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Higher Cortical Functions Examination 4may2020.pptx
- 1. Higher Cortical Functions BedsideExamination Yuttachai Likitjaroen MD, Faculty of Medicine, Chulalongkorn University
- 2. Cognitive domains • Memory •Language • Visuospatial • Praxia • Executive functions
- 3. Neurocognitive domains DSM 5Sachdev P.S. 2014
- 4. Cognitive test • Domainspecific cognitive test • Overall cognitive test
- 5. Overall cognitive tests •Mini-mental state examination (MMSE) • Montreal cognitive assessment (MoCA) • Saint Louis university mental status (SLUMS) • Alzheimer’s disease assessment scale (ADAS) • The Addenbrooke’s cognitive examination (ACE) • Cambridge cognitive examination (CAMCOG)
- 6. Specific domain cognitivetests • Memory: delayed recall, digit span • Language: naming test, category fluency, similarity • Visuo-perceptual: cancellation test, line bisection, face recognition • Attention: digit span, serial 7 subtraction, stoop color • Executive function: Trail making, clock drawing, proverb explanation, tower of London • Frontal inhibition: Luria's three-step test, go-no-go, copy alternate sequence
- 7. Memory Longterm Shortterm Explicit Implicit EpisodicSemantic Motorskill Classical condition Priming Working memory Other short term memories???
- 8. • Limited capacity •Temporarily holding information available for processing • Attention and rehearsal enhance the memory Attention Executive functions Working memory Visual information Auditory information Language loop Motor output Execute task
- 9. Working memory assessment • Digitspan forward and backward • Delay recall
- 10. Episodic memory Hathout, G.,& Ferguson, T. (2008). The cerebral cortex. In Clinical Neuroradiology: A Case-Based Approach (pp. 179-223). Anterior Cingulate Hippocampu Forni Mammillary Papaz's circuit Awareness Parietal lobe • • • Memory about space and time and what has happened Awareness and emotion enhance the memory Recognize the details of what has happened
- 11. Episodic memory assessment • Recentevents with time or place tag (when, where, what) • Delay recall • Head turning signs • Momentary confabulation
- 12. Semantic memory Network Anteriort e m p o ral cortexSensoryinput Languagearea Hippocampus??? • Memoryof general knowledge and personal information (autobiography) • Learning and repeated exposure enhance the memory • Retrieved when stimulated or internal thought
- 13. Semantic memory assessments • Namingand semantic knowledge • objects, pictures, famous faces Category fluency (animals, fruit) • • • General knowledge Personal knowledge
- 14. Procedural memory Ne two rk Basal ganglia Cerebellum • Memoryabout knowing to do things, motor skills • Learning and practicing enhance the memory
- 15. Priming • Memory ofeffect in which exposure to one stimulus influences the response to another stimulus Sensoryinput P astexperience Preparationfor mo to raction mo to routput
- 16. Priming อาหาร ข้า_มั_ ไ_ มั_ มั_ เครื่องแต่ง กาย เสื้อืื _ กาง _ _ _ ื _ ื Picture fragment Word fragment Word stem
- 17. Classic condition • Palovian •Amygdala Sensoryinput P astexperience Autonomic psychologicalresponse
- 18.
- 19. Lichtheim’s diagram Broca’s areaWernike’s area Concept center Semantic knowledge Fluent aphasia Non-fluent aphasia
- 20. Language assessment Naming Verbal fluency:Alphabet, category Comprehension: 3-step command, yes-no questions Repetition Reading and writing
- 21. Assess speech disorders Fluency Good Impaired Comprehension Repetition Y es NoY es No Transcortical global aphasia Transcortical motor aphasia Transcortical Sensory aphasia Naming aphasia No Y es Wernicke’s aphasia No Y es Conduction aphasia No Y es Broca’s aphasia No Y es Global aphasia Non-fluent aphsia Fluent aphasia Paraphasia Not recognized error Recognized error Agrammatism
- 22.
- 23. Apraxia • Disorder ofskill to execute tasks • Not caused by weakness, abnormal tone, movement disorders, akinesia, intellectual disorders • Usually involving dominant hemisphere frontal and parietal area
- 24. Limb-kinetic apraxia • Inabilityto handle tools for the purpose intended • Anatomy - Supplementary motor area - Basal ganglia
- 25. Assess apraxia withtool Give patient a tool Let the patient show how to use Cannot hold or manipulate properly Limb-kinetic Ideational Use the tool wrong way Conceptual Can hold the tool properly Wrong sequence
- 26. Ideomotor apraxia • Impairof sensori-motor programs that generate motor control • Timing and spatial organization of action • Anatomy - Left parietal
- 27. Assess apraxia withouttool Meaningful gesture Meaningless gesture Intransitive Command Conduction apraxia Perform example Visuoimitation apraxia Ideomotor apraxia Perform imaginary activitysuch as combing, ironing, hammering Transitive
- 28. Ideational apraxia Sequence error •Cannot perform purposeful task in order - Error preparing cups of coffee Conceptual error • Error of single action task • Demonstrate inappropriate use of tools - Brushing teeth with spoon Anatomy - Left temporal
- 29. Assess apraxia withtool Give patient a tool Let the patient perform task Cannot hold or manipulate properly Limb-kinetic Wrong sequence Sequence error Use the tool wrong way Conceptual Can hold the tool properly
- 30. Type of apraxia •Limb-kinetic (supplementary motor, basal ganglia) motor • Ideomotor (left parietal) spatial • Ideational (left temporal) semantic
- 31. Specific apraxia • Construction •Dressing • Speech • Gait • Gaze
- 32.
- 33. Visuos-perceptual ability • Abilityto interpret visual and spatial information about objects and space
- 34. Agnosia Apperceptive Associative Object descriptionAffected Spared Visual identification Affected Affected Copying drawing Affected Spared Object matching Affected Spared Object knowledge Spared Affected Tactile naming Spared Affected
- 35.
- 36. Visuos-perceptual assessment Object recognition Descriptionof presented objects Matching objects Copy drawing objects Verbal knowledge of objects Tactile naming Face recognition Famous face naming Face matching Face description
- 38.
- 39.
- 40. Attention assessments • Digitspan • Day of the week • Month of the year • Serial 7 subtraction • Stoop color
- 41. Attention assessments • Digitspan • Day of the week • Month of the year • Serial 7 subtraction • Stoop color
- 42. Orientation assessments Time Dayof week Place Bluiding Date Floor Month Town Season County Year Country
- 43.
- 44. Frontal lobe syndrome Medialfrontal Apathy Dorsolateral frontal Dysexecutive Inferior frontal Disinhibition
- 45. Inhibition • Luria’s three-steptest • Alternate hands movement • Go-No-GO • Copy alternate sequence
- 46. Frontal lobe releasingsigns • Grasping reflex • Palmomental reflex • Glabella tap • Snouting reflex • Rooting reflex