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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

Anatomy of aphasia
Transcorticalmotor

Conduction
Anomic

Brocas

Wernickes
Transcorticalsensory
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Global

Brocas Famous Patient

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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

Neglect

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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