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Tutorials Flashcards

1
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2
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What is executive functioning?

A
  • self-regulatory functions that organise, direct, and manage other cognitive abilities, emotional responses and behaviour
  • allow us to plan and carry out goals, adapt to novel situations, consider consequences
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3
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What are the aspects of executive functioning?

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Inhibition
Planning and organising
Cognitive flexibility
Concept formation, reasoning, problem solving

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4
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Are impairments of executive function specific to the frontal lobe?

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No - but most patients who have damage to the frontal lobes experience impairments in executive functioning.

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5
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How would we divide the various components of executive function in the frontal lobe?

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Dorsolateral PFC –> cognitive aspects

Orbitofrontal PFC –> behavioural aspects

Ventromedial PFC –> emotional aspects

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6
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What is the dorsolateral PFC associated with?

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Cognitive parts of executive functioning: problem solving, organisation, cognitive flexibility, emotional range

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7
Q

What is the orbitofrontal cortex associated with?

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Behavioural aspects of executive functioning:
- disinhibition
- impulsivity
- distractibility
- emotional lability (rapid changes in emotional states)

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8
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What is the ventromedial PFC associated with?

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Emotional aspects
- apathy (disinterest)
- emotional blunting (reduced reactivity)
- impaired decision making

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9
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Why are there problems associated with neuropsychological assessment of executive functioning?

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May not elicit impairments in executive functioning:
- the structure of the assessment leaves little room for inappropriate behaviour
- instead focus on qualitative assessment findings and informant reports

Tests also involve non-executive skills

Concerns regarding ecological validity (as you are in a 1 on 1 structured environment and are helping to regulate them)

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10
Q

What is the assessment of inhibition:

A

Inhibition = ability to withold automatic responding and instead respond in a novel (or less automatic) manner

Tests of inhibition:
- stroop test
- sentence completion test (complete the sentence in an unnatural way)

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11
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Assessment of planning and organisation:

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Planning and organisation = identification of steps and elements needed to achieve a goal (conceptualizing changes from present circumstances, dealing objectively with oneself in relation to the environment, conceiving alternatives, making decisions).

Tests of planning and organisation:
- clock drawing
- rey complex figure test
- key search test

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12
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Assessment of cognitive flexibility:

A

ability to switch between different ways of responding - respond to changing situational demands

Tests of cognitive flexibility
- trail making tests (1A2B3C, etc)
- clock drawing (perseverative behaviours)
- sorting task (into different categories)

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13
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Assessment of concept formation, reasoning and problem solving:

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= developing novel concepts and strategies to solve complex problems (evaluating performance, consider alternate solutions)

Assessment of concept formation, reasoning and problem solving:
- sorting task
- spatial anticipation task (predicting where the blue circle will move to)
- verbal fluency (FAS animal) –> semantic is usually easier, letter fluency involves more planning)
- reasoning based on verbal information (how are 2 words conceptually alike)
- reasoning based on non-verbal information (pick a tile that matches the pattern)
- tower task

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14
Q

What conditions affect executive functioning?

A
  • TBI
  • Frontotemporal Dementia
  • Schizophrenia
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15
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Outline how TBI affects executive functioning:

A
  • frontal lobes are particularly vulnerable to TBI due to their location and size
  • nature and severity of impairments depends on the exact location and severity of brain injury
  • e.g. Phineas Gage
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16
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Outline how frontotemporal dementia affects executive functioning:

A

This dementia is characterised by early and progressive changes in personality, behaviour and executive functioning.

Symptoms:
- disinhibition
- impulsivity
- mental rigidity
- perseveration
- poor insight
- loss of empathy
- apathy

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17
Q

Outline how schizophrenia impacts executive functioning:

A
  • poor cognitive flexibility
  • impaired planning and organisation
  • poor insight
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18
Q

What is visual attention?

A
  • supports conscious perception
  • capacity limited
  • selective in nature
  • involves fronto-parietal networks
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19
Q

Visual attention occurs in 2 methods:

A

Bottom up processing:
- processing directly informed by environmental stimuli and salience
- involuntary
- temporo-parietal junction, ventral frontal cortex (orange)
- ventral attention network

Top down processing
- processing influenced by sensory input as well as experience and expectations
- voluntary (goal directed)
- inferior and superior parietal sulcus, frontal eye fields
- dorsal attention network

These interact

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20
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Visual processing and blindness

A

Vision processing is hierarchical and contralaterally)
- damage to earliest visual brain area cause blindness
- damage to brain areas further along the pathway do not cause blindness, but cause an inability to process specific features of a stimulus
- damage even further along can cause specific object recognition deficits (agnosias) but intact processing of basic visual features

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21
Q

What is the difference between the ventral and dorsal pathway

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Ventral (bottom) = the ‘what’ pathway (object representation)

Dorsal (top) = the ‘where’ pathway (spatial representation)

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22
Q

What is the brief visual processing order:

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Local features (edges, lines) –> shape representation (shapes, surfaces) –> object representation (e.g. a cows face)

23
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What is an agnosia?

A

Inability to process sensory information.
Affects a signal sensory modality.

e.g. loss of ability to recognise objects, persons, sounds, shapes, smells, while the specific sense is not defect nor is there memory loss

24
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What are some types of visual agnosia:

A

Categories
- apperceptive visual agnosia
- associative visual agnosia

Subtypes of visual agnosia
- simultanagonisa (inability to process multiple stimuli at a time)
- prosopagnosia (face blindness)
- achromatopsia (inability to register colour)
- topographical agnosia (inability to orient oneself)

25
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What is apperceptive visual agnosia?

A

Difficulty assembling pieces / features together into common objects
- failure in earlier stage (perception)
- not very common

Have basic elementary features of vision (they can see it and attend to it, and semantic knowledge is intact) but they are unable to recognise or match objects.

impairments: object naming, object matching, object copying, shape identification, orientation judgment

i.e. impairment of shape representation

26
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What pathology is apperceptive visual agnosia associated with?

A
  • diffuse posterior damage
  • recovery from cortical blindness (damage to the occipital lobe)
27
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What is associative visual agnosia:

A

Can perceive an object but has difficulty naming it because they can’t link the visual percept to an identity (recognition without meaning)

  • able to object match but can’t tell you what it is
  • they are able to process the information / object through other modalities (therefore not anomia)

Can be material specific (e.g. letters = pure alexia), faces (prosopagnosia), navigation (topographical agnosia)

28
Q

What is the underlying pathology of associative visual agnosia

A

Due to a defect in later stages of visual processing involving object representation (can describe the shape, but can’t recognise it)

Bilateral damage to the inferior temporal occipital junction

29
Q

Outline the visual agnosia subtype: simultanagnosia

A
  • difficulty processing visual input as a whole
  • Dorsal: able to recognise elements but not the whole scene (bump into things in a room)
  • ventral: multiple objects can be seen, manipulated, counted but can’t grasp the meaning of the whole scene (can’t put together the cookie story)
30
Q

Prosopagnosia:

A

difficulty recognising faces
- known as face blindness

May recognise people based on extra facial features, gait, voice, etc

Acquired prosopagnosia (inferior medial temporo-occipital damage –> fusiform face area) due to TBI or stroke)

Congenital prosopagnosia (no neurological conditoin or intellectual impairment but may have a genetic component –> 2-3% prevalence rate)

31
Q

Outline hemispatial neglect

A
  • failure to attend / respond / orient to a stimulus or side opposite the lesion (not due to a sensory or motor deficit)
  • may extend to all sensory modalities
  • patient is often unaware of the deficit

Pathology: posterior parietal lesion of the right hemisphere
- right frontal lesions and lesions of the cingulate gyrus, thalamus, basal gnaglia

Transient (lasts no more than a few weeks)

32
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What occurs during the acute stages of hemispatial neglect

A
  • patients systematically orient towards stimuli on the extreme part of the non-neglected side
  • marked deviation of head, eyes, trunk away from contralesional field
  • compulsive orientation
  • scanning saccades restricted to the ipsi-lesional side even if patient has full ocular movement to command
33
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What happens during the later stages of hemispatial neglect

A

Extinction to double simultaneous stimulation
- patient asked to fix gaze: then test visual fields
- when two objects are presented at the same time, one in each visual field, only one will be reported

Line by section test
clock test

34
Q

How to differentiate between hemispatial neglect and visual field sensory loss

A

Hemispatial neglect:
- not aware of deficit
- do not compensate for deficit
- attentional rather than sensory

Visual field sensory loss
- aware of deficit
- compensate for deficit

35
Q

Constructional apraxia

A

an impairment in combinatory or organising activity so that desired synthesis cannot be achieved

seen on tests where individual elements must be arranged in a given spatial relationship to form a unitary structure
- inability to perceive how 2 or more parts form a whole

Test: copying, clock drawing, block design

36
Q

How is memory organised?

A

Human memory:
Sensory (<1 sec)
Working memory (<1 min) - our ability to hold information and manipulate that information for a goal.
Long-term memory = encoded and stored
- Explicit memory: information we can restate (declarative memory [facts], episodic memory [experiences] and semantic memory [facts, concepts])
- Implicit memory (procedural memory [skills, tasks])

37
Q

What is the process of remembering?

A
  • attention
  • encoding
  • storage
  • retrieval
38
Q

Outline verbal memory:

A

Structured; short stories and comprehension
Unstructured; word lists (if they aren’t getting better in each trial, they are bad at encoding)

39
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Outline visual memory

A

Draw the Rey figure - in 3 and 20 minutes ask them to recall as much of it as they can.

40
Q

What is a temporal lobectomy?

A
  • epilepsy = enduring brain disorder causing recurrent and unprovoked seizures
  • the most common type of focal onset epilepsy is temporal lobe epilepsy –> most common cause being scarring in the temporal lobe (hippocampal sclerosis)
  • hippocampal sclerosis causes isolated memory problems (storage issues)
41
Q

What does memory look like after temporal lobectomy:

A
  • unable to form new memories
  • could retain information from moment (by repeating it constantly)
  • could retain procedural memory (which relies on basal ganglia and cerebellum)
  • declarative memory was most impacted
42
Q

Outline how memory is impacted in Alzheimer’s disease:

A
  • causes hippocampal atrophy
  • primary memory impairment with later deterioration of other cognitive domains and functional decline
  • characterised by rapid forgetting (difficulty with word finding, temporally graded retrograde and anterograde amnesia)
  • storage and encoding is poor (recognition questions were performed poorly)
43
Q

Outline Wernicke Korsakoff syndrome:

A
  • due to malnutrition (thiamine deficiency)
  • associated with heavy and chronic consumption of alcohol (metabolism of alcohol is reliant on thiamine)
  • leads to lesions in mammillary bodies (encoding), thalamus, hypothalamus - and further lesions in frontal lobes, hippocampus, cerebellum
44
Q

What does memory look like after Wernicke-Korsakoff syndrome?

A
  • severe anterograde amnesia with confabulation (creating false memories)
  • temporally graded retrograde amnesia
  • recognition memory intact
45
Q

What does memory in herpes simplex encephalitis look like

A

Case study: the conductor :(
Herpes simplex is a viral infection leading to encephalitis (brain inflammation)

lesions:
- lateral and medial temporal cortex (hippocampus = memory)
- orbito-frontal cortex
- cingulate gyrus
- parietal lobe

Results:
- acute confusional states followed by permanent, irreversible memory disorder
- severe anterograde amnesia (inability to form new memories)
- possible semantic deficits
- intact implicit memory (procedural)
- intact working memory (1 min)

46
Q

What are the similarities:

A
  • impacted anterograde amnesia (hippocampus) therefore unable to learn new things
  • most impacted declarative memory
  • unable to properly store memory
  • procedural was kept intact
47
Q

Recommendations for memory:

A

For people with issues with retrieval:
Cues to prompt recognition:
- external strategies

Mental strategies - internal strategies:
- mnemonics
- alliterations for names
- active rehearsal (if they are poor at coding)
- associations w tunes
- chunking
- memory palace

48
Q

What is the process of information gathering?

A
  • medical history: hearing or vision concerns?
  • birth and developmental history
  • educational history
  • background history
  • family history: maternal and paternal
  • psychosocial context
  • current concerns: parent, teacher
  • current performance (social functioning, academic performance)
  • previous assessments?
  • observations of child and family
49
Q

Areas to look at!

A
  • presentation
  • intellect (verbal and nonverbal, working memory and processing speed)
  • learning and memory
  • attention (flexibility, sustained, divided)
  • academic functioning
  • executive functioning
50
Q

When doing test selection, you must consider:

A
  • referral question
  • area of concern (and strengths)
  • putting concerns into context
  • child’s age
  • potential ability level and likely impairments
  • availability of normative data
  • disabilities
  • prior assessment (if they have done assessment more than 12 months ago, use the same / similar batteries to compare - and be aware of practice affects)
51
Q

What are some tests for different domains?

A
  • IQ: WISC (verbal and nonverbal intellect, working memory, processing speed)
  • Diagnostic literacy (single word reading) = CC2 (Castle’s and Coltheart Test)
  • Academic functioning: WIAT
  • ADHD screening battery for children: Connor’s 3 Questionnaire
52
Q

Recommendations

A
  • psychoeducation and behavioural intervention
  • clinical psychologist (behavioural management)
  • review recommended
53
Q
A

Neuro (7 decks)

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