Higher-Order Cerebral Functions

Front 1

Most of the brain is made up of _________ cortex.

Back 1

Association

Front 2

The 2 types of association cortex are:

Back 2

Unimodal (modality-specific)
Heteromodal (Higher-order)

Front 3

Give 4 examples of unimodal association cortex

Back 3

Somatosensory Association
Visual Association
Auditory Association
Motor Association

Front 4

What are the 2 motor association cortex areas?

Back 4

Premotor cortex
Supplementary Motor Area

Front 5

From whence does the unimodal sensory association cortex receive its primary input

Back 5

Primary sensory cortex of a specific sensory modality

Front 6

What does the unimodal association cortex do with the input

Back 6

Performs higher-order sensory processing

Front 7

What connections does the heteromodal association cortex have (direction, areas)?

Back 7

Bidirectional connections with both motor and sensory association cortex of all modalities and bidirectional connections with limbic cortex

Front 8

What function does the heteromodal cortex serve?

Back 8

Highest-order mental functions.

Front 9

In what 2 areas is heteromodal association cortex found?

Back 9

Frontal lobes
Parieto-occipital junctions

Front 10

What information does the limbic system provide to the heteromodal association cortex (2 types)?

Back 10

emotional
motivational

Front 11

Simple motor movements are controlled by the __________ hemisphere while skilled complex motor tasks for both limbs are mainly controlled by the ______ hemisphere?

Back 11

contralateral
dominant/left (explains why apraxia usually due to dominant/left hemisphere damage)

Front 12

Define apraxia

Back 12

A disorder of formulating skilled movements

Front 13

The left hemisphere is dominant for language in over ____% of R handers and ____ % of L handers

Back 13

95%
60-70%

Front 14

List 5 skills associated with the dominant/left hemisphere

Back 14

Language
Skill motor formulation (praxis)
Arithmetic (sequential, analytical calculation skills)
Musical ability (sequential, analytical abilities in trained musicians)
Sense of direction (following written directions in sequence)

Front 15

List 5 functions of the nondominant/right hemisphere

Back 15

Prosody
Visuospatial analysis and spatial attention
Arithmetic (correctly line up numbers on a page)
Musical ability (untrained musicians; complex pieces for trained musicians)
Sense of direction (finding way by overall sense of spatial orientation)

Front 16

Define prosody

Back 16

Emotion conveyed by the tone of voice

Front 17

Which hemisphere is responsible for attention to both sides?

Back 17

Right (non-dominant)

Front 18

Which hemisphere is responsible for spatial perception of the overall gestalt?

Back 18

Right (non-dominant)

Front 19

Networks with connections to which 3 areas mediate dominant/non-dominant hemisphere functions?

Back 19

1. Frontoparietal
2. Connections with limbic structures
3. Reciprocal connections with subcortical nuclei

Front 20

What 2 ways can these networks be disconnected?

Back 20

Within each hemisphere

Between hemispheres at the corpus callosum

Front 21

Where is the primary auditory cortex located?

Back 21

The superior bank of the Sylvian fissure in the temporal lobe (See Blumenfeld p. 824 for diagram)

Front 22

What part of the brain is responsible for identifying particular sequences of sounds and comprehending words as meaningful?

Back 22

Wernicke's area

Front 23

What Brodmann's are is this?

Back 23

22

Front 24

Where is it located

Back 24

Posterior 2/3 of the superior temporal gyrus in the dominant hemisphere

Front 25

What adjacent Brodmann's areas/association cortex also produce Wernicke's aphasia

Back 25

37, 39, 40 (See Blumenfeld p. 828 for diagram)

Front 26

What part of the brain is responsible for articulation of sounds that result in speech

Back 26

Face area of the primary motor cortex

Front 27

Where is this located

Back 27

Inferior portion of the precentral gyrus

Front 28

What part of the brain is responsible for the motor program that activates sequences of sounds to produce words

Back 28

Broca's area

Front 29

What is/are the corresponding Brodmann's area(s)

Back 29

44, 45 (See Blumenfeld p. 828 for diagram)

Front 30

What is the mnemonic to remember Wernicke's and Broca's Brodmann's areas?

Back 30

Broca's (44) is twice Wernicke's (22)

Front 31

Describe where Broca's area is located in the brain

Back 31

In the opercular and triangular portions of the inferior frontal gyrus of the dominant hemisphere

Front 32

What other adjacent Brodmann's areas (6) also can produce Broca's aphasia

Back 32

9, 46, 47, 6, 8, 10

Front 33

What is the subcortical white matter pathway that connects Wernicke's and Broca's areas

Back 33

Arcuate fasciculus

Front 34

What other pathways are involved

Back 34

numerous polysynaptic connections that convey information along the intervening peri-Sylvian cortex

Front 35

To what areas does Broca's area connect for higher-order motor aspects of speech formulation and planning (3)

Back 35

Prefrontal cortex, premotor cortex, supplementary motor area

Front 36

What other important aspect of speech formulation are these areas responsible for

Back 36

Syntax (both in language comprehension and production)

Front 37

Define syntax

Back 37

Grammatical structure

According to the INS Dictionary of Neuropsychology: "The rules of language structure governing the assembly of words into sentences. Syntax represents the variety of relationships among words (i.e., word order) that helps convey information in a coherent and meaningful manner." (p. 155)

According to answers.com: "The study of the rules whereby words or other elements of sentence structure are combined to form grammatical sentences. "

Front 38

With which other brain areas does Wernicke's area have connections (3)

Back 38

Supramarginal gyrus of the parietal lobe, angular gyrus of the parietal lobe, other parts of the temporal lobe (e.g., Brodmann's area 37)

Front 39

In addition to comprehension, what other aspect of language do these areas assist with

Back 39

Lexicon (involved in both the comprehension and production of meaningful language)

Front 40

Define lexicon

Back 40

According to the INS Dictionary of Neuropsychology: "Knowledge of the phonological representation and grammatical aspects of words." (p. 97)

According to answers.com:
"The morphemes of a language considered as a group."

According to answers.com, a morpheme is: "A meaningful linguistic unit consisting of a word, such as man, or a word element, such as -ed in walked, that cannot be divided into smaller meaningful parts."

According to the INS Dictionary of Neuropsychology, a morpheme is: "The smallest unit of meaning in a language. Morphemes include words as well as meaningful prefixes, suffixes, and affixes." (p. 109)

Front 41

What part of the brain is also particularly involved in written language

Back 41

Language areas of the dominant parietal lobe, such as angular gyrus

Front 42

Describe the pathway taken by information that is read

Back 42

Primary visual cortex in occipital lobes, processed in visual association cortex, travels anteriorly via the angular gyrus to language areas

Front 43

What role does the right/non-dominant hemisphere play in language

Back 43

Recognition and production of affective elements of speech

Front 44

What pathway is involved

Back 44

Via the corpus callosum

Front 45

What language dysfunction do individuals with non-dominant hemisphere lesions display

Back 45

Difficulty judging the intended expression in the tone of voice, difficulty producing emotional expression in their voice

Front 46

Lesions in which subcortical areas reciprocally connected with language areas can produce similar language deficits (3)

Back 46

Thalamus, basal ganglia, subcortical white matter

Front 47

Define aphasia/dysphasia

Back 47

"A defect in language processing caused by dysfunction of the dominant hemisphere" (Blumenfeld, p. 829)

INS Dictionary of Neuropsychology: "Acquired disorder of symbolic language processing." (p. 15)

Front 48

What 5 other general conditions/situations must be ruled out before giving a diagnosis of aphasia

Back 48

1. Disorders of speech production, 2. Auditory disorders, 3. Defects in arousal and attention, 4. Psychiatric disorders, 5. Lack of cooperation

Front 49

Name 3 disorders of speech production

Back 49

Dysarthria, aphemia (verbal apraxia), mutism

Front 50

How can disorders of speech production be distinguished from aphasia

Back 50

The content and grammar are normal; written language is often normal; mutism may result from severe aphasia or from motor disorders, but writing may be intact

Front 51

Name 3 auditory disorders

Back 51

Peripheral hearing loss, pure word deafness, cortical deafness

Front 52

How can auditory disorders be distinguished from aphasia

Back 52

Reading and other aspects of language are intact

Front 53

Name some conditions that result in defects in arousal and attention

Back 53

Global confusional state (toxic/metabolic, post-ictal, brainstem ischemia), narcolepsy

Front 54

Name a couple of psychiatric conditions that may cause disruption of language

Back 54

Schizophrenia, conversion disorder and other somatoform disorders

Front 55

What are some aspects of langauge that characterize psychiatric disorders

Back 55

Disordered, nonsensical, clanging speech full or neologisms

Front 56

What is the most common cause of aphasia

Back 56

Cerebral infarction

Front 57

List 7 causes of aphasia

Back 57

1. Cerebral contusion; SDH, EDH
2. Ischemic or hemorrhagic vascular events
3. Ictal or post-ictal related to focal seizures in dominant hemisphere
4. Mass lesions (brain tumor, abscess, toxoplasmosis)
5. Inflammatory/autoimmune disorder (e.g., MS, vasculitis)
6. Developmental disorder (language delay, autism)
7. Degenerative disorder (primary progressive aphasia, moderately advanced Alzheimer's Disease, Huntington's Disease)

Hint 57

See neuroexam.com Videos 8-12 for 6-step bedside exam

Front 58

What is the most common cause of Broca's aphasia

Back 58

Infarct in the territory of the L MCA superior division

Front 59

What are other non-language features generally associated with Broca's aphasia (5)

Back 59

R hemiparesis affecting the face and UE>LE; dysarthria; frustration; depression; L sided and oral-buccal-lingual structures apraxia

Front 60

What is the most common cause of Wernicke's aphasia

Back 60

Infarct in the L MCA inferior division territory

Front 61

What non-language features are generally associated with Wernicke's aphasia (4)

Back 61

Contralateral visual field cut, usually R upper quadrant; apraxia (difficult to tell due to reduced comprehension); anosagnosia (acting as if conversation is normal); angry or paranoid behavior (may appear psychotic)

Front 62

What 3 aspects of language determine the type of aphasia

Back 62

Fluency, comprehension, repetition

Front 63

What are the 8 general types of aphasias

Back 63

Global, Mixed transcortical, Broca's, Transcortical Motor, Wernicke's, Transcortical Sensory, Conduction, Anomic

Front 64

What are the 4 aphasias related to reduced fluency

Back 64

Global, Mixed Transcortical, Broca's, Transcortical Motor

Front 65

What are the 4 aphasias related to relatively intact fluency

Back 65

Wernicke's, Transcortical Sensory, Conduction, Anomic

Front 66

Given reduced fluency, what 2 aphasias are related to reduced comprehension

Back 66

Global, Mixed Transcortical

Front 67

Given reduced fluency, which 2 aphasias are related to relatively intact comprehension

Back 67

Broca's, Transcortical Motor

Front 68

Given reduced fluency and comprehension, which aphasia cannot repeat

Back 68

Global

Front 69

Given reduced fluency and comprehension, which aphasia can repeat

Back 69

Mixed Transcortical

Front 70

Given reduced fluency and generally intact comprehension, which aphasia cannot repeat

Back 70

Broca's

Front 71

Given reduced fluency and generally intact comprehension, which aphasia can repeat

Back 71

Transcortical Motor

Front 72

Given relatively intact fluency, which 2 aphasias demonstrate reduced comprehension

Back 72

Wernicke's, Transcortical Sensory

Front 73

Given relatively intact fluency, which 2 aphasias demonstrated generally intact comprehension

Back 73

Conduction, Anomic

Front 74

Given relatively intact fluency and reduced comprehension, which aphasia cannot repeat

Back 74

Wernicke's

Front 75

Given relatively intact fluency and reduced comprehension, which aphasia can repeat

Back 75

Transcortical Sensory

Front 76

Given relatively intact fluency and comprehension, which aphasia cannot repeat

Back 76

Conduction

Front 77

Given relatively intact fluency and comprehension, which aphasia can repeat

Back 77

Anomic

Front 78

Draw the flow chart of Classification of Language Disorders using a decision tree of fluency, comprehension, and repetition

Back 78

See Blumenfeld Figure 19.4, p. 834

Front 79

Draw a lateral view of the dominant/L hemisphere and for each disorder (except anomic aphasia) indicate the usual area of infarction and the vascular/watershed territory usually involved

Back 79

See Blumenfeld p. 834