True: Anomic aphasia often co-occurs with alexia and agraphia. The neuropathology often involves the left angular gyrus or the left temporal pole (Yudofsky & Hales 2002, p. 572572).

False: In aphasia the acquired or second language tends to be more severely affected than the mother tongue.

False: Wernicke’s area is supplied by the middle temporal artery which is a cortical branch of the middle cerebral artery (Fitzgerald 1996, p. 57245).

False: Although the EEG is almost always abnormal, the changes are usually variable and non-specific, especially in the early stages. Initially, there may only be local or diffuse slowing. This may progress to paroxysmal sharp waves or slow spike and wave discharges. A characteristic pattern of 1–2 Hz periodic simple, biphasic, triphasic or polyspike sharp wave complexes on a slow background with loss of alpha rhythm occurs in 70–90% of cases late in the illness (Lishman 1997, p. 572478; Mitchell 2004, p. 572180; Sadock & Sadock 2005, p. 572469; Wright et al 2005, p. 572386).

True: There are many differences between CJD and nvCJD. nvCJD affects a younger age group than sporadic CJD. nvCJD is more commonly associated with a non-specific psychiatric prodrome of anxiety and depression and is therefore more likely to present to psychiatrists. Ataxia occurs relatively earlier in the course of nvCJD and myoclonus later. In nvCJD, the EEG lacks the characteristic 1–2 Hz sharp waves of CJD and histopathology shows increased plaque formation. nvCJD is strongly associated with methionine homozygosity at codon 129 where a met–val polymorphism is seen (Lishman 1997, p. 572476).

False: The alpha rhythm has a frequency range of 8–14 Hz. It is best recorded over the occipital and parietal region. It occurs during wakefulness on eye closure and attenuates on eye opening (Yudofsky & Hales 2002, p. 57245).

False: An epileptic automatism is a state of clouding of consciousness which occurs during or immediately after a seizure. During an automatism the individual retains control of posture and muscle tone and performs movements and actions without being aware of what is happening. They are usually brief, lasting a few seconds to a few minutes. In Knox’s 1968 series 80% lasted less than 5 minutes and another 12% less than 15 minutes (Lishman 1997, p. 572253).

False: Visual hallucinations and interpretative illusions of familiarity derive more commonly from the right than the left temporal lobe. However, interictal psychosis may be linked with dominant temporal lobe seizures (Lishman 1997, p. 572251; Mitchell 2004, p. 572119).

False: Non-epileptic seizures (NES) are notoriously difficult to distinguish from epileptic seizures. The diagnosis of NES depends not only on the duration of the seizure but also on other clinical characteristics. NES can follow a generalized tonic clonic seizure. A generalized tonic clonic seizure lasting more than 30 minutes could represent status epilepticus and should be taken seriously. Associations of NES include: more common in females; psychosocial disturbance; consciousness retained in the presence of bilateral jerking; resistance to examination; vocalization, pelvic thrusting, gaze aversion and normal pupillary reflexes during convulsion; normal pupillary, deep tendon and plantar reflexes immediately after a convulsion.

True: Hyperhomocysteinaemia is a risk factor for coronary artery disease, stroke, vascular dementia and Alzheimer’s disease. Methylenetetrahydrofolate reductase regulates homocysteine levels by converting it to methionine. Hence, methylenetetrahydrofolate reductase genotype influences the levels of homocysteine (Jacoby & Oppenheimer 2002, p. 572523; Sadock & Sadock 2005, p. 5723741).

True: Polymerase chain reaction is a laboratory technique for rapid amplification of DNA sequences. First, two oligonucleotide primers which flank the gene of interest are created. The DNA is heat treated in order to separate the two strands ready for replication. The DNA primers and DNA polymerase are incubated and replication of the original DNA sequence occurs. Because of the need to heat the DNA to separate the two strands, a special heat resistant DNA polymerase from a thermophilic bacterium is used. At the end of the first cycle two double stranded DNA molecules of the gene of interest are produced. The cycle is then repeated resulting in exponential growth in the number of copies of the gene with each cycle. Each replication takes about 5 minutes. This process is automated. Thus, genes can be amplified a billion fold using this technique (Alberts et al 2000, p. 572508).

True: Damage to the dorsolateral prefrontal cortex, on either side, causes slowness, apathy and perseveration (Yudofsky & Hales 2002, p. 572634).

True: In general, late stage HIV patients, especially those with AIDS dementia complex, are far more sensitive to the therapeutic effects, but even more so to the side-effects and toxic effects of antipsychotic drugs. Extrapyramidal side-effects, tardive dyskinesia and neuroleptic malignant syndrome are all more common in patients with AIDS, especially AIDS dementia complex. They are also more sensitive to anticholinergic side-effects and have a high risk of delirium (Gelder et al 2000, p. 5721170; Mitchell 2004, p. 572382; Sadock & Sadock 2005, p. 572438).

True: The figures are conflicting. However, the suicide rates are significantly greater than in the general population. The risk is particularly raised in the first 6 months after diagnosis and also in the late stages of HIV infection (symptomatic AIDS) (Lishman 1997, p. 572331; Mitchell 2004, p. 572457).

False: The EEG in Huntington’s disease shows loss of alpha rhythms. There may be generalized low voltage fast activity or random slow activity. As the disease progresses the EEG may become completely flat. These changes are not ubiquitous. Normal traces may be achieved even in advanced disease (Lishman 1997, p. 572470; Mitchell 2004, p. 572161; Yudofsky & Hales 2002, p. 572964).

False: Semantic dementia is a form of presenile dementia presenting as a selective loss of semantic knowledge, i.e. factual information and vocabulary. Episodic memory is memory for events. Three classic causes of episodic memory loss evident from an inability to retain new material for more than a few minutes are Korsakoff’s syndrome, transient global amnesia and hippocampal damage from herpes simplex encephalitis. The latter may also result in a semantic memory deficit. Other causes of semantic memory dysfunction include Picks’ disease, Alzheimer’s disease, head injury and vascular lesions (Hodges 1994, p. 57216; Lishman 1997, p. 572753; Mitchell 2004, p. 57269).

True: Euphoria is a manifestation of advanced multiple sclerosis, commensurate with extensive cerebral damage. Euphoria has been associated with greater physical disability and cognitive impairment, progressive disease course, enlarged ventricles on CT scan, frontal lesions and more widespread lesions on MRI. Lesion load and cognitive impairment are more strongly associated with high mood than with low mood. First onset mania in multiple sclerosis is likely to reflect new brain lesions (Feinstein 1999, p. 57259; Lishman 1997, p. 572694; Mitchell 2004, p. 572144).

False: ECT is not contraindicated in MS. However, ECT can cause neurological deterioration in 20% of patients with active disease. Ideally, an MRI should be done to aid decision-making. Active disease, i.e. white matter plaques on MRI, would indicate a higher risk of deterioration. In the presence of active disease, ECT should be used only in emergencies or if pharmacotherapy fails (Feinstein 1999, p. 57244).

True: Ideomotor apraxia refers to the inability of a patient with intact comprehension and motor system to carry out a motor action when instructed to do so, but at other times they may carry out this action spontaneously. Patients have difficulty with selection, sequencing and spatial orientation of movement in gestures, demonstrating the use of imagined items and imitating gestures. Lesions are usually found in the left parietal or frontal lobes.

Ideational apraxia refers to a patient’s inability to carry out a complex sequence of coordinated movements, for example lighting a cigarette, although in contrast to ideomotor apraxia, the patient can carry out the separate components of the action. Corpus callosum or generalized lesions are normally associated with this deficit.

Dressing apraxia is not an apraxia in the sense that it is not a motor disorder but rather seems to be related to visuospatial difficulties. Localized lesions in the right posterior parietal lobe can lead to this problem, but more often it is seen with generalized lesions to the right hemisphere.

Constructional apraxia refers to the inability to copy two-dimensional shapes and figures, and is a defect of visual analysis and visuomotor ability. It is more often seen in lesions of the right hemisphere, particularly if the parietal lobe is affected. It can however arise with right- or left-sided damage. Left-sided lesions often lead to oversimplified copying, whereas right-sided lesions may lead to gross distortions in spatial arrangement (Hodges 1994, p. 57270; Mitchell 2004, p. 57274).

True: Prosopagnosia is the inability to recognize the identities of previously well-known faces and the inability to learn new ones. Exposure to the voice of the unrecognized individual will elicit prompt recognition. It is associated with damage to the temporo-occipital junction or bilateral damage to the ventral aspect of the occipital lobes (Mitchell 2004, p. 57275; Yudofsky & Hales 2002, p. 57282).

True: The electrodermal system is under the sole control of the sympathetic nervous system rather than under a dynamic balance between sympathetic and parasympathetic systems. Sympathetic activation may be tonic or phasic. Activation increases sweating and hence increases conductance. Anxiety causes increased tonic activity. Depression may decrease skin conductance. Relaxation decreases skin conductance (Sadock & Sadock 2005, p. 5721729).

True: Young children show the highest proportion of slow wave sleep. This declines with age until slow wave sleep may disappear altogether after age 60 years. Sleep also becomes more fragmented with age and shows increased latency to sleep onset, increased nighttime arousals and daytime napping. REM sleep is preserved in the normal elderly but may be severely disrupted in Alzheimer’s disease (Sadock & Sadock 2005, p. 572283).

True: Sleepwalking represents partial arousal from the deep non-REM stages of sleep. It occurs most often during the first third of the night when stages 3 and 4 predominate.

Conditions that increase slow wave sleep, such as sleep deprivation, shift work or alcohol consumption may increase the frequency of sleepwalking (Lishman 1997, p. 572736).

True: Tau protein in its physiological state is essential for the formation and stability of microtubules. Abnormal phosphorylated tau is found in neurofibrillary tangles (Lishman 1997, p. 572422).

False: Both delusions and auditory and visual hallucinations are common in hypothyroidism (Lishman 1997, p. 572512).