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Cognition
Cognition (Latin: cognoscere, 'know') can be defined
as the ability to process information from perception,
or previously acquired knowledge (based in
experience)
Cognition is the set of skills and mental processes
related to knowledge: attention, memory, judgment,
reasoning, problem solving, production and
comprehension of language, navigation, etc.
Cognitive exam
History / examination
Overall cognitive state
For cognitive domains:
MMSE
30 puntos
Attention
Atencin:
valoracin global
Dgitos inversos
Deletrear al revs
Clculo mental
Das de la semana/
meses al revs
Memory
Memory
Alteration in the register of new information: anterograde
amnesia
Alteration in evoking memories already stored (before the
event):
retrograde amnesia (consolidation 1-2 years)
verbal memory
visual Memory
Immediate / working memory
recent memory
Remote / autobiographical memory
Explicit memory (declarative): episodic memory
semantic memory
Implicit memory
Dgitos:
Directos
I=Identificacin
Ensayo 1
Ensayo 2
Ensayo 3
Categora
tem
RL1
RF1
RL2
RF2
RL3
RF3
AVE
CUERVO
MAT. LECTURA
ENCICLOPEDIA
VERDURA
APIO
CALZADO
ALPARGATAS
REPTIL
CAIMN
M. CONSTRUCCIN
MRMOL
P.PRECIOSA
TURQUESA
EDIFICIO
PISO
MUEBLE
ESCRITORIO
10
VEHCULO
AUTOCAR
11
HERRAMIENTA
HOZ
12
INST. MUSICAL
ARMNICA
13
UT. COCINA
COLADOR
14
DEPORTE
GIMNASIA
15
PLANTA
JAZMN
16
TIPO BARCO
PESQUERO
30 minutos
RL Total
RF Total
Language
Praxias
Copia Figura
Compleja de Rey
Psicomotor speed
TMT A
Executive Functions :
Set of cognitive skills that allow anticipation and goal
setting, training plans and programs, the initiation of
activities and mental operations, self-regulation of the
tasks and the ability to carry out efficiently
Working memory
abstraction
planning
flexibility
Monitoring and inhibition of behavior
Memoria de trabajo
Dgitos directos
Flexibilidad cognitiva
Naranja-Pera
Chaqueta-Pantaln
Perro-Len
Calcetines-Zapatos
Tenedor-Cuchara
Mesa-Silla
Barco-Automvil
Piano-Tambor
Ojo-Odo
Aire-Agua
Ordenador-Libro
Poema-Estatua
Mosca-rbol
Huevo-Semilla
Vapor-Niebla
Amigo-Enemigo
Hibernacin-Migracin
Premio-Castigo
Trabajo-Juego
Respuesta
Puntuacin
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
Total
2
2
2
2
2
2
2
2
2
2
2
2
2
Perseveration/ cognitive
flexibility
echolalia
echopraxia
intrusions
"Response-to-next-patient-stimulation sd
Sg applause
Sg release
Sequential movements Luria
Tasks go-no go
Palmomentoniano
Prehension reflex
Snout
Flicker
Suction
Behaviour
Case 1: Mrs MB
Case 1 Mr MB
Aged 81, first seen May 2008
2 years history of increasing memory impairment
Medical observation
Time gradient
Constant question repetition
Looses things
Needs list for shopping
Instrumental ADLs preserved, although difficulties at the
subway
Screening testing:
MMSE 22/30
Clock drawing OK
Semantic fluency 13
T@M 24/50 Cutt off score 28/50
MRI
Neuropsychological exam
Blood analysis
Clinical diagnosis:
Alzheimers disease
Initial medication
Donepezil 5 mg, then 10 mg, daily
initiated
Slight improvement, but MMSE
unchanged
Family noted he was more confident
Improvement in mood
After 18 months MMSE dropped to 19
No additional behavioural or mood
changes
May 2002
Anxious, hypochondriac attitude
Speaks fluent, no signs of oral apraxia
Prosopagnosia and anomia
No signs of parkinsonism
Complementary studies:
neuropsychological study
cranial CT
cranial MRI
NPS junio02
NPS diciembre02
AVLT 6-7-8-10-10 B5 A6-6; Stagnant
learning curve.
BNT 8/15 Fluency FAS 08.05.11, animals
7
Numerous errors in nomination even
with
high-frequency stimuli. Verbal
fluency is
reduced, especially for
semantic slogan.
TMT A and B (N) He made executive
tasks quickly without interference
alteration .
Febrero03
Septiembre'02: lacunar left corona radiata
that coursed with mild paresis of right
limbs with complete recovery (vascular
etiology - CVRF: AHT)
Occasionally renames food
His wife has the impression that does not
follow/understand meetings or movies"
Octubre05
He has difficulty reading and having a
conversation because he has trouble
understanding things, "has lost the
meaning of the words"
Have a memory problem, but is able to
run errands
Does not recognize people
Computing capacity remains
Very obsessive: strict schedules, things
exact location sudokus compulsively,
very impatient
TC craneal septiembre06
RM septiembre06
Summary
Presenile onset dementia
Prosopagnosia, anomia, agnosia,
obsessive-compulsive disorder
Constructive praxis, ideomotor,
calculus, space-time orientation,
memory of "everyday" preserved
Diagnosis
Semantic dementia
Criteria for the clinical diagnosis of
dementia Semantics (semantic aphasia with
associative agnosia) (Neary, 1998)
The semantic disorder (difficulty
understanding the meaning of words and /
or identity of objects) is the most prominent
at the beginning and throughout the illness
alteration. Other cognitive functions,
including autobiographical memory, remain
unaffected or relatively preserved.
Gorno-Tempini04
R
Patologa esperable:
DLFT-U + (inclusiones
Neuropathol 2006)
tau -
predominio
neuritas,
Acta
Mr. MP
75 years old male
Irrelevant past medical history
Complains of vision difficulties
Not difficulties with seeing details, but
misses the whole picture
Takes his grandchildren and rotates them
to see them properly
Exploracin fsica:
aware of the problem
Reduction of left visual field by
confrontation
Right-left failures recognition
No increase in tone , and tremor
MMSE : 24/30
Copy Rey Complex Figure : Altered
Title ( Boston Naming Test ) : 45/60
Understanding orders ( Boston) : 10/15
Selective attention ( Trail Making Test A) :
Alter .
Memory. Curve Memory: 4,5,5,6,7 holds 4
Ideomotor praxis by imitation : 2/5
calculation
Copia Figura
Compleja de Rey
Comprensin rdenes
Ej: Ponga el lpiz al otro
lado del reloj y dele la vuelta a
la libreta
Puntuacin: 40/50
Corte para Deterioro cognitivo Leve: 37
Corte para Enfermedad de Alzheimer: 28/50
TAC craneal
RM craneal
RM (+2 aos)
Right
Right
SPECT cerebral
Oblicuo 0
Oblicuo +1
Oblicuo +2
Hypomimia and hypophonia
Balint syndrome "plus" left
predominance
generalized myoclonus
Normal pain and temperature
sensitivity
Reading, writing and calculation
impossible
IHQ
-A4 amiloideplacas difusas
Familial dementia
Actual problem:
Memory loss
In one occasion, spatial disorientation
Apathy
ADL preserved
Neurological exam
Lower body Parkinsonism
Freezing, short-shuffling steps, wide
based gait
Cognitive:
Oriented in time and space
Optimal attention level
Discrete memory alteration
No language impairment: neither in its
expression nor comprehension
Neuropsychological Results
Memory
Memory Texts (fixation) I (Test Barcelona): 7 N
Delayed Memory Texts : 2 (< 1,5 DE) Altered
CERAD memory List:
learning: 5,4,5 retention: 1 Altered
Neuropsychological Results
Language:
Praxis:
Constructive (CERAD): 11/11N
Imitational praxis: 5/5 N
Neuropsychological Results
Visual perception
Poppelreuter: 10/10 N
VOSP : 21/22 N
Frontal functions
Abstract thinking (similarities): 16 N
Phonetic fluency (FAS): 20 N
Trail Making Test (part A): 85 seconds.
MRI
MRI
Actual problem:
Dense memory loss: extremely repetitive
Forgets family names and the way back home, gets
lost
Apathy, inhibition and irritability
Worsening of previous obsessions
Neurological exam
Lower body Parkinsonism
Freezing, short-shuffling steps, wide
based gait
Cognitive:
Oriented in time and space
Optimal attention level
Marked memory deficit
Naming impaired
Neuropsychological Results
MMSE: 21/30
Memory (CERAD): 2,3,5 retention 0
Naming (Boston):47/60
Order comprehension (Boston):14/15
Trail Making Test A: normal.
Imitation Praxis:5/5
Calculus: normal
MRI
MRI
MRI
Evolution
Both siblings developed a
progressive motor (greater in the
man) and cognitive decline
Died after 7 years
Brain donors
Do they have the same disease?
Is this a genetic disease?
Pathological study
Banc de Teixits Neurolgics
Universitat de Barcelona - Hospital Clnic
A-beta
A-beta
cuerpo de Hirano
Tau-AT8
ubicuitina
Diagnsticos
I) AD pathology:
Braak stage V
CERAD Clasification: definite AD
NIA/RI: high probability AD diagnosis
Moderate amyloid angiopathy
II) Atherosclerotic vascular disease
Estudio neuropatolgico
caso 2
Banc de Teixits Neurolgics
Universitat de Barcelona - Hospital Clnic
Cortex frontal
Cortex temporal
Cortex
s. blanca
AT8
isoformas tau 3R
isoformas tau 4R
Hippocampus
Hippocampal sclerosis
Diagnsticos neuropatolgicos
Thank You