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Higher Mental Function

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CLINICAL NEUROLOGY

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Higher Mental Function

  1. 1. Higher mental function
  2. 2. 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
  3. 3. Mental status examination When • Known brain lesions • Suspected brain lesions • Psychiatric patients • Vague behavioral complaints
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. Frontal lobe syndrome • Apathy • Euphoria • Short lived irritability • Social inappropriateness
  10. 10. Frontal lobe tests • Visual pattern completion test
  11. 11. Frontal lobe tests Motor pattern tests • Fist-palm-side test • Fist –ring test • Reciprocal coordination test
  12. 12. Pseudo dementia&dementia
  13. 13. Level of consciousness • Alertness • Lethargy • Obtundation • Stupor or semicoma • coma
  14. 14. attention • Observation • History • Digit repetition • Sustained attention(A random letter test) • Unilateral inattention
  15. 15. language • Dysarthria • Apraxia • Aphasia • Alexia • agraphia
  16. 16. Anatomy of aphasia Conduction Transcortical- motor Anomic Broca’s Global Wernicke’s Transcortical- sensory 20
  17. 17. Broca’s Famous Patient 21
  18. 18. 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
  19. 19. Aphasic syndromes
  20. 20. 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
  21. 21. Constructional ability,reproduction drawings
  22. 22. Construction ability • Drawing to commands • Draw a clock face with all numbers • Set clock for a time
  23. 23. Neglect 27
  24. 24. Higher cognitive functions • Fund of information • Calculations verbal rote examples verbal complex examples written complex examples • Proverb interpretation • Similarities • Insight and judgement
  25. 25. Related cognitive functions • Ideomotor apraxia • Ideational apraxia • Right –left disorientation • Finger agnosia • Visual agnosia • Prosopognosia • simultagnosia • Asteriognosis • Geographic disorientation
  26. 26. 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
  27. 27. • Parietal lobe tests ideomotor apraxia ideational apraxia dressing apraxia calculation RT-LT disorientation finger agnosia stereognosis construction apraxia
  28. 28. • Temporal lobe tests verbal memory visual memory paired associate learning
  29. 29. • Occipital lobe tests visual agnosia prosopognosia simultagnosia

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