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What was the primary finding in the patient's MRI scan?
Which modifiable risk factor is NOT associated with dementia according to the content?
What percentage of dementia cases could potentially be prevented or delayed by modifying certain risk factors?
Which cognitive function is most prominently affected by small vascular disease (SVD) in aging?
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At what age does a noticeable decline in cerebral blood flow begin according to the content?
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What is a direct neurotoxic effect of alcohol on the brain?
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Which cognitive function is NOT notably impaired by Korsakoff's syndrome?
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What does the continuity hypothesis suggest regarding alcohol intake?
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Which vitamin deficiency is linked to the neurological effects observed in Korsakoff's syndrome?
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Which factor is NOT mentioned as a potential indirect neurotoxic effect related to Korsakoff's syndrome?
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What cognitive consequence is commonly associated with damage to the right side of the brain?
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What characterizes a Transient Ischaemic Attack (TIA)?
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Which of the following is a consequence of a stroke affecting the posterior cerebral artery?
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What factor is important in determining lasting damage after a hemorrhagic stroke?
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What percentage of individuals show cognitive impairments during the acute phase of a stroke?
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What characterizes anterograde amnesia?
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Which of the following describes spontaneous confabulations?
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What cognitive domain is least affected in Korsakoff syndrome?
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Which aspect of memory is not impaired in individuals with Korsakoff syndrome?
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What is one of the three dimensions of apathy?
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What effect does proactive interference have in memory conditions?
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Which memory is typically preserved and unaffected in Korsakoff syndrome?
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Which statement accurately describes the temporal gradient in memory?
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What is the primary aim of the procedure related to the epileptogenic zone in neurosurgery?
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How many chromosomes do humans typically have?
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What characterizes autosomal recessive inheritance?
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Which type of genetic disorder involves variations in a single gene?
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What does de novo variation refer to in genetics?
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Which of the following statements about genetic mutations is true?
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What type of genetic disorder is characterized by a combination of genetic variants and their interaction with environmental factors?
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What is the role of clinical neuropsychology in the context of genetic disorders?
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Study Notes
Spontaneous Confabulations
- Occur without a trigger, patient acts accordingly
- May diminish over time
- Provoked confabulations still present in chronic phase
Anterograde Amnesia
- Inability to store and retrieve new information
- Specifically in episodic memory ('everyday memory'; 'what, where and when')
- Contextual confusion: target information related to wrong time and/or place
- Increased (proactive) interference
- Can be established with any episodic memory test that includes:
- Delayed recall
- Free recall vs recognition
- Verbal and nonverbal stimuli
Proactive and Retroactive Interference
- Temporal gradient in memory: Memories from the more distant past are remembered better than memories from the recent past
Intact Memory Functions in Korsakoff's Syndrome
- Severe impairments in long-term episodic memory (anterograde and retrograde amnesia)
- Working memory is unimpaired (e.g., phone numbers)
- Long-term memory is intact (e.g., procedural memory)
- Priming is intact: Presented information had an effect on later performance
- Emotional memory is intact: KS patients remembered 9/11 (emotional tagging) as well as contextual details (flashbulb memories)
Non-memory Domains Affected in Korsakoff's Syndrome
- Executive functioning, especially shifting and updating
- Social cognition:
- Theory of mind: Ability to infer thoughts and feelings of others
- Emotion perception
- Relevant for successful social interaction
Apathy
- Neuropsychiatric symptom = lack of motivation not attributable to intellectual impairment, emotional distress, or diminished level of consciousness
- Three dimensions of apathy (often not present in KS patients):
- Behavioral activation: Immediately doing something after having planned it
- Social motivation: Starting a conversation with others
- Emotional sensitivity: Feeling bad when someone close to you is diagnosed with a serious illness
- Agitation is also sometimes seen in KS patients
The Effects of Alcohol on the Brain
- Estimate: 50% of people with alcohol-use disorder (AUD) have cognitive impairments
- 10% have severe cognitive impairments (including Korsakoff's syndrome)
- Mechanisms:
- Direct neurotoxic effect: Alcohol damages neurons and axons (but possibly reversible)
- Indirect neurotoxic effect: High calcium concentrations damage the neurons after sudden withdrawal/abstinence
- Indirect effect of vitamin deficiency (B1/thiamine) – Korsakoff
- Indirect effect of comorbidities (hepatitis, multiple drug use, traumatic brain injury, cerebrovascular risk factors)
Brain Abnormalities in Alcohol-Related Cognitive Disorders
- Impaired cognitive functions:
- Executive functions:
- Response inhibition
- Risk taking
- Decision making
- Abstract reasoning
- Mental flexibility
- Memory:
- Learning & retrieval efficiency
- Not an amnestic syndrome
- Visuospatial functions: Often with an executive component (e.g., Rey complex figure)
- Social cognition:
- Affective prosody
- Perception of facial expressions
- Interpersonal interaction
- Executive functions:
Ethanol Neurotoxicity
- Continuity hypothesis:
- Quantity of alcohol intake and duration predict the severity of cognitive disorders
- Continuity hypothesis also mentioned as an explanation of the memory disruptions with temporal gradient in Korsakoff's: old memories are better preserved than recent ones, with a gradient
- No recent support for this hypothesis
- Current view = a combination of factors explains the brain dysfunction seen in alcohol-related cognitive disorders
Modifiable Risk Factors of Dementia
- Cardiovascular risk factors make age-related changes more pronounced
- Examples: Hypertension, alcohol usage, obesity, smoking, physical inactivity, diabetes
- Modifying these might prevent or delay up to nearly half of all dementia cases
- Generally improve healthy aging
Aging, Cerebral Blood Flow, and Grey Matter Loss
- Decline in perfusion of the brain from age 30 – relatively small effect at this age
Prevalence of SVD (Small Vascular Disease) in Aging
- Cognitive profile of aging: Executive functioning and (psycho)motor speed are most prominently affected by SVD
- Around the age of 85 there is a big decline in cognitive functioning
- Accounts for approximately 80% of all stroke cases
Common Consequences of Stroke
- Memory disorders
- Aphasia
- Apraxia
- Hemispatial neglect - more common after right-sided damage
- Extinction
Supply Area of Posterior Cerebral Artery
- Supplies blood to the occipital and temporal lobes.
- Common consequences:
- Hemianopsia or quadrantanopsia
- Visual agnosia (e.g., object agnosia, proposagnosia)
Transient Ischaemic Attack (TIA)
- Recovery < 24 hours.
- Brief ischemic event.
- Focal symptoms: Problem is specific to a certain area of the brain.
- Abnormalities often also appear on acute brain scan.
- Increased risk of having a stroke.
- Many people still report cognitive problems three months after a TIA.
- Impairments on neuropsychological assessment.
- Temporary - shows that there is something wrong with the vessels because there is a (temporary) obstruction → higher risk at major stroke.
Cognitive Recovery
- 49% cognitive impairments in acute phase → 31% at follow-up
- 'Unimpaired' patients still unimpaired after six months.
- Other group generally shows progress:
- Dynamic recovery and not 'demented'
- Dependent on affected domain - ischemic stroke
- May be linked to location of recovery
- For hemorrhagic strokes, the size is an important factor to determine whether there is lasting damage - strategic strokes like basal ganglia has a big effect.
- Determinants:
- Schooling/age → 'cognitive reserve'?
Epileptogenic Zone
- Aims: Determinate epileptogenic zone
- The cortical area that is essential for generating seizures and if removed will lead to complete control of seizures
Wada Test
- Determine language dominance.
- Risk of language and memory problems post-surgery.
Genetics 101
- People have 46 chromosomes, 20.000 genes (2% of the genome; = coding DNA)
- A change in your DNA does not mean you have a genetic disorder - every human has them (genetic mutations/variations); they usually have no effect but they can even have a positive effect
- Genetic disorders are not always inherited
- Autosomal dominant inheritance - only one affected gene is needed for the disorder; autosomal recessive inheritance - two infected genes are needed for the disorder
- X-linked dominant inheritance - daughters of affected father are affected, when the mother is affected boys and girls can be affected; X-linked recessive inheritance - affected father → daughter that is a carrier, when the mother is a carrier, boys can be affected and daughters cannot be.
- De novo variation = people with the same genetic mutation don't have to be very similar, but they do probably have some of the same characteristics
- People with genetic disorders do not always have an intellectual disability
Types of Genetic Disorders
- Chromosomal disorders = partial or complete absence or duplication of a chromosome - Down/Turner syndrome
- Monogenic disorders = variation in a single gene - noonan syndrome
- Polygenic or multifactorial disorders = combination of different genetic variants at the same time and gene-environment interactions - cardiovascular disease
- Mitochondrial disorders = variation in DNA located outside the cell nucleus in the mitochondria
Clinical Neuropsychology and Genetic Disorders
- Clinical neuropsychology: Why? Clarity for client, Clear plan to improve.
-
Clinical neuropsychology: How?
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Description
This quiz focuses on the concepts of spontaneous confabulations, anterograde amnesia, and memory interference. It explores how these phenomena affect memory functions, particularly in cases like Korsakoff's syndrome. Test your understanding of these critical topics in psychology.
