The document discusses frontal subcortical circuits and their assessment. It describes the five main frontal-subcortical circuits, including the motor circuit, oculomotor circuit, dorsolateral prefrontal circuit, anterior cingulate circuit, and orbitofrontal circuit. It then examines each circuit in more detail, outlining their anatomical components and behavioral syndromes associated with dysfunction. A number of bedside assessment tests are also presented to help evaluate specific circuits.
This presentation looks at generalised periodic epileptiform discharges and the various disorders like Creutzfeldt Jacob disease (CJD), SSPE and metabolic encephalopathies in which it is seen. SIRPID is also discussed. Triphasic waves are described. Radermacker complexes in SSPE are described.
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
This presentation looks at generalised periodic epileptiform discharges and the various disorders like Creutzfeldt Jacob disease (CJD), SSPE and metabolic encephalopathies in which it is seen. SIRPID is also discussed. Triphasic waves are described. Radermacker complexes in SSPE are described.
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
Detailed description of clinical examination of higher mental functions like conscoiusness, cognition, memory, pereception,etc. in neurological conditions.
Clinical examination of higher function test By Pandian M, Tutor, Dept of Phy...Pandian M
Introduction
Examination of Higher Functions
Higher functions,
Examination of cranial nerves,
Sensory system,
Motor system,
Reflexes and
spine.
1.Level of consciousness:
2. Ask any history of suffering from hallucination or delusion or illusions.
3. Look for the appearance :
An overview of how to perform a paramedic neurological assessment. For more information about this lecture, please go to www.paramedicine.com/episode6.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging.
CONCEPT OF NODOPATHIES AND PARANODOPATHIES.pptxNeurologyKota
emergence of autoimmune neuropathies and role of nodal and paranodal regions in their pathophysiology.
Peripheral neuropathies are traditionally categorized into demyelinating or axonal.
dysfunction at nodal/paranodal region key for better understanding of patients with immune mediated neuropathies.
antibodies targeting node and paranode of myelinated nerves have been increasingly detected in patients with immune mediated neuropathies.
have clinical phenotype similar common inflammatory neuropathies like Guillain Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy
they respond poorly to conventional first line immunotherapies like IVIG
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
Entrapment Syndromes of Lower Limb.pptxNeurologyKota
This presentation contains information about the various Entrapment syndromes of Lower limb in descending order of topography. It also contains information about etiology, clinical features and management of each of these entrapment syndromes with special emphasis on electrodiagnostic confirmation.
This presentation consist information about Brain death with special emphasis to differences between Indian and Western Guidelines. Also consist information about Organ transplantation and related act.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Frontal Subcortical Circuits
And Their Assessment
Presenter:-
Dr Zuber Ali Quazi
Senior Resident
Department of Neurology
GMC Kota
2. Introduction
• The Frontal lobes can be divided into three major regions
a. Primary Motor Cortex,
b. Premotor And Supplementary Motor Cortices,
c. Association Cortices Comprising The Prefrontal Lobes
• The Prefrontal lobes is structurally divided into four areas:
1. Superior Medial Prefrontal Cortex, which includes the Anterior Cingulate
Cortex;
2. Lateral Prefrontal Cortex
3. Orbitofrontal Cortex
4. Frontal Poles.
3. Frontal Subcortical circuits
The 5 frontal-subcortical circuits
1. Motor circuit originating in the motor cortex and pre-motor cortex
2. Oculomotor unit originating in the frontal eye fields
3. Dorsolateral Prefrontal circuit------ Executive function
4. Anterior cingulate circuit------Motivation
5. Orbitofrontal circuit ---- Impulse control and social behavior.
MOTOR CORTEX
PREFRONTAL
CORTEX
5. ventralis
lateralis
ventralis
anterior,
pars
magnocellularis
medialis dorsalis,
pars multiformis
ventralis
anterior, pars
parvocellularis
medialis
dorsalis, pars
multiformis
medialis
dorsalis,
pars
magnocellularis
ventralis anterior,
pars
magnocellularis
medialis dorsalis,
pars multiformis
medialis
dorsalis,
pars
magnocellularis
Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci 1986;9(1):357–381.
doi:10.1146/annurev.ne.09.030186.002041.
6.
7. Behavioral Syndromes Associated With Dysfunction of the Motor Circuits
Poor organization strategies
Poor memory search
strategies
Stimulus-bound behavior
Environmental dependency
Impaired set-shifting and
maintenance
Emotional incontinence
Tactlessness
Irritability
Undue familiarity
Antisocial behavior
Environmental dependency
Mood disorders (depression,
lability, mania)
Obsessive-compulsive
disorder
Impaired motivation
Akinetic mutism
Apathy
Poverty of speech
Psychic emptiness
Poor response inhibition
DLPFC OFC
ANTERIOR
CINGULATE CIRCUIT
Bradley and Daroff’s Neurology in Clinical Practice, 8th edition
8. Disruption of the orbitofrontal circuit
Bradley and Daroff’s Neurology in Clinical Practice, 8th edition
9. DLPFC –Subcortical circuit
•Principally involved in
•ATTENTION and EXECUTIVE FUNCTIONS.
•These functions include the:-
•Ability to Shift Sets,
•Organize & Solve Problems
•Abilities of Cognitive Control
•Working Memory
10. • The circuit includes the
• Dorsolateral head of the caudate,
• Globus pallidus interna,
• Parvocellular aspects of the mediodorsal and ventral anterior thalamic
nuclei.
• Dysfunction in this circuit
• Environmental dependency syndromes
• Slowed information processing,
• Memory retrieval deficits,
• Mood and behavioral changes
• Poor organization and planning,
• Mental inflexibility,
• Working memory deficits.
E.g., Vascular dementias, PD, and HD
DLPFC –Subcortical circuit
11. DLPFC
Bedside tests:
1. Is the patient able to make an appointment and arrive on time?
2. Is the patient able to give a account of current problems and the reason for the being
brought to hospital? Is there evidence of thought disorder?
3. Digit span, days of the week or months of the year backwards.
4. Controlled oral word association test (COWAT): the patient is asked to produce as many
words as possible, in one minute, starting with F, then A, then S. (Benton, 1968).
Other categorical fluency tests naming animals, fruits and vegetables (Monsch et al, 1992).
Normal >10
Abnormal <8
Common errors include :- perseveration (repeating words), inappropriate words.
12. Alternating hand sequences.
One example is that one hand is placed palm upwards and the other is place
palm downwards, and the patient is then asked to reverse these positions as
rapidly as possible.
Another example is that the backs of the hands are both placed downwards,
but one hand is clenched and the other is open, then the patients is asked to
close the open hand and open the closed hand, and keep reversing the posture
of the hands as rapidly as possible.
A final example is that the patient taps twice with one fist and once with the
other, then after the rhythm is established, the patient is asked to change over
the number of beats (the fist which first tapped twice now taps only once).
13. Similarities (conceptualization)
In what way are they alike?”
Banana and a Orange
Table and a Chair
Tulip, a Rose, and a Daisy
Score: only category responses (fruits, furniture, flowers) are considered
correct.
i. Three correct: 3
ii. Two correct: 2
iii. One correct: 1
iv. None correct: 0
Site:- Left Perisylvian Prefrontal regions
14. Motor Luria test
The examiner performs alone three times with his left hand the series of
Luria “fist–edge–palm.”
The examiner performs the series three times with the patient, then says to
him/her: “Now, do it on your own.”
• Score:-
six correct consecutive series alone: 3
At least three correct consecutive series alone: 2
Fails alone, but performs 3 correct consecutive series with examiner: 1
Cannot perform 3 correct consecutive series even with the examiner: 0
15. Conflicting instructions
“Tap twice when I tap once.”
• To be sure that the patient has understood the instruction, a series of three trials is run:
1-1-1.
“Tap once when I tap twice.”
• To be sure that the patient has understood the instruction, a series of three trials is run:
2-2-2.
• The examiner performs the following series: 1-1-2-1-2-2-2-1-1-2.
Score:-
No error: 3
One or two errors: 2
More than two errors: 1
Patient taps like the examiner at least four consecutive times: 0
16. Environmental Autonomy
• “Do not take my hands.”
• The examiner is seated in front of the patient. Place the patient’s
hands palm up on his knees. Without saying anything or looking at
the patient, the examiner brings his hands close to the patient’s and
touches the palms of both the patient’s hands
• If the patient takes the hands, the examiner will try again after asking
him/her: “Now, do not take my hands.”
Score:-
Patient does not take the examiner’s hands: 3
Patient hesitates and asks what he/she has to do: 2
Patient takes the hands without hesitation: 1
Patient takes the examiner’s hand even after he/she has been told
not to do so: 0
17. OFC–subcortical circuit
• Mediates Empathy, Civil and Socially Appropriate Behavior.
• It pairs Thoughts, Memories, and Experiences with corresponding Visceral And
Emotional States.
• Medial OFC -----Reward processing and behavioral responses.
• Lateral OFC ----- External, sensory evaluations including decoding punishment.
• Anterior subregions process the reward value for more abstract and complex
secondary reinforcing factors such as money.
• Posterior areas -------concrete factors such as touch and taste.
• Posteromedial OFC ------evaluating the emotional significance of stimuli
18. • Site:-
• Ventromedial caudate
• Mediodorsal aspects of the globus pallidus interna
• Medial ventral anterior and inferomedial aspects of the magnocellular
mediodorsal thalamus.
• Classic personality change experienced by “Phineas Gage” following injury of his
left medial prefrontal cortex by a metal rod in a construction accident, is
associated with impulsivity, disinhibition, irritability, aggressive outbursts, socially
inappropriate behavior,and mental inflexibility
• E.g.,
Persons with bilateral OFC lesions may manifest “theory of mind” deficits.
Schizophrenia, depression, OCD, FTD, HD
Other condition that may affect are:- head trauma, rupture of anterior communicating
aneurysms, and subfrontal meningiomas.
OFC–subcortical circuit
19. Bedside tests:
1. Does the patient dress or behave in a way which suggests lack of concern with the
feelings of others or without concern to accepted social customs.
2. Test sense of smell - coffee, cloves etc.
3. Stroop test
4. Go/ No-Go test
OFC
21. “Tap once when I tap once.”
• To be sure that the patient has understood the instruction, a series of three trials is run:
1-1-1.
“Do not tap when I tap twice.”
• To be sure that the patient has understood the instruction, a series of 3 trials is run: 2-2-
2.
• The examiner performs the following series: 1-1-2-1-2-2-2-1-1-2.
Score:-
No error: 3
One or two errors: 2
More than two errors: 1
Patient taps like the examiner at least four consecutive times: 0
Go–No Go test
22. ACC and its subcortical connections
• Motivated behavior
• Conflict monitoring
• Cognitive control
• Emotion regulation. Subgenual and region rostral to the genu of the
corpus callosum with reciprocal amygdala
connections
· Cognitive Functions And
Behavioral Expression of
Emotional States
Dorsal ACC regions are
interconnected to lateral and
mediodorsal prefrontal regions
The Ability To Pursue and Regulate
Goal-oriented Behavior
23. • Site:-
• Nucleus Accumbens/ Ventromedial Caudate
• Ventral Globus Pallidus
• Ventral Aspects Of The Magnocellular Mediodorsal Thalamic Nuclei
• Ventral Anterior Thalamic Nuclei.
• Lesion:-
• Amotivational syndromes (apathy, abulia, akinetic mutism)
• Cognitive impairments including poor response inhibition, error detection,
and goal-directed behavior.
• E.g., AD, FTD, PD, HD, head trauma, brain tumors, cerebral infarcts, and
obstructive hydrocephalus.
ACC and its subcortical connections
24. Trail Making test A Trail Making test B
Sensitive to energization deficits
Assesses Visuomotor attention and
scanning.
Task setting and Monitoring errors
30. A 62-year-old man presented for evaluation of a 3-year history of new behavioral symptoms. He had become less
hard-driving in his work as an attorney, accepting fewer cases and taking longer to close them. Although he had
always been a diligent gardener, he left the yard unattended despite his wife’s encouragement. He became less
systematic when attempting to repair broken household fixtures or plan even short trips. His emotional range
diminished; he remained agreeable, almost malleable, and warm toward his wife, but his conversations with her
lacked depth. Spontaneous speech slowly diminished but was otherwise intact. He often repeated questions or
asked for clarification about recent events.
On examination, motor function was spared. His Mini-Mental State Examination (MMSE) score was 21/30.
Neuropsychological testing revealed executive deficits, especially in processing speed, generativity, and response
switching, as well as poor delayed verbal recall and spared visuospatial function. MRI revealed severe left-
predominant medial and dorsolateral frontal atrophy with conspicuous sparing of the anterior temporal lobe and
posterior brain regions but marked left hippocampal atrophy
31.
32. Differences between various types of FTD
Puppala GK, Gorthi SP, Chandran V, Gundabolu G. Frontotemporal Dementia – Current Concepts. Neurol India 2021;69:1144-52.
34. Q. Impulse control and social behavior is the function of which of the
following circuit?
1. Premotor-subcortical circuit
2. Orbitofrontal circuit
3. DLPFC circuit
4. Anterior Cingulate circuit
35. Q. The ability to pursue and regulate goal-oriented behavior, i.e.,
Cognitive control is mediated by :-
1. Orbitofrontal subcortical circuit
2. Dorsolateral prefrontal subcortical circuit
3. Anterior cingulate subcortical circuit
4. Dorsolateral head of the caudate
36. Q. Reward processing and behavioral responses is mediated by :-
1. Lateral Orbitofrontal cortex
2. Medial Orbitofrontal cortex
3. Anterior cingulate subcortical circuit
4. Posteromedial Orbitofrontal cortex
37. Q. Evaluation of the emotional significance of stimuli is done by:-
1. Lateral Orbitofrontal cortex
2. Medial Orbitofrontal cortex
3. Anterior cingulate subcortical circuit
4. Posteromedial Orbitofrontal cortex
38. Q. Conceptualization is mediated by which region of the brain?
1. Anterior cingulate subcortical circuit
2. Left Perisylvian area
3. Right Perisylvian area
4. Lateral Orbitofrontal cortex
39. Q. Obsessive-compulsive disorder is related to dysfunction of which of
the following circuits?
1. Orbitofrontal subcortical circuit
2. Dorsolateral prefrontal subcortical circuit
3. Anterior cingulate subcortical circuit
4. Dorsolateral head of the caudate
40. References
• Bradley and Daroff’s Neurology in Clinical Practice, 8th edition
• Continuum Journal
• Brazis, Paul W. Localization in clinical neurology.
• Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally
segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci
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Shifting sets is related to mental flexibility and consists of the ability to move between different concepts or motor plans or the ability to shift between different aspects of the same or related concept.
Working memory is the online maintenance and manipulation of information.
Proper nouns, surnames & previously used words with a different suffix are prohibited
The COWAT consists of three word conditions. The subjects’ task is to produce as many words as he can that begin with the given letter (F, A, or S) within a 1-min time period.
Theory of mind is a model of how a person understands and infers other people’s intentions, desires, mental states, and emotions
The patient is asked to make a response to one signal (the Go signal) and not to respond to another signal (the no-go signal).
MMSE for detecting MCI & early dementia and for identifying the various types of dementias
Apathy, impulsivity, and executive dysfunction, reflecting a more dorsal subtype involving dorsal anterior insula, anterior midcingulate, and dorsolateral/opercular prefrontal
Structures
Disinhibition, overeating, compulsivity, and loss of disgust, reflecting a more ventral subtype involving ventral anterior insula, pregenual and subgenual anterior cingulate, ventral striatum, amygdala, and orbitofrontal areas
Loss of sympathy/empathy and agnosia for person-specific semantic knowledge, reflecting focal anterior temporal lobe degeneration.
I) Behavioral variant FTD (Bv‑FTD).
ii) Primary progressive aphasia (PPA).
PPA can be either of the two types, such as
agrammatic (nonfluent) variant
semantic variant (svPPA).
The semantic variant can be of left‑svPPA (or) right‑svPPA.
Bv FTD:- apathy, loss of empathy, hyperorality, and social disinhibition
Agrammatic(Nonfluent) Apraxia of speech (or) Agrammatism (omission of closed class words such as a, the), nonfluent speech (halting or hesitant speech).[34]
Apraxia of speech is due to loss of connections between frontal operculum and supplemental motor area
Semantic deficits of semantic knowledge but with preserved speech fluency.(Atrophy of anterior temporal lobe)
L‑svPPA include word finding difficulties especially for verbs; in the critical stages, patient substitutes specific words with superordinate categories (e.g., vehicles for car) as
the disease advances loss of word meaning increases and have trouble recognizing what is shown to them.
R‑svPPA, early features are behavioral, while language problems occur late in the disease course. The early behavioral problems are due to involvement of right anterior temporal lobe and orbitofrontal cortex. As the disease progresses, it may involve visual temporal association area and posterior temporal association area and may develop prosopagnosia and visual agnosia.
40% of patients with Bv‑FTD may have motor neuron disease in which they may present either with UMN or LMN signs. 20% of Bv‑FTD may present with early Parkinsonism.
Bv‑FTD may be sometimes associated with corticobasal syndrome or PSP in which earlier may be associated with alien limb phenomenon, asymmetrical Parkinsonism, and dystonia.