what is the arousal response and course of a coma?
arousal response: no response to stimuli
course: no change
what is the arousal response and course of a stupor?
arousal response: sleepy - awakens to arousal but unable to maintain without stimulation
course: fluctuations build or fall as stimulation varies with return to sleep with decreased stimulation
what is the arousal state and course of delirium?
arousal response: awake with fluctuations in arousal, vacillations from hypo- to hyper-arousal
course: fluctuations based on environmental factors and medical factors. fluctuations may be rapid or prolonged
what are the characteristics of hypoarousal?
- stuporous: can’t maintain alertness without stimulation
- somnolent (sleepy)
what are the characteristics of hyperarousal?
- hyperactive
- delusions/hallucinations
- irritability/agitation
what are the causes of disrupted arousal?
- intracranial disease (brain bleed)
- systemic disease (diabetes, cancer, etc)
- toxins or metabolic conditions (hypoglycemia, hyponatremia)
- drug exposure/withdrawal
what are the characteristics of locked in syndrome?
- output pathways blocked
- incoming pathways intact
- mental status intact, can’t act on it
- eye movements only
what categories of medical conditions are associated with delirium?
- Infection
- Withdrawal
- Acute metabolic
- Trauma
- CNS pathology
- Hypoxia
- Deficiencies
- Endocrinopathies
- Acute vascular
- Toxins or drugs
- Heavy metals
what are the risk factors associated with increased delirium?
- increased age
- previous cognitive compromise
- chronic medical condition
- prolonged hospitalization
- sensory depravation, sleep-wake cycle disturbance
- medical procedures with high blood volume loss/exchange
- cardiac procedures with necessary prolonged cardio-pulmonary bypass
- occupational exposure to toxins
- use of, or change in dose of sedative, analgesic medications, or reaction to new medication
what is initial attention?
automatic or voluntary orientation to sensory stimuli
what is selective attention?
selection of stimuli from an array of competing sensory stimuli
what is concentration?
maintenance of focus on stimuli to complete a task
what structure orients visual stimuli?
superior colliculus
what structure orients auditory stimuli?
inferior colliculus
what is the dorsalateral prefrontal cortex responsible for in attention?
the initiation of attention
what is the orbitofrontal cortex responsible for in attention?
sustaining attentional focus
what types of attention are assessed in a clinical setting?
- simple attention
- focused attention
- sustained attention (vigilance)
- divided attention
- alternating attention
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Aphasia29
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Attention17
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Dementia17
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Frontal Lobe Syndromes20
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Memory & Learning16
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Affect, Emotions, and Mood13
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Parkinson's Disease and Other Movement Disorders17
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Epilepsy and Seizures41
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Multiple Sclerosis and Other Demyelinating Disorders31
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Moderate and Severe Traumatic Brain Injury13
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Mild Traumatic Brain Injury5
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Sports-Related Concussion2
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Post-Concussion Syndrome6
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Cognitive Decline in Childhood or Young Adulthood28
