Memory and Cognition Exam 3

What are the 3 classifications of TBI, and what is their occurrence?

• Mild —> 80%

• Moderate —> ~10%

• Severe —> ~10%

What are the most vulnerable regions for TBIs? (2)

Frontal and temporal regions

What are the age ranges for most TBIs? (2 ranges)

• 15-24 (vehicle accidents, sports, risky behaviors)

• 70+ (falls)

What is retrograde amnesia?

Issues with memory PRIOR TO head injury

What is post-traumatic amnesia?

Issues with memory AFTER head injury

What are the characteristics of the loss of consciousness

• “Sleep-like” state (excludes coma)

• “Knocked out”

What are the characteristics of Parkinson’s disease? (6)

• Parkinsonism

• Neuronal loss in substantia nigra

• Dopamine depletion in striatum

• Response to dopaminergic treatments

• Lewy Bodies (misfolded proteins in brain)

• Frontal-subcortical issues (processing speed)

What are the characteristics of Parkinsonism? (3)

• Bradykinesia: slowness of movement

• Rigidity: stiffness (cogwheel)

• Resting tumor: very slow; suppressed when movement is initiated

Imaging Findings for Parkinson’s

• MRI — Not super helpful

• PET — Can identify issues with striatum

• SPECT — Can identify dopamine issues

Epidemiology for Parkinson’s

• 2nd most common neurodegenerative disease

• 1 per 1000 (increases with age)

• Men have a 1.5x risk

Morbidity and Mortality for Parkinson’s

• Depression in 40%

• Increased fall risk

• Olfactory problems

• REM sleep disorder

• Dysphasia

• 14th leading cause of death in the U.S.

What is the progression of Parkinson’s for early onset?

Slower progression

Less cognitive decline

What is the progression of Parkinson’s for later onset?

More rapid progression

What happens to the brain with Human Immunodeficiency Virus (HIV)?

Gradual destruction of neuronal integrity

• Can also lead to opportunistic infection

What are the two key syndromes related to HIV?

• HIV-associated neurocognitive disorder (HAND)

• HIV-1 AIDS dementia complex (ADC) and HIV associated dementia

What does it mean when a process is lateralized?

It lives in one hemisphere (dominance)

What is the WADA test used for, and how is it conducted?

• Used to determine language dominance

• Put one half of brain to sleep at a time, then administer language tests

How are language centers distributed in right-handed people (left, right hemispheres, mixed)?

• 95% left

• 5% right

• 0% mixed

How are language centers distributed in left-handed people (left, right hemispheres, mixed)?

• 70% left

• 15% right

• 15% mixed

What is the recovery window for people with mild damage to language centers, as opposed to severe damage?

• Mild —> recovery within 3 months

• Severe —> recovery is unlikely

What are the symptoms of HIV-associated neurocognitive disorder?

• Deficits in attention, processing speed, executive function, and memory

• Decrease in left frontal attentional networks

What are the symptoms of HIV-1 ADC and HIV associated dementia?

• “Subcortical dementia”

• Looks like Parkinson’s

• Processing speed, attention, executive functioning, memory, learning are often impaired

What is prosody?

The rhythm, pattern, speed, etc. of speech

What percentage of strokes are ischemic and what percentage are hemorrhagic?

• 85% are ischemic

• 15% are hemorrhagic

How does an ischemic stroke occur, and what is the recovery rate?

• Blockage (e.g. clot or plaque), which impacts blood flow

• Recovery is variable

How does a hemorrhagic stroke occur, and what is the recovery rate?

• Bleed into brain regions (TBI/tumor)

• Roughly 40-50% die within 30 days

What are the “Big 3” cranial arteries?

1. Anterior (front)

2. Middle

3. Posterior

What is the Circle of Willis, and in how many people is it intact?

• Represents the flow of blood in brain —> allows for variation in flow when there is damage (depends)

• 25% of people have an intact circle

Characteristics of transient ischemic attacks (2)

• Most are unaware of it happening

• Increases rick of ischemic stroke later in life by about 10%

What could be another cause for what looks like Broca’s aphasia?

Facial muscle droop

What could be another cause for what looks like Wernicke’s aphasia?

Psychotic symptoms and/or delirium

How do children contract HIV?

• Typically perinatally (when they are born)

What treatment helps decrease HIV-associated dementia?

• Antiretroviral treatments (ART)

• Only ~25% of kids worldwide start ART

What can an MRI find in a patient with HIV? (4)

• Small areas of bilateral/subcortical hyperintensity

• Volume loss in basal ganglia

• Large lesions

• Diffuse atrophy

What are the types of attention, and what is the associated test? (4)

• Simple attention (repeat sequence of digits)

• Focused attention (translate numbers into symbols)

• Sustained attention (continuous performance test)

• Divided attention (mental math while listening)

What are 5 things that can cause issues with attention?

• Environment

• Lack of sleep

• Medications/substances

• Stress/MH symptoms

• Biological factors

What are the three criteria for a mild TBI?

• Loss of consciousness < 30 mins

• Post-traumatic amnesia < 24 hrs

• GCS 13-15

What are the three criteria for a moderate TBI?

• Loss of consciousness 30 mins - 24 hrs

• Post-traumatic amnesia 1-7 days

• GCS 9-12

What are the three criteria for a severe TBI?

• Loss of consciousness 24 hrs+

• Post-traumatic amnesia 7 days+

• GCS 3-8

What are other pathologies for TBIs? (4)

• Brain bleed (hitting an artery/vein)

• Hematoma (collection of blood in specific region)

• Edema (swelling)

• Ventricular dilation

How does axonal shearing occur, and what are the symptoms?

Occurs with acceleration/deceleration force

• White matter changes

• Reduced processing speed

• After ~1 year, volume loss

What is the diagnosis for a mild or major neurocognitive disorder (dementia)?

• Mild requires deficits on testing, but person is independent in day-to-day

• Major —> lots of decline, cannot live independently

What is the diagnosis for post-concussive syndrome (PCS)?

• No deficit on testing, but symptoms of TBI present (cannot diagnose NCD)

What are the neuropsych issues with TBIs? (3)

• Decreased attention/processing speed

• Decreased memory

• Decreased executive functioning

What are the risk factors for PD-Dementia? (7)

• 30% of patients with PD will also meet criteria for dementia

• Older than 70

• Diagnosis of mild cognitive impairment already

• Past/current depression

• Side effects to dopamine medications

• Increased sensitivity to medications

• REM sleep disorder

What are the considerations in treatment for PD? (6)

• Depending on severity — may need supervision of ADLs/IADLs

• Driving may become difficult; especially as disease progresses

• Employment — physical/cognitive issues may interfere

• Capacity — varies

• Functional issues —

• Risk factor modification (ex. fall risk)

What expectations regarding NP can we see for PD? (3)

• Attention is usually impaired

• Processing speed is impaired (motor and cognitive)

• Executive functioning is often impaired

What is coup-countercoup?

When you hit your head, brain hits the site of impact, then the opposite site (side-to-side or front-to-back, and vice versa)

What are the coup-countercoup symptoms? (10)

• Motor dysfunction

• Visual changes

• Disorientation/confusion

• Headache

• Balance issues/dizziness

• Memory issues/amnesia

• Speech issues

• Mental health concerns (increased depression/anxiety)

• Psychosis (rare)

• Sleep issues

What are the risk factors for Parkinson’s disease? (4)

• Viral incapacities, drugs with dopamine antagonistic properties (neuroleptics, toxins, herbicides, heavy metals like manganese)

• Some literature supports the idea that gut dysfunction could be a starting point for PD pathology

• More common in males (1.5x)

• Hereditary (10% of cases are familial)

What are some other signs of Parkinson’s disease? (4)

• Masked facies (lose some motor function in face)

• Hypophonia (less talking; cannot speak at a higher volume)

• Micrographia (small writing)

• Shuffling gait