Midterm 2 General Deck

Question 1

What is specific disorders (focal damage)?

Answer 1

The disorder depends on the area of of the brain affected (bullet wounds, strokes)

Question 2

What is generalized disorders (widespread damage)?

Answer 2

The disorder affects multiple cognitive abilities(Closed head injury, dementing disorders, demyelinating diseases, toxic substances)

Question 3

Aphasia

Answer 3

Lack of ability to understand or express SPEECH

Question 4

Apraxia

Answer 4

Inability to link skilled MOTOR movements to ideas or representations

Question 5

Agnosia

Answer 5

Deficit in recognizing OBJECTS that occurs in the absence of deficits in sensory processing

Question 6

Acalculia

Answer 6

The inability to perform simple mathematic calculation the patient previously knew

Question 7

Explain the types of dementias?

Answer 7

Cortical - co-occurance of many cognitive deficits including aphasia, apraxia, agnosia, acalculia, visuapatial defecits and memory problems (Alzheimer’s, Frontotemporal dementias)

Subcortical - More likely to manifest as personality changes, attention deficits, slowness in cognitive processing, difficulties with task requiring strategy (parkinsons, huntingtons)

Mixed - Vascular dementia, lewy body dementia. Mix of both

Question 8

Alzheimer’s Dementia

Answer 8

1. Impaired memory
2. Impairment in at least one other cognitive domain
3. Impairs social or occupational functioning
4. Gradual onset and continual decline

Question 9

Dementia With Lewy Bodies (DLB)

Answer 9

Presence of Lewy Bodies (alphasynuclein
neuronal inclusion bodies).
• Similar to AD in terms of cognitive
features and can sometimes be
confused with it, however it also
includes other symptoms e.g.
• Bradykinesia, rigidity (similar to Parkinson’s)
• Recurrent and well-formed hallucinations
• Memory deficits less severe than AD but visuospatial
deficits are more severe than AD.

Question 10

Frontotemporal Dementia (FTD)

Answer 10

No amnesia in the early stages
• Clinical syndrome associated with
shrinkage of the frontal and temporal
lobes
• Impulsive or bored and listless
• Inappropriate social behaviors
• Neglect of personal hygiene
• Repetitive or compulsive behavior
• Speech problems, semantic deficits

Question 11

Vascular Dementia

Answer 11

Also known as MULTI-INFARCT DEMENTIA (MID)

Caused by blockages in the brain’s blood supply
• The second most common form of dementia (behind
Alzheimer’s)
• May cause or exacerbate Alzheimer’s (complicates
diagnosis as vascular factors contribute to AD).
• Cognitive Profile:
• More impaired than AD patients on executive function
• Less impaired on episodic memory

Question 12

What are the risk factors if vascular dementia?

Answer 12

High blood pressure (about 50%
can be caused by hypertension)
• Diabetes
• High cholesterol
• Family history of heart problems
• Obesity
• Smoking

Question 13

Neuropathology

Answer 13

Degeneration of dopamine (DA) producing neurons in the brain (substantia nigra)

Question 14

What are the motor symptoms of Parkinson’s disease?

Answer 14

*Tremor
• Bradykinesia
• Rigidity

Question 15

What are the neuropsychiatric symptoms of Parkinson’s disease?

Answer 15

Executive dysfunction
• Memory deficits
• Attention deficits
• Visuospatial deficits
• Mood disturbances
• Impulse control behaviors (e.g. food, drugs, gambling)

Question 16

What are the Pharmacological treatment of Parkinson’s?

Answer 16

e.g. Levodopa
• Raise dopamine levels but will stop working eventually
as the cells producing dopamine will continue to
degenerate

Question 17

What are the surgical treatment of Parkinson’s?

Answer 17

• Deep brain stimulation (to stimulate dopamine
  production)
  • Lesions (to destroy the globus pallidus which is
  involved in motor control) - outcomes vary.

Question 18

Amyloid Plaques?

Answer 18

Protein Aggregates

• Insoluble extracellular deposits
which accumulate in the cortex and
hippocampus.
• Composed of amyloid – beta (Aß)
protein fragments: Aß40 and Aß42.

Question 19

Neurofibrillary Tangles

Answer 19

intracellular p-tau protein

* Bundles of insoluble helical fibers
within neurons.
• Composed of hyperphosphorylated
tau proteins that are normally
associated with microtubules.

Question 20

What is the only clearly and reliably identified risk factor of AD?

Answer 20

ApoE4.
but it’s only a risk factor and does not
mean if you have it you will get the disease.

Question 21

Tau Proteins

Answer 21

proteins that stabilize microtubules

microtubule-associated-proteins

Question 22

What is a tauopathy?

Answer 22

A class of neurodegenerative diseases that is
associated with pathological aggregation of tau protein
in the brain.

1. Alzheimer’s
2. Chronic Traumatic encephalopathy
3. Frontotemporal Lobar Degeneration

Question 23

Chronic Traumatic Encephalopathy

Answer 23

Progressive degenerative disease occurring in those
with multiple concussions and head injuries.

e.g. athletes

Question 24

What do three subtypes of Frontotemporal Lobar Degeneration share?

Answer 24

All share some common features
- à progressive decline in frontal
and temporal lobes.

Question 25

What is affected in progressive nonfluent aphasia

Answer 25

• Broca’s area primarily affected – speech production

Question 26

Semantic Dementia

Answer 26

Loss of semantic knowledge | loss of word meanings

Question 27

Frontotemporal Dementia

Answer 27

``` Begins in the frontal lobes • Orbitofrontal cortex: involved in emotional processing • Right-sided damage first: social behavioral impairments • Left sided damage first: language and semantic impairments • Loss of the anterior cingulate, which is critical for motivational behaviors and conflict resolution ```

Question 28

Characteristics of Frontotemporal Dementia

Answer 28

* Onset can be as early as twenties * Deficits in emotional processing * Deficits in behavioral and moral reasoning * Rather dramatic change early on in the disease * Inappropriate behaviors in public * Compulsive behaviors * Regression to child-like state of reasoning * Very difficult to diagnose

Question 29

PET scans in Alzheimer's patients show reduced _____

Answer 29

Brain Glucose Metabolism

Question 30

Treatment for Alzheimer's disease?

Answer 30

No treatment or cure.

Question 31

Symptomatic relief of alzheimer's

Answer 31

Acetylcholinesterase inhibitors NMDA receptor antagonist

Question 32

What are the risk factors for Alzheimer's?

Answer 32

Age is the #1 risk factor for Alzheimer’s disease • Genetics also plays a role: Known genetic basis (APP, PS-1, and PS-2), but mostly for early-onset (familial) AD. • ApoE4 is a reliably identified genetic risk factor for AD, but it’s only a risk factor and does not mean if you have it you will get the disease. • Non-genetic factors that have associated risk include: head trauma, high blood pressure, heart disease, stroke, diabetes, and high cholesterol

Question 33

Prevention of Alzheimer's

Answer 33

No evidence for prevention yet! • Cognitive and psychosocial activities may reduce risk for AD • Phase III Prevention trial: A4 Trial (Anti-Amyloid Treatment in Asymptomatic AD) • Physical activity linked to reduced risk for AD in epidemiological studies • Small benefits in clinical trials, most notably in executive function • Aerobic as well as strength training show positive effects * Engaging in mentally stimulating activities such as reading • Maintaining a larger social network High educational level and occupational attainment (high cognitive reserve) associated with decreased dementia incidence

Question 34

TRUE OR FALSE Adequate blood flow to the CNS must be | maintained at all times.

Answer 34

TRUE

Question 35

Why is the CNS sensitive to interruptions in blood flow?

Answer 35

1. Unlike other tissues, cells of CNS can’t store glycogen and therefore must obtain glucose directly from blood. 2. Most cells of CNS don’t have access to fatty acids for energy, which increase demands for glucose. 3. CNS cells can’t obtain energy from anaerobic metabolism during periods of reduced oxygen availability, thus requiring uninterrupted oxygen and glucose support to stay alive.

Question 36

What is a stroke?

Answer 36

Brain tissue is damaged from a sudden loss of blood flow, resulting in a loss of neurological function.

Question 37

What are the types of stroke?

Answer 37

1. Ischemic Stroke | 2. Hemorrhagic Stroke

Question 38

Ischemic stroke

Answer 38

• Blockage inside a blood vessel that deprives an area of the brain from glucose and oxygen • Embolic or thrombotic Thrombotic – atherosclerotic plaque occludes an artery Embolic – plaque or clot breaks off and blocks artery

Question 39

Hemorrhagic stroke

Answer 39

Bleeding into or around brain. Weakened blood vessel ruptures

Question 40

Penumbra

Answer 40

is a zone of reversible ischemia around the core of irreversible infarction – salvageable in the first few hours after ischemic stroke onset.

Question 41

Transient Ischemic Attacks (TIAs)

Answer 41

``` Stroke symptoms that resolve in less than 24 hours • Usually resolves in 15-20 mins • More that 1/3 of people will go on to have an actual stroke. ```

Question 42

Ischemic stroke: drug treatment

Answer 42

Only one FDA approved drug – TISSUE PLASMINOGEN ACTIVATOR (tPA) which acts to breakdown clots and reintroduce blood into an ischemic brain region.

Question 43

Major depression

Answer 43

A type of depressive disorder characterized by a depressed mood of at least two weeks in duration.

Question 44

Dysthymia

Answer 44

Chronic low-level depression.

Question 45

Bipolar disorders

Answer 45

A type of affective disorder characterized | by episodes of mania and depression that typically continue throughout a person’s lifetime.

Question 46

Cyclothymia

Answer 46

One of the bipolar disorders characterized by | less intense episodes of mania and depression than are seen in the bipolar disorder

Question 47

Hypomania

Answer 47

A milder form of mania in which occupational | or social functioning is not impaired.

Question 48

Depression - DSM Diagnosis

Answer 48

``` Depressed mood or loss of interest in activities for more than two weeks • Deviates from the person’s baseline (i.e. change from the norm) • Impaired function: social, occupational, educational ```

Question 49

Depression is associated with

Answer 49

``` increased levels of stress chemicals – cortisol (gluccocorticoids in the brain). • Gluccocorticoids reduce dendritic spines necessary for structural plasticity ```

Question 50

Stress affects the hippocampus

Answer 50

The hippocampus has a high concentration of gluccocorticoid receptors à responsive to stress. 1. Reduces excitability (more difficult to learn) 2. Inhibits neurogenesis in the hippocampus 3. Retracts dendrites in the hippocampus.

Question 51

Mood Disorders: Brain Changes

Answer 51

``` Reduced gray matter volume in orbitofrontal cortex, hippocampus, amygdala, entorhinal cortex, basal ganglia, and thalamic nuclei. ```

Question 52

Mood disorders: PET studies

Answer 52

• PET scans reveal lower-than-normal activity during depressive episodes and higher-than-normal activity during manic episodes. • In depression, the reduction is especially apparent in the left frontal cortex. • Decreased blood flow and metabolism have also been found in the cingulate gyrus and the basal ganglia of depressed individuals.

Question 53

In depression, what two regions in the prefrontal cortex (PFC) are dysfunctional?

Answer 53

``` Ventromedial (vmPFC) is hyperactive - associated with generating negative emotion and with self-reflection. • Dorsolateral (dlPFC) is hypoactive - associated with reappraisal and suppression of negative emotions. • Functional imbalance in these regions leads to a negativity bias and rumination of negative thoughts/memories. ```

Question 54

Risk factors and potential causes of depression

Answer 54

* Genetics: * A family history of mood disorder may increase the risk * Twin studies indicate 40-50% heritability * Environment: * History of physical, emotional, or sexual abuse * Major life events e.g. death of a loved one, loss of a job * Other mental illness e.g. schizophrenia, anxiety * Other serious illnesses e.g. cancer, auto-immune disease * History of, or current substance abuse

Question 55

Nonpharmacological Treatments of depression

Answer 55

1. Physical Exercise 2. Mindfulness Based Cognitive Therapy (MBCT) 3.

Question 56

Nonpharmacological Treatments of depression

Answer 56

``` Electroconvulsive Therapy • For drug-resistant depression • Disadvantages • High relapse rate • Memory deficits • A right unilateral ECT may work as well as a bilateral application with fewer side effects. ``` ``` A new promising alternative treatment is repetitive transcranial magnetic stimulation (rTMS). ```

Question 57

Schizophrenia

Answer 57

A psychotic disorder involving disturbance of thought, emotion, and behavior

Question 58

Characteristics of Schizophrenia?

Answer 58

* Broad Impairments * Thought disorder * Delusions * Hallucinations * Disorganized speech * Inappropriate emotions * Catatonia or immobility * Loss of touch with reality

Question 59

Positive Symptoms of Schizophrenia?

Answer 59

1. Hallucinations 2. Delusions 3. Disorganized thoughts

Question 60

Negative Symptoms of Schizophrenia?

Answer 60

1. Reduced speech (alogia) 2. Lack of emotional and facial expression (affective flatening) 3. Diminishing ability to begin and sustain activities (avolition) 4. Decreased ability to find pleasure in everyday (anhedonia) 5. Social withdrawal (asociality)