<?xml version="1.0" encoding="UTF-8"?>
<opml version="2.0">
  <head>
    <title>029-02 Network cognition, sleep-state control, and disorders of consciousness</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Network cognition, sleep-state control, consciousness">
      <outline text="Network approach and attention">
        <outline text="Poor memory: attention, consolidation, retrieval, output">
          <outline text="Identify failed operation, time course, network"/>
        </outline>
        <outline text="Alerting, orienting, executive attention systems"/>
        <outline text="Dorsal frontoparietal: goal-driven attention"/>
        <outline text="Ventral salience: interrupts for important stimuli"/>
        <outline text="Thalamus regulates access and synchronisation"/>
        <outline text="Right parietal lesion: profound left neglect"/>
        <outline text="Test arousal and attention first">
          <outline text="Digit span, months backward, consistency"/>
        </outline>
      </outline>
      <outline text="Executive control">
        <outline text="Prefrontal cortex coordinates a wider network"/>
        <outline text="Perseveration, impulsivity, poor sequencing"/>
        <outline text="Can describe steps yet fail to organise them"/>
        <outline text="Shaped by fatigue, medication, mood, environment">
          <outline text="Quiet examination underestimates daily disability"/>
        </outline>
      </outline>
      <outline text="Declarative memory">
        <outline text="Hippocampus binds elements of an episode">
          <outline text="Gradual integration into cortical representations"/>
        </outline>
        <outline text="Bilateral medial temporal injury: severe amnesia">
          <outline text="Immediate span and motor skills relatively spared"/>
        </outline>
        <outline text="Frontal disease: organisation and free recall">
          <outline text="Cueing or recognition improves performance"/>
        </outline>
        <outline text="Depression, pain, sleep loss, delirium imitate"/>
      </outline>
      <outline text="Language assessment">
        <outline text="Fluent speech is not necessarily meaningful"/>
        <outline text="Test comprehension without contextual clues"/>
        <outline text="Repetition vulnerable to several network lesions"/>
        <outline text="Naming failure: semantic, word form, or motor"/>
        <outline text="Acute aphasia is a stroke warning"/>
        <outline text="Reliable yes-or-no channel prevents misclassification"/>
      </outline>
      <outline text="Arousal and the sleep-wake switch">
        <outline text="Multiple ascending transmitter systems">
          <outline text="No single transmitter is a switch"/>
        </outline>
        <outline text="Wakefulness is a stabilised network state"/>
        <outline text="Cortical failure removes awareness, brainstem arousal"/>
        <outline text="Ventrolateral preoptic neurons inhibit arousal"/>
        <outline text="Orexin stabilises wakefulness">
          <outline text="Loss underlies narcolepsy type one"/>
          <outline text="Sleep attacks, cataplexy, sleep paralysis"/>
        </outline>
        <outline text="Adenosine builds sleep pressure">
          <outline text="Caffeine antagonises adenosine receptors"/>
        </outline>
        <outline text="Circadian alerting opposes pressure: second wind"/>
      </outline>
      <outline text="Sleep states and sleep disorders">
        <outline text="REM: pontine suppression of motor output">
          <outline text="Failed atonia permits dream enactment"/>
          <outline text="May precede synuclein neurodegeneration"/>
        </outline>
        <outline text="Sedation is not physiological sleep"/>
        <outline text="Obstructive apnoea: collapse, hypoxaemia, surges">
          <outline text="Fragmented sleep, rising cardiovascular load"/>
          <outline text="Severity beyond event count"/>
          <outline text="Airway pressure success needs fit and follow-up"/>
        </outline>
        <outline text="Insomnia maintained by more than low sedation">
          <outline text="Bed conditioned as a cue for vigilance"/>
          <outline text="Excess time in bed reduces sleep pressure"/>
          <outline text="Abrupt sedative withdrawal needs planned taper"/>
        </outline>
      </outline>
      <outline text="Disorders of consciousness">
        <outline text="Stabilise and localise in parallel">
          <outline text="Correct hypoxaemia, glucose, pressure, opioids"/>
        </outline>
        <outline text="Pupils, eye movements, corneal reflex, breathing"/>
        <outline text="Unilateral dilated pupil: third-nerve compression"/>
        <outline text="Glasgow Coma Scale is not a full examination">
          <outline text="Components and trend beat an isolated total"/>
        </outline>
        <outline text="Non-convulsive status needs electroencephalography"/>
        <outline text="Reassess with same stimulus and same scale"/>
        <outline text="Locked-in: seek eye movement or blink channel"/>
      </outline>
      <outline text="Delirium and dementia">
        <outline text="Acute change, fluctuating attention and arousal"/>
        <outline text="Hypoactive delirium mistaken for cooperation"/>
        <outline text="Treat causes, protect orientation and sleep"/>
        <outline text="Antipsychotics do not cure delirium"/>
        <outline text="Dementia increases vulnerability"/>
        <outline text="Family accounts of usual state are central"/>
        <outline text="Restraint and catheters reinforce the cycle"/>
      </outline>
      <outline text="Autonomic control and orthostasis">
        <outline text="Symptoms when cerebral perfusion falls"/>
        <outline text="Volume depletion: heart rate rises"/>
        <outline text="Neurogenic: small heart-rate rise">
          <outline text="Sympathetic efferent failure"/>
        </outline>
        <outline text="Measure after supine rest, continue standing"/>
        <outline text="Treat by mechanism: drugs, volume, counter-pressure">
          <outline text="Salt and fluid unsuitable in heart or kidney failure"/>
          <outline text="Volume or tone drugs: supine hypertension"/>
        </outline>
        <outline text="Goal is function, not a perfect pressure"/>
      </outline>
      <outline text="Safety and final assessment">
        <outline text="Driving, machinery, bathing, heights"/>
        <outline text="Share warning changes and emergency criteria"/>
        <outline text="Diary links symptoms to time, posture, medicines"/>
        <outline text="Name the unstable state transition or loop"/>
      </outline>
    </outline>
  </body>
</opml>
