higher mental functions

EXAMINATION OF HIGHER MENTAL

FUNCTIONS

BY,

RASHIKHA PARVIN A P.

• CONSCIOUSNESS

• ORIENTATION TO TIME ,PLACE AND PERSON

• INTELLIGENCE

• MEMORY

• EMOTIONAL DISTURBANCE OF SPEECH

• HANDEDNESS

• MINI MENTAL SCALE EXAMINATION

CONSCIOUS LEVEL IS GRADED AS FOLLOWS;

• Fully conscious

• Drowsy

Easily arousable by touch or noise-alertness will persist for short period

• Stupor

Arousable only by vigorous stimulation.

• Coma

Not arousable by any form of stimulus.

CONSCIOUS LEVEL

• Orientation to time ; Enquire the exact time during

the period of examination.

• Place; enquire where the patient is present at the

time of examination.

• Person; Identification of the relative or a bystander

at the time of examination.

ORIENTATION TO TIME PLACE AND

PERSON

• Ask the patient to do

simple mathematical

calculations.

INTELLIGENCE

Test the memory for ;

1.Immediate memory

• Memory of events occurred within 30seconds.

• Ask the patient to recall memory of digits forward

and backward(digit span).

• Centre for immediate memory; frontal lobe

perisylvian cortex.

MEMORY

2.Recent memory

• Memory of events occurred within minutes , weeks and

months.

• Patient is asked to recall repeat 3words after 3-5

minutes of telling.

• Centre ; mamillothalamic tract , hippocampus.

• Causes of recent memory loss ,

eg.Korsakoff’s psychosis.

3.Remote memory

• Memory of events occurred years back –like memory

of school days in adult patients.

• Centre ; Possibly in association cortex,limbic system.

• Causes of memory loss;Alzheimer’s disease,multi

infarct state,alcoholism,Wernicke’s encephalopathy.

• Episodes of spontaneous weeping or

laughing(without provocation).

• Occurs in conditions like pseudobulbar palsy

and frontal lobe disorders.

EMOTIONAL LABILITIES

Hallucination : Patience will have falls feelings without

an appropriate stimulus or cause.

Delusion:Patience will have falls beliefs,which are held

despite against to the preventing circumstances.

HALLUCINATION AND DELUSIONS

Hallucination and delusions are commonly associated with

temporal and occipital lobe lesions.

Test the following aspects

• Comprehension :ability to understand the conversation and

questioning.

• Spontaneous speech : observe for word output ,melody and

length of speech.

• Naming repetition :ask the patient to repeat short sentences

or single words

• Reading :assessing for defect in reading.

• Writing:assess grammer,word order and spelling.

SPEECH DISTURBANCES;EXAMINATION OF SPEECH

AND LANGAUGE

1.Broca’s (motor)aphasia

• Word output is decreased

• Speech is non-fluent and dysarthric

• Comprehension is intact

• Site of lesion:Broca’s area:posterior part of inferiorfrontal gyruswith surrounding cortex.

• Vascular territory involved;occlusion of superior division of left middle cerebral artery

• Causes;head injuries ,CVA,intracranial space-occupying lesion(ICSOL)

CENTRAL SPEECH DEFECTS(APHASIA/DYSPHASIA)

• Understanding for spoken and written langauge is impaired.

• Word output bis normal but with large number of inappropriate words(paraphasis)

• Site of lesion :Wernicke’s area-posterior third of temporal gyrus and surrounding cortex.

• Vascular territory involved ;occlusion of inferior division of left middle cerebral artery

• Causes;head injuries ,CVA, ICSOL

2.WERNICK’S SENSORY APHASIA

• WORD OUTPUT AND UNDERSTANDING IS

INTACT.WORD OUTPUT IS INTACT BUT WITH

WRONG WORDS,REPETITION AND MEMORY ARE

IMPAIRED.

• SITE OF LESION;AROUND AUDITORY CORTEX

AND ARCUATE FASCICULUS

• CONNECTION BETWEEN THE WERNICK’S AND

BROCA’S AREA ARE IMPAIRED.

3.GLOBAL APHASIA

• Naming and word findings become impared.

• Site of lesion: langauge areas in the left hemesphere

including middle and temporal gyrus.

• Causes:Alzheimer’s disease ,head injury, metabolic

encephalopathies.

4.ANOMIC APHASIA

Aprasodia;

impairment of melody and stress of speech

Site of lesion:perisylvian area in right hemesphere.

Aphemia

Fluency of speech is severely impaired with normal comprehension,reading and writing.

Lesion:partial involvement of motor speech area

Dysarthrias

Disordered articulation of speech.due to:

A .Defect in the vagal ,hypoglossal,facial nerves and their connections and

muscles supplied by them.

b. Disorders of cerebellum

Dysphonia:

disturbed voice production .due to

• Vocal cord paralysis-Recurrent laryngeal nerve palsy

• Respiratory muscle paralysis

• Spasm of the glottis-tetanus and tetany

• Local causes in the larynx-acute or chronic laryngitis

• Laryngeal polyp and growth

• Occasionaly hoarseness of voice may be due to

cigarette smoking and steroid inhalation.

• Date:

• Score:5(1 for each correct answer)

• 3(1 for each object)

• 5(1 for each correct answer)

• 3(1 for each under registration

correct answer)

• ORIENTATION;what is the date

,day, month, year, season etc.

• REGISTRATION:ask the patient to name 3

objects and ask him to repeat

• ATTENTION AND CALCULATION:ask the

patient to sustract 7 from 100 serially 5times

• RECALL:ask the patient to repeat 3objects

mentioned above

• LANGAUGE AND COPYING:ask the patient to

name a pencil and watch

repeat the following: no ifs ,ands or buts following

a 3stage command .

MINI MENTAL SCALE EXAMINATION

PATIENT’S NAME NAME OF THE EXAMINER

Picking up a paper with right hand ,fold it in half and place it on the floor read and obey the following

• Close your eyes

• Asking the patient to write a sentence

• Asking the patient to copy a design(like two intersecting pentagons)

Less than 23score soggestsan organic brain disorder.

• 3(1 for each command)

• Total score = 30

THANK YOU