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559 Cards in this Set
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In 1974, Baddeley and Fitch proposed |
a concept of working (short-term) memory.
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working (short-term) memory, definition
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Temporary storage of a limited amount of information in mind for execution of a goal or intention (learning, problem-solving, preparation for action) |
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Dependent on medial temporal lobe system involving the hippocampus and adjacent entorhinal, perirhinal, and parahippocampal cortices
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declarative memory
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Acquisition of motor skills with practice e.g., driving a car, riding a bike, mirror tracing
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procedural learning |
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CS à US à UR; CS à CR; e.g., eyeblink
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classical conditioning
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Which anatomical structures are important in classical conditioning?
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interpositus nucleus and overlying cerebellar cortex. |
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Which anatomical structure is important in evaluative learning?
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amygdala |
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Which anatomical structure is important in priming?
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neocortical regions engaged by the task. |
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this is primarily an attentional function mediated by dorsolateral prefrontal (and posterior parietal) cortex
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working (short-term) memory
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What is amygdala’s role in memory?
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emotionally arousing events (which activate it) remembered better than emotionally neutral events (depends, in turn, on release of cortisone and adrenaline) --> strengthens neural connections
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Which anatomical structures are important in procedural learning?
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cerebellum and striatum
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Different types of nondeclarative (implicit) memory include:
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procedural learning, classical conditioning, evaluative learning, and priming.
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Whether a stimulus or event has positive or negative valence (e.g., fear conditioning and extinction/ desensitization)
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evaluative learning
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Facilitation in processing a stimulus (faster response time, greater accuracy, less cuing required) as a result of a recent encounter with the same stimulus (in absence of conscious recollection)
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priming
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What kind of patients show impaired procedural learning?
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Those with Huntington’s disease and Parkinson’s disease
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Patients with prefrontal damage not amnesic but have deficits in
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executive processes involved in monitoring, organizing, and using memory effectively
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In addition to deficits in free recall involving strategic search, patients with prefrontal damage have deficits in
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memory for temporal order of events and source memory
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Meta-memory and “feeling of knowing”
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knowledge about one’s own memory capabilities, memory demands of particular tasks or situations, and potentially useful strategies relevant to given tasks or situations
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memory for temporal order of events
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recency judgments
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source memory
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recollection of context in which information was acquired.
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Prospective memory
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memory for future events, “remembering to remember” (time-based; event-based).
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Deficits in source memory and meta-memory are also characteristic in
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patients with prefrontal damage.
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Deficits observed in patients with prefrontal damage can also be observed in
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Diencephalic amnesics (e.g., Korsakoff disease patients), which differentiate them from bitemporal amnesics.
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Capgras Syndrome
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Pts have delusional belief that family members of friends are imposters. Confabulate to rationalize this belief.
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Capgras Syndrome is usually a result of
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partial or recovering limbic lesion superimposed on FL damage, especially in right hemisphere.
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Name paramnesic phenomena in frontal patients:
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confabulation; reduplicative paramnesia; Capgras syndrome.
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Reduplicative Paramnesia, definition:
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Pt convinced that a person, place, or object exists in duplicate.
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Reduplicative Paramnesia, cause: |
may be due to disturbed sense of familiarity rendering pt unable to associate/fuse present situation/stimulus with existing engram and so 2 parallel memories created.
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a condition or phenomenon involving distorted memory or confusions of fact and fantasy, such as confabulation or déjà vu
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paramneisa
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confabulation
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a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive
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What does FTLD stand for?
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frontotemporal lobar degeneration
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What does FTD stand for?
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frontotemporal dementia
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Name several FTLD clinical syndromes
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FTD, Progressive Aphasia, Semantic Dementia.
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Neuropathological topography of FTD:
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prefrontal/ anterior temporal
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Neuropathological topography of Progressive Aphasia:
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Left fronto-temporal
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Neuropathological topography of semantic dementia:
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temporal.
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What does FTD/MND stand for?
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frontotemporal dementia with motor neuron disease.
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What does PNFA stand for?
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progressive non-fluent aphasia
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What does PAX stand for?
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progressive apraxia.
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Main symptoms of semantic dementia:
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word finding difficulties; impaired knowledge of word meaning.
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Patients with anomia
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know the meaning of the word, but cannot retrieve the word.
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Patients with semantic dementia
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do not know the meaning of the word, even if it is familiar.
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If you notice a gradual reduction of vocabulary; use high frequency terms (thing, boy); speech is fluent and well articulated; no phonological or syntactic errors, you may suspect
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semantic dementia.
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How do you assess dissociation between two abilities: repetition and meaning knowledge?
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Ask to repeat the word, then ask what it means.
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What are the oral subtests of WAB-R?
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Spontaneous speech, auditory comprehension, repetition, naming.
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What does WAB-R stand for?
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Western Aphasia Battery Revised.
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Nonfluent type of progressive aphasia is characterized by:
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impaired fluency and apraxia of speech.
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Primary progressive aphasia is characterized by:
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: impairment in fluency and naming.
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A measure of discrepancy from normal language performance
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Aphasia Quotient (AQ) on WAB.
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Name different types of aphasia:
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isolation, conduction, anomic, transcortical motor, transcortical sensory, global, Wernicke’s, Broca’s.
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On WAB-R, reading and writing scores are used to calculate
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Language Quotient (LQ).
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Tests of apraxia, drawing, block design construction, calculation, and Raven’s Progressive Matrices are included in
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Cortical Quotient (CQ)
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On motor examination, deficient performance can indicate
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dysfunction in the hemisphere contralateral to the affected limb.
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Different types of apraxia include:
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melokinetic, ideomotor, ideational
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Melokinetic apraxia =
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limb-kinetic apraxia.
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Astereognosia
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inability to recognize objects by touch in context of intact sensation
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Attention and Information Processing Speed can be measured by these tests:
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Paced Auditory Serial Addition Test (PASAT); Symbol Digit Modalities Test (SDMT); CPT–II (Continuous Performance Test)
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Bottom–up influences in attention
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Attention is engaged involuntarily
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BVMT–R, CVLT–2, LAMB, MTOA, are all the tests of…
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Tests of Learning and Memory
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Damage to ARAS can lead to
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Permanent states of stupor and coma
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Define “clouded consciousness”
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alert but unable to direct/maintain attention on a task (wandering attention); easily distracted
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Define “Obtundation”
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Awake but drowsy; responsive but slow
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Define “Stupor”
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In deep sleep most of the time; can be aroused but only transiently; attention drifts, not sustained.
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Description of the flexibility of attention
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constantly shifting as goals change; same stimulus can be allocated more or less attention according to current context and past experience
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Divided attention
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attending to multiple events simultaneously
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General level of responsiveness (def. within attention topic)
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arousal
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Higher order regulatory influences that affect all sensory modalities in attention are mediated by
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ARAS (bottom–up) and higher order association cortex, especially frontal lobes (top–down).
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In what state of arousal the person is unarousable, no behavioral responsiveness?
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Coma.
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Name five levels of consciousness (arousal)
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Awake and alert; clouded consciousness, obtundation, stupor, coma.
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Orientation (def. within attention topic)
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(re)alignment of sensory organs (e.g., direction of gaze)
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Selective attention (def. within attention topic)
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preferential processing of some stimuli over others
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Set of processes that control which of many competing internal and external stimuli/events will have access to consciousness and/or will be acted upon
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attention
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Sustained attention
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vigilance; maintaining attention on a given stimulus over time without habituating
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The requirement of balance between concentration and distractibility is a description of which attribute of attention?
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Flexible
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The study of disturbances from congenital or acquired lesions which in turn affect the development of the individual
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Child Neuropsychology
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The study of disturbances of established patterns of behavior
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Adult Neuropsychology
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These are also tests of learning and memory
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WMS–IV, TOMM, WMT.
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These are language tests.
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Token Test; FAS & Animal Fluency (Controlled Oral Word Association Test)
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These are some of the characteristics of attention
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Finite and Flexible
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This is also a comprehensive, multi–domain test
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DRS
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To test of Visual Perceptual Abilities, you can also use…
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VMI, RCFT, Parietal Lobe Battery, Judgment of Line Orientation
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Top–down influences in attention
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Attention directed voluntarily
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What are the two main neurotransmitters involved in ARAS?
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Acetylcholine and norepinephrine
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What do attention processes involve?
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Selecting relevant inputs and filtering out less relevant ones.
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What do Auditory Consonant Trigrams and Trail Making Tests measure?
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Attention and Information Processing Speed
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What do Boston Diagnostic Aphasia Exam and Boston Naming Test a test of?
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Test of Language
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What do Cancellation tasks, Clock, Hooper Visual Organization and Embedded Figures tests measure?
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Visual Perceptual Abilities
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What do D–KEFS and WCST assess?
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Executive Abilities
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What does ARAS stand for?
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Ascending Reticular Activating System
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What does BVMT–R stand for?
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Brief Visuospatial Memory Test – Revised.
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What does CVLT–2 stand for?
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California Verbal Learning Test II
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What does DRS stand for?
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Dementia Rating Scale
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What does D–KEFS stand for?
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Delis–Kaplan Executive Function System
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What does LAMB stand for?
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Learning and Memory Battery
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What does MTOA stand for?
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Memory Test for Older Adults
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What does RBANS stand for?
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Repeatable Battery for the Assessment of Neuropsychological Status
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What does the ARAS projection through thalamus facilitate?
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Passage of sensory information, promoting cortical arousal.
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What does TOMM stand for?
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Test of Memory Malingering
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What does WCST stand for?
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Wisconsin Card Sorting Test
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What does WMS–IV stand for?
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Wechsler Memory Scale
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What does WMT stand for?
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Word Memory Test
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What engages the attention in bottom–up influences?
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Drive states or events or stimuli in the external environment
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What engages the attention in top–down influences?
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Conscious states such as motivation, volition.
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What is a prerequisite for all higher cognitive/ intellectual activity?
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Attention
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What is attention?
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Selective allocation of finite information processing resources and response channels to events that are behaviourally relevant
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What is CTIP (Computerized Test of Information Processing) a test of?
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Attention and Information Processing Speed
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What kind of test is RBANS?
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Comprehensive (multi–domain)
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Where does one of the two major upstream projections of ARAS pass through?
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thalamus
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Where is another one of the two major upstream projections of ARAS?
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from brainstem and basal forebrain to cerebral cortex
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What is the role of frontal lobes in attention?
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Top-down regulation: conscious direction, control of attention.
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What is the role of prefrontal cortex in attention?
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Regulates it in response to conscious volition/goals regardless of domain and modality.
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What can be thought of as an intermediate stage between attention and memory?
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Working memory can be thought of as an interface between these two.
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What do concepts of STM and WM have in common?
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Both characterized by limited storage capacity & brief duration.
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How is WM different from STM?
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Broader concept – refers both to maintenance and active manipulation of on-line info.
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What is WM comprised of?
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A “central executive” which regulates 2 slave systems. What does “WM” stand for?
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“Working Memory”
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What does “STM” stand for?
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“Short-Term Memory”
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What are the 2 slave systems regulated by the central executive in WM?
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Phonological loop; Visuospatial sketchpad
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What is a phonological loop?
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Auditory WM
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What is visuospatial sketchpad?
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Visual WM
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What part of the brain is activated during verbal WM tasks?
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Left dorsolateral prefrontal cortex.
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What part of the brain is activated during spatial WM tasks?
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Right dorsolateral prefrontal cortex.
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What is the hypothesized third WM slave system?
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Episodic buffer – links info across domains to form integrated units of visual, spatial, and verbal info and chronological ordering; assumed to have links to LTM.
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How does damage to frontal lobe affect response to novelty?
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It induces apathy and disinterest in environment.
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Name two clinical syndromes that can result from disturbances of attentional matrix.
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Acute confusional state, unilateral neglect.
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“acute confusional state”.
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Global impairment of the attentional matrix due to diffuse brain disease or dysfunction.
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“unilateral neglect”
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Example of impairment in domain-specific system that controls allocation of attention in extrapersonal space.
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Acute confusional state is also known as
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delirium
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What is the most common neurological disorder of mental state?
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Acute confusional state.
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Delirium: in what percentage of hospitalized patients over 65 y.o. ?
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20-25
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What drug’s toxicity is likely to cause an acute confusional state?
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anticholinergics
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Name cardinal features of delirium in addition to disturbance of vigilance, heightened distractibility and impaired wm.
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Inability to maintain coherent stream of thought and to carry out coherent sequence of goal-directed movements.
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What is the most prominent feature in delirium?
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Deficits in attention.
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Which patients are especially vulnerable to an acute confusional state? |
Elderly and patients with pre-existing brain disease or dementia.
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A domain-specific impairment of spatial attention in which individual fails to direct attention to space to the left of midline (“relative leftness”).
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Unilateral neglect.
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Unilateral neglect occurs almost exclusively after
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right hemisphere lesions
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What is the only way to detect unilateral neglect of milder form? (as it resolves?)
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Double simultaneous stimulation, i.e., when there is competition from stimulation in the other hemi-space.
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Frontal Lobe Attentional Deficits
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Distractibility; Difficulty sustaining attention over time; Difficulty inhibiting automatic, overlearned responses (e.g., Stroop effect, “stimulus pull”)
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Difficulty switching between tasks, categories, dimensions; Impairment in dual-task paradigms (e.g., CCCs)
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Frontal Lobe Attentional Deficits
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Behavioral observations, such as level of patient’s arousal, registering instructions, coherence in speech and action and distractibility are critical in ….
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Assessment of attention
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In addition to inability to follow through with task and need to redirect, what other behavioral observations are critical for the assessment of attention?
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Preoccupation with other thoughts; irrelevant comments or actions; intrusions, perseveration of previous tasks, need to stimulate physically to re-capture attention.
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To assess basic attention/ WM capacity
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Span tasks
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To assess divided attention
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Manipulation/ tracking /dual-task (e.g., bwd spans)
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Why is it important to read numbers at a steady pace during administration of the “digit span” task?
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“chunking” can enhance performance
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What are 3 conditions in the “digit span” task? (e.g., in WAIS-IV)
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Forward, backward, and ordering
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Spatial span (in WMS-III) is a
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Variant of Corsi Block-Tapping task
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Which span task has a larger age effect than digit span?
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Spatial span
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How are results on spatial span often differ from those on digit span?
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1-2 units shorter
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Spatial span < digit span when there may be a
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Right hemisphere lesion
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Digit span < spatial span when there may be a
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Left hemisphere lesion
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Visual analog of WAIS-IV digit span
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Symbol span (WMS-IV)
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What do patients do in Symbol Span (WMS-IV)?
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Patient views series of abstract designs (hard to verbalize) of increasing length, then must select correct designs from foils in correct sequences
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Mental Manipulation/Tracking Tasks
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Backward digit span and spatial span (WMS, WAIS); Digit Sequencing (WAIS-IV); Letter-Number Sequencing (WAIS-IV); Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs)
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Requires both maintenance (“visual sketchpad”) and manipulation (“central executive”) aspects of spatial WM, as well as ability to ignore distractors (“central executive”)
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Spatial Addition (WMS IV)
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What do patients do in Spatial Addition (WMS-IV)?
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views pattern of blue and red circles on a grid; then shown a second pattern on the grid; must “add” 2 images together, placing white circle in a location occupied by a blue circle on both grids, blue circle in location occupied by a blue circle on only 1 grid, and ignoring red circles.
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Arithmetic (WMS-IV); Spatial addition (WMS-IV); Paced Auditory Serial Addition Test (PASAT) are…
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Mental Manipulation/Tracking Tasks
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Paced Auditory Serial Addition Test (PASAT) are only suitable for
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high-functioning individuals who are not mathematically impaired
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Dual task paradigm that requires holding infraspan info in mind while performing a distraction task, Initially designed to prevent rehearsal to measure duration of STM
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Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs)
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Subtraction errors on Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs) are also indicative of
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problems with tracking & self-monitoring
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Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs) is sensitive (can detect)
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FL lesions, mTBI, ADHD
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To assess sustained attention (concentration)
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Vigilance tests
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Most common version of vigilance tests
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computerized continuous performance task requiring that subject detect target stimuli from among a series of stimuli over relatively long periods of time (monotonous)
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how are vigilance tests scored
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According to omission and commission errors and RT
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Stroop test is an example of a test that assesses
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Sustained attention (concentration)
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Slowed processing speed often underlies
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attentional deficits
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Slowed processing speed is particularly prominent after
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TBI (due to diffuse axonal injury) and diseases that affect subcortical white matter, such as MS and Parkinson’s disease
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Symbol Substitution Tests
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Multi-faceted—measure visual scanning, sustained attention, visuomotor coordination and incidental learning in addition to processing speed
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In basic neutoanatomy for vision, after the visual signal enters the retina, what happens to it before it gets to the thalamus?
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it projects through the optic radiations
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In basic neutoanatomy for vision, the visual signal enters the retina and then projects through the optic radiations to the thalamus and then to…
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the primary visual cortex
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Another name for the primary visual cortex
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striate cortex |
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Where is striate cortex located?
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in the medial portion of the occipital lobes above and below the calcarine fissure
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In vision, what role do association cortices in occipital, posterior temporal and parietal areas play?
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that’s where visual info combines with input from other sensory modalities and integrates with other cognitive functions
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What does ventral occipitotemporal visual processing system do?
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subserves ibject recognition (“what”)
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What does dorsal (occipitoparietal) visual processing system do?
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subserves appreciation of spatial relationships (“where”)
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Lesions to which hemisphere produce most severe deficits in visual processing?
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right
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Which lesions have worse outcomes for visual processing, anterior or posterior?
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posterior
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In terms of visual processing skills, right hemisphere is dominant for
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storage of visuospatial information, perception of depth, distance, direction, shape, orientation, position, perspective, and figure-ground
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In terms of visual processing skills, lesions in left hemisphere can result in
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sequencing errors, oversimplification of stimulus, and lack of detail, with general shape or outline retained, may be greater distortion in right half of drawing |
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Which hemisphere is specialized for analyzing internal details of a stimulus?
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left |
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According to Benton & Tranel, visual processing skills can be classified into which categories?
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Visuoperceptual, visuospatial, and visuoconstructive.
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Name two visuoperceptual deficits:
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Visual object agnosia; defective visual analysis and synthesis
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Impairment in discrimination and recognition of faces; impaired colour recognition (are what kind of deficit?)
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visuoperceptual
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Name two visuospatial deficits:
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Defective localization of points in space; defective judgment of direction and distance
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Visual inattention / Unilateral visual neglect; Balint’s syndrome (are what kind of deficit?)
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visuospatial
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When you see cortical paralysis of visual fixation, optic ataxia, disturbance of visual attention, you may consider diagnosis of…
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Balint’s syndrome.
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When you see defective assembly and drawing, you may suspect …
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visuoconstructive deficits.
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Define Visual Object Agnosia:
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inability to recognize a stimulus presented in a specific sensory modality not due to impairment of primary sensory processing, language deficits, attentional impairment, lack of experience with the stimulus, or generalized mental deterioration |
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In apperceptive visual agnosia, visual object recognition is disrupted due to …
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impairment in visual object agnosia (unable to be aware of the objects seen) |
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If a patient is unable to point to named objects and cannot match nor copy stimuli, you may suspect
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Apperceptive visual agnosia
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Patients with apperceptive visual agnosia may be better able to recognize
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real objects than geometric shapes
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Why are real objects easier to recognize than geometric shapes for people with apperceptive visual agnosia?
|
due to availability of such cues as size, color, and texture
|
|
|
|
What else can help improve recognition for people with apperceptive visual agnosia?
|
motion of stimulus
|
|
|
|
Describe associative visual agnosia
|
visual object recognition impaired in the context of preserved ability to copy or match the stimuli
|
|
|
|
In what modalities can patients with associative visual agnosia recognize objects?
|
tactile and auditory
|
|
|
|
Associative Visual Agnosia: in which areas of the brain is damage usually found?
|
Occipito-temporal region, in both gray and white matter.
|
|
|
|
What kind of visual processing skills are “Visual analysis and synthesis”?
|
visuoperceptual
|
|
|
|
Visual Analysis and Synthesis includes
|
simple and more complex visual discriminations; separating figure from ground.
|
|
|
|
Integration of separate elements of a complex stimulus array into a meaningful whole is a part of what processes?
|
visual analysis and synthesis
|
|
|
|
Simultanagnosia
|
inability to see more than one thing at a time or one aspect of an object at a time though details are correctly appreciated.
|
|
|
|
Deficits observed in interpretation of action pictures or HVOT may be indicative of
|
simultanagnosia.
|
|
|
|
In what type of prosopagnosia people may experience familiar as strange or imposters?
|
Capgras syndrome
|
|
|
|
If a patient can’t recognize even her own face in the mirror, you may suspect
|
prosopagnosia
|
|
|
|
Achromatopsia
|
acquired impairment in perception of colours. |
|
|
|
In assessing achromatopsia, you need to discriminate between
|
impaired color perception and color anomia
|
|
|
|
How large is the part of the visual field that is usually affected by achromatopsia?
|
one half to one quarter.
|
|
|
|
Lesions in region of occipito-temporal junction may result in
|
achromatopsia
|
|
|
|
Color agnosia
|
inability to identify characteristic colors of familiar objects (can’t name, recognize or match)
|
|
|
|
PASAT stands for
|
Paced Auditory Serial Addition Test
|
|
|
|
SDMT stands for
|
Symbol Digit Modalities Test
|
|
|
|
CPT-II stands for
|
Continuous Performance Test
|
|
|
|
A test that requires a patient to fill in missing elements, 2) organize fragmented elements into a whole percept or 3) impose structure onto ambiguous stimuli or those lacking inherent organization is likely a test of….
|
visual organization
|
|
|
|
An example of the visual organization test
|
HVOT (Hooper, 1983)
|
|
|
|
Which hemisphere is dominant for spatial attention?
|
right
|
|
|
|
If you notice that a patient fails to direct attention to space to the left of midline, you may suspect
|
right hemisphere lesion
|
|
|
|
Unilateral neglect, in addition to being a posterior parietal sign, can also be seen after
|
lesions to frontal lobes, cingulate gyrus, striatum, and thalamus
|
|
|
|
Hemianopia, or hemianopsia, is a
|
anopsia in half the visual field of one or both eyes, usually on one side of the vertical midline.
|
|
|
|
decreased vision or blindness
|
anopsia
|
|
|
|
dressing apraxia may be related to
|
left neglect, simultanagnosia, or optic ataxia
|
|
|
|
optic ataxia
|
problems with voluntary eye movements
|
|
|
|
Visual Angulation, definition
|
Perception of angular relationships
|
|
|
|
Visual Angulation (usually located where)
|
a right hemisphere function (temporo-occipital)
|
|
|
|
How does JLo examine the ability to estimate angular relationships between line segments?
|
by visually matching angle line pairs to numbered radii forming a semi-circle
|
|
|
|
On the Hooper, patients with right-sided lesions tend to…
|
give fragmented or part responses
|
|
|
|
On the Hooper, patients with left-sided lesions tend to….
|
make more naming errors
|
|
|
|
On the Hooper, pulls for perceptual fragmentation are often seen with …
|
executive dysfunction and right frontal lesions.
|
|
|
|
Hidden Figures Test (Thurstone, 1944) requires patient to
|
identify a simple figure embedded in the more complex one
|
|
|
|
On visuocontruction tasks, right hemisphere signs include (among others)
|
Distortion in general shape, orientation, organization, perspective and proportion; Piecemeal, fragmented approach, with loss of overall gestalt
|
|
|
|
On visuocontruction tasks, when you see repetitive over-detailing, errors of symmetry, failure to recognize errors, failure to benefit from model or practise, working from right to left, left-sided inattention with omission of left side or piled up on right side, it is probably
|
right hemisphere signs
|
|
|
|
On visuocontruction tasks, left hemisphere signs include (among others)
|
Sequencing errors; Greater distortion in right half of construction
|
|
|
|
On visuocontruction tasks, when you see over-simplification of stimulus and lack of detail with general shape or outline retained, it is probably
|
left hemisphere signs
|
|
|
|
On drawing tests, patients have a tendency to draw on the ….. side of page as lesion
|
same
|
|
|
|
Compared to copying, which tasks are even better at detecting unilateral inattention?
|
Free drawing and bilaterally symmetrical figures such as cross or star
|
|
|
|
Drawing of right hemisphere patients usually … ?... than left hemisphere patients
|
larger
|
|
|
|
This test involves copying 24 geometric figures of increasing difficulty
|
Beery Developmental Test of Visual-Motor Integration
|
|
|
|
On Beery Developmental Test of VMI, scores are expressed in terms of
|
developmental level of ability
|
|
|
|
What is Beery Developmental Test of VMI good for?
|
assessment of developmental cognitive deficits
|
|
|
|
On the clock test, patients with right-hemisphere damage
|
have a tendency to leave out numbers of left-side or bunch them on right.
|
|
|
|
On the clock test, including all numbers but having difficulties with spacing may be suggestive of
|
right hemisphere damage
|
|
|
|
On the clock test, patients with left-hemisphere damage
|
may be inattentive to right-side or have difficulty with sequencing
|
|
|
|
On the clock test, perseverative errors may be suggestive of
|
left hemisphere damage
|
|
|
|
On the clock test, trouble with hand placement may indicate
|
executive dysfunction
|
|
|
|
Does the ability to draw a clock change a lot over life span?
|
no
|
|
|
|
Is the clock test a good screening measure for brain dysfunction?
|
yes
|
|
|
|
On the House Drawing test, struggling with roof line or flattening corner between front and side of house more likely to reflect
|
right than left hemisphere dysfunction
|
|
|
|
On RCFT, what do healthy adults typically draw first?
|
large central rectangle
|
|
|
|
On RCFT, patients with brain dysfunction
|
take a more fragmented approach (lose overall configuration of design)
|
|
|
|
On RCFT, patients with right hemisphere damage
|
may omit elements altogether
|
|
|
|
On RCFT, patients with frontal lesions
|
show problems with repetition/perseveration of elements and disorganization
|
|
|
|
On Wechsler scales, which subtest is the best measure of visuospatial organization?
|
Block design
|
|
|
|
On the Block design, patients with left hemisphere lesions
|
approach in orderly manner, proceed from left to right, top to bottom, show simplification and concrete handling of design.
|
|
|
|
On Block Design, patients with left hemisphere lesions may be able to achieve normal scores
|
with additional time
|
|
|
|
On Block Design, in addition to problems with design orientation, distortion, misperception, and loss of overall configuration, patients with right hemisphere lesions
|
May work from right to left; fail to respect squared format of design; leave out left half or quadrant using less than full number of blocks.
|
|
|
|
On Block Design, if you observe stimulus boundedness, impulsivity and carelessness, concrete perspective, random approach to solution, failure to detect or correct errors, you may suspect
|
frontal lesions
|
|
|
|
Which visuocontruction test has the lowest correlation of all Wechsler subtests with general mental ability?
|
Object Assembly
|
|
|
|
On Object Assembly, L hemisphere patients
|
more likely to join pieces according to edge contours and to disregard internal details and relative sizes of pieces (such as the fingers on the hand)
|
|
|
|
On Object Assembly, R hemisphere patients
|
have more difficulty visualizing what puzzle pieces make and may not recognize until almost finished or may regard grossly inaccurate constructions as correct
|
|
|
|
This test is useful for differentiating between visuoperceptual and more motor-constructive problems
|
Hooper VOT
|
|
|
|
On HVOT, normal individuals generally fail no more than
|
6 items.
|
|
|
|
Examples of mild extrapyramidal findings in dementia with Lewy bodies
|
bradykinesia, rigidity, masked facies
|
|
|
|
Recurrent visual hallucination that are typically well-formed and detailed are common in (diagnosis)
|
Dementia with Lewy bodies.
|
|
|
|
In dementia with Lewy bodies, in addition to fluctuating cognition with variations in attention/ alertness/ arousal, you may see
|
Prominent visuoperceptual /constructional deficits on testing with frontal subcortical profile and reduced attention
|
|
|
|
Symptom triad of memory loss, anomia and visuospatial deficits has been suggested as hallmark of
|
Alzheimer’s disease
|
|
|
|
In Alzheimer’s disease, 1) getting lost in familiar surroundings or when driving, 2) becoming disoriented in their own home, 3) difficulty recognizing familiar faces can be seen as
|
functional evidence of visuospatial impairment
|
|
|
|
Hallmark deficit in classic limbic amnesia syndrome
|
anterograde amnesia
|
|
|
|
Anterograde amnesia
|
inability to establish new, permanent memories of an “explicit” nature from time of illness onset as evident in deficits in delayed recall and recognition
|
|
|
|
Retrograde amnesia
|
defect in ability to recall events that occurred prior to illness onset
|
|
|
|
In classic limbic amnesia syndrome, retrograde amnesia is
|
temporally graded (amnesia for unconsolidated info) |
|
|
|
In addition to previously learned skills and preferences, which other abilities are intact in classic limbic amnesia syndrome?
|
Immediate or “working” memory; Remote memory; Semantic (factual) knowledge and other
|
|
|
|
Abilities such as “implicit”, unconscious learning (e.g., new motor, perceptual, & cognitive skills), and intellectual function remain intact in
|
limbic amnesia syndrome.
|
|
|
|
Name temporal parameters of memory
|
echoic, short-term, long-term, remote
|
|
|
|
Memory process: registration. Description:
|
information perceived via sensory channels.
|
|
|
|
Memory process: registration. Anatomy:
|
Primary sensory processing pathways.
|
|
|
|
Memory process: Encoding. Description:
|
Process by which info (auditory, visual, motor) is initially organized for immediate repetition or later recall
|
|
|
|
Memory process: Encoding. Anatomy:
|
(Left) prefrontal-->temporal.
|
|
|
|
Processes by which memories converted from temporary to more permanent storage; bind elements together in a memory trace with a marker
|
consolidation memory process.
|
|
|
|
Memory process: Consolidation. Description:
|
Involves changes in cellular structure; usually not effortful, but active processing can improve later recall (e.g., spaced rehearsal)
|
|
|
|
The following anatomic structures -- medial temporal lobe, hippocampal formation, limbic structures – are particularly important for which memory process?
|
storage/ consolidation.
|
|
|
|
process by which previously learned information/skills are recalled, brought back to awareness (name the “memory process”)
|
retrieval (“remembering”)
|
|
|
|
Memory process: Retrieval. Anatomy:
|
Prefrontal regions (R > L for episodic; L > R for semantic).
|
|
|
|
a hypothetical permanent change in the brain accounting for the existence of memory; a memory trace
|
engram
|
|
|
|
Iconic or echoic memory
|
ultra STM, residual of sensory-perceptual processing, msecs
|
|
|
|
STM/WM
|
active, online maintenance and manipulation of information; interface between attention and memory; limited duration and storage capacity
|
|
|
|
LTM
|
information stored off-line for indefinite periods of time; capacity virtually infinite
|
|
|
|
Remote memory
|
well-consolidated information that no longer depends on hippocampus for reconstitution
|
|
|
|
limbic amnesia primarily
|
involves LTM
|
|
|
|
What does frontal lobe damage primarily affect?
|
WM |
|
|
|
In 1974, Baddeley and Fitch proposed
|
a concept of working (short-term) memory.
|
|
|
|
working (short-term) memory, definition
|
Temporary storage of a limited amount of information in mind for execution of a goal or intention (learning, problem-solving, preparation for action)
|
|
|
|
this is primarily an attentional function mediated by dorsolateral prefrontal (and posterior parietal) cortex
|
working (short-term) memory
|
|
|
|
Dependent on medial temporal lobe system involving the hippocampus and adjacent entorhinal, perirhinal, and parahippocampal cortices
|
declarative memory
|
|
|
|
What is amygdala’s role in memory?
|
emotionally arousing events (which activate it) remembered better than emotionally neutral events (depends, in turn, on release of cortisone and adrenaline) --> strengthens neural connections
|
|
|
|
Which anatomical structures are important in procedural learning?
|
cerebellum and striatum |
|
|
|
CS à US à UR; CS à CR; e.g., eyeblink
|
classical conditioning
|
|
|
|
Different types of nondeclarative (implicit) memory include:
|
procedural learning, classical conditioning, evaluative learning, and priming.
|
|
|
|
Which anatomical structures are important in classical conditioning?
|
interpositus nucleus and overlying cerebellar cortex.
|
|
|
|
Whether a stimulus or event has positive or negative valence (e.g., fear conditioning and extinction/ desensitization)
|
evaluative learning
|
|
|
|
Which anatomical structure is important in evaluative learning?
|
amygdala
|
|
|
|
Facilitation in processing a stimulus (faster response time, greater accuracy, less cuing required) as a result of a recent encounter with the same stimulus (in absence of conscious recollection)
|
priming
|
|
|
|
Which anatomical structure is important in priming?
|
neocortical regions engaged by the task.
|
|
|
|
What kind of patients show impaired procedural learning?
|
Those with Huntington’s disease and Parkinson’s disease
|
|
|
|
Patients with prefrontal damage not amnesic but have deficits in
|
executive processes involved in monitoring, organizing, and using memory effectively
|
|
|
|
In addition to deficits in free recall involving strategic search, patients with prefrontal damage have deficits in
|
memory for temporal order of events and source memory
|
|
|
|
Meta-memory and “feeling of knowing”
|
knowledge about one’s own memory capabilities, memory demands of particular tasks or situations, and potentially useful strategies relevant to given tasks or situations
|
|
|
|
memory for temporal order of events
|
recency judgments
|
|
|
|
source memory
|
recollection of context in which information was acquired.
|
|
|
|
Prospective memory
|
memory for future events, “remembering to remember” (time-based; event-based).
|
|
|
|
Deficits in source memory and meta-memory are also characteristic in
|
patients with prefrontal damage.
|
|
|
|
Deficits observed in patients with prefrontal damage can also be observed in
|
Diencephalic amnesics (e.g., Korsakoff disease patients), which differentiate them from bitemporal amnesics.
|
|
|
|
Capgras Syndrome
|
Pts have delusional belief that family members of friends are imposters. Confabulate to rationalize this belief.
|
|
|
|
Capgras Syndrome is usually a result of
|
partial or recovering limbic lesion superimposed on FL damage, especially in right hemisphere.
|
|
|
|
Name paramnesic phenomena in frontal patients:
|
confabulation; reduplicative paramnesia; Capgras syndrome.
|
|
|
|
Reduplicative Paramnesia, definition:
|
Pt convinced that a person, place, or object exists in duplicate.
|
|
|
|
Reduplicative Paramnesia, cause:
|
may be due to disturbed sense of familiarity rendering pt unable to associate/fuse present situation/stimulus with existing engram and so 2 parallel memories created.
|
|
|
|
confabulation
|
a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive
|
|
|
|
What does FTLD stand for?
|
frontotemporal lobar degeneration
|
|
|
|
What does FTD stand for?
|
frontotemporal dementia
|
|
|
|
Name several FTLD clinical syndromes
|
FTD, Progressive Aphasia, Semantic Dementia.
|
|
|
|
Neuropathological topography of FTD:
|
prefrontal/ anterior temporal
|
|
|
|
Neuropathological topography of Progressive Aphasia:
|
Left fronto-temporal
|
|
|
|
Neuropathological topography of semantic dementia:
|
temporal.
|
|
|
|
What does FTD/MND stand for?
|
frontotemporal dementia with motor neuron disease.
|
|
|
|
What does PNFA stand for?
|
progressive non-fluent aphasia
|
|
|
|
What does PAX stand for?
|
progressive apraxia.
|
|
|
|
Main symptoms of semantic dementia:
|
word finding difficulties; impaired knowledge of word meaning.
|
|
|
|
Patients with anomia
|
know the meaning of the word, but cannot retrieve the word.
|
|
|
|
Patients with semantic dementia
|
do not know the meaning of the word, even if it is familiar.
|
|
|
|
If you notice a gradual reduction of vocabulary; use high frequency terms (thing, boy); speech is fluent and well articulated; no phonological or syntactic errors, you may suspect
|
semantic dementia.
|
|
|
|
How do you assess dissociation between two abilities: repetition and meaning knowledge?
|
Ask to repeat the word, then ask what it means.
|
|
|
|
What are the oral subtests of WAB-R?
|
Spontaneous speech, auditory comprehension, repetition, naming.
|
|
|
|
What does WAB-R stand for?
|
Western Aphasia Battery Revised.
|
|
|
|
Nonfluent type of progressive aphasia is characterized by:
|
impaired fluency and apraxia of speech.
|
|
|
|
Primary progressive aphasia is characterized by:
|
: impairment in fluency and naming. |
|
|
|
Name different types of aphasia:
|
isolation, conduction, anomic, transcortical motor, transcortical sensory, global, Wernicke’s, Broca’s.
|
|
|
|
On WAB-R, reading and writing scores are used to calculate
|
Language Quotient (LQ).
|
|
|
|
Tests of apraxia, drawing, block design construction, calculation, and Raven’s Progressive Matrices are included in
|
Cortical Quotient (CQ)
|
|
|
|
On motor examination, deficient performance can indicate
|
dysfunction in the hemisphere contralateral to the affected limb.
|
|
|
|
Different types of apraxia include:
|
melokinetic, ideomotor, ideational
|
|
|
|
Melokinetic apraxia =
|
limb-kinetic apraxia.
|
|
|
|
Astereognosia
|
inability to recognize objects by touch in context of intact sensation
|
|
|
|
Attention and Information Processing Speed can be measured by these tests:
|
Paced Auditory Serial Addition Test (PASAT); Symbol Digit Modalities Test (SDMT); CPT–II (Continuous Performance Test)
|
|
|
|
Bottom–up influences in attention
|
Attention is engaged involuntarily
|
|
|
|
BVMT–R, CVLT–2, LAMB, MTOA, are all the tests of…
|
Tests of Learning and Memory
|
|
|
|
Damage to ARAS can lead to
|
Permanent states of stupor and coma
|
|
|
|
Define “clouded consciousness”
|
alert but unable to direct/maintain attention on a task (wandering attention); easily distracted
|
|
|
|
Define “Obtundation”
|
Awake but drowsy; responsive but slow
|
|
|
|
Define “Stupor”
|
In deep sleep most of the time; can be aroused but only transiently; attention drifts, not sustained.
|
|
|
|
Description of the flexibility of attention
|
constantly shifting as goals change; same stimulus can be allocated more or less attention according to current context and past experience
|
|
|
|
Divided attention
|
attending to multiple events simultaneously
|
|
|
|
General level of responsiveness (def. within attention topic)
|
arousal
|
|
|
|
Higher order regulatory influences that affect all sensory modalities in attention are mediated by
|
ARAS (bottom–up) and higher order association cortex, especially frontal lobes (top–down).
|
|
|
|
In what state of arousal the person is unarousable, no behavioral responsiveness?
|
Coma.
|
|
|
|
Name five levels of consciousness (arousal)
|
Awake and alert; clouded consciousness, obtundation, stupor, coma.
|
|
|
|
Orientation (def. within attention topic)
|
(re)alignment of sensory organs (e.g., direction of gaze)
|
|
|
|
Selective attention (def. within attention topic)
|
preferential processing of some stimuli over others
|
|
|
|
Set of processes that control which of many competing internal and external stimuli/events will have access to consciousness and/or will be acted upon
|
attention
|
|
|
|
Sustained attention
|
vigilance; maintaining attention on a given stimulus over time without habituating
|
|
|
|
The requirement of balance between concentration and distractibility is a description of which attribute of attention?
|
Flexible
|
|
|
|
The study of disturbances from congenital or acquired lesions which in turn affect the development of the individual
|
Child Neuropsychology
|
|
|
|
The study of disturbances of established patterns of behavior
|
Adult Neuropsychology
|
|
|
|
These are also tests of learning and memory
|
WMS–IV, TOMM, WMT.
|
|
|
|
These are language tests.
|
Token Test; FAS & Animal Fluency (Controlled Oral Word Association Test)
|
|
|
|
These are some of the characteristics of attention
|
Finite and Flexible
|
|
|
|
This is also a comprehensive, multi–domain test
|
DRS
|
|
|
|
To test of Visual Perceptual Abilities, you can also use…
|
VMI, RCFT, Parietal Lobe Battery, Judgment of Line Orientation
|
|
|
|
Top–down influences in attention
|
Attention directed voluntarily
|
|
|
|
What are the two main neurotransmitters involved in ARAS?
|
Acetylcholine and norepinephrine
|
|
|
|
What do attention processes involve?
|
Selecting relevant inputs and filtering out less relevant ones.
|
|
|
|
What do Auditory Consonant Trigrams and Trail Making Tests measure?
|
Attention and Information Processing Speed
|
|
|
|
What do Boston Diagnostic Aphasia Exam and Boston Naming Test a test of?
|
Test of Language
|
|
|
|
What do Cancellation tasks, Clock, Hooper Visual Organization and Embedded Figures tests measure?
|
Visual Perceptual Abilities
|
|
|
|
What do D–KEFS and WCST assess?
|
Executive Abilities
|
|
|
|
What does ARAS stand for?
|
Ascending Reticular Activating System
|
|
|
|
What does BVMT–R stand for?
|
Brief Visuospatial Memory Test – Revised.
|
|
|
|
What does CVLT–2 stand for?
|
California Verbal Learning Test II
|
|
|
|
What does DRS stand for?
|
Dementia Rating Scale
|
|
|
|
What does D–KEFS stand for?
|
Delis–Kaplan Executive Function System
|
|
|
|
What does LAMB stand for?
|
Learning and Memory Battery
|
|
|
|
What does MTOA stand for?
|
Memory Test for Older Adults
|
|
|
|
What does RBANS stand for?
|
Repeatable Battery for the Assessment of Neuropsychological Status
|
|
|
|
What does the ARAS projection through thalamus facilitate?
|
Passage of sensory information, promoting cortical arousal.
|
|
|
|
What does TOMM stand for?
|
Test of Memory Malingering
|
|
|
|
What does WCST stand for?
|
Wisconsin Card Sorting Test
|
|
|
|
What does WMS–IV stand for?
|
Wechsler Memory Scale
|
|
|
|
What does WMT stand for?
|
Word Memory Test
|
|
|
|
What engages the attention in bottom–up influences?
|
Drive states or events or stimuli in the external environment
|
|
|
|
What engages the attention in top–down influences?
|
Conscious states such as motivation, volition.
|
|
|
|
What is a prerequisite for all higher cognitive/ intellectual activity?
|
Attention
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|
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What is attention?
|
Selective allocation of finite information processing resources and response channels to events that are behaviourally relevant
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What is CTIP (Computerized Test of Information Processing) a test of?
|
Attention and Information Processing Speed
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What kind of test is RBANS?
|
Comprehensive (multi–domain)
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|
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Where does one of the two major upstream projections of ARAS pass through?
|
thalamus
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|
|
|
Where is another one of the two major upstream projections of ARAS?
|
from brainstem and basal forebrain to cerebral cortex
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|
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What is the role of frontal lobes in attention?
|
Top-down regulation: conscious direction, control of attention.
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|
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What is the role of prefrontal cortex in attention?
|
Regulates it in response to conscious volition/goals regardless of domain and modality.
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What can be thought of as an intermediate stage between attention and memory?
|
Working memory can be thought of as an interface between these two.
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What do concepts of STM and WM have in common?
|
Both characterized by limited storage capacity & brief duration.
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|
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How is WM different from STM?
|
Broader concept – refers both to maintenance and active manipulation of on-line info.
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What is WM comprised of?
|
A “central executive” which regulates 2 slave systems. What does “WM” stand for?
|
“Working Memory”
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|
|
What does “STM” stand for?
|
“Short-Term Memory”
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What are the 2 slave systems regulated by the central executive in WM?
|
Phonological loop; Visuospatial sketchpad
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What is a phonological loop?
|
Auditory WM
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What is visuospatial sketchpad?
|
Visual WM
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What part of the brain is activated during verbal WM tasks?
|
Left dorsolateral prefrontal cortex.
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What part of the brain is activated during spatial WM tasks?
|
Right dorsolateral prefrontal cortex.
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What is the hypothesized third WM slave system?
|
Episodic buffer – links info across domains to form integrated units of visual, spatial, and verbal info and chronological ordering; assumed to have links to LTM.
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How does damage to frontal lobe affect response to novelty?
|
It induces apathy and disinterest in environment.
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Name two clinical syndromes that can result from disturbances of attentional matrix.
|
Acute confusional state, unilateral neglect.
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“acute confusional state”.
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Global impairment of the attentional matrix due to diffuse brain disease or dysfunction.
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“unilateral neglect”
|
Example of impairment in domain-specific system that controls allocation of attention in extrapersonal space. |
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What is the most common neurological disorder of mental state?
|
Acute confusional state.
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Delirium: in what percentage of hospitalized patients over 65 y.o. ?
|
20-25
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What drug’s toxicity is likely to cause an acute confusional state?
|
anticholinergics
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Name cardinal features of delirium in addition to disturbance of vigilance, heightened distractibility and impaired wm.
|
Inability to maintain coherent stream of thought and to carry out coherent sequence of goal-directed movements.
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What is the most prominent feature in delirium?
|
Deficits in attention.
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Which patients are especially vulnerable to an acute confusional state?
|
Elderly and patients with pre-existing brain disease or dementia.
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Unilateral neglect occurs almost exclusively after
|
right hemisphere lesions
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What is the only way to detect unilateral neglect of milder form? (as it resolves?)
|
Double simultaneous stimulation, i.e., when there is competition from stimulation in the other hemi-space.
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|
Frontal Lobe Attentional Deficits
|
Distractibility; Difficulty sustaining attention over time; Difficulty inhibiting automatic, overlearned responses (e.g., Stroop effect, “stimulus pull”)
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Difficulty switching between tasks, categories, dimensions; Impairment in dual-task paradigms (e.g., CCCs)
|
Frontal Lobe Attentional Deficits
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Behavioral observations, such as level of patient’s arousal, registering instructions, coherence in speech and action and distractibility are critical in ….
|
Assessment of attention
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|
In addition to inability to follow through with task and need to redirect, what other behavioral observations are critical for the assessment of attention?
|
Preoccupation with other thoughts; irrelevant comments or actions; intrusions, perseveration of previous tasks, need to stimulate physically to re-capture attention.
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To assess basic attention/ WM capacity
|
Span tasks
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|
To assess divided attention
|
Manipulation/ tracking /dual-task (e.g., bwd spans)
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Why is it important to read numbers at a steady pace during administration of the “digit span” task?
|
“chunking” can enhance performance
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What are 3 conditions in the “digit span” task? (e.g., in WAIS-IV)
|
Forward, backward, and ordering
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Spatial span (in WMS-III) is a
|
Variant of Corsi Block-Tapping task
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|
Which span task has a larger age effect than digit span?
|
Spatial span
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How are results on spatial span often differ from those on digit span?
|
1-2 units shorter
|
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|
Spatial span < digit span when there may be a
|
Right hemisphere lesion
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|
Digit span < spatial span when there may be a
|
Left hemisphere lesion
|
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|
|
Visual analog of WAIS-IV digit span
|
Symbol span (WMS-IV)
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What do patients do in Symbol Span (WMS-IV)?
|
Patient views series of abstract designs (hard to verbalize) of increasing length, then must select correct designs from foils in correct sequences
|
|
|
|
Mental Manipulation/Tracking Tasks
|
Backward digit span and spatial span (WMS, WAIS); Digit Sequencing (WAIS-IV); Letter-Number Sequencing (WAIS-IV); Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs)
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|
|
|
Requires both maintenance (“visual sketchpad”) and manipulation (“central executive”) aspects of spatial WM, as well as ability to ignore distractors (“central executive”)
|
Spatial Addition (WMS IV)
|
|
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|
What do patients do in Spatial Addition (WMS-IV)?
|
views pattern of blue and red circles on a grid; then shown a second pattern on the grid; must “add” 2 images together, placing white circle in a location occupied by a blue circle on both grids, blue circle in location occupied by a blue circle on only 1 grid, and ignoring red circles.
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|
Arithmetic (WMS-IV); Spatial addition (WMS-IV); Paced Auditory Serial Addition Test (PASAT) are…
|
Mental Manipulation/Tracking Tasks
|
|
|
|
Paced Auditory Serial Addition Test (PASAT) are only suitable for
|
high-functioning individuals who are not mathematically impaired
|
|
|
|
Dual task paradigm that requires holding infraspan info in mind while performing a distraction task, Initially designed to prevent rehearsal to measure duration of STM
|
Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs)
|
|
|
|
Subtraction errors on Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs) are also indicative of
|
problems with tracking & self-monitoring
|
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|
|
Brown-Peterson Technique (Auditory Consonant Trigrams, CCCs) is sensitive (can detect)
|
FL lesions, mTBI, ADHD
|
|
|
|
To assess sustained attention (concentration)
|
Vigilance tests
|
|
|
|
Most common version of vigilance tests
|
computerized continuous performance task requiring that subject detect target stimuli from among a series of stimuli over relatively long periods of time (monotonous)
|
|
|
|
how are vigilance tests scored
|
According to omission and commission errors and RT
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|
|
Stroop test is an example of a test that assesses
|
Sustained attention (concentration)
|
|
|
|
Slowed processing speed often underlies
|
attentional deficits
|
|
|
|
Slowed processing speed is particularly prominent after
|
TBI (due to diffuse axonal injury) and diseases that affect subcortical white matter, such as MS and Parkinson’s disease
|
|
|
|
Symbol Substitution Tests
|
Multi-faceted—measure visual scanning, sustained attention, visuomotor coordination and incidental learning in addition to processing speed
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|
In basic neutoanatomy for vision, after the visual signal enters the retina, what happens to it before it gets to the thalamus?
|
it projects through the optic radiations
|
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|
|
In basic neutoanatomy for vision, the visual signal enters the retina and then projects through the optic radiations to the thalamus and then to…
|
the primary visual cortex
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|
|
|
Where is striate cortex located?
|
in the medial portion of the occipital lobes above and below the calcarine fissure
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|
In vision, what role do association cortices in occipital, posterior temporal and parietal areas play?
|
that’s where visual info combines with input from other sensory modalities and integrates with other cognitive functions
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|
What does ventral occipitotemporal visual processing system do?
|
subserves ibject recognition (“what”)
|
|
|
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What does dorsal (occipitoparietal) visual processing system do?
|
subserves appreciation of spatial relationships (“where”)
|
|
|
|
Lesions to which hemisphere produce most severe deficits in visual processing?
|
right
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|
|
Which lesions have worse outcomes for visual processing, anterior or posterior?
|
posterior
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|
|
In terms of visual processing skills, right hemisphere is dominant for
|
storage of visuospatial information, perception of depth, distance, direction, shape, orientation, position, perspective, and figure-ground
|
|
|
|
In terms of visual processing skills, lesions in left hemisphere can result in
|
sequencing errors, oversimplification of stimulus, and lack of detail, with general shape or outline retained, may be greater distortion in right half of drawing |
|
|
|
Which hemisphere is specialized for analyzing internal details of a stimulus?
|
left
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|
|
|
Name two visuoperceptual deficits:
|
Visual object agnosia; defective visual analysis and synthesis
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|
|
|
Impairment in discrimination and recognition of faces; impaired colour recognition (are what kind of deficit?)
|
visuoperceptual
|
|
|
|
Name two visuospatial deficits:
|
Defective localization of points in space; defective judgment of direction and distance
|
|
|
|
Visual inattention / Unilateral visual neglect; Balint’s syndrome (are what kind of deficit?)
|
visuospatial
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|
|
When you see cortical paralysis of visual fixation, optic ataxia, disturbance of visual attention, you may consider diagnosis of…
|
Balint’s syndrome.
|
|
|
|
When you see defective assembly and drawing, you may suspect …
|
visuoconstructive deficits.
|
|
|
|
Define Visual Object Agnosia:
|
inability to recognize a stimulus presented in a specific sensory modality not due to impairment of primary sensory processing, language deficits, attentional impairment, lack of experience with the stimulus, or generalized mental deterioration
|
|
|
|
2 types of visual object agnosia by Lissauer (1890)
|
Apperceptive visual agnosia; associative visual agnosia
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|
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|
In apperceptive visual agnosia, visual object recognition is disrupted due to …
|
impairment in visual object agnosia (unable to be aware of the objects seen)
|
|
|
|
If a patient is unable to point to named objects and cannot match nor copy stimuli, you may suspect
|
Apperceptive visual agnosia
|
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|
|
Patients with apperceptive visual agnosia may be better able to recognize
|
real objects than geometric shapes
|
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|
|
Why are real objects easier to recognize than geometric shapes for people with apperceptive visual agnosia?
|
due to availability of such cues as size, color, and texture
|
|
|
|
What else can help improve recognition for people with apperceptive visual agnosia?
|
motion of stimulus
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|
|
|
Describe associative visual agnosia
|
visual object recognition impaired in the context of preserved ability to copy or match the stimuli
|
|
|
|
In what modalities can patients with associative visual agnosia recognize objects?
|
tactile and auditory
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|
|
|
Associative Visual Agnosia: in which areas of the brain is damage usually found?
|
Occipito-temporal region, in both gray and white matter.
|
|
|
|
What kind of visual processing skills are “Visual analysis and synthesis”?
|
visuoperceptual
|
|
|
|
Visual Analysis and Synthesis includes
|
simple and more complex visual discriminations; separating figure from ground.
|
|
|
|
Integration of separate elements of a complex stimulus array into a meaningful whole is a part of what processes?
|
visual analysis and synthesis
|
|
|
|
Simultanagnosia
|
inability to see more than one thing at a time or one aspect of an object at a time though details are correctly appreciated.
|
|
|
|
Deficits observed in interpretation of action pictures or HVOT may be indicative of
|
simultanagnosia.
|
|
|
|
In what type of prosopagnosia people may experience familiar as strange or imposters?
|
Capgras syndrome
|
|
|
|
If a patient can’t recognize even her own face in the mirror, you may suspect
|
prosopagnosia |
|
|
|
In assessing achromatopsia, you need to discriminate between
|
impaired color perception and color anomia
|
|
|
|
How large is the part of the visual field that is usually affected by achromatopsia?
|
one half to one quarter.
|
|
|
|
Lesions in region of occipito-temporal junction may result in
|
achromatopsia
|
|
|
|
Color agnosia
|
inability to identify characteristic colors of familiar objects (can’t name, recognize or match)
|
|
|
|
PASAT stands for
|
Paced Auditory Serial Addition Test
|
|
|
|
SDMT stands for
|
Symbol Digit Modalities Test
|
|
|
|
CPT-II stands for
|
Continuous Performance Test |
|
|
|
Which hemisphere is dominant for spatial attention?
|
right
|
|
|
|
If you notice that a patient fails to direct attention to space to the left of midline, you may suspect
|
right hemisphere lesion
|
|
|
|
Unilateral neglect, in addition to being a posterior parietal sign, can also be seen after
|
lesions to frontal lobes, cingulate gyrus, striatum, and thalamus
|
|
|
|
Hemianopia, or hemianopsia, is a
|
anopsia in half the visual field of one or both eyes, usually on one side of the vertical midline.
|
|
|
|
decreased vision or blindness
|
anopsia
|
|
|
|
dressing apraxia may be related to
|
left neglect, simultanagnosia, or optic ataxia
|
|
|
|
optic ataxia
|
problems with voluntary eye movements
|
|
|
|
Visual Angulation, definition
|
Perception of angular relationships
|
|
|
|
Visual Angulation (usually located where)
|
a right hemisphere function (temporo-occipital)
|
|
|
|
How does JLo examine the ability to estimate angular relationships between line segments?
|
by visually matching angle line pairs to numbered radii forming a semi-circle
|
|
|
|
On the Hooper, patients with right-sided lesions tend to…
|
give fragmented or part responses
|
|
|
|
On the Hooper, patients with left-sided lesions tend to….
|
make more naming errors
|
|
|
|
On the Hooper, pulls for perceptual fragmentation are often seen with …
|
executive dysfunction and right frontal lesions.
|
|
|
|
Hidden Figures Test (Thurstone, 1944) requires patient to
|
identify a simple figure embedded in the more complex one
|
|
|
|
On visuocontruction tasks, right hemisphere signs include (among others)
|
Distortion in general shape, orientation, organization, perspective and proportion; Piecemeal, fragmented approach, with loss of overall gestalt
|
|
|
|
On visuocontruction tasks, when you see repetitive over-detailing, errors of symmetry, failure to recognize errors, failure to benefit from model or practise, working from right to left, left-sided inattention with omission of left side or piled up on right side, it is probably
|
right hemisphere signs
|
|
|
|
On visuocontruction tasks, left hemisphere signs include (among others)
|
Sequencing errors; Greater distortion in right half of construction
|
|
|
|
On visuocontruction tasks, when you see over-simplification of stimulus and lack of detail with general shape or outline retained, it is probably
|
left hemisphere signs
|
|
|
|
On drawing tests, patients have a tendency to draw on the ….. side of page as lesion
|
same
|
|
|
|
Compared to copying, which tasks are even better at detecting unilateral inattention?
|
Free drawing and bilaterally symmetrical figures such as cross or star
|
|
|
|
Drawing of right hemisphere patients usually … ?... than left hemisphere patients
|
larger
|
|
|
|
This test involves copying 24 geometric figures of increasing difficulty
|
Beery Developmental Test of Visual-Motor Integration
|
|
|
|
On Beery Developmental Test of VMI, scores are expressed in terms of
|
developmental level of ability
|
|
|
|
What is Beery Developmental Test of VMI good for?
|
assessment of developmental cognitive deficits
|
|
|
|
On the clock test, patients with right-hemisphere damage
|
have a tendency to leave out numbers of left-side or bunch them on right.
|
|
|
|
On the clock test, including all numbers but having difficulties with spacing may be suggestive of
|
right hemisphere damage
|
|
|
|
On the clock test, patients with left-hemisphere damage
|
may be inattentive to right-side or have difficulty with sequencing
|
|
|
|
On the clock test, perseverative errors may be suggestive of
|
left hemisphere damage
|
|
|
|
On the clock test, trouble with hand placement may indicate
|
executive dysfunction
|
|
|
|
Does the ability to draw a clock change a lot over life span?
|
no
|
|
|
|
Is the clock test a good screening measure for brain dysfunction?
|
yes
|
|
|
|
On the House Drawing test, struggling with roof line or flattening corner between front and side of house more likely to reflect
|
right than left hemisphere dysfunction
|
|
|
|
On RCFT, what do healthy adults typically draw first?
|
large central rectangle
|
|
|
|
On RCFT, patients with brain dysfunction
|
take a more fragmented approach (lose overall configuration of design) |
|
|
|
On RCFT, patients with right hemisphere damage
|
may omit elements altogether
|
|
|
|
On RCFT, patients with frontal lesions
|
show problems with repetition/perseveration of elements and disorganization
|
|
|
|
On Wechsler scales, which subtest is the best measure of visuospatial organization?
|
Block design
|
|
|
|
On the Block design, patients with left hemisphere lesions
|
approach in orderly manner, proceed from left to right, top to bottom, show simplification and concrete handling of design.
|
|
|
|
On Block Design, patients with left hemisphere lesions may be able to achieve normal scores
|
with additional time
|
|
|
|
On Block Design, in addition to problems with design orientation, distortion, misperception, and loss of overall configuration, patients with right hemisphere lesions
|
May work from right to left; fail to respect squared format of design; leave out left half or quadrant using less than full number of blocks.
|
|
|
|
On Block Design, if you observe stimulus boundedness, impulsivity and carelessness, concrete perspective, random approach to solution, failure to detect or correct errors, you may suspect
|
frontal lesions
|
|
|
|
Which visuocontruction test has the lowest correlation of all Wechsler subtests with general mental ability?
|
Object Assembly
|
|
|
|
On Object Assembly, L hemisphere patients
|
more likely to join pieces according to edge contours and to disregard internal details and relative sizes of pieces (such as the fingers on the hand)
|
|
|
|
On Object Assembly, R hemisphere patients
|
have more difficulty visualizing what puzzle pieces make and may not recognize until almost finished or may regard grossly inaccurate constructions as correct
|
|
|
|
This test is useful for differentiating between visuoperceptual and more motor-constructive problems
|
Hooper VOT
|
|
|
|
On HVOT, normal individuals generally fail no more than
|
6 items.
|
|
|
|
Examples of mild extrapyramidal findings in dementia with Lewy bodies
|
bradykinesia, rigidity, masked facies
|
|
|
|
Recurrent visual hallucination that are typically well-formed and detailed are common in (diagnosis)
|
Dementia with Lewy bodies.
|
|
|
|
In dementia with Lewy bodies, in addition to fluctuating cognition with variations in attention/ alertness/ arousal, you may see
|
Prominent visuoperceptual /constructional deficits on testing with frontal subcortical profile and reduced attention
|
|
|
|
Symptom triad of memory loss, anomia and visuospatial deficits has been suggested as hallmark of
|
Alzheimer’s disease
|
|
|
|
In Alzheimer’s disease, 1) getting lost in familiar surroundings or when driving, 2) becoming disoriented in their own home, 3) difficulty recognizing familiar faces can be seen as
|
functional evidence of visuospatial impairment
|
|
|
|
Hallmark deficit in classic limbic amnesia syndrome
|
anterograde amnesia
|
|
|
|
Anterograde amnesia
|
inability to establish new, permanent memories of an “explicit” nature from time of illness onset as evident in deficits in delayed recall and recognition
|
|
|
|
Retrograde amnesia
|
defect in ability to recall events that occurred prior to illness onset
|
|
|
|
In classic limbic amnesia syndrome, retrograde amnesia is
|
temporally graded (amnesia for unconsolidated info)
|
|
|
|
In addition to previously learned skills and preferences, which other abilities are intact in classic limbic amnesia syndrome?
|
Immediate or “working” memory; Remote memory; Semantic (factual) knowledge and other |
|
|
|
Name temporal parameters of memory
|
echoic, short-term, long-term, remote
|
|
|
|
Memory process: registration. Description:
|
information perceived via sensory channels.
|
|
|
|
Memory process: registration. Anatomy:
|
Primary sensory processing pathways.
|
|
|
|
Memory process: Encoding. Description:
|
Process by which info (auditory, visual, motor) is initially organized for immediate repetition or later recall
|
|
|
|
Memory process: Encoding. Anatomy:
|
(Left) prefrontal-->temporal.
|
|
|
|
Processes by which memories converted from temporary to more permanent storage; bind elements together in a memory trace with a marker
|
consolidation memory process.
|
|
|
|
Memory process: Consolidation. Description:
|
Involves changes in cellular structure; usually not effortful, but active processing can improve later recall (e.g., spaced rehearsal)
|
|
|
|
The following anatomic structures -- medial temporal lobe, hippocampal formation, limbic structures – are particularly important for which memory process?
|
storage/ consolidation.
|
|
|
|
process by which previously learned information/skills are recalled, brought back to awareness (name the “memory process”)
|
retrieval (“remembering”)
|
|
|
|
Memory process: Retrieval. Anatomy:
|
Prefrontal regions (R > L for episodic; L > R for semantic). |
|
|
|
Iconic or echoic memory
|
ultra STM, residual of sensory-perceptual processing, msecs
|
|
|
|
STM/WM
|
active, online maintenance and manipulation of information; interface between attention and memory; limited duration and storage capacity
|
|
|
|
LTM
|
information stored off-line for indefinite periods of time; capacity virtually infinite
|
|
|
|
Remote memory
|
well-consolidated information that no longer depends on hippocampus for reconstitution
|
|
|
|
limbic amnesia primarily
|
involves LTM |
|
|
|
What does frontal lobe damage primarily affect?
|
WM |
|
