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 .