What is the leading cause of non-traumatic neurological disability in young adults?
MS
What are Parkinsonian disorders? Name them and explain.
Corticobasal Degeneration (CBD): a combination of degeneration of the basal ganglia and asymmetric atrophy of the frontal and parietal lobes.
- Dementia: in the beginning of the disease, especially apraxia (difficulties with making voluntary movements in a certain order)
- Alien hand syndrome: the patient is not aware of the movements of his arm.
Progressive Supranuclear Palsy (PSP): especially bradykinesia, but also dementia from the fronto-subcortical pattern, and a lot of falling as initial symptom.
- Vertical supranuclear palsy: difficulties in moving the eyes (they can’t look down anymore)
Which 2 heriditary vascular dementia do exist? Explain them.
CADASIL = cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy
It’s caused by the NOTCH3 gene, which causes dementia and in 40% migraine with aura. It leads to:
- Arteriopathy: damage to the blood vessels, leading to infarcts and …
- … Leukoencephalopathy: white matter disease
HCHWA-D (Katwijkse ziekte) = hereditary cerebral hemorrhage with amyloidosis - dutch type
It’s caused by a mutation on the bètaPP gene, leading to a really high mortality. It’s a consequence of:
- Amyloidosis: amyloid that sticks to the blood vessels in the brain and eventually causing a bleeding
What are 3 frontal-subcortical circuits? And which cognitive functions do they preserve?
- Dorsolateral PFC network: executive dysfunction
- Lateral orbitofrontal network: disinhibition, personality changes
- Anterior cingulate network: apathy (absent motivation)
Which cognitive functions are preserved by the following neurotransmitters? And which are treatment options?
- Dopamine
- Norepinephrine
- Serotonin
- Acetylcholine
- Dopamine: set-shifting, inhibition, attention (stimulants such as methylphenidate/Ritalin)
- Norepinephrine: arousal (atomoxetine/Strattera for ADHD)
- Serotonin: general executive control, attention (anti-depressants, SSRI/Prozac)
- Acetylcholine: cognitive flexibility, attention (anti-psychotics)
Which personality changes when…
- Damage in orbitofrontal-subcortical circuits
- Damage in anterior cingulate-subcortical circuits
- Profane, disinhibited and socially inappropriate behaviors
- Apathy & indifference
Explain the following tests from the Brief Neuropsychological Battery (BRNB)
- SDMT
- SRT
- 10/36 SPART
- PASAT
- Word list generation
- Symbol Digit Modalities Test = most popular test in MS. It examines information processing speed and working memory (substitute meaningless symbols by corresponding numbers)
- Selective Reminding Test = to measure verbal learning and memory recall. Similar to the 15WT, but now there are 12 words and noly the words that are missed are given by the test instructor
- 10/36 Spatial Recall Test = to assess visuospatial learning and late recall (a board with dots that the subject has to reproduce)
- Paced Auditary Serial Addition Test = 2nd most popular test in MS, to assess processing speed and working memory (patients need to add pairs of digits presented at rates of speed, the 2 second condition is hard for MS patients)
- Word list generation = a semantic fluency test
What 3 types of treatments of cognitive disorders can be offered to patients with MS ?
- Disease modifying therapies
- Acetylcholinesterase inhibitors
- Behavioral interventions = cognitive/strategy training
Name 3 indirect types of treatment of the cognitive problems in epilepsy.
- Epilepsy surgery: reducing seizures
- Anti-epileptics: with limited cognitive side-effects
- Treatment of comorbid conditions: like depression
Name 4 direct types of treatment of the cognitive problems in epilepsy.
- Vagal nerve stimulation: some evidence for improved memory function
- Cholinergic replacement: some evidence for improved memory in partial (focal) epilepsy
- Stimulants: improvement of concentration and memory
- Memory rehabilitation strategies: psychoeducation/strategy straining
What type of ‘language’ is not affected in Broca’s and in Wernicke’s aphasia?
Broca’s: comprehension
Wernicke’s: fluency
What is Kluver-Bucy syndrome?
A destruction of amygdale resulting in inability to learn, eat a lot, and hyper sexuality.
How is a combination of rotational and translational accelaration called?
Angular acceleration
How is this called?
The occurence of progressive neuropathological changes when you experience repeated concussions.
Chronic traumatic encephalopathy (CTE)
What really differentiates PD patients from other patients with progressive dementia?
And with which 2 cognitive domains is this associated?
Abnormally slowed auditory evoked potential patterns
- Immediate verbal recall
- Visuoperceptual discrimination
Which brain tissue is in particular more dependent upon oxygen than other tissues? (3x)
Why?
Hippocampus
Basal ganglia
Cerebral cortex
Due to their distal/remote location in vascular distribution
How is PSP also called?
And which 4 areas are impaired?
Steele-Richardson-Olzewski syndrome (SRO)
Basal ganglia, brainstem, cerebellum, frontal cortex
How is CJD also called?
And in cattle?
Transmissible Spongiform Encephalopathy (TSE)
In cattle (vee): Bovine Spongiform Encephalopathy (BSE)
