Quiz 3/final Flashcards
1
Q
Explicit memory
A
Declarative memory
Facts, events
Hippocampus and medial temporal lobe
2
Q
Implicit memory
A
Procedural
Skills/habits
Emotional associations
Conditioned reflexes
3
Q
Skills/habits brain location
A
Motor cortex
Striatum
Cerebellum
4
Q
Emotional association brain area
A
Amygdala
5
Q
Conditioned reflexes brain location
A
Cerbellum
6
Q
Long term memory storage
A
Diffuse throughout association areas of cortex
7
Q
Hippocampus input
A
- Projections from cortex
- Amygdala
- Olfactory cortex
- Hypothalamus/septal nuclei/BG via fornix
8
Q
Hippocampus input pathway
A
Input fibers –> entorhinal cortex of temporal lobe –> dentate (granule) cells –> Pyramidal cells
9
Q
Hippocampus output pathway
A
Pyramidal cells –> fornix
Pyramidal cells –> subiculum layer –> entorhinal cortex/amygdala/fornix
Fornix –> hypothalamus/BG/mammillary bodies
Entrohinal cortex –> cortical areas
10
Q
Damage to hippocampus
A
Amnesia with inability to input new information
11
Q
Thiamine and amnesia
A
Low B1 –> amnesia
Wernicke-Korsakoff syndrome
12
Q
Process of explicit memory
A
Encoding - First encounter, attended
Consolidation - Alter information to make it more stable
Storage - Retaining of memory
Retrieval - Recall of stored memory
13
Q
NT involved in memory
A
Acetylcholine
14
Q
Hippocampus blood supply
A
Posterior cerebral artery
15
Q
Memory, Ach, and sleep
A
Wakefullness - High cortex –> hippocampus activity and high Ach
Slow wave sleep - Low Ach, hippocampus–> cortex activity
REM sleep - High Ach, High cortex –> hippocampus activity
16
Q
Waking and Ach
A
Acquisition of information
High Ach
High activity flowing from cortex to hippocampus
17
Q
Slow wave sleep and Ach
A
Low Ach
Hippocampus –> cortex activity
18
Q
REM sleep and Ach
A
High levels of Ach
Ongoing consolidation in cortex, incorporate information sent to cortex during SWS
Cortex –> Hippocampus –> cortex
19
Q
What type of damage causes anterograde amnesia?
A
Damage to hippocampus, fornix, mammillary bodies
Any memory storage output fibers
Damage to bilateral medial temporal lobes
20
Q
Damage that causes retrograde amnesia
A
Damage to cortex where memory is stored
21
Q
Global
A
Both retro and anterograde amnesia
Dementia, Alzheimers
22
Q
Long term potentiation
A
Repetitive stimulation of hippocampus that will result in potentiation of neurons in hippocampus in response to subsequent signals
23
Q
Receptors involved in learning and memory
A
Glutamate receptors are involved in memory and LTP
NMDA/AMPA - LTP specific
24
Q
AMPA vs NMDA
A
Both ligand gated
NMDA needs ligand AND depolarization b/c of Mg in pore
Glutamate opens AMPA channel –> Na influx –> depolarization –> NMDA channel can open by getting rid of Mg –> Na and Ca influx
25
Long Term Depression
Decreased stimulation = negative potentiation of post synaptic cell
Decrease in activity
26
Cellular plasticity
Increased synaptic stimulation --> increased protein synthesis and channel formation
Decreased synaptic stimulation --> decreased protein synthesis
27
BDNF
NGF
GDNF
Increases in spines/contacts of nerve fibers
Via alterations in gene transcription/translation
28
Electrical pattern during wake
Increased frequency
Decreased amplitude
29
Electrical pattern during SWS
Decreased frequency
Increased amplitude
30
Electrical pattern during REM
Increased frequency
Decreased amplitude
31
Heart rate/BP/Resp rate in SWS vs REM
SWS = decreased
REM = Higher than SWS
32
Blood flow to brain in SWS and REM
SWS = decreased
REM = Increased
33
Gut motility in SWS vs REM
SWS = Increase compared to wake
REM = Similar to SWS
34
Body Temp in SWS vs REm
SWS = Decreased from wake
REM = Lower than SWS
35
Muscle tone in SWS vs REM
SWS = Decreased from wake
REM = Lower than SWS
36
Ascending reticular activating system
Bathing brain with NT's to maintain wake state
NT's arise from brainstem
37
SWS and NT's
All NT's (Ach, DA, NE, 5HT) decrease
Medulla RF input - inhibitory
Burst mode, T type Ca channels activated
38
REM sleep and NT's
Complete shut off of DA, NE, 5HT
Increase in Ach and tonic mode
39
REM sleep Ach actions
Acts at thalamus
Acts at CN III/VI
Inhibits UMN activity
40
Lesion of caudal hypothalamus
Causes drowsiness (involved in wake state)
41
Lesion of rostral hypothalamus
Inability to sleep, insomnia
42
Tuberomammillary nucleus
Lateral hypothalamus
| Release histamine --> causes wakefullness
43
Suprachiasmatic nucleus
Circadian rhythm /clock
Input from sunlight (retina) and melatonin from pineal gland
44
Preoptic nuclei
Receives information from Suprachiasmaatic nucleus
GABAergic neurons project to tuberomammillary nucleus and shutdown histamine release --> sleep
45
Orexin
Secreted from posterior and lateral hypothalamus
Bathes brain to keep awake
Stimulates biogenic amines to keep awake
Controlled by preoptic nucleus
46
Affiliated components of limbic system
Nucleus Accumbens
PAG/VTA
Autonomic centers of brainstem
47
Cortical areas of limbic system
Cingulate
Insula
Orbital prefrontal cortex
Medial prefrontal cortex
48
Subcortical areas of limbic system
Amygdala
Hypothalamus
49
Hypothalamus limbic function
```
Feeding
Drinking
Temp
Mate seeking, sexual behavior
Species specific defense/aggression
```
50
Hippocampus limbic system funciton
Memories for survival value
Association of location and time to events
51
Pain and cingulate gyrus
Anterior cingulate gyrus
52
Basolateral nuclei of amygdala
Receives and sends information to cortex
53
Central nuclei of amygdala
Send and receive information from brainstem
54
Narcolepsy
Excessive daytime sleep
Cataplexy - emotion
Sleep Paralysis
Hallucinations
Loss of orexin neurons that promote wakefullness --> sleep
55
Narcolepsy treatment
Modanafil, armandanafil
Activation of biogenic amines: NE, DA, 5HT
Possibly increase orexin and subsequently histamine
56
Pathological anxiety signs
1. Autonomy
2. Intensity
3. Duration
4. Behavior
57
Anxiety amygdala efferents
To parabrachial nucleus --> Tachypnea
To locus cerulues --> Increase in BP/HR and fear response
To Lateral hypothalamus --> sympathetic response
To paraventricular nucleus of hypothalamus --> activation of H-P-A axis --> CRH to ACTH to Glucocorticoids
58
Generalized anxiety disorders characteristics
Excessive worry out of proportion
Less severe but more frequent than panic attacks
Occurs more often than not and longer for 6 months to diagnose
59
Panic attack characteristics
Episodic intense anxiety
Cardiac symptoms - palpitations, tachycardia, angina
Pulmonary - SOB
GI - Nausea, abdominal distress
Neurological - Trembling, shaking, dizziness
Autonomic arousal - sweating, chills, hot flashes
Psychological - going crazy
60
Anxiety stats
1/4 of US experiences pathological anxiety
Women are more likely
61
Anxiety and neuroanatomy
Hippocampal atrophy due to excessive levels of cortisol and stress hormones causing damage to hippocampus cells
62
Unipolar depression
Tendency towards the experience of depression
63
Bipolar depression
Upswing and downswing in mood
64
Depression etiology
Decrease serotonin
Bad early experiences in life
Left frontal lobe stroke
Dementia
Seasonal affective
Postpartum
Hypothyroidism
65
Major depressive disorder
One or more episodes of persistent depressed mood
Minimum of two weeks
66
Major depressive SIGECAPS
Sleep disturbance
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidal/homicidal
67
Dysthymic disorder
Depressed mood more days than not over 2 years
Less severe but longer duration than MDD
68
Bipolar type !
At least one manic episode
With or without major depressive episode
69
Bipolar type II
Hypomanic and major depression
70
Mania vs hypomania
Mania associated with social, occupational dysfunction
71
VM-PFC in depression and remission of symptoms
Hyperactive in depression
Decrease in remission
72
DL-PFC in depression and remission
Hypoactive in depression
Increases in remission
73
Cluster A personality disorders
Paranoid
Schizoid
Schizotypal
74
Cluster A characteristics
Disregard and sometimes complete isolation from others
75
Paranoid
Long standing suspiciousness and mistrust
Tendency to interpret others actions as threatening
76
Schizoid
Lifelong social withdrawal
Uncomfortable with human interaction
77
Schizotypal
Strikingly odd/strange
Magical, peculiar thinking. Illusions
Superstitious, have special powers
Isolated
Donnie Darko
78
Cluster B disorders
Antisocial
Borderline
Histrionic
Narcissitic
79
Cluster B characteristics
Wild, overly dramatic
High extroversion, high neuroticism
Greatest risk for suicide
80
Antisocial personality
Inability to conform to social norms
Antisocial, criminal acts
Areas of disordered life functioning
Lack of remorse
81
Borderline personality
Very unstable mood, behavior, self image
Often in state of crisis
Mood swings
Self destructive acts
Short lived psychotic episodes
82
Histrionic personality disorder
Excitable and emotional
Dramatic, colorful, extroverted fashion
Exaggerate their thoughts and feelings
Flamboyant aspects, need endless reassurance
Superficial relationships
83
Narcissistic personality disorder
Heightened sense of self importance
Grandiose feelings of uniqueness
No empathy, fake sympathy
Rejection is the worst
84
Cluster C disorders
Avoidant
Dependent
OCD
85
Cluster C characteristics
Anxious
Fearful
High extroversion, but too much emphasis on external with no internal
86
Avoidant personality
Sensitivity to rejection, socially withdrawn
Hypersensitive to rejection, afraid to speak up
Misinterpret others comments as derogatory
87
Dependent persolaity
Subordinate their own needs to those of others
Get others to assume responsibility
Lack self confidence
88
The Social Brain
1. Verbal communication areas: Comprehension, Brocas, Rt Frontal
2. Empathy and disgust areas: Insula
3. Emotional/Moral value areas: Medial and orbital surface of PFC
4. Facial processing areas: fusiform gyrus, sup temporal sulcus, amygdala
5. Pain areas: Insula, Ant Cingulate gyrus, PAG
6. Social perception and autonomic expression of emotions: amygdala
89
Borderline personality disorder brain anatomy
Decrease function/activity:
Anterior cingulate gyrus --> aggression
Insula --> no empathy
Orbitofrontal cortex --> poor emotional regulation
Amygdala --> Facial expression recognition
90
Antisocial brain anatomy
Disruption of NT balance
Increased DA:5HT ratio
Low serotonin + high testosterone = aggression
Low amygdala
91
Schizotypal brain anatomy
Reduced pulvinar and DM nucleus of thalamus
Corpus callosum shape
Temporal lobe abnormalities - Sup temp gyrus, parahippocamal gyrus, amygdala, hippocampus
Abnormal dopamine synthesis and metabolism
92
Schizotypal vs Schizophrenia
Schizophrenia has ventricular enlargement and hypo-frontality after first psychotic episode
Schizotypal can convert to schizophrenia
93
Treatments for anxiety
Benzodiazepines
Barbiturates
SSRI's
Buspirone
94
Treatments for PTSD
Decrease NE activity
Alpha 2 autoreceptor agonist - clonidine
Beta receptor antagonist - Propanolol
95
Clonidine
Alpha 2 autoreceptor agonist
Autoreceptors on presynaptic cell normally bound by NE to slow NE release
Clonidine binds autoreceptor and prevents NE release
96
Propanolol
Binds to post synaptic NE receptor to prevent NE activity
97
ADHD treatments
NE and DA reuptake inhibitors
Methylphenidate (Ritalin)
Amphetamine (Adderall)
98
TCA's
Antidepressants
Block reuptake of NE and Serotonin
99
SSNRI's
Block reuptake of NE and Serotonin
100
SSRI's
Selective reuptake block of serotonin only
101
Diazepam
Long acting Benzodiazepine
GABA-A modulator
102
Clonazepam
Long acting Benzodiazepine
GABA-A modulator
103
Alprazolam
Short acting benzo
GABA-A modulator
104
Midazolam
Short acting benzo
GABA-A modulator
105
Zolpidem
Non benzo GABA modulator
Sleep disorder
106
Zaleplon
Non benzo GABA modulator
Sleep disorder
107
Eszopiclone
Non benzo GABA modulator
Sleep disorder
108
Buspirone
5HT1-A partial agonist
Sleep disorders
Anti anxiety
109
Rameleton
Melatonin MT1 & MT2 agonist
Sleep disorders
110
Clonidine
Alpha 2 autoreceptor agonist
Prevents NE release
111
Propanolol
Post synaptic Beta blocker
No NE activity
112
Imipramine
TCA
NE and 5HT reuptake inhibitor
113
Amitriptyline
TCA
NE and 5HT reuptake inhibitor
114
Nortriptyline
TCA
NE and 5HT reuptake inhibitor
115
Bupropion
TCA
NE and 5HT reuptake inhibitor
AND Dopamine
116
Venlafaxine
SSNRI
117
Duloxetine
SSNRI
118
Fluoxetine
SSRI
119
Paroxetine
SSRI
120
Sertraline
SSRI
121
Citalopram
SSRI
122
Phenelzine
MAOI
Block breakdown of NE, DA, 5HT
123
Lithium
Bipolar treatment
Blocks IP3 --> PIP2 --> no signal transduction
124
Posterior portion of language areas
Language comprehension
125
Anterior portion of language areas
Language production
126
Parsody
Controlled by right parietal
Vocalization changes of speech
127
Praxis
Controlled complex muscular actions
Controlled by left parietal
Damage to left parietal can cause bilateral apraxia
128
Attention and spatial awareness sensory input
Input goes to contralateral lobe
Right side gets input from both left and right side
129
Left parietal damage and spatial awareness
Right side can compensate
130
Right side parietal damage and spatial awareness
Results in contralateral neglect (left world)
Left brain cannot compensate for left side world
131
Executive function location
Prefrontal cortex
132
Ventromedial prefrontal cortex
Involved in motivational issues
Reward/loss of decision
Social acceptability of decisions
133
Dorsolateral prefrontal cortex
Applying rules/strategies to making a decision
Higher level thinking
Working memory, problem solving
134
Damage to DL-PFC
Problems with working memory
No cognitive flexibility
Issues with problem solving, sequencing, planning
135
Damage to VM-PFC
Disruption of social behaviors
Impulse control problems
No concept of risk/reward
136
Frontal syndrome overall deficits
1. Cognitive deficits
2. Supervisory deficits
3. Initiation/inhibition deficits
137
Cognitive deficits, frontal syndrome
Inability to solve problems, plan and sequences thoughts/actions
Damage to DL-PFC
138
Supervisory deficits, frontal syndrome
Disruption in control of actions based on different social scenarios
Behavioral perseverance, no change based on different situation
VM-PFC
139
Deficits of initiation and inhibition, frontal syndrome
Motor/Verbal perseverance
Inability to function
VM and DL-PFC
140
ADHD and executive functions
Executive deficits
Deficits of concentration, planning organization
Unreliable, impulsive, inefficient
Cannot manage complex obligations ie family/money
141
Schizophrenia and executive functions
Executive deficits AND full frontal syndrome
Cannot separate task relevant and task irrelevant information
142
Disconnection syndromes
Lesions to thalamus or BG that damage circuits to PFC
143
Fear circuit
Fear stimulus --> BL nuclei of amygdala --> Sends outputs to cortex. Sends outputs to CM nucleus --> physiological changes
144
Anxiety and Amygdala
Hyperactivity of amygdala, everything perceived as fearful and can generate fear response
145
Social phobia and amygdala
Amygdala hyperactivity when making eye contact and having to judge faces
146
PTSD and amygdala
Hypersensitive and hyperactive amygdala/hippocampus circuits
Reactivation of traumatic memories
Decrease response to happy faces (?)
147
Attachment disorder and emotional memory
Failure to establish emotional bonds with parents in early life
Severe deficits of emotional regulation later in life
148
Somatization and emotional learning
Mental states can lead to visceral sensations based on previous trauma
Organ issues resolved when emotional problem addressed
149
Borderline personality disorder and emotional learning
Failure to learn to fear aversive stimuli
Continual repetition of counterproductive behaviors
150
Dopamine and emotional learning
Reward circuitry based on increased levels of dopamine
When reward is not present but expected, dopamine neurons decrease firing rate compared to baseline --> anti reward
151
Amygdala LTP
Amygdala has excitatory Glu neurons projected on it but are inhibited by GABAergic neurons
Dopamine from VTA (reward) acts on GABA neurons (D2 receptors) --> remove GABA inhibition so amygdala neuron can fire
Associate stimulus with reward
152
Amygdala connections
Direct connection to autonomics in brainstem and spinal cord
Connect to hypothalamus to modulate endocrine secretion (CRH--> ACTH-->Cortisol)
153
Positive symptoms of Schizophrenia
Hallucinations
Delusions
154
Negative symptoms of Schizophrenia
Decrease in body language
Decreased emotional range
Speech poverty
Decreased sense of purpose
Decreased interests
Diminished social drive
155
Positive vs Negative symptoms
Positive are easier to treat
Negative = poor prognosis and have greater impact
156
Categories of Schizophrenia
1. Paranoid
2. Disorganized
3. Catatonic
157
Paranoid Schizophrenia
Delusions and frequent auditory hallucinations
Someone is out to get them
158
Disorganized Schizophrenia
Regression to primitive, disinhibited, disorganized behaviors
Their lives have no order and make no sense
159
Catatonic Schizophrenia
Motor function disturbances
Strange postures
Mutism
Excitement to stupor and back
160
Brain abnormalities and Schizophrenia
Enlarged ventricles
Temporal lobe abnormalities
Reduced orbitofrontal and prefrontal
Reduced parietal lobe
Subcortical - corpus callosum and BG
DM of thalamus
161
Schizophrenia and social cognition
Face and voice perception deficits
Experience sharing deficits
Mentalizing deficit
Emotional regulation deficit
162
Treatment for Schizophrenia
Antipsychotics
D2 antagonists
163
Typical antipsychotics
More potent, do not treat negative symptoms
Result in significant side effects - motor function abnormalities
164
Atypical antipsychotics
Next generation
Less potent but less BG side effects
165
Fluphenazine
Typical antipsychotic
D1, D2, D4 antagonist
alpha 1 antagonist
5HT2 antagonist
H1 antagonist
Muscarinic antagonist
166
Haloperidol
Typical antipsychotic
D1, D2, D4 antagonist
alpha 1 antagonist
5HT2 antagonist
H1 antagonist
Muscarinic antagonist
167
Olanzepine
Atypical
D2/D4 antagonist
5HT2 antagonist
H1 antagonist
alpha 1 antagonist
168
Aripiprazole
Atypical
Partial D2 agonist
5HT1 partial agonist
169
Clozapine
Atypical
5HT antagonist
D4, D2, D1 antagonist
H1 antagonist
Anti muscarinic
Alpha 1 antagonist
170
Quetiapine
Atypical
5HT1/2 antagonist
D1, D2 antagonist
alpha 1/2 antagonist
H1 antagonist
171
Schizophrenia age of onset
Usually before 25
Earlier onset in men
172
Language region of brain
Predominantly left side
Perisylvian region: Brocas, Wernickes, arcuate fasiculus
173
Dysarthria
Failure of muscles involved in speech production
174
Apraxia
Dysfunction in complex motor programming for speech
175
Arcuate fasiculus
Connection between comprehension and production areas
176
Most common cause of aphasia
Ischemic stroke of MCA
177
Progressive aphasia
Slow onset
Tumors
Focal cortical atrophy
178
4 ways to categorize aphasias
Fluency
Comprehension
Repetition
Naming
179
Anomic aphasia
Fluency: Good
Comprehension: Good except for complex
Repetition: Preserved
Naming: Impaired
180
Anomic aphasia lesion localization
Angular gyrus or inferior temporal
181
Conduction aphasia
Fluency: Good
Comprehension: Good except for complex
Repetition: Impaired, paraphasias
Naming: Always fucked
182
Conduction aphasia lesion localization
Posterior perisylvian region
Arcuate fasiculus
Supramarginal gyrus in parietal lobe
183
Transcortical sensory aphasia
Fluency: Good
Comprehension: Impaired
Repetition: Intact
Naming: Fucked
184
Transcortical sensory aphasia lesion localization
Extrasylvian in POT
Posterior and deep to wernickes
Superior to inferior line characteristic
185
Wernickes aphasia
Fluency: Intact
Comprehension: Nooooo
Repetition: Impaired
Naming: Nope
186
Wernicke's aphasia lesion localization
Perisylvian lesion encompassing Wernicke's area (posterior)
187
Classes of neurodevelopmental disorders
1. Intellectual disability
2. Communication Disorder
3. Autism Spectrum
4. ADHD
5. Specific learning disorder
6. Motor disorder
188
Intellectual disability disorder
1. Intellectual disability - disorder in mental abilities ie reasoning/problem solving
2. Global developmental delay - Failure to meet developmental milestones
189
Communication Disorders
1. Language
2. Speech sound
3. Social communication
4. Stuttering
5. Unspecified
190
Motor development disorders
1. Development coordination
2. Stereotypic Movement
3. Tic
191
Autism spectrum disorder definition
Persistent deficits in social communication/interaction and restrictive/repetitive patterns of behaviors/interests
192
2 categories of diagnostic criteria for ASD
1. Deficits in social interaction and communication
| 2. Restrictive/repetitive patterns of behaviors/interests/activities
193
First domain of ASD - Deficits in social communication and interaction
1. Deficits in social- emotional reciprocity
2. Deficits in non verbal communication
3. Deficits in developing/maintaining/understanding relationships
194
Second domain of ASD - Restrictive/repetitive pattern of behavior/interests/activities
1. Stereotyped/repetitive motor movements
2. Insistence on sameness
3. Restricted and fixated interests
4. Hyper/hyporeactivity to sensory input
195
Indication for positive ASD outcomes
Lack of:
Intellectual disability
Language impairment
Seizures
196
Treatment for ASD
Applied behavioral Analysis
197
Pharmacological treatment for ASD
1. Treat irritability with antipsychotics - Risperidone, ariprprazole
2. Hyperactivity/inattention with stimulants - methylphenidate/amphetamine or alpha2 agonists
198
ASD associated features
Intellectual disabilities
Language impairment
Attention issues
Epilepsy
Motor deficits - gait, self injury, walking on tiptoes
199
Two domains of diagnostic criteria for ADHD
1. Inattention
| 2. Hyperactivity/impulsivity
200
Inattention domain of ADHD
Attention to detail
Sustaining attention
Does not listen when spoken to
Following instructions
Organizing
Wont engage in tasks
Distracted
Forgetful
201
Hyperactivity/impulsivity domain of ADHD
Fidgety
Leaves seat
Runs/climbs
Talking
Blurts answers
No waiting
Interrupts
202
ADHD treatment categories
1. Medication
2. Behavioral interventions
3. Psychoeducation
203
ADHD pharmacological treatments
Methylphenidate or Amphetamine
Alpha2 agonists - Clonidine/Guanfacine
204
Associated features of ADHD
Language, motor, social development delay
Irritability, mood lability, academic/work performance issues
```
Oppositional defiance
Conduct
Mood disorders
Learning
Sleep
Substance
```
205
Diagnostic domains for Tic disorders
1. Tourettes
2. Persistent motor/vocal tic
3. Provisional Tic
206
Tourettes diagnostic
Multiple motor AND vocal tic
Wax/wane but present for a year
Onset before 18yo
Not substance related
207
Persistent motor/vocal tic
One or multiple Vocal OR Motor Tic
208
Provisional tic
Less than a year
Motor and vocal
209
Tic treatment plan
Always treat most impairing first
210
Tic treatment options
Psychoeducation
Comprehensive behavioral intervention for Tics
Psychopharmacology
211
Psychopharmacology for Tic disorders
Alpha 2 agonists - Clonidine, Guanfacine
Typical Antipsychotics
Atypical Antipsychotics - Risperidone, aripiprazole FDA approved
Deep brain stimulation
212
Delirium definition, cause, treatments
Global disorder affecting cognition/consciousness
Usually secondary to systemic disease - infection, stroke, ischemia
Treat by fixing underlying disease
213
Dementia definition
Deterioration of multiple cognitive areas of a person who was previously normal
214
Alzheimers type dementia: Initial damage and initial presentation
Entrohinal cortex and hippocampus
Memory issues
215
Alzheimers dementia spread
Atrophy spreads to cortices but not occipital
216
Alzheimers -Progression of clinical presentation
Memory loss due to entrohinal and hippocampus atrophy
Visuospatial disorientation and agnosia - parietal lobe damage
Frontal executive function deficits and behavioral issues in later progression
217
Symptoms and progression of Alzheimers
Memory --> disorientation, spatial, confusion --> Severe memory loss, personality, behavior, sleep/wake, self care
218
Vascular dementia
Different decline path than Alzheimers
Stepwise progression with periods of stability and abrupt decline
Fixing vascular issues can mitigate alzheimers
219
Lewy body dementia
2nd most common degenerative dementia
Delusions and hallucinations
Sensitive to Dopamine drugs --> cause psychosis
Less motor issues
Lewy bodies in brainstem and cortex
220
Frontotemporal dementia - Age of onset and different forms
Occurs at a younger age - <60yo
Behavioral form
Language form
221
Behavioral form of frontotemporal dementia
Personality and behavioral changes
Disordered initiation, goal setting, planning
222
Language form of frontotemporal dementia
Profound anomia
Loss of conceptual knowledge of words
Rt temporal damage - Lack of knowledge/empathy of others emotions
Non fluent aphasia --> articulate deficit
Speech apraxia
223
Alzheimers treatment
AchE inhibitors - More Ach in brain
NMDA antagonists - Keep brain cells alive longer
224
Brain contusion
Altered consciousness secondary to head injury
Coup - Head not moving
Contrecoup - Head moving so damage on both sides. Opposite side more severe
Hemorrhage, necrosis, edema
225
Diffuse axonal injury
Occurs when axon fibers are torn/sheared
Movement of brain in skull
Axonal swell and subsequent degeneration
226
CTE
Repetitive mild TBI's
Accumulation of Tau protein --> axonal swelling and degeneration
Neurofibrillary triangles
227
Mild TBI
Synonymous with concussion
90% recover
Post concussion syndrome occurs
10% have symptoms throughout life
228
Moderate TBI
Ongoing symptoms for life but function may not be affected
229
Severe TBI
Lifelong symptoms that can affect function
Depends on location of injury
230
Differences between Mild, moderate, severe based on...
How long unconscious
Length of amnesia
Length of confusion
231
Symptoms of diffuse axonal injury
Slow responses
Inappropriate responses
Cannot make accurate connections within brain
Occurs in all levels of severity
232
Symptoms of Contusion
Symptoms based on location of damage
Hemiparesis if motor
Aphasia if in lateral dominant lobe
Occurs in moderate-severe
233
Categories of TBI symptoms
1. Somatic/physical
2. Behavior/emotional
3. COgnitive
234
Somatic/Physical TBI symptoms
Headache
Alteration of senses
Vertigo
Loss of balance
Sleep issues
Fatigue
235
Behavior/Emotion symptoms of TBI
Irritability
Depression, mania, psychosis
Anxiety
236
Cognitive symptoms of TBI
Slow speed of thinking
Attention issues
Memory
237
Characteristics of degenerative diseases
Insidious onset
Slow progression
Degeneration of neurons
Protein accumulation
238
Alzheimers pathology
Brain atrophy
Tau containing neurofibrillary tangles
Neuritic plaques
239
Tau protein and neurofibrillary tangles
Tau is important for microtubule
Hyperphosphorylated Tau protein aggregates and damages neurons
240
Neuritic plaques
Alzheimers
Amyloid Beta core with neuritic (Tau containing) processes surrounding
241
Amyloid hypothesis of Alzheimers
A-beta aggregation because of abnormal Beta secretase which cuts protein incorrectly --> accumulation
242
Frontotemporal lobe degeneration
pick's disease
Tau positive Pick bodies
Causes frontal and temporal lobe atrophy
243
Location of Parkinson's damage
Substantia nigra, causing motor deficits
244
Pathology of PD
Lewy Bodies - cytoplasmic inclusions in neuromelanin containing neurons
Alpha-synuclein positive
245
ALS pathology
Degeneration of UMN and LMN in brain and spinal cord
TDP43 positive
246
Creutzfeldt Jakob Disease
Rapid onset of dementia w/myoclonus
7mo progression to death
Sporadic, transmissible, inherited forms
Misfolded human prion protein
247
Prion protein and spongiform diseases
Misfolded prion protein accumulates and causes neuronal toxicity
Altered prion protein can change conformation of normal proteins
248
New variant CJD
Occurs in younger age group
Slower progression, longer duration of symptoms
Psychiatric symptoms
Cerebellar issues
Amyloid plaques!!!!!
From eating BSE cattle possibly
249
Loss of consciousness requires what kind of damage
Bilateral damage to modulatory nuclei network, axons leaving this network, or large areas of cortex/subcortical white matter
250
Alert
Patient is awake and attentive to normal stimulation levels
251
Lethargic
Patient is drowsy and may fall asleep if not stimulated
Difficulty focusing
Somnolent
252
Obtunded
Patient is difficult to arouse from somnolent state
Confused when awake
Need repetitive stimulation to keep awake
253
Stuporous
Semicoma
Patient only responds to strong, generally noxious stimuli
Returns to unconscious state when stimulation stopped
Unable to interact when aroused
254
Coma
Deep coma
Patient cannot be aroused by any stimulation
255
Decorticate posturing
Damage in rostral midbrain or above
256
Decerebrate posturing
Damage below rostral midbrain
257
Pacemaker neurons for respiration
Ventral respiratory group in brainstem
In Pre-Boztinger complex
258
Other neurons in ventral and dorsal respiratory groups
Followers
Coordinate inspiration, expiration
259
Substance P and pre-Botzinger complex
Accelerates breathing
260
Opioids and pre-Botzinger complex
Slows down breathing
261
Damage to hypothalamus and pontine centers - breathing
Respiratory rhythm alteration but breathing still occurs
262
Damage to pre-Botzinger complex and other medullary centers
Abolishment of breathing
Apnea, death
263
Cheyne-Stokes respiration
Waxing and waning breathing pattern
Bilateral diencephalon damage
Cardiac failure
Acidosis
264
Parabrachial nucleus (pontine center) damage
Apneustic breathing
Deep, gasping inspiration --> pause at full inspiration --> brief exhale
265
Upper medullary damage breathing pattern
Ataxic
Irregular and disorganized sequences
Periods of apnea
266
5 states produced by anesthesia
1. Analgesia
2. Amnesia
3. LOC
4. Muscle relaxation
5. Inhibition of sensory/autonomic reflexes
267
General anesthetic targets
GABA-A Cl- channel
Enhance GABA-A activity and resulting inhibitory effects
268
Halogenated inhalation agents
General anesthetic - GABA-A channel
Halothane
Sevoflurane
Desflurane
269
IV general anesthetics
Propofol
Etomidate
Pentobarbital
270
Ketamine
Inhibit NMDA channel
IV administration
271
Nitrous oxide
Inhalation
NMDA channel antagonist
272
Speed of onset of drug and blood:gas partition
Lower blood:gas partition coefficient = faster onset
273
Increased systemic uptake of anesthetic = faster or slower onset
Slower onset
274
Solubility of blood vs alveolar gas. Which do you want higher to lead to faster onset
Alveolar gas solubility should be higher
Blood:gas partition rule
275
Lower cardiac ouput...faster or slower anesthetic induction?
Lower CO = FASTER anesthetic induction
276
MoA and Side effects of halogenated volatile gases
Enhance GABA-A
Enhance Glycine
Enhance K channel opening
All can cause malignant hyperthermia
Decrease respiration
277
Desflurane, onset, MoA, and side effects
Most rapid onset of halogenated volatile gases
Enhance GABA at GABA-A channels
Airway irritation
Malignant hyperthermia
Tachycardia
278
Sevoflurane, onset, MoA, and side effects
Rapid onset and offset
Enhance GABA at GABA-A channels
Increased intracranial pressure
Decrease in cardiac function
Decrease respiration
279
Nitrous oxide onset, MoA, and side effects
Weak anesthetic alone with some analgesic properties
Inhibit NMDA channels, activates descending pain inhibitory pathway
Very rapid onset and offset
Diffusional hypoxia upon discontinuation
280
Propofol: Administration, MoA, side effects
IV administration
Enhance GABA at GABA-A
Decrease cardiac function, respiration, cerebral blood flow
Hypotension
281
Etomidate: Administration, MoA, side effects
IV administration
Enhance GABA at GABA-A
Decrease cerebral blood flow
NO Cardiac output decrease
282
Ketamine: Administration, MoA, side effects
IV administration
Inhibit NMDA channels
Dissociative anesthesia: analgesia, no response to command, but eyes open and limbs move involuntarily
Sympathomimetic
Emergence delirium
283
MAC
Minimal alveolar concentration
Concentration of vapors delivered to lungs that prevent motor responses in 50% of subjects in response to painful stimulus
Used to compare potency of drug
284
Xenon MoA
Inhibit NMDA channels
Some K channel agonist activity
285
Anterior cingulate gyrus function
Pain
Error detection and future simulation
286
Posterior cingulate gyrus function
Autobiographical information
Continuous with parahippocampal --> memory function
287
Cognitive flexibility - Test and PFC area
Wisconsin card test (change rules)
DL-PFC
288
Working memory - Test and PFC area
Delayed response test
DL-PFC
289
Impulsivity test and PFC area
Iowa Gambling test - Risk/Reward behavior
VM-PFC
290
Abstract thinking test and PFC area
Proverb
DL-PFC
291
Test planning/strategy test and PFC area
Tower of Hanoi
DL-PFC
292
PFC and amygdala connection - Extinction
PFC sends glutamic neurons --> intercalated cells --> GABA neurons to CM amygdala --> Stop
293
Lt parietal function
```
Arithmetic
Reading
Language
Science/math
Reasoning
```
294
Rt parietal function
```
Spatial awareness
Prosody
Intuition
Creativity
Art
```
295
Amblyopia
Failure of neural input to occipital lobe during development (Eye closed)
Decrease in synapses in that cortex compared to other side
296
Mitral cells
Cells that receive olfactory information
297
Medial frontal lobe blood supply
ACA
298
Lateral frontal lobe blood supply
MCA
299
Lateral temporal lobe blood supply
MCA
300
Anterior pole, temporal lobe, blood supply
MCA
301
Medial inferior lobe, temporal, blood supply
PCA
302
Lateral Parietal lobe blood supply
MCA
303
Medial parietal lobe blood supply
ACA
304
Lateral occipital lobe blood supply
MCA
305
Medial/inferior occipital lobe blood supply
PCA
306
Cingulate gyrus blood supply
ACA
307
Parahippocampal gyrus blood supply
PCA
308
Insula blood supply
MCA
309
Caudate blood supply
Perforating branches of ACA/MCA
310
Putamen blood supply
Perforating branches of MCA/ACA
311
Globus Pallidus blood supply
Anterior choroidal artery
MCA perforating branches
312
Nucleus Accumbens
ACA perforating branches
313
Amygdala blood supply
Anterior choroidal
314
Hippocampus blood supply
PCA
315
Thalamus blood supply
Perforating branches of PCA
Posterior comunicating
316
Hypothalamus blood supply
Posterior/Anterior communicating
Perforating branches of ICA
317
Anterior limb, internal capsule, blood supply
ACA perforating branches
318
Posterior limb blood supply
Lenticulostriate/anterior choroidal artery
319
Sub/retrolenticular blood supply
Perforating branches of PCA
320
Genu/body CC blood supply
ACA
321
Splenium blood supply
PCA
322
Medial Midbrain blood supply
PCA and Basilar
323
Lateral midbrain blood supply
SCA and Posterior communicating
324
Medial Pons blood supply
Basilar
325
Lateral pons blood supply
AICA
326
Medial Medulla blood supply
Vertebral and anterior spinal arteries
327
Lateral medulla blood supply
PICA
328
Anterior spinal cord blood supply
Anterior spinal artery
329
Posterior spinal cord blood supply
Posterior spinal arteries
330
Tay Sachs disease - genetic defect and accumulation
Beta Hexoaminidase A gene
Enzyme involved in ganglioside breakdown
331
Leukodystrophies - mutations
Mutations in genes whose protein products are involved in myelin generation/maintenence
332
Metachromatic Leukodystrophy
Lysosomal storage disease
Aryl sulphatase A deficiency
333
Huntington trinucleotide repeat and triad of symtoms
CAG
Choreiform movements
Dementia
Neuropsychic disturbances
334
Neurofibromatosis Type I
NF1 gene encodes neurofibromin - Tumor suppressor
Elevated dermal lesions with bad Schwanna cells and fibroblasts
335
Neurofibromatosis Type II
NF2 = Merlin protein, Tumor
Vestibular schwannomas, multiple meningiomas, spinal cord ependymomas
336
Neuron production in development
Overproduction, twice as many neurons as needed
Then, excess neurons undergo apoptosis - decrease in growth factors
337
Injury and trophic factors for neurons
Injury can trigger production of trophic factors and promote repair/rewiring
338
Neural processes and development
Overproduction of processes - Multiple neurons attached to one muscle fiber
Pruning/synaptic elimination
339
Ocular dominance columns and pruning
Experience and vision are key for visual development
If one eye closed during critical period then cortex and ocular dominance columns are deficient for that eye
340
Wallerian degeneration
Processes that follow injury to neuron
No transmission and distal processes degenerate
341
Damage to PNS/CNS cell body and regeneration
Usually no regeneration
342
Damage to CNS axons and regeneration
No regeneration
343
Damage to PNS axons
Regeneration occurs
344
PNS regeneration
Damage --> macrophages remove axonal debris
Schwann cells proliferate and secrete trophic factors --> axonal regeneration proximal to injury
Basal lamina still around, help with regrowing axons
345
CNS regeneration
Microglia remove degenerated processes
Astrocytes form scar to block regeneration
No growth factors
346
Neuroregenesis areas in adult
1. Granule cell layer of hippocampal dentate gyrus
Head of caudate nucleus and adjacent ventricle ependymal cells --> olfactory bulb
