Exam 3 Flashcards
Describe what a linear transformation of raw z-scores, t-scores, and IQ scores looks like.
Are Percentiles linear or non-linear?
(Q1)
A linear transformation is a transformation of the form X’ = a + bX. If a measurement system approximated an interval scale before the linear transformation, it will approximate it to the same degree after the linear transformation. Other properties of the distribution are similarly unaffected.
Percentiles are non-linear transformations. That is, the amount of raw score difference between 55%-60% does not necessarily represent the same amount of raw score difference as between 94%-99%
According to Posner & Peterson’s model of attention; the posterior attention system is responsible for _______________ whereas the anterior attention system is associated with ____________________
Posterior: Orienting– prioritize sensory input and locating signal sources location detection. Think: parietal=where=posterior
Anterior: signal detection / alerting. Think anterior=alerting
Alerting starts in locus coeruleus (norepi)
The most common neurologic manifestation of HIV is:
(Q5)
emotional lability and delirium associated with HIV-associated dementia.
HIV can cause encephalopathy, causing HAND.
HIV Associ Neurocog Disorder (HAND): affects cognition, motor, behavior. Pt can have low concentration, memory loss, irritability, depression, slowed motor.
Explain the difference between malingering on testing and performance related to fictitious disorder.
(Q6)
Malingering is intentional and motivated by an external reward. Factitious disorder is behavior motivated by an intrinsic reward such as assuming the sick role.
patients who are also motivated by an intrinsic reward can be demonstrating a negative response bias, but not a positive one.
True or False: There a single Standard Error of Measurement for a test score, regardless of the level of performance?
(Q7)
False.
The “Standard Error of Measurement” (SEM) refers to the statistical estimate of how much a person’s score on a test might vary if they were to take the same test multiple times, essentially representing the degree of error inherent in a single measurement, and therefore impacting how we interpret an individual’s performance on a test compared to their “true” ability level.
A single “standard error of measurement” (SEM) is not applied across all performance levels on a test; the SEM is typically calculated for the entire test and remains relatively consistent across different performance levels, but it can vary slightly depending on the specific test design and the individual’s score
What is considered the classic indication of normal pressure hydrocephalus? (classic triad of sx)
(Q8)
- Gait disturbance
- Dementia/mental decline
- urinary incontinence
Headaches are worse in AM.
What are key signs that are indicative of increased intracranial pressure?
Cushing’s Triad (hypertension, bradycardia, irregular respirations) = triad in sudden increase in ICP.
Breathing: shallow, slow, apnea
Headache worse in the morning, or when coughing, straining
Diplopia, blurry, or optic disc edema
Confusion, Attentional problems
Drowsy, nausea, low coordination
What is the difference between ICP and Normal Pressure Hydrocephalus?
Increased cranial pressure (ICP) and normal pressure hydrocephalus (NPH) are both disorders that affect cerebrospinal fluid (CSF) circulation, but they have different causes, symptoms, and treatments
ICP is caused by elevated pressure without ventricular enlargement, while NPH is caused by CSF accumulation that leads to ventricular enlargement.
Both ICP and NPH are treated by draining CSF. ICP treatments may also include breathing support and anti-swelling medications. NPH treatments traditionally involve surgery to implant a shunt that drains excess CSF to the abdomen.
ICP symptoms include headaches, blurred vision, and vomiting. NPH symptoms include gait imbalance, urinary incontinence, and dementia
ICP is also known as idiopathic intracranial hypertension (IIH) or pseudotumor cerebri. IIH is more likely to affect obese young women, while NPH is more likely to develop in adulthood.
The amygdale have been consistently identified as playing a crucial role in:
(Q9)
The perception of emotional cues and The production of emotional responses
diencephalic amnesia versus bilateral temporal lobe amnesia
(Q10)
Diencephalic amnesia - Seen in Korsakoff’s = trouble with temporal order of events.
Bilateral temporal lobe amnesia has impaired factual and long-term memory, and difficulty recognizing faces. Might have problems with temporal order, but this is more characteristic of diencephalic amnesia.
BOTH have problems with anterograde amnesia, retrograde amnesia, rate of forgetting, and autobiographical memory loss.
BOTH can occur with intact intellectual and perceptual functions.
The striatum receives most of its blood supply from the….?
(Q11)
Middle cerebral artery and Lenticulostriate arteries
Statistical significance versus clinical significance
(Q12)
Statistical significance measures the likelihood that a research finding is due to a real effect and is a direct function of sample size, while clinical significance assesses the impact of those findings on clinical practice
Explain a typical commissurotomy patient
If you placed a common object such as a key or pencil in the left hand and out of sight of the person… what would happen?
(Q14)
A commissurotomy, also known as a “split-brain” procedure, is a brain surgery that severs the corpus callosum, the area of the brain that connects the two hemispheres. This procedure is used to treat severe epilepsy in people who are unable to be controlled by anticonvulsants alone or who are not suitable for other types of surgery
The hemispheres cannot communicate in these patients, making one hand unaware of what the other is doing. And only input to the left hemisphere (i.e. the right hand) would allow verbal naming
Bipolar I versus Bipolar II
Hypomania versus Mania
(Q15)
Bipolar I
People with bipolar I experience more severe manic episodes, also known as mania, and may not experience depressive episodes. Manic episodes can sometimes cause a break from reality, known as psychosis.
Bipolar II
People with bipolar II experience less severe manic episodes, known as hypomania, and at least one major depressive episode. People with bipolar II tend to have longer and more frequent depressive episodes than people with bipolar I
Hypomania
A less severe form of mania that typically lasts a few days. It can involve increased energy, talkativeness, or irritability, but it usually doesn’t significantly impact your ability to function socially or at work.
Hypomania can evolve into mania, or it can switch to depression, and the pattern isn’t predictable
Mania
A period of at least one week of abnormally elevated or irritable mood that can severely impact your ability to function. Symptoms include increased energy, talkativeness, rapid speech, decreased need for sleep, racing thoughts, and distractibility
Mania tends to require more aggressive treatment than hypomania. Treatments for both conditions include psychotherapy, medication, and self-care strategies.
What is cortical blindness?
(Q16)
Cortical blindness (CB) is defined as loss of vision without any ophthalmological causes and with normal pupillary light reflexes due to bilateral lesions of the striate cortex in the occipital lobes. Cortical blindness is a part of cerebral blindness, defined as loss of vision secondary to damage to the visual pathways posterior to the lateral geniculate nuclei. Cortical blindness results from total destruction of the primary visual cortex.
Patients with cortical blindness may have blindsight in which they still have some perception outside of conscious awareness.
They can have anosognosia as in Anton’s syndrome and be unaware of their deficit.
Cortical blind patients can catch a ball and put an envelope in a slot
What characteristic most reliably distinguishes vascular dementia from Alzheimer’s dementia?
(Q18)
Focal neurological findings and the presence of either diffuse or focal cognitive findings is the most reliable distinguisher for VD.
While stepwise progression is associated with vascular or multi-infarct dementia, it is not a reliable distinction from AD.
MRI in vascular dementia may show infarcts but atrophy is not specific to VD.
Consolidation deficits on memory testing are indicative of AD but encoding deficits are not considered indicative of vascular dementia. In fact, memory performance on testing is often better than seen in AD.
Both achromatopsia and prospognosia are caused by lesions … where?
fusiform gyrus of the occipitotemporal cortex
The “fusiform gyrus of the occipitotemporal cortex” refers to a specific brain region located on the underside of the temporal and occipital lobes, primarily involved in high-level visual processing, particularly the recognition of complex stimuli like faces, and considered a key part of the ventral visual pathway; essentially, it’s a part of the occipitotemporal cortex known as the fusiform gyrus, which is spindle-shaped and crucial for object recognition and visual categorization.
It forms part of Brodmann area 37, along with the inferior and middle temporal gyri.
Describe the thalamic nuclei
There are about 60 nucelei.
The thalamic nuclei are groups of cells in the thalamus, an egg-shaped structure in the center of the brain that relays sensory and motor information
The thalamus is divided into three groups of thalamic nuclei on each side: lateral, medial, and anterior.
Each sensory system, except for olfaction, has a thalamic nucleus that receives, processes, and sends information to the associated cortical area. For example, the lateral geniculate nucleus receives visual information from the retina and sends it to the visual cortex
https://www.youtube.com/watch?v=L8SezbBHWJI
Sensitivity vs specificity
(Q21)
“sensitivity” refers to a test’s ability to correctly identify individuals who have a disease (i.e., detecting true positives)
“specificity” refers to a test’s ability to correctly identify individuals who do not have a disease (i.e., detecting true negatives).
Essentially, sensitivity focuses on catching all cases of a disease, while specificity aims to minimize false positives.
Explain these things… and for god’s sake stop confusing them…
Retrograde amnesia
Proactive interference
Anterograde amnesia
Retroactive interference
(Q22)
Retrograde amnesia is a form of memory loss that causes an inability to remember events from the past
Retroactive interference is when new information makes it difficult to recall previously learned information
Anterograde amnesia is a type of memory loss that occurs when you can’t form new memories
Proactive interference is when previously learned information makes it difficult to learn or recall new information. Think: Proactive=Trial B on CVLT
What are the primary diffuse modulatory systems in the brain, along with their associated neurotransmitters and nuclei
(Q23)- dont understand this Q
A “diffuse modulary system” is a group of neurons that influences many other neurons in the brain (AKA a nucleus)
Noradrenergic system:
Neurotransmitter - Norepinephrine (noradrenaline), Nucleus - Locus coeruleus
Serotonergic system:
Neurotransmitter - Serotonin (5-HT), Nucleus - Raphe nuclei
Dopaminergic system:
Neurotransmitter - Dopamine, Nucleus - Ventral tegmental area (VTA) and substantia nigra pars compacta
Cholinergic system:
Neurotransmitter - Acetylcholine, Nucleus - Basal forebrain complex (including Basal Meynert+medial spetal nucleus) + mesopontine tegmentum
A lesion in the cerebellum will cause upper extremity tremor: ipsilateral or contralateral ?
(Q26)
Ipsilateral
Cerebellar circuits decussate twice before reaching the lower motor neurons. Therefore, each side of the cerebellum controls the same side of the body, not the opposite side
Trunk is more medial and extremities are lateral in cerebellum
Describe the longitudinal course of neurocognitive impairments in individuals with schizophrenia
(Q27)
Measureable cognitive deficits, most often in attention, are seen prior to the first psychotic break
Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits pre-date the onset of frank psychosis and are stable throughout the course of the illness in most patients (not degenerative).
Meds don’t fix EF problems
Atrophy associated with normal aging generally reflects a loss of:
myelin / gray matter / white matter?
(Q30)
Myelin
Myelin sheaths can degenerate, forming splits and balloons. This can lead to a disruption in the timing of neuronal circuits, which may contribute to cognitive decline
what is Delusional Disorder, Erotomanic Type
(Q32)
People with erotomania may believe that someone important or famous is in love with them, and may try to contact them or stalk them. They may also experience obsessiveness and fantasizing
The Papez circuit refers to:
(Q33)
Neuroanatomical structures involved in emotion and memory, including hippocampus, cingulate, mamillary bodies, fimbria, and insula
MATCH
Mamillary bodies
Anterior Thalamic Nuclei
Cingulate gyrus
Hippocampus
In reviewing a patient’s medical records prior to an assessment you notice that the patient is reported to have a deficit of the first cranial nerve (CN I). You expect the patient to:
a) Perform poorly on tests requiring visual scanning and also have difficulty in recognizing friends’ voices
b) Perform poorly on the Smell Identification Test, and also have difficulty with impulse control
c) Perform poorly on tests involving auditorily-presented information and also have difficulty in recognizing friends’ voices
d) Perform poorly on the Smell Identification Test, and also have agraphesthesia
(Q34)
b) Perform poorly on the Smell Identification Test, and also have difficulty with impulse control
BUT this confuses me… 1 is Olfactory, and its a Sensory nerve… so I picked d here…
CN 1 is right next to orbitomedial PFC so if CN1 is damaged, that part of PFC may also be damaged. OFC damage can cause impulsivity.
graphasthesia (recognizing letters or # written on skin) is processed in somatosensory cortex
You are designing a longitudinal study of neuropsychological outcomes in normal adults utilizing the same test battery for 4 assessments over a 4 year span. Which of the following statements is most true regarding practice effects:
a) An equal improvement in the test scores across the four assessments is expected, due to practice effects.
b) The greatest improvement in test scores due to practice effects will be evident between the first and second assessments.
c) The greatest improvement in test scores due to practice effects will be evident between the third and fourth assessments.
d) Practice effects are unlikely if the assessments are at least one year apart
(Q36)
b) The greatest improvement in test scores due to practice effects will be evident between the first and second assessments.
ok fine.
Describe the Flynn Effect
(Q37)
The Flynn effect is a statistical phenomenon that describes the increase in average IQ scores over time
IQ scores increase at a rate of about 0.33 points per year, or 3.3 points per decade
The Flynn effect suggests that people are more likely to score higher on an older version of an IQ test than on a current version
Some possible explanations for the Flynn effect include:
Education: The tenor of education has changed, with more people having access to higher quality education.
Access to information: The internet has made it easier to research almost any topic.
Exposure to complex tasks: The world has become more complex, with new inventions and developments requiring a developed mind to understand them.
Improved nutrition: The average adult in an industrialized nation is taller than a comparable adult of a century ago.
However, a study from Northwestern University found evidence of a reverse Flynn effect in the United States between 2006 and 2018. In this study, scores for verbal reasoning, matrix reasoning, and letter and number series dropped, while scores for 3D rotation generally increased
Deficits in what cognitive domain is most commonly seen in early deterioration of children with x-linked adrenoleukodystrophy?
(Q38)
Visual-perception
This is a neurodegenerative condition seen in children that typically involves cerebral demyelination. Cognitive dysfunction is generally correlated with the extent of white matter changes on MRI. Hematopoetic stem cell transplant is the most effective treatment. Visual-spatial functioning is an excellent predictor of neurocognitive function after stem cell transplant for cerebral X-ALD. See work of Elsa Shapiro; Cox et al (2006), Archives of Neurology, 63; 69-73
The limbic system is important for _ _ , which involves this key structure ___
Which are the pairs:
4 Functions: 4 Structures
(Q42)
The limbic system is located deep within the brain, beneath the cerebral cortex and above the brainstem.
Procedural memory is often associated with the….
(Q43)
Procedural memory is considered a type of implicit memory, meaning you don’t have to consciously recall the steps to perform an action, it just happens automatically
The basal ganglia and cerebellum are key brain structures involved in procedural memory processing, also motor cortex in general.
In patients in the early stages of Alzheimer’s disease, WAIS profiles usually show:
a) Block Design is higher than Vocabulary
b) High scores are obtained on Information, Vocabulary, and Comprehension
c) High scores are obtained on digit symbol and digits backward
d) Low scores are obtained on similarities and digits forward
(Q44)
b) High scores are obtained on Information, Vocabulary, and Comprehension
Early Onset AD patients displayed worsened deficits in visual perception, praxis, and executive tasks (p < 0.05) in a 2022 study.
EO cases have worse prognosis.
EO with APOE have worse prognosis.
In Lewy Body Dementia, Lewy bodies are found in the ____
(Q46)
They can be found throughout the brain, but are particularly prevalent in the
cerebral cortex,
midbrain,
brainstem
Lewy bodies are primarily made up of a protein called alpha-synuclein which clumps together abnormally
The presence of Lewy bodies disrupts the normal function of brain cells, leading to symptoms of Lewy Body Dementia like cognitive decline, visual hallucinations, and motor impairments
Explain a bit about ..
Progressive supranuclear palsy (PSP)
Progressive supranuclear palsy (PSP) is a rare neurological disorder that affects body movements, walking and balance, and eye movements.
PSP is caused by damage to nerve cells in areas of the brain that control thinking and body movements.
People with progressive supranuclear palsy have higher amounts of a protein called tau in the brain. Higher levels of tau cause nerve cells to die.
Sometimes called Atypical Parkinsonism
One of the motor neuron FTD
Supplementary motor area partial seizures often include…
(Q48)
Fencing posture with extension of contralateral upper extremity, tonic posturing, speech arrest and unusual sounds
A supplementary motor area (SMA) seizure is a type of frontal lobe epilepsy that causes brief, sudden tonic posturing of one or more extremities. Other characteristics include:
Vocalization
Consciousness is initially preserved
Frequent seizures, up to 10 per day
Most often occur during sleep
The tonic posturing is often described as a fencing posture
SMA seizures are often misdiagnosed as pseudoseizures or sleep disorders. However, clinical phenomena can help distinguish between the two:
SMA seizures: Short in duration, stereotypic, and often occur during sleep. They often present with a tonic contraction of the upper extremities in abduction.
Pseudoseizures: Long in duration, nonstereotypic, and occur in the awake state.
The supplementary motor area controls a number of functions, including: Postural stabilization, Coordination of both sides of the body, Control of internally generated movements, and Control of sequences of movements
Posner & Peterson (1990) attention model includes what 3 parts
- anterior network - alerting - NorEpi
- posterior network - orienting - Ach
- executive control network (aka focal attention, selective attention) - Dopamine
Major types of seizure / classification of seizures
Heritability of Huntington’s
autosomal dominant (not sex linked) - so 1 copy will cause expression of disease.
50% chance of expressing when 1 parent has disease.
It’s from CAG repeats on chrom #4 (IT-15 gene aka HTT gene); more repeats predicts worse disease and earlier onset of disease.
More repeats are likely to happen when father passes the gene
Marfan’s syndrome
SX are mild to severe
autosomal dominant genetic disorder
Affects connective tissue
sx [sounds like Gumby]:
tall, long thin limbs, short torso, arm wingspan is longer than height, long narrow face, loose joints, chest caves in or out
Impaired: organs, blood vessels, bone deformities
Neglect is considered to be a failure to respond/report or orient to novel stimuli due to ….
(Q70)
Focal and possibly generalized lesions involving right parietal/frontal lesions
A lesion in the right lateral geniculate nucleus (LGN) of the thalamus, may cause…
(Q81)
Left homonymous visual field defects
A left homonymous visual field defect, also known as homonymous hemianopia, is a condition that causes a person to lose vision in the left half of their visual field in both eyes
Which of the following tumors would be most likely to cause bitemporal hemianopia?
a. Meningioma
b. Medulloblastoma
c. Pituitary adenoma
d. Pineoblastoma
(Q92)
Pituitary adenoma
A pituitary adenoma is a benign tumor that grows in the pituitary gland, which is located at the base of the brain. Pituitary adenomas are also known as pituitary neuroendocrine tumors (PitNETs)
Bitemporal hemianopsia is a partial loss of vision in the outer half of both the right and left visual fields. It’s usually caused by damage to the optic chiasm, the area where the optic nerves from each eye cross near the pituitary gland
Pituitary adenomas are usually slow-growing and can be classified by their size and whether they produce hormones
Symptoms of pituitary adenomas include:
Headaches
Vision problems
Weight gain
Easy bleeding or bruising
Changes in bone structure
Menstrual irregularities
Lactation
Erectile dysfunction
Heat intolerance
