- When you have problems with memory
- Don’t lose all aspects equally
- Several independent systems
- 1. Balint’s Syndrome
- Rare neurological disorder
- Can’t do common tasks
- First described in 1909
- Typically
- Acute onset
- 2+ strokes in same place?
- 3 impairments at once
- Simultanagnosia
- See parts, not whole
- e.g., 40 degrees off axis
- Optic ataxia
- Can’t use vision to guide hand
- Ocular apraxia
- Difficulty fixating eyes
- Hard to read or watch
- 2. Apraxia
- Movements of hand
- damage to left hemisphere
- organizes move for both hands
- Understand command
- Willing to do it & muscles work
- Can’t perform tasks when asked
- Can’t execute movements
- Disorder of motor planning
- Can’t remember
- how to brush teeth
- wave goodbye
- Can’t remember
- Caused by
- Brain tumor
- Gradual worsening
- Traumatic brain injury
- Stroke
- Dementia
- Damage to cerebellum
- Not lack of coordination (ataxia)
- Not unable to produce (aphasia)
- Not lack of desire (abulia)
- Not confused about which side to move (allochria)
- Often lesion in left hemisphere
- Parietal or frontal
- Often due to stroke
- Can be from birth
- Appears as child grows
- Cause unknown
- Mostly “acquired apraxia”
- Treatment
- Practice, practice, practice
- Repeating sounds over & over
- teach mouth movements
- Slow down when talk
- Communication techniques
- Frustration, profanity & depression
- Symptoms
- Unable to do muscle movements
- Different word than intended
- Usually aware of error
- Buccofacial
- Also called orofacial apraxia
- Can’t lick lips or whistle
- Can’t move face on demand
- Stick out tongue
- Ideational
- Also called conceptual apraxia
- Can’t sequence properly
- Butter bread before toaster
- Socks or shoes first?
- Comb hair with toothbrush
- Ideomotor
- Automatic-voluntary dissociation
- Can’t pretend to answer phone
- Answer phone when it rings
- Plan or complete motor actions
- Last of semantic memory
- Can explain how to do it
- Can’t imagine doing it
- Can’t actually do it
- Can’t
- Pretend to brush your teeth
- Puck like sucking a sour lemon
- Try to write with screwdriver
- Limb-kinetic
- Arms & legs don’t go where want
- Also called gait apraxia
- Can’t move arms & legs precisely
- Construction
- Can’t draw pentagons
- Can’t make intersecting figures
- Oculomotor
- Difficulty with saccade moves
- Apraxia of speech:
- Can say common phrases
- How are you?
- Can write better than speak
- Can’t
- Sounds & words
- distorted, repeated or omitted
- Hard to put in right order
- Struggle to find right word
- Longer words more difficult
- Movements of hand
- Apraxia & Aphasia
- Often go together
- Symptoms
- Inconsistent articulation errors
- Can’t find right mouth position
- More errors with longer phrases
- 3. Aphasia
- What is it?
- Inability to understand language
- Inability to write
- Inability to speak
- Symptoms
- Sentences that don’t make sense
- Don’t understand conversations
- Short or incomplete sentences
- Unrecognizable words
- Understand but not express
- Take things literally
- Spelling errors
- 3 Types
- 1. Non-fluent
- Usually aware of difficulty
- Broca’s area
- Often have right-side weakness-paralysis
- Struggle to get words out
- Telegraphic speech
- Walk park
- 2. Fluent
- Middle left side of brain
- Wernicke aphasia
- Long, complex sentences
- that don’t make sense
- Don’t realize not making sense
- Don’t understand other’s speaking well
- 3. Global
- Several areas damaged
- Frontal, temporal & parietal
- Difficulties in both
- Expression
- Comprehension
- 1. Non-fluent
- Primary progressive aphasia
- Language problems that gradually develop
- Brain cell degeneration
- Can progress to dementia
- 4. Stroke
- Diagnosis
- CT scan of cerebral artery
- Usually without contrast
- Neurological examination
- Doppler ultrasound
- Inverted T-wave
- MRI
- CT scan of cerebral artery
- Lasts 24+ hours
- Same symptoms
- Transicent Ischemic Attack
- Less than 24 hours
- Stroke symptoms
- Unless you die = stroke
- Two major risk factors
- High blood pressure
- Atrial fibrillation
- Other risk factors
- Alcohol & drug use
- Cigarettes
- Diabetes
- Cocaine
- Diet?
- Blood lipids
- High cholesterol levels?
- Inconsistent data
- Statins reduce risk
- Maybe not by lipids
- Diabetes mellitus
- High levels of sugar in blood
- Stroke 2-3 times more likely
- Often have hypertension
- Treating Stroke
- Aspirin works well
- Anticoagulation drugs
- Such as warfarin
- Used for over 50 years
- Surgery
- Remove significant narrowing
- Endarterectomy
- Nutrition
- Mediterranean Diet
- Reduce risk by half?
- Folic Acid
- To lower homocysteine
- Non-protein amino acid
- Reduce risk by half?
- Diagnosis
- What is a stroke
- Blood flow disruption
- Brain’s version of a heart attack
- Cells die
- Brain attack?
- 1. Ischemic Stroke
- Blocked-Clogged Arteries
- A. Thrombotic stroke
- Blocking narrow artery
- B. Cerebral embolism (stroke)
- Clot breaks off & travel to brain
- 2. Hemorrhagic stroke
- Weak blood vessel in brain bursts
- Blood leaks into brain
- Two types
- Aneurysms = ballooning region
- Arteriovenous malformations (AVMs) = bleeding from cluster of abnormally formed blood vessels
- Stroke Risk Factors
- High blood pressure
- Biggest risk factor
- Family history of stroke
- Diabetes
- Artial fibrillation
- Irregular, rapid heart rate
- Narrow arteries in other parts of body
- Legs
- Heart
- Too much food, alcohol, smoking, drugs
- Birth control pills
- In women over 35
- High blood pressure
- Symptoms
- Depends which part of brain
- Symptoms appear rapidly (usual)
- Can get gradually worse, gradually better or on and off
- Difficult to diagnose
- Coma, unconscious, sleepy
- Confused
- Clumsy
- Headache
- Starts suddenly
- Hurts most when lying flat
- Hurts when you cough or move
- Changes in sensory input
- Vision, hearing, taste, pain
- Changes in output
- Writing, speaking, walking
- What to do
- 911
- Hospital within 3 hours
- CT scan
- Drugs to breakup clots
- Blood thinners
- After the stroke
- Most people need rehab
- 50% have arm or hand problems
- Calcium
- Biofeedback
- Constraint-Induced Movement Therapy
- Daily sessions, 2-3 weeks
- Forced to use affected arm
- Cyclic Electrical Neuromuscular $
- Electrically stimulate muscles
- Improve range of movement
- Make muscles stronger
- Most people need rehab
- 5. Alzheimer’s
- Progressive disease
- Symptoms get worse with time
- Symptoms
- Inappropriate emotional R
- Decline in intellect
- Confused thinking
- Memory loss
- Repeated questioning
- Inappropriate emotional R
- Violence
- Memory
- Better procedural vs declarative
- Better implicit vs explicit
- Acquire new skills but not remember learning them
- Age related
- Likelihood increases with age
- Strikes 50% of those over 85
- Genetic components
- Person with Down’s syndrome
- (3 copies of chromosome 21)
- Always acquire Alzheimer’s in middle age
- Early onset
- chromosome 1 & 14
- Late onset
- chromosome 10 & 19
- Person with Down’s syndrome
- Environmental component
- 50% no relatives with disease
- Yoruba people of Nigeria
- high-risk genes
- low incidence
- Maybe due to diet?
- low-calorie, low fat, low salt diet
- Brain proteins fold abnormally
- Clump together
- Interfere with neuronal activity
- Amyloid protein
- Cause plaque between neurons
- Apolipoprotein E
- Causes cell loss
- Prevents plague removal
- Tau protein
- Tangles in cell bodies
- Treatment to improve memory
- Increase glucose & insulin
- Acetylcholine activator drugs
- Diet rich in antioxidants?
- Block Aß42 production, inoculate with small amounts of Aß42
- Inter-neuron plaque
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