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D A N I S H B H A T T I M DM O V E M E N T D I S O R D E R S D I V I S I O N
NEUROCOGNITIVEDISORDERS!
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
OUR INTENTIONS:THIS TALK
IS MEANT TOD B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
T H I N G S W E ’ R E D I S C U S S I N G F O R N E X T 5 6 M I N U T E S :
FU N CT I O N A L A N ATO MYL A N G UAG E A N D A P HA S I A S
V I SUA L P RO CE SS I N GFRO N TA L LO B E FU N CT I O NME MO RY A N D A MN E S I A
DE ME N T I A SU B T YP E SN E U RO PATHO LO GY
WO RK U PRE V I E W V I DE O S
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
BRODMANN AREASKorbinian Brodmann (1868-1918)
52areas,11histologicalsubgroups
Areaswithdifferentstructuresperformeddifferentfunctions
FLOW OF INFORMATIONPrimaryCortexArea
Unimodal SpecificAssociationArea
MultimodalAssociationAreas
Respond,FeelandRemember
PRIMARY CORTEX
SomatosensoryVisualAuditoryMotor
UNIMODALASSOCIATION
SomatosensoryVisualAuditoryMotor
MULTIMODALASSOCIATION
PosteriorAnterior
Limbic
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
HIGHER CORTICAL DYSFUNCTION,
APHASIAAPRAXIAAGNOSIA
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
Lefthemisphere
ANATOMY OF LANGUAGED A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
FUNCTIONAL IMAGING OF LANGUAGE
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
APHASIASAphasia Fluency Comprehension Repetition
Brocas No Yes No
Wernickes Yes No No
Conduction Yes Yes No
Global No No No
TransCortical Motor No Yes Yes
TransCortical Sensory Yes No Yes
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
LANGUAGE DYSFUNCTIOND A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
APROSODIAD A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
The right hemisphere controls non-verbal aspects of speech and language including producing and understanding intonation, hand gestures, and facial
expressions.The anatomy mirrors the left hemispheres location of language.
ALEXIA WITHOUT AGRAPHIA
O P T I C A P H A S I AABLETOWRITEUNABLETOREAD
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
GERSTMANN SYNDROMEAGRAPHIAACALCULIA
FINGER AGNOSIALR DISORIENTATION
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
GERSTMANN S YNDROME
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
GERSTMANN S YNDROME
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
VISUAL PROCESSINGWHERE PATHWAYDORSOLATERAL
OCCIPITOPARIETALSTREAM
HEMI-NEGLECTBALINT SYNDROME
WHAT PATHWAYVENTROMEDIAL
OCCIPITOTEMPORALSTREAM
VISUAL AGNOSIAPROSOPAGNOSIAACHROMATOPSIA
WHERE PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
WHERE PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
BALINT SYNDROME
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
BALINT SYNDROMESIMULTAGNOSIA
OPTIC ATAXIAOCULAR APRAXIA
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
WHERE PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
WHAT PATHWAYVISUAL AGNOSIAPROSOPAGNOSIA
F U S I F O R M G Y R U SACHROMATOPSIA
L I N G U A L G Y R U S
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
A P E R C E P T I V E V I S U A L A G N O S I A
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
A S S O C I A T I V E V I S U A L A G N O S I A
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
A S S O C I A T I V E V I S U A L A G N O S I A
“Idon’tknow!”
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
A S S O C I A T I V E V I S U A L A G N O S I A
“Couldbeadogoranyotheranimal!”
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
A S S O C I A T I V E V I S U A L A G N O S I A
“Couldbeabranchstump!”
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
A S S O C I A T I V E V I S U A L A G N O S I A
“Couldbeawagonoracar!”
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
P R O S O P A G N O S I A
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
P R O S O P A G N O S I A
WHAT PATHWAY
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
A C H R O M A T O P S I A
CONSTRUCTIONAL APRAXIA
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
FRONTAL LOBE,EXECUTIVECOGNITIVEFUNCTION
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
EXECUTIVE COGNITIVE FUNCTIONMOTOR PLANNING
INITIATION OF BEHAVIORCOGNITIVE PLANNING
SEQUENCINGJUDGEMENT
RULE SETTING AND FOLLOWING
FRONTAL LOBE DYSFUNCTIONORBITALFRONTAL
IRRITABILITYINAPPROPRIATEBEHAVIOR
LATERALFRONTALAPATHYABULIA
DIFFICULTYPLANNING
SEQUENCINGRULEMAKING
RULEFOLLOWING
EXECUTIVE COGNITIVE FUNCTION
TRAILS A AND BSTROOP TEST
WISCONSIN CARD SORT
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
TRA I LS A AND B
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
TRA I LS A AND B
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
STROOP TE ST
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
WI SCON S I N CA RD SORT I NG
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
WI SCON S I N CA RD SORT I NG
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
MEMORY,YOU CANT REMEMBER
EVERYTHING
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
HOW MEMORY WORKSIMMEDIATEMEMORY
SHORTTERMMEMORY
LONGTERMMEMORY
ActiveObservation,FocusingAttention
Rehearsal,EmotionalImpact,Interest,Motivation
PriorExperienceandKnowledge
Type Example Awareness Structures
Episodic What Ididlastnight ExplicitDeclarative
Medicaltemporallobe,hippocampus
Semantic Ahammer isatool ExplicitDeclarative
Inferior, lateraltemporallobes
Working Rehearsingaphone# ExplicitDeclarative
Multimodal andunimodalassociationcortices
Procedural Swinging agolfclub ImplicitNon-Declarative
BG,Cerebellum,Suppl.Motorarea
LONGTERMMEMORYD A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
LONG TERM MEMORY PATHWAYUnimodalandMultimodal
AssociationCorticies
ParahippocampalAndPerirhinal
Corticies
EntorhinalCortex
HippocampalFormation(dentategyrus,CA1,CA3,subiculum)
PapezandMacLeanCircuits
H I PPOCAMPUS
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
ANATOMY OF AMNESIAHippocampusandEntorhinal cortexareessentialfordeclarative
(explicit)memory(facts,events,etc)Hippocampusconvertsimmediatememoriesintoshortterm
andlongtermmemoriesbutisnotthesiteofstorage.Bilateralhippocampaldysfunctionisrequiredforamnesia.
Hippocampusalsohelpsretrieverecentlystoredmemoriesbutnotrequiredforolderorover-learnedmemories.
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
ANATOMY OF AMNESIAHippocampusandEntorhinal cortexareessentialfordeclarative
(explicit)memory(facts,events,etc)Hippocampusconvertsimmediatememoriesintoshortterm
andlongtermmemoriesbutisnotthesiteofstorage.Bilateralhippocampaldysfunctionisrequiredforamnesia.
Hippocampusalsohelpsretrieverecentlystoredmemoriesbutnotrequiredforolderorover-learnedmemories.
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
ANATOMY OF AMNESIAHippocampusandEntorhinal cortexareessentialfordeclarative
(explicit)memory(facts,events,etc)Hippocampusconvertsimmediatememoriesintoshortterm
andlongtermmemoriesbutisnotthesiteofstorage.Bilateralhippocampaldysfunctionisrequiredforamnesia.
Hippocampusalsohelpsretrieverecentlystoredmemoriesbutnotrequiredforolderorover-learnedmemories.
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
ANATOMY OF AMNESIAHippocampusandEntorhinal cortexareessentialfordeclarative
(explicit)memory(facts,events,etc)Hippocampusconvertsimmediatememoriesintoshortterm
andlongtermmemoriesbutisnotthesiteofstorage.Bilateralhippocampaldysfunctionisrequiredforamnesia.
Hippocampusalsohelpsretrieverecentlystoredmemoriesbutnotrequiredforolderorover-learnedmemories.
H.M.BilateralMedialtemporallobectomy
forseizures.CompleteAnterogradeamnesiaRetrogradeamnesiafor2-3yearsFullscaleIQremainednormal112
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
Word List Learning Test
0
20
40
60
80
100
0 1 3 10
Time
% R
ecal
l
NormalAmnesia
H.M.IMPLICITMEMORYAverageno.ofErrors
Day1=15Day2=7Day3=2
“Norecollectionofeverperformingthistask,eachtimeheperformedit.”
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
CLINICAL SYNDROMES OF AMNESIAHYPOXEMIA
CLOSED HEAD INJURYTHIAMINE DEFICIENCY
HERPES SIMPLEX ENCEPHALITISTRANSIENT GLOBAL AMNESIA
RARE STROKE SYNDROMESDEGENERATIVE DEMENTIAS
Memory:CellularEvents• Bothexplicitandimplicitmemoryhavesimilarmechanismsatthecellularlevel.
• Memoryinvolveschangesinsynapticactivityinresponsetoastimulus(eitherincreasedordecreased).
• Short-termmemoryinvolvesshort-termcellularchangesaffectingsynaptictransmission,causedbytheeffectsofsecondmessengers.
• Long-termmemoryinvolveslong-termchangesinsynaptictransmission,mediatedbygeneexpression,proteinsynthesis,andchangesinsynapticconnections.
EmotionsandFeelings• Emotionalstateshavetwocomponents
• “Emotion”(physicalsensation)• “Feeling”(conscioussensation)
• Emotionalstatesaremediatedbythehypothalamus• Autonomic,endocrineandskeletomotorresponsesproducethephysicalsensationofemotions
• Consciousfeelingismediatedbythecerebralcortex• Thecingulategyrusandinferiorfrontallobesareespeciallyimportantinconsciousfeelings
TheAmygdala’sRoleinEmotion
• Theamygdalaispositionedtoregulateboththesomaticexpressionofemotionandconsciousfeelingofemotion
• Theamygdalahasdirectconnectionwiththethalamustoallowshort-latency,primitiveemotionalresponseswithoutconsciousawareness
• Learnedemotionalresponses,suchasclassicalconditioningoffear,aremadeintheamygdala
• Bilaterallesionsarerequiredtoseverelyimpairtheamygdala’sfunction(Kluver-Bucysyndrome)
TheAmygdalaRegulatesEmotionalResponses
Happy
FearfulrCBF
TheAmygdala
StructuresImportantinEmotions
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
DEMENTIAS,ALZHEIMERS DEMENTIALEWY BODY DEMENTIA
FRONTOTEMPORAL DEMENTIASOTHER CAUSES
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
DEMENTIADeclineofcognitiveabilitiesincomparisontoa
previousleveloffunctioning.Causinganimpairmentoffunctionalabilities.
Withoutimpairedconsciousness.
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
DEMENTIADeclineofcognitiveabilitiesincomparisontoa
previousleveloffunctioning.Causinganimpairmentoffunctionalabilities.
Withoutimpairedconsciousness.
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
DEMENTIADeclineofcognitiveabilitiesincomparisontoa
previousleveloffunctioning.Causinganimpairmentoffunctionalabilities.
Withoutimpairedconsciousness.
FRONTAL LOBE DYSFUNCTIONDEMENTIACHRONIC
PROGRESSIVEALERT&ATTENTIVEMEMORYLOSSDISORIENTATION
APRAXIAS&APHASIAS
DELIRIUMACUTE
INCONSISTENTFLUCTUATINGALERTNESS
INATTENTIONHALLUCINATIONS
AGITATION
CAUSE S OF DEMENT IA
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
60%
15%
15% 10%
AD
VaD+
DLB/PD
Other
AD– Alzheimer’sDisease
• Gradual,progressive• Memorylossusuallyinitialandmostprominentsymptom• Nofocalweaknessorsensoryloss• Gaitnormalandcontinentuntillateinthedisease• Geneticformsandsusceptibilitygenes• Clinicalcriteriafordiagnosis
GENETICS OF ALZHEIMERSEARLYONSET
AUTOSOMALDOMINANTONSET30-65
PRESENILIN1,80%CHROMOSOME14PRESENILIN2,15%CHROMOSOME1
AMYLOIDPRECURSORPROTEIN,5%CHROMOSOME21
APOLIPOPROTEINETHREISOFORMS
E2,E3,E4E4ISOFROM
OVERREPRESENTEDINAD60%VS25%
EACHE4ALLELEDECREASESAGEOFONSETBY5YEARS
CARRIERSHAVEMOREAMYLOIDPLAQUES
APOL I POPROTE IN E
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
NEURO-PATHOLOGYOFALZHEIMERSDISEASE
AD
DLB
CholinesteraseInhibitorsforAD
n Cognex(tacrine)1993n Aricept(donepezil)1996n Exelon(rivastigmine)2000n Reminyl(galantamine)2001
CholinesteraseInhibitorsandCognition(MMSE)Over1Year
Winblad B, et al. Neurology 2001; 57:489-495.
CholinesteraseInhibitorsandFunctionalAbilities
Winblad B, et al. Neurology 2001; 57:489-495.
CholinesteraseInhibitorsandNeuropsychiatricSymptoms
Adapted from Feldman H, et al. Neurology 2001; 57:613-620.
MemantineinADn UncompetitiveN-methyl-D-aspartate(NMDA)receptorantagonist
n BlocksexcessiveactivationofNMDAreceptorsbyglutamate
n InU.S.,FDAisapprovedfortreatmentofmoderatetosevereAlzheimer’sdisease
n Trialsbeingconductedforvasculardementia,HIV-D,combinationtherapy,andearlytreatment
Danysz W, Parsons CG. Int J Geriatr Psychiatry 2003;18:S23-S32.
MemantineinModeratetoSevereAD
Reisberg B, et al. NEJM 2003; 348:1333-41.
VASCULAR DEMENTIASUDDEN ONSET
STEPWISE PROGRESSIONFOCAL NEUROLOGICAL SIGNS
FOCAL COGNITIVE IMPAIRMENTABNORMAL IMAGING
HACHINSKI ISCHAEMIC SCORENINDS-AIREN CRITERIA
VA S C U L A R D EM E N T I A S U B T Y P E S
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
74%
18%8%
Small Vessel
Large Vessel
Mixed
Severe
ModerateMild
SMALLVESSELDISEASE
LARGEVESSELDISEASE
LEWY BODY DEMENTIADEMENTIA +
PARKINSONISMFLUCTUATING COGNITIONVISUAL HALLUCINATIONS
SENSITIVITY TO MEDICATIONSFASTER PROGRESSION
SHORTER SURVIVAL
Neurofibrillarytanglesandsenile(neuritic)plaquesasseeninAD
LewybodiesinsubstantianigraandcortexasseeninPDandDLB
NEUROPATHOLOGY
FRONTO-TEMPORAL DEMENTIADEMENTIA +
PROMINENT BEHAVIORAL CHANGESFRONTAL RELEASE SIGNS
LANGUAGE INVOLVEMENTSUPPORTIVE NEUROPSYCHOLOGY
FRONTO-TEMPORAL ATROPHY FUNCTIONAL IMAGING
DIFFERENT SUBTYPES
Gross pathologydescribed by A. Pick
Microscopic pathologyfirst described by A. Alzheimer
PICKDISEASE
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
FTD SUBTYPESBEHAVIORALVARIANTFTD
PRIMARYPROGRESSIVEAPHASIASProgressivenon-f luentaphasia
SemanticdementiaLogopenic aphasia
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
NORMAL PRESSURE HYDROCEPHALUS
DEMENTIA +GAIT APRAXIA
URINE INCONTINENCEENLARGED VENTRICLES
WITHOUT OBSTRUCTION70% RESPOND TO SHUNTINGIDIOPATHIC vs SECONDARY
NORMALPRESSURE
HYDROCEPHALUS
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
INFECTIOUS DEMENTIASNEUROSYPHILIS
HIVASSOCIATEDDEMENTIACREUTZFELDJACOBDISEASE
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
INFECTIOUS DEMENTIASNEUROSYPHILIS
POSITIVEANTIBODIES(FTA-ABS)CSFPLEOCYTOSIS
ARGYLLROBERTSONPUPILTABESDORSALIS
HIGHDOSEPENICILLIN
HIVASSOCIATEDDEMENTIA30%WHODIEOFAIDS
RULEOUTOPPURTUNISITICINFECTIONS
MAXIMIZEANTI-RETROVIRALTHERAPY
CREUTZFELD JACOB DISEASE
DEMENTIA +RAPIDLY PROGRESSIVESTARTLE MYOCLONUS
GAIT APRAXIA EEG CHANGES 85%
PERIODIC SHARP WAVES 1-3 HzVARIANT CJD
CJD– PERIODICSHARPWAVESD A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
CJD– SYMPTOMPROGRESSION
FirstMonth
SecondMonth
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
CSFBIOMARKERD A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
CSFBIOMARKERD A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
FUNCTIONALIMAGINGD A N I S H B H AT T I M D
M O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .
THANK YOU!
D A N I S H B H AT T I M DM O V E M E N T D I S O R D E R S C o .
D B V S . P S Y C H – B O A R D R E V I E W L E C T U R E S E R I E S - “ N E U R O C O G N I T I V E D I S O R D E R S ”
N O V E M B E R 1 8 , 2 0 1 5 – U N M C – O M A H A , N E , U . S . A .