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Examination of Mental Functions

This document discusses examination of higher cerebral functions including attention, cognition, memory, reasoning, affect, and hemispheric dominance. It provides details on bedside tests to evaluate these functions, including digit span tests of attention and short-term memory, tests of verbal and visual memory, problem solving tests, and methods to determine hemispheric dominance. The document emphasizes the importance of a systematic and hierarchical neurological examination of mental functions.

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105 views13 pages

Examination of Mental Functions

This document discusses examination of higher cerebral functions including attention, cognition, memory, reasoning, affect, and hemispheric dominance. It provides details on bedside tests to evaluate these functions, including digit span tests of attention and short-term memory, tests of verbal and visual memory, problem solving tests, and methods to determine hemispheric dominance. The document emphasizes the importance of a systematic and hierarchical neurological examination of mental functions.

Uploaded by

kbsmalli
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Examination of higher cerebral

functions

Examination of higher cerebral


(mental) functions
It should be a requisite part of standard neurologic
examination at least Mini Mental State Examination
should be performed in neurologic pts.
It has to be systematic and hierarchic
(level of consciousness directed attention cognition, mood, speech)

Golden neurologic rule to localize a lesion should be


applied for mental functions too (neuronal networks).
Extremely important is thorough history taking (changes in pts
behavior) and focusing on the pts behavior during the
examination (evaluation of his/her appearance, cooperation, attention,
memory, mental flexibility, social adaptability, ability of nonverbal
communication, depressive symptomatology, etc.).

Bedside tests of attention


Luria (fist-palm-side) test

Luria sketch (visual completion test) (alternating square and pointed figs.)

Continuous performance test


After registering target digit in presented digit chain a subject has to knock on a table

4-9-1-7-5-4-0-7-9-2-4-3-7-5-0-2

Digit span test (3-7) subject has to learn and repeat long digit chains of
random numbers (also test on short-term memory)

Large-scale neural network for directed attention


(Mesulam MM)

Neglect syndrome
= a failure to report, respond, or orient to contralateral novel
stimuli that is caused by damage of large-scale neural
network for directed attention and not by an elemental
sensorimotor deficit.
It is a form of selective unawareness.
Pts with neglect syndrome often appears to be unaware of
contralateral stimuli, they ignore these items, and do not

Cognitive skills
Dominant hemisphere disorders
Listen to language pattern - hesitant
- fluent

Expressive dysphasia

Receptive dysphasia

Pt. does not understand simple/complex

spoken commands (e.g. Hold up both arms)

Ask the patient to name objects

Nominal dysphasia

Does the patient read correctly?

Dyslexia

Does the patient write correctly?

Dysgraphia

Ask the patient to perform a numerical


calculation, e.g. serial 7 test, where 7 is
subtracted serially from 100.
Can the patient recognise objects? Agnosia
e.g. ask patient to select an object from
a group.

Dyscalculia

Cognitive skills
Non-dominant hemisphere disorders
Note patients ability to find his way
around the word or his home.

Geographical agnosia

Can the patient dress himself?

Dressing apraxia

Note patients ability to copy a geometrical


pattern, e.g. ask patient to form a star with
matches or copy a drawing of a cube.

Constructional apraxia

Memory
episodic m.
(autobiographic data)

long-term m. (> 1 min)


Explicite memory
(declarative)

(mesiotemporal regions
hipp,entorh, perirh, GP)

semantic m.
(encyclopedic knowledge)

(visual x verbal, recall x recognition)


short-term (working) m. (30-40 s)
(digit span)

(more extensive reg. MT+LT,P,O)


F

procedural m. (completing word fragment, m. for movements)


Implicit memory
demonstrated by completion
priming (DLPFC + associative visual and auditory areas)
of tasks that do not require
conscious processing
= the ability to acquire a motor skills or cognitive routines by experience

(subcortical circuits BG, cerebellum + ctx visual, motor,..)

HOSP----

Bedside memory testing is limited!


Testing requires alertness and is not possible in a confused
or dysphasic patient!

Short-term memory DIGIT SPAN TEST ask the patient to repeat a


sequence of 5, 6, or 7 random numbers.

Long-term memory ask the patient to describe present illness,


duration of hospital stay or recent events in the news (RECENT
MEMORY), ask about events and circumstances occuring more than
five years previously (REMOTE MEMORY).

Verbal memory ask the patient to remember a sentence or a short


story and test after 15 minutes.

Visual memory ask the patient to remember objects on a tray and test
after 15 minutes

Reasoning and problem solving


Test patient with two-step calculation, e.g. I wish to
buy 12 articles at 7 cent each. How much change will
I receive from 1?.
Ask patient to reverse 3 or 4 random numbers.
Ask patient to explain proverbs.
The examiner must compare patients present
reasoning ability with expected abilities based on
job history and/or school work!

Affect
Note the patients affect!
Does the patient seem depressed?
Loss of interest, euphoria, or social disinhibition may
be signs of frontal lobe dysfunction. Emotional
behavior such as aggression and anger may arise
from damage to the limbic system.
Emotional lability should prompt further examination
to look for upper motor neuron signs and a
pseudobulbar palsy.

Determination of hemispheric
dominance
Interview about writing, eating with spoon, throwing a ball, kicking, step;
tapping domin. hand 50/min, nondomin. hand 45/min.
Left hemisphere is dominant in 95% right-handers and 60% left-handers!

Left hemisphere dominant for speech and motor functions,

reading, writing, counting, recognition of colors, verbal memory,


important for linguistic thinking, ...

Right hemisphere dominant for attentional functions,

prosopognosia, prosodia (affective component of speech),


nonverbal communication (ability to read from face), visuospatial perception, visual and topographical memory, recognition
of music,

; score > 24 normal; < 24 suggests dementia

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