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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 1
Objectives:1. Describe the neuroanatomy of attention, memory,
and cognitive intellectual capacities using gross
specimens.
2. Outline brain neuroanatomical areas implicated in cognitive
disorders.
3. Describe different pathologies associated with various
cognitive disorders (ie. Alzheimer’s dementia, Frontotemporal
dementia, Lewy Body dementia).
4. Describe the histopathological and molecular pathological
changes that characterize the common causes of dementia.
5. Describe the appropriate use of imaging in the diagnostic
work up of patients with new onset cognitive decline including the
strengths and limitations of CT, MRI and PET/CT.
6. Recognize the imaging findings of the various types of
dementia presented in lab.
** NOTE: Interactive PDFs are best viewed on desktop/laptop
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 2
Limbic SystemIdentify on gross specimens & micrographs:
Limbic lobe
Cingulate gyrus
Parahippocampal gyrus
Uncus
Fornix
Columns of the fornix
Anterior commissure
Identify on coronal brain sections:
Amygdala
Hippocampus
Fornix
Mammillothalamic tracts
Mammillary bodies
Anterior nucleus of thalamus
Anterior nucleus of hypothalamus (general location)
Amygdala
Hippocampus
Mammillothalamic tracts
Mammillary bodies
Anterior nucleus of thalamus
Locus ceruleus (noradrenergic neurons)
Raphe nuclei (serotonergic neurons)
Ventral tegmental area (dopaminergic neurons)
Medial Cortex
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 3
Fornix in Medial Cortex
Mammillary Body in Medial Cortex
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 4
Amygdala and Emotion• The amygdala associates experiences with
consequences and then programs the appropriate behavioral
response to the experience. Specifically, the amygdala plays a
role in emotional learning and emotional processing, with a
particular role in the expression of fear and anger.
• Input to the amygdala comes mainly from the cerebral
cortex.
• After assessing the nature of the input, i.e. friendly,
unfriendly, frightening, dangerous, etc., the amygdala sends
signals to centers in the hypothalamus that elicit the appropriate
autonomic and motor responses. Signals are also sent from the
basolateral amygdala via the dorsomedial nucleus of the thalamus to
the orbitofrontal cortex.
• The orbitofrontal cortex provides the perception of emotions,
whereas the hypothalamus provides the expression of emotions.
Hippocampus and MemoryImportant role in learning & formation
of new memories:
• Hippocampus acts as “encoding area” for translating short-term
memories into long-term memories. Important for declarative
memory.
• May be the initial storage site for memory. As process of
consolidation occurs, more permanent memories laid down (probably
diffusely) in cortex.
• Overlying cortex (uncus, entorhinal cortex) also plays
important role in memory.
• Bilateral removal of hippocampi results in inability to form
new memories of facts and events. Deficits less severe if overlying
cortex not involved.
• The hippocampus and amygdala are linked to two independent
memory systems. They act in concert when ‘emotion meets
memory’.
Amygdala and Hippocampus
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 5
Types of Memory and Their Neural Correlates
The Role of the Amygdala in Memory
Modified from Lippincott’s Illustrated Reviews: Neuroscience by
C. Krebs, J. Weinberg, E.J. Akesson, and E. Dilli. For educational
use only. Copyright © 2017 by Lippincott Williams & Wilkins.
All rights reserved.
Modified from Lippincott’s Illustrated Reviews: Neuroscience by
C. Krebs, J. Weinberg, E.J. Akesson, and E. Dilli. For educational
use only. Copyright © 2017 by Lippincott Williams & Wilkins.
All rights reserved.
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 6
Classic Papez Circuit
Extended Papez Circuit
Modified from Lippincott’s Illustrated Reviews: Neuroscience by
C. Krebs, J. Weinberg, E.J. Akesson, and E. Dilli. For educational
use only. Copyright © 2017 by Lippincott Williams & Wilkins.
All rights reserved.
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 7
Neuroimaging Normals For Reference
CT Scans
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 8
Neuroimaging Normals For Reference
MRIs
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 9
1. What is the most likely diagnosis?
Case 1This 76 year-old man had become increasingly forgetful and
confused over the past five years. He locked himself out of the
house on several occasions and could not find his way home. He
became unable to care for himself and had to be institutionalized.
He died of pneumonia. At autopsy, the brain weighed 1080 gms.
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 10
Case 1 (cont’d)
A B
C
D
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 11
2. What gross abnormalities are seen in figures A and B? (Figure
A = lateral view of fixed brain, Figure B = coronal section through
the frontal lobes)
3. What microscopic abnormalities are illustrated in figures C
and D? (Figure C = hippocampus, low power, Figure D = high power.
Bielschowsky silver stain)
6. What cerebral lobes are atrophied? And how might this explain
the clinical presentation?
4. What inherited factor might predispose to this condition?
5. When do patients usually present with this disease?
Case 1 (cont’d)
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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1. What is the general term for this neurologic syndrome?
Case 2This 66 year-old woman presented with antisocial behaviour
and changes in her personality, which became so severe that she had
to be institutionalized. She subsequently developed a progressive
language disorder, eventually resulting in mutism. Her memory
remained intact until the late stages of her disease.
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Case 2 (cont’d)
A
B2. What is the corresponding gross pathologic change,
illustrated in Figure A?
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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3. What specific diagnosis is characterized by the microscopic
changes shown in Figure B? (Bodian silver stain)
4. What cerebral lobes are atrophied? And how might this explain
the clinical presentation?
Case 2 (cont’d)
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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1. What gross abnormalities are seen in this post mortem brain
specimen?
Case 3This 77 year-old woman, with a history of diabetes
mellitus and hypertension, died of myocardial infarction. She had
suffered repeated neurologic events resulting in a visual field
defect, focal weakness and memory impairment.
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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2. How might this process result in dementia?
3. With what other type of pathology may this process combine to
produce dementia?
Case 3 (cont’d)
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 17
1. What is the definition of mild cognitive impairment?
2. Which patients with mild cognitive impairment receive
imaging?
3. What is the recommended management of this patient?
Case 465 year-old male with stepwise, progressive cognitive
decline with slow cognitive processing, executive dysfunction and
slow gait. He has a history of hypertension.
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 18
4. What abnormalities are depicted in Figures A (H&E) and B
(Luxol Fast Blue)? (normal shown on left)
Case 4 (cont’d)
A
B
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Neuroanatomy of Dementia Lab 8March 23, 2021 - Dr. Krebs
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Design & Artwork: The HIVE (hive.med.ubc.ca) 19
Recommended Textbooks:Lippincott Illustrated Reviews:
NeuroscienceBy: Claudia Krebs, Joanne Weinberg, Elizabeth J.
Akesson, Esma DilliLippincott Williams & WilkinsISBN
978-1-4963-6789-1
Neuroanatomy Through Clinical CasesBy: Hal BlumenfeldSinauerISBN
978-0-8789-3613-7
Neuroanatomy in Clinical Context: An Atlas of Structures,
Sections, Systems, and SyndromesBy: Duane E. HainesWolters kluwer
HealthISBN 978-1-4511-8625-3
Websites:Neuroanatomy | Entrada
RESOURCES
ACKNOWLEDGEMENTS
Artwork & Design:The HIVE, UBC Faculty of Medicine
Instructional Design: Monika FejtekMedical Illustration Lead:
Paige BlumerAcademic Lead: Claudia Krebs
Prosector: Lien Vo
THE HIVEUBC
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