Mental/Cognition/Learning Flashcards
communication
what is it, what means are used
exchange of information through common networks or system of symbols
language
formal set of rules used in communication for information and transfer of information by way of symbols
verbal communication
the produced sounds
nonverbal communication (10)
- hand gestures
- sign language
- eye contact
- body language
- written information
- facial expression
- gestures
- nodding
- information
- pitch and loudness of voice
Language Function
–what complex process does communication using language use?
communication using language involves a complex process IN RECEPTIVE LANGUAGE FUNCTION 1. hearing 2. comprehension
OUT EXPRESSIVE LANGUAGE FUNCTION 3. thought/word finding 4. voice production 5. articulation (motor control)
Language Function
Sensory Component
- visual (body position, face)
2. auditory (tone of voice, loudness, softness)
Language Function
motor component
- oral
- written
- gestures
Neuroanatomy of Language
- sensory
- motor
- articulate fasiculus
Sensory:
- primary auditory area: superior central gyrus (Heschel’s Gyrus)
- auditory association cortices: area 42 of superior temporal gyrus (Heschel’s Gyrus)
* *Wernickes area is in superior central gyrus
Motor
Broca’s area–located in the frontal lobe near the primary motor cortex
Articulate Fasiculus: connects brocas and wernickes area
Articulate Fasiculus:
connects two important areas for language use:
Broca’s area in the inferior frontal gyrus and
Wernicke’s area in the posterior superior temporal gyrus
Aphasia:
What is it
How does it effect the motor production of speech?
What centers are involved?
Name them (7)
inability to use language to communicate
- motor production of speech is not impaired
- the language centers are involved
- Wernicke’s aphasia
- Broca’s Aphasia
- Sensory/receptive aphasia
- expressive/motor aphasia
- semantic paraphasia
- phonemic paraphasia
- global aphasia
Wernicke’s Aphasia
what disability?
what is intact?
They cannot understand written or spoken words
FLUENT but words are MEANINGLESS
word salad: “door paper, fish, knife, banana, spoon”
LOW comprehension
HIGH production
**NOTE: they still have nonverbal communication and cab both express themselves and understand others nonverbally
bavel
Broca’s Aphasia
what disability?
what is intact?
NONFLUENT aphasia
(more common)
- no motor problem but they cannot produce words
- they HAVE comprehension but CANNOT get the words out
- -can be mute or certain words are difficult to say–word on the tip of tongue but cannot get the words out
- –may show telegramatic speech: overwhelm with gestures trying to get the words out - automatic language intact – can sing happy birthday–melodic intonation therapy
- LOW production
HIGH comprehension
Who would you test and ask to repeat:
“no ifs ands or buts?
Brocas Aphasia
they have a hard time with short words, connecting words, pronouns are hard for them
Sensory/receptor aphasia
what disability?
what is intact?
Wernicke’s Aphasia or fluent aphasia
patient cannot understand the written and/or spoken word despite intact hearing and vision
fluent speech that is often meaningless (unable to self monitor)
CAN do nonverbal communication
Expressive/motor aphasia
what disability?
what is intact?
broca’s aphasia/nonfluent aphasia
–have full understanding only cannot produce –strategy to ask YES/NO questions
inability to produce words but no problems with motor apparatus of speech
**spoken and written language (can draw pictures)
patient appears to hesitate, tries to adjust for errors
range of disability from problems with word finding to complete loss of speech
automatic language is usually intact (ie singing)
commonly have hemipareisis
Which aphasia:
inability to produce words but no problems with motor apparatus of speech
Broca’s
Which aphasia
patient cannot understand the written and/or spoken word despite intact hearing and vision
Wernicke’s
which aphasia
range of disability from problems with word finding to complete loss of speech
Broca’s
Which aphasia
fluent speech that is often meaningless (unable to self monitor)
Wernicke’s
which aphasia
CAN do nonverbal communication
both Broca and Wernicke’s
Which aphasia
automatic language is usually intact (ie singing)
Broca’s
Which aphasia
strategy: have full understanding only cannot produce –strategy to ask YES/NO questions
Broca’s
T/F
Broca’s Can draw Pictures
TRUE
Does Broca’s have:
agraphia?
alexia?
they have agraphia: cannot write
they do NOT have alexia
they can understand
Wernicke’s have:
agraphia?
alexia?
they can write but it will not make sense
they DO have alexia
Wordfinding Problems
what is the sx
name 2
patient appears to know what to say but cannot get the words out
semantic paraphasia
phonemic paraphasia
what type of aphasia commonly in hemiparesis
Broca’s Aphasia
semantic’s paraphasia
substitution of a similar word
phonemic aphasia
use of a similar sounding word – either real or neologistic
“I am holding a fen”
During a naming assessment task the following error type occurs;
Ex. target word: apple
Pt. response: fruit, pie, orange
a. semantic paraphasia
b. phonemic paraphasia
c. circumlocution
d. neologism
a. semantic paraphasia
An individual with aphasia produces a nonesense word or phrase bearing no apparent relationship to the target, he is exhibiting what kind of naming error? Target: cheese Response: butkey a. semantic paraphasia b. phonemic paraphasia c. circumlocution d. neologism
d. neologism
Aphasia naming errors that produce a real word but bear no apparent relationship to the target word is called a(n) ____________ error.
Target: car
Response: Moon
a. circumlocution
b. phonemic paraphasia
c. neologism
d. unrelated word
d. unrealted word error
An individual with aphasia produces a phonologically similar word such as Maggots for Maggie he has performed a(n) _________.
a. semantic paraphasia
b. phonemic paraphasia
c. circumlocution
d. neologism
b. phonemic paraphasia
An individual with Aphasia gives a meaningful description of the targeted word but never produces the target during a confrontation naming task, what error has occured?
a. semantic paraphasia
b. phonemic paraphasia
c. circumlocution
d. neologism
c. circumlocution
agraphia
cannot write or print words BUT upper extremity strength and coordination are intact
alexia
which aphasia can/cannot
cannot read printed words
BROCA’s CAN READ
which aphasia is fluent
wernicke
which aphasia is nonfluent
broca
which aphasia has alexia
wernicke’s
which aphasia has agraphia
broca’s
which have wordfinding problems:
PD
MS
SCI
BRain tumor
brain tumor–depending on where the lesion is
NOT parkinsons
NOT SCI
MS it is rare
Global aphasia
–what is it
–what can they do
–what causes it
both systems are affected: sensory and expressive (receptive and motor)
combined aspect of sensory and expressive aphasia
ability to gesture can be retained
large cortical lesion (MCA)
associated with hemiparesis
Dysarthria
what is it
cause
sx
speech production affected by
- weakness
- dyscoordination
- spasticity
- hypotonia
–nothing is wrong with comprehension, only speech production
IT IS NOT APHASIA
- speech is often slurred or distorted
- different types of dysarthria that depend on location of the injury
- phonation, respiration, resonance, prosady of speech, intonation, articulation, lack of motor control, or strength, breath support
is dysarthria a type of aphasia
dysarthria is NOT a type of aphasia
condition where speech is often slurred or distorted
dysarthria
speech production affected by
- weakness
- dyscoordination
- spasticity
- hypotonia
-phonation, respiration, resonance, prosady of speech, intonation, articulation, lack of motor control, or strength, breath support
ataxic dysarthria
what is it
what causes it
often sounds intoxicated (overshooting)
cerebellar lesion
need to control motor
disdiachokinesia to rapidly alternate movements
dysphonia
what is it
what causes it
hoarsness or low quality voice production
damage to vocal cords, throat, glossopharyngeal nerve
wiki: an impairment in the ability to produce voice sounds using the vocal organs (it is distinct from dysarthria which signifies dysfunction in the muscles needed to produce speech). Thus, dysphonia is a phonation disorder. The dysphonic voice can be hoarse or excessively breathy, harsh, or rough, but some kind of phonation is still possible (contrasted with the more severe aphonia where phonation is impossible).
aphonia
what is it
what causes it
is it aphasia
inability to speak
NOT APHASIA
often due to bilateral damage to reccurent laryngeal nerves
motor –> speech output is gone
wiki: Aphonia is the inability to produce voice. It is considered more severe than dysphonia. A primary cause of aphonia is bilateral disruption of the recurrent laryngeal nerve, which supplies nearly all the muscles in the larynx. Damage to the nerve may be the result of surgery (e.g., thyroidectomy) or a tumor
LITTLE MERMAID
Mental Status and Cognition
what should we observe in a patient
check appearance, posture, movement patterns
get a general sense of mood, affect, behavior, mental processing
make a decision about how to guide your questions to begin to assess mental status
Components of Mental Status (7)
- level of consciousness
- orientation to TIME, PLACE, PERSON
- attention
- concentration
- memory
- judgement
- language
What is the spectrum for level of consciousness?
Most–>least
- Alert (and oriented)
- lethargy-drowsy, inattentive, can participate with a stimulus and then go back to sleep
- obtunded: difficult to arouse and when arouse are confused and disoriented
- stupor: need noxious stimuli to awaken: sternal rub
- coma: semicoma, deep coma–cannot be arroused
Define: Alert
awake and attentive
highest level of consiousness alert lethargy obtunded stupor coma
Define: Lethargy
drowsiness or inattentive, will wake up on command and participate for a short interval of time (somnolence)
alert lethargy obtunded stupor coma
Define: obtunded
difficult to arouse, when aroused confused and disoriented
alert lethargy obtunded stupor coma
stupor
great effort to arouse, minimal physical and mental activity inadequate response to events
alert lethargy obtunded stupor coma
coma
unable to arouse
alert lethargy obtunded stupor coma
Semicoma
what does a pt respond to/what doesnt a pt respond to
what is a pts presentation
light coma
NO response to: verbal stimulus
RESPONDS TO: Pain (pressure into nailbed)
Presentation:
1. no movement except for decorticate/decerebrate positioning (a type of reflex)
- wandering or disconjugate eye movement (eyes wander in random fashion, not really fixating)
- decreased reflex activity, (babinski)
- may make sounds (unconnected to stimuli or the environment)
Does a semicoma patient show movement?
no movement except for decorticate/decerebrate positioning (a type of reflex)
Does a semicoma patient move eyes?
wandering or disconjugate eye movement (eyes wander in random fashion, not really fixating)
Does a semicoma patient speak?
may make sounds (unconnected to stimuli or the environment)
Does a semicoma pt show reflexes?
decreased reflex activity, (babinski)
Decorticate Posture
- what causes it
- what is the presentation
- cause
Lesion in the Premotor Cortex
or
Higher corticospinal tract lesion - presentation
FLEXION of the upper extremity
ADDUCTION of the shoulder
EXTENSION of the lower extremity
What do the extremities do in decorticate posture?
FLEXION of the upper extremity
ADDUCTION of the shoulder
EXTENSION of the lower extremity
Decerebrate Posture
- what causes it
- what is its presentation
- lesion in:
1. high brainstem at intercollicular area
2. midbrain and
3. pons
EXTENSION OF ALL EXTREMITIES
PRONATION OF ARM
FLEXION OF WRISTS
What do the extremities do in decerebrate posture?
EXTENSION OF ALL EXTREMITIES
PRONATION OF ARM
FLEXION OF WRISTS
Deep Coma
- response to painful stimuli
- level of movement
- reflexes
- respiration
- pupills
- eye status
no consistent response to verbal or painful stimuli
no movement
decreased or sporadic reflexes
decreased respiration
pupillary abnormalities are common
eyes may be open
T/F
In deep coma have eyes open
eyes may be open
T/F
in deep coma have respiration
have decreased respiration
T/F
deep coma have reflexes
decreased or sporadic reflexes
Irreversible Coma
- autoregulation
- cerebral artery activity
- EEG
brain death
loss of cerebral auto-regulation
intracranial circulatory arrest
–>necrosis–>stopping of meaningful cerebral activity
flat EEG
Coma Vigil
what reflexes are present?
what level of mental functioning?
special condition of coma
- increased DTR
- babinski sign
- no pupillary light reflex but may visually track
awake day and night but no higher mental functioning. lighter coma in the day than at night
other terms:
akinetic mutism
wakeful unresponsiveness
locked in syndrome
what deficit?
what can they do?
what causes it?
when do we commonly see it?
CANNOT speak, smile, or move
AWARE of environment and CAN communicate with eye movement
interruption of corticobulbar and corticalspinal
causes paralysis of lower cranial nerves and quadriplegia
Basilar Ponitne destruction or infarction
END STAGE OF ALS
How to test decreased consciousness
intensity of stimuli:
- call patient by name, normal tone
- call name in loud voice
- light touch on arm
- vigorous shake on shoulder
- painful stimulus on nailbed finger or toe
- noxious stimulus with sternal rub
HIGHEST LEVEL OF RESPONSE
- degree and quality of movement
- presence of coherent speech
- eyes open, eye contact
- what happens when stimulus off
Glasgow Coma Scale
- what does it judge
- what type of scale is used
- what does it describe
- what does it evaluate
- what is the highest score
- why use it
- WHAT SCORE INDICATES COMA
- judge immediate level of coma
- use ordinal data to
- briefly describe patient response following verbal cue or painful stimuli
4. evaluates 3 response categories: eye opening best verbal response best motor response
- highest score is 15
eyes (4), verbal (5), motor (6) - use it to monitor sudden changes in patient status and prognosis of coma
- IF IT IS LESS THAN 8 IT IS A COMA
Why use the glasgow scale
use it to monitor sudden changes in patient status and prognosis of coma
What score on glasgow coma scale indicates coma
8/15
GCS: Eye Opening 4 3 2 1
4 spontaneous: open eyes indep
- speech: open eyes when asked
- pain: open eyes with pressure
- pain: does not open eyes
GCS Motor 6 5 4 3 2 1
6: command: follow simple command
5: pain: pull examiner hand away
4. pain: pulls own body part away
3: pain flex body inappropriately to pain (decorticate posturing)
2. pain: body becomes rigid in extension upon pain (decerebrate posturing)
1: pain: no motor response to pain
GCS: verbal Response 5 4 3 2 1
5: speech: carries on conversation incl orientation
4: speech: seems confused or disoriented
3: talks so the examiner can understand but doesnt make sense
2. makes sounds the examiner cannot understand
1: no sounds made
B. Orientation to Person, Place, Time
what to assess
findings
during interview ask questions about:
TIME: day, week, month, season, year
PERSON: to self and/or others
PLACE: current setting, city, state, country
situation: current situation
FINDINGS:
INTACT: A.O. X 3 (or x4)
IMPAIRED: alert but not oriented to time and place
C. Attention
ability to concentrate on a specific stimulus without being distracted by a second stimulus (by an extraneous stimulus)
vigilance
ability to concentrate on a stimulus for > 30 seconds
inattention
2 types
clinical inattention: inability to pass a formal attention test [ie digit repetition test, normal 5-7]
specific inattention: inability to notice 2 stimuli presented at the same time. make sure the primary sensations are intact for that modality
Clinical Inattention
inability to pass a formal attention test
Tests for clinical inattention
- Digit repetition: normal 5-7
- Trails A and B:
A = average, 29 seconds, impaired >78 seconds
B= average 75 seconds, impaired >273 seconds
Trail making test: parts A and B
TEST FOR CLINICAL INATTENTION
Pt connects numbers in ascending order
***In homonymous hemianopsia would have a problem: in R homonymous hemianpsia the L eye works and the R eye does not work
Trails A and B:
A = average, 29 seconds, impaired >78 seconds
B= average 75 seconds, impaired >273 seconds
Specific Inattention
inability to notice 2 stimuli presented at the same time
make sure the primary sensations are intact for that modality
- auditory inattention:
sound heard at one ear and not the other, may not be hearing impaired but unable to comprehend spoken language - visual inattention:
letter cancelation test: cross out the A from a paper with As and Es (need to see if have homonymous hemianposia or field cut on one side so stimulate each field of vision) - tactile inattention:
stimulus or location on body
-double simultaneous extinction test
extinction phenomenon: supress recognition of one stimulus one one side of body
Specific Inattention:
Auditory Inattention
auditory inattention:
sound heard at one ear and not the other
may not be hearing impaired but unable to comprehend spoken language
Specific Inattention:
Visual Inattention
letter cancelation test: cross out the A from a paper with As and Es
(need to see if have homonymous hemianposia or field cut on one side so stimulate each field of vision)
Specific Inattention:
tactile inattention
stimulus or location on body
-double simultaneous extinction test
extinction phenomenon: supress recognition of one stimulus one one side of body
Interpretation of Specific Inattention
polymodal vs unimodal
polymodal: all sensory modalities affected
unimodal: one sensory modality affected
common syndromes involving inattention (8)
- anxiety + depression
- diffuse brain dysfunction,
- metabolic disturbance
- post surgical state
- systemic infection
- FRONTAL LOBE or limbic system lesions
- -apathy to surroundings
- -inaccurate random letter test
- –preservation
- –digit repetition is usually ok - PARIETAL LOBE LESION
either hemisphere, contralateral inattention to tactile - RIGHT HEMISPHERE LESION:
inattention and also see denial, unilateral neglect, extinction
Memory
- what is it
- what does it involve (4)
- prerequisites
retention of learned information and experiences
it involves:
- attention to information
- encoding of information
- storage of information
- retrieval of information
prerequisites
1. normal sensation, motion, and language
2 hippocampus-store and encode: cortical and subcortical function
Memory Processing
4 steps
- INPUT: register the specific sensory modality
- HOLD IT TEMPORARILY: short term memory (anterior hippocampus)
- STORE IT: long term memory (need limbic system)
- RECALL IT: need limbic system
what steps of memory processing need the limbic system?
hold temporarily-anterior hippocampus
store it
recall it
Immediate/Short term memory
how long?
recall after a few seconds
Recent Memory
how long?
remember day to day events, learn, retrieve a few hours later
Remote/long term memory
recall past events
Anterograde Amnesia
memory deficit:
cannot learn new material
(material post CNS insult event in which loss of consciousness)
Retrograde Amnesia
memory deficit:
cannot remember events prior to CNS insult
Psychogenic Amnesia
block out a period of time:
cannot remember the moment of the loss of consciousness
–due to emotional trauma have a blank space
Testing Memory
- short term memory
- recent memory
- remote memory
- new learning ability
- short term memory:digit repetition test
- orientation to person, place, time
- recent memory: recall 4 unrelated words in 10 minutes then in 30 minutes
remote memory: ask patients questions such as past presidents (personal information is not ideal, we wont even know if it is true)
-new learning ability
Syndromes Associated with Memory
- Alzheimer’s Disease
- Korsakoff’s Syndrome
- Anxiety Disorders
- Dissociative States
Alzheimer’s Disease
new learning and recent memory is impaired
ANTEROGRADE and RETROGRADE worsten
Korsakoff’s Syndrome
thiamine deficiency associated with ETOH abuse and malnutrition
organic amnesia state
RETROGRADE is INTACT
ANTEROGRADE CANNOT be formed
Anxiety Disorder
effect on memory
functional memory disturbances
Dissociative State
effect on memory
psychogenic amnesia
(block out a period of time:
cannot remember the moment of the loss of consciousness
–due to emotional trauma have a blank space)
-wiki: In psychology, the term dissociation describes a wide array of experiences from mild detachment from immediate surroundings to more severe detachment from physical and emotional experience. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.[1][2][3][4] Dissociative experiences are further characterized by the varied maladaptive mental constructions of an individual’s natural imaginative capacity.[citation needed]
Judgement:
define
test
use of a good sense or sound thought process to make a DECISION
test: hypothetical questions about hypothetical real events
ie what would you do if there was a fire in that wastebasket
Reasoning
ability to DRAW CONCLUSIONS and PROBLEM SOLVE when dealing with abstract thoughts
test for concrete thinking
test: explain the phrase: a rolling stone gathers no moss ( People who are always moving, with no roots in one place, avoid responsibilities and cares)
TBI patient will not get the metaphorical meaning
Mini Mental Status Examination
questions
scoring
what it is used for
7 componentes
30 questions scoring: ---normal: >28/30 ---mild dementia: 20-26 ---moderate dementia: 10-19 ---severe dementia < 10
used to assess cognition
includes:
- orientation
- registration
- attention
- calculation
- language
- basic motor skills
- memory
Scoring the Mental Status Exam
- –normal: >28/30
- –mild dementia: 20-26
- –moderate dementia: 10-19
- –severe dementia < 10
What components are represented in the mental status exam
includes:
- orientation
- registration
- attention
- calculation
- language
- basic motor skills
- memory
declarative memory:
remember words and concepts
procedural memory
retain physical motor skill
**PT SESSION!!!!
distinctive center, may not remember learning it but can improve on those learned motor skills
