higher mental function
DESCRIPTION
CLINICAL NEUROLOGYTRANSCRIPT
Higher mental function
Anatomical areas- functions
• Perisylvian net work –language• Parietofrotal network- spatial cognition• Occipito temporal –face &object recognition• Limbic net work – retentive memory• Pre frontal net work – attention& behavior
Mental status examination
When• Known brain lesions• Suspected brain lesions• Psychiatric patients• Vague behavioral complaints
History &behavioral observations
• +/- of classic behavioral changes indicative of organic dysfunction
• Possibility of both adjustment and functional psychiatric disorder
• Establish patients pre morbid behavior and level of functioning
• Patients general medical status
History out line• Description of present illness• Other organic behavioral symptoms unusual or bizarre behavior poor social judgment attention & concentration problems language problems reading ,writing, calculation difficulty memory difficulty geographic orientation• Psychiatric symptoms(hallucinations, delusion, depression, anxiety)• Past history (neurological, psychiatric , medical, drug & alcohol abuse , head trauma,
seizures , CNS infections, )• Birth and development history• Educational &vocational history• Family history
Physical appearance
• General appearance A)descriptive data (age, ht, wt) B)general impression of appearance
(appearance for chronologic age, posture, facial expression, eye contact)
• Personal cleanliness(hair, nails, teeth, beard, indications of unilateral neglect)
• Habits of dress• Motor activity
Mood&emotional status• Mood normal for situation sadness elation apathy & lack of concern fluctuations in mood• Emotional status cooperation with examiner depression anxiety suspiciousness anger reality testing (delusions, hallucinations) indications of non psychotic emotional symptoms(phobia, mania, obsessiveness ) abnormalities of language & speech
Delirium(acute confusional state)
• Confusion-mental &behavioral state of reduced comprehension , coherence and capacity to reason
• Delirium – a state of confusion accompanied by agitation, tremor, hallucination and illusion
-clouding of consciousness -inattention -confabulation - in coherent speech -acute symptoms
Frontal lobe syndrome
• Apathy• Euphoria• Short lived irritability• Social inappropriateness
Frontal lobe tests
• Visual pattern completion test
Frontal lobe tests
Motor pattern tests• Fist-palm-side test• Fist –ring test• Reciprocal coordination test
Pseudo dementia&dementia
Level of consciousness
• Alertness• Lethargy• Obtundation• Stupor or semicoma• coma
attention
• Observation• History• Digit repetition• Sustained attention(A random letter test)• Unilateral inattention
language
• Dysarthria• Apraxia• Aphasia• Alexia• agraphia
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Transcortical-motor
Anatomy of aphasia
Broca’s
Conduction
Wernicke’sTranscortical-sensory
Anomic
Global
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Broca’s Famous Patient
Evaluation of language• Handedness• Observing spontaneous speech• Verbal fluency animal naming FAS test• Comprehension yes or no questions pointing commands• Repetition• Naming and word finding• Reading• writing
Aphasic syndromes
memory
• Immediate digit repetition• Recent orientation to place, person and time• Remote personal information• New learning ability 4 unrelated words recalled after 5,10,30 mts• Verbal story for recall• Visual memory for hidden objects• Paired associate learning
Constructional ability,reproduction drawings
Construction ability
• Drawing to commands• Draw a clock face with all numbers• Set clock for a time
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Neglect
Higher cognitive functions
• Fund of information• Calculations verbal rote examples verbal complex examples written complex examples• Proverb interpretation• Similarities• Insight and judgement
Related cognitive functions
• Ideomotor apraxia• Ideational apraxia• Right –left disorientation• Finger agnosia• Visual agnosia• Prosopognosia• simultagnosia• Asteriognosis• Geographic disorientation
Lobar function tests
• Frontal lobe tests insight judgement proverb interpretation fund of information similarities visual pattern completion tests alternating motor pattern tests digit repetition test A random letter test
• Parietal lobe tests ideomotor apraxia ideational apraxia dressing apraxia calculation RT-LT disorientation finger agnosia stereognosis construction apraxia
• Temporal lobe tests verbal memory visual memory paired associate learning
• Occipital lobe tests visual agnosia prosopognosia simultagnosia