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69 Cards in this Set
- Front
- Back
- 3rd side (hint)
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True or False: Spontaneous speech in Wernicke’s aphasia has abnormal fluency and prosody.
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False
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Spontaneous speech in W aphasia has NORMAL fluency and prosody, as well as normal grammatical structure. This is because the main deficit in W aphasia is comprehension and repetition of language, not production of language.
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Define semantic paraphasia and give an example.
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Inappropriate substitution of a word for one of related meaning. For example: Saying “ink” instead of “pen”.
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By contrast, *phonemic* paraphasia is substitution to a similar *sounding* word—for example, “link” for “ink”, or “work” for “word”. Note that the substitution is close enough to the original that the intended word is still obvious.
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Define phonemic paraphasia and give an example.
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Inappropriate substitution of a similar sounding word. For example, saying “link” instead of “ink” or “work” instead of “word”.
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A phonemic paraphasia is also known as a “literal” paraphasia.
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Based on what you know about Broca’s aphasia, what would you guess is the most likely form of paraphasia (word substitition) associated with this disorder?
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Paraphasias are relatively infrequent in Broca's (as you might expect in the “bare-bones” utterance of Broca’s) and primarily consist of *phonemic* substitutions (usually simplifications of words).
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Reduced paraphasias is consistent with Broca’s “telegraphic” speech (simplified language) which consists primarily of nouns—somewhat like someone trying to speak a foreign language from a phrase book. Telegraphic speech omits prepositions and articles and has loss of inflections (endings) on verbs and nouns. Phonemic paraphasias are perhaps explained by the fact that Broca’s consists primarily of difficulties at the level of *physical sound* production (physical articulation, prosody) rather than word meaning (semantics).
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True or False: Alexia (reading) and agraphia (writing) tend to be affected independently of each other—for example, in Wernicke’s aphasia.
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False!.(See Hint card)
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Both require an intact central language-processing system, especially the angular gyrus and its connections. For example, successful writing requires translation of word sounds and images into motor patterns, while reading requires translation of word sounds and images into semantic meaning. Although there are infrequent cases of “alexia without agraphia”, as a general rule, you can assume that both will be affected in aphasias such as Broca’s and Wernicke’s. As you might guess, Broca’s tends affect writing (production) more than reading (comprehension), while Wernicke’s has the opposite effect—it affects reading (comprehension) more than writing (production).
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Broca’s aphasia is defined as a disorder with poor repetition and dysfluent speech but relatively good comprehension (although not perfect). Name two other associated characteristics of Broca’s aphasia.
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Possible answers include:
1) Frequent right-sided hemiplegia especially involving face and arms 2) acute awareness of deficits and resulting frustration 3) aprosodic speech (flat intonation/“melody of speech”, odd rhythm) 4) slow, telegraphic speech (mainly nouns and some verbs, reduced “function” words such as conjunctions and prepositions) 5) Difficulty with both writing and reading (alexia, agrapha) |
Recall that Broca’s involves damage to frontal areas next to premotor cortex. In addition, Broca’s may involve deeper damage to white-matter pathways connecting the basal ganglia.
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Wernicke’s aphasia is defined as a disorder with poor repetition and comprehension but relatively good fluency. Name three other typical characteristics of Wernicke’s aphasia.
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Possible answers include:
1) Frequent semantic paraphasias 2) Lack of awareness of deficits (a form of anosognosia) 3) Over-elaborate complex sentences which make no sense (“jargon aphasia” 3) pressured speech 4) Occasional visual-field cuts 5) Reduced ability to read and write 6) Apraxia due to proximity to the angular gyrus (e.g., Gerstmann syndrome) |
Many associated characteristics are intuitively obvious from the “jargon-aphasia” and lack of comprehension in Wernicke’s – e.g. pressured, elaborate speech, good fluency, lack of awareness of speech deficit (since can't understand own output), etc.
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What is ideomotor apraxia?
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The most common type of apraxia tested in neuropsych evaluation. It is the inability to perform *single, overlearned skilled tasks*, such as brushing one’s teeth, using a key to open a door, or using scissors. Deficits may be quite subtle and become apparent ONLY when asked to pantomime to verbal command.
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Deficits may consist of body-part substitution during pantomime (using finger as a toothbruth, fingers as “scissors”), wrongly oriented hands or fingers, or errors in sequence/timing. Recall that apraxia is typically caused by damage to the left parietal area near the angular gyrus (parietal lobe). Thus, apraxia may be associated with the Gerstmann syndrome (aarf!). Note that ideomotor apraxia has strong localizing value (i.e., tells you about the possible location of an injury). It may be associated with Wernicke’s aphasia, because they affect similar areas of the brain.
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Why is apraxia often associated with Wernicke’s aphasia?
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Because both disorders are typically caused by lesions in a similar anatomic location--specifically, near the angular gyrus. Indeed, you might consider "agraphia" (part of the Gerstmann syndrome) a kind of apraxia for writing.
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Look at Blumenfeld’s beautiful illustrations of the language centers affected in aphasia.
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What is “ideational” apraxia (versus “ideomotor” apraxia)?
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Ideational praxia is much less common than ideomotor apraxia and has almost NO localizing value (can have many causes). It is characterized by a problem in performing a sequence of many simple skilled movements, such as imitating how to make coffee, make a sandwich, or mail a letter.
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Recall that ideomotor (rather than ideational) apraxia involves just single skilled acts rather than a combination of skilled acts. You can remember the names by the fact that “ideomotor” is also a shorter name than “ideational”.
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What is conduction aphasia and where is the lesion usually located?
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Conduction aphasia is defined as a disturbance of repetition with relatively intact comprehension and spontaneous fluency. It usually affects the arcuate fasculus or related fiber tracts which connect Wernicke’s area with Broca’s area, disconnecting them.
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In effect, the “hearing” center is disconnected from the “talking” center, so that the person cannot repeat what they hear, even though they actually understand and can create their own novel sentences.
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Why is repetition always affected in Wernicke’s, Broca’s, and Conduction aphasia?
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Because repetition requires ALL three structures (Brocas, Wernickes, A.Fasciculus) to be intact for good repetition. Picture a microphone (Wernicke's area), a loudspeaker (Broca's area), and the wire connecting them Arcuate Fasciculus). You need all three work to hear your voice amplified and repeated.
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Picture a “wire” (arcuate fasculus) with a microphone (Wernicke’s) at one end and a loudspeaker at the other end (Broca’s) To get sound reproduction you need all three—the microphone, wire, and loudspeaker.
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It is believed that memory is ultimately stored in the cortical area it was first __________.
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Processed Z 161
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For example, auditory information tends to be stored in areas associated with language, such as the temporal lobe.
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Name three major constellations of brain structures involved in declarative memory. HINT: One is the medial temporal lobe.
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Areas around MEDIAL TEMPORAL LOBE (hippocampus and related structures), the DIENCEPHALON (thalamus, mamillary bodies), and basal forebrain (underside of the brain--especially the nucleus basalis of Meynert, substantia innomiata, septal nuclei, and diagonal band of Broca). Z 161
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We have not yet discussed the basal forebrain because its role in memory is less clear than other structures. The basal forebrain areas seem to provide acetylcholine to other parts of the brain and is believed damaged very early in Alzheimer’s Disease, in addition to hippocamus). Medications for Alzheimer’s try to increase production of acetylcholine from the basal forebrain.
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Multiple Choice: What memory syndrome is associated with alcoholism, and what kind of memory does it affect (encoding, storage, retrieval)?
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Wernicke-Korsakov syndrome, causes primarily severe encoding deficits
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Recall that the primary damage in Wernicke-Korsakov syndrome is in the thalamus (dorsomedial nucleus) which acts as a kind of “funnel” (relay) for both hippocampi, via the fornix. In addition, ,the mammilary bodies may also be affected. Look at the diagram in Blumenfeld (“Limbic System” chapter) which shows show the hippocampi, fornix, mammilary bodies, and thalamus are all closely interconnected. If you visualize this system it becomes easier to remember the parts affected in Wernicke-Korsakov syndrome and to remember the components of the “Circuit of Papez” memory system.
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What are the major components of the “Circuit of Papez”, and which are most affected in Wernicke-Korsakov syndrome?
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The circuit of Papez includes primarily :
(1) hippocampus and related structures, (2) the fornix, (3) mamillary bodies, (4) thalamus, (5) anterior cingulate gyrus, returning to the hippocampus. The thalamus and (to a lesser extent) mamillary bodies are most affected in Wernicke-Korsakov syndrome. |
See the diagram in Blumenfeld (“Limbic System” chapter) which shows how the hippocampus, fornix, mammilary bodies, and thalamus are connected.
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What is the major output system of the hippocampal formation?
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Fornix. Z 163
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See the illustration in Blumenfeld (“Limbic System” chapter).
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What is the most common disorder that affects the basal forebrain?
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Strokes. Z 163
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Note that Alzheimer’s disease also affects the basal forebrain, in addition to the hippocamus, causing severe memory encoding problems due to depletion of acetylcholine (neurotransmitter).
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___________ amnesia is the loss of the ability to encode and learn new information after a defined event such as a head injury, lesion, or disease onset
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Anterograde
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Think Antero, remember new. (Z pg. 158)
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__________ amnesia is the loss of old memories from before an event or illness
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Retrograde
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Think retro = “before” the injury/illness. (Z pg. 158)
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The older term “short-term memory” has been largely replaced with the term w__________ m____________.
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Working memory.
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There are two types of working memory—one passive (such as recalling digits forward in the WAIS) and one active (such as recalled digit backward or number-letter sequencing).
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____________ memory (also called “explicit” memory) stores consciously accessible “intellectual” information such as mental images and factual information. (Also called “graduate student memory”).
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Declarative
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Examples are remembering your name, the meaning of “dysdiachokinesis”, and your social security number. (Z pg. 160)
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____________ memory (also called “implicit” memory) stores “nonfactual” information such as perceptual-motor skills, conditioned reflexes , certain types of word “priming” memories
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Nondeclarative
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Example is riding a bike, driving a car, or playing the piano.. (Z pg. 160)
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____________ memory is a specific subtype of declarative memory that stores general knowledge (facts)
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Semantic memory
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Example is remembering the names of all of the states and their capitals. (Z pg. 161)
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____________ memory is a specific subtype of declarative memory that recalls personal experiences
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episodic or autobiographical memory
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Example is remembering your wedding day. Episodic memory is defined by the fact that it is associated with a specific time and place (contextual information or “source” memory) Z pg. 161
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_________ memory implies conscious awareness, but _________ memory does not require conscious awareness
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Explicit versus Implicit (or declarative and nondeclarative)
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“Explicit” is synonymous with “declarative” memory while “implicit” is synonymous with “nondeclarative” memory. The two different terminologies are the result of two different research traditions—one emphasizes the “conscious” versus “unconscious” memories (explicit/implicit), the other emphasizing the “factual” versus “nonfactual” memory (declarative/nondeclarative) Z pg. 161
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A form of memory that is explicit and accessible to conscious awareness (a synonym/alternate label for "explicit" memory).
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declarative memory
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A form of long term memory that is thought to encompass semantic memory and episodic memory. (Z pg. 161)
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Name three interconnecting brain structures believed to play crucial roles in declarative memory. HINT: basal forebrain is one.
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medial temporal lobes, the diencephalon, and basal forebrain.
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These structures play an important role in consolidating information into long-term memory, as it pass through the circuit of Papez. (Z. pg. 161)
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The m_______ t_______ lobe structures which are important for long-term declarative memory center around the hippocampus.
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medial temporal
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(Z. pg. 161)
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The famous clinical case of "____" (set of initials) illustrates the effects of bilateral removal of the hippocampus on declarative memory.
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H.M.(Z pg. 161)
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Bilateral removal caused near-complete anterograde amnesia. This case is very similar to the one we saw on the PBS video (Clive Waring, composer).
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True or False: H.M.’s amnesia was found to include difficulty learning both new visual spatial AND verbal information.
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True
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Both visuospatial information (images, drawings, diagrams) and verbal information are forms of declarative memory. (Z pg. 163)
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True or False: Visuospatial information (mental images of diagrams,pictures, etc) and verbal information are both forms of declarative memory.
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True.
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Both involve “conscious”, fact-based information, even though visuospatial information is typically not verbalizable (is not easily put into words).
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The anatomic system which is largely responsible for declarative memory system is the ____________ (includes several different structures as part of a single circuit).
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Papez Circuit. (NOTE: The basal forebrain also plays an important part in declarative memory,; but its exact role is rather unclear and only recently appreciated. We will discuss in class).
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Anatomic circuit centered around the hippocampus and other structures in the Circuit of Papez (fornix, mammillary bodies, thalamus, anterior cingulate, hippocampi). (Z pg. 163)
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The _________ is a fiber tract that relays information from the hippocampus to the mammillary bodies of the hypothalamus.
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fornix
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It collects information from both right and left hippocampi and brings them together in the mammllary bodies and then the thalamus, anterior cingulate, and back to hippampal formation. See the beautiful illustration in Blumenfeld’s “Limbic System” chapter. (Z.pg. 163)
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From the m_________ b_________ in the hypothalamus, memory information is projected to the anterior nucleus of the t_________, then travels to the c_______ g_______, and finally back to the hippocampus (and associated structures), thereby completing the Papez circuit .
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mammillary bodies, thalamus, cingulate gyrus
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(pg. 163-166)
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The hippocampus is said to have a distinctive _________ shape.
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seahorse
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(Z pg. 161)
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Limbic functions can be divided into these four sections: H_______, O________, M_________, E_________, and H___________
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Homeostasis, Olfaction, Memory, and Emotions (or drives). This can be easily remembered by using the mnemonic HOME. To memember this acronym, say to yourself three times, while clicking your ruby slippers, "There's no place like HOME. There's no place like HOME. There's no place like HOME." Then explain to your collegues why you have not taken your prescription medication.
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(B 762)
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Unlike the 95% of cortex which consist of 6 layers, the hippocampal formation (part of the limbic system-important for memory) has how many layers?
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Three. The six-layer portions of the cortex are called *neocortex* while the three layer portions are called *archicortex* (meaning “original” or “ancient” cortex)
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(B765)
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Two crucial parts of the brain that are responsible for the formation of new memories are the m______ t________ lobe memory areas and the m________ t________ memory areas
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Medial temporal lobe and medial thalamus. (Easy to remember because both have initials M.T.)
Additionally the vast network of white matter connections between these two portions of the brain are crucial for new memory formation, along with components of the medial forebrain |
(B772).
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The two most important structures of the medial temporal lobe memory system are the h________ f_________ and the p________________ g______
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hippocampal formation and parahippocampal gyrus.
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The “hippocampal formation” is a continuous, seahorse-shaped structure consisting of the _______ gyrus, the _____________ proper, and the ___________
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dentate gyrus, hippocampus, subiculum.
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The famous patient H.M. lost his ability to form new memories after surgery in which the bilateral __________ ________ were removed
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temporal lobes (actually, the anterior 1/3). “Hippocampus” is also OK for an answer.
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Multiple Choice: (Explicit/implicit) memory is involved in nonconscious learning of skills and habits, while (explicit/implicit) memory is involved in conscious recollection of facts and experiences.
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implicit, explicit.
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Explicit memory is also known as declarative memory and implicit memory is also known as nondeclarative memory (B 781).
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Multiple Choice: Unilateral lesions in the dominant medial temporal lobe typically lead to mild deficits in (verbal / visuospatial / somatosensory) memory while unilateral lesions on the nondominant medial temporal lobe can lead to mild (verbal / visuospatial / somatosensory) memory deficits.
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verbal memory, visual-spatial memory.
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Multiple Choice: A unilateral lesion in one medial temporal lobe (i.e., hippocampus and related structures) usually causes (mild / moderate / severe) declarative memory deficits.
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mild deficits
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This is why one temporal lobe can be removed in cases of severe epilepsy without disabling the individual.) You must remove/damage BOTH temporal lobes to get severe amnesia, such as seen in "H.M" or in the video (the composer who had a herpes simplex brain infection).
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There are two general types of amnesia. ___________ amnesia means one is unable to recall memories from the past while ___________ amnesia means one is not able to form new memories.
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retrograde amnesia, anterograde amnesia.
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Recent memories are dependent on the functions of the medial temporal and diencephalic structures of the brain for recall, unlike older memories which are reliant on cortex for recall.(B 783)
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In addition to bilateral removal of temporal lobes (hippocampi), damage to the ___________ can cause extremely severe memory deficits because it is the central “relay” or “funnel” for memory information.
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thalamus
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For example, Wernicke-Korsakov syndrome.
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What is the most commonly associated *sensorimotor* feature in Wernicke’s aphasia?
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Visual field cut, especially of the right upper quadrant of both eyes. In addition, apraxia may be present. (Blum 833)
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A visual field cut of the upper right quadrant is called “quandrantanopia” (quardra = 4). It is called “homonymous” because the visual field cuts are identical for both eyes (same location). Thus, we call this visual problem “homonymous quandrantanopia”.
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What is a “visual field cut”?
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Part of the visual field is impaired or completely missing.
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Visual field cuts occur occasionally in Wernicke’s aphasia (upper right quarter). This is because optical tracts (“optic radiations”) pass very near Wernicke’s area (left temporal lobe), and these fibers may be damaged by the same stroke/injury causing Wernicke’s aphasia. As a result, you may get impairment in one-quarter of the visual field (“quadrantonopia”) .
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What is the most commonly associated *sensorimotor* feature in Wernicke’s aphasia?
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Visual field cut, especially of the right upper quadrant of both eyes. In addition, apraxia may be present. (Blum 833)
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A visual field cut of a quarter of the visual field is called “quandrantanopia” (quardra = 4). It is called “homonymous” because the visual field cuts are identical for both eyes (same location). Thus, we call this visual problem “homonymous quandrantanopia”.
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What type of aphasia is diagnosed for a patient with normal fluency, normal comprehension but *impaired repetition*?
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Conduction Aphasia (Blum 834)
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Conduction is caused by an infarct or other lesions in perisylvian area (area surrounding the sylvian sulcus) that interrupt the arcuate fasciculus or other pathways that connect Wernicke’s area to Broca’s area.
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What is a “visual field cut”?
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Part of the visual field is impaired or completely missing.
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For example, visual field cuts occur occasionally in Wernicke’s aphasia (upper right quarter of both eyes). This is because optical tracts (“optic radiations”) pass very near Wernicke’s area (left temporal lobe), and these fibers may be damaged by the same stroke/injury causing Wernicke’s aphasia. As a result, you may get impairment in one-quarter of the visual field (“quadrantonopia”) .
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True/False: The term nondeclarative memory does not refer to a discrete (physically separate) memory system; rather it acknowledges that some memory functions operate outside the limbic circuitry system.
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True(Z. pg 166)
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True or False: Based on what you know about declarative and nondeclarative memory, can a severely amnesic Korsakoff’s patient show "implicit priming" (a type of nondeclarative/implicit memory)?
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True (pg 167)
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Multiple Choice: Specific lesions (tumors, stroke, penetrating wounds) are likely to have (less /more) effect on nondeclarative memory compared to declarative memory
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(less)
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Recall that declarative memory (e.g., learning word lists, remembering what you did yesterday for lunch) is far more sensitive to injury and neurological disorder—probably because it is more complex and more recent in evolutionary history.
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An area particularly important in habit formation and associated with OCD is ______________
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caudate nucleus (“basal ganglia” is also correct).
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As we learned, the basal ganglia constitute the major “procedural learning” center of the brain. So it makes sense that “procedural memory” is partly stored in the basal ganglia.
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Multiple Choice: “Amnesia” as assessed by neuropsychologists is typically related to (punctate / unilateral / bilateral / diffuse) damage in the medial temporal lobes lesions or similar damage in the medial diencephalic region (especially thalamus).
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bilateral
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You must have damage to BOTH hippocampi to get the dense amnesia seen in HM and the video. Damage to the thalamus is EVEN MORE powerful in creating amnesia, since it acts as a kind of “funnel” or central relay for information. A disturbance here disrupts the "grand central station" of memory processing.
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What is the literal meaning of "cingulate" (as in "cingulate gyrus"), and why is this an accurate description of its anatomical structure.
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cingulate = "girdle". It is accurate because the cingulate cortex (thin covering on the SURFACE of the brain) forms a girdle or boundary around the core of the brain (e.g., ventricles, thalamus, etc).
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Imagine a peach which has been cut in half. The pit represents the core of the brain (ventricles, thalamus, basal ganglia), while the dark area just outside the pit represents the cigulate gyrus.
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Symptoms experienced by Phineas Gage (iron rod through the brain) are the best example of which frontal-lobe syndrome?
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Orbital frontal syndrome. (The cingulate was also damaged but apparently less affected).
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The orbital frontal syndrome is typified by impulsivity, disinhibition, and poor judgment.
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The classic frontal lobotomy patient (flat affect, lack of emotionaly reactivity, lack of initiative / motivation) is typical of which frontal-lobe syndrome?
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The anterior cingulate gyrus syndrome.
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Recall that the cingulate gyrus is hidden inside the longitudinal fissure (the split between the two hemispheres). The ANTERIOR portion is just behind the frontal lobes!
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Name two important functions associated with the dorsolateral area of the frontal lobes.
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Possible answers include (among others):
1. Internal blackboard (e.g., digits backward, number-letter sequencing) 2. Productivity (e.g., verbal fluency, hypothesis generation) 3. Set-shifting (including inhibition, flexibility, etc). 4. Strategy/Planning (organization, chess, Rey Complex Figure, etc) 5. Memory retrieval (versus encoding problems) |
These various functions have been EMPIRICALLY defined on the basis of observation in injury and neurological disorder. They are NOT theoretically defined, so the classification is rather haphazard, intuitive, and not universally agreed vocabulary.
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What metaphor might be used to describe the relationship between the "umbrella" concept of executive functioning ("CEO", goal-oriented behavior, overriding "automatic pilot) and the many individual functions associated with frontal-network functioning, such as set-shifting, mental black-board, productivity, etc?
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The overall adaptive purpose of frontal-network functioning is analogous to *digestion* (deriving nutrition from food), while the individual skills are like the various organs which are involved collaboratively in digesting food (e.g., liver, pancreas, stomach, small intestine).
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Thus many different component skills must be coordinated to achieve goal-oriented behavior (over-ride habitual behavior).
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How would you assess for "ideomotor apraxia" and why is this assessment important?
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Ask the person to pantomime brushing their teeth, hammering a nail, using a key to open a door, etc. It's important because apraxia is often associated with aphasia, especially wernicke's aphasia, and damage to the LEFT PARIETAL LOBE (near angular gyrus).
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In thinking about "ideomotor apraxia", think also about Gerstmann's syndrome and reading, since all are in a similar location (left parietal lobe near the angular gyrus). Note also that damage to ONLY the left side is necessary to cause apraxia in BOTH hands!
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How would you assess for "ideational apraxia" and how does this form differ from "ideamotor apraxia"?
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Any series of sequential skilled motor acts, such as mailing a letter, making a sandwich, or the like. It differs because it is a SERIES of acts rather than a single skilled act. Note, also, that ideational apraxia it does not have localizing value and is less common.
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What is the most common form of apraxia and why is it important for neuropsychological diagnosis?
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Ideomotor apraxia. It's important because of its frequent association with aphasia, reading problems, and left parietal damage in general.
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To remember which is which, recall that "ideomotor" is a shorter than than "ideational", and also involves a shorter (single) series of motor actions.
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Multiple Choice: Ideomotor apraxia involves damage to the (left / right) parietal lobe
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Left. Note that damage to this ONE side causes apraxia in BOTH hands!
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Same side as Gerstmann syndrome and dyslexia caused by damage to the angular gyrus.
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Multiple Choice: Ideational apraxia (such as making a sandwich) is caused primarily by damage to the (left / right / many different) lobes.
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potentially many different lobes. In fact, damage to many different areas of the brain, including subcortical sites, may be responsible.
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Don't worry too much about assessing ideational apraxia--its less common and much less useful for diagnosis than "ideomotor" apraxia.
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Ideomotor apraxia is also called "_____" apraxia.
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limb (as in "arm").
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The following website has an extensive, very clear discussion of apraxia:
http://www.emedicine.com/neuro/topic438.htm |
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Ideomotor apraxia is a very useful diagnostic tool, not only because it is very powerful in localizing leasions but also because ______________________.
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It is more predictive of disability than aphasia, for example. This makes sense because in ability to use simple tools is very disabiling in cooking, washing, etc, while aphasia may be compensated in various ways.
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