an “event” through the circuit leads to physical changes in neurons that consolidated the memory
- once sufficiently strengthened, recall is independent of the hippocampus
- injury prevents new memories, but cannot erase CONSOLIDATED or OLD memories
memory problems present as difficulty in realizing new information
anterograde episodic memory deficits
_____________ not affected by MTL/Papez
non declarative (particularly Procedural)
_____________ problems are typically less severe than ______________.
retorgrade memory
anterograde
the greater the severity too retrograde
the greater the anterograde
Retrograde loss is typically with ___________________
episodic info
semantic knowledge retained autobiographical info retained
memory testing
- Expose the patient to new information, ask her to recall the information.
- Standardizes (controls) the exposure of info
- only measures learning & memory in the anterograde period
- only measures declarative memory
- need to test for stimuli type (verbal, nonverbal)
- need to test for recall under varying cue formats
Common Verbal
Memory tests
- Common Verbal memory tests
- memory for stories (e.g., WMS logical memory)
- word-lists
- Rey AVLT, CVLT, Selective reminding test
-paired associations
Common Nonverbal
Memory Tests
- Drawing designs
- WMS Visual Reproduction
- Benton Visual Retention Test
- Rey-Osterrieth Complex Figure
- Recognition of Nonverbal stimuli
- Benton visual retention test
- Warrington memory for faces
- WMS faces
- Continuous visual memory test
Rey Auditory Verbal Learning Test (RAVLT)
testing for verbal memory (without grouping/clusteing of categories)
The California Verbal Learning Test (CVLT)
memory test with words shown (words are in categories)
overtime this test can show recall under varying cue formats
Rey - Osterrieth Complex Figure
oPut a complex figure Infront of them and have them copy it
oChange the color of the pen as they are drawing to see their organizational strategy when they are drawing it
Basal Ganglia or frontal lobe damage
Memory deficits are in Retrieval (rather than encoding)
stages of memory
encoding, storage, retrieval
damage to the hippocampus
deficit is at the level of encoding transfer of information from Short term to long term memory
chucking
requires frontal lobe function
not prototypes
Cali test
The front lobes
largest region of the brain: 1/3rd of the cerebral cortex
Integration of multimedia sensory, motor, limbic information
numerous bidirectional cortical & subcortical connections
prefrontal area
anterior part, “higher cognitive functions,” personality
premotor area
modifies motor mints, stores motor
primary motor
nerve cells that produce voluntary movement
prefrontal area divided into two
dorsal lateral (on top) orbital frontal region (by eyes)
what are the connections with the frontal lobes - 3
Cortical connection
Subcortical (underneath the cortical portions)
Neurotransmitter Projections
Cortical connection
association cortices of temporal, parietal, occipital & limbic
subcortical
a. Orbitomedial connects with amygdala
b. prefrontal projects to basal ganglia via head of caudate
c. connections to anteromedial temporal, hippocampus
d. connections to mediodorsal nucleus of thalamus
neurotransmitter projections
Frontal lobe revive projections from multiple subcortical brainstem modulatory neurotransmitter systems: dopamine, acetylcholine
Functions of frontal lobes
- critical for sophisticated decisions we make
- subtle social interaction we engage in
- divergent thinking
- “seat of personality & intellect”
What does RIO stand for?
restrain
initiative
order
-we call these personalities
define Restraint
- Judgment
- Foresight
- Perseverance
- Delaying gratification
- Inhibiting socially inappropriate responses
- Concentration
- Self-awareness
define Initiative
motivation to pursue positive or produce positive activities
o Curiosity o Spontaneity o Motivation o Drive o Creativity o Shifting cognitive set o Mental flexibility o “personality”
define order
• Sequencing
• Organization
• Planning
• Working memory
• Temporal order
oPutting things in temporal order
o“ a week ago I did this, month ago I did this”
• Perspective taking
• Abstract reasoningcontradictory behaviors in Frontal Lobe disorders dorsolateral lesions
more of a loss
- Apathetic indifference (not caring either way)
- Abulia (lack of spontaneous behavior)
- Akinesia (loss of spontaneous movement)
- Preservation (readapted engagement in a behavior)
- Mutism
- “pseudo” depression (lacking drive to do anything)
- Hypo-sexuality
Contradictory Behaviors in FL Disorders
Orbitomedial lesions
more emotional
- explosive emotional lability
- environmental dependency (the women eating her muffin - her brain didnt intervene & say thats not your muffin)
- Distractibility
- Im-persistence (not wanting to continue to a behavior)
- confabulation (gaps in a person’s memory are unconsciously filled with fabricated, misinterpreted, or distorted information)
- Mania
- hypersexuality
Disorders Affecting Frontal Lobe neurologic
- head injury
- stroke
- Pick’s/Frontotemporal dementia
- Parkinsons
- Huntington’s
- others subcortical Frontal
- Lobotomy
- Alcohol use disorders
Disorders Affecting Frontal Lobe psychiatric
- Schizophrenia
- Depression
- OCD
- ADHD
- Psychopathy
evaluating executive function Best Test
Best test = Real world behavior, history from family or other may be more revealing than patient exam
-observations of behavior during tests of other function may capture deficits better
Behavioral observations
- Abulia spontaneity (lacking spontaneous behavior)
- Inappropriate jocularity (jocking inappropriate )
- confabulation (answering question with whatever comes to their mind, making things up)
- utilization, environmental dependency (a person is highly drawn to a stimulus, using the object for its purpose but the environment is not appropriate)
- perseveration, I’m-persistence (repeated behavior even though it doesn’t fit the situation)
Incontience
cognitive tests
Working memory
Digits backwards, months backwards
Perseveration and set-shifting ability
Luria Reciprocal Coordination & Alternating sequences
Trailmaking B, Wisconsin Card Sort
Inhibition Auditory or visual go-no tests, Stroop
Flexibility FAS, figure generation
Abstract reasoning
Similarities, proverb
interpretation, logic
Between task perseverations
switching to a different letter…words that begin with A then moving to B…patient starts repeating words words that begin with A
would be if instead of writing the peak & the plateau they reverted to ++0
within task perseveration
instead of writing ++0
where they were asked to come up with words starting with F, they said “forget, foot, fancy, friend, forget, friend” (repeating words they already said)
apraxia
neurological disorder
characterized by the inability to perform learned (familiar) movements on command, even though the command is understood & there is a willingness to perform the movement
loss of a set
is when they deviate from the rule but its not a previous rule:for the Above example if they said “Apple aardvark banana oranges lemons” thereby going by a different rule they came up with (in this case fruits) - & they aren’t reverting to a previous rule (which would be a between task persever)
“loss of filter”
would be verbal disinhibition
What is a TBI?
non degenerative, non congenital insult to the brain resulting from an external mechanical force applied to the cranium and the intracranial contents, leading to temporary or permanent impairments, functional disability, or psychosocial maladjustment
names for TBI
- traumatic brain injury
- Head injury (closed vs penetrating)
- Concussive injury
TBI also commonly have
frontal lobe damage
Glasgow Coma Scale
lowest score you can get & not be in a coma = 3
GCS Severity Classification
Severe = 3-8 Moderate = 9-12 Mild = 13-15
mild TBI defined by
13+
moderate TBI defined by
GCS 9-12
abnormal findings on CT Operative intracranial lesions
Length of hospital stay 48 hours or more
TBI Risk Groups
Males 2:1 Females
highest risk by age: 0-4 years, 15-19 years
“shaken baby” - 2nd leading cause of death for infants < 1 year age 3.
Adults 65+ highest rates of TBI - related hospitalizations & death
young drivers
TBI leading causes
- Falls (28%)
- Motor vehicle Crashes (20%) - 31.8% of TBI-related deaths due to traffic accidents
- being stuck by or against objects (19%) - 2/3rds of firearm related TBI involves suicide intent
- Assaults (11%)
