higher mental functions

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  • 1. EXAMINATION OF HIGHER MENTAL FUNCTIONS BY, RASHIKHA PARVIN A P.

2. CONSCIOUSNESS ORIENTATION TO TIME ,PLACE AND PERSON INTELLIGENCE MEMORY EMOTIONAL DISTURBANCE OF SPEECH HANDEDNESS MINI MENTAL SCALE EXAMINATION 3. 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 4. 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 5. Ask the patient to do simple mathematical calculations. INTELLIGENCE 6. 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 7. 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.Korsakoffs psychosis. 8. 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;Alzheimers disease,multi infarct state,alcoholism,Wernickes encephalopathy. 9. Episodes of spontaneous weeping or laughing(without provocation). Occurs in conditions like pseudobulbar palsy and frontal lobe disorders. EMOTIONAL LABILITIES 10. 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 11. Hallucination and delusions are commonly associated with temporal and occipital lobe lesions. 12. 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 13. 1.Brocas (motor)aphasia Word output is decreased Speech is non-fluent and dysarthric Comprehension is intact Site of lesion:Brocas area:posterior part of inferiorfrontal gyrus with 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) 14. Understanding for spoken and written langauge is impaired. Word output bis normal but with large number of inappropriate words(paraphasis) Site of lesion :Wernickes 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.WERNICKS SENSORY APHASIA 15. 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 WERNICKS AND BROCAS AREAARE IMPAIRED. 3.GLOBAL APHASIA 16. Naming and word findings become impared. Site of lesion: langauge areas in the left hemesphere including middle and temporal gyrus. Causes:Alzheimers disease ,head injury, metabolic encephalopathies. 4.ANOMIC APHASIA 17. 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 18. 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 19. 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. 20. 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 PATIENTS NAME NAME OF THE EXAMINER 21. 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 soggests an organic brain disorder. 3(1 for each command) Total score = 30 22. THANK YOU