4/3/2013
Jordi Serra-Mestres
Serra Mestres
Consultant Psychiatrist
Old People
Older
P
l & Healthy
H lth Ageing
A i
Ser ice Line
Service
I t d ti
€ Introduction
€ Subcortical
S
i
Ischaemic
i Vascular Disease
i
• Neuropsychiatric syndromes
• Bedside cognitive assessment
€ An
overview of “strategic”
strategic infarcts
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4/3/2013
€ Below
B l
the cerebral
th
b l cortex:
t
• Basal
B
lg
ganglia
gli
• Cerebral
C b l white
hit matter
tt
• Thalamus
• Certain Limbic structures
€
Caused by occlusion of small arteries or by
hypoperfusion
€
A major cause of cognitive impairment and
d
dementia
ti
€
Includes:
• Lacunar state ((état lacunaire))
• Multiple lacunes with extensive perifocal incomplete
infarcts
• Subcortical
S
i
arteriosclerotic
i
i encephalopathy
p
p y
(
(Bisnwanger’s)
g
)
• CADASIL
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€ Neuropsychiatric
• Subcortical Cognitive
•
•
•
•
•
i p i
t
impairment
Apathy
Disinhibition
Depression
P
d b lb affect
ff
Pseudobulbar
(P chotic symptoms)
to )
(Psychotic
€ Neurological
• Dysarthria
• Pseudobulbar palsy
S ll t pp d wideid
• Small-stepped,
based gait
• Parkinsonism
U i
y incontinence
i
i
• Urinary
P a idal signs
i
• Pyramidal
€ Caused
fronto
by disruption of frontosubcortical circuitry (here by SIVD)
€ Affecting
ff i
grey and/or
/ white
i matter
€ Characterised
Ch
t i d by:
by
x Reduced speed of information processing
(
(bradyphrenia)
yp
)
x Forgetfulness (retrieval
(retrieval-related)
related)
x Executive
dysfunction
ecut ve dys
u ct o
x Attentional difficulties
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Frontal Cortex
Thalamus
GPe
Striatum
STN
Gpi/SN
Excitatory pathway
Inhibitory pathway
€ Executive
dysfunction
€ Attentional
A
i
l
deficits
d fi i
Ap thy
€ Apathy
€ Lack
of interest and motivation
€ Perseverative
behaviour
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4/3/2013
€ Profound
change
€ Early
personality and behavioural
loss of insight and judgement
€ Early
E ly
b kd
breakdown
off social
i lk
knowledge
l dg and
d
behaviour
€ Disinhibition
Di i hibiti
p
€ Euphoria
€ Moria
(R > L)
y
or irritability
or Witzelsucht
€ Impulsive
behaviour
Obsessive-compulsive
€ Obsessive
compulsive
€ Environmental
i
phenomena
dependency syndrome
• Echophenomena
• Utilization
o behaviour
e
o
• Forced hyperphasia
€ Klüver
Klüver-Bucy
Bucy
syndrome
• Placidity,
Pl idity loss
l
off fear,
f
hyp
hypersexuality,
lity hyperorality,
hyp
lity
hypermetamorphosis, and associative visual agnosia
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6
4/3/2013
€take
in (encode)
€keep
k p
)
in
i (store)
(
€get
hold of (retrie
(retrieve)
e)
information
i f
ti
Memory
E li it
Explicit
STM
LTM
Epi di
Episodic
I li it
Implicit
g Priming
P i i g
M
Motor
skills
kill Conditioning
S
Semantic
ti
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4/3/2013
€ Memory
for events that have been personally
experienced
€ It
has 2 components:
• Anterograde
g
memory
y ((= new learning)
g)
• Retrograde memory (past events)
€ Functional
F
ti
l
neuroanatomy:
t y
Limbic diencephalic system
• Limbic-diencephalic
x Right:
information
g visuospatial
p
x Left: verbal information
€ Forgetfulness
for recent events (faulty learning
– anterograde amnesia)
• Misplacing items
• Forgetting
o gett g appointments/dates/people’s
appo t e ts/dates/peop e s
•
•
•
•
names/taking medication/what to buy in
supermarket
R p i g oneself
Repeating
lf
Temporal disorientation
Losing the thread of a conversation
Etc
8