cognitive disorders with answers

8/8/2019 Cognitive Disorders With Answers

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5. How would you test for this disorder in clinical practice?Naming components of MMTS and ACE-R. Less frequently used words areoften affected first.

b.Patrick is a 35 year old gentleman with Marfans Disease. While clearing hismothers garden, he experienced a sudden severe headache associated with

vomiting and slurred speech. He was rushed to hospital and underwent anumber of investigations. Nursing staff noticed that he seemed to not hearinstructions and would do what was asked.

Read the transcript

Interviewer; Hello Pat, how are things today?Pat; It could be revurded and spectdad but arent you careyInterviewer; We said that we were going to assess you in the kitchen, yes?

Could you show me how to make a cup of tea?(Pat continues to sit at the kitchen table, without moving to the kettle)Pat; possible query at the moment. I think all kisty the right shape for erskip

and brody.. Why and how is this type of curl.Interviewer; Perhaps you could boil some water in the kettle first?(Pat remains sitting)Pat; Ive not cooperized that this morning, where is mine gope or this tajet and I

do think lots of that and hers(Interviewer mimes sipping a cup of tea. Pat moves over to kettle and begins tomake cup of tea very normally)

Pat; Could it be now for this notty coowd yes.

Tasks

1. Describe Patricks speech

Speech is fluent, rapid but nonsensical with many meaningless words.Patricks responses convey little understanding or comprehension ofconversation.

2. Define the abnormality and summarise how it arises

This is a receptive or sensory dysphasia, indicating impaired comprehensionof speech. As the individual is unable to recognize errors in speech, there isno effort to correct. Therefore, speech remains fluent and effortless butcontains many errors.As received speech is not understood, instructions are not comprehendedand cannot be correctly interpreted and acted on. Patrick demonstrates thatnon speech language comprehension is understood, suggesting a fairly


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discrete lesion.

3. What brain area/s are likely to be affected?

Like Brocas area, Wernickes area is also found in the dominant hemisphere.

Wernickes area is located in the posterior, superior temporal gyrus.Wernickes area is involved in speech comprehension with adjacent areasbeing involved in other language comprehension eg; reading)

4. List possible causes of this presentation

CVACortical dementiasHead injurySpace occupying lesions

5. How would you test for this disorder in clinical practice?

3 stage command test in MMTS

6. Define conduction aphasia and summarise how it arises

Conduction aphasia is the inability to repeat a phrase while other expressiveand receptive language functions are retained.Therefore, naming and 3 stage command tests are normal, while repeatingno ifs, ands or buts is impaired.In order to be able to repeat a phrase, when instructed to do so, requires

intact receptive function (so that the instruction is understood),communication between receptive areas and expressive areas and intactexpressive function so the correct words can be generated.In conduction aphasia, receptive and expressive function is intact but thecommunication between them is impaired. The adjoining tract is called thearcuate fasciculus and this is where the lesion must be.

Case 2

Case 2

a. Martin is a 29 year old landscape gardener. While traveling home from workhe was involved in a head on collision with another car. He was unconscious for3 days and made a slow recovery, complicated by complex orthapaedic injuries.Martin needed to return to living with his parents, who helped him to maintain hisrecovery. However, Martins mum began to notice a lot of problems. Martinappeared to get very frustrated and irritable with frequent explosive outburstswhere he would threaten his parents and wreck their possessions. Martin was


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also very intolerant of change and did not cope well when his dad went back towork. He began to avoid his old friends and seemed unable to concentrate forany length of time. He was unable to cope with returning to work he could notcomplete jobs and was unable to organize his diary, frequently turning up to workwith the wrong equipment. He eventually stopped work altogether after he cut

down every tree in a clients orchard. He had been asked to prune 1 tree only.

b. The following was wriiten by Dr Harlow, an American GP, about his patientPhineas Gage

The equilibrium or balance, so to speak, between his intellectual faculties andanimal propensities, seems to have been destroyed. He is fitful, irreverent,indulging at times in the grossest profanity (which was not previously hiscustom), manifesting but little deference for his fellows, impatient of restraint oradvice when it conflicts with his desires, at times pertinaciously obstinate, yetcapricious and vacillating, devising many plans of future operations, which are no

sooner arranged than they are abandoned in turn for others appearing morefeasible. A child in his intellectual capacity and manifestations, he has the animalpassions of a strong man. Previous to his injury, although untrained in theschools, he possessed a well-balanced mind, and was looked upon by thosewho knew him as a shrewd, smart businessman, very energetic and persistent inexecuting all his plans of operation. In this regard his mind was radicallychanged, so decidedly that his friends and acquaintances said he was "no longerGage."

Tasks

1. List the symptoms of cognitive impairment present in both cases.

Impaired planningImpaired sequencingImpaired judgementPerseverationImpaired concentrationDisinhibition

2. Define the abnormality and summarise how it arises

This is referred to as the Dysexecutive Syndrome. In health, the normal brainis able to inhibit primitive urges (fight, flight. feed and f**k). When damaged,this inhibition may be lost with much challenging behaviour resulting fromimpulsivity and poor judgement.The brain also allows us to be rapidly adaptive to new situations or changeand when damaged this adaptability is impaired.


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The brain is able to filter out unwanted information so that we may focus ourattention on matters of interest (divided attention and dual task interference).

3. What brain are/s are likely to be affected?

Dorsolateral prefrontal cortex.

4. List possible causes of this presentation

Brain injuryCortical dementias (especially FTD and Alzheimers Disease)

5. How would you test for this in clinical practice?

Stroop TestWisconsin Card Sort Test

Trail making testTraffic JamACE-R, verbal fluency testACE-R clock drawingLuria 3 step hand testGo, no go testPrimitive reflexes

Case 3.

Ethel is a 75 year old lady who recently lost her husband, Dennis, after 55 yearsof marriage. Ethels daughter, Sharon, began to worry that her mum wasntcoping with the death of Dennis. Ethel seemed to lose her confidence and notlook after herself very well. Ethel seemed to constantly lose things and accusedher daughter of stealing things she had lost. Sharon noticed that Ethel asked thesame questions several times and would leave the gas cooker on and not lockthe doors at night.

Tasks

1. Identify the symptoms of cognitive impairment.Ethel appears to have poor short term memory and may be unaware of, orunable to meet her day to day care needs.

2. Define the abnormality and how it is caused

Poor short term memory is often the first sign of cognitive impairment that isobvious to family/ carers. Individuals cannot recall recent events and are unableto make new memory (anterograde amnesia) and can therefore not learn new


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information.

3. What brain area/s are likely to be affected

Temporal lobe atrophy, particularly involving the hippocampi and adjacent

diencephalic structures, correlates with memory impairment4. Outline how memory is organized

Memory can be divided into explicit and implicit.Explicit memory may be further divided into short term and long term.Short term memory may be additionally subdivided into anterograde andretrograde.

Long term memory may be considered as having two subtypes, semantic(localizing to the left temporal lobe) and episodic (less well localized but certainlyinvolving the hippocampi and limbic system).

Implicit memory consists of procedural memory and conditioned reflexes (andappear to localize to the basal ganglia).

5. List possible causes of this presentation and summarise their differingpathologies

Senile Dementia of Alzheimers Type STM impairment is often the first sign ofillness. Other cognitive functions are also affected (language, praxis, frontal lobefunctions, recognition). There is widespread cortical atrophy with particularneuronal loss in the hippocampal region. Histological findings include amyloidplaques and neurofibrillary tangles in the cerebral cortex.

Lewy Body Dementia characterised by dementia, parkinsonism, fluctuatingconsciousness and psychosis, this disease is caused by cortical and subcorticalneuronal loss with alpha synuclein being deposited in Lewy Bodies.

Frontotemporal Dementias complex group of disorders with pathologicalchanges confined to the cortex.

Vascular DementiaAlcohol Induced DementiaKorsakoffs Disease profound anterograde amnesia with preservation of othercognitive functions. Cause is thiamine depletion (usually due to alcohol use)thatoften causes demyelination of the mammillary bodies .

6. How would you test for this in clinical practice?

MMTS 3 minute recallACE-R anterograde memory test (address)

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