Lecture 15+16

Question 1

declarative (explicit) memory

Answer 1

facts and events

Question 2

procedural (implicit) memory

Answer 2

skills/habits

conditioning

Question 3

Episodic Memory

Answer 3

Personally experienced events within a spatiotemporal context

Question 4

stages of memory

Answer 4

encoding - consolidation - retrieval

sensory input…. sensory memory… encode… short-term or working memory…. consolidate to long term memory

rehearsal (Helps in long term memory) and forgetting

Question 5

retrograde and anterograde amnesia

Answer 5

retrograde: forgetting past memories
anterograde: cant form new memories

Question 6

infantile amnesia

Answer 6

early childhood events cannot be remembered

Question 7

transient global amnesia

Answer 7

typically occurs in older men

recent events and recent info can only be remembered for a few minutes

could be due to TIA, basilar A migraine, physical/psych stress

Question 8

Dissociative amnesia

Answer 8

A psychological reaction to a major stressor

Question 9

Wernicke-Korsakoff amnesia (diencephalic amnesia)

Answer 9

caused by thiamin deficiency in patients with alcohol abuse

symptoms include:
confusion, confabulation, and severe memory impairment

Question 10

The Hippocampal Trisynaptic Circuit

Answer 10

1. dentate gyrus
2. CA3 pyramidal cells
3. CA1 pyramidal cells

this is the pathway that generates synaptic plasticity

Question 11

delirium

Answer 11

A delirium is a disturbance in the level of
consciousness

deficits in awareness and attention

have at least one cognitive disturbance
(deficit in memory/language, delusions)

sudden onset of symptoms
will fluctuate during the day
symptoms will start over overs to days

must be due to a physiological cause
(no intoxication)

Question 12

typical clinical presentation of delirium

Answer 12

hyperactive (increased psychomotor activity, mood liability, agitation)

hypoactive (reduced psychomotor activity, lethargic)

sleep-wake disturbances

Question 13

etiology of delirium

Answer 13

multiple: it could be from dehydration, fever, UTI

widespread brain regions impacted

deficient:
Central cholinergic functioning

Reticular Activating System and its ascending connections (important for attention and arousal)

Question 14

risk factors and course of delirium

Answer 14

risk:
poor health or older age (non-modifiable)

immobilization, poor sleep, benzo use (modifiable)

course:
symptoms go until cause is reversed
resolution can take 3-7 days
amnesia for events during episode is common
results in longer ICU stays and poor long-term survival

Question 15

treatment for delirium

Answer 15

treat the underlying medical condition
manage the symptoms

can use antipsychotics or benzos

use benzos caused by alcohol withdraw

use environmental supportive factors

Question 16

A dementia

Answer 16

Refers to multiple and severe cognitive impairment without impaired consciousness

Is usually progressive and irreversible

Most commonly occurs in the elderly

Question 17

Alzheimer’s Dementia (AD)

Answer 17

Significant memory impairment plus impairment in at least 1 other cognitive domain

a gradual onset with a steady progressive decline

exclusion of other causes such as stroke

Question 18

neuropathology of AD

Answer 18

neuroanatomical:
cortical atrophy
hippocampal atrophy
enlarged ventricles

neurochemical:
multiple neurotransmitter deficiencies
loss of cholinergic neurons

neurofunctional:
posterior hypometabolism (parietal/temporal) 

histopathological:
ß-amyloid plaques and neurofibrillary tangles

biomarkers: CSF amyloid and tau levels
PET imaging of plaques

definitive diagnosis still depends on post-mortem confirmation

Question 19

AD treatment

Answer 19

cholinesterase inhibitors:
donepezil
galantamine
rivastigmine

NMDA receptor:
memantine

AD drugs are considered ineffective
side affects: hypotension / GI

non-pharm methods
antipsychotics
anticonvulsants and antidepressants