CORTICAL FUNCTION

Anatomy and physiology

Cortical function:Three major operation of neurons of the

CNS: Reception and registration of sensory

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

act. Intermediary processing.

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

Cerebral hemisphere : right and left connecting by corpus calosum

Cerebral hemisphere are divided

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

Cortical function : specific location Primary receptive area Secondary receptive area Association area

NEUROBEHAVIOR: How environmental stimuli are processed within the

central nervous system (CNS) to effect behavioral and emotional responses.

Processing of stimuli are recognition, interpretation, storage and retrieval of information to which meaning is attributed from the past and present experience.

Task performance in daily activities is a result of behavioral responses.

The mechanism of nervous system processing and neurobehavior is thus a complex interaction of processing and responses

NEURO-BEHAVIOR Mempelajari hubungan antara perilaku

dengan fungsi otak.

Behavior/perilaku: Hasil aksi dan reaksi psikomotor yang secara

objektif dapat diamati dan diinterpretasikan dan akan mempengaruhi lingkungan subyek tsb

Mencakup berbagai fungsi,aktifitas motorik,komunikasi,aksi/tindakan sosial dan ekspresi afektif.

Perilaku dapat dibedakan atas: Goal oriented behavior:

Komponen sensorik ,psikomotor,emosi dan kognitif bekerja harmonis sesuai dengan keinginan dan tujuan individunya.

Specific oriented behavior: Perilaku yang muncul pada situasi tertentu sebagai

suatu reaksi terhadap stimulus tertentu misalnya impulsif,kecewa,kekerasan.

Perilaku ini patologis,mencerminkan kegagalan kognitif,kepribadian yang abnormal atau disfungsi neurobiologik.

Behavior Neurology:Pengaruh penyakit otak pada perilaku

manusia dan fungsi kortikal luhurnya.Perilaku termasuk :

Perilaku spesifik seperti memori,komunikasi dan visuospatial.

Perilaku kompleks:Kualitas intelegensia,emosi,suasana hati dan kepribadian.

BEHAVIOR NEUROLOGY ;Bertujuan untuk membedakan perilaku

normal dan abnormal dalam kaitan dengan fungsi otak yang normal atau abnormal.

Neuropsikologi:Bagian dari psikologi yang berkaitan

dengan pemeriksaan fungsi otak dengan menggunakan tes psikologi yang baku.

Neuropsikologi membantu untuk mendapatkan data kuantitatif pemeriksaan neurobehavior yang penting dalam penatalaksanaan pasien.

Neuropsikiatri:Mempelajari abnormalitas fisik atau

organik yang mendasari gejala psikiatri dimana tidak dapat dibuktikan adanya lesi primer diotak

HIGHER COGNITIVE FUNCTION

HIGHER COGNITIVE FUNCTION:

Manipulation of well learned material, abstract thinking, arithmetic computations is the highest level of human intellectual functioning.

Represent the most advanced stages of intellectual development, often highly susceptible to neurological diseases

Higher Cognitive Function Coordination of external and internal factor

in human being Study of the relation between brain and

behavior Basic Processes :

1. Attention and consentration2. Language3. Memory4. Visual-spatial5. Executive 6. Emotion7. Praxis

1. Evaluation

1. The fund of acquired information or the store of knowlegde

• Assessed by :1. Simple verbal test of vocabulary

2. General information

3. Comprehension

2. Manipulation of old knowledge

Ability to apply information to new or unfamiliar situations

Assessed by :1. Calculation

2. Social comprehension

3. Social awareness and Judgement

Evaluated by :1. Knowledge of environmental or social

situation

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

4. Abstract Thinking

Assessed by :

1. Use of proverbs

2. Conceptual series

3. Analogy interpretation

Memory

Involves :1. Recognition

2. Registration

3. Recall – Retrieval Anatomical basis of memory

Hippocampus

The Anatomical Basis of Memory

Test of Memory

1. Immediate memory

2. Recent memory

3. Remote memory

Disorder of Memory(Amnesia Syndrome)

1. Retrograde amnesia Impairment of memory for events that

antedate illness or injury

2. Anterograde amnesia Inability to learn new verbal or non-verbal

information from onset of illness or injury

Disorders of Memory RetrievalSenescence – AAMI (Age Associated

Memory Impairment) – Rapid retrieval of stored memory become defective

Depression – disorder in motivation and concentration

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

Disorder of Language - Dysphasia

Language function of dominant hemisphere

Emotional - Instinctive expression of feelings

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

Dysphasia

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

Cortical Centers for Language

1. Broca’s Area Executive or motor for

production of language

Broca’s dysphasia Motor dysphasia Nonfluent / hesitant

speech Telegraphic speech Comprehension – good Handwriting - pure

Wernick’s Area – Receptive Area Wernick’s dysphasia :

Comprehension – Impaired

Speech fluent but nonsensical

Neologism Paraphasia – half right

words Patient unaware of

language problems Hand writing poor

Global DysphasiaNon-fluent speech Comprehension impaired

Receptive and expressive areas linked by arcuate fasciculus in order to

integrate function Conduction Dysphasia

Speech nonsensical but fluent Comprehension - normal Repetition - poor

Dysphasia may developed as a result of :

1. Vascular disorders

2. Space occupying lesion

3. Traumatic

4. Infection

5. Degenerative disorders

Mental State ExaminationMini Mental State Examination.

Score 0-30 Orientation (time.place) 0-10

Memory registration 0-3

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

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

Memory Registration

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

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

mind

Score 3

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

Memory Recall

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

Score 3

Language6. Show the patient two familiar objects (e.g.

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

Score 2

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

8. 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 3

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

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

Total Score 30A score below 24 indicates probable

cognitive impairmentA score below 17 indicates definite

cognitive impairment