This document provides an overview of a presentation on mental state examinations. It outlines learning objectives, suggested schemes for psychiatric and neurological examinations, and details on specific components of the neurological examination including consciousness, orientation, attention, memory, speech and language, abstract thinking, and calculations. Examples of tests that can be used to evaluate each component are also described.
Detailed description of clinical examination of higher mental functions like conscoiusness, cognition, memory, pereception,etc. in neurological conditions.
This document discusses higher mental functions including consciousness, cognition, and memory. It defines various levels of consciousness from alert to comatose. It describes the reticular activating system and its role in arousal and sleep-wake cycles. Tests of cognition are outlined including orientation, attention, memory, communication, and executive function. Methods for assessing each domain are provided along with typical findings in patients with brain injuries.
The document discusses disorders of memory from a biological and clinical perspective. It describes the biology of memory including neural plasticity and long-term potentiation. It examines different types of memory and various memory disorders like amnesia. Case studies of patients with memory disorders are presented to illustrate the role of medial temporal structures in memory. Assessment techniques for memory in clinical settings are also outlined.
Clinical examination of higher function test By Pandian M, Tutor, Dept of Phy...Pandian M
Introduction
Examination of Higher Functions
Higher functions,
Examination of cranial nerves,
Sensory system,
Motor system,
Reflexes and
spine.
1.Level of consciousness:
2. Ask any history of suffering from hallucination or delusion or illusions.
3. Look for the appearance :
Alzheimer's is an irremediable progressive brain disorder. A neurological disease that destroys brain cells leading to atrophy. The most common type of dementia. Mostly affect people in the old age group usually above 62-65 years old. Under-recognized disease becoming a major public health problem. symptoms include the inability to carry out the day-to-day tasks. Destruction of memory and thinking skills- also referred to as Mild Cognitive Impairment
Language problems. Unpredictable behavior (mood swings). Vision/spatial issues.
Impaired reasoning and judgment. With time as the disease progresses, some people become worried, angry, or violent. There are various factors responsible for this disease-
Accumulation of certain proteins such as tau and amyloid (form tangles inside neurons)
People with smoking habits, obesity, diabetes, and high blood pressure are at higher risk of developing this disease.
Age, family history, and people who have had severe head injuries develop this disease more compared to others.
A person with untreated depression. In a person suffering from Alzheimer's Brain cells start to deteriorate. Brain inflammation and may lack the glucose needed to power its activity.
The vascular system fails to deliver sufficient blood and nutrients to the brain.
Neurons lose their ability to communicate.The entorhinal cortex and hippocampus (parts of the brain involved in memory) are damagedIn later stages, it affects the areas in the cerebral cortex.
The document provides an overview of how to perform a neurological examination, including:
1) Assessing the level of consciousness using scales like the Glasgow Coma Scale.
2) Examining the cranial nerves and assessing functions like vision, hearing, smell, facial movement and strength.
3) Evaluating motor strength, tone, reflexes, and involuntary movements.
4) Testing sensory functions including pain, temperature, vibration and position sensation.
The examination aims to screen for neurological disorders by assessing different parts of the nervous system from the cortex to peripheral nerves.
An overview of how to perform a paramedic neurological assessment. For more information about this lecture, please go to www.paramedicine.com/episode6.
A neurological examination assesses the functioning of the nervous system through physical examination and review of medical history. It involves evaluating levels of consciousness, cranial nerve function, motor skills, sensation, coordination, and reflexes. Abnormal findings may indicate neurological disorders requiring further investigation.
Detailed description of clinical examination of higher mental functions like conscoiusness, cognition, memory, pereception,etc. in neurological conditions.
This document discusses higher mental functions including consciousness, cognition, and memory. It defines various levels of consciousness from alert to comatose. It describes the reticular activating system and its role in arousal and sleep-wake cycles. Tests of cognition are outlined including orientation, attention, memory, communication, and executive function. Methods for assessing each domain are provided along with typical findings in patients with brain injuries.
The document discusses disorders of memory from a biological and clinical perspective. It describes the biology of memory including neural plasticity and long-term potentiation. It examines different types of memory and various memory disorders like amnesia. Case studies of patients with memory disorders are presented to illustrate the role of medial temporal structures in memory. Assessment techniques for memory in clinical settings are also outlined.
Clinical examination of higher function test By Pandian M, Tutor, Dept of Phy...Pandian M
Introduction
Examination of Higher Functions
Higher functions,
Examination of cranial nerves,
Sensory system,
Motor system,
Reflexes and
spine.
1.Level of consciousness:
2. Ask any history of suffering from hallucination or delusion or illusions.
3. Look for the appearance :
Alzheimer's is an irremediable progressive brain disorder. A neurological disease that destroys brain cells leading to atrophy. The most common type of dementia. Mostly affect people in the old age group usually above 62-65 years old. Under-recognized disease becoming a major public health problem. symptoms include the inability to carry out the day-to-day tasks. Destruction of memory and thinking skills- also referred to as Mild Cognitive Impairment
Language problems. Unpredictable behavior (mood swings). Vision/spatial issues.
Impaired reasoning and judgment. With time as the disease progresses, some people become worried, angry, or violent. There are various factors responsible for this disease-
Accumulation of certain proteins such as tau and amyloid (form tangles inside neurons)
People with smoking habits, obesity, diabetes, and high blood pressure are at higher risk of developing this disease.
Age, family history, and people who have had severe head injuries develop this disease more compared to others.
A person with untreated depression. In a person suffering from Alzheimer's Brain cells start to deteriorate. Brain inflammation and may lack the glucose needed to power its activity.
The vascular system fails to deliver sufficient blood and nutrients to the brain.
Neurons lose their ability to communicate.The entorhinal cortex and hippocampus (parts of the brain involved in memory) are damagedIn later stages, it affects the areas in the cerebral cortex.
The document provides an overview of how to perform a neurological examination, including:
1) Assessing the level of consciousness using scales like the Glasgow Coma Scale.
2) Examining the cranial nerves and assessing functions like vision, hearing, smell, facial movement and strength.
3) Evaluating motor strength, tone, reflexes, and involuntary movements.
4) Testing sensory functions including pain, temperature, vibration and position sensation.
The examination aims to screen for neurological disorders by assessing different parts of the nervous system from the cortex to peripheral nerves.
An overview of how to perform a paramedic neurological assessment. For more information about this lecture, please go to www.paramedicine.com/episode6.
A neurological examination assesses the functioning of the nervous system through physical examination and review of medical history. It involves evaluating levels of consciousness, cranial nerve function, motor skills, sensation, coordination, and reflexes. Abnormal findings may indicate neurological disorders requiring further investigation.
Part 1 function of brain and history taking of a neurological patientAtul Saswat
This document provides an overview of neurological assessment and the function of the brain and nervous system. It discusses the classification of the nervous system and outlines the key functions of different parts of the brain like the frontal lobe, parietal lobe, temporal lobe, occipital lobe, brainstem, and cerebellum. It also summarizes the roles of structures like the basal ganglia, thalamus, limbic system, and reticular formation. The document describes how to take a history from a neurological patient, including gathering demographic data, clarifying symptoms, and doing a systemic inquiry. It provides examples of findings from the initial impression and neurological exam.
The Mental Status Examination (MSE) is used to evaluate a patient's current mental and emotional functioning. It involves observing elements like appearance, behavior, mood, affect, thought process, and thought content. The MSE provides essential information for diagnosis and treatment planning when integrated with a patient's history.
The document discusses various aspects of higher mental functions and clinical examination of consciousness. It describes different levels of consciousness ranging from fully conscious to coma. Specific altered states are explained such as lethargy, obtundation, stupor, twilight states, oneiroid states, automatism, akinetic mutism, and apallic states. The clinical examination of consciousness involves assessing orientation, attention, memory, language and other cognitive functions to evaluate any impairment.
The Mental State Examination aims to assess a patient's current psychological symptoms and observable behavior during an interview. It objectively evaluates a patient's appearance, behavior, speech, mood, thoughts, perceptions, cognition, and insight. It also subjectively examines the patient's reported mood, thoughts, and perceptions. The exam provides information on factors like activity level, thought content and organization, sensory experiences, orientation, memory, and understanding of their condition. Challenging patients may be unresponsive, overactive, or confused, requiring modified approaches.
This document discusses various topics related to memory, including the biology of memory, types of memory, and disorders of memory. It covers long-term potentiation as the candidate mechanism for mammalian long-term memory. It also describes different types of amnesia like organic amnesia, which can be acute, sub-acute or chronic, and psychogenic amnesia, which includes anxiety, katathymic and hysterical amnesia. Distortions of memory are also discussed, including confabulations, Munchausen's syndrome, and disorders of recognition like déjà vu and jamais vu.
This document provides an overview of memory disorders. It discusses the biology of memory including long term potentiation and the role of the CREB protein in memory formation. It describes different types of memory like sensory memory, short term memory, and long term memory. It also discusses various memory disorders like amnesia and distortions of memory. Organic amnesia can be acute, subacute, or chronic depending on the underlying brain disease. Psychogenic amnesia includes anxiety, katathymic, and hysterical amnesia. Memory can also be distorted through falsification, delusions, and confabulation.
This document provides a template for conducting a short neurological assessment. It includes sections to document subjective information, assess higher mental functions like orientation and memory, examine the 12 cranial nerves, perform sensory and motor testing, evaluate reflexes, coordination, gait, and balance. Specific tests are outlined to assess functions like vision, hearing, facial strength and sensation. The assessment also includes objective tests of functional movements and special tests as needed. The goal is to systematically evaluate the nervous system's input and output through sensory, motor and cognitive tasks.
The document provides information on conducting a mental status assessment. It discusses assessing a patient's appearance, behavior, cognitive functions, thought processes, perceptions, mood, affect and other areas. Key aspects include screening for anxiety, depression and suicidal thoughts. The assessment aims to evaluate orientation, attention, memory, reasoning and other mental functions to detect any abnormalities.
This document provides an overview of caring for older adults' cognition and perception. It describes normal cognitive and sensory functions and how they change with aging. Common sensory changes in older adults like presbyopia, cataracts, and hearing loss are outlined. Cognition involves intelligence, memory, language, and decision making. While intelligence does not automatically decline with age, processing speed and short-term memory are more likely to be affected. The nursing process for addressing disturbances in sensory perception, chronic confusion, impaired communication, and pain in older adults is reviewed. Appropriate nursing assessments, diagnoses, goals, and evidence-based interventions are discussed.
The document provides information on the aging brain including basic brain anatomy, the differences between normal aging, mild cognitive impairment, and dementia. It discusses factors that can affect memory and cognition with age as well as lifestyle habits and behaviors that can help maintain good brain health such as physical exercise, nutrition, sleep, and mental stimulation. The presentation outlines changes in memory and cognition that are normal with aging versus when further evaluation may be needed.
We have identified goals of education by viewing them from the point of neuroscience; through education, we have to produce individuals who are better problem solvers and decision. To achieve this goal, learners will have to transform what they have learned explicitly into implicit memories and vice versa. Further, through education, we enhance learner consciousness and wisdom. A number of pedagogical practices that are useful in achieving the above goals are presented. When new contents are presented in a teaching-learning environment, high-level concepts need to be highlighted; the concepts are likely to penetrate through multiple domain areas thus helping learners to form better neural networks of knowledge. In order to reach out to multiple brain regions, we need to get the frontal lobe involved essentially and hence the pace of presentation has to be controlled appropriately; as the frontal lobe connects to many brain regions, the processing occurs relatively slowly. The important task of motivating learners can be done by presenting learners with neuroscience-based facts about learning; even difficult content can be mastered by simply paying attention elaborately; human brains have the feature of plasticity and through learning, neural networks can grow throughout the lifespan. Taking into consideration the phenomenon of binocular rivalry - human brains can concentrate only on one thing at a time fully- we should encourage learners to engage in the discussion in a teaching-learning session fully. When setting assessment, we should focus on open-ended, novel conceptual questions so that learners use their frontal lobes connecting many other regions as well.
This document discusses different types and classifications of memory. It describes:
1. Memory can be classified based on content (long-term vs short-term), or duration (sensory, short-term, recent, long-term).
2. Long-term memory includes declarative (explicit) and procedural (implicit) memory. Declarative memory includes episodic and semantic memory.
3. The hippocampus is involved in forming new memories by converting short-term to long-term memories. Multiple brain regions are activated during memory encoding and recall.
Frontal lobe functions and assessmeny 20th july 2013Shahnaz Syeda
The frontal lobes have several functional areas that control motor functions like movement as well as higher cognitive functions. The primary motor cortex directly controls muscle movement while areas like the premotor cortex plan movements. The prefrontal cortex is involved in executive functions, problem solving, emotion regulation, and decision making through areas like the dorsolateral prefrontal cortex. Damage to different frontal lobe areas can cause syndromes like difficulties with movement, language, behavior, personality and cognition depending on the location of the lesion. A neuropsychological assessment can evaluate these frontal lobe functions.
This document discusses the management of patients with neurologic dysfunction and altered levels of consciousness. It defines altered LOC as being less responsive to the environment. Causes can be structural, metabolic, or due to trauma, vascular disease, infection, tumors, metabolic derangements, hypoxia, or toxicity. Clinical manifestations range from subtle changes to coma. Nursing assessments include responsiveness, orientation, motor function and respiratory status. Interventions focus on airway protection, injury prevention, meeting fluid and nutrition needs, and skin and sensory integrity.
The document discusses several topics related to brain anatomy and function, including:
1) Brodmann's cytoarchitectonic mapping of the human brain and the functions associated with different cortical areas.
2) The evolution of the frontal lobe in humans and its role in complex cognitive functions like empathy and understanding social cues.
3) Case studies of patients who suffered frontal lobe injuries and the behavioral changes they experienced, such as becoming unreliable and lacking impulse control.
4) Research on frontal lobe functions in primates and humans, finding it is involved in tasks like working memory, planning, problem solving, and flexible behavior.
The document discusses several topics related to brain anatomy and function, including:
1) Brodmann's cytoarchitectonic mapping of the human brain and the functions associated with different cortical areas.
2) The evolution of the frontal lobe in humans and its role in complex cognitive functions like empathy and understanding social cues.
3) Cases of frontal lobe injury and ablation studies in animals that demonstrated changes to personality, social behavior, and problem solving abilities.
4) The connectivity and functions of the prefrontal cortex, including planning, working memory, mental modeling of options, and behavioral regulation.
Higher mental functions include cognition and behavior such as orientation, attention, memory, communication, executive functions, and complex perception. These should be assessed first as they can impact motor and sensory exams. Orientation involves understanding time, place, and identity. Attention includes selective, sustained, alternating, and divided attention. Memory involves registration, retention, and recall, and can be impacted by amnesia or delirium. Communication assesses language comprehension and production. The brain regions responsible include the medial temporal lobe, hippocampus, and specific areas for aphasia or dysarthria. Higher mental functions can be quickly screened using the MMSE, with scores below 24 indicating impairment.
This document discusses examination of higher cerebral functions including level of consciousness, memory, orientation, judgement, reasoning, language, sensory functions, and motor functions. It provides details on testing various levels of consciousness from normal to impaired states like drowsiness, stupor, and coma. Memory is assessed using tests of immediate recall, recent memory, and remote memory. Related topics like persistent vegetative state, locked-in syndrome, and psychogenic unresponsiveness are also covered.
Memory is the encoding, storage, and retrieval of information. There are several theories of memory, including that it involves three processes: encoding, storage, and retrieval. Memory can be categorized as either explicit (declarative) or implicit (non-declarative). Explicit memory involves consciously recalling facts and events, and can be further divided into episodic memory of personal experiences and semantic memory of general knowledge. Implicit memory involves unconscious recall of skills and procedures. Disorders of memory include amnesia, which is the inability to recall information, and paramnesia, which involves distortions of memory such as false memories.
A neurological examination assesses the nervous system for impairment by evaluating sensory and motor responses, especially reflexes. It typically includes a physical examination and medical history review to determine neurological function without advanced testing. The exam can be used for both screening and investigation of suspected neurological disorders. Key components include evaluating mental status, cranial nerves, motor function, sensation, coordination, and reflexes to check the cortex, subcortical structures, brainstem, spinal cord, nerves, neuromuscular junction, and muscles. Abnormal findings may localize the source of neurological dysfunction.
The document discusses the neuroanatomy and neurolocalization of the basal ganglia and thalamus. It describes the basal ganglia as a collection of gray matter nuclei involved in motor control. It notes their role in initiating and modulating movement. It then describes the specific nuclei of the basal ganglia - the caudate, putamen, globus pallidus, subthalamic nucleus, and substantia nigra. It also discusses the direct and indirect pathways between these nuclei and their role in movement. Finally, it briefly discusses some movement disorders associated with lesions in different basal ganglia structures.
The document outlines an approach to evaluating neurologic patients based on three key questions: 1) Is the problem neurological? 2) Where is the lesion located? And 3) What is the lesion? It emphasizes using the neurological exam and patient history, particularly the temporal profile of symptoms, to help localize and identify the nature of the lesion. By considering features like acute vs. chronic onset and focal vs. diffuse signs, the differential diagnosis can be narrowed down. This systematic approach aids in evaluating complex neurologic presentations.
Part 1 function of brain and history taking of a neurological patientAtul Saswat
This document provides an overview of neurological assessment and the function of the brain and nervous system. It discusses the classification of the nervous system and outlines the key functions of different parts of the brain like the frontal lobe, parietal lobe, temporal lobe, occipital lobe, brainstem, and cerebellum. It also summarizes the roles of structures like the basal ganglia, thalamus, limbic system, and reticular formation. The document describes how to take a history from a neurological patient, including gathering demographic data, clarifying symptoms, and doing a systemic inquiry. It provides examples of findings from the initial impression and neurological exam.
The Mental Status Examination (MSE) is used to evaluate a patient's current mental and emotional functioning. It involves observing elements like appearance, behavior, mood, affect, thought process, and thought content. The MSE provides essential information for diagnosis and treatment planning when integrated with a patient's history.
The document discusses various aspects of higher mental functions and clinical examination of consciousness. It describes different levels of consciousness ranging from fully conscious to coma. Specific altered states are explained such as lethargy, obtundation, stupor, twilight states, oneiroid states, automatism, akinetic mutism, and apallic states. The clinical examination of consciousness involves assessing orientation, attention, memory, language and other cognitive functions to evaluate any impairment.
The Mental State Examination aims to assess a patient's current psychological symptoms and observable behavior during an interview. It objectively evaluates a patient's appearance, behavior, speech, mood, thoughts, perceptions, cognition, and insight. It also subjectively examines the patient's reported mood, thoughts, and perceptions. The exam provides information on factors like activity level, thought content and organization, sensory experiences, orientation, memory, and understanding of their condition. Challenging patients may be unresponsive, overactive, or confused, requiring modified approaches.
This document discusses various topics related to memory, including the biology of memory, types of memory, and disorders of memory. It covers long-term potentiation as the candidate mechanism for mammalian long-term memory. It also describes different types of amnesia like organic amnesia, which can be acute, sub-acute or chronic, and psychogenic amnesia, which includes anxiety, katathymic and hysterical amnesia. Distortions of memory are also discussed, including confabulations, Munchausen's syndrome, and disorders of recognition like déjà vu and jamais vu.
This document provides an overview of memory disorders. It discusses the biology of memory including long term potentiation and the role of the CREB protein in memory formation. It describes different types of memory like sensory memory, short term memory, and long term memory. It also discusses various memory disorders like amnesia and distortions of memory. Organic amnesia can be acute, subacute, or chronic depending on the underlying brain disease. Psychogenic amnesia includes anxiety, katathymic, and hysterical amnesia. Memory can also be distorted through falsification, delusions, and confabulation.
This document provides a template for conducting a short neurological assessment. It includes sections to document subjective information, assess higher mental functions like orientation and memory, examine the 12 cranial nerves, perform sensory and motor testing, evaluate reflexes, coordination, gait, and balance. Specific tests are outlined to assess functions like vision, hearing, facial strength and sensation. The assessment also includes objective tests of functional movements and special tests as needed. The goal is to systematically evaluate the nervous system's input and output through sensory, motor and cognitive tasks.
The document provides information on conducting a mental status assessment. It discusses assessing a patient's appearance, behavior, cognitive functions, thought processes, perceptions, mood, affect and other areas. Key aspects include screening for anxiety, depression and suicidal thoughts. The assessment aims to evaluate orientation, attention, memory, reasoning and other mental functions to detect any abnormalities.
This document provides an overview of caring for older adults' cognition and perception. It describes normal cognitive and sensory functions and how they change with aging. Common sensory changes in older adults like presbyopia, cataracts, and hearing loss are outlined. Cognition involves intelligence, memory, language, and decision making. While intelligence does not automatically decline with age, processing speed and short-term memory are more likely to be affected. The nursing process for addressing disturbances in sensory perception, chronic confusion, impaired communication, and pain in older adults is reviewed. Appropriate nursing assessments, diagnoses, goals, and evidence-based interventions are discussed.
The document provides information on the aging brain including basic brain anatomy, the differences between normal aging, mild cognitive impairment, and dementia. It discusses factors that can affect memory and cognition with age as well as lifestyle habits and behaviors that can help maintain good brain health such as physical exercise, nutrition, sleep, and mental stimulation. The presentation outlines changes in memory and cognition that are normal with aging versus when further evaluation may be needed.
We have identified goals of education by viewing them from the point of neuroscience; through education, we have to produce individuals who are better problem solvers and decision. To achieve this goal, learners will have to transform what they have learned explicitly into implicit memories and vice versa. Further, through education, we enhance learner consciousness and wisdom. A number of pedagogical practices that are useful in achieving the above goals are presented. When new contents are presented in a teaching-learning environment, high-level concepts need to be highlighted; the concepts are likely to penetrate through multiple domain areas thus helping learners to form better neural networks of knowledge. In order to reach out to multiple brain regions, we need to get the frontal lobe involved essentially and hence the pace of presentation has to be controlled appropriately; as the frontal lobe connects to many brain regions, the processing occurs relatively slowly. The important task of motivating learners can be done by presenting learners with neuroscience-based facts about learning; even difficult content can be mastered by simply paying attention elaborately; human brains have the feature of plasticity and through learning, neural networks can grow throughout the lifespan. Taking into consideration the phenomenon of binocular rivalry - human brains can concentrate only on one thing at a time fully- we should encourage learners to engage in the discussion in a teaching-learning session fully. When setting assessment, we should focus on open-ended, novel conceptual questions so that learners use their frontal lobes connecting many other regions as well.
This document discusses different types and classifications of memory. It describes:
1. Memory can be classified based on content (long-term vs short-term), or duration (sensory, short-term, recent, long-term).
2. Long-term memory includes declarative (explicit) and procedural (implicit) memory. Declarative memory includes episodic and semantic memory.
3. The hippocampus is involved in forming new memories by converting short-term to long-term memories. Multiple brain regions are activated during memory encoding and recall.
Frontal lobe functions and assessmeny 20th july 2013Shahnaz Syeda
The frontal lobes have several functional areas that control motor functions like movement as well as higher cognitive functions. The primary motor cortex directly controls muscle movement while areas like the premotor cortex plan movements. The prefrontal cortex is involved in executive functions, problem solving, emotion regulation, and decision making through areas like the dorsolateral prefrontal cortex. Damage to different frontal lobe areas can cause syndromes like difficulties with movement, language, behavior, personality and cognition depending on the location of the lesion. A neuropsychological assessment can evaluate these frontal lobe functions.
This document discusses the management of patients with neurologic dysfunction and altered levels of consciousness. It defines altered LOC as being less responsive to the environment. Causes can be structural, metabolic, or due to trauma, vascular disease, infection, tumors, metabolic derangements, hypoxia, or toxicity. Clinical manifestations range from subtle changes to coma. Nursing assessments include responsiveness, orientation, motor function and respiratory status. Interventions focus on airway protection, injury prevention, meeting fluid and nutrition needs, and skin and sensory integrity.
The document discusses several topics related to brain anatomy and function, including:
1) Brodmann's cytoarchitectonic mapping of the human brain and the functions associated with different cortical areas.
2) The evolution of the frontal lobe in humans and its role in complex cognitive functions like empathy and understanding social cues.
3) Case studies of patients who suffered frontal lobe injuries and the behavioral changes they experienced, such as becoming unreliable and lacking impulse control.
4) Research on frontal lobe functions in primates and humans, finding it is involved in tasks like working memory, planning, problem solving, and flexible behavior.
The document discusses several topics related to brain anatomy and function, including:
1) Brodmann's cytoarchitectonic mapping of the human brain and the functions associated with different cortical areas.
2) The evolution of the frontal lobe in humans and its role in complex cognitive functions like empathy and understanding social cues.
3) Cases of frontal lobe injury and ablation studies in animals that demonstrated changes to personality, social behavior, and problem solving abilities.
4) The connectivity and functions of the prefrontal cortex, including planning, working memory, mental modeling of options, and behavioral regulation.
Higher mental functions include cognition and behavior such as orientation, attention, memory, communication, executive functions, and complex perception. These should be assessed first as they can impact motor and sensory exams. Orientation involves understanding time, place, and identity. Attention includes selective, sustained, alternating, and divided attention. Memory involves registration, retention, and recall, and can be impacted by amnesia or delirium. Communication assesses language comprehension and production. The brain regions responsible include the medial temporal lobe, hippocampus, and specific areas for aphasia or dysarthria. Higher mental functions can be quickly screened using the MMSE, with scores below 24 indicating impairment.
This document discusses examination of higher cerebral functions including level of consciousness, memory, orientation, judgement, reasoning, language, sensory functions, and motor functions. It provides details on testing various levels of consciousness from normal to impaired states like drowsiness, stupor, and coma. Memory is assessed using tests of immediate recall, recent memory, and remote memory. Related topics like persistent vegetative state, locked-in syndrome, and psychogenic unresponsiveness are also covered.
Memory is the encoding, storage, and retrieval of information. There are several theories of memory, including that it involves three processes: encoding, storage, and retrieval. Memory can be categorized as either explicit (declarative) or implicit (non-declarative). Explicit memory involves consciously recalling facts and events, and can be further divided into episodic memory of personal experiences and semantic memory of general knowledge. Implicit memory involves unconscious recall of skills and procedures. Disorders of memory include amnesia, which is the inability to recall information, and paramnesia, which involves distortions of memory such as false memories.
A neurological examination assesses the nervous system for impairment by evaluating sensory and motor responses, especially reflexes. It typically includes a physical examination and medical history review to determine neurological function without advanced testing. The exam can be used for both screening and investigation of suspected neurological disorders. Key components include evaluating mental status, cranial nerves, motor function, sensation, coordination, and reflexes to check the cortex, subcortical structures, brainstem, spinal cord, nerves, neuromuscular junction, and muscles. Abnormal findings may localize the source of neurological dysfunction.
The document discusses the neuroanatomy and neurolocalization of the basal ganglia and thalamus. It describes the basal ganglia as a collection of gray matter nuclei involved in motor control. It notes their role in initiating and modulating movement. It then describes the specific nuclei of the basal ganglia - the caudate, putamen, globus pallidus, subthalamic nucleus, and substantia nigra. It also discusses the direct and indirect pathways between these nuclei and their role in movement. Finally, it briefly discusses some movement disorders associated with lesions in different basal ganglia structures.
The document outlines an approach to evaluating neurologic patients based on three key questions: 1) Is the problem neurological? 2) Where is the lesion located? And 3) What is the lesion? It emphasizes using the neurological exam and patient history, particularly the temporal profile of symptoms, to help localize and identify the nature of the lesion. By considering features like acute vs. chronic onset and focal vs. diffuse signs, the differential diagnosis can be narrowed down. This systematic approach aids in evaluating complex neurologic presentations.
A 17-year-old female presented with loss of consciousness after ingesting 8 grams of carbamazepine tablets. She was comatose on examination. After supportive care including cimetidine, tube feeding, and dialysis, her mental status improved and she was discharged. Carbamazepine toxicity can cause seizures, arrhythmias, respiratory depression, and coma. Treatment involves supportive care, activated charcoal, and enhanced elimination methods like hemodialysis for severe cases.
This document provides an overview of paraplegia including its causes, clinical presentation, evaluation, and management. Key points include:
- Paraplegia is weakness or paralysis of the lower extremities caused by lesions of the spinal cord or peripheral nerves. It can affect motor, sensory, and autonomic functions.
- Lesion localization is determined through assessment of sensory, motor, reflex, and autonomic functions to localize the level of injury.
- Common complications include autonomic dysreflexia, pain, spasticity, and bladder/bowel dysfunction. Treatment involves managing the underlying cause and associated complications through various pharmacological, surgical, and rehabilitative approaches.
This document provides an overview of techniques for examining pathologic reflexes, meningeal signs, and monofilament tests in neurologic examinations. It discusses the objective of gaining knowledge and skills in these areas. For pathologic reflexes, it describes what they are, examples like Babinski's reflex, and their significance. It covers various reflexes tested in the lower and upper extremities. For meningeal signs, it explains that signs are elicited when meninges are inflamed, defines meningismus, and describes techniques like assessing nuchal rigidity.
The auditory system allows humans to perceive sound. Sound waves travel through the external ear, middle ear bones, and inner ear fluid before causing hair cells to bend, stimulating nerve impulses that the brain interprets as sound. The cochlea contains the organ of Corti with hair cells connected to the cochlear nerve. Auditory pathways project from the cochlear nuclei to the brainstem and auditory cortex. Clinical exams include otoscopy, tuning fork tests, audiometry to evaluate air and bone conduction thresholds and speech discrimination.
The document provides an overview of the approach and management of acute kidney injury (AKI). It discusses definitions of AKI, etiologic diagnosis, prevention and management strategies. Regarding management, it focuses on identifying at-risk patients, fluid therapy, treatment of underlying conditions, managing complications, preventing further kidney damage, and initiating renal replacement therapy in a timely manner. Fluid management is emphasized as crucial to both preventing and treating AKI, with judicious use of fluids and diuretics recommended depending on the clinical scenario.
This document provides an outline for taking a thorough neurologic history. It emphasizes establishing rapport with the patient and asking open-ended questions to understand the chief complaint, history of present illness including symptom progression, past medical history, family history, social history, and review of systems. A skillful neurologic history focuses on determining the temporal course and characteristics of symptoms to identify the affected anatomic structures and likely etiologies.
This document summarizes the principles of managing acute stroke. It discusses the importance of timeliness in evaluation and treatment. The general approach involves assessing airway, breathing, circulation, neurological status, blood glucose, and performing a non-contrast CT scan. Key aspects of care include preventing complications through proper positioning, oxygenation, feeding, and rehabilitation strategies. Specific topics covered are dysphagia screening and management, infection prevention, deep vein thrombosis prophylaxis, and management of cerebral edema, fever, and blood pressure/glucose levels to protect the ischemic brain tissue. The presenter notes gaps in the local hospital's stroke management capabilities compared to recommended guidelines.
The document discusses the anatomy and functions of the diencephalon, thalamus, and hypothalamus. It describes the major parts and nuclei of the thalamus, their connections, and clinical effects of lesions. The thalamus is divided into anterior, posterior, medial, and lateral regions. Lesions can cause sensory and motor deficits as well as disturbances to alertness, mood, memory and executive function depending on the nuclei affected. The hypothalamus connects various regions of the brain and regulates autonomic, neuroendocrine, and behavioral functions. Anterior and posterior hypothalamic lesions have different clinical effects.
This document discusses different types of apraxia, which is the loss of the ability to perform purposeful skilled movements, caused by degenerative diseases. It describes five main types: limb-kinetic apraxia affects finger dexterity; ideomotor apraxia involves errors in pantomiming tool use; dissociation and conduction apraxia involve disconnection between brain areas; ideational apraxia is an inability to sequence multi-step actions; and conceptual apraxia is a loss of tool knowledge. The document provides details on testing, error types, pathophysiology, and diseases associated with each apraxia type.
This document summarizes a seminar on stance and gait abnormalities. It begins with an outline of the topics to be covered, including the anatomical and physiological bases of stance and gait, the gait cycle, and common gait abnormalities. The document then reviews normal and abnormal stances and gaits, caused by conditions such as hemiplegia, diplegia, cerebellar dysfunction, foot drop, and myopathies. It provides guidance on evaluating patients with gait disorders through history, physical exam testing of gait, balance, and posture.
This document provides an overview of ocular motility disorders, including:
1. The anatomy and function of the extraocular muscles and neural control centers.
2. Classification of abnormal eye movements including types (e.g. saccades, smooth pursuit) and causes (e.g. myopathies, nerve palsies).
3. Specific disorders are described in detail such as internuclear ophthalmoplegia, Parinaud's syndrome, and progressive supranuclear palsy.
4. Nystagmus is classified and mechanisms are discussed.
Motor neuron diseases affect motor neurons, leading to muscle weakness and atrophy. Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease in adults, characterized by both upper and lower motor neuron signs that spread to multiple body regions. While there is no cure for ALS, a multidisciplinary approach including symptomatic treatments can help manage the disease.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
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This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
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2. Outline
1. Learning objectives
2. General suggested schemes for psychiatric and neurological
mental state examinations
3. The Neurological Mental state examination
4. References
2
3. Learning Objective
• To acquire the needed knowledge and technique to have insight
into a person’s mental state dysfunction
– Neurologic versus psychiatric
– Responsible anatomic location
– Distribution of lesion - Focal/multifocal vs diffuse
• So that the information can be used in directing investigations, do
diagnostic reasoning, reach at a diagnosis and finally provide the
most appropriate management to-date targeting cure and/or
alleviation of the person’s suffering and improve his/her quality of
daily living.
3
4. Mental State Examination (MSE)
• May be classified as having Neurological and psychiatric
component.
• Observation of general appearance is vital to both but quite
different sets of diagnostic entities are suggested in the two
settings.
• Many other parts also tend to overlap.
4
5. Suggested scheme for a psychiatric mental state
examination
1) Appearance; Attitude (Cooperative, hostile, evasive, threatening, obsequious, belligerent); motor behavior
Psychomotor agitation or retardation); self care
2) Affect –
– The physician’s objective observation of the client’s inner emotional state
– Range (expansive, flat); appropriateness; stability (labile, shallow); quality (silly, anxious)
3) Mood –
– The client’s subjective expression of his inner emotional state
– Stated mood in response to question such as How are your spirits, How’s your mood been?
4) Speech –
– Rate (rapid, slow, pressured); volume (loud, soft, monotonous, histrionic); quality (fluent, neologisms, word salad); resonance, and
prosody (variations in pitch, rhythm, and stress of pronunciation)
5) Thought process
– Disorganized, illogical, loose associations, tangential, circumstantial, flight of ideas, perseveration, incoherent
6) Thought content
– Preoccupations, obsessions, overvalued ideas, delusions, suicidal or homicidal ideation
7) Perception
– Illusions, hallucinations
8) Cognition‐
– Orientation, attention & concentration, fund of knowledge, abstract thinking, memory, calculation, comprehension, Judgment and
insight
5
6. Suggested scheme for the neurological Mental State
Examination
1) Consciousness
2) Orientation
3) Attention and concentration
4) Memory
5) Speech & Language
6) Abstract thinking
7) Insight and Judgment
8) Calculations
9) Praxis
6
7. 1. Consciousness
• Awareness and wakefulness represent the two main components of
consciousness.
• Level of consciousness
– the degree of arousal (i.e., is the patient fully awake or does he or she
require stimulation to awaken and respond?),
• Content of consciousness or that wakeful state
– the degree of awareness (i.e., is the patient coherent or is he or she
confused, inattentive, or delusional?).
• Affected by
– Diffuse cortical, medial thalamic or brainstem RAS lesions
7
10. 10
As compared to GCS, The FOUR score
has better prognostication
For in Hospital Mortality by assessing
brain Stem functions better.
It has considerations for
• Locked-in Syndrome
• Vegetative State
It can be used in intubated patients.
FOUR SCORE TEST
12. Mini-mental state examination
1. Orientation to time and place (10)
2. Immediate memory… three unrelated objects(3)
3. Attention & concentration…serial 7 or 3, WORLD backward(5)
4. Delayed memory…previous 3 objects after 5-10min(3)
5. Language
1. Naming two familiar objects(2)
2. Repeating(1)
3. Three stage command(3)
4. Reading comprehension (1)
5. Writing a sentence(1)
6. Copying intersecting pentagons (1)
12
13. Mini-mental state examination…
• Result (out of 30) – several suggestions for interpretations, Tombaugh &
McIntyre suggested
– Normal >24
– Mild cognitive impairment 18 - 23
– Moderate impairment -
– Severe impairment < 17
• Age & educational level considered in interpreting
• Does not reliably exclude dementia
– Sensitivity 80%
– Specificity 98%
• Relatively high false positive rate
• Formal neuropsychological testing may be needed if abnormality identified
13
15. Orientation
• Before assessing orientation, we should check for language and
memory
• Generally, there are two types of orientation:
Spatial and non spatial
• Spatial orientation refers to the network of self-to-object distances
and directions in a given situation.
• Core regions at the precuneus and inferior parietal lobe areas for
multiple orientation domains;
• Posterior areas of the medial prefrontal cortex for time and
anterior for person.
2. Orientation
15
16. Cont….
Orientation to time: Ask time of day, day of week, date, month,
year
Orientation to place: Ask for address, current location,
Hospital, city
Orientation to person: Ask for names and age of family
members
16
17. Attention and Concentration
• Attention is the ability to focus selectively on a selected stimulus
• Concentration is sustained attention.
• Two types of attention
– Visuospatial attention
– Non spatial attention
• A function of Parietofrontal Network of the non dominant
hemisphere
– The Rt. hemisphere directs attention in both hemispaces
– The Lt. hemisphere directs attention within the contralateral right
hemispace
3. Attention and Concentration
17
18. • Inattentiveness & confusion
– seen in toxic or metabolic encephalopathy, frontal lobe or posterior
non‐dominant hemisphere lesions, increased ICP, abulic or frontal
lobe syndromes
• Examples of clinical abnormalities of Attention
– Hemispatial neglect
– Extinction phenomenon
– Anosognosia
• Asomatognosia
• Misoplegia
18
19. • Tests
– Digit span (normal 7+2 forward, 5+1 backward)
– Three step task
– Hemineglect‐ Line cancellation/bisection tests, task detection, clock
face drawing, simultaneous, bilateral stimulation
– Concentration‐ serial 7/3, months backward(<30second)
19
20. • Hemispatial Neglect
– Failure to appreciate the existence of ½ of the world and/or self.
– Patients may fail to:
• dress, shave, or groom the left side of the body
• eat food placed on the left side of the tray
• read the left half of sentences
20
23. • Extinction phenomenon:
– Failure to appreciate the contralateral stimulus with double simultaneous
stimulation on visual field or somatosensory testing
• Anosognosia:
– denial of a neurological deficit (e.g.; hemiplegia)
– Asomatognosia: severe form of anosognosia
• Patient denies ownership of a limb contralateral to the lesion
– Misoplegia
• The phenomenon in which a hemiplegic patient develops a morbid dislike towards
the offending immobile limbs.
• May attack their paretic limbs not recognized as self.
23
24. Memory
• Memory is the ability to register, store, and retrieve
information and can be impaired by either diffuse cortical or
bilateral temporal lobe disease.
4. Memory
24
25. • Temporal stages of memory
– Immediate (working)memory –
• Dorsolateral Prefrontal cortex (…cathecholamines)
• The amount of information a subject can keep in conscious awareness without active
memorization
• The normal human being can retain seven random digits
• It tends to decline with advancing age
– Short term memory (recent)
• Hippocampus and parahippocampal areas of the MTL for both storage and retrieval
• N-methyl-D-aspartate (NMDA) receptors and Cyclic AMP–responsive element-binding (CREB)
protein
• The ability to register and recall information after a delay of minutes or hours
– Long term memory
• Consolidation
• Diffuse cortical…Ach…
• Once memory is well stored in the neocortex, it can be retrieved without use of the hippocampal
system
• Types of memory
– Declarative‐ episodic & semantic memory
– Imperative‐ procedural, & classical/operant conditioning
25
30. Disorders of memory
• Amnestic Syndrome
– Profound loss of the second Stage of short-term (recent) memory
– It may be due to
• Bilateral hippocampal damage
• Wernicke-Korsakoff syndrome
– damage to the mamillary bodies & dorsomedial thalamic nuclei
• Head injury
– Pts. have normal immediate memory and normal ability to recall remote
memories, such as their childhood upbringing and education
– Other cognitive or HCFs may be intact, which distinguishes these Pts. from
those with dementias, such as AD.
30
31. • Anterograde amnesia
– Inability to acquire new information, i.e., to learn or to form new memories
• Retrograde amnesia
– Inability to recall events and other information that had been firmly established
before the onset of the illness
• Transient Global Amnesia
– A sudden temporary episode of all kinds of memory loss that can’t be attributed
to a more common neurological condition, such as epilepsy or stroke.
– Often affects people in middle or older age.
– Usually recover spontaneously and gradually over few hours.
31
32. Speech and Language
• Phonation
– The production of vocal sounds without word formation; it is entirely a
function of the larynx.
– Three types of dysphonia based on dysfunction of the vocal folds
• Adductor spasmodic dysphonia
• Abductor spasmodic dysphonia
• Mixed spasmodic dysphonia
• Vocalization
– The sound made by the vibration of the vocal folds, modified by
workings of the vocal tract.
5. Speech and Language
32
33. Cont….
• Speech is ability to vocalize by coordinating muscle controlling the
vocal apparatus.
– It is mechanical aspects of oral communication
– It consists of words, which are articulated vocal sounds that symbolize
and communicate ideas.
• Articulation is the enunciation of words and phrases;
– It is a function of organs and muscles innervated by the brainstem.
33
34. Cont….
• Language -
– A mechanism for expressing thoughts and ideas: by speech (auditory
symbols), by writing (graphic symbols), or by gestures and pantomime
(motor symbols).
– Any means of expressing or communicating feeling or thought using a
system of symbols.
– It is a function of the cerebral cortex.
• Grammar (or syntax)
– The set of rules for organizing the symbols to enhance their meaning.
34
35. ANATOMY AND PHYSIOLOGY OF ARTICULATION
• Sounds are produced by expired air passing through the vocal
cords.
• Properly articulated speech requires coordination between the
respiratory muscles and the muscles of the larynx, pharynx,
soft palate, tongue, and lips.
• All of these components are referred to as the vocal (oral)
tract.
35
36. No matter how garbled the speech, if the patient is speaking in correct sentences, using grammar and
vocabulary commensurate with their dialect and education, they have dysarthria and not aphasia.
36
38. EXAMINATION OF ARTICULATION/SPEECH
• Examination of articulation begins with noting the patient’s
spontaneous speech in normal conversation, usually during taking of the
history.
• The accuracy of pronunciation, rate of speech, resonance, and prosody
(variations in pitch, rhythm, and stress of pronunciation) are noted.
38
40. Language
ANATOMY
• The classical language centers are located in the perisylvian areas
of the language-dominant hemisphere.
• Broca’s speech area lies in the inferior frontal gyrus (Brodmann's
area 44 ).
• Wernicke’s speech area lies in the superior temporal gyrus
(Brodmann's area 22).
• The arcuate fasciculus
40
42. Assessment of language function
Spontaneous speech
Comprehension of spoken language
Naming
Reading
Writing, and
Repetition
42
43. EXAMINATION OF THE PATIENT WITH APHASIA
• Initial appraisal of language function takes place during the
taking of the history.
• Obvious deficits require exploration.
• There may be language deficits that are not readily apparent
during history taking.
• For example, the inability to repeat.
• Some degree of formal assessment is usually prudent.
43
44. Cont….
• In evaluating aphasia, it is important to know about the
patient’s:
handedness
languages spoken
vocabulary, and
intellectual capacity
44
45. Cont….
• About 90% to 95% of the population is right-handed.
• The left cerebral hemisphere is dominant for language in 99%
of right-handers, and 60% to 70% of left-handers.
• Of the remaining left-handers, about half are right-hemisphere
dominant and about half have mixed dominance.
45
46. The main aphasia syndrome
• Broca’s
• Wernicke’s
• Conduction
• Global
• Transcortical motor
• Transcortical sensory
• Transcortical mixed
• Anomic aphasia
46
47. • FLUENCY –
o Normal speech is 100 to 115 words per minute.
o Nonfluent Aphasia
• Speech output is often as low as 10 to 15 words
per minute, sometimes less
• Maximum sentence length is fewer than seven
words.
• Paraphasia –
o a speech error in which the patient substitutes a
wrong word or sound for the intended word or
sound.
o Two types:
o Phonemic -
o More typical of anterior persylvian lesions
o E.g.; “blotch” instead of watch, or
“thumbness” instead of numbness,
“Plentil” for pencil
o Semantic (Verbal) –
o More typical of posterior perysylvian
lesions
o the patient substitutes the wrong word
o E.g.; “ring” instead of watch
47
48. Subcortical aphasia
• Two types
– Anterior syndrome
• Caudate or striatocapsular aphasia
• Slow dysarthric speech with preserved phrase length, i.e., not telegraphic,
preserved comprehension, and poor naming.
• Resemble transcortical motor aphasia with hemiplegia
– Posterior syndrome
• Thalamic aphasia
• Fluent speech without dysarthria, poor comprehension, and poor naming
• Resemble transcortical sensory or wernicke aphasia with hemiplegia
48
49. ABSTRACT THINKING
• The ability to think abstractly is typically tested by asking the
patient to
describe similarities and differences,
find analogies, and
interpret proverbs and aphorisms.
• The patient may be asked how an apple and a banana, a car and an
airplane, a watch and a ruler, or a poem and a statue are alike, or to
tell the difference between a lie and a mistake.
6. Abstract Thinking
49
50. Cont….
• To test for the ability to find analogies,
• “Table is to leg as car is to what?”
• Some commonly used proverbs include:
a rolling stone gathers no moss,
a stitch in time saves nine, and
people who live in glass houses shouldn’t throw stones.
• Impaired abstraction occurs in many conditions but is particularly
common with frontal lobe disorders.
50
51. 7. Insight and Judgement
• Insight: awareness of one’s own illness and/situation
• Judgment: ability to anticipate the consequence one’s behavior
and make decision that protect oneself and others in the
context of ones own moral compass.
7. Insight and Judgement
51
52. Cont….
• Common question:
what the patient would do if she found a sealed, addressed,
stamped letter on the sidewalk, or smelled smoke in a crowded
theater
“What would you do if you found a wallet on the sidewalk?”
• Many neurologic conditions may impair judgment, particularly
processes that affect the orbitofrontal regions.
52
53. CALCULATIONS
• The ability to calculate depends on native intelligence, innate
number sense or mathematical ability, and educational level.
• The average normal patient can perform mental calculations
that involve two-digit operations and require simple carrying
and borrowing.
8. Calculations
53
54. Cont….
• A commonly used calculation task is subtracting serial 7s from 100
(failing that, serial 3s).
• This function also requires attention and concentration.
• Counting to 20 is more of a remote memory test and counting
backward from 20 more of an attentional task.
• There is little difference in calculating ability across age groups and
little impairment in early AD.
54
55. Cont….
• Impaired calculating ability may occur with posterior dominant
hemisphere lesions, either as an isolated defect or as part of
Gerstmann’s syndrome (non dominant posterior parietal lobe
lesion characterized by agraphia, acalculia, left-right confusion,
and finger agnosia).
55
56. • Praxis, or more specifically, ideomotor praxis, refers to the
performance of learned motor movements in the absence of
primary deficits in motor and spatial abilities.
• Ideomotor praxis is evaluated by asking the patient to perform
increasingly complex motor tasks.
• As an example, use of an object (e.g., comb, hammer, fork) with
and without the actual object in hand.
9. Praxis
56
57. Cont….
• A step-wise series of coordinated tasks "take this piece of
paper, fold it in half, and place it in the envelope" is another
way to demonstrate praxis, in this case, ideational praxis,
which refers to the capacity to carry out a sequential set of
actions toward a final goal.
57
58. Apraxia
• Defined as the inability to carry out on request a motor act in the
absence of any weakness, sensory loss, or other deficit involving
the affected part.
• Apraxia is an inability to correctly perform learned skilled
movements.
• The patient must have intact comprehension and be cooperative
and attentive to the task.
58
60. Cont….
• The major limb apraxias are limb kinetic, ideomotor, and
ideational.
• Limb kinetic apraxia: These patients have difficulty with fine
motor control
• Mild corticospinal tract lesion
• is due to dysfunction of the primary motor pathways.
60
61. Cont….
• Ideomotor apraxia the patient is unable to perform a complex
command:
• e.g., salute, wave goodbye, comb hair, use scissors.
• Ideational apraxia: the patient is able to carry out individual
components of a complex motor act, but patient cannot
perform the entire sequence properly.
61
62. Cont….
• The patient may perform each step correctly, but in attempting
the sequence, she omits steps or gets the steps out of order.
• There is an inability to correctly sequence a series of acts leading
to a goal.
• Ideational apraxia may occur with damage to the left posterior
temporoparietal junction or in patients with generalized
cognitive impairment
62
63. References
• Campell W.W: Dejong the neurologic examination 8th edition
• Bradley’s Neurology in clinical Practice 7th edition
• Fuller G: Neurological examination made easy,5th edition
63
It is important to remember that consciousness is best conceptualized as having two domains: level and content.
Awareness is defined by the content of consciousness, and arousal is defined by the level of consciousness.
The formal MSE usually begins with an assessment of orientation.
Centers important in language. A, angular gyrus; B, Broca’s area; EC,
Exner’s writing center; SP, superior parietal lobule, which with the PCG (postcentral
gyrus) is important in tactile recognition; T, pars triangularis; W, Wernicke’s area.
Reading…check for both reading aloud and reading for comprehension