Higher Cortical Function 2006
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Transcript of 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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