MEDD 422 Integrated Neuroanatomy, Neuropathology & …neuroanatomy.ca/syllabi/DementiaLab.pdf · MEDD 422 Integrated Neuro - Dementia Lab MEDD 422 Integrated Neuroanatomy, Neuropathology

Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs ([email protected])

Design & Artwork: The HIVE (hive.med.ubc.ca) 1

Objectives:1. Describe the neuroanatomy of attention, memory, and cognitive intellectual capacities using gross

specimens.

2. Outline brain neuroanatomical areas implicated in cognitive disorders.

3. Describe different pathologies associated with various cognitive disorders (ie. Alzheimer’s dementia, Frontotemporal dementia, Lewy Body dementia).

4. Describe the histopathological and molecular pathological changes that characterize the common causes of dementia.

5. Describe the appropriate use of imaging in the diagnostic work up of patients with new onset cognitive decline including the strengths and limitations of CT, MRI and PET/CT.

6. Recognize the imaging findings of the various types of dementia presented in lab.

** NOTE: Interactive PDFs are best viewed on desktop/laptop computers - functionality is not reliable on mobile devices **

mailto:[email protected]://hive.med.ubc.ca/https://www.youtube.com/watch?v=ErpxEwlWww4https://neuroanatomy.ca/syllabusM422.htmlhttps://www.youtube.com/watch?v=xlny7MR5AAAhttps://neuroanatomy.ca/modules/LimbicSystem/story.htmlhttps://skfb.ly/6QWz7https://skfb.ly/6QYCEhttps://skfb.ly/6XNUohttps://skfb.ly/6ZF7p



Limbic SystemIdentify on gross specimens & micrographs:

Limbic lobe

Cingulate gyrus

Parahippocampal gyrus

Uncus

Fornix

Columns of the fornix

Anterior commissure

Identify on coronal brain sections:

Amygdala

Hippocampus

Fornix

Mammillothalamic tracts

Mammillary bodies

Anterior nucleus of thalamus

Anterior nucleus of hypothalamus (general location)

Amygdala

Hippocampus

Mammillothalamic tracts

Mammillary bodies

Anterior nucleus of thalamus

Locus ceruleus (noradrenergic neurons)

Raphe nuclei (serotonergic neurons)

Ventral tegmental area (dopaminergic neurons)

Medial Cortex

mailto:[email protected]://hive.med.ubc.ca/https://neuroanatomy.ca/coronals.htmlhttps://neuroanatomy.ca/micrographs.html



Fornix in Medial Cortex

Mammillary Body in Medial Cortex

mailto:[email protected]://hive.med.ubc.ca/



Amygdala and Emotion• The amygdala associates experiences with consequences and then programs the appropriate behavioral

response to the experience. Specifically, the amygdala plays a role in emotional learning and emotional processing, with a particular role in the expression of fear and anger.

• Input to the amygdala comes mainly from the cerebral cortex.

• After assessing the nature of the input, i.e. friendly, unfriendly, frightening, dangerous, etc., the amygdala sends signals to centers in the hypothalamus that elicit the appropriate autonomic and motor responses. Signals are also sent from the basolateral amygdala via the dorsomedial nucleus of the thalamus to the orbitofrontal cortex.

• The orbitofrontal cortex provides the perception of emotions, whereas the hypothalamus provides the expression of emotions.

Hippocampus and MemoryImportant role in learning & formation of new memories:

• Hippocampus acts as “encoding area” for translating short-term memories into long-term memories. Important for declarative memory.

• May be the initial storage site for memory. As process of consolidation occurs, more permanent memories laid down (probably diffusely) in cortex.

• Overlying cortex (uncus, entorhinal cortex) also plays important role in memory.

• Bilateral removal of hippocampi results in inability to form new memories of facts and events. Deficits less severe if overlying cortex not involved.

• The hippocampus and amygdala are linked to two independent memory systems. They act in concert when ‘emotion meets memory’.

Amygdala and Hippocampus




Types of Memory and Their Neural Correlates

The Role of the Amygdala in Memory

Modified from Lippincott’s Illustrated Reviews: Neuroscience by C. Krebs, J. Weinberg, E.J. Akesson, and E. Dilli. For educational use only. Copyright © 2017 by Lippincott Williams & Wilkins. All rights reserved.





Classic Papez Circuit

Extended Papez Circuit





Neuroimaging Normals For Reference

CT Scans




Neuroimaging Normals For Reference

MRIs




1. What is the most likely diagnosis?

Case 1This 76 year-old man had become increasingly forgetful and confused over the past five years. He locked himself out of the house on several occasions and could not find his way home. He became unable to care for himself and had to be institutionalized. He died of pneumonia. At autopsy, the brain weighed 1080 gms.




Case 1 (cont’d)

A B

C

D




2. What gross abnormalities are seen in figures A and B? (Figure A = lateral view of fixed brain, Figure B = coronal section through the frontal lobes)

3. What microscopic abnormalities are illustrated in figures C and D? (Figure C = hippocampus, low power, Figure D = high power. Bielschowsky silver stain)

6. What cerebral lobes are atrophied? And how might this explain the clinical presentation?

4. What inherited factor might predispose to this condition?

5. When do patients usually present with this disease?

Case 1 (cont’d)




1. What is the general term for this neurologic syndrome?

Case 2This 66 year-old woman presented with antisocial behaviour and changes in her personality, which became so severe that she had to be institutionalized. She subsequently developed a progressive language disorder, eventually resulting in mutism. Her memory remained intact until the late stages of her disease.




Case 2 (cont’d)

A

B2. What is the corresponding gross pathologic change, illustrated in Figure A?




3. What specific diagnosis is characterized by the microscopic changes shown in Figure B? (Bodian silver stain)

4. What cerebral lobes are atrophied? And how might this explain the clinical presentation?

Case 2 (cont’d)




1. What gross abnormalities are seen in this post mortem brain specimen?

Case 3This 77 year-old woman, with a history of diabetes mellitus and hypertension, died of myocardial infarction. She had suffered repeated neurologic events resulting in a visual field defect, focal weakness and memory impairment.




2. How might this process result in dementia?

3. With what other type of pathology may this process combine to produce dementia?

Case 3 (cont’d)




1. What is the definition of mild cognitive impairment?

2. Which patients with mild cognitive impairment receive imaging?

3. What is the recommended management of this patient?

Case 465 year-old male with stepwise, progressive cognitive decline with slow cognitive processing, executive dysfunction and slow gait. He has a history of hypertension.




4. What abnormalities are depicted in Figures A (H&E) and B (Luxol Fast Blue)? (normal shown on left)

Case 4 (cont’d)

A

B




Recommended Textbooks:Lippincott Illustrated Reviews: NeuroscienceBy: Claudia Krebs, Joanne Weinberg, Elizabeth J. Akesson, Esma DilliLippincott Williams & WilkinsISBN 978-1-4963-6789-1

Neuroanatomy Through Clinical CasesBy: Hal BlumenfeldSinauerISBN 978-0-8789-3613-7

Neuroanatomy in Clinical Context: An Atlas of Structures, Sections, Systems, and SyndromesBy: Duane E. HainesWolters kluwer HealthISBN 978-1-4511-8625-3

Websites:Neuroanatomy | Entrada

RESOURCES

ACKNOWLEDGEMENTS

Artwork & Design:The HIVE, UBC Faculty of Medicine

Instructional Design: Monika FejtekMedical Illustration Lead: Paige BlumerAcademic Lead: Claudia Krebs

Prosector: Lien Vo

THE HIVEUBC

mailto:[email protected]://hive.med.ubc.ca/https://neuroanatomy.cahttps://entrada.med.ubc.ca/https://hive.med.ubc.ca/about/team/https://hive.med.ubc.ca/about/team/

Button 37: Button 39: Button 69: Button 77: Button 30: Button 17029: Button 57: Button 75: C31: OffC33: OffC32: OffC34: OffC35: OffC74: OffC86: OffC75: OffC82: OffC95: OffC76: OffC83: OffC77: OffC87: OffC78: OffC88: OffC79: OffC91: OffC84: OffC93: OffC85: OffC94: OffButton 71: Labels 23: LabelsOff 23: lateral 3: lateralL 3: Button 76: Labels 24: Labels 25: LabelsOff 24: LabelsOff 25: medial 3: medialL 3: lateral 4: lateralL 4: Labels 28: LabelsOff 28: lateral 6: lateralL 6: Text Field 49: Text Field 59: Text Field 60: Text Field 64: Text Field 61: Text Field 63: Text Field 65: Text Field 71: Text Field 67: Text Field 68: Text Field 72: Text Field 74: Text Field 75: Text Field 76: Text Field 79: Text Field 80: Text Field 78:

Documents

MEDD 422 Integrated Neuroanatomy, Neuropathology & …neuroanatomy.ca/syllabi/DementiaLab.pdf · MEDD 422 Integrated Neuro - Dementia Lab MEDD 422 Integrated Neuroanatomy, Neuropathology