• those capacities of thought which have reached their most complex levels in humans
• involve the multimodal association cortices (superior & inferior parietal lobules, prefrontal cortex)

sensory

motor

association cortex

• primary somatosensory cortex (post central gyrus)
• primary auditory cortex (temporal lobe)
• primary visual cortex (occipital lobe)

• primary motor cortex precentral gyrus)
• premotor area (frontal lobe)
• supplementary motor area (frontal lobe)

• unimodal association cortex- visual, auditory, somatosensory
• multimodal association cortex- parietal, association cortex; pre-frontral cortex

• parietal association cortex & prefrontal area
• these regions receive projections from several different sensory regions and integrate information 
• represent the highest level of cortical development
• responsible for: language, cognition, & memory

• Wernicke's Area
• Broca's Area
• Primary Motor Cortex
• Angular Gyrus
• Arcuate Fasciculus
• Supramarginal gyrus

spoken language →medial geniculate body →via internal capsule→to primary auditory cortex of both hemispheres→left association cortex (Wernicke's) determines sentence structure, semantic, phonological & syntactic rules→arcuate fasciculus sends anteriorly→to Broca's area to formulate a plan→primary motor strip refines→to cranial nerves→articulators activated and Wernicke's monitors and corrects

• doesn't accurately account for aphasic symptomology (i.e. Broca's aphasia with mild* comprehension deficits)
• better understood as a cluster of symptoms
• oversimplifies the linguistic components (i.e. expressive vs. receptive language→overlap)
• anatomical shortcomings (i.e. right hemisphere, regions are not homogenous, other areas involved)

• basal ganglia & thalamus
• cerebellum
• red nucleus
• rolandic cortex
• supplemental & presupplemental areas
• insula?
• auditory areas
• auditory cortex
• inferior frontal gyrus
• supramarginal and angular gyrus

• neuroimaging techniques
• microelectrode techniques
• computational modeling
• regional blood flow
• transcranial magnetic stimulation
• nural modeling

• MRI
• DTI

• EEG
• MEG

• PET
• SPECT
• fMRI

DIVA Model

Doral and Ventral Streams

• Directions Into Velocities of Articulators
• neural network modeling
• auditory/somatosensory and motor
• feedforward/feedback

• Hickok and Poeppel (2004)
• ventral stream- precesses speech signals for comprehension; bilaterally organized
• dorsal stream- maps acoustic speech signal to frontal lobe; left hemisphere dominant
• based on understanding of how vision works- mapping of so unds for meaning (Wernickes- ventral)

• site of lesion
• speech
• comprehension
• repetition (helps differentiate between types of aphasias)
• naming (reasons for naming deficits vary)
• reading and writing
• paraphasias

• site of lesion: anterior, broca's area
• speech: nonfluent (labored)
• Broca's area- close to motor area→deficit in motor control
• comprehension: intact
• repetition: impaired (want to repeat, can do some single words but multi-words they really drop off)
• naming: poor
• reading and writing: impaired
• paraphasias: rare

• site of lesion: posterior, wernicke's area
• speech: fluent (say alot but with little context)
• comprehension: impaired (sometimes can do Y/N)
• repetition: impaired 
• naming: poor
• reading & writing: impaired 
• paraphasias: common (strange)
• cannot self-monitor (get frustrated)
• hemianopsia (near occipital lobe)

• no real code for substitutions
• phonemic (literal)- "tevillision" for "television"
• neogilistic (jargon)-"lidip"
• semantic (verbal)- "door" for "window"
• preservative

• some say mild form of Broca's- is it really its own category???
• site of lesion: left angular gyrus; thalamus, parietal
• speech: fluent
• comprehension: intact
• naming: poor
• reading & writing: may be impaired
• paraphasias: rare but typically literal
• circumlocutions

• site of lesion: large left perisylvian region
• speech: non-fluent
• comprehension: impaired
• repetition: impaired
• naming: poor
• reading & writing: impaired
• paraphasias: common
• require more skilled care if spontaneous recovery/resolution does not occur
• can start as global and resolve to other types
• sometimes no speech only head nodding

• inability to repeat, everything else generally in tact, damage to arcuate fasciculus

• agnosia (damage to association cortex)
• apraxia (motor planning not there- apraxia of speech, of limbs, oral apraxia)
• hemiparesis (broca's)
• hemianopsia (wernickes)
• alexia (reading-posterior)
• agraphia (writing-posterior)

• mental functions of an individual which allow them to think, process information, learn, and remember
• includes:
• perception
• attention
• memory
• reasoning
• problem solving

• ability to retain and utilize acquired information or knowledge
• 3 processes related to memory
• encoding (formation of memory trace), storage(temporal maintenance of a memory trace) and recall (reactivating a stored memory for current use)

1st level- sensory memory

2nd level- short term (working) memory

3rd level longterm memory

• 1-2 minutes
• limited capacity storage of information (*7 chunks)
• allows us to hold and manipulate infromation in real time, as well as call up longeterm memory to interact with current memory traces 
• affected by temporal factors
• if memory trace is not rehearsed the memory will fade in a matter of minutes

• permanent and possible limiteless memory store, containing all our knowledge of the wordl and memories of the past
• *if there is a problem with short term memory it is hard to get things into long term memory, if long term problems then RECALL will be impaired

• declarative-name and lable
• epidsodic: memory of events ( you remember the feeling of attending a hs football game) 
• semantic: memory of knowledge, facts (remembering what lobe the supramarginal gyrus is in)

• unconcious memory from classical conditioning contexts or procedural learning
• aka procedural or implicit memory
• e.g. typing your shoelaces; hitting a golf ball

• frontal association areas- working memory, prefrontal association area, lesion result in ST memory difficulties
• hippocampus-for conversion of memory trace to lt memory, lesions result in amnesia & inability to form new lt memory; episodic & semantic memory
• amygdala-emotional memory, memory related to smell, taste, episodic and semantic memory
• parietal lobe- nonverbal memory
• temporal lobe- semantic memory
• basal ganglia- nondeclarative memory (motor learning)
• cerebellum- nondeclarative (motor learning)
• occipital lobe - visual memory

"degenerative process of the CNS, affecting oder adults. Diffuse impairment of memory, intellect and cognition. It may inclue behavioral and personality changes as well as physical impairments in the later stages"

-Brookshire, 2003

• impaired short term memory, long term memory; impairment of at least one of the following: abstract thinking, changes in personality & judgment, construct ability(puzzles, ability to draw face of clock), praxis, language or visual recognition

• acquired
• gradual onset
• persistent
• severe enough to interfere with work, social and relationships
• disorientation
• lapses in judgement
• difficulty performing mentially challenging tasks
• misplaced items
• apathy and loss of initiative
• mood changes
• difficulty in performing ADLs

• 65 year olds- 2%
• 80 year olds- 20%
• unknown etiology 50-80%
• rate and pattern of progression are variable (underlying cause)

neurodegenerative

-alzheimer's disease, VaD, LBD, FTD, PPA and MCI

subcortical

-PD, Huntington's Disease, PSP, CID

associated disorders

-wilson's disease, hiv encephalopathy, post-traumatic & alcohol-related

• 50-70% of all dementias
• 2-3 times more females
• unknown cause
• neurofibrilliary tangles (TAU)- intracellular, neuritic plaques (extracellular)  and granulovaculolar degeneration- fluid cavities within cells causes neuron to die→ within hippocampus
• intra & extracellular breakdown
• seems to be some kind of genetic predisposition
• neuron death→lack of firing of neurotransmitters (makes it possible to medically stage, along with behavior)

• medical treatment (aimed at maximizing neurotransmitters- does not address disease itself) : aimed at symptoms and slowing progression- cognex(early), aricept, excelon, razadyne; namanda-mid stage (memantine)
• stages: early, mid and late, memory and orientation first symptoms

Alzheimer's Disease- Speech and Language

(no set timeline depends on patient)

• early- mild word retrieval, occasional paraphasias and subtle comprehension problems
• middle- communication impairment more obvious, word retrieval, sentence fragments, passive, px with topic maintenance, conversation more difficult
• late-severely compromised, reading and writing non-functional, bizarre, devoid of meaning, unaware of errors, echolalic
• *always seem to maintain recognition of own name*

Pick's Disease (FTD)

"fronto-temporal lobar dementia"

• rare, 2% of dementia patients
• frontal lobe pathology
• ages 40-60 (early onset)
• shrinkage of brain, proliferation of glial cells
• often misdiagnosed as AD and depression
• possible genetic link
• personality and emotions initial symptoms
• apathy and indifference
• social problems
• obsessional behaviors
• language communication break down early in disease (opposite of alzheimers), memory and orientation remain intact until later progression
• *medication- anti-depressant may serve purpose early on

• vascular in nature
• cortical and subcortical processes
• CVD/HTN- preventable
• deficits in memory, cognition and ADL (variable)
• at risk for stroke factors (similar risk factors)

• change in basal ganglia, thalamus and brainstem
• begins with motor symptoms
• huntington's disease
• parkinson's disease
• symptoms- motor movement patterns

• inherited, degenerative
• chorea-mvt disoder
• cognitive decline
• personality changes, agitation, depression, paranoia and delusions
• 1 in 20,000
• loss of caudate nucleus, basal ganglia and frontal & temporal lobe
• eventually require complete physical assistance

• ages 40-60, death in 15-20 years 
• medical treatment: antidepressants, antipsychotics
• speech & language: hyperkinetic dysarthria (no coordination), dysphagia and memory (depends on stage)
• can work on compensatory strategies for communication

• age 50-65  yers old
• death 15-20 years post dx
• deterioration of dopamine production in basal ganglia
• pill rolling, resting tremor, rigidity, impaired gait and balance, masked face, parkinson's shuffle, get stuck- cortical stuttering
• dopamine/ACh balance off- hypokinetic rigidity

• 15-20% of parkinson's patients will have dementia
• medical tx: L-dopa, sinemet, deprenyl and bromocriptine; trying to manage dopamine and acetacholine; medication regime frequently changing for optimal benefit
• surgical tx: pallidotomy and fetal tissue transplant
• speech and language-voice, vocabulary, syntax, drooling and swallowing, fluency

• drugs that increase brain levels of dopamine- levodopa
  
• drugs that mimi dopamine (dopamine agonists)- apomorphine, bromocriptine, pramipecolse, ropinirole
• drugs that inhibit dopamine breakdown (MAO-8 inhibitors)- selegiline(deprenyl)
• drugs that inhibit dopamine breakdwon (COMT inhibitors)- entacapone, tolcapone
• drugs that decrease the action of ach anticholinergics-  trihexyphenidyl, benztropine, ethopropazine
• drugs with an unknown mechanism of action for PD- amantadine

• wilsons disease- body's difficulty/build-up of copper (red ring around eye, dysarthria, dementia)
• HIV/AIDS
• Wernicke's Encephalopathy→caused by chronic alcoholism, cerebellum, brainstem; lack of coordination, eye mvts, ataxia

• human immunodeficiency virus encephalopathy
• opportunistic disease
• most less than 35 yo
• 70% encephalopathy leading to dementia in late stages
• meds- slow progression and tx infections
• variable development
• can be gradual or sudden
• 6 mos post CNS signs
• speech and language- dysarthria

• normal pressure-hydrocephalus→fairly treatable
• delirium→drug withdrawal, fever→temporary
• brain tumor→symptoms of dementia
• depression→similar symptoms
• hypothyroidism (if untreated)→confusion, inability to focus, dementia/grave;s disease
• vitamin deficiency→ thiamine

• electroencephalography (EEG)
• MRI- alzheimer's→ventricles enlarged, gyri atrophy, shrinking hippocampus
• multi-infarct dementia (deep subcortical)→lesions in white matter→info going in and out will be disrupted
• huntington's disease→ atrophy of the caudate nucleus