Dementia. Defects of cognitive functions. Disorders of consciousness. Petr Maršálek Department Pathological Physiology 1st Medical faculty CUNI 1 Talks on NS Talk 1 - Pain and Motor disorders Talk 2 - Syndromes in neurosciences Talk 3 - Disorders of special senses Talk 4 - Cognitive functions, dementias, consciousness 2 (2) DEMENTIA 3 Dementia Definitions: Oligophrenia vs. dementia, Inborn vs. acquired Examples: Cretinism, Down syndrome vs Alzheimer disease, CO poisoning Intelligence, Intelect, IQ, D. is Generalized cognitive defect (as opposed to cog. funct. defects) example: Alzheimer’s disease etiology: mostly unknown symptomatology: Five A’s: asymbolia, agnosia, apraxia, aphasia, amentia, and memory deficit 4 Memory Q 18/1 Memory Short term Mid-term Long term Amnesia Anterograde Retrograde Disorders (examples only) Acute -posttraumatic Chronic: -Alzheimers disease -Korsakoff syndrome 5 Alzheimer disease 6 7 8 9 10 (*) Cogni- tive defects (3) Cognitive defects (*) (3) Cognitive(3) defects Occipital lobe 11 12 Disorders of visual association cortices Atlas of patophysiology, 1st EN edition, 2000, p. 327 13 Cognitive defects (occipital) (find five mismatches) 14 Blindsight (by Weisskrantz and others) 15 Temporal lobe 16 Auditory cortex and Two major speech centers 17 18 Parietal lobe 19 evitingoC Cognitive :(A) stcefed defects (A): „tcelgenimeH“ „Hemineglect“ 20 Frontal lobe 21 Lobotomy 22 Corpus callosum 23 Cognitive defects (B) Split brain: cognitive defect can be demonstrated only by a special test 24 Consciousness and unconsciousness 25 Consciuosness, unconsciousness 26 Levels of activation 27 Qualitative and quantitative disruptions of consciousness 28 Glasgow coma scale 29 Glasgow Coma Scale Glasgow Coma Scale 1 2 3 4 5 6 Opens eyes in Opens eyes Does not Opens eyes Eyes response to in response N/A N/A open eyes spontaneously painful stimuli to voice Utters Oriented, Makes no Incomprehensible Confused, Verbal inappropriate converses N/A sounds sounds disoriented words normally Abnormal Extension to flexion to Flexion / Localizes Makes no painful stimuli painful Withdrawal to Obeys Motor painful movements (decerebrate stimuli painful commands stimuli response ) (decorticate stimuli response ) The scale comprises three tests: eye , verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death ), while the highest is 15 (fully awake person). 30 To Do /1 31 To Do/ 2 32 To Do/ 3 33 Criteria for cerebral death 34.