This document examines higher mental functions including consciousness, orientation, intelligence, memory, emotional disturbances, speech, handedness, and the mini mental scale examination. It provides details on testing various aspects of these functions, such as grading levels of consciousness, assessing orientation to time, place and person, testing intelligence through simple math, and evaluating immediate, recent and remote memory. It also describes examining speech and language for disturbances, different types of aphasia and their lesion locations. The mini mental scale examination component outlines tasks to test orientation, registration, attention, calculation, recall, language and copying abilities.

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.Korsakoff’s 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;Alzheimer’s disease,multi
infarct state,alcoholism,Wernicke’s 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.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 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 :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

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 WERNICK’S AND
BROCA’S 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:Alzheimer’s 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
PATIENT’S 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