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Cognition, Dementia, and Behavioral Neurology

Manual: General · Subject: Neurology

Connect brain networks to memory, language, executive function, and neuropsychiatric symptoms.

How Cognition Is Organized

Network model

Cognition depends on distributed networks involving cortex, subcortex, and white matter. Damage to one node can disrupt memory, language, attention, or executive function.

Major cognitive domains

Attention
Focus and information selection
Memory
Encoding, storage, and retrieval
Language
Comprehension and expression
Executive function
Planning, inhibition, flexibility
Visuospatial function
Spatial perception and construction

Difficulty with planning, set shifting, and inhibition most strongly reflects dysfunction of the:

What is the difference between delirium and dementia in one phrase?

Dementia Syndromes and Localization

Pattern recognition in dementias

Alzheimer disease

  • Prominent episodic memory impairment early
  • Progressive decline over time

Vascular cognitive impairment

  • Stepwise or patchy decline
  • Focal neurologic signs may coexist
⚠️

Diagnostic caution

Cognitive decline in an older adult is not automatically dementia; depression, medications, sleep disorders, and metabolic problems can mimic it.

Early behavioral disinhibition and language change suggest which dementia syndrome?

What feature strongly suggests delirium rather than dementia?

Behavioral Neurology in Practice

Evaluation framework

  1. 1

    Step 1: Determine onset, tempo, and fluctuation.

  2. 2

    Step 2: Test attention, memory, language, and executive function.

  3. 3

    Step 3: Review medications, mood, sleep, and substance use.

  4. 4

    Step 4: Look for focal neurologic signs and functional impairment.

Visual hallucinations plus parkinsonism and cognitive fluctuations point most strongly to:

Why is medication review important in cognitive complaints?