Lecture 7 - Clinical Neuropsychology - disorders of executive function Flashcards
Is dementia a disease or clinical syndrome?
It is a clinical syndrome.
Is behavioural variant frontotemporal dementia (bvFTD) a clinical syndrome or a disease?
A clinical syndrome.
A syndrome refers to the signs and symptoms that go together reliably for a given disease.
Are dementias are always slow moving, and progressive?
Do they always involve impairments to activities of daily living?
Yes.
Is it true that PET scanning is not very sensitive to tau pathology in the mesial temporal lobes?
What does this mean for using this form of imaging as a way of determing whetther someone has AD?
Yes.
PET imaging is not very sensitive to hyperphosphorylated tau in the mesial temporal lobes.
What this means is that PET imaging is normally only useful when tau pathology has spread to the lateral temporal and parietal lobes. This occurs late in disease progression and therefore it is not that helpful in terms of prevention or management. Not useful for detecting AD early in progression.
Is bvFTD caused by a tauopathy (abnormality in tau)?
Would pts with this disorder have lowered amyloid in their CSF?
Yes.
No. Amyloid fucntion is normal.
What is underlying disease that causes frontotemporal dementia?
Frontotemporal lobar degeneration (FTLD).
Degeneration of neurons in the frontal and temporal lobes.
FTD causes a focal cortical atrophy. What does this mean?
That the clinical syndrome is caused by damage/impairment to the cortex that governs the function that is impaired in the syndrome.
What does FTLD stand for?
Frontotemporal lobar degeneration.
This causes FTD.
Are there multiple clinical syndromes of frontotemporal dementia?
Yes.
They are defined by the initial presenting symptoms, such as behaviour or language. As the disease progresses they often have similar presenting symptoms.
Does FTD often present in younger people than Alzheimer’s dementia?
Yes.
What percentage of bvFTD is caused by tauopathy?
About 50%. The rest are caused by multiple different pathologies.
Are some types of FTD caused by genetics, such as abnormalities in the tau gene?
Yes. But these cases are very rare.
Is it true that in those with bvFTD that they will experience behavioural changes before abnormalities become apparent on brain imaging scans?
Yes.
Brain imaging not that helpful in detecting early stages of bvFTD.
Those suffering with bvFTD are often brought into a clinic by a family member or friend?
Why is it quite rare for someone with bvFTD to present to a clinician themselves?
Oftentimes those suffering with bvFTD do not think that there is anything wrong. This is because insight/self-awareness is a frontal lobe function. Frontal lobes are disrupted in bvFTD.
Why are cognitive tests not that helpful at the beginning stages of bvFTD?
Cognitive scores tend to remain within healthy range well into the disease. Behavioural change is what is normally apparent initially.
This is why taking a client history is so important, so that you can see whether their current behaviour is significantly different to their prior behaviour?
“Living with a child.”
“Living with a different person.”
What are some examples of executive functions?
Emotional regulation.
Social awareness and interactions.
Goal-directed behaviour.
Behavioural initiation.
What type of functions are altered in those with bvFTD?
Executive functions.
What functions are generated or controlled by the DLPFC?
Cold cognitive tasks, such as planning, making a hypothesis.
E.g. saying the days of week backwards.
What functions is the ventromedial prefrontal cortex (VMPFC) responsible for?
‘Hot’ cognitive tasks, such as emotion regulation, social awareness, empathy.
What functions is the orbitofrontal prefrontal cortex responsible for?
Response inhibition, such as not hitting someone when you’re annoyed at them.
What parts of the brain are normally damaged in those with bvFTD?
The DLPFC, VMPFC and OFPFC.
Do FTDs progressive faster than AD?
Yes.
What is a test that examines response inhibition, and is used to assess whether there may be orbitofrontal prefrontal cortex degeneration?
The Stroop incongruent trials test.
The name of colours are written in an ink that is a different colour to the word written.
Person instructed to say the name of the ink, not the word written, as fast as they can. You have to actively inhibit yourself from reading and saying the word written.
Those with orbitofrontal prefrontal cortex damage would not get good results for this test.
What test can be used to examine executive functions?
The orthohraphic Lexical Retrieval test (OLR).
People are given a letter and they need to come up with as many words starting with that letter as they can in a given amount of time.
This can very difficult for those with FTLD.
