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