Higher Cortical Function

CORTICAL FUNCTIONCORTICAL FUNCTIONAnatomy and physiologyAnatomy and physiology

Cortical function:Cortical function:

Three major operation of neurons of the Three major operation of neurons of the CNS:CNS: Reception and registration of sensory stimuli Reception and registration of sensory stimuli

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

act.act. Intermediary processing.Intermediary processing.

.(thought,language,memory,self .(thought,language,memory,self awareness,mood and affect)awareness,mood and affect)

Cerebral hemisphere : right and left Cerebral hemisphere : right and left connecting by corpus calosumconnecting by corpus calosum

Cerebral hemisphere are dividedCerebral hemisphere are divided

Primary sensory cortex.Primary sensory cortex. Primary motor cortex.Primary motor cortex. Association cortex.Association cortex. Limbic-paralimbic cortexLimbic-paralimbic cortex

Cortical function : specific locationCortical function : specific location Primary receptive areaPrimary receptive area Secondary receptive areaSecondary receptive area Association areaAssociation area

HIGHER CORTICAL HIGHER CORTICAL FUNCTIONFUNCTION

Higher Cortical FunctionHigher Cortical Function

Coordination of external and internal factor Coordination of external and internal factor in human beingin human being

Study of the relation between brain and Study of the relation between brain and behaviorbehavior

Basic Processes :Basic Processes :1.1. AttentionAttention2.2. LanguageLanguage3.3. MemoryMemory4.4. Visual-spatialVisual-spatial5.5. Executive Executive 6.6. EmotionEmotion7.7. PraxisPraxis

1. Evaluation1. Evaluation

1.1. The fund of acquired information or the The fund of acquired information or the store of knowlegdestore of knowlegde

• Assessed by :Assessed by :1.1. Simple verbal test of vocabularySimple verbal test of vocabulary

2.2. General informationGeneral information

3.3. ComprehensionComprehension

2. Manipulation of old 2. Manipulation of old knowledgeknowledge

Ability to apply information to new or Ability to apply information to new or unfamiliar situationsunfamiliar situations

Assessed by :Assessed by :1.1. CalculationCalculation

2.2. Social comprehensionSocial comprehension

3. Social awareness and 3. Social awareness and JudgementJudgement

Evaluated by :Evaluated by :1.1. Knowledge of environmental or social Knowledge of environmental or social

situationsituation

2.2. Social appropriate responses in such Social appropriate responses in such situations and the ability to personally situations and the ability to personally apply the correct response when faced apply the correct response when faced with a real situationwith a real situation

4. Abstract Thinking4. Abstract Thinking

Assessed by :Assessed by :

1.1. Use of proverbsUse of proverbs

2.2. Conceptual seriesConceptual series

3.3. Analogy interpretationAnalogy interpretation

MemoryMemory

Involves :Involves :1.1. RecognitionRecognition

2.2. RegistrationRegistration

3.3. Recall – RetrievalRecall – Retrieval

Anatomical basis of memory Anatomical basis of memory

HippocampusHippocampus

The Anatomical Basis of MemoryThe Anatomical Basis of Memory

Test of MemoryTest of Memory

1.1. Immediate memoryImmediate memory

2.2. Recent memoryRecent memory

3.3. Remote memoryRemote memory

Disorder of MemoryDisorder of Memory(Amnesia Syndrome)(Amnesia Syndrome)

1.1. Retrograde amnesiaRetrograde amnesia Impairment of memory for events that Impairment of memory for events that

antedate illness or injuryantedate illness or injury

2.2. Anterograde amnesiaAnterograde amnesia Inability to learn new verbal or non-verbal Inability to learn new verbal or non-verbal

information from onset of illness or injuryinformation from onset of illness or injury

Disorders of Memory RetrievalDisorders of Memory Retrieval

Senescence Senescence – – AAMIAAMI (Age Associated (Age Associated Memory Impairment) – Rapid retrieval of Memory Impairment) – Rapid retrieval of stored memory become defectivestored memory become defective

DepressionDepression – disorder in motivation and – disorder in motivation and concentrationconcentration

Subcortical dementiaSubcortical dementia – Slowed (but – Slowed (but correct) response rate to questions of correct) response rate to questions of memory functionmemory function

Disorder of Language - DysphasiaDisorder of Language - Dysphasia

LanguageLanguage function of dominant function of dominant hemispherehemisphere

Emotional Emotional - Instinctive expression of - Instinctive expression of feelingsfeelings

Symbolic or proportional thoughts, Symbolic or proportional thoughts, opinions and concepts depend upon opinions and concepts depend upon culture, education, normal cerebral culture, education, normal cerebral developmentdevelopment

DysphasiaDysphasia

Acquired loss of production or Acquired loss of production or comprehension of spoken and / or comprehension of spoken and / or written language secondary to brain written language secondary to brain damagedamage

Cortical Centers for Language Cortical Centers for Language

1. Broca’s Area1. Broca’s Area

Executive or motor for Executive or motor for production of languageproduction of language

Broca’s dysphasia Broca’s dysphasia Motor dysphasiaMotor dysphasia Nonfluent / hesitant Nonfluent / hesitant

speechspeech Telegraphic speechTelegraphic speech Comprehension – goodComprehension – good Handwriting - pureHandwriting - pure

Wernick’s Area – Receptive AreaWernick’s Area – Receptive Area

Wernick’s dysphasia :Wernick’s dysphasia : Comprehension – ImpairedComprehension – Impaired Speech fluent but Speech fluent but

nonsensicalnonsensical NeologismNeologism Paraphasia – half right Paraphasia – half right

wordswords Patient unaware of Patient unaware of

language problemslanguage problems Hand writing poorHand writing poor

Global DysphasiaGlobal Dysphasia

Non-fluent speech Non-fluent speech Comprehension impairedComprehension impaired

Receptive and expressive areas linked Receptive and expressive areas linked by arcuate fasciculus in order to by arcuate fasciculus in order to

integrate functionintegrate function Conduction Dysphasia Conduction Dysphasia

Speech nonsensical but fluentSpeech nonsensical but fluent Comprehension - normalComprehension - normal Repetition - poorRepetition - poor

Dysphasia may developed as Dysphasia may developed as a result of :a result of :

1.1. Vascular disordersVascular disorders

2.2. Space occupying lesionSpace occupying lesion

3.3. TraumaticTraumatic

4.4. InfectionInfection

5.5. Degenerative disordersDegenerative disorders

Mental State ExaminationMental State Examination

Mini Mental State Examination.Mini Mental State Examination. Score 0-30Score 0-30

Orientation (time.place) 0-10 Orientation (time.place) 0-10 Memory registration Memory registration 0-30-3

Attention and Concentration 0-5Attention and Concentration 0-5 Memory Recall 0-3Memory Recall 0-3 Language 0-8Language 0-8 Visual-patial 0-1Visual-patial 0-1

OrientationOrientation

1.1. Ask the patient : Ask the patient : “What is this year, “What is this year, season, date, day, month?”season, date, day, month?”

Score 5Score 5

2.2. Ask : Ask : “Where are you?”“Where are you?” State, country, town, place, floor (or State, country, town, place, floor (or

ward)ward) Score 5Score 5

Memory RegistrationMemory Registration

3.3. Tell the patient that you want him /her Tell the patient that you want him /her to remember something for you, then to remember something for you, then name three unrelated objects (speak name three unrelated objects (speak clearly and slowly). Ask the patient to clearly and slowly). Ask the patient to repeat the three objects repeat the three objects

Score 3 pointsScore 3 points; if correct first time,; if correct first time, Score 2 pointsScore 2 points; if correct second time; if correct second time Score 1 pointScore 1 point: if correct third time: if correct third timeAsk the patient to keep the three things in Ask the patient to keep the three things in

mindmind

Score 3Score 3

Attention and ConcentrationAttention and Concentration

4.4. Ask the patient to take seven from Ask the patient to take seven from 100, then seven from the result, and 100, then seven from the result, and so on for five subtractions. Score 1 so on for five subtractions. Score 1 point for each correct answerpoint for each correct answer

oror

Ask the patient to spell “world” Ask the patient to spell “world” backwards, and score 1 point for each backwards, and score 1 point for each correct lettercorrect letter

Score 5Score 5

Memory RecallMemory Recall

5.5. Ask the patient to recall the three objects Ask the patient to recall the three objects from test 3from test 3

Score 3Score 3

LanguageLanguage6.6. Show the patient two familiar objects (e.g. Show the patient two familiar objects (e.g.

a pen, a watch) and ask him/her to name thema pen, a watch) and ask him/her to name them

Score 2Score 2

7.7. Ask the patient to repeat a sentence after you: Ask the patient to repeat a sentence after you: ”No ifs, ands or buts Score 1”No ifs, ands or buts Score 1

8.8. Ask the patient to follow a three-stage Ask the patient to follow a three-stage command: “Please take this paper in your left command: “Please take this paper in your left hand, fold it in half and put the paper on the hand, fold it in half and put the paper on the floor” Score 3floor” Score 3

9.9. Ask the patient to read and follow a written Ask the patient to read and follow a written instruction, e.g: “Close your eyes”instruction, e.g: “Close your eyes” Score 1 Score 1

Language (cont)Language (cont)

10.10.Ask the patient to write a simple Ask the patient to write a simple sentence. The sentence should contain sentence. The sentence should contain a subject and a verb and should make a subject and a verb and should make sense Score 1sense Score 1

11.11.Ask the patient to copy a picture of Ask the patient to copy a picture of intersecting pentagons Score 1intersecting pentagons Score 1

Total ScoreTotal Score 3030

A score below 24 indicates probable A score below 24 indicates probable cognitive impairmentcognitive impairment

A score below 17 indicates definite A score below 17 indicates definite cognitive impairmentcognitive impairment