higher cortical function 2006

7/28/2019 Higher Cortical Function 2006

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CORTICAL FUNCTION

Anatomy and physiology


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Cortical function:

Three major operation of neurons of theCNS:

Reception and registration of sensory

stimuli from outside and from within.Planning and execution of complex motor

act.

Intermediary processing.

.(thought,language,memory,selfawareness,mood and affect)


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Cerebral hemisphere : right and leftconnecting by corpus calosum


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Cerebral hemisphere are divided

Primary sensory cortex.

Primary motor cortex.

Association cortex.Limbic-paralimbic cortex


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Cortical function : specific location

Primary receptive area

Secondary receptive area

Association area


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HIGHER CORTICAL

FUNCTION


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Higher Cortical Function

Coordination of external and internal factorin human being

Study of the relation between brain and

behavior Basic Processes :

1. Attention

2. Language

3. Memory

4. Visual-spatial

5. Executive

6. Emotion

7. Praxis


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2. Manipulation of old

knowledge

Ability to apply information to new orunfamiliar situations

Assessed by :

1. Calculation2. Social comprehension


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3. Social awareness and

Judgement

Evaluated by :

1. Knowledge of environmental or socialsituation

2. Social appropriate responses in such

situations and the ability to personallyapply the correct response when faced

with a real situation


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4. Abstract Thinking

Assessed by :

1. Use of proverbs

2. Conceptual series3. Analogy interpretation


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Memory

Involves :

1. Recognition

2. Registration3. Recall Retrieval

Anatomical basis of memory

Hippocampus


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The Anatomical Basis of Memory


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Test of Memory

1. Immediate memory

2. Recent memory

3. Remote memory


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Disorders of Memory Retrieval

SenescenceAAMI (Age AssociatedMemory Impairment) Rapid retrievalof stored memory become defective

Depression disorder in motivation andconcentration

Subcortical dementia Slowed (but

correct) response rate to questions ofmemory function


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Disorder of Language - Dysphasia

Language function of dominanthemisphere

Emotional - Instinctive expression offeelings

Symbolic or proportional thoughts,opinions and concepts depend uponculture, education, normal cerebraldevelopment


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Dysphasia

Acquired loss of production or

comprehension of spoken and / or

written language secondary to braindamage


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1. Brocas Area

Executive or motor

for production of

language

Brocas dysphasia Motor dysphasia

Nonfluent / hesitant

speech

Telegraphic speech

Comprehension

good

Handwriting - pure


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Wernicks Area Receptive Area

Wernicks dysphasia :

Comprehension

Impaired

Speech fluent but

nonsensical Neologism

Paraphasia half right

words

Patient unaware of

language problems

Hand writing poor


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Global Dysphasia

Non-fluent speech

Comprehension impaired

Receptive and expressive areas linked


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Receptive and expressive areas linked

by arcuate fasciculus in order to

integrate function

Conduction Dysphasia

Speech nonsensical but fluent

Comprehension - normalRepetition - poor


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Dysphasia may developed as

a result of :

1. Vascular disorders

2. Space occupying lesion3. Traumatic

4. Infection

5. Degenerative disorders


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Mental State Examination

Mini Mental State Examination.

Score 0-30

Orientation (time.place) 0-10

Memory registration 0-3Attention and Concentration 0-5

Memory Recall 0-3

Language 0-8Visual-patial 0-1


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Orientation

1. Ask the patient : What is this year,season, date, day, month?

Score 5

2. Ask : Where are you?

State, country, town, place, floor (or

ward)Score 5


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Memory Registration

3. Tell the patient that you want him /herto remember something for you, thenname three unrelated objects (speak

clearly and slowly). Ask the patient torepeat the three objects

Score 3 points; if correct first time,

Score 2 points; if correct second time

Score 1 point: if correct third time

Ask the patient to keep the three things inmind

Score 3


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Attention and Concentration

4. Ask the patient to take seven from

100, then seven from the result, and

so on for five subtractions. Score 1

point for each correct answer

or

Ask the patient to spell world

backwards, and score 1 point for each

correct letter

Score 5


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Language

6. Show the patient two familiar objects (e.g.

a pen, a watch) and ask him/her to name themScore 2

7. Ask the patient to repeat a sentence after you:

No ifs, ands or buts Score 18. Ask the patient to follow a three-stage

command: Please take this paper in your left

hand, fold it in half and put the paper on the

floor Score 39. Ask the patient to read and follow a written

instruction, e.g: Close your eyes Score 1


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Language (cont)

10.Ask the patient to write a simple

sentence. The sentence should contain

a subject and a verb and should make

sense Score 1

11.Ask the patient to copy a picture of

intersecting pentagons Score 1


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Total Score 30

A score below 24 indicates probable

cognitive impairment

A score below 17 indicates definite

cognitive impairment


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higher cortical function 2006

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